When tuberculosis comes back: who develops recurrent tuberculosis in california?
When tuberculosis comes back: who develops recurrent tuberculosis in california?
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DOI：
10.1371/journal.pone.0026541
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Flood JM
中科院分区：
文献类型：
--
作者：
Pascopella L;Deriemer K;Watt JP;Flood JM
结核病的复发表明，结核病治疗和控制活动中存在着潜在的可改变的差距。治疗完成后晚期复发的频率尚未得到充分研究。我们确定了加州完成抗结核治疗后至少一年内结核病复发的频率和相关的危险因素。研究人群包括1993年至2007年向加州结核病病例登记处报告的完成抗结核治疗的培养阳性肺结核患者。晚期复发性结核病患者定义为在登记处出现一次以上的个体，通过姓名和出生日期的匹配确定，第一次发作的治疗完成和第二次发作的治疗开始之间至少有一年。在23，517例肺结核患者中，148例（0.63%）晚期复发。复发的独立风险因素包括：感染吡嗪酰胺单耐药分离株（校正风险比，2.93; p = 0.019）;开始异烟肼和利福平单药治疗方案（校正风险比，2.55; p = 0.0412）;痰涂片阳性疾病（校正风险比，1.96; p = 0.0003）;人类免疫缺陷病毒感染（校正风险比，1.81; p = 0.0149）;和在美国出生（校正风险比，1.88; p = 0.0002）。 异烟肼单耐药分离株感染具有保护作用（校正风险比，0.25; p = 0.0171）。 加州晚期复发性结核病的低发生率表明，当地结核病控制项目在预防这种不良后果方面基本上是成功的。尽管如此，我们确定了晚期结核病复发风险增加的亚群，这些亚群可能受益于额外的医疗或公共卫生干预。
Recurrent tuberculosis suggests potentially modifiable gaps in tuberculosis treatment and control activities. The frequency of late recurrences following treatment completion has not been well-studied. We determined the frequency of, and risk factors associated with, tuberculosis that recurs at least one year after completion of anti-tuberculosis therapy in California. The study population included culture-positive, pulmonary tuberculosis patients reported to the California tuberculosis case registry from 1993 to 2007 who completed anti-tuberculosis therapy. A person with late recurrent tuberculosis was defined as an individual that appeared in the registry more than once, determined by match on name and date-of-birth, with at least one year between treatment completion of the first episode and treatment initiation of the second episode. Among 23,517 tuberculosis patients, 148 (0.63%) had a late recurrence. Independent risk factors for recurrence included: infection with a pyrazinamide mono-resistant isolate (adjusted hazard ratio, 2.93; p = 0.019); initiation of an isoniazid- and rifampin-only treatment regimen (adjusted hazard ratio, 2.55; p = 0.0412); sputum smear-positive disease (adjusted hazard ratio, 1.96; p = 0.0003); human immunodeficiency virus infection (adjusted hazard ratio, 1.81; p = 0.0149); and birth in the United States (adjusted hazard ratio, 1.88; p = 0.0002). Infection with an isoniazid mono-resistant isolate was protective (adjusted hazard ratio, 0.25; p = 0.0171). The low frequency of late recurrent tuberculosis in California suggests that local TB control programs are largely successful at preventing this adverse outcome. Nonetheless, we identified subpopulations at increased risk of late tuberculosis recurrence that may benefit from additional medical or public health interventions.
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