title: Mortality rates and recurrent rates of tuberculosis in patients with smear-negative pulmonary tuberculosis and tuberculous pleural effusion who have completed treatment.
abstract: METHODS
  Queen Elizabeth Central Hospital, Blantyre, and Zomba Central Hospital, Zomba, Malawi.
  
  
  OBJECTIVE
  To follow-up human immunodeficiency virus (HIV) seropositive and HIV-seronegative patients with smear-negative pulmonary tuberculosis (PTB) and pleural TB who had completed treatment with two different regimens in Blantyre and Zomba, and to assess rates of mortality and recurrent TB.
  
  
  METHODS
  Patients with smear-negative and pleural TB who had completed 8 months ambulatory treatment in Blantyre or 12 months standard treatment in Zomba and who were smear and culture negative for acid-fast bacilli at the completion of treatment were actively followed every 4 months for a total of 20 months.
  
  
  RESULTS
  Of 248 patients, 150 with smear-negative PTB and 98 with pleural TB, who completed treatment and were enrolled, 205 (83%) were HIV-positive. At 20 months, 145 (58%) patients were alive, 85 (34%) had died and 18 (7%) had transferred out of the district. The mortality rate was 25.7 per 100 person-years, with increased rates strongly associated with HIV infection and age >45 years. Forty-nine patients developed recurrent TB. The recurrence rate of TB was 16.1 per 100 person-years, with increased rates strongly associated with HIV infection, having smear-negative PTB and having received 'standard treatment'.
  
  
  CONCLUSIONS
  High rates of mortality and recurrent TB were found in patients with smear-negative PTB and pleural effusion during 20 months of follow-up. TB programmes in sub-Saharan Africa must consider appropriate interventions, such as co-trimoxazole and secondary isoniazid prophylaxis, to reduce these adverse outcomes.
authors.affiliation: College of Medicine, Chichiri, Blantyre.
authors.forename: H
authors.initials: H
authors.lastname: Banda
authors.forename: C
authors.initials: C
authors.lastname: Kang'ombe
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.forename: D S
authors.initials: DS
authors.lastname: Nyangulu
authors.forename: C J
authors.initials: CJ
authors.lastname: Whitty
authors.forename: J J
authors.initials: JJ
authors.lastname: Wirima
authors.forename: F M
authors.initials: FM
authors.lastname: Salaniponi
authors.forename: D
authors.initials: D
authors.lastname: Maher
authors.forename: P
authors.initials: P
authors.lastname: Nunn
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000382:microbiology; D006801:Humans; D016867:Immunocompromised Host; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000382:microbiology*; D012008:Recurrence; D012698:Serologic Tests; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000401:mortality*
chemical_list: D000995:Antitubercular Agents