Burden Of Pulmonary Tuberculosis Research Articles

Trends and Projection of the Incidence of Active Pulmonary Tuberculosis in Southwestern China: Age-Period-Cohort Analysis.

The control of pulmonary tuberculosis (PTB) is critical for achieving the vision of World Health Organization's End TB goal. This study analyzes the temporal trends in PTB incidence associated with age, period, and birth cohorts from 2006 to 2020 in Yunnan, China; projects the PTB burden till 2030; and explores the drivers of PTB incidence. The aggregated PTB incidence rates between 2005 and 2020 were obtained from the National Notifiable Disease Reporting System. We used the age-period-cohort model to evaluate the age, period, and cohort effects on PTB incidence. We applied the Bayesian age-period-cohort model to project future PTB incidence from 2021 to 2030. We applied the decomposition algorithm to attribute the incidence trends to population aging, population growth, and age-specific changes from 2006 to 2030. From 2006 to 2020, the PTB incidence in Yunnan was relatively stable, although the absolute number showed an increase. The net drift was -1.56% (95% CI -2.41% to -0.70%). An M-shaped bimodal local drift and a longitudinal age curve were observed. The overall local drift was below zero for most age groups except for the age groups of 15-19 years (2.37%, 95% CI -0.28% to 5.09%) and 50-54 years (0.41%, 95% CI -1.78% to 2.64%). The highest risk of PTB incidence was observed in the age group of 65-69 years, and another peak was observed in the age group of 20-24 years. Downward trends were observed for both period and cohort effects, but the cohort effect trends were uneven. A higher risk was observed for the birth cohorts of 1961-1970 (rate ratio [RR]1961-1965=1.10, 95% CI 0.88-1.38; RR1966-1970=1.11, 95% CI 0.92-1.37) and 2001-2010 (RR2001-2005=0.92, 95% CI 0.63-1.34; RR2006-2010=0.84, 95% CI 0.45-1.58) than for the adjacent cohorts. The Bayesian age-period-cohort model projected that PTB incidence will continually increase from 2021 to 2030 and that PTB incidence in 2030 will be 2.28 times higher than that in 2006. The age-specific change was the leading cause for the growing PTB disease burden. Although there are several levels and measures for PTB control, the disease burden is likely to increase in the future. To bridge the gap of TB-free vision, our study suggests that public health policies be put in place soon, including large-scale active case-finding, priority prevention policies for high-risk older adult and young adult populations, and reduction of possible grandparent-grandchildren transmission patterns.

Pulmonary tuberculosis and diabetes mellitus: Epidemiology, pathogenesis and therapeutic management (Review).

The dual burden of pulmonary tuberculosis (PTB) and diabetes mellitus (DM) is a major global public health concern. There is increasing evidence to indicate an association between PTB and DM. DM is associated with immune dysfunction and altered immune components. Hyperglycemia weakens the innate immune response by affecting the function of macrophages, dendritic cells, neutrophils, and natural killer cells, and also disrupts the adaptive immune response, thus promoting the susceptibility of PTB in patients with DM. Antituberculosis drugs often cause the impairment of liver and kidney function in patients with PTB, and the infection with Mycobacterium tuberculosis weaken pancreatic endocrine function by causing islet cell amyloidosis, which disrupts glucose metabolism and thus increases the risk of developing DM in patients with PTB. The present review discusses the association between PTB and DM from the perspective of epidemiology, pathogenesis, and treatment management. The present review aims to provide information for the rational formulation of treatment strategies for patients with PTB-DM.

Short-term effects of high-resolution (1-km) ambient PM2.5 and PM10 on hospital admission for pulmonary tuberculosis: a case-crossover study in Hainan, China.

There is limited evidence regarding particulate matter (PM)'s short-term effects on pulmonary tuberculosis (PTB) hospital admission. Our study aimed to determine the short-term associations of the exposure to ambient PM with aerodynamic diameters <2.5 μm (PM2.5) and < 10 μm (PM10) with hospital admission for PTB in Hainan, a tropical province in China. We collected individual data on patients hospitalized with PTB, PM2.5, PM10, and meteorological data from 2016 to 2019 in Hainan Province, China. Conditional logistic regression models with a time-stratified case-crossover design were used to assess the short-term effects of PM2.5 and PM10 on hospital admission for PTB at a spatial resolution of 1 km × 1 km. Stratified analyses were performed according to age at admission, sex, marital status, administrative division, and season of admission. Each interquartile range (IQR) increases in the concentrations of PM2.5 and PM10 were associated with 1.155 (95% confidence interval [CI]: 1.041-1.282) and 1.142 (95% CI: 1.033-1.263) hospital admission risks for PTB at lag 0-8 days, respectively. The stratified analyses showed that the effects of PM2.5 and PM10 were statistically significant for patients aged ≥65 years, males, married, and those residing in prefecture-level cities. Regarding seasonal differences, the associations between PM and hospital admission for PTB were statistically significant in the warm season but not in the cold season. The effect of PM2.5 was consistently stronger than that of PM10 in most subgroups. Short-term exposure to PM increases the risk of hospital admission for PTB. The potential impact of PM with smaller aerodynamic diameter is more detrimental. Our findings highlight the importance of reducing ambient PM level to alleviate the burden of PTB.

Burden of pulmonary tuberculosis and challenges related to tuberculosis detection in Ethiopia.

Early and rapid diagnosis of Mycobacterium tuberculosis in clinical specimen is important for the treatment of patients and control of disease transmission to the community. The disease is largely preventable and curable, but without rapid, and correct diagnostic tools for tuberculosis (TB) infection and drug resistance, it is unlikely that we can meet the national TB elimination program in Ethiopia by 2035. Moreover, drug resistant TB is becoming more common and is a great challenge for the successful control and eradication of TB. The need for rapid, accurate and affordable methods for TB management should be considered by policy makers to improve TB detection rate and reduction of TB related deaths in line with the stop TB strategy by 2030 in Ethiopia.

Systemic Levels of Pro-Inflammatory Cytokines and Post-Treatment Modulation in Tuberculous Lymphadenitis

Pro-inflammatory cytokines are potent stimulators of inflammation and immunity and markers of infection severity and bacteriological burden in pulmonary tuberculosis (PTB). Interferons could have both host-protective and detrimental effects on tuberculosis disease. However, their role has not been studied in tuberculous lymphadenitis (TBL). Thus, we evaluated the systemic pro-inflammatory (interleukin (IL)-12, IL-23, interferon (IFN)α, and IFNβ) cytokine levels in TBL, latent tuberculosis (LTBI), and healthy control (HC) individuals. In addition, we also measured the baseline (BL) and post-treatment (PT) systemic levels in TBL individuals. We demonstrate that TBL individuals are characterized by increased pro-inflammatory (IL-12, IL-23, IFNα, IFNβ) cytokines when compared to LTBI and HC individuals. We also show that after anti-tuberculosis treatment (ATT) completion, the systemic levels of pro-inflammatory cytokines were significantly modulated in TBL individuals. A receiver operating characteristic (ROC) analysis revealed IL-23, IFNα, and IFNβ significantly discriminated TBL disease from LTBI and/or HC individuals. Hence, our study demonstrates the altered systemic levels of pro-inflammatory cytokines and their reversal after ATT, suggesting that they are markers of disease pathogenesis/severity and altered immune regulation in TBL disease.

High burden of pulmonary tuberculosis and missed opportunity to initiate treatment among children in Kampala, Uganda.

There is uncertainty about the actual burden of childhood TB in Uganda, but underestimation is acknowledged. We aimed at determining prevalence, factors associated with PTB among children attending PHC facilities in Kampala. This was a cross-sectional study of 255 children, with presumed TB, attending six health facilities in Kampala, Uganda, in March 2015. Socio-demographic, clinical, and laboratory data were collected using a questionnaire. TB was diagnosed using "Desk Guide" algorithms. Sputum based on ZN/FM and/or Gene-Xpert. Logistic regression was used to assess associations with outcomes. Overall, prevalence of PTB 13.7 % (2.6 - 24.8). Among HIV-positive, the prevalence of PTB was 41.7%, while among malnourished children, 21.7% and contacts, 89.3%. The factors that influenced PTB included: tobacco smoker at home (OR = 1.6, 95 % CI: 1.07 - 6.86), stunting (OR = 2.2, 95 % CI: 1.01 - 4.15). Only 5.3% of the smear-negative TB children and 81.3% of the smear-positive children were initiated on treatment within a month of diagnosis. Clinical TB among children is underdiagnosed and undertreated. There is a need for more sensitive and specific diagnostic tests, need ways to disseminate and promote uptake of standardized clinical algorithms. Also, contact TB tracing should be strengthened so that such cases can be actively detected even at community level.

Risk Factors Associated with Pulmonary Tuberculosis among HIV/AIDs Patients Visiting Mbagathi County Hospital, Nairobi, Kenya

Background: Pulmonary Tuberculosis (PTB) remains a serious global public health concern ranked second to HIV as the leading cause of mortality from infectious diseases especially in developing countries. In 2012, PTB was associated with a global morbidity of 8.6 million and a mortality of 1.3 million annually with 320,000 of these deaths associated with HIV-TB co-infection. Developing countries like Kenya accounts for over 80% of global PTB burden and also has the highest HIV prevalence (WHO, 2013; 2009). The objective of this study was to determine the risk factors associated with pulmonary tuberculosis among HIV/AIDs patients visiting Mbagathi County Hospital. Methods and Materials: A hospital-based, cross-sectional study design was conducted among 159 patients visiting Mbagathi County Hospital. Systematic random sampling method was used to select the study participants from the TB/HIV wards and from the CCC clinic until a sample size of 159 was achieved. A pre-tested, semi-structured questionnaire was used to collect data from the participants. Data was analyzed using SPSS software version 22.0. Results: A total of 159 (n) participants were selected to participate in the study in Mbagathi County Hospital. All the participants selected for the study were HIV patients above 18 years of age. Most of them were male (62.9%). Most of them were married (58.5%). Most of them did not have a family history of TB (86.2%). Most of the respondents completed their education in high school (52.8%). Most of them were unemployed (76.1%) and most of them had an income of less than 10,000 shillings a month (83.0%). In this study I found out that most respondents had poor dietary habits, most of the respondents were smokers (68.6%) and were not aware of the effects of smoking on their health and most of the respondents had poor adherence to drugs. Factors such as occupation, family income, balanced meal and stopping to take medication whenever they felt their condition was under control had a significant association with the occurrence of PTB. While factors like age, gender, number of meals taken in a day, wanting to quit smoking and forgetting to take medication had no significant association with the occurrence of PTB in this study. Conclusion: The study provides key insights into the risk factors associated with pulmonary tuberculosis among HIV/AIDs patients visiting Mbagathi County Hospital. The findings of this study therefore suggest that there was a significant association between level of education, monthly income, occupation, family history of PTB, lacking food appetite, taking a balanced meal, observing a healthy nutrition, smoking and stopping to take medication when one feels condition is under control with the occurrence of PTB among HIV/AIDs patients visiting Mbagathi County Hospital. Factors such as age, gender, marital status, number of meals eaten in a day, willingness to quit smoking and feeling hassled about sticking to treatment had no significant association with the occurrence of PTB.

Isolated epididymal tuberculosis: case report and review of literature

&lt;p&gt;Ethiopia is one of the countries with high burden of pulmonary tuberculosis and the number of cases of extra pulmonary is increasing. However, diagnostic evidence to initiate anti-tuberculosis treatment among extra pulmonary tuberculosis (EPTB) cases is not well known. We presented here a case of isolated tuberculosis epididymitis with scrotal sinus after developing nonspecific testicular symptoms for more than 2 months and review the literature. Tuberculous epididymitis is a form of urogenital tuberculosis that is particularly rare and has the same clinical manifestation that mimics other more common infectious causes of epididymitis, leading to delay in diagnosis. So, one should maintain a high-index of suspicion to accurately diagnose tuberculous epididymitis in individuals presenting with suggestive signs and symptoms.&lt;/p&gt;

Burden of Pulmonary Tuberculosis and Its Radiological Pattern, in Asymptomatic Young Males in Karachi, Pakistan

Objective: To estimate the burden of pulmonary tuberculosis among asymptomatic young male applicants in a government organization in Pakistan and to find out the pattern of disease on chest x-ray and high-resolution CT chest.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Pakistan Air Force (PAF) Faisal Base Hospital Karachi, Pakistan, from Dec 2017 to Feb 2019.&#x0D; Methodology: An active search for detecting pulmonary tuberculosis was conducted in 1819 asymptomatic young male adults between 18 and 30 years who had applied for employment in a government organization with a pay scale ranging from 2 to 14 grade. Screening chest x-ray (CXR) was done as a part of their medical examination. High-resolution CT chest, sputum smear bacilloscopic and GeneXpert mycobacterium tuberculosis/resistance to Rifampicin assay tests were done in cases in which chest x-ray was suggestive of pulmonary tuberculosis.&#x0D; Results: Chest x-Ray and high-resolution CT of five out of 1819 male applicants were suggestive of pulmonary tuberculosis. Three cases (0.16%) were confirmed as positive on lab tests. Radiographic and High-resolution CT patterns showed upper lobe lesions, consistent with the radiological appearance of the immuno-competent host disease.&#x0D; Conclusion: The considerable presence of pulmonary tuberculosis was detected among asymptomatic young adults of this region; therefore, formulating a strategy to actively detect and treat analogous populations with high susceptibility to Pulmonary tuberculosis could help reduce this endemic disease.

Antifungal therapy for chronic pulmonary aspergillosis

Chronic pulmonary aspergillosis is a progressive disease caused by Aspergillus spp in patients with underlying chronic lung disease and affects more than 3 million people worldwide.1 Diagnosis is on the basis of consensus criteria, and existing treatment guidelines are mainly based on cohort studies.2 Correct diagnosis is a huge challenge in countries with a high burden of pulmonary tuberculosis, as the clinical presentations are similar; in addition, chronic pulmonary aspergillosis is a well recognised complication of pulmonary tuberculosis.

Epidemiological Characteristics and Their Influencing Factors Among Pulmonary Tuberculosis Patients With and Without Diabetes Mellitus: A Survey Study From Drug Resistance Surveillance in East China.

BackgroundThe burden of pulmonary tuberculosis (TB) and diabetes mellitus (DM) have become serious global concerns, while the comprehensive evaluations of DM status and drug resistance in TB patients are still lacking.MethodsAll details of TB cases were collected from drug resistance monitoring sentinels in Zhejiang province. Fisher's exact test or Pearson chi-square test (χ2) was used to compare the baseline characteristics among TB with different DM statuses. The logistic regression model was used to estimate the relationship between DM and different drug resistance spectra. Univariate analysis and multivariate logistic model were used to explore the possible risk factors of drug resistance in TB patients with DM and no DM.Results936 TB cases with smear-positive in Zhejiang province were collected, in which 76 patients (8.12%) owned the co-morbidity of DM. TB-DM prevalence was higher in older, Han nationality, employed, accompanied by no health insurance and hepatitis B status. Among 860 cases of TB-no DM and 76 cases of TB-DM, drug resistance-TB accounted for 31.51% and 23.68% (P > 0.05), MR-TB accounted for 15.93% and 14.47% (P > 0.05), respectively. MDR-TB was 4.88% and 6.58% (P > 0.05). The incidence of poly-drug resistant tuberculosis (PDR-TB) in TB-no DM patients (10.70 vs. 2.63%, OR: 4.43; 95% CI, 1.07–18.36) was higher than that in the TB-DM group (P < 0.05). In univariate and multivariate analysis, none of the basic factors were statistically significant with drug resistance among TB-DM cases (all P > 0.05). Retreatment was the risk factor of drug resistance among TB-no DM cases.ConclusionsOur results showed that the drug resistance rate of the TB-DM group was not higher than that of the TB-no DM group. Patients with TB-no DM were at a higher risk for PDR-TB, but not for MDR-TB, MR-TB, and drug resistance-TB. Special attention should be paid to TB-no DM patients who have been previously treated. In the future, large-scale and well-designed prospective studies are needed to clarify the impact of DM on the drug-resistance among TB.

Pulmonary tuberculosis among young children with severe pneumonia at Al Sabah Children’s Hospital, Juba, South Sudan

Background: Tuberculosis is a major public health problem worldwide. It can present in an acute form especially in endemic settings, which might lead to missed and delayed diagnosis, prolonged hospital stays, and increased mortality in children. South Sudan has a high prevalence of tuberculosis in the adult population. However, there is no published data on paediatric tuberculosis. We aimed to determine the prevalence and factors associated with pulmonary tuberculosis in children admitted with pneumonia in Al Sabah Children’s Hospital, South Sudan.Method: This was a cross sectional study of 404 children aged 2 to 59 months admitted with severe pneumonia from June-October 2018 at Al Sabah Children’s Hospital. We excluded children on anti-TB treatment. Data were collected using a pretested questionnaire which captured socio-demographic characteristics, clinical history, physical examination, and laboratory investigations. Sputum examination for Mycobacterium tuberculosis was performed for all participants using X-pert MTB/RIF. Additional investigations included Chest X-ray and blood count.Results: We recruited 404 children, out of which 78 (19.3%) had pulmonary tuberculosis. Of these, 13 (16.7%) were bacteriologically confirmed while 65 (83.3%) were clinically diagnosed. The factors significantly associated with pulmonary tuberculosis were age above two years [AOR 2.32 (95% CI 1.04-5.17)] p value 0.039, positive HIV Status [AOR 24.2 (95% CI 2.88-202.62)] p value 0.003, severe acute malnutrition [AOR 15.67 (95% CI 6.68-36.73)] p value &lt;0.001, lack of BCG immunization [AOR 3.09 (95% CI 1.06-9.03)] p value 0.038, and contact with a known tuberculosis patient [AOR 55.14 (95% CI 10.12-300.6)] p value &lt;0.001.Conclusion: There is a high burden of pulmonary tuberculosis in children presenting with severe pneumonia. There is a need for screening for pulmonary tuberculosis in children with any of the associated factors to improve early diagnosis and treatment.

Population aging and trends of pulmonary tuberculosis incidence in the elderly

BackgroundTo explore population aging and the epidemic trend of pulmonary tuberculosis (PTB) in the elderly, and provide a basis for the prevention and control of pulmonary tuberculosis among the elderly.MethodsWe collected clinical information of 239,707 newly active PTB patients in Shandong Province from 2005 to 2017. We analyzed and compared the clinical characteristics, reported incidence and temporal trend of PTB among the elderly group (≥60 years) and the non-elderly group (< 60 years) through logistic model and Join-point regression model.ResultsAmong the total PTB cases, 77,192(32.2%) were elderly. Compared with non-elderly patients, newly active elderly PTB patients account for a greater proportion of male cases (OR 1.688, 95% CI 1.656–1.722), rural population cases (OR 3.411, 95% CI 3.320–3.505) and bacteriologically confirmed PTB cases (OR 1.213, 95%CI 1.193–1.234). The annual reported incidence of total, elderly, pulmonary bacteriologically confirmed cases were 35.21, 68.84, 35.63 (per 100,000), respectively. The annual reported incidence of PTB in the whole population, the elderly group and the non-elderly group has shown a slow downward trend since 2008. The joinpoint regression model showed that the overall reported incidence of PTB in the elderly significantly decreased from 2007 to 2017 (APC = -5.3, P < 0.05). The reported incidence of bacteriologically confirmed PTB among elderly patients declined rapidly from 2005 to 2014(2005–2010 APC = -7.2%, P < 0.05; 2010–2014 APC = -22.6%, P < 0.05; 2014–2017 APC = -9.0%, P = 0.1). The reported incidence of clinically diagnosed PTB among elderly patients from 2005 to 2017 (11.48–38.42/100,000) increased by about 235%. It rose significantly from 2007 to 2014 (APC = 9.4, P<0.05).ConclusionsCompared with the non-elderly population, the reported incidence of PTB in the elderly population is higher. The main burden of PTB will shift to the elderly, men, rural population, and clinically diagnosed patients. With the intensification of aging, more researches on elderly PTB prevention and treatment will facilitate the realization of the global tuberculosis (TB) control targets.

Histoplasmosis overlapping with HIV and tuberculosis in sub-Saharan Africa: challenges and research priorities.

Histoplasmosis, tuberculosis and HIV are all highly prevalent in sub-Saharan Africa (SSA). Co-occurrence of two or more of these infections has been reported in several populations of patients, especially those with advanced HIV infection where these opportunistic infections contribute to a significant morbidity and mortality. With a high burden of pulmonary tuberculosis (PTB) secondary to HIV in SSA, histoplasmosis is commonly misdiagnosed as smear-negative PTB in HIV patients due to similar clinical and radiological presentations. This is also partly the result of the lack of trained clinical and laboratory personnel to make a definite diagnosis of histoplasmosis. There is a low index of clinical suspicion for histoplasmosis, and cases are mostly discovered accidently and documented through case reports and case series. Similarly, the high cost and lack of fungal diagnostics in most SSA countries makes it difficult to make a diagnosis. There is a need to build local capacity for mycology so that patients are managed to improve on the index of clinical suspicion and diagnostic capabilities. Moreover, simple accurate point-of-care diagnostic tests and first-line antifungal treatment for histoplasmosis are not available in many SSA countries. This review describes the existence of co-infections of histoplasmosis, tuberculosis and HIV in SSA, highlighting the challenges and research priorities.

1661. The association of spirometric impairment and history of TB: a population based study in Uganda

BackgroundPulmonary tuberculosis (TB) is the leading infectious cause of death globally with an estimated 1.7 billion people currently infected with Mycobacterium tuberculosis and at risk of developing TB. While the treatment of drug-susceptible pulmonary TB is highly effective, up to 50% of TB survivors have varying degrees of residual pathological and functional conditions potentially leading to chronic sequelae. Post-TB patients have reported respiratory symptoms, reduced quality of life, and increased risk of mortality. The objectives of this study are to describe the prevalence and lung function in individuals with post-TB exposure status in Uganda.MethodsWe performed a secondary data analysis of the Lung Function in Nakaseke and Kampala (LiNK) study, which is a population-based cohort in urban and rural settings in Uganda. Trained fieldworkers randomly selected homes and administered standard questionnaires to adults 35 years or older that were full-time residents of each setting. Prior TB diagnosis and treatment was self-reported by participants.ResultsAmong the study population (N = 1559), 50 participants (3.2%) self-reported successfully treated TB. Among this subset of participants 21 (42.0%) were HIV positive, 9 (18.0%) were ever smokers, 6 (12.0%) were current smokers, and no participants had a prior COPD diagnosis. Mean (SD) age and body-mass index (BMI) at enrollment was 48.5 (SD 10.7) years and 22.2 (SD 3.9) kg/m2 respectively. The mean ± SD pre-bronchodilator FEV1/FVC was 72.9% (12.1%) for patients with successfully treated TB and 79.6% (0.08%) (p< 0.0001) for those without prior TB. Within these groups, 30% of patients with successfully treated TB and 9% of patients without prior TB had an FEV1/FVC suggestive of possible COPD.Comparison of FEV1/FVC ConclusionWe found a high burden of residual effects of pulmonary TB on lung function and development of COPD, potentially increasing the global burden of COPD. Screening for chronic respiratory diseases following successful TB treatment is needed to improve lung function. Further research is needed to study lung function and quality of life in TB survivors in LMICs, where the burden of pulmonary TB is highest.Disclosures All Authors: No reported disclosures

Pulmonary tuberculosis at Patan Hospital, Nepal: One year audit

BackgroundGlobally, Tuberculosis (TB) is one of the top 10 causes of death. In Nepal, poverty and malnutrition aggravate the burden of TB. To identify Mycobacterium tuberculosis sputum is the best sample to identify the bacterium which is helpful for diagnosis. The aim of this study is to identify the situation, burden and challenges of pulmonary tuberculosis in low-middle income country like Nepal. MethodA retrospective-audit with reliable-secondary-data of one year was collected (n = 4131). Descriptive-analysis was performed using frequency, percentage and analytical using chi-square-test. Level of significance was set at p < 0.05. Ethical Approval was obtained from IRC-PAHS. ResultThe prevalence of notified/suspected cases was highest among the patients having >60 years of age 1344(32.54%) and least among the patients with ≤15 years of age 239(5.79%). The male had 1.67 times more smear-positive pulmonary TB cases. Among the AFB-positive cases, smear 3+ was seen in most of the cases 69(38.54%) followed by smear 1+ and smear 2+ in 56(31.28%) and 54(30.16%) respectively. ConclusionThe prevalence of smear-positive pulmonary TB case is higher in male. Smear 3+ is seen in most of the followed by smear 1+ and smear 2+. The Burden of Pulmonary TB is more among adult and old-age-people and its control is a challenge for developing and low-middle income countries like Nepal.

Comparison of Auramine Phenol and ZN Staining in Diagnosis of Pulmonary Tuberculosis with GeneXpert MTB/RIF as Gold Standard

Background: Pakistan faces an immense burden of pulmonary tuberculosis (TB) due to large number of cases and limited resources. Despite the recent advancement in the diagnostic techniques for pulmonary TB, smear microscopy is still a useful technique for the diagnosis of this disease. This study was conducted in order to compare the diagnostic value of Auramine stain with the conventional Ziehl-Neelsen (ZN) stain on the sputum smear for the diagnosis of pulmonary TB, keeping GeneXpert MTB/RIF as the gold standard.&#x0D; Method: This cross-sectional study was conducted on 356 suspected patients of pulmonary TB referred to the Pathology laboratory from TB ward and OPD of District Head Quarter (DHQ) teaching hospital Rawalpindi, Pakistan. Sputum specimen were collected and two smears were prepared from each sputum sample on which Auramine phenol and Ziehl-Neelsen staining were carried out as per WHO recommendations. All these samples were further tested using Gene Xpert MTB/RIF technique. The sensitivity, specificity, Positive predictive value (PPV) and Negative predictive values (NPV) of ZN and Auramine stain were calculated and compared with GeneXpert MTB/RIF technique.&#x0D; Results: Out of the total 356 samples, 64(18%) were positive and 291(82%) were negative by GeneXpert which was taken as the gold standard. On comparison with GeneXpert, percentage of true positive was greater in case of Auramine than ZN stained samples (16.29% versus 12.92%), while the percentage of false positive was same for both staining techniques (0.28%). There were lesser false negative cases observed in samples stained by Auramine as compared to the ones stained by ZN (1.68% versus 5.05%). The sensitivity, specificity, positive predictive value and negative predictive values were 97.87%, 94.17%, 71.88 and 99.66%, respectively for the ZN staining and 98.31%, 97.98%, 90.63% and 99.66% respectively, for the Auramine phenol staining.&#x0D; Conclusion: Smear microscopy using Auramine phenol stain is a useful technique for the diagnosis of pulmonary TB. The Auramine phenol staining with fluorescent microscopy is found to be superior to ZN staining because of higher sensitivity and specificity.&#x0D; Keywords: Auramine phenol, Fluorescence microscopy, GeneXpert, Mycobacterium tuberculosis, Ziehl-Neelsen

Spatial-temporal analysis of tuberculosis in Chongqing, China 2011-2018

BackgroundChina is a country with a high burden of pulmonary tuberculosis (PTB). Chongqing is in the southwest of China, where the notification rate of PTB ranks tenth in China. This study analyzed the temporal and spatial distribution characteristics of PTB in Chongqing in order to improve TB control measures.MethodsA spatial-temporal analysis has been performed based on the data of PTB from 2011 to 2018, which was extracted from the National Surveillance System. The effect of TB control was measured by variation trend of pathogenic positive PTB notification rate and total TB notification rate. Time series, spatial autonomic correlation and spatial-temporal scanning methods were used to identify the temporal trends and spatial patterns at county level.ResultsA total of 188,528 cases were included in this study. A downward trend was observed in PTB between 2011 and 2018 in Chongqing. The peak of PTB notification occurred in late winter and early spring annually. By calculating the value of Global Moran’s I and Local Getis’s Gi*, we found that PTB was spatially clustered and some significant hot spots were detected in the southeast and northeast of Chongqing. One most likely cluster and three secondary clusters were identified by Kulldorff’s scan spatial-temporal Statistic.ConclusionsThis study identified seasonal patterns and spatial-temporal clusters of PTB cases in Chongqing. Priorities should be given to southeast and northeast of Chongqing for better TB control.

A spatial hierarchical model for integrating and bias-correcting data from passive and active disease surveillance systems

Disease surveillance data are important for monitoring disease burden and occurrence, and for informing a wide range of efforts to improve population health. Surveillance for infectious diseases may be conducted passively, relying on reports from healthcare facilities, or actively, involving surveys of the population at risk. Passive surveillance typically provides wide spatial coverage, but is subject to biases arising from differences in care-seeking behavior, diagnostic practices, and under-reporting. Active surveillance minimizes these biases, but is typically constrained to small areas and subpopulations due to resource limitations. Methods based on linkage of individual records between passive and active surveillance datasets provide a means to estimate and correct for the biases of each system, leveraging the size and coverage of passive surveillance and the quality of data in active surveillance. We develop a spatial Bayesian hierarchical model for bias-correcting data from both systems to yield an improved estimate of disease measures after adjusting for under-ascertainment. We apply the framework to data from a passive and an active surveillance system for pulmonary tuberculosis (PTB) in Sichuan, China, and estimate the average sensitivity of the active surveillance system at 70% (95% credible interval: 62%, 78%), and the passive system at 30% (95% CI: 24%, 35%). Passive surveillance sensitivity exhibited considerable spatial variability, and was positively associated with a site’s gross domestic product per capita. Bias-corrected estimates of county-level PTB prevalence in the province in 2010 identified regions in the southeast with the highest PTB burden, yielding different geographic priorities than previous reports.

Strongyloides stercoralis Coinfection Is Associated With Greater Disease Severity, Higher Bacterial Burden, and Elevated Plasma Matrix Metalloproteinases in Pulmonary Tuberculosis.

Helminths and tuberculosis (TB) largely overlap at the population level. Whether helminth infections influence disease severity and bacterial burdens in TB is not well understood. This study was conducted to examine the disease severity in a cohort of pulmonary TB (PTB) individuals with (Ss+) or without (Ss-) seropositivity for Strongyloides stercoralis infection. Ss+ was associated with increased risk of cavitation (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.33-9.04; P < .0001) and bilateral lung involvement (OR, 5.97; 95% CI, 3.03-12.09; P < .0001) in PTB individuals. Ss+ was also associated with higher bacterial burdens (OR, 7.57; 95% CI, 4.18-14.05; P < .0001) in PTB individuals. After multivariate analysis adjusting for covariates, Ss+ was still associated with greater risk of cavitation (adjusted OR [aOR], 3.99; 95% CI, 1.73-9.19; P = .0014), bilateral lung involvement (aOR, 4.09; 95% CI, 1.78-9.41; P = .0011), and higher bacterial burden (aOR, 9.32; 95% CI, 6.30-13.96; P < .0001). Finally, Ss+ was also associated with higher plasma levels of matrix metalloproteinases ([MMP]-1, -2, -7, -8, and -9) in PTB individuals. Therefore, our data demonstrate that coexistent Ss infection is associated with greater disease severity and higher bacterial burden in PTB. Our data also demonstrate enhanced plasma levels of MMPs in coinfected individuals, suggesting a plausible biological mechanism for these effects.