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Kerschberger B, Vambe D, Schomaker M, Mabhena E, Daka M, Dlamini T, Ngwenya S, Mamba B, Nxumalo B, Sibanda J, Dube S, Dlamini LM, Mukooza E, Ellman T, Ciglenecki I. Sustained high fatality during TB therapy amid rapid decline in TB mortality at population level: A retrospective cohort and ecological analysis from Shiselweni, Eswatini. Trop Med Int Health 2024; 29:192-205. [PMID: 38100203 DOI: 10.1111/tmi.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVES Despite declining TB notifications in Southern Africa, TB-related deaths remain high. We describe patient- and population-level trends in TB-related deaths in Eswatini over a period of 11 years. METHODS Patient-level (retrospective cohort, from 2009 to 2019) and population-level (ecological analysis, 2009-2017) predictors and rates of TB-related deaths were analysed in HIV-negative and HIV-coinfected first-line TB treatment cases and the population of the Shiselweni region. Patient-level TB treatment data, and population and HIV prevalence estimates were combined to obtain stratified annual mortality rates. Multivariable Poisson regressions models were fitted to identify patient-level and population-level predictors of deaths. RESULTS Of 11,883 TB treatment cases, 1302 (11.0%) patients died during treatment: 210/2798 (7.5%) HIV-negative patients, 984/8443 (11.7%) people living with HIV (PLHIV), and 108/642 (16.8%) patients with unknown HIV-status. The treatment case fatality ratio remained above 10% in most years. At patient-level, fatality risk was higher in PLHIV (aRR 1.74, 1.51-2.02), and for older age and extra-pulmonary TB irrespective of HIV-status. For PLHIV, fatality risk was higher for TB retreatment cases (aRR 1.38, 1.18-1.61) and patients without antiretroviral therapy (aRR 1.70, 1.47-1.97). It decreases with increasing higher CD4 strata and the programmatic availability of TB-LAM testing (aRR 0.65, 0.35-0.90). At population-level, mortality rates decreased 6.4-fold (-147/100,000 population) between 2009 (174/100,000) and 2017 (27/100,000), coinciding with a decline in TB treatment cases (2785 in 2009 to 497 in 2017). Although the absolute decline in mortality rates was most pronounced in PLHIV (-826/100,000 vs. HIV-negative: -23/100,000), the relative population-level mortality risk remained higher in PLHIV (aRR 4.68, 3.25-6.72) compared to the HIV-negative population. CONCLUSIONS TB-related mortality rapidly decreased at population-level and most pronounced in PLHIV. However, case fatality among TB treatment cases remained high. Further strategies to reduce active TB disease and introduce improved TB therapies are warranted.
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Affiliation(s)
- Bernhard Kerschberger
- Médecins sans Frontières, Mbabane, Eswatini
- Médecins sans Frontières/Ärzte ohne Grenzen, Vienna Evaluation Unit, Vienna, Austria
| | - Debrah Vambe
- National TB Control Programme (NTCP), Manzini, Eswatini
| | - Michael Schomaker
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Statistics, Ludwig-Maximilians University Munich, Munich, Germany
| | | | | | | | | | - Bheki Mamba
- National TB Control Programme (NTCP), Manzini, Eswatini
| | | | - Joyce Sibanda
- National TB Control Programme (NTCP), Manzini, Eswatini
| | - Sisi Dube
- National TB Control Programme (NTCP), Manzini, Eswatini
| | | | | | - Tom Ellman
- Médecins sans Frontières, Cape Town, South Africa
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Suhairi MH, Mohamad M, Isa MR, Mohd Yusoff MAS, Ismail N. Risk factors for tuberculosis-related death among adults with drug-sensitive pulmonary tuberculosis in Selangor, Malaysia from 2013 to 2019: a retrospective cohort study using surveillance data. BMJ Open 2024; 14:e080144. [PMID: 38413152 PMCID: PMC10900436 DOI: 10.1136/bmjopen-2023-080144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES Due to the paucity of literature on risk factors for tuberculosis (TB)-related death, we determine the sociodemographic and clinical risk factors associated with TB-related deaths among adult pulmonary TB (PTB) patients on treatment in Selangor, Malaysia. DESIGN Retrospective cohort study. SETTING Routinely collected primary care data from all government TB clinics in Selangor. PARTICIPANTS Data of 24 570 eligible adult PTB patients from 2013 to 2019 were obtained from Selangor's State Health Department surveillance records. We included PTB patients aged at least 15 years old at the time of diagnosis with complete documentation of the dates of diagnosis, treatment initiation, end of treatment/follow-up and treatment outcomes. We excluded patients whose diagnoses were changed to non-TB, post-mortem TB diagnosis and multidrug-resistant TB (MDR-TB) patients. PRIMARY AND SECONDARY OUTCOME MEASURES TB-related death, determined from the recorded physicians' consensus during the TB mortality meeting. RESULTS TB-related death was significantly associated with far (adjusted HR (aHR) 9.98, 95% CI 4.28 to 23.28) and moderately advanced (aHR 3.23, 95% CI 1.43 to 7.31) radiological findings at diagnosis; concurrent TB meningitis (aHR 7.67, 95% CI 4.53 to 12.98) and miliary TB (aHR 6.32, 95% CI 4.10 to 9.74) involvement; HIV positive at diagnosis (aHR 2.81, 95% CI 2.21 to 3.57); Hulu Selangor (aHR 1.95, 95% CI 1.29 to 2.93), Klang (aHR 1.53, 95% CI 1.18 to 1.98) and Hulu Langat (aHR 1.31, 95% CI 1.03 to 1.68) residing districts; no formal education (aHR 1.70, 95% CI 1.23 to 2.35); unemployment (aHR 1.54, 95% CI 1.29 to 1.84), positive sputum smear acid-fast bacilli (AFB) at diagnosis (aHR 1.51, 95% CI 1.22 to 1.85); rural residency (aHR 1.39, 95% CI 1.13 to 1.72) and advancing age (aHR 1.03, 95% CI 1.02 to 1.03). CONCLUSIONS Far and moderately advanced radiological findings, concurrent TB meningitis and miliary TB involvement, HIV positive, Hulu Selangor, Klang and Hulu Langat residing districts, no formal education, unemployment, positive sputum smear AFB, rural residency and advancing age are risk factors of TB-related death. Our findings should assist in identifying high-risk patients requiring interventions against TB-related death.
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Affiliation(s)
- Mohammad Haikal Suhairi
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
- Bahagian Pengurusan Latihan Kementerian Kesihatan Malaysia, Putrajaya, Malaysia
| | - Mariam Mohamad
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Mohamad Rodi Isa
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | | | - Nurhuda Ismail
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
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Wang Y, Chen H, Zeng X, Liao L, Lu X, Zhang A. Changes in tuberculosis burden and its associated risk factors in Guizhou Province of China during 2006-2020: an observational study. BMC Public Health 2024; 24:526. [PMID: 38378516 PMCID: PMC10877832 DOI: 10.1186/s12889-024-18023-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Understanding the trends of tuberculosis (TB) burden and its risk factors at the provincial level in the context of global End TB targets is crucial to identify the progress and challenges in TB control. We aimed to estimate the burden of TB and risk factors for death from 2006 to 2020 for the first time in Guizhou Province, China. METHODS Data were collected from the national TB surveillance system. Four indicators of TB burden and their corresponding age-standardized rates (ASRs), including incidence (ASIR), prevalence (ASPR), mortality (ASMR) and disability-adjusted life years (DALYs) (ASDR), were estimated and stratified by year, age, gender and prefecture. Temporal trends of ASRs were presented by locally weighted regression, and the annual percentage change was calculated. The correlation between gross domestic product (GDP) per capita and ASRs was evaluated by Pearson correlation analysis. The associated risk factors for death in PTB patients were determined using logistic regression models. RESULTS A total of 557,476 pulmonary TB (PTB) cases and 11,234 deaths were reported, including 2233 (19.9%) TB specific deaths and 9001 (80.1%) deaths from other causes. The 15-year average incidence, prevalence and mortality rates were 94.6, 102.6 and 2.1 per 100,000 population, respectively. The average DALY rate was 0.60 per 1000 population. The ASIR and ASPR have shown downward trends since 2012, with the largest percentage decrease in 2020 (ASIR: -29.8%; ASPR: -30.5%). The number in TB specific deaths consistently decreased during the study period (P<0.001), while the increase in deaths from other causes drove the overall upward trend in ASMR and ASDR. Four ASRs remained high in males and 5 prefectures. GDP per capita was negatively associated with the ASIR, ASPR and ASDR (P<0.05). Among PTB patients, men, patients with no fixed job, those with a low GDP level, patients with increasing age, those previously treated, those with severe symptoms, those transferred in and those receiving directly observed treatment were more likely to suffer death. CONCLUSION Guizhou has made progress in reducing PTB cases and TB specific deaths over the last 15 years. Targeted interventions are needed to address these risk factors for death in PTB patients and high-risk areas.
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Affiliation(s)
- Yun Wang
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
| | - Huijuan Chen
- Department of Tuberculosis Prevention and Control, Guizhou Center for Disease Prevention and Control, Guiyang, Guizhou, China.
| | - Xiaoqi Zeng
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
| | - Long Liao
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
| | - Xiaolong Lu
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, China
| | - Aihua Zhang
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
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Jeong YJ, Park JS, Kim HW, Min J, Ko Y, Oh JY, Lee EH, Yang B, Lee MK, Kim YS, Chang JH, Jegal Y, Lee SS, Kim JS, Koo HK. Deaths from tuberculosis: differences between tuberculosis-related and non-tuberculosis-related deaths. Front Public Health 2023; 11:1207284. [PMID: 37719730 PMCID: PMC10502314 DOI: 10.3389/fpubh.2023.1207284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/09/2023] [Indexed: 09/19/2023] Open
Abstract
Objective Tuberculosis (TB) is a major cause of ill health and one of the leading causes of death worldwide. The first step in developing strategies to reduce TB mortality is to identify the direct causes of death in patients with TB and the risk factors for each cause. Methods Data on patients with TB systemically collected from the National Surveillance System of South Korea from January 2019 to December 2020 were included in this study. We analyzed the clinical characteristics associated with TB and non-TB-related deaths, including TB-related symptoms, comorbidities, and radiographic and microbiological findings. Results Of the total of 12,340 patients with TB, 61% were males with a mean age of 61.3 years. During the follow-up period, the overall mortality rate was 10.6%, with TB-related deaths accounting for 21.3% of all TB deaths. The median survival time in the TB-related death group was 22 days. TB-related death was associated with older age, lower body mass index (BMI), dyspnea, fever, general weakness, bilateral radiographic patterns, and acid-fast bacilli (AFB)-positive smears. Non-TB-related deaths were associated with older age, male sex, lower BMI, comorbidities of heart, liver, kidney, and central nervous system (CNS) diseases, CNS TB involvement, the presence of dyspnea, general weakness, and bilateral radiographic patterns. Conclusion Patients with high-risk TB must be identified through cause-specific mortality analysis, and the mortality rate must be reduced through intensive monitoring of patients with a high TB burden and comorbidities.
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Affiliation(s)
- Yun-Jeong Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jae Seuk Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Hyung Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yousang Ko
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jee Youn Oh
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Hye Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Min Ki Lee
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Yun Seong Kim
- Department of Internal Medicine, School of Medicine, Pusan National University Yangsan Hospital, Pusan National University and Research Institute of Convergence Biomedical Science and Technology, Busan, Republic of Korea
| | - Jung Hyun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mokdong Hospital, Ewha Women's University, Seoul, Republic of Korea
| | - Yangjin Jegal
- Division of Pulmonology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sung Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
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Wang C, Yang X, Zhang H, Zhang Y, Tao J, Jiang X, Wu C. Temporal trends in mortality of tuberculosis attributable to high fasting plasma glucose in China from 1990 to 2019: a joinpoint regression and age-period-cohort analysis. Front Public Health 2023; 11:1225931. [PMID: 37575123 PMCID: PMC10413982 DOI: 10.3389/fpubh.2023.1225931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Background Nowadays, high fasting plasma glucose (HFPG) has been identified as the important risk factor contributing to the increased burden of diseases. But there remains a lack of research on tuberculosis (TB) mortality specifically attributable to HFPG. Thus, this study aims to explore the long-term trends in HFPG-related TB mortality in China from 1990 to 2019. Methods Data on HFPG-related TB mortality were obtained from the Global Burden of Disease (GBD) Study 2019. Analyzing the data using joinpoint regression and age-period-cohort methods adjusting for age, period, and cohort allowed us to assess the trends in TB mortality due to HFPG. Results The age-standardized mortality rates (ASMRs) of TB attributable to HFPG exhibited a downward trend in China from 1990 to 2019, with an average annual percentage change (AAPC) of -7.0 (95% CI, -7.5 to -6.6). Similar trends were found for male (AAPC of -6.5 [95% CI, -7.0 to -6.0]) and female (AAPC of -8.2 [95% CI, -8.5 to -7.9]), respectively. Local drifts curve with a U-shaped pattern reflected the AAPC of TB mortality due to HFPG across age groups. The greatest decline was observed in the age group of 60-64 years. The mortality rates related to HFPG first increased and then decreased with increasing age, peaking in the 55-59 age group. Our analysis of the period and cohort effects found that the rate ratios of TB mortality due to HFPG have decreased over the past three decades, more prominently in women. It is noteworthy that while both genders have seen a decline in HFPG-attributable TB mortality and risk, men have a higher risk and slightly less significant decline than women. Conclusion The present study shows that HFPG-related ASMRs and risk of TB in China decreased over the last 30 years, with similar trends observed in both men and women. In order to attain the recommended level set by the WHO, the effective strategies for glycemic control and management still needed to be implemented strictly to further decrease the burden of TB.
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Affiliation(s)
- Chao Wang
- National Center for Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xueli Yang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Honglu Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yanzhuo Zhang
- National Center for Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Jianfeng Tao
- National Center for Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xu Jiang
- Department of Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Chengai Wu
- National Center for Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
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Liao KM, Liu CF, Chen CJ, Feng JY, Shu CC, Ma YS. Using an Artificial Intelligence Approach to Predict the Adverse Effects and Prognosis of Tuberculosis. Diagnostics (Basel) 2023; 13:diagnostics13061075. [PMID: 36980382 PMCID: PMC10047137 DOI: 10.3390/diagnostics13061075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Tuberculosis (TB) is one of the leading causes of death worldwide and a major cause of ill health. Without treatment, the mortality rate of TB is approximately 50%; with treatment, most patients with TB can be cured. However, anti-TB drug treatments may result in many adverse effects. Therefore, it is important to detect and predict these adverse effects early. Our study aimed to build models using an artificial intelligence/machine learning approach to predict acute hepatitis, acute respiratory failure, and mortality after TB treatment. Materials and Methods: Adult patients (age ≥ 20 years) who had a TB diagnosis and received treatment from January 2004 to December 2021 were enrolled in the present study. Thirty-six feature variables were used to develop the predictive models with AI. The data were randomly stratified into a training dataset for model building (70%) and a testing dataset for model validation (30%). These algorithms included XGBoost, random forest, MLP, light GBM, logistic regression, and SVM. Results: A total of 2248 TB patients in Chi Mei Medical Center were included in the study; 71.7% were males, and the other 28.3% were females. The mean age was 67.7 ± 16.4 years. The results showed that our models using the six AI algorithms all had a high area under the receiver operating characteristic curve (AUC) in predicting acute hepatitis, respiratory failure, and mortality, and the AUCs ranged from 0.920 to 0.766, 0.884 to 0.797, and 0.834 to 0.737, respectively. Conclusions: Our AI models were good predictors and can provide clinicians with a valuable tool to detect the adverse prognosis in TB patients early.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan 722013, Taiwan
| | - Chung-Feng Liu
- Department of Medical Research, Chi Mei Medical Center, Tainan 710402, Taiwan;
- Correspondence: (C.-F.L.); (C.-J.C.)
| | - Chia-Jung Chen
- Department of Information Systems, Chi Mei Medical Center, Tainan 710402, Taiwan
- Correspondence: (C.-F.L.); (C.-J.C.)
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112304, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
- College of Medicine, National Taiwan University, Taipei 100233, Taiwan
| | - Yu-Shan Ma
- Department of Medical Research, Chi Mei Medical Center, Tainan 710402, Taiwan;
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Nordholm AC, Andersen AB, Wejse C, Norman A, Ekstrøm CT, Andersen PH, Lillebaek T, Koch A. Mortality, risk factors, and causes of death among people with tuberculosis in Denmark, 1990-2018. Int J Infect Dis 2023; 130:76-82. [PMID: 36907546 DOI: 10.1016/j.ijid.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVES This study aimed to analyze mortality, risk factors, and causes of death among people with tuberculosis (TB). METHODS This is a population-based cohort study with patients with TB ≥18 years notified from 1990 to 2018 in Denmark, compared with sex- and age-matched controls. Mortality was assessed in Kaplan-Meier models and risk factors for death were estimated in Cox proportional hazards models. RESULTS Overall mortality was twofold higher among people with TB compared with controls up to 15 years after TB diagnosis (hazard ratio [HR]: 2.18, 95% confidence interval [CI]: 2.06-2.29, P <0.0001). Danes with TB were three times more likely to die than migrants (adjusted HR: 3.13, 95% CI: 2.84-3.45, P <0.0001). Risk factors for death included living alone, being unemployed, having low income, and comorbidities such as mental illness with substance abuse, lung diseases, hepatitis, and HIV. TB was the most common cause of death (21%), followed by chronic obstructive pulmonary disease (7%), lung cancer (6%), alcoholic liver disease (5%), and mental illness with substance abuse (4%). CONCLUSION People with TB had substantially inferior survival up to 15 years after TB diagnosis, in particular, socially disadvantaged Danes with TB with specific comorbidities. This may reflect unmet needs for enhanced treatment of other medical/social conditions during TB treatment.
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Affiliation(s)
- Anne Christine Nordholm
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
| | - Aase Bengaard Andersen
- Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Center for Global Health, Aarhus University, Aarhus, Denmark
| | - Anders Norman
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Peter Henrik Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark; Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Koch
- Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
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The Dysbiosis Triggered by First-Line Tuberculosis Antibiotics Fails to Reduce Their Bioavailability. mBio 2023; 14:e0035323. [PMID: 36877010 PMCID: PMC10127996 DOI: 10.1128/mbio.00353-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Antituberculosis therapy (ATT) causes a rapid and distinct alteration in the composition of the intestinal microbiota that is long lasting in both mice and humans. This observation raised the question of whether such antibiotic-induced changes in the microbiome might affect the absorption or gut metabolism of the tuberculosis (TB) drugs themselves. To address this issue, we utilized a murine model of antibiotic-induced dysbiosis to assay the bioavailability of rifampicin, moxifloxacin, pyrazinamide, and isoniazid in mouse plasma over a period of 12 h following individual oral administration. We found that 4-week pretreatment with a regimen of isoniazid, rifampicin, and pyrazinamide (HRZ), a drug combination used clinically for ATT, failed to reduce the exposure of any of the four antibiotics assayed. Nevertheless, mice that received a pretreatment cocktail of the broad-spectrum antibiotics vancomycin, ampicllin, neomycin, and metronidazole (VANM), which are known to deplete the intestinal microbiota, displayed a significant decrease in the plasma concentration of rifampicin and moxifloxacin during the assay period, an observation that was validated in germfree animals. In contrast, no major effects were observed when similarly pretreated mice were exposed to pyrazinamide or isoniazid. Thus, the data from this animal model study indicate that the dysbiosis induced by HRZ does not reduce the bioavailability of the drugs themselves. Nevertheless, our observations suggest that more extreme alterations of the microbiota, such as those occurring in patients on broad-spectrum antibiotics, could directly or indirectly affect the exposure of important TB drugs and thereby potentially influencing treatment outcome. IMPORTANCE Previous studies have shown that treatment of Mycobacterium tuberculosis infection with first-line antibiotics results in a long-lasting disruption of the host microbiota. Since the microbiome has been shown to influence the host availability of other drugs, we employed a mouse model to ask whether the dysbiosis resulting from either tuberculosis (TB) chemotherapy or a more aggressive course of broad-spectrum antibiotics might influence the pharmacokinetics of the TB antibiotics themselves. While drug exposure was not reduced in animals previously described as exhibiting the dysbiosis triggered by conventional TB chemotherapy, we found that mice with other alterations in the microbiome, such as those triggered by more intensive antibiotic treatment, displayed decreased availability of rifampicin and moxifloxacin, which in turn could impact their efficacy. The above findings are relevant not only to TB but also to other bacterial infections treated with these two broader spectrum antibiotics.
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Association of Xpert MTB/RIF Cycle Threshold Values with Tuberculosis Treatment Outcomes. Lung 2020; 198:985-989. [PMID: 33128653 DOI: 10.1007/s00408-020-00398-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Considering the current recommendation of the World Health Organization to replace sputum smear microscopy with Xpert MTB/RIF as an initial diagnostic test for tuberculosis (TB), and that culture takes time to provide results, the cycle threshold (CT) of the Xpert test may be the only way to assess bacillary load. The objective of this study is to evaluate the association of bacillary load, measured by the Xpert CT, with the TB treatment outcomes. METHODS In cohort study, Xpert CT values were evaluated in cured and non-cured (failure and death) patients. Multivariate analysis was performed to evaluate if CT is independently associated with TB treatment outcomes. RESULTS During this study period, 155 patients (84 cured and 71 non-cured) met the inclusion and were included in the analysis. The mean CT value for Xpert MTB/RIF test was 20.7 ± 5.6 in cured patients and 17.1 ± 5.6 in non-cured patients (p < 0.0001). Previous TB was more frequent in non-cured (28.2%) than in cured patients (7.1%) (p < 0.0001). Non-cured patients were younger than cured ones (37.1 ± 13.3 vs 43.6 ± 16.2; p = 0.006). HIV was more frequent in non-cured (28.2%) than in cured patients (15.5%), although this difference was not statistically significant (p = 0.054). In multivariate analysis, CT values, age, previous TB, and HIV were independently associated with non-cure. CONCLUSIONS Lower Xpert MTB/RIF CT values were independently associated with worse treatment outcomes. The information from even a single test performed before starting treatment proved to be a relatively good predictor of TB treatment outcome.
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Ramakrishnan J, Sarkar S, Chinnakali P, Lakshminarayanan S, Sahu SK, Reshma A, Knudsen S, Das M, Thekkur P, Venugopal V, Hochberg NS, Salgame P, Horsburgh CR, Ellner J, Roy G. Risk factors for death during treatment in pulmonary tuberculosis patients in South India: A cohort study. Indian J Tuberc 2020; 68:32-39. [PMID: 33641849 DOI: 10.1016/j.ijtb.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Identifying the risk factors for deaths during tuberculosis (TB) treatment is important for achieving the vision of India's National Strategic Plan of 'Zero Deaths' by 2025. We aimed to determine the proportion of deaths during TB treatment and its risk factors among smear positive pulmonary TB patients aged more than 15 years. STUDY DESIGN We performed a cohort study using data collected for RePORT India Consortium (Regional Prospective Observational Research in Tuberculosis). SETTING Revised TB Control Program (RNTCP) in three districts of South India. PARTICIPANTS The cohort consisted of newly diagnosed drug sensitive patients enrolled under the Revised National TB Control Program during 2014-2018 in three districts of southern India. Information on death was collected at homes by trained project staff. PRIMARY OUTCOME MEASURES We calculated 'all-cause mortality' during TB treatment and expressed this as a proportion with 95% confidence interval (CI). Risk factors for death were assessed by calculating unadjusted and adjusted relative risks with 95% CI. RESULTS The mean (SD) age was of the 1167 participants was 45 (14.5) years and 79% of them were males. Five participants (0.4%) were HIV infected. Among the males, 560 (61%) were tobacco users and 688 (75%) reported consuming alcohol. There were 47 deaths (4%; 95% CI 3.0-5.3) of which 28 deaths (60%) occurred during first two months of treatment. In a bi-variable analysis, age of more than 60 years (RR 2.27; 95%CI: 1.24-4.15), male gender (RR 3.98; 95% CI: 1.25-12.70), alcohol use in last 12 months (RR 2.03; 95%CI: 1.07-3.87), tobacco use (RR 1.87; 95%CI: 1.05-3.36) and severe anaemia (RR 3.53: 95%CI: 1.34-9.30) were associated with a higher risk of death. In adjusted analysis, participants with severe anaemia (<7gm/dl) had 2.4 times higher risk of death compared to their counterparts. CONCLUSION Though deaths during TB treatment was not very high, early recognition of risk groups and targeted interventions are required to achieve zero TB deaths.
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Affiliation(s)
- Jayalakshmy Ramakrishnan
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Sonali Sarkar
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
| | - Palanivel Chinnakali
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Subitha Lakshminarayanan
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Swaroop Kumar Sahu
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ayiraveetil Reshma
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Selby Knudsen
- Boston University School of Public Health, Boston, MA, USA
| | | | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union-South East Asia Office, New Delhi, India
| | - Vinayagamoorthy Venugopal
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Natasha S Hochberg
- Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - C Robert Horsburgh
- Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Gautam Roy
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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11
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Holden IK, Lillebaek T, Andersen PH, Wejse C, Johansen IS. Characteristics and predictors for tuberculosis related mortality in Denmark from 2009 through 2014: A retrospective cohort study. PLoS One 2020; 15:e0231821. [PMID: 32497102 PMCID: PMC7272085 DOI: 10.1371/journal.pone.0231821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Mortality from tuberculosis (TB) has been declining since 2000, nevertheless there is still a significant number of patients who die before or during TB treatment. The aims were to examine and describe predictors associated with TB related mortality. Methods Patients notified with TB from 2009 though 2014 in Denmark were included. Data were extracted from national registers and patient records were examined for clinical information and treatment outcome. Cox proportional hazards regression was used to examine TB related mortality. Results A total of 2131 cases were identified, 141 (6.6%) patients died before or during TB treatment. TB related mortality accounted for 104 cases (73.8%) and decreased significantly from 6.7% to 3.2% (p = .04) during the study period. Within 1 months of diagnosis, 49% of TB related deaths had occurred. The strongest risk factors present at time of diagnosis, associated with TB related mortality, were: age > 70 years, Charlson comorbidity index > 1, alcohol abuse, weight loss, anemia, and C-reactive protein > 100 mg/L (p < .05). Conclusion The majority of TB related deaths occurred soon after diagnosis, emphasizing that TB patients identified to have a high risk of mortality should be closely monitored before and during the intensive treatment period to improve their outcomes.
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Affiliation(s)
- Inge K. Holden
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Mycobacterial Centre for Research Southern Denmark–MyCRESD, Odense, Denmark
- * E-mail:
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Peter H. Andersen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Isik S. Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Mycobacterial Centre for Research Southern Denmark–MyCRESD, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Bhargava A, Bhargava M. Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key. J Clin Tuberc Other Mycobact Dis 2020; 19:100155. [PMID: 32211519 PMCID: PMC7082610 DOI: 10.1016/j.jctube.2020.100155] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The goal of reducing tuberculosis (TB) mortality in the END TB Strategy can be achieved if TB deaths are considered predictable and preventable. This will require programs to examine and address some key gaps in the understanding of the distribution and determinants of TB mortality and the current model of assessment and care in high burden countries. Most deaths in high-burden countries occur in the first eight weeks of treatment and in those belonging to the age group of 15–49 years, living in poverty, with HIV infection and/or low body mass index (BMI). Deaths result from extensive disease, comorbidities like advanced HIV disease complicated with other infections (bacterial, fungal, bloodstream), and moderate-severe undernutrition. Most early deaths in patients with TB, even with TB-HIV co-infection, are due to TB itself. Comprehensive assessment and clinical care are a prerequisite of patient-centered care. Simple independent predictors of death like unstable vital signs, BMI, mid-upper arm circumference, or inability to stand or walk unaided can be used by programs for risk assessment. Programs need to define criteria for referral for inpatient care, address the paucity of hospital beds and develop and implement guidelines for the clinical management of seriously ill patients with TB, advanced HIV disease and severe undernutrition as co-morbidities. Programs should also consider notification and audit of all TB deaths, similar to audit of maternal deaths, and address the issues in delays in diagnosis, treatment, and quality of care.
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Affiliation(s)
- Anurag Bhargava
- Department of Medicine, Yenepoya Medical College, University Road, Deralakatte, Mangalore, 575018, India.,Department of Medicine, McGill University, 1001 Decarie Boulevard, suite D05-2212, Mail Drop Number: D05-2214, Montreal, H4A 3J1, Canada.,Center for Nutrition Studies, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore. 575018, India
| | - Madhavi Bhargava
- Department of Community Medicine, Yenepoya Medical College, University Road, Deralakatte, Mangalore. 575018, India.,Center for Nutrition Studies, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore. 575018, India
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13
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Pedrazzoli D, Kranzer K, Thomas HL, Lalor MK. Trends and risk factors for death and excess all-cause mortality among notified tuberculosis patients in the UK: an analysis of surveillance data. ERJ Open Res 2019; 5:00125-2019. [PMID: 31857993 PMCID: PMC6911924 DOI: 10.1183/23120541.00125-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/24/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction In the UK, several hundred patients notified with tuberculosis (TB) die every year. The aim of this article is to describe trends in deaths among notified TB patients, explore risk factors associated with death and compare all-cause mortality in TB patients with age-specific mortality rates in the general UK population. Methods We used 2001–2014 data from UK national TB surveillance to explore trends and risk factors for death, and population mortality data to compare age-specific death rates among notified TB patients with annual death rates in the UK general population. Results The proportion of TB patients in the UK who died each year declined steadily from 7.1% in 2002 to 5.5% in 2014. One in five patients (21.3%) was diagnosed with TB post-mortem. Where information was available, almost half of the deaths occurred within 2 months of starting treatment. Risk factors for death included demographic, disease-specific and social risk factors. Age had by far the largest effect, with patients aged ≥80 years having a 70 times increased risk of death compared with those aged <15 years. In contrast, excess mortality determined by incidence ratios comparing all-cause mortality among TB patients with that of the general population was highest among children and the working-age population (15–64 years old). Conclusions Efforts to control TB and improve diagnosis and treatment outcomes in the UK need to be sustained. Control efforts need to focus on socially deprived and vulnerable groups. There is a need for further in-depth analysis of deaths of TB patients in the UK to identify potentially preventable factors. Despite an overall decline in death among TB patients in the UK, patients with TB are still 6 times more likely to die during follow-up than the annual death rate in the general populationhttp://bit.ly/2MqDw9Q
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Affiliation(s)
- Debora Pedrazzoli
- Dept of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,These authors contributed equally to this work
| | - Katharina Kranzer
- Dept of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,These authors contributed equally to this work
| | - H Lucy Thomas
- TB Unit, Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging/Zoonotic Infections and Travel Migrant Health Division (TARGETS), National Infection Service, Public Health England, London, UK
| | - Maeve K Lalor
- TB Unit, Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging/Zoonotic Infections and Travel Migrant Health Division (TARGETS), National Infection Service, Public Health England, London, UK.,Institute for Global Health, University College London, London, UK
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14
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Rahimi BA, Rahimy N, Mukaka M, Ahmadi Q, Hayat MS, Wasiq AW. Determinants of treatment failure among tuberculosis patients in Kandahar City, Afghanistan: A 5-year retrospective cohort study. Int J Mycobacteriol 2019; 8:359-365. [PMID: 31793506 DOI: 10.4103/ijmy.ijmy_142_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Tuberculosis (TB) is a preventable and treatable chronic disease. Afghanistan is among the high-TB-burden countries. The aim of this study is to find the determinants of treatment failure among TB patients in Kandahar City, Afghanistan. Methods This was a retrospective cohort study conducted in Kandahar City during a period of 5 years (August 2014-July 2019). For data analysis; descriptive statistics, Chi-square test, and logistic regression were used. Results Among 1416 TB patients, 894/1416 (63.1%) had pulmonary TB (PTB), whereas 522/1416 (36.9%) had extrapulmonary TB (EPTB). Mean age in these patients was 34.7 years while most of them were females in PTB (530/894 [59.3%]) and EPTB (340/522 [65.1%]) patients. Sputum smear was positive in 618/860 (71.9%) and 16/404 (4%) of PTB and EPTB patients, respectively. TB treatment failure was more in PTB (56/894 [6.3%]) than EPTB (4/522 [0.8%]). Chi-square test of TB cases showed that statistically significant determinants that may cause the treatment failure were re-treatment cases (crude odds ratio [COR] 7.7, P < 0.001), absence of fever (COR 5.2, P < 0.001), absence of cough (COR 1.7, P = 0.004), living in rural areas (COR 1.4, P = 0.035), and no weight loss (COR 1.3, P = 0.033). Binary logistic regression of the statistically significant variables revealed only absence of fever (adjusted odds ratio 6.0, P < 0.001) as the risk factor for treatment failure in TB patients. Conclusion TB is still a major threat for Kandahar City. Low treatment success rate and increased number of defaulted cases are the major threats.
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Affiliation(s)
- Bilal Ahmad Rahimi
- Department of Paediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Najeebullah Rahimy
- Department of Histopathology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Mavuto Mukaka
- Department of Clinical Trials Support Group, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Qudratullah Ahmadi
- Department of Surgery, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Mohammad Sami Hayat
- Department of Internal Medicine, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Abdul Wahed Wasiq
- Department of Internal Medicine, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
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15
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Determinants of mortality among patients with drug-resistant tuberculosis in northern Nigeria. PLoS One 2019; 14:e0225165. [PMID: 31743358 PMCID: PMC6863558 DOI: 10.1371/journal.pone.0225165] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 10/30/2019] [Indexed: 12/02/2022] Open
Abstract
Background Drug-Resistant tuberculosis (DR-TB) is estimated to cause about 10% of all TB related deaths. There is dearth of data on determinants of DR-TB mortality in Nigeria. Death among DR-TB treated cohorts in Nigeria from 2010 to 2013 was 30%, 29%, 15% and 13% respectively. Our objective was to identify factors affecting survival among DR-TB patients in northern Nigeria. Methods Demographic and clinical data of all DR-TB patients enrolled in Kano, Katsina and Bauchi states of Nigeria between 1st February 2015 and 30th November 2016 was used. Survival analysis was done using Kaplan-Meier and multiple regression with Cox proportional hazard modeling. Results Mean time to death during treatment is 19.2 weeks and 3.9 weeks among those awaiting treatment. Death was recorded among 38 of the 147 DR-TB patients assessed. HIV co-infection significantly increased probability of mortality, with an adjusted hazard ratio (aHR) of 2.35, 95% CI: 1.05–5.29, p = 0.038. Treatment delay showed significant negative association with survival (p = 0.000), not starting treatment significantly reduced probability of survival with an aHR of 7.98, 95% CI: 2.83–22.51, p = 0.000. Adjusted hazard ratios for patients started on treatment more than eight weeks after detection or within two to four weeks after detection, was beneficial though not statistically significant with respective p-values of 0.056 and 0.092. The model of care (facility vs. community-based) did not significantly influence survival. Conclusion Both HIV co-infected DR-TB patients and DR-TB patients that fail to start treatment immediately after diagnosis are at significant risk of mortality. Our study showed no significant difference in mortality based on models of care. The study highlights the need to address programmatic and operational issues pertaining to treatment delays and strengthening DR-TB/HIV co-management as key strategies to reduce mortality.
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16
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Vakadem K, Anota A, Sa'avu M, Ramoni C, Comrie-Thomson L, Gale M, Commons RJ. A mortality review of adult inpatients with tuberculosis in Mendi, Papua New Guinea. Public Health Action 2019; 9:S62-S67. [PMID: 31579652 PMCID: PMC6735451 DOI: 10.5588/pha.18.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
SETTING Mendi Provincial Hospital, Southern Highlands Province, Papua New Guinea (PNG). BACKGROUND PNG is a high burden country for tuberculosis (TB) and TB-human immunodeficiency virus (HIV). TB is the second most common cause of death in PNG. OBJECTIVE To identify the number of adult inpatients with TB who died between 1 January 2015 and 30 August 2017; describe these patients' characteristics and identify contributing factors that could be modified. DESIGN This was a retrospective case series review. RESULTS Among 905 inpatients with TB during the study period, there were 90 deaths. The patients who died were older than those who survived (median age 40 years vs. 32 years, P = 0.011). The majority of patients who died lived less than 3 hours from the hospital (71%), were diagnosed after admission (79%) and were clinically diagnosed (77%). HIV status was not known in 50% of the deaths. Of patients with a known status, 27% (12/45) were HIV-positive. The median symptom duration prior to presentation was 28 days, with females presenting later than males (84 vs. 28 days, P = 0.008). CONCLUSION This study highlights areas where community and hospital-based management of TB could be improved to potentially reduce TB mortality, including earlier detection and treatment, improved bacteriological diagnosis and increased HIV testing.
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Affiliation(s)
- K Vakadem
- Mendi Provincial Hospital, Southern Highlands Provincial Health Authority, Southern Highlands Province, Papua New Guinea
- Tungaru Central Hospital, Ministry of Health and Medical Services, Tarawa, Republic of Kiribati
| | - A Anota
- Mendi Provincial Hospital, Southern Highlands Provincial Health Authority, Southern Highlands Province, Papua New Guinea
- Goroka Base Hospital, Eastern Highlands Province, Papua New Guinea
| | - M Sa'avu
- Mendi Provincial Hospital, Southern Highlands Provincial Health Authority, Southern Highlands Province, Papua New Guinea
| | - C Ramoni
- Mendi Provincial Hospital, Southern Highlands Provincial Health Authority, Southern Highlands Province, Papua New Guinea
| | - L Comrie-Thomson
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Uro-gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - M Gale
- Burnet Institute, Melbourne, Victoria, Australia
| | - R J Commons
- Burnet Institute, Melbourne, Victoria, Australia
- Global Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
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17
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Aljadani R, Ahmed AE, Al-Jahdali H. Tuberculosis mortality and associated factors at King Abdulaziz Medical City Hospital. BMC Infect Dis 2019; 19:427. [PMID: 31096930 PMCID: PMC6524290 DOI: 10.1186/s12879-019-4063-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) continues to be a public health challenge in Saudi Arabia, particularly for the elderly. This study was conducted to estimate mortality per 1000 person-year among TB and resistant TB cases and to identifying factors associated with mortality. METHODS This is a retrospective cohort study of 713 new TB cases at King Abdulaziz Medical City in Riyadh diagnosed between January 1, 2000, and December 31, 2016. Patient medical records and microbiology lab databases were used to identify TB cases. Through reviews were conducted of patients' medical records, including physician notes, physical examinations, radiology (scans and imaging), laboratory tests, and follow-up notes. Collected data include demographic information, clinical features, diagnoses, comorbidities, and death rates. RESULTS Of the 713 TB patients included in this study, 110 died, giving an average mortality rate of 22 per 1000 person-years (PY; 95% CI: 18.2-26.4). Elderly patients (≥ 60 years) had a higher mortality rate of 36.5 per 1000 PY (95% CI: 28.9-45.5). As age increases by one year, the hazard of mortality increase by 2.4% (aHR: 1.024 [95% CI: 1.009-1.039, P = 0.002]). Higher hazard of mortality was found among males (aHR: 2.014 [95% CI: 1.186-3.418, P = 0.010]). Patients with respiratory and other types of comorbidities and cancer had a higher mortality hazard (aHR: 1.898 [95% CI: 1.005-3.582, P = 0.048]; aHR: 2.346 [95% CI: 1.313-4.192, P = 0.004]; aHR: 3.292 [95% CI: 1.804-6.006, P = 0.001]), respectively. Multidrug-resistant TB (MDR-TB) was found in 2 cases (0.28%) (95% CI: 0.08-1.02), 1.68% were resistant to only one antibiotic, 0.14% had rifampicine-resistant TB (RR-TB), 0.28% had MDR-TB, and 0.14% had extensively drug-resistant TB (XDR-TB). CONCLUSIONS The mortality rate among TB patients was found to be 22 per 1000 person-year at our center. TB was associated with high mortality rates among males, the elderly, and patients with cancer, respiratory illness, and other comorbidities. Future clinical practice should include establishing an efficient TB diagnostic program and continued hazard assessment of TB treatment options.
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Affiliation(s)
| | - Anwar E Ahmed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hamdan Al-Jahdali
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
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18
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Somsong W, Lawpoolsri S, Kasetjaroen Y, Manosuthi W, Kaewkungwal J. Treatment outcomes for elderly patients in Thailand with pulmonary tuberculosis. ASIAN BIOMED 2019. [DOI: 10.1515/abm-2019-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Elderly patients with pulmonary tuberculosis are less likely to achieve treatment success than younger patients, and patients aged ≥60 years have a substantial increase in mortality.
Objectives
To compare treatment outcomes over 2 periods during the transition of Thai national tuberculosis (TB) reporting systems and determine treatment success rates and mortality for elderly patients in TB treatment-care settings in Thailand.
Methods
Retrospective cohort study of all records of elderly patients extracted from 2 national TB databases in Thailand: the TB Case Management (TBCM) database of the National TB Program (2014–2015) and the database of the National Health Security Office (NHSO; 2010–2011).
Results
There were 8,301 elderly patients with TB in the TBCM cohort and 11,869 in the NHSO cohort. Overall treatment success rates were 78.5% for patients in the TBCM cohort and 87.5% for patients in the NHSO cohort. High success rates for treatment were found for those aged 60–69 years: 91.1% in 2010–2011 and 85.0% in 2014–2015. High mortality was reported for patients aged ≥90 years: 34.6% in 2010–2011 and 50.0% in 2014–2015.
Conclusions
Compared with the NHSO historical cohort, success rates for treatment were lower and death rates were higher in the TBCM cohort. Because NHSO enforced intensive case monitoring and follow-up while TBCM has no such mechanism, the estimates from the TBCM database may be less accurate for TB circumstances in Thailand. Frequent routine home visits may ensure more complete treatment-care information and support, and increase the treatment success rate in the elderly.
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Affiliation(s)
- Wilawan Somsong
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University , Bangkok 10400, Thailand
- Bureau of Tuberculosis, Ministry of Public Health , Bangkok 10120, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University , Bangkok 10400, Thailand
| | | | - Weerawat Manosuthi
- Department of Medicine, Bamrasnaradura Infectious Disease Institute, Ministry of Public Health , Nonthaburi 11000, Thailand
| | - Jaranit Kaewkungwal
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University , Bangkok 10400, Thailand
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Singhi L, Sagili KD, Sharath BN, Bhandari K, Dadul PK, Gautam M, Ravichandra C, Chadha S, Satyanarayana S. Non-response to first-line anti-tuberculosis treatment in Sikkim, India: a risk-factor analysis study. Public Health Action 2018; 8:162-168. [PMID: 30775275 DOI: 10.5588/pha.18.0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023] Open
Abstract
Setting: Sikkim, India, has the highest proportion of tuberculosis (TB) patients on first-line anti-tuberculosis regimens with the outcome 'failure' or 'shifted to regimen for multidrug-resistant TB (MDR-TB)'. Objective: To assess the factors associated with non-response to treatment, i.e., 'failure' or 'shifted to MDR-TB regimen'. Methods: We conducted a retrospective cohort study using Revised National Tuberculosis Control Programme data of all TB patients registered in 2015 for first-line TB treatment. In addition, we interviewed 42 patients who had not responded to treatment to ascertain their current status. Results: Of 1508 patients enrolled for treatment, about 9% were classified as non-response to treatment. Patient factors associated with non-response were urban setting (adjusted odds ratio [aOR] 2.39, 95%CI 1.22-4.67), ethnicity (being an Indian tribal, aOR 1.73, 95%CI 1.17-2.57, Indian [other] aOR 1.83, 95%CI 1.29-2.60 compared to patients of Nepali origin) and those on retreatment (aOR 2.40, 95%CI 1.99-2.91). Of the patients interviewed, 28 (67%) had received treatment for drug-resistant TB. Conclusion: In Sikkim, one in 11 patients had not responded to first-line anti-tuberculosis treatment. Host-pathogen genetics and socio-behavioural studies may be required to understand the reasons for the differences in non-response, particularly among ethnic groups.
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Affiliation(s)
| | - K D Sagili
- International Union Against Tuberculosis and Lung Disease South-East Asia Office, New Delhi, India
| | - B N Sharath
- ESIC (Employees' State Insurance Act) Medical College and Post Graduate Institute of Medical Science and Research, Bangalore, India
| | | | | | | | | | - S Chadha
- International Union Against Tuberculosis and Lung Disease South-East Asia Office, New Delhi, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease South-East Asia Office, New Delhi, India
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20
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Mok J, An D, Kim S, Lee M, Kim C, Son H. Treatment outcomes and factors affecting treatment outcomes of new patients with tuberculosis in Busan, South Korea: a retrospective study of a citywide registry, 2014-2015. BMC Infect Dis 2018; 18:655. [PMID: 30545315 PMCID: PMC6293515 DOI: 10.1186/s12879-018-3574-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/30/2018] [Indexed: 01/30/2023] Open
Abstract
Background This study investigated the treatment outcomes, and factors affecting the outcomes, of new tuberculosis (TB) patients in Busan, South Korea. Methods We retrospectively analysed the citywide TB registry data (collected for the Korean National TB Surveillance System) of new TB patients registered in Busan from January 2014 to December 2015. Results A total of 4732 patients were included in this study (mean age, 52.5 ± 19.9 years; 58.4% male). The overall treatment success rate was 83.9% (cured, 20.2%; completed, 63.7%); 8.0% of patients died, and 3.6% were lost to follow-up. In multivariate analyses, a higher rate of loss to follow-up was associated with foreign nationality, registered as TB-positive at least twice, and being in Q4 (fourth quintile) or Q5 (fifth quintile) of the regional deprivation index. Conversely, a lower rate of loss to follow-up was associated with female gender, smear-positive for pulmonary TB (PTB), and the treatment outcome being reported by a public health centre. Higher mortality was associated with old age (≥ 75 years), smear-positive PTB, treatment outcome being reported by the hospital, and being registered as TB-positive twice. Lower mortality was associated with female gender, treatment outcome being reported by a public health centre or clinic, and Q5 of the regional deprivation index. Conclusions Treatment outcomes of new TB patients were sub-optimal in Busan. TB control programs should maintain close monitoring and provide greater socioeconomic support to patients at high risk of poor treatment outcomes.
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Affiliation(s)
- Jeongha Mok
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, South Korea.,Medical Research Institute, Pusan National University Hospital, Busan, South Korea.,Busan Center for Infectious Disease Control and Prevention, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea
| | - Daeseong An
- Department of Statistics, Pukyong National University, Busan, South Korea
| | - Seoungjin Kim
- Busan Center for Infectious Disease Control and Prevention, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea
| | - Miyoung Lee
- Busan Center for Infectious Disease Control and Prevention, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea
| | - Changhoon Kim
- Medical Research Institute, Pusan National University Hospital, Busan, South Korea.,Busan Center for Infectious Disease Control and Prevention, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea.,Department of Preventive Medicine, College of Medicine, Pusan National University, Busan, South Korea
| | - Hyunjin Son
- Busan Center for Infectious Disease Control and Prevention, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea.
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Rahimi BA, Rahimy N, Ahmadi Q, Hayat MS, Wasiq AW. Treatment outcome of tuberculosis treatment regimens in Kandahar, Afghanistan. Indian J Tuberc 2018; 67:87-93. [PMID: 32192624 DOI: 10.1016/j.ijtb.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/18/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tuberculosis (TB) is a chronic disease that mostly affects low-income countries. TB is transmitted through droplet aerosolization from a person with active pulmonary TB. Afghanistan is one of the 22 high TB burden countries where 39,445 people develop this disease and 7840 people die each year. Treatment outcome is one of the best measurements that explain how the current regimen works. MATERIAL AND METHODS This was a retrospective cohort study, conducted in Kandahar Province, to find out the treatment outcome of anti-TB drugs regimens in TB patients. Data of pulmonary and extra-pulmonary TB patients, who fulfilled the eligible criteria of the study and were treated from 2005 to 2015, was retrieved from their medical record forms. RESULTS Among 1000 TB patients, 599 (59.9%) were females and 401 (40.1%) males; most of the patients (678/1000 [67.8%]) were from Kandahar city while 322/1000 (32.2%) were from the other districts of Kandahar. Mean age of the patients were 36.1 years with SD of 19.3 years. Main signs and symptoms of fever, cough, and weight loss were present in 949/1000 (94.9%), 880/1000 (88%), and 544/1000 (54.4%) of the patients, respectively. On first visit 459/1000 (45.9%) patients were sputum AFB (acid fast bacilli) positive. Majority (247/459 [53.8%]) of these patients were AFB 2+. After 2 months of intensive anti-TB treatment, 9/459 (1.9%) patients were still AFB positive (1+). Treatment outcome of these 1000 patients showed that 479 (47.9%) completed the treatment, 298 (29.8%) were cured, 35 (3.5%) failed the anti-TB treatment, while 5 (0.5%) patients died. CONCLUSION This clearly shows that TB is still one of the major threats to the people of Kandahar Province. There are cases of TB who do not respond to the first line regimens of anti-TB drugs advised by WHO and Afghan Ministry of Public Health (MoPH).
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Affiliation(s)
- Bilal Ahmad Rahimi
- Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan.
| | - Najeebullah Rahimy
- Department of Histopathology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Qudratullah Ahmadi
- Department of Surgery, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Mohammad Sami Hayat
- Department of Internal Medicine, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Abdul Wahed Wasiq
- Department of Internal Medicine, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
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Min J, Mi Shin Y, Lee WJ, Truong TT, Kang ES, An JY, Choe KH, Man Lee K. Clinical features of octogenarian patients with tuberculosis at a tertiary hospital in South Korea. J Int Med Res 2018; 47:271-280. [PMID: 30343587 PMCID: PMC6384473 DOI: 10.1177/0300060518800597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The growth of the older population is a great challenge for tuberculosis (TB) control in South Korea. This study was performed to investigate the clinical characteristics of and treatment outcomes among octogenarian patients with TB. Methods We retrospectively analyzed the medical records of 109 patients with TB (age of ≥80 years) from January 2014 to March 2017. Clinical, microbiologic, and radiologic findings were obtained. Results Fifty-five patients (50.5%) were male, the mean age of the patients was 83.8 years, and 75 patients (68.8%) had pulmonary TB. All patients with pulmonary TB underwent either chest X-ray or chest computed tomography examination, and the results showed that only one-third (n = 33, 39.3%) had active lesions suggestive of TB. Twenty-nine patients (26.4%) had an unfavorable outcome (21 died and 8 were lost to follow-up). Only two TB-related deaths occurred, and both were caused by respiratory failure. Among the 15 non-TB-related deaths, the progression of malignancy and sepsis were the most frequent causes of death. Conclusions A high mortality rate was observed in octogenarian patients with TB, and most of these deaths were non-TB-related. Among all causes of mortality, solid malignancy was a significant risk factor for death.
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Affiliation(s)
- Jinsoo Min
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Yoon Mi Shin
- 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Won Jae Lee
- 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Tung Thanh Truong
- 3 Department of Tuberculosis and Lung Diseases, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Eun Seok Kang
- 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jin Young An
- 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.,4 Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kang Hyeon Choe
- 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.,4 Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ki Man Lee
- 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.,4 Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
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Wen Y, Zhang Z, Li X, Xia D, Ma J, Dong Y, Zhang X. Treatment outcomes and factors affecting unsuccessful outcome among new pulmonary smear positive and negative tuberculosis patients in Anqing, China: a retrospective study. BMC Infect Dis 2018; 18:104. [PMID: 29506480 PMCID: PMC5836329 DOI: 10.1186/s12879-018-3019-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/28/2018] [Indexed: 11/15/2022] Open
Abstract
Background Monitoring the treatment outcomes of tuberculosis and determining the specific factors associated with unsuccessful treatment outcome are essential to evaluate the effectiveness of tuberculosis control program. This study aimed to assess treatment outcomes and explore the factors associated with unsuccessful outcomes among new pulmonary smear positive and negative tuberculosis patients in Anqing, China. Methods A nine-year retrospective study was conducted using data from Anqing Center for Diseases Prevention and Control. New pulmonary tuberculosis patients treated with two six-month regimens were investigated. Non-conditional logistic regression was performed to calculate odds ratios and 95% confidence intervals for factors associated with unsuccessful outcomes. Results Among 22,998 registered patients (16,939 males, 6059 females), 64.54% were smear-positive patients. The treatment success rates was 95.02% for smear-positive patients and 95.00% for smear-negative patients. Characteristics associated with an higher risk of unsuccessful treatment among smear-positive patients included aged above 35 years, treatment management model of self-medication, full-course management and supervision in intensive phase, unchecked chest X-ray, cavity in chest X-ray, and miliary shadow in chest X-ray, while normal X-ray was negative factor. Unsuccessful treatment among smear-negative patients was significantly associated with age over 45 years, treatment management model of full-course management, unchecked chest X-ray, presence of miliary shadow in chest X-ray and delay over 51 days. Conclusions Tuberculosis treatment in Anqing area was successful and independent of treatment regimens. Special efforts are required for patients with unsuccessful outcomes.
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Affiliation(s)
- Yufeng Wen
- School of Laboratory Medicine, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, People's Republic of China.
| | - Zhiping Zhang
- Tuberculosis Prevention and Control Department, Anqing Center for Disease Control and Prevention, Anqing City, Anhui Province, 246003, People's Republic of China
| | - Xianxiang Li
- Tuberculosis Prevention and Control Department, Anqing Center for Disease Control and Prevention, Anqing City, Anhui Province, 246003, People's Republic of China
| | - Dan Xia
- School of Laboratory Medicine, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, People's Republic of China
| | - Jun Ma
- School of Laboratory Medicine, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, People's Republic of China
| | - Yuanyuan Dong
- School of Laboratory Medicine, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, People's Republic of China
| | - Xinwei Zhang
- School of Laboratory Medicine, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, People's Republic of China
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Reduction of HIV-associated excess mortality by antiretroviral treatment among tuberculosis patients in Kenya. PLoS One 2017; 12:e0188235. [PMID: 29145454 PMCID: PMC5690617 DOI: 10.1371/journal.pone.0188235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/05/2017] [Indexed: 12/01/2022] Open
Abstract
Background Mortality from TB continues to be a global public health challenge. TB ranks alongside Human Immunodeficiency Virus (HIV) as the leading infectious causes of death globally. HIV is a major driver of TB related morbidity and mortality while TB is the leading cause of mortality among people living with HIV/AIDS. We sought to determine excess mortality associated with HIV and the effect of antiretroviral therapy on reducing mortality among tuberculosis patients in Kenya. Methods We conducted a retrospective analysis of Kenya national tuberculosis program data of patients enrolled from 2013 through 2014. We used direct standardization to obtain standardized mortality ratios for tuberculosis patients compared with the general population. We calculated the population attributable fraction of tuberculosis deaths due to HIV based on the standardized mortality ratio for deaths among TB patients with HIV compared to TB patients without HIV. We used Cox proportional hazards regression for assessing risk factors for mortality. Results Of 162,014 patients included in the analysis, 6% died. Mortality was 10.6 (95% CI: 10.4–10.8) times higher among TB patients than the general population; 42% of deaths were attributable to HIV infection. Patients with HIV who were not receiving ART had an over four-fold risk of death compared to patients without HIV (aHR = 4.2, 95% CI 3.9–4.6). In contrast, patients with HIV who were receiving ART had only 2.6 times the risk of death (aHR = 2.6, 95% CI 2.5–2.7). Conclusion HIV was a significant contributor to TB-associated deaths in Kenya. Mortality among HIV-infected individuals was higher among those not on ART than those on ART. Early initiation of ART among HIV infected people (a “test and treat” approach) should further reduce TB-associated deaths.
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Mundra A, Deshmukh PR, Dawale A. Magnitude and determinants of adverse treatment outcomes among tuberculosis patients registered under Revised National Tuberculosis Control Program in a Tuberculosis Unit, Wardha, Central India: A record-based cohort study. J Epidemiol Glob Health 2017; 7:111-118. [PMID: 28315657 PMCID: PMC7320429 DOI: 10.1016/j.jegh.2017.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/18/2017] [Accepted: 02/22/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Deaths, defaults, relapses, and treatment failures have made the control of TB difficult across the globe. METHODOLOGY This study is a record-based follow-up of a cohort of patients registered under Revised National Tuberculosis Control Program in the year 2014 in Wardha Tuberculosis Unit, India. Data was collected from the records available at the District Tuberculosis Office. RESULTS Data of 510 patients was analyzed. The sputum conversion rate was 88%. The overall treatment success rate was 81.9%, and rates of any adverse outcome, deaths, defaults, failure, and shift to Category IV regimen were 32.60/100 person years at risk (PYAR), 16.88/100 PYAR, 11.12/100 PYAR, 3.45/100 PYAR, and 1.15/100 PYAR, respectively. The median times for the above outcomes were 81days, 110days, 66days, 118days, and 237days, respectively. The cumulative probability of occurrence at 6months of any adverse outcome, deaths, default, failure, and shift to Category IV regimen was 0.145, 0.056, 0.088, 0.002, and 0.004, respectively. On multivariate analysis, the determinant of any adverse outcome was age >45years, whereas extrapulmonary disease was protective. The hazard of defaulting was also significantly higher in male patients and those aged >45years. CONCLUSION Appropriate interventions and program implementation to reduce the adverse treatment outcomes and interruptions will help in improving program performance.
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Affiliation(s)
- Anuj Mundra
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India.
| | - Pradeep R Deshmukh
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India
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A Prediction Rule to Stratify Mortality Risk of Patients with Pulmonary Tuberculosis. PLoS One 2016; 11:e0162797. [PMID: 27636095 PMCID: PMC5026366 DOI: 10.1371/journal.pone.0162797] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/28/2016] [Indexed: 11/19/2022] Open
Abstract
Tuberculosis imposes high human and economic tolls, including in Europe. This study was conducted to develop a severity assessment tool for stratifying mortality risk in pulmonary tuberculosis (PTB) patients. A derivation cohort of 681 PTB cases was retrospectively reviewed to generate a model based on multiple logistic regression analysis of prognostic variables with 6-month mortality as the outcome measure. A clinical scoring system was developed and tested against a validation cohort of 103 patients. Five risk features were selected for the prediction model: hypoxemic respiratory failure (OR 4.7, 95% CI 2.8–7.9), age ≥50 years (OR 2.9, 95% CI 1.7–4.8), bilateral lung involvement (OR 2.5, 95% CI 1.4–4.4), ≥1 significant comorbidity—HIV infection, diabetes mellitus, liver failure or cirrhosis, congestive heart failure and chronic respiratory disease–(OR 2.3, 95% CI 1.3–3.8), and hemoglobin <12 g/dL (OR 1.8, 95% CI 1.1–3.1). A tuberculosis risk assessment tool (TReAT) was developed, stratifying patients with low (score ≤2), moderate (score 3–5) and high (score ≥6) mortality risk. The mortality associated with each group was 2.9%, 22.9% and 53.9%, respectively. The model performed equally well in the validation cohort. We provide a new, easy-to-use clinical scoring system to identify PTB patients with high-mortality risk in settings with good healthcare access, helping clinicians to decide which patients are in need of closer medical care during treatment.
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Yang JY, Han M, Koh Y, Kim WS, Song JW, Oh YM, Lee SD, Lee SW, Lee JS, Lim CM, Choi CM, Huh JW, Hong SB, Shim TS, Jo KW. Effects of Corticosteroids on Critically Ill Pulmonary Tuberculosis Patients With Acute Respiratory Failure: A Propensity Analysis of Mortality. Clin Infect Dis 2016; 63:1449-1455. [PMID: 27609755 DOI: 10.1093/cid/ciw616] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 09/01/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We investigated the effects of corticosteroids on the 90-day mortality outcomes in patients with pulmonary tuberculosis who were admitted to the intensive care unit (ICU) because of acute respiratory failure (ARF). METHODS The medical records of 124 patients who had pulmonary tuberculosis with ARF and were admitted to the ICU at our tertiary referral center in South Korea between March 1989 and December 2014 were retrospectively analyzed. The 90-day mortality rate in this population was analyzed after adjustments with the inverse probability of treatment weighted (IPTW) method. RESULTS The mean patient age was 62 years, and the 90-day mortality rate was 49.2% (61/124). Adjuvant steroids were used in 70 (56.5%) patients. The 90-day mortality rate was similar irrespective of corticosteroid use (48.6%, steroid group; 50.0%, nonsteroid group). The use of adjuvant steroids was not associated with the unadjusted 90-day mortality (odds ratio [OR], 0.94; 95% confidence interval [CI], .46-1.92; P = .875). In a comparison using an adjusted IPTW approach of the 90-day mortality between the 2 groups, we found that corticosteroid use was independently associated with reduced 90-day mortality (OR, 0.47; 95% CI, .22-.98; P = .049). CONCLUSIONS The study results showed that corticosteroids could reduce the 90-day mortality rate in critically ill pulmonary tuberculosis patients with ARF.
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Affiliation(s)
- Ji Young Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics
| | - Younsuck Koh
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Woo-Sung Kim
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jin-Woo Song
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yeon-Mok Oh
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang-Do Lee
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sei Won Lee
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jae-Seung Lee
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Chae-Man Lim
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Chang-Min Choi
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jin-Won Huh
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang-Bum Hong
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Tae Sun Shim
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kyung-Wook Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Beyene Y, Geresu B, Mulu A. Mortality among tuberculosis patients under DOTS programme: a historical cohort study. BMC Public Health 2016; 16:883. [PMID: 27561794 PMCID: PMC5000467 DOI: 10.1186/s12889-016-3557-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 08/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background In high human immunodeficiency virus (HIV) prevalence population, tuberculosis (TB) is the leading cause of morbidity and mortality. HIV is driving the TB epidemic in many countries, especially those in sub-Saharan Africa. We assessed the survival time and predictors of mortality among tuberculosis patients under directly observed treatment, short course (DOTS) strategy in Dessie Referral Hospital tuberculosis clinic, Northeast Ethiopia. Method A historical cohort design was utilized to assess survival time and determinants of mortality. A total of 1260 records of patients who started ant-tuberculosis treatment from January 2006 up to December 2010 were analyzed. Survival curves were estimated using Kaplan–Meier and were compared using the Log-rank test. The Cox proportional hazard model was used to assess the relationship between baseline variables and mortality. Results Out of the 1260 registered patients, 117 (9.3 %) died over the entire follow-up period. Among those died, 113 (18 %) were HIV positive and 4 (0.6 %) were HIV negative. The 1260 patients contributed a cumulative total of 634.25 person‑years observation. Conclusion The mortality of HIV positive tuberculosis patients was higher than those of HIV negative patients and the use of cotrimoxazole preventive therapy increased the survival time of patients.
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Affiliation(s)
- Yeshiwork Beyene
- Department of Nursing, College of Medicine and Health Sciences Wollo University, Dessie, Ethiopia
| | - Berhanu Geresu
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Assefa Mulu
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Rodrigo T, Casals M, Caminero JA, García-García JM, Jiménez-Fuentes MA, Medina JF, Millet JP, Ruiz-Manzano J, Caylá J. Factors Associated with Fatality during the Intensive Phase of Anti-Tuberculosis Treatment. PLoS One 2016; 11:e0159925. [PMID: 27487189 PMCID: PMC4972388 DOI: 10.1371/journal.pone.0159925] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the case-fatality rate (CFR) at the end of the intensive phase of tuberculosis (TB) treatment, and factors associated with fatality. METHODS TB patients diagnosed between 2006 and 2013 were followed-up during treatment. We computed the CFR at the end of the intensive phase of TB treatment, and the incidence of death per 100 person-days (pd) of follow-up. We performed survival analysis using the Kaplan-Meier method and Cox regression, and calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS A total of 5,182 patients were included, of whom 180 (3.5%) died; 87 of these deaths (48.3%) occurred during the intensive phase of treatment, with a CFR of 1.7%. The incidence of death was 0.028/100 pd. The following factors were associated with death during the intensive phase: being >50 years (HR = 36.9;CI:4.8-283.4); being retired (HR = 2.4;CI:1.1-5.1); having visited the emergency department (HR = 3.1;CI:1.2-7.7); HIV infection (HR = 3.4;CI:1.6-7.2); initial standard treatment with 3 drugs (HR = 2.0;CI:1.2-3.3) or non-standard treatments (HR = 2.68;CI:1.36-5.25); comprehension difficulties (HR = 2.8;CI:1.3-6.1); and smear-positive sputum (HR = 2.3-CI:1.0-4.8). CONCLUSION There is a non-negligible CFR during the intensive phase of TB, whose reduction should be prioritised. The CFR could be a useful indicator for evaluating TB programs.
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Affiliation(s)
- T. Rodrigo
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain
- Unidad de Investigación de Tuberculosis, Servicio de Epidemiologia, Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - M. Casals
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain
- Unidad de Investigación de Tuberculosis, Servicio de Epidemiologia, Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - J. A. Caminero
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Servicio de Neumología. Hospital General Universitario de Gran Canaria Dr, Negrín, Canary Islands, Spain
- International Union Against Tuberculosis and Lung Disease, París, France
| | - J. M. García-García
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Servicio de Neumología, Hospital San Agustín de Avilés, Asturias, Spain
| | - M. A. Jiménez-Fuentes
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Unidad de Tuberculosis, Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | - J. F. Medina
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Servicio de Neumología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J. P. Millet
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Unidad de Investigación de Tuberculosis, Servicio de Epidemiologia, Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - J. Ruiz-Manzano
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Servicio de Neumología, Hospital Universitario Germans Trías y Pujol de Badalona, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain
| | - J. Caylá
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain
- Unidad de Investigación de Tuberculosis, Servicio de Epidemiologia, Agencia de Salud Pública de Barcelona, Barcelona, Spain
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Zenebe Y, Adem Y, Mekonnen D, Derbie A, Bereded F, Bantie M, Tulu B, Hailu D, Biadglegne F. Profile of tuberculosis and its response to anti-TB drugs among tuberculosis patients treated under the TB control programme at Felege-Hiwot Referral Hospital, Ethiopia. BMC Public Health 2016; 16:688. [PMID: 27485507 PMCID: PMC4969724 DOI: 10.1186/s12889-016-3362-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/23/2016] [Indexed: 11/29/2022] Open
Abstract
Background Tuberculosis (TB) is a global concern for both developing and developed countries. Currently it becomes more complex due to increasing levels of drug resistance and HIV co-infection. Delayed diagnosis and high case load are major factors contributing to continued transmission and failure to the treatment outcome. The study was conducted to determine the profile and treatment outcomes of TB patients at Felege-Hiwot Referral Hospital. Methods We analyzed the records of 1761 TB patients registered for treatment in Felege Hiwot Referral Hospital from July 2010 to June 2015. Data on patients’ socio-demographic characteristics, type of TB, HIV status and treatment outcome were analysed. Descriptive statistics and binary logistic regression models were used to present data. The odds ratio and the 95 % confidence intervals were calculated. A p-value of < 0.05 was considered statistical significant. Results The proportion of smear positive, smear-negative and extra-pulmonary TB were 205 (11.6 %), 548 (31.1 %) and 1008 (57.2 %), respectively. The overall treatment success rate accounts 542(80.8 %) with unsuccessful treatment of 129(19.2 %). The treatment outcome varied by the years from 68.9 to 97.4 %. Among tuberculosis patients, 459(26.1 %) of them were HIV positive. Being HIV positive (AOR = 4.29, 95 % CI, 2.20–8.37 P = 0.001), retreatment (AOR = 5.32, 95 % CI, 1.92–14.3, P = 0.001), rural residency (AOR = 18.0, 95 % CI, 9.06–37.82, P = 0.001) and the age group of 15–24 years (AOR = 2.91, 95%CI, 1.00–8.45, P = 0.04) showed statistical significant association for poor treatment outcome. Conclusions In the studied region, the overall treatment success rate was still below the WHO target of success rate, 85 %. However, the trend of treatment success rate showed a promising increment. Patients at high risk of unsuccessful treatment outcome should be identified early and given additional follow-up, medical intervention and social support.
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Affiliation(s)
- Yohannes Zenebe
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Yesuf Adem
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Mekonnen
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Awoke Derbie
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fetlework Bereded
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Begna Tulu
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Derese Hailu
- Bahir Dar Regional Health Research Laboratory Institute, Bahir Dar, Ethiopia
| | - Fantahun Biadglegne
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Karo B, Hauer B, Hollo V, van der Werf MJ, Fiebig L, Haas W. Tuberculosis treatment outcome in the European Union and European Economic Area: an analysis of surveillance data from 2002-2011. ACTA ACUST UNITED AC 2016; 20:30087. [PMID: 26676247 DOI: 10.2807/1560-7917.es.2015.20.49.30087] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022]
Abstract
Monitoring the treatment outcome (TO) of tuberculosis (TB) is essential to evaluate the effectiveness of the intervention and to identify potential barriers for TB control. The global target is to reach a treatment success rate (TSR) of at least 85%. We aimed to assess the TB TO in the European Union and European Economic Area (EU/EEA) between 2002 and 2011, and to identify factors associated with unsuccessful treatment. Only 18 countries reported information on TO for the whole observation period accounting for 250,854 new culture-confirmed pulmonary TB cases. The 85% target of TSR was not reached in any year between 2002 and 2011 and was on average 78%. The TSR for multidrug-resistant (MDR)-TB cases at 24-month follow-up was 49%. In the multivariable regression model, unsuccessful treatment was significantly associated with increasing age (odds ratio (OR) = 1.02 per a one-year increase, 95% confidence interval (CI): 1.02-1.02), MDR-TB (OR = 8.7, 95% CI: 5.09-14.97), male sex (OR = 1.40, 95% CI: 1.28-1.52), and foreign origin (OR = 1.32, 95% CI: 1.03-1.70). The data highlight that special efforts are required for patients with MDR-TB and the elderly aged ≥65 years, who have particularly low TSR. To allow for valid monitoring at EU level all countries should aim to report TO for all TB cases.
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Affiliation(s)
- Basel Karo
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
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Balabanova Y, Ignatyeva O, Fiebig L, Riekstina V, Danilovits M, Jaama K, Davidaviciene E, Radiulyte B, Popa CM, Nikolayevskyy V, Drobniewski F. Survival of patients with multidrug-resistant TB in Eastern Europe: what makes a difference? Thorax 2016; 71:854-61. [PMID: 27012887 DOI: 10.1136/thoraxjnl-2015-207638] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/28/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND The quality of care for patients with TB in Eastern Europe has improved significantly; nevertheless drug resistance rates remain high. We analysed survival in a cohort of patients with multidrug-resistant and extensively drug-resistant (MDR-/XDR-) TB from Latvia, Lithuania, Estonia and Bucharest city. METHODS Consecutive adult new and retreatment patients with culture-confirmed pulmonary MDR-TB registered for treatment in 2009 (and in 2007 in Latvia) were enrolled; prospective survival information was collected. RESULTS A total of 737 patients were included into the cohort. Of all MDR-TB cases, 46% were newly diagnosed; 56% of all MDR-TB cases had no additional resistance to fluoroquinolones or injectable agents, 33% had pre-XDR-TB and 11% XDR-TB. Median survival was 5.9 years in patients with MDR-TB and XDR-TB; 1.9 years in patients coinfected with HIV. Older age, male gender, alcohol abuse, retirement, co-morbidities, extrapulmonary involvement and HIV coinfection independently worsened survival. Inclusion of fluoroquinolones and injectable agents improves survival in patients with MDR-TB. Pre-XDR and XDR status did not significantly shorten survival as long as fluoroquinolones and injectable agents were part of the regimen. Moxifloxacin seems to improve survival in ofloxacin-susceptible patients when compared with older generation fluoroquinolones. CONCLUSIONS The burden of additional resistances in patients with MDR-TB is high likely due to primary transmission of resistant strains. Social and programmatic factors including management of alcohol dependency, expansion of HIV testing and antiretroviral treatment need to be addressed in order to achieve cure and to interrupt transmission. The role of last generation fluoroquinolones and injectable agents in treatment of patients with pre-XDR and XDR-TB needs to be further investigated.
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Affiliation(s)
- Yanina Balabanova
- Blizard Institute, Queen Mary, University of London, London, UK Department of Infectious Diseases, Imperial College London, London, UK Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Olga Ignatyeva
- N.V. Postnikov Samara Region Clinical Tuberculosis Dispensary, Samara, Russia
| | - Lena Fiebig
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Vija Riekstina
- Department of Mycobacteriology, State Agency "Infectology Center of Latvia", Clinic for Tuberculosis and Lung Diseases, "Upeslejas" Stopinunovads, Riga, Latvia
| | - Manfred Danilovits
- United Laboratory, Department of Mycobacteriology, Tartu University Hospital, Tartu, Estonia
| | - Kadri Jaama
- United Laboratory, Department of Mycobacteriology, Tartu University Hospital, Tartu, Estonia
| | - Edita Davidaviciene
- National Tuberculosis and Infectious Diseases University Hospital, Vilnius, Lithuania
| | - Birute Radiulyte
- National Tuberculosis and Infectious Diseases University Hospital, Vilnius, Lithuania
| | | | - Vladyslav Nikolayevskyy
- Blizard Institute, Queen Mary, University of London, London, UK Department of Infectious Diseases, Imperial College London, London, UK
| | - Francis Drobniewski
- Blizard Institute, Queen Mary, University of London, London, UK Department of Infectious Diseases, Imperial College London, London, UK
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Velásquez GE, Cegielski JP, Murray MB, Yagui MJA, Asencios LL, Bayona JN, Bonilla CA, Jave HO, Yale G, Suárez CZ, Sanchez E, Rojas C, Atwood SS, Contreras CC, Santa Cruz J, Shin SS. Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study. BMC Infect Dis 2016; 16:45. [PMID: 26831140 PMCID: PMC4736097 DOI: 10.1186/s12879-016-1375-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 01/22/2016] [Indexed: 11/17/2022] Open
Abstract
Background Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting. Methods We conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment. Results Of 1701 participants treated for tuberculosis, 136 (8.0 %) died during tuberculosis treatment. HIV-positive patients constituted 11.0 % of the cohort and contributed to 34.6 % of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9 %, P < 0.001) and less likely to be cured (28.3 vs. 39.4 %, P = 0.003). On multivariate analysis, positive HIV status (hazard ratio [HR] = 6.06; 95 % confidence interval [CI], 3.96–9.27), unemployment (HR = 2.24; 95 % CI, 1.55–3.25), and sputum acid-fast bacilli smear positivity (HR = 1.91; 95 % CI, 1.10–3.31) were significantly associated with a higher hazard of death. Conclusions We demonstrate that positive HIV status was a strong predictor of mortality among patients treated for tuberculosis in the early years after Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality.
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Affiliation(s)
- Gustavo E Velásquez
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA. .,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - J Peter Cegielski
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
| | - Martin J A Yagui
- Oficina General de Investigación y Transferencia Tecnológica, Instituto Nacional de Salud, Lima, Perú. .,Departamento Académico de Medicina Preventiva y Salud Pública, Universidad Nacional Mayor de San Marcos, Lima, Perú.
| | - Luis L Asencios
- Laboratorio Nacional de Referencia de Micobacterias, Instituto Nacional de Salud, Lima, Perú.
| | - Jaime N Bayona
- Health, Nutrition and Population, The World Bank Group, Washington DC, USA.
| | - César A Bonilla
- Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud del Perú, Lima, Perú.
| | - Hector O Jave
- Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud del Perú, Lima, Perú.
| | - Gloria Yale
- Dirección de Salud V Lima Ciudad, Programa de Control de Tuberculosis, Lima, Perú.
| | - Carmen Z Suárez
- Dirección de Salud IV Lima Este, Programa de Control de Tuberculosis, Lima, Perú.
| | - Eduardo Sanchez
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Hipólito Unanue, Lima, Perú.
| | - Christian Rojas
- Servicio de Neumología, Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo", Lima, Perú.
| | - Sidney S Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
| | | | | | - Sonya S Shin
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. .,Partners In Health / Socios En Salud, Lima, Perú.
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Djouma FN, Noubom M, Ngomba AV, Donfack H, Kouomboua PSM, Saah MAF. Determinants of death among tuberculosis patients in a semi urban diagnostic and treatment centre of Bafoussam, West Cameroon: a retrospective case-control study. Pan Afr Med J 2015; 22:253. [PMID: 26958116 PMCID: PMC4764316 DOI: 10.11604/pamj.2015.22.253.6576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 11/04/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Tuberculosis (TB) remains a worldwide public health problem with 8.6 millions of new cases and 1.3 millions of death annually. Despite the progress recorded in fighting against this disease in the recent years, Africa is still not on the track to achieve the objective to reduce by half the death rate due to this disease by 2015. METHODS A case-control study was conducted on data of patients admitted for tuberculosis between 1996 and 2011 in the Diagnostic and Treatment Center of Baleng. Cases were patients who died from any cause during anti tuberculosis treatment. Logistic regression model was used to identify factors associated to death. RESULTS In 4201 patients treated during the study period, 3245 (77.24%) were included in the study. The mean age was 35.9 (SD 14.2) and male represent 62.2% (CI 60.6- 63.9) of them. At the end of the follow up, 2883 patients were successfully treated, 362 died during treatment and 132 (36.5%) deaths occurred during the first two months of TB treatment. HIV positive status, Extra-pulmonary TB, sputum smear-negative pulmonary TB and male sex were significant independent risk factors of death with adjusted odds ratio of 4.8 (CI 3.2- 7.4); 3.0 (CI 1.6- 5.4); 2.7 (CI 1.7- 4.4) and 1.5 (CI 1.0- 2.3) respectively. CONCLUSION The mortality rate of TB patients undergoing TB treatment remains high. Studies are needed to identify and test efficient interventions of mortality reduction among TB patients in resource limiting settings.
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Affiliation(s)
- Fabrice Nembot Djouma
- Department of Biomedical Sciences, University of Dschang, Cameroon, Dschang, Cameroon
| | - Michel Noubom
- Department of Biomedical Sciences, University of Dschang, Dschang, Diagnostic and Treatment Centre of Baleng, Bafoussam, Cameroon
| | - Armelle Viviane Ngomba
- Central Technical Group Expanded Program on Immunization, Ministry of Public Health, Yaounde, Cameroon
| | - Hubert Donfack
- Department of Biomedical Sciences, University of Dschang, Cameroon, Dschang, Cameroon
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Sun Y, Harley D, Vally H, Sleigh A. Comparison of characteristics and mortality in multidrug resistant (MDR) and non-MDR tuberculosis patients in China. BMC Public Health 2015; 15:1027. [PMID: 26444417 PMCID: PMC4596498 DOI: 10.1186/s12889-015-2327-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We conducted a cohort study to compare the characteristics of MDR-TB with non-MDR-TB patients and to measure long term (9-year) mortality rate and determine factors associated with death in China. METHODS We reviewed the medical records of 250 TB cases from a 2001 survey to compare 100 MDR-TB patients with 150 non-MDR-TB patients who were treated in 2001-2002. Baseline attributes extracted from the records were compared between the two cohorts and long-term mortality and risk factors were determined at nine-year follow-up in 2010. RESULTS Among the 234 patients successfully followed up, 63 (26.9%) were female and 171 (73.1 %) were male. MDR-TB patients had poorer socioeconomic status compared to non-MDRTB. Nine years after the diagnosis of TB, 69 or 29.5 % of the 234 patients had died (32 or 21.6 % of non-MDR-TB versus 37 or 43.0 % of MDR-TB) and the overall mortality rate was 39/1000 per year (PY) (27/1000 PY among non-MDR versus 63/1000 PY among MDR-TB). Factors associated with death included: MDR status (hazard ratio (HR): 1.86; CI: 1.09-3.13), limited education of primary school or lower (HR: 2.51; CI 1.34-4.70) and received TB treatment during the nine-year period (HR 1.82; 95 % CI 1.02-3.26). CONCLUSIONS MDR-TB was a strong predictor for poor long-term outcome. High quality diagnosis and treatment must be ensured. Greater reimbursement or free treatment may be needed to provide access for the poor and vulnerable populations, and to increase treatment compliance.
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Affiliation(s)
- Yanni Sun
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, 2601, Australia.
| | - David Harley
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, 2601, Australia.
| | - Hassan Vally
- School of Psychology and Public Health, La Trobe University, Melbourne, 3086, Australia.
| | - Adrian Sleigh
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, 2601, Australia.
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Wang W, Zhao Q, Yuan Z, Zheng Y, Zhang Y, Lu L, Hou Y, Zhang Y, Xu B. Tuberculosis-associated mortality in Shanghai, China: a longitudinal study. Bull World Health Organ 2015; 93:826-33. [PMID: 26668434 PMCID: PMC4669732 DOI: 10.2471/blt.15.154161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/18/2015] [Accepted: 07/28/2015] [Indexed: 11/27/2022] Open
Abstract
Objective To determine excess mortality in a cohort of people with tuberculosis in Shanghai. Methods Participants were local residents in 4 (of 19) districts in Shanghai, registered in one of four tuberculosis clinics between January 1, 2004 and December 31, 2008. Baseline data were collected at the most recent diagnosis of tuberculosis and mortality was assessed between March and May of 2014. We calculated standardized mortality ratios (SMR) and case-fatality rates for all participants and for subgroups. Univariate and multivariate Cox regression models were used to quantify associations between co-morbidities and mortality from all causes and from tuberculosis. Findings We registered 4569 subjects in the cohort. Overall, the cohort had an SMR for deaths from all causes of 5.2 (95% confidence interval, CI: 4.8–5.6). Males had a higher SMR than females (6.1 versus 3.0). After adjustment for age and sex, hazard ratios (HR) for deaths from all causes were significantly greater in previously treated people (HR: 1.26; 95% CI: 1.08–1.49) and sputum smear-test positive people (HR: 1.55; 95% CI: 1.35–1.78). The risk of death from tuberculosis was also significantly greater for previously treated people (HR: 1.88; 95% CI: 1.24–2.86) and smear positive people (HR: 3.16; 95% CI: 2.06–4.87). Conclusion People with tuberculosis in Shanghai have an increased risk of mortality. Earlier diagnosis and more vigilant follow-up may help to reduce mortality in this group.
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Affiliation(s)
- Weibing Wang
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Qi Zhao
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Zhengan Yuan
- Shanghai Center for Disease Control and Prevention, Shanghai, China
| | - Yihui Zheng
- Putuo District Center for Disease Control and Prevention, Shanghai, China
| | - Yixing Zhang
- Pudong District Center for Disease Control and Prevention, Shanghai, China
| | - Liping Lu
- Songjiang District Center for Disease Control and Prevention, Shanghai, China
| | - Yun Hou
- Yangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Yue Zhang
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Biao Xu
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
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The Xpert® MTB/RIF assay in routine diagnosis of pulmonary tuberculosis: A multicentre study in Lithuania. Respir Med 2015; 109:1484-9. [PMID: 26403251 DOI: 10.1016/j.rmed.2015.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/18/2015] [Accepted: 07/09/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Drug-resistant tuberculosis (TB) is an important public health problem in Lithuania with MDR rates in new cases reaching 11% in 2012. Currently available diagnostic tools are not fully adequate for an accurate and rapid result for diagnosis of TB and MDR-TB. OBJECTIVES To evaluate the performance of Xpert(®) MTB/RIF assay for an early diagnosis of TB and detection of rifampicin (RIF) resistance in routine settings in Lithuania. METHODS A total of 833 individual respiratory samples obtained from patients previously treated for TB and MDR-TB contacts were tested using the Xpert MTB/RIF assay. Performance characteristics of the assay for TB and RIF resistance detection were calculated using culture and phenotypical DST results as a gold standard. RESULTS The overall sensitivity and specificity of the Xpert MTB/RIF assay for TB detection were 93.7% and 91.7%, respectively with the sensitivity for smear-negative specimens reaching 82.5%. Resistance to RIF was detected in 81 (20.7%) primary specimens with no false negative results; there were 4/225 (1.8%) false-positives among strains sensitive to rifampicin. Overall sensitivity and specificity of the molecular assay for detection of RIF resistance calculated against phenotypic DST results were 100% and 98.2%, respectively. CONCLUSIONS Our results demonstrate very good performance of the Xpert MTB/RIF assay for the detection of TB and RIF resistance on primary respiratory specimens. It provides strong evidence that implementation of the assay for routine laboratory diagnosis in high drug-resistance settings may improve and facilitate TB diagnosis.
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Características de la tuberculosis en la población inmigrante en el Área de Salud Sur de Granada. Enferm Infecc Microbiol Clin 2015; 33:166-72. [DOI: 10.1016/j.eimc.2014.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 04/18/2014] [Accepted: 04/30/2014] [Indexed: 11/23/2022]
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Wejse C, Patsche CB, Kühle A, Bamba FJV, Mendes MS, Lemvik G, Gomes VF, Rudolf F. Impact of HIV-1, HIV-2, and HIV-1+2 dual infection on the outcome of tuberculosis. Int J Infect Dis 2014; 32:128-34. [PMID: 25499041 DOI: 10.1016/j.ijid.2014.12.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/06/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV-1 infection has been shown to impact the outcome of patients with tuberculosis (TB), but data regarding the impact of HIV-2 on TB outcomes are limited. The aim of this study was to assess the impact of HIV types on mortality among TB patients in Guinea-Bissau and to examine the predictive ability of the TBscoreII, a clinical score used to assess disease severity. METHODS In a prospective follow-up study, we examined the prevalence of HIV-1, HIV-2, and HIV-1+2 co-infection in TB patients in Guinea-Bissau, and the impact on outcomes at 12 months of follow-up. We included all adult TB patients in an observational TB cohort at the Bandim Health Project (BHP) in Guinea-Bissau between 2003 and 2013 and assessed survival status at 12 months after the start of treatment. RESULTS A total 1312 patients were included; 499 (38%) were female (male/female ratio 1.6). Three hundred and seventy-nine patients were HIV-infected: 241 had HIV-1, 93 had HIV-2, and 45 were HIV-1+2 dual infected. The HIV type-associated risk of TB was 6-fold higher for HIV-1, 7-fold higher for HIV-1+2 dual infection, and 2-fold higher for HIV-2 compared with the HIV-uninfected. Of the patients included, 144 (11%) died, 62 (12%) among females and 82 (9%) among males (hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.64-1.30; p=0.596). Compared to male patients, female patients were younger (1 year younger, 95% CI 0.5-2; p=0.04), reported a longer duration of symptoms (14 days longer, 95% CI 4-25; p=0.003), and had a higher TBscoreII (0.5 points more, 95% CI 0.3-0.7; p<0.001). More females than males were HIV-infected (36% vs. 25%; p<0.001) and more females had a body mass index (BMI) <15 kg/m(2) (11% vs. 6%; p<0.001) and a mid upper arm circumference (MUAC) <200 mm (13% vs. 7%; p < 0.001). HIV infection increased the mortality risk, with HIV-1 infection displaying the highest HR (5.0, 95% CI 3.5-7.1), followed by HIV-1+2 (HR 4.2, 95% CI 2.2-7.8) and HIV-2 (HR 2.1, 95% CI 1.2-3.8). A TBscoreII ≥4 was associated with increased mortality (HR 2.2, 95% CI 1.5-3.1). Significantly increased HRs were found for signs of wasting; a BMI <18 kg/m(2) was associated with a HR of 1.8 (95% CI 1.3-2.6) and a MUAC <220 mm with a HR of 3.8 (95% CI 2.7-5.2). CONCLUSION The HIV type-associated risk of TB was much higher for HIV-1 patients and higher but less so for HIV-2 patients, compared with the HIV-uninfected. Clinical severity at presentation was also higher for HIV-infected patients, although less so for HIV-2-infected patients, and all HIV-infected patients had a poorer outcome than the uninfected; mortality was 4-5-fold higher for HIV-1 and dually infected patients and two-fold higher for HIV-2-infected patients. These differences between HIV types did not disappear after adjusting for CD4 count.
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Affiliation(s)
- C Wejse
- Bandim Health Project, INDEPTH Network, Statens Serum Institut, Bissau, Guinea-Bissau; GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark.
| | - C B Patsche
- Bandim Health Project, INDEPTH Network, Statens Serum Institut, Bissau, Guinea-Bissau; Infectious Disease Research Unit, Aarhus University Hospital, Skejby, Denmark
| | - A Kühle
- Infectious Disease Research Unit, Aarhus University Hospital, Skejby, Denmark
| | - F J V Bamba
- Hospital Raoul Follereau, Hospital Nacionál de Tuberculosis, Bissau, Guinea-Bissau
| | - M S Mendes
- Hospital Raoul Follereau, Hospital Nacionál de Tuberculosis, Bissau, Guinea-Bissau
| | - G Lemvik
- Bandim Health Project, INDEPTH Network, Statens Serum Institut, Bissau, Guinea-Bissau; Infectious Disease Research Unit, Aarhus University Hospital, Skejby, Denmark
| | - V F Gomes
- Bandim Health Project, INDEPTH Network, Statens Serum Institut, Bissau, Guinea-Bissau
| | - F Rudolf
- Bandim Health Project, INDEPTH Network, Statens Serum Institut, Bissau, Guinea-Bissau; Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark
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Christensen ASH, Roed C, Andersen PH, Andersen AB, Obel N. Long-term mortality in patients with pulmonary and extrapulmonary tuberculosis: a Danish nationwide cohort study. Clin Epidemiol 2014; 6:405-21. [PMID: 25419160 PMCID: PMC4235508 DOI: 10.2147/clep.s65331] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Long-term mortality and causes of death in patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) are poorly documented. In this study, long-term mortality and causes of death in PTB and EPTB patients were compared with the background population and it was investigated whether mortality was associated with family-related risk factors. METHODS A NATIONWIDE COHORT STUDY WAS CONDUCTED INCLUDING: all adult Danes notified with PTB or EPTB from 1977 to 2008 and alive 1 year after diagnosis; a randomly selected comparison cohort matched on birth date and sex; adult siblings of PTB patients; and population controls. Data were extracted from national registries. All-cause and cause-specific mortality rate ratios were calculated for patients and siblings and compared with their respective control cohorts. A total of 8,291 patients (6,402 PTB and 1,889 EPTB), 24,873 population controls, 1,990 siblings of PTB patients and 11,679 siblings of PTB population controls were included. RESULTS Overall, the mortality rate ratio was 1.86 (95% confidence interval [CI] 1.77-1.96) for PTB patients and 1.24 (95% CI 1.12-1.37) for EPTB patients. Both patient cohorts had significantly increased risk of death due to infectious diseases and diabetes. Further, the PTB patients had increased mortality due to cancers (mainly respiratory and gastrointestinal tract), liver and respiratory system diseases, and alcohol and drug abuse. The PTB patients had increased mortality compared with their siblings (mortality rate ratio 3.55; 95% CI 2.57-4.91) as did the siblings of the PTB patients compared with the siblings of population controls (mortality rate ratio 2.16; 95% CI 1.62-2.87). CONCLUSION We conclude that adult PTB patients have an almost two-fold increased long-term mortality whereas EPTB patients have a slightly increased long-term mortality compared with the background population. The increased long-term mortality in PTB patients stems from diseases associated with alcohol, tobacco, and drug abuse as well as immune suppression, and family-related factors.
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Affiliation(s)
| | - Casper Roed
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter H Andersen
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | | | - Niels Obel
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Reeves A, Basu S, McKee M, Stuckler D, Sandgren A, Semenza J. Social protection and tuberculosis control in 21 European countries, 1995-2012: a cross-national statistical modelling analysis. THE LANCET. INFECTIOUS DISEASES 2014; 14:1105-1112. [PMID: 25303845 DOI: 10.1016/s1473-3099(14)70927-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND WHO stresses the need to act on the social determinants of tuberculosis. We tested whether alternative social protection programmes have affected tuberculosis case notifications, prevalence, and mortality, and case detection and treatment success rates in 21 European countries from 1995 to 2012. METHODS We obtained tuberculosis case notification data from the European Centre for Disease Prevention and Control's 2014 European Surveillance System database. We also obtained data for case detection, treatment success, prevalence, and mortality rates from WHO's 2014 tuberculosis database. We extracted data for 21 countries between Jan 1, 1995, and Dec 31, 2012. Social protection data were from EuroStat, 2014 edition. We used multivariate cross-national statistical models to quantify the association of differing types of social protection programmes with tuberculosis outcomes. All analyses were prespecified. FINDINGS After we controlled for economic output, public health spending, and country fixed effects, each US$100 increase in social protection spending was associated with a decrease per 100,000 population in the number of tuberculosis case notifications of -1·53% (95% CI -0·28 to -2·79; p=0·0191), estimated incidence rates of -1·70% (-0·30 to -3·11; p=0·0201), non-HIV-related tuberculosis mortality rate of -2·74% (-0·66 to -4·82; p=0·0125), and all-cause tuberculosis mortality rate of -3·08% (-0·73 to -5·43; p=0·0127). We noted no relation between increased social spending and tuberculosis prevalence (-1·50% [-3·10 to 0·10] per increase of $100; p=0·0639) or smear-positive treatment success rates (-0·079% [-0·18 to 0·34] per increase of $100; p=0·5235) or case detection (-0·59% [-1·31 to 0·14] per increase of $100; p=0·1066). Old age pension expenditure seemed to have the strongest association with reductions in tuberculosis case notification rates for those aged 65 years or older (-3·87% [-0·95 to -6·78]; p=0·0137). INTERPRETATION Investment in social protection programmes are likely to provide an effective complement to tuberculosis prevention and treatment programmes, especially for vulnerable groups. FUNDING European Centre for Disease Prevention and Control.
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Affiliation(s)
- Aaron Reeves
- Department of Sociology, University of Oxford, Oxford, UK.
| | - Sanjay Basu
- School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Martin McKee
- European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
| | - Andreas Sandgren
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Jan Semenza
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Kwon YS, Kim YH, Song JU, Jeon K, Song J, Ryu YJ, Choi JC, Kim HC, Koh WJ. Risk factors for death during pulmonary tuberculosis treatment in Korea: a multicenter retrospective cohort study. J Korean Med Sci 2014; 29:1226-31. [PMID: 25246740 PMCID: PMC4168175 DOI: 10.3346/jkms.2014.29.9.1226] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 06/03/2014] [Indexed: 11/27/2022] Open
Abstract
The data regarding risk factors for death during tuberculosis (TB) treatment are inconsistent, and few studies examined this issue in Korea. The purpose of this study was to evaluate baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea. A multicenter retrospective cohort study of 2,481 patients who received TB treatment at eight hospitals from January 2009 to December 2010 was performed. Successful treatment included cure (1,129, 45.5%) and treatment completion (1,204, 48.5%) in 2,333 patients (94.0%). Unsuccessful treatment included death (85, 3.4%) and treatment failure (63, 2.5%) occurred in 148 patients (6.0%). In multivariate analysis, male sex, anemia, dyspnea, chronic heart disease, malignancy, and intensive care unit (ICU) admission were significant risk factors for death during TB treatment. Therefore, male sex, anemia, dyspnea, chronic heart disease, malignancy, and ICU admission could be baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea.
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Affiliation(s)
- Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yee Hyung Kim
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junwhi Song
- Division of Pulmonology, Samsung Changwon Hospital, Changwon, Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine, Mokdong Hospital, Seoul, Korea
| | - Jae Chol Choi
- Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, College of Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Babalik A, Kiziltas S, Gencer S, Kilicaslan Z. An investigation into the relationship between region specific quality of life and adverse tuberculosis treatment outcomes in Istanbul, Turkey. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:248-53. [PMID: 24674616 DOI: 10.1016/j.rppneu.2014.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/21/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Istanbul has the highest incidence of tuberculosis (TB) in Turkey. It is also the largest city, with considerable differences in quality of life across its urban regions. The aim of this study is to investigate the relationship between (i) the diverse quality of life across specific urban regions, (ii) TB incidence rates, inclusive of demographic and clinical characteristics of TB patients, and (iii) adverse treatment outcomes. METHODS This retrospective study included 23,845 new TB patients (recorded in the National TB Registry between 2006 and 2010) in Istanbul. Thirty-nine urban districts of Istanbul were ranked into five groups on the basis of an urban quality of life index. Patient data were matched with these groups, and further categorized according to 'age', 'sex', 'country of birth' and 'antibiotics resistance'. Adverse treatment outcomes and TB incidence rates were extracted from official records. Logistic regression, clustered analyses, 95% CI and p values (STATA) were reported to describe the association between variables. RESULTS Six per cent of total cases had 'at least one adverse treatment outcome' (default 3.8%, failure 0.5%, death 1.7% in total cases). 'An adverse treatment outcome' was found to be associated with age OR (CI 95%) (1.02 (1.01-1.03)); 'male sex' 1.65 (1.28-2.12); 'other country of birth' 4.82 (3.05-7.62); 100,000 per 'over 60' insidence goups 1.61 (1.32-1.97), the lowest quality of life index 0.65 (0.47-0.83). CONCLUSIONS Patients with high tuberculosis risk factors living in high incidence regions need to be closely monitored. Patients living in lower ranking regions are more likely to have 'poor treatment outcomes'.
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Affiliation(s)
- A Babalik
- Department of Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
| | | | - S Gencer
- Clinic of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Z Kilicaslan
- Department of Pulmonology, Istanbul University Faculty of Medicine, Istanbul, Turkey
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Lowe DM, Bandara AK, Packe GE, Barker RD, Wilkinson RJ, Griffiths CJ, Martineau AR. Neutrophilia independently predicts death in tuberculosis. Eur Respir J 2013; 42:1752-1757. [PMID: 24114967 PMCID: PMC4176760 DOI: 10.1183/09031936.00140913] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- David M Lowe
- Department of Medicine, Imperial College London, London W2 1PG, UK
- Clinical Infectious Diseases Research Initiative, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory 7925, Cape Town, South Africa
| | - Asela K Bandara
- Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London E1 2AB, UK
| | | | - Richard D Barker
- Department of Respiratory Medicine, King's College Hospital, London SE5 9RS, UK
| | - Robert J Wilkinson
- Department of Medicine, Imperial College London, London W2 1PG, UK
- Clinical Infectious Diseases Research Initiative, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory 7925, Cape Town, South Africa
- Medical Research Council National Institute for Medical Research, London NW7 1AA, UK
| | - Christopher J Griffiths
- Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London E1 2AB, UK
| | - Adrian R Martineau
- Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London E1 2AB, UK
- Department of Medicine, Imperial College London, London W2 1PG, UK
- Medical Research Council National Institute for Medical Research, London NW7 1AA, UK
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Babalik A, Kilicaslan Z, Caner SS, Gungor G, Ortakoylu MG, Gencer S, McCurdy SA. A registry-based cohort study of pulmonary tuberculosis treatment outcomes in Istanbul, Turkey. Jpn J Infect Dis 2013; 66:115-20. [PMID: 23514907 DOI: 10.7883/yoken.66.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study is to evaluate the treatment outcomes and identify factors associated with adverse tuberculosis treatment outcomes for bacteriologically confirmed pulmonary tuberculosis. Treatment outcomes of pulmonary tuberculosis were evaluated retrospectively among 11,186 smear- and/or culture-positive patients treated between 2006 and 2009 in Istanbul, Turkey. Adverse treatment outcomes were identified in 1,010 (9.0%) patients including death (1.8%), treatment default (6.1%), and treatment failure (1.1%). Factors associated with adverse treatment outcomes included being born abroad (odds ratios [OR], 5.38; 95% confidence intervals [CI], 3.67-7.91), history of tuberculosis treatment (OR, 3.77; 95% CI, 3.26-4.36), age > 65 years (OR, 2.79; 95% CI, 2.21-3.53), and male gender (OR, 1.91; 95% CI, 1.59-2.27). Death was most strongly associated with age > 65 years (OR, 45.1; 95% CI, 27.0-75.6), followed by treatment default with history of interrupted treatment (OR, 11.6; 95% CI, 8.94-15.1), and treatment failure with prior history of treatment failure (OR, 17.1; 95% CI, 6.97-41.6). Multidrug resistance was strongly associated with adverse treatment outcomes (OR, 10.8; 95% CI, 8.02-14.6). Age > 65 years, male sex, being born abroad, and history of treatment failure were found to be risk factors for adverse treatment outcomes. Hence, patients with any of these characteristics should be carefully monitored and treated aggressively.
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Affiliation(s)
- Aylin Babalik
- Department of Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. aylinbabalik@gmail.com
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Experience of a monographic tuberculosis unit: the first 500 cases. Arch Bronconeumol 2013; 49:421-6. [PMID: 23791382 DOI: 10.1016/j.arbres.2013.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Tuberculosis (TB) remains a highly prevalent and potentially severe disease. However, since 2002 the annual incidence has been decreasing both worldwide and in Spain, where the incidence varies widely between regions. The main objective of this study is to describe the experience of a monographic TB unit in a second level hospital. PATIENTS AND METHODS A descriptive study was carried out which included all cases of TB diagnosed in a monographic unit of a secondary hospital between 2003 and 2011. Demographic, clinical, epidemiological and microbiological data were recorded. RESULTS We analyzed 500 TB cases and found an increasing annual incidence in all subgroups, including native and immigrant populations. Most cases (63.8%) were male, with a median age of 36 years (range 8 months-90 years). In total, 39.8% of patients were foreign born. Coinfection with human immunodeficiency virus was found in 11% of cases. The pulmonary form was most frequently diagnosed (63.8%). Overall mortality was 5.8% with no significant differences between groups (including foreign born and human immunodeficiency virus positive patients). CONCLUSIONS Although TB incidence is globally decreasing, in our study we found an increasing number of cases in recent years in all subgroups, which can be explained by this being a monographic unit with an intensive contact tracing program.
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Babalık A, Kılıçaslan Z, Kızıltaş S, Gencer S, Ongen G. A retrospective case-control study, factors affecting treatment outcomes for pulmonary tuberculosis in istanbul, Turkey. Balkan Med J 2013; 30:204-10. [PMID: 25207101 DOI: 10.5152/balkanmedj.2013.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/23/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tuberculosis is a public health problem and its transmission is a threat to the community. AIMS The aim of this study was to determine the factors influencing the treatment outcomes and the effectiveness of the National Tuberculosis Program (NTP) in relation to the application of the directly observed treatment, short-course (DOTS) program in various sites in Istanbul, Turkey. STUDY DESIGN Case-Control Study. METHODS A case-control study was used, where cases and controls were randomly selected from the Turkish Tuberculosis National Database, which includes complete data on treatment outcomes for patients recorded in the database from January 1, 2006 to December 31, 2009 and had one year follow-up. RESULTS The case group was composed of 464 patients with adverse outcome, while the control group was composed of 441 patients who had been cured of disease. Factors associated with adverse treatment outcome were >65 years of age (OR: 3.39 (1.99-5.76)) ; male gender (OR:2.11 (1.49-2.99)); born outside Turkey (OR: 5.48 (2.13-14.04)); co-morbidity (OR: 1.85 (1.29-2.65)); bilateral radiologic lesions (OR: 2.07 (1.41-3.00); previous treatment history (OR: 3.99 (2.78-5.74)); 3(rd) month positive microscopy (OR: 4.96 (3.04-8.09)) and any H&R +/- others multidrug resistant (MDR) resistance (OR: 22.64 (6.92-74.08)). There was no association between the adverse treatment outcome and the application site of direct observation treatment, short course (DOTS) delivery and the supervisors. CONCLUSION Our findings indicate similar quality in DOTS application and supervision among patients with or without adverse treatment outcomes. However, patients with certain characteristics should be carefully monitored and aggressively treated.
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Affiliation(s)
- Aylin Babalık
- Department of Pulmonology, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Zeki Kılıçaslan
- Department of Pulmonology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Sule Kızıltaş
- Department of Pulmonology, Kadıköy Tuberculosis Dispensary, İstanbul, Turkey
| | - Serap Gencer
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Gül Ongen
- Department of Pulmonology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey, Department of Pulmonology, İstanbul, Turkey
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Abstract
BACKGROUND AND OBJECTIVES Tuberculosis (TB) still contributes to deaths in Saudi Arabia, among both Saudis and non-Saudis. Exploring the trend of deaths caused by TB and determinants associated with high fatality rate among TB patients is considered as a part of monitoring and evaluation of the performance of National Tuberculosis Control Program to help planners improve policies and procedures used to achieve the targets of TB control. DESIGN AND SETTINGS The current study is a retrospective one, which used the official notifications of NTP in Saudi Arabia over a period of 10 years (2001-2010). METHODS A 10-year retrospective study included all TB cases registered in Saudi Arabia with known outcome of survival or death while under anti-TB therapy covering the period January 1, 2001, to December 31, 2010. RESULTS Mortality among TB patients show a declining trend among Saudis starting from the year 2003 (7.2%6.1%) and a stagnant trend among non-Saudis. Saudi nationality was associated with higher fatality rate compared to non-Saudis (6.4% and 5.4%, respectively). Mortality was positively correlated with advancing age, male sex among Saudis (7.3% compared to 5.3% among females), and female sex among non-Saudis (6% compared to 5% among males), prior history of anti-TB therapy, smear positivity, and human immunodeficiency virus (HIV) seropositivity. CONCLUSIONS We recommend WHO to modify the definition of death among TB patients. We recommend NTP in Saudi Arabia to adopt and implement International Classification of Diseases (ICD10) for TB patients' registration, improve health care services provided for elderly, monitor and strengthen NTP performance to decrease defaulter and early detect and treat patients, initiate a collaborative TB/HIV activities, and screen all suspected TB patients for HIV. In addition to these, more extended research has to be initiated concerning delayed diagnosis and comorbidities with TB.
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Kim CW, Kim SH, Lee SN, Lee SJ, Lee MK, Lee JH, Shin KC, Yong SJ, Lee WY. Risk factors related with mortality in patient with pulmonary tuberculosis. Tuberc Respir Dis (Seoul) 2012; 73:38-47. [PMID: 23101023 PMCID: PMC3475478 DOI: 10.4046/trd.2012.73.1.38] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 02/21/2012] [Accepted: 05/11/2012] [Indexed: 01/09/2023] Open
Abstract
Background The prevalence rate of pulmonary tuberculosis (PTB) is steadily decreasing in South Korea. However, PTB is a disease with relatively high mortality and morbidity rates throughout Korea. Although there are many studies and statistics about the risk factors of PTB mortality in many countries, there are only a limited number of domestic papers on this topic. The aim of this study is to determine predictive factors for mortality among in-hospital patients associated with PTB. Methods From December 2006 to January 2011, we reviewed medical records of 2,122 adult patients diagnosed with tuberculosis at a single tertiary hospital in a suburban area. In this study period, 960 patients were diagnosed with PTB by positive Acid fast bacilli smear and/or mycobacterial culture of the respiratory specimen. We compared the groups of patients deceased and patients discharged alive with PTB. The number of dead patients was 82 (47 males, 35 females). Results Mortality was significantly associated with increased values of white blood cells (WBC), blood urine nitrogen (BUN), creatinine, C-reactive protein (CRP), numbers of involved lung field, and length of hospitalization. Also, it was associated with the decreased values of hemoglobin, lymphocyte, sodium, albumin, and cholesterol. Furthermore, admission through the emergency department, initial intensive care unit admission, and drug resistant PTB affected mortality in PTB patients. Independent predictors associated with PTB mortality are BUN, initial intensive care unit care, and admission during treatment of tuberculosis. Conclusion In our study, mortality of pulmonary tuberculosis was related with parameters associated with nutritional status, disease severity at the time of admission, and drug resistance.
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Affiliation(s)
- Chong Whan Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Rossato Silva D, Müller AM, Dalcin PDTR. Factors associated with delayed diagnosis of tuberculosis in hospitalized patients in a high TB and HIV burden setting: a cross-sectional study. BMC Infect Dis 2012; 12:57. [PMID: 22420509 PMCID: PMC3350432 DOI: 10.1186/1471-2334-12-57] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 03/15/2012] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The most essential components of TB control are early diagnosis and adequate treatment. Delay in the diagnosis and treatment of tuberculosis may result in more extensive disease and more complications, increase severity of the disease and is associated with higher risk of mortality. The purpose of this study was to identify factors associated with delayed diagnosis of TB in hospitalized patients. METHODS We conducted a cross-sectional study in a general, tertiary care, university-affiliated hospital. Adult patients with TB that were hospitalized were identified retrospectively, and risk factors for delayed diagnosis were collected. RESULTS The median delay until diagnosis was 6 days (IQR: 2-12 days). One hundred and sixty six (54.4%) patients were diagnosed ≤ 6 days, and 139 (45.6%) > 6 days after admission. The main factors associated with diagnostic delay (> 6 days) were extra-pulmonary TB and negative sputum smear. CONCLUSIONS Although hospitalization permits a rapid management of the patient and favors a faster diagnosis, we found an unacceptable time delay before the diagnosis of pulmonary TB was made. Future studies should focus on attempt to explain the reasons of diagnostic retard in the patients with the characteristics related to delay in this study.
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Affiliation(s)
- Denise Rossato Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, Porto Alegre, RS, 90,035-903, Brazil.
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