The temporal dynamics of relapse and reinfection tuberculosis after successful treatment: a retrospective cohort study

There is increasing evidence from tuberculosis high-burden settings that exogenous reinfection contributes considerably to recurrent disease. However, large longitudinal studies of endogenous reactivation (relapse) and reinfection tuberculosis are lacking. We hypothesize a relationship between relap...

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Veröffentlicht in:Clinical infectious diseases Jg. 58; H. 12; S. 1676
Hauptverfasser: Marx, Florian M, Dunbar, Rory, Enarson, Donald A, Williams, Brian G, Warren, Robin M, van der Spuy, Gian D, van Helden, Paul D, Beyers, Nulda
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 15.06.2014
Schlagworte:
Adult
Child
Child, Preschool
DNA Fingerprinting
Female
Humans
Infant
Infant, Newborn
Longitudinal Studies
Male
Mycobacterium tuberculosis - genetics
Recurrence
Retrospective Studies
Time Factors
Tuberculosis, Pulmonary - drug therapy
Tuberculosis, Pulmonary - microbiology
Young Adult
recurrence
South Africa
reinfection
Mycobacterium tuberculosis
DNA fingerprinting
ISSN:1537-6591, 1537-6591
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Zusammenfassung:There is increasing evidence from tuberculosis high-burden settings that exogenous reinfection contributes considerably to recurrent disease. However, large longitudinal studies of endogenous reactivation (relapse) and reinfection tuberculosis are lacking. We hypothesize a relationship between relapse vs reinfection and the time between treatment completion and recurrent disease. Population-based retrospective cohort study on all smear-positive tuberculosis cases successfully treated between 1996 and 2008 in a suburban setting in Cape Town, South Africa. Inverse gaussian distributions were fitted to observed annual rates of relapse and reinfection, distinguished by DNA fingerprinting of Mycobacterium tuberculosis strains recultured from diagnostic samples. Paired DNA fingerprint data were available for 130 (64%) of 203 recurrent smear-positive tuberculosis cases in the 13-year study period. Reinfection accounted for 66 (51%) of 130 recurrent cases overall, 9 (20%) of 44 recurrent cases within the first year, and 57 (66%) of 86 thereafter (P < .001). The relapse rate peaked at 3.93% (95% confidence interval [CI], 2.35%-5.96%) per annum 0.35 (95% CI, .15-.45) years after treatment completion. The reinfection tuberculosis rate peaked at 1.58% (95% CI, .94%-2.46%) per annum 1.20 (95% CI, .55-1.70) years after completion. To our knowledge, this is the first study of sufficient size and duration using DNA fingerprinting to investigate tuberculosis relapse and reinfection over a lengthy period. Relapse occurred early after treatment completion, whereas reinfection dominated after 1 year and accounted for at least half of recurrent disease. This temporal relationship may explain the high variability in reinfection observed across smaller studies. We speculate that follow-up time in antituberculosis drug trials should take reinfection into account.
Bibliographie:ObjectType-Article-1
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ISSN:1537-6591
1537-6591
DOI:10.1093/cid/ciu186