الملخص
Tuberculosis (TB) is a major health problem in Nigeria. The country is currently fourth among the 22 highburden countries (HBCs) of the world, with an incident of all new cases of 311/100,000 population per year out of which 137/100,000 population are smear positive and prevalence of 616/100,000 population. To highlight the burden of re-treatment smear positive pulmonary TB with and without HIV infection and determine how Directly Observed Therapy (DOT) using the re-treatment regimen has affected the treatment outcome in the management of these patients. A Five-year retrospective study from April 2003 to March 2008 to evaluate the treatment outcome data of re-treatment pulmonary TB who were also screened and confirmed for HIV at the outpatient clinic of the University College Hospital Ibadan, Nigeria. The effect of HIV status and treatment outcome was assessed so also the prevalence of HIV among recurrent PTB patients. The total number of cases assessed was 127. Majority of the patients were between the ages of 20 to 49(73.2%). Forty-two of the PTB patients were HIV positive (33.1%). The treatment outcome was as follows: Cured 81(63.8); Treatment completed 13(10.2%); Died 22(17.3%); Defaulted four (3.1%) and transferred out seven (5.5%) More patients were cured and had treatment completion among the HIV negative patients compared with HIV positive patients (p<0.0001) The mortality was higher in those with HIV positive than negative patients (p <0.0001). Re-treatment pulmonary TB is frequent at this referral centre. A contribution to re-treatment prevention entails more rigorous management of new TB cases, particularly at lower levels of care. This effort will reduce the emergence of multi-drug resistant (MDR-TB) tuberculosis
Keywords: Tuberculosis; pulmonary; re-treatment; HIV prevalence and clinical outcome
Résumé
La tuberculose est un problème de santé majeur au Nigeria. Le pays est actuellement le quatrième parmi les 22 pays les plus attaques dans le monde, avec un incident de tout les nouveaux cas de 311/ 100 000 population par an desquels 137/100 000 population sont détectés positif et la prévalence de 616/100 000 population. Pour illuminer la souffrance des cas d’échecs des la tuberculose pulmonaire ayant les lames positives avec ou sans infection du VIH et déterminer comment une thérapie directement observée utilisant le régiment de retraitement avait affecte le résultat du traitement dans le management de ces patients. Une étude rétrospective de 5 ans (de Avril 2003 à Mars 2008) pour évaluer les données des résultats du retraitement pulmonaire de tuberculose qui
était aussi testés et confirmés séropositifs au Collège Hospitalier Universitaire Ibadan, Nigeria. L’effet du status sérologique et les résultats des traitements étaient déterminé, ainsi que la prévalence du VIH parmi les Patients Tuberculeux récurrents. Le nombre total des cas étudié était de 127. la majorité des patients était âgée de 20 à 49 (73.2%). Quarante deux des PTB était séropositifs (33.1%). Les résultats des traitements étaient tel qu’il suit: guéris 81 (63.8%); traitement complet 13 (10.2%); décédés 22 (17.3%); défectueux quatre (3.1%) et transférés ailleurs sept (5.5%). La plupart des patients était guéris et recevait des traitements complémentaires parmi les patients séronégatifs comparé aux patients séropositifs (p<,0.0001). Le taux de mortalité était plus élevé chez les patients séropositifs que chez ceux séronégatifs (p<0.0001). Le retraitement de la tuberculose pulmonaire est fréquent dans ce centre de référence. La contribution du retraitement de prévention demande un management plus rigoureux des nouveaux cas de TB, particulièrement à un niveau bas des soins. Cet effort va réduire l’émergence des souches résistantes a plusieurs antituberculeux.
Correspondence: Dr. OM Ige, Pulmonary Unit, Department of Medicine, University College Hospital, Ibadan, Nigeria. Email: olusojiige@yahoo.com.
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