Why do our patients die of active tuberculosis in the era of effective therapy?

Zafran, Noah; Heldal, Einar; Pavlovic, Slobodan; Vuckovic, Dejan; J, Bøe

doi:10.1016/0962-8479(94)90077-9

Cited by 37 publications

(28 citation statements)

References 10 publications

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“…14,17,20 Higher TB risk seen among the elderly was probably due their lower immunity, more diffi cult diagnosis of TB as well as to the fact that older cohorts were more exposed to infection in the past. 22 Higher TB death rates found among migrants from other Brazilian regions may be because they are usually older, 2,5 belong to the poorest segments of society and come from areas with high TB prevalence. 3 High TB prevalence among patients with diabetes, chronic obstructive pulmonary disease, smokers and those with past history of alcohol abuse suggest that biological, socioeconomic, and behavioral factors played a role in increasing their vulnerability and favored TB progressing to more severe forms and death.…”

Section: Discussionmentioning

confidence: 99%

Perfil de pacientes que evoluem para óbito por tuberculose no município de São Paulo, 2002

et al. 2008

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RESULTS:Of all tuberculosis deaths identifi ed, 78% had pulmonary form. Tuberculosis diagnosis was made after death in 30% and in primary health care units in 14%. Of them, 44% had not started treatment; 49% were not notifi ed; and 76% were men. The median age was 51 years; 52% had up to four years of schooling; 4% were probably living in the streets. Mortality rate increased with age; it was 5.0/100,000 for the entire city, ranging between zero to 35 according to the district. Previous treatment was reported for 82 out of 232 patients, and of them, 41 defaulted treatment. Diabetes (16%), chronic obstructive pulmonary disease (19%), HIV infection (11%), smoking (71%), and alcohol abuse (64%) were also reported. CONCLUSIONS:Adult males over 50, migrants and living in lower Human Development Index districts were more likely to die of tuberculosis. Low schooling and comorbidities are relevant characteristics. Low involvement of primary care units in tuberculosis diagnosis and high underreporting of cases were also seen.

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Section: Discussionmentioning

confidence: 99%

Perfil de pacientes que evoluem para óbito por tuberculose no município de São Paulo, 2002

et al. 2008

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“…A long delay in diagnosis was identified in 36.7% of the patients in an English hospital necropsy study (10). A large autopsy review of patients who died from TB in a Yugoslavian hospital for lung diseases found that late detection of TB was the main contributor to the TB fatalities (12). A study from New York City looking at newly diagnosed TB cases found that over the following 42 months, most HIV-infected patients whose anti-TB treatment was delayed died (13).…”

Section: Discussionmentioning

confidence: 99%

Patients with tuberculosis in Bolivia: why do they die?

Ollé-Goig¹

2000

Rev Panam Salud Publica

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“…(3)(4)(5)(6)(7)(8)(9) Finally, although the treatment does not differ from that for young adults, some measures should be taken into consideration during chemotherapy: dosage proportional to the weight; monitoring of the hepatic and renal functions; drug interactions; and direct or indirect supervision of the treatment. (4,9) The objective of this study was to increase the knowledge of the principal therapeutic aspects of pulmonary tuberculosis in elderly patients. To that end, we describe the frequency of smoking/alcoholism, the occurrence of concomitant diseases, and the severity of the adverse effects of treatment with regimen I (two months of rifampicin+i soniazid+pyrazinamide followed by four months of rifampicin+isoniazid), as well as the clinical profiles Table 1.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, in the last few years, various studies on clinical presentation, diagnostic methods, chemoprophylaxis, and antituberculosis chemotherapy in old age were organized to help understand this phenomenon. (3)(4)(5)(6)(7)(8)(9) Finally, although the treatment does not differ from that for young adults, some measures should be taken into consideration during chemotherapy: dosage proportional to the weight; monitoring of the hepatic and renal functions; drug interactions; and direct or indirect supervision of the treatment. (4,9) The objective of this study was to increase the knowledge of the principal therapeutic aspects of pulmonary tuberculosis in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Análise do tratamento da tuberculose pulmonar em idosos de um hospital universitário do Rio de Janeiro, RJ, Brasil

2007

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Objective: To describe the clinical and therapeutic aspects of pulmonary tuberculosis and compare the adverse effects of the treatment and its outcome in elderly and nonelderly patients. Methods: This was a case-control study of 117 elderly individuals (over the age of 60 years) and 464 nonelderly individuals (aged 15-49 years). All subjects presented pulmonary tuberculosis that had been diagnosed and treated at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro between 1980 and 1996. Results: In the elderly group, pulmonary tuberculosis was found to be correlated with diabetes (OR = 3.98; 95% CI = 2.07-7.65; p = 0.001), lung disease (OR = 7.24; 95% CI = 3.64-14.46; p = 0.001) and heart disease (OR = 5.86; 95% CI = 2.88-11.95; p = 0.001). Smoking (OR = 2.07; 95% CI = 1.26-3.42; p = 0.002) and alcohol abuse (OR = 1.63; 95% CI = 1.01-2.68; p = 0.041) were also more common in the elderly group. In the elderly group, the treatment more frequently resulted in adverse reactions (OR = 1.62; 95% CI = 1.04-2.54; p = 0.024), especially gastrointestinal reactions (OR = 1.64; 95% CI = 1.01-2.77; p = 0.047), and treatment efficacy was lower: cure rate, 51%; mortality rate, 24%. Treatment adherence was low (approximately 77%) in both groups. Conclusions: In the elderly group, adverse reactions were more common, treatment outcomes were less favorable, there was a greater frequency of clinical complications and deaths related to drug toxicity, and the prevalence of concomitant diseases was higher.

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Why do our patients die of active tuberculosis in the era of effective therapy?

Cited by 37 publications

References 10 publications

Perfil de pacientes que evoluem para óbito por tuberculose no município de São Paulo, 2002

Perfil de pacientes que evoluem para óbito por tuberculose no município de São Paulo, 2002

Patients with tuberculosis in Bolivia: why do they die?

Análise do tratamento da tuberculose pulmonar em idosos de um hospital universitário do Rio de Janeiro, RJ, Brasil

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