title: Tuberculosis-related deaths within a well-functioning DOTS control program.
abstract: 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.
authors.affiliation: Instituto Nacional de Salud Pública, Cuernavaca, México. garcigar@correo.insp.mx
authors.forename: Maria De Lourdes
authors.initials: Mde L
authors.lastname: García-García
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ponce-De-León
authors.forename: Maria Cecilia
authors.initials: MC
authors.lastname: García-Sancho
authors.forename: Leticia
authors.initials: L
authors.lastname: Ferreyra-Reyes
authors.forename: Manuel
authors.initials: M
authors.lastname: Palacios-Martínez
authors.forename: Javier
authors.initials: J
authors.lastname: Fuentes
authors.forename: Midori
authors.initials: M
authors.lastname: Kato-Maeda
authors.forename: Miriam
authors.initials: M
authors.lastname: Bobadilla
authors.forename: Peter
authors.initials: P
authors.lastname: Small
authors.forename: José
authors.initials: J
authors.lastname: Sifuentes-Osornio
mesh_terms: 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
chemical_list: D000995:Antitubercular Agents