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目的从某彝族初中首发涂阳肺结核学生的密切接触者中发现活动性肺结核病人。方法调查密切接触者和可疑症状者,行PPD试验、摄X线胸片、痰涂片抗酸杆菌和CT胸片检查。结果该校在校师生共606人,彝族学生523人(94.4%)。经筛查密切接触者73人,可疑症状者推荐70人。可疑症状者PPD试验强阳性率18.6%(13/70),患者所在的104班达24.5%(13/53);可疑症状者和PPD强阳性者X射线胸部摄片异常率7.2(6/83),CT胸片检查均不支持肺结核诊断;104班卡介苗接种卡痕率88.7%,6例X射线胸部摄片异常者均有卡痕;X射线胸部摄片异常者和PPD强阳性者痰涂片(3份痰)抗酸杆菌检查均为阴性。密切接触者中首发病例父亲X射线胸部摄片符合肺结核影像学诊断。结论该校所在乡结核病高发,首发病例的传染源来自于家庭成员,密切接触学生间还未引起播散,但隐性感染风险上升。
Objective To detect active pulmonary tuberculosis (TB) in close contacts of smear positive TB students in a Yi junior high school. Methods Investigate close contacts and suspicious symptoms, perform PPD test, take X-ray, sputum smear acid-fast bacilli and CT chest radiography. Results The school has a total of 606 teachers and students, 523 Yi students (94.4%). 73 people were screened for close contact and 70 were recommended for suspicious symptoms. The suspicious symptoms of PPD test strongly positive rate was 18.6% (13/70), the patient is located in 104 classes of 24.5% (13/53); suspicious symptoms and PPD strong positive X-ray chest radiography abnormalities rate of 7.2 (6/83 ), CT chest X-ray examination did not support the diagnosis of tuberculosis; BCG vaccination card rate of 104 was 88.7%, 6 cases of X-ray chest radiography abnormalities were card marks; X-ray chest radiograph abnormalities and PPD strongly positive phlegm Slices (3 phlegm) acid-fast bacilli test were negative. In close contact with the first case of father X-ray chest radiography in line with pulmonary tuberculosis imaging diagnosis. Conclusions The sources of TB infection in the township where the school is located originate from family members. The close contact with the students has not caused the spread yet, but the risk of latent infection is on the rise.