Extrapulmonary Tuberculosis Patients Research Articles

Factors associated with the delay in diagnosis of extrapulmonary tuberculosis at the patient and health system level: A study from a rural setting in India.

With the proportion of tuberculosis cases that are extrapulmonary tuberculosis (EPTB) increasing in recent years, understanding and addressing factors contributing to the prolonged time to diagnosis (TTD) of EPTB patients is vital. We enrolled presumptive EPTB patients for a cohort study from 2018-2020 in Ujjain, India. Based on a structured questionnaire, the patients were interviewed for socio-demographic and clinical information, including previously visited health facilities (HF) for this illness. We analysed patients' TTD, healthcare access, and referral pathways. EPTB (54%) and non-TB (58%) patients visited dispensaries during their first visit to a formal HF. Patients visited multiple HFs, including dispensaries (54%) and regional hospitals (32%), during 1-4 visits but did not receive an appropriate diagnosis. Less than 2% of the patients accessed private HFs. Most of the adult EPTB (83%) and non-TB (76%) patients were self-referred to our study site, where they were diagnosed. Our statistical models highlighted low-middle income groups, longer distances and longer travel time to HFs, and potentially less-empowered occupations as housewives with a prolonged TTD. Patients with a longer wait, including travel time, had a shorter TTD. We found individual, societal-level, and structural barriers to healthcare access and utilisation and their association with diagnostic delay among adult and paediatric EPTB patients.

Five-Year Incidence Rate of Tuberculosis Disease Among Household Contacts of Extrapulmonary Tuberculosis Patients In South-West Karnataka – A Retrospective Cohort Study

Five-Year Incidence Rate of Tuberculosis Disease Among Household Contacts of Extrapulmonary Tuberculosis Patients In South-West Karnataka – A Retrospective Cohort Study

Examining Tuberculosis Cases Using Sputum Testing Across Two Tehsils of District Okara, Punjab, Pakistan (2019-2023)

Tuberculosis (TB) is an age-old ailment that continues to provide a significant obstacle in both emerging and developed nations in the present era. Each year, millions of individuals get tuberculosis and millions of lives are lost as a result. This research aimed to assess the frequency of pulmonary and extra-pulmonary tuberculosis cases with positive sputum smear among individuals suspected of having TB. The study was conducted from January 2019 to June 2023 in two tehsils of Okara district, Pakistan. A total of 2079 cases were recorded at THQ hospital Depalpur, with 91.10% being pulmonary tuberculosis patients 8.90% being extrapulmonary tuberculosis patients. At DHQ hospital Okara, a total of 1090 cases were registered, with 80.46% being pulmonary tuberculosis patients and 19.54% being extrapulmonary tuberculosis patients. 650 patients (31.26%) in THQ Hospital Depalpur and 315 cases (28.90%) in DHQ Hospital Okara tested positive for AFB. The disease burden in females was 53.10%, while in males it was 46.90% for TB diagnosis at THQ Hospital Depalpur. At DHQ Hospital Okara, 63.66% of cases were detected in females and 36.34% in males. The age group with the highest frequency was 46-60 years, with a documented rate of 39.50% at THQ Hospital Depalpur. DHQ Hospital Okara had a lower prevalence rate of 32.57%. The present investigation also observed a significant disease burden among individuals aged 46-60 years. The research sheds light on the demographics and clinical symptoms of tuberculosis patients. More research is required to understand the considerable differences reported in particular risk variables and problems associated with tuberculosis management.

Phenotypic drug resistance and genetic mutations linked to resistance among extrapulmonary tuberculosis patients in Ethiopia: Insights from Whole Genome Sequencing.

Globally, drug-resistant tuberculosis (DR-TB) is responsible for 13% of mortality attributable to antimicrobial resistance. In Ethiopia, extrapulmonary tuberculosis (EPTB) is a significant public health challenge, and drug resistance (DR) in EPTB is often overlooked. In a cross-sectional study conducted between August 2022 and October 2023, we aimed to explore the magnitude of phenotypic drug resistance and identify genetic mutations linked to resistance using 189 Mycobacterium tuberculosis (MTB) isolates cultured from extrapulmonary clinical specimens. Additionally, we assessed the agreement of the phenotypic and whole genome sequencing (WGS) based genotypic drug resistance detection. We performed phenotypic drug sensitivity testing (pDST) using liquid culture BD BACTECTM MGITTM 960 system and WGS using Illumina NextSeq500/550. The genomic data analysis pipelines MTBSeq and TBProfiler were used to predict drug resistance-conferring mutations. The agreement between the pDST and WGS was analyzed using SPSS version 29.0 software. Our result demonstrated phenotypic resistance to at least one anti-TB drug was detected in 16.9% (32/189) of the study participants. Isoniazid-resistant rifampicin-susceptible-TB (Hr-TB) and multi-drug-resistant TB (MDR-TB) phenotypes accounted for 2.6% (5/189) and 4.2% (8/189) respectively. Prevalence of MDR-TB was 2.4% (4/170) among newly diagnosed and 21.1% (4/19) among previously treated cases. WGS identified more (14/160, 8.75%) rifampicin-resistant genotypes (RR-TB) compared to pDST (8/189, 4.2%). We have identified a putative compensatory mutation for rifampicin (rpoBSer450Leu, rpoCAsp747Ala) for the first time from an EPTB clinical specimen in Ethiopia. Overall, there was a 3.75% rifampicin mono-resistant-TB(RMR-TB) genotype, which remains undetected using the conventional pDST and represented 42.9% (6/14) of the identified RR-TB genotypes. Mutations conferring rifampicin resistance-interim (rpoB.Ser450Ala) represented the majority (83.3%) of RMR-TB. Changes in ethA genes associated with ethionamide resistance were the most common resistance (n=7, 87.5%) in MDR-TB cases. There was a strong agreement between the pDST and WGS-TB Profiler pipeline to detect RR-TB (kappa=0.8) compared to the MTBSeq pipeline (k=0.58). In conclusion, MDR-TB, Hr-TB, and interim-RMR-TB are equally important public health challenges in the realm of EPTB in Ethiopia. The role of WGS is tremendous in detecting borderline/interim RMR-TB, which will help for tailored, personalized treatment strategies.

Health-related quality of life among extrapulmonary tuberculosis patients and inequalities by disease manifestations: a longitudinal study analysing the impact of TB treatment.

To understand the impact of extrapulmonary tuberculosis (EPTB) and its treatment on quality of life, we analysed patient-reported outcome measures (PROMs) among presumptive ETPB patients. EuroQol's five-dimensional three-level (EQ-5D-3L) questionnaire and the Visual Analogue Scale (EQ-VAS) were used to measure PROMs by 274 presumptive EPTB patients at pre- and post-treatment stages. The patients were categorised as TB and non-TB by using a composite reference standard. Following the EuroQol suggested analysis methods, we calculated the health utility summary measure at the pre- and post-treatment stages. The health state density curve and index were used to analyse inequality in reported health profiles. We investigated factors associated with EPTB patients' health utility through multivariable regression at the pre-treatment stage. The analysis of PROMs showed both physical (mobility, self-care, usual activities) and psychological (pain, discomfort, anxiety & depression) health affected by all EPTB manifestations (lymphadenitis, pleuritis, meningitis and others). Moreover, we found inequality in reported health profiles across disease manifestations at pre- and post-treatment stages. Post-treatment, we found improvement in PROMs and no reports of extreme-level health problems. However, some problems persisted across all dimensions of EPTB manifestations. We found 100% improvement in pleuritis and meningitis manifestations. Socioeconomic status, type of health facility attended, and patients' working capacity were associated with health utility. Despite post-treatment improvement in health, inequality of reported health states by EPTB manifestations persisted, though decreased. This highlights that holistic patient- and health system-level interventions addressing the impact of illness should consider EPTB by its manifestations, not as a single disease entity.

Plasma ferritin, C-reactive protein, and adenosine deaminase levels in tuberculous lymphadenitis and pleuritis and their role in monitoring treatment response

BackgroundWe aimed to assess the plasma levels of ferritin, C-reactive protein (CRP), and adenosine deaminase (ADA) at baseline and their utility as biomarkers to monitor response to treatment in extrapulmonary tuberculosis (EPTB) patients.MethodsProspective measurements of ferritin, CRP, and ADA were done in unstimulated plasma samples of 92 EPTB (49 TB lymphadenitis and 43 TB pleuritis) patients registered for anti-TB treatment. Blood samples were taken at the start, 2, and 6 months of treatment, plasma levels of ferritin and CRP were measured by the enzyme-linked immunosorbent assay and ADA levels by kinetic chemistry method at each time point. Data was analyzed using SPSS version 22. Non-parametric tests were used for paired analysis and two groups’ comparison. Spearman’s rank test was used for correlation analysis. A Chi-square test was used for categorical variables. A p-value < 0.05 was considered statistically significant.ResultsBefore the start of treatment, plasma levels of ferritin were raised in 13% and 45%, CRP in 21% and 64%, and ADA in 70% and 60% of TB lymphadenitis and pleuritis cases respectively. Levels of all three biomarkers with raised values at baseline decreased significantly with treatment at both 2 and 6 months in all patients. [Ferritin (2 months p = 0.001, 6 months p < 0.001), CRP (2 months p < 0.001, 6 months p < 0.001), ADA (2 months p = 0.039, 6 months p < 0.004)]. Plasma levels of ferritin (median 300 ng/ml range = 145–758 ng/ml) and CRP (median 11.73 mg/L, range = 10.45–17.84 mg/L) were significantly higher in TB pleuritis patients, while the levels of ADA were not significantly different among the two groups. Biosignatures generated by different combinations showed that a combination of all three biomarkers could predict treatment response in 83% and 100% of all patients at 2 and 6 months of treatment respectively.ConclusionA combination of serum ferritin, CRP, and ADA shows a promising role in monitoring response to treatment in TB lymphadenitis and TB pleuritis patients. Similar studies in larger cohorts are needed to establish a definite role of these biomarkers in EPTB patients.

Diagnostic Delay, Expenditure Pattern and Treatment Outcome of Extra-Pulmonary TB Patients of Bangalore Urban District - A Mixed Method Study

Diagnostic Delay, Expenditure Pattern and Treatment Outcome of Extra-Pulmonary TB Patients of Bangalore Urban District - A Mixed Method Study

Diagnostic accuracy of truenat MTB plus for the detection of pulmonary and extrapulmonary tuberculosis

BackgroundThe diagnosis of Tuberculosis (TB) has been a challenge till the advent of rapid molecular diagnostic tests. The traditional diagnostic tests have its own limitations with regard to its performance or the turnaround time. Truenat MTB Plus assay, a battery-operated molecular assay developed in India has been introduced for its use in pulmonary TB (PTB). However, the diagnostic accuracy of the assay is not well studied in comparison with Mycobacterial culture, especially for extrapulmonary TB (EPTB). AimWe aimed at evaluating the diagnostic accuracy of Truenat MTB Plus assay for both PTB and EPTB comparing with culture for adult population. MethodsThe specimens from presumptive PTB and EPTB patients were processed for Truenat MTB Plus assay, solid or liquid culture and AFB staining. The electronic data of all the specimen reports collected retrospectively were analysed for the sensitivity and specificity. ResultsOut of the 736 samples which had valid culture reports, 364 (49.4 %) were respiratory and 372 (50.6 %) were extrapulmonary specimens. The test positivity rate for smear microscopy, Truenat MTB Plus assay and culture was 3.7 % (27), 8.2 % (60), 7.1 % (52) respectively. Of the 60 Truenat MTB Plus positive patients with TB, 33 (55 %) were PTB and 27 (45 %) were EPTB. We estimated overall sensitivity and specificity of Truenat MTB Plus as 90 % (95 % CI: 73.4–97.8) and 98. 2 (95 % CI:96–99.3) respectively for the detection of PTB. The overall sensitivity and specificity for EPTB was 81.8 % (95 % CI: 59.7–94.8) and 97.4 % (95 % CI: 95.1–98.8) respectively. ConclusionsTruenat MTB Plus assay has comparable diagnostic accuracy with other molecular assays. The Truenat MTB Plus assay can be used for the diagnosis of PTB and EPTB, especially in resource limited settings.

Factors associated with hospitalization and mortality in adult and pediatric extrapulmonary tuberculosis at a tertiary care hospital in Central India

Background Comorbidities complicate the management of tuberculosis (TB) and have become an essential part of the end TB strategy to eradicate TB. However, pulmonary TB has received the most attention, and little is known about the impact of comorbidities and other factors on outcomes in patients with extrapulmonary tuberculosis (EPTB). Objectives Our aim was to analyze the factors associated with hospitalization and mortality in EPTB at a hospital in Central India, using non-TB patients with similar clinical presentations as a comparison. Methods Patients with presumptive EPTB were prospectively enrolled and followed up until the end of treatment or for at least 6 months. Detailed demographic and clinical information was collected for all participants, and patients were categorized as TB or non-TB using a composite reference standard. Multivariate logistic regression was used to analyze the impact of various clinical findings and risk factors on hospitalization and mortality. Results A total of 276 patients were categorized as TB cases and 175 as non-TB cases. Factors associated with hospitalization in children were younger age and non-adenitis site of disease. In adults, factors associated with mortality were older age, non-adenitis site of disease and HIV infection regardless of TB diagnosis, while diabetes mellitus increased the odds of mortality in EPTB patients. Conclusion Our results show that comorbidities increase the odds of death in both TB and non-TB patients in low-resource settings. This argues for a shift away from the traditional vertical management of diseases in these areas and supports a continued focus on building robust healthcare systems.

Role of GeneXpert in the diagnosis of extrapulmonary tuberculosis.

The World Health Organization endorsed the cartridge-based nucleic acid amplification test Xpert MTB/RIF (GXP) for the diagnosis of tuberculosis (TB). Studies about GXP efficiency in extrapulmonary TB (EPTB) are scarce. Hence, we decided to study the role of GXP in EPTB. This prospective observational study, conducted in the pulmonary medicine department of a tertiary care hospital after ethics committee permission, recruited 200 EPTB patients. The diagnosis of TB was achieved with the help of clinico-radiological correlation with microbiological test positivity. Acid-fast bacilli (AFB) culture was treated as the comparative gold standard. Patients who had no or incomplete data were excluded from the study. Data was analyzed to calculate the sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of TB and the detection of rifampicin resistance. The majority of cases were women (126 patients: 63%). The mean age was 23.71 years. On GXP, 130 (65%) had detected mycobacterium tuberculosis (MTB), and 70 (35%) did not. Adding AFB culture data, 168 (81.5%) showed microbiological evidence of TB, and 32 (18.5%) were negative. On the drug susceptibility test, 131 cases were rifampicin-sensitive, 32 were rifampicin-resistant TB, and in 5 cases, data was unavailable. The most common extrapulmonary site of involvement was the lymph node, with 94 patients (47%). The most common lymph node involved was the cervical lymph node, with 70 patients (74.5%). The sensitivity, specificity, positive predictive value, and negative predictive value of GXP in EPTB collectively were 76.68%, 86.48%, 96%, and 45.7%, respectively. GXP is useful for the rapid detection of EPTB and the identification of rifampicin resistance, especially in a high-prevalence country like India.

Analysis of epidemiological characteristics of extrapulmonary tuberculosis from South-Central China.

This study aimed to investigate the epidemiological and drug resistance (DR) characteristics of extrapulmonary tuberculosis (EPTB) in South-Central China. EPTB inpatients who were culture-positive for Mycobacterium tuberculosis were retrospectively included in a study at a provincial TB hospital in Hunan, a province in South-Central China, from January 2013 to December 2021. Demographic, clinical, and drug susceptibility data were retrieved from TB treatment records. Descriptive statistical methods and a Chi-squared test were used to analyze the epidemiological and DR characteristics of EPTB patients. A logistic regression model was used to explore the risk factors of rifampicin-resistant/multidrug-resistant (RR/MDR)-EPTB. A total of 1,324 cases were included. The majority of EPTB patients were in the age range of 20-29 years, were predominantly men (male-to-female ratio: 2.03), and were farmers (65.63%). Most EPTB cases were found in 2013 and 2017 from 2013 to 2021. The most prevalent subtypes of EPTB were lymphatic TB (29.83%, 395/1,324), multiple EPTB (20.85%, 276/1,324), and musculoskeletal TB (14.65%, 194/1,324). Musculoskeletal TB and genitourinary TB predominantly presented as exclusive EPTB forms, while lymphatic TB and pharyngeal/laryngeal TB often co-occurred with pulmonary TB (PTB). Drug susceptibility testing results showed that total DR rates (resistance to any of RFP, isoniazid [INH], streptomycin [STR], and/or ethambutol [EMB]) and RR/MDR rates in EPTB were 25.23% and 12.39%, respectively. Musculoskeletal TB exhibited the highest rates of total DR (31.40%), INH resistance (28.90%), STR resistance (20.10%), EMB resistance (6.20%), MDR (13.90%), and poly-DR (6.70%). The multivariable logistic regression model showed that patients aged from 20 to 59 years (compared to those aged 10 years), workers (compared to retirees), and EPTB patients from the south and west of Hunan (compared to those from the east of Hunan) were at an increased risk of developing RR/MDR EPTB (all OR values > 1). Our study provided a detailed account of the epidemiological and DR characteristics of EPTB in Hunan province, China. The significant DR rates, particularly in musculoskeletal TB cases, highlight the need for timely diagnosis, effective drug susceptibility testing, and the development of more effective treatment regimens for EPTB, especially targeting musculoskeletal TB treatments.

Prevalence of vitamin D deficiency and the effect of vitamin D3 supplementation on response to anti-tuberculosis therapy in patients with extrapulmonary tuberculosis

BackgroundWe aimed to assess serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations in extrapulmonary tuberculosis (EPTB) patients and to evaluate the effect of vitamin D3 supplementation on their treatment course.MethodsSerum 25(OH)D3concentrations were measured in 47 newly diagnosed EPTB patients and 42 controls. Vitamin D-deficient EPTB patients were randomly assigned to receive 50,000 IU of vitamin D3 (cholecalciferol) orally once a week for 6 weeks (total 300,000 IU), followed by maintenance doses of 1000 IU a day besides anti-TB drugs or the first line anti-TB treatment only. Follow up serum 25(OH)D3 concentrations were measured after 3 months of starting vitamin D3 supplementation. Both groups were evaluated for clinical, laboratory, and radiological outcomes after treatment.ResultsSerum 25(OH)D3 concentrations were significantly lower among TB cases (17.1 ± 5.5 nmol/L) compared to healthy controls (51.8 ± 27.3 nmol/L), and vitamin D deficiency was observed in all EPTB patients (n = 47). Patients in VD3 supplementation group had significantly higher weight gain and serum albumin level at 2 months and end of treatment, higher hemoglobin concentration at the end of treatment, significantly lower CRP and ESR at 2 months and at the end of treatment. In cases with TB pleurisy, a significant higher rate of full resolution of pleural fluid after 6 months of anti-TB treatment and shorter treatment duration were noted compared to the other group.ConclusionsVitamin D deficiency is prevalent in EPTB patients, in whom, vitamin D supplementation is a useful adjunctive therapy to anti-TB drugs and improves treatment course.

Isoniazid-Induced Cerebellitis in a Chronic Kidney Disease Patient

Abstract The bacterial disease tuberculosis (TB), when it affects organs of the body other than the lungs, is called extrapulmonary TB. The treatment regimen includes the drugs isoniazid, rifampicin, pyrazinamide, and ethambutol, of which isoniazid is known to be the most active drug. Adverse drug reactions commonly include immunological as well as drug toxicity effects, with the latter being particularly important in renally impaired patients because of high risk of drug accumulation. Cerebellitis, which is an inflammatory condition that results in cerebellar dysfunction, is a rare complication of isoniazid use. Diagnosis is made after excluding all other possibilities. In the case described here, the extrapulmonary TB patient was a known case of chronic kidney disease (G4). He presented with slurred speech and sedation; magnetic resonance imaging scan showed bilateral fluid-attenuated inversion recovery hyperintensities in the dentate nuclei, indicative of cerebellitis. Dramatic improvement was seen upon replacing Isoniazid with levofloxacin and administration of antioxidants and pyridoxine supplements, which confirmed the diagnosis of isoniazid-induced cerebellitis.

Mortality among extrapulmonary tuberculosis patients in the HIV endemic setting: lessons from a tertiary level hospital in Mbeya, Tanzania

Extrapulmonary tuberculosis (EPTB) has received less attention than pulmonary tuberculosis due to its non-contagious nature. EPTB can affect any organ and is more prevalent in people living with HIV. Low- and middle-income countries are now facing the double burden of non-communicable diseases (NCDs) and HIV, complicating the management of patients with symptoms that could be compatible with both EPTB and NCDs. Little is known about the risk of death of patients presenting with symptoms compatible with EPTB. We included patients with a clinical suspicion of EPTB from a tertiary level hospital in Mbeya, Tanzania, to assess their risk of dying. A total of 113 (61%) patients were classified as having EPTB, and 72 (39%) as having non-TB, with corresponding mortality rates of 40% and 41%. Associated factors for mortality in the TB groups was hospitalization and male sex. Risk factors for hospitalization was having disease manifestation at any site other than lymph nodes, and comorbidities. Our results imply that NCDs serve as significant comorbidities amplifying the mortality risk in EPTB. To strive towards universal health coverage, focus should be on building robust health systems that can tackle both infectious diseases, such as EPTB, and NCDs.

Extra-pulmonary tuberculosis frequency and the risk factors influence (case of the PHE-Batna regional unit) (2017-2022)

Context: Tuberculosis is an infectious disease that is endemic in developing countries. The causal agent is Mycobacterium tuberculosis. Extra-pulmonary tuberculosis (EPTB) is receiving renewed attention due to an unexplained increase in its relative frequency. The aim of this study was to carry out a retrospective descriptive survey to assess the frequency of extra-pulmonary tuberculosis in an eastern Algeria population range. Methods: this study took place at the regional tuberculosis Batna’s Public hospitalian establishment unit; over a period of 64 months (2017-2022). 2405 files were studied through the collection of information recorded at laboratory level. Results: Out of 2405 samples, 102 were positive (4.24%). There was a clear predominance of females (64.70%) and males (35.29%), giving a sex ratio of 1.8. The age group most affected was 11 to 49. Pus was the most common specimen with a percentage of 44.12%, followed by urine (28.43%), CSF (14.70%). The incidence of extra pulmonary tuberculosis in patients in Batna’s Department and neighbouring Departments is 4.24%, with adult women being the most affected. Conclusion: Extrapulmonary tuberculosis is common and should not be neglected; it is no longer a pathology of the past but still remains relevant today.

Dynamics of Matricellular Protein Levels in Blood Predict Recovery in Patients with Human Immunodeficiency Virus-Tuberculosis Coinfection.

Chronic immune activation in tuberculosis (TB) associated with human immunodeficiency virus (HIV) infection (HIV/TB) modifies their clinical course. We prospectively measured osteopontin (OPN), full-length galectin-9 (FL-Gal9), and total-Gal9 (T-Gal9) levels in 32 patients with HIV/TB coinfection treated with anti-tuberculosis and antiretroviral therapies over 6-18 months to determine the amelioration of inflammatory conditions in response to the therapies. We observed a significant time-dependent decrease in FL-Gal9 in both pulmonary TB (PTB, n = 20) and extrapulmonary TB (EPTB, n = 12) patients. The levels of T-Gal9, OPN, and CRP decreased significantly after treatment in only PTB patients. We calculated the inflammatory score (INS) indicating immunologic recovery based on the decline in OPN, FL-Gal9, T-Gal9, and CRP levels. Baseline levels of T-Gal9 and OPN positively correlated with INS in all TB and only PTB patients, respectively, indicating that their levels predict better recovery. In contrast, FL-Gal9 levels at the second visit negatively correlated with INS in EPTB patients. The decrease rate in OPN levels at the second visit also correlated positively with INS in PTB patients. Women showed a higher INS and lower levels of FL-Gal9 than men. The patients with moderate grade severity on chest X-ray had higher CD4 cell numbers than those with limited grade severity. Monitoring these markers will help to predict and assess the response to therapy as well as to devise strategies to reduce the complications caused by chronic immune activation in patients with HIV/TB coinfection.

Change in psychological parameters and quality of life among individuals with pulmonary and extrapulmonary tuberculosis following the intensive phase of therapy: A longitudinal observational study from central India

BackgroundTuberculosis (TB) is a global health concern, impacting millions annually, with limited attention to the psychological distress it inflicts. Psychological comorbidities, such as depression, anxiety, and stress, significantly affect the quality of life (QoL) of TB patients. Available literature on this topic is restricted to the pulmonary TB (PTB) patients; while psychological issues of the extrapulmonary TB (EPTB) patients who comprise a significant proportion of this disease entity remains unexplored. Additionally, the impact of anti-TB treatment on psychological parameters has received limited attention and vice-versa. This study aimed to assess depression, anxiety, stress, and QoL of TB patients at diagnosis and to understand how these parameters change after the intensive phase of treatment. MethodsA longitudinal observational study involving 40 TB patients (31 EPTB and 9 TB) was conducted to assess depression, anxiety, stress and QoL among them. Participants were followed up after the intensive treatment phase. ResultsAt baseline, 32.5% (n = 13) and 65% (n = 26) participants experienced moderate-severe depression, and moderate-severe anxiety, and stress, respectively. QoL was notably compromised, especially in the psychological domain. Post-intensive treatment, anxiety and depression showed significant improvement (Z = −2.271, p = 0.023 and Z = −2.093, p = 0.036), but QoL and stress levels remained largely unchanged (p > 0.05). ConclusionThis study highlights the high prevalence of psychological distress and poor QoL among TB patients. Following intensive phase of therapy, severity of depression and anxiety reduced significantly; however, change in stress-level and QoL was non-significant. Although study is limited by in terms for small sample size, the need of holistic, multidisciplinary treatment approach (including mental health professionals) for such patients can't be overemphasized. Implementing baseline psychological screenings and providing mental health support if required, are critical to improve the overall health and QoL of these individuals.

Concomitant bedaquiline and delamanid therapy in patients with drug-resistant extra-pulmonary tuberculosis in Mumbai, India

BackgroundWorld Health Organization suggests concurrent bedaquiline-delamanid (BDQ-DLM) as part of individualised regimens for eligible patients with pulmonary drug-resistant tuberculosis (DR-TB); however, data for patients with drug-resistant extrapulmonary tuberculosis (EPTB) is extremely limited. This study documents the treatment outcomes and adverse events associated with concurrent BDQ-DLM-based regimens in patients with drug-resistant EPTB at a Médecins Sans Frontières clinic in Mumbai, India. MethodsRetrospective cohort study based on routinely collected programmatic data. Individualised regimens were based on drug-susceptibility testing and previous drug exposure. Drug-resistant EPTB patients initiated on regimens containing concurrent BDQ and DLM from April 2016 to October 2019 were included.Patients who completed treatment were followed up at 12 months. ResultsOf 17 patients, median age was 23 years (IQR = 21–30 years) and 12/17 (71 %) were female. Pre-extensively drug-resistant tuberculosis and extensively drug-resistant TB was reported in 13/17 (76.4 %) and 2/17 (11.7 %) patients respectively. Microbiological reports were unavailable for two patients with central nervous system TB. Lymph node TB was the commonest form of EPTB in 9/17 (53 %) of patients. Median duration of treatment was 18.9 months. At least one grade three or four severe adverse event (SAE) was reported by 13/17 (76.4 %) patients. Thirteen (76.4 %) patients had favourable outcomes. None of the patients relapsed or died in the one-year period of post-treatment follow-up. ConclusionConcurrent BDQ-DLM-based regimens in drug-resistant EPTB were effective and associated with manageable adverse events.

Frequency and Structure of Drug Resistance of M. tuberculosis in Pulmonary and Extrapulmonary Tuberculosis

The objective: to assess changes in the data on drug resistance of M. tuberculosis for 2015-2021 and compare it with data for 2012-2014.Subjects and Methods. Using continuous sampling, the frequency of drug resistance of Mycobacterium tuberculosis (MTB DR) was studied in isolates from 151 pulmonary tuberculosis (PTB) patients and isolates from 805 extrapulmonary tuberculosis (EPTB) patients, who were treated at the clinic of St. Petersburg Research Institute of Phthisiopulmonology in 2015-2021. The results were compared with similar data for 2012-2014 which was published in 2016.Results. In 2015-2021 versus 2012-2014, the overall frequency of MTB DR decreased by 4.2% in pulmonary tuberculosis patients (from 90.1 to 85.9%) and by 2.9% in extrapulmonary tuberculosis patients (from 80.2 to 77.4%). The structure of MTB DR in pulmonary tuberculosis changed insignificantly, the frequency of MDR decreased from 42.5 to 36.5%, and XDR (as per the definitions before 2022) remained the same – 39.5%. In extrapulmonary tuberculosis, the structure of MTB DR deteriorated due to lower frequency of MDR (from 66.3 to 48.3%) and higher frequency of XDR (from 3.2 to 19.0%, p&lt;0.01).

Clinical manifestations and prognosis of tuberculous spondylitis in an adolescent with disseminated tuberculosis: a case report

Indonesia is one of the countries with the highest number of tuberculosis (TB) cases globally. Around 10-20% of adolescents with TB infection progress to pulmonary TB, and less than 0.5% develop miliary or central nervous system TB. TB spondylitis occurs in only 5.6% of extrapulmonary TB patients. The clinical manifestations of disseminated and TB spondylitis are heterogeneous and insidious, with several potential risk- and prognostic factors. We report the case of a 16-year-old male admitted with abdominal distension, paraplegia, and urinary retention. He was diagnosed with disseminated TB with TB spondylitis. This case was unique because the patient had no classic symptoms of pulmonary TB. This report focuses on the diagnosis, comprehensive management, and prognosis of TB spondylitis, as well as the risk factors for disseminated TB. The management consisted of antituberculous agents and surgery. The prognosis is influenced by the patient’s age, severity of kyphosis deformity, number of vertebrae involved, lesion site, and patient’s health status, including nutritional status.