Revisiting the Natural History of Pulmonary Tuberculosis: A Bayesian Estimation of Natural Recovery and Mortality Rates.
Clin Infect Dis
; 73(1): e88-e96, 2021 07 01.
Article
en En
| MEDLINE
| ID: mdl-32766718
ABSTRACT
BACKGROUND:
Tuberculosis (TB) natural history remains poorly characterized, and new investigations are impossible as it would be unethical to follow up TB patients without treatment.METHODS:
We considered the reports identified in a previous systematic review of studies from the prechemotherapy era, and extracted detailed data on mortality over time. We used a Bayesian framework to estimate the rates of TB-induced mortality and self-cure. A hierarchical model was employed to allow estimates to vary by cohort. Inference was performed separately for smear-positive TB (SP-TB) and smear-negative TB (SN-TB).RESULTS:
We included 41 cohorts of SP-TB patients and 19 cohorts of pulmonary SN-TB patients in the analysis. The median estimates of the TB-specific mortality rates were 0.389 year-1 (95% credible interval [CrI], .335-.449) and 0.025 year-1 (95% CrI, .017-.035) for SP-TB and SN-TB patients, respectively. The estimates for self-recovery rates were 0.231 year-1 (95% CrI, .177-.288) and 0.130 year-1 (95% CrI, .073-.209) for SP-TB and SN-TB patients, respectively. These rates correspond to average durations of untreated TB of 1.57 years (95% CrI, 1.37-1.81) and 5.35 years (95% CrI, 3.42-8.23) for SP-TB and SN-TB, respectively, when assuming a non-TB-related mortality rate of 0.014 year-1 (ie, a 70-year life expectancy).CONCLUSIONS:
TB-specific mortality rates are around 15 times higher for SP-TB than for SN-TB patients. This difference was underestimated dramatically in previous TB modeling studies, raising concerns about the accuracy of the associated predictions. Despite being less infectious, SN-TB may be responsible for equivalent numbers of secondary infections as SP-TB due to its much longer duration.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Tuberculosis
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Tuberculosis Pulmonar
Tipo de estudio:
Etiology_studies
/
Incidence_studies
/
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
Clin Infect Dis
Asunto de la revista:
DOENCAS TRANSMISSIVEIS
Año:
2021
Tipo del documento:
Article
País de afiliación:
Australia