Risk factors for recurrent tuberculosis after successful treatment in a high burden setting: a cohort study

Autor:	Ted Cohen, Patrick G T Cudahy, Douglas Wilson
Jazyk:	angličtina
Rok vydání:	2020
Předmět:	0301 basic medicine Adult Male Mixed-infection medicine.medical_specialty Tuberculosis Genotype Antitubercular Agents Minisatellite Repeats lcsh:Infectious and parasitic diseases 03 medical and health sciences Young Adult South Africa Medical microbiology Pulmonary tuberculosis Recurrence Risk Factors Internal medicine medicine Humans lcsh:RC109-216 Relapse Tuberculosis Pulmonary business.industry Proportional hazards model Hazard ratio Sputum Mycobacterium tuberculosis Middle Aged medicine.disease 030112 virology Fuzzy match 030104 developmental biology Infectious Diseases Treatment Outcome Reinfection Tropical medicine Female medicine.symptom business Cohort study Research Article Follow-Up Studies
Zdroj:	BMC Infectious Diseases, Vol 20, Iss 1, Pp 1-8 (2020) BMC Infectious Diseases
ISSN:	1471-2334
Popis:	Background People successfully completing treatment for tuberculosis remain at elevated risk for recurrent disease, either from relapse or reinfection. Identifying risk factors for recurrent tuberculosis may help target post-tuberculosis screening and care. Methods We enrolled 500 patients with smear-positive pulmonary tuberculosis in South Africa and collected baseline data on demographics, clinical presentation and sputum mycobacterial cultures for 24-loci mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. We used routinely-collected administrative data to identify recurrent episodes of tuberculosis occurring over a median of six years after successful treatment completion. Results Of 500 patients initially enrolled, 333 (79%) successfully completed treatment for tuberculosis. During the follow-up period 35 patients with successful treatment (11%) experienced a bacteriologically confirmed tuberculosis recurrence. In our Cox proportional hazards model, a 3+ AFB sputum smear grade was significantly associated with recurrent tuberculosis with a hazard ratio of 3.33 (95% CI 1.44–7.7). The presence of polyclonal M. tuberculosis infection at baseline had a hazard ratio for recurrence of 1.96 (95% CI 0.86–4.48). Conclusion Our results indicate that AFB smear grade is independently associated with tuberculosis recurrence after successful treatment for an initial episode while the association between polyclonal M. tuberculosis infection and increased risk of recurrence appears possible.
Databáze:	OpenAIRE
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