Which factors set off TB recurrence?

Recurrence interval is associated with the endogenous reactivation of tuberculosis (TB), according to the results of a meta-analysis. On the other hand, infection with Beijing family strains, coinfection with HIV, imprisonment, and immigration contribute to an increased risk of exogenous TB reinfection.

Researchers performed a systematic review and searched multiple online databases for studies that examined the risk factors (eg, sex, length of time between first onset and recurrent diagnosis, extrapulmonary tuberculosis, sputum smear, pulmonary cavity, Beijing family strains, diabetes, HIV infection, history of imprisonment, and immigration) for TB reactivation, reinfection, or recurrence.

The initial search yielded 1,850 articles, of which 25 were included in the meta-analysis. These studies were conducted in Europe, North America, Africa, and Oceania. The total number of patients with recurrent TB was 1,477, among whom 1,025 had endogenous reactivation and 452 had exogenous reinfection.

Pooled data showed that a recurrence interval of <2 years was associated with a greater likelihood of experiencing endogenous reactivation (risk ratio [RR], 1.56, 95 percent confidence interval [CI], 1.33–1.85).

On the other hand, several risk factors were identified for exogenous reinfection, including coinfection with HIV (RR, 0.72, 95 percent CI, 0.63–0.83), Beijing family TB genotype (RR, 0.46, 95 percent CI, 0.32–0.67), history of imprisonment (RR, 0.36, 95 percent CI, 0.16–0.81), and immigration (RR, 0.66, 95 percent CI, 0.53–0.82).

The present data provide critical insights to inform ongoing global efforts to improve the management of recurrent TB.