Treatment outcome of extra-pulmonary tuberculosis in Finland: a cohort study

Treatment outcomes of extrapulmonary tuberculosis in Bahawalpur, Pakistan; a record review

Background

There is limited published data form Pakistan on treatment success rate among extrapulmonary tuberculosis (EPTB) patients. The aim of this study was to assess clinical form, treatment outcomes, and identify the factors associated with unfavorable treatment outcome among EPTB patients.

Methods

A retrospective study was conducted at the Chest Disease Unit of the Bahawal Victoria Hospital, Pakistan. Medical records of EPTB patients, registered at the study site from January 1, 2015 to September 30, 2017, were reviewed to obtain the data. Final treatment outcomes among EPTB patients were evaluated in accordance with the standard Word Health Organization (WHO) criteria. Multivariate binary logistic regression analysis was used to identify the factors associated with unfavorable treatment outcome.

Results

A total of 651 EPTB patients were included in the study. Highest proportion of patients had pleural TB (n = 217, 33.3%). Out of the total 651 patients, 463 (71.1%) successfully completed the treatment. Among 177 (27.2%) patients with unfavorable treatment outcome, 10 (1.5%) died, while 165 (25.4%) lost to follow-up the treatment. Lymph node TB (AOR 0.65, 95% CI 0.422, 0.989) and meningeal TB (AOR 2.1, 95% CI 1.065, 4.144) were significantly associated with unfavorable treatment outcome.

Conclusion

The treatment success (favorable outcome) rate among EPTB patients was less than the target (i.e., ≥ 90%) set by the WHO. Highest proportion of patients lost to follow-up during the treatment.

Extrapulmonary Tuberculosis in Denmark From 2009 to 2014; Characteristics and Predictors for Treatment Outcome

Background

Extrapulmonary tuberculosis (EPTB) represents an increasing percentage of tuberculosis (TB) cases in Europe. However, strategies on TB prevention and successful treatment outcomes primarily target pulmonary TB. In this nationwide study, we present characteristics of EPTB, treatment outcomes, and predictors for unfavorable treatment outcomes.

Methods

All patients diagnosed with EPTB from 2009 to 2014 were included. Logistic regression analyses were used to identify risk factors for unfavorable outcome. The following definitions were used: unfavorable outcome: the sum of treatment failed, lost to follow-up, and not evaluated; patient delay: time from TB-related symptom onset until first hospital contact related to TB; doctor delay: time from first TB-related contact in the health care system to start of TB treatment.

Results

A total of 450 EPTB cases were notified, which represented 21.1% of all TB cases in Denmark. Immigrants accounted for 82.9%. Lymph nodes were the most common site of EPTB (55.4%) followed by pleural TB (13.4%). Patient delay was significantly longer among immigrants than Danes (60 vs 30 days; P < .01), whereas doctor delay was significantly longer among Danes (38.5 vs 28 days; P < .01). Treatment completion rates were high and reached 90.9% in 2014. Male gender (odds ratio [OR], 5.18; 95% confidence interval [CI], 1.79–15.04) and age 0–24 years (OR, 16.39; 95% CI, 2.02–132.64) were significantly associated with unfavorable outcome.

Conclusions

EPTB represented a significant number of all TB cases and was predominantly seen among younger immigrants in Denmark. To maintain high treatment completion rates, increased focus on male gender and young age is needed.

Estimating the impact of tuberculosis anatomical classification on treatment outcomes: A patient and surveillance perspective analysis

Introduction

Tuberculosis anatomical classification is inconsistent in the literature, which limits current tuberculosis knowledge and control. We aimed to evaluate whether tuberculosis classification impacts on treatment outcomes at patient and aggregate level.

Methods

We analyzed adults from São Paulo State, Brazil with newly diagnosed tuberculosis from 2010–2013. We used an extended clinical classification of tuberculosis, categorizing cases as pulmonary, pulmonary and extrapulmonary, extrapulmonary and miliary/disseminated. Our primary outcome was unsuccessful outcome of treatment. To investigate the reported treatment outcome at the aggregate level, we sampled 500 different “countries” from the dataset and compared the impact of pulmonary and extrapulmonary classifications on the reported treatment success.

Results

Of 62,178 patients, 49,999 (80.4%) were pulmonary, 9,026 (14.5%) extrapulmonary, 1,651 (2.7%) pulmonary-extrapulmonary and 1,502 (2.4%) miliary/disseminated. Pulmonary-extrapulmonary cases had similar unsuccessful outcome of treatment compared with pulmonary (adjusted-OR 1.00, 95%CI, 0.88–1.13, p = 0.941), while extrapulmonary were associated with better (adjusted-OR 0.65, 95%CI, 0.60–0.71, p<0.001) and miliary/disseminated with worse outcomes (adjusted-OR 1.51, 95%CI, 1.33–1.71, p<0.001). We found that 60 (12%) countries would report a difference ≥10% in treatment success depending on whether they reported all clinical forms together (current WHO recommendation) or pulmonary forms alone, overestimating the treatment success of pulmonary forms.

Conclusions

The expanded anatomical classification of tuberculosis was strongly associated with treatment outcomes at the patient level. Remarkably, pulmonary with concomitant extrapulmonary forms had similar treatment outcomes compared with pulmonary forms after adjustment for potential confounders. At the aggregate level, reporting treatment success for all clinical forms together might hide differences in progress between pulmonary and extrapulmonary tuberculosis control.

Treatment outcome of extrapulmonary tuberculosis under Revised National Tuberculosis Control Programme

BACKGROUND

Extrapulmonary tuberculosis (EPTB) constitutes 15-20% of tuberculosis cases in India. Earlier studies have evaluated treatment outcomes of EPTB with little information on outcomes of individual site of EPTB.

AIMS

The objective was to study the outcome of Directly Observed Treatment Short course (DOTS) treatment of EPTB in different organ systems under Revised National Tuberculosis Control Programme.

METHODS

Multi-centric retrospectives record review was carried out in three states in India. Data were collected from TB registers and analysed.

RESULTS

Of the total 2219 patients studied, there were more males in age group 15-45. The commonest sites of EPTB were lymph node (34.4%) and pleural effusion (25.2%) followed by abdominal (12.8%) and central nervous system (CNS) (9.4%). Lymph node involvement was more common in females (58%) and pleural effusion in males (70%). Overall treatment completion rate was 84% in EPTB patients. Treatment completion was 86% in HIV negative EPTB patients compared to 66% in HIV positive patients. Individually, treatment completion rate observed as follows: lymph node 90.9%, genitourinary 92.6%, bone and joint 86%, pleural effusion 84.7%, abdominal 76% and CNS (tuberculoma and meningitis) 63.7%. The site of EPTB was not recorded in 173 (7.8%) patients.

CONCLUSION

Treatment outcome of EPTB was poor in HIV infected patients and those with CNS tuberculosis. More efforts are needed to improve the treatment completion rates in these groups of patients.

A retrospective case-control study, factors affecting treatment outcomes for pulmonary tuberculosis in istanbul, Turkey

BACKGROUND

Tuberculosis is a public health problem and its transmission is a threat to the community.

AIMS

The aim of this study was to determine the factors influencing the treatment outcomes and the effectiveness of the National Tuberculosis Program (NTP) in relation to the application of the directly observed treatment, short-course (DOTS) program in various sites in Istanbul, Turkey.

STUDY DESIGN

Case-Control Study.

METHODS

A case-control study was used, where cases and controls were randomly selected from the Turkish Tuberculosis National Database, which includes complete data on treatment outcomes for patients recorded in the database from January 1, 2006 to December 31, 2009 and had one year follow-up.

RESULTS

The case group was composed of 464 patients with adverse outcome, while the control group was composed of 441 patients who had been cured of disease. Factors associated with adverse treatment outcome were >65 years of age (OR: 3.39 (1.99-5.76)) ; male gender (OR:2.11 (1.49-2.99)); born outside Turkey (OR: 5.48 (2.13-14.04)); co-morbidity (OR: 1.85 (1.29-2.65)); bilateral radiologic lesions (OR: 2.07 (1.41-3.00); previous treatment history (OR: 3.99 (2.78-5.74)); 3(rd) month positive microscopy (OR: 4.96 (3.04-8.09)) and any H&R +/- others multidrug resistant (MDR) resistance (OR: 22.64 (6.92-74.08)). There was no association between the adverse treatment outcome and the application site of direct observation treatment, short course (DOTS) delivery and the supervisors.

CONCLUSION

Our findings indicate similar quality in DOTS application and supervision among patients with or without adverse treatment outcomes. However, patients with certain characteristics should be carefully monitored and aggressively treated.