Adult Pulmonary Tuberculosis Patients Research Articles

Risk factors for tuberculosis-related death among adults with drug-sensitive pulmonary tuberculosis in Selangor, Malaysia from 2013 to 2019: a retrospective cohort study using surveillance data

ObjectivesDue to the paucity of literature on risk factors for tuberculosis (TB)-related death, we determine the sociodemographic and clinical risk factors associated with TB-related deaths among adult pulmonary TB (PTB)...

Comparison of short term and long term multidrug resistant tuberculosis treatment outcomes in tertiary care settings

IntroductionTuberculosis is a contagious and communicable disease while drug resistant tuberculosis is difficult to treat and requires long duration. Various strategies are focused to treat the drug resistant tuberculosis focusing lesser side effects and shorter duration of treatment. ObjectiveTo compare treatment outcomes between short-term and long-term regimens among patients registered at a tertiary care hospital's Programmatic Management of Drug-Resistant TB (PMDT) site in Pakistan. MethodsA comparative prospective cohort study was conducted at IMBB, The University of Lahore, in collaboration with the Health Research Institute (HRI) TB Research Centre at King Edward Medical University/Mayo Hospital, Lahore. The study included a sample size of 136 patients, with 68 patients in each treatment regimen (long-term and short-term). Adult pulmonary MDR TB patients seeking treatment from the facility were included based on predefined criteria. Data was collected using a pre-designed questionnaire after obtaining ethical approval and informed consent. The rates of patients' cure, treatment completed, treatment failure and death were calculated. ResultsA total of 131 patients were successfully followed up and included in the final analysis. Of these, 66 patients were in the long-term treatment group and 65 patients were in the short-term treatment group. The cure rate was 74.8 %, with 98 patients successfully cured, and 13.8 % of patients completed their treatment successfully. In the long-term treatment group, the cure rate was 75.6 %, with a treatment failure rate of 6.2 %. In the short-term treatment group, the cure rate was 73.8 %, with a treatment failure rate of 6.1 %. The death rate was 4.5 % in the short-term treatment group and 6.2 % in the long-term treatment group. However, these differences in treatment outcomes were statistically insignificant (p-values > 0.05). The newer drugs, bedaquiline and delamanid, did not show significant improvements in the treatment of multidrug-resistant TB patients. Side effects at completion of treatment remained to be significantly lesser (p < 0.05) among short term treatment group as compared to long term treatment group. ConclusionThe findings suggest that short-term treatment regimens are equally effective as long-term treatment regimens, with the added benefit of presenting fewer side effects.

Magnitude and factors associated with delay in treatment-seeking among new pulmonary tuberculosis patients in public health facilities in Habro district, eastern Ethiopia.

In developing nations, almost two-thirds of people with active tuberculosis (TB) remain undetected and untreated. Delays in seeking treatment increase the severity of the illness, the likelihood of mortality, and the risk of the infection spreading to others in the community. Thus, this study aimed to assess the magnitude of delay in treatment-seeking and its associated factors among new adult pulmonary tuberculosis patients attending public health facilities in Habro District, West Harerge Zone, Oromia Region, Eastern Ethiopia. A health facility-based cross-sectional study design was conducted among 420 randomly selected patients with pulmonary tuberculosis who visited public health facilities in Habro District from September 5 to October 5, 2022. Binary logistic regression analysis was used to determine the relationship between the dependent and independent variables, and a 95% confidence interval was used to select significant variables. Twenty-one days after the start of their illness, 62.38% (95% CI: 57.4%, 66.6%) of the patients sought an initial consultation. Being female (AOR = 2.14, 95% CI: 1.26, 3.65), having poor knowledge about TB (AOR = 3.10, 95% CI: 1.77, 5.43), having no contact history with TB patients (AOR = 3.52, 95% CI: 1.29, 9.58), having clinically diagnosed pulmonary tuberculosis (AOR = 2.16, 95% CI: 1.26, 3.67), and living a long distance from the nearest health facility (AOR = 2.87, 95% CI: 1.31, 6.23) were important predictors contributing to TB patient treatment delay. In the current study, more than three-fifths of TB patients delayed seeking treatment. Thus, awareness of tuberculosis should be created, especially targeting females and communities found at a distance from the health facility. Additionally, health professionals should emphasise the importance of getting medical attention early and knowing how to suspect and identify tuberculosis symptoms.

Acceptability of hair harvest as a method of tuberculosis therapeutic drug monitoring among adult pulmonary TB patients: a qualitative study

Background: The current six months regimen for drug-susceptible tuberculosis (TB) is long, complex, and requires adherence monitoring. TB hair drug level assay is one innovative approach to monitor TB treatment adherence however, its acceptability in the context of African multi-cultural settings is not known.Objective: To determine the acceptability of hair harvest and testing as a TB therapeutic drug monitoring method.Methods: The study explored perceptions, and lived experiences among TB patients with regard to using hair harvest and testing as a method of tuberculosis therapeutic drug monitoring in the context of their cultural beliefs, and faith. We used a descriptive phenomenological approach.Results: Four main themes emerged namely: participants’ perceptions about the cultural meaning of their body parts; perceptions about hair having any medical value or meaning; perceptions about hospitals starting to use hair harvest and testing for routine hospital TB treatment adherence monitoring; and perceived advantages and disadvantages of using hair for treatment adherence monitoring. Overall, we found that using hair to monitor adherence was acceptable to TB patients provided the hair was harvested and tested by a medical worker.Conclusion: Hair harvest for medical testing is acceptable to TB patients on the condition that it is conducted by a medical worker.

Preferred techniques of hair harvest for medical testing among adult pulmonary TB patients

Background: Antiretroviral hair drug levels are currently being used to monitor adherence to HIV treatment. There is currently a dearth of literature on the preferred technique(s) of hair harvest for medical testing in the context of African multicultural settings.Objective: To explore the preferred techniques(s) of hair harvest for medical testing among TB patients.Methods: We used a descriptive phenomenological approach to conduct interviews for 15 TB patients from the 06th through the 24th of June 2022. Data was organized by N-VIVO version 10 and analysed step by step using a thematic analytical approach.Results: Participants aged &lt;30 years were more knowledgeable, positively perceived, and experienced about the salon-based hair cutting technique compared to those aged≥30 years old. Participants aged ≥30 had experience, flexibility to use, and were knowledgeable in all three techniques, Overall, for all age categories (&lt;30,30-40 and &gt;40 years), majority of the respondents were knowledgeable, flexible and experienced in using all the three techniques.Conclusion: The majority of TB patients were knowledgeable, experienced and flexible about the hair cutting techniques however, efforts are needed to educate the youth that hair for medical testing can be cut by any of the three techniques without changing their cosmetic look.

Approaches to Selection of Optimal Chemotherapy Regimens in Tuberculosis Patients with Concurrent Diabetes Mellitus

The objective: to develop approaches to selection of optimal chemotherapy regimens in tuberculosis patients with concurrent diabetes mellitus (DM), by studying complications of diabetes mellitus and adverse drug reactions to anti-tuberculosis drugs.Subjects and Methods. 235 adult pulmonary tuberculosis patients with concurrent diabetes were enrolled in the study. Of them, 123 were men (52.3%) and 112 were women (47.7%), and the age of the patients varied from 19 to 78 years old.Results. Complications of diabetes mellitus (DM) were reported in 190/235 (80.8%) patients. Encephalopathy occurred most often – in 147/190 (77.3%) patients, diabetic macroangiopathy developed less often - in 41 (21.6%), followed by diabetic retinopathy – in 20 (10.5%), diabetic nephropathy - in 11 (5.8%), ketoacidosis – in 4 (2.1%), and diabetic foot – in 4 (2.1%). Diabetic macroangiopathy was significantly more often observed in men (66.7%) versus women (31.7%); p&lt;0.01, and diabetic nephropathy was more common in women (81.8%) than men (18.2%); p&lt;0.01. As the age of patients and duration of diabetes increased, the incidence of complications of diabetes also increased. Adverse drug reactions (ADRs) to anti-tuberculosis drugs (TB drugs) occurred in 168/235 (71.4%) patients. ADRs to two or more TB drugs were registered in 140/168 (83.3%) patients. The most frequent irreversible ADRs were caused by the following drugs (of the number of patients taking them): aminoglycosides (58.8%), capreomycin (54.5%), PAS (50.0%), ethambutol (100.0%), cycloserine (40.0%), levofloxacin (33.3%), pyrazinamide (23.3%), terizidone (28.6%), prothionamide (26.3%), linezolid (21.4% ), and moxifloxacin (20.0%).Conclusion. When treating pulmonary tuberculosis in patients with diabetes mellitus, chemotherapy regimens containing aminoglycosides, capreomycin, prothionamide, and pyrazinamide should be avoided. If there is even an initial stage of retinopathy, ethambutol should be avoided. Patients with encephalopathy should be switched from cycloserine to terizidone.

ВОЗРАСТНЫЕ ОСОБЕННОСТИ ФОРМИРОВАНИЯ ВНЕКЛЕТОЧНЫХ ЛОВУШЕК НЕЙТРОФИЛОВ У ЗДОРОВЫХ ЛИЦ И БОЛЬНЫХ ТУБЕРКУЛЁЗОМ

Abstracts. Introduction. Forming a neutrophil extracellular trap (NET) from DNA (NETosis) is considered as a potentially significant marker in the diagnosis of tuberculosis. However, there is practically a lack of data regarding the age-related differences in forming extracellular traps in research publications. Aim. To determine the age-related differences of NETosis in healthy individuals and in tuberculosis (TB) patients. Materials and Methods. The ability of neutrophils to form extracellular traps was investigated in 4 groups: 1) 4-7-year-old children diagnosed with the primary tuberculosis complex, who fell ill within Omsk region; 2) healthy and uninfected children at the same age; 3) adults with tuberculosis, and 4) adults without tuberculosis. For this purpose, isolated fractions of neutrophils from peripheral blood of the groups under research were stimulated with a mixture of bacteria (probiotic) for 30 minutes. In the hanging-drop preparation, we analyzed the proportion of neutrophil extracellular traps and cells in the state of various motility degrees. Results and Discussion. Age-related differences in the ability of neutrophils to form extracellular traps were characterized by a more pronounced response of neutrophils to the NETosis stimulant in children in the control group in comparison with neutrophils isolated from blood in the group of healthy adult volunteers: Neutrophils of children (Me=16.1; Q1=12.8; Q3=18.3) were statistically significantly more intense (p=0.0002) than those of adults (Me=8.6; Q1=7.1; Q3=10.5) and formed filamentous NETs. In the groups of pediatric and adult pulmonary TB patients, the response of neutrophils to the NETosis stimulant was diametrically opposite. Neutrophils of children with primary tuberculosis complex, as of those in the control group, predominantly formed filamentous NETs, but in greater amounts, while neutrophils of adults with infiltrative or focal form and with at most 2 segments involved mainly formed cloudy NETs, whereas filamentous NETs prevailed for the adults in the control group after stimulation. At the same time, proportion of cloudy NETs did not exceed 5% in healthy children and healthy adults. Comparing the findings of our study with literature data, we hypothesized that, most likely, there is a greater increase in PAD4 expression and more pronounced histone H3 citrullination in children’s neutrophils than in those of adults. Conclusions. Our findings indicate more pronounced ex vivo processes induced by NETosis stimulator in both groups of children (healthy individuals and TB patients) as compared to adults in the respective groups, which should be considered by the researchers interpreting the findings of the ability of neutrophils to form extracellular traps in tuberculosis.

Treatment outcome and associated factors among adult patients with pulmonary tuberculosis in selected health centers in Addis Ababa Ethiopia.

The success rate of pulmonary tuberculosis in developing countries is different than expected despite effective treatment. We evaluated treatment outcomes and associated factors of pulmonary tuberculosis patients. A retrospective cross-sectional study was employed among randomly selected health centers in Addis Ababa, Ethiopia. Patient records of adult pulmonary tuberculosis patients treated between January 1st, 2017, and December 31st, 2019 were reviewed. Convenient sampling technique was used to select the study participants. Statistical package for social sciences (SPSS), version 24-computer software was used for analysis. Participants' characteristics were descriptively described, and Bivariate, and multivariate logistic regression analysis were used to determine independent variables related to clinical outcomes. The significance level was determined at p-value < 0.05 and a 95% confidence level. Six hundred thirty-six patient records with a mean age of 37.49± 2.99 were reviewed. The overall treatment success rate was 84.9%. Absence of comorbid illness [AOR = 0.444; 95% CI:0.219-0.900], non-smoking [AOR = 0.35; 95% CI:0.194-0.645], and being HIV negative [AOR = 0.22; 95% CI: 0.106-0.460] were associated with successful treatment outcomes, whereas, not having treatment supporter [AOR = 15.68; 95% CI: 8.11-30.33] was associated with unsuccessful treatment outcome. Treatment success in this study was below the average target set by WHO. HIV positivity, co-morbidities, and smoking increased risk of treatment failure. Patient education about cessation may improve treatment success.

Factors Influencing Adherence to Pulmonary Tuberculosis Treatment among Adult Patients at St Francis’ Hospital-Katete, Zambia

Background: Pulmonary tuberculosis (PTB) is a contagious bacterial infection of the lungs caused by mycobacterium tuberculosis, also known as tubercle bacilli. The symptoms of PTB can appear gradually and vary in severity. Malnutrition, Human Immunodeficiency Virus (HIV) infection/Acquired Immunodeficiency Syndrome (AIDs), age (young and old), diabetes mellitus, substance abuse, low socioeconomic status, malignancies, and or overcrowding are some of the common risk factors for PTB. According to the Zambia Demographic Health Survey (ZDHS, 2021), Zambia’s prevalence rate of PTB stood at 455 cases per 100,000 population. The World Health Organization (WHO) has recommended Direct Observation of Treatment (DOT) by a trained supervisor (WHO, 2019). However, implementing DOT in Zambia is challenging for both the patient and healthcare provider as it has been observed that a daily visit to a health facility for the first two months by PTB patients was very difficult for a range of reasons which included severe illness at the initiation of treatment, distance too far for walking, and high transportation costs. Objective: The study aimed at determining Factors Influencing Adherence to Pulmonary Tuberculosis Treatment among Adult PTB Patients at St Francis’ Hospital-Katete, Zambia. Methods and materials: Data was collected using a questionnaire and the study sample was one hundred (100) Adult PTB patients, who were selected by simple random sampling method. A quantitative descriptive cross-sectional study design was used. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 21. Chi-square test was used to determine the relationship between independent and dependent variables. Conclusion: The study revealed a significant association between ‘level of information and knowledge, individual motivational support, behavioural skill’ and ‘Adult PTB patients’ adherence to PTB treatment’. Level of Information and knowledge (p-value 0.001), Individual .........

Factors associated with treatment adherence among pulmonary tuberculosis patients in New Delhi

BackgroundTB is treated with a six-month course of four antimicrobial drugs, and nearly all cases of TB can be cured if the medications are given and taken correctly. Due to its prolong treatment plans, there can be reasons associated with non-adherence to treatment by TB patients. Hence, the present study aimed to explore the factors associated with medication adherence among TB patients. MethodA cross-sectional descriptive survey was conducted among adult pulmonary tuberculosis patients enrolled under RNTCP (now NTEP) in New Delhi among 27 functional RNTCP districts. Around 200 TB patients who are enrolled in the Nikshay App and are also on treatment were considered. A structured questionnaire was prepared for the interview guide. Analysis was done using bivariate analysis, chi-square tests, and Fisher's exact tests. ResultsAmong the total participants, 173 (86.5%) were adherent and the remaining 27 (13.5%) participants were non-adherent. The majority of the participants (91%) said they were able to follow the routine to the DOTS center, and 9% said they find it difficult to report to the DOTS center as per their schedule. Only 12.35% of non-adherent participants were seen among those who get regular reminders from their families to take medicines, as compared to 18.42% among those who did not get regular reminders from their families. More than one-fourth of the participants (25.9%) who report not getting necessary motivation from healthcare providers were non-adherent. Motivation by healthcare workers to follow drug schedules was found statistically significant to treatment compliance with a P-value of 0.0422. ConclusionTB is a curable disease; this belief has turned out to be a motivational factor for patients suffering from this disease. Studies have shown that faith in the efficacy of treatment helps adherence to TB treatment while other studies describe how patient adherence was adversely affected by the belief that TB is incurable or the treatment is inefficient or that alternative treatment such as traditional medicine is better.

Identification of Respondent Characteristics and Relationship of Clinical Manifestations with Chest Radiograph Lesion in Pulmonary Tuberculosis Patients at Aloei Saboe Hospital

Introduction: Tuberculosis (TB) is an infectious infectious disease caused by Mycobacterium tuberculosis. This study aimed to determine the relationship between clinical manifestations and the results of chest radiographs in adult pulmonary TB patients at Aloei Saboe Hospital.Method: The research design used in this study was cross-sectional by examining the relationship between clinical manifestations and chest radiography results in adult pulmonary TB patients at Aloei Saboe Hospital from October to November 2022. The population of this study was adult pulmonary TB patients using accidental sampling as a sampling technique. The research instrument used was the medical record which contained the patient's anamnesis status and the results of the chest radiography examination. The relationship between variables was then analyzed using the Kolmogorov-Smirnov test.Results: Of the 44 samples, the most common clinical manifestations were dyspnea and chest pain in 12 patients (26.67%). The most chest radiographic results were fibrotic in 21 patients (47.7%). According to the American Thoracic Association (ATA) classification, extensive lesions were predominantly found in 21 patients (47.7%). There was an association between productive cough and chest radiography results (p=0.012). Meanwhile, chest radiographs were not associated with productive cough, hemoptoe, and dyspnea.Conclusion: There is a relationship between productive cough and chest radiography lesions. Further study may determine samples for research that are minimally biased so that the results obtained are more representative of the population.

Analisis Faktor Risiko TB paru Anak yang Tinggal Serumah dengan Penderita TB paru Dewasa

Pulmonary tuberculosis (TB) is still a major public health problem in Indonesia. Based on the Household Health Survey (SKRT) results tuberculosis is the number one respiratory disease and infectious disease. Tuberculosis in children causes growth disorders and even death. If pulmonary tuberculosis in a child is not treated immediately, it can quickly develop into parenchymal or tubercular pneumonia, milliary tuberculosis, bone tuberculosis (scrofuloderma), joint tuberculosis, abdominal tuberculosis, and even meningitis. This study used a case-control design with analytical observation. Children who were exposed to and lived in the same household with adult pulmonary tuberculosis patients as many as 90 adults participated in the study. The case sample consisted of children aged 0-15 years who were diagnosed with Pulmonary TB by doctors at the Wania Health Center, Mimika Regency. The case sample size was 30 respondents and the control sample was 30 respondents. The free variables in this study were parental knowledge, BCG vaccination history, child nutritional status, occupancy density, the behavior of TB sufferers at home, and length of contact. Data were analyzed using univariate analysis, bivariate analysis, and multivariate analysis (multiple logistic regression). The results of the study analysis showed that the factors that influence the incidence of tuberculosis in children are parental knowledge (p = 0.001), BCG vaccination history (p = 0.001), and the behavior of adult tuberculosis sufferers in the household (p = 0.000) The conclusion of the study was that the behavior of adult pulmonary tuberculosis patients who lived in the same house with children was most influential in the transmission of pulmonary tuberculosis in children who lived in the same household as adult pulmonary tuberculosis patients at the Health Centre of Wania, Mimika District.

Long-Term Intake of Linezolid Elevates Drug Exposure and Reduces Drug Clearance and Elimination in Adults With Drug-Resistant Pulmonary Tuberculosis.

Pharmacokinetic (PK) studies are critical for dose optimization, and there is a paucity of linezolid (LZD) PK data for prolonged use in drug-resistant tuberculosis (DR-TB). Therefore, the authors evaluated the pharmacokinetics of LZD at two-time intervals in DR-TB during long-term use. PK evaluation of LZD was performed at the end of the 8th and 16th weeks of treatment in a randomly selected subset of adult pre-extensively drug-resistant pulmonary tuberculosis patients (n = 18) from a multicentric interventional study (Building Evidence to Advance Treatment of TB/BEAT study; CTRI/2019/01/017310), wherein a daily dose of 600 mg LZD was used for 24 weeks. Plasma LZD levels were measured using a validated high-pressure liquid chromatography (HPLC) method. The LZD median plasma C max was comparable between the 8th and 16th weeks [18.3 mg/L, interquartile range (IQR: 15.5-20.8 and 18.8 mg/L, IQR: 16.0-22.7, respectively)]. However, the trough concentration increased significantly in the 16th week (3.16 mg/L, IQR: 2.30-4.76), compared with the 8th week (1.98 mg/L, IQR: 0.93-2.75). Furthermore, compared with the 8th week, in the 16th week, there was a significant increase in drug exposure (AUC 0-24 = 184.2 mg*h/L, IQR: 156.4-215.8 versus 233.2 mg*h/L, IQR: 187.9-277.2), which corroborated with a longer elimination half-life (6.94 hours, IQR: 5.55-7.99 versus 8.47 hours, IQR:7.36-11.35) and decreased clearance (2.91 L/h, IQR: 2.45-3.33 versus 2.19 L/h, IQR: 1.49-2.78). Long-term daily intake of 600 mg LZD resulted in a significant elevation in trough concentration (>2.0 mg/L) in 83% of the study participants. Furthermore, increased LZD drug exposure may be partly because of decreased clearance and elimination. Overall, the PK data underscore the need for dose adjustment when LZDs are intended for long-term treatment.

Diabetes mellitus is associated with an increased risk of unsuccessful treatment outcomes among drug-susceptible tuberculosis patients in Ethiopia: A prospective health facility-based study

BackgroundThe impact of diabetes mellitus on tuberculosis (TB) treatment outcomes has not been well investigated in most sub-Saharan countries including Ethiopia. The current study aimed to determine the association between diabetes mellitus and unsuccessful TB treatment outcomes among drug-susceptible TB patients treated at selected health facilities in Addis Ababa, Ethiopia. MethodsThis health facility-based prospective cohort study was conducted at six randomly selected public health centers in Addis Ababa, from August 2020 until November 2021. Clinically diagnosed adult pulmonary and extra pulmonary TB patients were recruited at the time of treatment initiation. A multivariable logistic regression analysis was used to estimate the association between diabetes and unsuccessful TB treatment outcomes. ResultsAmong the total 267 enrolled participants, 9.7% of patients with TB were identified to have diabetes comorbidity. Of patients with diabetes and TB, 9 (34.6%) were newly diagnosed based on glucose test results. Despite an overall high TB treatment success rate (94.0%), more than one-fourth (26.9%) of patients with diabetes had a poor TB treatment outcome (26.9%), which was remarkably higher compared to patients without diabetes (3.7%). In multivariable regression, the adjusted odds of poor TB treatment outcome among those with diabetes was 14.8 (95% CI 3.5 – 62.7) times the odds of poor outcome patients without diabetes. ConclusionDiabetes was significantly associated with increased odds of poor TB treatment outcomes among patients in Addis Ababa, Ethiopia.

The radiologic findings, positivity rate of culture method examinations, correlation with the type of lower respiratory secretion of adult pulmonary Tuberculosis (TB) patients

Background: There are active and latent tuberculosis types, a global public health concern. Test confirmation is required to distinguish between active tuberculosis and nontuberculous mycobacterial infection. This study aims to evaluate the relationship between the type of lower airway secretion specimen, Mycobacterium tuberculosis positivity rate of MGIT-LJ, as well as the relationship between the Mycobacterium tuberculosis positivity rate in MGIT-LJ and radiological findings. Methods: This study is cross-sectional with a prospective design. The sample is the result of the examination of the MGIT-LJ method and medical record data of patients suspected of Pulmonary TB at Dr. Soetomo Academic Hospital Surabaya Indonesia that meets the inclusion criteria, analysis of the culture results of MGIT-LJ method and radiological findings were carried out to assess the relationship between the character of sputum, the positivity rate of Mycobacterium tuberculosis and radiological findings. Result: A total of 137 from June 2022 till November 2022 found 88 (64.2%) with spontaneous sputum, 6 (4,4%) aspirate ETT, and 43 (31.4%) BAL. The positivity rate of the MGIT-LJ culture method of the spontaneous sputum specimen to detect Mycobacterium tuberculosis was 20.5% higher than ETT or BAL specimens because the implementation of clinical indication to request MGIT-LJ culture method of ETT and BAL specimens is still confusing. The specificity of the chest radiography diagnostic test from all specimens type of 61.86%, with a weak accuracy rate. Conclusion: In this study, the positivity rate of the MGIT-LJ culture method of the spontaneous sputum specimen to detect Mycobacterium tuberculosis was 20.5% higher than ETT or BAL specimens. Chest radiography has a weak accuracy level and must be complemented test with the culture method.

The diagnostic value of an interferon gamma release assay in new cases of active pulmonary tuberculosis and the factors influencing its negative results

ObjectiveThe aim of the study was to investigate the diagnostic value of an interferon gamma release assay (IGRA) - QuantiFERON-TB GOLD in-tube (QFT-GIT) - to identify new cases of active pulmonary tuberculosis (PTB) in Quzhou City, and to assess possible factors associated with false-negative IGRA results in bacteriologically confirmed PTB. MethodsThis study collected clinical data of suspected adult PTB patients who underwent QFT-GIT in Quzhou People's Hospital between January 1, 2020 and December 31, 2020, and calculated the total sensitivity, specificity of QFT-GIT in new case of active PTB patients were 90.9% (401/448) and 72.9%(929/1275), respectively. Univariate and multivariate logistic regression were used to analyze the influencing factors of the false-negative results of QFT-GIT. ResultsA total of 1723 patients were enrolled, including 448(448/1723,26.0%) with new case of active PTB (389 cases were bacteriologically confirmed and 59 cases were clinically diagnosed) and 1275 non-PTB patients. There were 747(747/1723,43.4%) patients with positive results of QFT-GIT, among whom 401 were new case of active PTB patients (347 cases were bacteriologically confirmed and 54 cases were clinically diagnosed) and 346 were non-PTB patients. The total sensitivity and specificity of QFT-GIT in the diagnosis of new case of active PTB patients were 90.9% and 72.8% respectively. In bacteriologically comfirmed PTB patients, multivariate conditional logistic regression analysis showed that BMI and diabetes, malignant tumors and severe infections were all independent risk factors for the false-negative results of QFT-GIT. ConclusionQFT-GIT showed high sensitivity and relatively low specificity in the diagnosis of new case of active PTB patients. In clinical practice, we should analyze the suspected PTB patients comprehensively in terms of whether they are overweight or complicated with diabetes, malignant tumors or severe infections, and avoid missing the diagnosis of PTB.

Qualitative Assessment of Adherence to Anti-Tuberculosis Medication Among Active Tuberculosis Patients

Background: Non- adherence is one of the major risk factors for the emergence of MDR and XDR TB. It is also one of the key factors responsible for treatment failure, disease relapse, prolonged infection and death. This study was conducted to explore the various factors contributing to non-adherence to the Anti-TB medication. Methods: A qualitative study was done on Adult Pulmonary and extra pulmonary TB patients who were in course of the treatment. A total of 20 patients were enrolled. Socio –demographic details and specific questions regarding TB were collected using a semi-structured questionnaire. In depth telephonic interviews were conducted among all participants. Results: The study participants comprised between 15 to 68 years of age with a mean age of 36 ±14.9years. Factors influencing non-adherence to medication were grouped under Patient, medication, Socio-economic and Health care related factors, Motive. Almost all patients reported more than one factor. Conclusion: Increasing the awareness of various TB services in the community may increase knowledge and improve attitude among the patients. Providing more information about the effects of medication may reduce the risk of being non adherent. TB anonymous groups can be organized for patients to discuss their challenges while on treatment.

Socio-Demographic Determinants of Adult Pulmonary Tuberculosis Patients: A Hospital Based Study at Dhanmondi, Dhaka, Bangladesh

Background: Tuberculosis (TB) is a multi-system infectious disease with a major cause of morbidity and mortality all over the world but particularly in developing countries like Bangladesh. A normal healthy individual does not face the symptoms causing by tuberculosis due to their immune system that’s why infection among healthy individuals always remain silent. As it is highly infectious air borne disease that’s why treatment completion for TB is the cornerstone of its control and prevention. So to understand these factors efficiently this study was carried out about socio-demographic determinants of adult TB patients attending the tertiary care teaching hospital, Dhanmondi, Dhaka. Methodology: This was hospital based cross sectional observational study done at Bangladesh Medical College Hospital, Dhanmondi, Dhaka with the study period from January 2020 to December 2021.Total 410 patients of age group 18 years and above with persistent cough with sputum production for more than 2 weeks were enrolled for this study purpose. Results: Total prevalence of sputum positive adult pulmonary TB among the studied group was 69.02%. Majority 54% were male patients in the age group of 41-50 years (31.45%). Pulmonary TB was predominantly diagnosed among employed group 41.34%, those who have completed their high school level (34.28%) in mainly the rural (66.08%) locality. Joint family (61%) with 8-10 family members (43.46%) have been found mostly affected in our study. The cardinal features were cough with sputum production (80.21%) followed by fatigue (71.73%), fever (42.05%), sweating (46.99%), loss of appetite (32.86%) and weight loss (27.56%). Pulmonary TB was found mostly among smokers (57.23%) with normal BMI (44.88%). Conclusion: To decrease the rate of infection with Tuberculosis, a multi-factorial approach can play the pivotal role by improving the living conditions, education level, economic status and adequate sanitation. Awareness can bring a new dimension in this regard.

Evaluation of Pulmonary Tuberculosis Treatment in Adult Patients at Poly of Pulmonary Diseases Army Hospital Pematangsiantar City

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and is a health problem that still needs serious attention from the government and all levels of society because it can cause death. This study aims to determine the rationale for the treatment of pulmonary tuberculosis in adult patients at the Lung Disease Polyclinic at the Siantar City Army Hospital in 2021 which refers to the National Guidelines for Tuberculosis Management of the Indonesian Ministry of Health and treatment standards from WHO. This research is a non-experimental type with a descriptive evaluative design with retrospective data collection. The study was conducted using the medical records of adult pulmonary tuberculosis patients at the outpatient installation at the Pematang Siantar City Army Hospital in 2021. The results showed that the most common cases of pulmonary tuberculosis in adult patients were male patients, namely 61.22%, the diagnosis was for each patient suspected of pulmonary tuberculosis, a chest X-ray examination and smear test were carried out, pulmonary tuberculosis was treated using two anti-tuberculosis drugs, namely OAT-kombipak and OAT-FDC, 1 case was found with a duration of administration of anti-kombipak anti-tuberculosis drugs that did not comply with standard treatment and patients who received treatment received a score recovery of 97.96% and patients who failed treatment by 2.04%.

How much do smear-negative patients really contribute to tuberculosis transmissions? Re-examining an old question with new tools.

SummaryBackgroundSputum smear microscopy is a common surrogate for tuberculosis infectiousness. Previous estimates that smear-negative patients contribute 13–20% of transmissions and are, on average, 20 to 25% as infectious as smear-positive cases are understood to be high. Herein, we use an ideal real-world setting, a comprehensive dataset, and new high-resolution techniques to more accurately estimate the true transmission risk of smear-negative cases.MethodsWe treated all adult culture-positive pulmonary TB patients diagnosed in the province of Alberta, Canada from 2003 to 2016 as potential transmitters. The primary data sources were the Alberta TB Registry and the Provincial Laboratory for Public Health. We measured, as primary outcomes, the proportion of transmissions attributable to smear-negative sources and the relative transmission rate. First, we replicated previous studies by using molecular (DNA) fingerprint clustering. Then, using a prospectively collected registry of TB contacts, we defined transmission events as active TB amongst identified contacts who either had a 100% DNA fingerprint match to the source case or a clinical diagnosis. We supplemented our analysis with genome sequencing on temporally and geographically linked DNA fingerprint clusters of cases not identified as contacts.FindingsThere were 1176 cases, 563 smear-negative and 613 smear-positive, and 23,131 contacts. Replicating previous studies, the proportion of transmissions attributable to smear-negative source cases was 16% (95% CI, 12–19%) and the relative transmission rate was 0.19 (95% CI, 0.14–0.26). With our combined approach, the proportion of transmission was 8% (95% CI, 3–14%) and the relative transmission rate became 0.10 (95% CI, 0.05–0.19).InterpretationWhen we examined the same outcomes as in previous studies but refined transmission ascertainment with the addition of conventional epidemiology and genomics, we found that smear-negative cases were ∼50% less infectious than previously thought.FundingAlberta Innovates Health Solutions