@article {Rosser:2018:1027-3719:139,
title = "Recurrent tuberculosis in the pre-elimination era",
journal = "The International Journal of Tuberculosis and Lung Disease",
parent_itemid = "infobike://iuatld/ijtld",
publishercode ="iuatld",
year = "2018",
volume = "22",
number = "2",
publication date ="2018-02-01T00:00:00",
pages = "139-150",
itemtype = "ARTICLE",
issn = "1027-3719",
eissn = "1815-7920",
url = "https://www.ingentaconnect.com/content/iuatld/ijtld/2018/00000022/00000002/art00006",
doi = "doi:10.5588/ijtld.17.0590",
keyword = "low burden, Mycobacterium tuberculosis, relapse, re-infection, recurrence",
author = "Rosser, A. and Marx, F. M. and Pareek, M.",
abstract = "Recurrent tuberculosis (TB), defined as TB that recurs after a patient has been considered cured, constitutes a challenge to TB control. In low TB burden countries, the underlying causes and consequences of recurrent TB are poorly understood. We conducted a literature review to summarise
the evidence of recurrent TB in low-burden settings and to address current gaps in knowledge. We included peer-reviewed publications on studies conducted in countries with an estimated TB incidence of <100 cases per 100000 population. The Newcastle-Ottawa scale was used to assess
study quality. The review yielded 44 manuscripts, 39 of which were reports of observational studies and 5 of clinical trials. The median percentage of TB patients experiencing an episode of recurrent TB after treatment completion was 3.4% (interquartile range [IQR] 1.66.0, range 0.416.7)
in studies with a median follow-up of 7.8 years (IQR 512, range 233). The median percentage of recurrences attributable to endogenous reactivation (rather than exogenous reinfection) was 81% (IQR 73.185.5, range 49100). Commonly identified risk factors for recurrence
in low-burden settings included infection by the human immunodeficiency virus, low socio-economic status, foreign birth and infection with drug-resistant TB. Current understanding of recurrence in low-burden settings is limited, in part due to substantial methodological differences between
studies. Further research is required to delineate the mechanisms of TB recurrence, its health and clinical impact, as well as the implications for TB elimination efforts in low-burden countries.",
}