Management Of Tuberculosis Research Articles

A meta-analysis of technology-based interventions on treatment adherence and treatment success among TBC patients.

Various technology-based interventions have been designed to improve medication adherence and treatment success. However, research on the most effective mode to address this issue is still limited. Our study evaluated the effectiveness of technology-based interventions in improving treatment adherence, completion, and treatment success among tuberculosis (TBC) patients. We conducted a meta-analysis of randomized controlled trials by searching articles from six databases including PubMed, Science Direct, Cochrane, Jstor, Embase, and Scopus from 2018 to April 2023. Two independent reviewers assessed the study quality using the Cochrane Risk of Bias 2.0 tool. We analysed the data using a random-effects model. We also conducted publication bias and sensitivity analysis. In total, 13 studies were identified and 4,794 participants were included in the meta-analysis. The results indicated that technology-based interventions were effective in improving treatment adherence, completion, and success (Odds Ratio (OR): 2.57, 95% Confident Interval (CI): 1.01-6.50, I2 = 86.6%; OR: 1.77, 95% CI: 0.95-3.28, I2: 82.3%; OR: 1.61, 95% CI: 0.85-3.06, I2: 84%, respectively). We examined the possibility of publication bias in the published studies included in this systematic review. However, no evidence of publication bias was found. From the sensitivity analysis by removing one study randomly, we found that our results are robust. Based on the results, we can conclude that technology-based interventions like MERM, text-based messages, video conferencing, and VOT are effective in increasing treatment adherence and completion in tuberculosis management. Therefore, technology shows immense potential in enhancing patient outcomes.

Determinants of adherence towards tuberculosis guidelines among Indonesian private practitioners: a qualitative study

IntroductionIn high tuberculosis (TB) burden countries, the private sector manages a large proportion of initial visits by presumptive patients with TB. In Indonesia, the second largest contributor of TB cases...

Role of HRCT in Early Diagnosis and Management of Pulmonary Tuberculosis

Role of HRCT in Early Diagnosis and Management of Pulmonary Tuberculosis

Current Advances in Lipid-Based Drug Delivery Systems as Nanocarriers for the Management of Female Genital Tuberculosis

Current Advances in Lipid-Based Drug Delivery Systems as Nanocarriers for the Management of Female Genital Tuberculosis

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.

Platelets: The unsung heroes in the battle against tuberculosis – A comprehensive review of platelet indices as diagnostic beacons and pathophysiological players

This review explores the emerging role of platelet indices in tuberculosis (TB) as potential biomarkers for diagnosis, disease monitoring, and understanding pathogenesis. Platelet count, mean platelet volume, platelet distribution width, and plateletcrit have shown significant alterations in TB patients compared to healthy controls and those with other respiratory conditions. These changes are attributed to the inflammatory response, direct platelet activation by Mycobacterium tuberculosis, and involvement in granuloma formation. Recent studies have investigated the diagnostic and prognostic value of platelet indices in TB, including their potential for differentiating TB from other respiratory infections, monitoring treatment response, and assessing disease severity. However, challenges such as lack of specificity and measurement variability need to be addressed. The review also highlights the multifaceted role of platelets in TB pathogenesis, including immune modulation and antimicrobial functions. Future research directions include large-scale validation studies, exploration of combined biomarker panels, and investigation of platelet indices in pediatric TB and TB-diabetes comorbidity. As our understanding of platelet-TB interactions grows, these indices may contribute to more personalized and effective TB management strategies.

JIB-04, an inhibitor of Jumonji histone demethylase as a potent antitubercular agent against Mycobacterium tuberculosis.

The increasing drug resistance of Mycobacterium tuberculosis (Mtb), coupled with the limited availability of effective anti-tuberculosis medications, poses significant challenges for the management and treatment of tuberculosis (TB). Globally, non-tuberculous mycobacteria (NTM) infections are increasing, with Mycobacterium avium complex and Mycobacterium abscessus (Mab) being the most common in labs and having few treatment options. There's an urgent need for innovative therapies against Mtb and NTM that are effective and have minimal side effects. The study evaluated the in vitro efficacy of JIB-04, a Jumonji histone demethylase inhibitor, against Mtb, Mab, and multidrug-resistant (MDR) clinical isolates using the minimum inhibitory concentration (MIC) assay. We also determined the minimum bactericidal concentrations (MBCs) of JIB-04 against the H37Rv and H37Ra strains. A time-kill assay was performed to assess the comparative efficacy of JIB-04 and rifampicin against H37Ra. Additionally, the study investigated the impact of JIB-04 on biofilm formation and the persistence of H37Ra over extended periods. Our findings demonstrated a substantial inhibitory effect of JIB-04 on the growth of Mab, Mtb, and MDR clinical isolates. JIB-04 showed bactericidal effects at twice the MIC, outperforming rifampicin in reducing viable cell counts over 8 days. It showed moderate cytotoxicity to mammalian cells but effectively inhibited biofilm formation. In our anoxia model, JIB-04 induced a significant, concentration-dependent reduction in bacterial load. JIB-04 is a promising candidate for the treatment of MDR tuberculosis.

Host-Pathogen Interactions in Mycobacterium tuberculosis: Molecular Mechanisms and Implications for Treatment

Worldwide, tuberculosis (TB) due to Mycobacterium tuberculosis is a major public health problem with high morbidity and mortality. This review reviewed the molecular mechanisms and their implications for treatment of M. tuberculosis infection, as well as the complex host pathogen interactions underpinning M. tuberculosis infection. The ability of the pathogen to avoid the host immune responses by utilizing critical strategies for the evasion, for instance, inhibition of phagosome-lyosome fusion and modulation of the host cell pathways are discussed first. T cells play a critical role in the adaptive immune response, and granulomas develop, which are then examined in detail. It importantly informs current treatment protocols which struggle to overcome issues of patient compliance, drug resistance and toxicity. Explored are novel therapeutic approaches targeting bacterial cell wall synthesis, virulence factors and the use of host directed therapies. Recent advances in the development of vaccines, including the innovative endeavors that hope to improve or replace the BCG vaccine, are also reviewed. The review ends by anticipating future directions in TB management, which could be facilitated through efforts related to personalized medicine, and combination therapies, as well as rapid diagnostics to change how we think about treatment. The insights from this study are important for developing novel strategies to fight TB and to bring down its burden globally.

Implications of Asymptomatic Carriers for Tuberculosis Transmission and Control in Thailand: A Modelling Approach

Tuberculosis (TB) is a regional and global bacterial illness that has been expanding and affecting individuals in every generation. An unknown percentage of asymptomatic hosts have TB, and the infection can spread while exhibiting no symptoms. These asymptomatic TB carriers, who contribute to the spread of the illness yet go mostly undetected, may make it more difficult to prevent transmission. In this study, we utilized the concept of symmetry to construct a manageable disease modelling framework for TB transmission and control. We developed a TB model to investigate the potential influence of asymptomatic carriers, symptomatic infections, and the entirety of TB prevalence on different approaches to treatment and prevention in Thailand. Annual TB incidence data from Thailand from 2000 to 2022 were used to calibrate the model parameters. We assessed the potential for reaching conflicting results about the management and spread of tuberculosis in Thailand. Our results showed that some TB strategies that were thought to be effective in reducing transmission may have the opposite impact, or that an intervention’s effectiveness might be overestimated, making it seem unfeasible in certain scenarios. For example, the objective of TB treatment, which attempts to decrease the occurrence of symptomatic TB infections, is to decrease the TB infection and propagation rates if the relative carrier (η) is less than one. Nonetheless, our results indicate that this strategy may increase the frequency of asymptomatic TB patients, symptomatic TB viral infections, and overall TB prevalence if η has been sufficiently understated. We also found that reducing only the progression rate of symptomatic TB infections cannot stop asymptomatic TB carriers and total TB prevalence, even when the relative infection of carriers (η) is less than unity. Our research provides a better understanding of the role of asymptomatic patients in spreading TB and highlights the need to accurately include bearers in models that guide Thailand’s TB control strategy.

Treatment course of cavitary pulmonary tuberculosis combined with tuberculosis in a parotid Warthin’s tumor: a case report and literature review

BackgroundExtrapulmonary tuberculosis (TB) is a relatively rare form of tuberculosis infection, accounting for approximately 15% of all tuberculosis infections. Lymph nodes are the most commonly affected sites, while involvement of the parotid gland is extremely rare.Case presentationWe present the case of a 65-year-old male patient with a one-month history of a left parotid mass. The patient has a history of diabetes and long-term smoking, and a chest X-ray revealed secondary fibrotic pulmonary tuberculosis, while sputum smears were culture-negative for Mycobacterium tuberculosis (Mtb). The parotid mass was surgically removed and subjected to routine HE staining, acid-fast staining, and PCR molecular testing for Mtb. The final diagnosis was Warthin’s tumor of the parotid gland with concomitant tuberculosis. One month after removal of the parotid mass, the patient’s chest CT showed cavitary tuberculosis. Subsequently, the patient received anti-tuberculosis treatment; however, due to severe gastrointestinal adverse effects, the patient stopped the medication in less than a month and did not receive regular treatment. Four months after stopping the medication, the patient’s pulmonary tuberculosis progressed and worsened.ConclusionCombined tuberculosis in Warthin’s tumor is extremely rare, with only 14 cases reported to date. However, the specific pathogenesis of this condition is not yet fully understood, and the preliminary treatment and prognosis have not been conclusively determined. Early diagnosis of tuberculosis, standardized and effective use of anti-tuberculosis drugs, and personalized treatment are crucial in the management of tuberculosis. We have reviewed the treatment progress of this rare disease and analyzed the potential pathogenesis of the condition. Furthermore, we have summarized the current understanding of the pathogenesis of tuberculosis, drug resistance mechanisms, and the latest treatment advances. These studies have important clinical implications for better understanding and treating extrapulmonary tuberculosis and tuberculosis within Warthin’s tumor of the parotid gland. This comprehensive analysis sheds light on the complexities of tuberculosis and provides valuable insights for improved management and care of affected individuals.

Private sector tuberculosis care quality during the COVID-19 pandemic: a repeated cross-sectional standardised patients study of adherence to national TB guidelines in urban Nigeria

Only a third of tuberculosis (TB) cases in Nigeria in 2020 were diagnosed and notified, in part due to low detection and under-reporting from the private health sector. Using a...

Implementation of ward's agglomerative hierarchical clustering model to detect pulmonary tuberculosis endemic areas in Aceh Utara regency

This study aims to detect pulmonary Tuberculosis (TB) endemic areas in Aceh Utara Regency based on altitude, population density, and the number of TB cases. The Agglomerative Hierarchical Clustering (AHC) algorithm was used to cluster 27 subdistricts, each measured by these three factors. The clustering results divided the subdistricts into three main clusters with distinct characteristics. Cluster 1 consists of subdistricts with low altitude, high population density, and relatively high numbers of TB cases, identifying this area as having the highest risk of TB endemicity. Cluster 2 includes areas with moderate population density and TB case numbers, while Cluster 3 consists of subdistricts at higher altitudes with fewer TB cases. The clustering results were evaluated using three key metrics: Silhouette Score, Davies-Bouldin Index, and Dunn Index, which indicated that the clustering model performed well, although some subdistricts were positioned near the cluster boundaries. This research provides valuable information for health authorities to prioritize interventions and allocate resources to areas most in need of TB management.

Tuberculosis in Times of War and Peace

This chapter provides a comprehensive analysis of tuberculosis (TB) across different historical contexts of war and peace, underscoring the disease’s resilience and adaptability. It highlights the exacerbation of TB transmission due to war-related factors such as mass displacement, malnutrition, and compromised healthcare systems, while also noting periods of peace as opportunities for advancing TB control measures. The chapter examines the impact of major conflicts on TB incidence and management, including World Wars I and II and more recent conflicts like the Ukraine war. It also discusses the evolution of TB control efforts, from the discovery of Mycobacterium tuberculosis to modern strategies against drug-resistant TB, emphasizing the importance of international collaboration and integrated public health strategies to combat this enduring global health challenge.

Macrophage-derived extracellular vesicles from Ascaris lumbricoides antigen exposure enhance Mycobacterium tuberculosis growth control, reduce IL-1β, and contain miR-342-5p, miR-516b-5p, and miR-570-3p that regulate PI3K/AKT and MAPK signaling pathways.

Helminth coinfection with tuberculosis (TB) can alter the phenotype and function of macrophages, which are the major host cells responsible for controlling Mycobacterium tuberculosis (Mtb). However, it is not known whether helminth infection stimulates the release of host-derived extracellular vesicles (EVs) to induce or maintain their regulatory network that suppresses TB immunity. We previously showed that pre-exposure of human monocyte-derived macrophages (hMDMs) with Ascaris lumbricoides protein antigens (ASC) results in reduced Mtb infection-driven proinflammation and gained bacterial control. This effect was entirely dependent on the presence of soluble components in the conditioned medium from helminth antigen-pre-exposed macrophages. Our objective was to investigate the role of EVs released from helminth antigen-exposed hMDMs on Mtb-induced proinflammation and its effect on Mtb growth in hMDMs. Conditioned medium from 48-h pre-exposure with ASC or Schistosoma mansoni antigen (SM) was used to isolate EVs by ultracentrifugation. EVs were characterized by immunoblotting, flow cytometry, nanoparticle tracking assay, transmission electron microscopy, and a total of 377 microRNA (miRNA) from EVs screened by TaqMan array. Luciferase-expressing Mtb H37Rv was used to evaluate the impact of isolated EVs on Mtb growth control in hMDMs. EV characterization confirmed double-membraned EVs, with a mean size of 140 nm, expressing the classical exosome markers CD63, CD81, CD9, and flotillin-1. Specifically, EVs from the ASC conditioned medium increased the bacterial control in treatment-naïve hMDMs and attenuated Mtb-induced IL-1β at 5 days post-infection. Four miRNAs showed unique upregulation in response to ASC exposure in five donors. Pathway enrichment analysis showed that the MAPK and PI3K-AKT signaling pathways were regulated. Among the mRNA targets, relevant for regulating inflammatory responses and cellular stress pathways, CREB1 and MAPK13 were identified. In contrast, SM exposure showed significant regulation of the TGF-β signaling pathway with SMAD4 as a common target. Overall, our findings suggest that miRNAs in EVs released from helminth-exposed macrophages regulate important signaling pathways that influence macrophage control of Mtb and reduce inflammation. Understanding these interactions between helminth-induced EVs, miRNAs, and macrophage responses may inform novel therapeutic strategies for TB management.

The Treatment Outcomes of Tuberculosis Patients at Adare General Hospital, Southern Ethiopia (A Five-Year Retrospective Study).

Ethiopia is among the countries most heavily affected by tuberculosis, where it is the leading cause of morbidity, the third cause of hospital admission and the second cause of death. To improve tuberculosis management and control, the early detection of cases, effective treatment and the persistent evaluation of treatment outcomes are vital issues that should be taken into consideration. This study was designed to determine the treatment outcomes and associated risk factors among TB patients registered at Adare General Hospital in Southern Ethiopia. A five-year retrospective study was conducted by reviewing the files of the TB patients registered from September 2013 to August 2017. The data were coded, cleaned, entered and analyzed using SPSS version 20 statistical software. Bivariate and multivariable logistic regression with odds ratios (OR) along with a 95% confidence interval was computed and interpreted. A p-value < 0.05 was declared as statistically significant. Among the 1122 cases, 620 (55.3%) were male, 748 (66.7%) were from urban areas, 319 (28.4%) were smear positive, 352 (31.4%) were smear negative and 451 (40.2%) were extra-pulmonary patients. Among the treated patients, 284 were declared cured, 753 completed their treatment, 29 were defaulters, 3 failed to follow up, and 53 died. The overall treatment success rate was 92.4%. The TB patients from urban areas (AOR = 1.44, 95% CI: 0.28, 0.67), and the HIV-negative TB patients (AOR = 5.48, 95% CI; 3.474, 8.64) were significantly associated with successful treatment outcomes. The treatment success rates of tuberculosis at Adare General Hospital were comparable to the national health facility-level coverage, but they should be maintained and strengthened further to attain tuberculosis-related national and millennium goals.

Modeling the epidemiologic impact of age-targeted vaccination for drug-resistant tuberculosis

This study used a calibrated mathematical model to evaluate age-specific tuberculosis (TB) vaccination strategies, for drug-resistant (DR)-TB management in China. Prioritizing elderly vaccination significantly reduced multidrug-resistant or rifampicin-resistant TB incidence and mortality, while avoiding the need for second-line treatment, offering a promising approach to mitigate DR-TB burden by 2050.

Exploring the Impact of Social Support on Tuberculosis Treatment: A Thematic Review

Aims: Tuberculosis (TB) remains a critical global health issue, characterized by significant morbidity and mortality rates. Recent research highlights the potential of social support interventions to enhance TB treatment outcomes and improve patient quality of life. This study examines the positive effects of social support interventions on TB patients throughout their treatment process. Method: Utilizing a traditional review approach, this study applies thematic analysis to synthesize findings from the literature. The review encompasses 17 articles selected from reputable databases, including PubMed, Wiley Online Library, ProQuest, and Google Scholar, based on predefined inclusion criteria. These articles underwent quality assessment using the Critical Appraisal Skills Programme (CASP) tool. The PRISMA flowchart provided transparency in the selection process. Results: Key themes identified through the analysis include treatment adherence, psychological well-being, motivation to recover, health-related quality of life, prevention of TB transmission, successful TB treatment, and self-efficacy to recover. Conclusion: The findings suggest that social support interventions can play a crucial role in addressing the persistent challenges of TB management globally.

Cost-effective chemiresistive biosensor with MWCNT-ZnO nanofibers for early detection of tuberculosis (TB) lipoarabinomannan (LAM) antigen.

Thedevelopment of an affordable chemiresistive biosensor enhanced with a multi-walled carbon nanotube-zinc oxide (MWCNT-ZnO) nanofiber compositeis presented. The sensor leverages the precise interaction between lipoarabinomannan (LAM) tuberculosis (TB) antigens and antibodies to achieve high sensitivity and specificity. The MWCNT-ZnO nanofibers have a larger surface area and better electrical conductivity, which makes it easier for TB antibodies to stick to them. The binding of LAM TB antigens to the fixed Monoclonal Antibody-MBS320597 induces significant resistance changes in the chemiresistive sensor, enabling accurate TB detection. Performance evaluation reveals a linear detection range from 1.0 to 100.0pg/mL in the lower concentration range and up to 6.0ng/mL in the higher concentration range, with a sensitivity of 79.750mApgmL-1cm-2 and a lower limit of detection of 40.54fg/mL. The sensor exhibits a response time of 102s. Featuring rapid response time and high sensitivity, this biosensor is ideally suited for point-of-care (PoC) applications. The incorporation of MWCNT-ZnO nanofibers shows great potential for enhancing the development of sensitive and cost-effective TB diagnostic tools, which could play a crucial role in advancing global TB control and management efforts.

Leveraging digital adherence technologies to enhance public health: insights from TB care in Ukraine

Abstract Background Effective tuberculosis (TB) care is vital for public health, especially in war-affected Ukraine. In response to the complex healthcare delivery landscape, where traditional directly observation treatment methods became impractical, digital adherence technologies (DATs) emerged as a promising solution, offering more autonomy for people, and remote monitoring capabilities for healthcare providers. Intervention The PATH-led USAID-funded Support TB Control Efforts in Ukraine (STBCEU) project implemented smart pill boxes in eleven Ukrainian regions. These devices equipped with built-in reminders helped people adhere to their medication regimen, and signaled healthcare providers when the box was opened. Results Since April 2022, STBCEU has supported 2,022 people with TB who used smart pill boxes during their treatment, including 489 (24%) with drug-resistant TB (DR-TB). A total of 482 people continue utilizing boxes. Of 1,540 people with TB who completed the use of boxes, 1,207 people (78%) successfully completed TB treatment with an average of 84% treatment adherence rate digitally reported by the technology. Conclusions The integration of smart pill boxes in TB management has enhanced people-centered care, ensuring treatment continuity even in challenging circumstances and providing healthcare providers with real-time adherence data. The innovation contributed to TB control efforts and health equity through expanding opportunities for people to choose their treatment model based on their needs, available resources and community support programs. Leveraging digital solutions proved to be essential in strengthening healthcare systems. In the realm of TB management, DATs enhance differentiated care, embodying a harmonious integration of technology automation and provider interventions. Key messages • Integration of smart pill boxes enhanced patient-centered care, providing real-time adherence data and empowering individuals to choose personalized treatment models. • Digital technologies like smart pill boxes transformed TB care, offering tailored support for patients and remote monitoring capabilities for healthcare providers even in challenging circumstances.

Extrapulmonary tuberculosis - surgeons' experience at a district hospital: a study of 84 cases

Background: Managing extrapulmonary tuberculosis (EPTB) is challenging due to the non-specific signs and symptoms, the low sensitivity of diagnostic tests, and the potential for the disease to mimic other conditions. The aim of the study was to evaluate the clinical characteristics, surgical management, and outcomes of extrapulmonary tuberculosis at a district hospital, based on an analysis of 84 cases. Methods: This prospective study was conducted at the Department of Surgery in collaboration with the Department of Medicine at Magura District Hospital and private clinics of Magura District, Magura, Bangladesh, from January 1, 2013, to December 31, 2018, including 84 patients diagnosed with extrapulmonary tuberculosis. Informed consent was obtained from all participants or their guardians, and data on demographics, clinical presentation, diagnostic tests, and treatment outcomes were analyzed using SPSS version 20. Results: The study showed that 33 (39.29%) patients were aged 21-30 years, with a majority being female 49 (58.33%) and from rural areas 46 (54.76%). All patients had a palpable mass, with the cervical lymph nodes most affected 78 (92.86%). Lymph node tuberculosis was the most common site 55 (65.48%) and chest radiography was negative for tuberculosis in 81 (96.43%) patients. Treatment was medical only for 41 (48.81%) patients and combined medical and surgical for 43 (51.19%) patients. Conclusions: Extrapulmonary tuberculosis, particularly cervical lymph node involvement, remains prevalent in rural, low socio-economic populations, underscoring the importance of comprehensive diagnostic and treatment approaches.