Tuberculosis-related deaths within a well-functioning DOTS control program.
To describe the molecular epidemiology of tuberculosis (TB)-related deaths in a well-managed program in a low-HIV area, we analyzed data from a cohort of 454 pulmonary TB patients recruited between March 1995 and October 2000 in southern Mexico. Patients who were sputum acid-fast bacillus smear positive underwent clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) and received treatment from the local directly observed treatment strategy (DOTS) program. After an average of 2.3 years of follow-up, death was higher for clustered cases (28.6 vs. 7%, p=0.01). Cox analysis revealed that TB-related mortality hazard ratios included treatment default (8.9), multidrug resistance (5.7), recently transmitted TB (4.1), weight loss (3.9), and having less than 6 years of formal education (2). In this community, TB is associated with high mortality rates.
García-García
Maria De Lourdes
Mde L
Instituto Nacional de Salud Pública, Cuernavaca, México. garcigar@correo.insp.mx
Ponce-De-León
Alfredo
A
García-Sancho
Maria Cecilia
MC
Ferreyra-Reyes
Leticia
L
Palacios-Martínez
Manuel
M
Fuentes
Javier
J
Kato-Maeda
Midori
M
Bobadilla
Miriam
M
Small
Peter
P
Sifuentes-Osornio
José
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D016172:DNA Fingerprinting; D023801:Directly Observed Therapy; D024901:Drug Resistance, Multiple, Bacterial; D004493:Education; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D015431:Weight Loss
D000995:Antitubercular Agents