Cavitary Pulmonary Tuberculosis Research Articles

An Autopsy and Histopathology-based Study to Ascertain the Cause of Death of Brought Dead Cases

Abstract Background and Objectives: The cases of apparent natural deaths are encountered in the hospital casualties who are noted dead at the time of the first medical attention and as such are labeled as “Brought Dead.” These include the cases of sudden death, unexplained death, and unattended death. The cause of such deaths is reported in the literature to emanate principally from the cardiovascular system, though there are some documented geographical, racial, and other variations. In the present study, we endeavored to detect the cause of such natural deaths in terms of the disease and the organ system involved, in the deceased individuals of the contemporary Bengali population, with cases due to obvious unnatural causes being excluded. Materials and Methods: An observational, cross-sectional study with 105 (n = 105, male: 89, female: 16) study subjects of age group of 20–80 years, selected by systemic random sampling, from the brought dead subjects coming to the mortuary of the NRS Medical College and Hospital for medicolegal autopsy from April 2011 to March 2012, excluding cases having a history of the obvious unnatural event. Organ system-wise gross examination was done, followed by tissue sampling for histopathological examination. The case-wise findings were tabulated and analyzed for descriptive statistics using SPSS software. Results: In the present study, 89 cases were male (84.8%) and 16 cases were female (15.2%), which reflects a male: female ratio of 5.56:1. The dead bodies are mostly recovered from the footpaths (47 cases, 44%). Sixty-four (61%) cases are of known identity. In 54 cases out of 105 (51.4%), morbid pathology is detected in the respiratory system (RS), lobar pneumonia, and cavitary pulmonary tuberculosis being the most frequent disease entity, in both genders. Fifty-one years–sixty-five years is found to be the most commonly affected age group, in both genders. Interpretation and Conclusions: The present study shows that the most common organ system involved in brought dead cases is the RS, which is supported by a few Indian studies.

Extrapleural pneumonolysis: history of development, current state, and prospects for its use in the surgical treatment of pulmonary tuberculosis. Literature review

Tuberculosis (TB) is a major public healthcare problem. The fight against the disease is complicated due to the growing emergence of drug-resistant forms, the treatment of which can be quite difficult. Extrapleural pneumonolysis (EPP) with plombage was widely used to treat cavitary pulmonary tuberculosis in the late 1950s. The EPP surgical method is characterized by the creation of extrapleural space and its filling with plastic material to achieve long-term collapse. Plombage included a number of materials, such as fat, paraffin wax, bone, sponge, gelatin, silicone, methyl methacrylate (Lucite) or polyethylene balls. However, the presence of foreign structures for a long period of time can lead to complications in the form of malignant tumors, erosion of small and large vessels with bleeding, and migration of plombage material. In recent decades, WHO has noted that surgical therapy may play an important role in TB treatment. Collapse surgery may be the only hope for patients who are not eligible for resection-type surgery. Currently, EPP is actively used in leading institutions to treat the most severe patients. This operation is indicated for patients with concomitant diseases, poor functional reserves of the body, as well as advanced tuberculosis, which does not allow resection of healthy lung tissue.

Tuberculous Meningitis in Male Child and Cavitary Pulmonary Tuberculosis in Mother: Concurrent Familial Infective Disease as Evidence of Recent Transmission from Mother to Baby!

Tuberculosis (TB) is one of the leading causes of mortality in children worldwide, but there remain significant challenges in diagnosing and treating TB infection and disease. Tuberculous (TB) meningitis is the commonest infectious disease of the central nervous system in paediatric and geriatric cases. Childhood TB is an indication of failing TB control in the community. It allows disease persistence in the population. Tuberculosis can be prevented in children by diagnosing and treating cases of active TB amongst adults, as paediatric cases always acquire it passively from household contact of adults suffering from TB as disease in adults is multibacillary. Although significant data is available for the prevention of childhood extra-pulmonary and disseminated TB, offering Bacillus Calmette-Guerin (BCG) vaccination, it is still not routinely offered during vaccination. In this case report, a two-year child with a history of failure to thrive and constitutional symptoms diagnosed with disseminated extra-pulmonary TB presenting as TB meningitis with a history of contact with the mother suffering from active sputum positive pulmonary TB receiving anti-TB treatment. Child was evaluated with CT brain plain and contrast and documented meningeal enhancement. Cerebrospinal fluid analysis revealed tuberculous etiology in presence of lymphocytic predominance and raised ADA level in fluid. CSF fluid sent for cartridge based nucleic acid amplification test documented MTB genome with rifampicin sensitivity. We retrospectively analysed mothers’ sputum examination and observed higher grades of sputum AFB and her cartridge based nucleic acid amplification test revealed MTB genome with rifampicin sensitivity. Child and mother were treated with standard protocol recommended by NTEP (National Tuberculosis elimination program). In conclusion, we recommend BCG vaccination to all newborns, and tuberculin skin testing and isoniazid prophylaxis to the contact of adults with sputum positive pulmonary TB cases in India to prevent transmission of disease from mother to baby. A high index of suspicion is must while evaluating these cases and all possible measures should be taken to confirm tuberculosis to have successful treatment outcome.

Association between Serum Cys C and PTB Cavitation.

Cystatin C (Cys C) not only regulates the body's immune defenses but also contributes to tissue degradation and destruction by causing an imbalance between protease and antiprotease in infectious diseases. Is Cys C involved in pulmonary tuberculosis (PTB) infection and cavitation? We therefore conducted a retrospective study on this question to provide a basis for further studies. Cavitary PTB patients, noncavitary PTB patients, and healthy controls were recruited in our study. Serum Cys C, CRP, BUN, UA, and CR were measured in all subjects, and the Kruskal-Wallis test was used to compare medians of these clinical parameters in different groups. The Spearman rank correlation test was used to determine correlations between variables. In addition, a multivariate analysis using binary logistic regression was used to identify factors associated with PTB cavitation. In our study, elevated serum Cys C levels were found in cavitary PTB patients compared to healthy controls and noncavitary patients (p = 0.022). Serum Cys C levels were statistically correlated with serum BUN and CR concentrations (r = 0.278, p = 0.005; r = 0.281, p = 0.004) in PTB patients. The binary logistic regression analysis showed that elevated serum Cys C levels were correlated with pulmonary cavitation in PTB patients (OR = 1.426, 95% CI: 1.071-1.898). Elevated serum levels of Cys C are associated with pulmonary cavitation in PTB patients.

Correlations between clinical severity of pulmonary tuberculosis, thyroid function and some cytokines

To estimate the interrelations between thyroid profile, some cytokines and clinical severity of new case of cavitary pulmonary tuberculosis 43 patients with cavitary pulmonary tuberculosis and 10 healthy volunteers were studied. Thyroid glands of all patients before chemotherapy and volunteers from control group were examined by ultrasound. The levels of free thyroxine, thyroid stimulating hormone and antibodies to thyroglobulin and thyroid peroxidase in the serum were defined. At the same time the levels of tumor necrosis tumor necrosis factor, interferon-gamma and interleukin-2, -6, and -4 were measured. Correlations between clinical severity of new case of pulmonary tuberculosis, thyroid functions, and these cytokines were studied. The pathological changes of thyroid echo structures were recovered in more than half of patients. The level of thyroxine in tuberculous patients was decreased down to lower-normal significance. In tuberculous patients with pathological echo structure of the thyroid the thyroxine level decreasing was more significant. The thyroxine stimulating hormone level was increased in these patients. The increasing of tumor necrosis tumor factor and the interleukin-6 levels and the decreasing of interleukin-4 level were demonstrated in tuberculous patients comparing with healthy persons. Positive correlation between clinical severity of new case of pulmonary tuberculosis, thyroid functions, and these cytokines were determined. The high percentage defined cases of thyroid pathology in tuberculous patients is caused the necessity the screening of thyroid function in tuberculous patients for in time diagnosis of its subclinical disorders and their correction to restore cytokines balance and improving of antituberculosis chemotherapy efficacy.

空洞型肺结核的相关研究进展

空洞型肺结核的相关研究进展

Machine learning and radiomics for the prediction of multidrug resistance in cavitary pulmonary tuberculosis: a multicentre study.

ObjectivesMultidrug-resistant tuberculosis (MDR-TB) is a major challenge to global health security. Early identification of MDR-TB patients increases the likelihood of treatment success and interrupts transmission. We aimed to develop a predictive model for MDR to cavitary pulmonary TB using CT radiomics features.MethodsThis retrospective study included 257 consecutive patients with proven active cavitary TB (training cohort: 187 patients from Beijing Chest Hospital; testing cohort: 70 patients from Infectious Disease Hospital of Heilongjiang Province). Radiomics features were extracted from the segmented cavitation. A radiomics model was constructed to predict MDR using a random forest classifier. Meaningful clinical characteristics and subjective CT findings comprised the clinical model. The radiomics and clinical models were combined to create a combined model. ROC curves were used to validate the capability of the models in the training and testing cohorts.ResultsTwenty-one radiomics features were selected as optimal predictors to build the model for predicting MDR-TB. The AUCs of the radiomics model were significantly higher than those of the clinical model in either the training cohort (0.844 versus 0.589, p < 0.05) or the testing cohort (0.829 versus 0.500, p < 0.05). The AUCs of the radiomics model were slightly lower than those of the combined model in the training cohort (0.844 versus 0.881, p > 0.05) and testing cohort (0.829 versus 0.834, p > 0.05), but there was no significant difference.ConclusionsThe radiomics model has the potential to predict MDR in cavitary TB patients and thus has the potential to be a diagnostic tool.Key Points • This is the first study to build and validate models that distinguish MDR-TB from DS-TB with clinical and radiomics features based on cavitation. • The radiomics model demonstrated good performance and might potentially aid in prior TB characterisation treatment. • This noninvasive and convenient technique can be used as a diagnosis tool into routine clinical practice. Supplementary InformationThe online version contains supplementary material available at 10.1007/s00330-022-08997-9.

SEVERE COVID-19 ASSOCIATED WITH ADVANCED FORMS OF PULMONARY TB DISEASE IN AN ENDEMIC AREA OF ROMANIA

TYPE: Abstract TOPIC: Lung Pathology PURPOSE: of the study consisted in assessing the prevalence and severity of COVID-19 among patients diagnosed with pulmonary tuberculosis (PTB) in an endemic Romanian TB area. METHODS: A prevalence study, performed in a Pneumology Hospital, during COVID-19 pandemic year, 2020, from March to December, included 128 PTB patients, tested by real-time polymerase chain reaction SARS CoV2. Confirmed COVID-19 patients were evaluated for severity of both diseases. RESULTS: The prevalence of COVID-19 among hospitalized PTB patients was 8.59% (n=11/128). The association was frequent reported in males (n=8/11; 72.72%), smokers (72.72%) and elderly (n=4/11; 36.36%). Moderate to severe forms of COVID-19 were predominantly diagnosed (n=6/11; 54.54%) and death outcome was reported in 2 males (18.18%) with cavitary PTB, but no other comorbidities. Positive smears and/or cultures for Mycobacterium tuberculosis (n=7/11; 63.63%) were mostly associated with cavitary lung lesions. Miliary TB with positive smears was reported in a single case of a 49 year-old alcoholic male. CONCLUSIONS: The risk of interaction between PTB and COVID-19 is high among males, elderly and smokers. Delayed diagnosis of advanced contagious forms of hospitalized PTB could be a possible risk factor of SARS CoV2 infection's increased severity and death. CLINICAL IMPLICATIONS: The immunological and epidemiological interactions between PTB and COVID-19 are still debating. It seems a dual risk of SARS CoV2 infection is capable to reactivate PTB disease and TB is capable to aggravate the evolution of COVID-19. Screening of tuberculosis disease is mandatory among all COVID-19 patients especially in endemic TB areas and vice versa. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19

Cavitary lung disease in hospitalized patients: Differences between melioidosis and tuberculosis.

To differentiate cavitary lung lesions caused by melioidosis and tuberculosis is challenging, especially in endemic countries. A study with a matched-sampling method (16 cavitary pulmonary melioidosis vs. 16 cavitary pulmonary tuberculosis) showed characteristics of bacterial infection more obvious and severe in the melioidosis patients, which were useful to distinguish two conditions.

Clinical Factors Associated with Cavitary Tuberculosis and Its Treatment Outcomes.

Cavitary pulmonary tuberculosis (TB) is associated with poor outcomes, treatment recurrence, higher transmission rates, and the development of drug resistance. However, reports on its clinical characteristics, associated factors, and treatment outcomes are lacking. Hence, this study sought to evaluate the clinical factors associated with cavitary pulmonary TB and its treatment outcomes. We retrospectively evaluated 410 patients with drug-susceptible pulmonary TB in a university hospital in Korea between 2014 and 2019. To evaluate the factors associated with cavitary TB, multivariable logistic regression was performed with adjustments for potential confounders. We also compared the treatment outcomes between patients with cavitary TB and those without cavitary TB. Of the 410 patients, 244 (59.5%) had non-cavitary TB and 166 (40.5%) had cavitary TB. Multivariable logistic analysis with forward selection method showed that body mass index (BMI) (adjusted OR = 0.88, 95% CI: 0.81–0.97), previous history of TB (adjusted OR = 3.45, 95% CI: 1.24–9.59), ex- or current smoker (adjusted OR = 1.77, 95% CI: 1.01–3.13), diabetes mellitus (adjusted OR = 2.72, 95% CI: 1.36–5.44), and positive results on the initial sputum acid-fast bacilli (AFB) smear (adjusted OR = 2.24, 95% CI: 1.26–3.98) were significantly associated with cavitary TB. Although treatment duration was significantly longer in patients with cavitary TB than in those with non-cavitary TB (248 (102–370 days) vs. 202 (98–336 days), p < 0.001), the recurrence rate after successful treatment was significantly higher in the patients with cavitary TB than in those with non-cavitary TB (0.4% vs. 3.0% p = 0.042). In conclusion, ex- or current smoker, lower BMI, previous history of TB, diabetes mellitus, and positivity of the initial AFB smear were associated with cavitary TB. The patients with cavitary TB had more AFB culture-positive results at 2 months, longer treatment duration, and higher recurrence rates than those with non-cavitary TB.

Evaluation of School-Based Tuberculosis Screening Results After Index Case (Both Intellectual Disability and Cavitary Pulmonary Tuberculosis)

Objective: Tuberculosis is an important public health problem. Tuberculosis prevalence is high in low-income countries. It is contagious, and therefore a risk for people in public living areas. It is contagious, and therefore a risk for people in public areas. Also, people with intellectual disability stay in the same public areas. Therefore, they are also at risk. The aim of our study was to investigate the contact of persons in the same center with an index case. Materials and methods: Contact investigation was conducted in a training and rehabilitation center. Tuberculosis-specific parameters were measured from the patients. Results: All contacts (n=39) were male. Fifteen contacts were offered follow-up without medication. Fifteen contacts were given medication for prophylaxis. Latent tuberculosis was detected in 8 patients. Possible tuberculosis was detected in one patient. Contagion of tuberculosis from the index case to his roommates measured 16.6%. Tuberculosis contagion from the patient with possible tuberculosis to his roommates measured 37.5%. Patients with latent tuberculosis and possible tuberculosis were medicated according to international criteria. Conclusion: People with intellectual disability do not fully define the symptoms of the disease. Therefore, the prognosis may be made when the disease is diagnosed by a health professional. Also, some tests may not be performed because communication is not possible. For this reason, clinicians should be more careful in screening people with intellectual disability for TB. Also, the fight against tuberculosis should be continued without interruption.&nbsp;

Transbronchial tuberculosis cavity plugging therapy for pulmonary tuberculosis.

ObjectiveTo investigate the effect of drug treatment combined with interventional cavity therapy for cavitary pulmonary tuberculosis.MethodsOne-hundred thirty patients who underwent transbronchial tuberculosis cavity plugging (TTCP) combined with drug therapy from 2012 to 2018 were selected as the observation group, and 130 patients with cavitary tuberculosis who underwent treatment with drugs only were selected as the control group. Changes in cavity size and sputum tests were compared between the two groups. In addition, adverse reactions were monitored.ResultsThe number of cases with cavity closure was significantly higher in the observation group than in the control group at different time points. The number and proportion of negative sputum samples in the observation group were significantly higher than those in the control group. The treatment success rate was 98.46% in the observation group and 92.3% in the control group. No recurrence was observed in the observation group, and 8.3% of cases in the control group showed recurrence.ConclusionsTTCP for the treatment of cavity tuberculosis showed good outcomes, with limited side effects and minimal complications.

A preliminary investigation on a deep learning convolutional neural networks based pulmonary tuberculosis CT diagnostic model

Objective: To evaluate the clinical value of a pulmonary tuberculosis CT diagnostic model based on deep learning convolutional neural networks (CNN). Methods: From March 2017 to March 2018,a total of 1 764 patients with positive sputum for tuberculous bacterium and had received high-resolution chest CT scan in radiology department of Hebei province chest hospital were enrolled. Among them, 937 were male, and 827 were female, aging from 17-73 years (average 38.4). A total of 20 139 CT images (17 kinds of image features) classified by 4 radiologists were used as training dataset to create a tuberculosis CT CNN diagnostic model. The top 5 image features in training set were: infiltrative pulmonary tuberculosis, cavitary pulmonary tuberculosis, pleural thickening, caseous pneumonia and pleural effusion. A total of 302 images were randomly selected from the marked images as testing dataset. The diagnosis of 2 senior radiologists was taken as "golden standard". The differences of sensitivity and accuracy in CT diagnosis between the CNN diagnostic model and the radiologists were compared. The classification error types and numbers of the CNN diagnostic model were recorded. FROC(free response operating characteristic curve)curve was drawn and the highest diagnostic efficiency of the model was measured. Results: The diagnostic accuracy of infiltrative pulmonary tuberculosis, cavitary pulmonary tuberculosis, pleural thickening, caseous pneumonia and pleural effusion by the CNN diagnostic model were 95.33%(10 982/11 520), 73.68%(2 151/2 920), 73.07%(1 128/1544), 83.33%(1 020/1225)and 94.11%(814/865), respectively. The overall diagnostic sensitivity and accuracy of the CNN model were 95.49%(339/355)and 90.40%(339/375), respectively, and the corresponding values ​​of radiologists were 93.80%(348/371)and 92.80%(348/375), respectively, and there was no statistical difference between the CNN model and the radiologists(sensitivity χ2=1.022,P=0.312;accuracy χ2=1.404,P=0.236). FROC curve showed that when sensitivity of the CNN model was 78% and FPI value was 2.48, it reached the highest diagnostic efficiency. The classification error of CNN diagnostic models was mainly confusion of fiber stripe components, cavitary pulmonary tuberculosis, caseous pneumonia and infiltrative pulmonary tuberculosis. Conclusions: The CNN-based pulmonary tuberculosis CT diagnostic model exhibited high sensitivity and accuracy (95.49% and 90.40% respectively). It could assist radiologists in CT diagnosis of pulmonary tuberculosis and deserve further clinical application.

Sublobectomy is a safe alternative for localized cavitary pulmonary tuberculosis

ObjectiveSurgical resection plays an essential role in the treatment of Pulmonary Tuberculosis (PTB). There are few reports comparing lobectomy and sublobectomy for pulmonary TB with cavity. To compare the advantages between lobectomy and sublobectomy for localized cavitory PTB, we performed a single-institution cross sectional cohort study of the surgical patients.MethodsWe consecutively included 203 patients undergoing lobectomy or sublobectomy surgery for localized cavitary PTB. All patients were followed up, recorded and compared their surgical complication, outcome and associated characteristics.ResultsBoth groups had similar outcomes after follow up for 13.1 ± 12.1 months, however, sublobectomy group suffered fewer intraoperative blood losses, shorter length of stay, and fewer operative complications than lobectomy group (P < 0.05). Both groups obtained satisfactory outcome with postoperatively medicated for similar period of time and few relapse (P > 0.05).ConclusionBoth sublobectomy and lobectomy resection were effective ways for cavitary PTB with surgical indications. If adequate anti-TB chemotherapy had been guaranteed, sublobectomy is able to be recommended due to more lung parenchyma retain, faster recover, and fewer postoperative complications.

EXTRAPLEURAL PNEUMOLYSIS FOR CAVITARY PULMONARY TUBERCULOSIS TREATMENT

Objective. To increase efficiency of cavitary pulmonary tuberculosis treatment by developing modern indications and technology of extrapleural pneumolysis with filling material.Material and methods. We reviewed 25 patients with cavitary pulmonary tuberculosis and bacterial excretion who had undergone extrapleural pneumolysis with different types of filling material in 2004–2015. In 16 cases, we performed surgery in patients with one lung.Results. 56% of operated patients demonstrated extensively drug-resistant TB, 40% had multidrug-resistant TB. Cavities were closed and bacterial excretion ceased in 92% of patients at discharge. Long-term results with observation period from 1 to 12 years were analyzed in 24 patients, 17 (71%) of them had complete clinical efficacy.Conclusion. Extrapleural pneumolysis is a mini-invasive surgical treatment that can prove positive effect in patients with non-fibrotic changes in a cavity wall and pathological process in upper parts of the lungs.

Hydrogen sulfide dysregulates the immune response by suppressing central carbon metabolism to promote tuberculosis

The ubiquitous gasotransmitter hydrogen sulfide (H2S) has been recognized to play a crucial role in human health. Using cystathionine γ-lyase (CSE)-deficient mice, we demonstrate an unexpected role of H2S in Mycobacterium tuberculosis (Mtb) pathogenesis. We showed that Mtb-infected CSE-/- mice survive longer than WT mice, and support reduced pathology and lower bacterial burdens in the lung, spleen, and liver. Similarly, in vitro Mtb infection of macrophages resulted in reduced colony forming units in CSE-/- cells. Chemical complementation of infected WT and CSE-/- macrophages using the slow H2S releaser GYY3147 and the CSE inhibitor DL-propargylglycine demonstrated that H2S is the effector molecule regulating Mtb survival in macrophages. Furthermore, we demonstrate that CSE promotes an excessive innate immune response, suppresses the adaptive immune response, and reduces circulating IL-1β, IL-6, TNF-α, and IFN-γ levels in response to Mtb infection. Notably, Mtb infected CSE-/- macrophages show increased flux through glycolysis and the pentose phosphate pathway, thereby establishing a critical link between H2S and central metabolism. Our data suggest that excessive H2S produced by the infected WT mice reduce HIF-1α levels, thereby suppressing glycolysis and production of IL-1β, IL-6, and IL-12, and increasing bacterial burden. Clinical relevance was demonstrated by the spatial distribution of H2S-producing enzymes in human necrotic, nonnecrotic, and cavitary pulmonary tuberculosis (TB) lesions. In summary, CSE exacerbates TB pathogenesis by altering immunometabolism in mice and inhibiting CSE or modulating glycolysis are potential targets for host-directed TB control.

Outcomes of extended duration therapy for drug-susceptible cavitary pulmonary tuberculosis.

BackgroundExtending the continuation phase treatment duration is recommended to improve outcomes of drug-susceptible cavitary pulmonary tuberculosis (TB), but limited data are available on extended treatment outcomes.MethodsWe evaluated outcomes of 67 patients with drug-susceptible cavitary pulmonary TB who had received extended therapy. The primary endpoint of our study was the rate of a favorable outcome (cured or treatment completion without recurrence).ResultsOf the 67 patients, 40 (59.7%) were culture negative and 27 (40.3%) were culture positive two months after treatment initiation. The median treatment duration was 275 days. Extended duration therapy resulted in a 100% treatment success rate and 2.5% recurrence rate in patients with a negative culture at month 2. However, patients with a positive culture at month 2, showed a 74.1% treatment success rate and 8.0% recurrence rate (P<0.001 and P=0.554, respectively). In multivariable analyses, positive culture at month 2 was associated with greater odds of unfavorable outcomes (adjusted OR, 17.04, 95% CI, 1.68–177.92).ConclusionsWhile extending the continuation phase was associated with favorable outcomes in pulmonary TB patients with negative culture at month 2, the same could not be achieved in those with positive culture at month 2, suggesting that this condition might not be overcome by merely extending the continuation phase.

Secondary Cavitary Pulmonary Tuberculosis After Apatinib Treatment in Lung Squamous Cell Cancer.

Secondary Cavitary Pulmonary Tuberculosis After Apatinib Treatment in Lung Squamous Cell Cancer.

The Case for Retiring the Tuberculin Skin Test.

* Abbreviations: BCG — : Bacillus Calmette-Guerin CDC — : Centers for Disease Control and Prevention IGRA — : interferon γ release assay LTBI — : latent tuberculosis infection TST — : tuberculin skin test The Mantoux tuberculin test (TST) is likely the oldest widely used test in contemporary diagnostics. In the past, when its obvious weaknesses were considered, it always “received a pass” because of the lack of an alternative test. However, with the advent and improvement of interferon γ release assays (IGRAs), we feel it is past time to reconsider the widespread use of TSTs. An adolescent with inflammatory bowel disease refractory to steroids was tested for latent tuberculosis infection (LTBI). The TST result was read as positive by a nurse and negative by a physician who had never seen a positive TST result. The patient was not treated for LTBI, received infliximab, and 2 months later developed cavitary pulmonary tuberculosis. Contact tracing identified 2 relatives and several classmates with LTBI and a younger sibling with intrathoracic tuberculosis. How can we do better? IGRAs, or blood tests for the diagnosis of tuberculosis infection in place of TSTs, have been licensed in the United States since 2001. IGRAs are now recommended for use for children as young as 2 years of age1 and are recommended by the Centers for Disease Control and Prevention (CDC) for adults in all situations in which a TST has … Address correspondence to Andrea T. Cruz, MD, MPH, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin St, Suite A2210, Houston, TX 77030. E-mail: acruz{at}bcm.edu

Factors associated with underreporting of tuberculosis based on data from Sinan Aids and Sinan TB.

Tuberculosis (TB) is one of the world's major public health problems. Epidemiological surveillance has proved to be an important tool to assist in the control and prevention of communicable diseases such as TB and AIDS. This study aimed to estimate the rate and factors associated with the underreporting of TB among cases of coinfection with human immunodeficiency virus (HIV)/AIDS in the state of Pernambuco, based on data from the TB and Aids Notifiable Diseases Information System (Sinan TB and Sinan AIDS). A cross-sectional study was carried out based on the records of the TB and AIDS Notification System to identify cases of TB underreporting in the study period. In order to identify underreporting, a probabilistic linkage was undertaken using RecLink III software. The rate of TB underreporting was 29%, and the factors associated were: presenting a clinical form of TB as cavitary or unspecified pulmonary TB or having both kinds of TB at the same time; being treated outside the municipality of Recife; and being treated at health services not specialized for HIV/AIDS. The proportion of underreporting found in our study was lower than that observed in other Brazilian studies that took into account underreporting from mortality data. The variables associated with underreporting of TB were mostly related to the healthcare system rather than to individual characteristics, which points to the need for training of health professionals in order to notify the information systems correctly.