Drug-sensitive Tuberculosis Research Articles

BACTERIAL AND FUNGAL INFECTIONS IN PULMONARY TUBERCULOSIS PATIENTS AND THE DRUG SENSITIVITY TEST PATTERNS.

Other microbial infections in pulmonary tuberculosis (TB) patients pose significant challenges, complicating treatment outcomes and potentially increasing mortality rates. This study aims to characterize the bacterial and fungal infections profiles in pulmonary TB patients. A retrospective cross-sectional analysis was conducted at Adam Malik Hospital in Medan, Indonesia, from June 2020 to May 2022, involving inpatients diagnosed with drug-sensitive or drug-resistant TB. The data was analyzed from total sampling subjects based on medical records. From 125 pulmonary TB patients, 64% had drug-sensitive TB (DS-TB) and 36% had drug-resistant TB (DR-TB), with the majority being male and underweight. Microbial analysis showed 33.6% (n=42) of the subjects exhibited bacterial growth, 8.8% (n=11) had fungal growth and 30.4% (n=38) had mixed infection. Of 80 DS-TB patients, 80% had bacterial and fungal infections compared to 60% of 45 DR-TB patients, with Klebsiella pneumoniae and Candida albicans as the most common microbes. %<Microbial growth patterns were significantly different between DS-TB and DR-TB patients, with 38.8% (n=31) of DS-TB patients displaying mixed bacterial and fungal growth, in contrast to only 15.6% (n=7) of DR-TB patients. There were no significant differences in antibiotic resistance; however, antifungal sensitivity testing revealed a significant difference in response between DS-TB and DR-TB patients, particularly to Flucytosine, Fluconazole, and Micafungin. There is a considerable presence of bacterial and fungal infections, with Klebsiella pneumoniae and Candida albicans being the most prevalent. The antifungal sensitivity testing suggesting a need for personalized antifungal treatment strategies between DS-TB and DR-TB patients.

Karakteristik dan Analisis Risiko Kasus Tuberkulosis di Puskesmas Senen Jakarta Pusat tahun 2023

Indonesiaranks second globally with the highest number of Tuberculosis (TB) cases, following India. Consequently, TB remains a high-priority health issue requiring immediate attention. This study aims to describe the TB case characteristic and analyze the TB risk in each urban villages of Senen, Central Jakarta. This is a descriptive cross-sectional study. Data was obtained from medical records and the Tuberculosis Information System (SITB) at Senen Primary Health Care (PHC) during January – December2023. Demographic data, TB type, result of rapid molecular test, and comorbidities were presented in numbers and percentages. Total TB cases, incidence rate (IR), and standardized morbidity ratio (SMR) were calculated for each urban villages and the entire subdistrict. The distribution of the number of cases, IR, and SMR was displayed on a map. Overall, 300 TB cases were found among 3,421 suspected TB cases examined at the Senen PHC in 2023, with a positivity rate of 7.22% and an incidence rate of 240 per 100,000 population. The highest number of TB cases occurred in September 2023 with 52 cases (17.33%). Of the total TB cases in Senen, TB cases were commonly found in males (67.67%), the productive age group (15-59 years) accounted for73.33%,new TB cases accounted for 93.33%, 100% were pulmonary TB cases, 82.33% were bacteriologically confirmed with 93.36% of them being drug-sensitive TB (DS-TB), smokers (73.33%) and employed (72.67%). TB cases were spread across sixurban villages, with Kramat having the highest number of cases at 98 (32.67%), a TB IR of 78 per 100,000 population, and an SMR of 0.71. TB cases occurred throughout the year in the Senen Subdistrict. The characteristics of TB cases in Senen were dominated by males, productive age groups, pulmonary TB, new cases, bacteriologically confirmed cases, DS-TB, smokers, and employed individuals. The TB risk varied in each area, with the highest number of cases, IR, and SMR found in Kramat urban village A comprehensive strategy combining early detection, effective treatment, and preventive measures is essential to control the TB epidemic in the Senen Subdistrict.

Comorbidities, drug-resistance and length of hospital stay among tuberculosis inpatients in Northeastern China: a retrospective observational study from 2013 to 2021

BackgroundTuberculosis (TB) remains a significant global health issue. Drug-resistant TB and comorbidities exacerbate its burden, influencing treatment outcomes and healthcare utilization. Despite the growing prevalence of TB comorbidities, research often focuses on single comorbidities rather than comorbidity patterns. This study aims to evaluate comorbidity patterns among TB inpatients in Northeastern China from 2013 to 2021 and investigate the association between comorbidities and drug-resistance with length of hospital stay (LOS). Our findings could enhance the understanding of TB comorbidity interactions and provide evidence for targeted morbidity management strategies.MethodsNetwork analysis was used to evaluate comorbidity patterns, estimating centrality indices to understand the structural importance of each comorbidity. The Walktrap algorithm was used to identify clusters of highly connected comorbidities. Networks of drug-susceptible and drug-resistant TB inpatients were compared. Multivariable linear regression models were used to assess the associations between LOS with comorbidities and drug resistance.ResultsA total of 2,352 TB inpatients were included, with a median LOS of 31 (IQR: 16–51) days. Inpatients with multidrug-resistant TB (β = 12.88, 95%CI = 8.03–17.73), chronic hepatitis C (β = 31.89, 95%CI: 4.41–59.37), pneumonia (β = 37.14, 95%CI: 12.53 – 61.76), pneumoconiosis (β = 28.40, 95%CI: 11.92 – 44.87), pneumothorax (β = 19.88, 95%CI: 4.97 – 34.80), and dermatitis/eczema (β = 56.54, 95%CI: 8.18 – 104.89) were significantly associated with longer LOS. Frequent comorbidities included liver dysfunction(15.2%), hypoproteinemia (14.4%), diabetes (14.2%), pleural effusion (11.3%), and emphysema (10.2%). Hypoproteinemia showed high structural importance in the network, ranking second in strength and highest in betweenness. Nine clusters of comorbidities were detected. No significant differences were found between the networks of drug-sensitive and drug-resistant TB inpatients, except for the greater strength of cholecystitis among drug-resistant inpatients.ConclusionsEarly detection and management of drug-resistant TB and comorbidities that prolong LOS, as well as those with structural importance or within the same cluster in the comorbidity network, are crucial for improving patient outcomes.

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.

Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort study

Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country. We conducted a population-based national retrospective cohort study of children (0-9 years) and adolescents (10-17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively. A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9-3.1) and did not receive DOT (2.3, 1.9-2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2-2.0), illicit drug use (4.2, 3.4-5.1), tobacco use (1.6, 1.3-2.1), HIV infection (2.7, 2.2-3.4), and not receiving DOT (2.6, 2.3-2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3-0.9). In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated. Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK.

The Relationship Between Adequate Housing And Household Sanitation With The Success Of Tuberculosis Patient Treatment In Semarang City

Tuberculosis is a global health problem, including in Semarang City. There were 7,844 cases in 2023 in Semarang City. The success rate of treatment in Semarang City is still at 85%. Tuberculosis is closely related to environmental factors and housing quality. This study examined how adequate housing and household sanitation conditions for Tuberculosis patients are linked to their treatment success. Data on the housing and household sanitation of the patients were taken in the first quarter of 2024 based on home visits to drug-sensitive Tuberculosis patients domiciled in Semarang City who were diagnosed in 2023 and 2024 who were still undergoing treatment and the final results of their treatment were seen in the last quarter of 2024. The data were analyzed using linear regression to examine the relationship between adequate housing and patient treatment success and the link between household sanitation and the treatment outcomes of Tuberculosis patients in Semarang City. Of the 2,007 samples, 789 patients, or 39.3%, were children (aged &lt;15 years), and 1,119, or 55.8%, were male. It was found that 1,023 (50.9%) patients had inadequate houses, and 1,113 (55.5%) patients had poor household sanitation. The results showed that 119 (5.9%) patients recovered, 873 (43.5%) patients completed treatment, 27 (1.3%) patients died, 96 (4.8%) patients dropped out of treatment (lost to follow-up), and 4 (0.2%) patients failed. There was a significant association between housing adequacy and patient treatment outcomes (p = 0.042). Household sanitation does not show a significant relationship with treatment success (p-value = 0.564). There are still other factors that can affect the recovery of Tuberculosis patients. It is better to involve political, social, economic, and cultural sectors in addition to the health sector to carry out interventions to improve the adequacy of housing for Tuberculosis patients.

A CT-based radiomics analyses for differentiating drug‑resistant and drug-sensitive pulmonary tuberculosis

BackgroundTo explore the value of computed tomography based radiomics in the differential diagnosis of drug-sensitive and drug-resistant pulmonary tuberculosis.MethodsThe clinical and computed tomography image data of 177 patients who were diagnosed with pulmonary tuberculosis through sputum culture and completed drug-susceptibility testing from April 2018 to December 2020 at the Second Hospital of Nanjing were retrospectively analyzed. Patients with drug-resistant pulmonary tuberculosis (n = 78) and drug-sensitive pulmonary tuberculosis (n = 99) were randomly divided into a training set (n = 124) and a validation set (n = 53) at a ratio of 7:3. Regions of interest were drawn to delineate the lesions and radiomics features were extracted from non-contrast computed tomography images. A radiomics signature based on the valuable radiomics features was constructed and a radiomics score was calculated. Demographic data, clinical symptoms, laboratory results and computed tomography imaging characteristics were evaluated to establish a clinical model. Combined with the Rad-score and clinical factors, a radiomics-clinical model nomogram was constructed.ResultsThirteen features were used to construct the radiomics signature. The radiomics signature showed good discrimination in the training set (area under the curve (AUC), 0.891; 95% confidence interval (CI), 0.832–0.951) and the validation set (AUC, 0.803; 95% CI, 0.674–0.932). In the clinical model, the AUC of the training set was 0.780(95% CI, 0.700-0.859), while the AUC of the validation set was 0.692 (95% CI, 0.546–0.839). The radiomics-clinical model showed good calibration and discrimination in the training set (AUC, 0.932;95% CI, 0.888–0.977) and the validation set (AUC, 0.841; 95% CI, 0.719–0.962).ConclusionsSimple radiomics signature is of great value in differentiating drug-sensitive and drug-resistant pulmonary tuberculosis patients. The radiomics-clinical model nomogram showed good predictive, which may help clinicians formulate precise treatments.

Sex-dependent variability of isoniazid and rifampicin serum levels in patients with tuberculosis.

Drug-sensitive TB (DS-TB) is treated with isoniazid, rifampicin, ethambutol, and pyrazinamide. Factors like fast-metabolizing enzymes, malabsorption, and drug interactions can influence serum drug levels. Current TB treatment guidelines recommend weight-adapted dosing without considering sex differences. This study examines drug levels of isoniazid and rifampicin in TB patients treated between 2019 and 2023 at our center focusing on sex-specific aspects. Patients diagnosed with TB and available serum levels of isoniazid or rifampicin between 2019 and 2023 were retrospectively identified. Serum levels were measured using liquid chromatography-mass spectrometry and high-performance liquid chromatography. Patients were stratified by sex and a linear regression mixed effect model was used to assess predictors for different serum levels. The study included 281 single therapeutic drug monitoring (TDM) measurements from 59 patients (28 women, 47.5%). For isoniazid, no sex-specific differences in serum drug levels were identified. On the other hand, female sex was a significant predictor of higher rifampicin plasma levels (coefficient 4.16, 95% CI 0.74-7.59, p = 0.009). Only 38.2% of rifampicin serum level measurements in male patients were within target range, the majority (40/68, 58.8%) were below range and only 2 (2.9%) TDM-levels were above range. Women displayed higher overall rifampicin serum levels than men (median 13.7mg/l vs. 7.1mg/l, p = 0.04), although weight adjusted doses were not significantly different (median 10.0mg/kg vs. 9.8mg/kg p = 0.56). Adverse effects were noted in 42.9% (42/98) of measurements in women and 29.5% (54/183) of measurements in men (p = 0.03). Rifampicin levels were significantly lower in men compared to women, despite weight-adjusted dosing. Clinicians should consider TDM and potential sex differences when treating patients with TB.

To Assess the Effect of Dyslipidemia on Treatment Outcome of Drug Sensitive TB Patients at a Tertiary Health Care Centre of North India

To Assess the Effect of Dyslipidemia on Treatment Outcome of Drug Sensitive TB Patients at a Tertiary Health Care Centre of North India

Profile of Pulmonary Tuberculosis After COVID-19 at Toba District, North Sumatra Province

Background: Worldwide cases of pulmonary tuberculosis (PTB) have significantly increased since the COVID-19 pandemic. Indonesia accounted for 6,811,818 of the 767,518,723 cases reported by the World Health Organization. While the Indonesian Ministry of Health reported 824,000 cases, the Global Tuberculosis Report in 2022 reported 10.6 million cases. The pandemic has hampered the goal of eliminating PTB globally, with cases diagnosed after COVID-19 having a 7.15-fold increased risk of contracting the illness.Methods: This cross-sectional study was conducted using total sampling to identify the profile of patients with PTB after having COVID-19 based on age, gender, classification, and type of PTB, as well as the duration of occurrence of PTB after COVID-19. The data collected were from COVID-19 patients from 2020 to 2022, then compared with PTB data. All data were compared to ensure that COVID-19 and PTB patient data were the same.Results: Of the 2544 patients recorded, 29 (1.1%) were infected with PTB after COVID-19 infection. The mean age of patients was 34±18.9 and was dominated by men (68.9%). Most of the cases were drug-sensitive TB (96.6%) and clinically diagnosed TB (55.2%). Age had a statistically significant association with the occurrence of TB cases after COVID-19 infection (P&lt;0.0001). The mean time from the initial diagnosis of COVID-19 to the diagnosis of confirmed TB was approximately 203±34.3 days (6.7 months).Conclusion: After COVID-19, patients have the potential to be infected with TB. Screening former COVID-19 patients can be one solution to finding early cases of PTB.

The effectiveness of integrated health professional organization collaboration in the treatment of pulmonary tuberculosis: A qualitative study

Background: Tuberculosis (TB) is an infectious disease, the high incidence of tuberculosis and its impact have caused the world to pay special attention, one of which is through the target of the third issue of the sustainable development goals (SDGs), namely tackling the TB epidemic in 2030. Efforts to prevent and reduce TB incidence in Indonesia through to find, treat, and cure TB program. Approaches to finding, diagnosing, treating, and curing TB patients and stopping transmission in the community. The treatment is being carried out actively, massively, and intensively, but the problem-solving has not yet been completed, innovation is needed through the collaboration of integrated health professional organizations, to anticipate the treatment of TB independently, in the service units of private hospitals, clinics and doctors' independent practice places. This innovation is to increase the new case detection rate, and the tracking of initial lost to follow up patients. Purpose: To analyze the effectiveness of integrated health professional organization collaboration in the treatment of pulmonary tuberculosis Method: Qualitative research with descriptive and exploratory design. The source of data and information is informants from the health profession determined by purposive sampling. In-depth interview and focus group discussion interview methods. Informants are representative members of each health profession organization appointed by the organization's leadership. Results: Health professional organizations are committed to and contribute to the well-organized treatment of TB. Integrated activity programs, increasing the discovery of new case detection rates, identification of drug-resistant pulmonary tuberculosis (DR-PTB) and drug-sensitive pulmonary tuberculosis (DS-PTB), and active monitoring of patients initially lost to follow-up, as well as preventing independent case handling. Conclusion: The collaboration of health professional organizations is very effective in helping the government handle Tuberculosis, has a commitment to increase the new case detection rate, identification of drug-resistant pulmonary tuberculosis (DR-PTB) and drug-sensitive pulmonary tuberculosis (DS-PTB), and actively monitor patients who are initially Lost to follow up, which is carried out in an integrated manner.

Prevalence and Predictors of Depression Among Drug-Sensitive Tuberculosis Patients – A Cross-Sectional Study

Background: According to World Health Organization, India is a high tuberculosis (TB) and depression burden state. The risk of depression is higher among TB patients. Therefore, it is vital to focus on the mental well-being of TB patients. Objective: The present study aimed to determine the prevalence and predictors of depression among drug-sensitive TB patients in Chandigarh city. Methods: A cross-sectional study was conducted among 305 TB patients. Trained investigators administered Patient Health Questionnaire 9 to screen for depression. Data analysis was done using Epi info software for windows. Results: The prevalence rate of depression among drug-sensitive TB patients was 7.2%. Current nonworking individuals were more likely to be depressed than their counterparts (OR = 3.7 (1.2–10.9)). Conclusion: Around one-tenth of the TB patients were suffering from depression. This necessitates physicians to regularly screen TB patients for depression and manage accordingly, which will help improve treatment adherence and outcome.

Determination of Direct and Indirect Costs Incurred by Tuberculosis Patients During Diagnosis and Treatment in Urban Areas of South Gujarat: A Mixed Method Approach.

Though many initiatives and monetary benefits are incorporated under RNTCP/NTEP, many patients might incur some out-of-pocket expenditure (OOP) related to diagnosis, treatment, and hospitalization. Such costs lead to further poverty and default. This study estimated OOP costs. A cross-sectional mixed method study was conducted in 2020. Data were collected from two selected UHCs (both public and private sectors) from all eight administrative zones. A total of 278 newly registered drug-sensitive tuberculosis patients at different stages of treatment were enrolled, and 18 IDIs were done after obtaining the consent. Among 278, 231 (83%) were seeking the treatment from the public sector and 47 (17%) from the private sector. The average direct, indirect, and total costs were Rs. 8812, Rs. 4825, and Rs. 13,637, respectively. Extra food and supplements are the major field of expenditure for those enrolled in the public sector. Higher costs were incurred by the private sector patients. Longer distances, a long waiting time, belief systems, and unavailability of facilities or drugs were the common reasons for not visiting the public sector. IDI results also supported the cost heads. The majority of the expenses occurred at the private settings before diagnosis. IDIs suggested to changes in the programmatic approach toward migrants, industrial workers, and women.

Identifying risk factors for recurrent multidrug resistant tuberculosis based on patient’s record data from 2016 to 2021: retrospective study

Globally, the prevalence of multidrug-resistant tuberculosis (MDR-TB) has been increasing recently. This is a major public health concern, as MDR-TB is more difficult to treat and has poorer outcomes compared to drug-sensitive tuberculosis. The main objective of the study was to identify risk factors for recurrent multidrug-resistant tuberculosis, at Alert Specialized Hospital, Addis Ababa, by using different parametric shared frailty models. From January 2016 to December 2021, a retrospective study was conducted on MDR-TB patients at Alert Specialized Hospital in Addis Ababa. The data for the study were collected from the medical records of MDR-TB patients at the hospital during this time period. Gamma and inverse-Gaussian shared frailty models were used to analyze the dataset, with the exponential, Weibull, and lognormal distributions included as baseline hazard functions. The data were analyzed using R statistical software. The median recurrence time of the patients was 12 months, and 149 (34.3%) had recurrences. The clustering effect was statistically significant for multiple drug-resistant tuberculosis patients’ recurrence. According to the Weibull-Inverse-Gaussian model, factors that reduced time to MDR-TB recurrence included lower weight (ɸ = 0.944), smoking (ɸ = 0.045), alcohol use (ɸ = 0.631), hemoptysis (ɸ = 0.041), pneumonia (ɸ = 0.564), previous anti-TB treatment (ɸ = 0.106), rural residence (ɸ = 0.163), and chronic diseases like diabetes (ɸ = 0.442) were associated with faster recurrence. While, higher education (ɸ = 3.525) and age (ɸ = 1.021) extended time to recurrence. For weight increment, smokers and alcohol users, clinical complications of hemoptysis and pneumonia, patients with pulmonary disease who had a history of previous anti-TB treatment, and being rural residents are prognostic factors. There was a significant clustering effect at the Alert Specialized Hospital in Addis Ababa, Ethiopia. The Weibull-Inverse Gaussian Shared Frailty Model was chosen as the best model for predicting the time to recurrence of MDR-TB.

PET/CT guided tuberculosis treatment shortening: a randomized trial.

Six months of chemotherapy using current agents is standard of care for pulmonary, drug-sensitive tuberculosis (TB), even though some are believed to be cured more rapidly and others require longer therapy. Understanding what factors determine the length of treatment required for durable cure in individual patients would allow individualization of treatment durations, provide better clinical tools to determine the of appropriate duration of new regimens, as well as reduce the cost of large Phase III studies to determine the optimal combinations to use in TB control programs. We conducted a randomized clinical trial in South Africa and China that recruited 704 participants with newly diagnosed, drug-sensitive pulmonary tuberculosis and stratified them based on radiographic disease characteristics as assessed by FDG PET/CT scan readers. Participants with less extensive disease (N=273) were randomly assigned to complete therapy after four months or continue receiving treatment for six months. Amongst participants who received four months of therapy, 17 of 141 (12.1%) experienced unfavorable outcomes compared to only 2 of 132 (1.5%) who completed six months of treatment (treatment success 98.4% in B, 86.7% in C (difference -11.7%, 95% CI, -18.2%, -5.3%)). In the non-randomized arm that included participants with more extensive disease, only 8 of 248 (3.2%) experienced unfavorable outcomes. Total cavity volume and total lesion glycolysis at week 16 were significantly associated with risk of unfavorable outcome in the randomized participants. Based on PET/CT scans at TB recurrence, bacteriological relapses (confirmed by whole genome sequencing) predominantly occurred in the same active cavities originally present at baseline. Automated segmentation of the serial PET/CT scans was later performed, and machine-learning was used to classify participants according to their likelihood of relapse, allowing the development of predictive models with good performance based on CT, PET, microbiological and clinical characteristics. These results open the possibility for more efficient studies of future TB treatment regimens.

The Influence of Medication Non-Adherence on the Occurrence of Drug-Resistant Tuberculosis

Drug-resistant tuberculosis (DR-TB) presents a significant challenge to global TB control efforts, with medication non-adherence identified as a major contributing factor. This study aimed to investigate the influence of medication non-adherence on the occurrence of DR-TB in Serang City, Indonesia. Utilizing an observational analytic study with a case-control design, the research included 76 TB patients, comprising 38 DR-TB cases and 38 drug-sensitive TB controls. Data were collected from secondary sources and validated questionnaires and analyzed using univariate and bivariate methods, including Chi-square tests and Odds Ratios (OR). The findings revealed a significant relationship between medication non-adherence and DR-TB, with an OR of 11.56, indicating that non-adherent patients are 11.5 times more likely to develop DR-TB compared to adherent patients. However, demographic factors such as age, occupation, and education did not significantly influence the incidence of DR-TB. The study concludes that medication non-adherence is a critical risk factor for the development of DR-TB, underscoring the need for targeted interventions to improve treatment adherence, particularly through educational campaigns and community-based support. Health authorities are encouraged to implement intensive educational programs focused on the risks of non-adherence and ensure that TB treatment is accessible and supported by community health workers. Policymakers should allocate sufficient resources to these initiatives to effectively reduce the incidence of DR-TB.

Vitamin C Intake and Anti-Tuberculosis Drugs-Induced Hepatitis in Pulmonary Tuberculosis Patients

Introduction: Drug-induced hepatitis (DIH) is one of the serious side effects of anti-tuberculosis drugs (ATD) that can reduce patient compliance with tuberculosis (TB) treatment, increase the risk of treatment failure, or develop drug resistance. Vitamin C is a potential antioxidant known to have a protective effect against DIH. This study examined the relationship between vitamin C intake and the incidence of ATD-induced hepatitis (ATDIH) in pulmonary TB patients at Persahabatan National Respiratory Referral Hospital, Jakarta. Methods: This was a cross-sectional study of 108 patients with drug-sensitive pulmonary TB. Data was collected using a sociodemographic questionnaire, anthropometric measurements, semi-quantitative food frequency questionnaire (SQ FFQ), and data on the subject's liver function laboratory results in the last 1 month. Fisher exact test was utilized to analyze the association between adequacy of vitamin C intake and DIH. Results: The proportion of DIH in pulmonary TB patients in this study was 6.5%. Most subjects were males (54.6%) with a median age of 41. The median vitamin C intake was 66.65 mg/day, with 63.0% of patients having an intake below the recommendation. Fisher's exact test showed that vitamin C intake was not statistically significantly associated with the incidence of ATDIH (OR 3.77 95% CI 0.44-32.55, p-value 0.256). No factors also influenced the incidence of ATDIH in this study. Conclusion: No association was found between vitamin C intake and other factors related to the incidence of ATDIH. This is the first study in Indonesia to link vitamin C and E intake with the incidence of DIH in drug-sensitive pulmonary TB patients, providing information for future studies.

Characteristics of Drug Sensitive Pulmonary Tuberculosis Patients in Primary Health Center Laubaleng During Covid-19

Characteristics of Drug Sensitive Pulmonary Tuberculosis Patients in Primary Health Center Laubaleng During Covid-19

Treatment Outcomes of Tuberculosis Among Artisanal and Small-Scale Miners in Zimbabwe: A Follow-Up Observational Study Using Secondary Data.

In Zimbabwe, artisanal and small-scale miners (ASMs) are a key vulnerable group with high risk for tuberculosis (TB), HIV, and silicosis. The main purpose of this study was to investigate treatment outcomes of TB among ASMs. We conducted a follow-up observational study using secondary data. We analyzed data from 208 ASMs treated for TB at two occupational health clinics. We found a high treatment success rate of 87%, comparable to the national average for drug-sensitive TB. Unsuccessful outcomes were due to death (5%) and loss to follow-up (7%). Over a quarter of ASMs had unknown HIV status. Our study is the first to document treatment outcomes of TB among ASMs in Zimbabwe. Encouragingly, this study demonstrates the possibility of achieving good TB treatment outcomes even among highly mobile populations like ASMs. Further research is needed to analyze leakages across the whole TB patient pathway among ASMs. Additionally, addressing the high rate of unknown HIV statuses among ASMs is crucial to further improve overall TB treatment outcomes in this population.

Dynamic changes of respiratory microbiota associated with treatment outcome in drug-sensitive and drug-resistant pulmonary tuberculosis

BackgroundRespiratory microbiota is closely related to tuberculosis (TB) initiation and progression. However, the dynamic changes of respiratory microbiota during treatment and its association with TB progression remains unclear.MethodsA total of 16 healthy individuals and 16 TB patients (10 drug-sensitive TB (DS-TB) and 6 drug-resistant TB (DR-TB)) were recruited. Sputum samples were collected at baseline for all anticipants and after anti-TB treatment at Month-6 for TB patients. High throughput 16 S RNA sequencing was used to characterize the respiratory microbiota composition.ResultsCompared to the healthy individuals, TB patients exhibited lower respiratory microbiota diversity (p < 0.05). This disruption was alleviated after anti-TB treatment, especially for DS-TB patients. Parvimonas spp. numbers significantly increased after six months of anti-TB treatment in both DS-TB and DR-TB patients (p < 0.05). Rothia spp. increase during treatment was associated with longer sputum-culture conversion time and worse pulmonary lesion absorption (p < 0.05). Besides, Moraxella spp. prevalence was associated with longer sputum-culture conversion time, while Gemella spp. increase was associated with worsening resolving of pulmonary lesions (p < 0.05).ConclusionDynamic changes of respiratory microbiota during anti-TB treatment is closely related to TB progression. The involvement of critical microorganisms, such as Parvimonas spp., Rothia spp., Moraxella, and Gemella spp., appears to be associated with pulmonary inflammatory conditions, particularly among DR-TB. These microorganisms could potentially serve as biomarkers or even as targets for therapeutic intervention to enhance the prognosis of tuberculosis patients.