Risks of recurrence in people with pulmonary tuberculosis

I.O. Novozhylova, I.V. Bushura
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It was found that patients with RPTB are a difficult group because more than 1⁄2 of them have lung destruction, 3⁄4 isolate mycobacterium tuberculosis (MBT), and more than 1⁄2 have resistance to antimycobacterial drugs (AMBD). In 73.6 % of them, medical and social risk factors were noted that may have caused or contributed to TB relapse and negatively affected the results of treatment. These factors include: severe comorbidities in 53.7 %, alcohol and drug abuse in 34.9 %, HIV infection in 30.5 %, and others (homelessness, release from prison, contact with a TB patient, unemployment, smoking, etc.); 62.1 % of patients had ≥2 risk factors at the same time.&#x0D; We consider the effectiveness of treatment of this category of patients to be insufficient, as the outcome of the main course of treatment was unsatisfactory in more than half of them (48.5 % of unsuccessfully treated, 4.7 % interrupted treatment, 8.3 % died), and taking into account repeated courses, the rate of effective treatment in some of them was only 65.6 %.&#x0D; There was no significant difference (neither in clinical characteristics nor in medical and social risk factors) between the groups of patients “cured” or “completed treatment” as a result of treatment of the first case of TB, but it was found that only 23.2 % of patients with RPTB were found to be resistant to AMBD at the first case of the disease, and 50.0 % of them had it, with multidrug resistance (MDR) in half of them.&#x0D; It has been statistically proven that patients with RPTB are more likely to have the following symptoms than patients with NDPTB: lung destruction (43.2±3.2 vs. 20.4±4.0 %, p<0.05), sputum isolation of MBT (38.1±3.3 vs. 24.9±3.9 %, p<0.05), multi- and poly-resistance of MBT to AMBD (30.2±8.1 vs. 9.5±4.3 %, p<0.05), various medical and social risks (73.6±2.2 vs. 44.5±3.4 %, p<0.05), including alcohol abuse (21.3±3.7 vs. 8.7±4.3 %, p<0.05 %), unemployment (51.1±2.9 vs. 21.9±4.0 %, p<0.05), concomitant diseases (39.5±3.3 vs. 8.5±4.3 %, p<0.05), HIV infection (22.5±4.0 vs. 4.9±4.4 %, p<0.05) and others – lack of a fixed place of residence, release from prison, contact with a TB patient, lack of permanent employment, smoking, etc. (64.3±2.5 vs. 8.3±4.3 %, p<0.05), as well as ≥2 risk factors at the same time (45.7±3.1 vs. 20.0±4.0 %, p<0.05), which confirms the role of the above factors as probable risks of relapse in TB patients.&#x0D; CONCLUSIONS. Since the role of unfavourable NDPTB course, medical and social risk factors such as unemployment, severe comorbidities, alcohol abuse, HIV infection and some others (belonging to persons of no fixed abode, release from prison, contact with a TB patient) as possible causes of the development (or contributing to) RPTB, which subsequently negatively affect treatment outcomes, patients with these factors should be considered a particularly dangerous population for the development of PTB and, accordingly, should be screened and monitored for life in risk groups accordingly.&#x0D; Given that the detection of MDR-TB in the first case of PTB is the most dangerous risk factor for RPTB, it is necessary to introduce the determination of MDR-TB resistance in all patients with NDPTB and, despite the results of their treatment, to follow up such persons in risk groups.&#x0D; Late detection of RPTB (in 3⁄4) indicates organisational shortcomings of primary care in TB control, primarily in the formation of risk groups and work with them, and requires the implementation of preventive measures taking into account the new realities and challenges of wartime.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infusion & Chemotherapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.32902/2663-0338-2023-3-24-30","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

OBJECTIVE. To assess the risk of relapse in patients with pulmonary tuberculosis (PTB). MATERIALS AND METHODS. 569 people with relapsed PTB (RPTB) were selected from the TB register (e-TB manager programme): 300 with a first case treatment outcome of “completed treatment” and 269 “cured”. The groups were compared according to the course and outcome of treatment of RPTB, clinical characteristics of the first case, medical and social risk factors, and all patients with RPTB were compared with the group of newly diagnosed PTB (NDPTB). Mathematical and conventional statistical methods were used to analyse. RESULTS AND DISCUSSIONS. It was found that patients with RPTB are a difficult group because more than 1⁄2 of them have lung destruction, 3⁄4 isolate mycobacterium tuberculosis (MBT), and more than 1⁄2 have resistance to antimycobacterial drugs (AMBD). In 73.6 % of them, medical and social risk factors were noted that may have caused or contributed to TB relapse and negatively affected the results of treatment. These factors include: severe comorbidities in 53.7 %, alcohol and drug abuse in 34.9 %, HIV infection in 30.5 %, and others (homelessness, release from prison, contact with a TB patient, unemployment, smoking, etc.); 62.1 % of patients had ≥2 risk factors at the same time. We consider the effectiveness of treatment of this category of patients to be insufficient, as the outcome of the main course of treatment was unsatisfactory in more than half of them (48.5 % of unsuccessfully treated, 4.7 % interrupted treatment, 8.3 % died), and taking into account repeated courses, the rate of effective treatment in some of them was only 65.6 %. There was no significant difference (neither in clinical characteristics nor in medical and social risk factors) between the groups of patients “cured” or “completed treatment” as a result of treatment of the first case of TB, but it was found that only 23.2 % of patients with RPTB were found to be resistant to AMBD at the first case of the disease, and 50.0 % of them had it, with multidrug resistance (MDR) in half of them. It has been statistically proven that patients with RPTB are more likely to have the following symptoms than patients with NDPTB: lung destruction (43.2±3.2 vs. 20.4±4.0 %, p<0.05), sputum isolation of MBT (38.1±3.3 vs. 24.9±3.9 %, p<0.05), multi- and poly-resistance of MBT to AMBD (30.2±8.1 vs. 9.5±4.3 %, p<0.05), various medical and social risks (73.6±2.2 vs. 44.5±3.4 %, p<0.05), including alcohol abuse (21.3±3.7 vs. 8.7±4.3 %, p<0.05 %), unemployment (51.1±2.9 vs. 21.9±4.0 %, p<0.05), concomitant diseases (39.5±3.3 vs. 8.5±4.3 %, p<0.05), HIV infection (22.5±4.0 vs. 4.9±4.4 %, p<0.05) and others – lack of a fixed place of residence, release from prison, contact with a TB patient, lack of permanent employment, smoking, etc. (64.3±2.5 vs. 8.3±4.3 %, p<0.05), as well as ≥2 risk factors at the same time (45.7±3.1 vs. 20.0±4.0 %, p<0.05), which confirms the role of the above factors as probable risks of relapse in TB patients. CONCLUSIONS. Since the role of unfavourable NDPTB course, medical and social risk factors such as unemployment, severe comorbidities, alcohol abuse, HIV infection and some others (belonging to persons of no fixed abode, release from prison, contact with a TB patient) as possible causes of the development (or contributing to) RPTB, which subsequently negatively affect treatment outcomes, patients with these factors should be considered a particularly dangerous population for the development of PTB and, accordingly, should be screened and monitored for life in risk groups accordingly. Given that the detection of MDR-TB in the first case of PTB is the most dangerous risk factor for RPTB, it is necessary to introduce the determination of MDR-TB resistance in all patients with NDPTB and, despite the results of their treatment, to follow up such persons in risk groups. Late detection of RPTB (in 3⁄4) indicates organisational shortcomings of primary care in TB control, primarily in the formation of risk groups and work with them, and requires the implementation of preventive measures taking into account the new realities and challenges of wartime.
肺结核患者复发的风险
目标。评估肺结核(PTB)患者复发的风险。 材料和方法。从结核病登记册(e-TB管理人员规划)中选择了569名复发性肺结核(RPTB)患者:300例首次治疗结果为“完全治疗”,269例“治愈”。比较两组患者的肺结核病程、转归、首发病例的临床特征、医学及社会危险因素,并将所有肺结核患者与新诊断肺结核(NDPTB)组进行比较。采用数学和常规统计方法进行分析。 结果和讨论。结果发现,1 / 2以上的RPTB患者存在肺破坏,3 / 4的患者存在分离结核分枝杆菌(MBT), 1 / 2以上的患者存在抗结核药物耐药(AMBD),因此RPTB患者是一个困难的群体。其中73.6%的人指出,医疗和社会风险因素可能导致或促成结核病复发,并对治疗结果产生负面影响。这些因素包括:严重合并症占53.7%,酒精和药物滥用占34.9%,艾滋病毒感染占30.5%,以及其他因素(无家可归、出狱、接触结核病患者、失业、吸烟等);62.1%的患者同时存在≥2个危险因素。 我们认为这类患者的治疗效果不足,因为其中一半以上的患者主疗程的疗效不理想(48.5%的患者治疗失败,4.7%的患者中断治疗,8.3%的患者死亡),考虑到重复疗程,其中一些患者的有效治疗率仅为65.6%。由于第一例结核病的治疗而“治愈”或“完成治疗”的患者组之间没有显着差异(无论是临床特征还是医学和社会危险因素),但发现只有23.2%的RPTB患者在第一例疾病时发现对AMBD耐药,其中50.0%的患者患有该病,其中一半具有多药耐药(MDR)。经统计证实,RPTB患者比NDPTB患者更容易出现以下症状:肺损害(43.2±3.2 vs. 20.4±4.0%,p<0.05),痰液分离MBT(38.1±3.3 vs. 24.9±3.9%,p<0.05), MBT对AMBD的多重和多重耐药性(30.2±8.1 vs. 9.5±4.3%,p<0.05),各种医疗和社会风险(73.6±2.2 vs. 44.5±3.4%,p<0.05),包括酗酒(21.3±3.7 vs. 8.7±4.3%,p<0.05),失业(51.1±2.9 vs. 21.9±4.0%,p<0.05),伴随疾病(39.5±3.3 vs. 8.5±4.3%,p<0.05), HIV感染(22.5±4.0 vs. 4.9±4.4%,p<0.05),(p #x0D; 0.05)和其他-无固定住所、出狱、接触结核病患者、无固定工作、吸烟等(64.3±2.5比8.3±4.3 %,p #x0D; 0.05),以及同时存在≥2个危险因素(45.7±3.1比20.0±4.0%,p #x0D; 0.05),证实了上述因素在结核病患者复发的可能危险因素中的作用。结论。由于不利的耐结核结核病程、医疗和社会风险因素,如失业、严重合并症、酗酒、艾滋病毒感染和其他一些因素(属于无固定住所的人、从监狱释放、与结核病患者接触)可能导致(或促成)耐结核结核,并随后对治疗结果产生负面影响,因此应将具有这些因素的患者视为发生耐结核结核的特别危险人群。因此,应对高危人群进行筛查和监测。 鉴于在首例肺结核病例中检测到耐多药结核病是肺结核最危险的危险因素,有必要对所有肺结核患者进行耐多药结核病的检测,并对危险人群中的这些人进行随访,尽管他们的治疗结果很好。晚期发现RPTB(3 / 4)表明初级保健在结核病控制方面存在组织缺陷,主要是在形成风险群体并与他们合作方面,并要求在考虑战时新现实和挑战的情况下实施预防措施。
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