ORIGINAL RESEARCH 106 SARJ VOL. 23 NO. 4 2017 Background. Recurrent tuberculosis (TB) occurring >2 years afer completing treatment for a prior TB episode is most ofen due to reinfection with a new strain of Mycobacterium tuberculosis. Objectives. We determined the prevalence and outcome of late recurrent TB among hospitalised patients in Kampala, Uganda. Methods. We conducted a retrospective analysis of patients admitted to Mulago Hospital, who had a cough of >2 weeks’ duration and completed TB treatment >2 years prior to admission. All patients had mycobacterial culture performed on two sputum specimens and vital status ascertained 2 months post enrolment. We performed logistic regression and Cox proportional hazards modelling to identify predictors of recurrent TB and of survival, respectively. Results. Among 234 patients, 36% (n=84) had recurrent TB. Independent predictors included younger age (adjusted odds ratio (aOR) 0.64, 95% confdence interval (CI) 0.42 - 0.97; p=0.04), chest pain >2 weeks (aOR=3.32; 95% CI 1.38 - 8.02; p=0.007), severe weight loss of ≥5 kg (aOR 4.88; 95% CI 1.66 - 14.29; p=0.004) and the presence of ≥1 WHO danger sign of severe illness (aOR=3.55; 95% CI 1.36 - 9.29; p=0.01). Two-month mortality was 17.8% (95% CI 10.5 - 29.2), and was higher among patients who were not initiated on TB treatment (aHR 16.67; 95% CI 1.18 - 200; p=0.04), those who were HIV-positive and not on antiretroviral treatment (aHR 16.99; 95% CI 1.17 - 246.47; p=0.04) and those with a history of smoking (aHR 1.20; 95% CI 1.03 - 1.40; p=0.02). Conclusion. Te high prevalence of late recurrent TB likely refects high levels of TB transmission in Kampala. Increased use of empiric TB treatment and early ART treatment initiation if HIV-positive should be considered in patients with a prior history of TB, particularly if they are young, with weight loss ≥5 kg, chest pain >2 weeks or ≥1 WHO danger sign of severe illness. S Afr Respir J 2017;23(4):106-112. DOI:10.7196/SARJ.2017.v23i4.173 Recurrence of tuberculosis (TB) following completion of treatment is an important but understudied problem in high-burden countries. [1-3] Recurrent TB can result from relapse of the original Mycobacterium tuberculosis strain or from reinfection with a new strain. [4] Relapse usually occurs because of inadequate treatment, whereas reinfection reflects high rates of ongoing TB transmission in at-risk populations. [3,5] Data show that the risk of recurrent TB owing to reinfection is higher among HIV-positive than HIV- negative persons. [6] Thus, assessing the burden of recurrent TB and its causes in high TB-HIV incidence settings can help TB control programmes to determine whether limited additional resources should be focused on enhanced treatment monitoring and adherence to reduce relapse, or on TB case-finding and treatment to interrupt transmission. Molecular genotyping is the gold standard for assessing whether recurrent TB is due to relapse versus reinfection. Unfortunately, only a few studies in high-TB-burden settings have described the burden of recurrent pulmonary TB using molecular genotyping. Tese studies indicate that the length of time between completion of treatment and recurrence is indicative of whether recurrent disease is a result of reinfection or relapse. A study in southern India found that among patients who developed recurrent pulmonary TB 1 to 2 years following completion of treatment, the recurrence was due to relapse in 91% of HIV-uninfected patients, and was due to reinfection in 88% of HIV- infected patients. [7] In Uganda, relapse was found to be the cause of recurrence in 82% (n=80/98) of patients presenting with another episode of TB 1 - 2 years following treatment of prior disease. [8] In contrast, among patients who developed recurrent TB >2 years Predictors and short-term outcomes of recurrent pulmonary tuberculosis in Kampala, Uganda: A cohort study N Kalema, 1,2 MB ChB, MMed, MAS; C Lindan, 3 MD, MS; D Glidden, 3 PhD; S D Yoo, 1,4 MD; A Katamba, 2 MB ChB, PhD; A Alfred, 1 MSc; W Katagira, 1 MB ChB, MMed; P Byanyima, 1 DMLT, BIS; E Musisi, 1 MSc; S Kaswabuli, 1 BS/B; S Ingvar, 1 BSN, MPH; J Zawedde, 1 BSN; C Yoon, 1,5 MD, MPH; I Ayakaka, 1 MB ChB, MPH; J L Davis, 7,8 MD, MAS; L Huang, 1,5,6 MD, MAS; W Worodria, 1,2 MB ChB, MMed, PhD; A Cattamanchi, 1,3,5 MD, MAS 1 Infectious Diseases Research Collaboration, Kampala, Uganda 2 Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda 3 Department of Epidemiology and Biostatistics and Global Health Sciences, University of California San Francisco, San Francisco, California, USA 4 Department of Internal Medicine, Jimma University, Jimma, Ethiopia 5 Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 6 HIV, Infectious Diseases, and Global Medicine Division, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 7 Yale School of Public Health, New Haven, Connecticut, USA 8 Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA Corresponding author: N Kalema (kalemanelson@gmail.com)