title: Tuberculosis reactivation in referrals to public health clinics in Texas.
abstract: BACKGROUND
  Screening for and treatment of latent tuberculosis infection (LTBI) have been essential components of the TB elimination strategy.
  
  
  METHODS
  To estimate the rate of and to identify risk factors for reactivation TB in patients in Texas with LTBI, we retrospectively analyzed 51,959 patients with LTBI identified in Texas Department of State Health Services TB clinics from 1995 to 2008.
  
  
  RESULTS
  We identified 200 cases of reactivation TB among the 51,959 patients in this database. The overall rate of reactivation TB was 0.038 cases per 100 person-years (95% confidence interval [CI]: 0.032-0.043). The reactivation rate in patients who did not receive a complete treatment was 0.058. The relative risk (RR) for reactivation was higher in men (RR = 1.15; 95% CI: 0.86-1.54), patients older than 50 years (RR = 1.13; 95% CI: 1.04-1.22), African American (RR = 1.21; 95% CI: 1.09-1.34), U.S.-born referrals (RR = 1.4; 95% CI: 1.11-1.76), referrals with abnormal X-rays (RR = 1.07; 95% CI: 1.03-1.12) and patients receiving treatment other than isoniazid (RR = 1.08; 95% CI: 1.03-1.13).
  
  
  CONCLUSIONS
  The current rate of reactivation TB in Texas is much lower than rates reported in the United States in the 1950s. Certain patients are at increased risk for reactivation and should be monitored more closely during LTBI therapy.
authors: Department of Internal Medicine (HMA, KM), Texas Tech University Health Sciences Center, Lubbock, Texas; and Department of Internal Medicine (PL), University of Rochester Medical Center, Rochester, New York.
authors: Hoda
authors: H
authors: Mojazi-Amiri
authors: Panupong
authors: P
authors: Larppanichpoonphol
authors: Kenneth
authors: K
authors: Nugent
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000554:Ambulatory Care Facilities; D000995:Antitubercular Agents / Q000145:classification / Q000627:therapeutic use; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D055985:Latent Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013781:Texas / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents