BackgroundExtrapulmonary tuberculosis is likely a marker of underlying immune compromise. Our objective was to determine race and sex differences in extrapulmonary tuberculosis risk in order to identify the optimal population in which to assess for host factors associated with extrapulmonary tuberculosis.MethodsWe performed an observational study of all tuberculosis cases reported to the Tennessee Department of Health, January 1, 2000 to December 31, 2006. We compared the incidence of extrapulmonary tuberculosis by race and sex. We also examined risk factors associated with extrapulmonary disease among all persons with tuberculosis.ResultsExtrapulmonary tuberculosis incidence per 100,000 population was 5.93 in black men, 3.21 in black women, 1.01 in non-black men, and 0.58 in non-black women. Among those with tuberculosis, black women were most likely to have extrapulmonary disease (38.6%), followed by black men (28.1%), non-black women (24.6%) and non-black men (21.1%). In multivariate logistic regression among persons with tuberculosis, black women (OR 1.82 (95% CI 1.24-2.65), p = 0.002), black men (OR 1.54 (95% CI 1.13-2.09, p = 0.006), foreign birth (OR 1.55 (95% CI 1.12-2.14), p = 0.009), and HIV infection (OR 1.45 (95% CI 0.99-2.11), p = 0.06) were associated with extrapulmonary tuberculosis.ConclusionsBlack men and black women had the highest incidence of extrapulmonary tuberculosis, and high odds of extrapulmonary disease among persons with tuberculosis. These data suggest that factors in addition to tuberculosis exposure contribute to extrapulmonary tuberculosis risk in blacks.
Objective
To characterize risk factors for non-completion of treatment for latent tuberculosis infection (LTBI). Secondarily, to assess the impact of LTBI treatment regimen on subsequent risk of tuberculosis.
Methods
Close contacts of adults (≥15 years) with pulmonary tuberculosis were prospectively enrolled in a multi-center study in the U.S. and Canada from January 2002–December 2006. Close contacts to TB patients were screened and cross-matched with tuberculosis registries to identify those who developed active tuberculosis.
Results
Of the 3,238 contacts screened, 1,714 (53%) were diagnosed with LTBI. Preventive therapy was recommended in 1,371 (80%); 1,147 contacts (84%) initiated therapy, of whom 723 (63%) completed treatment. In multivariate analysis, study site, initial interview sites other than a home or healthcare setting, and treatment with isoniazid were significantly associated with LTBI treatment non-completion. Fourteen tuberculosis cases were identified in contacts, all of whom initiated isoniazid. There were two cases among persons who received six or more months of isoniazid (66 cases/100,000 person-years), and nine cases among persons who received 0–5 months (median 2 months) of isoniazid (792 cases/100,000 person-years; p<0.001); data on duration of isoniazid for three cases were not available.
Conclusion
Only 53% (723 of 1,371) of close contacts for whom preventive therapy was recommended actually completed treatment. Close contacts of TB patients were significantly less likely to complete LTBI treatment if they took isoniazid. Less than six months of isoniazid therapy was associated with increased risk of active TB.
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