BMC infectious diseases · 2026
Sputum-negative pulmonary tuberculosis in Shanghai, China: notification, clinical characteristics and outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Wu Zheyuan, Zhou Yaohan, Chen Jing, Rao Lixin, Xiao Xiao, Zu Ping, Shen Xin, Zhang Wenhong
Аннотация
BACKGROUND: With the scaling up of WHO-recommended diagnostics, 40% of pulmonary tuberculosis (PTB) cases were still clinically diagnosed without sputum biological confirmation in China. To better understand this early paucibacillary disease, we explored notification, clinical characteristics and outcomes of sputum-negative PTB in Shanghai, China.
METHODS: We accessed PTB surveillance data in Shanghai, China, from 2010 to 2019. All presumptive PTB patients underwent at least one sputum biological diagnostic (i.e., smear, culture, GeneXpert MTB/RIF). Any positive was defined as sputum-positive, otherwise sputum-negative. Data of newly diagnosed secondary PTB patients was extracted for analysis. The annual notification of sputum-negative PTB was calculated. Clinical characteristics and treatment outcomes were compared between sputum-negative and positive PTB. Missing data were addressed using multiple imputation. Log-binomial, logistic and Cox models were used to adjust potential confounders.
RESULTS: Of 56,851 PTB patients in 2010-2019, 26,858 (47.2%) were sputum-negative. The annual notification declined from 12.2 per 100,000 in 2010 to 7.9 per 100,000 in 2019 (P for trend < 0.001). The median age of sputum-negative PTB patients was 35 (interquartile range 25, 55), with 34.1% of females, 50.7% of local residents. Compared to patients with sputum-positive PTB, sputum-negative PTB patients had a shorter delay in health seeking (10 vs. 12 days, Padj<0.001), but a longer delay in diagnosis (11 vs. 7 days, Padj<0.001). Besides, they had a higher proportion of detection through active screening (Padj<0.001), pleurisy (Padj<0.001), and a lower proportion of pulmonary cavities (Padj<0.001), diabetes (Padj<0.001), bronchial tuberculosis (Padj<0.001). 53,204 PTB patients were successfully treated (95.7% in sputum-negative vs. 91.7% in sputum-positive) and were followed for 368804.5 person-years. Compared to sputum-positive patients, sputum-negative PTB patients showed lower rates of treatment failure (0.2% vs. 0.6%, ORadj=0.56, 95%CI 0.52-0.61), death (1.4% vs. 3.9%, ORadj=0.43, 95%CI 0.38-0.49) and recurrence (2.1% vs. 3.3%, HRadj=0.71, 95%CI 0.63-0.79).
CONCLUSIONS: As a less severe disease, sputum-negative PTB had fewer comorbidities, radiological abnormalities, and better treatment outcomes, but a longer delay in diagnosis, which indicated the urgent need for novel biomarkers to enhance early detection of sputum-negative PTB.
METHODS: We accessed PTB surveillance data in Shanghai, China, from 2010 to 2019. All presumptive PTB patients underwent at least one sputum biological diagnostic (i.e., smear, culture, GeneXpert MTB/RIF). Any positive was defined as sputum-positive, otherwise sputum-negative. Data of newly diagnosed secondary PTB patients was extracted for analysis. The annual notification of sputum-negative PTB was calculated. Clinical characteristics and treatment outcomes were compared between sputum-negative and positive PTB. Missing data were addressed using multiple imputation. Log-binomial, logistic and Cox models were used to adjust potential confounders.
RESULTS: Of 56,851 PTB patients in 2010-2019, 26,858 (47.2%) were sputum-negative. The annual notification declined from 12.2 per 100,000 in 2010 to 7.9 per 100,000 in 2019 (P for trend < 0.001). The median age of sputum-negative PTB patients was 35 (interquartile range 25, 55), with 34.1% of females, 50.7% of local residents. Compared to patients with sputum-positive PTB, sputum-negative PTB patients had a shorter delay in health seeking (10 vs. 12 days, Padj<0.001), but a longer delay in diagnosis (11 vs. 7 days, Padj<0.001). Besides, they had a higher proportion of detection through active screening (Padj<0.001), pleurisy (Padj<0.001), and a lower proportion of pulmonary cavities (Padj<0.001), diabetes (Padj<0.001), bronchial tuberculosis (Padj<0.001). 53,204 PTB patients were successfully treated (95.7% in sputum-negative vs. 91.7% in sputum-positive) and were followed for 368804.5 person-years. Compared to sputum-positive patients, sputum-negative PTB patients showed lower rates of treatment failure (0.2% vs. 0.6%, ORadj=0.56, 95%CI 0.52-0.61), death (1.4% vs. 3.9%, ORadj=0.43, 95%CI 0.38-0.49) and recurrence (2.1% vs. 3.3%, HRadj=0.71, 95%CI 0.63-0.79).
CONCLUSIONS: As a less severe disease, sputum-negative PTB had fewer comorbidities, radiological abnormalities, and better treatment outcomes, but a longer delay in diagnosis, which indicated the urgent need for novel biomarkers to enhance early detection of sputum-negative PTB.