Document details

Predictors and outcomes of disseminated tuberculosis in an intermediate burden setting

Author(s): Meira, L. ; Chaves, Catarina ; Araújo, D. ; Almeida, L. ; Boaventura, R. ; Ramos, A. ; Carvalho, T. ; Osório, Nuno S. ; Castro, António G. ; Rodrigues, Fernando José dos Santos ; Guimarães, J. T. ; Saraiva, M. ; Bastos, H. N.

Date: 2019

Persistent ID: https://hdl.handle.net/1822/62302

Origin: RepositóriUM - Universidade do Minho

Subject(s): Mycobacterium tuberculosis; Disseminated tuberculosis; Risk factors; Outcome; Science & Technology


Description

Setting: University-affiliated hospital located in Porto, North Portugal, an area with a low to intermediate incidence of tuberculosis (TB). Objective: To identify predictors and outcomes of disseminated TB (dTB). Design: A cohort of patients diagnosed with TB between 2007 and 2013 was retrospectively analysed. Patients with dTB criteria were characterized and compared to single organ TB cases. Factors independently associated with dTB were determined by multivariate logistic regression analysis. Results: A total of 744 patients were analysed, including 145 with dTB. Independent risk factors for dTB were pharmacological immunosuppression (OR 5.6, 95% CI 2.8–11.3), HIV infection (OR 5.1, 95% CI 3.1–8.3), chronic liver failure or cirrhosis (OR 2.3, 95% CI 1.4–4.1) and duration of symptoms (OR 2.3, 95% CI 1.4–3.8). Compared to single organ TB, the clinical presentation of dTB patients differed by the absence of haemoptysis (OR 3.2, 95% CI 1.3–8.4) and of dyspnoea (OR 1.9, 95% CI 1.2–3.1), presence of weight loss (OR 1.8, 95% CI 1.1–2.9), night sweats (OR 1.7, 95% CI 1.1–2.7) and bilateral lung involvement (OR 4.4, 95% CI 2.8–7.1). Mortality and time until culture conversion were higher for dTB patients, although not reaching statistical significance. Conclusion: Immunosuppressive conditions and chronic liver failure or cirrhosis were associated with increased risk of dTB. The haematogenous spread may be dependent on longer symptomatic disease and usually progresses with bilateral lung involvement.

HNB acknowledges the receipt of research scholarships from Bolsa D. Manuel de Mello and the Portuguese Society for Pneumology. NSO acknowledges FCT IF/00474/2014. The MS lab is financed by FEDER --- Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020 --- Operational Programme for Competitiveness and Internationalisation (POCI), Portugal 2020, and by Portuguese funds through FCT in the framework of the project ‘‘Institute for Research and Innovation in Health Sciences’’ (POCI-01-0145-FEDER-007274).

Document Type Journal article
Language English
Contributor(s) Universidade do Minho
facebook logo  linkedin logo  twitter logo 
mendeley logo

Related documents

No related documents