Positive Smear Results Research Articles

Profile of Leprosy Patients at the Dermatology and Venereology Polyclinic of Dr. M. Djamil Padang Hospital in 2018-2021

Leprosy is a chronic infectious disease caused by Mycobacterium leprae that attacks several parts of the body, especially the upper respiratory tract, skin, and peripheral nerves. Indonesia is the third country with the most leprosy in the world. This study aims to determine the profile of leprosy patients at the Dermatology and Venereology Polyclinic Dr. M. Djamil Padang Hospital in 2018-2021. This research is descriptive retrospective with total sampling technique using secondary data in the form of medical records. The sample of this study were all leprosy patients in 2018-2021 who were fulfilled inclusion criteria, with a total of 39 patients. The results showed that the most age group was >14 years (100%), the most gender was male (74.36%), the most residence was Padang (33.33%), and almost all leprosy patients (92.31%) had no history of household contact with leprosy patients. Most of the leprosy patients were of the multibacillary type (74.36%) with positive smear results (46.15%), without leprosy reaction (61.54%), and the most disability level that occurred was grade 0 disability (48.72%). The conclusion of this study is that most cases of leprosy at the Dermatology and Venereology Polyclinic RSUP Dr. M. Djamil Padang in 2018-2021 aged >14 years, male, having address in Padang City, had no history household contact, multibacillary type, positive smear result, without reaction, and level 0 disability.

Nosocomial Transmission of Mycobacterium tuberculosis in an Oncological Setting

Objective: Mycobacterium tuberculosis (MTB) is a contagious airborne disease that is spread from person to person via particles in the air which are expelled when speaking or coughing1. This retrospective observational study aims to assess the nosocomial transmission of pulmonary MTB among inpatient roommates in a high-risk oncological population over a 14-year period. With limited studies on the transmissibility of MTB in such environments, the investigation focuses on evaluating the risk of nosocomial transmission and implementation of appropriate infection control measures. Design: A retrospective analysis from 2010 – April 2023 was conducted in an acute care, 500-bed oncological center. Following exposure workups performed by the Department of Infection Prevention and Control, 17 of 57 identified patients with active pulmonary MTB had inpatient stays with roommates. Source infectivity showed 7 AFB smear positive results, 4 MTB PCR positive results, and 14 MTB culture positive results. Some index patients had a combination of AFB, PCR and/or culture positivity. A high-risk exposure is defined as any patient who shared a room with an index patient for >4 cumulative hours during the infectious period. Infectious period was determined for each index patient based on the onset of symptoms and laboratory results. Workups identified 33 exposed roommates who were notified and advised to undergo testing, employing QuantifERON (QFT-GIT) serum test or Tuberculin skin (TST) PPD test at least 8 weeks following their last day of exposure. The overlap between inpatient roommates and index patients ranged from 1 to 4 days, averaging 1.5 days. Results: Of the 33 high-risk roommates, 14 (42%) patients were unable to provide follow-up testing for various reasons including: patient expiration prior to testing, patient transfer to hospice, and being lost to follow up. Nineteen (58%) patients completed post-exposure testing. 12 patients underwent PPD testing (63%) and 7 patients underwent QuantifERON testing (37%). Zero (0%) were found to have a positive QuantifERON or PPD following their exposure. 15.8% (N=3) of exposed patients had hematologic malignancies, and 84.2% (N=16) of exposed patients had solid tumor malignancies. Conclusion: The risk of active pulmonary MTB transmission in an oncological, inpatient setting was determined to be low. The absence of positive conversions among roommates of confirmed MTB patients underscores the effectiveness of infection control measures, emphasizing the importance of isolating confirmed or suspected cases promptly. Ongoing efforts should continue to focus on these preventive measures to mitigate the risk of MTB transmission in similar high-risk settings.

Tuberculosis prevalence and demographic characteristics of population in Azad Jammu and Kashmir (Pakistan): A retrospective study.

Tuberculosis (TB) remains a serious problem for public health and a leading cause of death after COVID-19 and superior to even HIV/AIDS. It is a social health issue and can cause stigma and economic loss as the person cannot perform professionally due to lethargy caused by disease. It is a retrospective study done on data from National TB program Muzaffarabad chapter. The details were noted on SPSS and analysis was done to find important demographic characteristics. The total number of patients was 3441; among which 48.76% were males. Most of them (81.11%) belonged to the Muzaffarabad division of Azad Jammu and Kahmir (AJK). The microbiologically or culture positive cases were 440. Rifampicin resistance was present in 147 cases, further categorized as high (n = 143), very high (n = 3), or true positive (n = 1) resistance. Muti drug resistance was found in 19 cases. The microscopy culture is more sensitive (AUC = 0.511) than MTB/RIF or serology (AUC = 0.502) according to ROC. The rate of positive smear results is not very satisfactory in the present study as it cannot detect dormant or latent cases. There is a need to establish more sensitive tests for detection of cases and more research to combat the disease.

Understanding the role of serological and clinical data on assessing the dynamic of malaria transmission: a case study of Bagamoyo district, Tanzania.

naturally acquired blood-stage malaria antibodies and malaria clinical data have been reported to be useful in monitoring malaria change over time and as a marker of malaria exposure. This study assessed the total immunoglobulin G (IgG) levels to Plasmodium falciparum schizont among infants (5-17 months), estimated malaria incidence using routine health facility-based surveillance data and predicted trend relation between anti-schizont antibodies and malaria incidence in Bagamoyo. 252 serum samples were used for assessment of total IgG by enzyme-linked immunosorbent assay and results were expressed in arbitrary units (AU). 147/252 samples were collected in 2021 during a blood-stage malaria vaccine trial [ClinicalTrials.gov NCT04318002], and 105/252 were archived samples of malaria vaccine trial conducted in 2012 [ClinicalTrials.gov NCT00866619]. Malaria incidence was calculated from outpatient clinic data of malaria rapid test or blood smear positive results retrieved from District-Health-Information-Software-2 (DHIS2) between 2013 and 2020. Cross-sectional data from both studies were analysed using STATA version 14. this study demonstrated a decline in total anti-schizont IgG levels from 490.21AU in 2012 to 97.07AU in 2021 which was related to a fall in incidence from 58.25 cases/1000 person-year in 2013 to 14.28 cases/1000 person-year in 2020. We also observed a significant difference in incidence when comparing high and low malaria transmission areas and by gender. However, we did not observe differences when comparing total anti-schizont antibodies by gender and study year. total anti-schizont antibody levels appear to be an important serological marker of exposure for assessing the dynamic of malaria transmission in infants living in malaria-endemic regions.

Use of Nucleic Acid Amplification Testing for Rapid Detection of Mycobacterium tuberculosis Complex Among US Tuberculosis Patients, 2011‒2017.

Nucleic acid amplification (NAA) tests rapidly detect Mycobacterium tuberculosis complex directly from clinical specimens, providing valuable results for those evaluated for tuberculosis. We analyzed characteristics of cases with NAA testing performed, compared cases with positive and negative NAA test results, and calculated turnaround time and time to treatment for all verified cases reported to the National Tuberculosis Surveillance System in the United States during 2011-2017. Among 67082 verified tuberculosis cases with NAA testing information, 30820 (45.9%) were reported as not having an NAA test performed; the proportion without NAA testing declined annually, from 60.5% in 2011 to 33.6% in 2017. Of 67082 verified cases, 27912 (41.6%) had positive, 8215 (12.2%) had negative, and 135 (0.2%) had indeterminate NAA test results. Among the 33937 cases with an acid-fast bacilli (AFB) smear-positive result, 24093 (70.9%) had an NAA test performed; 11490 of the 30244 (38.0%) with an AFB smear-negative result had an NAA test performed. Although sputum was the most common specimen type tested, 79.8% (7023/8804) of nonsputum specimen types had a positive NAA test result. Overall, 63.7% of cases with laboratory testing had NAA test results reported <6 days following specimen collection; for 13891 cases not yet on treatment, median time to treatment after the laboratory report date was 2 days. Our analyses demonstrate increased NAA test utilization between 2011 and 2017. However, a large proportion of cases did not have an NAA test performed, reflecting challenges in broader uptake, suggesting an opportunity to expand use of this diagnostic methodology.

Spatial clustering and genetic diversity of Mycobacterium tuberculosis isolate among pulmonary tuberculosis suspected patients, Arsi Zone, Ethiopia

BackgroundTuberculosis remains a serious public health concern globally. The enormous social, economic, and health impacts of the diseases are attributed to the lack of updated data on the prevalence, geospatial distribution, population structures, and genotypic variants of the circulating M. tuberculosis.MethodsStructured questionnaire, mycobacterial culture, and standard 24-Mycobacterial Interspersed Repeated Units-Variable Number Tandem Repeats (MIRU-VNTR) were employed to collect sociodemographic characters, residence linked information, and genotype the isolates. The retrospective discrete Bernoulli model was used to identify the hot spot districts of sputum smear positivity, and Web-based Miru-VNTRPlus were used for the identification of lineages and sublineages.ResultsOut of 832 presumptive pulmonary tuberculosis (PTB) suspects, 119 (14.3%) were smear-positive. In the multivariate binary logistic model, PTB suspected patients in the age groups of 7–25 and 25–34 and those from rural residents were 4.53 (AOR = 4.53; 95% CI 2.25–9.13), 3.00 (AOR = 3.00; 95% CI 1.41–6.35) and 1.65 (AOR = 1.65; 95% CI 1.01–2.70) times at higher risk of turning smear-positive. Eleven (47.8%) districts of Arsi Zone were shown to have a high rate of clustering (RR = 2.27; 95% CI 1.62–3.2) of smear-positive PTB. Of 72 isolates queried for the lineage assignment, 59 (81.9%) were classified into the previously known lineages and 13 (18.1%) were not assigned to any known lineages. Overall, 42 (58.3%) belong to M. tuberculosis lineage 4 (Euro-American), 16 (22.2%) M. tuberculosis lineage 3 (Delhi/CAS), and 1 (1.4%) M. tuberculosis Lineage 1 (Indo-Oceanic/ East Africa Indian). Further classification to the sublineage indicates that the predominant lineage was Delhi/CAS comprising 16 (22.2%) isolates followed by 15 (20.8%) isolates belonging to Haarlem. The remaining isolates were distributed as 13 (18.1%) TUR, 6 (8.3%) LAM, 4 (5.5%) URAL, 4 (4.5%) NEW-1 and 1 (1.4%) EAI.ConclusionOur study showed higher smear-positive results among PTB suspected patients and remarkable spatial variation across districts of Arsi Zone in smear-positive PTB. This information together with the genotypic features could be used as input for the efforts of designing control strategies.

Isolated spleen tuberculosis in an immunocompetent patient, a rare case report.

IntroductionTuberculosis (TB), as a major public health concern, is affecting almost 10 million people globally. At present, diagnostic and screening efforts mainly focus on positive smear results. Therefore, the number of extra pulmonary and negative sputum TB is rising and hampering the diagnosis and treatment process due to the large number of false negatives. Rare cases such as solitary splenic TB are usually seen in patients with splenic abnormalities, spleen trauma, immunosuppression, sickle cell disease, pyogenic infections, etc.Presentation of caseA 40-year-old female with no comorbidity came with chief complaint of early satiety every mealtime and epigastric pain in the last 6 months prior to admission. There was no significant positive examination except for positive IGRA test and enlargement of spleen with multiple cystic lesions on abdominal CT. We performed laparotomy with splenectomy followed by a histopathology examination which showed features of primary tubercular abscess.DiscussionIn the immunocompromised patient, the visceral abdomen is usually involved and a part of miliary TB. However, this case revealed the rare possibility of a healthy person with primary isolated tubercular splenic abscess while being immunocompetent and lacking any comorbidity.ConclusionSplenic TB diagnosis is difficult in patients lacking pulmonary involvement and without specific symptoms. Thorough examinations and clinical expertise are needed to provide accurate diagnosis and treat uncommon forms of TB and cases with negative smear results in consideration of rising prevalence and difficult disease control.

Longitudinal-Survival Models for Case-Based Tuberculosis Progression

Introduction: Tuberculosis (TB) disease continues to be responsible for a high global burden with an estimated 10 million people falling ill each year and an estimated 1.45 million deaths. Widely carried out analyses to utilize routine data coming from this disease, and well-established in literature, have paid attention to time-to-event with sputum smear results being considered only at baseline or even ignored. Also, logistic regression models have been used to demonstrate importance of sputum smear results in patient outcomes. A feature presented by this disease, however, is that each individual patient is usually followed over a period of time with sputum smear results being documented at different points of the treatment curve. This provides both repeated measures and survival times, which may require a joint modeling approach. This study aimed to investigate the association between sputum smear results and the risk of experiencing unfavorable outcome among TB patients and dynamically predict survival probabilities.Method: A joint model for longitudinal and time-to-event data was used to analyze longitudinally measured smear test results with time to experiencing unfavorable outcome for TB patients. A generalized linear mixed-effects model was specified for the longitudinal submodel and cox proportional hazards model for the time-to-event submodel with baseline hazard approximated using penalized B-splines. The two submodels were then assumed to be related via the current value association structure. Bayesian approach was used to approximate parameter estimates using Markov Chain Monte Carlo (MCMC) algorithm. The obtained joint model was used to predict the subject's future risk of survival based on sputum smear results trajectories. Data were sourced from routinely collected TB data stored at National TB Program database.Results: The average baseline age was 35 (SD: 15). Female TB patients constituted 36.42%. Patients with previous history of TB treatment constituted 6.38% (event: 15.25%; no event: 5.29%). TB/HIV co-infection was at 31.23% (event: 47.87%; no event: 29.20%). The association parameter 1.03 (CI[1.03,1.04]) was found to be positive and significantly different from zero, interpreted as follows: The estimate of the association parameter α = 1.033 denoted the log hazard ratio for a unit increase in the log odds of having smear positive results. HIV status (negative) 0.47 (CI [0.46,49]) and history of TB treatment (previously treated) (2.52 CI [2.41,2.63]), sex (female) (0.82 CI [0.78,0.84]), and body mass index (BMI) categories (severe malnutrition being reference) were shown to be statistically significant.Conclusion: Sputum smear result is important in estimating the risk to unfavorable outcome among TB patients. Men, previously treated, TB/HIV co-infected and severely malnourished TB patients are at higher risk of unfavorable outcomes.

Tuberculosis in the Torres Strait: the lady doth test too much.

Smear-positive pulmonary tuberculosis (PTB) requires rapid diagnosis and treatment to prevent ongoing transmission. Collection of two sputum specimens is considered the minimum requirement for the diagnosis of PTB but current guidelines in the Torres Strait Islands, Australia, recommend three sputum specimens; this frequently delays treatment initiation. A retrospective study was performed to ascertain the diagnostic yield of sputum specimens collected in the Torres Strait Islands. The study assessed demographics and characteristics of all PTB cases diagnosed between 2000 and 2018, and assessed the diagnostic yield in 143 patients from whom at least three sputum specimens had been collected prior to treatment commencement. Incremental and cumulative yield was calculated for each sputum specimen. Data were further analysed using binary logistic regression to examine the association between selected characteristics and a smear-positive acid-fast bacilli (AFB) result. Overall, AFB was detected from the first or second sputum specimen in 97 of 101 PTB cases that were sputum smear positive. A smear-positive result was more common (odds ratio 2.84, 95% confidence interval 1.08-7.46) for Papua New Guinea nationals compared to Australian born patients. Of the 429 samples collected, 76 (18%) were of poor quality and the association between poor quality specimens and smear-negative results was significant (p<0.01). Among sputum smear-negative cases, 5/42 (12%) had three consecutive poor quality specimens. The most common collection modality in adults was voluntary expectoration; done in 391/429 (91%) of all specimens collected. Alternative specimen collection methods were mainly used in children; induced sputum 1/429 (0.2%), gastric aspirate 26/429 (6%) and nasopharyngeal aspirate 7/429 (1.6%). Errors with labelling, packaging and transportation occurred in 44 specimens from 15 patients. Two good quality specimens ensure adequate diagnostic yield for PTB and a third specimen should only be collected from patients with two negative specimens who have persistent symptoms. Ideally, decentralised Xpert Ultra&reg; should be the frontline diagnostic test in remote settings, especially in settings like the Torres Strait Islands with high rates of drug-resistant TB.

Drug-Resistant Mycobacterium tuberculosis Isolates from New and Previously Treated TB Patients in China, 2017-2019.

INTRODUCTION: Mycobacterium tuberculosis (MTB) is a causative agent of tuberculosis (TB) that causes death worldwide. METHODS: MTB was subjected to phenotypic drug-susceptibility tests (DST), and drug-resistant genes were sequenced. RESULTS: Previously treated patients were more likely to have positive smear results and exhibit drug resistance. New patients were more likely to be mono SM-resistant and less likely to be INH- and RIF-resistant. The most common mutations were katG (S315T), rpoB (S450L), rpsL (K43R), and embB (M306V). CONCLUSIONS: The proportion of mono-SM-resistant TB among new patients was higher.

Clinical spectrum of childhood tuberculosis and outcome at Mohammed Alamin Hamid Pediatric Hospital, Omdurman, Sudan.

The World Health Organization report in 2018 estimated 234,000 deaths due to tuberculosis (TB) in children less than 15 years; 40,000 of them occurring in human immunodeficiency virus (HIV) infected children. These deaths represent 15% of all TB deaths. This study aimed to determine the clinical spectrum and outcome of childhood TB at Mohamed Alamin Hamid Pediatric Hospital TB management unit. Retrospective observational hospital-based study was conducted during January 2017-December 2018, in children aged 0-18 years who were diagnosed with TB. A total of 174 patients were enrolled in this study. The majority of patients' ages ranged from 5 to 17 years (111, 63.8%). Most of the patients were males (92, 52.9%) and (142, 81.6%) resided in Khartoum State. Lung opacity and hailer parenchymal shadows were the common presenting features (83, 47.7%) in chest X-ray. Sputum for acid fast bacilli was positive in only 20 (11.5%) patients. Testing for HIV was negative in 41 (23.6%) patients and was not done in 133 (76.4%). A total of 107 (61.5%) children were diagnosed as having pulmonary TB; extra pulmonary tuberculosis (EPTB) was 67 (38.5%). Tuberculous lymphadenitis was the commonest type of EPTB and was diagnosed in 38 (56.7%) patients. The majority 94 (87.9%) completed their treatment and 13 (12.1%) with smear positive results were cured. Defaulters were 20 (11.5%), and 6 patients (3.4%) were retreated after default, 11 (6.3%) were transferred out, and 14 (8%) are still on treatment. Thirteen patients (7.5%) died, and the outcome of three patients was not documented.

Implementing universal rifampicin testing for TB in Pakistan: results and implications for the TB response.

SETTING: A large specialised chest hospital in Pakistan.OBJECTIVE: To study outcomes of comprehensive Xpert® MTB/RIF and universal rifampicin testing.DESIGN: A hospital-based, 3-year retrospective record review of registered TB patients.RESULTS: During the study, 11 744 TB patients were registered when the number of annual notifications remained stagnant. Xpert use increased dramatically in adults with pulmonary TB (PTB) from less than 1% tested with Xpert alone in 2016, to 81.6% by 2018. Significant increases were seen in bacteriologically confirmed PTB in adults from 64% to 77.3% (P < 0.001). No remarkable changes were seen in testing and confirmation of PTB in children or extrapulmonary TB. Significantly lower (P < 0.001) rifampicin resistance (RR) was observed among those with smear-negative compared to those with smear-positive results among new (1.0% vs. 5.1%) and previously treated PTB cases (2.0% vs. 14.4%). Most importantly, a significant decline in RR was observed among previously treated individuals, from 15.4% (95%CI 12.2-19.0) to 8.6% (95%CI 6.6-11.0) during the study. A decrease in RR was also documented in newly diagnosed PTB patients, but this was not statistically significant.CONCLUSION: Universal rifampicin testing is feasible in adult PTB patients; a decline in RR was seen among previously treated individuals with PTB.

How many sputum samples should be examined during follow-up of tuberculosis patients in Myanmar: two or one?

Setting: Ten selected microscopy centres in Sagaing Region, Myanmar, functioning under an external quality assurance system with no reported major errors. Objective: To assess the pattern of serial sputum results (NN, both smear-negative; NP, first smear-negative and second smear-positive; PN, first smear-positive and second smear-negative; and PP, both smear-positive) among follow-up sputum microscopy examinations of tuberculosis (TB) patients (end of intensive phase, mid-continuation phase and end of treatment) conducted from 1 November 2017 to 15 April 2018. Design: Cross-sectional study using secondary data (laboratory registers). Results: Of 2001 examinations, 94 (4.7%) were smear-positive: 66 PP (3.3%), 12 PN (0.6%) and 16 NP (0.8%); 75% of NP results were scanty. The proportion of NP results was 0.8% (95%CI 0.5-1.3), i.e., 125 smears (95%CI 77-200) were required to detect one additional smear-positive result in the second sample. Of the 16 NP results (15 patients), 14 were tested using Xpert® MTB/RIF and none had rifampicin resistance. During the continuation phase of treatment, 13 became smear-negative, one remained smear-positive and one had unknown follow-up smear status. Conclusion: The benefit of the second sputum sample for monitoring anti-tuberculosis treatment was negligible. Given the favourable resource implications (reduced laboratory workload and costs), we recommend changing the policy from two sputum smears to one during follow-up sputum examinations of TB patients.

High prevalence of infection and low incidence of disease in child contacts of patients with drug-resistant tuberculosis: a prospective cohort study

ObjectiveWe aimed to measure the prevalence and incidence of latent tuberculosis infection (LTBI) and tuberculosis (TB) disease in children in close contact with patients with drug-resistant TB (DR-TB) in a...

AN EPIDEMIOLOGICAL STUDY OF SUPERFICIAL FUNGAL INFECTIONS IN PATIENTS REFERRED TO YAZD CENTRAL LABORATORY, IRAN

Abstract Introduction: Superficial and cutaneous infections have high prevalence all over the world. It is necessary to be informed of disease prevalence in each zone and be able to identify its causes and dominant species to obtain proper diagnosis, early treatment, planning control, and prophylaxis. The main objective of the present paper is to determine the frequency of fungal infections and their agents and identify different kinds of dermatophytes and their distribution patterns in patients referred to Yazd Central Laboratory, Iran. Methods: In this retrospective descriptive study, patients suspected of having superficial fungal disease were surveyed from March 2011 to March 2013. Samples were taken from lesions, and diagnosis was made by means of fungal culture or direct microscope. In the case of observation of yeast, hyphae, mycelium, arthroconidia, spore, pseudohyphae, and budding cells in the samples, it was considered through positive smear result. The main values of this study were data analyzed by descriptive statistics in SPSS version 17 software; also, a chi-square test was used. Results: 2203 patients were studied: 685 patients (31.1% of all patients) suffered from superficial and cutaneous fungal infection; 498 patients (72.7%) suffered from dermatophytosis, the most prevalent infection, and respectively Cutaneous candidiasis (14.3%), erythrasma (10.3%), Tinea versicolor (2%), and nail aspergillus (0.7%) were next. In 125 cases, the upper limb was infected (25.1%). Conclusion: According to this study, dermatophytosis is the most prevalent and important fungal infection; thus, we should focus on educating and improving the hygiene of the societies in question to prevent and reduce the prevalence of these diseases.

Smear Positive Pulmonary Tuberculosis (TB) Patients Suspected to Have Drug Resistant TB in Programmatic Management of Drug Resistant TB Unit in Khyber Pakhtunkhwa, Pakistan

Background: Tuberculosis remains a major health problem with more than 3 million deaths and 9 million new cases annually. Pakistan ranks 5th in the top 22 tuberculosis burden countries. Prevalence of all tuberculosis cases is 342 per 100,000 individuals in Pakistan. Objectives: The objective of the present study was to assess the frequency and pattern of tuberculosis in a population from Khyber Pakhtunkhwa. Methods: This prospective study was conducted in programmatic management of drug resistant tuberculosis unit lady reading hospital Peshawar, Pakistan between January, 2014 and December, 2014. A total of 1330 specimens from suspected drug resistant tuberculosis patients were analyzed by light-emitting diodes-fluorescence microscopy (LED-FM). The SPSS 18 software was used for data analysis. Results: Of the 1330 drug resistant tuberculosis suspect patients tested by LED-FM microscopy, 824 (62%) were smear positive for Mycobacterium and 306 (38%) were negative. Mean age was 30.92 ± 14.91 years. Out of smear positive cases, 462 (56.1%) were female, 722 (87.6%) were previously treated, and 446 (54.1%) were in < 30 years old. A statistically significant association was observed between female gender, previous tuberculosis treatment, and age category (< 30 years) with smear positive results. Conclusions: Female gender, previous treatment, and young age (< 30 years) were significantly associated with smear positivity. Early detection and effective treatment of active tuberculosis cases is of paramount importance to reduce the burden of tuberculosis. Light-emitting diodes- fluorescence microscopy is the best method for early diagnosis of tuberculosis if performed by an experienced microbiologist, as it is reliable and inexpensive.

Diagnosis of tuberculosis in a high TB-HIV environment using microscopy and culture: The example of Kakiika Prison-Kyamugorani, Mbarara, Uganda

There is growing concern about the high transmission of tuberculosis (TB) in prisons posing a risk to the outside community. There are high levels of overcrowding in the Uganda Prisons Service (UPS) with some prisons accommodating 4 times above their designed capacities. Our objective was to determine the prevalence of active pulmonary tuberculosis among prisoners. In addition we assessed the accuracy and reliability of TB smear microscopy using culture as gold standard and determined TB-HIV co-infection. Using a cross-sectional survey, we enrolled 140 male inmates in Kakiika prison-Kyamugorani, Mbarara. TB diagnosis was performed using direct sputum smear microscopy (DSSM) and culture for mycobacteria. HIV results were obtained from the clinical register with consent from the study participants. The prevalence of active pulmonary MTB was 2.9% based on culture findings. Microscopy had no smear positive results. However, there was no evidence that culture is different from microscopy in this sample (P=0.13). The overall HIV prevalence was 15.7% and TB-HIV co-infection was 25%. TB prevalence in this prison was greater than that of other prisons in Uganda at 0.7% and the general opulation at 0.4%. This is because the social and economic conditions that increase vulnerability to TB also increase vulnerability to criminal behavior and imprisonment. In addition, the high TB burden is due to the high HIV prevalence in prisons. The study recommended the use of a more sensitive technique for TB diagnosis specially in settings where the level of transmission is presumed to be high. Keywords : Culture, Microscopy, Prisons, Tuberculosis, TB/HIV co-infection

Faktor yang berhubungan dengan tidak terkonversinya BTA positif pada pengobatan kasus baru di Semarang

Factors related to non-conversion smear positive among patients with pulmonary tuberculosis in the city of SemarangPurposeThe purpose of this study was to identify factors related to non-conversion of smear positive in treatment of new tuberculosis cases. MethodsThis study used a case control design and sampling by proportional random sampling technique. Samples were patients with smear grade positive pulmonary tuberculosis who were new cases of intensive phase of treatment and have repeated sputum examination. The numbers of samples in this research were 128 sample cases and 128 controls. ResultsThe factors associated with the conversion of smear positive pulmonary tuberculosis treatment of new cases were age, sex, drug side effects, comorbidities and gradation smear results. The three variables that proved to jointly influence the incidence of smear positive conversion in the treatment of new cases of pulmonary tuberculosis were sputum smear results gradation, comorbidities and gender. ConclusionIt is necessary to design an appropriate drug taking supervisor for patients with positive smear positive results with +2 and +3 gradations and patients with comorbidities (HIV, hepatitis, diabetes mellitus).

Tuberculosis Treatment Outcomes and Determinants among Patients Treated in Hospitals in Imo State, Nigeria

Introduction: Tuberculosis is a highly feared disease, known for centuries to affect, debilitate, impoverish large sections of the population and continues to ravage the world and especially the developing world. TB is curable and its effective treatment has shown a significant effect on the control of the disease. Methodology: This was a retrospective hospital based study carried out on records of 1025 TB cases, treated from 2009-2012 cohorts. A structured proforma was used to collect information from the TB registers, individual cards and folder records of the patients. Data were analyzed using a software package, EPI INFO version 7.1.3. Frequencies tables and summary indices were generated and chi-square was used to test association between variables where appropriate. P-value of ≤0.05 was considered significant. Results: Most of the cases reviewed had pulmonary tuberculosis. 96.7% and majority (86.3%) of them had sputum smear positive results at diagnosis. Majority, 79.7% of the patients were new cases and the treatment outcome showed a total success rate of 81.4%, (cured, 46.3% and completed treatment, 35.1%), default, (9.8%), died (6.5%) and failed treatment (1.5%). Factors found to significantly affect treatment outcome in this study were; age, gender, educational status, religion, living with someone, treatment regimen, HIV status of patients and type of patient at presentation/diagnostic criteria, p < 0.05. Conclusion: The success rate recorded in this study was below the set target by WHO, thus there was a need to put in place appropriate measures to improve the outcome of TB treatment in Imo State, Nigeria.

Enhancing TB case detection: experience in offering upfront Xpert MTB/RIF testing to pediatric presumptive TB and DR TB cases for early rapid diagnosis of drug sensitive and drug resistant TB.

BackgroundDiagnosis of pulmonary tuberculosis (PTB) in children is challenging due to difficulties in obtaining good quality sputum specimens as well as the paucibacillary nature of disease. Globally a large proportion of pediatric tuberculosis (TB) cases are diagnosed based only on clinical findings. Xpert MTB/RIF, a highly sensitive and specific rapid tool, offers a promising solution in addressing these challenges. This study presents the results from pediatric groups taking part in a large demonstration study wherein Xpert MTB/RIF testing replaced smear microscopy for all presumptive PTB cases in public health facilities across India.MethodsThe study covered a population of 8.8 million across 18 programmatic sub-district level tuberculosis units (TU), with one Xpert MTB/RIF platform established at each study TU. Pediatric presumptive PTB cases (both TB and Drug Resistant TB (DR-TB)) accessing any public health facilities in study area were prospectively enrolled and tested on Xpert MTB/RIF following a standardized diagnostic algorithm.Results4,600 pediatric presumptive pulmonary TB cases were enrolled. 590 (12.8%, CI 11.8–13.8) pediatric PTB were diagnosed. Overall 10.4% (CI 9.5–11.2) of presumptive PTB cases had positive results by Xpert MTB/RIF, compared with 4.8% (CI 4.2–5.4) who had smear-positive results. Upfront Xpert MTB/RIF testing of presumptive PTB and presumptive DR-TB cases resulted in diagnosis of 79 and 12 rifampicin resistance cases, respectively. Positive predictive value (PPV) for rifampicin resistance detection was high (98%, CI 90.1–99.9), with no statistically significant variation with respect to past history of treatment.ConclusionUpfront access to Xpert MTB/RIF testing in pediatric presumptive PTB cases was associated with a two-fold increase in bacteriologically-confirmed PTB, and increased detection of rifampicin-resistant TB cases under routine operational conditions across India. These results suggest that routine Xpert MTB/RIF testing is a promising solution to present-day challenges in the diagnosis of PTB in pediatric patients.