National Tuberculosis Center Research Articles

Drug Resistance and Mutation Patterns Among Tuberculosis Patients in National Tuberculosis and Leprosy Training Centre Zaria

Drug Resistance and Mutation Patterns Among Tuberculosis Patients in National Tuberculosis and Leprosy Training Centre Zaria

Prevalence of HIV Among Drug Resistance Tuberculosis Cases at the National Tuberculosis and Leprosy Training Centre Zaria

Prevalence of HIV Among Drug Resistance Tuberculosis Cases at the National Tuberculosis and Leprosy Training Centre Zaria

Bayesian estimation of the time-varying reproduction number for pulmonary tuberculosis in Iran: A registry-based study from 2018 to 2022 using new smear-positive cases

IntroductionTuberculosis (TB) is one of the most prevalent infectious diseases in the world, causing major public health problems in developing countries. The rate of TB incidence in Iran was estimated to be 13 per 100,000 in 2021. This study aimed to estimate the reproduction number and serial interval for pulmonary tuberculosis in Iran. Material and methodsThe present national historical cohort study was conducted from March 2018 to March 2022 based on data from the National Tuberculosis and Leprosy Registration Center of Iran's Ministry of Health and Medical Education (MOHME). The study included 30,762 tuberculosis cases and 16,165 new smear-positive pulmonary tuberculosis patients in Iran. We estimated the reproduction number of pulmonary tuberculosis in a Bayesian framework, which can incorporate uncertainty in estimating it. Statistical analyses were accomplished in R software. ResultsThe mean age at diagnosis of patients was 52.3 ± 21.2 years, and most patients were in the 35–63 age group (37.1%). Among the data, 9121 (56.4%) cases were males, and 7044 (43.6%) were females. Among patients, 7459 (46.1%) had a delayed diagnosis between 1 and 3 months. Additionally, 3039 (18.8%) cases were non-Iranians, and 2978 (98%) were Afghans. The time-varying reproduction number for pulmonary tuberculosis disease was calculated at an average of 1.06 ± 0.05 (95% Crl 0.96–1.15). ConclusionsIn this study, the incidence and the time-varying reproduction number of pulmonary tuberculosis showed the same pattern. The mean of the time-varying reproduction number indicated that each infected person is causing at least one new infection over time, and the chain of transmission is not being disrupted.

Prevalence of hepatitis B surface antigen among HIV/AIDS patients attending national tuberculosis and leprosy training center, Saye-Zaria, Nigeria

Prevalence of hepatitis B surface antigen among HIV/AIDS patients attending national tuberculosis and leprosy training center, Saye-Zaria, Nigeria

Prevalence of Diabetes Mellitus among Patients with Tuberculosis and Its Associated Factors in Sana'a, Yemen, 2021.

Diabetes mellitus (DM) is one of tuberculosis' (TB) ending barriers. TB patients with DM are at a higher risk than non-diabetes patients to develop complication, relapse and die. In Yemen, information on TB-DM comorbidity is lacking. This study aimed to determine the prevalence and associated factors of diabetes among TB patients at the National Tuberculosis Center (NTC) in Sana'a. A facility-based cross-sectional study was conducted. All TB patients aged >15 years who attended the NTC from July to November 2021 were screened for DM. Socio-demographic and behavioral information were collected through face-to-face interviews using questionnaires. A total of 331 TB patients were enrolled, 53% were males, 58% aged <40 years, and 74% were newly diagnosed with TB. Overall, DM prevalence was 18%. Higher rates of DM were found among TB patients that were male (OR = 3.0; 95% CI; 1.4-6.7), ≥50 years of age (OR = 10.8; 95% CI; 4.3-27.3), and those with a family history of diabetes (OR = 3.4; 95% CI; 1.6-6.9). Almost one fifth of TB patients had DM. The early detection of DM through immediate screening after a TB diagnosis and periodically during the course of treatment is crucial for TB patients' optimal care. Dual diagnostics for reducing the dual burden of TB-DM comorbidity is recommended.

Prevalence of disseminated Histoplasma capsulatum in pulmonary infection patients, attending National Tuberculosis and Leprosy Training Centre, Saye – Nigeria

Prevalence of disseminated Histoplasma capsulatum in pulmonary infection patients, attending National Tuberculosis and Leprosy Training Centre, Saye – Nigeria

Evaluation of Xpert MTB/RIF Assay, MTB Culture and Line Probe Assay for the Detection of MDR Tuberculosis in AFB Smear Negative Specimens.

The global burden of tuberculosis (TB), particularly with multidrug resistance (MDR), is escalating and has become a major health challenge. It is well known that acid-fast bacilli (AFB) smear-negative TB patients are the major source of spreading TB to healthy individuals when left untreated. Early diagnosis of TB and rapid detection of drug resistance are important for the proper management of drug-resistant TB (DR-TB). Therefore, a laboratory based cross-sectional study was conducted from July to December 2019 at the National Tuberculosis Centre, Thimi, Nepal, with the objective of evaluating the diagnostic performance of Xpert MTB/RIF assay, Mycobacterium tuberculosis (MTB) culture and line probe assay (LPA) for the detection of MDR-TB in AFB smear-negative sputum samples. We evaluated a total of 222 AFB smear-negative sputum specimens, of which 21.6% (n = 48) showed MTB positive with Xpert MTB/RIF assay and, while culturing on Lowenstein-Jensen (LJ) media, 21.2% (n = 47) were MTB culture positive. The sensitivity, specificity, PPV and NPV at 95% confidence interval of Xpert MTB/RIF assay on diagnosing M. tuberculosis from smear-negative specimens were 73% (57-84), 92% (87-96), 71% (59-81) and 93% (89-95), respectively. In addition, the sensitivity of Xpert MTB/RIF assay and LPA in detecting rifampicin resistance was 75% (42-94, 95% CI) and 91.67% (62-99, 95% CI), respectively. The current study also assessed a significant association between the occurrence of pulmonary tuberculosis with different age group, TB history and alcohol consumption. These findings indicate that Xpert MTB/RIF assay and LPA are appropriate methods for early detection and accurate diagnosis of TB and RIF mono-resistant cases.

QuantiFERON-TB Gold plus testing for the detection of LTBI among health care workers in major TB hospitals of the Northern Kyrgyz Republic

BackgroundHealth care workers (HCW) are at increased risk of TB infection due to their close contact with infected patients with active TB. The objectives of the study were (1) to assess the prevalence of LTBI among HCW in the Northern Kyrgyz Republic, and (2) to determine the association of LTBI with job positions or departments.MethodsHCWs from four TB hospitals in the Northern Kyrgyz Republic were tested with the interferon-gamma release assay (IGRA) Quantiferon-TB Gold plus (QFT) for the detection of an immune response to TB as marker of TB infection. Age was controlled for as a confounder. Univariate and multivariable analysis were performed using logistic regression to assess the association of the risk factors (job position, and department) with having a QTF positive result. Firth’s penalized-likelihood estimates were used to account for the small-sample size. Pairwise comparisons using the Bonferroni correction (conservative) and comparisons without adjusting for multiple comparisons (unadjusted) were used to identify the categories where differences occurred.ResultsQFT yielded valid results for 404 HCW, with 189 (46.7%) having a positive test. In the National Tuberculosis Center there was an increased odds to have a positive QFT test for the position of physician (OR = 8.7, 95%, CI = 1.2–60.5, p = 0.03) and laboratory staff (OR = 19.8, 95% CI = 2.9–135.4, p < 0.01) when administration staff was used as the baseline. When comparing departments for all hospitals combined, laboratories (OR 7.65; 95%CI 2.3–24.9; p < 0.001), smear negative TB (OR 5.90; 95%CI 1.6–21.8; p = 0.008), surgery (OR 3.79; 95%CI 1.3–11.4; p = 0.018), and outpatient clinics (OR 3.80; 95%CI 1.1–13.0; p = 0.03) had higher odds of a positive QFT result than the admin department. Fifteen of the 49 HCW with follow-up tests converted from negative to positive at follow-up testing.ConclusionsThis is the first report on prevalence and risk factors of LTBI for HCW in the Kyrgyz republic, and results indicate there may be an increased risk for LTBI among physicians and laboratory personnel. Further research should investigate gaps of infection control measures particularly for physicians and laboratory staff and lead to further improvement of policies.

Tuberculosis in Baghdad, Iraq 2012-2016: Retrospective Study

Objective (s): The present study intended at examining the prevalence of tuberculosis in Baghdad City, Iraqfor the period of 2012-2016.Methodology: A descriptive “retrospective” design was applied throughout the present study from theperiod of November 12th 2017 to February 13th 2018 in order to detect the tuberculosis cases with regardto patients’ demographic characteristics in Baghdad City, Iraq for 2012-2016. A total of (11680) registeredpatients with tuberculosis are selected. An instrument was constructed for the purpose of the study. Datawere collected from the health records at the National Tuberculosis Center, State TB center, and district TBcenter for the period of 2012 to 2016 with the use of the study instrument. Data were analyzed through theapplication of descriptive statistical data analysis approach of frequency, percent and total scores.Results: The study findings revealed that there was a significant difference among them pairwise fromthis point of view; i.e., the number of married people is more than single, more than divorced and morethan a patient with a dead spouse the literacy level of TB patients is significantly different, with (59.77%)of illiterate patients, (2.27%) of elementary education, (18.30%) of secondary education, (19.04%) ofsecondary education and diploma and (0.61%) university degree. Most of the patients had experiencedExtra-pulmonary Tuberculosis (52.36%).Conclusion: The study concluded that the gender ratio was accounted for the most (2.14:1) in the year of2015. The urban zone the incidence rate was greater than that of the rural zone.

Predictors of Intensive Phase Treatment Outcomes among Patients with Multi-Drug Resistant Tuberculosis in Zaria, North-Western Nigeria

Background: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a threat to successful TB treatment outcomes in developing nations like Nigeria. This study determined the predictors of intensive phase treatment outcomes in MDR-TB patients in Zaria, Nigeria.Methods: This was a retrospective cross-sectional review of the records of 124 MDR-TB patients registered between September 2012 and August 2017 at the National Tuberculosis and Leprosy Training Centre, Saye, Zaria. Data were analyzed using IBM SPSS version 25.0 and the StataCorp STATA/SE 14.Results: The median age (IQR) of the respondents was 32 (15) years. The gene Xpert test detected Mycobacterium Tuberculosis (MTB) and rifampicin resistance (RIF) in 119 (96.0%) cases. The treatment success rate was 97 (78.2%). MDR-TB and HIV co-infection rate was 17 (13.7%) while the case fatality rate was 16.1%. Bivariate analysis showed that being male (p=0.001), not currently in marital union (p=0.01) and positive smear results at 1 month (p=0.027)) were significantly associated with treatment success. Multivariate logistic regression showed that the odds for successful treatment outcome was 4 times higher for the MDR-TB patients who were employed than the unemployed (AOR= 3.98, 95% CI= 1.15-13.74). No significant relationship between MDR-TB-HIV comorbidity (AOR=1.89, 95% CI=0.44-8.19), MDR-TB susceptible to Isoniazid (AOR= 0.49, 95% CI =0.15-1.56) and successful treatment outcome.Conclusion: Unemployment was a predictor of poor treatment outcome in this study. Cause-specific mortality due to the MDR TB was high in this setting. We advocate for optimization of access to treatment and social support system, especially for the female patients.&#x0D; Keywords: Gene Xpert; Intensive phase; MDR-TB; Treatment outcomes; Nigeria.

Risk factors of tuberculosis in human and its association with cattle TB in Nepal: A one health approach

Tuberculosis (TB) in humans is primarily caused by Mycobacterium tuberculosis (M. tuberculosis), with millions of infections and hundreds of thousands of deaths worldwide. It creates a substantial economic burden on the community. Unlike M. tuberculosis, Mycobacterium bovis infects cattle and causes bovine TB, also known as zoonotic TB. People can contract zoonotic TB after consumption of unpasteurized dairy products, handling the sick animals, and via occupational exposures. The association between the zoonotic TB in humans and cattle is not well known in Nepal. The study examined the associated risk factors, including exposure to infected cattle, that contribute to TB's development in human beings in Nepal.The study consists of human and animal subjects. Firstly, a retrospective matched case-control study was conducted at the National Tuberculosis Center (NTC), Bhaktapur, Nepal. A total of 290 people (equal numbers of TB cases and control subjects) were interviewed to obtain information on socio-demographic, behavioral, and occupational risks, including the history of cattle related exposures. Secondly, a cross-sectional study was performed among the cattle owned by the TB-confirmed patients. Comparative tuberculin skin test, rapid antibody test, and ELISA were used in parallel to detect M. bovis infection in cattle.The risk factors for the development of TB in humans were smokers (OR = 4.6, 95% CI: 2.1–10.0, p < 0.001), previous history of TB (OR = 7.9, 95% CI: 3.0–20.6, p < 0.001) and history of cattle exposures (OR = 3.9, 95% CI: 2.1–7.4, p = 0.001). Out of 123 cattle sampled, 12 cattle (9.76%, 95% CI: 5.37–16.76, p < 0.0001) were positive by the tuberculin test, 46 (37.4%, 95% CI: 28.97–46.62, p = 0.007) were tested positive by the rapid test, and 7 (5.7%, 95% CI: 2.52–11.80, p < 0.0001) by ELISA test. The inter-test agreement between the tuberculin and ELISA was very strong (κ = 0.72, 95% CI: 0.48–0.95, p < 0.01).This study indicates that exposure to infected cattle and socio-demographic risk factors can contribute to the development of TB in human beings.

Study of Tuberculosis Related Topics in Baghdad, Iraq 2012-2016 Tuberculosis Related Topics

Objective(s): The present study designed to explore topics related to Tuberculosis, such as new smear positive cases, causes, treatment and new pulmonary positive cases in Baghdad City, Iraq for 2012-2016. Methods: A descriptive “retrospective” design was performed throughout the present study from the period of November 12th 2017 to February 13th 2018. All registered tuberculosis patients in Baghdad, Iraq for the period of 2012-2016. An instrument was constructed for the purpose of the study. Data were collected from the health records at the National Tuberculosis Center, State TB center, and district TB center for the period of 2012 to 2016 with the use of the study instrument. Data were analyzed through the application of descriptive statistical data analysis approach of frequency, percent, incidence rate and ratio. Results: The study findings depicted that most of the new smear positive cases are accounted for the age group of (15-24) year old during the years of 2012-2016. Causes of Tuberculosis in the rural area were accounted for poverty (39.95%), smoking (22.39%), untreated cases (12.4%), alcoholism (11.32%), malnutrition (10.30%) and overcrowded (3.57%) respectively, and accounted for alcoholism (27.77%), overcrowded (27.16%), malnutrition (24.69%), smoking (11.93%), poverty (7.62%) and untreated cases of Tuberculosis (0.80%) respectively in the urban area. Conclusion: The study concluded that Most of the new smear positive cases are accounted for the age group of (15-24) year old during the years of 2012-2016. Patients, in 2014, had benefited out of the Tuberculosis Program more than others based on the success rate.

A 5-year experience characterizing the demographic and clinical profile and directly observed treatment short-course treatment outcome in National Tuberculosis Center of Duhok province, Iraqi Kurdistan.

Background:The objectives were to describe the demographic and clinical profile and treatment outcomes in the National Tuberculosis Program Center of Duhok governorate.Methods:This was a descriptive retrospective study of all forms of drug-susceptible tuberculosis cases in the National Tuberculosis Program Center of Duhok. The Electronic Nominal Recording Reporting System data of tuberculosis cases were reviewed during 2014–2018. Information on the demographic, clinical, and laboratory characteristics of the patients were analyzed. Tuberculosis trends and treatment outcomes were determined.Results:A total of 1063 tuberculosis patients visited the National Tuberculosis Program Center, of whom 905 were from Duhok. The estimated tuberculosis notification rate per 100,000 people in Duhok governorate was 14.06, 16.16, 10.43, 11.05, and 10.34 for the years 2014, 2015, 2016, 2017, and 2018, respectively. The most affected age group was 15–24 years. The male cases were predominant. Most patients (97.3%) were native Iraqi. There were 718 (67.5%) pulmonary tuberculosis cases and 345 (32.5%) extra-pulmonary tuberculosis cases; tuberculosis lymphadenitis was the most common presentation. The majority of extra-pulmonary tuberculosis patients were females aged 15–24 years (p = 0.019), and patients aged ⩾65 years were associated with pulmonary tuberculosis and extra-pulmonary tuberculosis in males (p ⩽ 0.001). The highest tuberculosis incidence occurred in winter (288 patients). The patient treatment outcomes were as follows: 90.7% successful treatment, 1.6% lost to follow-up, 6.7% death, 0.3 transferred out, and 0.8 treatment failure.Conclusion:There was a high frequency of extra-pulmonary tuberculosis, which may reflect overestimation in its diagnosis. Therefore, meticulous evaluations should be provided. The treatment outcome was satisfactory in the center. Hence, we should maintain the favorable work to attain tuberculosis control objectives. Performing GeneXpert for all tuberculosis cases and introducing culture and drug susceptibility testing should be an urgent plan to strengthen the diagnosis of susceptible and drug-resistant tuberculosis cases.

Construction of an exchange interface for the transmission of laboratory results: a case of the National Tuberculosis Center.

Introduction The transmission of test results by laboratories and their receipt by health facilities are common tasks in the processing of medical information. Managing the flow of information generated by these tasks remains a challenge for these centers. We describe a new system that will allow for electronic management of the transmission of results. Materials and methods The information system implemented is a client-server system consisting three main components: the server installed in the laboratory, the client distributed in the Anti-Tuberculosis Center and the communication channel represented by a Virtual Network. The exchange protocol is based on the HL7 standard that used messages of type ORU_R01. Results During the two months of implementation of this electronic result transmission system between the National Tuberculosis Reference Center in Abidjan and the Anti-Tuberculosis Center in Adzopé, which is about 110 kilometers away, twenty laboratory results were transmitted as soon as they left the laboratory, an improvement from the previous long turn-around-time of about 1 month. The minimalist interface and ease of use of the system have allowed it to be adopted by users. Discussion The use of the HL7 protocol for electronic notifications has proven its effectiveness in making transmissions of results instantaneous. Our system specifically addresses the problems related to efficient transmission of results; reduction of transmission time, information loss attributed to the use of paper, and transport costs incurred when transmitting results from remote sites. This system representing the 1rst version use a local codification that limits it to an interoperability with other environment that use a different code system. The use of a code system such as LOINC would allow full interoperability between different information systems.

An 8-year study on the prevalence and drug resistance of mycobacteria in clinical specimens (2011–2018)

Non-tuberculous mycobacteria cause a wide range of clinical disorders. Isoniazid (INH) and rifampin (RIF) are the most effective first-line antibiotics against for Mycobacterium tuberculosis. The aim of this study was to investigate the prevalence of mycobacteria in clinical samples collected during 8 years (2011–2018) in the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran and to determine the tuberculosis drug resistance to first-line antibiotics, INH and RIF. In this study, 15829 different clinical specimens were collected at the NRITLD National Tuberculosis Center. A multiplex allele specific polymerase chain reaction (MAS-PCR) was used to identify mutations related to RIF and INH resistance. The genes involved were katG315, inhA for INH and rpoB516, rpoB526 and rpoB531 for RIF. In total (7528/15829, 47.56%), mycobacterial isolates including 6937 MTBC (43.82%) and 591 NTM (3.73%) were obtained. The frequency of MTBC isolates decreased from 65.17% (2015/3092) in 2011 to 47.06% (1224/2601) in 2018. Among NTM isolates, M. simiae was the most prevalent with 55.33% (327/591). The average INH resistance ratio between 7528 MTB and NTM isolates was 21%, from 15.98% in 2011 to 18.76% in 2018. In the case of RIF, the same resistance trend has been gradually increasing from 12.45% in 2011 to 14.55% in 2018. The prevalence of MDR TB has increased during the study period, from 6.49% (134/2065) in 2011 to 12.58% (174/1354) in 2018. The results of this study indicate that early detection of mycobacterial strains and determination of their drug resistance are necessary.

Effective use of Penicillin to Improve Culture Yield for Mycobacterium tuberculosis

Objective: To compare LJ media and LJ media with penicillin for the growth of Mycobacterium tuberculosis and contamination, in pulmonary tuberculosis (PTB) suspected patients.&#x0D; Methods: A total of 300 PTB suspected cases at National Tuberculosis center (NTC) for analyzed for culture and contamination. Early morning sputum samples were collected in sterile leak-proof falcon tube. Digestion, decontamination and homogenization of sputum were done using NALC-NaOH (Modified Petroff method). The sputum sample was processed on LJ media and penicillin added LJ media and incubated at 37. Cultures were examined after 8 weeks.&#x0D; Results: All the PTB suspected cases were compared in LJ media and LJ media with penicillin, 29.7% (89) were positive, 21% (63) were contaminated on LJ media whereas 41% (123) were positive, 3.7 % (11) were contaminated on penicillin added LJ media. Also, 25 (8%) were 1+ grading, 14 (4.7%) were 2+ grading, whereas 81 (27%) and 45 (15%) were 3+ grading LJ + Penicillin and LJ media respectively.&#x0D; Conclusion: Contamination was reduced by 17.3% with the addition of penicillin to LJ media. And isolation of total positive cultures was enhanced by 11.3%.

Drones Optimized Therapy System (DrOTS): Use of Drones for Tuberculosis Diagnosis in Nepal

Over 50% of the total Nepalese population lives in hilly and mountainous areas with extremely poor transportation and access to health care facilities. With advanced health centers concentrated only in urban areas, and diagnostic laboratories not being present in most primary healthcare facilities, majority of people are forced to have to walk by foot, in an average 6-8 hours, to access proper healthcare facilities. Drone Optimized Therapy System, (DrOTS) aims to improve access to healthcare access in rural villages of Nepal. The pilot phase currently involved improving the accessibility of Tuberculosis diagnostic tests by linking communit y health workers (CHWs) with state-of-the-art diagnostic tools (GeneXpert) via drones in two municipalities of Pyuthan district, Nepal. The drones fly from central Hospitals to remote healthcare centers and bring back sputum samples for diagnosis. The purpose of this project is to assist the Ministry of Health and Population (MoHP) and National Tuberculosis Center (NTC) by generating the data necessary to assess the suitability of the drones-based services for nationwide expansion. The aerial distance between any two points being lesser than the actual road distance, drone technology has come out as a very popular tool in transporting medical samples/medicines between health centers. Drones can be used as crucial tools to connect primary healthcare facilities to hospitals by delivering patient information such as blood, urine, sputum, stool etc. samples required for diagnosis from primary facilities to hospitals, and medicines from hospitals to patients in nearby rural locations for treatment. The project team consists of multisector experts; Public Health- Birat Nepal Medical Trust (BNMT), Drones &amp; Tech - WeRobotics, Nepal Flying Labs &amp; DroNepal, Research: The Liverpool School of Tropical Medicine, Govt. stakeholders: MoHP Nepal, the National TB Center and the District Public Health Office (DPHO Pyuthan) is supported by Stony Brook University and the Simons Foundation.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 14

Comparison of Led Fluorescent Microscopy and the Gene Xpert MTB/RIF Assay in Diagnosis of Pulmonary and Extrapulmonary Tuberculosis

Objectives: The objective of this study was to evaluate Gene Xpert MTB/RIF Assay and anid fast staining (AFB) for rapid detection of Mycobacterium tuberculosis in specimen of patients suspected of pulmonary tuberculosis (PTB) and extra pulmonary tuberculosis (EPTB).&#x0D; Methods: A comparative cross-sectional study of 400 samples (PTB-365 and EPTB-35) of patients visiting National Tuberculosis Centre (NTC) was conducted from July 2018 to December 2018. Gene Xpert MTB/ RIF Assay, smear microscopy were performed under standard guideline inside biosafety cabinet class II. The result obtained from both the tests were analyzed using SPSS 20.0 software and Excel 2019.&#x0D; Results: Of the total samples, 18% (72/400) and 39% (156/400) were positive by AFB smear microscopy and Xpert MTB/RIF assay respectively. Prevalence of MTB positive was highest in the age group 35-44 years, 33 cases (17.74%) were detected in total, with a male to female ratio of 2.3:1. Pleural fluid, pus, and CSF fluid also yielded positive results with the Gene Xpert MTB/RIF assay accounting 1.28%, 0.64% and 1.28% of MTB positive case respectively. Rifampicin resistance was observed in 1.28% of the cases.&#x0D; Conclusion: The key findings of this study suggest that Gene Xpert test should be implemented as primary diagnostic test for PTB and EPTB.

Ocular Manifestations among Systemic Tuberculosis Cases: A Hospital Based Study from Nepal

Aim: To study the frequency of various ocular manifestations in diagnosed cases of active pulmonary and extra pulmonary tuberculosis in two different major hospitals in Nepal. Method: A hospital based, cross sectional descriptive study was conducted in the National Tuberculosis Centre, Bhaktapur and BP Koirala Lions Center for Ophthalmic Studies (BPKLCOS), Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal during a period of 18 months from February 2010 to August 2011. Diagnosed cases of systemic tuberculosis were evaluated by ophthalmologists for any ophthalmic manifestations. Results: There were 585 cases in the study. 399 (68%) were cases of pulmonary tuberculosis and 186 (32%) were that of extra pulmonary tuberculosis. Ocular manifestations were seen in 2.6% (15 patients) of the study population; 1.25% (6 patients) in cases of pulmonary tuberculosis and 5.37% (9 patients) in extra pulmonary tuberculosis cases. Uveitis (40%) followed by papilloedema (33%) were the two most common ocular manifestations. Of the 25 affected eyes of 15 patients, 2 eyes of patients with choroiditis involving the macular area were legally blind. Majority of the affected cases (67%) had bilateral involvement. Conclusion: Ocular manifestations in tuberculosis vary greatly ranging from mild episcleritis to potentially blinding posterior uveitis, clinical acumen being of great importance in timely diagnosis and treatment so that vision threatening complications can be prevented. Ocular manifestations are more common in extra pulmonary tuberculosis cases.

Factors Associated with Health-care Service Delay in Diagnosis among Tuberculosis Patients in National Tuberculosis and Leprosy Training Centre in Zaria-Nigeria

Factors Associated with Health-care Service Delay in Diagnosis among Tuberculosis Patients in National Tuberculosis and Leprosy Training Centre in Zaria-Nigeria