Family History Of Tuberculosis Research Articles

Child with Rifampicin‑Resistant Tuberculous Meningitis: A Case Report

Background: Tuberculosis remains a significant global health concern, with increasing incidence of drug-resistant strains posing challenges to effective treatment. We present a case of rifampicin-resistant tuberculous meningitis in an immunocompetent child, highlighting the severity and complexity of tuberculosis in pediatric populations. Case report: An 11-year-old child with a family history of tuberculosis was hospitalized for febrile meningeal syndrome. Symptoms included progressively developing headaches, vomiting, food refusal, and right hemiparesis over 10 days. Upon admission, the patient was conscious with a fever of 38.2°C and a stiff neck. Biological analyses revealed neutrophil-predominant hyperleukocytosis, lymphopenia, and hyponatremia. Cerebrospinal fluid analysis showed a predominance of lymphocytes and hypoglycorrhachia. The Xpert MTB/RIF ultra test confirmed tuberculous meningitis with detection of the rifampicin resistance gene. Imaging revealed active hydrocephalus. Second-line treatment was initiated, involving multiple medications over 24 months. This observation underscores the complexity of tuberculous meningitis in children, necessitating an individualized therapeutic approach. Conclusion: Drug-resistant tuberculous meningitis in children represents a complex and devastating medical challenge. Progress in diagnosis, while significant, underlines the need for a nuanced approach and ongoing research to improve screening tools.

Diabetes Mellitus as a Risk Factor for Tuberculosis: A Community Based Case Control Study.

Prevention of diabetes in the general population can help reduce the incidence of tuberculosis. Hence it is necessary to document that diabetes is strongly associated with tuberculosis as a risk factor. To study if diabetes is associated with tuberculosis compared to controls. A community based case-control study was carried out. 215 newly diagnosed cases of tuberculosis on treatment for not more than three months were selected randomly from the randomly selected tuberculosis unit. 215 neighbourhood controls were selected. They were matched for the age group of ± 10 years and sex. Fasting blood sugar (FBS) was estimated using a glucometer. Tobacco chewing, residence and family history of TB were significantly more in cases (P < 0.05). Mean BMI was significantly lower in cases compared to controls. The proportion of TB cases among the known cases of diabetes was 67% compared to 33% in controls, which was statistically significant. Mean FBS was significantly higher in cases compared to controls (P < 0.05). The odds of cases being diabetic was 2.456 times more than those of controls. On binary logistic regression, diabetes was an independent risk factor for tuberculosis. Other independent risk factors were tobacco chewing, and family history of TB. Family history of tuberculosis, and tobacco chewing were positively associated with tuberculosis whereas body mass index was negatively associated with tuberculosis. Diabetes was significantly associated with tuberculosis.

Knowledge and Practices of Airborne Infection Control at the Household Level among Pulmonary Tuberculosis Patients Attending a Tertiary Care Teaching Hospital in Central Karnataka, India

Abstract Background: Airborne transmission of tuberculosis (TB) is a major route of spread. Household contacts of TB patients are at high risk of infection. However, there is limited evidence on airborne infection control knowledge and practices among TB patients in India. This study was done to assess the knowledge and practices related to airborne infection control among pulmonary TB (PTB) patients at the household level and determine associated factors. Subjects and Methods: A cross-sectional study was conducted among 157 smear-positive PTB patients at a tertiary care hospital in Karnataka, India, using a pretested questionnaire. Knowledge and self-reported practices regarding airborne precautions were assessed. Bivariate analysis was done to determine associated factors. P &lt;0.005 was considered significant. Results: Major gaps were found in knowledge about ventilation (50.3%), avoiding visitors (39.5%), and sputum disposal (33.8%). Suboptimal practices were reported for using tissues (19%), handwashing (25%), ventilation (66%), sputum handling (54%), and waste disposal (30%). Good knowledge was associated with younger age, higher education, Hindu religion, family history of TB, intensive phase treatment, and presence of symptoms (P &lt; 0.05). Participants with good knowledge had significantly better preventive practices (P &lt; 0.00001). Conclusion: Tailored education on airborne precautions focusing on identified knowledge gaps and risky practices can help improve the adoption of infection control measures among TB patients at the household level. A multifaceted approach is required to translate improved awareness into optimal preventive behaviors.

IJCM_275A: Implementation of WHO recommended 4-Symptom Screening Tool for tuberculosis in Northern India

Background: World Health Organization (WHO) suggests using symptom- based screening tools to improve early detection of tuberculosis (TB). The WHO recommended 4-symptom screening (W4SS) is one such tool. Although, found to be effective in screening TB among HIV patients, its implementation among general patients have not been well-studied. Objectives: To assess the predictive value of W4SS in TB screening among outpatients and inpatients in North India. Methodology: A prospective cohort study starting July 1, 2023 included patients in the outdoor or indoor of any department (except Chest TB). Patients were screened with W4SS (cough &gt; 2 weeks, fever &gt; 2 weeks, significant weight loss, night sweats). A presumptive TB case (presence of any one symptom), was further examined by the Chest TB consultant, completing the diagnostic algorithm as per National Tuberculosis Elimination Program guidelines for final diagnosis. Data were collected using a semi-structured study proforma and analysed using JAMOVI version 2.0, an open-source software for statistical analysis. Results: During 5 months of data collection, 8609 patients were screened for TB using the W4SS. Of these, 201 (2.3%) were W4SS positive, and of W4SS positive, 25 had confirmed diagnosis of TB. The positive predictive value of W4SS was 12.4% (95% confidence interval 10.9% to 14.1%). Among W4SS positive patients, being unmarried (p value &lt; 0.05), uneducated (p value &lt; 0.05), family history of TB (p value &lt; 0.01), fever (p value &lt; 0.01), significant weight loss (p value &lt; 0.01) and night sweats (p value &lt; 0.01) were significantly associated with final diagnosis of TB. Age, gender, employment and presence of cough were not significantly associated with confirmed diagnosis of TB among W4SS positive patients. Conclusion: W4SS in its present form has limited usability in screening general patients for TB. A multi-centric study is required to improve the scale.

The prevalence of pulmonary and extrapulmonary tuberculosis in forensic autopsies in a teaching hospital in South India.

An autopsy is a valuable tool for finding the cause of death, exploring the clinical diagnosis, documenting unexpected findings, and resolving diagnostic questions. However, this may subject the forensic pathologist and other workers to a wide variety of blood-borne and aerosolized pathogens. Tuberculosis (TB) is the most common cause of illness and death, resulting in infection transmission in the autopsy room. Our objective in this study was to estimate the prevalence of pulmonary and extrapulmonary tuberculosis among forensic autopsies in a tertiary care hospital in South India. We identified positive TB cases from acid-fast bacteria staining and culture (Mycobacterium Growth Indicator Tube and Lowenstein-Jensen medium) out of 380 autopsy cases. The prevalence of tuberculosis was 2.4% (n = 9), among which 2.1% of cases were positive for only pulmonary tuberculosis (n = 8), and 0.3% of cases had both pulmonary and extrapulmonary involvement (n = 1). In the bivariate analysis of TB cases, sex, occupation, family history of TB, habit of smoking, BCG vaccine scar, period of hospital stay, and cause of death were potentially significant. The prevalence of TB in forensic autopsy cases were similar to forensic autopsy-based studies, and it was less as compared to the prevalence of TB in the general population.

MODIFIABLE AND NON-MODIFIABLE RISK FACTORS FOR TUBERCULOSIS AMONG ADULTS IN INDONESIA: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Controlling tuberculosis (TB) determinant factors in Indonesia is one way to control TB in the community. A review is needed to explore risk factors for TB in Indonesia as the key strategies for accelerating the TB preventive program.The purpose of this review was to determine modifiable and non-modifiable risk factors for TB among adults in Indonesia. A meta-analysis was undertaken to review current studies related to modifiable and non-modifiable risk factors for TB among adults in Indonesia. A search of PubMed, ProQuest, and Google Scholar for related articles published (January 2000 until December 2023). The Pooled Odds Ratio (POR) from the acquired data were calculated with a 95% CI. The fixed and random effects analysis was performed. The results were presented as forest plots, and Begg's test and Egger's test were used to examine study bias. Review Manager (RevMan) 5.4 and Stata 14.2 were used to process and analyze all of the data. This study results revealed the POR of non-modifiable risk factor (family history of TB) for TB among adults in Indonesia was 6.08 (95% CI 2.99-12.34). Based on modifiable risk factors, it is known that household contact have the highest POR (6.01, 2.57-14.04), followed by malnutrition (5.86, 2.50-13.69), inappropriate ventilation (5.57, 1.74-17.86), diabetes mellitus (4.92, 3.04-7.96), smoking behavior (3.24, 2.22-4.72), and low-income level (2.34, 1.42-3.87). Based on significant factors that are related to TB incidence, the results of this review may be valuable to the government in identifying the optimal strategy for TB prevention among adults.

Empowering care: Unleashing pharmaceutical care to confront MDR-TB transmission risks-A prospective interventional study

IntroductionAccording to recent NTEP report it was estimated that in India the MDR-TB cases were 9.1/lakh population. Patients undergoing the pulmonary TB are known to cause MDR-TB due to multi drug resistance. Early identification of risk elements in Multidrug resistant-TB patients is crucial to managing and preventing the disease. ObjectiveTo evaluate risk variables that contribute to cause Multidrug resistant tuberculosis and to providing patient counselling to TB patients regarding risk factors. Methodology: A Prospective interventional study to assess the various Risk factors involved in cause of Multi drug resistance tuberculosis. This study was conducted for period of 09 months. The study is conducted with standard validated questionnaires which are prepared to assess the risk factors among Multidrug resistant-TB patients. Study site includes the tertiary care hospitals in Belagavi. ResultOverall, 120 Multidrug resistant tuberculosis patients were recruited from the district tuberculosis centre, Belagavi District, Karnataka. India. Most patients (47.50%) were aged 25–44 years. Of the 120 MDR-TB patients, 67.50% are male and 32.5% are female. Of 120 MDR-TB patients, 7.50% are HIV positive. As part of the study, smoking (26.67%), chewing tobacco (50%), and alcohol consumption (33.33%) were found to be other major risk factors. 24.17% of patients had a family history of tuberculosis, of which 5% had contact with an infected person as a source of infection. ConclusionThis study documented various risk variables involved in the emergence of Multidrug resistant TB. This research also highlighted the significance of pharmaceutical care in the effective management of multidrug-resistant tuberculosis (MDR-TB). This study identified risk variables that contribute to MDR-TB and helped educate tuberculosis patients about these risk factors.

Risk factors in the delay of treatment of childhood tuberculosis in a Peruvian Hospital

To determine the risk factors associated with delayed initiation of tuberculosis (TB) treatment in children under 15 years of age. Case-control study. Patients <15 years of age with a diagnosis of childhood pulmonary tuberculosis (c-PTB) with delayed treatment initiation >24 hours were included. Clinical and epidemiological variables were evaluated: age, gender, guardian's education, poverty level, origin, family history of TB, altered imaging findings, symptomatic, PPD >10mm, histology, bacteriology, resistance to treatment, and healthcare network. Bi and multivariate logistic regression analysis was performed, through which odds ratios were calculated. We evaluated 116 patients with c-PTB with a delayed initiation of specific treatment of more than 24 hours, and 264 with start of treatment in the first 24 hours. The delay in anti-tuberculosis treatment had a median of 3 days with an interquartile range of 2 to 7 days. The patient with the least educated guardian had a delay in treatment initiation with an odds ratio of 7.47 (95%CI: 4.13 - 13.52). Belonging to the healthcare network A of Callao decreased the probability of having tuberculosis by 0.224 times (95%CI:0.11 - 0.46). Incomplete education level of the guardian is a risk factor associated with delayed initiation of c-PTB treatment in children under 15 years of age while belonging to the Callao healthcare network A is a factor that decreases the risk in the group under study.

Latent tuberculosis infection (LTBI) in health-care workers: a cross-sectional study at a northern Peruvian hospital

BackgroundHealthcare workers (HCWs) have a higher risk of latent tuberculosis infection (LTBI) and active tuberculosis than the general population. In HCWs, the risk of tuberculosis infection depends on the local tuberculosis prevalence, HCWs’ characteristics, the healthcare facility, and prevention and control measures. We aimed to estimate the prevalence and risk factors for LTBI in HCWs at a northern Peruvian hospital.MethodsThis study had two phases: (1) a cross-sectional phase involving recruitment, history taking, and sampling for the Interferon-Gamma Release Assays (IGRA test), and (2) a prospective follow-up of IGRA-positive participants. We enrolled direct and non-direct patient caregivers among HCWs. We defined an LTBI case if the IGRA test was positive and clinical, laboratory, and radiological evaluations for active tuberculosis were negative.ResultsWe recruited 308 participants between November 2022 and May 2023. The mean age was 38.6 ± 8.3 years. Over 75% of the participants were female. The most common job category was technicians (30.5%), physicians (22.7%), nurses (20.5%), and other HCWs groups (17.5%). Most participants worked in hospital wards (28.2%), diagnostics departments (16.9%), and critical care departments (15.6%). The LTBI prevalence among HCWs was 17.86% (95% CI 13.84–22.70). In multivariate analysis, after adjusting for age, time working in our hospital, and family history of tuberculosis, males had a higher risk of LTBI (aPR 1.69, 95% CI 1.01–2.77) than females. Working for more than 10 years increased the risk of LBTI (aPR 2.4, 95% CI 1.44–3.97) compared to working for ≤10 years. Even further, participants who had worked for more than 20 years had an aPR of 4.31 (95% CI 1.09–13.65) compared to those with ≤10 years. Similarly, occupational exposure increased the risk of LTBI (aPR 2.21, 95% CI 1.27–4.08) compared to those HCWs not occupationally exposed.ConclusionThe LTBI prevalence in HCWs at a northern Peruvian hospital was lower compared to other Peruvian cities. Males, more experienced, and occupational exposed HCWs are at higher risk of LTBI. LTBI prevalence in Peruvian HCWs is still high. More studies are needed to address some aspects this study has not examined.

Knowledge, Attitude and Practice towards Tuberculosis and its Treatment in Qassim Region, Saudi Arabia: A Cross-sectional Study

Purpose: Tuberculosis (TB) remains a major public health concern worldwide and is considered one of the leading causes of death globally. Presently, TB control remains a global struggle, despite a decline in the percentage of cases. In Saudi Arabia, the annual incidence rate of TB is 12 per 100,000 individuals. Although TB incidence has decreased in the country, it has not been fully controlled. Awareness and public education are important in preventing the spread of TB. The objective of this study is to evaluate the knowledge, attitudes, and practices (KAP) regarding TB and its treatment within the community, while also examining potential gender differences in KAP. Methods: A cross-sectional survey was carried out online among the general population in the Qassim Region of Saudi Arabia, and statistical analysis was performed using multivariate logistic regression, chi-square, and t-tests. Results: A total of 450 participants were included in the study; 71.6% of respondents were males, and most of the respondents (71.3%) had a high level of education. Slightly more than half (55.3%) of the respondents have a good level of knowledge. The total percentage of people who have positive attitudes is 46.7%. Within gender, analysis shows that about 48.4% of males and 42.2% of females have a positive attitude. The total percentage of people who have a good practice is 82.4%. Within gender, analysis shows that females (91.4%) have a good practice compared to males (78.9%). The multivariate logistic regression analysis showed that having a family history of TB was independently associated with a higher level of knowledge, whereas younger age was associated with a positive attitude. On the other hand, gender and education were independently associated with the practice. Conclusion: The knowledge and attitude towards TB among the targeted population were generally moderate, with slightly higher levels of knowledge observed among females. Furthermore, a positive trend of good practices was observed within the study population, particularly among females

Clinical and Diagnostic Findings Among Tubercular Meningitis Patients without Pulmonary Signs and Symptoms

Background: Tubercular meningitis (TBM) is the most frequent one among the different forms of CNS tuberculosis. Early diagnosis, as well as treatment of tubercular meningitis (TBM), can give an excellent outcome with minimal residual morbidity. Clinical and diagnostic findings of patients without pulmonary signs and symptoms may be useful for the treatment of suspected tubercular meningitis patients. Aim of the study: This study aimed to make a patient profile on the clinical and diagnostic findings of tubercular meningitis patients without pulmonary signs and symptoms. Methods: This cross-sectional study was conducted in the Department of Medicine, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, from September 2020 to August 2021. A total of 77 confirmed cases of tubercular meningitis without pulmonary signs and symptoms admitted to the mentioned hospital were enrolled in this study as the study population. A purposive sampling technic was used in sample selection. Along with the clinical and diagnostic findings, all relevant information was recorded in a data collection sheet. Results: In this study, 61% of the study population had a family history of TB. Among all the patients, all had fever, 80.5% had headache, 68.8% had altered sensation, 62.3% had anorexia and nausea, 55.8% had vomiting, 19.5% had a convulsion and 15.6% had neck stiffness. In our settings, the majority (46.8%) of the respondents had TBM Grade II. The mean WBC count was 134.80±34.59 106/L, Lymphocyte (%) was 79.49±11.77, Glucose was 26.49±5.43 mg/dl, Protein was 142.8±72.5 and ADA level was 12.08±1.29 U/L. In our settings, 58.4% of the respondents had Mantoux test and 36.4% showed chest X-ray positive. In this study, 22.1% of the respondents had CT scan or MRI findings normal. Conclusion: A family history of tuberculosis may be a potential factor for TBM. Fever, headache, altered sensation, anorexia/nausea and vomiting are very common clinical features in such patients. Chest X-ray ..

Impact of human immunodeficiency virus on category I pulmonary tuberculosis cases in a tertiary care hospital: a case control study

Background: Tuberculosis (TB) is an opportunistic infection (OI). OIs are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems. Human immunodeficiency virus (HIV) weakens the immune system, increasing the risk of TB in people with HIV. This case control study was done to assess the impact of HIV on clinical aspects and treatment outcome of newly diagnosed bacteriologically positive pulmonary tuberculosis. Methods: This study was done among unmatched 75 cases and 75 controls who were pulmonary TB and TBHIV co-infected patients. Data were collected using a pretested, structured, interviewer-administered questionnaire and was analyzed using descriptive and analytical statistics. Results: Total 150 patients were enrolled in the study out of which 75 patients had HIV-TB co-infection while remaining 75 patients were diagnosed as pulmonary TB. Treatment success rates are 74.7 % (56/75) for TB-HIV co-infected patients and 82.7% (62/75) for pulmonary TB patients. TB-HIV co-infected patients had a higher risk of an unsuccessful treatment outcome [(p = 0.232) with OR and 95% CI of 0.68 (0.28-1.36)]. The risk of unsuccessful treatment outcome was associated with family history of TB, Tobacco use, low BMI. Conclusions: TB treatment success rate is good as compared to the WHO minimum requirement. Successful treatment outcome is lower among patients with HIV infection, tobacco use, low BMI, &lt;200 /mm3 CD4 count patients. Therefore, due emphasis should be given to these high-risk groups.

Socioeconomic Determinants of Pulmonary Tuberculosis during Covid-19 Pandemic: Case Control Study

Background: Tuberculosis (TB) is a public health issue of paramount importance. Pakistan ranks 5th amongst the high burden TB countries globally with the prevalence, incidence and mortality per 100,000 population per year from TB being 348, 276 and 34 respectively. Socio-economic determinants like income, house, family size, ventilation, etc. play a vital role in the epidemiology of TB. Aim: To analyzes the socioeconomic determinants of pulmonary tuberculosis (PTB) during Covid-19 pandemic. Study Design: Case study Methodology: This case-control study was undertaken at Gulab Devi Hospital, Lahore, over a period of 8 months. 50 cases of confirmed Pulmonary tuberculosis and 50 controls were interviewed using a questionnaire containing demographic variables like gender, age, and socioeconomic status. Data was analyzed by using SPSS Results: The sociodemographic profile of our respondents showed that 62 (62%) were males, 55 (55%) belonged to rural areas and, 52(52%) were employed. The socioeconomic determinants which were significantly associated with PTB were gender, residence, occupation, number of family members, and history of smoking. Practical Implementation: Due to the emerging nature of the COVID-19 crisis, this study helped researchers investigate the role of socio-economical determinant of TB during Covid-19 pandemic infection. Conclusion: Gender, residence, occupation, number of family members, and history of smoking were significantly associated with PTB. However, ventilation, family history of TB, and previous history of PTB were not found to have a statistically significant association with PTB. Keywords: Pulmonary Tuberculosis, Covid-19, Incidence, Pandemic Condition and Socioeconomic Determinants.

Factors Associated with Knowledge, Attitudes, and Practices about Tuberculosis in Peruvians

Objective: To determine the factors associated with knowledge, attitudes, and practices (KAPs) about tuberculosis (TB) in the Peruvian population.&#x0D; Materials and Methods: A cross-sectional, analytical study was carried out by conducting a virtual survey. The instrument that was used consisted of 4 sections: sociodemographic variables (9 questions), knowledge (23 questions), attitudes (9 questions), and practices (8 questions) about tuberculosis. Univariate and bivariate analyses and the Poisson regression model with robust variance were used to obtain crude and adjusted prevalence ratios (PRa).&#x0D; Results: The sample consisted of 1284 participants. Regarding knowledge, attitudes, and practices about TB, an insufficient level was found in 47.97%, 50.3%, and 54.36% of the cases, respectively. The variables that increased the probability of having sufficient knowledge were sex, grade, area, family history, and history of having TB. While only the area and both antecedents were for attitudes. Finally, the age, degree, and history of TB were for the practices.&#x0D; Conclusion: There are insufficient KAPs in around half of the population studied. In addition, there are differences according to the epidemiological characteristics, such as sex, age, academic degree, area, and family history of TB and having had this disease. Therefore, the importance of research in this field should be emphasized in the face of a disease that is related to the differences in the levels of these variables between different strata of the general population.

Weight variation increases the risk of death during the intensive phase of treatment among MDR-TB patients: A retrospective study.

To estimate the predictors of death during intensive phase of Multidrug resistant tuberculosis treatment according to the weight of patients at the time of diagnosed. A retrospective study was conducted at three public hospitals in the Lahore, Punjab region, namely Jinnah Hospital, Mayo Hospital and Gulab Devi Hospital on 1,496 patients receiving treatment for MDR-TB from January 2018 to December 2020. Data were collected from electronically nominating and recording system of the hospitals. Data were fitted to Cox proportional hazards regression model with 95% confidence interval (CI) to evaluate the associations between predictors of death and weight of MDR-TB patients during the intensive phase of treatment. This analysis revealed a MDR-TB mortality rate of 30% and the mortality rate due to MDR-TB during the intensive phase of treatment was 23%. The variables related to increased mortality among underweight patients were age more than 60 years (HR: 0.398, 95% CI: 0.314-0.504) , diabetes (HR: 1.496, 95% CI: 1.165-1.921), current smoking (HR: 0.465, 95% CI: 0.222-0.973), history of MDR-TB (HR: 0.701, 95% CI: 0.512-0.959) and culture positive at the time of diagnosed (HR: 0.499, 95% CI: 0.379-0.659) during the intensive phase of treatment. The high mortality rate among the underweight MDR-TB patients during the intensive phase of the treatment requires the nutritional support for malnourishment and ensured a close follow-up of the elderly patients with co-morbidities as well as family history of Tuberculosis.

Two Clinical Prediction Tools to Inform Rapid Tuberculosis Treatment Decision-making in Children.

In the absence of bacteriologic confirmation to diagnose tuberculosis (TB) in children, it is suggested that treatment should be initiated when sufficient clinical evidence of disease is available. However, it is unclear what clinical evidence is sufficient to make this decision. To identify children who would benefit from rapid initiation of TB treatment, we developed 2 clinical prediction tools. We conducted a secondary analysis of a prospective intensified TB patient-finding intervention conducted in Pakistan in 2014-2016. TB disease was determined through either bacteriologic confirmation or a clinical diagnosis. We derived 2 tools: 1 uses classification and regression tree (CART) analysis to develop decision trees, while the second uses multivariable logistic regression to calculate a risk score. Of the 5162 and 5074 children included in the CART and prediction score, respectively, 1417 (27.5%) and 1365 (26.9%) were eligible for TB treatment. CART identified abnormal chest radiographs and family history of TB as the most important predictors (area under the receiver operating characteristic curve [AUC], 0.949). The final prediction score model included age group (0-4, 5-9, 10-14), weight <5th percentile, cough, fever, weight loss, chest radiograph suggestive of TB disease, and family history of TB; the identified best cutoff score was 9 (AUC, 0.985%). Use of clinical evidence was sufficient to accurately identify children who would benefit from treatment initiation. Our tools performed well compared with existing algorithms, though these results need to be externally validated before operationalization.

Detection of Tuberculosis in Toddlers and its Risk Factor at East Perak Health Center Surabaya

Introduction: Tuberculosis is a contagious disease that can grow fast due to its transmissibility through aerosols. One of the countries with the highest tuberculosis rates is Indonesia with a case fatality rate of 11.59%. This study's objective was to examine the relationship between the physical condition of the house and the immune system and the incidence of tuberculosis in toddlers in Surabaya. Methods: This study used an analytic survey research design with a case control research methodology. The case population consisted of pediatric patients aged 0-5 years who were clinically diagnosed with pulmonary tuberculosis. The Chi-Square test was used to analyze bivariate data with a confidence level of 0.05 (α = 5%). Results and Discussion: The physical condition of the house that influenced the incidence of tuberculosis in toddlers were room temperature (p = 0.009; OR = 8.300; CI = 1.480-46.936) and room humidity (p = 0.000; OR = 7.600; CI = 1.609-35.906) while the immune system that affected the incidence of tuberculosis in toddlers were history of tuberculosis sufferers in the family (p = 0.018; OR = 6.000; CI = 1.266-28.498) and exclusive breastfeeding (p = 0.003; OR = 10.000; CI = 1.998-50.042). Conclusion: Houses with inadequate room temperature and humidity have an increased risk of tuberculosis development. Moreover, tuberculosis risk factors include a history of exclusive breastfeeding and a family history of tuberculosis. Health promotion by community health centers is expected to increase awareness of pediatric tuberculosis.

Granulomatous mastitis – An uncommon finding

A 19-year-old female came with complaints of multiple lumps in her right breast of different sizes, which she had noticed one month back. The woman also gave a lactating history and family history of tuberculosis. After obtaining informed consent from the patient, minimally invasive procedure, Fine Needle Aspiration Cytology (FNAC) was performed and about 2 ml of pus like material was aspirated. Giemsa stained microscopic finding showed epithelioid cells along with lymphocytes in a necrotic background that were consistent with Granulomatous mastitis. Sometimes epithelial atypia can be worrisome in cases of mastitis. Hence clinical correlation is necessary along with cytological findings for interpretation. Open biopsy is the gold standard for definitive diagnosis.

Comparative Evaluation of Multidetector Computed Tomography and Dual-Energy Computed Tomography Findings in Gastrointestinal Tuberculosis.

To compare multidetector computed tomography (MDCT) and dual-energy computed tomography (DECT) imaging findings in gastrointestinal (GI) tuberculosis. To study imaging findings of MDCT and DECT in GI tuberculosis. All the patients falling in the sampling frame and fulfilling the eligibility criteria were clinically examined and demographic details, presenting complaints, medical history, history of anti-tubercular treatment (ATT) intake, personal habits,and family history of tuberculosis were noted. All the patients underwent sputum acid-fast bacilli (AFB) assessment. Outcomes of investigations like bronchoscopy and fine-needle aspiration cytology (FNAC)/biopsy were also noted wherever available. Ascitic fluid AFB and culture assessments were also performed wherever feasible. All CT scans were performed on a 384-slice dual-energy CT scanner (Somaton Force, Siemens Healthcare) and all the images were post-processed on a workstation using syngo.via software that allows the analysis of images using three material decompositions. Features like peritonitis, lymph node involvement, GI wall thickening, and solid organ involvement were focused on. Subjective assessment of images of both MDCT and DECT were assessed by two experienced radiologists to prepare the CT diagnosis. The mutual agreement of the two observers was considered final. The findings of the study showed that both MDCT, as well as DECT, were useful in the diagnosis of GI tuberculosis. On the basis of these findings, DECT could be considered to have an edge over MDCT in the diagnosis of GI tuberculosis. Keeping in view the small sample size and high prevalence, further studies on a larger sample size with relaxed sampling criteria are recommended to validate the findings of the present study.

Evaluation of the 10 Warning Signs in Primary and Secondary Immunodeficient Patients.

ObjectivesTen warning signs of primary immunodeficiency (PID) were suggested by the Jeffrey Modell Foundation (JMF), to increase physician awareness of PID. These warning signs have not yet been evaluated for patients with secondary immunodeficiency (SID). This study investigated whether the 10 warning signs used for the diagnosis of PID were also sufficient for the diagnosis of SID, and explored the possibility of additional signs.MethodsThis prospective study was conducted between June and December 2020. The mothers of 162 patients with PID and SID, and mothers of 200 healthy children, were asked to complete a questionnaire about family and personal history in addition to the warning signs of PID developed by the JMF. A JMF score was created by giving one point for each “Yes” answer for the 10 warning signs of PID. Medical records of the patients were evaluated for possible additional warning signs for PID and SID.ResultsThe JMF scores of the PID (3.36 ± 1.65) and SID (3.72 ± 1.12) groups were significantly higher than the scores of the control group (0.34 ± 0.61) (p < 0.05). A sign for immunological evaluation in two patients without warning signs in the PID group was found to be chronic diarrhea. In addition to the 10 JMF warning signs, we found that consanguinity and a family history of tuberculosis were statistically significant in our PID group, compared with the SID and control groups.ConclusionsThe JMF warning signs are important for early diagnosis of PID. Our study showed that these signs may also be used for the early diagnosis of SID in patients and, according to our results, in addition to the 10 JMF signs for PID, parental consanguinity, chronic diarrhea, and a family history of tuberculosis may also be considered warning signs for the early diagnosis of PID.