title: Drug-resistant tuberculosis in patients with minimal symptoms: favourable outcomes in the absence of treatment.
abstract: Referral hospital for drug-resistant tuberculosis (DR-TB) in KwaZulu-Natal Province, South Africa.
  
  
  
  To review the clinical outcomes of patients (age  14 years) with a laboratory-confirmed diagnosis of DR-TB who had minimal symptoms and/or did not have chest radiographic evidence of active disease at referral. These patients were not started on treatment, but were enrolled in an observation programme with follow-up at 2, 6 and 12 months.
  
  
  
  Of 3345 referred patients diagnosed with DR-TB, 192 (6%) were enrolled in the observation programme. The median duration from initial sputum collection in primary care to examination at our hospital was 92 days (IQR 64-124). After 12 months, 120 (62%) patients were well, 36 (19%) were lost to follow-up, 30 (16%) had deteriorated and were started on second-line anti-tuberculosis treatment and 6 (3%) had died. Bilateral disease (OR 4.25, 95%CI 1.14-15.77, P = 0.030) and previous TB (OR 2.14, 95%CI 1.10-4.19, P = 0.026) were independent predictors of an unfavourable end result in a multivariate model.
  
  
  
  In our high-burden setting, most patients diagnosed with DR-TB who had minimal symptoms at referral remained well without treatment. Longitudinal observation, coupled with symptom checking and chest radiograph, is a viable strategy.
authors.affiliation: South African Medical Research Council (SAMRC), Cape Town.
authors.forename: M
authors.initials: M
authors.lastname: Loveday
authors.affiliation: King Dinuzulu Hospital, KwaZulu-Natal Department of Health, Durban.
authors.forename: A
authors.initials: A
authors.lastname: Ramjee
authors.affiliation: King Dinuzulu Hospital, KwaZulu-Natal Department of Health, Durban.
authors.forename: G
authors.initials: G
authors.lastname: Osburn
authors.affiliation: King Dinuzulu Hospital, KwaZulu-Natal Department of Health, Durban.
authors.forename: I
authors.initials: I
authors.lastname: Master
authors.affiliation: South African Medical Research Council (SAMRC), Cape Town, Department of Statistics, University of South Africa, Pretoria, South Africa.
authors.forename: G
authors.initials: G
authors.lastname: Kabera
authors.affiliation: Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: J C M
authors.initials: JC
authors.lastname: Brust
authors.affiliation: Centre for the AIDS Programme of Research in South Africa, SAMRC Extramural TB-HIV Pathogenesis Unit, Durban.
authors.forename: N
authors.initials: N
authors.lastname: Padayatchi
authors.affiliation: Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Warren
authors.affiliation: Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: G
authors.initials: G
authors.lastname: Theron
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D059012:Lost to Follow-Up; D008297:Male; D015999:Multivariate Analysis; D011320:Primary Health Care; D012017:Referral and Consultation; D013019:South Africa; D013183:Sputum / Q000382:microbiology*; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000628:therapy*; D057832:Watchful Waiting / Q000379:methods*