Recurrence of tuberculosis in a low-incidence setting

Dobler, Claudia C.; Crawford, Archibald Barclay Hamish; Jelfs, Peter; Gilbert, Gwendolyn L.; Marks, Guy B.

doi:10.1183/09031936.00104108

Cited by 42 publications

(43 citation statements)

References 27 publications

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“…In New South Wales, Australia, an analysis of 3,731 culture-positive TB cases in the 1994-2006 period revealed that 15 (0.4%) patients had recurrent TB. Based on IS6110-RFLP typing, 11 (73%) cases were attributable to reactivation, and 4 (27%) were attributable to reinfection (482). Very similar data had previously been reported from The Netherlands, where 16% of all recurrent TB cases proved to result from reinfection on the basis of IS6110-RFLP typing (483).…”

Section: Applications Of Strain Typing To M Tuberculosis Complex Isosupporting

confidence: 68%

Methodological and Clinical Aspects of the Molecular Epidemiology of Mycobacterium tuberculosis and Other Mycobacteria

et al. 2016

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SUMMARYMolecular typing has revolutionized epidemiological studies of infectious diseases, including those of a mycobacterial etiology. With the advent of fingerprinting techniques, many traditional concepts regarding transmission, infectivity, or pathogenicity of mycobacterial bacilli have been revisited, and their conventional interpretations have been challenged. Since the mid-1990s, when the first typing methods were introduced, a plethora of other modalities have been proposed. So-called molecular epidemiology has become an essential subdiscipline of modern mycobacteriology. It serves as a resource for understanding the key issues in the epidemiology of tuberculosis and other mycobacterial diseases. Among these issues are disclosing sources of infection, quantifying recent transmission, identifying transmission links, discerning reinfection from relapse, tracking the geographic distribution and clonal expansion of specific strains, and exploring the genetic mechanisms underlying specific phenotypic traits, including virulence, organ tropism, transmissibility, or drug resistance. Since genotyping continues to unravel the biology of mycobacteria, it offers enormous promise in the fight against and prevention of the diseases caused by these pathogens. In this review, molecular typing methods forMycobacterium tuberculosisand nontuberculous mycobacteria elaborated over the last 2 decades are summarized. The relevance of these methods to the epidemiological investigation, diagnosis, evolution, and control of mycobacterial diseases is discussed.

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Section: Applications Of Strain Typing To M Tuberculosis Complex Isosupporting

confidence: 68%

Methodological and Clinical Aspects of the Molecular Epidemiology of Mycobacterium tuberculosis and Other Mycobacteria

et al. 2016

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“…Regardless, without the M. tuberculosis genotyping results of both the initial and subsequent TB episode, the proportion of recurrent TB attributable to reinfection is rarely certain (11,12). In our earlier study of recurrent TB in the United States (22), we had genotyping results from both TB episodes for only 24 patients, similar to other previous studies of recurrent TB (9,(13)(14)(15)(17)(18)(19)(20)(21).…”

supporting

confidence: 59%

“…Among U.S.-born persons (n = 78; 57%), 30 (38%) were black non-Hispanic and 12 (15%) were Hispanic ( Table 1). Foreignborn persons with recurrent TB (n = 58; 43%) had immigrated a median of 12 years earlier at the time their second TB episode in the United States was diagnosed (interquartile range [IQR], [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Mexico was the most frequently reported country of origin of these immigrants (n = 19; 14%).…”

Section: Resultsmentioning

confidence: 99%

“…Although reactivation appears to be the primary cause of TB recurrence in the United States (9,11,13), Western Europe (14)(15)(16)(17), and Australia (18), molecular data from South Africa (19)(20)(21) suggest that reinfection may be responsible for a larger proportion of TB recurrences in highincidence settings. Regardless, without the M. tuberculosis genotyping results of both the initial and subsequent TB episode, the proportion of recurrent TB attributable to reinfection is rarely certain (11,12).…”

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confidence: 99%

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Exogenous Reinfection as an Etiology of Late Recurrent Tuberculosis in the United States

et al. 2015

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Rationale: The etiology of recurrent tuberculosis is typically presumed to be reactivation of residual Mycobacterium tuberculosis infection, but reinfection may account for a greater proportion of recurrent tuberculosis than previously recognized.Objective: To use M. tuberculosis genotyping to characterize the etiology of recurrent tuberculosis occurring 12 months or more after treatment completion. Methods:The study population for this national population-based cohort was drawn from the estimated 3,039 persons reported to the National Tuberculosis Surveillance System with two episodes of tuberculosis in the United States during 1993-2011, 194 of whom had genotyping results from both the initial and subsequent episode. We analyzed the proportion of recurrent tuberculosis attributable to and risk factors associated with reinfection.Measurements and Main Results: Among 136 recurrences meeting inclusion criteria, genotypes between episodes were the same for 116 (85%) recurrences during 1996-2011; the 20 (15%) with differing genotypes were categorized as reinfections. Using exact logistic regression, factors associated with reinfection included Mexican birth with both TB episodes diagnosed in the United States within 12 years of immigration (adjusted odds ratio, 10.7; 95% confidence interval, 1.7-86.3) and exclusive use of directly observed therapy for treatment of the first episode (adjusted odds ratio, 4.5; 95% confidence interval, 1.0-29.2). Conclusions:Reinfection was the cause of 15% of late recurrent tuberculosis cases in this U.S. cohort. The proportion caused by reinfection increased to 60% in certain subpopulations, such as recent immigrants from Mexico, suggesting that, despite successful treatment for tuberculosis during their first episode, these individuals remain in a social environment where they are reexposed to M. tuberculosis. Public health interventions to prevent novel reinfection might require a broader focus in these communities.

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“…In any model simplifying assumptions have to be made in order to develop a feasible model. The simplification that patients only develop active TB once (no recurrent episodes of TB) seems reasonable based on a study we conducted in a low incidence setting for TB that showed that the risk of TB recurrence (re-infection with a new TB strain or reactivation with the previous TB strain) was only 0.4% over 13 years [31]. However, this assumption limits the applicability of the decision aid to settings with a low incidence of TB, as the risk of recurrent TB via re-infection is substantial in settings with a high incidence of TB, and a previous course of treatment for LTBI does not protect a person from being re-infected.…”

Section: Discussionmentioning

confidence: 99%

Benefit of treatment of latent tuberculosis infection in individual patients

2015

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We aimed to develop a decision aid that estimates whether treatment of latent tuberculosis infection (LTBI) is likely to have a net gain in quality-adjusted life-years for an individual.A Markov model was developed which incorporated personalised estimates for risk of tuberculosis (TB) reactivation, TB death, quality-of-life impairments and treatment side-effects. The net effect of LTBI treatment was quantified in terms of quality-adjusted life-years gained or lost. Analyses were conducted for a representative set of hypothetical patients.LTBI treatment was estimated to be beneficial when the annual risk of TB reactivation exceeded 13/100 000 to 93/100 000 for females aged 10-75 years and 15/100 000 to 119/100 000 for males aged 10-75 years; the numbers needed to treat to avoid one case of TB were 93, 77, 85 and 72, respectively, at these threshold levels.LTBI treatment was estimated to confer a positive net benefit across a broad range of patients with characteristics typically seen in a low incidence setting for TB. Use of the decision aid has the potential to facilitate and increase confidence with LTBI treatment decisions by providing clinicians and patients with personalised estimates of likely net benefit. @ERSpublications Personalised analysis showed that most people with latent tuberculosis infection benefit from preventive treatment

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Recurrence of tuberculosis in a low-incidence setting

Cited by 42 publications

References 27 publications

Methodological and Clinical Aspects of the Molecular Epidemiology of Mycobacterium tuberculosis and Other Mycobacteria

Methodological and Clinical Aspects of the Molecular Epidemiology of Mycobacterium tuberculosis and Other Mycobacteria

Exogenous Reinfection as an Etiology of Late Recurrent Tuberculosis in the United States

Benefit of treatment of latent tuberculosis infection in individual patients

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