Tuberculosis-Related Deaths within a Well-Functioning DOTS Control Program

Abstract

To describe the molecular epidemiology of tuberculosis (TB)-related deaths in a well-managed program in a low-HIV area, we analyzed data from a cohort of 454 pulmonary TB patients recruited between March 1995 and October 2000 in southern Mexico. Patients who were sputum acid-fast bacillus smear positive underwent clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) and received treatment from the local directly observed treatment strategy (DOTS) program. After an average of 2.3 years of follow-up, death was higher for clustered cases (28.6 vs. 7%, p=0.01). Cox analysis revealed that TB-related mortality hazard ratios included treatment default (8.9), multidrug resistance (5.7), recently transmitted TB (4.1), weight loss (3.9), and having less than 6 years of formal education (2). In this community, TB is associated with high mortality rates.

Factors associated with death among HIV‐uninfected TB patients in Thailand, 2004–2006

“…A number of studies from the pre-HIV era or from low HIV incidence regions have found that co-morbid medical conditions, which are likely to be common among the elderly in Thailand, are potent risk factors for death during TB treatment. The list of such conditions is long, including: congestive heart failure (Dewan et al 2004), chronic obstructive lung disease or silicosis (Xie et al 2001;Oursler et al 2002;Dewan et al 2004), cirrhosis (Garcia-Garcia Mde et al 2002;Walpola et al 2003), diabetes (Fielder et al 2002;Oursler et al 2002), renal failure (Rao et al 1998;Xie et al 2001;Walpola et al 2003), low body weight and under-nutrition (Cauchie et al 1988;Rao et al 1998;Garcia-Garcia Mde et al 2002;Santha et al 2002;Walpola et al 2003) and cancer (Xie et al 2001;Dewan et al 2004). Another possible explanation for the association between age and TB death could be delayed TB diagnosis, which many studies have found is a risk factor for death in HIV-uninfected patients (Enarson et al 1978;Allan et al 1981;Bandele & Olude 1985;Cauchie et al 1988;Naalsund et al 1994;Hooi & Goh 1995;PablosMendez et al 1996;Olle-Goig 2000).…”

Tuberculosis and Diabetes in Southern Mexico

“…Adult patients (Ͼ19 years of age) with positive results of acid-fast bacilli sputum smear or positive culture underwent epidemiologic, clinical (standardized questionnaire, physical examination, chest x-ray study, human immunodeficiency virus [HIV] test), and mycobacteriologic evaluation. Treatment was provided in accordance with official norms (9). Informed consent was obtained from participants.…”

“…Isolates were genotyped and compared using IS6110-based restriction fragment-length polymorphisms (RFLPs) and spoligotyping if the isolate's IS6110 RFLP patterns had fewer than six bands, as previously described (9).…”

Community-Based Rapid Oral Human Immunodeficiency Virus Testing for Tuberculosis Patients in Lima, Peru

“…2,3 Tuberculosis is currently the leading cause of death among HIV-positive patients worldwide, 1 with excess morbidity and mortality among co-infected individuals compared with HIV-negative TB cases and HIV-positive persons without active TB. [4][5][6][7][8][9] Among co-infected persons, early HIV diagnosis is critical not only to ensure timely initiation of highly active antiretroviral therapy (HAART), but also to guide decisions about TB treatment regimens [10][11][12][13][14] and to prevent further spread of infection. If one considers that the largest proportion of TB-related mortality occurs within the first two months of treatment, delays in HAART initiation can lead to worsening of illness and death.…”