Cough Frequency During Treatment Associated With Baseline Cavitary Volume and Proximity to the Airway in Pulmonary TB

Chest: The Journal of Circulation, Respiration and Related Systems

Brian H. Tracey^10¹  Daniel J. Mollura^11²  Eduardo Ticona^13,14³  David P. Bui^2⁴  Ziyue Xu^11⁵  Germán Comina^12,9⁶  Marjory A. Bravard^6,7,8⁷  Lilia Cabrera⁸  Jon S. Friedland^15⁹  David A.J. Moore^1,7,16^1,10  Gwenyth O. Lee^9^1,11  Nancy M. Vu^5^1,12  José W. López^3,4^1,13  Alvaro Proaño^1^1,14  Marco Varela^1,15  Philip Caligiuri^17^1,16  Carlton A. Evans^6,7,15^1,17  Robert H. Gilman^1,7,18^1,18 

[1] Asociación Benéfica PRISMA, Lima, Peru^7;Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD^11;Department of Electrical and Computer Engineering, Tufts University, Medford, MA^10;Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ^2;Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA^8;Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA^9;Department of Internal Medicine, Cleveland Clinic, Cleveland, OH^5;Department of Radiology & Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT^17;Escuela Profesional de Ingeniería Física, Facultad de Ciencias, Universidad Nacional de Ingeniería, Lima, Peru^12;Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru^13;Innovation for Health and Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru^6;Instituto Nacional de Salud del Niño San Borja, Lima, Peru^4;Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru^3;Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru^1;Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD^18;Section of Infectious Diseases & Immunity and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, London, England^15;Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Peru^14;TB Centre, London School of Hygiene and Tropical Medicine, London, England^16

关键词: cough;    CT;    mycobacteria;    tuberculosis;    CayeCoM;    Cayetano Cough Monitor;    CXR;    chest radiography;    HR;    hazard ratio;    MD;    mean difference;    MODS;    microscopic observation drug susceptibility;    RR;    rate ratio;    TTP;    time to positivity;   

DOI  :  10.1016/j.chest.2018.03.006

学科分类：呼吸医学

来源: American College of Chest Physicians

【 摘 要 】

Background Cough frequency, and its duration, is a biomarker that can be used in low-resource settings without the need of laboratory culture and has been associated with transmission and treatment response. Radiologic characteristics associated with increased cough frequency may be important in understanding transmission. The relationship between cough frequency and cavitary lung disease has not been studied. Methods We analyzed data in 41 adults who were HIV negative and had culture-confirmed, drug-susceptible pulmonary TB throughout treatment. Cough recordings were based on the Cayetano Cough Monitor, and sputum samples were evaluated using microscopic observation drug susceptibility broth culture; among culture-positive samples, bacillary burden was assessed by means of time to positivity. CT scans were analyzed by a US-board-certified radiologist and a computer-automated algorithm. The algorithm evaluated cavity volume and cavitary proximity to the airway. CT scans were obtained within 1 month of treatment initiation. We compared small cavities (≤ 7 mL) and large cavities (> 7 mL) and cavities located closer to (≤ 10 mm) and farther from (> 10 mm) the airway to cough frequency and cough cessation until treatment day 60. Results Cough frequency during treatment was twofold higher in participants with large cavity volumes (rate ratio [RR], 1.98; P = .01) and cavities located closer to the airway (RR, 2.44; P = .001). Comparably, cough ceased three times faster in participants with smaller cavities (adjusted hazard ratio [HR], 2.89; P = .06) and those farther from the airway (adjusted HR, 3.61;, P = .02). Similar results were found for bacillary burden and culture conversion during treatment. Conclusions Cough frequency during treatment is greater and lasts longer in patients with larger cavities, especially those closer to the airway.

【 授权许可】

CC BY