Published ahead of print on April 14, 2005, doi:10.1164/rccm.200409-1200OC
Am. J. Respir. Crit. Care Med., Volume 171, Number 12, June 2005, 1430-1435
A more recent version of this article appeared on June 15, 2005
Submitted on September 14, 2004
Accepted on April 6, 2005
Rate of Reinfection TB After Successful Treatment is Higher than the Rate of New TB
Suzanne Verver1*, Robin M Warren2, Nulda Beyers3, Madalene Richardson2, Gian D van der Spuy2, Martien W Borgdorff4, Donald A Enarson5, Marcel A Behr6, and Paul D van Helden2
1 Department of Pediatrics and Child Health, Stellenbosch University, Desmond Tutu TB Center, Cape Town, South Africa; KNCV Tuberculosis Foundation, The Hague, The Netherlands,
2 Department of Medical Biochemistry, Stellenbosch University, MCR Center for Molecular and Cellular Biology, Cape Town, South Africa,
3 Department of Pediatrics and Child Health, Stellenbosch University, Desmond Tutu TB Center, Cape Town, South Africa,
4 KNCV Tuberculosis Foundation, The Hague, The Netherlands; Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands,
5 International Union Against Tuberculosis and Lung Diseases (IUATLD), Paris, France,
6 Department of Medicine, Division of Infectious Diseases, McGill University Health Center, Montreal, Quebec, Canada
* To whom correspondence should be addressed. E-mail: ververs{at}kncvtbc.nl.
Rationale. In a high tuberculosis incidence area of Cape Town, South Africa, there is a very high rate of unexplained recurrent tuberculosis. The incidence of new bacteriologically confirmed disease in the area is 313/100,000.
Objective. To estimate the rate of recurrent tuberculosis attributable to reinfection after successful treatment.
Methods. All reported TB patients in the area between 1993-1998 were followed-up to 2001 for disease needing retreatment (recurrences). Patients who were multi-drug resistant, who had treatment failure, were transferred or died during treatment, were excluded. Analysis was restricted to patients for whom DNA fingerprinting of their Mycobacterium tuberculosis isolates was obtained Reinfection tuberculosis was defined as a recurrent TB episode in which the strains of the separate episodes differed by more than 4 bands.
Measurements and main results. 612/897 (68%) patients had a DNA fingerprint available at enrollment. Median duration of follow-up was 5.2 years. Recurrent TB occurred in 108/612 (18%) patients, of whom in 61/447 (14%) after successful treatment, and in 47/165 (28%) after default. Of the 108 patients with recurrent tuberculosis 68 (63%) had a DNA fingerprint in the second episode. Among these patients, 24/31 (77%) recurrences after successful treatment and 4/37 (11%) recurrences after default were attributable to reinfection. The reinfection disease rate after successful treatment was estimated at 2.2/100 person-years.
Conclusions. The age-adjusted incidence rate of tuberculosis attributable to reinfection after successful treatment was four times that of new tuberculosis. People who had tuberculosis once are at a strongly increased risk of developing tuberculosis when reinfected.
Key words: molecular epidemiology, recurrence, incidence, survival analysis, Mycobacterium tuberculosis
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Copyright © 2005 American Thoracic Society
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