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1.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1409-1413, 2019 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-31838813

RESUMO

Objective: To investigate the survival time of multidrug-resistant tuberculosis (MDR-TB) patients and the influential factors in Wuhan. Methods: The relevant information were collected from TB management information system, cause of death reporting system and medical records by trained doctors. The univariate and multivariate Cox proportional hazards model were applied to analyze the factors affecting survival time of patients. Results: A total of 552 patients with MDR-TB were included in the analysis. After the diagnosis of MDR-TB, the cumulative survival rates from the first year to the third year were 0.94, 0.88, and 0.80, respectively. The mortality density of MDR-TB patients was 6.52/100 person-years, and the median survival time was (89.52±1.85) months. Kaplan-Meier analysis showed that the cumulative survival rate of the standardized treatment group was significantly higher than that of the non-standardized treatment group (Log rank=101.070, P<0.001). Compared with the patients aged <30 years, the HR of the patients aged 30-years and ≥60 years were 2.987 (95%CI: 1.268-7.036), 4.957 (95%CI: 1.942-12.653). Compared with the patients with the education level of high school and above, the HR of the patients with education level of junior high school/primary school and below were 1.908 (95%CI: 1.152-3.160), 1.681(95%CI: 1.033-2.735). Compared with the patients without diabetes, the HR of the patients with diabetes was 1.961(95%CI: 1.347-2.854). Compared with the patients without other serious diseases, the HR of the patients with other serious diseases was 2.597 (95%CI: 1.820-3.706). Compared with the patients who had been treated less than one time, the HR of the patients having previous treatment with more than 2 times was 1.611 (95%CI: 1.077-2.409). Compared with patients receiving standard MDR regimen treatment, the HR of the patients receiving no standard MDR regimen treatment was 3.155 (95%CI: 2.132-4.670). Conclusions: The cumulative survival rate of MDR-TB patients without standard treatment was significantly lower than that of patients with standard treatment. Older age, low educational level, diabetes mellitus, other serious diseases, more than two times treatment in the past, and receiving no multi-drug resistance regimen treatment were the risk factors affecting the survival of MDR-TB patients.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade , Adulto , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Modelos de Riscos Proporcionais , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia
2.
Pan Afr Med J ; 33: 326, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692828

RESUMO

Introduction: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the prevalence of HIV infection among children treated for TB in Directly Observed Treatment Short-Course (DOTS) clinics in Lubumbashi and to identify risk of death during this co-infection. Methods: This is a cross-sectional study of children under-15, treated for tuberculosis from January 1, 2013 to December 31, 2015. Clinical, paraclinical and outcome data were collected in 22 DOTS of Lubumbashi. A statistical comparison was made between dead and survived HIV-infected TB children. We performed the multivariate analyzes and the significance level set at p-value <0.05. Results: A total of 840 children with TB were included. The prevalence of HIV infection was 20.95% (95% CI: 18.34-23.83%). The mortality rate was higher for HIV-infected children (47.73%) compared to HIV-uninfected children (17.02%) (p<0.00001). Age <5 years (aOR=6.50 [1.96-21.50]), a poor nutritional status (aOR=23.55 [8.20-67.64]), and a negative acid-fast bacilli testing (aOR=4.51 [1.08-18.70]) were associated with death during anti-TB treatment. Conclusion: TB and HIV co-infection is a reality in pediatric settings in Lubumbashi. High mortality highlights the importance of early management.


Assuntos
Antituberculosos/administração & dosagem , Infecções por HIV/epidemiologia , Estado Nutricional , Tuberculose/epidemiologia , Criança , Pré-Escolar , Coinfecção , Estudos Transversais , República Democrática do Congo/epidemiologia , Terapia Diretamente Observada , Feminino , Infecções por HIV/mortalidade , Humanos , Masculino , Prevalência , Fatores de Risco , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade
3.
BMC Infect Dis ; 19(1): 859, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623569

RESUMO

BACKGROUND: Tuberculosis (TB) remains one of the infectious diseases with a leading cause of death among adults worldwide. Metformin, a first-line medication for the treatment of type 2 diabetes, may have potential for treating TB. The aims of the present systematic review were to evaluate the impact of metformin prescription on the risk of tuberculosis diseases, the risk of latent TB infection (LTBI) and treatment outcomes of tuberculosis among patients with diabetic mellitus. METHODS: Databases were searched through March 2019. Observational studies reporting the effect of metformin prescription on the risk and treatment outcomes of TB were included in the systematic review. We qualitatively analyzed results of included studies, and then pooled estimate effects with 95% confidence intervals (CIs) of different outcome using random-effect meta-analyses. RESULTS: This systematic review included 6980 cases from 12 observational studies. The meta-analysis suggested that metformin prescription could decrease the risk of TB among diabetics (pooled odds ratio [OR], 0.38; 95%CI, 0.21 to 0.66). Metformin prescription was not related to a lower risk of LTBI (OR, 0.73; 95%CI, 0.30 to 1.79) in patients with diabetes. Metformin medication during the anti-tuberculosis treatment is significantly associated with a smaller TB mortality (OR, 0.47; 95%CI, 0.27 to 0.83), and a higher probability of sputum culture conversion at 2 months of TB disease (OR, 2.72; 95%CI, 1.11 to 6.69) among patients with diabetes. The relapse of TB was not statistically reduced by metformin prescription (OR, 0.55; 95%CI, 0.04 to 8.25) in diabetics. CONCLUSIONS: According to current observational evidence, metformin prescription significantly reduced the risk of TB in patients with diabetes mellitus. Treatment outcomes of TB disease could also be improved by the metformin medication among diabetics.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Tuberculose/patologia , Antituberculosos/uso terapêutico , Humanos , Razão de Chances , Fatores de Risco , Escarro/microbiologia , Resultado do Tratamento , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade
4.
BMC Infect Dis ; 19(1): 865, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638949

RESUMO

BACKGROUND: Tuberculosis is an important health concern in Iraq, but limited research has examined the quality of tuberculosis care and the survival of the patients. This study aimed to assess the 12-month survival of tuberculosis patients and evaluate the effect of the associated risk factors on patients' survival. METHODS: We reviewed the records of 728 patients with tuberculosis who were registered and treated at the Chest and Respiratory Disease Center in Erbil, Iraqi Kurdistan Region, from January 2012 to December 2017. Demographic data, the site of the disease, and treatment outcomes were retrieved from patients' records. Data analysis included the use of the Kaplan-Meier method and the log-rank test to calculate the estimates of the survival and assess the differences in the survival among the patients. The Cox regression model was used for univariate and multivariate analysis. RESULTS: The mean period of the follow-up of the patients was 7.6 months. Of 728 patients with tuberculosis, 50 (6.9%) had died. The 12-month survival rate of our study was 93.1%. A statistically significant difference was detected in the survival curves of different age groups (P < 0.001) and the site of the disease (P = 0.012). In multivariate analysis, lower survival rates were only observed among patients aged ≥65 years (hazard ratio = 9.36, 95% CI 2.14-40.95) and patients with extrapulmonary disease (hazard ratio = 2.61, 95% CI 1.30-5.27). CONCLUSION: The 12-month survival rate of tuberculosis patients managed at the Chest and Respiratory Disease Center in Erbil was similar to the international rates. The high rates of extrapulmonary tuberculosis and the low survival rate necessitate further studies and action with a possible revision to the tuberculosis management strategy.


Assuntos
Estimativa de Kaplan-Meier , Tuberculose/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Conscientização , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Iraque , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Tuberculose/prevenção & controle , Adulto Jovem
5.
Int J Mycobacteriol ; 8(3): 244-251, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31512600

RESUMO

Background: Tuberculosis (TB) with human immunodeficiency virus (HIV) coinfection is the highest clinical epidemiology and public health issue. Despite many programs established to tackle the epidemic, TB target controls have not been reached. One of the many factors attributed to the failure in TB treatment is HIV coinfection. The aim of this study is to assess the survival rate of HIV infection among TB patients and the risk factors of death among the TB patients with HIV coinfection during the retro of directly observed treatment, short-course (DOTS) program. Methods: This study is a retrospective cohort conducted to compare the survivorship between TB/HIV patients for 8 months DOTS. Death among TB patients was considered as failures and those defaulted or survived were censored. The Cox proportional-hazards regression and log-linear model were used to establish the hazard ratio (HR) of death for each variable at baseline and estimate the risk factors effect among TB patients. Results: The findings revealed that 50% of death from TB/HIV patients were from HIV coinfection (advanced HR = 2.01, 95% confidence interval = 1.13-3.17). The risk of death was significantly higher in HIV-positive TB patients (P = 0.000) during the extension care phase. TB/HIV-positive patients on antiretroviral therapy have decreased survival rate (log-rank test = 14.88, df = 2, P = 0.0001). The probability of TB patients surviving is significantly decreased in HIV positive with some factors such as age, weight, smoking, and alcohol found significant. Conclusion: The probability of survival in HIV-positive TB patients was significantly lower during the TB treatment. Weight loss, age, alcohol, smoking, and pregnancy were showed to affect the survival probability of TB/HIV patients' coinfection significantly.


Assuntos
Antituberculosos/uso terapêutico , Coinfecção/mortalidade , Infecções por HIV/microbiologia , Tuberculose/tratamento farmacológico , Contagem de Linfócito CD4 , Coinfecção/microbiologia , Coinfecção/virologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Humanos , Masculino , Gravidez , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , África do Sul , Taxa de Sobrevida , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/mortalidade
6.
Pan Afr Med J ; 33: 111, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489089

RESUMO

Introduction: High mortality among individuals receiving retreatment for tuberculosis (RT-TB) persists, although reasons for these poor outcomes remain unclear. Methods: We retrospectively reviewed 394 RT-TB patients diagnosed between January 2010 and June 2016 in Accra, Ghana. Results: Of RT-TB patients, 161 (40.9%) were treated empirically (negative/absent smear, culture or Xpert), of whom 30.4% (49/161) had only extrapulmonary TB signs or symptoms. Mortality during treatment was 19.4%; 15-day mortality was 10.8%. In multivariable proportional hazards regression, living with HIV (aHR=2.69 [95 CI: 1.51, 4.80], p<0.01) and previous loss-to-follow up (aHR=8.27 (95 CI: 1.10, 62.25), p=0.04) were associated with mortality, while drug susceptibility testing (DST, aHR=0.36 (95 CI: 0.13, 1.01), p=0.052) was protective. Isoniazid resistance was observed in 40% (23/58 tested) and rifampin resistance in 19.1% (12/63 tested). Conclusion: High rates of extrapulmonary TB and smear/culture negative disease highlight the barriers to achieving DST-driven RT-TB regimens and the need for improved diagnostics. Our finding of poly-drug resistance in rifampin-susceptible cases supports access to comprehensive first line DST. Additionally, interventions to reduce mortality, especially in HIV co-infected RT-TB patients, are urgently needed.


Assuntos
Antituberculosos/administração & dosagem , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose/tratamento farmacológico , Adulto , Antituberculosos/farmacologia , Estudos de Coortes , Farmacorresistência Bacteriana Múltipla , Feminino , Gana , Infecções por HIV/epidemiologia , Humanos , Isoniazida/farmacologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Retratamento , Estudos Retrospectivos , Rifampina/farmacologia , Tuberculose/microbiologia , Tuberculose/mortalidade , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade
7.
BMC Infect Dis ; 19(1): 767, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477055

RESUMO

BACKGROUND: Tuberculosis (TB) is among the world's top public health challenges and the leading killer of people with HIV, yet is a treatable disease. This study aimed to assess, in a real-world setting, the implementation of antiretroviral therapy (ART) and Cotrimoxazole preventive therapy (CPT) policy, specific interventions proven to benefit patients in HIV-associated TB care. METHODS: This retrospective cohort study was conducted in Botswana in the Serowe/Palapye district, a largely urban district with a high burden of HIV-associated TB with a high case fatality, at Segkoma and Palapye hospitals and their feeder clinics. Between 1 January 2013 and 31 December 2013, confirmed HIV-positive patients aged ≥15 years with a confirmed TB diagnosis and medical record available were included in the analysis. The Kaplan-Meier method was used to compare time to death for the group of patients on ART and the group of patients not on ART during TB treatment. Cox proportional hazard regression was undertaken to identify predictors of mortality. RESULTS: Of the 300 patients included in the study, 217 (72%) were ART experienced at TB diagnosis. Of these, 86 (40%) had TB within 3 months following ART initiation. Of the 83 (28%) patients who were ART-naïve at TB diagnosis, 40 (48%) were commenced on ART during TB treatment, with 24 (60%) patients commencing within 4 weeks following TB treatment initiation. The overall ART uptake was 84%, while cotrimoxazole preventive therapy uptake was 100%. There were 45 deaths (15%), ART-experienced patients during TB treatment accounted for 30 deaths (30/257; 14%), while those who were not ART-experienced during TB treatment accounted for 15 deaths (15/43; 35%). There was a significant difference in survival time between patients with no ART use during TB treatment and those with ART use during TB treatment (log rank p < 0.001). Patients with no ART use during TB treatment were more likely to die within the first 2 months. CONCLUSION: The implementation of CPT policy is a substantial success. Strengthening the implementation of ART policy could improve survival among HIV-associated TB patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Antirretrovirais/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade , Adulto , Botsuana/epidemiologia , Coinfecção/tratamento farmacológico , Coinfecção/mortalidade , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , HIV/fisiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Implementação de Plano de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose/complicações , Tuberculose/virologia
8.
Pan Afr Med J ; 33: 31, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31384346

RESUMO

Tuberculosis (TB) is endemic in the Central African Republic (CAR) with an incidence rate of 391 per 100,000 population in 2015. This study aims to analyze current epidemiological and clinical features of TB at the Hôpital de l'Amitié in the Central African Republic. We conducted an analytic retrospective study of patients hospitalized in the Department of Medicine at the Hôpital de l'Amitié from 15 April 2010 to 14 October 2011. Data were collected using a questionnaire and then analyzed with Epi info software 3.5.3. Chi-square test was used to compare proportions, using a threshold significance level of 5%. The study included 220 patients, of whom 128 were women (58.18%). The average age of patients was 35.69± 10.65 years. In 42.70% of cases, patients had no professional activity. Prevalence of tuberculosis in hospital was 10.99%. On average, 12 cases of TB were recorded each month. Most common clinical signs included: chronic cough (71.81%), fever (96.82%), alteration of the general state (91.36%) and pulmonary condensation syndrome (63.64%). The diseases most commonly associated with tuberculosis were HIV/AIDS (73.36%), malaria (48.63%) and anemia (31.81%). The mean time between symptom onset and diagnosis was 37.65 days. Mortality rate was 18.63%. TB/HIV co-infection and neuromeningeal TB were associated with a high mortality rate (p < 0.05). Tuberculosis is a common disease in Bangui and it is often associated with HIV infection. Prognosis is poor in the case of neuromeningeal involvement. Prevention and routine monitoring in HIV infected patients may contribute to reduce the extent and severity of TB.


Assuntos
Infecções por HIV/epidemiologia , Hospitalização , Tuberculose Meníngea/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Anemia/epidemiologia , República Centro-Africana/epidemiologia , Coinfecção , Feminino , Humanos , Malária/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Tuberculose/diagnóstico , Tuberculose/mortalidade , Tuberculose Meníngea/mortalidade , Adulto Jovem
9.
Przegl Epidemiol ; 73(2): 211-226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385679

RESUMO

AIM OF THE STUDY: To evaluate the main features of TB epidemiology in 2017 in Poland and to compare with the situation in the EU/EEA countries. METHODS: Analysis of case- based data on TB patients from National TB Register, data on anti-TB drug susceptibility testing results in cases notified in 2017, data from National Institute of Public Health- National Institute of Hygiene on cases of tuberculosis as AIDS-defining disease, data from Central Statistical Office on deaths from tuberculosis based on death certificates, data from ECDC report "European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2019-2017 data. Stockholm: European Centre for Disease Prevention and Control, 2019". RESULTS: In 2017, 5 787 TB cases were reported in Poland. The incidence rate was 15.1 cases per 100 000, with large variability between voivodeships from 8.9 to 21.9 per 100 000. The mean annual decrease of TB incidence in 2013-2017 was 4.2%. In 2017, 5127 cases were newly diagnosed with no history of previous treatment i.e. 13.3 per 100 000. 660 cases i.e. 1.7 per 100 000 ­ 11.4% of all registered subjects were previously treated for tuberculosis. In 2017, the number of all pulmonary tuberculosis cases was 5 531 i.e. 14.4 per 100 000. Pulmonary cases represented 95.6% of all TB cases. In 2017, 256 extrapulmonary TB cases were found. In the whole country there were 68 pediatric cases of tuberculosis. TB in children represented 1.2% of all cases notified in Poland in 2017. The incidence rates of tuberculosis were growing along with the age group from 1.2 per 100 000 among children to 25.6 per 100 000 among subjects in the age group 45-64 years (the highest incidence rate). In 2017, the incidence rate in the age group ≥65 years was 22.6 per 100 000. The TB incidence among men i.e. 22.2 per 100.000 was 2.4 times higher than among women i.e. 8,4 per 100 000. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 45 to 49 years ­ 36.1 vs. 8.1 and in age group 55- 59 years ­ 45.2 vs. 10.7. The TB incidence in rural population was lower than in urban, respectively 14.2 per 100.000 and 15.6 per 100 000. The number of all registered culture positive TB cases was 4 179. Pulmonary tuberculosis was bacteriologically confirmed in 4 057 subjects. Culture-confirmed cases represented 72.2% of all TB cases and 73.4% of all pulmonary TB cases. The number of smear-positive pulmonary TB cases reported in 2017 was 2 472 i.e. 6.4 per 100 000 accounting for 44.7% of all pulmonary TB cases and 60.9% of culture confirmed pulmonary TB cases.. TB was AIDS indicative disease in 16 subjects. In all patients with tuberculosis in Poland in 2017 there were 44 cases with MDR-TB (among them 12 foreigners) and 85 patients with resistance to isoniazid only, representing respectively 1.2% and 2.2% of cases with known DST results (DSTs were available in 90.5% of all cultureconfirmed TB cases). In 2017, there were 108 patients of foreign origin among all cases of tuberculosis in Poland. TUBERCULOSIS MORTALITY: There were 543 deaths due to tuberculosis reported in 2016 ­ 1.4 per 100 000; 526 people died from pulmonary and 17 from extrapulmonary tuberculosis. Mortality among males ­ 2.2 per 100 000 ­ was 3.7 X higher than among females ­ 0.6. 37.9% of all TB deaths were cases 65 years old and older ­ 3.3 per 100 000. In 2016, there was one death from tuberculosis in children and no deaths in adolescents. In 2016, tuberculosis represented 0.14% of total mortality in Poland and 28.1% of mortality from infectious diseases. CONCLUSIONS: In 2017, the incidence of tuberculosis in Poland was lower than in 2016. Despite a continuous decline it is still higher than the average in the EU/EEA countries. The highest incidence rates were observed in older age groups. The incidence in males was more than 2 times higher than in females. The impact of migration on the characteristics of tuberculosis in Poland is not substantial. In Poland, tuberculosis in children, tuberculosis in persons infected with HIV and MDR-TB is less common than the average in the EU/EEA countries.


Assuntos
Sistema de Registros , Tuberculose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Antituberculosos/uso terapêutico , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , População Rural , Distribuição por Sexo , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/epidemiologia , População Urbana , Adulto Jovem
10.
BMC Infect Dis ; 19(1): 749, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455234

RESUMO

BACKGROUND: Tuberculosis (TB) is a leading cause of death in children and adults. Unlike for adults, there is paucity of data on childhood TB in several countries in Africa. The study objective was to assess the characteristics and treatment outcomes of children with TB from multiple health facilities in Accra, Ghana. METHODS: A retrospective analyses was conducted using secondary data on children less than 15 years collected from 11 facilities during a TB case finding initiative in Accra from June 2010 to December 2013. Demographic and clinical characteristics as well as treatment outcomes were assessed. Multivariable logistic regression was conducted to assess predictors of mortality. RESULTS: Out of the total 3704 TB cases reported, 5.9% (219) consisted of children with a female: male ratio of 1:1.1. Children less than 5 years made up 56.2% of the patients while 44.2% were HIV positive. The distribution of TB type were as follows: smear positive pulmonary TB (SPPTB), 46.5%, clinically diagnosed pulmonary TB 36.4%.%, extra-pulmonary TB 17.4%. Among the 214 children (97.7%) for whom treatment outcome was documented, 194 (90.7%) were successfully treated consisting of 81.3% who completed treatment and 9.4% who were cured. Eighteen children (8.4%) died. Mortality was significantly higher among the 1-4 year group (p < 0.001), those with SPPTB (p < 0.001) and HIV positive children (p < 0.001). In logistic regression, SPPTB and HIV positivity were predictors of mortality. CONCLUSION: The proportion of children in Accra successfully treated for TB met the target of END TB Strategy treatment success indicator. HIV positivity was a risk factor for death. Reducing mortality in TB-HIV co-infected children will further improve treatment outcomes of children with TB in Accra.


Assuntos
Tuberculose/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Coinfecção/epidemiologia , Feminino , Gana/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Tuberculose/epidemiologia , Tuberculose/mortalidade , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
11.
Rev Bras Epidemiol ; 22: e190043, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31460662

RESUMO

INTRODUCTION: The mortality rate among tuberculosis patients (TB fatality) has been attributed to irregular chemotherapy, delay in diagnosis, multidrug resistance, and HIV coinfection. OBJECTIVE: To analyze TB fatality rates by sex, clinical presentation and HIV coinfection in Campinas, São Paulo, Brazil. METHODS: Cohorts of residents in the city of Campinas who either died during treatment for tuberculosis or had the disease confirmed after death were divided into three intervals: 2001-2003, 2004-2006, and 2007-2009. Data were obtained from the database of the Tuberculosis Surveillance System of the University of Campinas, and notifications were gathered through TB-WEB Health São Paulo Secretary. Statistical significance was determined using a chi-square test, considering p < 0.05. RESULTS: Between 2001 and 2009, 3,416 TB patients were diagnosed: 2,827 (82.8%) were new TB cases and 589 (17.2%) were retreatments. Between the first and second triennium, the number of new patients decreased by 18%, and 23% among retreatments. Between the second and third intervals, the reduction was 5% and 21%, respectively. General case fatality rate declined from 11.4% to 9.9% across intervals, and was most significant among patients that had previously abandoned treatment (17.3% to 5.1%). Fatality rates among patients coinfected with TB-AIDS were 2-3 times that of patients not infected with TB-AIDS throughout the intervals. Fatality between the first and third triennium among TB-AIDS co-infected patients declined (24.8% to 19.5%), while increasing slightly among non-AIDS TB patients (7.3% to 8%) during this period. CONCLUSION: Though mortality among TB-AIDS patients declined from 2001-2009, rates among non-AIDS TB remained stagnant. Improved TB diagnosis and treatment is needed to further decrease TB mortality in Campinas.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Coinfecção/mortalidade , Tuberculose/mortalidade , Brasil/epidemiologia , Feminino , Humanos , Masculino , Mortalidade/tendências , Distribuição por Sexo , Fatores de Tempo
12.
BMC Infect Dis ; 19(1): 735, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438876

RESUMO

BACKGROUND: Although the incidence of tuberculosis (TB) has decreased in South Korea, the mortality rate remains high. TB mortality is a key indicator for TB control interventions. The purpose of this study was to assess early and TB-related mortality during anti-TB treatment and describe the associated clinical characteristics. METHODS: A multicenter cross-sectional study was performed across South Korea. Patients with pulmonary TB who died during anti-TB treatment and whose records were submitted to the national TB surveillance system between 2015 and 2017 were enrolled. All TB deaths were categorized based on cause (TB-related or non-TB-related) and timing (early or late). We identified statistical associations using the frequency table, chi-square test, and binary logistic regression. RESULTS: Of 5595 notifiable mortality cases, 3735 patients with pulmonary TB were included in the analysis. There were 2541 (68.0%) male patients, and 2935 (78.6%) mortality cases were observed in patients older than 65 years. There were 944 (25.3%) cases of TB-related death and 2545 (68.1%) cases of early death. Of all cases, 187 (5.0%) patients were diagnosed post-mortem and 38 (1.0%) patients died on the first day of treatment. Low body mass index (adjusted odds ratio (aOR) = 1.26; 95% confidence interval (CI) = 1.08-1.48), no reported illness (aOR = 1.36; 95% CI = 1.10-1.68), bilateral disease on chest X-ray (aOR = 1.30; 95% CI = 1.11-1.52), and positive acid-fast bacilli smear result (aOR = 1.30; 95% CI = 1.11-1.52) were significantly associated with early death, as well as TB-related death. Acute respiratory failure was the most common mode of non-TB-related death. Malignancy was associated with both late (aOR = 0.71; 95% CI = 0.59-0.89) and non-TB-related (aOR = 0.35; 95% CI = 0.26-0.46) death. CONCLUSIONS: A high proportion of TB death was observed in elderly patients and attributed to non-TB-related causes. Many TB-related deaths occurred during the intensive phase, particularly within the first month. Further studies identifying risk factors for different causes of TB death at different phases of anti-TB treatment are warranted for early targeted intervention in order to reduce TB mortality.


Assuntos
Tuberculose/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mortalidade , República da Coreia/epidemiologia , Fatores de Risco , Fatores de Tempo , Tuberculose/epidemiologia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/mortalidade , Adulto Jovem
13.
Epidemiol Health ; 41: e2019032, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31319655

RESUMO

OBJECTIVES: Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran. METHODS: This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages. RESULTS: The risk of mortality from TB was found to increase with the unemployment rate (߈=0.02), illiteracy (߈=0.04), household density per residential unit (߈=1.29), distance between the center of the county and the provincial capital (߈=0.03), and urbanization (߈=0.81). The following other risk factors for TB mortality were identified: diabetes (߈=0.02), human immunodeficiency virus infection (߈=0.04), infection with TB in the most recent 2 years (߈=0.07), injection drug use (߈=0.07), long-term corticosteroid use (߈=0.09), malignant diseases (߈=0.09), chronic kidney disease (߈=0.32), gastrectomy (߈=0.50), chronic malnutrition (߈=0.38), and a body mass index more than 10% under the ideal weight (߈=0.01). However, silicosis had no effect. CONCLUSIONS: The results of this study provide useful information on risk factors for mortality from TB.


Assuntos
Tuberculose/mortalidade , Adulto , Idoso , Estudos Transversais , Humanos , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Modelos Estatísticos , Sistema de Registros , Fatores de Risco , Fatores Socioeconômicos
14.
Pan Afr Med J ; 32: 206, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312318

RESUMO

Introduction: Tuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally. Ghana as one of the 30 high burden TB/HIV countries has a high annual TB case-fatality rate of 10%. The study sought to assess the effect of HIV infection on TB treatment outcomes and assess the time to mortality after treatment onset. Methods: We conducted a review of treatment files of TB patients who were treated from January 2013 to December 2015 in two urban hospitals in the Accra Metropolis. Modified Poisson regression analysis was used to measure the association between HIV infection and TB treatment outcomes. Kaplan-Meier survival estimates were used to plot survival curves. Results: Seventy-seven percent (83/107) of HIV infected individuals had successful treatment, compared to 91.2% (382/419) treatment success among HIV non-infected individuals. The proportion of HIV-positive individuals who died was 21.5% (23/107) whilst that of HIV-negative individuals was 5.5% (23/419). Being HIV-positive increased the risk of adverse outcome relative to successful outcome by a factor of 2.89(95% CI 1.76-4.74). The total number of deaths recorded within the treatment period was 46; of which 29(63%) occurred within the first two months of TB treatment. The highest mortality rate observed was among HIV infected persons (38.6/1000 person months). Of the 107 TB/HIV co-infected patients, 4(3.7%) initiated ART during TB treatment. Conclusion: The uptake of ART in co-infected individuals in this study was very low. Measures should be put in place to improve ART coverage among persons with TB/HIV co-infection to help reduce mortality.


Assuntos
Antituberculosos/uso terapêutico , Infecções por HIV/epidemiologia , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Estudos de Coortes , Coinfecção , Feminino , Gana/epidemiologia , Infecções por HIV/mortalidade , Soropositividade para HIV/epidemiologia , Hospitais Urbanos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Tuberculose/mortalidade , Adulto Jovem
15.
S Afr Med J ; 109(7): 480-485, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31266573

RESUMO

BACKGROUND: The Rapid Mortality Surveillance System has reported reductions in child mortality rates in recent years in South Africa (SA). In this article, we present information about levels of mortality and causes of death from the second SA National Burden of Disease Study (SA NBD) to inform the response required to reduce child mortality further. OBJECTIVES: To estimate trends in and causes of childhood mortality at national and provincial levels for the period 1997 - 2012, to highlight the importance of the SA NBD. METHODS: Numbers of registered child deaths were adjusted for under-reporting. Adjustments were made for the misclassification of AIDS deaths and the proportion of ill-defined natural causes. Non-natural causes were estimated using results from the National Injury Mortality Surveillance System for 2000 and the National Injury Mortality Survey for 2009. Six neonatal conditions and 11 other causes were consolidated from the SA NBD and the Child Health Epidemiological Reference Group lists of causes of death for the analysis. The NBD cause-fractions were compared with those from Statistics South Africa, the United Nations Children's Fund (UNICEF) and the Institute for Health Metrics and Evaluation (IHME). RESULTS: Under-5 mortality per 1 000 live births increased from 65 in 1997 to 79 in 2004 as a result of HIV/AIDS, before dropping to 40 by 2012. The neonatal mortality rate declined from 1997 to 2001, followed by small variations. The death rate from diarrhoeal diseases began to decrease in 2008 and the death rate from pneumonia from 2010. By 2012, neonatal deaths accounted for 27% of child deaths, with conditions associated with prematurity, birth asphyxia and severe infections being the main contributors. In 1997, KwaZulu-Natal, Free State, Mpumalanga and Eastern Cape provinces had the highest under-5 mortality, close to 80 per 1 000 live births. Mortality rates in North West were in the mid-range and then increased, placing this province in the highest group in the later years. The Western Cape had the lowest mortality rate, declining throughout the period apart from a slight increase in the early 2000s. CONCLUSIONS: The SA NBD identified the causes driving the trends, making it clear that prevention of mother-to-child transmission of HIV, the Expanded Programme on Immunisation and programmes aimed at preventing neonatal deaths need to be equitably implemented throughout the country to address persistent provincial inequalities in child deaths. The rapid reduction of childhood mortality since 2005 suggests that the 2030 Sustainable Development Goal target of 25 per 1 000 for under-5 mortality is achievable for SA. Comparison with alternative estimates highlights the need for cause-of-death data from civil registration to be adjusted using a burden-of-disease approach.


Assuntos
Causas de Morte/tendências , Mortalidade da Criança/tendências , Asfixia Neonatal/mortalidade , Criança , Pré-Escolar , Diarreia/mortalidade , Infecções por HIV/mortalidade , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , Pneumonia/mortalidade , Vigilância da População , África do Sul/epidemiologia , Tuberculose/mortalidade , Ferimentos e Lesões/mortalidade
16.
PLoS Med ; 16(7): e1002840, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31276515

RESUMO

BACKGROUND: In high-burden settings, case fatality rates are reported to be between 11% and 32% in hospitalized patients with HIV-associated tuberculosis, yet the underlying causes of mortality remain poorly characterized. Understanding causes of mortality could inform the development of novel management strategies to improve survival. We aimed to assess clinical and microbiologic determinants of mortality and to characterize the pathophysiological processes underlying death by evaluating host soluble inflammatory mediators and determined the relationship between these mediators and death as well as biomarkers of disseminated tuberculosis. METHODS AND FINDINGS: Adult patients with HIV hospitalized with a new diagnosis of HIV-associated tuberculosis were enrolled in Cape Town between 2014 and 2016. Detailed tuberculosis diagnostic testing was performed. Biomarkers of tuberculosis dissemination and host soluble inflammatory mediators at baseline were assessed. Of 682 enrolled participants, 576 with tuberculosis (487/576, 84.5% microbiologically confirmed) were included in analyses. The median age was 37 years (IQR = 31-43), 51.2% were female, and the patients had advanced HIV with a median cluster of differentiation 4 (CD4) count of 58 cells/L (IQR = 21-120) and a median HIV viral load of 5.1 log10 copies/mL (IQR = 3.3-5.7). Antituberculosis therapy was initiated in 566/576 (98.3%) and 487/576 (84.5%) started therapy within 48 hours of enrolment. Twelve-week mortality was 124/576 (21.5%), with 46/124 (37.1%) deaths occurring within 7 days of enrolment. Clinical and microbiologic determinants of mortality included disseminated tuberculosis (positive urine lipoarabinomannan [LAM], urine Xpert MTB/RIF, or tuberculosis blood culture in 79.6% of deaths versus 60.7% of survivors, p = 0.001), sepsis syndrome (high lactate in 50.8% of deaths versus 28.9% of survivors, p < 0.001), and rifampicin-resistant tuberculosis (16.9% of deaths versus 7.2% of survivors, p = 0.002). Using non-supervised two-way hierarchical cluster and principal components analyses, we describe an immune profile dominated by mediators of the innate immune system and chemotactic signaling (interleukin-1 receptor antagonist [IL-1Ra], IL-6, IL-8, macrophage inflammatory protein-1 beta [MIP-1ß]/C-C motif chemokine ligand 4 [CCL4], interferon gamma-induced protein-10 [IP-10]/C-X-C motif chemokine ligand 10 [CXCL10], MIP-1 alpha [MIP-1α]/CCL3), which segregated participants who died from those who survived. This immune profile was associated with mortality in a Cox proportional hazards model (adjusted hazard ratio [aHR] = 2.2, 95%CI = 1.9-2.7, p < 0.001) and with detection of biomarkers of disseminated tuberculosis. Clinicians attributing causes of death identified tuberculosis as a cause or one of the major causes of death in 89.5% of cases. We did not perform longitudinal sampling and did not have autopsy-confirmed causes of death. CONCLUSIONS: In this study, we did not identify a major contribution from coinfections to these deaths. Disseminated tuberculosis, sepsis syndrome, and rifampicin resistance were associated with mortality. An immune profile dominated by mediators of the innate immune system and chemotactic signaling was associated with both tuberculosis dissemination and mortality. These findings provide pathophysiologic insights into underlying causes of mortality and could be used to inform the development of novel treatment strategies and to develop methods to risk stratify patients to appropriately target novel interventions. Causal relationships cannot be established from this study.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Coinfecção , Infecções por HIV/mortalidade , Mortalidade Hospitalar , Tuberculose/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Biomarcadores/sangue , Causas de Morte , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/imunologia , Infecções por HIV/virologia , Interações Hospedeiro-Patógeno , Humanos , Hospedeiro Imunocomprometido , Mediadores da Inflamação/sangue , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Sepse/imunologia , Sepse/microbiologia , Sepse/mortalidade , África do Sul/epidemiologia , Fatores de Tempo , Tuberculose/diagnóstico , Tuberculose/imunologia , Tuberculose/microbiologia
17.
Rev. méd. Urug ; 35(2): 102-112, jun. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-999579

RESUMO

Introducción y objetivo: la tuberculosis (TB) es una de las principales causas de mortalidad a nivel mundial con tendencia al estancamiento en su control, situación a la que no es ajena Venezuela, y particularmente el estado Carabobo con importantes cifras de enfermedades respiratorias. El objetivo de este trabajo fue describir las características clínico-epidemiológicas de la TB ocurrida durante un año en el estado Carabobo. Método: estudio descriptivo, de campo y retrospectivo. Resultados: fueron en total 712 casos de TB pulmonar y 15 de TB extrapulmonar, mayoritariamente del municipio Valencia del estado Carabobo con afectación fundamental del sexo masculino (76% y 67%, respectivamente), además 67% de los afectados con la forma pulmonar se encuentran en edad económicamente productiva así como 53% de los pacientes con la variante extrapulmonar, siendo la meníngea la variante extrapulmonar de mayor frecuencia. Asimismo, 16,1% de los pacientes con TB pulmonar tenían privación de libertad. Los afectados con TB tienen en mayor proporción como factor de riesgo la ingesta de alcohol y como patología sobreagregada la desnutrición. Los afectados con TB pulmonar muestran la sintomatología clásica con patrón radiológico bilateral cavitario de TB secundaria. Conclusiones: la tasa de morbilidad por TB en 2017 muestra importante alza para el estado Carabobo, contraria a la tendencia mundial al descenso. Este trabajo se constituye en una puesta al día en la caracterización clínica-epidemiológica de la TB en el estado Carabobo con el objeto de aportar a los organismos oficiales información para la toma de decisiones sanitarias en el efectivo control de esta enfermedad.


Introduction: tuberculosis (TB) is one of the main causes of mortality worldwide with a tendency to stagnation in its control. Venezuela follows the global tendency, and in particular the state of Carabobo, which accounts for significant numbers of respiratory diseases. Objective: to describe the clinical-epidemiological characteristics of TB that occurred during one year in the state of Carabobo. Method: descriptive, field and retrospective study. Results: A total of 712 cases of pulmonary TB and 15 cases of extrapulmonary TB were part of the study, most of them in the municipality of Valencia of the state of Carabobo, with fundamental involvement of the male gender (76% and 67% respectively), and 67% of the patients affected being economically productive, as well as 53% of the patients with the extrapulmonary variant, being the meningeal the extrapulmonary variant of greater frequency. Likewise, 16.1% of patients with pulmonary TB were deprived of their liberty. Those affected with TB have a higher risk of alcohol intake as a risk factor and malnutrition as an added pathology. Those affected with pulmonary TB show the classic symptomatology with a bilateral cavitary radiological pattern of secondary TB. Conclusions: the TB morbidity rate in 2017 shows an important increase for the Carabobo state, contrary to the global tendency to decrease, and this study constitutes an update on the clinical-epidemiological characterization of TB in the state of Carabobo with the purpose of providing official organizations with information for making health decisions for the effective control of this disease.


Introdução e objetivo: a tuberculose (TB) é uma das principais causas de mortalidade no mundo, com tendência à estagnação no seu controle, uma situação que não é alheia na Venezuela, e particularmente no estado de Carabobo com um número significativo de doenças respiratórias. O objetivo deste trabalho é descrever as características clínico-epidemiológicas da TB ocorridas durante um ano no estado de Carabobo. Método: estudo descritivo, de campo e retrospectivo. Resultados: foram registrados 712 casos de tuberculose pulmonar e 15 extrapulmonar principalmente no município de Valencia em Carabobo com maior incidência em pacientes do sexo masculino (76% e 67%, respectivamente); mais de 67% dos pacientes com a forma pulmonar estavam em idades economicamente produtivas, bem como 53% dos pacientes com a variante extrapulmonar, sendo a variante meníngea extrapulmonar a de maior frequência. 16,1% dos pacientes com TB pulmonar estavam privados de liberdade. Uma maior proporção dos pacientes afetados pela tuberculose apresenta como fator de risco a ingestão de álcool e de desnutrição como patologia adicional. Os acometidos por TB pulmonar apresentam a sintomatologia clássica com padrão radiológico cavitário bilateral de TB secundária. Conclusões: a taxa de morbidade por TB em 2017 mostrou um aumento relevante no estado de Carabobo, oposta a tendência mundial de redução; este trabalho apresenta uma atualização sobre as características clínicas e epidemiológicas da tuberculose no estado de Carabobo com o objetivo de fornecer às organizações oficiais informação para a tomada de decisões sanitárias para o controle efetivo dessa doença.


Assuntos
Humanos , Tuberculose/mortalidade , Tuberculose/epidemiologia , Venezuela
18.
Tuberculosis (Edinb) ; 116S: S59-S65, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31064712

RESUMO

BACKGROUND: Tuberculosis (TB) and diabetes mellitus (DM) comorbidity (TB-DM) is a major public health challenge worldwide. This analysis aimed to determine the risk factors and trends associated with TB-DM morbidity and mortality. METHODS: Risk factors for TB-DM morbidity and mortality were identified by logistic regression using de-identified surveillance data of all TB patients from Texas, USA. reported between 01/2010-12/2016. Non-parametric testing was used for the morbidity and mortality trends. RESULTS: From 2010 to 2016, 1400/9002 (15.6%) TB patients were diabetic with an annual prevalence increase from 12.5% to 18.7% (p = 0.005). Reported TB-DM patients had a higher mortality (10.3%) than non-DM patients (7.6%, p = 0.001) with nearly a 3-fold increase in the odds of death (overall and during treatment). Older age, being Hispanic, chronic kidney failure, pulmonary cavitation and positive TB culture or smear were associated with TB-DM. Age ≥45, US-birth, resident of long-term care facility, injecting-drug user, chronic kidney disease, TB meningitis, abnormal chest radiograph, non-conversion of culture, and HIV(+) were independently associated with a higher mortality. CONCLUSIONS: TB-DM is an increasing public health problem in Texas with significantly high mortality. Risk factors for mortality determined by multivariate modeling will provide a foundation for the development of more effective strategies for TB-DM management.


Assuntos
Diabetes Mellitus/mortalidade , Tuberculose/mortalidade , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Comorbidade , Bases de Dados Factuais , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Texas/epidemiologia , Fatores de Tempo , Tuberculose/diagnóstico , Adulto Jovem
19.
BMC Public Health ; 19(1): 446, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035984

RESUMO

BACKGROUND: Childhood tuberculosis (TB) diagnoses often lack microbiologic confirmation and require empiric treatment. Barriers to empiric treatment include concern for poor outcomes and adverse effects. We thus determined the outcomes of empiric TB treatment from a retrospective cohort of children at a national referral hospital in Kampala, Uganda from 2010 to 2015. METHODS: Children were diagnosed clinically and followed through treatment. Demographics, clinical data, outcome and any adverse events were extracted from patient charts. A favorable outcome was defined as a child completing treatment with clinical improvement. We performed logistic regression to assess factors associated with loss to follow up and death. RESULTS: Of 516 children, median age was 36 months (IQR 15-73), 55% (95% CI 51-60%) were male, and HIV prevalence was 6% (95% CI 4-9%). The majority (n = 422, 82, 95% CI 78-85%) had a favorable outcome, with no adverse events that required treatment discontinuation. The most common unfavorable outcomes were loss to follow-up (57/94, 61%) and death (35/94, 37%; overall mortality 7%). In regression analysis, loss to follow up was associated with age 10-14 years (OR 2.38, 95% CI 1.15-4.93, p = 0.02), HIV positivity (OR 3.35, 95% CI 1.41-7.92, p = 0.01), hospitalization (OR 4.14, 95% CI 2.08-8.25, p < 0.001), and living outside of Kampala (OR 2.64, 95% CI 1.47-4.71, p = 0.001). Death was associated with hospitalization (OR 4.57, 95% CI 2.0-10.46, p < 0.001), severe malnutrition (OR 2.98, 95% CI 1.07-8.27, p = 0.04), baseline hepatomegaly (OR 4.11, 95% CI 2.09-8.09, p < 0.001), and living outside of Kampala (OR 2.41, 95% CI 1.17-4.96, p = 0.02). CONCLUSIONS: Empiric treatment of child TB was effective and safe, but treatment success remained below the 90% target. Addressing co-morbidities and improving retention in care may reduce unfavorable outcomes.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Adolescente , Fatores Etários , Criança , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Comorbidade , Feminino , Infecções por HIV/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Modelos Logísticos , Masculino , Prevalência , Estudos Retrospectivos , Fatores Socioeconômicos , Resultado do Tratamento , Tuberculose/mortalidade , Uganda/epidemiologia
20.
Respir Res ; 20(1): 85, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060621

RESUMO

BACKGROUND: Although bronchodilator inhaler therapy can improve lung function in patients with tuberculous destroyed lung (TDL), its effect on mortality has not been studied. We evaluated the effect of tiotropium inhaler therapy on mortality in patients with TDL. METHODS: A retrospective cohort of 963 patients with TDL was followed for up to ten years by linking hospital and nationwide health insurance claims data. We compared patients receiving tiotropium inhaler with patients without tiotropium after matching with propensity scores. In addition, we elucidated the risk factors of mortality using Cox proportional hazards model. RESULTS: After the propensity score matching, the baseline characteristics were balanced in both the tiotropium group (n = 105) and the non-tiotropium group (n = 105); including mean age (63.9 vs. 64.4 years, P = 0.715), mean forced expiratory volume in 1 s (FEV1) (45.0 vs. 45.3%, P = 0.903), and others. After the propensity score matching, the tiotropium group showed better survival than the non-tiotropium group (median survival period: not reached for the tiotropium group vs. 7.24 years for the non-tiotropium group, Prentice-Wilcoxon test, P = 0.008). Multivariate Cox proportional hazard analysis revealed that tiotropium inhaler usage was associated with lower risk of mortality in the multivariate analysis (HR, 0.560; 95% CI, 0.380-0.824; P = 0.003) after adjusting age, sex, BMI, smoking history, mMRC dyspnea score, Charlson Comorbidity Index, concomitant COPD diagnosis, FEV1, X-ray severity score, and home oxygen usage. CONCLUSIONS: Our results suggest that tiotropium inhaler is associated with decreased all-cause mortality in TDL. Further prospective study is required for validation.


Assuntos
Broncodilatadores/administração & dosagem , Hospitalização , Revisão da Utilização de Seguros , Pulmão/efeitos dos fármacos , Brometo de Tiotrópio/administração & dosagem , Tuberculose/tratamento farmacológico , Administração por Inalação , Idoso , Estudos de Coortes , Bases de Dados Factuais/tendências , Feminino , Hospitalização/tendências , Humanos , Revisão da Utilização de Seguros/tendências , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Nebulizadores e Vaporizadores/tendências , República da Coreia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose/mortalidade
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