Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patientsMarieaM. tuberculosis: risque d'infection et de maladie chez les conjoints de patients tuberculeux a frottis positifCasadas con M.tuberculosis: riesgo de infeccion y enfermedad en esposas de pacientes Tuberculosos con lamina positiva

• Published in: Tropical medicine & international health 2011-07, Vol.16 (7), p.811-818
• Main Authors: Crampin, A, Kasimba, S, Mwaungulu, N J, Dacombe, R, Floyd, S, Glynn, J R, Fine, PEM
• Format: Article
• Language: English
• Subjects: Human immunodeficiency virus; Mycobacterium
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2011.02763.x

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV-positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24months. Results We recruited 148 spouses of smear-positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear-positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2years (95% CI 1.15-5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was greater than or equal to 10mm in 80% of HIV negative and in 57% of HIV-positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV-positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV-positive community controls. Of 54 HIV-positive spouses, 18 completed 6-month IPT. At 2year follow-up, 87% of surviving spouses had TST greater than or equal to 10mm and the rate of TB was 1.1 per 100py (95% CI 0.34-3.29). Conclusions Spouses are a high-risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short-duration therapy.Original Abstract: Objectifs: Quantifier le risque d'infection et de maladie chez les conjoints de patients atteints de tuberculose (TB) et la mesure dans laquelle l'intervention pourrait reduire le risque dans ce groupe tres expose. Methodes: Nous avons compare la prevalence du VIH, la prevalence et l'incidence de la TB et les resultats du test cutane tuberculinique (TCT) chez les conjoints de patients atteints de TB et de temoins dans la communaute. De l'isoniazide en traitement preventive (ITP) a ete offert aux conjoints VIH-positifs et le TCT a ete repetee a 6, 12 et 24 mois. Resultats: 148 conjoints de patients TB a frottis positifs, confirmes de facon prospective ont ete recrutes. 3% avaient une TB active. Nous avons aussi identifie 203 conjoints de patients TB a frottis positif, precedemment diagnostiques. 11 avaient deja eu la TB et le taux de TB etai