Clinical and Imaging Features of Adults with Recurrent Pulmonary Tuberculosis - A Prospective Case-Controlled Study.

Humans Tuberculosis, Pulmonary / diagnostic imaging
Associated factors Clinical Imaging Pulmonary tuberculosis Recurrent

Journal

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
ISSN: 1878-3511
Titre abrégé: Int J Infect Dis
Pays: Canada
ID NLM: 9610933

Informations de publication

Date de publication:
Dec 2021
Historique:
received: 07 01 2021
revised: 14 01 2021
accepted: 17 01 2021
pubmed: 16 3 2021
medline: 22 12 2021
entrez: 15 3 2021
Statut: ppublish

Résumé

Recurrent pulmonary tuberculosis (RPTB) is a growing, important and neglected problem affecting treated TB patients and TB health services across the world, particularly in sub-Saharan Africa. Analyses and identification of differences in clinical features between recurrent PTB and newly diagnosed PTB may lead to improved management recommendations. Between September 1 A total of 312 patients with PTB were enrolled (104 RPTB cases and 208 newly diagnosed controls). Clinically hemoptysis was more common in RPTB compared to controls 28/104 (26.9%) vs 35/208 (16.8%), P = 0.036. Chest pain was significantly less common among patients with RPTB compared to controls 33 (31.7%) vs 92 (44.2%), P = 0.034. A higher proportion of RPTB presented with cavitation 34/104 (32.7%) compared to control 44/208 (21.2%) P = 0.027. The median score for lung pathology was higher among patients with RPTB (50) compared to controls (30); P = 0.001. Lung function of patients with RPTB at diagnosis of index TB were more likely to show mixed restrictive and obstructive pattern 36/104 (34.6%) compared to controls 31/208 (14.9%). p<0.001. Multivariate analysis showed that patients older than 45 years of age (adjusted odds ratio [aOR]: 3.59, 95% CI: 1.38 - 9.32), those with hemoptysis (aOR 1.96, 95% CI: 1.04 - 3.69) p=0.04) and fibrosis on chest x rays (aOR 2.18, 95% CI: 1.16 - 4.10) were significantly associated with recurrent PTB. Hemoptysis, lung parenchymal damage, and patients being older than 45 years of age are significant features of RPTB. Management should focus on risk factors for recurrence, and a more holistic model of care to prevent long term lung injury.

Sections du résumé

BACKGROUND BACKGROUND
Recurrent pulmonary tuberculosis (RPTB) is a growing, important and neglected problem affecting treated TB patients and TB health services across the world, particularly in sub-Saharan Africa. Analyses and identification of differences in clinical features between recurrent PTB and newly diagnosed PTB may lead to improved management recommendations.
METHODS METHODS
Between September 1
RESULTS RESULTS
A total of 312 patients with PTB were enrolled (104 RPTB cases and 208 newly diagnosed controls). Clinically hemoptysis was more common in RPTB compared to controls 28/104 (26.9%) vs 35/208 (16.8%), P = 0.036. Chest pain was significantly less common among patients with RPTB compared to controls 33 (31.7%) vs 92 (44.2%), P = 0.034. A higher proportion of RPTB presented with cavitation 34/104 (32.7%) compared to control 44/208 (21.2%) P = 0.027. The median score for lung pathology was higher among patients with RPTB (50) compared to controls (30); P = 0.001. Lung function of patients with RPTB at diagnosis of index TB were more likely to show mixed restrictive and obstructive pattern 36/104 (34.6%) compared to controls 31/208 (14.9%). p<0.001. Multivariate analysis showed that patients older than 45 years of age (adjusted odds ratio [aOR]: 3.59, 95% CI: 1.38 - 9.32), those with hemoptysis (aOR 1.96, 95% CI: 1.04 - 3.69) p=0.04) and fibrosis on chest x rays (aOR 2.18, 95% CI: 1.16 - 4.10) were significantly associated with recurrent PTB.
CONCLUSIONS CONCLUSIONS
Hemoptysis, lung parenchymal damage, and patients being older than 45 years of age are significant features of RPTB. Management should focus on risk factors for recurrence, and a more holistic model of care to prevent long term lung injury.

Identifiants

DOI: 10.1016/j.ijid.2021.01.071 PMID: 33716197
pubmed: 33716197
pii: S1201-9712(21)00084-9
doi: 10.1016/j.ijid.2021.01.071
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

S33-S39

Informations de copyright

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

Auteurs

Tumaini J Nagu (TJ)

School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania; Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania. Electronic address: jtjoyce20@gmail.com.

Monica A Mboka (MA)

School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania. Electronic address: monicambokatz@gmail.com.

Zuhura F Nkrumbih (ZF)

School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania. Electronic address: znkrumbih@yahoo.com.

Grace Shayo (G)

School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania; Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania. Electronic address: mundibilinga@yahoo.com.

Mucho M Mizinduko (MM)

School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Electronic address: mmizinduko@gmail.com.

Ewaldo V Komba (EV)

School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania; Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania. Electronic address: kombaewaldo@gmail.com.

Markus Maeurer (M)

Champalimaud Centre for the Unknown, Lisbon, Portugal; I Medical Clinic, University of Mainz, Germany. Electronic address: markus.maeurer@fundacaochampalimaud.pt.

Alimuddin Zumla (A)

Division of Infection and Immunity, CCM, University College London, London, United Kingdom; University College London Hospitals NHS Foundation Trust NIHR Biomedical Research Centre, London, United Kingdom. Electronic address: a.i.zumla@gmail.com.

Ferdinand Mugusi (F)

School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania; Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania. Electronic address: fm.mugusi@gmail.com.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Clinical and Imaging Features of Adults with...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Tuberculose pulmonaire › Clinical and Imaging Features of Adults with...