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Tuberculosis recurrence and mortality after successful treatment : impact of drug resistance

Document type: article
Download file(s): 113748 (571 KB)
Abstract: A DOTS (directly observed treatment short-course) programme was implemented progressively in Karakalpakstan, Uzbekistan starting in 1998. The total case notification rate in 2003 was 462/ 100,000, and a drug resistance survey found multidrug-resistant (MDR) Mycobacterium tuberculosis strains among 13% of new and 40% of previously treated patients. A retrospective, observational study was conducted to assess the capacity of standardized short-course chemotherapy to effectively cure patients with TB in this setting. Using routine data sources, 213 patients who were sputum smear-positive for TB, included in the drug resistance survey and diagnosed consecutively in 2001–2002 from four districts, were followed up to a median of 22 months from diagnosis, to determine mortality and subsequent TB rediagnosis. Valid follow-up data were obtained for 197 (92%) of these patients. Mortality was high, with an average of 15% (95% confidence interval, 11% to 19%) dying per year after diagnosis (6% of 73 pansusceptible cases and 43% of 55 MDR TB cases also died per year). While 73 (74%) of the 99 new cases were ‘‘successfully’’ treated, 25 (34%) of these patients were subsequently rediagnosed with recurrent TB (13 were smear-positive on rediagnosis). Recurrence ranged from ten (23%) of 43 new, pansusceptible cases to six (60%) of ten previously treated MDR TB cases. MDR M. tuberculosis infection and previous TB treatment predicted unsuccessful DOTS treatment, while initial drug resistance contributed substantially to both mortality and disease recurrence after successful DOTS treatment. These results suggest that specific treatment of drug-resistant TB is needed in similar settings of high drug resistance. High disease recurrence after successful treatment, even for drugsusceptible cases, suggests that at least in this setting, end-of-treatment outcomes may not reflect the longer-term status of patients, with consequent negative impacts for patients and for TB control.
Authors: Cox, H. , Kebede, Y. , Allamuratova, S. , Ismailov, G. , Davletmuratova, Z. , Byrnes, G. , Stone, C. , Niemann, S. , Rüsch-Gerdes, S. , Blok, L. , Doshetov, D.
Country: Uzbekistan
Category: Research
End Page: 1843
Serial number: 10
Volume: 3
Journal: PLoS Medicine
Keywords: health services , disease prevention and control
Language: eng
Organization: KIT - Royal Tropical Institute
Year: 2006
Region: Asia , Central Asia
Right: © 2006 Cox et al. This article is licensed under a Creative Commons Attribution License.
Subject: Health and Nutrition
Start Page: 1836
Title: Tuberculosis recurrence and mortality after successful treatment : impact of drug resistance