Your browser doesn't support javascript.
loading
Revisiting the Natural History of Pulmonary Tuberculosis: A Bayesian Estimation of Natural Recovery and Mortality Rates.
Ragonnet, Romain; Flegg, Jennifer A; Brilleman, Samuel L; Tiemersma, Edine W; Melsew, Yayehirad A; McBryde, Emma S; Trauer, James M.
Afiliação
  • Ragonnet R; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
  • Flegg JA; School of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia.
  • Brilleman SL; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
  • Tiemersma EW; Victorian Centre for Biostatistics, Melbourne, Victoria, Australia.
  • Melsew YA; KNCV Tuberculosis Foundation, South Holland, The Hague, The Netherlands.
  • McBryde ES; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
  • Trauer JM; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Clin Infect Dis ; 73(1): e88-e96, 2021 07 01.
Article em En | MEDLINE | ID: mdl-32766718
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.
Assuntos
Palavras-chave

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tuberculose / Tuberculose Pulmonar Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tuberculose / Tuberculose Pulmonar Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article