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. 2020 Oct 23;20(1):789.
doi: 10.1186/s12879-020-05515-4.

Risk factors for recurrent tuberculosis after successful treatment in a high burden setting: a cohort study

Patrick George Tobias Cudahy  1   2 , Douglas Wilson  3 , Ted Cohen  4
Affiliations

Risk factors for recurrent tuberculosis after successful treatment in a high burden setting: a cohort study

Patrick George Tobias Cudahy et al. BMC Infect Dis. .

Abstract

Background: People successfully completing treatment for tuberculosis remain at elevated risk for recurrent disease, either from relapse or reinfection. Identifying risk factors for recurrent tuberculosis may help target post-tuberculosis screening and care.

Methods: We enrolled 500 patients with smear-positive pulmonary tuberculosis in South Africa and collected baseline data on demographics, clinical presentation and sputum mycobacterial cultures for 24-loci mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. We used routinely-collected administrative data to identify recurrent episodes of tuberculosis occurring over a median of six years after successful treatment completion.

Results: Of 500 patients initially enrolled, 333 (79%) successfully completed treatment for tuberculosis. During the follow-up period 35 patients with successful treatment (11%) experienced a bacteriologically confirmed tuberculosis recurrence. In our Cox proportional hazards model, a 3+ AFB sputum smear grade was significantly associated with recurrent tuberculosis with a hazard ratio of 3.33 (95% CI 1.44-7.7). The presence of polyclonal M. tuberculosis infection at baseline had a hazard ratio for recurrence of 1.96 (95% CI 0.86-4.48).

Conclusion: Our results indicate that AFB smear grade is independently associated with tuberculosis recurrence after successful treatment for an initial episode while the association between polyclonal M. tuberculosis infection and increased risk of recurrence appears possible.

Keywords: Fuzzy match; Mixed-infection; Reinfection; Relapse; South Africa.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Participant flow diagram
Fig. 2
Fig. 2
Kaplan Meier estimates for freedom from recurrent tuberculosis after completion or cure
Fig. 3
Fig. 3
Adjusted hazard ratios for recurrent TB
See this image and copyright information in PMC

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