Incidence Of Tuberculosis In India Research Articles

Serum Protein Electrophoresis Bands As Biomarkers for Drug-Sensitive Pulmonary Tuberculosis.

India has the highest cases of tuberculosis worldwide. According to WHO (2022), the incidence of tuberculosis in India is 210 per 100,000 population. Their incidence of new positive smear cases is 75 per 100,000 population per year. In tuberculosis, the level of albumin decreases while globulin increases leading to a low albumin to globulin (A/G) ratio, and electrophoresisof serum proteins aregood diagnostic approach and provides essential information for monitoring treatment outcomes. The present study includes 50 cases of pulmonary tuberculosis and 50 age-sex-matched healthy controls. Initially, serum protein estimation and electrophoresis were performed in newly diagnosed patients and controls. All drugs were given as National Tuberculosis Elimination Programme (NTEP) guidelines and blood samples were collected at two-month, four-month, and six-month intervals, and different serum protein fractions were compared and analyzed. The total serum protein was significantly lower in the cases than in the controls; 6.12±0.61 vs. 7.02±0.56 g/dL (p˂0.0020, t-value=3.12). The mean serum albumin was also significantly lower in the cases compared to the controls; 1.65±0.69 vs. 3.87±0.47g/dL (p˂0.0001, t-value=10.98). The α1 globulin started to rise after four months of treatment and at six months level was 0.262±0.32 g/dL. The level of γ globulin continuously decreases after antituberculous treatment to 1.56±0.67 gm/dL at six months. The cause of the decrease in total protein and albumin may be due to malnutrition leading to low cellular immunity. Serum protein leveland protein electrophoresis should be analyzed as routine tests inpatients before, during, and after treatment.It helps us in identifying patients at risk of pulmonary tuberculosis as well prognosis of the disease.This study is avaluable guide in deciding the effective management of tuberculosis patients with drug treatment plans and appropriate dietary intake. Hence, it highlights the complex relationship that exists between poverty and disease.

Tuberculosis control by novel vaccines development and Indian initiatives

Abstract Pulmonary tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) is one of the worst microbial diseases of humankind and an awful societal problem, especially in underdeveloped countries. The enormous TB-infected individuals were in the Southeast Asian Region (46%), about 23% in the African Region, 18% in the West Pacific region, and the rest in other regions. While TB is often effectively treatable, untreated cases can lead to drug-resistant forms that are harder to manage and may kill the infected sooner after the disease flares up. In 2021, approximately 1.6 million individuals succumbed to TB worldwide. Although the Bacillus Calmette–Guérin (BCG) vaccine is currently the only approved anti-TB vaccine, its effectiveness in adolescents and adults is limited. Globally, several vaccines are in the developmental stage. This review narrates the progress made in developing 23 candidate anti-tuberculosis vaccines (including developing more immunogenic and safer recombinant Mtb strains) by different scientific groups worldwide. Additionally, the incidence of TB in India, along with the Indian initiatives and activities in controlling the disease, has been briefly discussed.

"Better to Die Than Take These Medicines": A Community-Based Qualitative Study on the Determinants of Treatment Loss-to-Follow-Up in Tuberculosis Patients in District Faridabad, Haryana, India.

IntroductionIndia is the biggest contributor to the global incidence of tuberculosis (TB). A major reason behind the persistently high incidence of TB in India is treatment loss-to-follow-up (LTFU). The consequences of LTFU include continuous transmission to uninfected individuals, drug resistance, and a higher rate of death in incompletely treated patients. It is a significant hurdle to making India ‘TB-Free’ by 2025. Hence, we conducted a community-based qualitative study to understand the determinants of treatment of LTFU in TB patients in the Faridabad district of Haryana, India. MethodologyWe enrolled TB patients who had completed treatment as well as those who had been LTFU. We also enrolled National Tuberculosis Elimination Programme (NTEP) functionaries, healthcare providers, family members, and community members. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted to understand stakeholders’ perceptions of reasons for LTFU. The grounded theory approach was used with inductive analysis. Data were triangulated from stakeholders’ interviews. Themes and sub-themes were identified. A Health Belief Model for TB treatment completion was developed.ResultsFifty-eight IDIs and four FGDs were conducted between May-June 2018. The major themes influencing the treatment of LTFU which emerged from the analyses were - the role of external motivators, regular use of alcohol, lack of/or inappropriate knowledge related to treatment, lack of family support, and side effects of anti-tubercular drugs, and a poor experience with the health system. Stigma was not found to be a major determinant - in the few cases that it affected treatment, it spurred treatment completion rather than LTFU.“I completed the course with great difficulty. Then they started it again! […] I said-Sorry, sir, I can’t go through this again. It’s better to die once than to die a thousand deaths.” - Fifty-one-year-old male patient who was lost-to-follow-up on re-treatment.DiscussionThis study was a comprehensive multi-stakeholder qualitative undertaking to identify the determinants of LTFU. Our qualitative approach explained the associations between LTFU and certain factors (e.g.: alcohol use, side effects, etc.) found in previous quantitative studies. The strength of this study was that we ensured participation by patients as well as all district-level stakeholders from the national health programme, which no previous qualitative study on the treatment LTFU in India had achieved. The entire qualitative analysis was done manually and in Hindi (the language in which interviews were conducted). Hence, no data were lost in translation. The limitation was that its findings were specific to the study area and study population, as is the case with all qualitative studies.ConclusionAll healthcare providers should be sensitised to the determinants of treatment LTFU, so that they can pay special attention to at-risk patients and take appropriate steps to prevent LTFU. For instance, patients with a pattern of regular alcohol use should be counselled and may be referred to deaddiction centres, with the continuum of care maintained. The journey from tuberculosis diagnosis to treatment completion is often extremely traumatic for the patient. The onus to successfully complete treatment lies not with the patient alone, but with the health system as well.

Utility of cartridge based nucleic acid amplification test in diagnosis of tubercular lymph nodes on fine needle aspiration and its comparison with zeihl-neelsen staining and concentration bleach method

Tuberculosis (TB) is one of the oldest disease known to humanity and among the deadliest epidemics and is in the top 10 causes of death worldwide. The incidence of tuberculosis in India has dramatically increased and contributing to it is Human Immunodeficiency Virus (HIV). Various diagnostic methods are available for detection of tubercular bacilli. Only full proof criteria for diagnosis of TB is to demonstrate the bacilli from affected tissue. This study was planned in extra pulmonary tuberculosis cases to evaluate different staining methods for demonstration of mycobacterium on FNAC material. To evaluate efficacy of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) in the initial cytodiagnosis of Tubercular Lymphadenitis 147 clinically suspected cases of extra pulmonary tuberculosis mainly TB lymphadenitis who attended cytology OPD were selected irrespective of age and sex. FNAC was performed. Slides stained for PAP, ZN and concentration bleach. Material remained in hub was sent for CBNAAT. PAP stained slides were observed for various morphological pattern.Six morphological patterns were observed. Positivity for acid fast bacilli by ZN staining, concentration bleach method and CBNAAT were compared. Detection of acid-fast bacilli by CBNATT was found more as compared to ZN and Concentration bleach method.

Abstract #992844: Development of Addison’s Disease during Treatment of Disseminated Tuberculosis with Bilateral Adrenal Mass: A Case Report

Recently, the incidence of adrenal tuberculosis has been greatly decreased due to the introduction of antituberculosis (ATT) drugs. The estimated incidence of tuberculosis in India is 204/100,000 population in 2017. it is estimated that disseminated tuberculosis accounting for < 2% of all cases of TB and up to 20% of all extrapulmonary TB cases.

Rapid Diagnosis of Pulmonary and Extrapulmonary Tuberculosis by Cartridge-Based Nucleic Acid Amplification Test (CBNAAT)

Introduction: Tuberculosis incidence in India is 2.74 million including 0.13 million drug resistant cases. According to WHO 0.41 million death in India due to tuberculosis in 2017. Sputum smear microscopy is facing variable sensitivity issue particularly in patients with sputum smear-negative and/or extrapulmonary disease, and drug-resistant Tuberculosis. To overcome this problem, WHO’s current policies and guidance recommend to use Xpert MTB/RIF as an initial diagnostic test. Materials and Methods: This study done at RNTCP lab, Microbiology Dept., Govt. Medical College Khandwa, M.P., India, is a Retrospective observational record based analysis from 01 January 2018 to 31 May 2019 (1 year 5 months) on 1993 samples. Results: Out of 1736 samples, 1537 were pulmonary & 199 Extrapulmonary included in this study. Samples positivity rate were (727) 41.87 %, of which (680) 39.17% Rifampicin sensitive & (47) 2.7% resistant for Mycobacterium tuberculosis. Pleural fluid 43.7%, Pus 27% & cervical lymph node 16.6% were most common extrapulmonary sample. 37 extrapulmonary samples were positive for Mycobacterium tuberculosis, out of this 33 sensitive & 4 were resistant to Rifampicin. Discussion: Rifampicin resistance by CBNAAT was found to be 6.47% in our study. Gour Sanjay M et al found this 6.38%, 13.55% by D. Pragati Rao et al, 25% by R Dewan et al & very high (53%) by R Tripathi et al in their study. Pleural fluid (43.7%) was the most common extrapulmonary samples followed by Pus (27%) & lymph node (16.6%). Gour Sanjay M et al also found Pleural fluid 49.81% as most common sample followed by lymph node. 40%, Pus 37.73%. Extrapulmonary sample distribution pattern like our study. Conclusion: Rifampicin resistant Mycobacterium tuberculosis is low in our area as compare to other part of India. Keywords: MTB, CBNAAT.

INCIDENCE OF MALIGNANCY IN MEDIASTINAL LYMPHADENOPATHY IN INDIAN POPULATION USING CT GUIDED BIOPSY AS AN EVALUATING TOOL

Causes of mediastinal lymphadenopathy are many, ranging from reactive lymphadenopathy to malignancy. With high incidence of tuberculosis in India, our aim was to determine the incidence of malignancy in mediastinal nodes with no primary lung lesion using computed tomography (CT) guided biopsy as an evaluating tool and highlighting the superiority of this procedure over others described in literature.

Estimating tuberculosis incidence from primary survey data: a mathematical modeling approach.

SUMMARYBACKGROUND:There is an urgent need for improved estimations of the burden of tuberculosis (TB).OBJECTIVE:To develop a new quantitative method based on mathematical modelling, and to demonstrate its application to TB in India.DESIGN:We developed a simple model of TB transmission dynamics to estimate the annual incidence of TB disease from the annual risk of tuberculous infection and prevalence of smear-positive TB. We first compared model estimates for annual infections per smear-positive TB case using previous empirical estimates from China, Korea and the Philippines. We then applied the model to estimate TB incidence in India, stratified by urban and rural settings.RESULTS:Study model estimates show agreement with previous empirical estimates. Applied to India, the model suggests an annual incidence of smear-positive TB of 89.8 per 100 000 population (95%CI 56.8–156.3). Results show differences in urban and rural TB: while an urban TB case infects more individuals per year, a rural TB case remains infectious for appreciably longer, suggesting the need for interventions tailored to these different settings.CONCLUSIONS:Simple models of TB transmission, in conjunction with necessary data, can offer approaches to burden estimation that complement those currently being used.

Primary tubercular mastitis masquerading as malignancy

The significance of primary tubercular mastitis is due to rare occurrence and often overlooked and misdiagnosed as pyogenic breast abscess or malignancy. Despite the high incidence of tuberculosis in India, reports of breast tuberculosis among the total number of mammary conditions varies between 0.64% and 3.59%. We report a case of a 35-year-old lady with breast lump of 3 months duration, which simulated malignancy on clinical examination but fine needle aspiration cytology revealed granulomatous mastitis secondary to tuberculosis. High level of suspicion and simple fine needle aspiration procedure with micro-biological tests will clinch the final diagnosis.

Successful repair of tubercular tracheal stenosis: a rare case report

We report a rare case of successful surgical management of tubercular tracheal stenosis. There was no history of tracheostomy except for trauma management. A 24-year-old man presented with breathing difficulty. He had previously sustained blunt chest injury, a fractured mandible and minor head injury in a traffic accident. Despite successful mandibular fracture fixation, he subsequently developed progressive breathing difficulty with stridor. The patient was treated successfully with surgical resection and bronchoplastic reconstruction. Post-operatively, endotracheal tuberculosis was diagnosed. Endotracheal tuberculosis is rare despite the high incidence of pulmonary tuberculosis in India. Early diagnosis and prompt treatment are necessary to prevent tuberculous tracheobronchial stenosis, an extremely rare but serious clinical problem which can cause obstructive pneumonia and exertional dyspnoea. Surgical resection and bronchoplastic reconstruction is the established treatment for such stenosis. Patients with active tuberculosis usually respond to conventional antitubercular treatment.

Strengthening TB surveillance system in India: Way forward for improving estimates of TB incidence

One of the key indicators used under India’s TB control program is the DOTS case detection rate of new sputum smear positive TB whose estimates in India are based on incidence estimates derived from Styblo’s rule. Styblo’s rule was formulated in an era without well-established tuberculosis control program, effective tuberculosis drugs, and emergence of TB-HIV coinfection, so today it does not reflect the true incidence of TB. Considering various loopholes in different methods of measurement of incidence (prevalence surveys of disease/ infection, vital registration system and Styblo’s rule), strengthening of existing surveillance system is the best tool to obtain correct estimates of tuberculosis incidence in India.

Assessment of immune response to repeat stimulation with BCG vaccine using in vitro PBMC model

BackgroundTuberculosis (TB) is one of the most prevalent cause of death due to a single pathogen. Bacillus Calmette Guérin (BCG) is the only vaccine available for clinical use that protects against miliary TB; however, this vaccine has shown variable levels of efficacy against pulmonary TB. In India, a single dose of BCG vaccine is given and there are few countries where repeated doses of BCG are given. The incidence of TB in India is very high inspite of primary vaccination in neonatal period and therefore requires consideration for repeated immunization.MethodsTo improve BCG immunogenicity, we have evaluated specific antimycobacterial immune responses (anti-BCG IgG and IFN-γ), T cell activity-ADA, CD4 and CD8 T cell count, and CD4/CD8 ratio in a peripheral blood mononuclear cells (PBMC) model using boost immunization protocols with the BCG vaccine. PBMC were induced with a repeat dose of BCG at 24 and 72 hrs of cell culture.ResultsAt the end of the experimental time, supernatant was collected to estimate anti-BCG IgG titer, interferon γ, ADA activity, CD 4 and CD8 T cell count, and CD4/CD8 ratio. We demonstrated that PBMC induced with a repeat dose of BCG showed an increased specific anti-mycobacterial immune responses, T cell activity, and ADA activity as compared to PBMC induced with BCG alone or without BCG induction.ConclusionThe repeat BCG stimulation of PBMC obtained from BCG vaccinated individuals shows enhanced immune activation with respect to increased anti-BCG titre, IFN-γ and ADA activity without concomitant increase in CD4 and CD8 cells. This study provides some basic data in future experiments in animal models with respect to repeat BCG vaccination.

Reply to Yasan and Dogran

The patient’s family and social history did not suggest contact with any person having tuberculosis or having been exposed to it, so the source of infection could not be determined. The treatment was thus based on the World Health Organization’s four-drug antitubercular regimen. To make the case report concise, only positive points related to the case history were included, as the reviewers advised. Noncontributory and negative points were thus not included. It is to be considered natural for a clinician to have taken a detailed family, medical, and social history, as without that information, proceeding in such cases would be difficult. (See the last paragraph of the discussion). Gastric lavage was not acid-fast bacilli (AFB) positive. Fluid analysis and biopsy are necessary for correct diagnosis and treatment. Treatment was initiated when the biopsy report was available, and the culture report would have taken 6 weeks. Bearing this in mind, emphasis was not laid on the culture report. Because the incidence of tuberculosis in India is nearly 2% and the paediatric population is 40%, susceptibility testing would be an impossible task considering the cost burden and the financial status of the governmental institutions. I purposely did not discuss this. The chest x-ray was not mentioned because it showed no abnormalities. In this country when tuberculosis is suspected in a child, routine screening that includes a chest x-ray, erythrocyte sedimentation rate, and sputum/ gastric lavage for AFB is always done. I agree that in the abstract, contrast enhanced computed tomography of the neck was overlooked and so was not mentioned. The two types of ADA (ADA1 and ADA2) stated are not done in our institution. Moreover, because the patient was non-affording, only ADA could be done. As the treatment of tuberculosis worldwide is standardized regularly through the WHO regimen, I thought that itemizing it would not add anything new to the existing knowledge of the journal’s elite readers. The patient has now almost completed the antitubercular treatment and is regularly following up with us, having responded to the treatment wonderfully. If you are interested in seeing the post-treatment x-rays, they can be sent, thus proving favorable treatment for this particular disease. Pediatr Surg Int (2003) 19: 750 DOI 10.1007/s00383-003-1134-y