Identification of subclinical tuberculosis in household contacts using exposure scores and contact investigations

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dc.contributor.authorBekken, Gry K.en_ZA
dc.contributor.authorRitz, Christianen_ZA
dc.contributor.authorSelvam, Sumithraen_ZA
dc.contributor.authorJesuraj, Nelsonen_ZA
dc.contributor.authorHesseling, Anneke C.en_ZA
dc.contributor.authorDoherty, T. M.en_ZA
dc.contributor.authorGrewal, Harleen M. S.en_ZA
dc.contributor.authorVaz, Marioen_ZA
dc.contributor.authorJenum, Synneen_ZA
dc.date.accessioned2020-02-03T06:28:47Z
dc.date.available2020-02-03T06:28:47Z
dc.date.issued2020-01-31
dc.date.updated2020-02-02T04:20:26Z
dc.descriptionCITATION: Bekken, G. K. 2020. Identification of subclinical tuberculosis in household contacts using exposure scores and contact investigations. BMC Infectious Diseases, 20:96, doi:10.1186/s12879-020-4800-y.
dc.descriptionThe original publication is available at https://bmcinfectdis.biomedcentral.com
dc.description.abstractBackground: The goal of tuberculosis elimination put forward in the End TB Strategy prioritizes diagnosis and treatment of incipient and subclinical TB, recently defined by key stakeholders as “asymptomatic, early pre-clinical disease during which pathology evolves”. Regarded as indicative of a high risk of TB progression, considerable efforts have been made to identify these cases through exploration of biomarkers. The present study aimed to evaluate simple scoring systems for TB exposure as screening tools for subclinical TB, the only identifiable of the incipient and subclinical disease states, in a contact investigation (CI) setting of low HIV-prevalence. Methods: Nested within a large prospective study in household contacts (HHCs) of smear positive pulmonary TB cases in South-India conducted 2010–2012, we assessed 1) the association between the Tuberculosis Contact Score (TCS) and the Infectivity Score, with established tools for Mycobacterium tuberculosis (Mtb) infection, corrected for established TB risk factors, and 2) the capability of the TB exposure scores to identify subclinical TB defined by Mtbculture positivity in sputum or gastric aspirate (subjects < 5 years) specimen. Results: Of 525 HHCs, 29 were Mtb-culture positive and 96.6% of these asymptomatic. The TCS and the Infectivity Score associated with positive Tuberculin Skin Test and QuantiFeron TB-Gold In-tube assay (QFT) results in multivariate analyses (TCS: ORTST 1.16, 95% CI: 1.01, 1.33; ORQFT 1.33 95% CI: 1.16, 1.51. Infectivity Score: ORTST 1.39, 95% CI: 1.10, 1.76; ORQFT 1.41 95% CI: 1.16, 1.71). The Infectivity Score showed a moderate capability to identify subclinical TB (AUC of 0.61, 95% CI: 0.52, 0.70). Conclusions: Although our results did not identify an easily applicable screening tool for subclinical TB, the present study indicates that focusing on TB-related symptoms in CI settings may be of limited value for early identification of HHCs with high risk for TB progression.en_ZA
dc.description.urihttps://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-4800-y
dc.description.versionPublisher's version
dc.format.extent11 pagesen_ZA
dc.identifier.citationBekken, G. K. 2020. Identification of subclinical tuberculosis in household contacts using exposure scores and contact investigations. BMC Infectious Diseases, 20:96, doi:10.1186/s12879-020-4800-y
dc.identifier.issn1471-2334 (online)
dc.identifier.otherdoi:10.1186/s12879-020-4800-y
dc.identifier.urihttp://hdl.handle.net/10019.1/107411
dc.language.isoen_ZAen_ZA
dc.publisherBMC (part of Springer Nature)en_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectPulmonary tuberculosisen_ZA
dc.subjectTuberculosis — Risk Managementen_ZA
dc.subjectCohort studiesen_ZA
dc.subjectTuberculosis — Transmissionen_ ZA
dc.titleIdentification of subclinical tuberculosis in household contacts using exposure scores and contact investigationsen_ZA
dc.typeArticleen_ZA
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