Original research

Predictors and short-term outcomes of recurrent pulmonary tuberculosis in Kampala, Uganda: A cohort study

N Kalema, C Lindan, D Glidden, S D Yoo, A Andama, W Katagira, P Byanyima, E Musisi, S Kaswabuli, I Sanyu, J Zawedde, C Yoon, I Ayakaka, LJ Davis, L Huang, W Worodria, A Cattamanchi

Abstract


Background. Recurrent tuberculosis (TB) occurring >2 years after completing treatment for a prior TB episode is most often due to reinfection with a new strain of Mycobacterium tuberculosis.

Objectives. We determined the prevalence and outcome of late recurrent TB among hospitalised patients in Kampala, Uganda.

Methods. We conducted a retrospective analysis of patients admitted to Mulago Hospital, who had a cough of >2 weeks’ duration and completed TB treatment >2 years prior to admission. All patients had mycobacterial culture performed on two sputum specimens and vital status ascertained 2 months post enrolment. We performed logistic regression and Cox proportional hazards modelling to identify predictors of recurrent TB and of survival, respectively.

Results. Among 234 patients, 36% (n=84) had recurrent TB. Independent predictors included younger age (adjusted odds ratio (aOR) 0.64, 95% confidence interval (CI) 0.42 - 0.97; p=0.04), chest pain >2 weeks (aOR=3.32; 95% CI 1.38 - 8.02; p=0.007), severe weight loss of ≥5 kg (aOR 4.88; 95% CI 1.66 - 14.29; p=0.004) and the presence of ≥1 WHO danger sign of severe illness (aOR=3.55; 95% CI 1.36 - 9.29; p=0.01). Two-month mortality was 17.8% (95% CI 10.5 - 29.2), and was higher among patients who were not initiated on TB treatment (aHR 16.67; 95% CI 1.18 - 200; p=0.04), those who were HIV-positive and not on antiretroviral treatment (aHR 16.99; 95% CI 1.17 - 246.47; p=0.04) and those with a history of smoking (aHR 1.20; 95% CI 1.03 - 1.40; p=0.02).

Conclusion. The high prevalence of late recurrent TB likely reflects high levels of TB transmission in Kampala. Increased use of empiric TB treatment and early ART treatment initiation if HIV-positive should be considered in patients with a prior history of TB, particularly if they are young, with weight loss ≥5 kg, chest pain >2 weeks or ≥1 WHO danger sign of severe illness.


Authors' affiliations

N Kalema, Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda

C Lindan, Department of Epidemiology and Biostatistics and Global Health Sciences, University of California San Francisco, San Francisco, California, USA

D Glidden, Department of Epidemiology and Biostatistics and Global Health Sciences, University of California San Francisco, San Francisco, California, USA

S D Yoo, Infectious Diseases Research Collaboration, Kampala, Uganda;Department of Internal Medicine, Jimma University, Jimma, Ethiopia

A Andama, Infectious Diseases Research Collaboration, Kampala, Uganda

W Katagira, Infectious Diseases Research Collaboration, Kampala, Uganda

P Byanyima, Infectious Diseases Research Collaboration, Kampala, Uganda

E Musisi, Infectious Diseases Research Collaboration, Kampala, Uganda

S Kaswabuli, Infectious Diseases Research Collaboration, Kampala, Uganda

I Sanyu, Infectious Diseases Research Collaboration, Kampala, Uganda

J Zawedde, Infectious Diseases Research Collaboration, Kampala, Uganda

C Yoon, Infectious Diseases Research Collaboration, Kampala, Uganda;Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA

I Ayakaka, Infectious Diseases Research Collaboration, Kampala, Uganda

LJ Davis, Yale School of Public Health, New Haven, Connecticut, USA;Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA

L Huang, Infectious Diseases Research Collaboration, Kampala, Uganda;Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA;HIV, Infectious Diseases, and Global Medicine Division, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA

W Worodria, Infectious Diseases Research Collaboration, Kampala, Uganda;Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda

A Cattamanchi, Infectious Diseases Research Collaboration, Kampala, Uganda;Department of Epidemiology and Biostatistics and Global Health Sciences, University of California San Francisco, San Francisco, California, USA;Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA

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Cite this article

African Journal of Thoracic and Critical Care Medicine 2017;23(4):106-112. DOI:10.7196/SARJ.2017.v23i4.173

Article History

Date submitted: 2017-12-04
Date published: 2017-12-05

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African Journal of Thoracic and Critical Care Medicine| Online ISSN: 2617-0205

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