High Prevalence Of Tuberculosis Research Articles

Latent and active tuberculosis infection in allogeneic hematopoietic stem cell transplant recipients: a prospective cohort study.

Tuberculosis (TB) is a major infectious complication in hematopoietic stem cell transplant (HSCT) recipients in countries with high TB prevalence. Identifying and treating latent tuberculosis infection (LTBI) helps to prevent TB reactivation after transplantation. Few studies have compared the tuberculin skin test (TST) with interferon Gamma release assays (IGRA) to diagnose LTBI in HSCT candidates. We compared TST and QuantiFeron TB gold in tube (QTF-GIT) and prospectively evaluated the incidence of active tuberculosis in 126 HSCT candidates and 58 HSCT recipients with chronic GVHD followed at the outpatient clinic. TB was diagnosed by culture in Mycobacteria media and by commercial real-time PCR kit. Considering the positivity of any test, the prevalence of LTBI was 8.7% in HSCT candidates (11 out of 126) and 12.5% in HSCT recipients with chronic GVHD (6 out of 48). QTF-GIT indeterminate results were detected in 2.4% of the HSCT candidates. Fair to good agreement (K > 0.50) between tests was observed in both cohorts. Cumulative incidence of TB was 3% in the GVHD cohort. TB was diagnosed in 2 chronic GVHD recipients, both cases confirmed by positive culture and PCR. None of the 11 patients with LTBI diagnosed pre-HSCT who received INH prophylaxis developed TB.

Diabetes and Tuberculosis: Is There a Relationship?

Background: There is growing evidence that Diabetes Mellitus (DM) is an important risk factor for Tuberculosis (TB) and might affect disease presentation and treatment response. Risk factors for TB include HIV/AIDS, immune suppression (i.e. steroids), silicosis, malnutrition, smoke from domestic stoves and cigarettes, and DM. In recent decades, TB incidence has declined in high-income countries, but incidence remains high in countries that have high rates of HIV infection, malnutrition, and crowded living conditions. Furthermore, DM prevalence is increasing globally, fueled by obesity. Several case–control studies have shown that the odd ratios of developing TB in diabetic patients ranges from 2.44 to 8.33 compared with non-diabetic patients. Several large-scale longitudinal cohort studies have shown similar findings. Case: A 63-year-old male with poorly controlled type 2 DM (HbA1C of 15%), HTN, COPD and history of pulmonary TB who had previously received 2 courses of treatment, was admitted with sudden dyspnea with non-productive cough. In the ED, he was hypoxic, had bilateral pleural effusions, lower extremity edema and newly diagnosed acute systolic CHF. Sputum smear analysis was AFB positive and Mycobacterium tuberculosis was confirmed via PCR. The smear microbes were resistant to rifampin, poor sample limited further sensitivities, and the patient was started on empiric treatment for multi drug resistant TB with RIPE, Capreomycin, Linezolid, and Moxifloxacin. Endocrinology was consulted to assist in control of hyperglycemia. The patient was managed with high doses of insulin. At the time of discharge his blood glucose where in the range of 120–180 mg/dl during the entire day and the importance of having good BG control was reinforced. He continues his treatment for TB. Discussion: Diabetes leads to increased susceptibility to Mycobacterium tuberculosis infection and disease via multiple mechanisms, including those directly related to hyperglycemia, as well as indirectly via the effect on macrophage and lymphocyte function, leading to diminished ability to contain the organism. It is possible the refractory course of this patient’s TB and subsequent development of MDR disease was in part due to his poorly controlled diabetes due to poor compliance to prior regimens. Conclusion: DM is associated with increased risk of contracting TB, the possible delay in sputum culture conversion, increased mortality, and increased risk of recurrent and refractory disease. Adequate screening and treatment of DM may be essential to help prevent patients with diabetes from contacting the disease especially in countries with high prevalence of TB. Also, it is important to ensure adequate treatment response and prevent the development of multidrug resistant disease in diabetics who have already contracted TB.

International Adoption: A Review and Update.

1. Judith Kim Eckerle, MD*,† 2. Megan Marie Bresnahan, OTR/L† 3. Maria Kroupina, PhD, LP*,† 4. Dana Ernest Johnson, MD, PhD*,† 5. Cynthia Ruth Howard, MD, MPHTM*,† 1. *Department of Pediatrics, University of Minnesota, Minneapolis, MN 2. †MHealth Fairview University of Minnesota Masonic Children’s Hospital, Minneapolis, MN * Abbreviations: Ab : : antibody ACE : : adverse childhood experience CDC : : Centers for Disease Control and Prevention CXR : : chest radiography IA : : international adoptee TB : : tuberculosis 1. Key information for accurate assessment of the preadoption referral. 2. Determining immunization status and planning catch-up strategy. 3. Updated screening protocol for and treatment of latent tuberculosis infection. 4. Evaluation of developmental delays in the context of international adoption. 5. Screening for risk factors indicating the need for referral to child mental health and developmental specialists. After completing this article, readers should be able to: 1. Review the basic components of an adoption referral file and know when to consult an international adoption medicine expert. 2. Perform the initial medical assessment of a newly arrived international adoptee, including evaluation of the efficacy of previous immunizations and planning of catch-up immunization based on new recommendations. 3. Screen for tuberculosis and treat latent tuberculosis infection based on recent Centers for Disease Control and Prevention (CDC) guidelines. 4. Understand the multiple areas of a developmental baseline of adopted children and assess for catch-up needs. 5. Identify the child with multiple risk factors and/or parental or family stressors who needs a referral to an adoption-competent mental health specialist. Although interest in intercountry adoption continues to be high, the numbers of international adoptions have changed dramatically since the peak in 2004 when 45,483 international adoptees (IAs) were placed in families worldwide. By 2017, the number dropped 79% to 9,387. In the United …

Hubungan Lingkungan Fisik Rumah dan Kepadatan Hunian dengan Prevalensi Tuberkulosis di Kecamatan Sungai Kunjang Kota Samarinda

Background: The physical environment of the house becomes the main medium of transmission of Mycobacterium Tuberculosis through droplets of tuberculosis patients in the home. The physical environment of the house includes ventilation, lighting and overcrowding. The highest prevalence of tuberculosis in East Kalimantan Province is Samarinda City. Objective: To determine the relationship between the physical environment of the house and the density of the occupancy with the prevalence of tuberculosis in Sungai Kunjang District, Samarinda City. Method: This type of research was quantitative with a case control design, carried out from August to October 2020 with a population of patients diagnosed with tuberculosis at Loa Bahu, Karang Asam and Loa Bakung Public Health Centers, a total of 57 respondents were taken and 57 respondents as controls. The research instruments were questionnaires and observation sheets. The analysis was carried out by univariate and bivariate using the chy square. Results: There was a significant relationship between the physical environment of the house and the occupancy density with the prevalence of tuberculosis, respectively: home lighting p-value = 0.001 (OR = 3.532), house ventilation p-value = 0.000 (OR = 55.467), occupancy density house p-value = 0.018 (OR = 3.317), and room area p-value= 0.004 (OR = 3.609). Conclusion: There was a relationship between the physical environment of the house and the density of occupancy with the prevalence of tuberculosis. Education needs to be given to the community in order to physically modify the house to maintain health and avoid transmission of tuberculosis in the home environment.Keywords: Ventilation; lighting; occupancy density; house area; tuberculosis.

Anticipating the impact of COVID19 and comorbidities on the South African healthcare system by agent-based simulations

Tuberculosis (TB) is the 10th leading cause of death worldwide, and since 2007 it has been the main cause of death from a single infectious agent, ranking above HIV/AIDS. The current COVID-19 is a pandemic which caused many deaths around the world. The danger is not only a coinfection as observed for TB and HIV for a long time, but that both TB and SARS-CoV-2 affect the respiratory organs and thus potentiate their effect or accelerate the critical course. A key public health priority during the emergence of a novel pathogen is the estimation of the clinical need to assure adequate medical treatment. This requires a correct adjustment to the critical case detection rate and the prediction of possible scenarios based on known patterns. The African continent faces constraining preconditions in regard to healthcare capacities and social welfare which may hinder required countermeasures. However, given the high TB prevalence rates, COVID-19 may show a particular severe course in respective African countries, e.g. South Africa. Using WHO’s TB and public infrastructure data, we conservatively estimate that the symptomatic critical case rate, which affects the healthcare system, is between 8 and 12% due to the interaction of COVID-19 and TB, for a TB population of 0.52% in South Africa. This TB prevalence leads to a significant increase in the peak load of critical cases of COVID-19 patients and potentially exceeds current healthcare capacities.

Tuberculosis or Sarcoidosis a Case Report

Distinguishing sarcoidosis from pulmonary tuberculosis can be a great challenge to physicians, especially in Tunisia where there is high prevalence of tuberculosis. Both tuberculosis and sarcoidosis are granulomatous diseases; however, necrosis is commun in tuberculosis and less commun in sarcoidosis. The presence of necrosis may lead to an excessive diagnosis of tuberculosis. We present the case of a 48 years old female in which nasosinusal tuberculosis was retained face to granulomatous inflammation with little fields of necrosis. The patient was treated for many months without healing. The diagnosis was revised when evolutive pulmonary lesions were observed while the patient was under well conducted anti-tubercular treatment. Sarcoidosis was in fine retained with good response to corticosteroid therapy.

Tuberculosis or Sarcoidosis a Case Report

Distinguishing sarcoidosis from pulmonary tuberculosis can be a great challenge to physicians, especially in Tunisia where there is high prevalence of tuberculosis. Both tuberculosis and sarcoidosis are granulomatous diseases; however, necrosis is commun in tuberculosis and less commun in sarcoidosis. The presence of necrosis may lead to an excessive diagnosis of tuberculosis. We present the case of a 48 years old female in which nasosinusal tuberculosis was retained face to granulomatous inflammation with little fields of necrosis. The patient was treated for many months without healing. The diagnosis was revised when evolutive pulmonary lesions were observed while the patient was under well conducted anti-tubercular treatment. Sarcoidosis was in fine retained with good response to corticosteroid therapy.

What did we learn from South Africa's first-ever tuberculosis prevalence survey?

The World Health Organization (WHO) has urged countries to conduct tuberculosis (TB) prevalence surveys to better understand the burden of TB and to enable the WHO to conduct global estimates. Until the report from the first-ever prevalence survey in South Africa (SA), the country had to rely on WHO estimates. The recently published report on the SA TB prevalence survey provides important estimates of the burden of TB disease as well as information on health-seeking behaviour. This review notes the key findings of the 2018 prevalence survey. The high prevalence of TB in SA continues to be a major cause for concern, and calls for a significantly improved response to reach the End TB targets set by the WHO.

High prevalence of extrapulmonary tuberculosis in dairy farms: Evidence for possible gastrointestinal transmission.

Bovine tuberculosis (bTB) caused by Mycobacterium bovis (M. bovis) represents one of major zoonotic diseases among cattle, it also affects the health of human, other domestic animals and wild life populations. Inhalation of infected aerosol droplets is considered as the most frequent route of the infection. This study aims to investigate the current forms of tuberculosis in cattle and identify the possible transmission modes in dairy farms of China. 13,345 cows from eight dairy farms in three provinces were comprehensively diagnosed by a multitude of assays, including SIT, CIT, IFN-γ assay and ELISA. It has been indicated that advanced infection of bTB was found in 752 (5.64%) cattle, suggesting a high prevalence of tuberculosis in these dairy farms. In the necropsy examination of 151 positive cattle, typical bTB lesions were observed in 131 cattle (86.75%), of which, notably, 90.84% lesions appeared in liver, spleen, mesenteric lymph nodes, mammary lymph nodes and other organs, taking up a large proportion among cattle with advanced bTB infection. 71.26% extrapulmonary tuberculosis (EPTB) was related to gastrointestinal system. M. bovis nucleic acid was further found in milk and feces samples and M. bovis was even isolated from milk samples. Phylogenetic analysis based on whole genome sequencing unraveled that six isolates were closely related to M. bovis AF2122/97 originated from UK, whereas four isolates shared close relation to M. bovis 30 from China, respectively. Our data demonstrate that the increase of EPTB transmitted by digestive tract is implicated in the current high prevalence rate of bTB in China, which also provides leads for bTB control in other countries with high prevalence of bTB in the future.

PREVALENCE OF TUBERCULOSIS, DRUG-RESISTANT TUBERCULOSIS AND HIV/TB CO-INFECTION IN ENUGU, NIGERIA.

Background:Tuberculosis (TB) remains a global public health problem, with developing countries bearing the highest burden. Nigeria is first in Africa and sixth in the world among the countries with the highest TB burden, but is among the 10 countries accounting for over 70% of the global gap in TB case detection and notification. Enugu State, Nigeria reportedly has a notification gap of almost 14,000 TB cases; a situation which must be addressed.Materials and Methods:A total number of 868 individuals accessing DOTS services in designated centres within the six Local Government Areas (LGAs) of Enugu North geographical zone, was recruited into the study. The participants were screened for HIV seropositivity by standard protocols, while screening for TB and drug-resistant TB were conducted by a combination of Zhiel Neelsen staining and Nucleic Acid Amplification Test (Xpert® MTB/Rif).Results:Of the 868 subjects that participated in the study, 176 (20.3%) were HIV seropositive. The highest prevalence (26.7%) of HIV was recorded in Udenu LGA, while the least (13.1%) was recorded in Nsukka LGA. Overall TB prevalence was found to be 22.1% and 21.3% by sputum-smear and NAAT, respectively. Uzo Uwani LGA recorded the highest prevalence of both TB (33.3%) and TB/HIV co-infection (16.7%), but the lowest prevalence of resistant TB. Nsukka LGA had the highest prevalence of resistant TB.Conclusion:Enugu North geographical zone, Nigeria, has a high prevalence of both HIV and TB, including resistant TB and there is need to increase monitoring of individuals resident in this region.

Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan

In Karachi, Pakistan, a South Asian megacity with a high prevalence of tuberculosis (TB) and low HIV prevalence, we assessed the effectiveness of fluoroquinolone-based preventive therapy for drug-resistant (DR) TB exposure. During February 2016–March 2017, high-risk household contacts of DR TB patients began a 6-month course of preventive therapy with a fluoroquinolone-based, 2-drug regimen. We assessed effectiveness in this cohort by comparing the rate and risk for TB disease over 2 years to the rates and risks reported in the literature. Of 172 participants, TB occurred in 2 persons over 336 person-years of observation. TB disease incidence rate observed in the cohort was 6.0/1,000 person-years. The incidence rate ratio ranged from 0.29 (95% CI 0.04–1.3) to 0.50 (95% CI 0.06–2.8), with a pooled estimate of 0.35 (95% CI 0.14–0.87). Overall, fluoroquinolone-based preventive therapy for DR TB exposure reduced risk for TB disease by 65%.

Implementation of a Mobile Health Strategy to Improve Linkage to and Engagement with HIV Care for People Living with HIV, Tuberculosis, and Substance Use in Irkutsk, Siberia.

In Irkutsk, Siberia, there is a high prevalence of HIV and tuberculosis (TB) coinfection. Mobile health (mHealth) strategies have shown promise for increasing linkage to and engagement in care for people living with HIV (PLWH) in other contexts. We evaluated outcomes for a cohort of PLWH, TB, and substance use in Irkutsk after participation in a multi-feature mHealth intervention called MOCT. Sixty patients were enrolled during hospitalization for TB. We evaluated participant app usage, linkage to HIV care postdischarge, perception of self-efficacy related to HIV care, and HIV-related clinical outcomes at 6 months. We also performed an exploratory analysis to compare a subset of 49 patients with a pre-intervention cohort matched for age and gender. Participants demonstrated engagement with app features examined at 6 months. The majority linked to HIV care by 6 months (83%). Self-scoring of confidence in ability to communicate with HIV providers improved from baseline (median score 8, scale 1–10) to 6 months (10, p = 0.004). A higher proportion of the MOCT subset refilled antiretroviral therapy (69% vs. 43% in pre-intervention cohort, p = 0.01), with fewer deaths in the MOCT subset at 6 months (1 death vs. 10 deaths in pre-intervention cohort, p = 0.02) and a decreased likelihood of developing the composite outcome of death/failure to achieve viral suppression at 6 months (adjusted odds ratio = 0.33, p = 0.029). This study demonstrates preliminary intervention uptake and improvement in short-term outcomes for an urban cohort of PLWH, TB, and substance use enrolled in a multi-feature mHealth intervention, a novel strategy for the context.Clinical Trial Registration Number: NCT03819374.

Association of interferon-gamma release assay and SARS-CoV-2 reverse transcriptase polymerase chain reaction test results in adults tested in a tertiary medical center

<strong>Introduction:</strong> For a country with high Tuberculosis (TB) prevalence, infection of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus with a covert co-infection of <em>Mycobacterium Tuberculosis</em> (MTB) is a real concern.

Association of interferon-gamma release assay and SARS-CoV-2 reverse transcriptase polymerase chain reaction test results in adults tested in a tertiary medical center

<strong>Introduction:</strong> For a country with high Tuberculosis (TB) prevalence, infection of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus with a covert co-infection of <em>Mycobacterium Tuberculosis</em> (MTB) is a real concern.

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.

Genital tuberculosis role in female infertility in Portugal.

Genitourinary tuberculosis is the fourth most common cause of extrapulmonary tuberculosis, although often underestimated by clinicians due to its rare and non-specific symptoms. One of the disease's complications is infertility. Although Portugal is one of the European countries with the highest prevalence of tuberculosis, its impact on Portuguese female fertility is unknown. With this study, we intend to evaluate the prevalence of genital tuberculosis, its presenting symptoms, and pregnancy outcomes in infertile women followed in a Portuguese tertiary hospital. Retrospective and descriptive study, performed using an electronic database and consultation of clinical files. Studied population: infertile women followed from 2000 until 2019 at the reproductive unit of a Portuguese tertiary hospital, who underwent endometrial biopsy/curettage in the context of their etiological investigation. The diagnosis of genital tuberculosis was based on histological criteria. Over the 19years, 2653 endometrial specimens were analyzed. Pathological evaluation was positive for tuberculosis in 19 cases (0.72%). There was a decrease in new diagnoses throughout the observation period. Despite being one of the European countries with the highest prevalence of tuberculosis, genital TB does not appear to have a significant impact on the etiology of female infertility in Portugal. Nevertheless, it is a diagnosis to be considered in selected patients.

Hybrid PET/MRI findings in a case of pulmonary and extra-pulmonary tuberculosis associated with motor-neuron disease-like illness\u2014a coincidence or a causation?: a case report

BackgroundThe association of tuberculosis and motor neuron disease-like illness has not been described previously. We present a case of co-existent pulmonary and extra-pulmonary tuberculosis in a young man whose clinical presentation was suggestive of a motor neuron disease-like illness and was subsequently diagnosed with tubercular infection. This case provokes our thought as to whether the association between tuberculosis and motor neuron dysfunction was just a co-incidence, given the high prevalence of tuberculosis in our set-up, or does it point towards a possible causative role of infection in motor neuron disease.Case presentationA 31-year-old man presented with progressive thinning of bilateral upper and lower limbs with associated pain and twitching sensation in upper and lower limb muscles. He had a history of loss of appetite and unintentional weight loss. On clinical examination, there was evidence of fasciculations in bilateral quadriceps, bilateral biceps, and paraspinal muscles which was further confirmed with electrophysiology. The work-up for underlying autoimmune, toxic and metabolic aetiology, and paraneoplastic aetiology was found to be negative. CT scan of the chest was suggestive of consolidations in bilateral upper lobes with multiple tree-in-bud nodules in both the lungs. Hybrid 18-Flourine-flourodeoxyglucose positron emission tomography and magnetic resonance imaging (F-18-FDG PET/MRI) imaging was also suggestive of pulmonary and extra-pulmonary tuberculosis. Imaging of the brain revealed atrophy along bilateral motor cortices with reduced tracer uptake. Diagnosis of tubercular infection was confirmed with nucleic acid amplification test and the patient was put on anti-tubercular therapy. On follow-up after 6 months, the patient reported improvement in the symptoms and the muscle power in bilateral upper and lower limbs.ConclusionWe have described a very rare association of pulmonary and extra-pulmonary tuberculosis with motor neuron-like illness. It may be debated that such an association may just be co-incidental; however, given the improvement in the symptoms and signs of the motor neuron disease-like illness on follow-up while the patient was on anti-tubercular therapy, it may point towards a causative relationship between tubercular infection and motor neuron dysfunction. Further epidemiological studies should be sought for in order to reach a conclusive answer.

Extensively drug-resistant tuberculosis treated with bedaquiline: A case report in the particularly vulnerable tribal group of Madhya Pradesh, India

The management of drug-resistant (DR) tuberculosis (TB) remains a challenge particularly in remote rural areas of the country. Although the treatment with wholly oral drug regimens, including bedaquiline (BDQ) and delamanid, is rolled out under the National TB Elimination Program, little is known about its coverage and the effectiveness in hard-to-reach tribal areas. The present report describes the early identification and successful management, through team effort, of a case of extensively DR TB belonging to the Saharia tribe - a Particularly Vulnerable Tribal Groups (PVTGs) of Madhya Pradesh, which has a very high prevalence of TB. The BDQ-containing regimen was well tolerated and found effective with minimal side effects and contributed to the reduced time to culture conversion and radiological improvements. The concerted efforts and strategies need to be adopted for effective implementation of Programmatic management of DR TB (PMDT) guidelines in remote tribal areas of the country.

Diagnostic Importance of Cerebrospinal Fluid Adenosine Deaminase Levels in Tuberculous Meningitis

Introduction: Estimation of Cerebrospinal Fluid (CSF) Adenosine Deaminase (ADA) is used for early diagnosis of Tuberculous Meningitis (TBM) and has got importance in differentiating TBM from bacterial and viral types of meningitis. Hence, estimation of ADA in CSF can be carried out in all clinically suspected meningitis patients, especially in developing countries like India with high prevalence of Tuberculosis (TB). Aim: To evaluate CSF ADA as a diagnostic test for TBM. Materials and Methods: The prospective study was done on 80 cases admitted with meningitis in Government General Hospital Kakinada, Andhra Pradesh, India, in a period of eight months during August 2018 to March 2019. In all the subjects the concentrations of CSF ADA, Glucose, Total proteins, Calcium, and Phosphorus were assayed. Results: The results shows that the mean values of CSF ADA in TBM were significantly increased (15.13±12.2) when compared with other types of meningitis due to stimulation of T-cells by Mycobacterium antigens. Mean values of CSF glucose were significantly decreased in bacterial and TBM. Mean values of CSF total proteins were increased in all three types. Conclusion: Therefore, this study suggests the need for routine measurement of CSF ADA in the diagnosis of TBM and thus helps in early detection of TBM which warrants timely intervention leading to lowered morbidity and mortality.

Latent Tuberculosis in Psoriasis Patients Planned for Systemic Therapy - A Prospective Observational Study.

Background:India has a high prevalence of tuberculosis and latent tuberculosis infection (LTBI) is common in the general population. LTBI can progress to active tuberculosis in almost 10% patients and the risk increases with immunosuppression. This predisposes patients of psoriasis on systemic therapy for the development of active tuberculosis.Aims:To find the prevalence of LTBI in patients with psoriasis planned for systemic therapy.Methodology:It was a prospective observational study conducted in a tertiary care center during period Jan-Dec 2019. Patients older than 18 years with chronic plaque psoriasis planned for systemic therapy and willing to be part of the study were included. Baseline clinical data were collected. Radiograph of chest and tuberculin skin test (TST) was performed in all patients. Detailed evaluation including sputum examination and computed tomography of the chest and abdomen were performed in patients with TST >10 mm.Results:A total of 105 patients met the inclusion criteria of the study, with the mean age of patients being 29.5 ± 2.12 years. Out of these patients, 58 were males and 47 females. The mean duration of psoriasis was 2.95 ± 1.3 years. The mean PASI score was 16.71 ± 4.384. Mantoux was positive (>10 mm) in 33 (31.42%) patients. Two patients were found to have features of active tuberculosis based on imaging and microbiological investigations. Totally, 31 (29.5%) patients had LTBI and were treated with isoniazid and rifampicin for three months while 2 (1.9%) patients were treated with four drugs antitubercular regimen.Limitations:Small sample size, convenience method of sampling and study population limited to those visiting medical college hospital are its major limitations.Conclusion:LTBI is common in study population and screening for LTBI should be performed in all patients of psoriasis planned for systemic therapy. A thorough search for active tuberculosis should be performed. Timely detection of LTBI helps in the prevention of development of active tuberculosis in the patients on immunosuppressive treatment.