South African respiratory journal最新文献

{"title":"Predictors and short-term outcomes of recurrent pulmonary tuberculosis, Uganda: a cohort study.","authors":"Nelson Kalema, Christina Lindan, Dave Glidden, Samuel D Yoo, Achilles Katamba, Andama Alfred, Winceslaus Katagira, Patrick Byanyima, Emmanuel Musisi, Sylvia Kaswabuli, Sanyu Ingvar, Josephine Zawedde, Christina Yoon, Irene Ayakaka, J Lucian Davis, Laurence Huang, William Worodria, Adithya Cattamanchi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrent tuberculosis (TB) occurring >2 years after completing treatment for a prior TB episode is most often due to reinfection with a new strain of <i>M. tuberculosis</i>.</p><p><strong>Objectives: </strong>We determined the prevalence and outcome of late recurrent TB among hospitalized patients in Kampala, Uganda.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients admitted to Mulago Hospital who had cough of >2 weeks' duration and completed TB treatment >2 years prior to admission. All patients had mycobacterial culture performed on two sputum specimens and vital status ascertained 2-months post-enrollment. We performed modeling to identify predictors of recurrent TB and of survival.</p><p><strong>Results: </strong>Among 234 patients, 84 (36%) had recurrent TB. Independent predictors included younger age (aOR=0.64, 95% CI=0.42-0.97, p=0.04), chest pain >2 weeks (aOR=3.32, 95% CI=1.38-8.02, p=0.007), severe weight loss ≥5 kilograms (aOR=4.88, 95% CI=1.66-14.29, p=0.004) and presence of ≥1 WHO danger sign of severe illness (aOR=3.55, 95% CI=1.36-9.29, p=0.01). Two-month mortality was 17.8% (95% CI=10.5-29.2%), and was higher among patients not initiated on TB treatment (aHR=16.67, 95% CI=1.18-200, p=0.04), not on ART if HIV-positive (aHR=16.99, 95% CI=1.17-246.47, p=0.04) and with a history of smoking (aHR=1.20, 95% CI=1.03-1.40, p=0.02).</p><p><strong>Conclusion: </strong>The high prevalence of late recurrent TB likely reflects high levels of TB transmission in Kampala. Increased use of empiric TB treatment and early ART treatment initiation if HIV-positive should be considered in patients with a prior history of TB, particularly if young, with weight loss ≥5kgs, chest pain >2 weeks or ≥1 WHO danger sign of severe illness.</p>","PeriodicalId":92294,"journal":{"name":"South African respiratory journal","volume":"23 4","pages":"106-112"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777612/pdf/nihms919910.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35765758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}