The Impact of Influenza and Tuberculosis Interaction on Mortality Among Individuals Aged ≥15 Years Hospitalized With Severe Respiratory Illness in South Africa, 2010-2016.

HIV South Africa coinfection influenza mortality tuberculosis

Journal

Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045

Informations de publication

Date de publication:
Mar 2019
Historique:
received: 10 01 2019
accepted: 22 01 2019
entrez: 26 3 2019
pubmed: 25 3 2019
medline: 25 3 2019
Statut: epublish

Résumé

Data on the prevalence and impact of influenza-tuberculosis coinfection on clinical outcomes from high-HIV and -tuberculosis burden settings are limited. We explored the impact of influenza and tuberculosis coinfection on mortality among hospitalized adults with lower respiratory tract infection (LRTI). We enrolled patients aged ≥15 years admitted with physician-diagnosed LRTI or suspected tuberculosis at 2 hospitals in South Africa from 2010 to 2016. Combined nasopharyngeal and oropharyngeal swabs were tested for influenza and 8 other respiratory viruses. Tuberculosis testing of sputum included smear microscopy, culture, and/or Xpert MTB/Rif. Among 6228 enrolled individuals, 4253 (68%) were tested for both influenza and tuberculosis. Of these, the detection rate was 6% (239/4253) for influenza, 26% (1092/4253) for tuberculosis, and 77% (3113/4053) for HIV. One percent (42/4253) tested positive for both influenza and tuberculosis. On multivariable analysis, among tuberculosis-positive patients, factors independently associated with death were age group ≥65 years compared with 15-24 years (adjusted odds ratio [aOR], 3.6; 95% confidence interval [CI], 1.2-11.0) and influenza coinfection (aOR, 2.3; 95% CI, 1.02-5.2). Among influenza-positive patients, laboratory-confirmed tuberculosis was associated with an increased risk of death (aOR, 4.5; 95% CI, 1.5-13.3). Coinfection with other respiratory viruses was not associated with increased mortality in patients positive for tuberculosis (OR, 0.7; 95% CI, 0.4-1.1) or influenza (OR, 1.6; 95% CI, 0.4-5.6). Tuberculosis coinfection is associated with increased mortality in individuals with influenza, and influenza coinfection is associated with increased mortality in individuals with tuberculosis. These data may inform prioritization of influenza vaccines or antivirals for tuberculosis patients and inform tuberculosis testing guidelines for patients with influenza.

Sections du résumé

BACKGROUND BACKGROUND
Data on the prevalence and impact of influenza-tuberculosis coinfection on clinical outcomes from high-HIV and -tuberculosis burden settings are limited. We explored the impact of influenza and tuberculosis coinfection on mortality among hospitalized adults with lower respiratory tract infection (LRTI).
METHODS METHODS
We enrolled patients aged ≥15 years admitted with physician-diagnosed LRTI or suspected tuberculosis at 2 hospitals in South Africa from 2010 to 2016. Combined nasopharyngeal and oropharyngeal swabs were tested for influenza and 8 other respiratory viruses. Tuberculosis testing of sputum included smear microscopy, culture, and/or Xpert MTB/Rif.
RESULTS RESULTS
Among 6228 enrolled individuals, 4253 (68%) were tested for both influenza and tuberculosis. Of these, the detection rate was 6% (239/4253) for influenza, 26% (1092/4253) for tuberculosis, and 77% (3113/4053) for HIV. One percent (42/4253) tested positive for both influenza and tuberculosis. On multivariable analysis, among tuberculosis-positive patients, factors independently associated with death were age group ≥65 years compared with 15-24 years (adjusted odds ratio [aOR], 3.6; 95% confidence interval [CI], 1.2-11.0) and influenza coinfection (aOR, 2.3; 95% CI, 1.02-5.2). Among influenza-positive patients, laboratory-confirmed tuberculosis was associated with an increased risk of death (aOR, 4.5; 95% CI, 1.5-13.3). Coinfection with other respiratory viruses was not associated with increased mortality in patients positive for tuberculosis (OR, 0.7; 95% CI, 0.4-1.1) or influenza (OR, 1.6; 95% CI, 0.4-5.6).
CONCLUSIONS CONCLUSIONS
Tuberculosis coinfection is associated with increased mortality in individuals with influenza, and influenza coinfection is associated with increased mortality in individuals with tuberculosis. These data may inform prioritization of influenza vaccines or antivirals for tuberculosis patients and inform tuberculosis testing guidelines for patients with influenza.

Identifiants

DOI: 10.1093/ofid/ofz020 PMID: 30906797 PMC: PMC6424478
pubmed: 30906797
doi: 10.1093/ofid/ofz020
pii: ofz020
pmc: PMC6424478
doi:

Types de publication

Journal Article

Langues

eng

Pagination

ofz020

Subventions

Organisme : NCIRD CDC HHS
ID : U01 IP001048
Pays : United States
Organisme : NCIRD CDC HHS
ID : U51 IP000155
Pays : United States

Références

Acta Tuberc Scand. 1954;29(2):125-39
pubmed: 13188754
Bull Acad Natl Med. 1962 Feb 20-27;146:139-45
pubmed: 13868007
Clin Infect Dis. 2005 May 15;40(10):1500-7
pubmed: 15844073
Monaldi Arch Chest Dis. 2005 Mar;63(1):37-46
pubmed: 16035563
J Clin Microbiol. 2007 Aug;45(8):2460-6
pubmed: 17537936
BMC Public Health. 2008 Feb 21;8:68
pubmed: 18289392
Soc Sci Med. 2009 May;68(9):1599-608
pubmed: 19304361
J Exp Med. 1947 Aug 31;86(3):203-14
pubmed: 19871671
Euro Surveill. 2009 Oct 22;14(42):null
pubmed: 19883549
QJM. 2010 May;103(5):319-25
pubmed: 20219780
Clin Infect Dis. 2010 Dec 15;51(12):1362-9
pubmed: 21070141
PLoS One. 2011;6(5):e20111
pubmed: 21637856
Curr HIV/AIDS Rep. 2011 Sep;8(3):181-91
pubmed: 21710214
J Assoc Physicians India. 2011 Jan;59:14-6, 18
pubmed: 21751659
Vaccine. 2011 Jul 22;29 Suppl 2:B38-41
pubmed: 21757102
Lancet. 2011 Dec 3;378(9807):1917-30
pubmed: 22078723
Crit Care Med. 2012 May;40(5):1487-98
pubmed: 22511131
Influenza Other Respir Viruses. 2013 May;7(3):244-8
pubmed: 22817684
Comput Math Methods Med. 2012;2012:124861
pubmed: 22848231
J Infect Dis. 2012 Dec 15;206 Suppl 1:S159-65
pubmed: 23169964
Emerg Infect Dis. 2013 Jan;19(1):165-7
pubmed: 23260033
Tuberculosis (Edinb). 2013 May;93(3):338-42
pubmed: 23474302
J Immunol. 2013 Jul 1;191(1):302-11
pubmed: 23698750
J Infect Dis. 2014 Jan 15;209(2):270-4
pubmed: 23935205
Emerg Infect Dis. 2013 Nov;19(11):1766-74
pubmed: 24209781
Clin Infect Dis. 2014 May;58(9):1241-9
pubmed: 24567249
BMC Infect Dis. 2015 Jan 27;15:26
pubmed: 25623944
PLoS One. 2015 Mar 18;10(3):e0118884
pubmed: 25786103
Emerg Infect Dis. 2015 Apr;21(4):600-8
pubmed: 25811455
Clin Infect Dis. 2015 Oct 1;61(7):1063-70
pubmed: 26060287
PLoS One. 2015 Jun 15;10(6):e0129173
pubmed: 26076197
PLoS One. 2016 Oct 5;11(10):e0162575
pubmed: 27706149
Intensive Care Med. 2017 Jan;43(1):48-58
pubmed: 27709265

Auteurs

Sibongile Walaza (S)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Stefano Tempia (S)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.

Halima Dawood (H)

Pietermaritzburg Metropolitan Hospital Complex, KwaZulu-Natal, South Africa.

Ebrahim Variava (E)

Department of Medicine, Klerksdorp Tshepong Hospital, North West Province.
School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB.

Nicole Wolter (N)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Andries Dreyer (A)

Centre for Tuberculosis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.

Jocelyn Moyes (J)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Claire Von Mollendorf (C)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Meredith McMorrow (M)

Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.
Division of Global Health Protection, Centers for Disease Control and Prevention, Pretoria, South Africa.

Anne Von Gottberg (A)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Sumayya Haffejee (S)

Pietermaritzburg Metropolitan Hospital Complex, KwaZulu-Natal, South Africa.

Marietje Venter (M)

Zoonosis Research Program, Department of Medical Virology, University of Pretoria, Pretoria, South Africa.

Florette K Treurnicht (FK)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.

Orienka Hellferscee (O)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Neil A Martinson (NA)

Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB.
DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, University of the Witwatersrand, Johannesburg, South Africa.
Johns Hopkins University Center for TB Research, Baltimore, Maryland.

Nazir Ismail (N)

Centre for Tuberculosis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
Faculty of Health Sciences, University of Pretoria, Pretoria.

Cheryl Cohen (C)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Classifications MeSH