Negative Pulmonary TB Research Articles

НЕРЕШЕННЫЕ ВОПРОСЫ ХИМИОТЕРАПИИ ТУБЕРКУЛЕЗА У ДЕТЕЙ

Тhe current standards of chemotherapy of childhood TB recommend a specific set of drugs for treatment initiation, an optimal consequence of drug replacement, and treatment duration; however, they cannot recommend the most appropriate alternative for a specific patient in a special situation. The articlescribes two clinical cases illustrating individualized approaches to chemotherapy of childhood TB, which cannot be treated using standard chemotherapy regimens due to various reasons; these approaches have resulted in favourable outcomes of the disease. The individualized approach to treatment of a patient co-infected with HIV/TB excluded rifampicin despite preserved sensitivity to first- and second-line drugs and involved continued antiretroviral therapy (ART) without correction. A patient with advanced sputum negative pulmonary TB without risk of developing MDR received additional second-line drugs and a prolonged intensive phase of treatment up to 8 months. In both cases effective treatment results were achieved without surgical interventions.

Significance of serum copper zinc ratio in smear negative pulmonary tuberculosis cases in Rohilkhand region

Tuberculosis being a highly contagious chronic pulmonary and systemic disease is explicit cause of morbidity and mortality worldwide. There is a direct relationship between zinc and copper in maturation of immunity, Cu/Zn ratio in serum serves to assess levels of oxidative stress in infectious diseases and thus could be used as a diagnostic tool in early diagnosis of smear negative tuberculosis. To study and evaluate significance of serum Cu and Zn concentration and Cu/Zn ratio in smear negative pulmonary tuberculosis patients in comparison to apparently healthy controls. Observational case control study was carried out on patients attending IPD and OPD, Department of Pulmonary Medicine, RMCH. Fifty cases of smear negative PTB patients(group A) was taken and compared with fifty age and sex matched apparently healthy controls(group B). Serum Cu and Zn were estimated in both groups by colorimetric method using EM Chem5Plus V2 Semi autoanalyzer. Data is presented as mean ± SD. Comparison of serum levels of the parameters between the two groups was performed by Student’s‘t’ test. The p value <0.05 was considered as statistically significant. We found serum Zinc to be significantly lower in group I than group II(p<0.00), serum Copper & Cu/Zn ratio to be significantly higher in group I than II(p<0.00). The results suggests that early estimation of serum Cu, Zn & Cu/Zn ratio serves as useful diagnostic marker for smear negative pulmonary TB cases though more extensive multicentric study will provide more insights.

Role of fiberoptic Bronchoscopy in diagnosis of smear negative pulmonary TB

Role of fiberoptic Bronchoscopy in diagnosis of smear negative pulmonary TB

Persistent expression of activation markers on Mycobacterium tuberculosis-specific CD4 T cells in smear negative TB patients.

T cell activation (HLA-DR, CD-38), proliferation (KI-67), and functional (IFN-γ, TNF-α) markers have recently been shown to be useful in predicting and monitoring anti-TB responses in smear positive TB, but previous research did not characterize the activation and proliferation profiles after therapy of smear negative TB. In this study, we used polychromatic flow cytometry to assess selected PPD-specific T cell markers using fresh PBMC of smear negative and positive pulmonary tuberculosis (PTB) patients, recruited from health facilities in Addis Ababa. Levels of activation (HLA-DR, CD38) and proliferation (Ki-67) among total unstimulated CD4 T cells decreased significantly after therapy, particularly at month 6. Similarly, levels of PPD-specific T cell activation markers (HLA-DR, CD-38) were significantly lower in smear positive PTB patients following treatment, whereas a consistent decline in these markers was less apparent among smear negative PTB patients at the sixth month. After six months of standard anti-TB therapy, persistent levels of activation of HLA-DR and CD-38 from PPD specific CD4+T cells in this study could indicate that those markers have little value in monitoring and predicting anti-TB treatment response in smear negative pulmonary TB patients in Ethiopian context.

Pulmonary tuberculosis: An observational study to compare radiographic abnormalities with reference to smear microscopy status

Interpretation of Chest X Ray (CXR) in relation to sputum smear microscopy can be useful in early diagnosis of pulmonary TB. The study aimed to compare the CXR findings in pulmonary TB cases with positive sputum microscopy and negative sputum microscopy. Patients with presumptive pulmonary TB were grouped into smear positive pulmonary TB and smear negative pulmonary TB groups based on CXR and sputum smear microscopy. CXR findings in the two groups were compared using chi square and students- t test. A total of 225 patients with presumptive pulmonary TB were evaluated. Of these, 174 subjects were included in the study: 129 (74.2%) in smear positive pulmonary TB group and 45(25.8%) in smear negative pulmonary TB group. Parenchymal involvement was the most common finding in both smear positive and smear negative groups seen in 118 (91.5%) and 42 (93.3%) subjects, respectively. The area of parenchymal involvement was significantly more in smear positive group as compared to smear negative group (p<0.001). Cavitation was more commonly associated with smear positive group (p=0.005) Nodal enlargement was significantly more common among smear negative subjects (p<.001). CXR could detect 25.8% smear negative pulmonary TB cases. Extensive parenchymal infiltration and cavitation were more commonly associated with smear positive patients whereas nodal involvement was significantly more common in smear negative patients.

Accuracy of GeneXpert in Diagnosis of Smear Negative Tuberculosis: A Cross-Sectional Study

Objective: This study was aimed to compare the diagnostic accuracy of GeneXpert in smear negative as compared to smear positive pulmonary tuberculosis patients.
 Methods: This comparative cross sectional study was undertaken at Health Research Institute (National Institute of Health) TB Research Centre, Pulmonology King Edward Medical University Lahore, Pakistan. A total of 101 patients in each smear negative and positive groups were included. After taking the informed consent a predesigned questionnaire was used to collect the data.
 Results: A total of 202 patients consisting of 94 (46.5%) male and 108 (53.5%) females with mean age of patients as 39.83±18.14 years were included in this study. Highest proportion of 45% patients remained to be in age range of 18-35 years. Culture presented the highest accuracy of 96.1% with sensitivity, specificity and positive predictive value of 95.9%, 100%, and 100% respectively while GeneXpert remained to be 94.6%, 94.9%, 80%, and 99.5% respectively in this study.
 Conclusion: Accuracy of GeneXpert is excellent in diagnosis of smear positive pulmonary tuberculosis patients and very well in diagnosing smear negative pulmonary TB patients and a great addition in early and definite diagnosis of TB and keeps the ability to confirm around 75% smear negative pulmonary tuberculosis.

The Role of High Resolution Computed Tomography in the Diagnosis of Suspected Sputum Smear Negative Active Pulmonary TB

Objective: To evaluate the diagnostic accuracy of high resolution CT (HrCT) for confirmatory evaluation of patients having active pulmonary TB (PTB) taking Acid-fast bacillus (AFB) culture reporting as standard parameter. Methods: In this cross-sectional (validation) analysis we included 200 patients having chest X-rays and clinical evidence of active TB and sputum smear (SS) –ve results. These patients were recruited from March-2019 to December-2019. Data of patients regarding baseline hematology investigations, sputum smear findings, and presenting symptoms was obtained. Sputum samples were obtained again for each patients, and sent for AFB culture reporting. The HrCT was performed in the radiology unit using a 64 slices CT machine. Results: The mean age of included patients was 53.61 ± 11.96 years. There 81 (40.5%) female and 119 (59.5%) male patients. The proportion of true positive (TP) cases was 79 (39.5%), true negative cases was 96 (48.0%), false positive (FP) cases 11 (5.5%) and false negative (FN) was 14 (7.0%). The HrCT was found to have sensitivity of 84.9%, specificity 89.7%, PPV 87.8% and NPV 87.3%. Conclusion: HrCT is a reliable imaging method for accurately diagnosis the active Pul. TB with a good sensitivity and specificity. In our view, HrCT can be used as a firstline imaging evaluation test for diagnosing pul. TB in suspected patients. Keywords: Pulmonary TB, Microbial culture, high resolution CT.Objective: To evaluate the diagnostic accuracy of high resolution CT (HrCT) for confirmatory evaluation of patients having active pulmonary TB (PTB) taking Acid-fast bacillus (AFB) culture reporting as standard parameter. Methods: In this cross-sectional (validation) analysis we included 200 patients having chest X-rays and clinical evidence of active TB and sputum smear (SS) –ve results. These patients were recruited from March-2019 to December-2019. Data of patients regarding baseline hematology investigations, sputum smear findings, and presenting symptoms was obtained. Sputum samples were obtained again for each patients, and sent for AFB culture reporting. The HrCT was performed in the radiology unit using a 64 slices CT machine. Results: The mean age of included patients was 53.61 ± 11.96 years. There 81 (40.5%) female and 119 (59.5%) male patients. The proportion of true positive (TP) cases was 79 (39.5%), true negative cases was 96 (48.0%), false positive (FP) cases 11 (5.5%) and false negative (FN) was 14 (7.0%). The HrCT was found to have sensitivity of 84.9%, specificity 89.7%, PPV 87.8% and NPV 87.3%. Conclusion: HrCT is a reliable imaging method for accurately diagnosis the active Pul. TB with a good sensitivity and specificity. In our view, HrCT can be used as a firstline imaging evaluation test for diagnosing pul. TB in suspected patients. Keywords: Pulmonary TB, Microbial culture, high resolution CT.

Evaluation of BAL versus sputum specimen for the diagnosis of pulmonary tuberculosis in sputum AFB smear negative patients- retrospective study at PIMSR, Gujarat

Aims and Objective: Early diagnosis of smear negative tuberculosis is a significant challenge in control of tuberculosis. The present retrospective study was done on sputum and BAL samples of the same patients for better diagnosis of pulmonary tuberculosis. Material and Methods: A total of 1000 (700 sputum and 300 BAL) specimens were processed to rule out tuberculosis in suspected cases during the period of August 2015 to March 2018. The result of sputum as well as BAL specimens from 300 same patients were examined for ZN staining and GeneXpert tests. The samples of sputum and BAL were processed as per the standard guidelines. Results: Total of 1000 specimens (700 sputum & 300 BAL) were considered for the results. Out of 1000 specimens 300 patients had submitted both sputum as well as BAL specimens. These 300 specimens were analyzed for comparative results. Out of 300 common samples, 109 (36.3%) sputum and 136 (45%) BAL samples are positive by ZN stain. Whereas, Out of 300 common samples, 149 (49.6%) sputum and 170 (56.6%) BAL samples are positive by GeneXpert method. Out of 149 common specimens that were positive by GeneXpert, 5(3.3%) were found to be Rifampicin resistant. Conclusion: Incidence of MDR TB is 3.3% in our hospital. BAL was found to be superior specimen to sputum for the diagnosis of ZN smears negative pulmonary TB. Sensitivity and specificity of GeneXpert is higher than AFB smear microscopy. Keywords: Sputum, BAL, GeneXpert, MDR-TB (Multidrug Resistance Tuberculosis).

Application of CBNAAT (Xpert MTB/RIF assay) in new smear negative pulmonary tuberculosis patients.

Presumptive pulmonary tuberculosis (PTB) patients whose sputum are detected to be smear negative for acid fast bacilli (AFB) present a significant challenge for a treating physician. Initiating these patients on anti tuberculous treatment (ATT) on empirical basis is not a good strategy as many were found to be sputum culture for tuberculosis negative on further evaluation according to many previous studies. In India due to resource limited settings and lack of knowledge about newest diagnostic modalities patients are often initiated only on the basis of characteristic clinical symptoms and chest radiographic abnormalities. This study was conducted to identify the advantage of application of sputum cartridge based nucleic acid amplification test (CBNAAT) in sputum AFB smear negative presumptive pulmonary TB patients. Our study concluded that clinical symptoms and radiological characteristics cannot differentiate TB patients from non-TB patients. Treating patients only on empirical basis would have resulted in unnecessary treatment of 41 patients.

RELATIONSHIP OF INDIVIDUAL CHARACTERISTICS, PHYSICAL HOME ENVIRONMENT AND BEHAVIOR WITH THE INCIDENCE OF PULMONARY TB IN CIJORO PASIR VILLAGE, MUARA VILLAGE EAST CIUJUNG AND WEST RANGKASBITUNG VILLAGE, RANGKASBITUNG SUBDISTRICT, LEBAK REGENCY 2019

This study entitled "Relationship of Individual Characteristics, Physical Environment of the House and Behavior with the incidence of pulmonary TB in Cijoro Pasir Village, Muara Ciujung Timur Village and Rangkasbitung Barat Village, Rangkasbitung District, Lebak Regency in 2019" and behavior with pulmonary TB incidence. The design of this study was cross sectional. Data was analyzed using univariate tests and bivariate tests consisting of chi-square. The total population is 123 The results showed that the incidence of pulmonary TB as many as 37 patients with positive pulmonary TB (60.7%) and 24 patients with negative AFB pulmonary TB and still found a physical environment that did not meet the requirements as many as 42 houses (68.9%), lighting as many as 38 houses (63.3%), humidity of 43 houses (70.5%), BCG immunization 35 people (57.4%), closing mouths of cough / sneezing compilation 38 people (62.3%), phlegm carelessly 32 people (52.5%) and use of eating utensils 39 people (63.9%).

Prevalence of tuberculosis, multidrug resistant tuberculosis and associated risk factors among smear negative presumptive pulmonary tuberculosis patients in Addis Ababa, Ethiopia

BackgroundThe diagnoses of active smear negative PTB, remains difficult. As a result, treatment is often carried out empirically relaying on clinical criteria. The distribution and magnitude of smear negative PTB, smear negative MDR-TB and associated factors in the same day diagnosis strategy are not clearly known in the study area. Therefore, this study aimed to determine the prevalence of TB, MDR-TB and associated risk factors among presumptive smear negative pulmonary tuberculosis patients in Addis Ababa, Ethiopia.MethodsAnalytic cross sectional study design was used. A total of 418 smear negative presumptive pulmonary TB patients were enrolled from selected health facilities since August 01, 2017 to January 5, 2018. Sputum samples were examined by Ziehl Neelsen microscopy, Xpert MTB/RIF assay and Culture. Drug susceptibility testing was performed by line probe assay and BACTEC MGIT 960 system. These laboratory tests were performed in Ethiopian Public Health Institute, National TB Reference Laboratory. Data was analyzed by SPSS Ver.20.ResultsFrom the total of 418 enrolled patients, 27 (6.5%) were Xpert MTB/ RIF and 26 (6.4%) were culture confirmed smear negative PTB patients. The positivity rate among male and female was 10.2 and 3.5% (p = 0.005) respectively. From 26 culture positive isolates 3 (11.54%) were MDR TB; from MDR-TB confirmed isolates 2/23 (8.7%) were among new and 1/3 (33.3%) was among retreatment smear negative presumptive pulmonary TB patients. All Rifampicin resistant smear negative pulmonary TB isolates by Xpert MTB/ RIF assay were found to be MDR TB and 7/26 (26.9%) isolates were INH mono resistant. History of migration found to be a potential factor for developing smear negative pulmonary TB.ConclusionIn this study a significant proportion of smear negative pulmonary TB was diagnosed. Furthermore, a high smear negative multi drug resistant (MDR) TB and other mono drug resistant TB prevalence was confirmed. Due to the limitations of smear microscopy which is used as a primary diagnostic tool, these TB strains are missed to be diagnosed and transmission continues in the community.

Factors associated with unsuccessful treatment outcome in tuberculosis patients among refugees and their surrounding communities in Gambella Regional State, Ethiopia.

BackgroundTuberculosis (TB) is a leading cause of public health challenges among immigrant refugees and their surrounding communities in developing countries. Evaluating the treatment outcome of TB patients is one of the key indicators to understand the performance of TB control program. Hence, this study aims to assess profile, treatment outcome and factors associated with unsuccessful outcome of TB patients treated under the TB control program among refugees and their surrounding communities (SCs) in Gambella Regional State, Ethiopia.MethodologyRetrospective study was conducted in the health facilities of refugee and their SCs in Gambella Regional State from March 1 to May 30, 2017. Demographic and related data of all TB patients registered in TB Control Program between September, 2008 and October, 2017 in health facilities of refugee and the SCs was extracted using data extraction format. Eight years trend of TB, treatment outcome and factors associated with unsuccessful outcome among refugees and the SCs were computed using SPSS version 20.0 software.ResultA total of 886 refugees and 3284 SCs TB patients, registered for anti TB treatment in the last eight years, were evaluated in the study. The trend of all forms of TB is progressively increasing among refugees contrary to the SCs in the course of the study period (X2 trend = 207.7; P<0.0001). Smear positive pulmonary TB (PTB+) was found to be predominant (57.6%) TB form in refugees while smear negative pulmonary TB (PTB-) (44.8%) is in the SCs (X2 = 185.834; P<0.0001). There was also significant difference in the treatment outcome (X2 = 170.915; P<0.0001). Mean treatment success rate was 74.2% and 88.1% for refugees and the SCs, respectively (X2 = 92.887; P<0.0001). The study also revealed that the risk of unsuccessful TB treatment outcome was significantly higher among refugee (AOR = 2.17; 95% CI: 1.69–2.77), retreated cases (AOR = 1.53; 95% CI: 1.07–2.17), patients aged between 35–44 years (AOR = 1.38; 95% CI: 1.0–1.91), and greater than 44 years old (AOR = 1.77; 95% CI: 1.28–2.44), and patients with extra pulmonary TB (EPTB) form (AOR = 1.34; 95% CI: 1.04–1.73) compared to their counterparts. Patient coming from rural area (AOR = 0.77; 95% CI: 0.62–0.97), who are female (AOR = 0.76; 95% CI: 0.63–0.91) and TB/HIV non-infected (AOR = 0.63; 95% CI: 0.51–0.77) were more likely to be successfully treated.ConclusionThe study confirmed that there was low treatment success rate among refugees compared to the SCs. Being refugee, retreated case, patient’s age ≥35 years old, EPTB form, gender, rural patient address and HIV status were predictor factors for unsuccessful treatment outcome. Hence, the study urges the need for strengthened TB prevention program among refugees with due consideration of identified predictor factors to prevent the potential effect of hosting refugee to the SCs and the nations at large.

Phenotypic and functional heterogeneity of peripheral \u03b3\u03b4 T cells in pulmonary TB and HIV patients in Addis Ababa, Ethiopia

BackgroundPrevious studies reported HIV infection alters the distribution and function of γδ T cells and their subsets. γδ T phenotypes in healthy and diseased individuals has received little attention in Ethiopia. We conducted this study to analyze the distribution of γδ T cells, the subsets and levels of expression of activation (CD38), exhaustion or anergy (CD95, PD1), adhesion (N-CAM/CD56 and CD103), among HIV and TB infected patients.MethodThe distributions of total γδ T cells, Vδ1 and Vδ2 T cells subsets were analyzed in clinical samples collected from asymptomatic HIV, pulmonary TB patients and apparently healthy controls. Multicolor flow cytometry and IFN-γ ELISA were used to assess surface markers and functional responses of Vδ2 T cells to isopentenyl pyrophosphate stimulation, respectively.ResultA total of 52 study participants were enrolled in this study, 22 HIV + TB-, 10 HIV-TB+ and 20 healthy controls. No significant differences were observed in the distribution of total γδ T cells and in the proportion of Vδ1 subsets in all study groups, though slightly higher proportions were observed in HIV + TB- patients for the latter, of borderline statistical significance (p = 0.07). However, the proportion of Vδ2 T cells, as well as the IFN-γ response to IPP stimulation, was significantly reduced in HIV + TB- patients compared to healthy controls (p < 0.002). Expression of the activation marker CD38 (p < 0.001) and adhesion marker CD103 (αEβ7) were significantly higher in the Vδ1 T cell subset among both HIV + TB- (p = 0.013) and HIV-TB+ (p = 0.006) patients compared to healthy controls. Similarly, exhaustion markers, CD95 and PD1, were significantly higher in these two T cell subsets among both HIV + TB- and HIV-TB+ patients (p < 0.01). Interestingly, we also observed an increased proportion of effector memory (CD45RA-CD27-) and effector cytotoxic (CD45RA + CD27-) Vδ2 T cell subsets in HIV negative pulmonary TB patients.ConclusionIn sum, HIV infection was associated with an increase in Vδ1 and a decrease in the function and frequencies of Vδ2 T cells. Moreover, increased effector Vδ2 T cells were observed among HIV negative pulmonary TB patients suggesting a potential role of these T cells in the host response to TB.

Tuberculosis Among Young People on Rise in Sri-Lanka (An Analysis of Trend and Associated Factors)

Introduction: A descriptive cross sectional study was carried out in 5 randomly selected districts i.e Gampaha, Kandy, Badulla, Nuwara Eliya and Ratnapura during the period of March to September 2014. The general objective of the study was to describe the trend of TB among young population over past 6 years in Sri Lanka and to determine contributory factors associated with TB among young population.Methodology: The study was carried out in two stages. The first stage was analysis of the trend of TB over the 6 year period of 2008-2014. The analysis of the trend was carried out using the existing secondary data at the Medical Records Division of the National Programme for Tuberculosis Control and Chest Diseases (NPTCCD). Trend was analyzed for new cases of TB patients of 15--34 years of age and separately for 15-24 and 25-34 age groups and for each type of new TB cases. The second stage was a descriptive cross sectional study which was carried out to determine the associated factors. All the patients (new/ retreatment)in age group of 15-34 years and registered at the selected district chest clinics with confi rmed TB were selected as the study subjects. Operational Definitions were used to identify confi rmed TB cases ie, Sputum smear positive TB, smear negative pulmonary TB and Extra pulmonary TB. The data were collected using a pre tested interviewer administered questionnaire by the District Tuberculosis Control Officers attached to the relevant District Chest Clinics.Result: The main findings of the study were, The two peaks of TB incidence were observed in the trend across age groups and first one was in the age group of 25-34 years second peak in the age group of 45-54.Overall trend of TB in the country is more towards the older age groups (over 45 years), but shift to younger age groups were observed in 15 out of 16 districts in the country. A total of 223 patients were included in the descriptive study. The highest proportion (34%) of study population was from the district of Gampaha while least proportion (10%) of it was from Nuwara Eliya. Nearly 53% of the study population was above 25 years of age with the sex ratio of 1:1. A majority (68%) of the study population was Sinhalese while nearly 70% of the study population has passed the O/L, A/L, Diploma or a degree. About one third of the study population was unemployed. Nearly half (50.4%) of the study population was having monthly income of about Rs. 20,000.00 or above. 31% of the study population were current or past alcohol consumers and 29% were smokers and 7% of the study population were current or past cannabis consumers. Majority (77%) of the study population were under-nourished while 14% of them were less than 15 kg/m2. Nearly three fourth (72%) of the study population have been diagnosed by a consultant. Statistically signifi cant associations were found between the age category and more than 3 family members (χ2=5.063, df=1, p&lt;0.017), ethnicity (χ2=4.229, df=1, p&lt;0.04), employment category (χ2=13.859, df=3, p&lt;0.003). Statistically significant associations were not found between the age category and residing district (χ2=5.962, df=4, p&lt;0.202) and type of house (χ2=1.875, df=1, p&lt;0.110),Conclusion: The study recommends more detailed assessment regarding the dietary habits of the patients, Emphasis on community awareness regarding nutritional aspects. Improving the nutritional status among adolescents and young adults. Modification of risky life style factors, Improvement of socio economic status through enhancement of financial stability, minimizing overcrowding and improvement of housing conditions and involving of non NTP health care providers and health professionals for TB diagnosis and management through capacity building and awareness. SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, Vol. 14, No. 2, 2017, Page: 18-30

Factors Affecting Treatment Outcome of Tuberculosis among Tuberculosis Patients in West Ethiopia

Background: Tuberculosis is a life threatening disease caused by mycobacterium tuberculosis. In developing countries the incidence of tuberculosis has been increasing steadily since the 1990s, particularly in African countries. Several European countries have lately reported a slight increase in tuberculosis, but these are mostly related to immigrants from high-incidence countries.Objective: To assess the treatment outcomes of tuberculosis and its associated factors among tuberculosis patients on anti-tuberculosis therapy in Nekemte Referral Hospital, West Ethiopia.Methods: A four years retrospective cross-sectional study was used and all patients’ information that fulfilled the inclusion criteria was retrieved from records of patients with basic information for all registered patients. We analyzed the records of 315 tuberculosis patients who had known outcome in Nekemte Referral Hospital from September 2012-August 2016.Results: From the total of 315 patients who had known treatment out come in Nekemte Referral Hospital, tuberculosis type was categorized as smear positive pulmonary TB in 68(21.5%), smear negative pulmonary TB in 107(34.0%), and extra pulmonary in 140(44.4%) cases. Records of the 315 TB patients showed that 54(17.01%) were cured, 206(65.4%) completed treatment, 24(3.5%) had treatment failure, 11(3.5%) defaulted, 20(6.3%) were died. The overall treatment success rate of the TB patients was 82.5%. Age ≥ 45 years (AOR=7.1, 95% CI=1.5-34.3, p=0.014), smear negative PTB (AOR=3.4, 95%, CI=1.5-9.5, P=0.023) and retreatment cases (AOR=12.0, 95%, CI=4.2-34.4, P<0.001) were significantly associated with unsuccessful treatment outcome.Conclusion: Successful treatment outcome of TB patients was below standard. To improve treatment outcome among TB patients health education on the importance of TB treatment and the consequences of poorly treated TB have to be provided to patients during their follow up.

The burden of HIV on Tuberculosis patients in the Volta region of Ghana from 2012 to 2015: implication for Tuberculosis control

BackgroundThe impact of HIV on TB, and the implications for TB control, has been acknowledged as a public health challenge. It is imperative therefore to assess the burden of HIV on TB patients as an indicator for monitoring the control efforts of the two diseases in this part of the world. This study aimed at determining the burden of HIV infection in TB patients.MethodsWe conducted a retrospective review of TB registers in five districts of the Volta Region of Ghana. Prevalence of TB/HIV co-infection was determined. Bivariate and multivariate logistic regression were used to identify the predictors of HIV infection among TB patients and statistical significance was set at p-value <0.05.ResultsOf the 1772 TB patients, 1633 (92.2%) were tested for HIV. The overall prevalence of TB/HIV co-infection was (18.2%; 95% CI: 16.4–20.1). The prevalence was significantly higher among females (24.1%; 95%CI: 20.8–27.7), compared to males (15.1%; 95% CI: 13.1–17.4) (p < 0.001) and among children <15 years of age (27.0%; 95% CI: 18.2–38.1), compared to the elderly ≥70 years (3.5%; 95% CI: 1.6–7.4) (p < 0.001). Treatment success rate was higher among patients with only TB (90%; 95% CI: 88.1–91.5) than among TB/HIV co-infected patients (77.0%; 95% CI: 71.7–81.7) (p < 0.001). Independent predictors of HIV infection were found to be: being female (AOR: 1.79; 95% CI: 1.38–2.13; p < 0.001); smear negative pulmonary TB (AOR: 1.84; 95% CI: 1.37–2.47; p < 0.001); and patients registered in Hohoe, Kadjebi, and Kpando districts with adjusted odds ratios of 1.69 (95% CI: 1.13–2.54; p = 0.011), 2.29 (95% CI: 1.46–3.57; p < 0.001), and 2.15 (95% CI: 1.44–3.21; p < 0.001) respectively. Patients ≥70 years of age and those registered in Keta Municipal were less likely to be HIV positive with odds ratios of 0.09 (95% CI: 0.04–0.26; p < 0.001) and 0.62 (95% CI: 0.38–0.99; p = 0.047) respectively.ConclusionTB/HIV co-infection rate in five study districts of the Volta region is quite high, occurs more frequently in female patients than males; among smear negative pulmonary TB patients, and children <15 years of age. Findings also demonstrate that HIV co-infection affects TB treatment outcomes adversely. Strengthening the TB/HIV collaborative efforts is required in order to reduce the burden of co-infection in patients.

Profile and treatment outcomes of patients with tuberculosis in Northeastern Ethiopia: A cross sectional study

Data on the epidemiology of tuberculosis and its treatment outcomes were incomplete in the study area and this study was done to fill this gap. Institution based cross sectional study was conducted from January 2011 to December 2014. A total of 949 TB patients who were on treatment in North Eastern Ethiopia, Eastern Amhara region were included. Data was analyzed using SPSS version 20. Frequency, percentages and means were used to present data. To assess the associations of treatment outcomes with sex, age, type of TB and human immunodeficiency virus (HIV), logistic regression was used. The proportion of smear positive and negative pulmonary TB, and extra pulmonary TB were 187/949 (19.7%), 322/949 (33.9%) and 440/949 (46.4%), respectively. Treatment success rate was 853/949 (89.9%). Smear positive pulmonary TB and TB/HIV co-infections were significantly associated with unsuccessful treatment outcome, P≤ 0.002. Extra pulmonary TB was the most prevalent types of TB followed by smear negative pulmonary TB. Treatment success rate was above the WHO target of 85%. The causes for the high proportion of smear negative PTB and EPTB should be further investigated. Special emphasis should be put on smear positive PTB patients and TB/HIV co-infected patients to decrease unsuccessful treatment outcome and TB transmissions.

HIV and Tuberculosis: the impact goes beyond those infected with HIV/AIDS

1 Medical officer, Department of Medicine, NMCH, Govt Medical College Kota, Rajasthan, India 2 Assistant Professor, Department of Medicine, NMCH, Govt Medical College Kota, Rajasthan, India 3 Professor, Department of Medicine, NMCH, Govt Medical College Kota, Rajasthan, India 4 Senior Professor, Department of Medicine, NMCH, Govt Medical College Kota, Rajasthan, India Corresponding Author Dr Sanjay Kumar Garg House no. 6, Suman Vihar, Bundi Road, Kunhari, Kota Rajasthan, India Pincode-324008 Emaildoctorsanjaygarg@yahoo.com, Mobile – +91 9414331357 Abstract Background & objectives: Tuberculosis is said to be one of the commonest opportunistic infection in patients with HIV/ AIDS. In this study the clinical profile of tuberculosis in patient with HIV infection /AIDS and to study the pulmonary and extra pulmonary tuberculosis involvement and clinical profile in HIV infection/AIDS subjects. Methods: HIV sero-positive patients with symptoms suggestive of pulmonary and extra pulmonary tuberculosis, attending the Outpatient Departments and indoor at Department of Medicine, Govt. Medical College, Kota. Results: fever (97.1%), weight loss (85.7%) cough (80%), pallor (68.5%) mouth ulcer (41.4%) and lymphadenopathy (33%). Incidence of both Pulmonary and extra pulmonary tuberculosis were almost same (45.71%).Among extra pulmonary tuberculosis, abdominal TB was (18.57%). Infiltrative lesions were (54.28%) on chest x-ray. Sputum positivity was seen only in 31.25% of patients. Mean CD4 counts was 133.95+141.89 cells/ μl. Most of the patients (78.57%) had CD4 counts 50 cells/μl. Conclusionmost common manifestation of TB in HIV infected patients were sputum negative pulmonary TB. A high proportion of cases with extra pulmonary TB were also found. There is an urgent need to strengthen the information, education and expand the ART services to meet the requirement of early testing and treatment initiation in patients co-infected with HIV-TB. KeywardsHIV/TB, AIDS, Tuberculosis, Extrapulmonary TB.

C-reactive protein, Neopterin and Beta2 microglobulin levels pre and post TB treatment in The Gambia.

BackgroundTuberculosis is one of the leading causes of morbidity and mortality in developing countries. Analysis of the host immune response may help with generating point-of-care tests for personalised monitoring. Thus, the aim of this study was to assess the relationship between immune activation markers: C-reactive protein (CRP), Beta2 microglobulin (B2M) and Neopterin, disease severity prior to treatment and response to therapy in adult pulmonary TB patients.MethodsHIV negative adult pulmonary TB index cases (n = 91) were recruited from the TB clinic at MRC, The Gambia. Plasma samples were collected at enrolment and at 2 and 6 months following TB treatment initiation. An enzyme linked immunosorbent assay (ELISA) was performed for evaluation of CRP, B2M and Neopterin levels and correlated with clinical and microbiological parameters including strain of infection. Disease severity was determined using Chest X-ray (CXR), Body Mass Index (BMI) and sputum smear grade.ResultsPlasma levels of all three markers were highly elevated in patients at recruitment and declined significantly during TB therapy. No correlation with disease severity was seen at recruitment. CRP showed the most significant decrease by 2 months of treatment (p < 0.0001) whereas levels of B2M and Neopterin showed little change by 2 months but a significant decrease by 6 months of treatment (p = 0.0002 and p < 0.0001 respectively). At recruitment, B2M levels were significantly higher in subjects infected with Mycobacterium africanum (Maf) compared with those infected with Mycobacterium tuberculosis sensu stricto (Mtb) (p = 0.0075). In addition, while CRP and Neopterin showed a highly significant decline post-treatment regardless of strain (p < 0.0001 for all), B2M showed differential decline depending on strain (p = 0.0153 for Mtb and p = 0.0048 for Maf) and levels were still significantly higher at 6 months in Maf compared to Mtb infected subjects (p = 0.0051).ConclusionOur findings suggest that activation markers, particularly CRP, may have a role in identifying good response to TB therapy regardless of the strain of infection and could be further developed as point-of-care tests. In addition, B2M levels may allow differentiation between Mtb and Maf-infected subjects.

Impact of CD4 Count on sputum smear for AFB in HIV-TB Co infection

Background: Human immunodeficiency virus (HIV) infection is a major threat in the world population and in the control of tuberculosis in developing countries. HIV-TB co infected patients with CD4 counts above 200 cells/cu µl, are likely to have typical symptoms and most of the sputum shows positive for acid fast bacilli (AFB). Patient withCD4 count less than 200 are with high risk of getting (Tuberculosis) TB, but diagnosis is difficult as there is more chances of sputum becoming negative, which requires sputum culture for diagnosis of (TB). Although sputum smear negativity is high in most cases of dual infection, particularly in patients with low immunity, it is an essential component in the diagnosis of tuberculosis in countries like India. Methodology: A cross sectional study of 50 HIV-TB patients admitted to tertiary care hospital were studied for correlation between CD4 count and sputum smear results. Results: 50 HIV-TB patients studied for a period of 1 year. Majority were in the age group of 30-40 years 20 (78%). In the study 29 (58%) were males and 21(42%) were females. The common presentations were cough 48 (96%), fever 44 (88%), weight loss 42(84%) and diarrhoea 25(50%). Mean CD4 count being 146.6±88. Most patients had CD4 count < 200 cells/cu µl. Mean CD4 count in sputum positive TB was 254.8±77.3 and in sputum negative TB was 97.2±33.8. Conclusion: Patients with CD4 count > 200cells/cuµl are likely to have sputum positive pulmonary TB and typical presentations. Patients with CD4count < 200cells/cuµl are more of sputum negative pulmonary TB with atypical presentations which poses diagnostic difficulty and needs newer diagnostic tests. Key words: HIV-TB co infected patients, CD4 count, Sputum for AFB