Emerging Infectious Diseases (Nov 2002)

Tuberculosis-Related Deaths within a Well-Functioning DOTS Control Program

  • Maria de Lourdes García-García,
  • Alfredo Ponce-de-León,
  • Maria Cecilia García-Sancho,
  • Leticia Ferreyra-Reyes,
  • Manuel Palacios-Martínez,
  • Javier Fuentes,
  • Midori Kato-Maeda,
  • Miriam Bobadilla,
  • Peter Small,
  • Jose Sifuentes-Osornio

DOI
https://doi.org/10.3201/eid0811.020021
Journal volume & issue
Vol. 8, no. 11
pp. 1327 – 1333

Abstract

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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.

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