Subclinical pulmonary tuberculosis, which presents without recognisable symptoms, is frequently detected in community screening. However, the disease category is poorly clinically defined. We explored the prevalence of subclinical pulmonary tuberculosis according to different case definitions. We did a one-stage individual participant data meta-analysis of nationally representative surveys that were conducted in countries with high incidence of tuberculosis between 2007 and 2020, that reported the prevalence of pulmonary tuberculosis based on chest x-ray and symptom screening in participants aged 15 years and older. Screening and diagnostic criteria were standardised across the surveys, and tuberculosis was defined by positive sputum culture. We estimated proportions of subclinical tuberculosis for three case definitions: no persistent cough (ie, duration ≥2 weeks), no cough at all, and no symptoms (ie, absence of cough, fever, chest pain, night sweats, and weight loss), both unadjusted and adjusted for false-negative chest x-rays and uninterpretable culture results. We identified 34 surveys, of which 31 were eligible. Individual participant data were obtained and included for 12 surveys (620 682 participants) across eight countries in Africa and four in Asia. Data on 602 863 participants were analysed, of whom 1944 had tuberculosis. The unadjusted proportion of subclinical tuberculosis was 59·1% (n=1149/1944; 95% CI 55·8–62·3) for no persistent cough and 39·8% (773/1944; 36·6–43·0) for no cough of any duration. The adjusted proportions were 82·8% (95% CI 78·6–86·6) for no persistent cough and 62·5% (56·6–68·7) for no cough at all. In a subset of four surveys, the proportion of participants with tuberculosis but without any symptoms was 20·3% (n=111/547; 95% CI 15·5–25·1) before adjustment and 27·7% (95% CI 21·0–36·4) after adjustment. Tuberculosis without cough, irrespective of its duration, was more frequent among women (no persistent cough: adjusted odds ratio 0·79, 95% CI 0·63–0·97; no cough: adjusted odds ratio 0·76, 95% CI 0·62–0·93). Among participants with tuberculosis, 29·1% (95% CI 25·2–33·3) of those without persistent cough and 23·1% (18·8–27·4) of those without any cough had positive smear examinations. The majority of people in the community who have pulmonary tuberculosis do not report cough, a quarter report no tuberculosis-suggestive symptoms at all, and a quarter of those not reporting any cough have positive sputum smears, suggesting infectiousness. In high-incidence settings, subclinical tuberculosis could contribute considerably to the tuberculosis burden and to transmission. Mr Willem Bakhuys Roozeboom Foundation.

中文翻译：

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社区环境中成人亚临床肺结核的患病率：个体参与者数据荟萃分析


亚临床肺结核没有明显的症状，经常在社区筛查中被发现。然而，临床上对该疾病类别的定义很差。我们根据不同的病例定义探讨了亚临床肺结核的患病率。我们对 2007 年至 2020 年间在结核病高发国家进行的全国代表性调查进行了一项单阶段个体参与者数据荟萃分析，报告了基于胸部 X 光检查和症状筛查的老年参与者的肺结核患病率15 岁及以上。整个调查的筛查和诊断标准均已标准化，结核病的定义是痰培养阳性。我们根据三种病例定义估计了亚临床结核病的比例：无持续咳嗽（即持续时间≥2周）、完全没有咳嗽和无症状（即没有咳嗽、发烧、胸痛、盗汗和体重减轻） ，未调整和针对假阴性胸部 X 光检查和无法解释的培养结果进行调整。我们确定了 34 项调查，其中 31 项符合条件。获得并纳入了非洲 8 个国家和亚洲 4 个国家的 12 项调查（620-682 名参与者）的个人参与者数据。对 602–863 名参与者的数据进行了分析，其中 1944 人患有结核病。未调整的亚临床结核病比例为 59·1% (n=1149/1944; 95% CI 55·8–62·3)（无持续性咳嗽）和 39·8% (773/1944; 36·6–43·0) ）没有任何持续时间的咳嗽。调整后的无持续咳嗽比例为 82·8% (95% CI 78·6–86·6)，完全不咳嗽为 62·5% (56·6–68·7)。 在四项调查的子集中，调整前患有结核病但无任何症状的参与者比例为 20·3% (n=111/547；95% CI 15·5–25·1)，调整后为 27·7% (95% CI 21·0–36·4) 调整后。无论持续时间长短，无咳嗽的结核病在女性中更为常见（无持续咳嗽：调整后的比值比 0·79，95% CI 0·63–0·97；无咳嗽：调整后的比值比 0·76，95% CI 0·62–0·93）。在患有结核病的参与者中，29·1% (95% CI 25·2–33·3) 的无持续咳嗽者和 23·1% (18·8–27·4) 的无咳嗽者涂片检查呈阳性。社区中大多数肺结核患者没有报告咳嗽，四分之一的人报告根本没有结核病提示症状，四分之一的没有报告任何咳嗽的人痰涂片呈阳性，表明有传染性。在高发地区，亚临床结核病可能会极大地增加结核病负担和传播。威廉·巴库伊斯·鲁兹布姆先生基金会。