[Predictive factors for recurrence of pulmonary tuberculosis in Tunisia: a retrospective study]

Tuberculosis is still endemic in Tunisia. Even though recurrent TB (RT) is rare, there is an increased risk of resistance. The purpose of this study is to investigate predictors of RT.

This was a case controlled retrospective study, comparing two groups of patients with confirmed pulmonary tuberculosis: a relapse group (GR) of 64 patients with RT and a control group (GT) of 105 patients.

Between September 1995 and December 2007, the incidence of RT was 9.48%. All the patients were male. There was no difference in the average age of the two groups. A smoking history of greater than 20 pack-years was more common in the GR (44.89% versus 21.4%, P=0.055). No difference was found regarding the history and clinical signs except that chest pain and dyspnoea were more frequent in the GR. A low haemoglobin was more common in the GR (11.33 ± 1.57g/dL versus 12.41 ± 1.66g/dL, P=0.008). The tuberculin skin test was negative in 73.7% of GR versus 31.1% of GT (P=0.001). Adverse liver reactions are more frequent in the GR (27.3% versus 8.6%, P<0.05). Discontinuation of TB treatment was more common in the GR (36.7% versus 3.8%, P<0.001). The achievement of sputum negativity was delayed in the GR (46.32 ± 54.01 versus 9.35 ± 11.84 days, P<0.001). Despite this, we have noted no significant difference in drug resistance. In multivariate analysis, hepatic cytolysis and a negative tuberculin skin test were independent predictive factors for RT.

All tuberculous patients should have a carefully adapted treatment regimen, particularly the presence of factors predictive for recurrence.