History Of anti-TB Treatment Research Articles

Trends and risk factors for drug-resistant tuberculosis among children in Sichuan, China: A 10-year retrospective analysis, 2013-2022.

To investigate the status of the drug-resistant tuberculosis (DR-TB) among children in Sichuan, and to find out the risk factors and high-risk population related to drug resistance among children. The clinical data of tuberculosis patients ≤14 years old with culture-confirmed tuberculosis hospitalized in Chengdu Public Health Clinical Center from January 2013 through December 2022 were collected. Clinical data such as gender, age, ethnicity, history of anti-TB treatment, history of exposure to tuberculosis, nutritional status, and specific drug resistance of the children were collected and recorded. The drug resistance of children in different age groups (0-4 years old, 5-9 years old, 10-14 years old) and different periods (2013-2017 and 2018-2022) were grouped and compared. Logistic regression analysis was to analyze analysis of risk factors of drug resistance in children. A total of 438 children with culture-confirmed tuberculosis were screened. Among them, 26.19% (11/42) were 0 to 4 years old, 33.33% (22/66) were 5 to 9 years old, and 36.67% (121/330) were 10 to 14 years old among the resistant children. There was no statistically significant difference in the resistance rate among the 3 groups (P = .385). The proportions of DR-TB, monoresistant tuberculosis, polydrug-resistant tuberculosis were decreased during 2019 to 2022 compared with 2013 to 2017 (P < .0001). The resistance rates of drug resistant, monoresistant, polydrug-resistant, isoniazid-resistant, and rifampicin resistant during 2018 to 2022 were decreased compared with those from 2013 to 2017 (P < .05), but the multi-drug resistance rate was not decreased (P = .131, without statistical difference). The results of logistic regression analysis showed that male gender OR = 1.566 (95% CI 1.035-2.369), a history of antituberculosis therapy OR = 4.049 (95% CI 1.442-11.367), and pulmonary and extrapulmonary tuberculosis OR = 7.335 (95% CI 1.401-38.392) were risk factors for the development of drug resistance; but fever OR = 0.581 (95% CI 0.355-0.950) was Protective factor. The total drug resistance rate of children in Sichuan showed a downward trend, but the rate of multi-drug-resistant tuberculosis was still at a high level, and the form of drug resistance was still severe. Absence of fever, male, retreatment, and pulmonary concurrent with extrapulmonary tuberculosis are risk factors for DR-TB in children.

Pre-treatment loss to follow-up in adults with pulmonary TB in Kenya

&lt;sec&gt;&lt;title&gt;SETTING&lt;/title&gt;County referral hospital in western Kenya.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;OBJECTIVES&lt;/title&gt;To ascertain the proportion of pre-treatment loss to follow-up (PTLFU) and associated patient factors in adults with pulmonary TB (PTB) in western Kenya.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;DESIGN&lt;/title&gt;A retrospective data review of laboratory and treatment registers for adults with bacteriologically confirmed PTB between January 2018 to December 2021. We defined PTLFU as failure to initiate treatment within 14 days of diagnosis. We used multivariable logistic regression modelling to identify patient factors associated with PTLFU.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;RESULTS&lt;/title&gt;Of 476 patients with PTB, 67.2% were male; the mean age was 36.1 years; 37.0% were HIV-positive; 5.7% had a history of anti-TB treatment; 40.6% were not traceable in the treatment register; 202 (42.4%, 95% CI 38.1–46.9) experienced PTLFU. Age ≥55 years (aOR 2.6, 95% CI 1.0–6.7) and providing only an address (aOR 34.2, 95% CI 18.7–62.5) or only a telephone contact number (aOR 22.3, 95% CI 3.5–141.1) were associated with PTLFU. Sex, HIV status, history of anti-TB treatment and place of residence were not associated with PTLFU.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;CONCLUSION&lt;/title&gt;PTLFU contributes markedly to TB patient losses in western Kenya. Strengthening systems for documenting patient information and actively monitoring PTLFU are crucial for attrition reduction.&lt;/sec&gt;

Trends of Mycobacterium tuberculosis and Rifampicin resistance in Northwest Ethiopia: Xpert® MTB/RIF assay results from 2015 to 2021

BackgroundTuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide, particularly in countries with limited resources. The emergence of drug resistance in mycobacterium tuberculosis (MTB), particularly rifampicin (RIF) resistance, hindered TB control efforts. Continuous surveillance and regular monitoring of drug-resistant TB, including rifampicin resistance (RR), are required for effective TB intervention strategies and prevention and control measures.ObjectiveDetermine the trend of TB and RR-TB among presumptive TB patients in Northwest Ethiopia.MethodA retrospective study was conducted at the University of Gondar Comprehensive Specialized Hospital (UoG-CSH). The study included TB registration logbook data from all patients who visited the hospital and were tested for MTB using the Xpert® MTB/RIF assay between 2015 and 2021. The SPSS version 26 software was used to enter, clean, and analyze the laboratory-based data.ResultsA total of 18,787 patient results were included, with 93.8% (17,615/18787) of them being successful, meaning they were not invalid, error, or aborted. About 10.5% (1846/17615) of the 17,615 results were MTB-positive, with 7.42% (137/1846) RIF resistant. Age, anti-TB treatment history, and diagnosis year were associated with the presence of MTB and RR-MTB. Tuberculosis (TB) prevalence was higher in productive age groups, whereas RR-TB prevalence was higher in the elderly. Regarding diagnosis year, the prevalence of TB and RR-TB showed a declining trend as the year progressed. While MTB was detected in 12.8% (471/3669) of new and 22.2% (151/679) of re-treatment presumptive TB patients, RR-MTB was detected in 8.5% (40/471) of new and 18.5% (28/151) of re-treatment TB cases.ConclusionThe prevalence of TB and RR-TB in the study area showed a declining trend over the years. While TB was more prevalent in productive age groups (15 to 45 years), RR-TB was more prevalent in older populations (over 45 years), than others. Moreover, patients with a history of anti-TB drug exposure were more likely to be positive for DR-TB, highlighting the need to strengthen DOT programs for proper management of TB treatment.

Profile and risk factors of pre-XDR-TB and XDR-TB patients in a national reference hospital for Sumatra region of Indonesia.

The low treatment rate, low treatment success rate and high mortality rate of patients with pre-extensively drug-resistant tuberculosis (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB) need serious attention. The aim of this study was to describe the profiles of patients with pre-XDR-TB and XDR-TB cases and to determine associated risk factors of their incidence in Indonesia. A retrospective case-control study was conducted at H. Adam Malik General Hospital in Medan, North Sumatra of which all sensitive-drug TB (SD-TB), pre-XDR-TB, and XDR-TB patients aged 18 years or older treated between October 2019 to June 2022 were included. Chi-squared test or Kruskal Wallis test and multiple logistic regression were used to determine the risk factors associated with pre-XDR-TB and XDR-TB incidence. A total 16 patients of case group (15 pre-XDR-TB and one XDR-TB) and 116 SD-TB patients (control group) were included in the final analysis. Out of total patients within case group, 62.5% were male, 43.8% aged between 56-65 years, 62.5% graduated from high school or equivalent, and 25% were unemployed. The majority of patients had no comorbid (62.5%), had history of anti-TB treatment (93.8%), and had secondary resistance (93.8%). Multivariate analysis indicated that age (OR: 10.01; 95%CI: 1.49- 66.91, p=0.018) and previous history of anti-TB treatment (OR: 216.25; 95%CI: 18.62- 2511.60, p<0.001) were significantly associated with incidence of pre-XDR-TB and XDR-TB. This study highlights that having previous history of anti-TB treatment and older age are the predictors of the incidence of pre-XDR-TB and XDR-TB.

Efficacy of clofazimine-containing regimens for treatment of Mycobacterium avium complex–pulmonary disease in patients unsuitable for standard treatment regimen

ObjectivesPatients with Mycobacterium avium complex-pulmonary disease (MAC-PD) can exhibit contraindications in applying the recommended treatment regimens by the guidelines. Clofazimine (CFZ) is considered a promising drug for MAC-PD treatment and is frequently included in alternative regimens; however, its efficacy remains unclear. MethodsMAC-PD patients, unsuitable for standard regimens, were enrolled continuously in a prospective study at Beijing Chest Hospital. The treatment response of the CFZ-containing regimen was monitored. ResultsFifty patients were enrolled in the initial treatment, and 25 patients had a history of anti-TB treatment. Nodular bronchiectasis was observed in 34 patients, while 8 patients exhibited fibrocavitary changes. Additionally, eight patients displayed a combination of both patterns. In a multivariate analysis, MAC-PD patients with CFZ MIC < 0.25 mg/L were significantly associated with culture conversion [OR 8.415, 95% CI (1.983–35.705); P = 0.004]. Among patients who had previous TB treatment history, patients with CFZ MIC < 0.25 mg/L had a higher chance of acquiring culture conversion outcomes [(OR 7.737, 95% CI 1.032–57.989); P = 0.046]. In contrast, among patients with no previous TB treatment history, the RIF-containing regimen had a higher chance of acquiring culture conversion outcomes [(OR 11.038, 95%CI 1.008–120.888); P = 0.049]. ConclusionMAC-PD patients unsuitable for standard regimens could benefit from a CFZ-containing regimen, especially for patients with previous TB treatment history and baseline CFZ MIC values lower than 0.25 mg/L.

Detection of antigen Ag85B expression is useful for the diagnosis of tuberculosis, especially for those with an antituberculosis treatment history.

The present study used immunohistochemistry (IHC) to detect antigen Ag85B in tissue sections and aimed to evaluate its validity in histopathologic diagnosis of tuberculosis (TB). In total, 204 patients with confirmed TB and 40 other diseases were included in the present study. Ziehl-Neelsen (Z-N) stains, IHC (anti-Ag85B), and quantitative fluorescence polymerase chain reaction were used to detect acid-fast bacilli, Mycobacterium tuberculosis (MTB) antigen, and MTB DNA. Immunohistochemistry was significantly more sensitive than Z-N stains (93.1% vs 67.2%; P < .001). The sensitivity of Z-N stains significantly correlated with anti-TB treatment history. The sensitivity of Z-N stains was lower in rifampicin (RIF)-resistant TB compared with RIF-sensitive TB (52.8% vs 69.0%; P = .091) and those without treatment history (52.8% vs 84.0%; P = .015). However, IHC was not significantly affected by treatment history (P = .410). Moreover, expression patterns of Ag85B were dependent on treatment history and commonly showed weak scattered spots in RIF-susceptible TB. Conversely, strong brown rods were often found in those with RIF-resistant TB. Immunohistochemistry is a simple, sensitive technique for the diagnosis of TB, especially for those patients with treatment history. The expression pattern of Ag85B is a potential marker for evaluating anti-TB treatment response.

Clinical Epidemiology of Multidrug Resistant Tuberculosis in a Nodal Drug Resistant- TB Centre in Southern Odisha: A Cross-sectional Study

Introduction: Multidrug-Resistant Tuberculosis (MDR-TB) is a significant public health problem. The number of MDR-TB cases is very high in India and the management is inadequate due to resource constraints. The assessment of MDR-TB burden has to be reliable for programmatic management of MDR-TB under the Revised National Tuberculosis Control Program (RNTCP) of India. Aim: To find the clinico-demographic profile and pattern of MDR-TB among the tuberculosis patients reporting to a nodal tuberculosis centre in Southern Odisha, India. Materials and Methods: The patient record based cross-sectional study was carried out on a convenience sample of 125 sputum positive MDR-TB cases admitted to the Directly Observed Treatment Short-course (DOTS) plus centre of the Nodal Tuberculosis Centre at Berhampur, Odisha, India, during the period from April 2017 to March 2018. A predesigned case record form was used to collect data on the socio-demographic profile, addictions, co-morbidity, Human Immunodeficiency Virus (HIV) status, Bacille Calmette-Guerin (BCG) immunisation status, pattern of drug resistance, history of anti-TB treatment, presenting symptoms at admission, adverse drug reactions observed during the treatment for MDR-TB. The data was analysed using GraphPad Prism trial version 7.0. Descriptive statistics were used to present the final data. Results: Highest number of study participants (95, 76%) were within 18-45 years age group and 90 (72%) of the patients were males. Rural habitation (90, 72%), engagement in labour works (65, 52%), low socio-economic status (75, 60%) were the common socio-economic characteristics. Resistance to rifampicin was the commonest variety 101 (80.8%) and 80 (64%) were newly diagnosed cases of tuberculosis. The commonest presenting symptom was cough in 97 (77.6%) patients and gastrointestinal upset was the commonest adverse drug reaction encountered during therapy. Conclusion: The MDR-TB affects the population in their most productive age. Rifampicin resistant TB was the predominant variety observed in the study population. The MDR-TB can be successfully treated with maximally effective and complete drug regimes.

Comparative Yield of Pulmonary Tuberculosis by Different Symptoms among Saharia Tribe of Madhya Pradesh, India.

Background:Symptom elicitation is a simple and inexpensive screening tool used for population screening in tuberculosis (TB) prevalence surveys. However, the information on the yield of TB cases by symptoms is sparsely available.Methods:A cross-sectional pulmonary TB (PTB) prevalence survey was conducted. All available eligible individuals were interviewed for symptoms of PTB. Sputum samples were collected and tested for PTB by smear microscopy and culture.Results:Among 2890 individuals tested for PTB, 77% had cough for 2 weeks or more and one-third reported chest pain for 1 month or more. About 31% were having a history of anti-TB treatment. Cough contributed to 82% PTB cases and the history of anti-TB treatment contributed to another 8.4% confirmed cases. Fever recorded lowest yield among the symptoms of PTB.Conclusion:The study suggests that fever alone may be ignored from symptomatic elicitation, and history of previous anti-TB treatment should be treated as an important indication for PTB symptomatic elicitation.

Level of and associated factors for non-adherence to anti-tuberculosis treatment among tuberculosis patients in Gamo Gofa zone, southern Ethiopia: cross-sectional study

BackgroundNon-adherence to anti-TB treatment is one of the crucial challenges in improving tuberculosis (TB) treatment outcomes and reducing healthcare costs. The poor adherence to anti-TB treatment among patients with TB is a major problem in Ethiopia. This study aimed to assess the level of and associated factors for non-adherence to anti-TB therapy among patients with tuberculosis in the Gamo Gofa Zone.MethodsA cross-sectional study was conducted at Gamo Gofa Zone from July 20 – August 30, 2017. A multi-stage sampling technique was used. The study included 289 patients who were on anti-TB treatment. Data were collected by trained data collectors using a structured and pre-tested questionnaire through interviews. A multiple logistic regression model was fitted using SPSS 23 to identify factors associated with non-adherence to anti-TB treatment at a 5% significance level.ResultsWe found that 16.5% of the participants were non-adherent for anti-TB treatment. Failure to disclose one’s TB status to his or her family (AOR = 31.7; 95% CI: 9.1–111.1), having no information on the expected adverse events (AOR = 31.1; 95% CI: 7.5–128.3), past anti-TB treatment history (AOR = 5.3; 95% CI: 1.5–18.8) and a smoking cigarette (AOR = 11.7; 95% CI: 3.2–43.03) were found to be associated with a higher odds of being non-adherent to anti-TB treatment.ConclusionsThe level of non-adherence to anti-TB treatment among TB patients was high. Health care providers should counsel TB patients on the expected adverse events and measures to be taken when patients face the expected adverse events. They should also counsel their patients to disclose their TB status to his or her family and for ceasing cigarette smoking.

Prevalence of multi-drug resistant (MDR) pulmonary tuberculosis in a tertiary care rural hospital in Western Maharashtra, India

Prevalence of multi-drug resistant (MDR) pulmonary tuberculosis in a tertiary care rural hospital in Western Maharashtra, India - IJMR- Print ISSN No: - 2394-546X Online ISSN No:- 2394-5478 Article DOI No:- 10.18231/j.ijmr.2019.052, Indian Journal of Microbiology Research-Indian J Microbiol Res

Pattern of Anti-Tuberculosis Drug Resistance in HIV-Associated Tuberculous Meningitis Patients

Multidrug-resistant tuberculosis (MDR-TB) is a major public health problem worldwide. Human immunodeficiency virus (HIV) infection-associated tuberculous meningitis (TBM) further complicates the patient management and causes poor prognosis. A cross-sectional study was carried out to determine anti-TB drug susceptibility pattern of Mycobacterium tuberculosis (MTB) isolates from HIV-associated TBM patients at Waibagi, Thakayta and Mingaladon Specialist Hospitals in Yangon, Myanmar. From January to October 2017, cerebrospinal fluid (CSF) specimens collected from 140 HIV infected patients with clinically presumptive TBM were applied for isolation and drug susceptibility testing. First-line drug susceptibility testing were carried out by solid culture-based proportion method. Drug susceptibility patterns of pyrazinamide, fluoroquinolones and second-line injectable drugs were determined by liquid culture-based Mycobacterial Growth Indicator Tube method. There were 17 culture positives and confirmed as MTB out of 140 specimens. Among them,10 isolates (58.8%) were resistant to at least one of the first-line anti-TB drugs. Eight isolates (47.1%) showed multidrug resistance but there was no extensively drug resistance. HIV-associated TBM patients with previous anti-TB treatment history and CD4 cell count of less than 100 cells/μl were significantly more prone to develop drug resistance. These findings highlight burdens of anti-TB drug resistance among HIVassociated TBM patients and support the need of elaborative management strategies.

Rifampicin resistant tuberculosis in presumptive pulmonary tuberculosis cases in Dubti Hospital, Afar, Ethiopia.

Ethiopia stood third in drug-resistant tuberculosis (TB) in Africa, and more than 5,000 MDR-TB patients are reported each year. Greater than 90% of rifampicin (RIF) resistant strains are resistant to isoniazid (INH) and hence the objective of this study was to determine the prevalence and risk factors of RIF resistant MTB among presumptive TB cases at Dubti General Hospital, Afar, Ethiopia. In this cross-sectional study, 384 presumptive TB cases were recruited and a structured questionnaire was used to collect socio-demographic and clinical data. Sputum samples were collected and examined using X-pertMTB/RIF assay. Bivariate, multivariate logistic regressions, and fishers' exact analysis were done to assess the associations between the prevalence of TB and MDR-TB with different socio-demographic and clinical variables. In the present study, the overall prevalence of pulmonary TB was 24.5% (94/384), of this 4 (4.3%) isolates were resistant to RIF. History of anti-TB treatment (AOR = 2.4, 95% CI: 1.3-4.4 and TB contact (AOR = 3.6, 95% CI: 2.1-6.2 were significantly associated with gene X-pert MTB/RIF positive TB. Moreover, resistance to rifampicin was statistically associated with the history of TB contact with multi-drug resistant TB (P = 0.027) and khat chewer cases (P = 0.04). The overall prevalence of TB and its drug-resistant were relatively higher than that of in the general population in Ethiopia. History of anti-TB treatment and TB contact were significantly associated with X-pert MTB/RIF positive MDR-TB.

Risk factors of multidrug-resistant tuberculosis in China: A meta-analysis.

Multidrug-resistant tuberculosis (MDR-TB) brings major challenges to the health care workers (HCWs). This study is to determine the risk factors for MDR-TB, latent tuberculosis infection (LTBI), and tuberculosis (TB) disease among HCWs in China. A meta-analysis was conducted to evaluate the risk factors for MDR-TB, LTBI, and TB disease among HCWs using a random-effects model, and the pooled odds ratios (ORs) with 95% confidence interval (CI) were used as effect indicators. We identified 46 eligible studies and found eight factors were associated with MDR. The ORs with 95% CI are migrant population 1.96 (95% CI, 1.50-2.57), low family income 2.23 (95% CI, 1.74-2.85), retreatment 7.22 (95% CI, 5.63-9.26), anti-TB treatment history 5.65 (95% CI, 4.80-6.65), multiple episodes of treatment 3.28 (95% CI, 2.60-4.13), adverse reactions 3.48 (95% CI, 2.54-4.76), interrupted treatment 3.18 (95% CI, 2.60-3.89), and lung cavities 1.42 (95% CI, 1.14-1.77). Work duration as a HCW for 5years and above increased the risk of LTBI and TB. HCWs aged 30years and above were more susceptible to TB (OR=1.70, 95% CI: 1.37-2.09). The risk factors for MDR-TB in China are possibly migrant population, low family income, retreatment, anti-TB treatment history, adverse reactions, interrupted treatment, and lung cavities. Longer work duration and greater age are risk factors for LTBI and TB among HCWs.

800. Drug-Resistant TB: An Experience From Qatar

BackgroundDrug-resistant tuberculosis (DR-TB) is an important issue for public health. This study was conducted to evaluate the characteristics, treatment outcome, and risk factors associated with 223 DR-TB cases in the State of Qatar.MethodsA descriptive records-based retrospective study was conducted on patients registered at Communicable Disease Centre (CDC), Qatar to all consecutive microbiologically confirmed tuberculosis cases for the period January 2010–March 2015. Demographic and clinical data extracted included: patient’s age, sex, and country of origin; disease site (pulmonary or extra-pulmonary); presence of comorbidities, HIV/AIDS status, previous chemoprophylaxis and/or previous treatment for TB, and anti-TB drug resistance the resistance pattern of isolated mycobacteria. The sputum culture conversion rate and treatment outcome was assessed for the patient who completed their treatment in QatarResultsOf 3,301 patients with positive M. tuberculosis culture were analyzed; 223 (6.7%) were resistant to one or more first-line drugs, to isoniazid in 3.1% (n = 102), streptomycin in 1.2% (n = 41), rifampicin in 0.2% (n = 6), ethambutol in 0.15% (n = 5), and multi-drug resistance in 1.2% (n = 38) of patients. Among the resistant TB patients, more common demographic characteristics were former resident of Indian subcontinent (64.1%). A history of anti-TB treatment was not a risk factor with drug resistance in our cohort. Only 111 (49.7%) patients were tested for HIV antibodies and the results were all negative. There was significant correlation between the type of drug-resistance and CXR finding (23.3% had cavity—P = 0.019). Sputum culture conversion to negative at 2 month of therapy was 94% (n = 101), whereas 122 cases lost follow-up. The outcome of treatment was assessed for 85 resistant cases with follow-up after completion of treatment, show cure rate of 97.6%, and relapse of 2.4%. However, 137 cases (61.4% from total) they left the country before completion of therapy.ConclusionDrug-resistant TB in Qatar is influenced by migration, especially from the Indian subcontinent, where the patients were probably infected. Rapid sputum sampling performed in the early stages of the disease, patient isolation, and drug susceptibility testing should be the standard of care to avoid further transmission and improve TB control.Disclosures All authors: No reported disclosures.

Sensitivity and specificity of screening tools and smear microscopy in active tuberculosis case finding

SettingCommunity based five pulmonary tuberculosis (PTB) surveys among adults. ObjectivesEstimate sensitivity and specificity of screening tools for PTB and sputum microscopy. MethodsFor each survey site, we estimated sensitivity and specificity of different screening criteria and microscopy against culture; pooled estimates were obtained using Random Effects Model. ResultsSensitivity of cough alone, screening for any symptom (persistent cough ≥2 weeks, fever or chest pain ≥1 month, hemoptysis), any symptom or history of anti-TB treatment (h/o ATT) were 56.2%, 66% and 71.2% respectively; specificities were 95.3%, 93.8% and 92.7% respectively.X-ray when used alone for primary screening had sensitivity and specificity of 76.6% and 97.3% respectively. When used along with screening for cough, these figures were 94.3% and 93.1%, and 100% and 97.3% when used with any symptom and h/o ATT. When used for secondary screening, sensitivity and specificity of X-ray was 66.8% and 87.8% respectively after primary screening for cough, 65.0% and 89.8% after screening for any symptom, and 67.1% and 86.7% when used after screening for any symptom or h/o ATT.Pooled sensitivity and specificity of smear was 46.2% and 99.3% respectively. ConclusionProgram managers may use these estimates while evaluating algorithms for active case finding.

Comparative study of LoopampTM Mycobacterium tuberculosis Complex Kit for Rapid Detection of Mycobacterium tuberculosis complex in cameroon

Background: The most practical test for identifying tuberculosis (TB) in developing countries remains smear microscopy. However, due to its low sensitivity, a new point-of-care diagnostic method has been developed. The purpose of this study was to assess the performance of TB-Loop-mediated isothermal amplification (TB-LAMP) test on sputum samples of suspected TB cases. Methods: Suspected pulmonary TB patients (527) from Jamot Hospital and without any history of anti-TB treatment were consecutively included in the study. Smear microscopy, TB-LAMP, GeneXpert® MTB/RIF, and liquid culture using BACTEC 960 Mycobacteria Growth Indicator Tube (MGIT) were performed on sputum samples collected from these patients. The sensitivity and specificity of TB-LAMP were compared with smear microscopy and GeneXpert® MTB/RIF. MGIT culture was the gold standard. Results: TB-LAMP and smear microscopy showed sensitivities of 82.6% (95% confidence interval [CI], 76.9–87.2) and 53.6% (95% CI, 46.8–60.3), respectively, and specificities of 96.0% (95% CI, 93.2–97.7) and 99.0% (95% CI, 97.1–99.7), respectively. The sensitivity and specificity of TB-LAMP were similar to GeneXpert®, (89.9%; 95% CI, 85.0–93.3 and 97.0%; 95% CI, 94.4–98.4). Conclusion: TB-LAMP is more sensitive than currently used microscopy. It presents a favorable diagnostic tool for TB in peripheral laboratories with limited equipment, such as those in developing countries.

Comparison of Histological, Microbiological, and Molecular Methods in Diagnosis of Patients with TBLN Having Different Anti-TB Treatment Background

ObjectiveThe influence of anti-tuberculosis (TB) treatment history on tuberculous lymphadenitis (TBLN) diagnosis is unclear. Therefore, this study aims to evaluate the diagnostic methods, including histology, microbiology, and molecular tests, used for TBLN. MethodsIn this study, suspected patients with TBLN and having different anti-TB treatment background were enrolled. All the samples were tested simultaneously by histology, Ziehl-Neelsen (ZN) staining, mycobacterial culture (culture), Xpert MTB/RIF (xpert), real-time PCR, and high-resolution melting curve PCR (HRM). Thereafter, the performance of these methods on samples with different anti-TB treatment background was assessed. ResultsIn our study, 89 patients were prospectively included 82 patients with TBLN and 7 with other diseases. The overall sensitivities of Xpert, real-time PCR, histology, ZN staining, and culture were 86.6%, 69.5%, 58.5%, 43.9%, and 22.0%, respectively. The anti-TB treatment history revealed dramatic influences on the sensitivity of culture (P < 0.0001). In fact, the treatment that lasted over 3 months also influenced the sensitivity of Xpert (P < 0.05). However, the treatment history did not affect the performance of remaining tests (P > 0.05). For rifampicin drug susceptibility test (DST), the anti-TB treatment showed only significant influence on the success rate of culture DST (P = 0.001), but not on those of Xpert and HRM tests (P > 0.05). ConclusionOther tests as well as culture should be considered for patients with TBLN having retreatment history or over 1-month treatment to avoid false negative results.

Situation of multidrug-resistant pulmonary tuberculosis in Alexandria governorate from July 2008 to December 2012

The aim of this study was to estimate the prevalence, possible risk factors, patterns of resistance, and fate of multidrug-resistant pulmonary tuberculosis (MDR-TB) in Alexandria governorate as a representative part of Egypt during the period between July 2008 and December 2012. This retrospective study included all patients with pulmonary TB that was recorded in Alexandria governorate during the period between July 2008 (the time that MDR ward was held in Alexandria) and December 2012. They were divided into two groups: group I included patients with pulmonary TB that was recorded in Alexandria governorate (1893 cases), and group II included patients with pulmonary TB who were admitted in El-Maamoura Chest Hospital (509 cases). They were subdivided into two subgroups: group IIa included patients with MDR pulmonary TB (82 cases), and group IIb included patients with pulmonary TB not categorized as MDR-TB (427 cases). All patients with MDR-TB had acquired resistance. MDR-TB was more common in the male population, diabetic patients, and those with chronic chest disease. The effect of treatment of MDR-TB cases was as follows: cured patients, 49 (59.8%); patients under treatment, 10 (12.2%); treatment failure, four cases (4.9%); deceased patients, 10 (12.2%); and defaulters, nine (10.9%). The overall total prevalence rate of MDR-TB in Alexandria governorate from 2008 to 2012 was 4.3%. There was a decreasing trend of MDR-TB cases. History of anti-TB treatment is the strongest independent predictor of MDR-TB. The highest figures of resistance in the MDR group besides isoniazide and rifampicin were for streptomycin, whereas the lowest resistance was for ethambutol.

Induced sputum versus bronchial washings in the diagnosis of sputum negative pulmonary tuberculosis.

Introduction:Tuberculosis (TB) is one of the most important public health problems worldwide. Detecting patients with active pulmonary TB (PT) is an important component of TB control programs. However, at times in patients even with a compatible clinical picture, sputum smears do not reveal acid-fast bacilli (AFB) and smear-negative PT remains a common problem. This study compares the results of induced sputum (IS) and bronchial washings (BWs) in detecting sputum negative PT.Materials and Methods:A prospective study conducted from June 2014 to June 2015, comprising 120 patients fulfilling study criteria. Patients with respiratory symptoms and chest roentgenogram suspicious of PT with no previous history of antiTB treatment (ATT) and two spontaneous sputum smear samples negative for AFB were included in the study. Patients with active hemoptysis and sputum positive were excluded from the study. Sputum induction was done using 5–10 ml of 3% hypertonic saline through ultrasonic nebulizer taking safety precautions. All the patients underwent fiberoptic bronchoscopy after 6 h fasting on the same day. About 20 ml of normal saline instilled into the suspected pathology area and washings were taken with gentle suction. The sample processing and fluorescent staining for AFB were done in a designated microscopy laboratory.Results:Of 120 smear-negative PT patients, IS smear examination detected AFB in 76 patients (63.3%) and AFB detected from BWs in 94 patients (78.5%). Smear positivity higher in cavitary and infiltrative lesions compared to consolidation and infrahilar pattern disease.Conclusions:Even though both IS and BWs procedures were valuable for the diagnosis of smear-negative TB, sputum induction with hypertonic saline should be the initial procedure of choice, which can be repeated twice/thrice in a day or 2 consecutive days. If the patient remains IS smear-negative and if the clinical probability of TB is high, starting ATT and closely monitoring patient and reserving bronchoscopy to those patients who do not improve and to exclude alternative diagnosis seems to be a practically useful approach.

Prevalence of pulmonary tuberculosis in Wardha district of Maharashtra, Central India

A house based survey was conducted during 2007–2009 in a representative sample of population in Wardha district implementing Directly Observed Treatment Short Course strategy for tuberculosis (TB) control since 2001. The objective was to estimate prevalence of bacillary pulmonary TB (PTB) in individuals aged 15years or above, and to estimate trends in prevalence when compared to a previous survey carried out in mid 1980’s. Two sputum samples (one spot, one early morning) collected from individuals having symptoms suggestive of PTB, history of previous anti-TB treatment (ATT) or abnormal pulmonary shadow on Mass Miniature Radiography (MMR) consistent with possibly or probably active tuberculosis were subjected to Ziehl–Neelsen microscopy and culture on Lowenstein–Jensen medium.Of 55,096 individuals registered into the survey, 50,332 (91.4%) were screened by interview for symptoms and history of ATT and/or by MMR. Of them, 4805 were eligible for sputum collection; both specimens were collected in 4285 (89.2%) and only one specimen in 27 (0.6%).A total of 86 bacillary cases were detected during the survey. Prevalence of bacillary PTB was estimated at 188.7 (140.3–236.9) per 100,000 populations. There was a decline of 61% in the prevalence of PTB over a period of 22years.