High Incidence Of Tuberculosis Research Articles

Efficacy of Xpert MTB/RIF assay in detecting Mycobacterium tuberculosis in samples with different results by smear and culture in a coastal city with high incidence of tuberculosis

BackgroundTuberculosis (TB) is a global problem that seriously jeopardizes human health. Among them, the diagnosis and treatment of smear- or culture-negative TB patients is a challenge. The Xpert MTB/RIF (Xpert) assay has been reported to be a novel molecular diagnostic tool for rapidly detecting TB. Still, there is limited data on this assay's performance in subgroups of TB patients. This study aimed to evaluate the diagnostic value of the Xpert method in patients with different smear and culture results and to assess its efficacy for rifampicin resistance (RR) detection.MethodsWe retrospectively collected data from 1,721 patients with a clinical diagnosis of tuberculosis. Smear, Xpert, and traditional solid culture methods were used to detect TB infection and explore the detection rate of Xpert in the grouping of results from different smear and culture methods. Information on RR detected by the Xpert method and proportional method of drug sensitivity test (DST) was also recorded and kappa values, sensitivity, and specificity were calculated.ResultsWe observed that among the three methods, the Xpert method had the highest detection rate of 66.8%, followed by the culture method at 56.0% and the smear method had the lowest at 40.0%. The detection rate of Xpert was 98.3% (642/653) when both smear and culture were positive, 85.1% (296/348) when only one of the two methods, smear and culture, was positive, and 29.4% (212/720) when both smear and culture were negative. The Xpert method and DST showed a high agreement (κ = 0.92) for RR detection. The highest mutation rate was observed for probe E (64.7%), and the least number of probe C mutations occurred (1.5%).ConclusionThe Xpert method has high detection efficiency. It has good diagnostic value in detecting MTB and RR, especially in cases where traditional culture and sputum smear results are negative, and significantly reduces the rate of missed diagnosis.

Challenging Diagnosis of Intestinal Tuberculosis: A Review

Intestinal tuberculosis (ITB), a subset of extrapulmonary tuberculosis (EPTB), arises from Mycobacterium tuberculosis infection, primarily affecting the ileocecal region due to its lymphatic tissue richness. Representing approximately 10% of global EPTB cases, ITB is most prevalent in regions with high tuberculosis (TB) incidence. Its nonspecific symptoms—abdominal pain, diarrhea, fever, and weight loss—pose significant diagnostic challenges and frequently overlap with conditions like Crohn’s disease (CD). This diagnostic complexity is compounded by shared clinical, endoscopic, and histological features, with misdiagnosis risking inappropriate immunosuppressive therapy that exacerbates TB progression. Diagnostic tools include endoscopy with biopsy, imaging modalities (CT, MRI, ultrasound), and molecular assays like GeneXpert for rapid detection and drug resistance assessment. While histological markers such as caseating granulomas aid differentiation, advanced molecular methods enhance diagnostic precision. Emerging technologies, including next-generation sequencing, CRISPR-based diagnostics, and artificial intelligence in imaging, show promise in addressing diagnostic gaps. However, resource-limited settings face significant barriers, relying on less sensitive conventional methods. Integrated approaches combining clinical, histopathological, and molecular evaluations are essential for accurate diagnosis and effective management. Strengthening healthcare infrastructure, expanding access to advanced diagnostics, and leveraging innovative technologies are critical for reducing ITB-related morbidity and mortality. Keywords: Intestinal tuberculosis, Diagnostic challenges, Molecular diagnostics, Artificial intelligence, GeneXpert.

Efficiency of Artificial Intelligence for Interpretation of Chest Radiograms in the Republic of Tajikistan

The article presents data from recent publications and own data on screening studies with interpretation of chest radiographs using artificial intelligence CAD (Computer-Assisted Diagnosis), which, according to WHO recommendations, provides more accurate clinical thresholds for deciding who needs to take a sputum test. Another aspect of the WHO recommendations is the cost-effectiveness of CAD as a tool for triaging patients with tuberculosis symptoms in low-income countries with a high incidence of tuberculosis. Compared with smear microscopy and GeneXpert, without preliminary sorting, the use of mobile digital X-ray machines equipped with a CAD tool reduces costs, allowing sorting of individuals suspected of having tuberculosis for testing on GeneXpert, while reducing the time to start tuberculosis treatment. Thus, conducting a study using portable X-ray machines using a CAD program is a low-cost and easy-to-implement method, does not require large funds, does not require separate rooms, is highly effective, has good image quality, allows you to quickly clarify individuals suspected of having tuberculosis, differentiating it from other pathological changes in the lungs. Our experience shows that machine analysis of chest computed tomography data, due to the higher resolution capabilities of the method and the absence of fundamental disadvantages of radiography, including the effect of shadow summation, the presence of “blind” zones, etc., is finding increasing application in both diagnostics and screening of respiratory diseases. Our use of this tool allowed us to identify additional new cases of phthisio-onco-pulmonary diseases in field conditions.

Dissecting regional variability in Pyrazinamide prescribing practices for tuberculosis treatment in Japan

ObjectivesTo investigate regional variations in pyrazinamide (PZA) prescribing across Japan’s 47 prefectures and associated influential factors. MethodsThis study utilized the Standardized Claim Ratio (SCR) for PZA from Japan’s National Database of Health Insurance Claims in 2018. Pearson’s correlation coefficients assessed relationships between SCR and tuberculosis (TB) incidence, patient characteristics (age, liver disease), and healthcare resources (specialists, TB beds). Multiple regression analysis identified independent predictors of SCR. ResultsMedian SCR for PZA was 90.0 (range 40.2–187.1), with a 3-fold difference between top and bottom prefectures. In univariate analysis, SCR correlated positively with TB incidence (r = 0.42), respiratory/infectious disease/TB specialists, and negatively with elderly TB patients (r = -0.33) and liver disease per TB case. Multiple regression revealed higher SCR associated with higher TB incidence (β = 0.44, p < 0.001), lower elderly patients (β = -0.33, p = 0.005), and more respiratory specialists (β = 0.41, p < 0.001). ConclusionsRegional PZA prescription patterns are multifaceted, significantly influenced by TB prevalence, elderly patient ratios, and the availability of respiratory specialists. To enhance PZA prescribing conformity and TB management, fostering respiratory expertise across Japan is imperative.

Analysis of Tuberculosis Epidemiological Distribution Characteristics in Fujian Province, China, 2005-2021: Spatial-Temporal Analysis Study.

Tuberculosis (TB) is a chronic infectious disease that harms human health for a long time. TB epidemiological distribution analysis can help governments to control TB in high TB incidence areas. The distribution trend of TB cases varies in different regions. The unbalanced temporal and spatial trends of pulmonary TB (PTB) risk at a fine level in Fujian Province remain unclear. The purpose was to analyze different distribution characteristics, explore the prevalence of TB in this region, and provide a scientific basis for further guidance of TB control work in Fujian Province, China. Prefectural-level and county-level notified PTB case data were collected in Fujian Province. A joinpoint regression model was constructed to analyze the unbalanced temporal patterns of PTB notification rates from 2005 to 2021 at prefecture-level city scales. The spatial clustering analysis and spatial autocorrelation analysis were performed to assess the inequality of the locations of PTB cases. Demographical characteristics were explored by the method of descriptive analysis. TB cases reported in Fujian showed an overall downward trend from 2005 to 2021 (in 2005: n=32,728 and in 2021: n=15,155). TB case numbers showed obvious seasonal changes. The majority of TB cases were middle-aged and older adult male patients (45 years and older; n=150,201, 42.6%). Most of the TB cases were farmers (n=166,186, 47.1%), followed by houseworkers and the unemployed (n=48,828, 13.8%) and workers (n=34,482, 9.8%). Etiologically positive TB cases continue to be the main source of TB cases (n=159,702, 45.3%). Spatially, the reported TB cases were mainly distributed in cities in southeastern Fujian, especially at the county level. TB case numbers showed 2 spatial groups; cases within each group shared similar case characteristics. In terms of geographical distribution, TB showed obvious spatial correlation, and local areas showed high aggregation. The TB incidence trend decreased annually in Fujian Province. TB cases distributed commonly in the male population, middle-aged and older people, and farmers. Etiologically positive cases are still the main source of Mycobacterium tuberculosis infection. TB incidence is higher in the cities with a developed economy and large population in the southeast. TB control should be strengthened in these populations and areas, such as via early screening of cases and management of confirmed cases.

Tuberculosis Preventive Treatment for Pregnant People With Human Immunodeficiency Virus in South Africa: A Modeling Analysis of Clinical Benefits and Risks.

Although prior studies of tuberculosis-preventive treatment (TPT) for pregnant people with human immunodeficiency virus (PPWH) report conflicting adverse pregnancy outcome (APO) risks, international guidelines recommend TPT for PPWH. We used a microsimulation model to evaluate 5 TPT strategies among PPWH receiving antiretroviral therapy in South Africa: No TPT; 6 months of isoniazid (6H) or 3 months of isoniazid-rifapentine (3HP) during pregnancy (Immediate 6H or Immediate 3HP) or post partum (Deferred 6H or Deferred 3HP). The primary outcomes were maternal, fetal/infant, and combined deaths from causes potentially influenced by TPT (maternal tuberculosis, maternal hepatotoxicity, stillbirth, low birth weight [LBW], and infant tuberculosis). Tuberculosis during pregnancy confers 250% and 81% higher modeled risks of stillbirth and LBW, respectively. In lower-risk or higher-risk scenarios, immediate TPT confers 38% lower or 92% higher risks of stillbirth and 16% lower or 35% higher risks of LBW. Immediate TPT would minimize deaths among PPWH. When TPT confers higher stillbirth and LBW risks, immediate TPT would produce the most combined maternal and fetal/infant deaths, even with low maternal CD4 cell count and high tuberculosis incidence. If immediate TPT yields a <4% or <20% increase in stillbirth or LBW, immediate TPT would produce fewer combined deaths than deferred TPT (sensitivity analysis range, <2%-22% and <11%-120%, respectively). If APO risks are below identifiable thresholds, TPT during pregnancy could decrease combined maternal and fetal/infant deaths. Given uncertainty around isoniazid's risks, and the low threshold at which APO risks could outweigh benefits from tuberculosis deaths averted, studies of newer TPT regimens among PPWH are warranted to inform guidelines.

Mycobacterium tuberculosis infection and tuberculosis disease in the first decade of life: a South African birth cohort study

Paediatric tuberculosis leads to more than 200 000 deaths annually. We aimed to investigate the incidence of Mycobacterium tuberculosis infection and tuberculosis disease in the first decade of life in the Drakenstein Child Health Study (DCHS), a South African cohort in a community with high tuberculosis and HIV incidence. In this prospective birth cohort study, we enrolled pregnant women aged 18 years or older who were between 20 and 28 weeks' of gestation in a peri-urban setting outside of Cape Town, South Africa. We followed up their children for tuberculosis until age 10 years. To measure M tuberculosis infection tuberculin skin tests were administered to children at age 6 months, 12 months, and then annually in children with a negative test, and at the time of a lower respiratory tract infection. Tuberculin skin test conversion was defined by an induration reaction of 10 mm or more. To measure tuberculosis disease, active surveillance was done throughout follow-up. Each episode of presumed tuberculosis disease was investigated using sputum induction, tested with Xpert MTB/RIF and liquid culture for M tuberculosis. Survival analyses were performed and multivariable Cox regression was used to measure factors associated with M tuberculosis infection or disease. Between March 5, 2012, and March 31, 2015, 1137 women and their 1143 children (248 [21·7%] of 1143 children were HIV-exposed, two [0·2%] children with HIV) were included in the analysis. Children were followed up for 8870 person-years (median follow-up 9·1 years [IQR 8·2-10·2]). The annual risk of tuberculin conversion during follow-up was 6·6 infections per 100 person-years (95% CI 5·8-7·3) but ranged from 4-9 infections per 100 person-years over the follow-up period. 98 children developed tuberculosis (1105 cases per 100 000 person-years; 95% CI 906-1347). The cumulative hazard of tuberculin conversion was 36% (95% CI 32-41) at age 8 years and the cumulative hazard of tuberculosis disease was 10% (8-12) at age 10 years. Preventive treatment was associated with a reduction in tuberculosis disease among children who had tuberculin conversion (adjusted hazard ratio 0·23 [95% CI 0·12-0·47]). Most cases of tuberculosis disease (78 [79%; 95% CI 69-86] of 98 children) occurred among children who had tuberculin skin test conversion but were not administered preventive treatment. In this prospective South African birth cohort, M tuberculosis transmission was consistently high throughout the first decade of life leading to approximately 10% of children developing tuberculosis disease. A multipronged approach to decrease paediatric tuberculosis is needed that combines preventive treatment for children at risk, reducing community M tuberculosis transmission, and active case finding. Bill & Melinda Gates Foundation, Medical Research Council South Africa, and National Research Foundation South Africa.

The effectiveness of integrated health professional organization collaboration in the treatment of pulmonary tuberculosis: A qualitative study

Background: Tuberculosis (TB) is an infectious disease, the high incidence of tuberculosis and its impact have caused the world to pay special attention, one of which is through the target of the third issue of the sustainable development goals (SDGs), namely tackling the TB epidemic in 2030. Efforts to prevent and reduce TB incidence in Indonesia through to find, treat, and cure TB program. Approaches to finding, diagnosing, treating, and curing TB patients and stopping transmission in the community. The treatment is being carried out actively, massively, and intensively, but the problem-solving has not yet been completed, innovation is needed through the collaboration of integrated health professional organizations, to anticipate the treatment of TB independently, in the service units of private hospitals, clinics and doctors' independent practice places. This innovation is to increase the new case detection rate, and the tracking of initial lost to follow up patients. Purpose: To analyze the effectiveness of integrated health professional organization collaboration in the treatment of pulmonary tuberculosis Method: Qualitative research with descriptive and exploratory design. The source of data and information is informants from the health profession determined by purposive sampling. In-depth interview and focus group discussion interview methods. Informants are representative members of each health profession organization appointed by the organization's leadership. Results: Health professional organizations are committed to and contribute to the well-organized treatment of TB. Integrated activity programs, increasing the discovery of new case detection rates, identification of drug-resistant pulmonary tuberculosis (DR-PTB) and drug-sensitive pulmonary tuberculosis (DS-PTB), and active monitoring of patients initially lost to follow-up, as well as preventing independent case handling. Conclusion: The collaboration of health professional organizations is very effective in helping the government handle Tuberculosis, has a commitment to increase the new case detection rate, identification of drug-resistant pulmonary tuberculosis (DR-PTB) and drug-sensitive pulmonary tuberculosis (DS-PTB), and actively monitor patients who are initially Lost to follow up, which is carried out in an integrated manner.

High incidence of multidrug-resistant tuberculosis in Bhutan: A cohort study based on national TB surveillance data

ObjectivesThe emergence of multidrug-resistant tuberculosis (MDR-TB) has made the elimination of TB difficult. Currently, there are limited data on MDR-TB and other drug-resistant TB in Bhutan. We aimed to estimate the incidence and explore the potential risk factors associated with MDR/pre-extensively drug-resistant (pre-XDR)-TB using comprehensive national TB data. MethodsWe used the data from the Tuberculosis Information Surveillance System of the National Tuberculosis Reference Laboratory to analyze the resistance pattern and epidemiologic data for all TB cases tested for resistance for the year 2018-2021. Multiple logistic regression was performed to identify risk factors associated with MDR/pre-XDR-TB. ResultsOf the 2,290 samples tested for drug resistance, 10.6% (n = 243) was MDR-TB, 3.5% (n = 81) was isoniazid-resistant TB, and 0.61% (n = 14) was pre-XDR-TB. A high incidence of MDR/RR-TB/pre-XDR-TB was documented among patients in Thimphu, Samtse, and Sarpang districts. MDR/pre-XDR-TB was more likely documented among patients aged 18-39 years (adjusted odds ratio [aOR] 2.79; 95% confidence interval [CI] 1.46-6.07), female sex (aOR 1.37; 95% CI 1.01-1.86), and patients previously treated for TB (aOR 2.98; 95% CI 1.99-4.42). ConclusionsGiven the high burden of MDR-TB in some districts, decentralization of diagnostic facilities for more rapid characterization could improve early recognition of drug-resistant cases and assist in management. Comprehensive follow-up and monitoring of high-risk groups should be performed.

Combination of serological and cytokine release assays for improved diagnosis of childhood tuberculosis in Zambia (PROMISE-TB)

ObjectivesThe diagnostic gaps for childhood tuberculosis (TB) remain considerable in settings with high TB incidence and resource constraints. We established and evaluated the performance of a scoring system based on a combination of serological tests and T-cell cytokine release assays, chosen for their ability to detect immune responses indicative of TB, in a context of high prevalence of pediatric HIV infection. MethodsWe enrolled 628 consecutive children aged ≤15 years, admitted for TB suspicion. Multiple cytokine levels in QuantiFERON Gold In-Tube supernatants and antigen 85B (Ag85B) antibodies were assessed in children who tested positive with either Xpert TB or mycobacterial culture. The results were compared with those of control children. ResultsAmong the biomarkers most strongly associated with TB, random forest classification analysis selected Ag85B antibodies, interleukin-2/interferon-γ ratio, and monokine induced by interferon-γ for the scoring system. The receiver operating characteristic curve derived from our scoring system showed an area under the curve of 0.95 (0.91-0.99), yielding 91% sensitivity and 88% specificity. The internal bootstrap validation gave the following 95% confidence intervals for the score performance: sensitivity 71%-97% and specificity 79%-99%. ConclusionsThis study suggests that supplementing the QuantiFERON assay with a combination of serological and T-cell markers could enhance childhood TB screening regardless of HIV status and age. Further validation among the target population is necessary to confirm the performance of this scoring system.

Coexistence of Tuberculosis and Malignancy in a Single Cervical Lymph Node: A Case Series.

Background: The coexistence of tuberculosis (TB) and malignancy within the same lymph node is a rare, if not exceptional, pathology, with only a few cases reported. Methods: We collected patients who presented concomitant TB and malignancy within the same cervical lymph node diagnosed during the period (2010-2023). Results: Ten patients were included. They received or were receiving treatment for cancer or TB in 7 cases. All patients presented with recurrent or new lymph nodes despite being under treatment. The 3 remaining patients did not have a history of cancer or TB. Histopathological examination confirmed the coexistence of TB and malignancy within the same lymph node. Histological types of diagnosed cancers included laryngeal squamous cell carcinoma, papillary thyroid carcinoma, nasopharyngeal carcinoma, medullary carcinoma of the thyroid gland, Hodgkin lymphoma, and non-Hodgkin lymphoma. All patients received treatment for TB and cancer. Two patients died from septic complication in 1 case and from pulmonary complication due to miliary TB in 1 case. Conclusions: Concomitant TB and malignancy are possible, especially in countries with a high incidence of TB. Immunocompromised states related to cancer, and its treatments can add the risk of flare-up of a latent infection.

Epidemiological and genetic aspects of pulmonary tuberculosis in Kazakhstan

ObjectiveTuberculosis is a major health problem in many countries, including Kazakhstan. Host genetics can affect TB risk, and epidemiological and social factors may contribute to disease progression. Due to the high incidence of pulmonary tuberculosis in the country, our research aimed to study the epidemiological and genetic aspects of pulmonary tuberculosis in Kazakhstan. Material and methods1026 participants of Central Asian origin were recruited in the study: 342 individuals diagnosed with active PTB, 342 household contacts, and 342 controls without a family history of TB. Genetic polymorphisms of selected genes were determined by real-time polymerase chain reaction. The association between the risk of pulmonary TB and polymorphisms was evaluated using logistic regression and assessed with the ORs and their corresponding 95 % CIs, and the significance level was determined as p < 0.05. ResultsEpidemiological data revealed that underweight BMI (χ² = 89.97, p < 0.001), employment (χ² = 39.28, p < 0.001), and diabetes (χ² = 12.38, p < 0.001) showed a significant association with PTB. A/T polymorphism of the IFG gene showed a lower risk, and A/A polymorphism showed an increased risk of susceptibility to TB. A/A polymorphism of the IFG gene was associated with an almost 3-fold increased risk of PTB, and A/T polymorphism of the IFG gene was associated with a decreased risk of PTB (OR = 0.67, 95 % CI = 0.49–0.92, p = 0.01). The analysis revealed a decreased risk of PTB for A/A polymorphism of the VDR ApaI (OR = 0.67, 95 % CI = 0.46–0.97, p < 0.05). A/A polymorphism of the TLR8 gene was associated with a 1.5-fold increased risk of PTB (OR = 1.53, 95 % CI = 1.00–2.33, p < 0.05). ConclusionResults showed that gender, employment, underweight BMI and diabetes are associated with PTB incidence in our study cohort. The A/A genotype of the IFG (rs2430561) and an A/A genotype of the TLR8 (rs3764880) genes were associated with an increased risk of PTB. A/T polymorphism of the IFG (rs2430561) and A/A polymorphism of the VDR ApaI were associated with a decreased risk of PTB.

ROLE PLAY METHOD ON TUBERCULOSIS PREVENTION BEHAVIOR IN SCHOOL-AGED CHILDREN

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Indonesia is the country with the second highest incidence of TB in the world, and the incidence of treatment interruption has increased after Covid-19. School-age children are at high risk of contracting TB from AFB-positive adults who experience ineffective treatment in the community. This study aims to determine the effect of the role play method on TB transmission prevention behavior in school-age children in Baturaja. This study is a quantitative study using a quasi-experimental design with a control group with a pretest and posttest type. The sample size in this study was 43 students in each intervention and control group. The intervention provided was education with the role play method for 5 training sessions with a therapist in the intervention group, and conventional education in the control group. Data collection using a questionnaire on TB transmission prevention behavior to school-age children. The results of the statistical test obtained a significant increase in the behavior of students in the intervention group with a p value of 0.000 (p &lt;0.05). The results of the study showed a significant effect on the respondents' TB prevention behavior after the role play intervention was carried out. The results of this study are expected to be applied as an alternative method of nursing education for school-age children in improving behavior to prevent TB transmission in the community.

Cost-effectiveness and health impact of screening and treatment of Mycobacterium tuberculosis infection among formerly incarcerated individuals in Brazil: a Markov modelling study

Individuals who were formerly incarcerated have high tuberculosis incidence, but are generally not considered among the risk groups eligible for tuberculosis prevention. We investigated the potential health impact and cost-effectiveness of Mycobacterium tuberculosis infection screening and tuberculosis preventive treatment (TPT) for individuals who were formerly incarcerated in Brazil. Using published evidence for Brazil, we constructed a Markov state transition model estimating tuberculosis-related health outcomes and costs among individuals who were formerly incarcerated, by simulating transitions between health states over time. The analysis compared tuberculosis infection screening and TPT, to no screening, considering a combination of M tuberculosis infection tests and TPT regimens. We quantified health effects as reductions in tuberculosis cases, tuberculosis deaths, and disability-adjusted life-years (DALYs). We assessed costs from a tuberculosis programme perspective. We report intervention cost-effectiveness as the incremental costs per DALY averted, and tested how results changed across subgroups of the target population. Compared with no intervention, an intervention incorporating tuberculin skin testing and treatment with 3 months of isoniazid and rifapentine would avert 31 (95% uncertainty interval 14-56) lifetime tuberculosis cases and 4·1 (1·4-5·8) lifetime tuberculosis deaths per 1000 individuals, and cost US$242 per DALY averted. All test and regimen combinations were cost-effective compared with no screening. Younger age, longer incarceration, and more recent prison release were each associated with significantly greater health benefits and more favourable cost-effectiveness ratios, although the intervention was cost-effective for all subgroups examined. M tuberculosis infection screening and TPT for individuals who were formerly incarcerated appears cost-effective, and would provide valuable health gains. National Institutes of Health. For the Portuguese translation of the abstract see Supplementary Materials section.

Improving Pulmonary Tuberculosis Treatment Adherence: The role of patient knowledge in Cirebon, West Java, Indonesia

Background: With 10 million cases around the world, pulmonary tuberculosis (TB) has been classified as a highly contagious disease and mostly affecting low and middle countries. Having the second highest incident cases in West Java of Indonesia, Cirebon becomes a challenging city in order to reduce the number of TB cases in the country. Aims: This study aims to identify the patients’ knowledge and treatment phases, and how the two factors encourage patients to comply with their medication. Methods : This cross-sectional observational study was conducted among 91 new pulmonary tuberculosis patients at the Cirebon City Community Lung Health Centre, selected using random sampling. Not only respondent characteristics, but also data on the patients' knowledge levels, treatment phases, and medication adherence were collected using a questionnaire and medical records. To assess the relationship between these variables, the collected data was then analyzed using the Spearman Correlation test. Ethical clearance was obtained from the Health Research Ethics Commission, and informed consent was gathered from all participants. Results: This study reveals the most updated characteristics of the Tuberculosis patients at the Cirebon City Community Lung Health Center aged 15-64 years old with treatment duration ranged 1-6 months. The majority have insufficient knowledge about tuberculosis (45.1%), and 75.8% of patients adhered to their prescribed medication regimen, regardless of their knowledge level. The data indicates a significant positive correlation between knowledge level and medication adherence (p = 0.015), with 95% of patients with good knowledge adhering to treatment compared to only 34% with poor knowledge. Furthermore, there is a significant relationship between adherence and treatment duration (p = 0.002), as 85% of patients who adhered to treatment did so for more than two months. Conclusion: The study shows that patients with better knowledge of tuberculosis are more likely to stick to their medication, which also leads to longer treatment durations. Given the high incidence of TB in the region, these findings suggest the need for targeted educational programs to enhance patients' understanding of TB, thereby improving adherence to treatment protocols. Received: 20 May 2024, Reviewed: 09 June 2024, Revised: 26 August 2024, Accepted: 30 August 2024.

Multidisciplinary Effort Leading to Effective Tuberculosis Community Outbreak Containment in Israel.

Tuberculosis (TB) is the second-most prevalent cause of mortality resulting from infectious diseases worldwide. It is caused by bacteria belonging to the Mycobacterium tuberculosis complex (MTBC). In Israel, TB incidence is low, acknowledged by the WHO as being in a pre-elimination phase. Most cases occur among immigrants from high TB incidence regions like the Horn of Africa and the former Soviet Union (FSU), with occasional outbreaks. The outbreak described in this report occurred between 2018 and 2024, increasing the incidence rate of TB in the region. Control of this outbreak posed challenges due to factors including a diverse population (including Ethiopian immigrants, Israeli-born citizens, and immigrants from other countries), economic and social barriers, and hesitancy to disclose information. The unique multidisciplinary team formed to address these challenges, involving the local TB clinic, district health ministry, health maintenance organization (HMO) infectious disease consultant, neighborhood clinic, and National Mycobacterium Reference Laboratory (NMRL), achieved effective treatment and containment. Whole genome sequencing (WGS) proved pivotal in unraveling patient connections during the outbreak. It pinpointed those patients overlooked in initial field investigations, established connections between patients across different health departments, and uncovered the existence of two distinct clusters with separate transmission chains within the same neighborhood. This study underscores collaborative efforts across sectors that successfully contained a challenging outbreak.

THE FACTORS CONTRIBUTE TO INCIDENCE TUBERCULOSIS AT IN PATIENT DEPARTMENT IN REFERRAL HOSPITAL OF BAUCAU, TIMOR-LESTE

Background: Tuberculosis (TB) is a communicable disease that not only causes illness health but also ranks among, one of the top 10 causes of death worldwide. In fact, it is and the leading cause of death from a single infectious agent (surpassing even HIV/AIDS). TB is caused by the bacillus Mycobacterium tuberculosis, which is spread through the air when individuals who are sick with TB expel bacteria for instance, by coughing. Globally, an estimated 10.0 (range, 8.9–11.0 million) people fell illness with TB in 2019, a number that has been declining very slowly in recent years. TB can affect to anyone and, the number of cases at the national level varies. In most countries, the majority of cases occur in 30 areas with highest incidence of TB were more than 90% of cases are reported. The global burden also includes an estimated 1.3 million peoples who are infected with TB and at risk of developing the disease. In Timor Leste, the recent WHO report on TB indicated a reduction in the incidence of TB in 2021 (WHO, TB Epidemiological Review 2023 Timor-Leste, 2023). The countrys incidence of TB has been 489 per 100.000 populations for the last few years. However, in 2021 there has been a decrease to 486 per 100.000 populations. Objective: The purpose of this study is to identify the factors that contribute the occurrence of Tuberculosis at the Referral Hospital of Baucau. Methodology: This descriptive study used both quantitative and quantitative methods together, specifically a cross-sectional study. Data were gathered using both methods concurrently. Quantitative data were analyzed using descriptive and analytic statistics with approach and spearman rank correlation coefficient as the statistical test The sampling technique that was employed the study was total sampling (50 sample). The data collected for of this study was primary data obtained gained from patients using a questionnaire as the instrument. Results: The results indicated 58% the incidence TB by environmental, 66% of nutritional and 52% by access health information. And also enviroment contribution to incidence TB was postive relationship because the result analysis showed value r=0,518. Its mean 51.8% of TB incidence caused by enviroment but 48,2% by another factors. Another factor likely nutrition status also mayority factor contribute incidence TB because value r=0,799. The hypothesis test indicated value significant fom enviroment and nutrition status showed 0.00. Conclusion: There was a significant value and positive contribution between the environment and nutritional status to incidence TB.

Strong effect of demographic changes on Tuberculosis susceptibility in South Africa.

South Africa is among the world's top eight tuberculosis (TB) burden countries, and despite a focus on HIV-TB co-infection, most of the population living with TB are not HIV co-infected. The disease is endemic across the country, with 80-90% exposure by adulthood. We investigated epidemiological risk factors for (TB) in the Northern Cape Province, South Africa: an understudied TB endemic region with extreme TB incidence (926/100,000). We leveraged the population's high TB incidence and community transmission to design a case-control study with similar mechanisms of exposure between the groups. We recruited 1,126 participants with suspected TB from 12 community health clinics and generated a cohort of 774 individuals (cases = 374, controls = 400) after implementing our enrollment criteria. All participants were GeneXpert Ultra tested for active TB by a local clinic. We assessed important risk factors for active TB using logistic regression and random forest modeling. We find that factors commonly identified in other global populations tend to replicate in our study, e.g. male gender and residence in a town had significant effects on TB risk (OR: 3.02 [95% CI: 2.30-4.71]; OR: 3.20 [95% CI: 2.26-4.55]). We also tested for demographic factors that may uniquely reflect historical changes in health conditions in South Africa. We find that socioeconomic status (SES) significantly interacts with an individual's age (p = 0.0005) indicating that protective effect of higher SES changed across age cohorts. We further find that being born in a rural area and moving to a town strongly increases TB risk, while town birthplace and current rural residence is protective. These interaction effects reflect rapid demographic changes, specifically SES over recent generations and mobility, in South Africa. Our models show that such risk factors combined explain 19-21% of the variance (r2) in TB case/control status.

An epidemiological investigation into the reasons for high bovine tuberculosis incidence in cattle herds of the Burren, Ireland, prior to 2020

Herd-level bovine tuberculosis (bTB) incidence was examined in the Burren, an area in the west of Ireland where herd owners practice distinctive transhumance practices, with upland winter grazing. Prior to the initiation of our study in 2020, bTB incidence had for many years been unusually high in the Burren in comparison with the rest of the country, although the most recent figures have come down to being closer to the national average. Using data from the period prior to 2020, we mapped bTB infection in Burren herds alongside a range of indicators thought to have an association with it - herd size, herd density, herd type, cattle movement, and badger (Meles meles) population and control data, as well as rainfall and altitude. We also looked at how summary statistics for these variables differed when Burren herds with a history of bTB were compared to other Burren herds, as well as bTB positive and negative herds from outside the Burren. We found that for many indicators Burren herds would be expected to be low risk when compared to other herds in Ireland. An exception to this was for rainfall: hot spot areas for bTB in the Burren were found in areas of higher rainfall, on average herds in the Burren experienced more rainfall than those outside it, and bTB herds in the Burren experienced higher rainfall than non-bTB herds. Separately, for Burren herds only, a logistic regression model was developed to explain bTB breakdown occurrence using a matched case-control approach. Cases were herds which had experienced a new bTB breakdown between 2015 and 2019 (n = 260) and these were matched on herd type and herd size with the same number of herds not experiencing a breakdown during this period. This showed that, of a range of exogenous variables, rainfall was the most strongly associated with herd-level bTB incidence. These results suggest that high levels of exposure to inclement weather, and/or better environmental survival of Mycobacterium bovis in the environment, may contribute to high bTB rates in the Burren. However, as rainfall showed a highly aggregated distribution, this relationship may be due to an unmeasured factor correlated with it. Mapping and graphical output suggested that, although herd sizes in the Burren were on average lower than nationally, within the Burren they were higher in areas of higher prevalence, suggesting that mechanisms associated with herd size, such as increased contacts between and within herd, and with wildlife, may also play a role.

Socialization and Evaluation of The Level of Compliance of Tuberculosis Patients to The Use Anti-Tuberculosis Drugs to Pharmacy Students of The Lubuk Pakam Medical Health Institute in 2023

The incidence of Tuberculosis (TB) is a health issue that must be paid attention to, especially at the Limapuluh Community Health Center. This health center is a health service center in the Fifty District which experiences a high incidence of TB, with the number of TB cases in 2022 increasing from the previous year. The level of patient compliance with treatment is one of the determining factors for the success of therapy. This study aims to provide an understanding of the factors that influence the level of compliance of TB patients with the use of Anti-Tuberculosis Drugs (OAT) at the Limapuluh Community Health Center. The method of service carried out is in the form of communication, information and education related to the use of Anti-Tuberculosis Drugs. The socialization was carried out online through a zoom meeting with the presentation of material and continued with a pretest and posttest as a measuring tool regarding the increase in participants' understanding of the material presented. This activity was carried out on January 06, 2024 at 10.00-12.00 WIB. The results of this service are the counseling material provided to students seen from the posttest results which show that the understanding and increase in knowledge of the participants is good compared to the results of the previous pretest points. In conclusion, students who take part in this activity can further explore the factors that affect patient compliance in taking OAT drugs so that similar activities can be carried out regularly to prevent errors in the use of Anti Tuberculosis drugs.