High Prevalence Of Tuberculosis Research Articles

Effects of tuberculosis and/or HIV-1 infection on COVID-19 presentation and immune response in Africa

Few studies from Africa have described the clinical impact of co-infections on SARS-CoV-2 infection. Here, we investigate the presentation and outcome of SARS-CoV-2 infection in an African setting of high HIV-1 and tuberculosis prevalence by an observational case cohort of SARS-CoV-2 patients. A comparator group of non SARS-CoV-2 participants is included. The study includes 104 adults with SARS-CoV-2 infection of whom 29.8% are HIV-1 co-infected. Two or more co-morbidities are present in 57.7% of participants, including HIV-1 (30%) and active tuberculosis (14%). Amongst patients dually infected by tuberculosis and SARS-CoV-2, clinical features can be typical of either SARS-CoV-2 or tuberculosis: lymphopenia is exacerbated, and some markers of inflammation (D-dimer and ferritin) are further elevated (p < 0.05). Amongst HIV-1 co-infected participants those with low CD4 percentage strata exhibit reduced total, but not neutralising, anti-SARS-CoV-2 antibodies. SARS-CoV-2 specific CD8 T cell responses are present in 35.8% participants overall but undetectable in combined HIV-1 and tuberculosis. Death occurred in 30/104 (29%) of all COVID-19 patients and in 6/15 (40%) of patients with coincident SARS-CoV-2 and tuberculosis. This shows that in a high incidence setting, tuberculosis is a common co-morbidity in patients admitted to hospital with COVID-19. The immune response to SARS-CoV-2 is adversely affected by co-existent HIV-1 and tuberculosis.

The burden of tuberculosis in the Russian Federation. Part 3. Dynamics of the prevalence of tuberculosis with HIV infection

Tuberculosis in combination with HIV infection (TB/HIV) poses a threat to the TB epidemic well-being. Pur-pose: to study trends in the prevalence of tuberculosis (TB), including TB/HIV, in Russia as a whole and by re-gions. Methods: official statistics were used. The list of regions with a high burden of TB and TB/HIV included 10 regions with the highest number of TB and TB/HIV cases, respectively, and 5 regions with the highest prev-alence of TB and TB/HIV. Results. The proportion of TB/HIV patients in public health care increased from 82.8% in 2015 to 88.7% in 2021. There are three periods of TB/HIV prevalence dynamics: growth (until 2016), stabiliza-tion (2016–2019), decline (2020 and 2021). In contrast to the continuous decline in the number of TB cases with-out HIV infection, the number of diagnosed TB/HIV pa-tients grew until 2016 and after stabilizing at the level of 12–13 thousand patients per year, decreased to 9,817 in 2020 and 9,493 patients in 2021. This was consistent with the maximum levels (29–31 thousand) of the number of patients in 2015–2019 with a decrease to 25,359 in 2020 and 23,352 patients in 2021. The largest burden and the largest proportion of TB/HIV patients (with a tendency to increase) is observed in the Volga, Urals and Siberian districts. Conclusion. Currently, the TB/HIV problem is beginning to prevail. Russia was included in the WHO list of countries with a high burden of TB/HIV, in which it was previously absent. Since 2020, the period of reducing the burden of TB/HIV has begun, which has a multifactorial nature: a decrease in the incidence of HIV, an increase in the coverage of antiretroviral therapy, and a decrease in the incidence of tuberculosis. The geographic features of the TB/HIV burden may be related to drug trafficking and religious characteristics. The solution to the problem of TB/HIV depends on the coordinated actions of TB doctors and infectious disease specialists.

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

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

Costs and Coping Strategies of Tuberculosis Inpatients in Tertiary Care Hospital Settings in Lahore, Pakistan

Background: Despite free treatment and screening programs, Tuberculosis can reduce the working capability of patients due to the costs they incur. Eventually, it can lead to economic crises in low- and middle-income countries with a high prevalence of Tuberculosis. The objectives were to look into the costs incurred by Tuberculosis patients and to determine the coping strategies they adopted while admitted to the Hospitals for treatment of Tuberculosis. Methods: In this cross-sectional study, data was collected using an adapted questionnaire based on World Health Organization’s TB patient cost survey protocol. The study was conducted in two tertiary care hospitals in Lahore from November to December 2019. In all 309 TB patients admitted in these hospitals were administered the questionnaire. The data was analyzed with SPSS version 23 software. Results: The estimated direct medical costs per TB patient were 42,106.7 Pakistani Rupees ($271.65). Indirect costs per patient were double of this i.e. 76,013.4 Pakistani Rupees ($490.40). About 65.3 % of patients suffered Catastrophic Health Expenditure with a significant difference between the household income before and during TB treatment. About 52.10% of total patients borrowed money from others and 28.76% sold their assets for meeting the costs incurred. Conclusion: Disparities in household income and treatment total costs lead to a decrease in financial risk protection of TB inpatients. A multi-sectoral approach may help cope with the costs of patients and increase the knowledge of newly diagnosed TB patients to decrease the incidence and achieve the END TB goals by 2035.

340. GeneXpert Ultra for Diagnosis of Central Nervous System Tuberculosis in the High Tuberculosis Prevalence Country - A Prospective Study from India

Abstract Background Early diagnosis and initiation of antitubercular treatment are vital steps to reducing the impact of TB in high burden countries. The molecular method like GeneXpert has significantly improved the diagnosis of TB. GeneXpert Ultra is more sensitive to the diagnosis and helps in paucibacillary samples like cerebrospinal fluid (CSF). This study aims to provide its utility in diagnosis of central nervous system tuberculosis (CNS TB) in high TB burden geography. Methods This prospective observational study included the suspected cases of CNS TB with age ≥12 years. Patients who presented with ≥ 5 days history of CNS symptoms suggestive of tuberculosis with a lancet score of ≥ 6 on combination of clinical, CSF and imaging criteria were included in the study. Patients diagnosed with aetiology other than tuberculosis for CNS disease were excluded. CSF was analysed for GeneXpert Ultra and mycobacterial culture. The sensitivity, specificity, positive predictive value (PPV), and Negative predictive value (NPV) of GeneXpert Ultra were analysed in comparison with culture results. Results A total of 107 patients with mean age of 33.2±18.5 years were analysed. CSF mycobacterial culture was positive in 45.8% (n=49) of patients. However, Mycobacterial tuberculosis via GeneXpert Ultra was detected in 57.9% (n=62) of patients. Sensitivity, specificity, PPV and NPV for GeneXpert Ultra were found 83.7%, 63.8%, 20.4% and 97.2% respectively. According to the lancet score, 70.1% (n=75) and 29.9% (n=32) of patients had probable and possible CNS TB, respectively. Among them, definitive CNS TB were diagnosed in 65.3% (n=49) and 65.6% (n=21) patients with probable and possible CNS TB, respectively. Conclusion GeneXpert Ultra has an excellent sensitivity and negative predictive value for the diagnosis of CNS TB in CSF samples. Even with possible CNS TB according to the lancet score, it is better to consider antitubercular treatment in a high TB burden country. Disclosures All Authors: No reported disclosures.

Database System for Storing Tuberculosis Sputum Sample Images as an AI Training Dataset

The high prevalence of Tuberculosis (TB) in Indonesia puts Indonesia in the second-highest national TB prevalence in the world after India. This high prevalence can cause a failure to deliver medical treatments to TB patients, which is exacerbated by the disproportionate distribution of doctors in Indonesia. To address this issue, an AI system is necessary to help doctors in screening a large number of patients in a short time. However, to develop a robust AI for this purpose, we need a large dataset. This study aims to develop a database system for storing TB sputum sample images, which can be used as the dataset to train an AI for TB detection. The developed system can help doctors and health workers to manage the images during their daily job. After a period of time, the stored images can be utilized as the dataset to train AI.

Pancreatic Tuberculosis: A Diagnosis Dilemma; About A Case Report and Review of the Literature

Pancreatic tuberculosis is a rare entity despite the high prevalence of tuberculosis in the world and in Morocco in particular. The pancreas, an organ normally protected against this infection, is only affected by hematogenous diffusion or not by contiguity through the peripancreatic lymph nodes. Its clinical expression can be either in the form of a pancreatic mass simulating a cancer, or an obstructive jaundice. The diagnosis, difficult to make, is often made only after surgical exploration. Here, we report a case of pancreatic pseudo-tumoral tuberculosis, presented with abdominal pain and weight loss.

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 &lt;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.