Decline In Incidence Of Tuberculosis Research Articles

HIV-associated tuberculosis: Watch for it in your ICU

In 1986, for the first time since the system of national surveillance began 33 years before, the number of reported cases of tuberculosis in the United States increased compared to those reported the year before [1]. In 1987 and 1988 the number decreased slightly from that in 1986, but then in 1989 once again there was another sharp increase. Recently, the prevailing rate of decline in the annual incidence of tuberculosis in France has slowed noticeably [2] and striking increases have been noted in several countries in Africa [3, 4]. It is now evident that this remarkable global upsurge in tuberculosis has been caused by the widespread presence of a second infectious agent, the human immunodeficiency virus (HIV). When HIV infection and Mycobacterium tuberculosis coexist, the inevitable HIV-induced immunosupression favors progression of latent tuberculous infection to serious tuberculous disease [5]. There seem to be 2 types of tuberculosis associated with HIV infection. One form occurs relatively early in the evolution of HIV-induced immunosuppression and is indistinguishable from ordinary tuberculosis; its characteristics are cutaneous reactivity to tuberculin, formation of granulomata, upper lobe pulmonary disease with cavitation, and infrequent extrapulmonary involvement [6]. In contrast, the second type occurs in patients with more advanced immune depression and is often atypical and aggressive in its presentation; noteworthy features are the loss of tubercufin sensitivity (with consequent absence of necrosis and granulomata formation), diffuse lung involvement, and frequent extrapulmonary dissemination [7]. Thus, because of the substantial increase in tuberculosis in many countries, both developed and underdeveloped, related to HIV infection, and because of the clinical behavior of the second type of HIV-associated tuberculosis described above, it its not surprising that these patients are now being encountered in intensive care units

Nontuberculous, nonleprous mycobacterioses

The role of tuberculoid mycobacteria as causes for disease in humans is continually expanding. New species continue to be recognized as pathogens, and the increasing number of immunosuppressed patients with ever lengthening survivals increases the potential for these environmental Mycobacterium spp. to become pathogens. The decline in incidence of tuberculosis has made disease caused by these organisms of greater importance. Much remains to be learned clinically, microbiologically, and genetically about tuberculoid bacilli. The optimal treatment for most diseases caused by the tuberculoid mycobacteria is unknown, susceptibility testing has frequently failed to predict clinical responses, and many species are resistant to all conventional anti-tuberculous agents. Great attention by clinicians to the disease potential of these organisms and by pharmaceutical companies to the need for better therapeutic agents will be required to control these not so anonymous and certainly not atypical mycobacteria.

Tuberculosis Burden in Ethiopia from 1990 to 2016: Evidence from the Global Burden of Diseases 2016 Study.

The burden of Tuberculosis (TB) has not been comprehensively evaluated over the last 25 years in Ethiopia. In this study, we used the 2016 Global Burden of Diseases, Injuries and Risk Factors (GBD) data to analyze the incidence, prevalence and mortality rates of tuberculosis (TB) in Ethiopia over the last 26 years. The GBD 2016 is a mathematical modeling using different data source for Ethiopia such as verbal autopsy (VA), prevalence surveys and annual case notifications. Age and sex specific causes of death for TB were estimated using the Cause of Death Ensemble Modeling (CODEm). We used the available data such as annual notifications and prevalence surveys as an input to estimate incidence and prevalence rates respectively using DisMod-MR 2.1, a Bayesian meta-regression tool. In 2016, we estimated 219,186 (95%UI: 182,977-265,292) new, 151,602 (95% UI: 126,054-180,976) prevalent TB cases and 48,910(95% UI: 40,310-58,195) TB deaths. The age-standardized TB incidence rate decreased from 201.6/100,000 to 88.5/100,000 (with a total decline of 56%) between 1990 to 2016. Similarly, the age-standardized TB mortality rate declined from 393.8/100,000 to 100/100,000 between 1990 and 2016(with a total decline of 75%). Ethiopia has achieved the 50% reduction of most of the Millennium Development Goals (MDGs) targets related to TB. However, the decline of TB incidence and prevalence rates has been comparatively slow. The country should strengthen the TB case detection and treatment programs at community level to achieve its targets during the Sustainable Development Program (SDGs)-era.

The decline in incidence of tuberculosis of bones and joints

An actual decrease in the number of patients suffering from tuberculosis of the bones and joints has been observed at the New York Orthopaedic Dispensary and Hospital. The percentage of patients with tuberculosis of bones and joints, as compared with total new patients applying for dispensary care, has fallen from 65.3 per cent to 0.6 per cent during the past seventy years. Similarly the incidence of bone and joint tuberculosis in children, in relation to all new dispensary patients, has fallen during the past twenty-five years from 9.7 per cent to 0.1 per cent. It is emphasized that these figures are unreliable in estimating the general incidence of tuberculosis of bones and joints throughout the country, and it is hoped that other hospitals will make comparable reports. A discussion of factors entering into the decline of tuberculosis of bones and joints has been presented.