Mithunage C T, Denning D W
Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
IJTLD Open. 2024 Oct 1;1(10):456-465. doi: 10.5588/ijtldopen.24.0222. eCollection 2024 Oct.
Pulmonary TB (PTB) may recur due to reinfection or relapse after initial successful treatment. Based on microbiologically documented cases, we searched Embase, PubMed, Web of Science, and Medline for PTB recurrence. The timeframe of overall recurrences, relapse, reinfection, and risk factors were assessed. We compared the time to recurrence, relapse, and reinfection from treatment completion and plotted this using Kaplan-Meier curves. This systematic review included 23 articles describing 2,153 PTB recurrences in 75,224 treated people across all continents. Genotyping data to distinguish relapse from reinfection was available for 402 recurrences. The cumulative recurrence percentage was 2.9% over 5 years, and the median time for recurrence was 18 months (95% CI 16.99-19.0). Most recurrences (93%) were in HIV-negative people. Relapse occurred earlier than reinfection at 12 months (95% CI 10.86-13.14) vs 24 months (95% CI 21.61-26.39) ( < 0.001, χ 59.89). In low TB burden settings, recurrences were mainly caused by relapse (85%), whereas in high-burden settings, relapses comprised 56% of recurrences. Recurrences occurred slightly earlier in HIV-positive patients ( = 0.038, χ 4.30). The emergence of resistance to one or more first-line anti-TB agents was documented in 40 of 421 cases (9.5%). Early recurrences are mainly relapses, while late recurrences are mainly reinfections.
肺结核（PTB）在初始治疗成功后可能因再感染或复发而再次出现。基于微生物学确诊的病例，我们在Embase、PubMed、Web of Science和Medline数据库中检索了PTB复发的相关文献。评估了总体复发、复发、再感染的时间范围以及危险因素。我们比较了治疗结束后复发、复发和再感染的时间，并使用Kaplan-Meier曲线进行绘制。这项系统评价纳入了23篇文章，描述了来自各大洲的75224名接受治疗的患者中的2153例PTB复发情况。402例复发病例可获得用于区分复发和再感染的基因分型数据。5年累计复发率为2.9%，复发的中位时间为18个月（95%CI 16.99-19.0）。大多数复发（93%）发生在HIV阴性人群中。复发比再感染出现得更早，分别为12个月（95%CI 10.86-13.14）和24个月（95%CI 21.61-26.39）（<0.001，χ59.89）。在低结核病负担地区，复发主要由复发引起（85%），而在高负担地区，复发占复发病例的56%。HIV阳性患者的复发时间略早（=0.038，χ4.30）。在421例病例中有40例（9.5%）记录到对一种或多种一线抗结核药物产生耐药。早期复发主要是复发，而晚期复发主要是再感染。
