TY - JOUR
T1 - The natural history of untreated pulmonary tuberculosis in adults
T2 - a systematic review and meta-analysis
AU - Sossen, Bianca
AU - Richards, Alexandra S.
AU - Heinsohn, Torben
AU - Frascella, Beatrice
AU - Balzarini, Federica
AU - Oradini-Alacreu, Aurea
AU - Odone, Anna
AU - Rogozinska, Ewelina
AU - Häcker, Brit
AU - Cobelens, Frank
AU - Kranzer, Katharina
AU - Houben, Rein M. G. J.
AU - Esmail, Hanif
N1 - Funding Information:
No funding was received for the writing of this Review. HE, RMGJH, BS, ASR, FC, and KK received research funding from the Bill & Melinda Gates Foundation (TB MAC OPP1135288) through the TB Modelling and Analysis Consortium. HE is funded by the Medical Research Council (MRC; MR/V00476X/1). HE and ER are funded through MRC unit grants (MC_UU_00004/04, MC_UU_00004/06). RMGJH and ASR are funded by the European Research Council (Starting Grant Action Number 757699). These funders had no role in the design, conduct, or interpretation of this systematic review and meta-analysis. We thank Adrienne Burrough, Bridget Chivers, and Rohisha Luchun for assistance with hand searches of Index Medicus and the collection of literature from various English libraries. We also thank the German Tuberculosis Archives team in Heidelberg for assistance with the collection of German literature.
Funding Information:
No funding was received for the writing of this Review. HE, RMGJH, BS, ASR, FC, and KK received research funding from the Bill & Melinda Gates Foundation (TB MAC OPP1135288) through the TB Modelling and Analysis Consortium. HE is funded by the Medical Research Council (MRC; MR/V00476X/1). HE and ER are funded through MRC unit grants (MC_UU_00004/04, MC_UU_00004/06). RMGJH and ASR are funded by the European Research Council (Starting Grant Action Number 757699). These funders had no role in the design, conduct, or interpretation of this systematic review and meta-analysis. We thank Adrienne Burrough, Bridget Chivers, and Rohisha Luchun for assistance with hand searches of Index Medicus and the collection of literature from various English libraries. We also thank the German Tuberculosis Archives team in Heidelberg for assistance with the collection of German literature.
Publisher Copyright:
© 2023 Elsevier Ltd
PY - 2023/4
Y1 - 2023/4
N2 - Stages of tuberculosis disease can be delineated by radiology, microbiology, and symptoms, but transitions between these stages remain unclear. In a systematic review and meta-analysis of studies of individuals with untreated tuberculosis who underwent follow-up (34 cohorts from 24 studies, with a combined sample of 139 063), we aimed to quantify progression and regression across the tuberculosis disease spectrum by extracting summary estimates to align with disease transitions in a conceptual framework of the natural history of tuberculosis. Progression from microbiologically negative to positive disease (based on smear or culture tests) in participants with baseline radiographic evidence of tuberculosis occurred at an annualised rate of 10% (95% CI 6·2–13·3) in those with chest x-rays suggestive of active tuberculosis, and at a rate of 1% (0·3–1·8) in those with chest x-ray changes suggestive of inactive tuberculosis. Reversion from microbiologically positive to undetectable disease in prospective cohorts occurred at an annualised rate of 12% (6·8–18·0). A better understanding of the natural history of pulmonary tuberculosis, including the risk of progression in relation to radiological findings, could improve estimates of the global disease burden and inform the development of clinical guidelines and policies for treatment and prevention.
AB - Stages of tuberculosis disease can be delineated by radiology, microbiology, and symptoms, but transitions between these stages remain unclear. In a systematic review and meta-analysis of studies of individuals with untreated tuberculosis who underwent follow-up (34 cohorts from 24 studies, with a combined sample of 139 063), we aimed to quantify progression and regression across the tuberculosis disease spectrum by extracting summary estimates to align with disease transitions in a conceptual framework of the natural history of tuberculosis. Progression from microbiologically negative to positive disease (based on smear or culture tests) in participants with baseline radiographic evidence of tuberculosis occurred at an annualised rate of 10% (95% CI 6·2–13·3) in those with chest x-rays suggestive of active tuberculosis, and at a rate of 1% (0·3–1·8) in those with chest x-ray changes suggestive of inactive tuberculosis. Reversion from microbiologically positive to undetectable disease in prospective cohorts occurred at an annualised rate of 12% (6·8–18·0). A better understanding of the natural history of pulmonary tuberculosis, including the risk of progression in relation to radiological findings, could improve estimates of the global disease burden and inform the development of clinical guidelines and policies for treatment and prevention.
UR - https://www.scopus.com/pages/publications/85150858695
U2 - 10.1016/S2213-2600(23)00097-8
DO - 10.1016/S2213-2600(23)00097-8
M3 - Review article
C2 - 36966795
SN - 2213-2600
VL - 11
SP - 367
EP - 379
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
IS - 4
ER -
SDG 3 Good Health and Well-being