Mortality rates and recurrent rates of tuberculosis in patients with smear-negative pulmonary tuberculosis and tuberculous pleural effusion who have completed treatment

SETTING: Queen Elizabeth Central Hospital, Blantyre, and Zomba Central Hosp ital, Zomba, Malawi. OBJECTIVE: Th follow-up human immunodeficiency virus (HIV) seropositive and HIV-seronegative patients with smear-negative pulmonary tuberculosis (PTB) and pleural TB who had completed treatment with two different regimens in Blantyre and Zomba, and to assess rates of mortality and recurrent TB. DESI GN: patients with smear-negative and pleural TB who had completed 8 months ambulatory treatment in Blantyre or 12 months standard treatment in Zomba a nd who were smear and culture negative for acid-fast bacilli at the complet ion of treatment were actively followed every 4 months for a total of 20 mo nths. RESULTS: Of 248 patients, 150 with smear-negative PTR and 98 with pleural T B, who completed treatment and were enrolled, 205 (83%) were HIV-positive. At 20 months, 145 (58%) patients were alive, 85 (34%) had died and IS (7%) had transferred out of the district. The mortality rate was 25.7 per 100 pe rson-years, with increased rates strongly associated with HIV infection and age >45 years. Forty-nine patients developed recurrent TB. The recurrence rate of TB was 16.1 per 100 person-years, with increased rates strongly ass ociated with HIV infection, having smear-negative PTB and having received ' standard treatment'. CONCLUSION: High rates of mortality and recurrent TB were found in patients with smear-negative PTB and pleural effusion during 20 months of follow-up . TB programmes in sub-Saharan Africa must consider appropriate interventio ns, such as co-trimoxazole and secondary isoniazid prophylaxis, to reduce t hese adverse outcomes.