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Tuberculosis Transmission by Patients with Smear‐Negative Pulmonary Tuberculosis in a Large Cohort in The Netherlands
Open accessAbstract
BACKGROUND: Sputum smear microscopy is commonly used for diagnosing tuberculosis (TB). Although patients with sputum smear-negative TB are less infectious than patients with smear-positive TB, they also contribute to TB transmission. The objective of this study was to determine the proportion of TB transmission events caused by patients with smear-negative pulmonary TB in The Netherlands. METHODS: All patients in The Netherlands with culture-confirmed TB during the period 1996-2004 were included in this study. Patients with identical DNA fingerprints in Mycobacterium tuberculosis isolates from sputum samples were clustered. The first patients in a cluster were considered to be the index patients; all other patients were considered to have secondary cases. In addition, we examined transmission from sources by conventional contact tracing. RESULTS: We analyzed 394 clusters with a total of 1285 patients. On the basis of molecular linkage only, 12.6% of the secondary cases were attributable to transmission from a patient with smear-negative TB. The relative transmission rate among patients with smear-negative TB, compared with patients with smear-positive TB, was 0.24 (95% confidence interval, 0.20-0.30). Secondary cases in clusters with an index patient with smear-negative TB more frequently had smear-negative status (odds ratio, 1.86; 95% confidence interval, 1.18-2.93), compared with secondary cases in clusters with an index patient with smear-positive TB. Conventional contact tracing revealed that 26 (6.2%) of the 417 sources, as identified by the Municipal Health Services, had smear-negative TB. CONCLUSIONS: In The Netherlands, patients with smear-negative, culture-positive TB are responsible for 13% of TB transmission. Countries that have ample resources should expand their TB-control efforts to include prevention of transmission from patients with smear-negative, culture-positive pulmonary TB.
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Cited by
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A multisite assessment of the quantitative capabilities of the Xpert MTB/RIF assay
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Metadata
- Authors
- Tostmann, A., Kik, S. V., Kalisvaart, N. A., Sebek, M. M., Verver, S., Boeree, M. J., & van Soolingen, D.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-11
- Volume
- 47
- Issue
- 9
- Pages
- 1135-1142
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2164988748
- Cited by
- 320
- References
- 20
- FWCI
- 6.82
- Type
- journal article
- Language
- en
- Open access
- bronze
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- Tostmann, A., Kik, S. V., Kalisvaart, N. A., Sebek, M. M., Verver, S., Boeree, M. J., & van Soolingen, D. (2008). Tuberculosis Transmission by Patients with Smear‐Negative Pulmonary Tuberculosis in a Large Cohort in The Netherlands. Clinical Infectious Diseases. https://doi.org/10.1086/591974
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