Drug-resistant tuberculosis in patients with minimal symptoms: favourable outcomes in the absence of treatment

作者：Loveday M; Ramjee A; O**urn G; Master I; Kabera G; Brust J C M; Padayatchi N; Warren R; Theron G

来源：International Journal of Tuberculosis and Lung Disease, 2017, 21(5): 556-563.

DOI：10.5588/ijtld.16.0779

• asymptomatic
• management
• human immunodeficiency virus

SETTING: Referral hospital for drug-resistant tuberculosis (DR-TB) in KwaZulu-Natal Province, South Africa.
OBJECTIVE: 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.
RESULTS: 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.
CONCLUSION: 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.

• 出版日期2017-5