Rate of reinfection tuberculosis after successful treatment is higher than rate of new tuberculosis

被引:319
作者
Verver, S
Warren, RM
Beyers, N
Richardson, M
van der Spuy, GD
Borgdorff, MW
Enarson, DA
Behr, MA
van Helden, PD
机构
[1] KNCV TB Fdn, NL-2501 CC The Hague, Netherlands
[2] Univ Stellenbosch, Dept Pediat & Child Hlth, Desmond Tutu TB Ctr, Cape Town, South Africa
[3] Univ Stellenbosch, MRC, Ctr Cellular & Mol Biol, Dept Med Biochem, Cape Town, South Africa
[4] Univ Amsterdam, Acad Med Ctr, Dept Infect Dis Trop Med & AIDS, NL-1105 AZ Amsterdam, Netherlands
[5] IUATLD, Paris, France
[6] McGill Univ, Ctr Hlth, Dept Med, Div Infect Dis, Montreal, PQ, Canada
关键词
incidence; molecular epidemiology; Mycobacterium tuberculosis; recurrence; survival analysis;
D O I
10.1164/rccm.200409-1200OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: In a high-tuberculosis (TB) incidence area of Cape Town, South Africa, there is a very high rate of unexplained recurrent TB. The incidence of new bacteriologically confirmed disease in the area is 313 per 100,000 individuals. Objective:To estimate the rate of recurrent TB attributable to reinfection after successful treatment. Methods: All patients with reported TB in the area between 1993 and 1998 were followed up to 2001 for disease needing retreatment (recurrences). Patients who were multi-drug-resistant or who had treatment failure, were transferred, or died during treatment were excluded. Analysis was restricted to patients for whom DNA fingerprinting of their Mycobacterium tuberculosis isolates was obtained. Reinfection TB was defined as a recurrent TB episode in which the strains of the separate episodes differed by more than four bands. Measurements and Main Results: 612 of 897 (68%) patients had a DNA fingerprint available at enrollment. Median duration of follow-up was 5.2 years. Recurrent TB occurred in 108 of 612 (18%) patients, of whom 61 of 447 (14%) experienced recurrence after successful treatment, and 47 of 165 (28%) experience recurrence after default. Of the 108 patients with recurrent TB, 68 (63%) had a DNA fingerprint in the second episode. Among these patients, 24 of 31 (77%) recurrences after successful treatment and 4 of 37 (11%) recurrences after default were attributable to reinfection. The reinfection disease rate after successful treatment was estimated at 2.2 per 100 person-years. Conclusions: The age-adjusted incidence rate of TB attributable to reinfection after successful treatment was four times that of new TB. People who had TB; once are at a strongly increased risk of developing TB when reinfected.
引用
收藏
页码:1430 / 1435
页数:6
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