High TB Incidence Research Articles

Quantitative MODS-Wayne assay for rapid detection of pyrazinamide resistance in Mycobacterium tuberculosis from sputum samples.

PZA susceptibility testing continues to be a challenge, particularly in countries with high TB incidence. In response to this pressing need, we have developed a quantitative MODS-Wayne (MODS-WQ) assay. This approach offers a direct and cost-effective solution representing a significant advancement in TB diagnostics, particularly benefiting resource-limited laboratories, primarily in developing regions. The MODS-WQ assay stands out for its ability to quantify pyrazinoic acid (POA) production, as a reliable indicator of PZA resistance. Unlike traditional qualitative assays, MODS-WQ eliminates the inherent subjectivity in interpretation, providing more accurate and actionable results. Moreover, the MODS-WQ approach accounts for critical factors influencing PZA resistance, including enzymatic efficiency and efflux pump activity. By integrating these factors into the detection process, our methodology offers a comprehensive understanding of PZA resistance levels, enabling tailored treatment strategies for patients.

Critical assessment of infants born to mothers with drug resistant tuberculosis

There have been no detailed descriptions of infants born to mothers treated for drug resistant TB in pregnancy. Critical case history assessment is important to identify risks and guide clinical practice. In a cohort of pregnant women with multidrug or rifampicin resistant (MDR/RR)-TB enrolled between 1 January 2013 and 31 December 2022, we followed mother-infant pairs until the infant was 12 months old. We performed critical case history assessments to explore potential mechanisms of Mycobacterium tuberculosis transmission to the infant, and to describe the clinical presentation and disease trajectories observed in infants diagnosed with TB. Among 101 mother-infant pairs, 23 (23%) included infants diagnosed with TB disease; 16 were clinically diagnosed and seven had microbiological confirmation (five MDR/RR-TB, two drug-susceptible TB). A positive maternal sputum culture at the time of delivery was significantly associated with infant TB risk (p=0.023). Of the 12 infants diagnosed with TB in the first three months of life, seven (58%) of the mothers were culture positive at delivery; of whom four reported poor TB treatment adherence. However, health system failures, including failing to diagnose and treat maternal MDR/RR-TB, inadequate screening of newborns at birth, not providing appropriate TB preventive therapy (TPT), and M.tuberculosis transmission from non-maternal sources also contributed to TB development in infants. Infants born to mothers with MDR/RR-TB are at greatest risk if maternal adherence to MDR/RR-TB treatment or antiretroviral therapy (ART) is sub-optimal. In a high TB incidence setting, infants are also at risk of non-maternal household and community transmission. Ensuring maternal TB diagnosis and appropriate treatment, together with adequate TB screening and prevention in all babies born to mothers or households with TB will minimise the risk of infant TB disease development. South African Medical Research Council.

Readability of Patient-Facing Information of Antibiotics Used in the WHO Short 6-Month and 9-Month All Oral Treatment for Drug-Resistant Tuberculosis

ObjectivesReadability of patient-facing information of oral antibiotics detailed in the WHO all oral short (6 months, 9 months) has not been described to date. The aim of this study was therefore to examine (i) how readable patient-facing TB antibiotic information is compared to readability reference standards and (ii) if there are differences in readability between high-incidence countries versus low-incidence countries.MethodsTen antibiotics, including bedaquiline, clofazimine, ethambutol, ethionamide, isoniazid, levofloxacin, linezolid, moxifloxacin, pretomanid, pyrazinamide, were investigated. TB antibiotic information sources were examined, consisting of 85 Patient Information Leaflets (PILs) and 40 antibiotic web resouces. Of these 85 PILs, 72 were taken from the National Medicines Regulator from six countries (3 TB high-incidence [Rwanda, Malaysia, South Africa] + 3 TB low-incidence [UK, Ireland, Malta] countries). Readability data was grouped into three categories, including (i) high TB-incidence countries (n = 33 information sources), (ii) low TB-incidence countries (n = 39 information sources) and (iii) web information (n = 53). Readability was calculated using Readable software, to obtain four readability scores [(i) Flesch Reading Ease (FRE), (ii) Flesch-Kincaid Grade Level (FKGL), (iii) Gunning Fog Index and (iv) SMOG Index], as well as two text metrics [words/sentence, syllables/word].ResultsMean readability scores of patient-facing TB antibiotic information for FRE and FKGL, were 47.4 ± 12.6 (sd) (target ≥ 60) and 9.2 ± 2.0 (target ≤ 8.0), respectively. There was no significant difference in readability between low incidence countries and web resources, but there was significantly poorer readability associated with PILs from high incidence countries versus low incidence countries (FRE; p = 0.0056: FKGL; p = 0.0095).ConclusionsReadability of TB antibiotic PILs is poor. Improving readability of PILs should be an important objective when preparing patient-facing written materials, thereby improving patient health/treatment literacy.

Evaluation Of The Level Of Compliance Of Tuberculosis Patients To The Use Of Anti-Tuberculosis Drugs In Puskesmas Lima Puluh In 2023

The incidence of Tuberculosis (TBC) is still a priority health problem, especially in the working area of the Puskesmas Lima Puluh . The Puskesmas Lima Puluh is a health center in the Fifty District which has a high incidence of TB, where the number of TB cases in 2022 has increased from the previous year. Patient compliance with treatment is one of the factors that determine the success of therapy. This study aims to describe the level of adherence of TB patients to the use of OAT and determine the factors that influence the level of adherence to taking OAT at the Puskesmas Lima Puluh . After the selection was carried out, 40 patients were obtained, then the probably sampling method was carried out so that 29 respondents were obtained. Data collection through direct interviews using questionnaires, bivariate and univariate data analysis. The results of statistical tests using the Chi Test showed a significant relationship with several variables including last education (p = 0.001), knowledge (p = 0.003), family support (p = 0.018) and distance traveled to health services (0.010) with adherence taking OAT in TB patients.

Prevalence estimates of tuberculosis infection in adults in Denmark: a retrospective nationwide register-based cross-sectional study, 2010 to 2018.

BackgroundTuberculosis (TB) elimination requires identifying and treating persons with TB infection (TBI).AimWe estimate the prevalence of positive interferon gamma release assay (IGRA) tests (including TB) and TBI (excluding TB) in Denmark based on TBI screening data from patients with inflammatory bowel disease (IBD) or inflammatory rheumatic disease (IRD).MethodsUsing nationwide Danish registries, we included all patients with IBD or IRD with an IGRA test performed between 2010 and 2018. We estimated the prevalence of TBI and positive IGRA with 95% confidence intervals (CI) in adolescents and adults aged 15-64 years after sample weighting adjusting for distortions in the sample from the background population of Denmark for sex, age group and TB incidence rates (IR) in country of birth.ResultsIn 13,574 patients with IBD or IRD, 12,892 IGRA tests (95.0%) were negative, 461 (3.4%) were positive and 221 (1.6%) were indeterminate, resulting in a weighted TBI prevalence of 3.2% (95% CI: 2.9-3.5) and weighted positive IGRA prevalence of 3.8% (95% CI: 3.5-4.2) among adults aged 15-64 years in the background population of Denmark. Unweighted TBI prevalence increased with age and birthplace in countries with a TB IR higher than 10/100,000 population.ConclusionEstimated TBI prevalence is low in Denmark. We estimate that 200,000 persons have TBI and thus are at risk of developing TB. Screening for TBI and preventive treatment, especially in persons born in high TB incidence countries or immunosuppressed, are crucial to reduce the risk of and eliminate TB.

Nutritional status in patients with tuberculosis and diabetes mellitus: A comparative observational study

BackgroundIndia has been estimated to have 14 % of malnourished population and a high TB incidence burden with a 26.9 lakh cases. Malnutrition and diabetes mellitus are major risk factors for tuberculosis infection. Malnutrition in patients with both tuberculosis and diabetes (TB-DM) population worsens the disease severity, treatment outcomes and increases morbidity and mortality risk. ObjectiveTo assess the nutritional status in patients with TB-DM compared with patients with TB and DM alone. MethodRecords from January 2016 to November 2020 for patients admitted to Kasturba Hospital, Manipal were assessed. Data pertaining to glycemic parameters, nutritional parameters, and other relevant laboratory parameters were extracted for assessment. The study population were divided into three groups i.e. patients with TB-DM, TB and DM. The statistical association was carried out with one-way ANOVA method, considering p < 0.05 as statistically significant. ResultsA total of 291 patients were included, with 97 patients in each group; among those, male and female were 86.27 % and 13.73 % respectively. Cardiovascular co-morbidity was predominant in the DM (68.04 %) and TB-DM (26.8 %) group. The mean value of HbA1c (10.47 %) was found to be highest for the TB-DM group. Low levels of albumin were reported by 71.91 % of patients of the TB group, whereas 73.68 % patients in TB-DM group had vitamin D deficiency. Moreover, higher prevalence of low MCV and MCH in the TB-DM group suggest an increased risk of iron-deficiency anemia. ConclusionThe findings of our study reflect the need for implementation of nutritional support in patients with TB-DM.

Impact of annual TB screening on stone quarry workers in high-incidence Portuguese municipalities.

<sec id="st1"><title>SETTING</title>The Portuguese municipalities of Penafiel and Marco de Canaveses are high TB incidence areas, where stone quarry workers represent a vulnerable population.</sec><sec id="st2"><title>OBJECTIVE</title>To assess the annual rate of TB infection (ARI) in stone quarry workers and to compare it with the TB notification rate in the general community.</sec><sec id="st3"><title>DESIGN</title>An annual TB infection screening strategy using interferon-gamma release assay (IGRA) was implemented in 2018 for workers from high-risk stone quarries. A prospective cohort was enrolled and workers screened in periods of 2 years were included. IGRA-positive workers were referred for preventive treatment. ARI was calculated as the proportion of workers with IGRA conversion.</sec><sec id="st4"><title>RESULTS</title>Of the 232 IGRA-negative workers in 2018, 20 tested positive in 2019 (8.6% ARI). Of 171 IGRA-negative workers in 2019, eight tested positive in 2021 (4.7% in 2 years). Two of the 150 IGRA-negative workers in 2021 tested positive in 2022 (1.3% ARI). ARI decreased by 84.9% between 2019 and 2022. In the two municipalities, the TB notification rate declined 23.9% between 2018 and 2021.</sec><sec id="st5"><title>CONCLUSION</title>A more pronounced reduction in ARI was observed among stone quarry workers regularly screened for TB infection compared to the notification rate among the general population in high-incidence municipalities. A screening strategy for high-risk populations, together with enforced community measures, could foster risk reduction in the community.</sec>.

Evaluation of a short training course of chest X-ray interpretation for the diagnosis of paediatric TB.

Chest X-ray (CXR) interpretation is challenging for the diagnosis of paediatric TB. We assessed the performance of a three half-day CXR training module for healthcare workers (HCWs) at low healthcare levels in six high TB incidence countries. Within the TB-Speed Decentralization Study, we developed a three half-day training course to identify normal CXR, CXR of good quality and identify six TB-suggestive features. We performed a pre-post training assessment on a pre-defined set of 20 CXR readings. We compared the proportion of correctly interpreted CXRs and the median reading score before and after the training using the McNemar test and a linear mixed model. Of 191 HCWs, 43 (23%) were physicians, 103 (54%) nurses, 18 (9.4%) radiology technicians and 12 (6.3%) other professionals. Of 2,840 CXRs with both assessment, respectively 1,843 (64.9%) and 2,277 (80.2%) were correctly interpreted during pre-training and post-training (P < 0.001). The median reading score improved significantly from 13/20 to 16/20 after the training, after adjusting by country, facility and profession (adjusted β = 3.31, 95% CI 2.44-4.47). Despite some limitations of the course assessment that did not include abnormal non-TB suggestive CXR, study findings suggest that a short CXR training course could improve HCWs' interpretation skills in diagnosing paediatric TB.

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

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

QuantiFERON Gold-In-Tube for the diagnosis of mycobacterial tuberculosis infection in children under 5 years of age: A systematic review and meta-analysis.

Previous meta-analysis regarding the performance of QuantiFERON Gold-In-Tube in children have yielded contrasting results. Emerging data in children younger than 5 years of age necessitates a new analysis. Systematic searches were conducted of MedLINE, EMBASE and Cochrane databases between 1998-2023. Pooled estimates of sensitivities and specificities of QFT-GIT compared to tuberculin skin test (TST) were calculated. The Kappa (k) coefficient was calculated for each study to determine the degree of congruence between TST and QFT-GIT results. Studies including patients co-infected with HIV or other immune compromising conditions or those treated with anti-tubercular treatment were excluded. Seventeen studies (4335 patients) were included in quantitative analysis. All studies were conducted in middle to high income countries. They were conducted across 14 countries and 4 studies in countries with high TB incidence. The pooled sensitivity, specificity and DOR were 0.45 (0.42-0.48), 0.96 (0.96-0.97) and 18.84 (7.33-48.41) respectively. The ability of QFT-GIT to discriminate with disease and no disease was "good" as demonstrated by a summary receiver operating characteristic curve with area under curve of 0.7812. The average Kappa (k) co-efficient was 0.501 with a wide variety of values between studies (0.167 to 0.800). The findings of this meta-analysis support the judicious use of QFT-GIT in children 5 years and under, with caution as a sole test to exclude Tuberculosis in this age group. The heterogeneity and methodological quality of diagnostic studies limits the generalisability of results.

Screening of household contacts for TB infection in Cote d'Ivoire.

Côte d'Ivoire is a country with a high incidence of TB. The control of TB infection is focused on high-risk patients but has limited implementation. Cost-benefit analysis of TB infection (TBI) screening of household contacts in Côte d'Ivoire to evaluate economic implications of the implementation of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST). We compared the effectiveness of QuantiFERON-TB Gold Plus (QuantiFERON) with the TST using an economic model previously evaluated in medium TB incidence settings. Principal outcomes relating to TBI screening, as well as the lifetime costs and benefits of the patient cohort, were captured using a decision tree, followed by a Markov model. QuantiFERON proved to be both more effective and less costly than TST. Compared to QuantiFERON, TST use leads to an approximate 33% increase in the lifetime risk of developing active TB. For household contacts of active TB cases in Côte d'Ivoire, QuantiFERON is cost-effective when compared with TST. R shiny interactive interface enables model customisation for different scenarios, settings, risk groups and TBI screening methods. Further research should be conducted in similar settings to generalise the results.

The Relationship Between Family Motivation and The Role of Health Workers With Adherence to Treatment for TB Patients at Puskesmas Pagar Jati

The high incidence of TB in Indonesia is one of them caused by the lack of family motivation and the role of health workers in the healing process of TB disease, many TB sufferers do not finish treatment due to non-compliance in consuming drugs in large quantities and for a long time. TB disease if not treated immediately can have a bad impact on the sufferer himself or family around him because TB can spread quickly and can endanger health and can cause death. The purpose of this study was to see if there is a relationship between motivation and the role of health workers on adherence in treatment. The research method used a cross sectional design, data was taken by distributing questionnaires, samples of 30 people who had been determined according to research criteria, data were tested with Chi square (alpa 0.05). The test results showed that there was a relationship between family motivation and TB patient treatment adherence p value 0.00 and there was a relationship between the role of health workers and TB treatment adherence p value 0.01. It is recommended that TB sufferers must remain enthusiastic in carrying out treatment and remain obedient in taking drugs in order to achieve maximum recovery.

THE EFFECTIVENESS OF HEALTH EDUCATION USING VIDEO MEDIA ON KNOWLEDGE OF PULMONARY TB PREVENTION IN NURSING STUDENT IN WAMENA

Indonesia is the fifth country in Southeast Asia with the most cases of pulmonary TB. Papua is one of the provinces with a high incidence of pulmonary TB. One of the efforts to reduce the number of pulmonary TB is providing health education about tuberculosis prevention efforts using audiovisual media. This study aims to determine the effectiveness of health education using video media on knowledge of pulmonary TB prevention. The research used the design of The One Group Pre Test – Post Test, with the type of research being Quasi Experiment. It was carried out in the Wamena Nursing DIII Study Program with a sample of 32 respondents. Respondents were given a pre-test questionnaire and a health education intervention using video. After ten days of providing health education, respondents were given a questionnaire (post-test). Statistical analysis using Wilcoxon. The results showed a significant increase in knowledge about pulmonary TB prevention between the pre-test and post-test (p=0.000). It was concluded that health education using audiovisual media was more effective in providing information on the prevention of pulmonary TB.

Latent Tuberculosis Infection in Users of Drug Dependence Care and Follow-up Centers in Barcelona in 2017–2021: A Cross-sectional Descriptive Study

IntroductionPeople who consume drugs have a higher risk of latent tuberculosis infection (LTBI). Our objective was to study the characteristics of people who use drugs and who attended the Centers for Drug Dependence Care and Follow-up of Barcelona during 2017–2021 and presented LTBI or did not perform the reading of the tuberculin skin test (TST) after the test had been done. Material and methodsA cross-sectional, descriptive study in Centers for Drug Dependence Care and Follow-up of Barcelona was performed during 2017–2021. The sociodemographic and epidemiological profile of people who use drugs that underwent a TST was analyzed and were examined the factors associated with LTBI. Additionally, the same sociodemographic and epidemiological analyses were made in PWUD that did not perform the reading of the TST after the test had been done. Adjusted odds ratios (ORa) and 95% confidence intervals (95% CI) were calculated. ResultsNine hundred forty-eight persons were profiled. The prevalence of LTBI was 22.9%, and the following factors were associated with it: be older than 41 years; be users of CAS Baluard, or CAS Horta-Guinardó; coming from a WHO region of high TB incidence; be homeless; and low territorial socioeconomic index. The following factors were associated with not performing the reading of the TST after the test had been done: be users from the CAS Baluard, Barceloneta, Nou Barris and Robadors; be homeless and low TSI. ConclusionsThis study improves TB control and highlights the need for this LTBI control program in CASs.

Socioeconomic disparities and multidrug-resistant tuberculosis in South Korea: Focus on immigrants and income levels.

Risk factors of MDR-TB remain unclear in South Korea, despite being an important public health issue. Findings from this study, which included ≥50,000 patients with TB from South Korea, suggests that immigrants and patients with lower income levels were strong predictors of MDR-TB in a high-income, high TB incidence country.

Pediatric tuberculosis under six years old: an 18-year experience of a level II hospital

Background: Tuberculosis disease under six years is an indicator of recent transmission within the community. We aim to characterize tuberculosis disease in children under six years in a pediatric department of a level II hospital in the Lisbon metropolitan area, which serves a high percentage of immigrants from Portuguese-speaking African countries. Methods: Retrospective and descriptive study of tuberculosis disease cases treated in our Department between January 2004 and December 2021 (18 years). Descriptive analysis of the collected data was performed using SPSS Statistics® 25. Results: 25 patients were included, 60% diagnosed between 2016 and 2021. Five patients were born in countries with high TB incidence and 11 other patients had immigrant families from such countries. Ten out of 13 patients not immunized with BCG had the recommendation to do so. A close contact with tuberculosis was known in 15 patients, and in seven of those the system for TB prevention failed. At diagnosis: 4/25 patients had disseminated tuberculosis (three miliary and one congenital). Conclusions: The increase in tuberculosis disease cases under six years in the last three years points to some pitfalls in tuberculosis surveillance and transmission prevention. New studies and institutional protocols are needed to improve the effectiveness of the network involved in TB prevention and treatment.

1448. Socio-demographic and clinical characteristic of Tuberculosis in Tor Vergata Hospital, Rome: a 9-years analysis

Abstract Background Tuberculosis (TB) represents one of the major global health problems worldwide. Italy is a low-incidence country for TB with a prevalence of 23% of extrapulmonary forms (EPTB). Migrants coming from high TB incidence country might modify local epidemiology. Methods We conducted a retrospective, single-center observational study including data from patients with an active TB diagnosis, admitted to the Infectious Diseases Department of Tor Vergata Hospital, Rome, from 2013 to 2021 Results The study included 210 patients with a median age of 38 years (IQR 36-46), 77% were male, 74% were not Italians (31% Africans,26% East-Europeans,11% Asian and 6% Latin Americans) 28% of patients were immunocompromised: 5.7% tested positive for HIV, 4.7% were on immunosuppressive treatment with anti-TNF drugs, 4.7% had onco-hematological diseases, 15.7% had severe malnutrition. PPD, performed in 90 patients, resulted positive in 77; QuantiFERON-TB Gold (QTF), performed in 187 patients, resulted positive in 149, indeterminate in 9 and negative in 29 patients. 43% of patients presented with EPTB, of whom 38 had lymph node TB, 24 bone TB, 20 pleural TB, 17 abdominal TB, 9 central nervous system TB and 23 were disseminated TB (≥3 systems involved). EPTB forms, compared to pulmonary TB (PTB), were significantly more common in males (p=0.027), of younger age (p&amp;lt; 0.001), from Africa and Asia (p&amp;lt; 0.01). Immunosuppression was not significantly associated with EPTB. Lymphocytes and monocytes absolute count were significantly lower in patients with EPTB, compared to PTB (Fig. 1). Lymphocyte subpopulations were analyzed in 89 patients, showing a significantly lower CD4 count in patients with EPTB, compared to PTB (p=0.006) (Fig. 2). QTF tube 2 titer was higher in the EPTB forms (p=0.024), no association was found with QTF tube 1 (p=0.069) and QTF mitogen (p=0.118) with TB localization. (Fig.3) QTF negativity rate was higher in patients with EPTB (p=0.063). Lymphocytes and monocytes in extrapulmonary TB (E) and pulmonary TB (P) Analysis of lymphocytes subpopulations in extrapulmonary TB (E) and pulmonary TB (P) Analysis of Quanti-FERON titer in extrapulmonary TB (E) and pulmonary TB (P) Conclusion In our cohort, there was a high prevalence of EPTB (43%), mainly diagnosed in young, otherwise healthy men from high-endemic areas, highlighting the connection of EPTB with socio-demographic determinants. Although QFT negativity rate was higher in EPTB patients, a prudent interpretation of QFT might be needed in patients with high suspicion of EPTB. Disclosures All Authors: No reported disclosures.

Drug-Resistant Tuberculosis Treatment Outcomes among Children and Adolescents in Karachi, Pakistan.

Significant data gaps exist for children and adolescents with drug-resistant (DR) TB, particularly from high TB incidence settings. This report provides a descriptive analysis of programmatic outcomes among children and adolescents treated for DR-TB in Pakistan. We extracted programmatic data from January 2014 to December 2019 from a tertiary care hospital with specialised child and adolescent DR-TB services. A physician assessed all children and adolescents (0-19 years) with presumptive DR-TB, including details of exposure to DR-TB, medical history, radiology, and laboratory results. All patients received treatment as per national DR-TB management guidelines based on WHO recommendations. There were 262 treatment episodes for 247 patients enrolled during the study period. The median age of the cohort was 16 years (IQR: 13-18 years) with 16 (6.1%) children being under 5 years; 237 (90.5%) patients had pulmonary TB. The majority of the patients (194 or 74.1%) experienced a favourable treatment outcome and 26 (9.9%) died while on treatment. Female patients (78.5%) were more likely to experience favourable outcomes compared to males (64.7%; chi-sqr p-value = 0.02). We found high rates of favourable outcomes in children and adolescents treated for DR-TB. However, there were few young children in our cohort and there was a considerable gender gap that enhanced efforts to diagnose DR-TB in young children and to elucidate and mitigate the reasons for poor outcomes amongst males.

Case report: Tuberculosis as a cause unilateral of sacroiliitis in lupus patients

Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease, with variable manifestations, which is frequently exacerbated, requiring differential diagnosis with infectious conditions. In the case report, the patient satisfied the following criteria as per ACR/EULAR (2019): FAN 1:640 homogeneous nuclear, fever, alopecia, hypocomplementemia, antidsDNA 1:80 and lymphopenia. She was on: prednisone 20mg/day, hydroxychloroquine 400mg/day and calcium+vitamin D3. She was pale (3/4+), dehydrated and tachycardic. Osteoarticular examination: Patrick-Fabere positive for left sacroiliac; pain in external and internal rotation in left hip and painful palpation in the metacarpal, proximal interphalangeal, wrists, knees, ankles, hip and thigh joints, especially in the left and right. Radiography showed extensive sclerosis (grades 3 and 4) in left sacroiliac and rectified lumbar lordosis. Later, magnetic resonance imaging revealed extensive subcortical bone marrow edema at the left sacroiliac associated with capsulitis. In addition to positive BAAR TRM-TB, Lupus patients present a high incidence of TB, which is an important hypothesis in febrile cases with inflammatory lombalgy, since its osteoarticular form mainly affects the spine. Therefore, the importance of differential diagnosis for effective management is evident.

TB in migrants residing in the Netherlands for at least 5 years at diagnosis, 2003-2018.

<b>BACKGROUND:</b> One of the challenges of TB elimination in low-incidence countries is the relatively high incidence of TB in migrants in these countries, even after multiple years of residence.<b>OBJECTIVE:</b> To describe and compare TB incidence and characteristics of migrant TB patients residing in the Netherlands for at least (≥)5 years at diagnosis with non-foreign-born TB patients in order to identify additional strategies that could reduce TB incidence in the former group.<b>METHODS:</b> A retrospective cohort study was conducted in migrants from Somalia, Morocco, Suriname, Turkey and Indonesia who were diagnosed with TB in the Netherlands in 2003-2018. TB incidences were calculated and multivariate logistic regression was used to identify differences in characteristics of TB patients per country of birth compared to non-foreign-born patients.<b>RESULTS:</b> TB incidence was highest in individuals from Somalia (162.5/100,000 population in 2018), followed by individuals from Morocco (37.1/100,000). In the non-foreign-born population, TB incidence was 1.2/100,000. Differences in characteristics of TB patients compared to non-foreign-born patients varied by country of birth.<b>CONCLUSION:</b> Our findings underline the importance of being aware of the heterogeneity of TB incidence and characteristics of patients in the migrant population residing ≥5 years in the Netherlands.