High Prevalence Of Tuberculosis Research Articles

944. Pneumocystis-Tuberculosis Co-infection in the HIV Positive Host

BackgroundConcurrent infection with Pneumocystis Jirovecii (PJP) and Tuberculosis (TB) has been described in HIV infected patients. Developed countries, where guidelines on the treatment of PJP have been created have dramatically lower rates of latent and active TB than developing countries. PJP may obscure the diagnosis or delay the treatment of TB. Furthermore, treatment of PJP with corticosteroids may be detrimental to the course of TB. The objective of this study was to examine the frequency and the clinical characteristics of the co-infection of PJP and TB in HIV.MethodsThe clinical details of all HIV patients being treated at Amrita Hospital in South India have been prospectively collected in an electronic database since 2006. We compiled the data from 2006 to 2018 and further examined the clinical and laboratory results from electronic charts of patients admitted with PJP. Statistical analysis of the data was performed with descriptive analysis.ResultsA total of 21 of the 576 HIV patients were had admissions for PJP. Of these, 43% were co-infected with PJP and TB. In all cases PJP was the opportunistic infection leading to a HIV diagnosis. When comparing the PJP and MTB group with the PJP only group, the dual infected group was younger (40 vs 45), however there was no difference in length of stay (16.5 days vs 11.8), ICU admission rate (33% vs 36%), or mortality (0 vs 3 patients died).Demographic Data Comparison of TB-PCP and PCP only groups ConclusionOur report highlights the need to increase awareness of occurrence of this dual infection in HIV infected patients, as both infections can mimic each other clinically and radiologically, and are potentially fatal if not recognized promptly. Furthermore tuberculosis has the risk of transmission to health care personnel and other patients. In addition we report a much higher rate of underlying TB in our patients with PJP than what has been generally reported in the literature and conclude that higher clinical suspicion for this entity is warranted, particularly in countries with a high prevalence of TB.Immunology and Pathophysiology of HIV-PJP-TB triple infection Disclosures Indira Brar, MD, Gilead (Speaker’s Bureau)janssen (Speaker’s Bureau)ViiV (Speaker’s Bureau)

Urine Lipoarabinomannan Testing for All HIV Patients Hospitalized in Medical Wards Identifies a Large Proportion of Patients With Tuberculosis at Risk of Death.

BackgroundDiagnosing tuberculosis (TB), the leading cause of death in people with HIV, remains a challenge in resource-limited countries. We assessed TB diagnosis using a strategy that included systematic urine lipoarabinomannan (LAM) testing for all HIV patients hospitalized in medical wards and 6-month mortality according to LAM results.MethodsThis prospective, observational study included adult HIV patients hospitalized in the medical wards of a public district hospital in Malawi regardless of their TB symptoms or CD4 count. Each patient had a clinical examination, and Alere Determine TB-LAM, sputum microscopy, sputum GeneXpert MTB/RIF (Xpert), chest x-ray, and CD4 count were systematically requested.ResultsAmong 387 inpatients, 54% had a CD4 <200 cells/µL, 64% had presumptive TB, and 90% had ≥1 TB symptom recorded in their medical file. LAM results were available for 99.0% of patients, microscopy for 62.8%, and Xpert for 60.7%. In total, 26.1% (100/383) had LAM-positive results, 48% (48/100) of which were grades 2–4. Any TB laboratory test result was positive in 30.8% (119/387). Among patients with no Xpert result, 28.5% (43/151) were LAM-positive. Cumulative 6-month mortality was 40.1% (151/377): 50.5% (49/97) in LAM-positives and 36.2% (100/276) in LAM-negatives (P = .013). In multivariable regression analyses, LAM-positive patients had a higher risk of mortality than LAM-negatives (adjusted odds ratio, 2.5; 95% CI, 1.1–5.8; P = .037).ConclusionsIn resource-limited hospital medical wards with high TB prevalence, a diagnostic strategy including systematic urine LAM testing for all HIV patients is an easily implementable strategy that identifies a large proportion of patients with TB at risk of death.

Extra Pulmonary Tuberculosis: A Retrospective Study in Matara District, Sri Lanka

Background: Despite improvements in prevention, diagnosis and treatment, tuberculosis continues to be a leading cause of death globally. Since extra pulmonary tuberculosis does not contribute significantly to the transmission of the disease, it is not given priority in public health agenda. But it contributes significantly to tuberculosis related morbidity and mortality.Objectives: To identify the various presentations of extra pulmonary tuberculosis in Matara district, Sri Lanka and to evaluate the response to anti tuberculosis treatment.Methods: A descriptive study was conducted among the patients registered in District Chest Clinic, Matara. Data analysis were done by using SPSS version 25. Chi-square test was used to assess the association be­tween variables.Results: Among 147 patients 50.3% were female (mean age = 44years). 93.2% were Sinhalese. 11.6% of the study population were from Matara municipal council MOH area. 32.7% of the sample was diagnosed to have pleural effusion. 9.5% were current smokers. 9.5% were diagnosed with diabetes.98% of patients had completed treatment.Conclusions: There was high prevalence of pleural tuberculosis. The diagnosis of lymphatic tuberculosis was lower. Prevalence of extra pulmonary tuberculosis was high in MOH areas with high population density. Significantly high treatment completion rate than the national target was noted at district chest clinic Matara.

Verification of tuberculosis infection among Vác mummies (18th century CE, Hungary) based on lipid biomarker profiling with a new HPLC-HESI-MS approach

Tuberculosis (TB) was a large burden of infections that peaked during the 19th century in Europe. Mummies from the 18th century CE, discovered in the crypt of a church at Vác, Hungary, had high TB prevalence, as revealed by amplification of key fragments of TB DNA and genome-wide TB analysis. Complementary methods are needed to confirm these diagnoses and one approach uses the identification of specific lipid biomarkers, such as TB mycocerosic acids (MCs). Previously, MC derivatives were profiled by specialised gas chromatography-mass spectrometry (GC-MS), so an alternative more direct approach has been developed. Underivatized MCs are extracted and analysed by high-performance liquid chromatography linked to a mass spectrometer, in heated electrospray ionisation mode (HPLC-HESI-MS). The method was validated using representatives of the Mycobacterium tuberculosis complex and other mycobacteria and tested on six Vác mummy cases, previously considered positive for TB infection. Analysing both rib and soft tissue samples, four out of six cases gave profiles of main C32 and major C29 and C39 mycocerosates correlating well with those of M. tuberculosis. Multidisciplinary methods are needed in the diagnosis of ancient tuberculosis; this new protocol accesses important confirmatory evidence, as demonstrated by the confirmation of TB in the Vác mummies.

Long-term efficacy of BCG vaccination in goat herds with a high prevalence of tuberculosis

Vaccination of goats against tuberculosis (TB) has been promoted as an ancillary tool for controlling the disease in infected livestock herds. A three-year trial to assess the efficacy of BCG vaccine was carried out in five goat herds. At the beginning of the trial (month 0), all animals were tested for TB using thee different diagnostic tests. Animals negative to all tests were vaccinated with BCG and all replacement goat kids were also systematically vaccinated throughout the trial. All animals were tested by Interferon-gamma release assay (IGRA) using vaccine compatible reagents at months 6, 12, 24, and 36. The risk factors for TB infection were also evaluated. At the end of the study, four out of five farms showed variable reductions of the initial prevalence (93.5%, 28.5%, 23.2%, and 14.3% respectively), and an overall incidence reduction of 50% was observed in BCG vaccinated goats, although adult vaccinated goats showed higher incidences than vaccinated goat kids. The unvaccinated positive animals remaining in herds and adult BCG vaccinated goats significantly enhanced the risk of infection in vaccinated animals. A systematic vaccination of goats with BCG, together with the removal of positive unvaccinated animals, may contribute to reducing the TB prevalence in goat herds.

Diagnostic efficacy of EBUS-TBNA in benign diseases in a population with a high prevalence of tuberculosis.

Although endobronchial ultrasonography-transbronchial needle aspiration (EBUS-TBNA) has a well-known place in the staging and diagnosis of lung cancer, the place of EBUS is not clear in the diagnosis of benign diseases, especially in countries with a high prevalence of tuberculosis. The aim of this study is to investigate the diagnostic efficacy of EBUS-TBNA in benign diseases in a population with a high prevalence of tuberculosis. Between October 2011 and March 2018, 1077 EBUS-TBNA was applied. The diagnosis was reached with mediastinoscopy or video assisted thoracic surgery (VATS) in 41 (74.5%) and with the second EBUS-TBNA performed in 14 (25.5%) of 55 EBUS practices in 41 patients with malignancy diagnosis. The final diagnosis was achieved with clinical/radiological features in 7 (77.7%) cases of sarcoidosis, with VATS/mediastinoscopy in 2 (22.2%) cases, with EBUS-TBNA performed for the second time in 6 (54.5%) tuberculosis cases and with acid-resistance bacilli reproduction in Lowenstein-Jensen culture in 5 (45.4%) cases. Two hundred and ninety-five (79.7%) patients were accepted as "benign disease" due to the absence of radiological and clinical progression of lesions in the follow-up. The diagnostic accuracy of EBUS-TBNA is high in benign diseases such as sarcoidosis and tuberculosis.

Prevalence and Risk Factors for Mycobacterium tuberculosis Infection Among Adolescents in Rural South Africa.

BackgroundWe aimed to estimate the prevalence of and explore risk factors for Mycobacterium tuberculosis infection among adolescents in a high tuberculosis (TB) and human immunodeficiency virus (HIV) prevalence setting.MethodsA cross-sectional study of adolescents (10–19 years) randomly selected from a demographic surveillance area (DSA) in rural KwaZulu-Natal, South Africa. We determined M tuberculosis infection status using the QuantiFERON-TB Gold-plus assay. We used HIV data from the DSA to estimate community-level adult HIV prevalence and random-effects logistic regression to identify risk factors for TB infection.ResultsWe enrolled 1094 adolescents (548 [50.1%] female); M tuberculosis infection prevalence (weighted for nonresponse by age, sex, and urban/rural residence) was 23.0% (95% confidence interval [CI], 20.6–25.6%). Mycobacterium tuberculosis infection was associated with older age (adjusted odds ratio [aOR], 1.37; 95% CI, 1.10–1.71, for increasing age-group [12–14, 15–17, and 18–19 vs 10–11 years]), ever (vs never) having a household TB contact (aOR, 2.13; 95% CI, 1.25–3.64), and increasing community-level HIV prevalence (aOR, 1.43 and 95% CI, 1.07–1.92, for increasing HIV prevalence category [25%–34.9%, 35%–44.9%, ≥45% vs <25%]).ConclusionsOur data support prioritizing TB prevention and care activities in TB-affected households and high HIV prevalence communities.

COVID-19 in Latin America: Symptoms, Morbidities, and Gastrointestinal Manifestations

COVID-19 in Latin America: Symptoms, Morbidities, and Gastrointestinal Manifestations

The Comprehensive Organization of Identification of Tuberculosis in Population of the Eastern Siberian Region

The early detection of tuberculosis is one of the priority targets in the system of anti-tuberculosis care of population, regardless of epidemiological and socio-economic conditions. The effectiveness of these activities depends on system of organization, methods of detection, quality of planning and implementing preventive examinations for tuberculosis among population. Despite decreasing of morbidity and mortality from tuberculosis in the Irkutsk oblast, it belongs to the territories with high prevalence of tuberculosis. Until 2011, the increasing of incidence of tuberculosis in the Irkutsk region occurred mainly due to increasing of effectiveness of measures of active detection of tuberculosis in population. In 2012-2019, the incidence rate tends to decrease while maintaining appropriate level of efficiency of active detection of disease. In context of improving epidemiological situation of tuberculosis, it is necessary to focus organizational efforts on active detection of tuberculosis mainly in risk groups, with simultaneous increasing of detection of disease in population by referral to medical organizations of primary medical care.

Tuberculosis prevention in children: a prospective community-based study in South Africa.

Tuberculosis (TB) preventive therapy reduces TB risk in children. However, the effectiveness of TB preventive therapy in children living in high TB burden settings is unclear.In a prospective observational community-based cohort study in Cape Town, South Africa, we assessed the effectiveness of routine TB preventive therapy in children ≤15 years of age in a high TB and HIV prevalence setting.Among 966 children (median (interquartile range) age 5.07 (2.52–8.72) years), 676 (70%) reported exposure to an adult with TB in the past 3 months and 240 out of 326 (74%) eligible children initiated isoniazid preventive therapy under programmatic guidelines. Prevalent (n=73) and incident (n=27) TB were diagnosed among 100 out of 966 (10%) children. Children who initiated isoniazid preventive therapy were 82% less likely to develop incident TB than children who did not (adjusted OR 0.18, 95% CI 0.06–0.52; p=0.0014). Risk of incident TB increased if children were <5 years of age, living with HIV, had a positive Mycobacterium tuberculosis-specific immune response or recent TB exposure. The risk of incident TB was not associated with sex or Mycobacterium bovis bacille Calmette–Guérin vaccination status. Number needed to treat (NNT) was lowest in children living with HIV (NNT=15) and children <5 years of age (NNT=19) compared with children of all ages (NNT=82).In communities with high TB prevalence, TB preventive therapy substantially reduces the risk of TB among children who are <5 years of age or living with HIV, especially those with recent TB exposure or a positive M. tuberculosis-specific immune response in the absence of disease.

Influence of Strongyloides stercoralis Coinfection on the Presentation, Pathogenesis, and Outcome of Tuberculous Meningitis.

BackgroundHelminth infections may modulate the inflammatory response to Mycobacterium tuberculosis and influence disease presentation and outcome. Strongyloides stercoralis is common among populations with high tuberculosis prevalence. Our aim was to determine whether S. stercoralis coinfection influenced clinical presentation, cerebrospinal fluid (CSF) inflammation, and outcome from tuberculous meningitis (TBM).MethodsFrom June 2017 to December 2019, 668 Vietnamese adults with TBM, enrolled in the ACT HIV or LAST ACT trials (NCT03092817 and NCT03100786), underwent pretreatment S. stercoralis testing by serology, stool microscopy, and/or stool polymerase chain reaction. Comparisons of pretreatment TBM severity, CSF inflammation (including cytokines), and 3-month clinical end points were performed in groups with or without active S. stercoralis infection.ResultsOverall, 9.4% participants (63 of 668) tested positive for S. stercoralis. Active S. stercoralis infection was significantly associated with reduced pretreatment CSF neutrophil counts (median [interquartile range], 3/μL [0–25/μL] vs 14 /μL [1–83/μL]; P = .04), and with reduced CSF interferon ɣ, interleukin 2, and tumor necrosis factor α concentrations (11.4 vs 56.0 pg/mL [P = .01], 33.1 vs 54.5 pg/mL [P = .03], and 4.5 vs 11.9 pg/mL [P = .02], respectively), compared with uninfected participants. Neurological complications by 3 months were significantly reduced in participants with active S. stercoralis infection compared with uninfected participants (3.8% [1 of 26] vs 30.0% [33 of 110], respectively; P = .01).Conclusions S. stercoralis coinfection may modulate the intracerebral inflammatory response to M. tuberculosis and improve TBM clinical outcomes.

Prevalence of Some Opportunistic Infections (OIs) and Co-infections among HIV-Infected Persons in Port Harcourt, Nigeria

Aim: HIV/AIDS continues to spread globally and remains a worldwide pandemic. Opportunistic infections (OIs) occur more and are severe in people living with HIV who have weakened immune systems, and co-infection is another major challenge because it affects the rate to which the disease progress to AIDS. In the present study, a total of 100 HIV positive patients were recruited and evaluated for the presence of common opportunistic infections (OIs) and co-infections among HIV-infected individuals in Port Harcourt, Nigeria.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Prime Medical Consultants in Port Harcourt, Nigeria, between June 2012 and July 2015.&#x0D; Methods: A total of 100 HIV-infected individuals were recruited for this study (ages 1 to 70 years, 62 males and 38 females). Samples of blood, sputum, high vaginal swabs (HVS) and scrapped lesion from the mouth of the patients were collected. Blood samples were re-screened for the presence of HIV antibodies and HBsAg using the Determine HIV-1/2 (Alere), HIV ½ Stat-Pak (Chembio), HIV-1/2/P24/O ELISA kit and HBsAg one Ultra ELISA kit (Dia.Pro) following the respective manufacturer's instructions. The Ziehl-Neelsen sputum smear microscopy method was used for identifying tuberculosis (TB). Microscopical examination was done on HVS samples and lesions scrapings from the mouth to observe for Candida. Chi-square test was used to establish relationships between demographic factors and prevalence, and significance level was set at P ≤ 0.05.&#x0D; Results: Of the 100 HIV positive patients, suspected case were 32.0% of TB, 28.0% of oral thrush and vaginosis, and 19.0% of hepatitis. The results of the laboratory analysis further showed that tuberculosis was the most common OI among others. Overall prevalence was 22.0% for TB, 11.0% for Candida albicans (oral thrush), 28.9% for Candida albicans (vaginosis) and 4.0% for HBV. Higher prevalence of TB was observed in the age groups 41 years &amp; above (35.7%, P=0.14) and in males (22.6%, P=0.86). As for Candida albicans, the higher prevalence was found in age groups 21-40 years (19.1%, P=0.03) and in females only (28.9%), and higher prevalence of HBV was found in age groups 41 years &amp; above (9.1%, P=0.78) and in females (5.3%, P=0.61). None of the variables (age and sex) evaluated in this study was statistically associated (P&gt;0.05) with TB, Candida and HBV prevalence.&#x0D; Conclusion: The study has also shown that some opportunistic infections (candidiasis and Tuberculosis) and coinfections with HBV is prevalent among HIV infected individuals and this could largely be due to a compromised immune system as a result of the viral activities in the host cell. There is need therefore to routinely check for OIs and co-infections especially in the case of an immunocompromised individual. It is also imperative to note that the appropriate use of drugs against these OIs may be one of the strategies to extend the life span of AIDS patients. This will help to monitor how the disease progresses and its complications.

A rapid review of the effectiveness of screening practices at airports, land borders and ports to reduce the transmission of respiratory infectious diseases such as COVID-19

Travel screening for infectious diseases is often implemented to delay or prevent the entry of infected persons to a country/area. To evaluate the effectiveness of different point-of-entry screening strategies in achieving a reduction in imported COVID-19 transmission. A rapid evidence review was conducted, systematically searching PubMed and Google Scholar and grey literature on 27 March 2020. We screened 1194 records. Nine potential full-text articles were assessed for eligibility and included. Three articles investigated the effectiveness of entry-based thermal and body temperature scanning. Entry-based infrared thermal or body temperature scanning for COVID-19 was unlikely to be effective. Two systematic reviews found no additional benefit of travel restrictions/screening. In a COVID-19 modelling study, airport screening was not effective, with exit and entry thermal scanning identifying half and missing almost half of infected travellers. Two other modelling studies found that entry-based travel screening would achieve only modest delays in community transmission, while international travel quarantine could reduce case importations by 80%. There is insufficient evidence to support entry and exit screening at points of entry, as these strategies detect just over half of the infected cases, missing almost half at entry points. The benefits of airport screening therefore need to be context specific and weighed against the resources and cost of implementation, the contribution of imported cases to total cases, and the benefits of identifying 50% of cases in the South African context with the country's high HIV and tuberculosis prevalence and limited resources to deal with a pandemic of this nature.

A rare case of actinomycotic osteomyelitis of calcaneum: Presented with subtalar arthritis

We are reporting an unusual case of actinomycosis infection which presented with subtalar arthritis. Actinomycosis is a chronic granulomatous disease caused by Gram-positive anaerobic bacteria. Actinomycosis is very rare and of the cases reported Cervicofacial infection is the most frequent clinical presentation. Hematogenous osteomyelitis at distant sites can occur in the rare instance in immunocompromised or pediatric patients, only a few cases have been reported in healthy patients. Case Report: A 39years, female patient presented with pain, swelling around the right ankle for 4 years with healed sinuses over the lateral aspect. She was treated for the discharging sinuses of right ankle and foot 5 years back with antibiotics and surgery elsewhere. She had a history of taking treatment (ATT for 6months) for pulmonary TB, 10years back. X-rays and Magnetic resonance imaging showed a distorted subtalar joint with multifocal intraosseous lesions in the calcaneum. Curettage and subtalar arthrodesis with Cannulated cancellous screws was done and supported with short-term immobilization. The tissue culture, fungus culture, acid-fast bacillus (AFB) culture, AFB smear, and tuberculosis polymerase chain reaction test results of intraop samples were negative. A pathologic examination confirmed the presence of actinomycosis. The patient was treated with intravenous penicillin for 2 weeks followed by Oral Doxycycline for 6 weeks, given no evidence of active infection intraoperatively. After 1year follow-up, the patient had no signs of recurring infection or complications and she is ambulant pain-free.Conclusion: Actinomycosis of the foot, though rare, can mimic tuberculosis in areas with a high prevalence of tuberculosis. In patients with recurrent discharging sinuses, a high index of suspicion is warranted to early diagnose it.

PREVALENCE OF LATENT TB AMONG US ADULTS WITH CHRONIC HEPATITIS B VIRUS: A RETROSPECTIVE STUDY OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Tuberculosis (TB) and hepatitis B virus infection (HBV) are treatable, communicable diseases that can exist as chronic, asymptomatic infections with a significant global burden. Guidelines recommend screening TB patients for HBV if they have risk factors prior to initiating tuberculosis therapy. However, there are no clear general guidelines regarding TB screening among patients with chronic HBV or vice versa, and rates of co-infection with latent TB (LTBI) and HBV have not been well described. We aim to evaluate prevalence ratios of LTBI and HBV co-infection among U.S. adults using a large population-based database. METHODS: Using the National Health and Nutrition Examination Survey (NHANES), a cross-sectional, stratified, multistage probability sample of the U.S. population, we retrospectively evaluated the prevalence of LTBI and HBV co-infection among adults age 20 and older for the 1990-2000 and 2011-2012 cycles. LTBI was assessed using NHANES data reported for the tuberculin skin test (TST). Data for the QuantiFERON-TB Gold In-Tube test (QFT-GIT) was reported for the 2011-2012 cycle only. The presence/absence of HBV was analyzed using the hepatitis B surface antigen (HBsAg) test result. Observations with missing data were excluded from this study. Between-group comparisons used chi-squared testing with a statistical significance set at a two-tailed p<0.05. RESULTS: Overall prevalence of LTBI was 4.2%, HBV was 0.3% and prevalence of LTBI and HBV coinfection was low (0.03%). Prevalence of LTBI was higher among individuals with HBV compared to those without HBV (15.3% [95% CI 6.6-31.7%] vs. 4.3% [95% CI 3.5-5.2%] respectively, p=0.004). LTBI increased among those with HBV (6.8% [95% CI 1.4-27.1%] in 1999-2000 to 21.9% [95% CI 8.0-47.6%] in 2011-2012; p=0.16), while it remained stable among those without HBV (4.3% [95% CI 3.5-5.4%] in 1999-2000 to 4.2% [95% CI 3.0-5.8%] in 2012-2012; p=0.89). TB prevalence based on the QFT-GIT was 22.7% (95% CI 11.5-40.0) in 2011-2012. In NHANES, among the subset of patients with LTBI, prevalence of HBV showed a non-significant increase (0.4% [95% CI 0.1-1.7%] in 1999-2000 to 1.4% [95% CI 0.5-3.8%] in 2011-2012; p=0.12). CONCLUSIONS: This study is one of the first to describe TB and HBV co-infection prevalence rates using U.S. population-based data. In 2011-2012, prevalence of LTBI was 3.6 times higher among individuals with HBV compared to those without, which may reflect the importance of shared risk factors in affecting disease epidemiology. CLINICAL IMPLICATIONS: This study highlights the high prevalence of TB among chronic HBV patients, which may help guide screening practices and may suggest a potential role for co-screening for TB and HBV among these high-risk patients with shared risk factors. This is particularly important given the potential impact of HBV co-infection on the risk of drug-induced liver injury related to anti-tuberculosis therapies. DISCLOSURES: No relevant relationships by Amit Chitnis, source=Web Response No relevant relationships by Grishma Hirode, source=Web Response No relevant relationships by Ashley Hubbard, source=Web Response No relevant relationships by Robert Wong, source=Web Response

Tuberculosis versus COVID-19 Mortality: A New Evidence

BACKGROUND: Coronavirus current pandemic (COVID-19) is the striking subject worldwide hitting countries in an unexplained non-universal pattern. Bacillus Calmette–Guérin (BCG) vaccine was an adopted recent justification depending on its non-specific immune activation properties. Still the problem of post-vaccine short duration of protection needs to be solved. The same protective mechanism was identified in active or latent tuberculosis (TB). For each single patient of active TB, there are about nine cases of asymptomatic latent TB apparently normal individuals living within the community without restrictions carrying benefits of immune activation and involved in re-infection cycles in an excellent example of repeated immunity training sessions of the whole community.&#x0D; AIM: We aimed to asses the correlation between TB burden and COVID-19 mortality in all affected countries having different BCG vaccination policies.&#x0D; METHODS: Publicly available data were extracted for 191 countries including population size, TB estimations, national BCG vaccination policy, the World Health Organization regions and economic classification, and COVID-19 mortality and number of cases. The analysis was performed using Spearman’s correlation test.&#x0D; RESULTS: Significant large negative correlation (−0.539, p &lt; 0.001) was found between TB prevalence and COVID-19 mortality rate worldwide. Medium negative significant correlations were found between TB cases and COVID-19 mortality in the high and lower middle-income countries, and those having current BCG vaccination programs (−0.395, p = 0.001, −0.365, p = 0.015, and −0.476, p &lt; 0.001, respectively).&#x0D; CONCLUSION: Countries with high TB prevalence have higher chances of protection against COVID-19 mortality through the theory of widely distributed natural immune activation within community. Confounders should be assessed separately.

Co-existence of diabetes and TB among adults in India: a study based on National Family Health Survey data.

Multiple studies suggest that diabetes mellitus (DM) is a potential risk factor for tuberculosis (TB) development and treatment, especially in low- and middle-income countries. The study aimed to test concomitancy between DM and TB among adults in India. Data were from the 2015-16 National Family Health Survey (NFHS-4). The study sample comprised 107,575 men aged 15-54 and 677,292 women aged 15-49 for which data on DM status were available in the survey. The association between state-level prevalence of TB and DM was examined and robust Poisson regression analysis applied to examine the effect of DM on TB. A high prevalence of TB was observed among individuals with diabetes in India in 2015-16. A total of 866 per 100,000 men and 405 per 100,000 women who self-reported having diabetes also had TB; among those who self-reported not having diabetes the ratios were 407 per 100,000 men and 241 per 100,000 women. The risk of having TB among those who self-reported having DM was higher for both men (2.03, 95% CI: 1.26, 3.28) and women (1.79, 95% CI: 1.48, 2.49) than for those who did not self-report having DM. Adults who were diagnosed with diabetes (including pre-diabetes) also had a higher rate of TB (477 per 100,000 men and 331 per 100,000 women) than those who were not diagnosed (410 per 100,000 men and 239 per 100,000 women). Adults from poor families, with lower BMIs, lower levels of literacy and who were not working had a higher risk of TB-DM co-morbidity. The state-level pattern of co-morbidity, the under-reporting of DM (undiagnosed) and TB stigmatization are discussed. The study confirms that diabetes is an important co-morbid feature with TB in India, and reinforces the need to raise awareness on screening for the co-existence of DM and TB with integrated health programmes for the two conditions.

OVERVIEW OF TUBERCULOSIS PREVENTIVE TREATMENT AMONG CHILDREN IN SURABAYA

Background: A high prevalence of tuberculosis (TB) infection rates is followed by high rates of TB infection in children. The TB Preventive Treatment (TPT) for children with Isoniazid (INH) is one of the primary activities to improve TB cases by finding them early to prevent the transmission of TB to children. Purpose: This study aimed to describe the implementation of TPT with prophylactic INH among children in Surabaya. Methods: This research was a descriptive observational study with a case series design using secondary data on the provision of TPT in children, child TB cases in Surabaya City in 2016–2018, and a network of partnerships with hospitals/clinics/doctors’ private practices for the prevention and control of TB in the city of Surabaya in 2016–2018 as the population. The data were collected by in-depth interviews with the holders of the TB prevention and control program of Surabaya. The data were analyzed by comparing and describing the targets and achievements of the INH administration in children. Results: The implementation of INH for children in Surabaya is not optimal and has not reached the targets. The networking of health facilities with providers for the provision of TPT with INH for children is still low in Surabaya City. Conclusions: Delivery of INH for children in Surabaya has been implemented and has increased, however, it is not optimal because it has not reached the targeted districts/municipalities that determined.

Detection of Serum IgG Antibodies against Mycobacterium tuberculosis among University Athletes in Rivers State, Nigeria

Aim: Mycobacterium tuberculosis (MTB), the causative agent of tuberculosis, is a strictly aerobic bacterium that grows fastidiously and slow, which is among the top 10 causes of death globally and the leading cause from a single infectious agent (above HIV/AIDS). Among the deadly diseases ravaging the world, tuberculosis remains one of the commonest and deadliest. The objective of this study is to determine the prevalence of tuberculosis (TB) among the athletes of the University of Port Harcourt (UNIPORT), Rivers State, Nigeria.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Sports Institute, University of Port Harcourt (UNIPORT), Nigeria, between June 2012 and July 2015.&#x0D; Methods: A total of 100 university athletes (51 males and 49 females, the age ranged from 15-47 years) was recruited for this study. Blood samples were collected from the athletes and analyzed for serum IgG antibodies against Mycobacterium tuberculosis. OneStep Tuberculosis (TB) rapid test was used for the detection of TB antibody (Isotypes IgG, IgM and IgA) in whole blood samples from the subjects. Commercially available ELISA based kits (manufactured by Dia.Pro, Milano, Italy) were also used.&#x0D; Results: The seropositivity of TB among the athletes was 5.0%. The result of the study showed that male athletes had a higher prevalence of tuberculosis than their female counterpart (5.9% vs 4.1%). Subsequently, the age groups 15-25 years had a higher prevalence of tuberculosis (6.5%) compared to age groups 26 years and above (2.6%). A significant association existed between the athletes' ages and TB prevalence (p= 0.035) and none existed with gender (p=0.654).&#x0D; Conclusion: This study confirms the presence of Mycobacterium tuberculosis-specific antibodies among university athletes. Strict surveillance of the diseases is highly recommended to curb its spread and the potential increase in Multidrug-resistance tuberculosis (MDR-TB) and Extensively drug-resistance Tuberculosis (XDR-TB) as it is highly contagious.

Pulmonary tuberculosis masquerading as coronavirus disease 2019 in an HIV-infected individual with advanced immune suppression

Pulmonary tuberculosis masquerading as coronavirus disease 2019 in an HIV-infected individual with advanced immune suppression