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Fulltext A retrospective study of death among patients treated for tuberculosis in the Klang Chest Clinic for the year 1999

Venugopalan B, Rajendra P

Med J Malaysia, 2001 Mar;56(1):39-43.
PMID: 11503294

A retrospective epidemiological study was done on 41 deaths among patients treated for TB in the Klang Chest Clinic for the year 1999. The findings revealed a male preponderance of TB deaths with Indians having the highest case fatality rate (8.6%). The majority of deaths occurred within the 25-44 year age group. Of those cases diagnosed as Pulmonary TB, 69% were diagnosed as far-advanced, at presentation, based on chest x-rays reported. Eighty three percent of these patients were still on treatment when they died. HIV was the most common co-existing disease condition and was implicated in 14.6% of the deaths. The recommendations include implementation of clinical guidelines on TB screening for HIV patients, a study to evaluate the effectiveness of the current TB surveillance programme and for chest x-rays of all sputum smear negative patients to be reported by the radiologist to reduce the risk of misdiagnosis.
Study site: Chest clinic, Kelang, Selangor, Malaysia

Matched MeSH terms: Tuberculosis/mortality*
Fulltext A hospital based audit of tuberculosis deaths

Hooi LN, Goh KY

Med J Malaysia, 1995 Dec;50(4):306-13.
PMID: 8668048

An audit was done on 54 tuberculosis patients presenting to Penang Hospital who died during 1993. Active tuberculosis was the cause of death in 29 (53.7%) and 48.3% were aged under 50 years. Tuberculosis was a contributory cause of death in 8 patients and in 17 patients tuberculosis was irrelevant to the cause of death. The diagnosis of tuberculosis was made after death in 17 patients (31.5%). Late diagnosis was the most important factor resulting in death. Only 41.4% of the deaths from active tuberculosis were correctly certified in government hospitals. Medically inspected and certified deaths from tuberculosis is an unreliable indicator of tuberculosis mortality because of inaccuracies in death certification, tuberculosis deaths occurring outside hospital and tuberculosis patients undiagnosed until after death.

Matched MeSH terms: Tuberculosis/mortality*
Epidemiology of tuberculosis and leprosy, Sabah, Malaysia

Dony JF, Ahmad J, Yap KT

Tuberculosis (Edinb), 2004;84(1-2):8-18.
PMID: 14670341 DOI: 10.1016/j.tube.2003.08.002

The objectives in this epidemiology review are to measure and report the extent of morbidity and mortality due to tuberculosis (TB), the proportion of new sputum smear positive cases in districts and the status of cohort analysis as of 1999. As for leprosy, the main objective is to determine morbidity and the treatment outcomes of Multiple Drug Therapy (MDT). Based on the results obtained, a comprehensive action plan for prevention, control and monitoring of tuberculosis and leprosy cases and patients is being produced and implemented throughout the state. The analysis concentrated on patients diagnosed at all out-patient units and admitted in all of the state's hospitals. The patient particulars were recorded using a standardized format based on TB and Leprosy Health Management Information System (TB HMIS). TB was the second highest by notification of communicable diseases in Malaysia in 2001. 29% or about one-third of the national TB cases are from Sabah. However, it has been noted that there was an average decline of 2.6% in annual notification since 10 years ago to date. There was also a reduction of 11.4% in 2001 as compared to annual notification in 2000. Immigrants contribute more than 24% in detection of new cases since 1990. Treatment success rate in term of completion of treatment to date is 82%. Mortality rate has steadily declined from 14 deaths to 7 deaths per 100,000 population. Leprosy in Sabah also contributes to 30% of the yearly total caseload of Malaysia and has the highest notification rate of 2 per every 100,000 population as compared to other states. The average registered leprosy cases over the past 5 years are 239 cases and the prevalence rate is 0.7/10,000 population. The state has successfully achieved its goal to decrease leprosy as per the World Health Organization (WHO) goal of yearly overall prevalence rate of less than 1 case for every 10,000 population. However, the districts of Kudat, Tawau, Lahad Datu, Kota Kinabalu and Semporna are still within the prevalence rate of more than one per 10,000 population. This review highlights some interesting findings which can be incorporated into the State and Districts action plans and strategies. It is also noted that in order to translate National Plans and Strategies into effective action at the community level, health workers need relevant up-to-date knowledge of the pattern of health and disease, and of their determinants, in each district. The Sabah Health Department continues to organize and support programs related to management and control of tuberculosis and leprosy to progressively reduce the incidence of these diseases in the community by breaking the chain of transmission of Mycobacterium tuberculosis and M. leprae, respectively.
Study site: outpatient clinics, inpatients, hospitals, Sabah, Malaysia

Matched MeSH terms: Tuberculosis/mortality
Tuberculosis Incidence and Factors Associated With Mortality Among Health Care Workers in Malaysia

Liew SM, Khoo EM, Ho BK, Lee YK, Mimi O, Fazlina MY, et al.

Asia Pac J Public Health, 2019 01;31(1):61-71.
PMID: 30541329 DOI: 10.1177/1010539518817980

This study aims to determine tuberculosis incidence, all-cause mortality, and its associated factors among health care workers (HCWs) registered in 2012 to 2014 with the Malaysian National Tuberculosis (MyTB) Surveillance Registry. Regression analysis was used to determine factors associated with all-cause mortality. Incidence rates ranged from 135.18 to 156.50/100 000 and were higher for HCWs compared with the general population (risk ratio = 1.70-1.96). The mean age at notification was 34.6 ± 10.55 years; 68.9% were female. Most were paramedics (44.3%) followed by other HCWs (41.9%) and doctors (13.8%). Nearly a quarter (23.8%) had extrapulmonary tuberculosis. There were 23 deaths giving a case fatality rate of 2.4%. Factors associated with death were older age (odds ratio [OR] =1.05; confidence interval [CI] =1.01-1.10), diabetes (OR = 3.83; CI = 1.32-11.08), HIV positivity (OR = 18.16; CI = 4.60-71.68), and not receiving directly observed therapy (DOTS) (OR = 10.97; CI = 3.61-33.38). It is important for HCWs to be aware of these increased risks and for authorities to implement protective measures.

Matched MeSH terms: Tuberculosis/mortality
Fulltext Determinants of unsuccessful treatment outcomes and mortality among tuberculosis patients in Malaysia: A registry-based cohort study

Tok PSK, Liew SM, Wong LP, Razali A, Loganathan T, Chinna K, et al.

PLoS One, 2020;15(4):e0231986.
PMID: 32320443 DOI: 10.1371/journal.pone.0231986

INTRODUCTION: The monitoring of tuberculosis (TB) treatment outcomes and examination of the factors affecting these outcomes are important for evaluation and feedback of the national TB control program. This study aims to assess the TB treatment outcomes among patients registered in the national TB surveillance database in Malaysia from 2014 until 2017 and identify factors associated with unsuccessful treatment outcomes and all-cause mortality.
MATERIALS AND METHODS: Using registry-based secondary data, a retrospective cohort study was conducted. TB patients' sociodemographic characteristics, clinical disease data and treatment outcomes at one-year surveillance were extracted from the database and analyzed. Logistic regression analysis was used to determine factors associated with unsuccessful treatment outcomes and all-cause mortality.
RESULTS: A total of 97,505 TB cases (64.3% males) were included in this study. TB treatment success (cases categorized as cured and completed treatment) was observed in 80.7% of the patients. Among the 19.3% patients with unsuccessful treatment outcomes, 10.2% died, 5.3% were lost to follow-up, 3.6% had outcomes not evaluated while the remaining failed treatment. Unsuccessful TB treatment outcomes were found to be associated with older age, males, foreign nationality, urban dwellers, lower education levels, passive detection of TB cases, absence of bacille Calmette-Guerin (BCG) scar, underlying diabetes mellitus, smoking, extrapulmonary TB, history of previous TB treatment, advanced chest radiography findings and human immunodeficiency virus (HIV) infection. Factors found associated with all-cause mortality were similar except for nationality (higher among Malaysians) and place of residence (higher among rural dwellers), while smoking and history of previous TB treatment were not found to be associated with all-cause mortality.
CONCLUSIONS: This study identified various sociodemographic characteristics and TB disease-related variables which were associated with unsuccessful TB treatment outcomes and mortality; these can be used to guide measures for risk assessment and stratification of TB patients in future.

Matched MeSH terms: Tuberculosis/mortality*
Fulltext Predictors of death during tuberculosis treatment in TB/HIV co-infected patients in Malaysia

Ismail I, Bulgiba A

PLoS One, 2013;8(8):e73250.
PMID: 23951346 DOI: 10.1371/journal.pone.0073250

BACKGROUND: Mortality among TB/HIV co-infected patients is still high particularly in developing countries. This study aimed to determine the predictors of death in TB/HIV co-infected patients during TB treatment.
METHODS: We reviewed medical records at the time of TB diagnosis and subsequent follow-up of all newly registered TB patients with HIV co-infection at TB clinics in the Institute of Respiratory Medicine and three public hospitals in the Klang Valley between January 2010 and September 2010. We reviewed these medical records again twelve months after their initial diagnosis to determine treatment outcomes and survival. We analysed using Kaplan-Meier and conducted multivariate Cox proportional hazards analysis to identify predictors of death during TB treatment in TB/HIV co-infected patients.
RESULTS: Of the 227 patients studied, 53 (23.3%) had died at the end of the study with 40% of deaths within two months of TB diagnosis. Survival at 2, 6 and 12 months after initiating TB treatment were 90.7%, 82.8% and 78.8% respectively. After adjusting for other factors, death in TB/HIV co-infected patients was associated with being Malay (aHR 4.48; 95%CI 1.73-11.64), CD4 T-lymphocytes count < 200 cells/µl (aHR 3.89; 95% CI 1.20-12.63), three or more opportunistic infections (aHR 3.61; 95% CI 1.04-12.55), not receiving antiretroviral therapy (aHR 3.21; 95% CI 1.76-5.85) and increase per 10(3) total white blood cell count per microliter (aHR 1.12; 95% CI 1.05-1.20).
CONCLUSION: TB/HIV co-infected patients had a high case fatality rate during TB treatment. Initiation of antiretroviral therapy in these patients can improve survival by restoring immune function and preventing opportunistic infections.

Matched MeSH terms: Tuberculosis/mortality
Fulltext Lessons learned about opportunistic infections in southeast Asia

Nissapatorn V

Southeast Asian J. Trop. Med. Public Health, 2008 Jul;39(4):625-41.
PMID: 19058599

Southeast Asia is a region where the number of people infected with HIV/AIDS is one of the fastest growing in the world. Tuberculosis (TB) has grown along with the HIV epidemic. TB is not only the most common AIDS-defining illness but is also the leading cause of morbidity and mortality in AIDS patients. Cryptococcosis (meningitis or disseminated) is one of the most common opportunistic infections in AIDS patients. Cryptococcal meningitis is the first in the differential diagnosis considered with meningeal irritation. Penicillosis, a unique systemic mycosis, is an important emerging public health problem and has been classified as an AIDS defining illness in endemic areas like Thailand. Pneumocystis carinii (jiroveci) pneumonia has been one of the most important opportunistic infections in AIDS patients. Among parasitic infections, cryptosporidiosis is the most common intestinal protozoan infection relating to diarrhea in AIDS patients and toxoplasmosis is the only parasitic infection of the nervous system with a substantial incidence, up to 14.8%. Cytomegalovirus (CMV) retinitis has a lower prevalence compared to other opportunistic infections. In the era of highly active antiretroviral therapy (HAART), the incidence of opportunistic infections has significantly reduced in the past few years. Subsequently, the phenomena of immune restoration inflammatory syndrome (IRIS) in AIDS patients has been reported in this region as a result of HAART.

Matched MeSH terms: Tuberculosis/mortality
Fulltext Tuberculosis in Malaysia: predictors of treatment outcomes in a national registry

Liew SM, Khoo EM, Ho BK, Lee YK, Mimi O, Fazlina MY, et al.

Int J Tuberc Lung Dis, 2015 Jul;19(7):764-71.
PMID: 26056099 DOI: 10.5588/ijtld.14.0767

OBJECTIVES: To determine treatment outcomes and associated predictors of all patients registered in 2012 with the Malaysian National Tuberculosis (TB) Surveillance Registry.
METHODS: Sociodemographic and clinical data were analysed. Unfavourable outcomes included treatment failure, transferred out and lost to follow-up, treatment defaulters, those not evaluated and all-cause mortality.
RESULTS: In total, 21 582 patients were registered. The mean age was 42.36 ± 17.77 years, and 14.2% were non-Malaysians. The majority were new cases (93.6%). One fifth (21.5%) had unfavourable outcomes; of these, 46% died, 49% transferred out or defaulted and 1% failed treatment. Predictors of unfavourable outcomes were older age, male sex, foreign citizenship, lower education, no bacille Calmette-Guérin (BCG) vaccination scar, treatment in tertiary settings, smoking, previous anti-tuberculosis treatment, human immunodeficiency virus infection, not receiving directly observed treatment, advanced chest radiography findings, multidrug-resistant TB (MDR-TB) and extra-pulmonary TB. For all-cause mortality, predictors were similar except for rural dwelling and nationality (higher mortality among locals). Absence of BCG scar, previous treatment for TB and MDR-TB were not found to be predictors of all-cause mortality. Indigenous populations in East Malaysia had lower rates of unfavourable treatment outcomes.
CONCLUSIONS: One fifth of TB patients had unfavourable outcomes. Intervention strategies should target those at increased risk of unfavourable outcomes and all-cause mortality.

Matched MeSH terms: Tuberculosis/mortality*
Fulltext Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV

Ku SW, Jiamsakul A, Joshi K, Pasayan MKU, Widhani A, Chaiwarith R, et al.

J Int AIDS Soc, 2019 Mar;22(3):e25264.
PMID: 30924281 DOI: 10.1002/jia2.25264

INTRODUCTION: Cotrimoxazole (CTX) is recommended as prophylaxis against Pneumocystis jiroveci pneumonia, malaria and other serious bacterial infections in HIV-infected patients. Despite its in vitro activity against Mycobacterium tuberculosis, the effects of CTX preventive therapy on tuberculosis (TB) remain unclear.
METHODS: Adults living with HIV enrolled in a regional observational cohort in Asia who had initiated combination antiretroviral therapy (cART) were included in the analysis. Factors associated with new TB diagnoses after cohort entry and survival after cART initiation were analysed using Cox regression, stratified by site.
RESULTS: A total of 7355 patients from 12 countries enrolled into the cohort between 2003 and 2016 were included in the study. There were 368 reported cases of TB after cohort entry with an incidence rate of 0.99 per 100 person-years (/100 pys). Multivariate analyses adjusted for viral load (VL), CD4 count, body mass index (BMI) and cART duration showed that CTX reduced the hazard for new TB infection by 28% (HR 0.72, 95% CI l 0.56, 0.93). Mortality after cART initiation was 0.85/100 pys, with a median follow-up time of 4.63 years. Predictors of survival included age, female sex, hepatitis C co-infection, TB diagnosis, HIV VL, CD4 count and BMI.
CONCLUSIONS: CTX was associated with a reduction in the hazard for new TB infection but did not impact survival in our Asian cohort. The potential preventive effect of CTX against TB during periods of severe immunosuppression should be further explored.

Matched MeSH terms: Tuberculosis/mortality