Past Tuberculosis Research Articles

Nontuberculous Mycobacteria Infections at a Provincial Reference Hospital, Cambodia.

Prevalence of nontuberculous mycobacteria (NTM) disease is poorly documented in countries with high prevalence of tuberculosis (TB). We describe prevalence, risk factors, and TB program implications for NTM isolates and disease in Cambodia. A prospective cohort of 1,183 patients with presumptive TB underwent epidemiologic, clinical, radiologic, and microbiologic evaluation, including >12-months of follow-up for patients with NTM isolates. Prevalence of NTM isolates was 10.8% and of disease was 0.9%; 217 (18.3%) patients had TB. Of 197 smear-positive patients, 171 (86.8%) had TB confirmed (167 by culture and 4 by Xpert MTB/RIF assay only) and 11 (5.6%) had NTM isolates. HIV infection and past TB were independently associated with having NTM isolates. Improved detection of NTM isolates in Cambodia might require more systematic use of mycobacterial culture and the use of Xpert MTB/RIF to confirm smear-positive TB cases, especially in patients with HIV infection or a history of TB.

Association of Tuberculosis Status with Neurologic Disease and Immune Response in HTLV-1 Infection

The human T cell lymphotropic virus type 1 (HTLV-1) is the etiologic agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HTLV-1 infected individuals have increased susceptibility to Mycobacterium tuberculosis infection but the influence of tuberculosis (TB) on the course of HTLV-1 infection is unknown. The aim of this study was to evaluate the influence of TB on immunological, virologic, and neurologic features of HTLV-1 infection. This is a retrospective analysis of individuals enrolled in a cohort study from an HTLV-1 clinic who were evaluated for past or latent tuberculosis (LTB) and classified clinically as HTLV-1 carriers, probable HAM/TSP and definite HAM/TSP. Spontaneous cytokine production (interferon-gamma [IFN-γ], tumor necrosis factor [TNF], and interleukin[IL]-10), serum chemokines (CXCL9 and CXCL10) and HTLV-1 proviral load were evaluated. Of 172 participants, 64 did not have histories of TB (TB- group), 81 had LTB and 27 had TB in the past (TB+ group). In the TB+ group, there was a higher frequency of HAM/TSP patients (35%) than in HTLV-1 carriers (10%) (OR = 3.8, p = .0001). HAM/TSP patients with histories of TB had higher IFN-γ/IL-10 and TNF/IL-10 ratios when compared with HAM/TSP patients without histories of TB. There were no differences in serum chemokine production and proviral load across TB groups stratified on HTLV-1 clinical status. In conclusion, TB may influence the development of HAM/TSP, and patients with these two diseases have an impairment in the modulation of immune response.

Nontuberculous mycobacterial infection in rheumatoid arthritis patients: a single-center experience in South Korea.

Background/AimsNontuberculous mycobacteria (NTM) infection has been increasing worldwide in both general population and immunocompromised patients, which has also been reported in rheumatoid arthritis (RA) patients. This study aimed to identify the incidence and clinical characteristics of NTM infection in RA patients living in tuberculosis (TB) infection endemic area.MethodsWe performed a retrospective analysis of NTM infection cases in our RA registry at a tertiary referral center from January 1995 to December 2013. The clinical features of them were compared to those of 52 TB infection patients from same registry.ResultsAmong 1,397 patients with RA, NTM infection was newly developed in 26 patients and the incidence of NTM infection was 164.8 per 100,000 patient-years. The Mycobacterium avium complex was the most frequent isolate (76.9%). None of the NTM infections had extrapulmonary involvement, which was rather common in TB infection (26.9%). Patients with NTM infection were older, received higher cumulative steroid doses, and had higher rates of past TB infection history and concomitant interstitial lung disease (ILD) than cases with TB infection.ConclusionsIn South Korea, NTM infection is not rare in RA patients, and infection rates are growing. Physicians should be cautious about NTM infection in patients with a history of TB infection or concomitant ILD, even living in TB endemic area.

The role of tuberculosis in COPD.

BackgroundInfluence of tuberculosis (TB) on the natural course of COPD has not been well known. This study was designed to investigate the effects of history of TB on the long-term course of COPD.MethodsPatients hospitalized with COPD exacerbation were consecutively included (n=598). Cases were classified into two categories: those with TB history and those without. Clinical, demographic, and radiological features were meticulously recorded, and patients were followed up for hospitalizations due to exacerbation and for overall mortality.ResultsA total of 93 patients (15%) had a history of TB. On average, patients with past TB history were 4 years younger than the rest of the patients (P=0.002). Our study revealed that patients with past TB were diagnosed with COPD 4 years earlier and died 5 years earlier as compared to the patients without TB. In addition, in the past TB group, rate of hospital admissions per year was higher compared to the group that lacked TB history (2.46±0.26 vs 1.56±0.88; P=0.001). Past TB group had higher arterial carbon dioxide tension (PaCO2) and lower forced expiratory volume in 1 second (FEV1; P=0.008 and P=0.069, respectively). Median survival was 24 months for patients who had past TB and 36 months for those who had not. Kaplan–Meier analysis revealed that although 3-year survival rate was lower in patients with past TB, it was not statistically significant (P=0.08). Cox regression analysis showed that while factors such as age, PaCO2, hematocrit, body mass index (BMI) and Charlson index affected mortality rates in COPD patients (P<0.05), prior history of TB did not.ConclusionOur results showed that a history of TB caused more hospitalizations, reduced respiratory functions and increased PaCO2. It was found that, despite similarity of the overall mortality, COPD diagnosis and death occurred 5 years earlier in patients with past TB. We conclude that history of TB has an important role in the natural course of COPD.

The Definition of Past Tuberculosis Affects the Magnitude of Association between Pulmonary Tuberculosis and Respiratory Dysfunction: Korea National Health and Nutrition Examination Survey, 2008-2012.

Tuberculosis (TB) is associated with an increased risk of chronic lung impairment. The aim of this study was to compare the clinical characteristics and lung functions according to definition of past TB. We used the population-based, Korea National Health and Nutrition Examination Survey (KNHANES) (2008–2012) to analyze 13,522 subjects age 40 years or older who underwent spirometry and chest X-ray (CXR). Subjects with TB lesions on CXR (with or without a history of TB) were older, more likely to be male, ever smokers, and of low socioeconomic status than subjects with only a history of TB or without evidence of TB. Airflow obstruction (AFO) was associated with only a history of TB (odds ratio [OR] 1.53, 95% confidence interval [CI] 0.95–2.46), only TB lesion on CXR (OR 2.37, 95% CI 1.80–3.12), and both a history and TB lesions on CXR (OR 4.47, 95% CI 3.07–6.51) after adjustment for gender, age, body mass index, education, income, and smoking amount (P for trend < 0.001). Spirometric restriction was associated with only a history of TB (OR 1.29, 95% CI 0.80–2.08), only TB lesions on CXR (OR 2.03, 95% CI 1.49–2.76), and both a history and TB lesions on CXR (OR 2.65, 95% CI 1.74–4.05) after adjustment for the above variables (P for trend < 0.001). How to define past TB in population study affects the magnitude of association between past TB and respiratory dysfunction. Without considering TB lesions on CXR, the association between TB and respiratory dysfunction could be underestimated.

P1.04-020 Management of Lung Cancer in Patients with past Pulmonary Tuberculosis and Their Possible Causative Link

Lung cancer and tuberculosis cause significant morbidity and mortality worldwide. In the past, it was well known that lung cancer is a specific epidemiological successor of pulmonary tuberculosis (PTB) and that it often develops in scars caused by PTB. In recent years, the relevance of the two diseases has drawn attention in terms of the close epidemiological connection and chronic inflammation-associated carcinogenesis. Although studies have found a relationship between PTB and lung cancer, results for the long-term risk and the role of confounding factors remain inconclusive. Therefore, it is important to delineate the relationship between PTB and lung cancer. Clinical files of all patients diagnosed with lung malignancy between 2011 and 2016 were investigated retrospectively in terms of patient characteristics, definite histopathological diagnosis and stage of tumor, operation methods, and associated complications. Mean age was 56.4 years. Past PTB was detected in 3% of operated carcinoma patients and in 6% of all patients diagnosed with lung malignancy. Central lung cancer was diagnosed in 80% of cases and peripheral in 20%. Epidermoid cancer was diagnosed in 51% of cases, adenocarcinoma in 24% and adenoepidermoid carcinoma in 25%. All cases of operable lung cancers were in stage I and II, while inoperable lung cancers were in stage IIIB and IV. Lobectomy was performed in 100% of the operated cases. None of the patients received anti-TB treatment preoperatively or postoperatively because by the time they were diagnosed with lung cancer, their sputum culture for M.Tuberculosis had converted negative. No postoperative mortality or reactivation of TB was seen. PTB is an important risk factor for lung cancer, possibly related to chronic inflammation and shared risk factors. Our study adds to the evidence that implicates chronic inflammation and pulmonary scarring in the etiology of lung cancer. However, further studies are needed to clarify whether there is a direct causative link between PTB and lung cancer. Surgery is the method of choice in treatment of lung cancer in subjects with past PTB history.

Tuberculosis, Airway Obstruction and Mortality in a Finnish Population

ABSTRACTThere is little long-term follow-up data concerning the association between past pulmonary tuberculosis (TB), airway obstruction and mortality. We aimed to analyse a national health examination survey data from 6701 adult Finns undergoing spirometry between 1978 and 1980 (follow-up through 2013). We identified TB either through a disease history or by a TB-indicative scar on a chest x-ray. We specified obstruction using the lower limit of normal (LLN) and classified severity using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1–4. After adjusting for smoking and other confounders, past TB associated with obstruction. Compared to non-TB patients, the adjusted odds ratio (OR; 95% CI) of obstruction reached 2.21 (1.52–3.21) among patients with a scar recorded by one radiologist, 2.48 (1.63–3.78) when recorded by both radiologists and 4.59 (2.86–7.37) among patients with a disease history. Among those with neither past TB nor obstruction, with past TB only, with an obstruction only and with both, we found hazard ratios (HRs; 95% CIs) for subsequent mortality of 1.00 (reference), 1.11 (1.03–1.20), 1.62 (1.31–2.00) and 1.77 (1.45–2.16), adjusted for age, gender, smoking, body mass index (BMI), physical activity, education and general health. In conclusion, past TB strongly determines obstruction, although on its own quite weakly predicts premature death. TB and obstruction combined predict an additive mortality pattern.

Non CF-bronchiectasis: Aetiologic approach, clinical, radiological, microbiological and functional profile in 277 patients

Background and objectivesNon-Cystic Fibrosis (CF) bronchiectasis is common in Greece but little attention has been paid to the investigation of its aetiology, clinical, radiological, microbiological and lung function profile. MethodsWe prospectively evaluated patients with non-CF bronchiectasis confirmed by high resolution computed tomography (HRCT) of the chest. Aetiology, clinical data, radiology score, microbiological profile and lung function were investigated. ResultsWe evaluated 277 patients (170 women) with bronchiectasis (mean age: 60.5 ± 16 years), 64% of them being non-smokers. Post-infectious (25.2%) and past tuberculosis (TB) (22.3%) were the most commonly identified underlying conditions, while no cause was found in 34% of the patients. The main symptoms were cough (82%), mucopurulent sputum (80%), dyspnea (60%) and haemoptysis (37%). Mean duration of symptoms was 9.7 (SD 10.7) years. Infectious exacerbations were observed in 67.5% of the patients with a mean frequency of 2.3 (SD 1.4) per year.The most frequent lung function pattern was the obstructive (43.1%) while 38% of the patients had normal spirometry. Pseudomonas aeruginosa was the most common pathogen yielded in sputum cultures (43%) followed by Haemophilus influenzae (12.6%). Patients with P. aeruginosa had a more long-standing disease and worse lung function. Radiological severity of the disease was mainly related to impaired lung function, P. aeruginosa isolation in sputum and frequent exacerbations. ConclusionData indicate that in Greece, “past” tuberculosis remains an important cause of bronchiectasis. P. aeruginosa was the predominant pathogen in the airways, associated with disease severity, while the most common lung function impairment was obstruction.

A comparative analysis of two interferon-γ releasing assays to detect past tuberculosis infections in Japanese rheumatoid arthritis patients

Objectives: To compare the utility of QuantiFERON-TB Gold in tube (QFT-GIT) and T-SPOT.TB assays to detect past tuberculosis infection in Japanese rheumatoid arthritis patients receiving methotrexate.Methods: We compared the sensitivities and specificities, the rates of indeterminate results, and the rates of positive results in patients with total and CD4-positive lymphocyte counts of both assays simultaneously performed on 68 rheumatoid arthritis patients receiving methotrexate, in whom 33 had evidence of past tuberculosis infection by chest computed tomography and the other had neither history of tuberculosis exposure nor abnormalities in chest computed tomography.Results: The sensitivities, specificities, and the rates of indeterminate results of QFT-GIT were 21.2%, 100%, and 4.4%, and those of T-SPOT.TB were 21.9%, 100%, and 1.5%, respectively. The overall agreement of both assays was good (κ = 0.68). In patients with past tuberculosis infection, there are significant positive linear trends in positive rates of both assays across ranges of larger numbers of total and CD4-positive lymphocyte counts.Conclusions: Both assays were equally useful with high specificities, but may falsely identify past tuberculosis infection owing to low sensitivities. In patients with low total and CD4-positive lymphocyte counts, both assays might give higher rates of false negative results.

Tuberculous Spondylitis: Clinical Features of 36 Patients

We report 36 cases of spinal tuberculosis who were evaluated at the Internal Medicine Department of Istanbul University between January 1990 and March 2016. Twelve cases were accompanied by active pulmonary tuberculosis while ten patients had a previous history of tuberculosis. Eight patients had diabetes mellitus; six patients were on chronic steroid treatment with a mean dose of 24 mg/day while two patients used azathioprine and methotrexate. The dominant symptom was back pain that was present in 64% of the subjects followed by low grade fever (42%), and malaise (38%). Lytic and destructive lesions were noted in various vertebrae in all of the cases while four patients had spinal compression, and two patients had iliopsoas abscess. The preliminary diagnosis was myeloproliferative disease with vertebral metastasis in eight patients. Tuberculin test was over 15 mm in 20 patients (58.8%) while ERS and Creactive protein were highly elevated in 78%, and 84% of the patients. Diagnosis of tuberculosis was confirmed by culture of aspirated material from intervertebral disc space, collection under CT guidance, sputum or bronchial lavage, and by retrospective anti-tuberculous treatment response. MRI revealed compatible findings with spinal tuberculosis in 30 (80%) patients. In endemic countries, tuberculous spondilitis should be considered in immunosuppressed patients with back pain. Current or past tuberculosis infection is not a reliable indicator for Pott’s disease in these patients. Laboratory findings were not usually useful to support the diagnosis. The low sensitivity of the tuberculin test may lead to an erronous diagnosis. Sensitivity of vertebral radiography and CT was low. MRI was the most useful radiologic investigation for the diagnosis of spinal tuberculosis. Tuberculosis of the spine is a diagnostic impasse notably in immunodeficient patients for the clinician.

&amp;ldquo;Tuberculosis in the past, present and in future&amp;rdquo;

&amp;ldquo;Tuberculosis in the past, present and in future&amp;rdquo;

Psychological distress and its effect on tuberculosis treatment outcomes in Ethiopia

BackgroundPsychological distress is the major comorbidity among tuberculosis (TB) patients. However, its magnitude, associated factors, and effect on treatment outcome have not been adequately studied in low-income countries.ObjectiveThis study aimed to determine the magnitude of psychological distress and its effect on treatment outcome among TB patients on treatment.DesignA follow-up study was conducted in Addis Ababa, Ethiopia, from May to December 2014. Patients (N=330) diagnosed with all types of TB who had been on treatment for 1–2 months were enrolled consecutively from 15 randomly selected health centers and one TB specialized hospital. Data on sociodemographic variables and economic status were collected using a structured questionnaire. The presence of psychological distress was assessed at baseline (within 1–2 months after treatment initiation) and end point (6 months after treatment initiation) using the 10-item Kessler (K-10) scale. Alcohol use and tobacco smoking history were assessed using WHO Alcohol Use Disorder Identification Test and Australian Smoking Assessment Checklist, respectively. The current WHO TB treatment outcome definition was used to differentiate the end result of each patient at completion of the treatment.ResultsThe overall psychological distress was 67.6% at 1–2 months and 48.5% at 6 months after treatment initiation. Multiple logistic regression analysis revealed that past TB treatment history [adjusted odds ratio (AOR): 3.76; 95% confidence interval (CI): 1.67–8.45], being on anti-TB and anti-HIV treatments (AOR: 5.35; 95% CI: 1.83–15.65), being unmarried (AOR: 4.29; 95% CI: 2.45–7.53), having alcohol use disorder (AOR: 2.95; 95% CI: 1.25–6.99), and having low economic status (AOR: 4.41; 95% CI: 2.44–7.97) were significantly associated with psychological distress at baseline. However, at 6 months after treatment initiation, only being a multidrug-resistant tuberculosis (MDR-TB) patient (AOR: 3.02; 95% CI: 1.17–7.75) and having low economic status (AOR: 3.75; 95% CI: 2.08–6.74) were able to predict psychological distress significantly. Past TB treatment history (AOR: 2.13; 95% CI: 1.10–4.12), employment status (AOR: 2.06; 95% CI: 1.06–7.00), and existence of psychological distress symptoms at 6 months after treatment initiation (AOR: 2.87; 95% CI: 1.05–7.81) were found to be associated with treatment outcome.ConclusionsThe overall magnitude of psychological distress was high across the follow-up period; this was more pronounced at baseline. At baseline, past TB treatment history, being on anti-TB and anti-HIV treatments, being unmarried, and having symptoms of alcohol use disorder were associated with psychological distress. However, both at baseline and end point, low economic status was associated with psychological distress. Screening and treatment of psychological distress among TB patients across the whole treatment period is needed, and focusing more on patients who have been economically deprived, previously treated for TB, and on MDR-TB treatment are important.

“Years ago”: reconciliation and First Nations narratives of tuberculosis in the Canadian Prairie Provinces

For First Nations tuberculosis (TB) patients in the Prairie Provinces, the past matters. In this paper, we draw on the analysis of historical statements made by 20 First Nations interviewees with infectious TB to explore the function of talking about the past in relation to a current diagnosis of TB and the implications of historicity on contemporary TB prevention, programming and care. Despite interviewees not being asked directly about past contexts of TB treatment, they talked about historical topics such as the removal of First Nations TB patients from communities for treatment in distant sanatoria, painful and invasive surgical procedures once used to treat TB, and the attitudes that persist due to the ongoing failure to eliminate TB from First Nations communities. In these narratives, past experiences of TB treatment are intimately connected to present-day experiences and context. What happened ‘years ago’ profoundly affects the health and well-being of people diagnosed with TB today. Attempts to eliminate TB among First Nations peoples in Canada must also address its historical legacy. Understanding the contemporary effects of past TB treatment and mistreatment among First Nations peoples in the Prairie Provinces can also be seen as part of a larger project of truth and reconciliation in Canada, which involves both Indigenous and non-Indigenous Canadians.

Latent Tuberculosis Infection and Associated Factors among Health Care Workers in Kigali, Rwanda.

IntroductionData are limited regarding tuberculosis (TB) and latent TB infection prevalence in Rwandan health facilities.MethodsWe conducted a cross-sectional survey among healthcare workers (HCWs) in Kigali during 2010. We purposively selected the public referral hospital, both district hospitals, and randomly selected 7 of 17 health centers. School workers (SWs) from the nearest willing public schools served as a local reference group. We tested for latent TB infection (LTBI) using tuberculin skin testing (TST) and asked about past TB disease. We assessed risk of LTBI and past history of TB disease associated with hospital employment. Among HCWs, we assessed risk associated with facility type (district hospital, referral hospital, health center), work setting (inpatient, outpatient), and occupation.ResultsAge, gender, and HIV status was similar between the enrolled 1,131 HCWs and 381 SWs. LTBI was more prevalent among HCWs (62%) than SWs (39%). Adjusted odds of a positive TST result were 2.71 (95% CI 2.01–3.67) times greater among HCWs than SWs. Among HCWs, there was no detectable difference between prevalence of LTBI according to facility type, work setting, or occupation.ConclusionHCWs are at greater risk of LTBI, regardless of facility type, work setting, or occupation. The current status of TB infection control practices should be evaluated in the entire workforce in all Rwandan healthcare facilities.

Combined antigen-specific interferon-γ and interleukin-2 release assay (FluoroSpot) for the diagnosis of Mycobacterium tuberculosis infection.

BackgroundTo evaluate interleukin (IL)-2 and interferon (IFN)-γ secreting T-cells in parallel for the differentiation of latent infection with Mycobacterium tuberculosis infection (LTBI) from active tuberculosis.MethodsFollowing ex-vivo stimulation of peripheral blood mononuclear cells (PBMC) with M. tuberculosis-specific antigens early secretory antigenic target (ESAT)-6 and culture filtrate protein (CFP)-10, immune responses were assessed by enzyme-linked immunospot IFN-γ release assay (EliSpot-IGRA) and a novel dual cytokine detecting fluorescence-linked immunospot (FluoroSpot) in 18 patients with pulmonary tuberculosis, 10 persons with previously cured tuberculosis, 25 individuals with LTBI and 16 healthy controls.ResultsCorrelation of IFN- γ+ spot-forming cells in EliSpot-IGRA and FluoroSpot were R2 = 0.67 for ESAT-6 and R2 = 0.73 for CFP-10. The number of IL-2- IFN- γ+ producing cells was higher in patients with tuberculosis compared with past tuberculosis (CFP-10-induced p = 0.0068) or individuals with LTBI (ESAT-6-induced p = 0.0136). A cutoff value of >16 CFP-10-induced IFN-γ+ secreting cells/200.000 PBMC in the EliSpot-IGRA discriminated with highest sensitivity and specificity (89% and 76%, respectively). However, overlap in cytokine responses precludes distinction between the cohorts on an individual basis.ConclusionsCombined analysis of IFN-γ and IL-2 secretion by antigen specific T-cells does not allow a reliable differentiation between different states of M. tuberculosis infection in clinical practice.

Comparison of interferon gamma release assay & tuberculin skin tests for diagnosis of latent tuberculosis in patients on maintenance haemodialysis.

Background & objectives:Tuberculosis (TB) is a common infection in patients on haemodialysis. There is a definite role of treatment of latent TB (LTB) in these patients. However, diagnosis of LTB in these patients by tuberculin skin test (TST) is unreliable. There is suggestion that interferon gamma release assay (IGRA) will be more reliable test for diagnosis of LTB in this setting. Thus, we evaluated value of IGRA and TST for the diagnosis of LTB in patients on dialysis in an Indian setting.Methods:Patients with end stage kidney disease on dialysis were included. Patients with active TB were excluded. Each patient was subjected to TST (induration of ≥10 mm was taken as positive) and QuantiFERON TB Gold In-Tube test (QFT-GIT) for diagnosis of LTB.Results:A total of 185 patients were included; 129 (69.7%) were males and mean age was 36.7 ± 12.3 yr. Past history of TB was present in 18 (9.7%) patients. One hundred and thirty four (72.4%) patients had scar of BCG vaccination. QFT-GIT test was positive in 66 (36%), TST in 32 (17%) and both in 13 (7%) patients. Of the 66 patients positive with QFT-GIT, only 13 (19.6%) were positive for TST. Of the 32 patients positive with TST, only 13 (40.6%) were positive with QFT-GIT; 100 (54%) patients were negative for both the tests. Overall, 85 (45.9%) patients were positive for either of the two tests. Poor agreement was shown between the two methods. On logistic regression analysis, odds of QFT-GIT to be positive in patients with BCG vaccination was 1.23 and with history of TB 0.99, both being insignificant. odds of tuberculin skin test to be positive in patients with BCG vaccination was 1.04 and with history of TB 0.99, both again being insignificant.Interpretation & conclusions:Our findings showed that more number of patients (36%) on haemodialysis were positive for QuantiFERON Gold In-Tube test as compared to TST (17%). There was poor agreement between the two tests. No significant effect of BCG vaccination and history of TB in past was observed on both tests.

Trends of tuberculosis case notification and treatment outcomes in the Sidama Zone, southern Ethiopia: ten-year retrospective trend analysis in urban-rural settings.

BackgroundEthiopia is one of the high tuberculosis (TB) burden countries. An analysis of trends and differentials in case notifications and treatment outcomes of TB may help improve our understanding of the performance of TB control services.MethodsA retrospective trend analysis of TB cases was conducted in the Sidama Zone in southern Ethiopia. We registered all TB cases diagnosed and treated during 2003–2012 from all health facilities in the Sidama Zone, and analysed trends of TB case notification rates and treatment outcomes.ResultsThe smear positive (PTB+) case notification rate (CNR) increased from 55 (95% CI 52.5–58.4) to 111 (95% CI 107.4–114.4) per 105 people. The CNRs of PTB+ in people older than 45 years increased by fourfold, while the mortality of cases during treatment declined from 11% to 3% for smear negative (PTB-) (X2 trend, P<0.001) and from 5% to 2% for PTB+ (X2 trend, P<0.001). The treatment success was higher in rural areas (AOR 1.11; CI 95%: 1.03–1.2), less for PTB- (AOR 0.86; CI 95%: 0.80–0.92) and higher for extra-pulmonary TB (AOR 1.10; CI 95%: 1.02–1.19) compared to PTB+. A higher lost-to-follow up was observed in men (AOR 1.15; CI 95%: 1.06–1.24) and among PTB- cases (AOR 1.14; CI 95%: 1.03–1.25). More deaths occurred in PTB-cases (AOR 1.65; 95% CI: 1.44–1.90) and among cases older than 65 years (AOR 3.86; CI 95%: 2.94–5.10). Lastly, retreatment cases had a higher mortality than new cases (6% vs 3%).ConclusionOver the past decade TB CNRs and treatment outcomes improved, whereas the disparities of disease burden by gender and place of residence reduced and mortality declined. Strategies should be devised to address higher risk groups for poor treatment outcomes.

High rate of completion of preventive therapy for latent tuberculosis infection among asylum seekers in a Swiss Canton

Preventive treatment may avoid future cases of tuberculosis among asylum seekers. The effectiveness of preventive treatment depends in large part on treatment completion. In a prospective cohort study, asylum seekers of two of the Swiss Canton Vaud migration centres were screened with the Interferon Gamma Release Assay (IGRA). Those with a positive IGRA were referred for medical examination. Individuals with active or past tuberculosis were excluded. Preventive treatment was offered to all participants with positive IGRA but without active tuberculosis. The adherence was assessed during monthly follow-up. From a population of 393 adult migrants, 98 (24.9%) had a positive IGRA. Eleven did not attend the initial medical assessment. Of the 87 examined, eight presented with pulmonary disease (five of them received a full course of antituberculous therapy), two had a history of prior tuberculosis treatment and two had contraindications to treatment. Preventive treatment was offered to 75 individuals (4 months rifampicin in 74 and 9 months isoniazid in one), of whom 60 (80%) completed the treatment. The vulnerability and the volatility of this population make screening and observance of treatment difficult. It seems possible to obtain a high rate of completion using a short course of treatment in a closely monitored population living in stable housing conditions.

English

Psuedallescheria boydii is a common soil fungus that is increasingly reported as a human pathogen. Lung is the most common extra cutaneous site of infections .Invasive pulmonary disease is seen usually in an immunocompromised host. We are reporting an unusual first case of invasive pulmonary pseudoallescheria sis in an immunocompetent patient from Central India.Microscopy of bronchoalveolar lavage of a treated and cured patient of past pulmonary tuberculosis revealed hyphae (approx 3-5 µ) which were septate & dichotomously branched resembling aspergillus species.The organism was cultured & identified as P.boydii. . Previously recognized causative agent of disease in an immunocompromised host is now causing disease in immunocompetent host.

Antigen 85A and mycobacterial DNA‐binding protein 1 are targets of immunoglobulin G in individuals with past tuberculosis

Development of accurate methods for predicting progression of tuberculosis (TB) from the latent state is recognized as vitally important in controlling TB, because a majority of cases develop from latent infections. Past TB that has never been treated has a higher risk of progressing than does latent Mycobacterium tuberculosis infection in patients who have previously received treatment. Antibody responses against 23 kinds of M. tuberculosis proteins in individuals with past TB who had not been medicated were evaluated. These individuals had significantly higher concentrations of antibodies against Antigen 85A and mycobacterial DNA-binding protein 1 (MDP1) than did those with active TB and uninfected controls. In addition, immunohistochemistry revealed colocalization of tubercle bacilli, antigen 85 and MDP1 inside tuberculous granuloma lesions in an asymptomatic subject, showing that M. tuberculosis in lesions expresses both antigen 85 and MDP1. Our study suggests the potential usefulness of measuring antibody responses to antigen 85A and MDP1 for assessing the risk of TB progression.