Quantifying progression and regression across the spectrum of pulmonary tuberculosis: a data synthesis study. Richards, A. S, Sossen, B., Emery, J. C, Horton, K. C, Heinsohn, T., Frascella, B., Balzarini, F., Oradini-Alacreu, A., Häcker, B., Odone, A., McCreesh, N., Grant, A. D, Kranzer, K., Cobelens, F., Esmail, H., & Houben, R. M G J The Lancet Global Health, Elsevier, mar, 2023. ![Quantifying progression and regression across the spectrum of pulmonary tuberculosis: a data synthesis study [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Summary Background Prevalence surveys show a substantial burden of subclinical (asymptomatic but infectious) tuberculosis, from which individuals can progress, regress, or even persist in a chronic disease state. We aimed to quantify these pathways across the spectrum of tuberculosis disease. Methods We created a deterministic framework of untreated tuberculosis disease with progression and regression between three states of pulmonary tuberculosis disease: minimal (non-infectious), subclinical (asymptomatic but infectious), and clinical (symptomatic and infectious). We obtained data from a previous systematic review of prospective and retrospective studies that followed and recorded the disease state of individuals with tuberculosis in a cohort without treatment. These data were considered in a Bayesian framework, enabling quantitative estimation of tuberculosis disease pathways with rates of transition between states and 95% uncertainty intervals (UIs). Findings We included 22 studies with data from 5942 individuals in our analysis. Our model showed that after 5 years, 40% (95% UI 31˙3–48˙0) of individuals with prevalent subclinical disease at baseline recover and 18% (13˙3–24˙0) die from tuberculosis, with 14% (9˙9–19˙2) still having infectious disease, and the remainder with minimal disease at risk of re-progression. Over 5 years, 50% (40˙0–59˙1) of individuals with subclinical disease at baseline never develop symptoms. For those with clinical disease at baseline, 46% (38˙3–52˙2) die and 20% (15˙2–25˙8) recover from tuberculosis, with the remainder being in or transitioning between the three disease states after 5 years. We estimated the 10-year mortality of people with untreated prevalent infectious tuberculosis to be 37% (30˙5–45˙4). Interpretation For people with subclinical tuberculosis, classic clinical disease is neither an inevitable nor an irreversible outcome. As such, reliance on symptom-based screening means a large proportion of people with infectious disease might never be detected. Funding TB Modelling and Analysis Consortium and European Research Council.
@article{Richards2023,
abstract = {Summary Background Prevalence surveys show a substantial burden of subclinical (asymptomatic but infectious) tuberculosis, from which individuals can progress, regress, or even persist in a chronic disease state. We aimed to quantify these pathways across the spectrum of tuberculosis disease. Methods We created a deterministic framework of untreated tuberculosis disease with progression and regression between three states of pulmonary tuberculosis disease: minimal (non-infectious), subclinical (asymptomatic but infectious), and clinical (symptomatic and infectious). We obtained data from a previous systematic review of prospective and retrospective studies that followed and recorded the disease state of individuals with tuberculosis in a cohort without treatment. These data were considered in a Bayesian framework, enabling quantitative estimation of tuberculosis disease pathways with rates of transition between states and 95{\%} uncertainty intervals (UIs). Findings We included 22 studies with data from 5942 individuals in our analysis. Our model showed that after 5 years, 40{\%} (95{\%} UI 31{\textperiodcentered}3–48{\textperiodcentered}0) of individuals with prevalent subclinical disease at baseline recover and 18{\%} (13{\textperiodcentered}3–24{\textperiodcentered}0) die from tuberculosis, with 14{\%} (9{\textperiodcentered}9–19{\textperiodcentered}2) still having infectious disease, and the remainder with minimal disease at risk of re-progression. Over 5 years, 50{\%} (40{\textperiodcentered}0–59{\textperiodcentered}1) of individuals with subclinical disease at baseline never develop symptoms. For those with clinical disease at baseline, 46{\%} (38{\textperiodcentered}3–52{\textperiodcentered}2) die and 20{\%} (15{\textperiodcentered}2–25{\textperiodcentered}8) recover from tuberculosis, with the remainder being in or transitioning between the three disease states after 5 years. We estimated the 10-year mortality of people with untreated prevalent infectious tuberculosis to be 37{\%} (30{\textperiodcentered}5–45{\textperiodcentered}4). Interpretation For people with subclinical tuberculosis, classic clinical disease is neither an inevitable nor an irreversible outcome. As such, reliance on symptom-based screening means a large proportion of people with infectious disease might never be detected. Funding TB Modelling and Analysis Consortium and European Research Council.},
author = {Richards, Alexandra S and Sossen, Bianca and Emery, Jon C and Horton, Katherine C and Heinsohn, Torben and Frascella, Beatrice and Balzarini, Federica and Oradini-Alacreu, Aurea and H{\"{a}}cker, Brit and Odone, Anna and McCreesh, Nicky and Grant, Alison D and Kranzer, Katharina and Cobelens, Frank and Esmail, Hanif and Houben, Rein M G J},
doi = {10.1016/S2214-109X(23)00082-7},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Richards et al. - 2023 - Quantifying progression and regression across the spectrum of pulmonary tuberculosis a data synthesis study.pdf:pdf},
issn = {2214-109X},
journal = {The Lancet Global Health},
keywords = {OA,fund{\_}not{\_}ack,original},
mendeley-tags = {OA,fund{\_}not{\_}ack,original},
month = {mar},
pages = {https://doi.org/10.1016/ S2214--109X(23)00082--7},
pmid = {36966785},
publisher = {Elsevier},
title = {{Quantifying progression and regression across the spectrum of pulmonary tuberculosis: a data synthesis study}},
url = {http://www.thelancet.com/article/S2214109X23000827/fulltext http://www.thelancet.com/article/S2214109X23000827/abstract https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00082-7/abstract},
year = {2023}
}
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Methods We created a deterministic framework of untreated tuberculosis disease with progression and regression between three states of pulmonary tuberculosis disease: minimal (non-infectious), subclinical (asymptomatic but infectious), and clinical (symptomatic and infectious). We obtained data from a previous systematic review of prospective and retrospective studies that followed and recorded the disease state of individuals with tuberculosis in a cohort without treatment. These data were considered in a Bayesian framework, enabling quantitative estimation of tuberculosis disease pathways with rates of transition between states and 95% uncertainty intervals (UIs). Findings We included 22 studies with data from 5942 individuals in our analysis. Our model showed that after 5 years, 40% (95% UI 31˙3–48˙0) of individuals with prevalent subclinical disease at baseline recover and 18% (13˙3–24˙0) die from tuberculosis, with 14% (9˙9–19˙2) still having infectious disease, and the remainder with minimal disease at risk of re-progression. Over 5 years, 50% (40˙0–59˙1) of individuals with subclinical disease at baseline never develop symptoms. For those with clinical disease at baseline, 46% (38˙3–52˙2) die and 20% (15˙2–25˙8) recover from tuberculosis, with the remainder being in or transitioning between the three disease states after 5 years. We estimated the 10-year mortality of people with untreated prevalent infectious tuberculosis to be 37% (30˙5–45˙4). Interpretation For people with subclinical tuberculosis, classic clinical disease is neither an inevitable nor an irreversible outcome. As such, reliance on symptom-based screening means a large proportion of people with infectious disease might never be detected. 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