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Dynamics of Cough Frequency in Adults Undergoing Treatment for Pulmonary Tuberculosis.

Proaño, A; Bravard, MA; López, JW; Lee, GO; Bui, D; Datta, S; Comina, G; Zimic, M; Coronel, J; Caviedes, L; et al. Proaño, A; Bravard, MA; López, JW; Lee, GO; Bui, D; Datta, S; Comina, G; Zimic, M; Coronel, J; Caviedes, L; Cabrera, JL; Salas, A; Ticona, E; Vu, NM; Kirwan, DE; Loader, M-CI; Friedland, JS; Moore, DAJ; Evans, CA; Tracey, BH; Gilman, RH; Tuberculosis Working Group in Peru (2017) Dynamics of Cough Frequency in Adults Undergoing Treatment for Pulmonary Tuberculosis. Clin Infect Dis, 64 (9). pp. 1174-1181. ISSN 1537-6591 https://doi.org/10.1093/cid/cix039
SGUL Authors: Friedland, Jonathan Samuel

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Abstract

Background: Cough is the major determinant of tuberculosis transmission. Despite this, there is a paucity of information regarding characteristics of cough frequency throughout the day and in response to tuberculosis therapy. Here we evaluate the circadian cycle of cough, cough frequency risk factors, and the impact of appropriate treatment on cough and bacillary load. Methods: We prospectively evaluated human immunodeficiency virus-negative adults (n = 64) with a new diagnosis of culture-proven, drug-susceptible pulmonary tuberculosis immediately prior to treatment and repeatedly until treatment day 62. At each time point, participant cough was recorded (n = 670) and analyzed using the Cayetano Cough Monitor. Consecutive coughs at least 2 seconds apart were counted as separate cough episodes. Sputum samples (n = 426) were tested with microscopic-observation drug susceptibility broth culture, and in culture-positive samples (n = 252), the time to culture positivity was used to estimate bacillary load. Results: The highest cough frequency occurred from 1 pm to 2 pm, and the lowest from 1 am to 2 am (2.4 vs 1.1 cough episodes/hour, respectively). Cough frequency was higher among participants who had higher sputum bacillary load (P < .01). Pretreatment median cough episodes/hour was 2.3 (interquartile range [IQR], 1.2-4.1), which at 14 treatment days decreased to 0.48 (IQR, 0.0-1.4) and at the end of the study decreased to 0.18 (IQR, 0.0-0.59) (both reductions P < .001). By 14 treatment days, the probability of culture conversion was 29% (95% confidence interval, 19%-41%). Conclusions: Coughs were most frequent during daytime. Two weeks of appropriate treatment significantly reduced cough frequency and resulted in one-third of participants achieving culture conversion. Thus, treatment by 2 weeks considerably diminishes, but does not eliminate, the potential for airborne tuberculosis transmission.

Item Type: Article
Additional Information: © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: airborne transmission, cough, infectiousness, tuberculosis, Peru, Adolescent, Adult, Aged, Aged, 80 and over, Antitubercular Agents, Circadian Rhythm, Cough, Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Tuberculosis, Pulmonary, Young Adult, Tuberculosis Working Group in Peru, Humans, Tuberculosis, Pulmonary, Cough, Antitubercular Agents, Longitudinal Studies, Prospective Studies, Circadian Rhythm, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Young Adult, tuberculosis, airborne transmission, infectiousness, cough, Peru, Science & Technology, Life Sciences & Biomedicine, Immunology, Infectious Diseases, Microbiology, tuberculosis, airborne transmission, infectiousness, cough, Peru, MULTIDRUG-RESISTANT TUBERCULOSIS, EARLY BACTERICIDAL ACTIVITY, DRUG-SUSCEPTIBILITY ASSAY, MYCOBACTERIUM-TUBERCULOSIS, MICROSCOPIC-OBSERVATION, ANTITUBERCULOSIS DRUGS, TREATMENT RESPONSE, TRANSMISSION, SYMPTOMS, DISEASE, 06 Biological Sciences, 11 Medical And Health Sciences, Microbiology
Journal or Publication Title: Clin Infect Dis
ISSN: 1537-6591
Language: eng
Dates:
DateEvent
1 May 2017Published
27 January 2017Published Online
13 January 2017Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
5D43TW006581National Institutes of Healthhttp://dx.doi.org/10.13039/100000002
5R21AI094143-02National Institutes of Healthhttp://dx.doi.org/10.13039/100000002
5D43TW009349-03National Institutes of Healthhttp://dx.doi.org/10.13039/100000002
0539-01-10Grand Challenges Canadahttp://dx.doi.org/10.13039/501100004828
078067/Z/05/ZWellcome Trusthttp://dx.doi.org/10.13039/100004440
105788/Z/14/ZWellcome Trusthttp://dx.doi.org/10.13039/100004440
201251/Z/16/ZWellcome Trusthttp://dx.doi.org/10.13039/100004440
MR/K007467/1Joint Global Health TrialsUNSPECIFIED
OPP1118545Bill and Melinda Gates Foundationhttp://dx.doi.org/10.13039/100000865
PubMed ID: 28329268
Web of Science ID: WOS:000399377100005
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110599
Publisher's version: https://doi.org/10.1093/cid/cix039

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