Months Of Anti-tuberculosis Treatment Research Articles

3166 Association between HIV and early weight loss and the impact on subsequent treatment outcomes among patients with tuberculosis

OBJECTIVES/SPECIFIC AIMS: Previous research suggests that weight loss during early TB treatment (first two months of anti-TB therapy) is a predictor of poor tuberculosis (TB) treatment outcomes among HIV-negative populations, but the relationship has not been well studied in the context of HIV. We examined the association between HIV and weight change during the first two months of anti-tuberculosis treatment, and also assessed the effects of HIV and early weight change on tuberculosis (TB) treatment outcomes. METHODS/STUDY POPULATION: Adults with culture-confirmed, drug-susceptible, pulmonary TB, regardless of HIV status, were enrolled into the Regional Prospective Observational Research for Tuberculosis (RePORT)-Brazil cohort and followed on standard anti-TB therapy. For the primary analysis, we compared weight change in persons living with HIV (PLWH) and HIV-negative patients between baseline and two months using multivariable bootstrapped quantile regression and modified Poisson regression. For secondary analysis, we examined the separate effects of HIV and weight change on poor TB treatment outcome (treatment failure, TB recurrence, or death) using Cox proportional hazards regression. RESULTS/ANTICIPATED RESULTS: Among 323 participants, 45 (14%) were HIV-positive. On average, PLWH lost 0.7% (interquartile range (IQR): −5.1%, 4.4%) of their baseline body weight between baseline and two months; those without HIV gained 3.5% (IQR: 0.8%, 6.7%). After adjusting for age, sex, and baseline BMI, PLWH lost 4.1% (95% confidence interval (CI): −6.5%, −1.6%) more weight during the first two months of anti-TB treatment than HIV-negative individuals. HIV infection was associated with weight loss ≥5% (adjusted odds ratio = 9.3; 95% CI: 4.2-20.6). Regarding the secondary analysis, 14 patients had a poor TB treatment outcome: 2 treatment failures, 4 cases of recurrent TB, and 8 deaths. PLWH and patients who lost ≥5% weight had significantly increased risk of poor TB treatment outcome with hazard ratios of 8.77 (95% CI: 2.96-25.94) and 4.09 (95% CI: 1.11-15.14), respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: Our results suggest that HIV is associated with weight loss during early TB treatment, and both HIV and early weight loss were associated with poor treatment outcome. Future research should examine the potential etiologies of these findings and identify the types of interventions that would best promote weight gain during TB treatment, especially among PLWH, in order to prevent poor TB treatment outcomes.

Risk of adverse treatment outcomes among new pulmonary TB patients co-infected with diabetes in Pakistan: A prospective cohort study.

PurposeThe escalating burden of diabetes in countries tackling high burden of tuberculosis (TB) has adverse implications for co-infected individuals and National TB control efforts. We aimed to study whether there was a difference in treatment outcome among diabetic and non-diabetic pulmonary TB patients and identify the determinants of treatment outcome among the two groups.Materials and methodsThis prospective cohort study recruited new patients of pulmonary tuberculosis (PTB) aged 15 years and above who were diagnosed at and registered with Gulab Devi Chest Hospital, Lahore, Pakistan for anti-tuberculosis treatment (ATT). PTB patients were screened for diabetes using random and fasting blood glucose tests. Diabetic and non-diabetic PTB patients were followed up at second, fifth and sixth month of ATT and 6 months after ATT completion to determine treatment outcome. Multivariate logistic regression analysis was conducted to assess association between various factors and treatment outcome.ResultsOf 614 PTB patients, (n = 113 [18%]) were diabetic and (n = 501 [82%]) non-diabetic. Final model showed that diabetics were more likely to experience an unfavorable outcome as compared to non-diabetics (adjusted odds ratio [aOR] = 2.70, 95% Confidence Interval [CI] = 1.30 to 5.59). Other predictors of unfavorable outcome included rural residence (aOR = 1.98, 95% CI = 1.14 to 3.47), body mass index less than 18.50 (aOR = 1.89, 95% CI = 1.03 to 3.47) and being a smoker (aOR = 2.03, 95%CI = 1.04 to 3.94).ConclusionOur study shows unfavorable treatment outcome among diabetic PTB patients. Integrated models of care with screening/testing and management for diabetes and TB could improve TB treatment outcomes.

Tuberculosis-associated mortality and its risk factors in a district of Shanghai, China: a retrospective cohort study.

Pulmonary tuberculosis (PTB) causes a considerable number of deaths in China; however, the factors related to mortality are not well known. To determine mortality among PTB patients and to explore its risk factors in Shanghai, China. This was a retrospective population-based study. A cohort of PTB patients who initiated treatment in a district of Shanghai from 2004 to 2015 was evaluated. Mortality in PTB patients was studied using the standardised mortality ratio (SMR) and Cox's proportional hazards model. Of 2741 PTB patients recruited in our study, 394 (14.4%) died during the 12-year follow-up. The summarised SMR was 2.8, and death was most likely to occur during the first months of anti-tuberculosis treatment. Age 60 years (adjusted hazard ratio [aHR] 4.039, P < 0.001), male sex (aHR 1.603, P < 0.001), sputum smear test positivity (aHR 1.945, P < 0.001), multidrug-resistant TB (MDR-TB; aHR 3.502, P = 0.001), diabetes mellitus (aHR 1.422, P = 0.012), chronic obstructive pulmonary disease (aHR 2.505, P < 0.001) and having cancer (aHR 4.319, P < 0.001) were risk factors for PTB mortality. The overall mortality in PTB patients was higher than that in the general population. MDR-TB and comorbidity were the two leading risk factors for mortality in PTB patients. Early, accurate diagnosis, together with comprehensive management and treatment, can reduce the mortality rate in PTB patients.

Primary Conjunctival Tuberculosis.

A 12-year-old girl was referred to our clinic because of unilateral conjunctivitis not responding to treatment. In the left eye, lower bulbar and tarsal conjunctiva had a polypoidal appearance due to micronodules and there was a subconjunctival nodular mass in the inferior fornix. Systemic examination was unremarkable except for a left preauricular lymphadenopathy. Excision biopsy of the subconjunctival mass revealed a granulomatous inflammation with caseation necrosis, but acid-fast bacilli (AFB) was negative. Fine needle-aspiration biopsy of the preauricular lymph node was performed. In microbiological examination, both AFB and mycobacterial culture were positive. The isolated mycobacteria strains were identified as Mycobacterium tuberculosis complex and full remission was achieved with 6 months of anti-tuberculosis treatment. Although primary tuberculous conjunctivitis is a very rare condition, it should be considered in the differential diagnosis of treatment-resistant unilateral conjunctivitis. For definitive diagnosis, microbiological and histopathological examinations should be performed both in conjunctiva and regional lymph node.

Tuberculosis among the elderly in Tanzania: disease presentation and initial response to treatment.

Reports on tuberculosis (TB) presentation among the elderly in sub-Sahara Africa are scarce at a time when the elderly population is increasing. This dearth of information is likely to lead to an increase in the number of undetected TB cases in the region. To describe TB presentation and response to anti-tuberculosis treatment at 2 months among elderly patients. Consecutive patients referred to TB centres in Dar es Salaam, Tanzania, underwent clinical, microbiological and chest X-ray (CXR) evaluations at baseline and after 2 months of anti-tuberculosis treatment. Patients aged 60 years were considered elderly and those aged 18-59 years formed the comparison group. Elderly patients with TB were more likely to have smear-negative TB (76.7% vs. 49.3%, P < 0.0001) and lower-zone lesions on CXR (41% vs. 17%, P < 0.001), but less likely to have cavities on CXR (77.6% vs. 50.4%, P < 0.0001) than the comparison group. Hypertension and diabetes mellitus were more common among the elderly than among controls. Mortality at 2 months was respectively 18.6% and 8.1% among the elderly and among controls. Human immunodeficiency virus infection and smoking increased mortality, while hypertension was associated with reduced mortality. TB in the elderly was associated with atypical clinical and radiological presentations. A high index of suspicion could minimise delays in diagnosis and treatment.

Biochemical abnormalities and Vitamin D levels in sputum positive pulmonary tuberculosis

Background: Tuberculosis has been associated with various biochemical abnormalities including low hyponatremia, serum albumin, hypocalcaemia, low vitamin D levels. Methods: 50 patients aged ? 18years of age with of sputum positive pulmonary tuberculosis were included in the study. Renal function, liver function, electrolytes and Vitamin D levels were measured at 0, 2 and 6 months of anti-tuberculosis treatment. The qualitative variables were analysed by chi-square tests. The quantitative variables were analysed by using paired t test. Five percent probability level was considered as statistically significant i.e., p<0.05. Results: The mean age was 38.5 years with a male to female ratio of 1.08:1. Hyponatremia was present in 24% of the patients. The mean total serum protein value were 6.720.89,7.420.74 and 8.150.68 g/dl and serum albumin of 2.970.50, 3.370.39 and 3.750.37 g/dl respectively at 0, 2 and 6 months. The mean serum calcium values observed were 8.20.63, 8.820.68 and 9.450.63 mg/dl at 0, 2 and 6 months respectively. The mean values for vitamin D at 0, 2 and 6 months were 9.146.94, 15.336.42 and 23.176.86 ng/ml respectively. 92% of the patients had low serum levels of vitamin D and 66% of the patients had serum vitamin D levels less than 10 ng/ml at presentation. Conclusion: Various biochemical abnormalities including hyponatraemia, low serum albumin and protein levels and low serum calcium levels are seen in pulmonary tuberculosis. Vitamin D levels are significantly lower in patients with TB and there is a significant improvement in the vitamin D levels with treatment of TB.

Cerebrospinal fluid adenosine deaminase and its dynamic changes in tuberculous meningitis

Objective: To explore the diagnostic value of cerebrospinal fluid (CSF) adenosine deaminase (ADA) level in tuberculous meningitis. Methods: We retrospectively analyzed 139 patients (73 males, 66 females) who visited Beijing Chest Hospital for suspected TBM from January 2010 to June 2015. Of them, 99 patients were diagnosed to have TBM, with 45 males and 54 females, and a mean age of (33±15) years. Forty patients were diagnosed as having Non-TBM, with 28 males and 12 females, and a mean age of (35±18) years. All patients underwent lumbar puncture, and CSF ADA, routine, biochemical and bacteriological tests were performed. Thirty-five TBM patients reviewed CSF ADA test after treatment for 4 weeks, 8 weeks and 6 months. Results: The level of CSF ADA in TBM group was higher than that in the non-TBM group, the difference being statistically significant (5.6 U/L vs 2.3 U/L, P=0.000). When the cut-off value of the CSF ADA was 3.8 U/L , the sensitivity and specificity for diagnosis of TBM were 60.6% (95%CI 50.3%-70.1%) and 87.5% (95%CI 72.4%-95.3%), respectively, and the area under the ROC curve was 0.734.The CSF ADA level was (6.7±4.2) U/L in the 35 cases of TBM before treatment. After 4 weeks, 8 weeks and 6 months of anti-tuberculosis treatment, the CSF ADA levels were (4.5±3.3) U/L, (3.7±2.7) U/L and (2.0±1.5) U/L, respectively; all significantly decreased as compared to that before treatment (P<0.001). There was no significant change in the ADA level between 8 weeks and 4 weeks (P=0.128). After 6 months of treatment, the level of CSF ADA was significantly lower than those after 4 and 8 weeks' treatment (P<0.001). Conclusions: CSF ADA in TBM patients was significantly higher than in non-TBM patients. The sensitivity of CSF ADA level in the diagnosis of TBM was poor, but the specificity was better. CSF ADA was significantly reduced and showed dynamic changes with effective anti-tuberculosis treatment and maybe helpful in evaluating the effect of treatment.

A 34-Year-Old Obese Woman with Rash, Finger Swelling and Fever

Disseminated tuberculosis first presenting as cutaneous lesion is uncommon and difficult to diagnose on account of its divers clinical forms. We present a 34-year-old obese woman with rash, finger swelling and fever. The patient was firstly manifested by fever and mass in palm and finger, gradually involving multisystems injury. She was diagnosed with disseminated tuberculosis in consideration of multiple system involvement, imaging characteristics, tuberculous granuloma in dermis and positive result of Mycobacterium culture. After two months of anti-tuberculosis treatment, fever and multisystems injury were controlled effectively, but skeletal and bone marrow involvement continued to progress, experiencing tuberculosis related acute hematopoietic stagnation. Continuing intensive therapy to one year, skeletal and hematological involvement improved and treatment was discontinued after two years. Follow-up to now with drug withdrawal for more than 1year, the patient remains in remission.

Prevalence of Treatment Failure among Pulmonary Tuberculosis Patients in a Tertiary Care Teaching Hospital

1.1.Background:Failure of anti tuberculosis treatment can lead to some serious and unwanted consequences. This study aimed to determine the prevalence of treatment failure among patients diagnosed with pulmonary tuberculosis at Mufti Mahmood Memorial Teaching Hospital Dera Ismail Khan Pakistan. 1.2.Materials and methods:Consecutive patients of smear positive PTB, managed between February 2011 to October 2013 at the directly observed therapy (Tuberculosis) unit of Mufti Mahmood Memorial Teaching Hospital Dera Ismail Khan Pakistan were enrolled for the study. Each patient was required to have a sputum specimen collected and examined for the presence of acid fast bacilli (AFB). This was done at the time of enrolment into the study and at the end of 2nd (in category I cases only), 3rd (in category II cases only) and at the end 5th and 7th month of anti-tuberculosis treatment. 1.3.Results:144 patients were recruited and 20 were lost to follow up or had transferred out. 124 patients consisting of 53 (42.74%) males and 71 (57.26%) females aged 14-85 years completed the study. Ninety three (75%) of the patients were New (category I) at the time of enrolment while 31 (25%) were Retreatment cases (category II). Among 124 smear positive patients at baseline, 22 (17.74%) out of 93 were sputum smear positive at the end of 2nd month, 2 (2.15%) patients at were sputum smear positive at the end of 5th and 7th month respectively in category-1 patients, and 10 (32.26%) out of 31 patients from category 2 had been sputum positive at the end of3rd month of treatment and 4 (12.90%) patients remained positive at the end of 5th and 7th month of treatment respectively. 1.4.Conclusion:Prevalence of treatment failure was significant in our study (4.84%) and it demonstrated a requirement of vigilance on part of health personnel because drug resistant tuberculosis, if untreated, poses a threat to all contacts of patients with tuberculosis.

Effect of antituberculosis treatment on CYP2C19 enzyme activity in genetically polymorphic South Indian Tamilian population.

Patients on antituberculosis therapy (ATT) are more prone to drug interactions in the presence of coexisting illnesses which require drug therapy. Rifampicin is a pleiotropic inducer of CYP enzymes, and isoniazid is an enzyme inhibitor. Genetic variations are common in the gene coding for CYP2C19 enzyme. These variations would be important in predicting the individual variations in CYP2C19 activity. The objectives of the study were to find the net effect of 1-month ATT on CYP2C19 enzyme activity and its association with CYP2C19 genetic polymorphisms. Newly diagnosed tuberculosis patients (n = 125) were included in the study. Before commencing ATT, they were given a single dose of omeprazole 20 mg as a probe drug for CYP2C19. Blood sample was collected after 3 h to carry out phenotyping for CYP2C19 enzyme by measuring omeprazole hydroxylation index (OHI) using LC-MS/MS. The phenotyping procedure was repeated after 1 month of ATT. CYP2C19 genotyping was carried out by PCR-RFLP method. Significant reduction in OHI was observed after 1 month of ATT in all the metabolizer groups. The percentage reduction in OHI was maximum with poor metabolizers, 84.1 (IQR - 74.6, 86.6), and minimum with ultra-rapid metabolizers, 39.6 (IQR - 12.7, 54.7). CYP2C19 enzyme induction is predominant in patients after 1 month of antituberculosis treatment (ATT). Genetic variations in the enzyme could not clearly explain the interindividual differences in induction. There is a potential risk of drug failure/adverse effect in poor metabolizers regardless of their genotype after ATT.

Incidence and outcome of anti-tuberculosis drug-induced hepatotoxicity in tuberculosis inpatients

Based on the medical records and follow-up records of hospitalized patients who received anti-tuberculosis therapy in the Third People's Hospital of Zhenjiang in Jiangsu province from 2006 to 2012, we investigated the incidence and outcome of anti-tuberculosis drug induced hepatotoxicity(ATDH)and provided evidence for the prevention of ATDH. According to tuberculosis patients' medical information and liver function test records, ATDH patients were diagnosed according to the criteria of International Consensus Meeting and American Thoracic Society respectively, then the related factors and outcomes were analyzed. A total of 1 967 hospitalized tuberculosis patients were reviewed retrospectively, in which 1 403(71.3%)were men, 1 790(91.0%)were pulmonary tuberculosis patients, 1 528(77.8%)were patients receiving initiative treatment, 979(49.8%)were sputum smear-positive patients, and 1 297(65.9%)had other complicated diseases. According to the criterion of International Consensus Meeting, the incidence of ATDH was 16.5%, the median time of onset was 25 days. According to the criterion of American Thoracic Society, the incidence of ATDH was 8.3%, the median time of onset was 23 days. The incidence of ATDH was significantly higher in males and HRZE therapy group(P<0.05). Under the two liver criteria, 69.5% and 70.1% of the patients changed primary therapy respectively after ATDH occurred. 89.8% and 88.4% patients' liver function returned to normal range after changing or stopping therapy. According to two liver injury criteria, the incidences of ATDH were 16.5% and 8.3% in hospitalized tuberculosis patients respectively, and ATDH mainly occurred in the first month of anti-tuberculosis treatment. The monitoring of liver function should be strengthened in males and HRZE therapy group to reduce the incidence of ATDH.

Factors associated with extended treatment among tuberculosis patients at risk of relapse in California.

California, United States. To determine the frequency of tuberculosis (TB) patients at risk for relapse who received at least 9 months of anti-tuberculosis treatment (extended treatment) and to identify factors associated with not receiving extended treatment. We analyzed characteristics of culture-confirmed pulmonary TB patients reported to the California TB Registry during 2004-2009. Patients with cavities on initial chest radiograph and delayed culture conversion (⩾70 days) were at 'high risk of relapse', and anti-tuberculosis treatment of ⩾270 days was 'extended treatment'. We used a generalized linear model to identify independent risk factors for absence of extended treatment in the high risk of relapse group. Among 5680 TB patients, 483 (8.5%) were at high risk of relapse: 372 (77%) received extended treatment but 111 (23%) did not. Factors associated with absence of extended treatment included negative sputum smears (adjusted prevalence ratio [aPR] 2.62, 95%CI 1.69-4.05), residence in three specific counties (aPR 1.71, 95%CI 1.19-2.46) and Black race (aPR 1.56, 95%CI 1.03-2.38). Nearly a quarter of TB patients at high risk of relapse did not receive extended treatment. Increased efforts are needed to ensure that all patients who may benefit from extended anti-tuberculosis treatment receive it.

Diabetes mellitus and its influence on sputum smear positivity at the 2nd month of treatment among pulmonary tuberculosis patients in Kuala Lumpur, Malaysia: A case control study

Objective/backgroundMany studies have suggested that sputum smear conversion after 2months of antituberculosis treatment is an important determinant of treatment success and can be a predictor for relapse. The objective of this study is to determine the factors that influence sputum smear conversion after 2months of treatment among pulmonary tuberculosis patients receiving treatment in the Institute of Respiratory Medicine in Kuala Lumpur, Malaysia. MethodsA total of 75 cases and 75 controls were interviewed, and their medical records were retrieved in order to extract the information needed. All analyses were conducted using SPSS version 17, and binary logistic regression analysis was used to determine the predictors of sputum smear nonconversion. ResultsResults showed that the following factors were associated with sputum smear positivity after 2months of intensive treatment: diabetes mellitus (p=.013, odds ratio [OR]=2.59, 95% confidence interval [CI] 1.27–5.33), underweight body mass index (p=.025, OR=1.67, 95% CI 0.80–3.49), nonadherent to tuberculosis treatment (p=.024, OR=2.85, 95% CI 1.21–6.74), and previous history of tuberculosis (p=.043, OR=2.53, 95% CI 1.09–5.83). Multivariable analysis identified diabetes mellitus (p=.003, OR=4.01, 95% CI 1.61–9.96) as being independently associated with the risk of persistent sputum smear positivity after 2months of intensive treatment. ConclusionBased on the findings, identification of these factors is valuable in strengthening the management and treatment of tuberculosis in Malaysia in the future. This study emphasizes the importance of diabetes screening and integration of diabetic controls among tuberculosis patients in achieving better treatment outcome.

Direct Detection by the Xpert MTB/RIF Assay and Characterization of Multi and Poly Drug-Resistant Tuberculosis in Guinea-Bissau, West Africa

BackgroundThis study aimed to evaluate the usefulness of the Xpert MTB/RIF assay for the rapid direct detection of M. tuberculosis complex (MTBC) strains and rifampicin resistance associated mutations in a resource-limited setting such as Guinea-Bissau and its implications in the management of tuberculosis (TB) and drug resistant tuberculosis, complementing the scarce information on resistance and genotypic diversity of MTBC strains in this West African country.Methods and ResultsThis cross-sectional prospective study included 100 consecutive TB patients with positive acid-fast smears at two months of anti-tuberculosis treatment or in a re-treatment situation, between May and December 2012. Resistance to rifampicin was detected using the GeneXpert system and the Xpert MTB/RIF assay. MTBC isolates obtained with the BACTEC MGIT 960 system were tested for susceptibility to first- and second-line anti-tuberculosis drugs. Overall, the prevalence of multidrug-resistant tuberculosis (MDR-TB) was found to be 9 cases. Of these, 67% (6 patients) of confirmed MDR-TB cases had no past history of TB treatment and 33% (3 patients) were previously treated cases. Extensively drug-resistant TB was not found. Molecular typing of the MDR-TB strains revealed recent transmission patterns of imported MDR strains.ConclusionsThe Xpert MTB/RIF assay was reliable for the detection of rifampicin resistant MTBC strains directly from sputum samples of patients undergoing first-line treatment for two months, being more trustworthy than the simple presence of acid-fast bacilli in the smear. Its implementation is technically simple, does not require specialized laboratory infrastructures and is suitable for resource-limited settings when a regular source of electricity and maintenance is available as well as financial and operation sustainability is guaranteed by the health authorities. A high prevalence of MDR-TB among patients at risk of MDR-TB after two months of first-line treatment was found, in support of the WHO recommendations for its use in the management of this risk group.

Ultrasound in diagnose &amp; treatment follow-up of abdominal pain due to intestinal tuberculosis

Preceding treatment All with recurrent colic abdomen pain (some very severe), diarrhea/obstipation, distention, “doughy & dam-board phenomena”, constitutional symptoms, cough and X-ray suggestive lung tuberculosis. Intestinal ultrasound on the tympanic area were normal, but on dullness pain area were: a/hypo-peristaltic, irregular thickening heterogenic hypo-echoic, irregular margin of the wall, loss differentiation of the wall layers, with several oval/round nodular structures (patchy hyper-echoic non-shadowing with an irregular rim of lower echo-density, those suggestive granuloma process) within the wall and narrowing of the lumen. During 9-12 months of anti tuberculosis treatment All the symptoms & signs, dullness area, wall thickening, lumen narrowing were disappeared gradually with better peristaltic at the affected area.

Decompression of Enlarged Mediastinal Lymph Nodes Due to Mycobacterium Tuberculosis Causing Severe Airway Obstruction in Children

Large airway compression by enlarged tuberculosis (TB) lymph nodes results in life-threatening airway obstruction in a small proportion of children. The indications, safety, and efficacy of TB lymph node decompression are inadequately described. This study aims to describe the indications and efficacy of TB lymph node decompression in children with severe airway compression and investigate variables influencing outcome. A prospective cohort of children (aged 3 months to 13 years) with life-threatening airway obstruction resulting from TB lymph node compression of the large airways were enrolled. The site and degree of airway obstruction were assessed by bronchoscopy and chest computed tomography scan. Of the 250 children enrolled, 34% (n= 86) required transthoracic lymph node decompression, 29% as an urgent procedure and 71% (n= 63) after failing 1 month of antituberculosis treatment that included glucosteroids. Compression (less than 75%) of the bronchus intermedius (odds ratio 2.28, 95% confidence interval: 1.29 to 4.02) and left main bronchus (odds ratio 3.34, 95% confidence interval: 1.73 to 6.83) were the best predictors for lymph node decompression. Human immunodeficiency virus status, drug resistance, and malnutrition were not associated with decompression. Few complications (self-limiting, 8%) or treatment failures (2%) resulted from the decompression. There were no deaths. In one third of children with TB, severe airway obstruction caused by enlarged lymph nodes requires decompression. Transthoracic decompression can be safely performed with low complication, failure, and fatality rates.

Profile and determinants of treatment failure among smear-positive pulmonary tuberculosis patients in Ebonyi, Southeastern Nigeria

BackgroundEarly identification of determinants of tuberculosis (TB) treatment failure is urgently needed in resource-limited settings. This study describes the profile and determinants of TB treatment failure in a high-incidence setting where patients were managed at a TB control program with significant resource limitations. MethodsThis was a retrospective case-control study carried out in one tertiary and one secondary hospital in Southeastern Nigeria. Cases were adult (⩾15years) TB patients with a positive sputum smear after 5months of treatment (treatment failure). Controls were adult TB patients whose sputum smear was positive at the beginning of the treatment but who were smear-negative in the last month of treatment and on at least one previous occasion (cured). Cases were compared with controls to assess determinants of treatment failure. ResultsOf the 1668 TB patients registered during the study period, 985 (59%) had smear-positive pulmonary TB. Of these, 694 (70.5%) were aged ⩽40years, 602 (61.1%) were males, 707 (71.8%) were rural residents, and 898 (91.2%) received care at the private facility. The prevalence of treatment failure was 2.5%. Significant determinants of treatment failure were: older age (>40years) (P<0.001), male gender (P=0.04), previous treatment for TB (P=0.045), and positive sputum smears after two month of anti-tuberculosis treatment (0.001). ConclusionThis study showed that the treatment failure rate among smear-positive TB patients is low in Nigeria. Education and improved clinical and laboratory interventions for the identified at-risk groups may reduce TB treatment failure in resource-limited settings.

English

BACKGROUND: Tuberculosis of the breast is a very rare occurrence accounting for approximately 4% of all breast lesions in countries where tuberculosis is rampant1. Tuberculosis of breast is a disease seen in young lactating multiparous women. Tuberculosis of breast has varied presentation ranging from an abscess or a painless breast mass. India is a country which is endemic for tuberculosis; henceearly diagnosis of tuberculosis is needed so that effective anti-tuberculous therapy can be started and the disease can be eradicated.AIMS: In view of the above said we considered to study the varied presentations of lactational abscess and to highlight the importance of tuberculosis as a cause of breast abscess in lactating mothers.METHODS AND MATERIAL: This is a prospective study done between over a period of 1 year from between January 2011 to December 2011 chosen by purposive sampling technique. The patients who met the inclusion and exclusion criteria were subjected to a thorough anesthetic workup and then the drainage was done using Hiltons method, the pus was sent for culture and abscess wall contents and the cavity tissue for histopathological examination. The collected data was analyzed.Statistical Analysis: Percentage and frequency were used for statistical analysis.RESULTS: Out of the 55 patients the commonest age group was between 2130 years (32%) and symptom was mastalgia (100%). Both patients (100%) responded well to 6 months of anti-tuberculosis treatment with disappearance of axillary lymph nodes.CONCLUSION: Lactational abscess can be one of the presentations of tuberculosis of breast. In an endemic area careful evaluation of the lactational abscess has to be done so that early diagnosis of can be done and effective anti-tuberculous therapy can be given.

Nutritional status of HIV-infected women with tuberculosis in Dar es Salaam, Tanzania.

Tuberculosis (TB) treatment clinics in Dar es Salaam, Tanzania. To quantify anthropometrics and intake of en-ergy and protein among human immunodeficiency virus (HIV) positive women with TB. HIV-positive women with newly diagnosed TB were assessed on their anthropometric characteristics and dietary intake. Energy and protein intake were determined using Tanzania food composition tables and compared with standard recommendations. Patients were re-evaluated after 4-6 months of anti-tuberculosis treatment. Among 43 women, the baseline median CD4 count was 209 cells/µl (range 8-721); 19 (44%) had a CD4 count of <200; 20 (47%) were on antiretroviral therapy. Body mass index was <18.5 kg/m(2) in 25 (58%); the median food insecurity score was 6. The median level of kcal/day was 1693 (range 1290-2633) compared to an estimated need of 2658; the median deficit was 875 kcal (range -65-1278). The median level of protein/day was 42 g (range 27-67) compared to 77 g estimated need; the median protein deficit was 35 g (range 10-50). The median weight gain among 29 patients after 4-6 months was 6 kg. HIV-positive women with TB have substantial 24-h deficits in energy and protein intake, report significant food insecurity and gain minimal weight on anti-tuberculosis treatment. Enhanced dietary education together with daily supplementation of 1000 kcal with 40 g protein may be required.

Predictors of tuberculosis (TB) and antiretroviral (ARV) medication non-adherence in public primary care patients in South Africa: a cross sectional study

BackgroundDespite the downward trend in the absolute number of tuberculosis (TB) cases since 2006 and the fall in the incidence rates since 2001, the burden of disease caused by TB remains a global health challenge. The co-infection between TB and HIV adds to this disease burden. TB is completely curable through the intake of a strict anti-TB drug treatment regimen which requires an extremely high and consistent level of adherence.The aim of this study was to investigate factors associated with adherence to anti-TB and HIV treatment drugs.MethodsA cross-sectional survey method was used. Three study districts (14 primary health care facilities in each) were selected on the basis of the highest TB caseload per clinic. All new TB and new TB retreatment patients were consecutively screened within one month of anti-tuberculosis treatment. The sample comprised of 3107 TB patients who had been on treatment for at least three weeks and a sub-sample of the total sample were on both anti-TB treatment and anti-retro-viral therapy(ART) (N = 757). Data collection tools included: a Socio-Demographic Questionnaire; a Post-Traumatic-Stress-Disorder (PTSD) Screen; a Psychological Distress Scale; the Alcohol Use Disorder Identification Test (AUDIT); and self-report measures of tobacco use, perceived health status and adherence to anti-TB drugs and ART.ResultsThe majority of the participants (N = 3107) were new TB cases with a 55.9% HIV co-infection rate in this adult male and female sample 18 years and older. Significant predictors of non-adherence common to both anti-TB drugs and to dual therapy (ART and anti-TB drugs) included poverty, having one or more co-morbid health condition, being a high risk for alcohol mis-use and a partner who is HIV positive. An additional predictor for non-adherence to anti-TB drugs was tobacco use.ConclusionsA comprehensive treatment programme addressing poverty, alcohol mis-use, tobacco use and psycho-social counseling is indicated for TB patients (with and without HIV). The treatment care package needs to involve not only the health sector but other relevant government sectors, such as social development.