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Dynamics of Cough Frequency in Adults Undergoing Treatment for Pulmonary Tuberculosis

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dc.contributor.author Proano, Alvaro
dc.contributor.author Bravard, Marjory A.
dc.contributor.author Lopez, Jose W.
dc.contributor.author Lee, Gwenyth O.
dc.contributor.author Bui, David
dc.contributor.author Datta, Sumona
dc.contributor.author Comina, German
dc.contributor.author Zimic, Mirko
dc.contributor.author Coronel, Jorge
dc.contributor.author Caviedes, Luz
dc.contributor.author Cabrera, Jose L.
dc.contributor.author Salas, Antonio
dc.contributor.author Ticona, Eduardo
dc.contributor.author Vu, Nancy M.
dc.contributor.author Kirwan, Daniela E.
dc.contributor.author Loader, Maria-Cristina I.
dc.contributor.author Friedland, Jon S.
dc.contributor.author Moore, David A. J.
dc.contributor.author Evans, Carlton A.
dc.contributor.author Tracey, Brian H.
dc.contributor.author Gilman, Robert H.
dc.date.accessioned 2019-01-25T16:59:37Z
dc.date.available 2019-01-25T16:59:37Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4893
dc.description.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. en_US
dc.language.iso eng
dc.publisher Oxford University Press
dc.relation.ispartof urn:issn:1537-6591
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Adolescent en_US
dc.subject Adult en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Young Adult en_US
dc.subject Aged en_US
dc.subject Middle Aged en_US
dc.subject Aged, 80 and over en_US
dc.subject Longitudinal Studies en_US
dc.subject Prospective Studies en_US
dc.subject Peru en_US
dc.subject airborne transmission en_US
dc.subject cough en_US
dc.subject infectiousness en_US
dc.subject tuberculosis en_US
dc.subject Antitubercular Agents/therapeutic use en_US
dc.subject Circadian Rhythm en_US
dc.subject Cough/pathology en_US
dc.subject Tuberculosis, Pulmonary/drug therapy/pathology en_US
dc.title Dynamics of Cough Frequency in Adults Undergoing Treatment for Pulmonary Tuberculosis en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1093/cid/cix039
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08


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