High Tuberculosis Incidence Rates Research Articles

Prevalence and incidence rates of tuberculosis in people with HIV during the coronavirus 2019 pandemic: a single center retrospective analysis

Background Tuberculosis (TB) poses a significant risk to people with HIV (PWH), with heightened incidence and prevalence rates, especially in countries with a high TB burden. This study assesses the prevalence and incidence rates of TB among PWH during the COVID-19 pandemic, and on treatment outcomes in TB-HIV co-infections. Methods A retrospective study was conducted at Suddhavej Hospital, Faculty of Medicine, Mahasarakham University, Maha Sarakham, Thailand, from January 2020 to September 2023, involving newly diagnosed adult PWH. Data were collected on TB prevalence and incidence rates, with TB cases categorized as definite or possible. The primary outcomes were TB prevalence and incidence rates per 100,000 person-years of follow-up. Results Among 171 newly diagnosed PWH, the prevalence of TB was 5.85%, with an incidence rate of 4,568.71 per 100,000 person-years. All but one TB cases were diagnosed before antiretroviral therapy (ART) initiation. There was no incident TB during the follow-up period during ART. Nearly half of the TB cases required therapeutic trials without microbiological confirmation. Conclusions The study revealed a high prevalence and incidence rate of TB among PWH during the COVID-19 pandemic, comparable to pre-pandemic rates in Thailand. The findings highlight the necessity of comprehensive TB screening prior to ART initiation and the cautious implementation of universal TB preventive therapy. The use of molecular diagnostics, in addition to symptom screening, can enhance TB diagnosis among PWH, though accessibility remains an issue in many regions.

Pulmonary tuberculosis epidemiology and genetics in Kazakhstan.

Tuberculosis (TB) is a major public health emergency in many countries, including Kazakhstan. Despite the decline in the incidence rate and having one of the highest treatment effectiveness in the world, the incidence rate of TB remains high in Kazakhstan. Social and environmental factors along with host genetics contribute to pulmonary tuberculosis (PTB) incidence. Due to the high incidence rate of TB in Kazakhstan, our research aimed to study the epidemiology and genetics of PTB in Kazakhstan. 1,555 participants were recruited to the case-control study. The epidemiology data was taken during an interview. Polymorphisms of selected genes were determined by real-time PCR using pre-designed TaqMan probes. Epidemiological risk factors like diabetes (χ2 = 57.71, p < 0.001), unemployment (χ2 = 81.1, p < 0.001), and underweight-ranged BMI (<18.49, χ2 = 206.39, p < 0.001) were significantly associated with PTB. VDR FokI (rs2228570) and VDR BsmI (rs1544410) polymorphisms were associated with an increased risk of PTB. A/A genotype of the TLR8 gene (rs3764880) showed a significant association with an increased risk of PTB in Asians and Asian males. The G allele of the rs2278589 polymorphism of the MARCO gene increases PTB susceptibility in Asians and Asian females. VDR BsmI (rs1544410) polymorphism was significantly associated with PTB in Asian females. A significant association between VDR ApaI polymorphism and PTB susceptibility in the Caucasian population of Kazakhstan was found. This is the first study that evaluated the epidemiology and genetics of PTB in Kazakhstan on a relatively large cohort. Social and environmental risk factors play a crucial role in TB incidence in Kazakhstan. Underweight BMI (<18.49 kg/m2), diabetes, and unemployment showed a statistically significant association with PTB in our study group. FokI (rs2228570) and BsmI (rs1544410) polymorphisms of the VDR gene can be used as possible biomarkers of PTB in Asian males. rs2278589 polymorphism of the MARCO gene may act as a potential biomarker of PTB in Kazakhs. BsmI polymorphism of the VDR gene and rs2278589 polymorphism of the MARCO gene can be used as possible biomarkers of PTB risk in Asian females as well as VDR ApaI polymorphism in Caucasians.

Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho.

Lesotho is one of the 30 countries with the highest tuberculosis incidence rates in the world, estimated at 650 per 100,000 population. Tuberculosis case detection is extremely low, particularly with the rapid spread of COVID-19, dropping from an estimated 51% in 2020 to 33% in 2021. The aim of this study is to understand the barriers to tuberculosis diagnosis and treatment completion. We used a convergent mixed methods study design. We collected data on the number of clients reporting symptoms upon tuberculosis screening, their sputum test results, the number of clients diagnosed, and the number of clients who started treatment from one district hospital and one health center in Berea district, Lesotho. We conducted in-depth interviews and focus group discussions with 53 health workers and patients. We used a content analysis approach to analyze qualitative data and integrated quantitative and qualitative findings in a joint display. During March-August, 2019, 218 clients at the hospital and 292 clients at the health center reported tuberculosis symptoms. The full diagnostic testing process was completed for 66% of clients at the hospital and 68% at the health center. Among clients who initiated tuberculosis treatment, 68% (61/90) at the hospital and 74% (32/43) at the health center completed treatment. The main barriers to testing and treatment completion were challenges at sample collection, lack of decentralized diagnostic services, and socioeconomic factors such as food insecurity and high patient movement to search for jobs. Tuberculosis diagnosis could be improved through the effective decentralization of laboratory services at the health facility level, and treatment completion could be improved by providing food and other forms of social support to patients.

The Environmental and Socioeconomic Effects and Prediction of Tuberculosis Patients in different age groups in the Southwest of China: a population based study.

While the End Tuberculosis (TB) Strategy has been implemented worldwide, the cause of TB epidemic is multifactorial and has been not fully understood. To investigate the risk factors of TB and incorporate these factors to forecast the incidence of TB infection across different age groups in Sichuan, China. Correlation and linear regression analyses were conducted to assess the relationships between TB cases and ecological factors, including environmental, economic, and social factors in Sichuan Province from 2006 to 2017. The transfer function-noise (TFN) model was used to forecast trends, considering both time and multi-factors effects. From 2006 to 2017, Sichuan Province had a reported cumulative incidence rate of 1321.08 cases/100,000 in males and 583.04 cases/100,000 in females. There were significant sex differences in the distribution of cases among age groups (trend χ2=12,544.416, P<.001). Ganzi Tibetan Autonomous Prefecture had the highest incidence rates of TB in both males and females in Sichuan. Correlation and regression analyses shown that the total illiteracy rate and averagepressure ateachmeasuring station (for individuals aged 15-24) were risk factors for TB. The protective factors follows: the number of families with the minimum living standard guarantee in urban areas, average wind speed, number of discharged patients with invasive TB, number of people with the minimum living standard guarantee in rural areas, total health expenditure as a percentage of regional GDP, being a single male (for individuals aged 0-14), number of hospitals, number of health workers in infectious disease hospitals (for individuals aged 25-64), amount of daily morning and evening exercise, number of people with the urban minimum living standard guarantee, and being married (for females aged >64 years). The TFN model indicated that the incidence of TB in males aged 0-14 and 15-24 will continue to rise, and the incidence of TB in females aged 0-14 and >64 will continue to increase rapidly in Sichuan, by 2035. The End TB Strategy in Sichuan should take into account environmental, educational, medical, social, personal and other conditions, and further substantial efforts are needed especially in aged 0-24 males, aged 0-14 females, and 64 years elder females. Data collection of TB was required by the Law of the People's Republic of China on Prevention and Treatment of Infectious Diseases. The ethical approval in this study was granted by the Ethics Committee of Sichuan CDC (SCCDCIRB2022-001).

Identification of Mycobacterium tuberculosis in pulmonary and extrapulmonary specimens of Iranian hospitalized patients during 2017-2021.

Tuberculosis (TB) is one of the most serious public health problems worldwide which is a chronic infectious disease and is still one of the major challenges for developing countries. This study was undertaken to identify Mycobacterium TB (MTB) in clinical specimens in hospitalized patients. The study was carried out on specimens from pulmonary and extrapulmonary suspected TB patients that were admitted to one of the largest tertiary hospitals located in Tehran, Iran from 2017 to 2021. The GeneXpert MTB/rifampin (RIF) method was applied to detect MTB and RIF resistance. Characteristics of demography, clinical features, and lifestyle were obtained from medical case records registered in the hospital. Of 957 specimens, 92 (9.61%) were found positive for TB by GeneXpert assay. Of positive samples, 72 (78.26%) were considered pulmonary TB, and 20 (21.73%) of them are associated with extrapulmonary involvement. Four (4.3%) positive TB cases were categorized as rifampicin-resistant. This study showed a relatively high incidence rate of TB in distinct types of specimens in Iranian hospitalized patients but a low level of RIF resistance.

Ang II-Induced Hypertension Exacerbates the Pathogenesis of Tuberculosis.

It has been known that infection plays a role in the development of hypertension. However, the role of hypertension in the progression of infectious diseases remain unknown. Many countries with high rates of hypertension show geographical overlaps with those showing high incidence rates of tuberculosis (TB). To explore the role of hypertension in tuberculosis, we compared the effects of hypertension during mycobacterial infection, we infected both hypertensive Angiotensin II (Ang II) and control mice with Mycobacterium tuberculosis (Mtb) strain H37Ra by intratracheal injection. Ang II-induced hypertension promotes cell death through both apoptosis and necrosis in Mtb H37Ra infected mouse lungs. Interestingly, we found that lipid accumulation in pulmonary tissues was significantly increased in the hypertension group compared to the normal controls. Ang II-induced hypertension increases the formation of foamy macrophages during Mtb infection and it leads to cell death. Moreover, the hypertension group showed more severe granuloma formation and fibrotic lesions in comparison with the control group. Finally, we observed that the total number of mycobacteria was increased in the lungs in the hypertension group compared to the normal controls. Taken together, these results suggest that hypertension increases intracellular survival of Mtb through formation of foamy macrophages, resulting in severe pathogenesis of TB.

Spatial pattern of tuberculosis (TB) and related socio-environmental factors in South Korea, 2008-2016.

Tuberculosis (TB) incidence and corresponding mortality rates in S. Korea are unusual and unique compared to other economically developed countries. Korea has the highest TB incidence rate in Organization for Economic Co-operation and Development (OECD) countries. TB is known as a disease reflecting socio-economic and environmental conditions of a society. Besides, TB is an infectious disease spread through the air, naturally forming spatial dependence of its incidence. This study investigates TB incidences in Korea in socio-economic and environmental perspectives. Eigenvector spatial filtering applied accounts for spatial autocorrelation in the TB incidence, and Getis-Ord statistic tracks the changes of TB clusters at given time. The results show that population composition ratio, population growth rate, health insurance payment, and public health variables are significant throughout the study period. Environmental variables make minor effects on TB incidence. This study argues that unique demographic features of Korea are a potential threat to TB control in the future.

Incident tuberculosis disease in patients receiving biologic therapies in the Western Cape, South Africa from 2007 to 2018

BackgroundSouth Africa has one of the highest tuberculosis incidence rates. Biologic disease-modifying anti-rheumatic drugs are associated with an increased risk of tuberculosis. The objective of this study was to describe the tuberculosis disease incidence rate among public sector patients receiving biologic therapies in the Western Cape Province.MethodsA retrospective, descriptive analysis was undertaken using routine health data collated by the Provincial Health Data Centre from January 2007 (first use of biologic therapy in the Western Cape) to September 2018.ResultsWe identified 609 patients treated with tumour necrosis factor-alpha (TNF-α) or non-TNF-α biologic therapies. Thirty-seven (37) patients developed tuberculosis after biologic therapy exposure, of whom the majority (78%) had an immune mediated inflammatory disease and the remainder (22%) a haematologic malignancy. The incidence rate of tuberculosis per 100,000 person-years was 2227 overall [95% confidence interval (CI): 1591, 3037]. Patients treated with TNF-α inhibitors and non-TNF-α inhibitors had estimated incidence rates of 2819 [95% CI: 1669, 4480] and 1825 [95% CI: 1131, 2797], respectively (p = 0.10).ConclusionPatients exposed to both TNF-α and non-TNF-α biologic therapies may have a higher incidence of tuberculosis disease compared to the background risk of 681 cases per 100,000 per year in the Western Cape.

Social determinants, ethical issues and future challenge of tuberculosis in a pluralistic society: the example of Israel.

SummaryTuberculosis is a very serious respiratory infectious disease, caused by the bacillus Mycobacterium tuberculosis, which generates a relevant societal and clinical burden. It has always represented a permanent concern and a public health challenge over the course of human history, because of its severe epidemiological, and economic-financial implications. The present review aims at over-viewing the impact of tuberculosis on the Israeli healthcare system, its temporal trend and evolution, stratified according to ethnicities and minorities, the need of establishing new facilities and implementing screening techniques, public health strategies and diagnostic tests, following massive immigration waves from countries characterized by a high incidence rate of tuberculosis during the fifties-sixties until the nineties, and the policies implemented by the Israeli government in the control, management and treatment of tuberculosis, as well as the role played by Israeli prominent scientists in discovering new druggable targets and finding bioactive compounds and bio-molecules in the fight against tuberculosis. Israel represents a unique, living laboratory in which features of developed and developing countries mix together. This country as a case-study of immigrant, pluralistic society underlines the importance of adopting a culturally-sensitive community intervention approach. The understanding of the subtle interplay between race/ethnic host and pathogen factors, including the role of gene variations and polymorphisms can pave the way for a personalized treatment and management of tuberculosis patients, contributing to the development of new tools for targeted tuberculosis therapeutics, immunodiagnostics and vaccination products.

The Features of the Course and Outcomes of HIV Infection Diagnosed at the Stage of Pronounced Immunosuppression

Objective: to present the features of the course and outcomes of HIV infection diagnosed at the stage of pronounced immunosuppression.Material and methods. Based on the primary CD4 + T-lymphocytes count, 492 patients living with HIV were divided into 2 groups: group 1 - 220 patients (CD4 + TL less than or equal to 350 cells/μl), group 2 - 272 patients (CD4 + TL more than 350 cells/µl). The statistical analysis was performed using the package «Statisticа» v.10.Results. Among the patients of the first group there were more men than in the second group: 136 (61.8 %) and 125 (46 %), p &lt; 0.001, respectively; more patients in HIV clinical stages 3 and 4 - 52.7 % and 27.6 %, p &lt; 0.05; more ART patients: 208 (94.5 %) and 148 (54.4 %) p &lt; 0.001, respectively. The levels of T-helpers and IRI (immunoregulatory index) in the patients of group 2 in the follow-up dynamics remained significantly higher compared with those of the patients of group 1. The incidence of tuberculosis was higher in group 1: 33 (15 %) and 15 (5.5 %), respectively, p &lt; 0.05. In the first group, 23 (10.5 %) patients died, in the second - 9 (3.3 %), p &lt; 0.003.Conclusion. HIV-infection at the stage of pronounced immunosuppression was diagnosed in 220 patients - 44.7 % (95 % CI: 40.4-49.1) of the cases. Severe immunosuppression in the primarily diagnosed patients was associated with the presence of HIV clinical stages 3 and 4 (OR - 2.9; 95 % CI: 2.0-4.3), higher incidence rates of tuberculosis (OR - 3.02; 95 % CI: 1.6-5.7) and fatal outcomes (OR - 3.4; 95 % CI: 1.5-7.5), a slower increase in T-helpers and IRI counts.

Small-scale stable clusters of elevated tuberculosis incidence in Moscow, 2000–2015: Discovery and spatiotemporal analysis

ObjectivesTo find residential areas with high incidence rate of tuberculosis in Moscow using spatio-temporal analysis of incidence data. MethodsWe analyzed the spatial patterns of residence locations of smear or culture positive patients with pulmonary tuberculosis in Moscow. To identify clusters with high local incidence rates, the neighborhoods of detected cases were studied. We assessed the spatial and temporal stability of clusters. ResultsFor 19033 cases diagnosed with smear or culture positive pulmonary tuberculosis among residents of Moscow in 2000–2015 we identified 18 small-scale clusters of increased incidence rate responsible for 3% of all registered cases identified on a territory inhabited by only 1% of the population. Locations of clusters were sufficiently stable in space throughout the whole period. The local incidence rate inside clusters was significantly (3–4 times) higher than the city average during the whole observation period. The presence of clusters was associated with the incidence rate in the surrounding area. Socio-demographic characteristics of patients in clusters were not significantly different from the average characteristics of patients in the city. ConclusionsThe detected small-scale clusters of increased incidence may be used to target active case finding for tuberculosis. The causes and mechanisms of cluster formation and stability need further study.

Childhood tuberculosis in Vienna between 2010 and 2016.

Tuberculosis (TB) has become arare disease in developed countries. Austria is alow incidence country for TB with an incidence rate of 7.2/100,000 in 2016. The incidence of TB has shown aconstant decline in Austria from 2008 (9.8/100,000) to 2015 (6.7/100,000) but recently stagnated in 2016 (7.2/100,000). In recent years migration to Austria from countries with high TB incidence rates has increased. Therefore, this study aimed to describe the recent epidemiology of childhood TB in Vienna. Data of pediatric patients with active TB infections, who were hospitalized for further investigations or isolation precautions between 2010 and 2016 at the Wilhelminenspital, Austria's reference center for childhood tuberculosis, were retrospectively analyzed. Demographic and clinical data (symptoms, microbiology, radiology, immunology) were collected, compared and evaluated. A total of 127 patients with active tuberculosis were included in the study. The number of admissions varied between n = 7 in 2010 and n = 26 in 2016. There were two age peaks of infected children (0-5years: n = 41 and 15-18years: n = 45). In 35% of the cases one parent had active TB and was suspected to be the index case. In 36% the source of infection remained unknown. Compared to young children (<5years), adolescents (15-18years) showed proportionally more TB-related symptoms, such as cough (41% vs. 24%), fever (15% vs. 14%) and weight loss (22% vs. 0%). At the time of admission 51% of the young children and 33% of the adolescents were free of symptoms. Intrathoracic disease was found in 80.8%, extrathoracic disease in 19.2% and 11% of the cases were tuberculous lymphadenitis. Of the patients with intrathoracic TB 54% (n = 64) had apositive microbiological result (auramine staining, bacteriological culture, PCR). In young children hilar lymphadenopathy was the most frequent radiological finding (50%), whereas in adolescents lung infiltrates were most common (36%). The sensitivity of interferon-gamma release assays (IGRA) was 0.94 compared to 0.88 of the tuberculin skin test (TST). Both test methods showed moderate concordance (ϕ-coefficient = 0.48). A high number of asymptomatic children and adolescents with active TB were observed, which underlines the importance of efficient screening measures. Thorough history taking in all patients with TB is essential to maximize the effect of contact tracing. Overall, infection rates remained consistently low during the observation period.

Diabetes mellitus and tuberculosis in Korean adults: impact on tuberculosis incidence, recurrence and mortality.

<sec id="st1"> <title>SETTING</title> The prevalence of diabetes mellitus (DM) worldwide is increasing markedly, and many countries with rising rates also have a high incidence rate of tuberculosis (TB). </sec> <sec id="st2"> <title>OBJECTIVE</title> To investigate the relationships of fasting serum glucose (FSG) and DM with TB incidence, recurrence and mortality risk in a prospective cohort study in South Korea. </sec> <sec id="st3"> <title>DESIGN</title> Our study comprised 1 267 564 Koreans who received health insurance from the National Health Insurance System, had an initial medical evaluation between 1997 and 2000 and were prospectively followed biennially. </sec> <sec id="st4"> <title>RESULTS</title> Participants with DM had a higher risk for incident TB (hazard ratio [HR] 1.81, 95%CI 1.71-1.91 in males, HR 1.33; 95%CI 1.20-1.47 in females) than those without DM. There was a strong positive trend for TB risk with rising FSG among males. The risk for recurrent TB among those with previous TB was significantly higher in males (HR 1.58, 95%CI 1.43-1.75) and in females with DM (HR 1.38, 95%CI 1.08-1.76). The increased risk of death from TB during follow-up was also significant in men (HR 1.91, 95%CI 1.87-1.95) and in women (HR 1.71, 95%CI 1.65-1.77). </sec> <sec id="st5"> <title>CONCLUSIONS</title> A diagnosis of DM is a risk factor for TB, TB recurrence and death from TB. Screening for TB should be considered among people living with DM in Korea, particularly those with severe DM. </sec>.

Political, economic, and health system determinants of tuberculosis incidence

Although global tuberculosis (TB) rates have decreased, multidrug-resistant strains have become a concern. Traditionally, causes of infectious diseases are determined through health and health system factors, yet socioeconomic and political variables may influence a nation’s vulnerability and response to infectious disease control. This study explores relationships among political stability, economic stability, tuberculosis detection policies, health system constructs, and the incidence of tuberculosis. A retrospective, cross-sectional, observational design was employed using open-source, secondary, 2014 country-level data from the World Bank and World Health Organization. A structural equation model examined the direct and indirect effects of economic, political, and other constructs on tuberculosis incidence rates. Political and economic stability, health system indicators, and detection policies all covaried. Political stability, health system indicators, and detection policies directly affected tuberculosis incidence rates, but economic stability did not. Political stability and health system indicators were negatively associated with tuberculosis incidence, while detection policies were positively associated. Countries with greater political stability and better health systems experienced lower TB incidence, but countries with more detection policies in place had higher TB incidence rates. Economic stability did not directly affect TB incidence, but covaried positively with political stability, indicating strong links to political stability.

[Factors associated with the occurrence of tuberculosis and its spatial distribution in a Brazilian city, 1991-2010].

This article seeks to identify factors associated with the incidence of tuberculosis and the spatial distribution of the disease in Olinda, Pernambuco, from 1991 to 2010. In order to study the factors associated with the disease, Poisson regression was applied and standardized morbidity ratios were utilized for the spatial exploratory analysis. Although a reduction in the average incidence of tuberculosis in Olinda was observed, the rate remains high in comparison with the national average. Mapping according to five-year periods suggests rate increases until 2005, with a decline between 2006 and 2010 and the persistence of high incidence in areas of greater socioeconomic need. The highest tuberculosis incidence rates were associated in each area with the proportions of illiteracy, of heads of household without income, of households lacking water supply and of older adults, as well as with the presence of cases of retreatment and of households with two or more new cases of tuberculosis. Incorporating a spatial component is key for the organization of health services and the planning of epidemiological surveillance for tuberculosis.

CHILDHOOD TUBERCULOSIS IN GOMELREGION

Objective: to analyze cases of childhood tuberculosis in Gomel region over the last 12 years. Material and methods. We have conducted a retrospective study of tuberculosis cases in children aged 1-14 over the period 2006-2017. Results. The ratio of childhood tuberculosis was 0.7% (0.5-0.8) among all new cases of the disease. A high level of microbiological confirmation of tuberculosis (26.7%, 16.0-39.6) was observed. Contact with a tuberculosis patients was found in 53.3% (40-66.3). The Mantoux test remains relevant in the diagnosis of childhood tuberculosis (the size of the papule is 12.3 ± 4.8 mm). More than a third of the sick children were in a socially dangerous situation. HIV-associated tuberculosis in the children was 18.3%. Most of those children lived in families being in contact with tuberculosis patients. Conclusion. A low rate of childhood tuberculosis has been recorded in the region. A high incidence rate of tuberculosis in children in contact with tuberculosis patients indicates a low grade of measures against the exposure to tuberculosis infection. The prevention and detection of tuberculosis among HIV-positive children are a topical issue.

Knowledge about tuberculosis transmission and prevention and perceptions of health service utilization among index cases and contacts in Brazil: Understanding losses in the latent tuberculosis cascade of care.

IntroductionTuberculosis contacts are candidates for active and latent tuberculosis infection screening and eventual treatment. However, many losses occur in the different steps of the contacts’ cascade of care. Reasons for this are poorly understood.ObjectiveTo describe the different steps where losses in the contact cascade occur and to explore knowledge and attitudes regarding tuberculosis transmission/prevention and perceptions about tuberculosis services in order to understand the reasons for losses from the tuberculosis service users’ perspective.DesignWe collected routine data from the index case and contact registry books and from patients’ records to build the cascade of care of contacts in 12 health facilities in three Brazilian cities with high tuberculosis incidence rates. During a knowledge, attitudes and practices (KAP) survey, trained interviewers administered a semi-structured questionnaire to 138 index cases and 98 contacts.ResultsMost of the losses in the cascade occurred in the first two steps (contact identification, 43% and tuberculin skin testing placement, 91% of the identified contacts). Among KAP-interviewed contacts, 67% knew how tuberculosis is transmitted, 87% knew its key symptoms and 81% declared they would take preventive therapy if prescribed. Among KAP-interviewed index cases, 67% knew they could spread tuberculosis, 70% feared for the health of their families and 88% would like their family to be evaluated in the same services.ConclusionOnly a small proportion of contacts are evaluated for active and latent tuberculosis, despite their—and their index cases’—reasonable knowledge, positive attitudes towards prevention and satisfaction with tuberculosis services. In these services, education of service users would not be a sufficient solution. Healthcare workers’ and managers’ perspective, not explored in this study, may bring more light to this subject.

Clinical implication of novel drug resistance-conferring mutations in resistant tuberculosis.

Evolving novel and/or unfamiliar mutations are revolutionizing the pathways of antibiotic resistance of clinical tuberculosis. The accumulation and interaction of these poorly characterized mutations augment the complexity of resistant pathogenic strains and raise public health concerns. This article reviews our current understanding of the genetic changes that characterize drug resistance in tuberculosis and highlights the imperative for further investigations focusing on the effects of an individual mutation and interacting mutations with detailed strain epidemiology, particularly as these pertain to technology-limited countries with high tuberculosis incidence rates. Concomitantly, there is a need for the development, testing, and uptake of new tools for studying the effects of these mutations in drug resistance and fitness cost of the pathogen. Such genetic data are critical for effective localized and global tuberculosis control interventions and for accurate epidemiological predictions.

Prevalence of zoonotic tuberculosis and associated risk factors in Central Indian populations

In the present study, we aimed to estimate the occurrence of bovine tuberculosis (TB) and examine the determinants of distribution of the disease in three high-risk populations of Central India. A prospective cohort study was conducted in Central India between March 2014 and June 2015. Based on the requisite inclusion criteria, we recruited a total of 301 participants whose blood samples were subjected to polymerase chain reaction-based detection and differentiation of Mycobacterium bovis and Mycobacterium tuberculosis. M. bovis was detected in 11.4%, 8.9%, and 12.6% of the recruited participants belonging to three distinct population groups (Groups A, B, and C, respectively). The highest proportion of cases infected with M. bovis was observed in Group C, who lived in the high TB endemic region. Previous contact with active TB cases (odds ratio=3.7; 95% confidence interval, 0.9612–14.4533) and raw milk consumption (odds ratio=5.3472; 95% confidence interval, 1.9590–14.5956) were found to be important determinants of bovine TB in this population. The high incidence rates of bovine TB in the Central Indian populations indicate the substantial consequences of this disease for some population groups and settings. However, more research is necessary to identify the main transmission drivers in these areas.

Incidence Rates of Tuberculosis among Children and Adolescents Living in Areas Most Affected by the Chernobyl Disaster.

The Chernobyl accident has attracted the attention of healthcare experts all over the world due to the unprecedented scale of damage the disaster inflicted upon human health. To examine incidence rates of tuberculosis and patterns among children and adolescents living in areas most affected by the Chernobyl disaster between 2004 and 2014. The tuberculosis incidence rate was calculated per 100,000 people. Incidence dynamics were traced for the period 2004 to 2014 and average rates were measured. Average incidence rates were calculated for different age groups, including 0-4 years, 5-9 years, 10-14 years, and 15-19 years, as well as the total value for all those between 0-19 years of age. Average incidence rates were estimated for tuberculosis, pulmonary tuberculosis and extrapulmonary tuberculosis. A comparative analysis of incidence rates of tuberculosis in areas more and less affected by the Chernobyl disaster was conducted. To avoid gender and age disparities among the population in the two different study areas, a method of direct standardization was applied. Tuberculosis incidence rates showed identical patterns among the population across all areas in this region. At the same time, the incidence rates of tuberculosis, pulmonary tuberculosis, and extrapulmonary tuberculosis were higher among children and adolescents living in the most affected areas in comparison to those living in less affected areas. The results do not allow us to conclude whether radioactive pollution has a direct impact on incidence of tuberculosis among children and adolescents in the most radioactively contaminated areas. The author believes that the higher incidence rates of tuberculosis in the most affected areas are conditioned by a set of negative factors that have a pernicious influence on the general health of the population, and on the health of children and adolescents in the areas most affected by the Chernobyl disaster.