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Free Content The value of end-of-treatment chest radiograph in predicting pulmonary tuberculosis relapse

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Abstract:

SETTING: Patients with cavitary pulmonary tuberculosis (TB) on baseline chest radiograph (CXR) who remain culture-positive after 8 weeks of treatment are at high risk of relapse. The role of end-of-treatment (EOT) CXR in predicting relapse is unclear.

OBJECTIVE: To determine whether EOT CXR independently predicts TB relapse.

DESIGN: We conducted a secondary analysis of a randomized trial of intermittent treatment using rifapentine in the continuation phase of TB treatment among 1004 human immunodeficiency virus seronegative adults with culture-proven pulmonary TB.

RESULTS: Relapse occurred in 17.3% of subjects with persistent cavity on EOT CXR, in 7.6% of subjects with a cavity that resolved by EOT, and 2.5% (P = 0.002 for trend) of subjects who never had a cavity. In multivariable analysis, patients with persistent cavity on EOT CXR were significantly more likely to relapse than patients with no cavity on baseline or 2-month CXR (hazard ratio [HR] 4.22, 95%CI 2.00–8.91), and were more likely to relapse than subjects whose early cavity had resolved by EOT CXR (HR 1.92, 95%CI 1.09–3.39).

CONCLUSION: A persistent cavity after 6 months of TB treatment was independently associated with disease relapse after controlling for other variables. EOT CXR may help predict those likely to relapse.

Keywords: chest radiograph; relapse; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Division of Infectious Diseases & International Health, Duke University Medical Center and the Durham Veterans' Affairs Medical Center, Durham, North Carolina, USA 2: Division of Chest Radiography, Duke University Medical Center, Durham, North Carolina, USA 3: Montreal Chest Institute, McGill University, Montreal, Quebec, Canada 4: Division of Pulmonary Allergy & Critical Care Medicine, Columbia University College of Physicians & Surgeons, New York, New York, USA 5: Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 6: Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio, USA

Publication date: September 1, 2008

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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