High Prevalence Of Pulmonary Tuberculosis Research Articles

Primary Infection by Pericardial Tuberculosis in Immunocompetent Patient

The high prevalence of pulmonary tuberculosis, which is endemic in some countries, is the main cause of pericardial tuberculosis, a figure that increases even more in immunocompromised patients, but nevertheless the incidence of primary pericardial infection by tuberculosis is low and therefore there are only case reports in literature. The prevalence of pericardial effusion secondary to tuberculosis in immunocompetent patients is low and only case reports have been found, perhaps due to low suspicion, so we intend to provide more evidence to the literature. For diagnosis we have imaging studies, culture, Xpert MTB/RIF system, Adenosine Aminase.

Interaction between air pollutants and meteorological factors on pulmonary tuberculosis in northwest China: A case study of eight districts in Urumqi.

Meteorological factors and air pollutants are associated with the spread of pulmonary tuberculosis (PTB), but few studies have examined the effects of their interactions on PTB. Therefore, this study investigated the impact of meteorological factors and air pollutants and their interactions on the risk of PTB in Urumqi, a city with a high prevalence of PTB and a high level of air pollution. The number of new PTB cases in eight districts of Urumqi from 2014 to 2019 was collected, along with data on meteorological factors and air pollutants for the same period. A generalized additive model was applied to explore the effects of meteorological factors and air pollutants and their interactions on the risk of PTB incidence. Segmented linear regression was used to estimate the nonlinear characteristics of the impact of meteorological factors on PTB. During 2014-2019, a total of 14,402 new cases of PTB were reported in eight districts, with March to May being the months of high PTB incidence. The exposure-response curves for temperature (Temp), relative humidity (RH), wind speed (WS), air pressure (AP), and diurnal temperature difference (DTR) were generally inverted "U" shaped, with the corresponding threshold values of - 5.411 °C, 52.118%, 3.513m/s, 1021.625hPa, and 8.161 °C, respectively. The effects of air pollutants on PTB were linear and lagged. All air pollutants were positively associated with PTB, except for O3, which was not associated with PTB, and the ER values for the effects on PTB were as follows: 0.931 (0.255, 1.612) for PM2.5, 1.028 (0.301, 1.760) for PM10, 5.061 (0.387, 9.952) for SO2, 2.830 (0.512, 5.200) for NO2, and 5.789 (1.508, 10.251) for CO. Meteorological factors and air pollutants have an interactive effect on PTB. The risk of PTB incidence was higher when in high Temp-high air pollutant, high RH-high air pollutant, high WS-high air pollutant, lowAP-high air pollutant, and high DTR-high air pollutant. In conclusion, both meteorological and pollutant factors had an influence on PTB, and the influence on PTB may have an interaction.

Role of Aspergillus Specific IgG Titres as a Therapeutic Target for Chronic Pulmonary Aspergillosis: A Longitudinal Study

Introduction: Chronic Pulmonary Aspergillosis (CPA) continues to be an enigma to clinicians in regions with a high prevalence of pulmonary tuberculosis and is often misdiagnosed as the latter, attributable to the significant overlap in symptoms and radiology. Moreover, although the diagnostic criteria for CPA have been standardised, the role of serological markers in monitoring disease activity and response to therapy is still not well characterised. Aim: To understand the characteristics, risk factors and treatment outcomes in patients developing CPA and to determine the role of serological markers as indicators of disease activity. Materials and Methods: The present longitudinal study was conducted in the Department of Respiratory Medicine, University College of Medical Sciences and its associated Guru Teg Bahadur Hospital, Delhi, India from February 2021 to June 2022. Study included 46 patients suspected of harbouring CPA attributable to their clinico-radiological presentation. The diagnosis of CPA was made using the established criteria. Patients with a confirmed diagnosis of CPA received oral azole antifungals for 6 months and were monitored at 3-monthly intervals for reduction in baseline parameters to determine treatment success/failure. Paired and unpaired parametric variables were compared using the t-test and non parametric methods were compared using the Chisquare test. Results: The diagnosis of CPA was established in 31 (67.4%) patients of whom 77.6% were males and the mean age was 47.3±2.2 years. These patients had been symptomatic for 5.8±1.2 years. Underlying risk factors (such as the history of tuberculosis, chronic obstructive pulmonary disease, diabetes mellitus, history of long-term glucocorticoid use etc.) had been present for 6.9±1.3 years. Patients harboured an average of two risk factors with tuberculosis and diabetes mellitus being the most common local and systemic affliction, respectively. Patients with tuberculosis (p-value=0.001) and chronic steroid use (p-value=0.029) were significantly at higher risk of developing CPA. 6 months of azole therapy led to significant reduction in specific IgG titres (p-value=0.001), and serum precipitins (p-value=0.004). Two patients on itraconazole relapsed within 12 months but were successfully treated with voriconazole. Conclusion: Tuberculosis was the most significant local risk factor leading to the development of CPA, which developed soon after diagnosis of another systemic risk factor. Six months of azole therapy was adequate to induce remission of the disease, activity of which can be monitored though the measurement of serum IgG antibody titres.

Prevalence of pulmonary tuberculosis and the associated clinical symptoms in Western Uganda

Pulmonary tuberculosis is a public health problem affecting over 5.8 million people worldwide per year. Burden of the disease varies across populations due to differences in biological and behavioral factors. In Western Uganda, the prevalence of pulmonary tuberculosis was not established and there was continued use of a biased clinical tuberculosis description guideline during treatment. Therefore, a cross-sectional study was conducted among people ≥12 years attending Buhinga hospital in Western Uganda from April to June 2019 to achieve the following specific objectives; (1)-Determine prevalence of pulmonary tuberculosis by age group and sex, 2-Assess the clinical symptoms associated with pulmonary tuberculosis amongst the participants. Participants were recruited by simple random sampling technique and standardized questionnaire were administered to obtain demographic and clinical data. 379 sputum specimens were collected and tested for M. tuberculosis using Gene X-pert and Classical Real Time PCR. Data was analyzed using SPSS software version 13. Prevalence of pulmonary tuberculosis by age group was highest in 20-29 years, high in 30-39 years and ≥50 years and least in 10-19 years old individuals. Females had a slightly higher prevalence of pulmonary tuberculosis than males. Youthful behavior of active participation in social activities and advanced age health associated factors contributed to the high prevalence of pulmonary tuberculosis amongst the participants. There was no significant relationship between pulmonary tuberculosis disease and demography; - age group and sex (P-value = 0.24). All pulmonary tuberculosis cases presented with persistent fevers, coughs for ≥ 2 weeks, night sweats and noticeable weight loss in the hierarchical order. The relationship between pulmonary tuberculosis disease and clinical symptoms; - persistent fevers, cough, noticeable weight loss and night sweats (P-values; <0.001, <0.001, 0.001 and <0.001 respectively) was significant. Age and clinical symptoms are important pulmonary tuberculosis control hotspots.

A CROSS-SECTIONAL STUDY TO FIND THE PREVALENCE OF IMPAIRED GLUCOSE TOLERANCE IN PULMONARY TUBERCULOSIS PATIENTS

Introduction: Higher prevalence of pulmonary tuberculosis in a diabetic patient is a well-known fact. The inverse relationship i.e. higher prevalence of impaired glucose tolerance in a tuberculous population is also being increasingly realized now and it becomes more relevant due to increased prevalence of DM in general population. Aim/ Objective: To nd the prevalence of abnormal glucose tolerance in pulmonary tuberculosis patients and to correlate the glycaemic parameters with the grades of sputum AFB positivity. Materials & Methods: A hospital based prospective observational comparative study was conducted at a tertiary care hospital. A total of 100 consecutive eligible patients of tuberculosis, were included after taking informed parental consent. Data was analyzed using statistical software SPSS ver. 21. Results: Mean age of the study cases was 42.59 years with 78% males to 22% females. On Oral glucose tolerance test, 56% had normal results while 44% had deranged results. Out of the total 44 cases with deranged results, 13% had IGT and 31% had diabetes. A signicant association was observed between deranged OGTT values and higher sputum grades (p<0.05). Glycemic control as measured by glycated haemoglobin was signicantly associated with grade of sputum positivity. HbA1c levels were 5.98% in cases with “scanty” grade while it was 6.18%, 6.53% and 6.99% in cases with grade +1, +2 and +3 respectively (p<0.05). Conclusion: We observed high prevalence of impaired glucose tolerance and diabetes in tuberculosis patients. Impaired results were signicantly associated with higher degree of sputum positivity. We thus recommend diabetes screening in all TB patients by either HbA1c or OGTT and glucose levels should be measured at least every 2 months after the initiation of anti-tuberculosis treatment.

Microscopic Profile of AFB in the Sputum of a Patient's Family Diagnosed with Positive AFB in the Advanced Phase

Tuberculosis (TBC) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. The high prevalence of pulmonary tuberculosis in the community, the coverage of the prevention program with the DOTS strategy is still low, so the aspects of controlling transmission risk factors are important, especially transmission of high risk to the families of sufferers. The method of examination performed to diagnose TBC is microscopic examination of sputum. This study aims to determine the microscopic description of Acid Resistant Basil (ARB) in family members who live in one house with patients with TBC smear positive treatment advanced phase at the Balkesmas Semarang area. This research method is descriptive (non-experimental) with total sampling. The results of the study were that there was no ARB in the sputum of family members living in one house with patients with TBC smear positive treatment advanced phase of 31 samples from 17 respondents with 11 (32.3%) sputum samples mixed with saliva, 20 (58.8%) samples saliva and 3 respondents did not give two samples (8.8%). The conclusion of the study is the microscopic description of examination of sputum preparations as many as 31 samples from 17 respondents and 6 families 100% no BTA was found.

Lower vitamin D level is associated with higher prevalence of pulmonary tuberculosis in under-five children actively living in tropical countries

Objective: Indonesia accounted for 845.000 tuberculosis (TB) cases, ranked as the second-highest TB incidence in the world. Various studies in childhood TB and vitamin D has overgrown in recent years, but there is no study for vitamin D status in under-five children with pulmonary tuberculosis in Indonesia as tropical country that has an abundant sun exposure. This study evaluates the vitamin D level in under-five children with pulmonary TB compared with healthy children control group. Materials and Methods: This comparative study with a cross-sectional design was conducted in outpatient clinic from February 2019 – February 2020. We selected children ≤5 years old, diagnosed with pulmonary TB; the control group was the random siblings or neighbors who did not have tuberculosis. Differences in 25-hydroxyvitamin D levels in both groups were statistically analyzed with independent t-test. The vitamin D cutoff values were determined using receiver operating characteristic (ROC) curve analysis. Results: A total of 70 patients aged ≤5 years old met the inclusion criteria, 35 childrens were assigned for each group. The 25-hydroxy vitamin D mean level in the TB group was 42.72 nmol/L and 97.74 nmol/L in control group. The TB group has significantly lower 25-hydroxy vitamin D levels than control group (p<0.001). With sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 97.1%, 97.2%, and 100%, respectively, the optimal cutoff point level for 25-hydroxy vitamin D was 80nmol/L. Conclusion: Serum levels of 25-hydroxy vitamin D in children with pulmonary TB are significantly lower than in healthy children. Further study should be conducted to determine the efficacy of vitamin D supplementation in the treatment of children with tuberculosis.

A Fuzzy Strategy to Eliminate Uncertainty in Grading Positive Tuberculosis

Sputum smear microscopic examination is an effective, fast, and low-cost technique that is highly specific in areas with a high prevalence of pulmonary tuberculosis. Since manual screening needs trained pathologist in high prevalence zones, the possibility of deploying adequate technicians during the epidemic sessions would be impractical. This condition can cause overburdening and fatigue of working technicians which may tend to reduce the potential efficiency of Tuberculosis (TB) diagnosis. Hence, automation of sputum inspection is the most appropriate aspect in TB outbreak zones to maximize the detection ability. Sputum collection, smear preparing, staining, interpreting smears, and reporting of TB severity are all part of the diagnosis of tuberculosis. This study has analyzed the risk of automating TB severity grading. According to the findings of the analysis, numerous TB-positive cases do not fit into the standard TB severity grade while applying direct rule-driven strategy. The manual investigation, on the other hand, arbitrarily labels the TB grade on those cases. To counter the risk of automation, a fuzzy-based Tuberculosis Severity Level Categorizing Algorithm (TSLCA) is introduced to eliminate uncertainty in classifying the level of TB infection. TSLCA introduces the weight factors, which are dependent on the existence of maximum number of Acid-Fast Bacilli (AFB) per microscopic Field of View (FOV). The fuzzification and defuzzification operations are carried out using the triangular membership function. In addition, the [Formula: see text]-cut approach is used to eliminate the ambiguity in TB severity grading. Several uncertain TB microscopy screening reports are tested using the proposed TSLCA. Based on the experimental results, it is observed that the TB grading by TSLCA is consistent, error-free, significant and fits exactly into the standard criterion. As a result of the proposed TSLCA, the uncertainty of grading is eliminated and the reliability of tuberculosis diagnosis is ensured when adapting automatic diagnosis.

Persistent high prevalence of pulmonary tuberculosis in a resource-limited setting: threat to India's TB Free campaign

Tuberculosis (TB) is a major public health problem among Saharia, a particularly vulnerable tribal group residing in remote rural areas in central India. This article presents the findings from the baseline survey among Saharias and provides comprehensive prevalence data of pulmonary TB (PTB) in this marginalised community. A community-based cross-sectional PTB prevalence survey was carried out during January-May 2019 in selected villages using multistage stratified cluster sampling. All eligible adults (≥15years of age) were screened for the symptoms of PTB. Sputum samples were collected and processed for microscopy and culture for Mycobacterium tuberculosis. A total of 20114 eligible individuals were screened for symptoms of PTB. Among these, 3001 (14.9%) individuals reported at least one PTB symptom and sputum was collected from 2890 (96.3%) individuals. Among these, 273 (9.4%) were bacteriologically positive for PTB. The overall prevalence was 1357 per 100000 population. The findings indicate that TB continues to be a major health problem in this marginalised community despite large investments by the government for TB control. This emphasizes the need to look into the causes and barriers in implementation of the TB elimination programme in the community, especially in view of India's TB elimination goal by 2025.

The Association of Pulmonary Tuberculosis, Abnormal Glucose Tolerance, and Type 2 Diabetes Mellitus: A Hospital-Based Cross-Sectional Study.

IntroductionTuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and is the second leading infectious cause of death worldwide. The higher prevalence of pulmonary TB in patients with type 2 diabetes mellitus (T2DM) is a well-known fact. The inverse relationship is also being increasingly recognized. Very few studies are available on the correlation of glycemic parameters with grades of sputum acid-fast bacilli (AFB) positivity and disease severity. Hence, this study is undertaken to determine the prevalence of impaired glucose tolerance (IGT), new-onset T2DM, and to correlate glycemic parameters with sputum positivity grades in pulmonary TB patients.MethodsThe is a cross-sectional study that included 93 patients with confirmed pulmonary TB, who presented to the General Medicine and Pulmonary Medicine departments of a tertiary care teaching hospital in southern India. All the patients included in the study underwent oral glucose tolerance (OGTT; 75 g) and glycated hemoglobin (HbA1c) tests. The results were analyzed and interpreted using statistical applications (SPSS software version 21, IBM Corp., Armonk, NY).ResultsAmong the 93 patients included in the study, 73 (78.4%) were males and the mean age was 42.5+1.5 years. The OGTT revealed abnormal results in 44 (47.3%) patients. Thirteen (14%) patients showed IGT and 31 (33.3%) had newly been detected with T2DM. The mean HbA1C of the study participants was noted to be 6.413%.ConclusionThe prevalence of IGT and T2DM among pulmonary TB patients was noted to be 14% and 33.3%, respectively. The grade of sputum positivity and the severity of the disease did not correlate with the serum of HbA1c levels.

High prevalence of pulmonary tuberculosis among female sex workers, men who have sex with men, and transgender women in Papua New Guinea

BackgroundPapua New Guinea (PNG) has a tuberculosis (TB) case notification rate of 333 cases per 100,000 population in 2016 and is one of the 14 countries classified by the World Health Organization (WHO) as “high-burden” for TB, multi-drug-resistant TB (MDR-TB), and TB/HIV. HIV epidemic is mixed with a higher prevalence among key populations, female sex workers (FSW), men who have sex with men (MSM), and transgender women (TGW).MethodsWe conducted a cross-sectional HIV biobehavioral survey (BBS) using respondent-driven sampling method among FSW, MSM, and TGW in Port Moresby, Lae, and Mt. Hagen (2016–2017). As part of the study, participants were screened for the four symptoms suggestive of TB infection using the WHO TB screening algorithm. Sputum and venous whole blood samples were collected and tested for pulmonary TB and HIV infection, respectively. Pulmonary TB testing was performed using GeneXpert®MTB/RIF molecular point-of-care test, and HIV testing was done following the PNG national HIV testing algorithm. All data discussed are weighted unless otherwise mentioned.ResultsAmong FSW, 72.6%, 52.0%, and 52.9% in Port Moresby, Lae, and Mt. Hagen, respectively, experienced at least one symptom suggestive of TB infection. Among MSM and TGW, 69% and 52.6% in Port Moresby and Lae, respectively, experienced at least one symptom suggestive of TB infection. Based on GeneXpert®MTB/RIF results, the estimated TB prevalence rate among FSW was 1200, 700, and 200 per 100,000 in Port Moresby, Lae, and Mt. Hagen, respectively. Among MSM and TGW, the estimated TB prevalence rate was 1000 and 1200 per 100,000 in Port Moresby and Lae, respectively. Co-prevalence of TB/HIV among FSW was 0.1% in Port Moresby and 0.2% in Lae. There were no co-prevalent cases among FSW in Mt. Hagen or among MSM and TGW in Port Moresby and Lae.ConclusionsKey populations have a higher estimated rate of pulmonary TB than the national rate of pulmonary and extra-pulmonary TB combined. This showed that screening key populations for TB should be integrated into HIV programs regardless of HIV status in PNG’s national TB response.

Clinical characteristics of aspergillus infection and colonization in 35 patients with acquired immune deficiency syndrome

Objective To analyze the clinical characteristics of aspergillus infection and colonization in acquired immune deficiency syndrome (AIDS) patients. Methods A retrospective study was performed in 35 AIDS patients who were admitted to Shanghai Public Health Clinical Center between January 2011 and December 2016 with etiology or histopathological evidence of aspergillus infection and colonization. Results The median age of these patients was 47 years old and 33 patients (94.3%) were male. The median CD4+ T cell count was 24 cells/μL, and 29 (82.9%) patients had a CD4+ T cell count <100 cells/μL. Twenty-three patients (65.7%) were diagnosed with aspergillosis, including 20 pulmonary aspergillosis (brain was involved in 1 case), 1 renal aspergillosis and 2 intestinal aspergillosis. Twelve patients (34.3%) were diagnosed with respiratory tract colonization. The most frequently cultured aspergillus species was Aspergillus fumigatus (45.2%). Other infections and underlying risk factors coexisted in 32 patients (91.4%), of which pneumocystis jirovecii pneumoni (34.3%) and pulmonary tuberculosis (25.7%) were the most common. The patients with aspergillus colonization showed a significantly higher prevalence of pulmonary tuberculosis (PTB) than those with aspergillosis (58.3% vs 10%, P=0.006). The most common symptoms in pulmonary aspergillosis were cough (100.0%), fever (90.0%), expectoration (60.0%), dyspnea (55.0%) and hemoptysis (10.0%). The death rate within one year after diagnosis in pulmonary aspergilosis group was significantly higher than colonization group (55% vs 0%, P=0.000). Conclusions Pulmonary aspergilosis is the most common disease caused by aspergillus in AIDS patients, and frequently occurs in those with CD4+ T cell counts <100 cells/μL, with a high mortality rate. Coinfections with other opportunistic pathogens and combination with other risk factors are common. Clinicians should be alert that aspergillus may colonize in AIDS patients with PTB when sputum aspergillus is positive. Key words: Acquired immunodeficiency syndrome; Aspergillus; Pulmonary aspergillosis

Infantile intrathoracic large airway obstruction in a setting with a high prevalence of tuberculosis/HIV

BackgroundThere has been no detailed analysis of the cause of intrathoracic large airway obstruction in infants in a resource-limited environment with a high prevalence of pulmonary tuberculosis (PTB) and human immunodeficiency virus (HIV).AimTo define the aetiology and severity of intrathoracic large airway obstruction in infants in a tertiary South African hospital with a high prevalence of PTB and HIV.MethodsA retrospective study of infants was conducted with computerised tomography (CT) evidence of intrathoracic large airway obstruction from 1 January 2011 to 31 May 2014. CT scans were evaluated for the cause, site and severity of airway narrowing, with severity stratified as ‘mild’ (<50%), ‘moderate’ (51–75%) or ‘severe’ (>75%).ResultsForty-four patients (28 males, 64%; median age 145 days, range 5–331), and 79 sites of attenuation were included. Vascular (22/44, 50%) and nodal (18/44, 41%) compressions accounted for over 90% of cases. Thirty-five patients (79.5%) had at least one site of moderate/severe attenuation, and 26 (59%) had multiple such sites. Adenopathy was the commonest cause of moderate/severe compression (18/35, 51%). All cases of nodal compression were of tuberculous origin. HIV-serology was recorded in 32 patients (73%), one of whom, with vascular compression, was HIV-infected. Half of the patients (11/22, 50%) with vascular compression had congenital abnormalities, most commonly cardiac anomalies (7/22, 32%). There were no synchronous vascular and nodal compressions.ConclusionInfantile intrathoracic large airway obstruction where there is a high prevalence of PTB and HIV is characterised by its extrinsic aetiology, severity and multicentricity, with more than half of all moderate/severe obstructions being caused by tuberculous adenopathy.

The impact of the roll-out of rapid molecular diagnostic testing for tuberculosis on empirical treatment in Cape Town, South Africa.

ObjectiveTo investigate the impact of introducing a rapid test as the first-line diagnostic test for drug-sensitive tuberculosis in Cape Town, South Africa.MethodsXpert® MTB/RIF (Xpert®), an automated polymerase-chain-reaction-based assay, was rolled out between 2011 and 2013. Data were available on 102 007 adults treated for pulmonary tuberculosis between 2010 and 2014. Tuberculosis notification rates per 100 000 population were calculated for each calendar year and for each year relative to the test roll-out locally, overall and by bacteriological confirmation. Empirical treatment was defined as treatment given without bacteriological confirmation by Xpert®, sputum smear microscopy or sputum culture.FindingsBetween 2010 and 2014, the proportion of human immunodeficiency virus (HIV)-negative patients treated empirically for tuberculosis declined from 23% (2445/10 643) to 11% (1149/10 089); in HIV-positive patients, it declined from 42% (4229/9985) to 27% (2364/8823). The overall tuberculosis notification rate decreased by 12% and 19% among HIV-negative and HIV-positive patients, respectively; the rate of bacteriologically confirmed cases increased by 1% and 3%, respectively; and the rate of empirical treatment decreased by 56% and 49%, respectively. These changes occurred gradually following the test’s introduction and stabilized after 3 years.ConclusionRoll-out of the rapid test in a setting with a high prevalence of pulmonary tuberculosis and HIV infection was associated with a halving of empirical treatment that occurred gradually after the test’s introduction, possibly reflecting the time needed for full implementation. More than a quarter of HIV-positive patients with tuberculosis were still treated empirically, highlighting the diagnostic challenge in these patients.

The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV

ABSTRACTBackground: Bronchoscopy, an important investigation for the diagnosis and management of respiratory diseases, is widely used in high income countries. There is limited information on value of paediatric bronchoscopy in low and middle income countries (LMIC).Aims and Objectives: Aim was to describe the indications, findings and complications of bronchoscopy in a middle income country with a high prevalence of tuberculosis and HIV.Methodology: A retrospective analysis of a database over a 3.5 year period.Results: A total of 509 bronchoscopies were performed on neonates (2.3%) and children (median age = 18 months) of which 5.1% were HIV-infected. The main indications were: possible large airway compression 40%, complicated pneumonia (25%) and persistent stridor (15%). Pathology was observed in 64% of bronchoscopies. The most findings were lymph node compression of the airways (21%), and upper airway pathology (12%). Interventional procedures were performed in 112 cases (22%), the commonest being foreign bodies removal (30%), endobronchial lymph node enucleation (30%) and transbronchial needle aspiration (20%). No major complications.Conclusion: The diagnostic yield of paediatric bronchoscopy did not differ from high income countries emphasising the importance of paediatric bronchoscopy in the management of childhood lung disease in LMICs.

Clinical-Laboratory Prediction Rule Derivation for Pulmonary Tuberculosis Diagnosis in General Hospitals in a High-Burden Country

Background Clinical prediction rules (CPR) for pulmonary tuberculosis (PTB) diagnosis in the hospital setting in countries with high prevalence of PTB are rare. Methods With the purpose to derive a CPR for PTB and assess its accuracy in patients 15 years or older admitted to a general hospital in Rio de Janeiro city, Brazil, a diagnostic accuracy study was conducted with hospitalized patients from 2008 to 2013. Reference standard: positive Mycobacterium tuberculosis culture in respiratory specimens. Logistic regression-adjusted odds ratios, receiver operating characteristic curve of the value predicted by the model and its accuracy parameters were calculated. Results This study assessed 284 patients, 52 with PTB (18.3%). The score of the derived CPR ranged from 0 to 5, 2 points being attributed to fever and 1 to each of the following predictors: weight loss greater than 10%, alcohol consumption and typical/compatible chest imaging. The cutoff point was 3 or greater, with 0.70 area under the receiver operating characteristic curve, 72.1% sensitivity, 64.5% specificity, 30.1% and 91.6% positive and negative predictive values, respectively, and 2.0 and 0.4 positive and negative likelihood ratios, respectively. Conclusions The derived CPR corroborated the result of a recent systematic review of PTB predictors for hospitalized patients, but should be prospectively validated. The high false-positive rate justifies its combination with PTB-specific tests.

Prevalence of pulmonary tuberculosis in young adult patients with Type 1 diabetes mellitus in India

Background: There is limited information on prevalence of pulmonary tuberculosis (PTB) in patients with type-1- diabetes. We assessed the prevalence of PTB in patients with type-1-diabetes attending the outpatient-clinic in a tertiary-care hospital. Methods: 151 patients with type-1-diabetes were screened for PTB by clinical examination and chest-radiography. Sputum Acid-Fast Bacilli Test (AFB) and Mycobacterium tuberculosis (M.tb) culture were performed in patients with clinical and radiological features suggestive of a possibility of PTB and also in those with history of PTB in the past. Their average glycated haemoglobin (HbA1c) during preceding 2 years was assessed. Sputum culture positive patients were managed by a pulmonologist. Results: 5/151 patients had respiratory symptoms and radiographic findings suggestive of PTB. 20/151 patients were asymptomatic but had history of PTB. Four of the five symptomatic patients and 12 with past PTB were positive for sputum M.tb by culture, giving a prevalence of 10.6 % sputum culture positive in type-1-diabetes. Average HbA1c was comparable in patients with and without positive sputum culture. ESR and Mantoux test were not discriminatory in these groups. Four clinically symptomatic M.tb culture positive and four asymptomatic patients with sputum culture positive for M.tb on two occasions (6 weeks apart) were put on antitubercular treatment (ATT). Patients who were culture positive for M.tb only on one occasion were kept on a close follow up. Conclusions: Patients with type-1-diabetes mellitus in India have high prevalence of PTB. They need to be actively screened for PTB by sputum M.tb culture in order to initiate early treatment and to prevent transmission in the community.

Prevalence of pulmonary tuberculosis in young adult patients with Type 1 diabetes mellitus in India.

BackgroundThere is limited information on prevalence of pulmonary tuberculosis (PTB) in patients with type-1-diabetes. We assessed the prevalence of PTB in patients with type-1-diabetes attending the outpatient-clinic in a tertiary-care hospital.Methods151 patients with type-1-diabetes were screened for PTB by clinical examination and chest-radiography. Sputum Acid-Fast Bacilli Test (AFB) and Mycobacterium tuberculosis (M.tb) culture were performed in patients with clinical and radiological features suggestive of a possibility of PTB and also in those with history of PTB in the past. Their average glycated haemoglobin (HbA1c) during preceding 2 years was assessed. Sputum culture positive patients were managed by a pulmonologist.Results5/151 patients had respiratory symptoms and radiographic findings suggestive of PTB. 20/151 patients were asymptomatic but had history of PTB. Four of the five symptomatic patients and 12 with past PTB were positive for sputum M.tb by culture, giving a prevalence of 10.6 % sputum culture positive in type-1-diabetes. Average HbA1c was comparable in patients with and without positive sputum culture. ESR and Mantoux test were not discriminatory in these groups. Four clinically symptomatic M.tb culture positive and four asymptomatic patients with sputum culture positive for M.tb on two occasions (6 weeks apart) were put on antitubercular treatment (ATT). Patients who were culture positive for M.tb only on one occasion were kept on a close follow up.ConclusionsPatients with type-1-diabetes mellitus in India have high prevalence of PTB. They need to be actively screened for PTB by sputum M.tb culture in order to initiate early treatment and to prevent transmission in the community.

English

A 45 year old man with malignant pleural mesothelioma had symptoms of prolonged cough, heamoptysis, breathlessness, weight loss and low grade persistent fever. The high prevalence of pulmonary tuberculosis in this environment, coupled with paucity of radiologists in rural areas to competently review his chest radiograph, resulted in making the wrong diagnosis of pulmonary tuberculosis (PTB) as against malignant pleural mesothelioma. He was also wrongly treated for PTB for a period of nine months before referral to a Teaching Hospital. The correct diagnosis was made in a university teaching hospital where adequate specialized manpower was available. Distant metastasis to the liver was already observed at presentation. He was treated with six courses of chemotherapy (Peclitaxel and Cisplastin) and he did well before he was lost to follow-up. Key words: Malignant pleural mesothelioma, PTB, liver metastasis.

Estimating the burden of fungal disease in Vietnam.

SummaryData regarding the prevalence of fungal infections in Vietnam are limited yet they are likely to occur more frequently as increasingly sophisticated healthcare creates more iatrogenic risk factors. In this study, we sought to estimate baseline incidence and prevalence of selected serious fungal infections for the year 2012. We made estimates with a previously described actuarial method, using reports on the incidence and prevalence of various established risk factors for fungal infections from Vietnam, or similar environments, supplemented by personal communications. Global data were used if local data were unavailable. We estimated 2 352 748 episodes of serious fungal infection occurred in Vietnam in 2012. Frequent conditions included recurrent vaginal candidiasis (3893/100 000 women annually), tinea capitis (457/100 000 annually) and chronic pulmonary aspergillosis (61/100 000/5 year period). We estimated 140 cases of cryptococcal meningitis, 206 of penicilliosis and 608 of Pneumocystis jirovecii pneumonia. This is the first summary of Vietnamese fungal infections. The majority of severe disease is due to Aspergillus species, driven by the high prevalence of pulmonary tuberculosis. The AIDS epidemic highlights opportunistic infections, such as penicilliosis and cryptococcosis, which may complicate immunosuppressive treatments. These estimates provide a useful indication of disease prevalence to inform future research and resource allocation but should be verified by further epidemiological approaches.