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Factors Involved in Tuberculosis Recurrence in a Low-incidence Setting; Reactivation Predominates Over Reinfection in
Xunxiao Lin1,2, Daniel Ibarz1,2, Alberto Cebollada3
1Grupo de Genética de Micobacterias, Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain.
Open Forum Infectious Diseases
|March 18, 2026
Summary
Tuberculosis (TB) recurrence is rare in low-incidence areas, primarily due to reactivation. Reinfections, though less common, are linked to factors like mobility and HIV, highlighting the need for ongoing surveillance.
Area of Science:
- Epidemiology
- Infectious Diseases
- Molecular Biology
Background:
- Tuberculosis (TB) recurrence is a global health issue, even in low-incidence regions.
- Recurrence can stem from endogenous reactivation or exogenous reinfection.
- Differentiating recurrence mechanisms is vital for effective TB control.
Purpose of the Study:
- To determine the frequency of TB recurrence in Aragón, Spain (a low-incidence area).
- To identify factors associated with TB reactivation and reinfection over 30 years.
Main Methods:
- Retrospective analysis of genotyped Mycobacterium tuberculosis isolates (1993-2022).
- IS6110-RFLP genotyping used to classify recurrences as reactivation or reinfection.
- Clinical and epidemiological data were collected and statistically analyzed.
Main Results:
- Overall recurrence rate was 2.30% (81/3510 cases), with reactivation at 1.93% and reinfection at 0.42%.
- Reinfection was associated with residential changes, HIV, cancer, and multimorbidity.
- Recurrence time was longer for reinfections (7.0 years) than reactivations (2.0 years).
Conclusions:
- TB recurrence is infrequent in low-incidence settings, predominantly reactivation.
- Reinfection is less common but linked to mobility, HIV, and compromised health.
- Long-term molecular surveillance and targeted patient follow-up are essential.
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