Cases Of Active Pulmonary Tuberculosis Research Articles

Tuberculosis Outbreak in a Long-term Care Facility

Tuberculosis (TB) was a major cause of morbidity and mortality in Canada early in the 20th century. Elderly populations in Canada remain at high risk for TB disease. Elderly patients may present atypically, with the result that many active cases can remain undiagnosed. We present an outbreak of TB that occurred in a Residential and Long-Term Care (LTC) facility in Ontario. Case finding was carried out through the conventional concentric circle approach. Three rounds of tuberculin skin testing were conducted at 8-12 week intervals. Laboratory analysis was conducted at the Public Health Ontario Laboratories. An indoor air quality assessment was conducted to determine whether inadequate engineering controls were a transmission risk factor. A case of active pulmonary TB was confirmed in May 2010 in a staff member at the facility. By January 2011, 3 additional active cases and 24 latent tuberculosis infections among residents and staff had been identified. Genotyping methods confirmed that the 4 active cases were infected by an identical strain. Nine of 15 locations tested in the facility had air exchange rates below published guidelines. Prompt reporting of the initial case allowed for a quick initiation of the epidemiologic investigation. Given the epidemiology of TB in elderly populations, outbreaks should remain a concern for LTC facilities and physicians, even in jurisdictions of low TB incidence. Baseline and annual TB screening for residents and staff, early diagnosis of active TB, and adequate ventilation are important to reduce the incidence of disease.

Knowledge, experiences, and attitudes of medical students in Rome about tuberculosis

BackgroundTuberculosis is the second leading cause of death from infectious disease. Insufficient knowledge among doctors about tuberculosis is one of the reasons for the increased tuberculosis rates in several low-endemic countries. The purpose of this study was to assess knowledge, experience, and attitude about tuberculosis among medical students.Material/MethodsAfter a pilot study, a cross-sectional survey was performed on fifth-year medical students at the Catholic University of Rome (Italy), using a self-administered questionnaire on attitude, experience and knowledge about epidemiology, diagnosis, and treatment of tuberculosis. The t test and multivariable linear regression analysis were performed to estimate the association between TB knowledge and investigated variables.ResultsAmong 220 fifth-year medical students, the response rate was 83.1%. The mean percentage of correct answers was 56.6% (63.5% for epidemiology and prevention, 54.1% for diagnosis, and 45.7% for treatment). Associations between internships in wards and greater knowledge of tuberculosis diagnosis (55.9% vs. 51.6%, p=0.02), treatment (48.4% vs. 41.8%, p=0.03) and total score (58.1% vs. 54.5%, p=0.04) were found.Students who reported receiving the Mantoux test had higher knowledge of tuberculosis epidemiology and prevention (65.4% vs. 53.3%, p=0.001), diagnosis (55.2% vs. 48.3%, p=0.005), and total score (58.0% vs. 49.1%, p=0.001). Students who had observed at least 1 active pulmonary tuberculosis case had a higher percentage of correct answers about diagnosis (55.5% vs. 51.4%, p=0.03) and total score (57.9% vs. 54.0%, p=0.03).The multivariable linear regression confirmed the association between higher knowledge and receiving the Mantoux test (β coefficient=7.2; 95% CI 2.6–11.7), as well as having observed at least 1 X-ray of a TB patient (β coefficient=5.3; 95% CI 1.0–9.7).ConclusionsA moderate level of general knowledge about tuberculosis was found, which suggests the need to modify current programs of infectious diseases in the curriculum of medical schools.

Prevalence of pulmonary tuberculosis among expatriates subjected to medical visa screening in Abu Dhabi, United Arab Emirates

IntroductionAll applicants for work and/or residence in Abu Dhabi are screened for tuberculosis at the time of issuing or renewing their residence visa. The purpose of this study is to assess the prevalence of TB among visa applicants and the likelihood of testing positive among different subgroups. MethodsData from the electronic visa screening system was used for a total of 948,504 applicants screened for residence in Abu Dhabi from January to December 2010. ResultsThe screening identified 4577 suspected cases of pulmonary tuberculosis (PTB); 1558 people with chest X-ray findings suggestive of prior PTB; 235 smear-positives; and 132 culture-positive cases. The prevalence of active PTB was 39/100,000, with new applicants significantly more likely to test positive compared with renewals (OR: 2.05, 95% CI: 1.5–2.7, P<.001). People coming from African countries had the highest prevalence of TB compared with people from other regions (OR: 21.25, 95% CI: 6.72–67.17, P<.001). ConclusionThe number of active PTB cases among applicants for visa screening is still of a real concern. Without a rigorous screening system, the disease can spread to the community and hit other people. Certain subgroups were more likely to have the disease; this could provide the scientific foundation for future amendments in the screening requirements.

Diagnostic value of the commercial MycoDotTM test in the diagnosis of active pulmonary tuberculosis in Nepalese population

Background: A rapid, technically non-demanding and inexpensive diagnostic test is needed to improve the early detection and better management of active pulmonary tuberculosis especially in resource limited areas. Objective: To assess the diagnostic value and usefulness of the commercially available MycoDot TM (DynaGen Inc., Cambridge, MA, USA) in the diagnosis of active pulmonary tuberculosis in Nepalese population. Materials and Methods: A prospective study was done from January 2008 to August 2008 on a group of 120 sputum smear positive adult patient group aged 17 to 78 years, confirmed cases of active pulmonary tuberculosis (with TB) were enrolled and sera samples collected from them. The second group comprised of 105 healthy controls with no history of pulmonary tuberculosis (without TB) and sera samples collected from them. The MycoDot TM serologic test was done on the sera samples collected from both the study groups according to the manufacturer's instructions. Results: Of the sera collected from 120 sputum smear positive cases (with TB group), 48 sera specimens were MycoDot TM test positive (sensitivity = 40%; 95% CI 31.68-48.94). Healthy controls (without-TB group) - 8 sera samples were found to be positive by the MycoDot TM test and the remaining 97 sera samples tested negative by this serologic test (specificity = 92.38%; 95% CI 85.68-96.09). The value for % false positive was 7.61% and for % false negative was 60%. The positive predictive value and the negative predictive value was 85.71% (95% CI 73.22-93.20) and 57.4% (95% CI 49.56-64.88), respectively. Conclusion: The MycoDot TM test with its rapidity (completed within 20 min), easy - to - perform format and no expensive instrumentation required - had high specificity but a relatively low sensitivity in the study group subjects and thus could be used only as an additional test in the diagnosis of active pulmonary tuberculosis and to be interpreted judiciously along with clinical findings.

Evaluation of the Xpert MTB/RIF Assay at a Tertiary Care Referral Hospital in a Setting Where Tuberculosis and HIV Infection Are Highly Endemic

BACKGROUND. There were 1.45 million deaths from tuberculosis in 2011. A substantial proportion of active pulmonary tuberculosis cases in countries where tuberculosis, human immunodeficiency virus (HIV) infection, and AIDS are highly endemic remain undiagnosed because of the reliance on sputum-smear microscopy. This study evaluated the performance of the Xpert MTB/RIF assay at a tertiary care referral center in Zambia, a country where the burden of tuberculosis and HIV infection is high. METHODS. A total of 881 adult inpatients admitted to University Teaching Hospital in Lusaka who were able to produce sputum were enrolled and analyzed in the study, irrespective of admission diagnosis. Sputum specimens were analyzed by fluorescence smear microscopy, the Xpert MTB/RIF assay, mycobacterial growth indicator tube (MGIT) culture,and MGIT drug-susceptibility testing. The sensitivity and specificity of the Xpert MTB/RIF assay were evaluated using culture as the gold standard. RESULTS. Culture-confirmed tuberculosis was found in 201 of 881 patients (22.8%). The specificity of the Xpert MTB/RIF assay was 95.0% (95% confidence interval [CI], 92.4%–96.8%),and the sensitivity was 86.1% (95% CI, 80.3%–90.4%). In sputum smear–negative, culture-positive cases, the assay was 74.7% sensitive (95% CI, 64.6%–82.8%), identifying 71 additional tuberculosis cases that were not detected by smear microscopy.A total of 18 of 111 patients with tuberculosis who were tested (16.2%) had multidrug-resistant (MDR) tuberculosis.The sensitivity and specificity of the Xpert MTB/RIF assay for detecting culture-confirmed, rifampicin-resistant tuberculosis was 81.3% (95% CI, 53.7%–95.0%) and 97.5% (95% CI,90.4%–99.6%), respectively. CONCLUSIONS. The Xpert MTB/RIF assay performs better than smear microscopy in an inpatient setting in a country where tuberculosis and HIV infection are highly endemic. Assessment of its usefulness and cost-effectiveness for increased detection of tuberculosis cases missed by sputum smear and for concomitant screening for MDR tuberculosis among adult inpatients attending tertiary care referral centers in other countries with a high burden of tuberculosis and HIV infection is warranted [corrected].

Genetic diversity of Mycobacterium tuberculosis in Madang, Papua New Guinea

Madang and surroundings, Papua New Guinea (PNG). To characterise the genetic diversity and drug susceptibility of Mycobacterium tuberculosis isolates collected in Madang and surroundings. M. tuberculosis was isolated from sputum samples from active pulmonary tuberculosis cases. Drug resistance profiles were obtained by drug susceptibility testing. M. tuberculosis lineages were identified by single nucleotide polymorphisms and sub-typing was performed by spoligotyping. Spoligotyping and 24 locus mycobacterial interspersed repetitive units-variable number of tandem repeats were combined to identify clustered isolates. The 173 M. tuberculosis isolates collected belonged predominantly to the Euro-American lineage (Lineage 4) and the East-Asian lineage (Lineage 2). Multidrug-resistant M. tuberculosis were observed in 5.2% of isolates. Lineage 2 M. tuberculosis, which includes the 'Beijing' genotype, was significantly associated with any drug resistance (OR 5.2, 95%CI 1.8-15.1). Cluster analyses showed 44% molecularly clustered isolates, suggesting transmission of M. tuberculosis in the community, including transmission of primary drug-resistant M. tuberculosis. These data provide the first insight into the molecular characteristics of M. tuberculosis in the Madang area of PNG, and indicate substantial drug resistance with evidence of ongoing transmission.

Value of Examining 3 Sputum Samples in the Diagnosis of Active Pulmonary Tuberculosis in Qatar

Objective To assess the need for testing a third sputum sample for the diagnosis of active pulmonary tuberculosis (PTB). Method Review of the records of all sputum culture proven cases of active PTB in the state of Qatar diagnosed from 2002 to 2008. Results During the 7-year study period, 687 cases of culture proven PTB were diagnosed in Qatar. Five hundred one cases had at least one positive sputum smear for acid-fast bacillus (73%). Among these, 363 cases had 3 consecutive sputum samples tested. There was no statistically significant difference in sensitivity between the first, second, and third sputum samples in detecting the acid-fast bacilli on direct fluorescent microscopy (81.3%, 83.5%, and 82.3%, respectively). The sensitivity of the first sample in establishing diagnosis was 81.3%, increasing to 96.2% if 2 sputum specimens were tested (14.9% incremental benefit). Testing a third specimen increased the sensitivity to 100% (3.8% incremental benefit). Conclusion Based on our results and to deal with the increasing number of cases of suspected PTB seen in the State of Qatar in the last few years as well as to minimize the increasing demand for isolation rooms and the burden on our laboratory, we recommend that testing only 2 sputum specimens for acid-fast bacilli instead of 3 is probably safe and is adequate for the diagnosis of PTB.

Diagnostic value of the commercial MycoDotTMtest in the diagnosis of active pulmonary tuberculosis in Nepalese population

International Journal of Medicine and Public Health,2012,2,4,32-36.DOI:10.5530/ijmedph.2.4.7Published:Oct 2012Type:Original ArticleDiagnostic value of the commercial MycoDotTM test in the diagnosis of active pulmonary tuberculosis in Nepalese populationAnil Chander, and Chandrika Devi Shrestha Anil Chander and Chandrika Devi Shrestha Department of Microbiology, Kathmandu Medical College Teaching Hospital, Sinamangal, Duwakot, Kathmandu, Nepal Abstract:Background: A rapid, technically non-demanding and inexpensive diagnostic test is needed to improve the early detection and better management of active pulmonary tuberculosis especially in resource limited areas. Objective: To assess the diagnostic value and usefulness of the commercially available MycoDotTM (DynaGen Inc., Cambridge, MA, USA) in the diagnosis of active pulmonary tuberculosis in Nepalese population. Materials and Methods: A prospective study was done from January 2008 to August 2008 on a group of 120 sputum smear positive adult patient group aged 17 to 78 years, confirmed cases of active pulmonary tuberculosis (with TB) were enrolled and sera samples collected from them. The second group comprised of 105 healthy controls with no history of pulmonary tuberculosis (without TB) and sera samples collected from them. The MycoDotTM serologic test was done on the sera samples collected from both the study groups according to the manufacturer’s instructions. Results: Of the sera collected from 120 sputum smear positive cases (with TB group), 48 sera specimens were MycoDotTM test positive (sensitivity = 40%; 95% CI 31.68–48.94). Healthy controls (without-TB group) – 8 sera samples were found to be positive by the MycoDotTM test and the remaining 97 sera samples tested negative by this serologic test (specificity = 92.38%; 95% CI 85.68–96.09). The value for % false positive was 7.61% and for % false negative was 60%. The positive predictive value and the negative predictive value was 85.71% (95% CI 73.22–93.20) and 57.4% (95% CI 49.56–64.88), respectively. Conclusion: The MycoDotTM test with its rapidity (completed within 20 min), easy – to – perform format and no expensive instrumentation required – had high specificity but a relatively low sensitivity in the study group subjects and thus could be used only as an additional test in the diagnosis of active pulmonary tuberculosis and to be interpreted judiciously alongwith clinical findings. Keywords:Immunodiagnosis, MycoDotTM test, Pulmonary tuberculosis, Sensitivity, SpecificityView:PDF (336.21 KB)

Chemotherapeutic evaluation of pulmonary tuberculosis patients with a complication of hepatic dysfunction

A retrospective study on the evaluation of antituberculous drugs for patients with hepatic dysfunction was undertaken to clarify treatment regimens. The values of GOT, GPT and T. Bil were used as indicators of liver function, and the "deterioration" in the liver function was defined as a level greater than 1.5 times the initial value. Of total 538 cases of active pulmonary tuberculosis, 103 cases (19.1%) had abnormalities in liver functions before chemotherapy, and 21 of 103 cases showed the deterioration in their liver functions during chemotherapy. There was little relationship between the initial status of liver functions and the incidence of their deteriorations after chemotherapy. Nine of 21 cases did not exceed the 3 times of normal ranges of liver functions. These nine cases could tolerate the same regimens of chemotherapy, and showed satisfactory clinical responses to chemotherapy with two exceptions: one died of tuberculosis and the other cerebrovascular disease. On the other hand, of 12 cases with elevated values of hepatic function greater than 3 times the normal limits, 6 cases discontinued chemotherapy. One case, however, died of hepatic failure related to chronic active hepatitis. Eight of 12 cases showed the rapid improvement of liver dysfunctions. These results suggest that antituberculous drugs are acceptable to patients with hepatic dysfunction as long as the elevations of GOT, GPT and T. Bil stay within 3 times of normal limits. Further chemotherapy could be continued under careful monitoring of liver functions even if the cases exhibit elevated levels of liver functions greater than 3 times the normal ranges.

Active Pulmonary Tuberculosis Case Detection and Treatment Among Floating Population in China: An Effective Pilot

China has more and more floating population because of reform and opening-up. As one of the high burden countries in tuberculosis (TB) control in the world, China has to face more challenges about the TB case detection and treatment among floating population in China. Aim to evaluate the effect of case detection and treatment of the Floating Population TB Control Pilot Project from Global Fund Round Five (GFR5) TB Control Program in China. During October 2006 to September 2008, the pilot project was implemented gradually in 60 counties in Tianjin, Shanghai, Jiangsu, Zhejiang, Fujian, Shandong and Guangdong. All quarterly reports of the pilot project were collected, and these materials were summarized and analyzed. In seven coastal provinces, 19,584 active pulmonary TB (PTB) cases were registered among floating population in 2 years. Among the active PTB cases, 87.2% were 15-45 years old, and 62.8% were male. In second year, 15,629 active PTB cases were registered, and the overall registration rate was 68 per 100,000 people. DOT treatments were provided for 18,125 active PTB cases in 2 years, and overall DOT treatment rate was 92.6%. There were 3,955 active PTB cases registered in first year, and the overall cure rate was 86.0%. Through the implementation of the pilot project, the TB case detection and treatment among floating population have been enhanced in pilot areas of China. The useful experience and results from the pilot project have been being gradually generalized nationally.

Immunogenicity of Novel DosR Regulon-Encoded Candidate Antigens of Mycobacterium tuberculosis in Three High-Burden Populations in Africa

Increasing knowledge about DosR regulon-encoded proteins has led us to produce novel Mycobacterium tuberculosis antigens for immunogenicity testing in human populations in three countries in Africa to which tuberculosis (TB) is endemic. A total of 131 tuberculin skin test-positive and/or ESAT-6/CFP10-positive, human immunodeficiency virus-negative adult household contacts of active pulmonary TB cases from South Africa (n = 56), The Gambia (n = 26), and Uganda (n = 49) were tested for gamma interferon responses to 7 classical and 51 DosR regulon-encoded M. tuberculosis recombinant protein antigens. ESAT-6/CFP10 fusion protein evoked responses in >75% of study participants in all three countries. Of the DosR regulon-encoded antigens tested, Rv1733c was the most commonly recognized by participants from both South Africa and Uganda and the third most commonly recognized antigen in The Gambia. The four most frequently recognized DosR regulon-encoded antigens in Uganda (Rv1733c, Rv0081, Rv1735c, and Rv1737c) included the three most immunogenic antigens in South Africa. In contrast, Rv3131 induced the highest percentage of responders in Gambian contacts (38%), compared to only 3.4% of Ugandan contacts and no South African contacts. Appreciable percentages of TB contacts with a high likelihood of latent M. tuberculosis infection responded to several novel DosR regulon-encoded M. tuberculosis proteins. In addition to significant similarities in antigen recognition profiles between the three African population groups, there were also disparities, which may stem from genetic differences between both pathogen and host populations. Our findings have implications for the selection of potential TB vaccine candidates and for determining biosignatures of latent M. tuberculosis infection, active TB disease, and protective immunity.

Tuberculosis Is Associated with a Down-Modulatory Lung Immune Response That Impairs Th1-Type Immunity

Immune mediators associated with human tuberculosis (TB) remain poorly defined. This study quantified levels of lung immune mediator gene expression at the time of diagnosis and during anti-TB treatment using cells obtained by induced sputum. Upon comparison to patients with other infectious lung diseases and volunteers, active pulmonary TB cases expressed significantly higher levels of mediators that counteract Th1-type and innate immunity. Despite the concomitant heightened levels of Th1-type mediators, immune activation may be rendered ineffectual by high levels of intracellular (SOCS and IRAK-M) and extracellular (IL-10 and TGF-betaRII, IL-1Rn, and IDO) immune suppressive mediators. These modulators are a direct response to Mycobacterium tuberculosis as, by day 30 of anti-TB treatment, many suppressive factors declined to that of controls whereas most Th1-type and innate immune mediators rose above pretreatment levels. Challenge of human immune cells with M. tuberculosis in vitro up-regulated these immune modulators as well. The observed low levels of NO synthase-2 produced by alveolar macrophages at TB diagnosis, along with the heightened amounts of suppressive mediators, support the conclusion that M. tuberculosis actively promotes down-modulatory mediators to counteract Th1-type and innate immunity as an immunopathological strategy. Our data highlight the potential application of immune mediators as surrogate markers for TB diagnosis or treatment response.

High-Level Rifampin Resistance Correlates with Multiple Mutations in the rpoB Gene of Pulmonary Tuberculosis Isolates from the Afghanistan Border of Iran

The aim of this study was to investigate the significance of multiple mutations in the rpoB gene as well as predominant nucleotide changes and their correlation with high levels of resistance to rifampin (rifampicin) in Mycobacterium tuberculosis isolates that were randomly collected from the sputa of 46 patients with primary and secondary cases of active pulmonary tuberculosis from the southern region (Afghanistan border) of Iran where tuberculosis is endemic. Drug susceptibility testing was performed using the CDC standard conventional proportional method. DNA extraction, rpoB gene amplification, and DNA sequencing analysis were performed. Thirty-five (76.09%) isolates were found to have multiple mutations (two to four) in the rpoB (beta-subunit) gene. Furthermore, we demonstrate that the combination of mutations with more prevalent nucleotide changes were observed in codons 523, 526, and 531, indicating higher frequencies of mutations among patients with secondary infection. In this study, 76.08% (n = 35) of all isolates found to have mutation combinations involving nucleotide changes in codons 523 (GGG-->GCG), 531 (TCG-->TTG or TTC), and 526 (CAC-->CGC, TTC, AAC, or CAA) demonstrated an association with higher levels of resistance to rifampin (MIC, >or=100 microg/ml).

Potential of Mw as a prophylactic vaccine against pulmonary tuberculosis

Mycobacterium w (Mw), is a cultivable, non-pathogenic mycobacterium and has been tried extensively as an immunomodulator in leprosy. This has been found to be safe and has shown beneficial immunoprophylactic effect in population based, double blind placebo controlled trials in North India. These effects were also observed in the vaccine trials in South India. Keeping in view these beneficial effects and its earlier reported protective effect against tuberculosis in animals, its protective efficacy was evaluated in a rural population of about 28,948 people belonging to 272 villages in Ghatampur, Kanpur (India). The population was vaccinated with two doses (1st dose of 1x10(9) heat killed organisms followed 6 months later with a 2nd dose of 5x10(8) organisms) of Mw 10-13 years ago originally to investigate its effect against leprosy. The vaccine/placebo was given to healthy contacts of leprosy patients who had no evidence of suffering from tuberculosis. Incidence and prevalence of pulmonary tuberculosis in the present study was assessed in a blind manner by an active field survey and also retrospectively by history of anti tuberculosis treatment received by the patient in the intervening period (since vaccination), which was also corroborated by scrutinizing the medical records. Diagnosis was confirmed by standard clinical and bacteriological criteria. A total of 69 patients were diagnosed to be suffering from pulmonary tuberculosis during the survey which included 17 new sputum smear positive cases and 52 previously partially treated but still active pulmonary tuberculosis cases. The difference in the new sputum positive cases between the vaccinated (5/17) and placebo groups (12/17) was significant at 5% level of significance for 1 tailed test (Z>1.64). As 75% (52/69) of the cases had been diagnosed as suffering from pulmonary tuberculosis but had not taken adequate therapy all the cases diagnosed during the intervening period were recorded and re-analysis done. The differences are more significant at 1% level of significance for 1 tail test (Z>2.59) when all cases were analysed as a group. A small proportion 12.85% (total number=3036) of the contacts in the study population had BCG scars. On analysis of results on protection against tuberculosis in this group, BCG did provide protection against tuberculosis (p<0.01). In the placebo group the prevalence of tuberculosis was 1.11% which reduced to 0.70% for those who received Mw vaccine (p<0.01) which further decreased to 0.53% in those who had BCG scars and received Mw. These results thus provide evidence suggesting protective efficacy of Mw against pulmonary tuberculosis and that Mw merits investigation in future prospective immunoprophylactic trials along with other candidates for protection against pulmonary tuberculosis.

The presence of a booster phenomenon among contacts of active pulmonary tuberculosis cases: a retrospective cohort

BackgroundAssuming a higher risk of latent tuberculosis (TB) infection in the population of Rio de Janeiro, Brazil, in October of 1998 the TB Control Program of Clementino Fraga Filho Hospital (CFFH) routinely started to recommend a two-step tuberculin skin test (TST) in contacts of pulmonary TB cases in order to distinguish a boosting reaction due to a recall of delayed hypersensitivity previously established by infection with Mycobacterium tuberculosis (M.tb) or BCG vaccination from a tuberculin conversion. The aim of this study was to assess the prevalence of boosted tuberculin skin tests among contacts of individuals with active pulmonary tuberculosis (TB).MethodsRetrospective cohort of TB contacts ≥ 12 years old who were evaluated between October 1st, 1998 and October 31st 2001. Contacts with an initial TST ≤ 4 mm were considered negative and had a second TST applied after 7–14 days. Boosting reaction was defined as a second TST ≥ 10 mm with an increase in induration ≥ 6 mm related to the first TST. All contacts with either a positive initial or repeat TST had a chest x-ray to rule out active TB disease, and initially positive contacts were offered isoniazid preventive therapy. Contacts that boosted did not receive treatment for latent TB infection and were followed for 24 months to monitor the development of TB. Statistical analysis of dichotomous variables was performed using Chi-square test. Differences were considered significant at a p < 0.05.ResultsFifty four percent (572/1060) of contacts had an initial negative TST and 79% of them (455/572) had a second TST. Boosting was identified in 6% (28/455). The mean age of contacts with a boosting reaction was 42.3 ± 21.1 and with no boosting was 28.7 ± 21.7 (p = 0.01). Fifty percent (14/28) of individuals whose test boosted met criteria for TST conversion on the second TST (increase in induration ≥ 10 mm). None of the 28 contacts whose reaction boosted developed TB disease within two years following the TST.ConclusionThe low number of contacts with boosting and the difficulty in distinguishing boosting from TST conversion in the second TST suggests that the strategy of two-step TST testing among contacts of active TB cases may not be useful. However, this conclusion must be taken with caution because of the small number of subjects followed.

Prevalence of Tuberculous Infection and Active Tuberculosis in Old Age Homes in Hong Kong

To assess the prevalence of tuberculous infection and active tuberculosis (TB) in old age homes in Hong Kong and to determine whether there is institutional transmission in these homes. Cross-sectional. Old age homes. Total of 2,243 residents, representing 84.6% of all residents in 15 old age homes; 1,698 were women, and 545 were men, with an average age of 82. All residents had a questionnaire-based interview, medical record review, two-stage tuberculin testing using two units purified protein derivative-RT23, and a chest x-ray. Those with radiological abnormalities had sputum examined for acid-fast bacilli. The estimated prevalence rate of active TB in this population was 669 per 100,000, significantly higher in men than in women (1,101 per 100,000 vs 530 per 100,000). The proportion with positive tuberculin reactivity (> or =10 mm induration) after two-stage testing was 68.6%, significantly higher in men than in women. There was no evidence of active transmission of disease in these old age homes, with restriction fragment length polymorphism (RFLP) analysis performed on five cases of active pulmonary TB in the home with the highest rate of TB showing unique RFLP patterns. The rate of active TB and TB infection in old age homes in Hong Kong is still high. Because treatment for latent TB carries a high risk for liver dysfunction in this population, clinicians and other healthcare workers need a high index of suspicion and to diagnose and treat this disease as early as possible to prevent transmission.

Active Pulmonary Tuberculosis with Vertebra and Rib Involvement: Case Report

Multifocal skeletal tuberculosis is defined as osteoarticular lesions that occur simultaneously at two or more locations and is generally associated with disseminated disease. Although involvement of bones accounts for 1 to 5% of all tuberculosis cases, multifocal involvement of the skeleton is extremely rare. We present a case of active pulmonary tuberculosis (TB) with vertebral and rib involvement and multiple hypodense lytic lesions accompanied by a paravertebral mass lesion. In the differential diagnosis, metastases, lymphoma, multiple myeloma, chordoma sarcoidosis and rare spinal infections such as brucellosis and fungal disease were considered. The diagnosis was established by surgical biopsy, taken by video-assisted thoracoscopic surgery. Especially for patients from TB-endemic areas, tuberculosis must be considered in the differential diagnosis and treatment should be started without delay.

The Clinical Value about Pulmonary Tuberculosis of Indirect Chest Radiography in Physical Examination for Conscription

Background : This study examined the clinical utility of using indirect chest radiography during a physical examination of new conscripts for determine the presence of pulmonary tuberculosis. Methods : Over an eight-month period, this study examined 25386 people who underwent a physical examination after conscription. The abnormal findings on mass miniature radiography were followed-up using direct chest radiography. The positive predictive value of mass miniature radiography and direct chest radiography was compared. The incidence, degree of infiltration and clinical outcome of active pulmonary tuberculosis were also evaluated during a follow-up examination. Results : The positive rate of mass miniature radiography was 1.19% (n=302). Various lesions were identified: Parenchymal lesions (n=109), mediastinal lesions (n=6), cardiovascular lesions (n=45), pleural lesions (n=49), bony lesions (n=90) and miscellaneous lesions (n=7). The incidence of active pulmonary tuberculosis by mass miniature radiography was 0.26% (n=67). The first diagnosis was made in 50 people; active pulmonary tuberculosis (n=42), pneumonia (n=1), a mediastinal mass (n=1), a rib fracture (n=2) and a pneumothorax (n=4). Most cases of active pulmonary tuberculosis were mildly infiltrated and either improved or were cured by the follow-up examination. Conclusion : Although mass miniature radiography in a physical examination after conscription has limitations, but it is a useful means for detecting the presence of early disease, particularly in active pulmonary tuberculosis.

Changes in Serum Cytokine Levels in Active Tuberculosis With Treatment

It has been reported that IFN-γ, TNF-α, and IL-12 stimulate, and that IL-10, TGF-β, and IL-4 suppress the protective immune response against tuberculosis. We aim to evaluate changes in the serum levels of pro and antiinflammatory cytokines in active pulmonary tuberculosis (APTB) and the possible effects of treatment on these changes. Serum IL-12p40, IL-4, IL-10, TNF-α, IFN-γ, and TGF-β1 levels were determined in 20 APTB cases (group 1) before and 2, 4, and 6 months after therapy. The same parameters were also determined in 9 inactive pulmonary tuberculosis (IPTB) cases (group 2) and 9 healthy controls (HC, group 3). Before treatment, the mean serum IFN-γ, TNF-α, and IL-10 levels in group 1 were statistically higher than those in group 2 (P = .001, P = .024, P = .016, resp) or group 3 (P = .003, P = .002, P = .011, resp). The levels in group 1 decreased significantly after treatment (P = .001 for IFN-γ, P = .004 for TNF-α, P = .000 for IL-10). The serum levels of IL-12p40 were significantly higher in group 1 than in group 3 (P = .012) and decreased insignificantly after treatment. There was no difference in serum IL-4 and TGF-β1 levels among the groups (P > .05). Because the serum IL-12p40, IL-10, TNF-α, and IFN-γ levels were high in APTB, we believe that these cytokines have important roles in the immune response to Mycobacterium tuberculosis (M tuberculosis). These parameters could be used in follow-up as indicators of the success of APTB therapy.

The epidemic of childhood tuberculosis in China

To analyze the epidemic situation of children Tuberculosis (TB) in China. To sum up the data of four times national TB epidemic survey from 1979 to 2000, and analyze the epidemic situation of children whose age were between 0 and 14. The TB prevalence rates in children were 8.8%, 9.6%, 7.5% and 9.0% in 1979, 1984/85, 1990, 2000. The active pulmonary TB (PTB) prevalence rates in children were 241.7/100 000 172.1/100 000, 91.8/100 000 in 1979, 1990 and 2000, the bacteriological positive PTB prevalence rates were 12.7/100 000, 12.3/100 000 in 1990 and 2000, the smear positive PTB prevalence rates were 7.5/100 000, 7.5/100 000 and 6.7/100 000 in 1979, 1990 and 2000; It was estimated there were 26.08 million children who were infected by microbacterial TB, 266 thousands children active PTB cases, 36 thousands children bacteriological positive PTB cases and 19 thousands children smear positive PTB cases in 2000 according to the data of the national population survey. the rates were 4.5%, 5.9%, 1.8%, 1.3% when comparing them to the all patients. the ratio of children TB prevalence rates between city and country were 1.8, 1.8, 1.7 and 1.2 in the four survey. The TB prevalence rates in children had not obvious decrease from 1979 to 2000 were not allowed to optimize to the epidemic of children TB. The bacteriological negative PTB had a bigger. The difference of children TB prevelance between city and country reduced gradually. The quantity of sample and other factors influenced the forecast value of PPD to disease, so it would be a trend of using the routine surveillance to replace the national epidemic survey. BCG still would be the an important content in our national TB control before the emergence of the new and more efficient vaccine.