Recurrent tuberculosis in an urban area in China: Relapse or exogenous reinfection? - 18/04/17

Doi : 10.1016/j.tube.2017.01.007

Xin Shen ^a,^b,^{^{2
These authors contributed equally to this article.}}, Chongguang Yang ^b,^d,^{^{2
These authors contributed equally to this article.}}, Jie Wu ^a, Senlin Lin ^a, Xu Gao ^b,^{^{1
Current address. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120 Heidelberg, Germany.}}, Zheyuan Wu ^a, Jiyun Tian ^b, Mingyu Gan ^b, Tao Luo ^b, Lili Wang ^a, Chenlei Yu ^a, Jian Mei ^a, Qichao Pan ^a, Kathryn DeRiemer ^c,^⁎,^{^{3
These senior authors contributed equally to this article.}} , ZhengAn Yuan ^a,^⁎,^{^{3
These senior authors contributed equally to this article.}} , Qian Gao ^b,^⁎,^{^{3
These senior authors contributed equally to this article.}}
^a Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
^b The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China
^c School of Medicine, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA
^d Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06510, USA

^∗Corresponding author. The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China.The Key Laboratory of Medical Molecular Virology of Ministries of Education and HealthInstitutes of Biomedical Sciences and Institute of Medical MicrobiologySchool of Basic Medical ScienceFudan University138 Yi Xue Yuan RoadShanghai200032China^∗∗Corresponding author. Departments of Public Health Sciences, and Medical Microbiology and Immunology, School of Medicine, University of California, Davis, One Shields Avenue, Davis, CA, 95616, United States.Departments of Public Health Sciences, and Medical Microbiology and ImmunologySchool of MedicineUniversity of California, DavisOne Shields AvenueDavisCA95616United States^∗∗∗Corresponding author. Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China.Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention1380 West Zhong Shan RoadShanghai200336China

Abstract

Recurrent tuberculosis is an important indicator of the effectiveness of tuberculosis control and can occur by relapse or exogenous reinfection. We conducted a retrospective cohort study on all bacteriologically confirmed tuberculosis cases that were successfully treated between 2000 and 2012 in Shanghai, an urban area with a high number but a low prevalence rate of tuberculosis cases and a low prevalence of HIV infection. Genotyping the Mycobacterium tuberculosis from clinical isolates was used to distinguish between relapse and reinfection. In total, 5.3% (710/13,417) of successfully treated cases had a recurrence, a rate of 7.55 (95% CI 7.01–8.13) episodes per 1000 person-years, more than 18 times the rate of tuberculosis in the general population. Patients who were male, age 30–59, retreatment cases, had cavitation, diabetes, drug-resistant or multidrug-resistant tuberculosis in their initial episode of tuberculosis, were at high risk for a recurrence. Among 141 recurrent cases that had paired isolates, 59 (41.8%) had different genotypes, indicating reinfection with a different strain. Patients who completed treatment were still at high risk of another episode of tuberculosis and exogenous reinfection contributed a significant proportion of the recurrent tuberculosis cases. Targeted control strategies are needed to prevent new tuberculosis infections in this setting.

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Keywords : Tuberculosis, Recurrence, Exogenous reinfection, China

Plan

Introduction

Patients and methods

Study setting and population

Data linkage and definitions

Classification of relapse and reinfection

Statistical analysis

Ethics statement

Results

Frequency and description of recurrences

Risk factors associated with recurrence

Classification of relapse and exogenous reinfection

Risk factors associated with relapse and exogenous reinfection

Discussion

Funding

Role of the funding source

Conflict of interest statement

Author contribution

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Vol 103

P. 97-104 - mars 2017 Retour au numéro

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Recurrent tuberculosis in an urban area in China: Relapse or exogenous reinfection? - 18/04/17

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