Tuberculosis Comorbidity Research Articles

Frequency and Predictors of Diabetes Mellitus in Smear-Positive Pulmonary Tuberculosis Patients: A Cross-Sectional Study.

Introduction Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Various studies have established an association between diabetes mellitus (DM) and pulmonary TB. This study describes the prevalence of DM and its predictors in smear-positive TB patients. Methods This descriptive cross-sectional study was conducted at the Department of Chest Medicine at Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan, from December 2015 to June 2016. The inclusion criteria were as follows: drug-sensitive pulmonary TB patients of either gender, age ≥ 18 years, registered at the TB clinic JPMC, who consented to participate in the study. Pregnant/lactating patients, drug-resistant TB patients, and those who did not consent to participate in the study were excluded. Fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) were done for all patients included in the study. Sociodemographic data, along with FBS, random blood sugar (RBS), and HbA1c, were entered in a pre-designed proforma. A sedentary lifestyle was recorded as a subjective measure of the proforma. Diabetes was diagnosed if FBS was ≥126 mg/dL or HbA1c was ≥6.5%. Results Out of 100 TB patients included in the study, 18 (18%) were diagnosed with diabetes. Patients who were smokers, had a sedentary lifestyle, and had a family history of diabetes had a significantly high prevalence of diabetes (p-value < 0.0001). Age, gender, and body mass index (BMI) did not influence the prevalence of diabetes in TB patients. Conclusion The study revealed an increased occurrence of diabetes among patients with smear-positive pulmonary TB. Diabetes is more common in TB patients who smoke, have a sedentary lifestyle, and those who have a family history of diabetes. A comprehensive management plan shall be in place to cater to TB and diabetes comorbidity, including effective management of TB and optimal glycemic control.

Platelets: The unsung heroes in the battle against tuberculosis – A comprehensive review of platelet indices as diagnostic beacons and pathophysiological players

This review explores the emerging role of platelet indices in tuberculosis (TB) as potential biomarkers for diagnosis, disease monitoring, and understanding pathogenesis. Platelet count, mean platelet volume, platelet distribution width, and plateletcrit have shown significant alterations in TB patients compared to healthy controls and those with other respiratory conditions. These changes are attributed to the inflammatory response, direct platelet activation by Mycobacterium tuberculosis, and involvement in granuloma formation. Recent studies have investigated the diagnostic and prognostic value of platelet indices in TB, including their potential for differentiating TB from other respiratory infections, monitoring treatment response, and assessing disease severity. However, challenges such as lack of specificity and measurement variability need to be addressed. The review also highlights the multifaceted role of platelets in TB pathogenesis, including immune modulation and antimicrobial functions. Future research directions include large-scale validation studies, exploration of combined biomarker panels, and investigation of platelet indices in pediatric TB and TB-diabetes comorbidity. As our understanding of platelet-TB interactions grows, these indices may contribute to more personalized and effective TB management strategies.

Determinants of tuberculosis site among 1035 cases in Frankfurt, 2008-2023: does lineage matter?

Abstract Extrapulmonary tuberculosis (EPTB) presents with nonspecific symptoms which can pose a diagnostic challenge. Currently, there are no clear predictors for EPTB. We aimed to identify these factors for better diagnosis and disease control. We included tuberculosis cases reported in Frankfurt from 2008-2023, with available clinical and whole genome sequencing data. According to WHO criteria, cases with pulmonary or combined pulmonary and extrapulmonary symptoms were categorised as pulmonary tuberculosis, while exclusively extrapulmonary symptoms were categorised as extrapulmonary tuberculosis. We assessed the association between EPTB and M. tuberculosis lineage, comorbidities and demographic characteristics using logistic regression, calculating crude and adjusted odds ratios (aOR). Of the 1035 reported tuberculosis cases, 272 had exclusively extrapulmonary disease and 136 had both pulmonary and extrapulmonary disease. In the univariable analysis, lineages 1 and 3 were significantly associated with extrapulmonary disease compared to lineage 4. However, this association was not observed in the multivariable analysis. In the final regression model, females were more likely to develop EPTB than men (aOR: 1.65, CI: 1.19-2.27). The odds of developing extrapulmonary disease were higher among patients born in the South-East Asian (aOR: 6.48, CI: 3.72-11.43) and Eastern Mediterranean (aOR: 5.54, CI: 3.41-9.11) than in other regions. Among the comorbidities, diabetes was found to be negatively associated with extrapulmonary disease (aOR: 0.50, CI: 0.26-0.91). Our results indicate that host factors such as geographic origin and sex are stronger predictors for extrapulmonary presentation of tuberculosis than a specific lineage. We recommend increasing physicians’ awareness of the nonspecific presentation of EPTB and adapting screening programmes, particularly for patients from South-East Asian and Eastern Mediterranean regions to foster more effective tuberculosis control measures. Key messages • Our study highlights the importance of considering host factors in predicting extrapulmonary tuberculosis, indicating their stronger influence compared to specific M. tuberculosis lineages. • Increased physicians’ awareness of the nonspecific symptoms of EPTB and targeted screening programs for high-risk populations are crucial for enhancing tuberculosis control measures.

HIV co-infection increases the risk of post-tuberculosis mortality among persons who initiated treatment for drug-resistant tuberculosis

Little is known regarding the relationship between common comorbidities in persons with tuberculosis (TB) (including human immunodeficiency virus [HIV], diabetes, and hepatitis C virus [HCV]) and post-TB mortality. We conducted a retrospective cohort study among persons who initiated treatment for rifampicin-resistant or multi/extensively drug-resistant (RR or M/XDR) TB reported to the country of Georgia’s TB surveillance during 2009–2017. Exposures included HIV serologic status, diabetes, and HCV status. Our outcome was all-cause post-TB mortality determined by cross-validating vital status with Georgia’s death registry through November 2019. We estimated adjusted hazard rate ratios (aHR) and 95% confidence intervals (CI) of post-TB mortality among participants with and without comorbidities using cause-specific hazard regressions. Among 1032 eligible participants, 34 (3.3%) died during treatment and 87 (8.7%) died post-TB treatment. The median time to post-TB death was 21 months (interquartile range 7–39) after TB treatment. After adjusting for confounders, the hazard rates of post-TB mortality were higher among participants with HIV co-infection (aHR = 3.74, 95%CI 1.77–7.91) compared to those without HIV co-infection. In our cohort, post-TB mortality occurred most commonly in the first 3 years post-TB treatment. Linkage to care for common TB comorbidities post-treatment may reduce post-TB mortality rates.

Diabetes and tuberculosis comorbidity: a cross-sectional study of patients attending diabetes clinic in Accra, Ghana

Background: Diabetes and tuberculosis have significantly increased health-related and socioeconomic implications on individuals, families, health systems, and the global economy at large, making them a serious global health concern. The objective of this study is to determine the prevalence of diabetes-tuberculosis co-morbidity and the socio-demographic, behavioral and clinical factors associated with this comorbidity. Methodology: This was a cross-sectional study of selected diabetic patients at the diabetic clinic of the Shai Osudoku District Hospital-Dodowa in the Greater Accra Region, Ghana. Sputum samples from confirmed diabetics were screened for tuberculosis using GeneXpert MTB/RIF Test and Ziehl-Neelsen AFB Microscopy. The patients’ awareness of their susceptibility to diabetes-tuberculosis, treatment compliance and care manager attentiveness, were assessed through semi-structured questionnaire. Statistical analyses of data were performed using Microsoft Analysis Tool Pak. Results: The prevalence of diabetes-tuberculosis comorbidity in the study was 7.0% (7/100). The occurrence of diabetes-tuberculosis comorbidity among the participants seemed to be higher in males (11.1%, 3/27) as compared to female (5.5%, 4/73), with no statistically significant difference (p=0.327). The females with diabetes-tuberculosis comorbidity statistically demonstrated poorer glycaemic control (females: 17.08±0.79 mmol/L and males: 15.95±0.79 mmol/L; 95% Cl; 7.15, p&lt;0.001). Participants in the age group 61-80 years had the highest prevalence of 11.4% (4/35) for diabetics-tuberculosis comorbidity but this was not statistically significant (p=0.509), although their mean blood glucose was significantly higher than other age groups (p=0.0137). The mean of patients with no awareness of their susceptibility to diabetic-tuberculosis co-morbidity was 77±28.97% (95% CI=3.79-46.62, p=0.4648). Treatment compliance was observed in 91.0% of the study participants mainly due to high level of attentiveness by care providers at the diabetic clinic for 69.0% of the participants. Conclusions: The prevalence of diabetes-tuberculosis comorbidity in this study is 7.0%, with majority of the diabetics not aware of their susceptibility to tuberculosis although there was high treatment compliance. There is the need for the adoption of a collaborative framework and integrated approach in the clinical management and control of diabetes and tuberculosis.

Sociocultural features of lifestyle modifications among TB–diabetes comorbid patients in Satara, India and its implications for planning self-management interventions for TB–diabetes comorbid patients

BackgroundLifestyle modifications (LM) are crucial in managing comorbid Tuberculosis (TB) and Diabetes Mellitus (DM) patients, significantly impacting treatment outcomes and overall health. In view of this, a study was conducted to clarify sociocultural features associated with LM among TB–diabetes comorbid patients.MethodsA cross-sectional descriptive study among randomly selected 180 adult TB–diabetes-comorbid-patients was conducted using a semi-structured interview schedule. Mann–Whitney-U-test was used to examine differences in means between patterns of distress (PDs) and perceived causes (PCs) regarding TB and Diabetes for two identified LM strategies among comorbid patients. Stepwise logistic regression was used to study factors associated with these LM strategies.ResultsTB–diabetes-comorbid-patients reporting physical symptoms as PDs preferred to follow the LM-1 strategy for TB and LM-2 for Diabetes. In contrast, patients reporting health-illness-injury-related causes follow LM-2 for TB and LM-1 for Diabetes. Further patients reporting hypertension for Diabetes (AOR = 2.916, 95% CI 0.9262–9.1788) and concerns-about-the-course-of-TB-illness (AOR = 3.746, 95% CI 1.4683–9.5593) as PDs were 3–4 times more likely to follow LM-1. While those reporting prior illnesses (AOR = 4.255, 95% CI 1.3941–12.9837) and sanitation (AOR = 5.242, 95% CI 1.2028–22.8446) as PCs for TB were 4–5 times follow LM-2. Patients who perceived consumption of alcohol as PCs of Diabetes were 10 times more likely to stop addictions (AOR = 9.680, 95% CI 2.5555–36.6639) and follow the LM-2 strategy.ConclusionGiven significant associations of sociocultural features with LM strategies, consideration of sociocultural features vis-à-vis these strategies is indispensable for managing TBDM comorbidity, emphasizing the need for developing comprehensive, patient-centred self-management interventions to enhance adherence and improve health outcomes.

The impact of diabetes mellitus on tuberculosis recurrence in Eastern China: a retrospective cohort study

BackgroundThe comorbidity of tuberculosis (TB) and diabetes mellitus (DM) is a significant global public health issue. This study aims to explore the recurrence risk and related factors of active pulmonary TB, specifically focusing on the impact of DM.MethodsA retrospective cohort study was conducted in Lianyungang City, Jiangsu Province, Eastern China by recruiting 12,509 individuals with newly diagnosed pulmonary TB between 2011 and 2019. The Cox proportional hazards models were performed to identify risk factors of recurrence and assess the association between DM and recurrence. The hazard ratio (HR) and 95% confidence interval (CI) were used to estimate the strength of the association.ResultsAfter a median follow-up period of 5.46 years, we observed 439 recurrent cases (incident recurrence rate: 6.62 per 1000 person-years). Males (HR: 1.30, 95% CI: 1.03–1.64), patients aged ≥ 60 years (HR: 1.39, 95% CI: 1.15–1.70), DM (HR: 2.40, 95% CI: 1.68–3.45), and etiologic positivity in the initial episode (HR: 2.42, 95% CI: 2.00-2.92) had a significantly increased risk of recurrence.ConclusionsRecurrence of pulmonary TB patients who have completed treatment, especially those who also suffer from DM, should be a concern. Enhanced follow-up and targeted surveillance of these high-risk groups are needed.

Correlation Between Tuberculosis Type and Comorbidities with Nutritional Recovery Rates Post-Tuberculosis Treatment in Pediatric Patients

Background: Tuberculosis remains a significant cause of mortality in children. Nutritional status is one of the major risk factors for tuberculosis severity. This study investigated the factors influencing nutritional status in tuberculosis patients. Methods: This is a retrospective, cross-sectional study conducted in the tertiary national-referral hospital in Jakarta, Indonesia. Data were obtained from electronic health records from 2012-2018. This study included patients aged 0-18 years-old who were diagnosed and treated with anti-tuberculosis drugs. Patients who did not complete the therapy for minimum 2 months were excluded. Results: A total of 207 patients were included in this study. The type of tuberculosis was associated with the nutritional status of children after 2 months of treatment (p value = 0.014; 95% CI = 0.422 - 0.914). Children with extrapulmonary TB showed better improvement in nutritional status compared to those with pulmonary TB. Comorbidities were also associated with nutritional status (p-value = 0.020; CI95% = 1.063 - 2.382). Patient without comorbidities experience better nutritional status improvement than those with comorbidities. Conclusion: The nutritional status of tuberculosis patients improved after the 2-months of treatment. The type of tuberculosis and the presence of comorbidities influence the outcomes of nutritional status during anti-tuberculosis treatment.

An approach to integrated management of diabetes in tuberculosis patients: Availability and readiness of the health facilities of Bangladesh.

Comorbidity of diabetes mellitus and tuberculosis (TB) is a major public health concern in low- and middle-income countries including Bangladesh. An integrated approach is required for adequate management of diabetes mellitus and TB. The objective of the present study was to investigate the availability and readiness of the TB care centers of Bangladesh toward diabetic patients' management. The present study was conducted based on existing data obtained from the Bangladesh Health Facility Survey (BHFS) 2017. Data collected from a total of 303 facilities providing TB services were retrieved. The outcome variables of the present study were availability and readiness of the TB health facilities for providing diabetes mellitus service. Readiness was measured for four domains: staff and guidelines, equipment, diagnostic facility and basic medicine. The independent variables were: facility level, management authority and location of the facility. Binary and multiple logistic regression models were constructed for both the outcome variables (availability and readiness) to find out their predictors. Services for diabetes mellitus were available in 68% of the TB facilities while high readiness was present in 36% of the facilities. For domain-specific readiness index, readiness for the domains of staff and guidelines, equipment, diagnostic facility and basic medicine was reported in 46%, 96%, 38% and 25% facilities respectively. In the logistic regression model, availability of diabetes mellitus services was better in primary level (aOR 2.62, 95% CI 1.78-4.77) and secondary level (aOR 3.26, 95% CI 1.82-9.05) facilities than community facilities. Similarly, readiness of diabetes mellitus care was also better in these facilities (aOR 2.55, 95% CI 1.05-4.71 for primary and aOR 2.75, 95% CI 1.80-4.32 for secondary facilities). Besides, private TB facilities had better availability (aOR 2.84, 95% CI 1.75-5.89) and readiness (aOR 2.52, 95% CI 1.32-4.29) for diabetes mellitus care. Availability and readiness for providing diabetes mellitus services in TB care providing facilities in Bangladesh is inadequate.

Clinical Features, Treatment Outcome and Potential risk Factors for Recurrence Among Patients with Chronic Pulmonary Aspergillosis in a Resource-limited Setting: A Retrospective Observational Study.

To evaluate the clinical characteristics and treatment outcomes of patients with chronic pulmonary aspergillosis (CPA) and to determine risk factors for disease recurrence. A total of 43 patients with CPA (mean ± SD age: 61.4 ± 10.5years, 83.7% were males) were included in this retrospective study. Data on demographic, clinical and disease-related characteristics, galactomannan (GM) test positivity in bronchoalveolar lavage (BAL) samples, histopathological diagnosis, imaging (CT) findings and CPA forms, antifungal therapy, recurrence rate and time to recurrence were recorded. Chronic obstructive pulmonary disease (COPD;76.7%) was the leading predisposing factor, and the aspergillus nodule (37.2%) was the most prevalent CPA form.GM test positivity was noted in 89.7% (35/39) of BAL samples. Median duration of voriconazole treatment was 180days. CPA recurrence was noted in 14.0% of patients, while the comorbid tuberculosis sequela (66.7% vs. 16.2%, p = 0.02) and mild immunosuppressive disorder (100.0% vs. 51.4%, p = 0.032) were significantly more common in patients with recurrence vs. those without recurrence. Recurrence rate was 50.0% (3 of 6 patients) in patients with simple aspergilloma, and ranged from 0.0% to 25.0% in those with other CPA forms. Treatment duration and time to recurrence ranged 70-270days and 1.1-37months, respectively in simple aspergilloma, while they were ranged 150-180days and 30-43.3months, respectively in other CPA forms. Our findings indicate the importance of considering CPA in differential diagnosis in patients with predisposing conditions, and emphasize the tuberculosis sequela, immunosuppressive disorder and the certain CPA forms managed with shorter duration of antifungal therapy (i.e., simple aspergilloma) as the potential risk factors of CPA recurrence.

Non-communicable comorbidities in pulmonary tuberculosis and healthcare utilization: a cross-sectional study of 2021 Indonesian national health insurance data

BackgroundLimited research exists on the comorbidity of pulmonary tuberculosis with non-communicable diseases (NCDs) and its implications for healthcare utilization in Indonesia. The lack of investigation into NCD comorbidity among pulmonary tuberculosis patients could adversely affect both the healthcare system and the national health insurance scheme. Understanding the NCD comorbidity among pulmonary tuberculosis patients, associated factors, and healthcare utilization is crucial for ensuring the effective and efficient delivery of health services.MethodThis study utilized an observational cross-sectional design based on anonymized sample data from tuberculosis cases covered by Indonesia's National Health Insurance in 2021. Chi-square tests were employed to analyze dependent and independent variables, while unadjusted and adjusted logistic regressions were used to explore further associations.ResultsThe prevalence of NCD comorbidity in tuberculosis patients was 11.81%. Aged over 60 (aOR 5.16; [CI] 4.23—6.3), married (aOR 1.19; [CI] 1.05—1.34), and unemployed (aOR 1.27; [CI] 1.08—1.49) were associated with the NCD comorbidity in pulmonary tuberculosis patients. Factors associated with increased inpatient service utilization among pulmonary tuberculosis patients included aged over 60 (aOR 5.69; [CI] 4.81—6.74), male (aOR 1.32; [CI] 1.23—1.40), self-employment (aOR 1.42; [CI] 1.29—1.56), having insurance subsidized by central government (aOR 1.89; [CI] 1.73—2.08) or local government funds (aOR 1.75; [CI] 1.58—1.93), and having comorbidity non-communicable diseases (aOR 1.80; [CI] 1.66—1.96).ConclusionPulmonary tuberculosis patients exhibit a significant prevalence of NCD comorbidity, which substantially impacts healthcare utilization. Early detection and management of these conditions are critical to mitigate burdens on both the healthcare system and the financial sustainability of the national health insurance scheme. Integrating health services for tuberculosis and NCDs through bidirectional screening is essential for comprehensive patient care.

Intestinal Parasitic Infections May Be Overlooked Drivers of the Tuberculosis Pandemic.

The burden of tuberculosis (TB) is disproportionate in tropical and subtropical regions, where parasitic coinfections are common. Given the significant geographical overlap between TB and intestinal parasitic infections, it is important to consider the implications of intestinal parasitic infections for the TB pandemic. Intestinal parasitic infections have been theorized to increase vulnerability to TB by altering the inflammatory milieu, inducing undernutrition that blunts the immune response, and affecting drug pharmacokinetics. In this perspective piece, we provide a background of the epidemiological and immunological evidence that links parasitic infections to increased risk of TB progression and worse treatment outcomes. We also identify gaps in our knowledge and call for increased research on TB-parasitic coinfections to ensure action on a potentially widespread TB comorbidity.

Tuberculosis Infection and Comorbidities: A Public Health Issue in Baja California, Mexico

Tuberculosis Infection and Comorbidities: A Public Health Issue in Baja California, Mexico

Tuberculosis-related Mood Disorders: Probiotics as a Next-Generation Strategy

Introduction: Tuberculosis-related mood disorders are well-known but least researched. As frequent comorbidity of tuberculosis (TB), depression is linked to poor adherence to treatment for a number of illnesses. The exact causal mechanism and pathways behind TB disease and associated mental illnesses are unclear. The disease's severity and duration impact the occurrence of depression, and MDR-TB enhances this risk. To summarise the information on the association between depression and unfavourable outcomes of TB treatment, we carried out a narrative review. Objective: The objective of this study is to provide an overview of probiotics as a cutting-edge treatment for mood disorders linked to tuberculosis. Methods: A systematic stepwise online database research was done for systematic reviews, original studies, and review papers published on probiotics and mental disorders associated with tuberculosis in PubMed/MEDLINE, Google Scholar, and Web of Science. The reference lists for these articles were also used as sources for the bibliography Results: The gut microbiota and the brain are connected by neuroendocrine-immune pathways. The diversity and abundance of microbiota Proteobacteria, Actinobacteria Bacteroides, and Firmicutes are reduced in tuberculosis patients. Through the stimulation of different immunological responses or visceral sensory pathways, these changes in the gut microbiome may be a contributing factor in emotional instability and mood disorders. Probiotics also lessen the stress response caused by cortisol, in addition to releasing neurotransmitters, including GABA, serotonin, noradrenaline, acetylcholine, and dopamine, in various brain regions. Probiotics are the most prevalent in the sensory brain network of the brain, which controls the brain's core processing of emotions and sensations. In addition, they produce short-chain fatty acids (SCAFs) from the bacterial fermentation of fibre in the colon, such as butyrate, which inhibits histone deacetylase, binds to G protein-coupled receptors, and serves as an energy metabolite. Butyrate plays a significant role in maintaining brain health by having antimanic and antidepressant effects. Several clinical research on patients with MDD has revealed that probiotics have favourable effects on depressive symptoms. Conclusion: The central dopamine system, inflammation, the BDNF system, and the gut-brain axis are all recognised to play crucial roles in the pathogenesis of MDD. Commercial probiotics that generate butyrate-producing SCFAs and those resistant to metabolic disorders (such as Bacteroidetes) may be beneficial for tuberculosis-related MDD during and after treatment. In this situation, using bacteria that produce SCFA could be a cutting-edge method of treating clinical MDD.

PPARdelta: A key modulator in the pathogenesis of diabetes mellitus and Mycobacterium tuberculosis co-morbidity

The interplay between lipid metabolism and immune response in macrophages plays a pivotal role in various infectious diseases, notably tuberculosis (TB). Herein, we illuminate the modulatory effect of heat-killed Mycobacterium tuberculosis (HKMT) on macrophage lipid metabolism and its implications on the inflammatory cascade. Our findings demonstrate that HKMT potently activates the lipid scavenger receptor, CD36, instigating lipid accumulation. While CD36 inhibition mitigated lipid increase, it unexpectedly exacerbated the inflammatory response. Intriguingly, this paradoxical effect was linked to an upregulation of PPARδ. Functional analyses employing PPARδ modulation revealed its central role in regulating both lipid dynamics and inflammation, suggesting it as a potential therapeutic target. Moreover, primary monocytic cells from diabetic individuals, a demographic at amplified risk of TB, exhibited heightened PPARδ expression and inflammation, further underscoring its pathological relevance. Targeting PPARδ in these cells effectively dampened the inflammatory response, offering a promising therapeutic avenue against TB.

A cross-sectional observational study to assess socio-demographic factors in newly diagnosed TB DM comorbidity

Background Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is one of the rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum positive pulmonary TB patients registered in District Tuberculosis Centre and to assess the risk factors of DM among TB patients. Methods In a cross-sectional study, newly detected sputum positive pulmonary TB patients were screened for DM (those having symptoms of DM). Furthermore, they were diagnosed by detecting blood glucose levels (≥200 mg/dL). Mean, standard deviation (SD), Chi-squared and Fisher-Freeman-Halton exact tests were used to determine the significant associations. P-values less than 0.05 were considered to be statistically significant. Results A total of 215 TB patients were included in this study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (&gt;46 years old), educational status, smoking habits, alcohol consumption, physical activity, presence of DM symptoms and family history of DM. Conclusions Routine screening for DM is mandatory due to its increasing prevalence, which may help in early diagnosis and to reduce complications by proper management that in turn helps in the successful outcome of TB treatment.

A systematic review of the prevalence of psychosis in people with tuberculosis

IntroductionTuberculosis is a bacterial infectious disease caused by Mycobacterium tuberculosis. This disease predominately affects the lungs but also affects other parts of the body, including the central nervous system. According to the the World Health Organization (2023), tuberculosis has an incidence of 6.4 million people in 2022, with 1.5 million deaths attributed to this disease. Psychosis describes a group of disorders that affects a person’s thought process and perception. It is a serious disorder that can have a profound impact on a person’s mental and physical health. As a result, psychosis symptoms and its treatment can complicate the management of tuberculosis.Objectives The aim of this systematic review is to explore the association between tuberculosis and psychosis. It has been shown that up to 70% of patients with tuberculosis also have comorbid mental illness, this is likely to include psychosis. There are also shared risk factors between tuberculosis and psychosis, including poverty and homelessness, substance abuse, HIV positive serology and isolation. Tuberculosis medication, including isoniazid and rifampicin have been shown to have adverse psychiatric effects and we will examine if this includes psychosis.MethodsA systematic review was pre-registered with PROSPRO and performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, OVID and PsychINFO databases were searched from beginning of records to September 2023. This included hand-search of relevant reference lists. Observational and epidemiological studies were included along with population based registries.ResultsOver one thousand (1,154) articles were identified and screened. There was significant heterogenity in results and over half of studies were from Asia and Africa. Many studies reported cases of drug-induced psychosis from anti-tubercular agents. Studies also discussed the increased risk of TB incidence among patients with psychosis and other psychiatric disorders.ConclusionsThis study identifies the importance of training healthcare workers in rapid detection of co-morbid psychosis in patients with tuberculosis, along with neuropsychiatric side effects of antitubercular agents. Integration of psychiatric and medical care of these patients would be of benefit to improve outcomes in this patient population. More research is needed on co-morbidity of tuberculosis and psychosis.Disclosure of InterestNone Declared

Treatment Outcomes of Tuberculosis and Associated Factors Among Tuberculosis and Human Immunodeficiency Virus Co-infected Patients in Public Health Facilities in Jigjiga, Somali Region, Ethiopia.

Worldwide, tuberculosis (TB) is a serious public health issue, especially in low-income countries, including Ethiopia. For those who are HIV-positive, TB poses a major risk to their health. The development of chemotherapy and the effectiveness of treatment have resulted in notable increases in patient survival. The evaluation of TB treatment outcomes is an essential metric for determining the success of TB and HIV co-morbidity control strategies. This study aims to identify TB treatment outcomes and associated factors among TB/HIV co-infected patients in public health facilities in Jigjiga, Somali Region, Ethiopia, in 2021. A hospital-based cross-sectional study design was done on three facilities (Karamara, Hasan Yabare Referral Hospital, and Jigjiga Health Center) with a total of 194 study participants. Data were extracted using a checklist, entered into EpiData version 3 (The EpiData Association, Odense, Denmark), and analyzed using SPSS Statistics version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) for descriptive and inferential analysis of the study objectives. Variables in the bivariate logistic regression analysis with p-values less than 0.25 were entered into a multivariate logistic regression to identify the independent factors of TB treatment outcome. Associations were computed using an adjusted odds ratio with a 95% CI. P-values less than 0.05 were finally considered statistically significant. The following TB treatment outcomes were observed among all TB/HIV co-infected patients enrolled in this study: 126 (67.4%) completed treatment, three (1.8%) died, 42 (22.5%) were cured, and 16 (8.6%) were transferred out; 168 (89.8%) had a successful treatment outcome. Category of the patient (AOR = 0.194, 95% CI: 0.041, 0.923), sex of the patient (AOR = 1.490, 95% CI: 1.449, 4.951), and cotrimoxazole preventive therapy (CPT) initiation (AOR = 0.073, 95% CI: 0.021, 0.254) were found to be significant predictors for successful TB treatment outcome at a p-value less than 0.05 with a 95% CI. Overall, 89.8% of TB treatments were successful among TB/HIV co-infected patients. This study has found sex, socioeconomic status, and CPT initiation were significant factors for a successful TB treatment outcome. Based on these findings, governmental and non-governmental organizations should facilitate the implementation and enforce the availability of all TB/HIV co-infected patients.

Tuberculosis and diabetes mellitus comorbidity in an adult Ugandan population

BackgroundDiabetes mellitus (DM) has a direct impact on the clinical manifestation and prognosis of active tuberculosis disease (TB) and is known to increase the chance of developing the condition. We sought to determine the prevalence of DM in adult Ugandan patients with recently diagnosed TB and the associated sociodemographic, anthropometric, and metabolic characteristics of TB-DM comorbidity.MethodsIn this cross-sectional study conducted at the adult TB treatment centres of three tertiary healthcare facilities in Uganda, we screened adult participants with recently diagnosed TB (diagnosed in < 2 months) for DM. All participants were screened with five tests; initially with a random blood glucose (RBG) test, and then later with fasting blood glucose (FBG), laboratory-based glycated hemoglobin (HbA1c), point-of-care (POC) HbA1c, and oral glucose tolerance test (OGTT) if the RBG was ≥ 6.1 mmol/l. The WHO guidelines for diagnosing and managing DM were used to support the DM diagnosis. To identify the factors associated with DM-TB comorbidity, logistic regression was used.ResultsA total of 232 participants with recently diagnosed TB were screened for DM. Of these, 160 (69%) were female. The median (IQR) age, body mass index, and RBG of all study participants was 35 (27–42) years, 19.2 (17.6–21.3) kg/m2, and 6.1 (5.5–7.2) mmol/l, respectively. About half of the participants (n = 117, 50.4%) had RBG level ≥ 6.1 mmol/l. Of these, 75 (64.1%) participants returned for re-testing. Diabetes mellitus was diagnosed in 32 participants, corresponding to a prevalence of 13.8% (95% CI 9.9–18.9). A new diagnosis of DM was noted in 29 (90.6%) participants. On logistic regression, age ≥ 40 years was associated with increased odds of TB and DM comorbidity (AOR 3.12, 95% CI 1.35–7.23, p = 0.008) while HIV coinfection was protective (AOR 0.27, 95% CI 0.10–0.74, p = 0.01).ConclusionTB and DM comorbidity was relatively common in this study population. Routine screening for DM in adult Ugandan patients with recently diagnosed TB especially among those aged ≥ 40 years and HIV-negative patients should be encouraged in clinical practice.

Costs incurred by people with co-morbid tuberculosis and diabetes and their households in the Philippines.

Diabetes is a risk factor for TB mortality and relapse. The Philippines has a high TB incidence with co-morbid diabetes. This study assessed the pre- and post-TB diagnosis costs incurred by people with TB and diabetes (TB-DM) and their households in the Philippines. Longitudinal data was collected for costs, income, and coping mechanisms of TB-affected households in Negros Occidental and Cebu, the Philippines. Data collection was conducted four times during TB treatment. The data collection tools were developed by adapting WHO's cross-sectional questionnaire in the Tuberculosis Patient Cost Surveys: A Handbook into a longitudinal study design. Demographic and clinical characteristics, self-reported household income, number of facility visits, patient costs, the proportion of TB-affected households facing catastrophic costs due to TB (>20% of annual household income before TB), coping mechanisms, and social support received were compared by diabetes status at the time of TB diagnosis. 530 people with TB were enrolled in this study, and 144 (27.2%) had TB-DM based on diabetes testing at the time of TB diagnosis. 75.4% of people with TB-DM were more than 45 years old compared to 50.3% of people with TB-only (p<0.001). People with TB-DM had more frequent visits for TB treatment (120 vs 87 visits, p = 0.054) as well as for total visits for TB-DM treatment (129 vs 88 visits, p = 0.010) compared to those with TB-only. There was no significant difference in the proportion of TB-affected households facing catastrophic costs between those with TB-DM (76.3%) and those with TB-only (68.7%, p = 0.691). People with TB-DM in the Philippines face extensive health service use. However, this does not translate into substantial differences in the incidence of catastrophic cost. Further study is required to understand the incidence of catastrophic costs due to diabetes-only in the Philippines.