anti-TB Medications Research Articles

A Propensity Score-Matched Study on the Changes of TB Status and TB-IGRA Values in Patients with Psoriasis with Latent TB Receiving Secukinumab.

The utilization of biologics in patients with psoriasis with latent tuberculosis infection (LTBI) has garnered significant attention. Although the tuberculosis (TB) safety profile of second-generation biologics, including secukinumab, has been partially confirmed in both clinical trials and real-world studies, the necessity for prophylactic therapy in patients with LTBI prior to administering this class of biologics remains a topic of controversy. This study enrolled 62 patients with psoriasis with LTBI who underwent secukinumab with routine TB reexamination. Patients were divided into two groups based on whether they received antituberculosis therapy (ATB; n = 48) or not (NTB; n = 16). We performed a propensity score-matched (PSM) analysis between ATB and NTB subgroups and retrospectively reviewed their interferon-gamma release assays (IGRA) and radiographic results. No active TB case was reported on the basis of medical records and chest radiographs in either two group. Before PSM, the mean reexamining IGRA value was significantly elevated in patients who received prophylactic therapy (P = 0.00), but no significant increase was observed in patients who were not. After PSM, there was no significant IGRA value enhancement whether or not patients received prophylactic treatment. Our data provide additional information on the safety profile of secukinumab in patients with psoriasis with LTBI. Furthermore, our presentation of the reexamined IGRA results revealed no significant elevation in the ATB or NTB group. As such, we believe further exploration is necessary to determine whether anti-TB medication is required prior to administering secukinumab.

Evaluating the effectiveness of first-Line anti-tuberculosis in Al Dhafra Hospitals

Background: Tuberculosis (TB) continues to be a significant public health issue despite extensive efforts to control it. The standard treatment for TB involves the use of first-line anti-TB drugs administered at a standard dose. However, the effectiveness of this treatment can vary between individual patients, resulting in differing cure rates.
 Methodology: The objective of this retrospective study was to assess the effectiveness and safety of first-line generic anti-TB medications administered at Liwa Hospital in the Al Dhafra Region. Data was collected from the electronic medical records of 140 TB patients admitted to Liwa Hospital from January to December 2022. The study included patients with positive acid-fast bacillus (AFB) or polymerase chain reaction (PCR) test results, indicating active TB infection. Patients resistant to first-line anti-TB medications or with lung cancer were excluded. Data collected included demographic information, length of stay conversion time, hospital admission, prescribed medications, treatment duration, and treatment outcomes.
 Results: This study observed an average length of stay of 21 days for patients treated with first-line generic anti-TB medications at Liwa Hospital. Over 80% of the patients were discharged within 30 days of admission, indicating a positive response to the medications. Approximately 13% of the patients required a longer duration of treatment and were discharged between 30 and 60 days after admission. Only 5% of the patients had a prolonged stay of over 60 days, most of whom had co-morbidities or rifampicin resistance, but achieved AFB conversion within three months. The average conversion time for patients was 25 days, with over 92% achieving conversion within two months.
 Conclusion: This study demonstrated the efficacy and safety of first-line generic anti-TB medications in treating TB patients at Liwa Hospital. The majority of patients responded well to the medications, leading to discharge within 30 days.
 Keywords: Tuberculosis, Ethambutol, Pyrazinamide, Rifampicin, Isoniazid, First line drugs, Anti TB drugs

Tuberculosis medication adherence in a secondary care center in SouthEastern Nigeria

Adherence to a treatment strategy known as Directly Observed Treatment Short course (DOTS) by patients diagnosed of tuberculosis is essential in the effective treatment of the disease. This is in order to avoid recurrence, resistance and complications that results from non-adherence. This paper assessed the adherence to anti-tuberculosis medications among tuberculosis patients in a secondary healthcare facility in Anambra State, Nigeria. This was a descriptive crosssectional study and a semi-structured interviewer-administered questionnaire was used. The study population comprised of tuberculosis patients who has been on anti-TB medications for at least four weeks at the Tuberculosis clinic. A systematic random sampling technique was used to enrol the respondents into the study. The mean age of the respondents was 39.68±16.66 years. Majority of the respondents correctly alluded to tuberculosis as being caused by bacteria (91.7%); and that the duration of treatment was at least six months (100.0%). A great proportion of the respondents affirmed that a vaccine is available for prevention of tuberculosis infection (91.7%); also all the respondents agreed that covering mouth and nose while coughing/sneezing is a preventive measure of TB spread (100.0%). About 15.2% of the respondents sometimes stop taking their medications when they feel their health condition is under control, however, a great proportion of the respondents had good adherence to medications (76.0%). Major reasons for missing medication among the non-adherent were that they forgot (91.8%) and that there were too much medication to take at once (1.2%). Statistically significant associations existed between drug adherence and age, sex and educational qualification; as respondents within the age range of 60-69 years, female and those who had completed tertiary education had better adherence to anti-TB medications. TB medication non-adherence is a potential risk factor for poor health outcomes, hence more effort is needed to increase the rate of adherence.

Assessment of TB treatment adherence using computer-assisted self-interviewing.

OBJECTIVES: To evaluate the correlation and agreement between computer-assisted self-interviewing (CASI) and home-based unannounced pill counts (HUPC) for assessing anti-TB medication adherence (MA) and to examine the relationship between MA and treatment success.METHODS: Individual CASI-evaluated MA was compared three times with HUPC MA over the treatment course. The relationship between the two methodologies was determined using correlation coefficients (r) and intraclass correlation coefficients (ICC). The association between MA and efficacy was evaluated using odds ratios (ORs).RESULTS: According to CASI assessments, MA rates of 52 TB patients were 92.2%, 90.6%, and 87.5% at Week 4, 8 and 16-24, respectively, with a strong correlation (r > 0.76) and agreement (ICC > 0.88) with HUPC evaluations. CASI missed one-third of the non-adherent cases reported by HUPC based on patient adherence status. The treatment success rates of patients with >90% adherence, as measured by CASI and HUPC, did not differ significantly; however, >85% adherence was associated with higher treatment success (OR 45.1) than 90% adherence (OR 21.9).CONCLUSION: CASI results were comparable to those of HUPC. As it increased the likelihood of successful treatment, a threshold of >85% may be more appropriate than >90% for defining medication-adherent patients.

Immune Reconstitution Inflammatory Syndrome and Drug-Induced Liver Injury During Treatment of Disseminated Tuberculosis in a Liver Transplant Recipient: A Case Report

Studies have shown that tuberculosis (TB) incidence is 20 to 70 times higher in solid organ transplantation recipients. Immunosuppression makes transplant recipients more vulnerable to infection and can interfere with the treatment. Our case report describes a patient who experienced immune reconstitution inflammatory syndrome (IRIS) and drug-induced liver injury (DILI) related to TB medications for disseminated pulmonary and hepatic TB. In addition to anti-TB medication, the patient received a high-dose steroid for IRIS and a change of anti-TB medication to a secondary regimen for DILI. This case illustrates various responses to anti-TB treatment in a liver transplant recipient and the necessity of closely monitoring immune suppression and liver function.

The Detection of Mutations and Genotyping of Drug-Resistant Mycobacterium tuberculosis Strains Isolated from Patients in the Rural Eastern Cape Province.

Drug-resistant tuberculosis (DR-TB) is still a major public health concern in South Africa. Mutations in M. tuberculosis can cause varying levels of phenotypic resistance to anti-TB medications. There have been no prior studies on gene mutations and the genotyping of DR-TB in the rural Eastern Cape Province; hence, we aimed to identify DR-TB mutations, genetic diversity, and allocated lineages among patients in this area. Using Xpert® MTB/RIF, we assessed the rifampin resistance of sputum samples collected from 1157 patients suspected of having tuberculosis. GenoType MTBDR plus VER 2.0 was used for the detection of mutations causing resistance to anti-TB medications. The next step was to spoligotype 441 isolates. The most prevalent rifampin resistance-conferring mutations were in rpoB codon S531L in INH-resistant strains; the katG gene at codon S315TB and the inhA gene at codon C-15TB had the most mutations; 54.5% and 24.7%, respectively. In addition, 24.6% of strains showed mutations in both the rpoB and inhA genes, while 69.9% of strains showed mutations in both the katG and rpoB genes. Heteroresistance was seen in 17.9% of all cases in the study. According to spoligotyping analysis, Beijing families predominated. Investigation of the evolutionary lineages of M. tuberculosis isolates can be carried out using the information provided by the study's diversity of mutations. In locations wherein these mutations have been discovered, decision-making regarding the standardization of treatment regimens or individualized treatment may be aided by the detection frequency of rpoB, katG, and inhA mutations in various study areas.

H15 A treatment for leprosy developed on the edge of Europe: Vincent Barry (1908–1975)

Abstract Leprosy is the prototype of a biblical disease. Without an effective cure, it was deemed a ‘curse’ for millennia. It is an infection caused by Mycobacterium leprae and Mycobacterium lepromatosis. With an affinity for peripheral skin (due to lower temperatures), a rash is a common presenting feature. A tropism to infiltrate neural tissue causes a reduction in sensation leading to repeated injury, infection and disfigurement. Affected individuals were often shunned from society and sent to leper colonies. Treatment for leprosy only became effective in the mid-20th century. Initial treatment for leprosy was with promin and dapsone. Clofazimine and rifampicin were later added in the 1960s–70s. Treatment for leprosy consists of a multidrug therapy regime of rifampicin, dapsone and clofazimine for 6–12 months. This was first recommended by the World Health Organization (WHO) in 1981 and remains the recommended treatment. Clofazimine was developed in a laboratory in Trinity College Dublin by Vincent Barry and his scientific team. Vincent Barry was born in Cork, Ireland, and later graduated in chemistry from University College Dublin. He became associate professor of chemistry in Galway where he lectured bilingually in Irish and English and co-authored the first Irish-language textbook for chemistry (Ceimic). Barry spent time working in and observing leper colonies in both Zimbabwe and India. In 1943, he was given a fellowship by the Medical Research Council of Ireland to carry out research on the chemotherapy of tuberculosis (TB). However, as TB became more curable, he focused his attention on leprosy. His team were given laboratory space in Trinity College Dublin, and in 1957, they developed compound B663, clofazimine. Intended as an anti-TB medication, clofazimine showed more effectiveness against leprosy. The product was launched in 1969 after several clinical trials in Nigeria. In 1974, they devoted the patents of the drug to India to allow it to be produced in a more cost-effective manner. The team was not interested in fame or fortune; their goal was simply to make the drug available in the developing world. They received the Boyle Award from the Royal Dublin Society in 1969, and the UNESCO Science prize in 1980 ‘for their work on the synthesis of an anti-leprosy agent, B-633’. The achievements of Mr Barry and his team, seldom discussed, have led to millions of lives being saved. Clofazimine is part of the WHO Model list of Essential Medicines.

Pott’s Disease– When & How to Operate?

Background: Pott’s disease is a rare form of extrapulmonary tuberculosis that manifests in a variety of clinical patterns. Delays in diagnosis and treatment can lead to serious complications. About 10-40% of patients with spinal tuberculosis may have a neurological deficit. Urgent measures are needed to halt the progression of the disease and deformity, especially to prevent and overcome paraplegia. In regards to management, every case is different and has a unique procedure. It includes simple medical management, simple decompression and debridement, anterior approach, and posterior approach, etc. Surgical decompression of the cord and instrumentation are needed in many cases besides chemotherapy. Although the anterior approach is used for cervical Pott’s disease but this procedure is very time-consuming and technically difficult in the lumbar and dorsal spine, especially in compromised patients and morbidity is more. The posterior approach alone is enough for achieving adequate decompression, debridement, reduction, fusion, reconstruction of the body, and maintaining sagittal alignment in the dorsal and lumbar Pott’s spine. The aim of the study was to describe the treatment modality and observe the outcome of treatment methods and incidence rate of infection sites among the patients of Potts spine. Material & Methods: This retrospective study was conducted at the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Bangladesh. The study duration was 7 years, from March 2016 to January 2023. During this period, a total of 30 cases of Pott’s disease were included in the study following inclusion and exclusion criteria. Results: 53.33% had been from the youngest age group of 15-34 years, and 80 % were male. Very few participants had been female in the present study. Back pain was the primary complication for 50% of cases, while spinal infection was observed in the cervical region for 16.67% of cases, 43.33% had infections in the dorsal region, and 30 % in the lumbar region. 10.00% of the participants had been treated with non-surgical methods, with only anti-TB medication for 18 months or more. Posterior decompression was the most common treatment method, with 23.33% having only posterior decompression, and 40.00% having posterior decompression with the use of additional instruments. Conclusion: The study observed that Pott’s disease was most common among young adult males, and the most common sites of spinal infections were in the dorsal and lumbar regions in the present study population, contradictory to the general findings. Decompression treatment, with and without additional instruments, was the most common form of treatment among the present study population.

Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study.

Ensuring the completion of treatment for tuberculosis (TB) remains a key challenge in many high-burden countries. 99DOTS is a low-cost digital adherence technology that has emerged as a promising tool for monitoring and supporting TB treatment completion. We aimed to understand the feasibility and acceptability of 99DOTS, a mobile phone-based TB treatment support method, and characterize barriers and facilitators to its implementation during a pragmatic trial in Uganda. Between April 1 and August 31, 2021, we conducted in-depth interviews with people with TB and key informant interviews with health workers and district and regional TB officers involved in the implementation of 99DOTS at 18 health facilities in Uganda. Semistructured interview guides were informed by the capability, opportunity, motivation, and behavior (COM-B) model and explored perceptions of, and experiences with, 99DOTS, including barriers and facilitators to its use. Qualitative analysis was conducted using the framework approach. Interviews were conducted with 30 people with TB, 12 health workers, and 7 TB officers. All people with TB, health workers, and TB officers noted that 99DOTS supported and encouraged people with TB to take their anti-TB medication, facilitated treatment monitoring, and improved relationships between people with TB and health workers. Participants also liked that the platform was free, easy to use, and improved TB treatment outcomes. Barriers to 99DOTS implementation for some people with TB were related to limited literacy, including technology literacy; limited access to electricity to charge their mobile phone to make dosing confirmation calls; and poor network connection. Gender differences in 99DOTS uptake also emerged. Specifically, women with TB were described to be more concerned that 99DOTS use would expose them to TB stigma and to be more likely to have mobile phone-access issues than men with TB. By contrast, men with TB not only had access to mobile phones but also received substantial support from their female partners to take their anti-TB medication and make 99DOTS dosing confirmation calls. Finally, although women with TB were described to face more barriers to 99DOTS use than men with TB, the women's narratives centered on the ways the platform facilitated and improved their adherence, whereas the men's narratives did not. Overall, 99DOTS seems to be a feasible and acceptable strategy to support anti-TB medication adherence in Uganda. However, access to mobile phones, inability to charge mobile phones, and concerns about stigma should be considered and addressed as part of programmatic implementation to maximize uptake among all people with TB, particularly women and those with fewer financial resources.

Use of standardised patients to assess tuberculosis case management by private pharmacies in Patna, India: A repeat cross-sectional study.

As the first point of care for many healthcare seekers, private pharmacies play an important role in tuberculosis (TB) care. However, previous studies in India have showed that private pharmacies commonly dispense symptomatic treatments and broad-spectrum antibiotics over-the-counter (OTC), rather than referring patients for TB testing. Such inappropriate management by pharmacies can delaye TB diagnosis. We assessed medical advice and OTC drug dispensing practices of pharmacists for standardized patients presenting with classic symptoms of pulmonary TB (case 1) and for those with sputum smear positive pulmonary TB (case 2), and examined how practices have changed over time in an urban Indian site. We examined how and whether private pharmacies improved practices for TB in 2019 compared to a baseline study conducted in 2015 in the city of Patna, using the same survey sampling techniques and study staff. The proportion of patient-pharmacist interactions that resulted in correct or ideal management, as well as the proportion of interactions resulting in antibiotic, quinolone, and corticosteroid are presented, with standard errors clustered at the provider level. To assess the difference in case management and the use of drugs across the two cases by round, a difference in difference (DiD) model was employed. A total of 936 SP interactions were completed over both rounds of survey. Our results indicate that across both rounds of data collection, 331 of 936 (35%; 95% CI: 32-38%) of interactions were correctly managed. At baseline, 215 of 500 (43%; 95% CI: 39-47%) of interactions were correctly managed whereas 116 of 436 (27%; 95% CI: 23-31%) were correctly managed in the second round of data collection. Ideal management, where in addition to a referral, patients were not prescribed any potentially harmful medications, was seen in 275 of 936 (29%; 95% CI: 27-32%) of interactions overall, with 194 of 500 (39%; 95% CI: 35-43%) of interactions at baseline and 81 of 436 (19%; 95% CI: 15-22%) in round 2. No private pharmacy dispensed anti-TB medications without a prescription. On average, the difference in correct case management between case 1 vs. case 2 dropped by 20 percent points from baseline to the second round of data collection. Similarly, ideal case management decreased by 26 percentage points between rounds. This is in contrast with the dispensation of medicines, which had the opposite effect between rounds; the difference in dispensation of quinolones between case 1 and case 2 increased by 14 percentage points, as did corticosteroids by 9 percentage points, antibiotics by 25 percentage points and medicines generally by 30 percentage points. Our standardised patient study provides valuable insights into how private pharmacies in an Indian city changed their management of patients with TB symptoms or with confirmed TB over a 5-year period. We saw that overall, private pharmacy performance has weakened over time. However, no OTC dispensation of anti-TB medications occurred in either survey round. As the first point of contact for many care seekers, continued and sustained efforts to engage with Indian private pharmacies should be prioritized.

Factors associated with the unsuccessful TB treatment outcomes in the northern regions of Namibia: a mixed methods study

BackgroundTuberculosis (TB) is among the leading causes of death globally. The disease has a huge burden in Namibia, with a case notification rate of at least 442 per 100,000. To date, Namibia is among the countries with the highest global TB burden, despite all efforts to reduce it. This study aimed to determine the factors associated with the unsuccessful treatment outcomes of the Directly Observed Therapy Short course (DOTS) programme in the Kunene and Oshana regions.MethodsThe study utilised a mixed-methods explanatory-sequential design to collect data from all TB patient records and healthcare workers who work directly with the DOTS strategy for TB patients. The relationship between independent and dependent variables was analysed using multiple logistic regression analysis, while interviews were analysed using inductive thematic analysis.ResultsThe overall treatment success rates of the Kunene and Oshana regions throughout the review period were 50.6% and 49.4%, respectively. The logistic regression analyses showed that in the Kunene region, the type of DOT used (Community-based DOTS) (aOR = 0.356, 95% CI: 0.835–2.768, p = 0.006) was statistically significant with the unsuccessful treatment outcomes. While in the Oshana region, age groups 21–30 years old (aOR = 1.643, 95% CI = 1.005–2.686, p = 0.048), 31–40 years old (aOR = 1.725, 95% CI = 11.026–2.9, p = 0.040), 41–50 years old (aOR = 2.003, 95% CI = 1.155–3.476, p = 0.013) and 51–60 years old (aOR = 2.106, 95% CI = 1.228–3.612, p = 0.007) had statistically significant associations with the poor TB-TO. Inductive thematic analysis revealed that patients in the Kunene region were challenging to reach owing to their nomadic lifestyle and the vastness of the area, adversely affecting their ability to observe TB therapy directly. In the Oshana region, it was found that stigma and poor TB awareness among adult patients, as well as mixing anti-TB medication with alcohol and tobacco products among adult patients, was a prevalent issue affecting TB therapy.ConclusionThe study recommends that regional health directorates embark on rigorous community health education about TB treatment and risk factors and establish a robust patient observation and monitoring system to enhance inclusive access to all health services and ensure treatment adherence.

Potential Repurposed Drug Candidates for Tuberculosis Treatment: Progress and Update of Drugs Identified in Over a Decade.

The devastating impact of Tuberculosis (TB) has been a menace to mankind for decades. The World Health Organization (WHO) End TB Strategy aims to reduce TB mortality up to 95% and 90% of overall TB cases worldwide, by 2035. This incessant urge will be achieved with a breakthrough in either a new TB vaccine or novel drugs with higher efficacy. However, the development of novel drugs is a laborious process involving a timeline of almost 20-30 years with huge expenditure; on the other hand, repurposing previously approved drugs is a viable technique for overcoming current bottlenecks in the identification of new anti-TB agents. The present comprehensive review discusses the progress of almost all the repurposed drugs that have been identified to the present day (∼100) and are in the development or clinical testing phase against TB. We have also emphasized the efficacy of repurposed drugs in combination with already available frontline anti-TB medications along with the scope of future investigations. This study would provide the researchers a detailed overview of nearly all identified anti-TB repurposed drugs and may assist them in selecting the lead compounds for further in vivo/clinical research.

Rigid Bronchoscopy for Post-Tuberculosis Tracheobronchial Stenosis.

The healing process of tracheobronchial tuberculosis (TB) result in tracheobronchial fibrosis causing airway stenosis in 11-42% of patients. In Korea, where pulmonary TB is still prevalent, post-TB tracheobronchial stenosis (PTTS) is one of the main causes of benign airway stenosis causing progressive dyspnea, hypoxemia and often representing life-threatening respiratory insufficiency. The development of rigid bronchoscopy replaced surgical management since last 30 years, and nowadays PTTS is mainly managed by bronchoscopic intervention in Korea. When diagnosed, tracheobronchial TB is treated by combination of anti-TB medications as other pulmonary TB. The indication of rigid bronchoscopy is more than ATS grade 3 dyspnea in PTTS patients. At first narrowed airway is dilated by multiple techniques, including ballooning, laser resection, bougienation under general anesthesia. Then, most of patients need silicone stenting to maintain the patency of dilated airway. 1.5~2 years after indwelling, the stent could be removed with 70% of success rate. Acute complications develops in less than 10% of patients without mortality. Subgroup analysis showed successful removal of stent was significantly associated with male sex, young age, good baseline lung function and absence of complete one lobe collapse. In conclusion, rigid bronchoscopy could be applied to PTTS patients with acceptable efficacy and tolerable safety.

An Insight into Advances in Developing Nanotechnology Based Therapeutics, Drug Delivery, Diagnostics and Vaccines: Multidimensional Applications in Tuberculosis Disease Management.

Tuberculosis (TB), one of the deadliest contagious diseases, is a major concern worldwide. Long-term treatment, a high pill burden, limited compliance, and strict administration schedules are all variables that contribute to the development of MDR and XDR tuberculosis patients. The rise of multidrug-resistant strains and a scarcity of anti-TB medications pose a threat to TB control in the future. As a result, a strong and effective system is required to overcome technological limitations and improve the efficacy of therapeutic medications, which is still a huge problem for pharmacological technology. Nanotechnology offers an interesting opportunity for accurate identification of mycobacterial strains and improved medication treatment possibilities for tuberculosis. Nano medicine in tuberculosis is an emerging research field that provides the possibility of efficient medication delivery using nanoparticles and a decrease in drug dosages and adverse effects to boost patient compliance with therapy and recovery. Due to their fascinating characteristics, this strategy is useful in overcoming the abnormalities associated with traditional therapy and leads to some optimization of the therapeutic impact. It also decreases the dosing frequency and eliminates the problem of low compliance. To develop modern diagnosis techniques, upgraded treatment, and possible prevention of tuberculosis, the nanoparticle-based tests have demonstrated considerable advances. The literature search was conducted using Scopus, PubMed, Google Scholar, and Elsevier databases only. This article examines the possibility of employing nanotechnology for TB diagnosis, nanotechnology-based medicine delivery systems, and prevention for the successful elimination of TB illnesses.

Unraveling the Secrets Behind the Multidrug-Resistant Tuberculosis Treatment Outcome in Chronic Renal Failure Patients Requiring Hemodialysis: A Systematic Review.

Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR TB) is a global concern, with 450,000 new cases and 191,000 deaths in 2021. TB and chronic kidney disease (CKD) have been associated since 1974, with suggested explanations such as oxidative stress, malnutrition, dysfunction in vitamin D metabolism, and a compromised cell-mediated immune response. End-stage renal failure patients are more likely to acquire drug resistance due to poor adherence, adverse drug reactions, and inappropriate dose adjustment. We then aim to evaluate the therapeutic outcome of multidrug-resistant TB of the lungs in patients who require hemodialysis in terms of successful treatment (cured and treatment completed) and the associated factors for a favorable outcome. Our secondary goal is to identify unfavorable treatment outcomes (treatment failed, patient died, or patient lost to follow-up) and the underlying associated factors. We conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Guidelines for this systematic review. We included adults (>19 years old) with chronic kidney disease who needed hemodialysis and had microbiologically confirmed multidrug-resistant pulmonary TB, excluding patients who had a renal allograft transplant, were on peritoneal dialysis, hadextrapulmonary TB, were childrenand pregnant patients. We searched PubMed, MEDLINE, PubMed Central, ScienceDirect, Public Library of Science (PLOS), and Google Scholar. Keywords were combined with the Boolean "AND" operator to gather results as well as the medical subject heading (MeSH) search strategy. After screening study articles by reading their titles and abstracts, the following tools were used to assess the risk of bias: the Newcastle-Ottawa scale for observational studies, the Assessment of Multiple Systematic Reviews (AMSTAR) checklist for systematic reviews, and the Joanna Briggs Institute (JBI) assessment tool for case reports.Primary and secondary outcomes were assessed, and a conclusion was made. We gathered 21,570 studies from the databases between 2013 and 2023, with 30,062 total participants. There were eight eligible studies for review. Patients with CKD, particularly those on dialysis, are at increased risk of TB due to a combination of factors that contribute to immunosuppression. TB reactivation is common in chronic renal failure patients. Diagnostic samples such as sputum and pleural fluid had lower sensitivity rates compared to tissue samples, which led to delays in diagnosis and treatment and, most importantly, contributed to drug resistance. All new dialysis patients should undergo interferon-gamma release assay testing. TB-infected patients with severe renal disease (eGFR 30 ml/min) had increased morbidity and mortality; however, the use of directly observed treatment, short-course (DOTS), and renal-dose adjustment of anti-TB medications significantly reduced these risks. Drug-induced hepatitis and cutaneous reactions were common adverse effects of anti-TB medications. A therapeutic drug monitoring guideline is required to reduce these adverse events and even mortality. Additional research is required to assess the safety and efficacy of therapeutic regimens, as well as their outcomes, in this population with multidrug-resistant TB.

Risk for multidrug-resistant tuberculosis in patients treated with anti-tumor necrosis factor agents.

There are few studies on medical conditions associated with the development of drug-resistant TB. We investigated the risk factors for the occurrence of multidrug-resistant (MDR) tuberculosis (TB) in patients with pulmonary TB. Based on claims data from the Health Insurance Review and Assessment service in South Korea, we retrospectively investigated patients aged 18 years or older with active pulmonary TB who were treated with anti-TB therapy between January 1, 2008, and February 28, 2021. Among 248,176 patients with pulmonary TB who underwent anti-TB therapy, 2.0% were identified as having MDR-TB. MDR-TB showed male predominance compared to patients without MDR-TB, and patients with MDR-TB were younger. The risk for MDR-TB in patients treated with anti-TB therapy was 3.26 times higher in patients who received anti-tumor necrosis factor (TNF) agents before prescription of anti-TB medications than in those who had never been exposed to anti-TNF agents after adjusting for other TB risk factors (age, sex, inhaled corticosteroid, diabetes mellitus, liver disease, pneumoconiosis, and organ or blood recipients). The risk for MDR-TB was also increased in males and younger patients. Treatment with an anti-TNF agent could be a driver of MDR-TB in patients with pulmonary TB.

The Effect of the Community-Based- Directly Observed Therapy on the Treatment Outcome of Tuberculosis Patients in Mitooma District, Western-Uganda

Tuberculosis (TB) remains the ninth leading cause of death in the world and a leading cause of death among infectious diseases. Sub-Saharan Africa has nearly all high TB burden countries including Uganda which contributes to the highest Tuberculosis related mortality globally. Poor adherence to Tuberculosis treatment can lead to prolonged infection and poor treatment outcomes. Directly Observed Treatment (DOT) seeks to improve adherence to TB treatment by observing patients while they take their anti-TB medications. The aim of the study was to determine the effect of the Community Based- DOT on the Treatment Outcomes of Tuberculosis Patients in Mitooma District, Western Uganda. A cross-sectional survey research design was adopted and data were collected from the TB patients. Results revealed that TB patients who were not educated were 9.01 times more likely to get cured compared to the educated patients (AOR=9.01; 95% CI (1.6-5.9); p=0.013). Duration or time spent on TB medication was associated with TB treatment outcome because the patients who had spent 6 months on TB medication (AOR=2.9; 95% CI (1.14 – 7.9); p=0.004) were threefold more likely to get cured compared to those who had spent less than one month. Similarly, patients who had spent six months and above (AOR=4.1; 95%CI (0.07 – 0.87); p=0.026) were more than four times more likely to get cured compared to those who had spent less than one month. Results further showed that patients who were neutral in attributing their health state to the way they swallowed the TB medication (AOR = 0.33; 95%CI (0.12 – 0.9); p=0.001) were 67% less likely to get cured compared to patients who strongly agreed that their health status were attributed to the way they swallowed TB medication. Majority of the TB patients described the program as vital in treatment of TB disease as health caregivers would work closely with TB patients to adhere to treatment. Further, the study revealed that CB-DOT improved TB treatment outcomes. Monitoring the swallowing of TB drugs by health workers, health education and regular visits were highly recommended. Therefore, studies on policies for implementation of patient-centered and community-centered CB-DOT deserve further attention.

Course of untreated depression in people with tuberculosis in Ethiopia: a cohort study

IntroductionCo-morbid depression is common in people with tuberculosis (TB) but little is known about the course over time.ObjectivesOur objectives were to determine the level of remission and factors associated with failure to remit in depressive symptom scores in people with TB undergoing treatment in primary care facilities in Ethiopia.MethodsWe assessed 648 people with newly diagnosed TB for depressive symptoms using Patient Health Questionnaire (PHQ-9) at the time of starting anti-TB medication, and again at two and six months. Remission was defined as more than 50% reduction in baseline depressive symptom scores. We analyzed factors associated with failure of depressive symptom score to remit at the end of the follow up using multilevel mixed-effects logistic regression by taking individuals as nested within 14 health institutions. Adjustment was made for socio-demographic characteristics, baseline depression score, stigma, type of TB, outcome of TB treatment, perceived severity of TB, substance use, perceived social support, substance use, and HIV status.ResultsCompared to the baseline, the mean PHQ-9 scores declined at two months (Hedge’s G: 0.82; 95%CI: 0.71, 0.94) and six months (Hedge’s G: 1.20; 95%CI: 1.08, 1.33). However, depressive symptom scores failed to remit in 176 (33.1%) of the 532 people with TB who completed the follow up. . Stigma (AOR: 2.23; 95%CI: 1.09, 4.55), older age (AOR: 2.2; 95%CI: 1.13, 4.29), and treatment completion without a bacteriological proof of cure (treatment complete as compared to treatment cure) (AOR: 2.47; 95%CI: 1.37, 4.48) were independent predictors of failure of depressive symptom score to remit. Surprisingly, baseline lower depressive symptom score was more persistent than higher baseline depressive symptom score (AOR: 2.93; 95%CI: 1.56, 5.47).ConclusionsIn one-third of people with newly diagnosed TB, baseline depressive symptom scores did not remit after full course of TB treatment. TB treatment guidelines require in-built mental health component. Studies are required to understand course of depression beyond six months and effective interventions in this population.Disclosure of InterestNone Declared

Stocking Practices of Anti-Tuberculosis Medications among Community Pharmacists and Patent Proprietary Medicine Vendors in Two States in Nigeria.

Evidence has shown that non-fixed-dose combination (non-FDC) anti-TB drugs could promote the spread of drug-resistant tuberculosis (DR-TB). We aimed to determine anti-TB medication stocking and dispensing practices among patent medicine vendors (PMVs) and community pharmacists (CPs) and their determinants. This was a cross-sectional study using a structured, self-administered questionnaire among 405 retail outlets (322 PMVs and 83 CPs) across 16 Lagos and Kebbi local government areas (LGAs) between June 2020 and December 2020. Data were analyzed with Statistical Program for Social Sciences (SPSS) for Windows version 17 (IBM Corp., Armonk, NY, USA). Chi-square test and binary logistic regression were used to assess the determinants of anti-TB medication stocking practices at a p-value of 0.05 or less for statistical significance. Overall, 91%, 71%, 49%, 43% and 35% of the respondents reported stocking loose rifampicin, streptomycin, pyrazinamide, isoniazid and ethambutol tablets, respectively. From bivariate analysis, it was observed that being aware of directly observed therapy short course (DOTS) facilities (OR 0.48, CI 0.25-0.89, p < 0.019) and having previous training on TB (OR 0.32, CI 0.14-0.73, p < 0.005) reduced the odds of stocking anti-TB medication, while operating more than 1 shop (OR 3.32, CI 1.44-7.57, p = 0.004), having 3 or more apprentices (OR 5.31, CI 2.74-10.29, p < 0.001) and seeing over 20 clients/day (OR 3.02, CI 1.18-7.71, p = 0.017) increased the odds of stocking loose anti-TB medications. From multivariate analysis, it was observed that only the variable having three or more apprentices (OR 10.23, CI 0.10-0.49, p = 0.001) significantly increased the odds of stocking anti-TB medications. The stocking of non-FDC anti-TB medications was high and largely determined by the number of apprentices among PMVs and CPs in Nigeria, and this may have serious implications for drug resistance development. However, the results linking the stocking of anti-TB to the number of apprentices should be interpreted cautiously as this study did not control for the level of sales in the pharmacies. We recommend that all capacity-building and regulatory efforts for PMVs and CPs in Nigeria should include not just the owners of retail premises but also their apprentices.

Pretreatment CT differential diagnosis of tuberculous peritonitis from peritoneal carcinomatosis of advanced epithelial ovarian cancer

Delayed diagnosis of female genital tuberculosis (FGTB) can lead to inappropriate treatment and unnecessary surgical procedures rather than standard anti-TB medication. We tried to evaluate the use of computed tomography (CT) imaging to differentiate TB peritonitis from peritoneal carcinomatosis of advanced epithelial ovarian cancer (AEOC). We investigated women who underwent CT to distinguish between TB peritonitis and peritoneal carcinomatosis of AEOC. We evaluated various CT imaging features to identify differences between the two diseases. In addition, we performed univariate and multivariate logistic regression analyses to identify the independent imaging parameters associated with TB peritonitis and evaluated the diagnostic performance of the combined imaging parameters. We also performed the histopathological analysis of the available salpinx specimens of TB peritonitis. We included 25 women with TB peritonitis and 34 women with peritoneal carcinomatosis of AEOC. A multivariate analysis of the discriminant CT imaging features between the two diseases revealed that changes in fallopian tubes and peritoneal micronodules were independent parameters associated with TB peritonitis (p ≤ 0.012). Combining the two imaging parameters showed an area under the receiver operating characteristic curve of 0.855, a sensitivity of 88.0%, and a specificity of 67.7% for differentiating TB peritonitis from peritoneal carcinomatosis. Furthermore, changes in fallopian tubes were correlated with histopathological abnormalities in salpinx specimens. Pretreatment CT evaluation with useful imaging features could help differentiate TB peritonitis from peritoneal carcinomatosis of AEOC.