Tuberculosis treatment outcome in a tertiary care setting

ABSTRACT

The outcome of chemotherapy for pulmonary, extrapulmonary, and disseminated tuberculosis is not well documented, especially in developing countries. This study assessed tuberculosis treatment outcome, cure-to-treatment ratio and mortality among all types of tuberculosis patients in a tertiary care setting in Saudi Arabia. All cases diagnosed and treated for active Mycobacterium tuberculosis infection between 1991 and 2000 were included retrospectively. Data collected included type of tuberculosis involvement, treatment outcome, relapse, and co-morbidities. Over a ten-year period, 535 cases of tuberculosis were diagnosed and treated. Isolated pulmonary tuberculosis was identified in 141 cases [26.4%], extrapulmonary tuberculosis in 339 cases [63.3%], and combined pulmonary and extrapulmonary disseminated involvements in 55 cases [10.3%]. Co-morbidities were noted in 277 [52%] patients. Immunosuppression was found in 181 [34%] patients. The cure rate was 82%. The cure-to-treatment ratio was 86% in extrapulmonary tuberculosis and 78% in pulmonary tuberculosis, and 65% in disseminated tuberculosis. Overall mortality was 18%. Disseminated tuberculosis had the highest mortality [34.9%], followed by pulmonary [21.8%], then extrapulmonary tuberculosis [13.6%]. Forty-seven percent of all mortalities were directly related to tuberculosis. Relapse was documented in 14 out of 349 patients [4%] who had 24 months of follow up. Despite tertiary care support, complicated tuberculosis carries a high mortality. Earlier diagnosis and complete appropriate chemotherapy are essential for improved outcome: