High Prevalence Of Tuberculosis Research Articles

Prevalence of Diabetes Mellitus and its Related Factors in Patients with Tuberculosis.

Considering the high prevalence of tuberculosis (TB) in developing countries and the fact that comorbidity with diabetes mellitus (DM) imposes a higher burden on the society, this study was carried out to assess the prevalence of diabetes and its related factors in patients with TB in Mashhad, Iran. In this study, we enrolled 405 patients over the age of 18 who had been diagnosed with TB between the years 2015 and 2016 according to the documents of the ministry of health. The participants were selected randomly from five health center domains based on the stratified sampling method. The patients were screened for diabetes according to HbA1c over 6.5% or a fasting blood sugar (FBS) level over 126 mg/dL at different time points and the patient's self-report of having DM. The mean age of participants was 51.14±20.52 (19-92 years). The prevalence of DM in patients with TB was 21.2%, of whom 3.5% were newly diagnosed. Among potential factors, age with OR=3.786 (1.183, 12.113), body mass index with OR=9.149 (3.182, 26.302), nationality with OR=2.149 (1.122, 4.117) and TB type with 3.328 (1.44, 7.689) were associated with DM in patients with TB. The prevalence of DM in our study was higher than that observed in other countries. Our study showed associated factors like age, body mass index, and TB type to be very important. Also, the prevalence of DM was different in patients with different nationality.

Association between percentage of smokers and prevalence of smoking attributable morbidity in Indonesia: one decade after implementation of smoke-free area regulation

BackgroundFor more than ten years, Indonesia has health law, one of which states that local governments are mandated to establish Smoke Free Area (SFA). The results of 2018 National Basic Health Research shows tobacco consumption is still quite high and increasing compared to the results of 2007 and 2013 National Basic Health Research. The burden of disease in Indonesia is increasing every year. MethodsThis study aims to describe SFA regulation and analyze the relationship between the percentage of smokers and the prevalence of smoking attributable morbidity. Data from the 2018 Basic Health Research in Indonesia with the number of units of analysis were 514 districts and cities level. The design of the study was cross-sectional study. The variables analyzed were the percentage of smokers, the prevalence of diabetes, hypertension, upper respiratory tract infections (URTI), pneumonia, lung tuberculosis, asthma, and mental emotional disorders. Geographical mapping of the distribution of District/City with Smoking-Free Areas was made using QGIS 3·16. ResultsAround 72% of districts/cities in Indonesia already had local regulations of SFA after more than ten years implementation of the regulation of the health law. There was a significant relationship between the high percentage of smokers and the high prevalence of diabetes (p value: 0·000, PR: 1·342, 95%CI 1·135 to 1·587), hypertension (p value: 0·000, PR 1·631, 95%CI 1·252 to 2·124), and lung tuberculosis (p value: 0·008, PR 1·219, 95%CI 1·049 to 1·417) at the District/City level. However, there was no significant association between URTI, pneumonia, asthma, and mental emotional disorders.ConclusionThe percentage of smokers in an area was associated with diabetes, hypertension, and lung tuberculosis. The implementation of Smoke Free Area should be evaluated.

To study the occurrence of risk factors for pulmonary tuberculosis in the homeless population in areas of Delhi, India

BackgroundIn India, there are only a few studies done in the area of assessing the risk factors of Tuberculosis (TB) among the homeless population. The homeless population has quite a higher chance of developing Pulmonary Tuberculosis (PTB) as compared with the general population due to the presence of an inappropriate environment and high prevalence of risk factors. MethodsThis study was done among the homeless population in both males and females aged 18 years and above in areas of Delhi (Yamuna Pusta and Mansarovar Park). The participants were screened for TB symptoms and risk factors to diagnose active PTB in them. ResultsOut of 200 participants, 17 were diagnosed with active PTB. The overall occurrence of Tuberculosis among the studied homeless population was found to be 85 cases per 1000 population. The occurrence of behavioral habits such as smoking was found to be 41.2% (7/17), tobacco chewing at 47.1% (8/17), and alcohol at 47.1% (8/17) among the cases. The occurrence of HIV coinfection was 5.9% (1/17) and diabetes was 5.9% (1/17). The prevalence of TB among homeless females was 1.5 times higher than homeless males but out of 17 diagnosed patients, males had a higher prevalence of TB as compared to females. ConclusionThe occurrence of PTB in the homeless population is quite high as it is also reported in a study in the United States that the national incidence of tuberculosis in the homeless population was 36 cases/100,000 and it needs to be addressed to eliminate tuberculosis.7 Moreover, the risk factors such as tobacco, smoking, alcohol, coinfections, etc. might have played a major role in the development of PTB. Also, there is a need for larger studies with large sample sizes to provide evidence against the same.

Spatial Co-Clustering of Tuberculosis and HIV in Ethiopia.

Tuberculosis (TB) and HIV are epidemiologically associated, and their co-dynamics suggest that the two diseases are directly related at the population level and within the host. However, there is no or little information on the joint spatial patterns of the two diseases in Ethiopia. The main objective of the current study was to assess the spatial co-clustering of TB and HIV cases simultaneously in Ethiopia at the district level. District-level aggregated data collected from the national Health Management Information System (HMIS) for the years 2015 to 2018 on the number of TB cases enrolled in directly observed therapy, short course (DOTS) who were tested for HIV and the number of HIV patients enrolled in HIV care who were screened for TB during their last visit to health care facilities were used in this study. The univariate and bivariate global and local Moran's I indices were applied to assess the spatial clustering of TB and HIV separately and jointly. The results of this study show that the two diseases were significantly (p-value <0.001) spatially autocorrelated at the district level with minimum and maximum global Moran's I values of 0.407 and 0.432 for TB, 0.102 and 0.247 for HIV, and 0.152 and 0.251 for joint TB/HIV. The district-level TB/HIV spatial co-clustering patterns in Ethiopia in most cases overlapped with the hot spots of TB and HIV. The TB/HIV hot-spot clusters may appear due to the observed high TB and HIV prevalence rates in the hot-spot districts. Our results also show that there were low-low TB/HIV co-clusters or cold spots in most of the Afar and Somali regions, which consistently appeared for the period 2015-2018. This may be due to very low notifications of both diseases in the regions. This study expanded knowledge about TB and HIV co-clustering in Ethiopia at the district level. The findings provide information to health policymakers in the country to plan geographically targeted and integrated interventions to jointly control TB and HIV.

Validation of the Sarcoidosis Diagnostic Score in a Multicontinental Study.

Rationale: The Sarcoidosis Diagnostic Score (SDS) has been established to quantitate the clinical features consistent with sarcoidosis in a monocentric study. Objectives: We aimed to confirm the diagnostic value of SDS in a large, multicontinental study and to assess the utility of SDS in differentiating sarcoidosis from alternative diagnoses, including infectious and noninfectious granulomatous diseases. Methods: We included patients with biopsy-confirmed sarcoidosis at nine centers across the world. Patients without sarcoidosis seen at the same sites served as control patients. Using a modified World Association of Sarcoidosis and Other Granulomatous Disorders organ assessment instrument, we scored all patients for the presence of granuloma on biopsy, highly probable symptoms, and least probable symptoms for each area. Two sarcoidosis scores were generated: SDS Biopsy (with biopsy) and SDS Clinical (without biopsy). SDS Clinical and Biopsy were calculated for all patients. We calculated and compared the area under the curve (AUC) for SDS Clinical and Biopsy according to different diagnosis scenarios. Results: A total of 1,041 patients with sarcoidosis and 1,035 without sarcoidosis were included. The results for SDS Clinical (AUC, 0.888; 95% confidence interval [CI], 0.874-0.902) and SDS Biopsy (AUC, 0.979; 95% CI, 0.973-0.985) according to AUC were good to excellent for differentiating sarcoidosis from alternative diagnosis. SDS Clinical was less discriminatory in males (P = 0.01) and in high tuberculosis prevalence centers (P < 0.001). However, SDS Clinical (AUC, 0.684; 95% CI, 0.602-0.766) and SDS Biopsy (AUC, 0.754; 95% CI, 0.673-0.835) were not sufficiently discriminative for noninfectious granulomatous diseases, but both SDSs could differentiate sarcoidosis from infectious granulomatous diseases. Algorithms were proposed for the SDS Clinical and SDS Biopsy to assist the clinician in the diagnostic process, and cutoff values were proposed for the SDS Clinical and SDS Biopsy, allowing the diagnosis of sarcoidosis to be safely confirmed or rejected in most cases except for noninfectious granulomatous disease. Conclusions: This multicontinental study confirms that both SDS Clinical and SDS Biopsy have good to excellent performance in discriminating sarcoidosis from alternative diagnoses. Differences in the AUC were seen for high tuberculosis prevalence versus low tuberculosis prevalence centers and for males versus females. Both SDSs had good discriminatory function for infectious granulomatous disease but failed in cases of noninfectious granulomatous disease such as berylliosis.

Tuberculosis and Diabetes Mellitus Co-morbidity

: Tuberculosis (TB) and Diabetes Mellitus (DM) association poses the re-emerging problem nowadays and challenge on the way towards a tuberculosis-free world. There are some peculiarities in the immune function of DM patients, which make them more susceptible to infections, including TB. This results in a higher prevalence of TB among DM patients (OR=1.15 according to the last meta-analysis). Clinical manifestations of DM/TB often differ from the classical course of the disease - these patients are more frequently symptomatic, more inclined to cavitary disease and, according to some data, to lower lobe involvement. Data on multi-drug resistance prevalence among DM/TB patients are controversial and need further research, especially in terms of primary resistance. Higher frequency of adverse reactions, slower sputum conversion and foci regression make treatment in this population more difficult and worsen outcomes. Potential measures to lower the burden of co-morbidity are: new treatment regimens, bi-directional screening, proper DM managing and controlling, testing for latent tuberculosis infection and its treatment, and new vaccines development. Feasibility and efficacy of these measures are to be investigated in the context of settings with different DM and TB prevalence and available resources.

Milk Contamination by Mycobacterium tuberculosis Complex, Implications for Public Health in Amazonas, Brazil

In Brazil, contamination of raw milk with Mycobacterium tuberculosis complex (MTC) has been reported in several states. The highest rate of consumption of raw milk and its derivatives in Brazil occurs in Amazonas. This state also has the highest prevalence of tuberculosis in both humans and livestock. We assessed the contamination of cow's milk and buffalo's milk with MTC in Amazonas, focusing on Mycobacterium bovis, the species most commonly found in cattle and buffalo. In 2019, 250 samples of raw milk (91 from cattle, 159 from buffalo) were collected before processing from three milk plants in the state of Amazonas. The samples were placed into 21 pools and analyzed using shotgun metagenomic sequencing and taxonomic classification with Kraken 2 and MegaBLAST. To confirm the identity of mycobacterial species found, BLASTN was used to identify specific genomic positions in the TbD1 and RD1 regions and flanking RD4 region. MTC genetic material was identified in all pools of raw milk. Genetic material consistent with M. bovis was identified in seven pools of raw milk (1 from cattle, 6 from buffalo). Buffalo's milk had significantly higher MTC reads than did cow's milk. The common practice of consumption of raw milk and its derivatives in Amazonas presents a risk to public health. Urgent measures to prevent transmission of foodborne tuberculosis are needed in the Amazon region. Greater efforts and resources also should be directed toward elimination of bovine tuberculosis in cattle and buffalo herds in Amazonas and the rest of Brazil.

Risk of tuberculosis among renal transplant recipients receiving rituximab therapy.

Rituximab is an anti-CD 20 agent used widely in renal transplant recipients. Its use is associated with various infections; however, its association with tuberculosis (TB) is not well established and has not been studied in post renal transplantation patients. This is a single-center, retrospective analysis of 56 renal transplant recipients who received rituximab as a part of desensitization protocol or as rescue therapy for rejections and 287 post-renal transplant patients who did not receive rituximab during the study period from January 2013 to June 2017. The association between use of rituximab and occurance of TB was studied. Other factors associated with TB were also investigated. Baseline characteristics were similar in both the groups. Mean time for occurrence of TB was 18.4 ± 10.6months after renal transplantation. Rituximab use was not significantly associated with TB or any other infection. Higher number of rejection episodes (60% vs. 32.72%, p = .029) was the only factor associated with greater incidence of TB. However, no specific type of rejection was associated with TB. Use of plasmapheresis in post-transplant period for treatment of humoral rejections was associated with significantly higher incidence of TB (33.33% vs. 13.41%, p = .031); however, when pre-transplant plasmapheresis was also considered, there was no significant difference. The choice of induction agent was not associated with higher incidence of TB. Use of rituximab is not associated with higher incidence of TB when compared to other immunosuppressive agents. Routine screening and prophylaxis may not be advisable, especially in a country like India with high prevalence of TB, as it will further delay transplantation and may adversely affect the outcome of the patients.

COVID-19 and tuberculosis reactivation: a systematic review assessing most common risk factors

COVID-19 as a pandemic not only shifted the focus of the healthcare system from other diseases but also affected the disease progression of infections like tuberculosis which remained a leading killer in the past worldwide. COVID-19 itself is said to reactivate latent tuberculosis as shown in animal experiments. Immunomodulators such as corticosteroids and tocilizumab which are being used for covid treatment even further predisposes patients to tuberculosis reactivation and increased progression of the disease. Diabetes is already known to be a risk factor for tuberculosis reactivation and impact tuberculosis progression and worsen the situation. The exact mechanism of interaction of covid-19 and tuberculosis and their effect on each other remains unknown. Considering high prevalence of tuberculosis and the current scenario of covid-19 in world, there is need to study the impact of covid-19 infection on tuberculosis progression or reactivation and commonly associated risk factors. We conducted a systematic search of the online databases to collect data of patients who had tuberculosis reactivation or increased progression of disease after covid-19 infection. Data of a total of 18 patients was retrieved and used for the syntheses of the study. Diabetes was present in 50% of the patients. 55.5% patients were administered corticosteroids for covid-19 treatment later presenting with tuberculosis. Tocilizumab however was administered to 22.2% patients who also received corticosteroids. 27.7% patients suffered tuberculosis reactivation after covid-19 infection without history of diabetes and corticosteroid or tocilizumab administration. None of the patients were reported to have HIV infection. Major risk factors present in patients included corticosteroid administration and diabetes. However, tuberculosis reactivation was seen even in absence of these factors indicating that covid-19 infection may itself be responsible for tuberculosis reactivation. The exact mechanism however remains unknown and further clinical studies are needed to know the same.

Epileptic spasms: A South African overview of aetiologies, interventions, and outcomes.

To better understand the aetiologies of epileptic spasms in infants, as well as the safety and efficacy of high dose corticosteroids in tuberculosis and human immunodeficiency virus (HIV) endemic resource-limited settings. This was a retrospective analysis of infants with epileptic spasms managed at the tertiary referral centres in the Western Cape, South Africa. Of 175 children with epileptic spasms, the median age at onset was 6 months (interquartile range 4-8 months). Structural aetiologies were most common (115 out of 175 [66%]), with two-thirds related to perinatal insults. A lead time to treatment (LTTT) of less than 1 month was more likely in the epileptic encephalopathy/developmental and epileptic encephalopathy (DEE) group: 58 out of 92 (63%), compared to 28 out of 76 (37%) of those with developmental encephalopathy (p=0.001). Failure to recognize preceding developmental delay was common. Ninety-nine children (57%) received first line hormonal therapy such as adrenocorticotropic hormone. A total of 111 out of 172 children (65%) from the developmental encephalopathy and epileptic encephalopathy/DEE groups had clinical and/or electroencephalogram resolution of spasms within 14 days. In our population, children in whom an aetiology could not be identified were statistically more likely to have moderate to profound developmental delay at 1 year of age: 33 out of 44 (p=0.001). Based on reported incidence of epileptic spasms, 23 to 58 cases per annum would be expected but a far smaller proportion presented to our centres. Whilst this is the largest cohort of infants with epileptic spasms from sub-Saharan Africa, the study size is less than expected; this may reflect misdiagnosis and failure of referral pathways. Despite a reported shorter LTTT, infants with DEE had worse developmental outcomes compared to international studies. Hormonal therapy was safe and effective in our setting, despite exposure to high levels of tuberculosis and HIV. The number of unreferred cases of epileptic spasms in South Africa remains high. Caregivers and health care workers in primary care facilities often fail to recognize developmental delay. The burden of disease from hypoxic-ischaemic encephalopathy remains high in our resource-limited setting. Hormonal treatment (e.g. adrenocorticotropic hormone) was safe and effective despite the high prevalence of human immunodeficiency virus and tuberculosis.

S790 The Safety of Ustekinumab Treatment in Patients With Moderate-to-Severe Crohn’s Disease and Latent Tuberculosis/HBV Infection: A Nationwide Retrospective Study

Introduction: Ustekinumab is a human monoclonal antibody specially blocking interleukin-12/23 has been approved in China for moderate-to-severe Crohn's disease in 2020. There is concern about the risk of infectious among biological agents treated patients, because of the high prevalence of tuberculosis and hepatitis B viral (HBV) infection in China and the expected risk of reactivation is higher in these patients. We aimed to assess the risk of tuberculosis and hepatitis B virus reactivation in Crohn’s disease patients with latent tuberculosis infection (LTBI) and previous HBV infection who are receiving Ustekinumab. Methods: A multi-center retrospective cohort study was performed at 68 hospitals in China of 721 adult patients with CD receiving ustekinumab from May 1, 2020 to October 31, 2021, Crohn's disease with concomitant LTBI or HBV carrier were included. All patients were tested for hepatitis B serology, T-SPOT TB and tuberculin skin tests at baseline. LTBI was defined as positive of T-SPOT TB or tuberculin skin tests, HBV carrier was defined as hepatitis B surface antigen and isolated anti-HBc positivity. The primary outcome of this study was tuberculosis or hepatitis B reactivation. Results: Patients with Crohn's disease concomitant LTBI or HBV carrier receiving ustekinumab therapy were retrospectively enrolled from 17 hospitals in China. Fifty-three Crohn’s disease with LTBI patients and seventeen Crohn’s disease patients with HBV carrier patients receiving ustekinumab were included. Figure summarized the inclusion of the latent TB patients treated with ustekinumab. The average follow-up was 32 ± 20 weeks and 28 ± 16 weeks, respectively. Twenty-five Crohn’s disease patients with LTBI received chemoprophylaxis regimen and eleven HBV carrier patients received antiviral prophylaxis. No cases of LTBI reactivation, virologic reactivation, and liver dysfunction were observed during the follow-up period. (Figure) Conclusion: The risk of reactivation of HBV/TB infection during immunosuppressant treatment is dependent on many factors and it influences the choice of practice significantly. This study has a medium time follow-up period and it is the largest studies involving patients with CD coexistent with TB or HBV receiving ustekinumab therapy in a high TB/HBV burden region. The outcomes indicate that ustekinumab could be safe for Crohn’s disease since whether received prophylaxis regimen or not, none developed tuberculosis, liver enzymes increasing, persistent hepatitis or acute liver failure during therapy.Figure 1.: Analysis of the incidence of active TB in the latent TB infection with UST therapy

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; &lt;0.001, &lt;0.001, 0.001 and &lt;0.001 respectively) was significant. Age and clinical symptoms are important pulmonary tuberculosis control hotspots.

Tularemia in children during the last outbreak in Kosovo.

Tularemia is a zoonotic disease that primarily affects adults and children in rural areas. Late diagnosis in children is often associated with treatment failure and accessory surgical procedures. To analyze the diagnostic and treatment options of pediatric tularemia during the last outbreak in Kosovo during years 2014 and 2015. This retrospective study includes 36 children treated for Tularemia at pediatric department. The diagnosis was based on clinical, serological, and PCR testing. Of the 230 patients treated for tularemia, 36 (16%) were children with a median age of 9.4 years old (range 2-15 years). Major clinical manifestations included fever (97%) and swelling of lymph glands (94%), and the duration of symptoms prior to hospitalization was two weeks (range 3-60 days). Leukocytosis (41%), along with an elevated erythrocyte sedimentation rate (97%) characterized the laboratory findings. Both serology and PCR were used to confirm tularemia in children in 100% of cases. Due to abscess formation, suppuration, and high prevalence of tuberculosis, surgical procedures were used as accessory therapy and for diagnosis in half of the patients (50%). Gentamycin was the first drug of choice (97%), while 3 patients experienced relapses. Since the majority of the patients (72%) used unsafe water from wells in rural regions, the outbreak was thought to be water-related. Every febrile child with swollen glands should be suspected of having tularemia. Gentamycin continues to be the preferred treatment for unilateral cervical glandular type. Successful therapy depends on early diagnosis and supplemental surgical procedures.

Endosonographic characteristics of mediastinal lymph nodes for predicting malignancy in high tuberculosis burden settings: a study of 774 subjects

ABSTRACT Background Whether sonographic features of mediastinal lymph nodes can differentiate malignancy from tuberculosis remains unclear. Research design and methods We retrospectively identified subjects with a confirmed diagnosis of tuberculosis or malignancy on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Our primary objective was to compare the endosonographic characteristics of lymph nodes on EBUS between tuberculosis and malignancy. Our secondary objective was to assess the diagnostic performance of endosonographic characteristics in predicting malignancy. Results We included 774 subjects (1,498 lymph nodes) with a confirmed diagnosis of tuberculosis (n = 497) or malignancy (n = 277). Distinct lymph node margins (84.1% vs. 93.8%, P < 0.001) and coagulation necrosis sign (11.2% vs. 29.8%, P < 0.001) were less common in malignancy than tuberculosis. The absence of central hilar structure had the highest sensitivity (92.1%) for malignancy. Endosonographic characteristics had poor specificity for malignancy(round shape and coagulation necrosis sign, 77.3% and 70.2%. In multivariate analysis, coagulation necrosis sign was associated with a lower odds of malignancy (odds ratio 0.45 [95% confidence intervals, 0.21–0.95]). Conclusions Endosonographic characteristics, such as round shape and the coagulation necrosis sign, are not specific for malignancy in high tuberculosis prevalence areas.

Population benefits of addressing programmatic and social determinants of gender disparities in tuberculosis in Viet Nam: A modelling study.

High prevalence of infectious tuberculosis among men suggests potential population-wide benefits from addressing programmatic and social determinants of gender disparities. Utilising a sex-stratified compartmental transmission model calibrated to tuberculosis burden estimates for Viet Nam, we modelled interventions to increase active case finding, to reduce tobacco smoking, and to reduce alcohol consumption by 2025 in line with national and global targets. For each intervention, we examined scenarios differentially targeting men and women and evaluated impact on tuberculosis morbidity and mortality in men, women, and children in 2035. Active case finding interventions targeting men projected greater reductions in tuberculosis incidence in men, women, and children (16.2%, uncertainty interval, UI, 11.4-23.0%, 11.8%, UI 8.0-18.6%, and 21.5%, UI 16.9-28.5%, respectively) than those targeting women (5.2%, UI 3.8-7.1%, 5.4%, UI 3.9-7.3%, and 8.6%, UI 6.9-10.7%, respectively). Projected reductions in tuberculosis incidence for interventions to reduce male tobacco smoking and alcohol consumption were greatest for men (17.4%, UI 11.8-24.7%, and 11.0%, UI 5.4-19.4%, respectively), but still substantial for women (6.9%, UI 3.8-12.5%, and 4.4%, UI 1.9-10.6%, respectively) and children (12.7%, UI 8.4-19.0%, and 8.0%, UI 3.9-15.0%, respectively). Comparable interventions targeting women projected limited impact, with declines of 0.3% (UI 0.2%-0.3%) and 0.1% (UI 0.0%-0.1%), respectively. Addressing programmatic and social determinants of men's tuberculosis burden has population-wide benefits. Future interventions to increase active case finding, to reduce tobacco smoking, and to reduce harmful alcohol consumption, whilst not ignoring women, should focus on men to most effectively reduce tuberculosis morbidity and mortality in men, women, and children.

Effect of BCG Vaccination on Childhood Tuberculosis in a Region with High Prevalence of Tuberculosis

Introduction. BCG vaccination is included in the vaccination schedules of many countries. Numerous studies show its high efficacy, especially in regions with a high prevalence of the disease, and the limited efficacy of revaccination.The objective of the study: to estimate the occurrence of clinical forms of childhood tuberculosis (TB) depending on BCG vaccination in regions with a high prevalence of TB.Materials and Methods. The research design is a retrospective continuous comparative study. We analyzed the data of registration forms No. 089/y-tub of children aged 0 to 17 years with primary active tuberculosis (n = 450) over the period from 2017 to 2020 in Primorsky Territory. Children were divided into groups: 0-3 years old (n = 124), 4-6 (n = 88), 7-10 (n = 61), 11-14 (n = 75), and 15-17 (n = 102).Results. Contact with TB patients was a significant risk factor for children aged from 0 to 3 years.The study revealed a significant predominance of primary tuberculosis among non-BCG-vaccinated children aged 0 to 17 (60.7 and 84.2%, χ2 = 8.234, p = 0.005). Secondary tuberculosis prevailed in vaccinated children (32.3 and 5.6%, χ2 = 12.094, Pearson's contingency coefficient was 0.134 for primary forms and 0.162 for secondary forms).There were no significant differences between the generalized and extrapulmonary forms depending on the vaccination. At the same time, extrapulmonary forms were more common in unvaccinated children (4.9 and 10.5%, χ2 = 2.217, p = 0.137). Revaccination had no significant effect on the occurrence of clinical forms of TB.Conclusions. BCG vaccination has a protective effect against TB. The main preventive measures are early diagnosis of latent tuberculosis using a recombinant tuberculosis allergen skin test. Also, preventive therapy protects against endogenous and secondary TB. No convincing evidence of an additional protective effect of BCG revaccination was obtained.

Sputum smear positivity grade and chest X-ray findings in tuberculosis: a cross-sectional study

Despite many advances in the diagnosis, screening, and rapid treatment of tuberculosis, it is still a public health concern in the world. Due to the importance of this issue in diagnosis and reduction of transmission of infection and treatment of the disease especially where this study was conducted due to the high prevalence of tuberculosis, the aim of our study was to determine the relationship between sputum smear positivity grade and chest X-ray findings in pulmonary tuberculosis patients in a hospital in southeast of Iran. This cross-sectional study was performed on all patients with pulmonary TB referencing the health centers in the Zabol city from January 1, 2015 to December 30, 2020. Sputum smear and radiographic findings of the chest X-ray were evaluated. Data was collected using a form of information and finally analyzed by SPSS 22. Out of 101 patients examined in the present study, 71 were women and 30 were men. The mean age of the patients was 62.6813.61 years. The frequency of opacity in patients with grades 1, 2, and 3 was 71.4, 78.5, and 76.5%, respectively. Frequency of cavitation in patients with grade 1, 2 and 3 was 11.5%, 28.5% and 52.9% respectively (P value 0.001). The frequency of reticulonodular presentations in patients with grade 1, 2, and 3 was 24.2, 7.1, and 0%, respectively. In general, the results of this study showed that, with increasing grading of smears (1+, 2+, and 3+), the frequency of cavitation presentation increased significantly and the frequency of reticulonodular presentations decreased significantly. The findings of the present study can help physicians to improve TB diagnostics.

Synergizing early detection and comprehensive mandatory notification to improve Tuberculosis case finding through public private mix

Tuberculosis (TB) is a priority health problem in Indonesia. Incidence rate estimation for TB in 2020 was 301 per 100,000 population or 824,000 new cases per year which is the third highest worldwide. The Corona Virus Disease (COVID-19) Pandemic has caused decreasing performance of TB control program globally, including Indonesia. The treatment coverage was declined from 67% in 2019 to 48% in 2020 and 54% in 2021, far behind the 80% target. This fact signifies that around a half of people with TB in Indonesia are overlooked, which is estimated to be accounted for over 400,000 cases. Another TB Program’s main indicator, treatment success rate at 86%, remains below the target of 90%. Low achievement of the two main indicators may result in the increasing of TB transmission, morbidity and mortality in population. Besides, Indonesia also faces the triple burden of TB, high prevalence of drug resistance TB and coinfection of TB and HIV

Cytomorphological study of lymph node lesions at a tertiary care center

Introduction: Lymphadenopathy is one of the most common clinical presentations of patients attending the outpatient department. The degree and pattern of morphological changes depend on inciting stimulus and the intensity of the response. Fine-needle aspiration cytology (FNAC) is an important procedure in establishing the diagnosis of various lymph node lesions. It is a widely accepted, accurate, sensitive, and specific test used in an outpatient setting. Methodology: An observational study was carried out at the department of pathology of a tertiary care hospital in North India from July 2019 to February 2020. A total of 100 lymphadenopathy cases were taken. Smears were stained with Giemsa and categorized according to the cytomorphological pattern. Ziehl - Neelsen (ZN) stain was done in clinically suspicious cases of tuberculosis (TB). Data regarding brief history, site, age, and cytomorphologic features were collected and analyzed. Results: Out of 100 cases of lymph node aspirations, 70 cases showed features of tubercular lymphadenitis followed by reactive lymphadenitis, 29 cases while 1 malignancy. TB was prevalent in all age groups. Conclusion: Lymph node FNAC is a simple, cost-effective investigation with great importance in view of high prevalence of TB in our country, where an atypical presentation of TB can be screened. Purulent aspirate smears which do not show typical features of TB can be dismissed as acute suppurative lymphadenitis in the absence of ZN staining. Acid-fast bacillus positivity in such cases confirms the diagnosis and helps in better patient management.

IS6110 Copy Number in Multi-Host Mycobacterium bovis Strains Circulating in Bovine Tuberculosis Endemic French Regions

IS6110 is an insertion sequence found in the Mycobacterium tuberculosis complex, to which Mycobacterium bovis belongs, which can play a role in genome plasticity and in bacterial evolution. In this study, the abundance and location of IS6110 on M. bovis genomic data of French animal field strains were studied. A first analysis was performed on a panel of 81 strains that reflect the national M. bovis population’s genetic diversity. The results show that more than one-third of them are IS6110 multicopy and that 10% have IS6110 in a high copy number (more than 6 copies). Multicopy strains are those circulating in the regions where prevalence was above the national average. Further study of 93 such strains, with an IS6110 copy number of 10-12, showed stability of IS6110 copy number and genome location over time and between host species. The correlation between M. bovis multicopy strains and high bovine tuberculosis (bTB) prevalence leads us to consider whether their epidemiological success could be partly due to genetic changes originated by IS6110 transposition.