Kalema Nelson, Lindan Christina, Glidden Dave, Yoo Samuel D, Katamba Achilles, Alfred Andama, Katagira Winceslaus, Byanyima Patrick, Musisi Emmanuel, Kaswabuli Sylvia, Ingvar Sanyu, Zawedde Josephine, Yoon Christina, Ayakaka Irene, Davis J Lucian, Huang Laurence, Worodria William, Cattamanchi Adithya
Infectious Disease Research Collaboration, Kampala, Uganda.
Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda.
S Afr Respir J. 2017;23(4):106-112.
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 .
We determined the prevalence and outcome of late recurrent TB among hospitalized patients in Kampala, Uganda.
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.
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).
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.
在完成先前一次结核病发作的治疗后2年以上发生的复发性结核病，多数情况下是由于再次感染了一种新的结核菌株。
我们确定了乌干达坎帕拉住院患者中晚期复发性结核病的患病率和转归。
我们对穆拉戈医院收治的咳嗽持续时间超过2周且在入院前2年以上完成结核病治疗的患者进行了回顾性分析。所有患者均对两份痰标本进行了分枝杆菌培养，并在入组后2个月确定了生命状态。我们进行了模型分析以确定复发性结核病和生存的预测因素。
在234例患者中，84例（36%）发生了复发性结核病。独立预测因素包括年龄较小（调整后比值比[aOR]=0.64，95%置信区间[CI]=0.42-0.97，p=0.04）、胸痛超过2周（aOR=3.32，95%CI=1.38-8.02，p=0.007）、体重严重减轻≥5千克（aOR=4.88，95%CI=1.66-14.29，p=0.004）以及存在≥1项世界卫生组织严重疾病危险体征（aOR=3.55，95%CI=1.36-9.29，p=0.01）。2个月死亡率为17.8%（95%CI=10.5-29.2%），在未开始结核病治疗的患者中更高（调整后风险比[aHR]=16.67，95%CI=1.18-200，p=0.04），HIV阳性但未接受抗逆转录病毒治疗（ART）的患者中更高（aHR=16.99，95%CI=1.17-246.47，p=0.04）以及有吸烟史的患者中更高（aHR=1.20,95%CI=1.03-1.40,p=0.02）。
晚期复发性结核病的高患病率可能反映了坎帕拉结核病的高传播水平。对于有结核病既往史的患者，尤其是年龄较小、体重减轻≥5千克、胸痛超过2周或存在≥1项世界卫生组织严重疾病危险体征的患者，应考虑增加经验性结核病治疗的使用，并在HIV阳性时尽早开始ART治疗。
