Prevalence, chronological trends and predictors of treatment outcomes among patients with tuberculosis in Southern Tunisia across two decades (1995-2016).

INTRODUCTION: Tuberculosis (TB) is a communicable disease common worldwide. Influencing factors in TB outcomes include socio-demographics, as well as disease-related and treatment-related factors. This study aimed to analyze the prevalence trends of unsuccessful treatment outcomes in Southern Tunisia during 1995-2016 and to identify their risk factors. METHODS: This was a retrospective study including all notified cases from the tuberculosis center reporting registers in Southern Tunisia between 1995 and 2016. RESULTS: Overall, 2771 TB cases were notified. Unsuccessful treatment outcomes were noted in 196 cases (7%). Unsuccessful treatment outcome was associated with male gender (OR=1.4; p=0.023), elderly status (≥60 years, OR=2.3; p<0.001), joints and bones site (OR=2.2; p=0.002) as well as meningeal involvement (OR=2.4; p=0.023). Lymph node (OR=0.4; p<0.001) and therapy duration ≥6 months (OR=0.003; p<0.001) were statistically associated with lower rate of unsuccessful outcome. Multivariate regression analysis showed that elderly status (AOR=2.3; p<0.001), meningeal involvement (AOR=2.2; p<0.027) as well as bone and joints involvements (AOR=2; p=0.027) were independently associated with unsuccessful outcome. Trends analysis showed that the case-fatality rate significantly increased from 1995 to 2016 (Rho=0.4; p=0.032). CONCLUSIONS: The high prevalence of unsuccessful outcome suggested important inadequacies in the TB program. An effective strategy to improve therapeutic education of patients with TB is therefore urgently needed.

Prognosis of urinary tract infections: predictive factors and role of Ramadan fasting.

BACKGROUND: The role of Ramadan fasting (RF) as a predictive factor of urinary tract infection (UTI) recurrence was controversially discussed in the literature. AIM: The present study aimed to identify the prognosis factors of recurrent UTIs. METHODS: Data were retrospectively collected from patients with UTI diagnosed at the infectious diseases department and its affiliated outpatient department in Hedi Chaker University Hospital, Sfax, Tunisia, between 2010 and 2017. Kaplan-Meier method was used to generate recurrence-free survival (RFS) curves for first episode of UTI diagnosed in two groups: during and outside Ramadan, which were compared using Log-rank test for statistical inference. Univariate and multivariate Cox proportional hazards regression models were used to identify UTI recurrence factors (sex, age, age group, season, comorbidities, first UTI episode diagnosed during Ramadan, UTI requiring hospitalization, length of hospital stay, nosocomial UTI, clinical presentation). RESULTS: During the follow up, among the 867 patients with UTI, 105 (12.1%) developed a recurrent UTI one. The RFS median [95% confidence interval] was 60 [40 to 82] days. Survival curves showed that patients with UTI diagnosed during Ramadan had shorter RFS compared with those diagnosed outside of Ramadan (32 vs. 60 days, respectively, p=0.002). RF (hazard ratio = 2.96; p = 0.033) and diabetes mellitus (hazard ratio =1.6; p = 0.033) were independently associated with UTI recurrence in multivariate Cox regression analysis. CONCLUSION: Recurrent UTI was a prevalent and challenging condition among patients with UTI. Diabetes mellitus and RF had a prognosis value for recurrence in UTI.

Epidemiology and disease burden of tuberculosis in south of Tunisia over a 22-year period: Current trends and future projections.

BACKGROUND: Tuberculosis (TB) is a public health problem worldwide. Characterizing its trends over time is a useful tool for decision-makers to assess the efficiency of TB control programs. We aimed to give an update on the current chronological trends of TB in Southern Tunisia from 1995 to 2016 and to estimate future trajectories of TB epidemic by 2030. METHODS: We retrospectively collected data of all notified TB new cases by the Center of Tuberculosis Control between 1995 and 2016 in South of Tunisia. Joinpoint Regression Analysis was performed to analyze chronological trends and annual percentage changes (APC) were estimated. RESULTS: In the past 22 years, a total of 2771 cases of TB were notified in Southern Tunisia. The annual incidence rate of TB was 13.91/100,000 population/year. There was a rise in all forms of TB incidence (APC = 1.63) and in extrapulmonary tuberculosis (EPTB) (APC = 2.04). The incidence of TB increased in children and adult females between 1995 and 2016 (APC = 4.48 and 2.37, respectively). The annual number of TB declined in urban districts between 2004 and 2016 (APC = -2.85). Lymph node TB cases increased (APC = 4.58), while annual number of urogenital TB decreased between 1995 and 2016 (APC = -3.38). Projected incidence rates would increase to 18.13 and 11.8/100,000 population in 2030 for global TB and EPTB, respectively. CONCLUSIONS: Our study highlighted a rise in all forms of TB and among high-risk groups, notably children, females and lymph node TB patients in the last two decades and up to the next one.