Patients Undergoing Tuberculosis Treatment Research Articles

Diagnostic and Treatment Challenges of Recurrent Tuberculosis in Patient with Drug-Induced Hepatotoxicity: A Case Report

Introduction: Pulmonary tuberculosis (TB) remains one of the most significant global health challenges, especially complicated by cases with incomplete treatment histories. The recurrence of TB poses diagnostic and therapeutic dilemmas that significantly impact patient outcomes. Case Presentation: We report a case of a 57-year-old female patient presenting with recurrent pulmonary TB after an incomplete treatment course. The patient's history revealed gaps in adherence to the prescribed TB regimen, leading to multiple relapses. In this study, we found that patients undergoing TB treatment may experience liver damage as a result of the TB medication, also known as DIH. Comprehensive diagnostic procedures, including chest radiography, sputum culture, and molecular testing, confirmed recurrent TB. The patient's clinical manifestations, treatment plan, and response to therapy are detailed. Conclusion: Recurrent TB is common, particularly in older adults, and is influenced more by environmental factors than occupation. Additionally, ATT poses risks of hepatotoxicity, especially in malnourished patients, underscoring the importance of managing side effects and addressing factors like malnutrition to prevent complications and improve outcomes. This case underscores the importance of complete adherence to TB treatment regimens and highlights the challenges in managing recurrent TB. It emphasizes the need for robust follow-up, patient education strategies, early diagnosis, and prompt intervention to prevent recurrence and enhance patient outcomes.

Percentage and Absolute CD4+ Count and Factors Influencing Their Levels in Tuberculosis Patients in a Tetiary Hospital, Kaduna, Nigeria

Background: The role of CD4+ T cells in immunity against tuberculosis have been widely acknowledged. This study determined CD4+ absolute, CD4 percentage and haemoglobin (HB) levels in tuberculosis (TB) patients undergoing TB treatment and compared these levels with presence of some factors which could modify the quantities of CD4+, CD4% and HB in TB patients. Methods: A cross-sectional study of eighty-five persons attending TB DOTS clinic in tertiary hospital between 2020 to 2021. Multicolour fluorescence imaging and absorbance spectrometry microscopy was used to enumerate CD4+ absolute count, CD4+ percentage and HB concentration in whole blood. Questionnaire and interviews were used to determine history, demographic data, BCG vaccination, BCG scar, vitamin A supplementation, awareness of zoonotic diseases and zoonotic TB, maternal BCG vaccination status, maternal BCG scar and undernutrition for each respondent. Results: CD4% significantly differed between forty-seven males (mean age: 33.5) and thirty-eight females (mean age: 32.2) (p <0.05). T-test indicated no significant difference in CD4+ count, CD4% and HB compared with BCG vaccination status, presence of BCG scar, knowledge of zoonotic diseases, knowledge of zoonotic TB and with vitamin A supplementation (p <0.05). There was also significant difference in CD4% compared with undernutrition and in absolute CD4+ counts compared with drug resistance (p <0.05). Conversely, there was significant difference in CD4% and absolute CD4+ count when compared with maternal BCG vaccination, presence of maternal BCG Scar. Pearson correlation coefficient indicated weak negative relationship between CD4%, absolute CD4+ count and age. Also, weak positive relationship between HB and age. Both relationships were not significant (p <0.05). Conclusion: Undernutrition, gender, maternal BCG vaccination (with or without scaring) and age influence levels of CD4+ in TB patients.

Relationship between Side Effects of Anti-tuberculosis Drugs (ATDs) and Adherence to Medication in Elderly Patients with Tuberculosis

One of the obstacles to the treatment of tuberculosis (TB) patients is the sideeffects of anti-tuberculosis drugs (ATDs) which cause patients to be reluctant to continue the medication. The elderly experience various physical and physiological changes in the bodysystem, including susceptibility to drug side effects, decreased knowledge and memory,resulting in non-compliance with taking the medication. This study aims to determine therelationship between ATDs side effects and compliance with taking medication for elderlypatients at the Tanjung Selor Health Center, Bulungan Regency, North Kalimantan Province.This study used a quantitative cross-sectional approach. The sample was taken by totalpopulation, namely elderly tuberculosis patients undergoing tuberculosis treatment as many as30 respondents. The research instrument was a questionnaire of drug side effects and ATDscompliance. Statistical test used Fisher's Exact. The results showed that most patients (76.7%)complained of OAT side effects and the rest without OAT side effects (23.3%). Treatmentcompliance was 20% compliant, and 80% were non-compliant. Fisher's Exact statistical testobtained p-value = 0.016 (< α = 0.05). It was concluded that there was a significant relationship between OAT side effects and treatment compliance in elderly patients with tuberculosis. Recommendations for health workers to give special attention to elderly patients with medication monitoring and compliance motivation. Future researchers should identify the involvement of family and health workers to monitor the side effects of anti-tuberculosis drugs.

Recommendations for Use of Video Directly Observed Therapy During Tuberculosis Treatment - United States, 2023.

U.S. clinical practice guidelines recommend directly observed therapy (DOT) as the standard of care for tuberculosis (TB) treatment (1). DOT, during which a health care worker observes a patient ingesting the TB medications, has typically been conducted in person. Video DOT (vDOT) uses video-enabled devices to facilitate remote interactions between patients and health care workers to promote medication adherence and clinical monitoring. Published systematic reviews, a published meta-analysis, and a literature search through 2022 demonstrate that vDOT is associated with a higher proportion of medication doses being observed and similar proportions of cases with treatment completion and microbiologic resolution when compared with in-person DOT (2-5). Based on this evidence, CDC has updated the recommendation for DOT during TB treatment to include vDOT as an equivalent alternative to in-person DOT. vDOT can assist health department TB programs meet the U.S. standard of care for patients undergoing TB treatment, while using resources efficiently.

Proceedings of the 17th Annual International INEBRIA Conference

Proceedings of the 17th Annual International INEBRIA Conference

Cross-sectional study of nutritional intake among patients undergoing tuberculosis treatment along the Myanmar–Thailand border

ObjectiveThis study summarises nutritional intake among patients with tuberculosis (TB) along the Myanmar–Thailand border according to the local diet.SettingTB clinic along the Myanmar–Thailand border.ParticipantsCross-sectional surveys of 24-hour food recall were...

Homozygotes NAT2*5B slow acetylators are highly associated with hepatotoxicity induced by anti-tuberculosis drugs.

BACKGROUND Distinct N-acetyltransferase 2 (NAT2) slow acetylators genotypes have been associated with a higher risk to develop anti-tuberculosis drug-induced hepatotoxicity (DIH). However, studies have not pointed the relevance of different acetylation phenotypes presented by homozygotes and compound heterozygotes slow acetylators on a clinical basis.OBJECTIVES This study aimed to investigate the association between NAT2 genotypes and the risk of developing DIH in Brazilian patients undergoing tuberculosis treatment, focusing on the discrimination of homozygotes and compound heterozygotes slow acetylators.METHODS/FINDINGS The frequency of NAT2 genotypes was analysed by DNA sequencing in 162 patients undergoing tuberculosis therapy. The mutation analyses revealed 15 variants, plus two new NAT2 mutations, that computational simulations predicted to cause structural perturbations in the protein. The multivariate statistical analysis revealed that carriers of NAT2*5/*5 slow acetylator genotype presented a higher risk of developing anti-tuberculosis DIH, on a clinical basis, when compared to the compound heterozygotes presenting NAT2*5 and any other slow acetylator haplotype [aOR 4.97, 95% confidence interval (CI) 1.47-16.82, p = 0.01].CONCLUSION These findings suggest that patients with TB diagnosis who present the NAT2*5B/*5B genotype should be properly identified and more carefully monitored until treatment outcome in order to prevent the occurrence of anti-tuberculosis DIH.

Associated Factors of the Results of Pulmonary Tuberculosis Treatment During the COVID-19 Pandemic in Makassar City

BACKGROUND: A regimen directly observed treatment-short course is recommended by the World Health Organization as a strategy for controlling tuberculosis (TB). AIM: This treatment was carried out for 6 months despite the COVID-19 pandemic situation. The purpose of the study was to determine the factors associated with the treatment outcomes of pulmonary TB undergoing treatment during the COVID-19 pandemic, with the research target was Category I pulmonary TB patients. METHOD: The type of research was observational analytic with a cohort study design. This research was conducted at the Pulmonary Center in October 2020-May 2021 involved 62 samples. RESULTS: About 75.8% (47 respondents) successfully treated and 24.2% (15 respondents) decided unsuccessful. There was a significant association between diabetes status (p = 0.014), anemia status (p = 0.035), knowledge of TB (p = 0.009), knowledge of COVID-19 (p = 0.014), and family history of COVID-19 exposure (p = 0.011) to the treatment outcomes of pulmonary TB treatment during the pandemic. CONCLUSION: Associated factors to the outcome of treatment for pulmonary TB patients undergoing TB treatment during a pandemic included diabetes mellitus status, anemia status, knowledge of TB, knowledge of COVID-19, and family history of exposure to COVID-19.

Psychoactive substance use in patients with tuberculosis, treatment adherence, Brief Interventions

Abstract Background Psychoactive substance use associated with tuberculosis therapy is an urgent public health issue in the contemporary world. Objective To characterize the profile and psychoactive substance use of patients undergoing tuberculosis treatment and to analyze the association between health-related variables, consumption, and treatment adherence, from the perspective of Brief Interventions. Methodology Descriptive transversal epidemiological study, carried out in primary care units, with 114 patients undergoing tuberculosis treatment, from June 2016 to July 2017. The Self-Reporting Questionnaire (SRQ-20) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used. Results Smokers who drank alcohol (p = 0.058) and those who reported not having chronic diseases (p = 0.024) had a need to receive brief interventions. Cannabis use was more frequent among smokers (p = 0.009). With regard to cocaine use, a significant association was found between smoking and the number of chronic diseases. In this sample, 40% of smokers, 21.1% of alcohol drinkers, 10.5% of cannabis users, and 13.7% of cocaine/crack users adhered to treatment. Conclusions These results demonstrated the vulnerability of this population to psychoactive substance use based on treatment adherence and the importance of using Brief Interventions for monitoring, especially in primary care settings. Key messages The study showed an opportunity to apply the diagnostic strategy of brief intervention in this population in primary care. It showed an impact on the change in behavior of these patients, in view of greater adherence to treatment and improvement in quality of life.

Acceptance and Commitment Therapy on Depression of Pulmonary Tuberculosis Patient: An Intervention Based on the Health Belief Model

Introduction: Depression is a psychological disorder often experienced by patients undergoing tuberculosis treatment. The purpose of this study was to determine the effect of acceptance and commitment therapy based on the health belief model on the depression of pulmonary tuberculosis patients. Methods: This research used a quantitative quasi-experiment design with pre-posttest control group design. There were 56 respondents in this study selected using consecutive sampling among the Primary Healthcare Center in Sidoarjo district. The independent variables were acceptance and commitment therapy based on the health belief model. The dependent variable was depression. Measurement of depression used the Beck Depression inventory II questionnaire. Analysis of the data in this study used the Wilcoxon Signed Rank Test and Mann-Whitney U Test. Results: The results showed that the treatment group p=0.000 (p<0.05) and control group p=0.000 (p<0.05), but the delta of the treatment group higher than the control group (delta: -9.79). There were differences in depression values obtained between the treatment group and the control group p=0.001 (p<0.05). Conclusion: Acceptance and commitment therapy based on the health belief model given four sessions for 30-45 minutes each session can lower depression level in pulmonary tuberculosis patients rather than a single intervention of health education. This intervention can be used by nurses to help pulmonary tuberculosis patients overcome psychological problems during treatment.

Analysis of Concordance of Medication-Taking Behaviour in Tuberculosis Patients in Medan, Indonesia.

AIM:This study aimed to analyse tuberculosis (TB) medication-taking behaviour based on the concept of concordance between health workers and TB patients in Medan, Indonesia.METHODS:This study was an analytical study with a cross-sectional design. A total of 100 patients undergoing TB treatment at several public health centres in Medan City participated in the study.RESULTS:The results showed that there was a relationship between the concordance behaviour of the health workers with the attitude and medication-taking behaviour of the patients (p < 0.05). However, there was no relationship found between concordance and knowledge of the patients (p > 0.05).CONCLUSION:The results showed that most of the concordance behaviour, knowledge, attitude, and behaviour in the sample were good.

Survival rate among tuberculosis patients identified in south of Iran, 2005-2016

Objective: To determine the survival rate of tuberculosis (TB) patients and to identify the important factors associated with the survival of these patients in southern Iran. Methods: The present retrospective cohort study extracted and reviewed available medical records of 134 TB patients undergoing TB treatment centre, during 2005 to 2016. The Survival rate of patients for the outcome of the interval from diagnosis until death was plotted using life table and Kaplan-Meier survival curve. Cox proportional hazard regression model was used to examine the simultaneous effect of variables on survival rate. The significance level was considered to be 0.05. Results: In this study, 64.2% of the participants were male, 73.1% had pulmonary TB and 5.22% had HIV. The survival rate of one, five and thirteen years after diagnosis were 93%, 78% and 69%, respectively. The risk of death in patients with extrapulmonary TB (95% CI=1.96-15.83, P=0.001) was 5.58 times higher than in patients with pulmonary TB. The risk of death in smokers with TB (95% CI=1.74-2.46, P

Metformin Use Reverses the Increased Mortality Associated With Diabetes Mellitus During Tuberculosis Treatment.

The global type 2 diabetes mellitus (DM) epidemic threatens progress made in reducing tuberculosis (TB)-related mortality worldwide. Previous clinical studies have not fully evaluated potential confounding variables in addressing the impact of DM on TB treatment outcomes. The antidiabetic agent metformin regulates autophagy and may play a role as a host-directed therapeutic adjuvant to antitubercular treatment. We conducted a retrospective cohort study comprising patients aged ≥13 years undergoing treatment for culture-confirmed, drug-susceptible pulmonary TB. We assessed the effect of DM on mortality during TB treatment and 2-month TB sputum-culture conversion. We also evaluated the effect of metformin use on survival during TB treatment. Among 2416 patients undergoing TB treatment, after adjusting for age, sex, chronic kidney disease, cancer, hepatitis C, tobacco use, cavitary disease, and treatment adherence, patients with DM had 1.91 times higher odds (95% confidence interval [CI], 1.51-2.40) of death during TB treatment than patients without DM, and 1.72 (95% CI, 1.25-2.38) times higher odds of remaining culture-positive at 2 months. Metformin use in patients with DM was significantly associated with decreased mortality during TB treatment (hazard ratio, 0.56 [95% CI, .39-.82]), and metformin users had similar mortality as patients without DM. This study suggests that despite multiple potential confounding variables, DM poses an increased risk of adverse TB treatment outcomes. There was a significant association between metformin use and decreased mortality during TB treatment, suggesting a potential role for this agent as adjunctive, host-directed therapy.

Dietary counseling adherence during tuberculosis treatment: A longitudinal study

The World Health Organization (WHO) recommends the use of dietary counseling to overcome malnutrition for patients with tuberculosis, with or without HIV, however the response to nutritional treatment depends on patient's adherence to nutritional counseling. Identify the degree of adherence to dietary counseling and predictors of adherence among patients undergoing tuberculosis treatment. Observational prospective follow-up study conducted in adults treating for tuberculosis with or without HIV. Self-reported adherence and 24-hdiet recall were checked. Diet counseling according to WHO strategy was offered at each visit for all patients. The endpoint was the adherence to the recommended dietary allowance (RDA) and total calories consumed during tuberculosis treatment. Data were mainly analyzed with marginal models to estimate adjusted trajectories. Sixty-eight patients were included in the study. The maximum probability of total calories consumption of at least one RDA was 80%. The adherence to dietary counseling was low regardless of HIV infection. The negative determinants of adherence were the presence of loss of appetite and nausea/vomiting. For patients with loss of appetite and nausea/vomiting, the probability of total calories consumption of at least one RDA is less than 20% at any time. The loss of appetite and nausea/vomiting are highly prevalents and were the main causes of non-adherence to dietary counseling.

Urine colorimetry to detect Low rifampin exposure during tuberculosis therapy: a proof-of-concept study

BackgroundThe cost and complexity of current approaches to therapeutic drug monitoring during tuberculosis (TB) therapy limits widespread use in areas of greatest need. We sought to determine whether urine colorimetry could have a novel application as a form of therapeutic drug monitoring during anti-TB therapy.MethodsAmong healthy volunteers, we evaluated 3 dose sizes of rifampin (150 mg, 300 mg, and 600 mg), performed intensive pharmacokinetic sampling, and collected a timed urine void at 4 h post-dosing. The absorbance peak at 475 nm was measured after rifamycin extraction. The optimal cutoff was evaluated in a study of 39 HIV/TB patients undergoing TB treatment in Botswana.ResultsIn the derivation study, a urine colorimetric assay value of 4.0 × 10−2 Abs, using a timed void 4 h after dosing, demonstrated a sensitivity of 92 % and specificity of 60 % to detect a peak rifampin concentration (Cmax) under 8 mg/L, with an area under the ROC curve of 0.92. In the validation study, this cutoff was specific (100 %) but insensitive (28 %). We observed similar test characteristics for a target Cmax target of 6.6 mg/L, and a target area under the drug concentration-versus-time curve (AUC0–8) target of 24.1 mg•hour/L.ConclusionsThe urine colorimetric assay was specific but insensitive to detect low rifampin serum concentrations among HIV/TB patients. In future work we will attempt to optimize sampling times and assay performance, with the goal of delivering a method that can translate into a point-of-care assessment of rifampin exposure during anti-TB therapy.

Outcome of Tuberculosis Treatment on Measures of Obesity and Adiposity Indices Among the Tribals of Northeast India

A cross sectional study was conducted among adult patients (N=280) between 20-40 years at different stages of tuberculosis (TB) treatment. The data was collected from the different DOTS centres in Manipur, Northeast India. Several anthropometric measurements and the indices of adiposity like body mass index (BMI), waist hip ratio (WHR), waist height ratio (WHtR) and grand mean thickness (GMT) were studied. Wasting of muscle mass and decrease in fat percentage because of chronic disease (TB) and overall improvement in these components with antitubercular treatment was observed. This study suggests that body composition is a useful marker to indicate temporal recovery of patients undergoing tuberculosis treatment and determine treatment outcome.

Determinants of death among tuberculosis patients in a semi urban diagnostic and treatment centre of Bafoussam, West Cameroon: a retrospective case-control study.

IntroductionTuberculosis (TB) remains a worldwide public health problem with 8.6 millions of new cases and 1.3 millions of death annually. Despite the progress recorded in fighting against this disease in the recent years, Africa is still not on the track to achieve the objective to reduce by half the death rate due to this disease by 2015.MethodsA case-control study was conducted on data of patients admitted for tuberculosis between 1996 and 2011 in the Diagnostic and Treatment Center of Baleng. Cases were patients who died from any cause during anti tuberculosis treatment. Logistic regression model was used to identify factors associated to death.ResultsIn 4201 patients treated during the study period, 3245 (77.24%) were included in the study. The mean age was 35.9 (SD 14.2) and male represent 62.2% (CI 60.6- 63.9) of them. At the end of the follow up, 2883 patients were successfully treated, 362 died during treatment and 132 (36.5%) deaths occurred during the first two months of TB treatment. HIV positive status, Extra-pulmonary TB, sputum smear-negative pulmonary TB and male sex were significant independent risk factors of death with adjusted odds ratio of 4.8 (CI 3.2- 7.4); 3.0 (CI 1.6- 5.4); 2.7 (CI 1.7- 4.4) and 1.5 (CI 1.0- 2.3) respectively.ConclusionThe mortality rate of TB patients undergoing TB treatment remains high. Studies are needed to identify and test efficient interventions of mortality reduction among TB patients in resource limiting settings.

Diabetes is a strong predictor of mortality during tuberculosis treatment: a prospective cohort study among tuberculosis patients from Mwanza, Tanzania

Strong evidence suggests diabetes may be associated with tuberculosis (TB) and could influence TB treatment outcomes. We assessed the role of diabetes on sputum culture conversion and mortality among patients undergoing TB treatment. A total of 1250 Tanzanian TB patients were followed prospectively during TB treatment with sputum culture after 2 and 5months. Survival status was assessed at least 1year after initiation of treatment. At baseline, all participants underwent testing for diabetes and HIV, and the serum concentration of the acute phase reactant alpha-1 glycoprotein (AGP) was determined. There were no differences between participants with and without diabetes regarding the proportion of positive cultures at 2 (3.8% vs. 5.8%) and 5 (1.3% vs. 0.9%) months (P>0.46). However, among patients with a positive TB culture, relatively more patients with diabetes died before the 5-month follow-up. Within the initial 100days of TB treatment, diabetes was associated with a fivefold increased risk of mortality (RR 5.09, 95% CI 2.36; 11.02, P<0.001) among HIV uninfected, and a twofold increase among HIV co-infected patient (RR 2.33 95% CI 1.20; 4.53, P=0.012), while diabetes was not associated with long-term mortality. Further adjustment with AGP did not change the estimates. Diabetes considerably increases risk of early mortality during TB treatment. The effect may not be explained by increased severity of TB, but could be due to impaired TB treatment response. Research is needed to clarify the mechanism and to assess whether glycaemic control improves survival.

Evaluation of directly observed treatment for tuberculosis in the Bojanala health district, North West Province of South Africa

BackgroundTuberculosis (TB) remains one of the top public health problems in South Africa. Approximately 150 000 new cases and 10 000 TB-related deaths are reported in South Africa annually. In declaring TB a global emergency in 1993, the World Health Organization developed control strategies that include active case finding, laboratory support, directly observed treatment (DOT), contact tracing, and prevention of multidrug– and extreme drug-resistant tuberculosis (MDR-TB and XDR-TB). High DOT rates reported in some countries have been discordant with ‘low cure’ and ‘high MDR’ rates.ObjectivesThe aim of the study was to evaluate the use of DOT for TB in the Bojanala health district, North West Province, South Africa, by estimating the proportion of DOT use (1) amongst all TB patients and (2) in the initial TB treatment regimen compared to retreatment regimens.MethodA cross-sectional, descriptive study was conducted in 2008. Data regarding implementation of DOT were collected from eight purposefully selected primary health care clinics and one prison clinic in the health district. Upon receiving their informed consent, a questionnaire was administered to patients receiving TB treatment at the selected facilities.ResultsA total of 88 (of 90 selected) patients participated in the study, of whom 50 (56.8%) were on DOT and had DOT supporters. However, 35 (40%) had never heard of DOT. DOT was used mainly for patients on the retreatment regimen (87.5%), rather than for those on first-line treatment (48.6%).ConclusionIn this South African rural health district, the DOT utilisation rate for TB was 56.8%, mainly for patients on the TB retreatment regimen. Strict implementation of DOT in all patients undergoing TB treatment is a known strategy for improving TB cure rate and preventing recurrence and drug resistance.

Evaluation of directly observed treatment for tuberculosis in the Bojanala health district, North West Province of South Africa

Background: Tuberculosis (TB) remains one of the top public health problems in South Africa. Approximately 150 000 new cases and 10 000 TB-related deaths are reported in South Africa annually. In declaring TB a global emergency in 1993, the World Health Organization developed control strategies that include active case finding, laboratory support, directly observed treatment (DOT), contact tracing, and prevention of multidrug– and extreme drugresistant tuberculosis (MDR-TB and XDR-TB). High DOT rates reported in some countries have been discordant with ‘low cure’ and ‘high MDR’ rates. Objectives: The aim of the study was to evaluate the use of DOT for TB in the Bojanala health district, North West Province, South Africa, by estimating the proportion of DOT use (1) amongst all TB patients and (2) in the initial TB treatment regimen compared to retreatment regimens. Method: A cross-sectional, descriptive study was conducted in 2008. Data regarding implementation of DOT were collected from eight purposefully selected primary health care clinics and one prison clinic in the health district. Upon receiving their informed consent, a questionnaire was administered to patients receiving TB treatment at the selected facilities. Results: A total of 88 (of 90 selected) patients participated in the study, of whom 50(56.8%) were on DOT and had DOT supporters. However, 35 (40%) had never heard of DOT. DOT was used mainly for patients on the retreatment regimen (87.5%), rather than for those on first-line treatment (48.6%). Conclusion: In this South African rural health district, the DOT utilisation rate for TB was 56.8%, mainly for patients on the TB retreatment regimen. Strict implementation of DOT in all patients undergoing TB treatment is a known strategy for improving TB cure rate and preventing recurrence and drug resistance.