Awareness Of Tuberculosis Research Articles

The rural-to-urban migrant population in China: Gloomy prospects for tuberculosis control

The migrant population is a population with a high risk of tuberculosis (TB) infection and transmission. Globally, migration is likely to have a significant impact on TB epidemiology, particularly in countries that receive substantial numbers of migrants from countries with a high infection burden. China, a country with the world's second highest TB burden, faces a considerable increase in the number of rural-to-urban migrants. This population has a significant impact on urban TB epidemics and is specifically targeted by national guidelines for TB control. TB control among the migrant population has had relatively poor outcomes. Barriers to detection and treatment have both financial and non-financial aspects, such as the "migratory" nature of the migrant population, their marginalized working and living environment, poor financial status, little awareness of TB, inadequate referral to TB dispensaries, and potential social stigma in the workplace. Currently, the free TB treatment policy has limited ability to relieve the financial burden on most migrant TB patients as would allow optimal outcomes of TB detection and treatment. Universal health insurance coverage and fostering of personnel in community-based primary health care for the rural-to- urban migrant population represent two pillars of successful TB control.

Abdominal tuberculosis may masquerade many diseases

Background/Aim:Intestinal tuberculosis needs to be considered in the differential diagnosis when patients with intestinal pathology are encountered. Tuberculosis can mimic other disease entities like, ischemic enteritis, inflammatory bowel diseases, malignancies, intussusception etc., clinically as well as morphologically in resected intestinal specimens. We aimed to study the various clinical presentations leading to intestinal resection, with identification of different etiological factors by histopathological examination; and to illustrate, discuss and describe the various histopathological features of the lesions in these resected intestinal specimens with clinicopathological correlation.Materials and Methods:We studied 100 cases of resected intestinal specimens received during September 2002 to December 2003. We totally encountered 22 request forms with clinical suspicion of ileoceocal tuberculosis.Results:Abdominal tenderness and mass in ileoceocal region were noted in all cases. In many instances, the cases were operated for acute/subacute intestinal obstruction. Clinical and intra-operative diagnoses of tubercular enteritis, in many instances, were finally diagnosed histopathologically as ischemic enteritis (nine cases), chronic nonspecific enteritis (four cases), adenocarcinoma of the caecum, Crohn’s disease, intussusception (each one case), and correctly as intestinal tuberculosis in only six cases.Conclusion:Tuberculosis can mimic various disease entities, clinically and sometimes morphologically. Vice versa is also true. An increased awareness of intestinal tuberculosis coupled with varied clinical presentations, nonspecific signs and symptoms, difficulties in diagnostic methods and need of early and specific treatment should improve the outcome for patients with this disease.

Multihost Tuberculosis: Insights from the Portuguese Control Program

This paper describes the current situation of animal tuberculosis in Portugal, reviewing the accomplishments and constraints of the 2001–2009 period. Notwithstanding the substantial progress achieved with the implementation of a comprehensive test and cull scheme, notification, postmortem inspection and surveillance at slaughterhouses, herd and animal prevalence have unexpectedly increased in 2009. In parallel, the recent awareness of tuberculosis in local free-ranging wildlife species causes concern regarding the final steps towards eradication, demanding new approaches to the existing disease control policies.

S4 Evaluation of TB peer educators—essential partners in metropolitan TB control

BackgroundOne in six of all notified tuberculosis (TB) cases in London are among homeless people, problem drug and alcohol users and prisoners (hard-to-reach). These groups are at high risk of...

Analysis of a mathematical model for tuberculosis: What could be done to increase case detection

This paper presents qualitative and quantitative study of a TB mathematical model to test results from a survey carried out in Benin City, Nigeria. The purpose of the survey was to determine factors that could enhance the case detection rate of tuberculosis. Results from the survey identified four key factors that must be combined for an effective control of TB and increase the case detection rate: effective awareness programme, active cough identification, associated cost factor for treatment of identified cases and effective treatment. The overall effect of these factors on the basic reproduction number under treatment, RT, of the TB model was considered. In all, a serious concentration on tuberculosis awareness programmes and active cough identification as a marker for someone having TB was shown to significantly reduce the value of the reproduction number, hereby reducing the severity of the disease in the presence of treatment.

Tuberculosis burden in an urban population: a cross sectional tuberculosis survey from Guinea Bissau

BackgroundLittle is known about the prevalence of pulmonary tuberculosis (TB) in low income countries. We conducted a cross sectional survey for pulmonary TB and TB symptoms in Bissau, Guinea-Bissau, in an urban cohort with known HIV prevalence. TB surveillance in the area is routinely based on passive case finding.MethodsTwo cohorts were selected based on a previous HIV survey, but only 52.5% of those enrolled in the adult cohort had participated in the HIV survey. One cohort included all adults living in 384 randomly selected houses; in this cohort 8% (135/1687) were HIV infected. The other included individuals 50 years or older from all other houses in the study area; of these 11% (62/571) were HIV infected. Symptom screening was done through household visits using a standardised questionnaire. TB suspects were investigated with sputum smear microscopy and X-ray.ResultsIn the adult cohort, we found 4 cases among 2989 individuals screened, giving a total TB prevalence of 134/100,000 (95% CI 36-342/100,000). In the >50 years cohort, we found 4 cases among 571 individuals screened, giving a total prevalence of 701/100,000 (191-1784/100.000). Two of the eight detected TB cases were unknown by the TB program. Of the total TB cases five were HIV uninfected while three had unknown HIV status. The prevalence of TB symptoms was 2.1% (63/2989) and 10.3% (59/571) in the two cohorts respectively.ConclusionsIn conclusion we found a moderately high prevalence of pulmonary TB and TB symptoms in the general population, higher among elderly individuals. By active case finding unknown cases were detected. Better awareness of TB and its symptoms needs to be promoted in low income settings.

Analysis of some indicators of tuber­cular morbidity in Varna region in 2008

SUMMARY According to the information from the World Health Organization (WHO) about 1\3 of the world population i.e.2 milliard people are infected with Mycobacterium tuberculosis and they are at risk that their condition may deteriorate. More than 8 million people are annually infected and approximately 2 million die of tuberculosis. Bulgaria is a country with an average level of incidence – between 12 to 80 per 100 000. In Varna region the number of the people infected with tuberculosis in 2008 was 143 - 37 patients more than those registered in 2007. Aim: To make an analysis of some tubercular infection indicators in Varna region in 2008. Materials and methods: A research was carried out in the Pneumophthisiatric Clinic in Varna, concerning the patients undergoing treatment there in 2008. Apart from that information was collected from the Center for Disease Control at the Regional Sanitary Inspection in Varna. Results: The number of people infected with tuberculosis in 2008 was 143 – 37 more compared to 2007.The cases of pulmonary consumption had increased by 36.There were patients infected with tuberculosis in Varna Municipality, Provadia, Dolni Chiflik, Aesakovo, Vulchi dol, etc. The highest number of patients suffering from tuberculosis were among the people over 65 years of age and the unemployed between 30 and 35 years of age especially the ones with low standard of life. In the group of the infected people there were 17 children and the youngest patient was 9 months old. Susceptible to the disease were people with weak immune system, low social status, alcoholics, smokers and unemployed. Conclusion: Reducing the incidence of tuberculosis in Varna region can be achieved by: control over the range and quality of the specific immunoprophylaxis with BCG vaccine, raising the public health awareness of tuberculosis, enhancing and monitoring the activity of the non-governmental organizations (NGOs) that work on the problem of tuberculosis in the region of Varna.

Cattle owners' awareness of bovine tuberculosis in high and low prevalence settings of the wildlife-livestock interface areas in Zambia.

BackgroundAwareness of bovine tuberculosis (BTB) by cattle owners is of extreme importance to policy makers when considering mitigation. However, to our knowledge, little is known on cattle owners' awareness of BTB in Zambia. Similarly, such knowledge is uncommon within and outside Africa. The current study investigates the epidemiological characteristics of BTB in Zambian cattle in relation to awareness by cattle owners in high and low cattle BTB prevalence settings. A cross sectional study was designed and data was gathered based on 106 cattle owners and cattle herds; subjected to an interviewer-administered questionnaire and comparative intradermal tuberculin test using a cut-off for positivity of 4 mm, respectively.ResultsReported levels of cattle and wildlife contact by respondents was at 40%, 58.2% and 1.8%, were relatively proportional to herd level prevalence of cattle BTB at 64.8%, 58.1% and 5.9% in Blue lagoon, Lochinvar and Kazungula respectively. Although 42/106 (39.6%) of cattle owners had heard of BTB, only 3 (7%) had an idea on how the disease was spread. Cattle contact with wildlife was associated with high levels of awareness by cattle owners (χ2 = 43.5, df = 2, P < 0.001). Awareness of BTB in low prevalence settings was lower compared to high prevalence settings.ConclusionsOur study has revealed low levels of awareness among cattle owners on BTB. These results could be useful for policy makers when planning mitigation measures to consider awareness levels by cattle owners for effective implementation. Such information is useful for determining sensitisation programs for cattle owners before mitigation. These results further provide useful insights that disease control is a multi-factorial process with cattle owners as an integral part that can support policy implementation.

Impact of a simple educational intervention on the knowledge and awareness of tuberculosis among high school children in Vellore, India

Tuberculosis is a disease of great significance in India. With the advent of the HIV/AIDS epidemic the problem has been compounded. The Millenium Development Goal number 6, target 8, is ‘Halt and begin to reverse the incidence of TB by 2015’. In order to achieve this goal the World Health Organization (WHO) launched the Stop TB program; one of the important strategies of which was education and empowerment of communities. It is hypothesized that improving the knowledge and awareness about tuberculosis in school going children will spread the awareness in the general community. This study was done to assess the level of knowledge of high school children, about various aspects of tuberculosis, and to assess the impact of a simple educational intervention on the knowledge of the children, with regard to tuberculosis.

10 years of experience of Tuberculous Vertebral Osteomyelitis in Sheffield

Approximately 10% of tuberculosis involves the skeletal system, up to half affecting the spine. Diagnosis of tuberculous vertebral osteomyelitis is frequently delayed due to its insidious onset, particularly in areas in the United Kingdom with a low incidence of tuberculosis. In recent years there have been efforts nationally to increase awareness of tuberculosis with the publication of a number of documents such as the Chief Medical Officer's Tuberculosis Action Plan, and the National Institute for Clinical Excellence Tuberculosis guidelines. We performed a retrospective case note review of patients with tuberculous vertebral osteomyelitis treated in Sheffield over the past 10 years to review epidemiology, clinical and radiological features and outcomes, and diagnostic delays.

Intestinal tuberculosis

Intestinal tuberculosis (TB) is increasing due partly to the HIV pandemic. Its clinical presentation mimics inflammatory conditions such as Crohn's disease and malignancies, which are becoming more prevalent, so the diagnosis is problematic. Greater awareness of intestinal TB is needed, both in countries where TB is endemic and developed countries with immigrant populations. Some strains of Mycobacterium tuberculosis are associated with more extrapulmonary disease and greater dissemination, thereby exacerbating the rise in HIV-associated extrathoracic TB. Recent retrospective and prospective studies are leading to the development of diagnostic algorithms. A wide range of imaging techniques is available for sampling and diagnosis. New biochemical, immunological and molecular diagnostic methods are being developed but must be standardized and validated. Developments in drug delivery will facilitate oral therapy even in patients suffering from malabsorption. There is an increasing consensus on the risk factors and clinical presentations of intestinal TB. Imaging techniques, coupled with fine needle biopsies, are useful aids to diagnosis, but most important is a greater awareness of the condition by clinicians.

Use of a T Cell Interferon-γ Release Assay to Evaluate Tuberculosis Risk in Newly Qualified Physicians in Singapore Healthcare Institutions

Surveillance for latent tuberculosis in high-risk groups such as healthcare workers is limited by the nonspecificity of the tuberculin skin test (TST) in BCG-vaccinated individuals. The Mycobacterium tuberculosis antigen-specific interferon-gamma release assays (IGRAs) show promise for more accurate latent tuberculosis detection in such groups. To compare the utility of an IGRA, the T-SPOT.TB assay, with that of the TST in healthcare workers with a high rate of BCG vaccination. Two hundred seven medical students from 2 consecutive cohorts underwent the T-SPOT.TB test and the TST in their final year of study. Subjects with negative baseline test results underwent repeat testing after working for 1 year as junior physicians in Singapore's public hospitals. The baseline TST result was an induration 10 mm or greater in diameter in 177 of the 205 students who returned to have their TST results evaluated (86.3%), while the baseline T-SPOT.TB assay result was positive in 9 (4.3%) of the students. Repeat T-SPOT.TB testing in 182 baseline-negative subjects showed conversion in 9 (4.9%). A repeat TST in 18 subjects with baseline-negative TST results did not reveal any TST result conversion. The high rate of positive baseline TST results in our BCG-vaccinated healthcare workers renders the TST unsuitable as a surveillance tool in this tuberculosis risk group. Use of an IGRA has enabled the detection and treatment of latent tuberculosis in this group. Our T-SPOT.TB conversion rate highlights the need for greater tuberculosis awareness and improved infection control practices in our healthcare institutions.

Localisations inhabituelles de la tuberculose : à propos de trois observations

We report three cases of tuberculosis of unusual location in Malagasy patients. The first patient presented with intracardiac tuberculoma during pulmonary tuberculosis. The second patient who had no significant musculoskeletal past medical history presented with tuberculous polymyositis. The remaining one presented with tuberculous epididymitis without involvement of the urinary tract. Diagnosis was histopathological. The outcome was favorable in the two last patients with antituberculous therapy. This report emphasizes the necessary awareness of tuberculosis even in the presence of unusual manifestations in hyper-endemic area of tuberculosis.

Intensified Case Finding for Tuberculosis in Prevention of Mother-to-Child Transmission Programs: A Simple and Potentially Vital Addition for Maternal and Child Health

The intersection of HIV and tuberculosis (TB) poses a serious threat to HIV-infected women and their children. The majority of patients with TB in sub-Saharan Africa are infected with HIV and together the overlapping epidemics synergistically accelerate illness and death. Escalating case rates increased mortality and the recent emergence of extensively drug-resistant TB highlights how catastrophic a once preventable and curable disease has become among people with HIV/AIDS. The HIV epidemic requires new strategies to control TB in high-burden areas especially as women of reproductive age are disproportionately affected by the epidemic. Intensified case finding for TB has the potential to reduce morbidity and mortality for people living with HIV especially pregnant women their families and infants. (excerpt)

Treatment of Extensively Drug‐Resistant Tuberculosis and Role of the Pharmacist

Abstract Outbreaks of extensively drug-resistant tuberculosis (XDR-TB) in developing countries and recent headlines of an American traveling with a resistant variant of tuberculosis have brought XDR-TB into the spotlight. The World Health Organization and the United States Centers for Disease Control and Prevention have identified XDR-TB as a serious public health threat and are mandating increased efforts at control of tuberculosis. Although XDR-TB is believed to be no more infectious than other variants of tuberculosis, infection with and spread of XDR-TB are concerning because of the ineffectiveness, toxicity, and cost of the available tuberculosis treatment options. Pharmacists may not be aware of the recent trends in tuberculosis resistance or of the impact that they can have on educating the public about this disease. To gain a better understanding of this disease and the potential roles for pharmacists in public health awareness of tuberculosis and in the care of patients with and at risk for this disease, we undertook an extensive search of the Internet, including Web sites of tuberculosis advocacy groups, and of MEDLINE from January 1968-March 2008. Currently, XDR-TB infection is uncommon in the United States, but if history is any indication, there is a high potential for an outbreak or epidemic. The XDR-TB variant has emerged from mismanaging multidrug-resistant tuberculosis, treating tuberculosis with too few drugs, using less effective second-line drugs, and not educating patients about the dangers of nonadherence. With only limited hopes of a novel effective drug combination regimen, use of available antimycobacterial drugs needs to be optimized. Pharmacists can be key players in the prevention and treatment of tuberculosis by promoting adherence, assessing patients for risk factors for resistant disease, providing information about disease control and prevention, and monitoring for effectiveness, adverse effects, and drug interactions.

The influence of socio-economic deprivation on tuberculosis treatment delays in England, 2000–2005

This study investigates the association between socio-economic deprivation and tuberculosis (TB) treatment delays in England, 2000-2005. Patients reported to the Enhanced TB Surveillance system were assigned a deprivation score based on residential postcode, and categorized into deprivation quartiles. Data were analysed using Cox regression. The median interval from symptom onset to treatment initiation was 67 days (inter-quartile range 30-131). The effect of deprivation on this interval was modified by ethnic group and place of birth/time since entry into the United Kingdom. Longer intervals were experienced by the most deprived black Africans, Indians/Pakistanis/Bangladeshis and recent entrants to the United Kingdom, compared to the least deprived. In contrast, among white and UK-born patients, longer intervals were experienced by the least deprived. In conclusion, the effect of deprivation on TB treatment delays varies in different population groups. Efforts are needed to reduce delays including improving awareness of TB and increasing the index of clinical suspicion.

Knowledge and Perceptions of Tuberculosis Among a Sample of Urban Aboriginal People

Achieving a high level of tuberculosis (TB) awareness is crucial for the success of prevention and treatment efforts in high-risk groups, and thus represents a key challenge for public health initiatives. Research exploring knowledge and perceptions of TB in Aboriginal populations has been lacking to date. We sought to explore the knowledge and perception of TB in a sample of high-risk Aboriginal peoples in Montreal who were undergoing a tuberculin skin test (TST) as part of a larger study. We conducted standardized, face-to-face interviews using a structured interview guide. The interview explored participants' knowledge and perception of TB using a combination of both structured and open-ended questions. We also asked a series of open-ended questions that probed for participants' experiences with urban health services, whether TB is discussed in Aboriginal communities and participants' intentions should their TST result be positive. A total of 164 eligible Aboriginal persons volunteered to participate in our study. Close to one-third (54/164) reported knowing little about TB, and participant responses indicated that there were many prevalent misconceptions about the symptoms, transmission, cause and risk factors for the disease. The majority of respondents felt that TB was not openly discussed in their homes and communities, and approximately half (90/164) of respondents reported that they were not concerned about contracting TB. We conclude that there is a lack of knowledge and several misconceptions about TB among our sample of urban Aboriginal peoples.

A 17-Years Old Man of Colitis Tuberculosis with Fistula Perianal

Tuberculosis (TB) remains to be one of the most common problems in developing countries such as Indonesia. It can involve many organs including gastrointestinal tracts. Colonic tuberculosis is an ancient disease and has long been recognized. However, it is sometimes difficult to make early diagnosis due to its nonspecific signs and symptoms. Perianal granulomas or perianal fistula presents some degree of diagnostic difficulty. A spectrum of diseases can produce granulomas in perianal region and perineum. Most are infectious or inflammatory diseases. Standard histological diagnosis often less significant to clarify the etiology and treatment will vary from one to another disease entity. In this report, we present a case 17-years old man with colitis TB and fistula perianal, in which the initial diagnostic workup suggested Crohn’s disease. Mantoux test, Acid Fast Bacilli test on fecal examination and polymerase chain reaction analysis revealed negative result. The chest X-ray was normal; while the fistulography X-ray: revealed 2 orifices in rectosigmoid area. The colonoscopy revealed mucosa edema with ulceration in rectosigmoid and pedincular polyp in the caecum. Initial colonoscopy diagnosis was Crohn’s disease with differential diagnosis colitis ulcerative, colitis TB, colitis infection. results of direct or post homogenizes examination (Ziel–Nielsen staining) revealed that no acid-fast bacilli was found. Multiple biopsies were done, which indicated mucosa edema with ulceration in rectosigmoid area, pedincular polyp in the caecum, and surrounded by fistula perianal; while histopathological examination showed inflammatory-caseating-epithelioid-granulomas and giant cells (Langhans datia cell) caused by tuberculosis. It highlights the need for awareness of intestinal TB along with the differential diagnosis of chronic intestinal disease. Standard regimen of antituberculosis treatment was given and the patient showed good clinical response. Keywords: Crohn’s disease, caseating epithelioid granuloma, giant cell, colitis TB, perianal fistula

Scrotal Tuberculosis in Adult Patients: A 10-Year Clinical Experience

Twenty-nine adults (mean age, 59.9 +/- 13.5 years) with scrotal tuberculosis (TB) were retrospectively analyzed. The mean interval from emergence of symptoms suggestive of scrotal TB to diagnosis established was 142.44 +/- 227.66 days. Scrotal TB was initially suspected in only five (17.2%) patients, and infection caused by bacteria other than Mycobacterium tuberculosis (55.2%) was the leading presumptive diagnosis. Of 28 patients with chest radiographs available, 7 (25%) disclosed active pulmonary TB, and 9 (32.1%) showed a TB scar. All patients received anti-TB chemotherapy; 20 (69%) additionally underwent surgery. Pathologic examination of resected tissue at therapeutic surgery, biopsy, or polymerase chain reaction assay of urine led to rapid diagnosis of scrotal TB. Although evidence of scrotal TB was easily obtainable, the lack of alertness made clinicians avert from the appropriate diagnostic approaches and rendered a delayed diagnosis. Our report underscores the urgent need for improving clinicians' awareness of scrotal TB.

Beyond the medical-informational model: Recasting the role of communication in tuberculosis control

Although communication has recently gained increased recognition in tuberculosis (TB) control programs, current thinking and practice remains boxed within the epistemological boundaries of the “bio-medical” model. The latter posits that information about transmission and care is crucial to promote early diagnosis and treatment. However, when populations confront a series of socio-cultural and structural barriers to access TB care, medical knowledge and awareness alone cannot effectively promote ideal practices. The article suggests that communication programs need to adopt a “social rationality” perspective based on nuanced understanding of community experience of TB. Suggestions are offered about how communication contributes to addressing challenges in TB control.