Active TB Cases Research Articles

Nanopore-targeted sequencing (NTS) for intracranial tuberculosis: a promising and reliable approach

BackgroundThe World Health Organization predicted 10.6 million new tuberculosis cases and 1.5 million deaths in 2022. Tuberculous meningitis, affecting 1% of active TB cases, is challenging to diagnose due to sudden onset, vague symptoms, and limited laboratory tests. Nanopore-targeted sequencing (NTS) is an emerging third-generation sequencing technology known for its sequencing capabilities. We compared its detection efficiency with Xpert, MTB culture, PCR, and AFB smear in cerebrospinal fluid samples to highlight the substantial potential of NTS in detecting intracranial tuberculosis.MethodsThis study included 122 patients suspected of having intracranial tuberculosis at the Second Hospital of Nanjing in Jiangsu Province, China, between January 2021 and January 2024. The Univariate logistic regression and random forest regression identified risk factors and clinical markers. A chi-square test evaluated diagnostic accuracy for different image types of intracranial tuberculosis.ResultsThe research involved 100 patients with intracranial tuberculosis. Among them, 41 had tuberculous meningitis, 27 had cerebral parenchymal tuberculosis, and 32 had mixed intracranial tuberculosis. Besides, 22 patients were diagnosed with other brain conditions. In diagnosing intracranial tuberculosis, NTS demonstrated a sensitivity of 60.0% (95% CI: 49.7-69.5%) and a specificity of 95.5% (95% CI:75.1-99.8%), with an AUC value of 0.78 (95% CI: 0.71 to 0.84), whose overall performance was significantly better than other detection methods. There was no notable difference (P > 0.05) in diagnostic accuracy between NTS and the final diagnosis for intracranial tuberculosis patients with varying imaging types. Furthermore, patients who tested positive had a 31.500 (95% CI: 6.205-575.913) times higher risk of having intracranial tuberculosis compared to those with negative results.ConclusionDue to its convenience, efficiency, quick turnaround time, and real-time sequencing analysis, NTS might become a promising and reliable method for providing microbiological diagnoses for patients with intracranial tuberculosis and for screening populations at risk.

Routine tuberculosis contact investigation yield and preventive treatment cascade in central Ethiopia

IntroductionThere is a global gap between tuberculosis incident cases and the notified cases. Active household contact investigation is one of the strategies to narrow this gap. It has the advantage of giving early diagnosis and preventive treatment to vulnerable and eligible groups. This study assessed the practice of contact investigation and tuberculosis preventive treatment adherence in central Ethiopia. MethodA cross-sectional study covering all registered bacteriologically confirmed pulmonary tuberculosis patients and their close contacts was conducted in central Ethiopia from January 1, 2022, to December 30, 2022. ResultA total of 1372 household contacts were declared by the index cases. From these 79.44 % (1090) contacts received a one-time tuberculosis screening giving a total of four (0.36 %) active TB cases. Among 484 household contacts of drug-resistant tuberculosis index cases, 5.53 % (14) had presumptive tuberculosis and 0.79 % (2) had active tuberculosis. While among 837 household contacts of drug-susceptible tuberculosis index cases presumptive TB cases were 1.91 % (16) and active TB cases were 0.23 % (2). Of the 142 eligible under 15 children 81.69 % (116) had started tuberculosis preventive treatment and 84.48 % (98) completed the treatment. On multivariable logistic regression, the associated factor for tuberculosis preventive treatment non-adherence was age 2–5 years (aOR, 0.02, 95 % CI (0.002–0.20) and age 5–15 years (aOR, 0.04,95 % CI (0.002–0 0.95)) P=<0.05). ConclusionThere was low contact screening practice in the DR-TB index cases as compared to national and global targets. The yield of routine contact investigation was low and it indicates the quality of screening. Tuberculosis preventive treatment initiation and completion rates were also low as compared to those of many other countries and global achievements which need further improvement, especially for completion. Alternative mechanisms should be planned to increase the yield of tuberculosis screening and tuberculosis preventive treatment adherence.

Screening of household contacts for TB infection in Cote d'Ivoire.

Côte d'Ivoire is a country with a high incidence of TB. The control of TB infection is focused on high-risk patients but has limited implementation. Cost-benefit analysis of TB infection (TBI) screening of household contacts in Côte d'Ivoire to evaluate economic implications of the implementation of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST). We compared the effectiveness of QuantiFERON-TB Gold Plus (QuantiFERON) with the TST using an economic model previously evaluated in medium TB incidence settings. Principal outcomes relating to TBI screening, as well as the lifetime costs and benefits of the patient cohort, were captured using a decision tree, followed by a Markov model. QuantiFERON proved to be both more effective and less costly than TST. Compared to QuantiFERON, TST use leads to an approximate 33% increase in the lifetime risk of developing active TB. For household contacts of active TB cases in Côte d'Ivoire, QuantiFERON is cost-effective when compared with TST. R shiny interactive interface enables model customisation for different scenarios, settings, risk groups and TBI screening methods. Further research should be conducted in similar settings to generalise the results.

Histoplasma Seropositivity in TB Patients in The Gambia: Evidence to Drive Research on a High-Priority Fungal Pathogen.

Inclusion of Histoplasma in the World Health Organization's first Fungal Priority Pathogens List under "high-priority" fungal species highlights the need for robust surveillance of Histoplasma spp. in endemic and underrepresented regions. Despite increasing reports of histoplasmosis in Africa, data on the burden of this fungal disease are sparse in The Gambia. This baseline study examined the human seroprevalence of anti-Histoplasma antibody in a TB patient group in The Gambia, explored associations between seropositivity and demographic and clinical variables, and proposes future research directions. Biobanked plasma samples were selected from active TB cases with variable HIV infection status. Latex agglutination tests were performed on samples from 52 study participants to detect the presence of anti-Histoplasma antibodies. Potential risk factors for Histoplasma exposure were explored using logistic regression analysis. The sample seroprevalence of anti-Histoplasma antibody was 28.8% (n = 15/52; 95% CI, 17.1%-43.1%). Multivariable logistic regression analysis identified a statistically significant association between Histoplasma seropositivity and age (odds ratio, 0.91; 95% CI, 0.84-0.98; P = .008). This baseline study provides evidence of Histoplasma seropositivity in TB patients in The Gambia and explores risk factors for exposure. The small sample size and use of the LAT in TB and HIV-positive patient groups are significant study limitations. Future research directions are proposed to ascertain the burden of Histoplasma in general and patient populations and explore the context-specific risk factors for exposure and infection in The Gambia.

Prevalence of Various Forms of Active Tuberculosis in Patients with Diabetes

A diabetic foot ulcer (DFU) is a persistent complication of diabetes mellitus. Diabetes is linked to a two to four-fold higher likelihood of developing peripheral arterial disease (PAD) when compared to individuals without diabetes. Objective: To determine the incidence of various forms of active tuberculosis in patients with diabetes. Methods: It was a cross-sectional study conducted at the Department of General Medicine from August 2022 to February 2023. 175 patients, including both males and females, participated in this study. Comprehensive demographic information was meticulously documented for each patient following the appropriate consent procedures. These patients had symptoms such as cough with or without phlegm, hemoptysis, persistent fever, and unexplained weight loss, and their ages ranged from 10 to 85 years. Comprehensive medical history, clinical examination, and TB screening tests were conducted and data analysis were done by SPSS version-24 for further analysis. Results: The mean age was 51.34 years with a standard deviation of 3.61. Among the patients, 107 (61.14%) were male, and 68 (38.85%) were female. The overall prevalence of active TB was 38 cases, accounting for 21.71% of the total. Among these cases, 18 were pulmonary TB, making up 47.36% of the active TB cases, while 13 were extra-pulmonary TB, constituting 34.21% of the total. Additionally, 5 cases were identified as multidrug-resistant TB, representing 13.15% of the active TB cases. Conclusions: In conclusion, our study reveals a higher prevalence of various forms of active tuberculosis in patients with diabetes with pulmonary tuberculosis accounting for 47.35% and extra pulmonary tuberculosis for 34.21% of cases.

Facilitators and barriers to tuberculosis active case findings in low- and middle-income countries: a systematic review of qualitative research

BackgroundTuberculosis (TB) is an ancient infection and a major public health problem in many low- and middle-income countries (LMICs). Active case finding (ACF) programs have been established to effectively reduce TB in endemic global communities. However, there is little information about the evidence-based benefits of active case finding at both the individual and community levels. Accurately identifying the facilitators and barriers to TB-ACF provides information that can be used in planning and design as the world aims to end the global TB epidemic by 2035. Therefore, this study aimed to identify the facilitators and barriers to tuberculosis ACF in LMICs.MethodsA systematic search was performed using recognized databases such as PubMed, Google Scholar, SCOPUS, HINARI, and other reference databases. Relevant studies that assessed or reported the ACF of TB conducted in LMICs were included in this study. The Joanna Briggs Institute’s (JBI) Critical Appraisal Tool was used to assess the quality of the selected studies. The Statement of Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) was used to strengthen the protocol for this systematic review. The Confidence of Evidence Review Quality (CERQual) approach was also used to assess the reliability of the review findings.ResultsFrom 228 search results, a total of 23 studies were included in the final review. Tuberculosis ACF results were generated under two main themes: barriers and facilitators in LMICs, and two sub-themes of the barriers (healthcare-related and non-healthcare-related barriers). Finally, barriers to active TB case finding were found to be related to (1) the healthcare workers’ experience, knowledge, and skills in detecting TB-ACF, (2) distance and time; (3) availability and workload of ACF healthcare workers; (4) barriers related to a lack of resources such as diagnostic equipment, reagents, and consumables at TB-ACF; (5) the stigma associated with TB-ACF detection; (6) the lack of training of existing and new healthcare professionals to detect TB-ACF; (7) communication strategies and language limitations associated with TB ACF; and (8) poor or no community awareness of tuberculosis. Stigma was the most patient-related obstacle to detecting active TB cases in LMICs.ConclusionThis review found that surveillance, monitoring, health worker training, integration into health systems, and long-term funding of health facilities were key to the sustainability of ACF in LMICs. Understanding the elimination of the identified barriers is critical to ensuring a maximum tuberculosis control strategy through ACF.

Serum proteomics analysis for differentiation among Mycobacterium tuberculosis infection categories

Inhalation of Mycobacterium tuberculosis (Mtb) bacilli can lead to a range of TB categories including early clearance (EC), latent TB infection (LTBI) and active TB (ATB). There are few biomarkers available to differentiate among these TB categories: effective new biomarkers are badly needed. Here, we analyzed the serum proteins from 26 ATB cases, 20 LTBI cases, 34 EC cases and 38 healthy controls (HC) using label-free LC-MS/MS. The results were analyzed using MaxQuant software and matched to three different bacterial proteomics databases, including Mtb, Mycobacterium spp. and normal lung flora. PCA of protein candidates using the three proteomics databases revealed 44.5% differentiation power to differentiate among four TB categories. There were 289 proteins that showed potential for distinguishing between each pair of groups among TB categories. There were 50 candidate protein markers specifically found in ATB and LTBI but not in HC and EC groups. Decision trees using the top five candidate biomarkers (A0A1A2RWZ9, A0A1A3FMY8, A0A1A3KIY2, A0A5C7MJH5 and A0A1X0XYR3) had 92.31% accuracy to differentiate among TB categories and the accuracy was increased to 100% when using 10 candidate biomarkers. Our study shows that proteins expressed from Mycobacterium spp. have the potential to be used to differentiate among TB categories.

Practice regarding tuberculosis care among physicians at private facilities: A cross-sectional study from Vietnam.

To evaluate the practice of TB care among physicians at private facilities. A cross-sectional study was conducted using questionnaires on knowledge, attitude, and practice related to TB care. The responses to these scales were used to explore latent constructs and calculate the standardized continuous scores for these domains. We described the percentages of participant's responses and explored their associated factors using multiple linear regression. A total of 232 physicians were recruited. The most important gaps in practice included requesting chest imaging to confirm TB diagnosis (~80%), not testing HIV for confirmed active TB cases (~50%), only requesting sputum testing for MDR-TB cases (65%), only requesting follow-up examination at the end of the treatment course (64%), and not requesting sputum testing at follow-up (54%). Surgical mask was preferred to N95 respirator when examining TB patients. Prior TB training was associated with better knowledge and less stigmatizing attitude, which were associated with better practice in both TB management and precautions. There were important gaps in knowledge, attitude, and practice of TB care among private providers. Better knowledge was associated with positive attitude towards TB and better practice. Tailored training may help to address these gaps and improve the quality of TB care in the private sector.

1434. Incidence of Tuberculosis after Transplantation: A Nationwide Cohort Study in South Korea, 2008-2020

Abstract Background Tuberculosis (TB) is one of the leading causes of morbidity and mortality among transplant recipient. The purpose of this study is to evaluate the standard incidence ratios (SIRs) of TB in all transplant recipient and to compare which is more risk by transplant type. Methods We conducted a nationwide population-based retrospective study using data retrieved from the Health Insurance Review and Assessment Service. Active TB case were studied, and SIRs was calculated based on the most recent year, 2019. SIRs were computed as the ratio of observed to expected numbers of TB, based on national age and sex. All analyses were conducted by transplant type and age group. Results From 2008 to 2020, a total of 57,103 patients who underwent transplantation were included. 830 cases were confirmed with TB (1.45%) and median time to develop TB was 1.74 year following transplantation. When analyzing the cumulative incidence by transplant group, it was in the order of allogenic hematopoietic stem cell transplantation (HSCT), solid organ transplantation (SOT), and autologous HSCT (P&amp;lt; 0.001). In SOT, liver transplantation had the highest incidence of TB, followed by lung, heart, and kidney (P&amp;lt; 0.001). The cumulative incidence for the age group increased with age (P&amp;lt; 0.001). Incidence of TB was markedly increased among transplant recipients compared with general population (SIR: 3.53, Confidence interval (CI): 3.38-3.67). SIR varied according to age group: age under 20 years (SIR: 4.98 CI: 3.16-7.47), age between 20 and 40 years (SIR: 5.83 CI: 5.22-6.49), age between 40 and 60 years (SIR: 4.66 CI: 4.42-4.92), age over 60 years (SIR: 2.05 CI: 1.89-2.21). Based on a multivariate analysis, male sex (hazard ratio (HR) = 1.398; P &amp;lt; 0.001), previous TB history (HR = 1.515; P=0.014) were the common independent risk factors for TB after transplantation. Baseline characteristics of study population Cumulative incidence of TB following transplant Risk factor of tuberculosis after transplanatation Conclusion The incidence of TB in transplant recipient is at least three times higher than the general population in South Korea. Regardless of the type of transplant, TB should be considered as a complication within 1 years of transplantation and special attention should be paid to patients with a history of previous TB history. Disclosures All Authors: No reported disclosures.

Individuals' Vulnerability Based Active Surveillance for TB: Experiences from India.

Community-based active TB case finding (ACF) has become an essential part of TB elimination efforts in high-burden settings. In settings such as the state of Kerala in India, which has reported an annual decline of 7.5% in the estimated TB incidence since 2015, if ACF is not well targeted, it may end up with a less-than-desired yield, the wastage of scarce resources, and the burdening of health systems. Program managers have recognized the need to optimize resources and workloads, while maximizing the yield, when implementing ACF. We developed and implemented the concept of 'individuals'-vulnerability-based active surveillance' as a substitute for the blanket approach for population/geography-based ACF for TB. Weighted scores, based on an estimate of relative risk, were assigned to reflect the TB vulnerabilities of individuals. Vulnerability data for 22,042,168 individuals were available to the primary healthcare team. Individuals with higher cumulative vulnerability scores were targeted for serial ACF from 2019 onwards. In 2018, when a population-based ACF was conducted, the number needed to screen to diagnose one microbiologically confirmed pulmonary TB case was 3772 and the number needed to test to obtain one microbiologically confirmed pulmonary TB case was 112. The corresponding figures in 2019 for individuals'-vulnerability-based ACF were 881 and 39, respectively. Individuals'-vulnerability-based active surveillance is proposed here as a practical solution to improve health system efficiency in settings where the population is relatively stationary, the TB disease burden is low, and the health system is strong.

Association of in vitro fertilization with maternal and perinatal outcomes among pregnant women with active tuberculosis: A retrospective hospital-based cohort study.

Study on effect of fertilization methods on maternal and perinatal outcomes with respect to TB during pregnancy was scarce. This study aimed to analyze maternal and perinatal outcomes in active TB cases after in vitro fertilization (IVF) treatment vs. normal pregnancy. Clinical data of 80 pregnant women with active TB hospitalized at Shanghai Public Health Clinical Center between June 1st, 2014 and November 30th, 2020 were extracted and retrospectively analyzed. History of receiving IVF was recorded at admission and its association with maternal and perinatal outcomes were assessed using multivariable logistic regression models with adjustment for potential confounders. Of the 80 pregnant women with active TB, 28 (35.0%) received IVF treatment and 52 (65.0%) did not receive IVF treatment. After adjusting for potential confounders, receiving IVF was associated with worse maternal and perinatal outcomes, including maternal criticality (21.4 vs. 2.0%, adjusted OR = 28.3, P = 0.015), miliary TB (89.3 vs. 13.5%, adjusted OR = 75.4, P < 0.001), TB meningitis (32.1 vs. 7.7%, adjusted OR = 6.2, P = 0.010), and perinatal mortality (64.3 vs. 28.8%, adjusted OR = 9.8, P = 0.001). The additional risk of TB to women receiving IVF treatment is a public health challenge specific to countries with a high tuberculosis burden. Increased awareness of latent tuberculosis infection in women receiving IVF treatment is needed.

Management of Latent Tuberculosis Infection in Saudi Arabia: Knowledge and Perceptions Among Healthcare Workers.

BackgroundTuberculosis (TB) continues to pose a serious threat to public health despite great efforts. For many years, management and screening for active TB cases have been the main focus of TB control programs. Latent TB is a stage where TB can be prevented and controlled. Therefore, designing a comprehensive TB control program that includes latent tuberculosis infection (LTBI) management diseases is needed to be implemented among the healthcare workers (HCWs) who have been found to be at a higher risk for active TB compared to the general population.The objective of the studyThe objective of the study is to assess the knowledge and perceptions of LTBI among HCWs. In addition to estimating the prevalence of LTBI among HCWs using closed-end questions in a self-administered questionnaire.Subjects and methodsThrough a cross-sectional study and non-random sampling technique, 324 (84%) healthcare workers who met the inclusion criteria completed and submitted the electronic questionnaire.ResultsAmong all participants, the study reported a good knowledge about LTBI; however, a third of HCWs had poor knowledge about the difference between LTBI and active TB. Eighteen percent of participants were diagnosed with LTBI, and two-thirds accepted the treatment. Of all participants who started the treatment, 55% completed the treatment course. The compliance rate was high among young HCWs and physicians who had a short course of LTB treatment regimen. ConclusionThe study reported a low acceptance and completion rate of LTBI therapy among HCWs. Low knowledge about some clinical facts of LTBI, the long duration of treatment, and being the treatment optional in Saudi health institutes were all barriers to accepting and completing the treatment of LTBI. All of these factors need to be addressed to increase the compliance rate to LTBI treatment.

Screening of latent tuberculosis infection among patients with diabetes mellitus from a high-burden area in Brazil.

Although several cohort studies have raised the important association between diabetes mellitus (DM) and latent tuberculosis infection (LTBI), evidences are limited and controversial. Furthermore, it is well documented that the poor glycemic control may exacerbate the risk for active TB. Thus, the monitoring of diabetic patients living in high-incidence areas for TB is an important concern in views of available diagnostic tests for LTBI. In this cross-sectional study, we estimate the association of DM and LTBI among diabetic patients classified as type-1 DM (T1D) or type-2 DM (T2D) living in Rio de Janeiro, RJ, Brazil - considered a high TB burden region of these country. Non-DM volunteers were included as endemic area healthy controls. All participants were screened for DM using glycosylated-hemoglobin (HbA1c) and for LTBI using the QuantiFERON-TB Gold in Tube (QFT-GIT). Demographic, socioeconomic, clinical and laboratorial data were also assessed. Among 553 included participants, 88 (15.9%) had QFT-GIT positive test, of which 18 (20.5%) were non-DM, 30 (34.1%) T1D and 40 (45.4%) T2D. After adjustments for potential baseline confounders, age, self-reported non-white skin color and an active TB case in the family were significantly associated with LTBI among the studied population by using a hierarchical multivariate logistic regression analysis. Additionally, we verified that T2D patients were able to produce significant increased interferon-gamma (IFN-γ) plasma levels in response to Mycobacterium tuberculosis-specific antigens, when compared to non-DM individuals. Altogether, our data showed an increased prevalence of LTBI among DM patients, albeit non-statistically significant, and point out to important independent factors associated with LTBI, which deserve attention in monitoring patients with DM. Moreover, QFT-GIT test seems to be a good tool to screening LTBI in this population, even in a high TB burden area.

Sildenafil, a Type-5 Phosphodiesterase Inhibitor, Fails to Reverse Myeloid-Derived Suppressor Cell-Mediated T Cell Suppression in Cells Isolated From Tuberculosis Patients.

Successful TB treatment is hampered by increasing resistance to the two most effective first-line anti-TB drugs, namely isoniazid and rifampicin, thus innovative therapies focused on host processes, termed host-directed therapies (HDTs), are promising novel approaches for increasing treatment efficacy without inducing drug resistance. We assessed the ability of Sildenafil, a type-5 phosphodiesterase inhibitor, as a repurposed compound, to serve as HDT target, by counteracting the suppressive effects of myeloid-derived suppressor cells (MDSC) obtained from active TB cases on T-cell responsiveness. We confirm that MDSC suppress non-specific T-cell activation. We also show that Sildenafil treatment fails to reverse the MDSC-mediated suppression of T-cell functions measured here, namely activation and proliferation. The impact of Sildenafil treatment on improved immunity, using the concentration tested here, is likely to be minimal, but further identification and development of MDSC-targeting TB host-directed therapies are warranted.

To study the prevalence of latent tuberculosis infection among medical students

Background: Risk of developing latent tuberculosis infection increases in medical students with their higher exposure to TB care facilities. Objective: To study the prevalence of latent TB infection among students attending professional degrees MBBS, BDS, MD, MS, MDS at King George’s Medical University, India. Methods: This study was carried out with Tuberculin skin testing among students and active TB cases were excluded. A standard dose of 0.1?mL of purified protein derivative was slowly injected intra dermally into non-dominant forearm. After 48-72 hours, the reaction was estimated by measuring the transverse diameter of the induration. Results: Total 561 students had given consent to get enrolled. Prevalence of latent tuberculosis infection was significant with period of clinical exposure (p-value &lt; 0.05), average size of induration (p-value &lt; 0.001), and history of prior Tuberculin Skin Test (p-value &lt; 0.001). However it was not significant with the age (p-value &gt; 0.05), gender (p-value &gt; 0.05), and history of contact with active cases of TB (p-value &gt; 0.05). Conclusion: The prevalence of latent tuberculosis infection is higher in post graduate students followed by interns and final year students due to more exposure to patients in wards and clinics at King George’s Medical University, India.

Quality assurance practices in tuberculosis diagnostic health facilities in Ethiopia.

The quality of tuberculosis laboratory services in health facilities is a mandatory component of detecting active pulmonary TB cases and treatment follow-up. However, ensuring the quality of laboratory test results is a concern. This study aimed to assess the quality assurance practices in the tuberculosis diagnostic health facilities of Ethiopia. A cross-sectional study was conducted from October 2018 to March 2019 at nine governmental TB-culture laboratories and 34 randomly selected GeneXpert® MTB/RIF (Xpert® MTB/RIF) testing health facilities in Ethiopia. Participating health facilities were interviewed and laboratory documents and records present since 2017 were observed. Prior to the data collection, training was given to the data collectors. Descriptive statistics were used to produce results and were presented with tables and graphs. From a total of 34 Xpert® MTB/RIF testing laboratories, 50% run Internal Quality Control (IQC) for Acid-Fast Bacillus (AFB) Microscopy and 67.6% had lot-to-lot verification of staining reagents. For the Xpert® MTB/RIF assay, a lot-to-lot verification of cartridge and method validation was performed only in 8.8%and 20.6% of Xpert® MTB/RIF testing laboratories respectively. All TB-culture laboratories included in the study ran negative control (start and end IQC) during TB-culture sample processing and performed lot-to-lot verification for Mycobacteria Growth Indicator Tube (MGIT) in 88.9% of TB-culture laboratories. External Quality Assessment (EQA) Proficiency Testing (PT) for AFB microscopy is practiced in 79.4% Xpert® MTB/RIF testing laboratories and 100.0% for the Xpert® MTB/RIF assay. TB-Culture PT participation practice among TB-culture laboratories was 88.9%. A major challenge for health facilities during PT participation was the AFB PT-sample transportation delay (40.7%) and the Xpert® MTB/RIF assay EQA-PT feedback missing (38.2%). This assessment reveals that IQC for AFB microscopy, lot-to-lot verification, method validation, and equipment calibration were not well-practiced. The majority of TB diagnostic health facility laboratories had EQA-PT participation practice, but a significant gap in PT-sample transportation and missing feedback was identified.

P2X7 1513A/C loss-of-function polymorphism and active tuberculosis disease in a cohort of Egyptian population: a pilot study

BackgroundTuberculosis (TB) is a multifactorial disease, and increasing evidence shows that genetic variants in regulating genes of immune response confer susceptibility to active TB at the individual level. We aimed to identify the contribution of P2X7 receptor 1513A/C genetic polymorphisms to different clinical forms of active tuberculosis in a cohort of Egyptian population.MethodsA case–control study that enrolled 25 newly diagnosed pulmonary TB (PTB) patients by positive sputum for AFB or positive culture, 25 extrapulmonary TB (EPTB) diagnosed by pathological/bacteriological/immunological studies and 25 healthy controls. A blood sample was taken before starting of therapy for P2X7 1513A/C polymorphism genotyping using PCR-restriction fragment length polymorphism.ResultsFifty-two percent of the participants were in the third decade with equal gender distribution. P2X7 receptor 1513AA (homozygote wild), AC (heterozygote) and CC (homozygote mutant) genotypes were identified. AC and CC genotypes distribution were significantly more frequent in the active TB cases (either PTB or EPTB) rather than controls (p < 0.05). Further, P2X7 1513A/C genotypes’ distribution did not associate with old TB or gender (p > 0.05), but significantly associated with history of smoking (x2 trend analysis p = 0.036).ConclusionsThere is positive association between P2X7 receptor 1513A/C polymorphism and active tuberculosis in the Egyptians.

Pendidikan Kesehatan Terhadap Tingkat Kemandirian Keluarga Dalam Merawat Penderita TB di Wilayah Kerja Puskesmas Lembang

In 2014, the highest number of cases of pulmonary TB were in Africa (37%), Southeast Asia (28%), and the Eastern Mediterranean region (17%). In West Sulawesi (2016) the number of new cases of positive and active BTA pulmonary TB as many as 1,240 patients, the most cases are men, namely, 771 (62%) while women 469 (38%). BTA positive pulmonary tuberculosis coverage is cured, complete treatment, and treatment success rate by province in 2016, treatment success 1,077 with successful treatment as much as 84.8. This study aims to find out the relationship of health education to the level of family independence in caring for tb sufferers. The type of research used is observational analytical research using cross sectional research designs. The research was conducted in the Lembang Majene Health Center Work area. A sample of 33 people. Fisher's Exact Test result was obtained a value of P = 0.000 (&lt;0.05). Then it can be concluded that there is a relationship between knowledge and the level of family independence in caring for TB sufferers. It is expected to puskesmas officers to socialize home care nursing (home visits) and further improve the quality of service to people with Pulmonary TB, especially in terms of drug taking schedules.

Comparison of Cytokines Expression from Human Monocyte-Derived Macrophages Infected with Different Species of Mycobacteria.

Cytokines have an important role in mounting effective host immune response against mycobacteria. Latent tuberculosis infection (LTBI) is an indication of containment of mycobacteria by the host immune response, whereas active TB is an indication of a failure of the immune response to contain Mycobacterium tuberculosis. The dynamics of this host-immune response during in vitro infection experiment is believed to be indicative of behavior in the LTBI and active-TB cases. This relationship is, however, not fully elucidated. We investigated the cytokines expression at mRNA and protein level across 2 different protocols, that is, an in vitro protocol comparing human monocyte-derived macrophages (hMDMs; n = 12) infected with different species of mycobacteria, and a clinical protocol comparing TB-Antigen-Nil specimens from LTBI (n = 12) and active-TB (n = 12) cases. We found that in vitro infection of hMDMs with Mycobacterium bovis Bacillus Calmette-Guérin (BCG) and M. tuberculosis R179 showed increased colony-forming units at all time points postinfection. M. bovis BCG-infected hMDMs demonstrated higher levels of 5 cytokines [interferon (IFN)-γ, interleukin (IL)-6, IL-1β, IL-12p40, and IL-12p70] at different intervals compared to M. tuberculosis R179. Compared to LTBI, active-TB cases had higher mRNA expression of IFN-α, IL-6, and IL-8, and lower expression of IFN-γ, IL-1α, IL-1β, IL-4, and tumor necrosis factor-α. Overall, we observed differential host responses at mRNA and protein levels during experimentally controlled in vitro infection, but no prominent differences were observed in the clinical protocol. Therefore, the result of the in vitro experiment model of cytokine response against mycobacteria should be interpreted cautiously when relating to LTBI and active-TB.

Global Control of Tuberculosis: Current Status and Future Prospects

Tuberculosis is a zoonotic disease that is caused by mycobacterium tuberculosis complex and can infect humans, livestock, and wildlife. It spreads primarily through the respiratory tract and was the leading cause of death due to a single infectious disease before the COVID-19 pandemic. TB is a global public health emergency that has reemerged over the past few decades. Substantial efforts are needed to achieve the goals of the End TB Strategy. The World Health Organization has estimated that approximately 9.9 million people worldwide contracted TB in 2020 and that approximately 140,000 of the 10 million new cases of active TB in 2019 were zoonotic TB. During the COVID-19 pandemic, the number of new TB diagnoses and reports decreased sharply, from 7.1 million in 2019 to 5.8 million in 2020, returning to 2012 levels far below the approximately 10 million TB cases in 2020. Simultaneously, the global decrease in the absolute number of TB deaths until 2019 was followed by an increase in 2020 in four of the six WHO regions and most of the 30 high-TB-burden countries. Therefore, extensive immediate actions worldwide are required to restore the health system, and innovations are needed to accelerate progress toward a tuberculosis-free world.