Rate of Reinfection Tuberculosis after Successful Treatment Is Higher than Rate of New Tuberculosis

In a high-tuberculosis (TB) incidence area of Cape Town, South Africa, there is a very high rate of unexplained recurrent TB. The incidence of new bacteriologically confirmed disease in the area is 313 per 100,000 individuals. To estimate the rate of recurrent TB attributable to reinfection after su...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine Vol. 171; no. 12; pp. 1430 - 1435
Main Authors: Verver, Suzanne, Warren, Robin M, Beyers, Nulda, Richardson, Madalene, van der Spuy, Gian D, Borgdorff, Martien W, Enarson, Donald A, Behr, Marcel A, van Helden, Paul D
Format: Journal Article
Language:English
Published: New York, NY Am Thoracic Soc 15.06.2005
American Lung Association
American Thoracic Society
Subjects:
Adolescent
Adult
Age Distribution
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Antitubercular Agents - therapeutic use
Biological and medical sciences
Child
Cohort Studies
Confidence Intervals
Developing Countries
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Emergency and intensive care: techniques, logistics
Female
Humans
Incidence
Intensive care medicine
Male
Medical sciences
Middle Aged
Monitoring
Mycobacterium tuberculosis - isolation & purification
Odds Ratio
Prognosis
Recurrence
Retrospective Studies
Risk Assessment
Severity of Illness Index
Sex Distribution
South Africa - epidemiology
Survival Analysis
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - drug therapy
Tuberculosis, Pulmonary - epidemiology
Urban Population
South Africa
molecular epidemiology
Intensive care
Mycobacterial infection
Reinfection
Epidemiology
Survival
Incidence
Infection
recurrence
Treatment
Tuberculosis
Mycobacterium tuberculosis
survival analysis
Mycobacteriales
Bacteriosis
Mycobacteriaceae
Bacteria
Actinomycetes
Resuscitation
ISSN:1073-449X, 1535-4970
Online Access:Get full text
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Summary:In a high-tuberculosis (TB) incidence area of Cape Town, South Africa, there is a very high rate of unexplained recurrent TB. The incidence of new bacteriologically confirmed disease in the area is 313 per 100,000 individuals. To estimate the rate of recurrent TB attributable to reinfection after successful treatment. All patients with reported TB in the area between 1993 and 1998 were followed up to 2001 for disease needing retreatment (recurrences). Patients who were multi-drug-resistant or who had treatment failure, were transferred, or died during treatment were excluded. Analysis was restricted to patients for whom DNA fingerprinting of their Mycobacterium tuberculosis isolates was obtained. Reinfection TB was defined as a recurrent TB episode in which the strains of the separate episodes differed by more than four bands. 612 of 897 (68%) patients had a DNA fingerprint available at enrollment. Median duration of follow-up was 5.2 years. Recurrent TB occurred in 108 of 612 (18%) patients, of whom 61 of 447 (14%) experienced recurrence after successful treatment, and 47 of 165 (28%) experience recurrence after default. Of the 108 patients with recurrent TB, 68 (63%) had a DNA fingerprint in the second episode. Among these patients, 24 of 31 (77%) recurrences after successful treatment and 4 of 37 (11%) recurrences after default were attributable to reinfection. The reinfection disease rate after successful treatment was estimated at 2.2 per 100 person-years. The age-adjusted incidence rate of TB attributable to reinfection after successful treatment was four times that of new TB. People who had TB once are at a strongly increased risk of developing TB when reinfected.
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ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.200409-1200OC