Risk factors for treatment failure in multidrug resistant tuberculosis in Tunisia: An analytic study.

INTRODUCTION-AIM: The emergence of multidrug resistant tuberculosis (MDR-TB) is a threat to global public health. The aim of our study was to determine risk factors for treatment failure in MDR-TB. METHODS: Retrospective study conducted between January 2000 and March 2019 including patients with MDR-TB. Characteristics of patients with therapeutic failure were compared to cured ones. Logistic regression analysis was used to identify risk factors for treatment failure. RESULTS: Our study included 140 patients aged of 42±13 years (18-80). Fifty-seven percent of patients had treatment success and 12% had treatment failure. In multivariate logistic regression analysis, treatment failure was associated with age over 45 years (OR=1.05; 95%CI, 1.024-7.736;p=0.014), primary education level and illiteracy (OR=5.022; 95%CI, 1.316-19.161;p=0,018), history of incarceration (OR=3.291; 95%CI, 1.291-21.083;p=0.016), undernutrition (OR=4.544; 95%CI, 2.304-54.231;p=0,027), extensive TB (OR=6.406; 95%CI, 1.761-23.922; p=0.038), initial high grade positive smears (OR=1.210; 95%CI, 1.187-32.657; p=0.045), positive smear culture at 90 days of treatment (OR=6.871, 95%CI, 3.824-23.541; p=0.003), poor adherence (OR=6.110; 95%CI, 2.740-12.450; p=0.021) and occurrence of psychiatric adverse events (OR=3.644 95%CI, 2.560- 27.268; p=0.041). CONCLUSION: Therapeutic education, nutritional and psychological support and close follow-up are strongly recommended to optimize the prognosis of MDR-TB.

Does incarceration change the profile of pulmonary tuberculosis in Tunisia?

INTRODUCTION: Tuberculosis of the prisoner remains unknown in Tunisia. The aim of our study was to establish the clinical, radiological, bacteriological and prognostic features of pulmonary tuberculosis in patients with a history of incarceration. METHODS: Case-control study conducted between 2010 and 2016 in two pulmonology departments of Abderrahmane Mami Hospital. The cases were male patients, hospitalized for pulmonary tuberculosis with a history of incarceration. Three controls for one case were randomly selected from the list of male patients hospitalized for pulmonary tuberculosis in the same departments as the cases but with no history of incarceration. RESULTS: The study included 58 cases and 174 controls. The average age of cases was lower than in controls (36,5 years vs 43,4 years; p <0.001). The cases had a significantly worse socioeconomic conditions and educational level with no more frequent social coverage of the disease. Risk factors for TB (smoking, alcoholism, substance abuse, unprotected sex, tuberculosis contagion, viral hepatitis C) were significantly higher among cases. Weight loss and night sweats were significantly more common in both cases, as was undernutrition. Positive bacilloscopies prevailed in the cases (36,5 vs 43,4;p = 0.047). In controls, the institution delay was longer (4.38 days vs 10.24 days; p= 0.004) and the total duration of treatment was lower (7.16 mounths vs 6.55 mounths; p = 0.048). CONCLUSION: Pulmonary TB in prisoner predominates in young people with poor socio-economic status and poor educational attainment. It is associated with several risk factors for TB and malnutrition. Health education in prisons is needed to combat this condition.