Tuberculosis in leprosy patients detected between 1902 and 1991 in French Polynesia.
From 1902 onward, notification and follow up of leprosy patients has been systematic in French Polynesia. Since 1960, a tuberculosis control program and a register has also been implemented. From 1902 to 1959, 673 cases of leprosy were detected [346 multibacillary (MB), 138 paucibacillary (PB), and 179 unclassified due to the loss of medical files by the time of classification which was done during the 1980s]. Of these 673 cases, 89 (13.2%) died from tuberculosis, giving a mean annual death rate of tuberculosis in leprosy patients of 232 per 100,000. Mortality from tuberculosis in leprosy patients detected between 1901 and 1930 was 20.7%, and decreased to 8.04% in patients detected from 1931 to 1959. In total, it was estimated that 26.4% of the leprosy cases had developed tuberculosis. From 1960 to 1991, 350 new cases of leprosy were detected (141 MB, 209 PB). Of them, 12 (3.4%) developed tuberculosis (7 before detection of leprosy, 5 after detection of leprosy). The dramatic decrease of the proportion of leprosy patients who developed tuberculosis between the periods 1902-1959 (26.4%) and 1960-1991 (3.4%) might be related to the important decline of the tuberculosis situation since 1960. From 1902 to 1959, mortality from tuberculosis occurred significantly more frequently in MB patients (13%) than in PB patients [4%, relative risk (RR) = 3.21, p = 0.003]. From 1960 to 1991, the incidence of tuberculosis seemed more frequent in MB patients (RR = 2.96, p = 0.07) whatever the sequence of detection of the two diseases. Our study suggests that lepromatous patients could share factors of susceptibility to mycobacterial diseases with patients developing tuberculosis.
Institut Territorial de Récherches Médicales Louis Malardé, Papéete, Tahiti, French Polynesia.
P
P
Glaziou
J L
JL
Cartel
J P
JP
Moulia-Pelat
L N
LN
Ngoc
S
S
Chanteau
R
R
Plichart
J H
JH
Grosset
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D049673:History, 20th Century; D006801:Humans; D015994:Incidence; D015440:Leprosy, Lepromatous / Q000266:history* / Q000401:mortality; D015441:Leprosy, Tuberculoid / Q000266:history* / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D011114:Polynesia / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D014376:Tuberculosis / Q000266:history* / Q000401:mortality