Past History Of Tuberculosis Research Articles

HIV Care in Ukrainian Migrants in Two European Countries: All the Same?

Introduction: War in Ukraine prompted an enormous refugee influx into Europe, including approximately 4200 people with HIV. The unique healthcare features of Ukrainian refugees living with HIV were compared between two infectious disease departments in Bonn, Germany, and Szczecin, Poland. Methods: This is a retrospective study on 161 people living with HIV (PLWH) refugees from Ukraine seeking care in Bonn (n = 30) and Szczecin (n = 131) between April 2022 and May 2023. Demographic, virologic, immunologic, and coinfection data were analyzed. Results: The majority of the studied individuals were female: 64% (n = 84) in Szczecin and 60% (n = 18) in Bonn. The main HIV transmission mode was heterosexual sex in 73.5% (n = 114). All were on combined antiretroviral therapy (cART) on arrival, primarily on the TLD regimen (TDF/3TC/DTG) (68.4%, n = 106). In Germany, cART was most frequently switched to BIC/TAF/FTC in 83.4% (n = 25); in Poland, the most common combination was TDF/FTC + DTG (58%, n = 76). A prevalence of replicating hepatitis C was in 11.7% (n = 15), and that for chronic hepatitis B (HBV) was in 4.7% (n = 4). History of past tuberculosis was reported in 16.9% (n = 14, Poland, and n = 7, Germany). Follow-up after 6 months showed immunological reconstitution with a mean increase of CD4+ of 10 (IQR: -69.5-120.5) cells/µL in Poland and 51.5 (IQR: -22.5-135.5) cells/µL in Germany; p = 0.04. Virologic suppression (<40 HIV-RNA/mL) was high in care entry (n = 62; 98%) for Poland, and n = 26 (92.6%) for Germany, and suppression was achieved in the majority of patients in the 6-month control (89.7% in Poland vs. 95.7% in Germany). Conclusions: Health challenges posed by war migration extend beyond HIV to coinfections as HBV, HCV, and tuberculosis give an indication for a broader search for coinfections, often less common in the new country.

Accuracy of chest x-ray screening of silica-exposed miners for tuberculosis.

The World Health Organization recommends systematic chest X-ray (CXR) screening for tuberculosis (TB) in silica-exposed workers. However, evidence on the accuracy of CXR screening in such populations is lacking. To measure the accuracy of CXR screening for active TB in silica-exposed miners, in a population with a high prevalence of silicosis, post-TB lung disease and HIV. A secondary analysis of data from a miner screening programme in Lesotho was undertaken. We measured the performance of CXR (in participants with and without cough) for 'abnormalities suggestive of TB' against Xpert MTB/RIF (Xpert). The sample size was 2572 and positive Xpert prevalence was 3%. CXR alone had high sensitivity (0.93, 95% confidence interval [CI] 0.87-0.99), but low specificity (0.41, 95% CI 0.39-0.42). Requiring cough and a positive CXR increased specificity (0.79, 95% CI 0.77-0.81), resulting in reduced sensitivity (0.41, 95% CI 0.30-0.52). There was no difference in CXR accuracy by HIV status. However, specificity was markedly reduced in the presence of silicosis (from 0.70, 95% CI 0.68-0.72, to 0.03, 95% CI 0.02-0.04) or past TB history (from 0.59, 95% CI 0.56-0.62 to 0.27, 95% CI 0.25-0.29). Throughout, positive predictive value remained very low (5%) and negative predictive value very high (99%). CXR screening accurately identifies TB-negative CXRs in this population, but post-TB lung disease and silicosis would result in a high proportion of Xpert-negative referrals and an increased risk of unneeded empirical treatment. Adapted screening algorithms, practitioner training and digital access to previous mining CXRs are needed.

Evaluation of a population-wide, systematic screening initiative for tuberculosis on Daru island, Western Province, Papua New Guinea

BackgroundA population-wide, systematic screening initiative for tuberculosis (TB) was implemented on Daru island in the Western Province of Papua New Guinea, where TB is known to be highly prevalent. The initiative used a mobile van equipped with a digital X-ray device, computer-aided detection (CAD) software to identify TB-related abnormalities on chest radiographs, and GeneXpert machines for follow-on diagnostic testing. We describe the results of the TB screening initiative, evaluate its population-level impact and examine risk factors associated with TB detection.MethodsThrough a retrospective review of screening data, we assessed the effectiveness of the screening by examining the enrolment coverage and the proportion of people with TB among screened subjects. A cascade analysis was performed to illustrate the flow of participants in the screening algorithm. We conducted univariate and multivariate analyses to identify factors associated with TB. Furthermore, we estimated the number of additional cases detected by the project by examining the trend of routine TB case notifications during the intervention period, compared to the historical baseline cases and trend-adjusted expected cases.ResultsOf the island’s 18,854 residents, 8,085 (42.9%) were enrolled and 7,970 (98.6%) had chest X-ray interpreted by the CAD4TB software. A total of 1,116 (14.0%) participants were considered to have abnormal CXR. A total of 69 Xpert-positive cases were diagnosed, resulting in a detection rate of 853 per 100 000 population screened. 19.4% of people with TB had resistance to rifampicin. People who were in older age groups (aOR 6.6, 95%CI: 1.5–29.1 for the 45–59 age group), were severely underweight (aOR 2.5, 95%CI:1.0-6.1) or underweight (aOR 2.1, 95%CI: 1.1–3.8), lived in households < 5 people (aOR 3.4, 95%CI:1.8–6.6) and had a past history of TB (aOR 2.1, 95%CI: 1.2–3.6) were more likely to have TB. The number of bacteriologically confirmed TB notified during the intervention period was 79.3% and 90.8% higher than baseline notifications and forecasted notifications, respectively.ConclusionThe screening project demonstrated its effectiveness with the high Xpert-positive TB prevalence among the participants and by successfully yielding additional cases of bacteriologically confirmed TB including rifampicin-resistant TB. The results and lessons learnt from the project should inform future TB screening initiatives in Papua New Guinea.

Breakthrough SARS-CoV-2 infection and disease flares in patients with rheumatoid arthritis: result from COVAD e-survey study.

COVID-19 has been suggested as a possible trigger of disease flares in patients with rheumatoid arthritis (RA). However, factors associated with disease flares remain unknown. This study aimed to identify factors associated with breakthrough infection (BIs) and disease flares in patients with RA following COVID-19. We analysed data from RA patients who participated in the COVID-19 vaccination in autoimmune diseases (COVAD) study. Demographic data, patient-reported outcomes, comorbidities, pharmacologic treatment and details regarding disease flares were extracted from the COVAD database. Factors associated with disease flare-ups were determined by multivariate logistic regression analysis. The analysis comprised 1928 patients with RA who participated in the COVAD study. Younger age, Caucasian ethnicity, comorbidities with obstructive chronic pulmonary disease and asthma were associated with COVID-19 breakthrough infection. Moreover, younger age (odds ratio (OR): 0.98, 95% CI 0.96-0.99, p < 0.001), ethnicity other than Asian, past history of tuberculosis (OR: 3.80, 95% CI 1.12-12.94, p = 0.033), treatment with methotrexate (OR: 2.55, 95% CI: 1.56-4.17, p < 0.001), poor global physical health (OR: 1.07, 95% CI 1.00-1.15, p = 0.044) and mental health (OR: 0.91, 95% CI 0.87-0.95, p < 0.001) were independent factors associated disease flares in patients with RA. Our study highlights the impact of socio-demographic factors, clinical characteristics and mental health on disease flares in patients with RA. These insights may help determine relevant strategies to proactively manage RA patients at risk of flares.

Bronchiectasis-COPD Overlap Syndrome (BCOS) among the Nepalese Patients: Emerging disease from a developing country

Background and objective: There is no clearly specified diagnostic criteria to identify BCOS in Nepalese context. So this first, observational cross-sectional study was conducted to determine the current situation, main clinical practices, and features of BCOS in Nepalese patients, exploring its clinical trajectory and severity. Methods: This is a hospital based descriptive cross-sectional study conducted, where patients presenting with respiratory symptoms complex were subsequently enrolled by purposive sampling. Descriptive Statistics was calculated using Absolute and Relative Frequencies for categorical variables and mean and standard deviation for numerical ones. P-value of &lt;0.05 was considered significant. Results: Out of 236 patients of Respiratory Symptoms Complex, prevalence of BCOS was 22.03%. 57.7% were males with mean age of 67.8 years. Among BCOS cohorts, 92.3% were smokers and 73 % had significant exposure to indoor air pollution. 63.5% of the patients had past history of tuberculosis and cardio-metabolic co-morbidities were seen in 34.6% of the patients. The most frequent symptoms were cough and shortness of breath and the commonest sign was bilateral basal coarse crackles. Frequent exacerbations were present in 25% of the patients and PFT revealed obstructive pattern in 71% of the BCOS patients with a mean FACED score of 3.94±1.62. Conclusion: Among the patients presenting with Respiratory symptom complex in Nepal, BCOS is common and is more prevalent in elderly male, having a high co-morbidities, usually following a course of slowly progressive breathlessness, with higher incidence of exacerbation and poorer functional outcome.

Multiple Intracranial Tuberculomas In Immunocompetent Patient: An Uncommon Primary Manifestation Of Central Nervous System Tuberculosis (CNS TB)

Tuberculosis (TB) is a serious yet potentially-curable health issue among most developing countries including Pakistan. We report the case of an immunocompetent patient having multiple intracranial tuberculomas without evidence of meningitis which is an uncommon manifestation of CNS tuberculosis. A 50-year old man presented with 5 episodes of tonic-clonic generalized fits for 1 day, right sided body weakness for 2 weeks, generalized headaches and intermittent low-grade fever for 1 month. No contact or past history of tuberculosis was reported. On neurologic examination, there was hypertonia, exaggerated deep tendon reflexes and power of 3/5 in both right upper limb and right lower limb with a right plantar extensor response. CT scan (Brain) showed hyperdense areas in left frontal and temporal lobes with surrounding vasogenic edema. ESR was raised at 86 mm/hour. CSF analysis demonstratedRBC 0 cells/uL, WBC 783 cells/uL with 100% lymphocytes, Glucose 39 mg/dl andProtein 81 mg/dl with negative organism microscopy onAFB and Giemsa staining. However, CSF was positive for GeneXpert-PCR-MTB but drug resistance was not detected to rifampicin. Brain MRI with FLAIR demonstrated multiple disseminated, rim enhancing lesions with perilesional edema in bilateral cerebral hemispheres, thalami, left basal ganglia, medulla oblangata and cerebellum having no meningeal enhancement. Workup for immune-suppression was normal. A diagnosis of multiple intracranial tuberculomas was established and Anti-tubercular therapy was commenced. He was asymptomatic and taking ATT with good compliance having no adverse affects by 6-week follow up.

Prevalence and factors associated with tuberculosis infection in India

BackgroundThe risk of tuberculosis (TB) disease is higher in individuals with TB infection. In a TB endemic country like India, it is essential to understand the current burden of TB infection at the population level. The objective of the present analysis is to estimate the prevalence of TB infection in India and to explore the factors associated with TB infection. MethodsIndividuals aged > 15 years in the recently completed National TB prevalence survey in India who were tested for TB infection by QuantiFERON-TB Gold Plus (QFT-Plus) assay were considered for this sub-analysis. TB infection was defined as positive by QFT-Plus (value >0.35 IU/ml). The estimates for prevalence, prevalence ratio (PR) and adjusted risk ratio (aRR) estimates with 95% confidence intervals (CIs) were calculated. ResultsOf the 16864 individuals analysed, the prevalence of TB infection was 22.6% (95% CI:19.4 −25.8). Factors more likely to be associated with TB infection include age > 30 years (aRR:1.49;95% CI:1.29–1.73), being male (aRR:1.26; 95%CI: 1.18–1.34), residing in urban location (aRR:1.58; 95%CI: 1.03–2.43) and past history of TB (aRR:1.49; 95%CI: 1.26–1.76). ConclusionAbout one fourth (22.6%) of the individuals were infected with TB in India. Individuals aged > 30 years, males, residing in urban location, and those with past history of TB were more likely to have TB infection. Targeted interventions for prevention of TB and close monitoring are essential to reduce the burden of TB in India.

Clinical and Radiological Parameters to Discriminate Tuberculous Peritonitis and Peritoneal Carcinomatosis.

It is challenging to differentiate between tuberculous peritonitis and peritoneal carcinomatosis due to their insidious nature and intersecting symptoms. Computed tomography (CT) is the modality of choice in evaluating diffuse peritoneal disease. We conducted an ambispective analysis of patients suspected as having tuberculous peritonitis or peritoneal tuberculosis between Jan 2020 to Dec 2021. The study aimed to identify the clinical and radiological features differentiating the two entities. We included 44 cases of tuberculous peritonitis and 45 cases of peritoneal carcinomatosis, with a median age of 31.5 (23.5-40) and 52 (46-61) years, respectively (p ≤ 0.001). Fever, past history of tuberculosis, and loss of weight were significantly associated with tuberculous peritonitis (p ≤ 0.001, p = 0.038 and p = 0.001). Pain in the abdomen and history of malignancy were significantly associated with peritoneal carcinomatosis (p = 0.038 and p ≤ 0.001). Ascites was the most common radiological finding. Loculated ascites, splenomegaly and conglomeration of lymph nodes predicted tuberculous peritonitis significantly (p ≤ 0.001, p = 0.010, p = 0.038). Focal liver lesion(s) and nodular omental involvement were significantly associated with peritoneal carcinomatosis (p = 0.011, p = 0.029). The use of clinical features in conjunction with radiological findings provide better diagnostic yields because of overlapping imaging findings.

Assessment of peripheral lymph node tuberculosis: a prospective study of 24 cases

Abstract Introduction: Tubercular lymphadenitis which comes under Extra-pulmonary Tuberculosis (EPTB) has been affecting mankind since ancient times. Peripheral lymph node involvement is the commonest form of EPTB among which cervical lymph nodes are most frequently affected. Objectives: The aim of this study was to evaluate the demographic, clinical characteristics and treatment outcomes of peripheral lymph node Tuberculosis cases in a rural tertiary health care centre. Methods: The study was conducted prospectively at Prathima Institute of Medical Sciences, Nagunur, Karimnagar between January 2021 to August 2022. Pathologically confirmed cases of lymph node Tuberculosis were assessed and followed up. Results: 24 cases of lymph node TB were included with 83.3% females and 16.6% males (p=0.02) with a mean age of 32.6 ± 15.24 years. The mean age among males was 37 ± 15.59 years and among females was 31.75 ± 15.24 years. 58.3% were from rural areas. All of them presented with a history of swelling, 37.5% had a fever, 50% had a loss of appetite and 54.1% had a loss of weight. 8% had a past history of tuberculosis. 79.1% had cervical swelling and 20.8% had axillary swelling. 83.3% had multiple lymph nodes and 33.3% had lymph node matting. Three cases were lost to follow-up, 79% improved with standard anti-Tuberculosis treatment (ATT) and one case died during treatment. Conclusion: Lymph node TB is still prevalent in TB endemic countries and has to be considered first in the differential diagnosis of peripheral lymph node swellings.

Assessment of risk factors associated with drug-resistant tuberculosis in pulmonary tuberculosis patients

IntroductionTuberculosis remains a global health problem worldwide and the risk progression of Tuberculosis to Drug Resistant Tuberculosis is influenced by various factors. These include immunocompromised status, past history of tuberculosis, life style and nutritional level. Hence, identifying the population at risk of multidrug-resistant tuberculosis is essential and may help in developing appropriate case-finding strategies. Therefore, the present study was designed to study the contributing risk-factors associated with Drug resistant Tuberculosis. Materials and methodsIn this prospective observational study, we assessed 189 Pulmonary tuberculosis diagnosed patients during the period of 2 years at government recognized tertiary care centers. Data was collected from all these patients checked to investigate risk factors associated with Drug resistant tuberculosis development by multivariant analysis. ResultsOf the 189 participants, 36 were diagnosed with drug resistant tuberculosis and 153 with drug sensitive tuberculosis. Factors associated with drug resistant tuberculosis include low-weight (OR 8.50; p = 0.0008430991), low-BMI (p = 0.0000527166), lower economic status (OR-2.1351; p = 0.048608696) and tobacco (OR-4.5192; p = 0.0023003189) were found clinically and statistically significant in development of drug resistant tuberculosis. Binary logistic regression was performed to ascertain the effects of various statistically significant factors. Drug resistant tuberculosis patients were 7.77 times more likely to be tobacco users than drug sensitive tuberculosis. ConclusionsOur study suggests that, there is a compelling and urgent need for increasing public awareness, initiating better nutrition and food programs, regular screening, and better management & control of MDR-TB.

Factors affecting tuberculosis treatment outcome among newly diagnosed tuberculosis patients – A longitudinal study

BackgroundTuberculosis disease epidemiology is closely related to social and economic conditions which make its prevention, control and cure challenging. Early diagnosis and adequate treatment will help to prevent various tuberculosis related morbidities. Factors such as adverse effects of drugs, transportation cost, family support, distance to the treatment center, personal habits, co morbid conditions, and patients’ multiple obligations concerning to their employment, family and society have an impact on the treatment outcomes. ObjectiveTo know the factors affecting tuberculosis treatment outcome among newly diagnosed tuberculosis patients. Materials and methodsA total of 261 Tuberculosis patients registered in NTEP under District tuberculosis centre were enrolled using universal sampling method. First follow up was done at the end of intensive phase i.e. End of 2 months. Second follow up was done after completion of treatment i.e., End of 6th month. ResultsMajority 59% participants were diagnosed as smear negative at 2nd month follow up and 45.21% and 28.73% participants were diagnosed as cured and treatment completed respectively at 6th month follow up. 73.95% participants had successful outcome.Multivariate logistic regression analysis showed that treatment outcomes of tuberculosis were affected by type of house (pucca house), presence of cough, past history of tuberculosis, family support, supervision by family and support of supervisor. ConclusionOverall treatment success rate was 73.95%. The contributing factors for successful outcome of tuberculosis were age, past history of TB, type of house, presence of cough and fever, weight gain, family support, supervision by family and support of supervisor.

Study of Post-hysterectomy Vault Prolapse and Surgical Management.

To study the epidemiology and various methods of repair of vaginal vault prolapse in selected group of patients and the benefits of various modes of treatment in the management of vault prolapse. Thirty-seven patients with grade lll or lV vault prolapse were enrolled in our study. Sacrospinous fixation was performed in 37 patients. High risk factors for prolapse, surgical results and complications were evaluated. In the current study, maximum cases of vault prolapse, 67.6%, were in the age group of 51-60years. Out of 37 patients, 18.9% had a history of chronic cough secondary to bronchial asthma or past history of tuberculosis And 13.5% had a bowel dysfunction (chronic constipation). Vaginal vault prolapse most commonly was seen following vaginal hysterectomy (43.3%) as compared to total abdominal hysterectomy (29.7%). Most common surgery was performed for post-hysterectomy vault prolapse being sacrospinous fixation in the current study. In total, 29.7% of the patients had early post-operative complications like urinary tract infection (16.2%), urinary retention (5.4%) and buttock pain (5.4%), and 2.7% had vaginal cuff cellulitis. Dyspareunia is a common complication post-operatively following sacrospinous fixation, due to shortening of vaginal length post-procedure. Only 29.7% patients had complications, among which most common complication was urinary tract infection, which was treated with injectable antibiotics, urinary retention and buttock pain being the less common complication. Dyspareunia was present only in 18.9% cases post-operatively due to vaginal shortening associated with the procedure. Sacrospinous fixation is a safe and effective procedure. The online version contains supplementary material available at 10.1007/s13224-023-01757-9.

Management of bronchopleural fistula using Amplatzer duct occluder device.

Management of bronchopleural fistula using Amplatzer duct occluder device.

A descriptive study of chronic granulomatous mastitis in Central India

Background: Chronic granulomatous mastitis is a rare benign breast condition that can mimic breast cancer. The present study was undertaken to assess the demographics, clinical presentation, etiology, diagnostic tools and management of patients with CGM.Methods: This descriptive observational study was conducted in total 83 women who presented with breast lump with tenderness associated with fever for more than 4 weeks of duration in the Department of General Surgery at Tertiary Care Centre from June 2018 to December 2020.Results: In all cases breast lump was chief complaint, of maximum (38.5%) had this illness since last 1 to 4 months. 48 patients had past history of tuberculosis. Axillary lymph node was enlarged in 24.1% and body temperature was raised in 57.8% of cases. Skins over the lump were presented with indurated with multiple pus discharging sinuses (50.6%) and palpable mass with erythema and ulcerative skin lesion (49.4%). On biopsy all the patients presented with granulomatous mastitis and on USG, hypoechoic mass was presents in all cases. Patients were managed medically by IV antibiotic and AKT (57.8%) and IV antibiotic with oral corticosteroid (42.2%). Incision and drainage were done in 74 cases while 8 required wide local excision and in 1 patient mastectomy was done.Conclusions: The histopathology remains the optimal diagnostic tool. Corticosteroid therapy has been shown to be efficacious for CGM, but in the existence of many complications, surgical treatment has been first method of choice. We consider that wide local excision is the better treatment choice if possible.

S4.2d Efficacy of LD Bio Aspergillus ICT lateral flow assay for serodiagnosis of chronic pulmonary aspergillosis

S4.2 Advances in diagnosis of invasive fungal infection, September 22, 2022, 10:30 AM – 12:00 PM BackgroundThe diagnosis of chronic pulmonary aspergillosis (CPA) relies on the detection of IgG Aspergillus antibody which is not freely available, especially in resource-poor settings. Point-of-care tests like LDBio, evaluated in only a few studies, have shown promising results for the diagnosis of CPA. However, no study has compared the diagnostic performances of LDBio in the setting of tuberculosis endemic countries and has compared it with that of IgG Aspergillus.ObjectivesThis study aimed to evaluate the diagnostic performances of LDBio in CPA and compare it with the existing diagnostic algorithm utilizing ImmunoCAP IgG Aspergillus.MethodsSerial patients presenting with respiratory symptoms (cough, hemoptysis, fever, etc) for >4 weeks were screened for eligibility. Relevant investigations including respiratory secretions stain/culture, IgG Aspergillus, chest imaging, etc were done according to the existing algorithm. Serum of all patients was tested by LDBio and IgG Aspergillus (ImmunoCAP) and their diagnostic performances were compared.ResultsA total of 218 patients were screened and 174 patients were included in the study with ∼ 66.7% of patients having a past history of tuberculosis. A diagnosis of CPA was made in 74 (42.5%) patients. The estimated sensitivity and specificity of LDBio was 67.6% [95% confidence interval (CI), 55.7%-78%] and 81% (95% CI, 71.9%-81%) respectively which increased to 73.3% (95% CI, 60.3%-83.9%), and 83.9% (95% CI, 71.7%-92.4%) respectively in patients with past history of tuberculosis. The sensitivity and specificity of IgG Aspergillus was 82.4% (95% CI, 71.8%-90.3%) and 82% (95% CI, 73.1-89%); 86.7% (95% CI, 75.4%-94.1%), and 80.4% (95% CI, 67.6%-89.8%) in the whole group and those with past history of tuberculosis respectively. The baseline characteristics and diagnostic accuracies are listed in Tables 1 and 2 respectively.ConclusionsLDBio is a point-of-care test with reasonable sensitivity and specificity. However, further tests may have to be done to rule-in or rule-out the diagnosis of CPA in the appropriate setting.

POS-077 RISK FACTORS AND OUTCOMES OF TUBERCULOSIS IN INDIAN KIDNEY TRANSPLANT RECIPIENTS

Tuberculosis (TB) is one of the commonest opportunistic infections in kidney transplant recipients and can have diverse clinical presentations leading to a delay in the diagnosis. We evaluated risk factors, clinical presentation, impact of TB on patient, and the graft outcomes. We studied 703 kidney transplant recipients from 1985-2018 at a tertiary care centre in western India. Demographic details, past history of TB, immunosuppression regimens, time to diagnosis of tuberculosis post-transplant, clinical presentations, duration of treatment, adverse effects of treatment, and its outcome on patient and graft were studied. Tuberculosis was diagnosed in 103 recipients (14.6%) post-transplant. The mean (SD) age of recipients was 35.12±10 years, with 93 (90.2%) being males and 102 recipients (99.1%) from a living donor. Nineteen recipients (18.4%) had tuberculosis before transplant. The median (IQR) time to diagnosis of TB post-transplant was 24 months (8-48). In 41(39.8%) recipients, development of tuberculosis was preceded by anti-rejection therapies. Pulmonary involvement was the most common organ involvement in 72 recipients (69.9%), extrapulmonary in 31 (30%) and disseminated in 2 (1.9%). Among the extrapulmonary involvements, gastrointestinal involvement was seen in 9 recipients (8.7%) followed by musculoskeletal in 7(6.8%), lymphadenitis in 6 (5.8%), central nervous system in 3 (2.9%), cutaneous involvement in 2 (1.9%), genitourinary TB in 1 (0.9%) and transplant kidney in 1 (0.9%). The median (IQR) duration of treatment was 12 months (5-18). Four recipients had relapses after completion of treatment. Adverse effects of treatment included transaminase elevation seen in 38 (38.6%) recipients followed by acute gastritis in 19 (18.4%), hyperuricemia in 17 (16.5%) and sensorineural hearing loss in 3 (2.9%). Multidrug-resistant TB was diagnosed in 3 recipients (2.9%). The pre-transplant median (IQR) dialysis vintage was 8 months (6-12). New onset diabetes after transplant was the most common comorbidity observed in 28 (27.18%) recipients, followed by Hepatitis C in 16 (15.55%), Hepatitis B in 12 (11.6 %), Cytomegalovirus (CMV) in 6(5.8%) and HIV in 2 recipients (1.9%). Immunosuppressive regimens at time of transplant included azathioprine in 61 recipients (59.2%), mycophenolate mofetil in 40(38.8%), tacrolimus in 38(36.8%), cyclosporine in 26(25.2%) and steroids in 103(100%) recipients. Acute graft dysfunction during treatment was seen in 42 recipients (40.7%). Three recipients (2.9%) developed graft failure. Seventy-two recipients (69.9%) survived after treatment, 16 (15.5%) expired due to TB, and 15(14.5%) were lost to follow-up. Tuberculosis remains a common infectious complication after kidney transplant and is associated with significant morbidity and mortality.

Efficacy of LD Bio Aspergillus ICT Lateral Flow Assay for Serodiagnosis of Chronic Pulmonary Aspergillosis.

Background: The diagnosis of CPA relies on the detection of the IgG Aspergillus antibody, which is not freely available, especially in resource-poor settings. Point-of-care tests like LDBio Aspergillus ICT lateral flow assay, evaluated in only a few studies, have shown promising results for the diagnosis of CPA. However, no study has compared the diagnostic performances of LDBio LFA in setting of tuberculosis endemic countries and have compared it with that of IgG Aspergillus. Objectives: This study aimed to evaluate the diagnostic performances of LDBio LFA in CPA and compare it with existing the diagnostic algorithm utilising ImmunoCAP IgG Aspergillus. Methods: Serial patients presenting with respiratory symptoms (cough, haemoptysis, fever, etc.) for >4 weeks were screened for eligibility. Relevant investigations, including direct microscopy and culture of respiratory secretions, IgG Aspergillus, chest imaging, etc., were done according to existing algorithm. Serums of all patients were tested by LDBio LFA and IgG Aspergillus (ImmunoCAP Asp IgG) and their diagnostic performances were compared. Results: A total of 174 patients were included in the study with ~66.7% patients having past history of tuberculosis. A diagnosis of CPA was made in 74 (42.5%) of patients. The estimated sensitivity and specificity of LDBio LFA was 67.6% (95% CI: 55.7–78%) and 81% (95% CI: 71.9–88.2%), respectively, which increased to 73.3% (95% CI: 60.3–83.9%) and 83.9% (95% CI: 71.7–92.4%), respectively, in patients with a past history of tuberculosis. The sensitivity and specificity of IgG Aspergillus was 82.4% (95% CI: 71.8–90.3%) and 82% (95% CI: 73.1–89%); 86.7% (95% CI: 75.4–94.1%) and 80.4% (95% CI: 67.6–89.8%), in the whole group and those with past history of tuberculosis, respectively. Conclusions: LDBio LFA is a point-of-care test with reasonable sensitivity and specificity. However, further tests may have to be done to rule-in or rule-out the diagnosis of CPA in the appropriate setting.

Aspergilloma Morphology on Computed Tomography Angiography and its Clinical Impact in Patients of Haemoptysis

Amongst various manifestations of pulmonary aspergillosis, chronic pulmonary aspergillosis (CPA) is the most common. We conducted this study to identify different morphological forms of CPA, on computed tomography angiography (CTA), and to correlate these with clinical presentation, as well as, associated imaging features. The study design was cross-sectional, with a final sample size of 65 patients, recruited over a period of 2years from January 2017 to October 2018. Patients with past history of tuberculosis (TB), presenting with haemoptysis and found to have aspergilloma on computed tomography and lab tests were included in the study. All patients underwent CTA for evaluation of haemoptysis. Three morphological types of intracavitary aspergilloma on imaging were identified: type 1-nodular soft tissue along the cavity-wall, type-2 soft tissue density with multiple air lucencies and type-3 homogenous soft tissue opacity with air-crescent sign. Aspergilloma types were correlated with grade and duration of haemoptysis, associated imaging findings and vascularity score on CTA. Mean age of the patients was 40.97 +/- 13.69 years. As the type of aspergilloma changed from 1 to 3, there was a decrease in cavity wall thickness, peri-cavitary inflammation and vascularity. It is the type 1 and 2 aspergillomas, which caused more inflammation in the lungs, and hence recruited more abnormal vasculature. No significant correlation was found between haemoptysis severity and type of aspergilloma; type 3 aspergilloma however had longer duration of haemoptysis.In conclusion, the initial stages of formation of aspergilloma (type 1 and 2) cause more parenchymal inflammation and symptoms. The classical Monod sign is observed in the late stage of aspergilloma, since the peri-cavitary inflammation is reduced by then and thus the symptoms.

P502 Different presentation of tuberculosis associated with anti-TNF therapy among patients with Inflammatory Bowel Disease in endemic area: observation from China

Abstract Background Anti-tumor necrosis factor (TNF) therapy increased the risk of tuberculosis(TB), and the characteristic clinical feature of western patients with inflammatory bowel disease (IBD) receiving anti-TNF therapy were predominantly extrapulmonary TB. We aimed to analyze the clinical features of patients with IBD who in TB-endemic area (China) that developed active tuberculosis after receiving anti-TNF therapy. Methods Patients from 9 hospital in 7 provinces developed active TB after the initial treatment with infliximab. Demographics, interval between the time at the first dose of anti-TNF therapy and active TB development, tests for latent TB infection (LTBI), concomitant medications, and the details of diagnosis were analyzed in our study. The diagnosis of active TB and LTBI were made based on comprehensive evaluation including TB skin test (TST), interferon gamma releasing assay (IGRA), X-ray test and computed tomography (CT). Results Totally 43 patients developed active TB during infliximab therapy. Among 43 patients, 6 patients had a past TB history and 11 patients were confirmed as LTBI before infliximab treatment. Six patients with LTBI received anti-TB prophylaxis as the same time as anti-TNF treatment. The mean time between initiation of infliximab therapy and active tuberculosis diagnosis in patients with LTBI was significantly shorter than patients without LTBI (216.9±83.2 days versus 410.9±220.3 days, p=0.042). Among 43 active TB patients, 29 patients (29/43, 67.4%) had isolated pulmonary tuberculosis and 11 patients (11/43, 25.6%) had pulmonary TB concomitantly with other organ involvement. Conclusion IBD patients with LTBI develop TB earlier than those without LTBI during anti-TNF treatment, and history of treatment and anti-TB prophylaxis didn’t fully prevent active TB. The most common disease site is lung in China, most of cases were diagnosed by imaging. Chinese physicians should be aware of the potential for TB development during anti-TNF therapy, especially pulmonary tuberculosis.

Independent evaluation of 12 artificial intelligence solutions for the detection of tuberculosis

There have been few independent evaluations of computer-aided detection (CAD) software for tuberculosis (TB) screening, despite the rapidly expanding array of available CAD solutions. We developed a test library of chest X-ray (CXR) images which was blindly re-read by two TB clinicians with different levels of experience and then processed by 12 CAD software solutions. Using Xpert MTB/RIF results as the reference standard, we compared the performance characteristics of each CAD software against both an Expert and Intermediate Reader, using cut-off thresholds which were selected to match the sensitivity of each human reader. Six CAD systems performed on par with the Expert Reader (Qure.ai, DeepTek, Delft Imaging, JF Healthcare, OXIPIT, and Lunit) and one additional software (Infervision) performed on par with the Intermediate Reader only. Qure.ai, Delft Imaging and Lunit were the only software to perform significantly better than the Intermediate Reader. The majority of these CAD software showed significantly lower performance among participants with a past history of TB. The radiography equipment used to capture the CXR image was also shown to affect performance for some CAD software. TB program implementers now have a wide selection of quality CAD software solutions to utilize in their CXR screening initiatives.