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

BMC Infectious Diseases

Ted Cohen¹  Douglas Wilson²  Patrick George Tobias Cudahy³ 

[1] Department of Epidemiology (Microbial Diseases), Yale University School of Public Health, New Haven, CT, USA;Department of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, 5th Floor, Private Bag X 509, Plessislaer, KZN, 3216, Pietermaritzburg, South Africa;Section of Infectious Disease, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA;Department of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, 5th Floor, Private Bag X 509, Plessislaer, KZN, 3216, Pietermaritzburg, South Africa;

关键词: Mixed-infection;    South Africa;    Relapse;    Reinfection;    Fuzzy match;   

DOI  :  10.1186/s12879-020-05515-4

来源: Springer

【 摘 要 】

BackgroundPeople 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.MethodsWe 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.ResultsOf 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).ConclusionOur 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.

【 授权许可】

CC BY