Tuberculosis treatment outcome in a tertiary care setting

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Despite tertiary care support, complicated tuberculosis carries a high mortality. Earlier diagnosis and complete appropriate chemotherapy are essential for improved outcome.