Risk Factors of Childhood Tuberculosis in the Centre Region of Cameroon: An Unmatched Case–Control Study

In Pakistan, the prevalence of diabetes (DM) among adults is 6.9% and expected to double by 2040. DM may facilitate transmission and halter the elimination of tuberculosis (TB). We aimed to determine the prevalence of DM among patients with TB in Pakistan, and to investigate anthropometric biochemical and haemodynamic associations between TB patients with and without DM. We conducted a cross-sectional study at Gulab Devi Chest Hospital in Lahore, Punjab. A total of 3027 newly diagnosed smear-positive TB patients ≥25 years of age were screened for DM by HbA1c regardless of previous DM history. The prevalence of screen-detected DM and known DM among the TB participants was 13.5% and 26.1%, respectively, resulting in a combined DM prevalence of 39.6%. Most participants were male (64.4%). Using bivariate analyses, participants with DM were significantly older (49.8 vs. 40.6 years) with higher haemoglobin (men, 12.1 vs. 11.8 g/dl, women 11.5 vs. 10.7 g/dl), body mass index (21.0 vs. 17.6 kg/m2 ) and waist-hip ratio (men, 0.87 vs. 0.81, women, 0.87 vs. 0.79) (all P < 0.05) than participants without DM. Stratifying by screen-detected and known DM, these differences remained significant when using multivariate analysis. We report a high prevalence of DM among patients with TB who may be anthropometrically and biochemically distinct from TB patients without DM, and this heterogeneity further transcends the different DM groups.

Epidemiology of co-infections in tuberculosis patients in Tanzania : HIV, helminth infection and respiratory pathogens

The studies on the risk of tuberculosis (TB) in patients with type 1 diabetes mellitus (T1DM) alone are limited. We examined this relationship using a population-based retrospective cohort study. From claims data of the National Health Insurance system of Taiwan, we identified 5195 patients with T1DM newly diagnosed from 2002 to 2011 and 20,780 randomly selected controls without T1DM, frequency matched by age, sex, and year of diagnosis. Both cohorts were followed up until the end of 2011 to evaluate the risk of TB. The overall incidence of TB was 4.07-fold higher in the T1DM cohort than in the control cohort (1.18 vs 0.29 per 1000 person-years, P < 0.001). Compared with the controls, the Cox model estimated adjusted hazard ratios (HRs) of TB in patients with T1DM were greater in men than in women (4.62 vs 3.59) and in adults than in children (4.06 vs 3.37), but not significant. The adjusted HR was much greater for those with comorbidities than those without comorbidities (14.6 vs 1.62, P < 0.001). Compared with the controls, the patients with T1DM were also more likely to develop TB with multiple emergency room visits (adjusted HR: 116.1, 95% confidence interval [CI] = 43.8–307.4) or hospitalizations (adjusted HR: 86.5, 95% CI = 33.7–222.4). Patients with T1DM are at elevated risks of developing TB with much higher HRs for those with comorbidities, within the first year of diagnosis, and with frequent emergency cares or hospitalizations.

Background: The prevalence of pulmonary tuberculosis (TB) increases along with the increasing prevalence of Type 2 Diabetes Mellitus (T2DM) patients. The frequency of TB in type 2 DM patients (10 to 15%) and the prevalence of this infectious disease is 2 to 5 times higher in DM patients compared to non-diabetics. This study aimed to analyze the risk factors for pulmonary TB in T2DM patients in Yogyakarta.Subjects and Method: This study uses a case-control study design conducted at RESPIRA Lung Hospital Yogyakarta from January 16 to February 20, 2023. The number of samples was 52 people with a total of 26 people in the case and control groups. Samples were taken by consecutive sampling technique. The independent variables were age, gender, employment, education, BMI, smoking status, clinical symptoms, family history of TB, previous history of TB, and income level). The dependent variable is the incidence of TB in DM patients. Control groups are respondents without a diagnosis of DM and TB patients. Conversely, the cases are personal with diagnosis TB and DM patient Data were collected using a questionnaire. Data analysis was carried out descriptively, bivariate with Chi-square, and multivariate with multiple logistic regression.Results: The demonstrated research that the risk factors that influence the incidence of TB in T2DM patients are gender (aOR = 9.60; 95% CI: 0.14 to 55.96; p=0.012), Age (aOR=0.24; 95% CI: 0.07 to 0.76; p=0.015).Conclusion: The female sex has a 9.60 times higher risk of experiencing TB compared to men in T2DM patients.

Tuberculosis

Background and ObjectivesTuberculosis (TB) is a global public health issue. The emergence of multidrug-resistant (MDR) TB has further complicated the situation in the form of poor treatment outcomes and costs to individuals and health-care systems. We therefore aimed to measure the prevalence and associated risk factors of MDR TB among TB patients in Makkah city.Patients and MethodsThis was a cross-sectional study conducted at Al-Noor Specialist Hospital, a public-sector hospital in Makkah. We included records of 158 confirmed TB patients from the list of all patients admitted in the hospital from January 2009 to January 2019 by systematic random sampling. Data were collected on socio-demographics, clinical profile and drug resistance patterns. Analysis was done in SPSS version 21.0.ResultsThe mean age of the participants was 43.4 ± 18.7 years, and two-thirds (66.5%) were male. About 40% of the patients had chronic disease while lung disease other than TB was present in 5% patients. About 13% of cases were extrapulmonary infections. Prevalence of drug resistance was found to be 17.1% among TB patients. Among the resistant cases, streptomycin (25.9%) and isoniazid (11.1%) were the drugs most commonly affected by resistance. Prevalence of MDR TB was 5% among TB patients. Age, smoking, lung disease and previous TB were significant factors associated with MDR TB.ConclusionPrevalence of MDR TB, although comparable to current national estimates, is higher compared to previous reports. There is a need to reduce this burden through strengthening TB control programs to prevent further emergence of a public health threat of MDR TB. History of previous TB was the strongest risk factor in this study. This calls physicians, program managers and policy makers to focus on counselling and support of TB patients for compliance with the regimen to complete treatment without interruption.

BackgroundSlow decline in the incidence of tuberculosis (TB) has been observed in most high TB burden countries. Knowledge of the prevalence of different TB risk factors can help expand TB control strategies. However with the exception of Human Immunodeficiency Virus (HIV) the prevalence of the other TB risk factors are poorly studied in Uganda. We aimed to determine the prevalence of different TB risk factors and TB disease presentation among TB patients in Kampala Uganda.MethodsWe assessed 365 adult TB patients and used descriptive statistics to summarize their socio-demographic, clinical, radiological, sputum mycobacteriology and TB risk factors (HIV, diabetes, TB contact, alcohol use, tobacco smoking, poverty and overcrowding) data.ResultsA total of 158 (43.3%) patients were male and the median age was 29 (IQR 28–30). Majority of the patients (89.2%) had pulmonary TB, 86.9% were new and 13.2% were retreatment. Wasting (i.e. body mass index of <18.5 kg/m2) was found in 38.5% of the patients and 63% presented with cough. Constitutional symptoms (fever, anorexia, night sweats and weight loss) were reported by 32.1%. Most patients (78.6%) presented with non-cavity lung parenchyma disease (infiltrates, nodules, masses) but 35.2% had cavity disease. Pleural disease was detected in 19.3% of patients. Positive smear microscopy and culture (irrespective of month of treatment) was found in 52.7% and 36.5% of patients respectively. Any drug resistance was detected in 21.1% of patients while multidrug resistance (MDR) TB defined as resistance to rifampicin and isoniazid was detected in 6.3% of patients. All MDR patients were new patients.The prevalence of TB risk factors were as follows: HIV 41.4%, diabetes 5.4%, close contact 11.5%, family history 17.5%, smoking 26.37%, poverty 39.5%, overcrowding 57.3% and alcohol use 50.7%. Overcrowding increased smear positive rate, prevalence ratio 1.22, p = 0.09 but all the other studied risk factors did not affect clinical, radiological and mycobacteriological study patient characteristics.ConclusionsAmong TB patients in Kampala, Uganda, there is high prevalence of the known TB risk factors. Targeting reducing their prevalence may lead to better TB control in the country. Tuberculosis, risk factors, Uganda.

Risk factors associated with paediatric tuberculosis in an endemic setting

Drug resistance (DR) is an important problem in tuberculosis (TB) control programs. This study investigated the university hospital records of TB patients, along with the drug resistance ratios, the risk factors for developing multi drug resistance and their effects. Multi drug resistance is defined as the presence of both isoniazid (H) and rifampicin (R) resistance. The records of TB patients who had been diagnosed between January 2002 and December 2011 were evaluated retrospectively. Multi drug resistance was determined in 59 patients. The control group included 127 patients whose antibiograms had shown susceptibility to H, R, ethambutol (E) and streptomycin(S) (drug susceptible: DS) or who were resistant to one or more of these drugs, but not to both H and R simultaneously (mono resistant: MR). We randomly selected these 127 patients from 600 cases of TB that had been recorded through laboratory culture antibiogram data. There were no differences in age, gender, marital status or TB type between the multidrugresistant (MDR) and the control group, nor for the presence of cavities on their chest radiographies or smear positivity (p<0.05). The study found a significantly increased risk of multi drug resistance among those with poor socioeconomic status, at 7.17 times higher (2.61-19.67), and those with a previous history of TB, at 5.61 times higher (2.10-15.07), as well as in patients who had diabetes mellitus, at 3.68 higher (1.15-11.79), in logistic regression analysis. Determining the risk factors for developing multi drug resistance in TB patients is critical in order to be able to prioritize the interventions to address this drug resistance. Although many risk factors for MDR TB have been reported, the most important appear to be a previous history of TB, previously administered TB treatment and inappropriate TB treatment. Key words: Tuberculosis, multi drug resistance, risk factor.

BackgroundChildhood tuberculosis (TB) patients under India's Revised National TB Control Programme (RNTCP) are managed using diagnostic algorithms and directly observed treatment with intermittent thrice-weekly short-course treatment regimens for 6–8 months. The assignment into pre-treatment weight bands leads to drug doses (milligram per kilogram) that are lower than current World Health Organization (WHO) guidelines for some patients.ObjectivesThe main aim of our study was to describe the baseline characteristics and treatment outcomes reported under RNTCP for registered childhood (age <15 years) TB patients in Delhi. Additionally, we compared the reported programmatic treatment completion rates between children treated as per WHO recommended anti-TB drug doses with those children treated with anti-TB drug doses below that recommended in WHO guidelines.MethodsFor this cross-sectional retrospective study, we reviewed programme records of all 1089 TB patients aged <15 years registered for TB treatment from January to June, 2008 in 6 randomly selected districts of Delhi. WHO disease classification and treatment outcome definitions are used by RNTCP, and these were extracted as reported in programme records.Results and ConclusionsAmong 1074 patients with records available, 651 (61%) were females, 122 (11%) were <5 years of age, 1000 (93%) were new cases, and 680 (63%) had extra-pulmonary TB (EP-TB)—most commonly peripheral lymph node disease [310 (46%)]. Among 394 pulmonary TB (PTB) cases, 165 (42%) were sputum smear-positive. The overall reported treatment completion rate was 95%. Similar reported treatment completion rates were found in all subgroups assessed, including those patients whose drug dosages were lower than that currently recommended by WHO. Further studies are needed to assess the reasons for the low proportion of under-5 years of age TB case notifications, address challenges in reaching all childhood TB patients by RNTCP, the accuracy of diagnosis, and the clinical validity of reported programme defined treatment completion.

An Outbreak of Tuberculosis Among Adults With Mental Illness

To study recurrence rate over a long period after recovery from previous tuberculosis history, we examined the frequency of previous tuberculosis history in patients who were admitted to our hospital in 1980-83 and in 1997-99 and the comparison was made between cases with and without culture-positive tuberculosis. The tuberculosis groups comprised of 297 patients in 1980-83 and 688 patients in 1997-99. The non-tuberculosis groups (control groups) comprised of 373 patients in 1980-83 and 1092 patients in 1997-99 with non-tuberculosis diseases other than the tuberculosis-related diseases such as non-tuberculosis mycobacteriosis, pulmonary aspergillosis, bronchiectasis, chronic bronchitis and tuberculosis sequelae. The patients with viral chronic hepatitis previously operated and transfused were also excluded as they might be operated because of pulmonary tuberculosis in the era of surgical treatment for tuberculosis. In both tuberculosis and control groups, they had previous tuberculosis history most frequently when they were twenties. In the control groups, the frequency of previous tuberculosis history among cases admitted in 1980-83 and were born in 1910-19, 20-29, 30-39, 40-49 were 15/84 (17.9%), 22/93 (23.7%), 11/77 (14.3%) and 3/43 (7.0%), respectively, and those admitted in 1997-99 were 11/70 (15.7%), 30/231 (13.0%), 28/288 (9.7%), and 10/230 (4.3%), respectively. In these 4 birth year groups, frequency of previous tuberculosis history among cases admitted in 1997-99 were significantly lower than that admitted in 1980-83 (p < 0.05, one-sided paired t-test), and the fact suggests that persons with tuberculosis history died earlier than those without it. In the tuberculosis groups, the frequencies of previous tuberculosis history among cases admitted in 1980-83 and were born in 1910-19, 20-29, 30-39 and 40-49 were 20/35 (57.1%), 31/58 (53.4%), 19/48 (39.6%), and 11/53 (20.8%), respectively, and those among cases admitted in 1997-99 were 30/99 (30.3%), 58/125 (46.4%), 22/102 (21.6%) and 17/136 (12.5%), respectively. The frequency of previous tuberculosis history among cases admitted in 1997-99 was significantly lower than that admitted in 1980-83 (p < 0.01) as was the case in the control groups. As recurrence within 5 years had occurred in only 4 out of 113 tuberculosis patients (3.5%) in the above-mentioned 4 birth year groups, almost all tuberculosis patients were assumed to have recovered completely from previous tuberculosis. Comparison between the recurrence rate from previous tuberculosis and the incidence rate from the remotely infected persons without previous tuberculosis history in the same birth year group can be done by calculating the prevalence of tuberculosis infection for each birth year group using a model of annual risk of tuberculosis infection appropriate for Japanese. The ratios between the recurrence rate from previous tuberculosis patients and the incidence rate from remotely infected persons without previous tuberculosis history were 4.71, 2.33, 1.78 and 1.11 in 1980-83 and 1.84, 3.99, 1.80 and 1.11 in 1997-99 for groups born in 1910-19, 20-29, 30-39 and 40-49, respectively. The ratio did not change systematically with time in these groups, indicating the recurrence rate did not change with time more than ten years after recovery from previous tuberculosis. The ratio was about 3 for groups born in 1910-19 and 20-29 and 1 for group born in 1940-49. Almost all patients born in 1940-49 could receive chemotherapy for tuberculosis in their twenties, while most of the patients born in 1910-29 could not. Therefore, the above-mentioned fact may reflect the recurrence rate of patients treated successfully with chemotherapy is almost the same as the incidence rate from remotely infected persons, while that the recurrence rate from previous tuberculosis patients spontaneously recovered is 3 times higher than the incidence rate from remotely infected persons.

BackgroundClose contacts of tuberculosis (TB) patients are at increased risk of developing tuberculosis. Although passive contact screening guidelines are incorporated in the national TB control program, currently it is unknown how frequent close contacts are screened for TB in Vietnam. This study assesses current contact screening practices in Vietnam and determines the proportion of household contacts screened of newly registered TB patients.MethodSurvey of household contacts of smear-positive TB patients (index patients) registered for treatment in 2008 in three Vietnamese cities. Households were interviewed in 2010 about screening for TB since treatment registration date of the index patient.ResultsWe interviewed 4,118 household contacts of 1,091 identified index cases. Contact screening mainly relied on self-referral by household contacts. Of the 4,118 household contacts, 474 (11.5%) self-referred for TB screening, while this screening proportion was only 5.5% among contacts under 5 years old (16/293). Sputum examinations were performed in 374 (78.9%) of the screened contacts. Contact screening identified 27 cases of pulmonary TB (0.7%; or 656 cases/100,000 contacts), of which 20 were detected by sputum smear.ConclusionsThe low proportion of household TB contacts screened for TB illustrates the limitations of passive contact screening as currently practiced in Vietnam. Children under 5 years of age are particularly neglected with this approach. Active contact screening with fixed follow-up times of close contacts of newly diagnosed TB patients should be considered in Vietnam, particularly in case of young children and drug-resistant TB.

To study risk factors for tuberculosis (TB) patients with diabetes mellitus (DM) living in Western China and analyze the baseline characteristics and clinical data of those patients for developing an effective screening strategy. We enrolled 3548 TB patients who were admitted to our hospital from 2014 to 2018. The baseline characteristics and clinical data of TB patients with and without DM were compared. Besides, risk factors were presented, and their effects on TB patients with and without DM were analyzed. The prevalence of DM among TB patients was 7.7%, which increased with elevation of the patients’ age, and 63.1% of TB patients with DM had hemoglobin A1c (HbA1c) ≥ 7.0%. The prevalence of DM in the Han patients with TB was the highest (8.8%), which was roughly three times higher than that in the Tibetan patients with TB (3.0%). In the multivariate logistic regression analysis, elevated values of the patients’ age (odds ratio (OR), 1.047 (1.033–1.062, p < 0.01), blood pressure (OR, 1.735 (1.101–2.734), p = 0.04), proportion of cavity in pulmonary TB (PTB) (OR, 2.167 (1.272–3.656), p = 0.004), fasting blood glucose (OR, 2.248 (1.997–2.555), p < 0.001), erythrocyte sedimentation rate (ESR) (OR, 1.007 (1.001–1.012), p = 0.027), and proportion of patients with PTB (OR, 2.426 (1.425–4.104), p < 0.001) were significantly associated with increased prevalence of DM in TB patients. For evaluation of the model, the receiver operating characteristic (ROC) curve was plotted, in which the area under the curve (AUC) value of 0.924 was obtained for an optimal cutoff value of 0.052. The re-sampling method was utilized to verify the regression model, and the mean squared error (MSE) was 0.00026. The prevalence of DM in TB patients is high and is associated with severe clinical symptoms. Therefore, early screening of DM for TB patients is highly recommended.

Purpose of the study. To establish risk factors for tuberculosis (TB) in children perinatally exposed to HIV and HIV-infected for the development of corrective measures.Materials and methods. Outpatient records (form No. 025/y) of 216 children perinatally exposed to HIV and 121 children with HIV infection and their parents (281 individuals) were analyzed. The control group consisted of 100 healthy children. Epidemiological (descriptive, evaluative and analytical) and statistical research methods were used in the study.Results. The likelihood of contact with a patient with an active form of TB was significantly higher in perinatally exposed to HIV and HIV-infected children compared to children in the control group (p 0.001). The risk of TB in HIV-exposed children was 5.3 times higher in foci where both parents were HIV-infected than in foci formed by discordant couples (RR = 5.3; 95% CI 1.7–21.7). Children in study groups who were not vaccinated with BCG had the highest risk of TB compared to children in the control group (RR = 1.9; 95% CI 1.6–2.2).Conclusion. Risk factors for TB in children perinatally exposed to HIV are untimely vaccination against TB or its absence and living in the foci where both parents are HIV-infected. The predictors of the development of TB in HIV-infected children are household contacts with TB patient , late diagnosis of HIV infection, and late prescription of highly active antiretroviral therapy after the formation of severe immunosuppression.