Positive Tuberculosis Patients Research Articles

Risk factors for death during treatment in pulmonary tuberculosis patients in South India: A cohort study

ObjectiveIdentifying the risk factors for deaths during tuberculosis (TB) treatment is important for achieving the vision of India's National Strategic Plan of ‘Zero Deaths’ by 2025. We aimed to determine the proportion of deaths during TB treatment and its risk factors among smear positive pulmonary TB patients aged more than 15 years. Study designWe performed a cohort study using data collected for RePORT India Consortium (Regional Prospective Observational Research in Tuberculosis). SettingRevised TB Control Program (RNTCP) in three districts of South India. ParticipantsThe cohort consisted of newly diagnosed drug sensitive patients enrolled under the Revised National TB Control Program during 2014–2018 in three districts of southern India. Information on death was collected at homes by trained project staff. Primary outcome measuresWe calculated ‘all-cause mortality’ during TB treatment and expressed this as a proportion with 95% confidence interval (CI). Risk factors for death were assessed by calculating unadjusted and adjusted relative risks with 95% CI. ResultsThe mean (SD) age was of the 1167 participants was 45 (14.5) years and 79% of them were males. Five participants (0.4%) were HIV infected. Among the males, 560 (61%) were tobacco users and 688 (75%) reported consuming alcohol. There were 47 deaths (4%; 95% CI 3.0–5.3) of which 28 deaths (60%) occurred during first two months of treatment. In a bi-variable analysis, age of more than 60 years (RR 2.27; 95%CI: 1.24–4.15), male gender (RR 3.98; 95% CI: 1.25–12.70), alcohol use in last 12 months (RR 2.03; 95%CI: 1.07–3.87), tobacco use (RR 1.87; 95%CI: 1.05–3.36) and severe anaemia (RR 3.53: 95%CI: 1.34–9.30) were associated with a higher risk of death. In adjusted analysis, participants with severe anaemia (<7gm/dl) had 2.4 times higher risk of death compared to their counterparts. ConclusionThough deaths during TB treatment was not very high, early recognition of risk groups and targeted interventions are required to achieve zero TB deaths.

Treatment outcome of tuberculosis patient of Samtse General Hospital, Bhutan.

BackgroundTuberculosis (TB) is one of the major public health problems in Bhutan. Evaluation of treatment outcomes of TB and identification of the risk factors are important components for the success of National TB control program. Therefore, this study was undertaken to assess the TB treatment outcome and factors associated with it in Samtse General Hospital.MethodsThis was a retrospective, cross sectional study using the TB data from Samtse General Hospital from 2008–2019. A univariate and multiple logistic regression was used to check for associations between the outcome and other independent variables.ResultsThe study included a total of 634 TB patients. Of this, 44.0% (279) were smear positive TB (PTB+), 36.1% (229) were extra pulmonary TB (EPTB) and 19.9% (126) were smear negative TB (PTB-). During the study period, 56.2% (356) of them completed treatment, 33.3% (211) were declared cured, 0.2% (1) had defaulted, 5.1% (32) died and 5.4% (34) had treatment failure. The mean treatment success rate (TSR) was 89.4% (567). The TSR was highest for EPTB with 96.9% (222/229), followed by PTB- at 88.1% (111/126) and lowest for PTB+ with 83.9% (234/279). Successful treatment outcome was observed in EPTB patients (AOR: 7.3; 95% CI: 2.46-21.36), patients in age 15-28 years (AOR: 3.4; 95% CI: 1.59-7.46) and 29-42 years (AOR: 9.1; 95% CI: 2.44-33.61).ConclusionThe treatment outcome of TB in Samtse General Hospital is satisfactory and at par with the national level. Since, smear positive TB and elderly patients are prone to develop poor treatment outcome, they need to be monitored and followed up adequately.

Prevalence of Tuberculosis among bedside contacts of Smear Positive Tuberculosis Patients at The University Teaching Hospital, Lusaka, Zambia

Background: Screening of contacts of tuberculosis (TB) patients is not routinely done in resourcelimited countries like Zambia despite the World Health Organization (WHO) recommendations, leading to missed opportunities for prevention, early diagnosis and high mortality.Objective: Main objective was to establish the prevalence of latent and active tuberculosis in bedside contacts of smear-positive index patients and associated risk factors.Methods: The study was carried at the University Teaching Hospital, a tertiary level facility. We conducted a cross sectional analytical study. We included 64 TB-unexposed and 69 TB-exposed contacts in this analysis. We recruited bedside contacts of smear-positive TB patients (TB Exposed group) in medical wards and contacts of surgical patients (TB Unexposed group) as a comparison group. A structured questionnaire was used to collect data on demographic, laboratory and clinical parameters among them being, age, gender, residence, relationship index patient's sputum grades BMI and HIV status. Active TB was diagnosed microbiologically and radiologically, while latent tuberculosis infection (LTBI) by tuberculin skin test (TST). Collected data was analysed using STATA 13 to determine the prevalence of TB and LTBI and the associated factors. A p value of &lt; 0.05 was considered statistically significant.Results: The mean age for TB unexposed and that of TB exposed was of 41.2 [±13.5] years and 40.2 [±14.7] years respectively. The Prevalence of active TB in TB exposed and in TB unexposed was 13.0% and 0% respectively. The prevalence of LTBI among TB exposed and TB unexposed was 83.1% and 38.3% respectively. Active TB in TB exposed bedside contact was associated with duration of hospital stay (AOR 2.45, 95% CI 1.0 – 5.9, p = 0.03) and index patient's sputum grade of 2+ (AOR 4.4, 95% CI 1.07 -18.3, p = 0.04).Conclusion: Bedside contacts of active TB patients are at an increased risk of contracting both latent and active TB. Further, our findings suggest a significant prevalence of LTBI in the general population of Lusaka. Bedside contact tracing is an effective approach to finding the missing TB patients our setting of a high TB burden country/community. The findings call for an urgent need to institute effective TB control/preventive measures with active case finding as a priority and LTBI screening finding and treatment.

Prevalence of Tuberculosis among bedside contacts of Smear Positive Tuberculosis Patients at The University Teaching Hospital, Lusaka, Zambia

background &#x0D; Screening of contacts of TB patients is not routinely done in resource-limited countries like Zambia despite WHO recommendations, leading to missed opportunities for prevention, early diagnosis and high mortality.&#x0D; OBJECTIVES &#x0D; Main objective was to establish the prevalence of latent and active tuberculosis in bedside contacts of smear-positive index patients and associated risk factors.&#x0D; METHODS &#x0D; We recruited bedside contacts of smear-positive TB patients in medical wards and contacts of surgical patients as a comparison group using a questionnaire to collect data on various variables. Active TB was diagnosed microbiologically and radiologically, while LTBI by TST.&#x0D; RESULTS &#x0D; We had 64 TB-unexposed and 70 TB-exposed, with a mean age of 41.2 [±13.5] years and 40.2 [±14.7] years respectively. Prevalence of active TB in the two groups was 10.0% and 0% respectively while that of LTBI was 83.1% and 38.3% respectively. TB exposure was significantly associated with active TB (p=0.014), LTBI (p&lt;0.001) and type of contact (p&lt;0.001)] but not duration of exposure (p=0.057). &#x0D; CONCLUSION &#x0D; Bedside contacts were at increased risk of contracting both latent and active TB. Given the significant burden of LTBI in the general population without documented TB exposure, there is an urgent to institute preventive measures to protect/treat contacts of TB patients.

Delay in diagnosis of tuberculosis and related factors from a district in Kerala, India

BackgroundEarly diagnosis and treatment of tuberculosis is of vital importance both to cure patients and to reduce transmission for effective control of tuberculosis, It is important to know whether tuberculosis is diagnosed in time and also what causes delay if any. ObjectivesThe study was conducted with the objective of knowing the time taken to diagnose tuberculosis from the onset of symptoms and to identify the causes for delay if any. MethodsA study was conducted in the District of Malapppuram Kerala, South India among newly diagnosed smear positive tuberculosis patients. 489 patients were interviewed soon after diagnosis and their socio-demographic characteristics and details from onset of symptoms to diagnosis were collected using a structured format. ResultsThe mean time taken by the patient for consultation after onset was 36 days and the mean time for diagnosis was 42 days and total time until diagnosis was 78 days. 72.8% patients consult within 6 weeks of onset and 74.7% are diagnosed within 6 weeks of consultation. The delay for diagnosis was more with private institutions. Diagnosis took less time when government facilities are consulted and when cough was a prominent symptom. Socio demographic factors are seen not affecting the time. ConclusionsThere is delay in diagnosing tuberculosis especially with private health providers and more efforts are required to reduce the same.

Impact of health education on preventive therapy with integrated monitoring of Tuberculosis cases

Abstract Background The hilly state of Sikkim has the highest proportion of Tuberculosis (TB) cases in India. Increasing compliance of preventive therapy among paediatric contacts will help to cut down transmission. Separate visits are being made under the current National TB control programme to monitor preventive therapy &amp; treatment of index Tuberculosis cases in the same house. Integrated monitoring for preventive therapy of the contacts &amp; treatment of index cases will ensure compliance of both but at no extra cost. Methods It was a prospective study with universal sampling of all the sputum positive TB patients in East Sikkim. Home visits were conducted initially, after 3 months with health education intervention and finally at the end of 6 months. Focus group discussion (FGD) was done amongst the TB home visitors regarding monitoring visits. Results Out of the total 124 paediatric contacts, 86 (69.4%) initiated Isoniazid Preventive Therapy (IPT). After 6 months of follow up, 114 (91.9%) children had completed IPT after the health education intervention. In 96.7% of the houses, it was possible to monitor both index cases and the paediatric contacts simultaneously with the same work force. Content analysis of FGD among TB home visitors revealed lack of programme clarity regarding integrated visits for monitoring of both contacts and index cases. Conclusions Health education intervention was found to be an effective tool for increasing compliance of IPT. This study had a huge &amp; far-reaching impact in terms of providing the evidence that integrated monitoring for preventive therapy of the contacts along with health education &amp; monitoring of treatment of index cases can be done simultaneously with no extra cost in the ongoing TB Control Programme. Key messages Health education intervention increased compliance of IPT. Integrated monitoring for preventive therapy along with health education &amp; monitoring of index cases can be done with no extra cost.

Haematological profiles after Intensive phase of Anti Koch Treatment with special emphasis on bone marrow changes

BackgroundTuberculosis remains a major public health problem in various parts of the world. It leads to various haematological changes. Study of these haematological changes will help better patient management. Objective & methodsIt is to evaluate haematological changes in tuberculosis patients and compare the result with special emphasis to bone marrow changes as active case search is sharply decreasing the miliary tuberculosis. It is also to evaluate the patients with before and after the Intensive Phase of Anti Koch Treatment. Sputum positive and sputum negative tuberculosis patients confirmed by other ancillary techniques were included into this study. It is conducted at a tertiary level hospital in rural area. ResultIn this study bone marrow hypercellularity was of erythroid series with only 1.92% patients showed granuloma in bone marrow aspiration. In addition to bone marrow changes, significant changes were evident in haemoglobin level, Erythrocyte Sedimentation Rate (ESR) Total White Blood Cell count and RBC count. DiscussionIn majority cases this study showed Erythroid Hyperplasia. It is sharp contrast with other study where myeloid hyperplasia was evident. This study also differs from other study where high number of bone marrow granuloma was reported. In this study only 1.92% cases showed bone marrow granuloma. This study also documented higher number of anaemic cases mostly because of the institute serves poor and tribal population. ConclusionIn our study the cases showing granuloma and hyperplasia of myeloid series were limited. With introduction of Directly Observed Treatment and house to house active case search helped to sharply decrease bone marrow granuloma by limiting multi-organ spread. This study showed, ESR level may be considered as prognostic parameters of tuberculosis.

Characteristics of tuberculosis patients in the integrated tuberculosis control model in Chongqing, China: a retrospective study

BackgroundChina ranks second in the world in terms of numbers of tuberculosis (TB) cases and is one of the top three countries with the largest number of multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB). It also has high mortality and low cure rates of human immunodeficiency virus (HIV)-positive TB patients. This study aimed to analyse, under the integrated TB control model, the characteristics of TB patients seeking healthcare in the largest designated TB hospital in Chongqing.MethodsThis was a retrospective study of TB registers in a health facility. Record data of 1827 TB patients who had attended the Chongqing Public Health Medical Center (CPHMC) from 1 January to 31 December 2018 were included. The Statistical Package for Social Science (SPSS 18.0; IBM Corporation, Armonk, NY, USA) was used to analyse the data. Counting data were compared using the chi-square test or Fisher’ s exact test. Among the results of the univariate analysis, the variables with statistical significance were included in the binomial stepwise logistic regression, with odds ratio and 95% confidence interval calculated. A two-tailed probability level of P < 0.05 was considered statistically significant.ResultsThe majority of registered patients were men (1197), of Han ethnicity (1670), aged 21–60 years (1331), farmer/unemployed (1075), and living in county/district (1207). Approximately 24.9% of patients (455/1827) contracted DR-TB, 6% (110/1827) were co-infected with HIV, and 41.0% (749/1827) had drug-related hepatotoxicity. Among those patients, DR-TB was more likely to develop among farmers who received retreatment and had drug-related hepatotoxicity (P < 0.05). Women who received retreatment and lived in county/district were less likely to be HIV positive (P < 0.05). Compared with farmers, patients who were unemployed were more likely to be HIV positive, and those aged 21–60 years had a higher risk of being tested as HIV positive (P < 0.05).ConclusionFarmers who received retreatment and had drug-related hepatotoxicity are more susceptible to DR-TB; young unemployed men have a higher risk of contracting HIV-positive TB. The demographic and clinical characteristics of TB patients should be taken into consideration in DR-TB and HIV-positive TB screening in the future.

Designing fusion molecules from antigens of Mycobacterium tuberculosis for detection of multiple antibodies in plasma of TB patients

Tuberculosis (TB) is amongst the deadliest diseases worldwide. For effective control of TB a rapid, reliable and sensitive method for its diagnosis is essential. Serodiagnosis detecting multiple antibodies against antigens of Mycobacterium tuberculosis (Mtb) in blood samples could prove beneficial. Based on the epitope position in the molecule, two truncated variants of Rv1984c, i.e., Tn1Rv1984c and Tn2Rv1984c were expressed in Escherichia coli. Screening of the Rv1984c, Tn1Rv1984c and Tn2Rv1984c against 231 sera samples from the culture positive TB patients showed sensitivities of 34.2%, 49.4% and 26.8%, respectively. Another antigen Rv1352 was analyzed for the location of epitopes, which had not been reported before. A fusion molecule consisting of Tn1Rv1984c and Rv1352, expressed in E. coli, showed enhanced sensitivity of 62.8%. Joining another antigen Rv2031c to the N-terminus of Tn1Rv1984c-Rv1352, improved sensitivity to 71.4%. The fusion construct Rv2031c-Tn1Rv1984c-Rv1352 showed comparatively higher sensitivity of 73.4% in the male group as compared to 67% in the female group. Data derived for the secondary structure analysis through Circular Dichroism (CD) spectroscopy and prediction on the basis of molecular modelling was also in agreement. This construct can be a potential base for producing constructs with greater sensitivity through fusion of epitopes from additional Mtb antigens.

Factors associated with delays in seeking tuberculosis treatment among patients at Muhima district hospital, Rwanda

Background: Few studies exist in Rwanda to establish the reasons behind delays in seeking treatment in the health institutions which further affected timely diagnosis and case detection. The study investigated factors associated with delays in seeking treatment among tuberculosis (TB) patients at Muhima District Hospital, Rwanda.Methods: The study adopted descriptive cross- sectional study of 49 smear-positive TB patients derived using proportion estimation of case registry (November 2016 to January 2017) newly- diagnosed patients, first and second months treatment. Systematic sampling technique used to select 60 TB patients from target population. Data collected by researcher and trained research assistant, using a close- ended questionnaire through a translation in local dialect.Results: About 49% (24) of the smear- positive TB patients experienced delayed in seeking treatment for more than 180 days (6 months). Also 53% (26) were within the 36-45 age-cohort, while majority 75.5% (37) of the respondents was male. About 57% (28) of the respondents have poor knowledge of TB transmission. Similarly, about 51% (25) were the results on the perception of taking anti- TB medication, while median time interval from onset of symptoms and initiation of treatments was 45 days, average 71 days between 15 -180 days.Conclusions: Statistically significant relationship exist between initial source of treatment using home remedies (p=0.0) and private insurance cover (p=0.0) in relation to delay, which further contributed to delay among majority. Recommendations of the study are strengthening medical services utilization, improving case detection, medical infrastructures and collaboration with non- formal healthcare practices.

Prevalence of LTBI among household contacts of sputum positive TB patients receiving DOTS chemotherapy

Objectives1. To estimate the prevalence of latent tuberculosis infection among household contacts of sputum positive pulmonary tuberculosis patient receiving DOTS chemotherapy. 2. To evaluate the risk factors among household contacts of sputum positive pulmonary tuberculosis patient receiving DOTS chemotherapy. 3. To evaluate the degree of exposure among household contacts of sputum positive pulmonary tuberculosis patient receiving DOTS chemotherapy. MethodsThis study was a cross sectional done among 220 household contacts of age 12 years and above (male and female) of the index sputum positive patients receiving DOTS. Mantoux skin test (Tuberculin Skin Test - TST) was administered by the principal investigator along with TST reading & final diagnosis. Chi-square test was done to find out the association. ResultsOut of 220 household contacts tested, 43.6% (96) tested positive for latent TB (induration ≥10mm) with 95% CI ranging from 37% to 50%. The prevalence of latent TB among men and women are 35.6% and 49.2% respectively the difference between which is found to be statistically significant (p = 0.04). Odds Ratio of 5.5 was noted among study subjects who were diabetic (p = 0.018). Household contacts of index patients taking CAT II were at a higher risk than that of CAT I. ConclusionThis study clearly shows the high prevalence of latent TB infection among household contacts of sputum positive patients receiving DOTS and so RNTCP should include them in IPT along with under 6 children. The household contacts who spend most time with the index case, who sleep close to them within 5 feet, female household contacts, students, diabetic household contacts are at a significantly higher risk than others.

Three decades History of Tuberculosis Control in Kerbala/Iraq

Objective: To assess tuberculosis control between 1988 and 2017 and evaluate the outcomes of treatment among the October patients put on DOTS in Karbala governorate since the initiation of DOTS strategy in 2000.&#x0D; Material and methods: Data on tuberculosis incidence between 1988 and 2017 were assessed. In addition, all quarterly reports were collected in addition to the annual reports to estimate the outcome indices of DOTS in the governorate. Evaluation indices included the incidence and death rates; case detection rate for smear positive and total tuberculosis patients; cure rate; treatment success rate; default rates; treatment failure rates; drug resistance rates; contact tracing during the study period between 2005 and 2014. These indices were compared to the available national indices in the whole country. The indices of treatment success and failure rates were compared to the available previous reported rates in the governorate and in Iraq. Analysis used SPSS-20 and Excel data sheet.&#x0D; Discussion with experts working for decades in TB control programs revealed some defect in determining these indices.&#x0D; Results: Between 1988 and 2017 there was a total of 8665 TB patients, while between 2005 and 2017 the total was 4055: 2592 pulmonary TB patients (62%) and 1541 extra-pulmonary tuberculosis patients (38%). Gender distribution showed male predilection (60.3%) and a mean age of patients was 41.88±19.74 year and one half of the patients were above 44 year of age, but the most frequent age group was 25-34 year.&#x0D; Positive smear Case Detection rates were below the WHO planned goals ranging from 11.5% and 29.1%. The total reported deaths during the study period were 78 deaths. Defaulters were 97 patients at a rate of 2.39, while treatment failure cases amounted to 33 patients (a rate of 0.81%). Drug sensitivity test was introduced to country in 2010 and was done only in Baghdad till the introduction of Genexpert MTB/RIF test in January 2014 and a total of 72 patients were MDR cases. Case detection rate among contacts was 0.31%.&#x0D; Conclusions: The success in DOTS in Karbala is similar to the results in the whole country and in most developing countries and approaching the WHO set goals, while the case detection rates were behind. However, some defect areas need further support to prevent failure and aid continuous tuberculosis control and stop TB.

An Epidemiological Study of Sputum Positive TB Patients &amp; Burden of Tuberculosis amongst their Contacts in East District of Sikkim

Background- Tuberculosis (TB) is a major public health problem all over the world and more so in India as it reports the highest burden of TB (both Drug sensitive and Drug resistant TB) globally. The magnitude of TB in Sikkim is enormous as is evident by the number of cases being reported (275 per 100,000 population) which is higher than the national average. It is a known fact that one single active case of TB can infect about 10 to 15 persons in a year. Early identification of the contacts ensures a better chance at cure and also helps to reduce the transmission. Materials and Method - It was a cross sectional study conducted among all the Sputum Positive cases of Tuberculosis and their household contacts in East District of Sikkim that were registered with RNTCP for the first and second quarters of the year 2017. Results- A total of 55 sputum positive cases of Tuberculosis and 196 household contacts were included in the study. Nearly 60% of the index cases reported having cough for more than two weeks along with fever in the beginning of their illness. On assessment of the past medical history of the contacts, it was observed that 8 (4.08%) had a history of TB in past. Almost a quarter of the contacts spent all their time in the same room as the index cases, another quarter spent only night time in the same room while about 61(30%) spend only daytime in the same room as index cases. Among the contacts, 5 were referred for sputum microscopy out of which 1 was found to be positive and 1 was negative. The remaining 3 didn’t get themselves tested. Conclusions- With the burden of TB being highest in India and having a goal to end TB by 2025, a more active approach to diagnose TB among contacts is the need of the hour which can led to early treatment and cut down transmission among the contacts.

Contact Screening and Isoniazid Preventive Therapy Initiation for Under-Five Children among Pulmonary Tuberculosis-Positive Patients in Bahir Dar Special Zone, Northwest Ethiopia: A Cross-Sectional Study.

Background Children are highly susceptible to Mycobacterium tuberculosis infection, and about 70% of children living in the same households with pulmonary tuberculosis-positive patients will become infected. However, pulmonary positive tuberculosis is a common phenomenon and the implementation of the recommended contact screening and initiation of isoniazid preventive therapy is very low. Therefore, this study is aimed at assessing contact screening practice and initiation of isoniazid preventive therapy of under-five children among pulmonary tuberculosis-positive patients in Bahir Dar, northwest Ethiopia. Methods A facility-based cross-sectional study was conducted from March 1 to 30, 2016. A total of 267 pulmonary tuberculosis-positive patients were included in this study. To identify independent predictors of contact screening and isoniazid preventive therapy initiation, we performed multivariable logistic regression analyses using SPSS version 20 with CI of 95% at p value < 0.05. Results A total of 230 (90.2%) pulmonary tuberculosis-positive patients had single contacts with their under-five children. One hundred nine (64.8%) children were screened. From those screened, 11 (7.4%) developed tuberculosis disease and started antituberculosis treatment. Forty-four (31.9%) children started isoniazid preventive therapy. Sex of the participants, place of service delivery, relationship with contacts, HIV status, and attitude of PTB+ cases were significant predictors of contact screening (p < .05). Participant's knowledge, attitude of participants, and relationship of the child with participant were significant predictors of isoniazid preventive therapy initiation (p < 0.05). Conclusion Contact screening practice and isoniazid preventive therapy initiation of children under the age of 5 in Bahir Dar zone were very low. Intimate family contact with pulmonary tuberculosis-positive patients, place of service delivery, and attitude towards screening are the key factors of contact screening. Participant's knowledge, attitude of participants, and relationship of the child with participant are the key factors of isoniazid preventive therapy initiation. Therefore, household contact screening and isoniazid preventive therapy initiation should be paid attention to reduce transmission.

Pre-treatment lost to follow up among presumptive tuberculosis patients in a tertiary care centre, South India

Background: At tertiary care centres, presumptive tuberculosis (TB) patients who come from far off places and are more likely to drop out during diagnosis or before treatment initiation. We aimed to describe the proportion lost during diagnosis or before treatment and also assessed the reasons for the loss to follow up.Methods: We did a hospital based descriptive study, reviewing laboratory register and referral register to assess the status of submission of second sputum and referral letter, respectively, for patients visiting a designated microscopy centre at a teaching hospital. Reasons for lost to follow up were assessed through telephonic interviews.Results: Out of a total 2025 presumptive TB patients, 315 (15.6%, 95% CI 14.0-17.2) did not provide a second sputum sample. ‘Symptoms had reduced or subsided’ (30%), ‘not aware that second sample needs to be given’ (23%) and ‘visited other hospital’ (14%) were the common reasons reported for the same. A total of 270 (13.3%) patients were sputum smear positive; of them 92 (34.1% CI 28.4-40.1) did not collect referral letter. Among those who were referred, 66% were referred within a week. Deaths, ‘busy in routine work’ and treatment at other government hospitals were the common reasons reported for not collecting referral letter.Conclusions:One out of seven patients did not submit a second sputum sample and one third of sputum smear positive TB patients did not collect the referral letter. Follow up mechanisms needs to be strengthened in the national program to reduce this pre-treatment lost to follow up.

Comparison of Clinical, Radiological and Laboratory Parameters Between Elderly and Young Patient With Newly Diagnosed Smear Positive Pulmonary Tuberculosis: A Hospital-Based Cross Sectional Study.

IntroductionTo compare clinical, radiological and haematological manifestations among newly diagnosed smear positive tuberculosis patients between Group I (Elderly >60 yrs) and Group II (Younger age between 13 and 60 years).MethodologyThis was a hospital-based cross-sectional study conducted at the out-patient department of pulmonary medicine, between March 2014 and December 2017. There were 61 patients in Group I (Elderly > 60 yrs) and 110 patients in Group II (Younger age between 13 and 60 years). Continuous variables were compared using student’s t-test and Mann-Whitney test. Chi square test and Fischer test was used for analysing categorical variables. All statistics were two-tailed, and a p-value of 0.05 was considered to be statistically significant.ResultsThe mean age for Group I (Elderly >60 yrs) was 65 ± 2 years and for the Group II (Younger age between 13 and 60 years) was 40 ± 1 years. There was a statistically significant association of cavitation with infiltrates (p = 0.007) in younger age group. Bilateral multiple zone (48, 64.86%) involvements were commonly observed in both the age groups. There was no significant difference between two groups with regard to haematological and clinical parameters.ConclusionWe did not find any difference in the presentation of tuberculosis in both the groups. Radiologically, there was more of cavitating lesion in younger age group. So, they should be isolated and followed up at regular intervals.

Detection of Tuberculosis by The Analysis of Exhaled Breath Particles with High-resolution Mass Spectrometry

Tuberculosis remains a global health threat killing over 1 million people per year. Current sputum-based diagnostics are specific but lack sensitivity resulting in treatment of many sputum negative cases. In this proof-of-concept study, we used high-resolution mass spectrometry to identify specific lipids in peripheral lung fluid samples of TB patients and controls, captured using a novel non-invasive sampling system. Exhaled respiratory particles were collected in liquid and after concentration and lipid extraction directly infused into a high-resolution mass spectrometer. High-resolution mass spectrometric data collection was conducted in a dual ion mode and chemical compositions were constructed using accurate mass measurement. Over 400 features with high segregating capacity were extracted and optimized using feature selection algorithm and machine learning, from which the accuracy of detection of positive tuberculosis patients was estimated. This current strategy provides sensitivity offered by high-resolution mass spectrometry and can be readily susceptible for developing a novel clinical assay exploring peripheral lung fluid for the detection of active TB cases.

Pilot testing of sticker tool method for monitoring DOTS providers under revised national tuberculosis control program in Khammam: operational research

Background: Globally, tuberculosis (TB) is one of the leading causes of death. In 2016, 10.4 million people were affected with TB and accounted for 1.7 million deaths. India ranks the first among the seven leading countries that account for 64% of the total burden of TB. To fill the gaps in adherence to therapy and to make the TB Control programs successful, evidence based supplementary low cost effective monitoring tools and techniques are needed. The aims were to determine whether the new sticker tool method acts as supplementary to direct observation component of ‘Directly observed treatment, short course (DOTS) strategy’ used for monitoring adherence to anti-tuberculosis therapy among newly diagnosed sputum positive TB patients; and to compare Sputum smear conversion rate between the intervention group and control group at the end of Intensive phase (IP).Methods: A pragmatic cluster randomized control trial was conducted for a period of 9 months from April 2018 to December 2018 in Rural Khammam district. Data was represented in frequencies and percentages and Means.Results: The delay in sending SMS decreased after field visit (1st week of therapy) but delay again increased as the days passed. The study measured indirectly measured the adherence to the therapy by sputum conversion rate (83.3%). It was noticed that 45.5% stickers did not tally with the date of consumption of TB medications or with the date of sticking on the sticker chart. Conclusions: The study shows self administration is also a good option. There may be other factors that play an important role in adherence to anti tuberculosis treatment (ATT).

Comparison of neurocognitive changes among newly diagnosed tuberculosis patients with and without dysglycaemia

BackgroundDiabetes often occurs together with tuberculosis (TB) and both may affect each other negatively. Diabetes may be associated with neurocognitive dysfunctioning in affected patients and may negatively impact treatment adherence and outcomes. This study compared the neurocognitive status between newly diagnosed smear positive tuberculosis patients with dysglycaemia and those with normoglycaemia.MethodsThe current study was a cross-sectional study involving one hundred and forty-six (146) newly diagnosed smear positive TB patients. Oral glucose tolerance test (OGTT) was performed and the results were categorized as either normoglycaemia, impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or diabetes.Neurocognitive functioning among study participants was assessed at the time of TB diagnosis using Cognitive Failure Questionnaire (CFQ), Montreal Cognitive Assessment tool (MoCA), California Verbal Learning Test (CVLT), Brief Symptom Inventory (BSI) and the Spitzer Quality of Life Index (QLI).ResultsThe mean age of the participants (n = 146) was 38.7 years with 78.8% being males and 21.2% females. Using the fasting blood glucose test, the prevalence of impaired fasting glucose and diabetes were 5.5 and 3.4% respectively, both representing a total of 13 out of the 146 participants; whilst the prevalence of impaired glucose tolerance and diabetes using 2-h post-glucose values were 28.8 and 11.6% respectively, both representing a total of 59 out of the 146 participants.There were no significant differences in the mean scores on the neurocognitive measures between the dysglaycaemia and normoglycamic groups using fasting plasma glucose (FPG). However, there were significant differences in the mean scores between the dysglycaemia and normal groups using 2-h postprandial (2HPP) glucose values on Phobic Anxiety (Normal, Mean = 0.38 ± 0.603; dysglycaemia, Mean = 0.23 ± 0.356; p = 0.045), and Montreal Cognitive Assessment (MoCA) scores (17.26 ± 5.981 vs. 15.04 ± 5.834, p = 0.037).ConclusionNewly diagnosed smear positive patients with dysglycaemia were associated with significantly lower mean cognitive scores and scores on phobic anxiety than those with normoglyacaemia. The latter finding must be further explored.

Tuberculosis in Children

Background The rate of tuberculosis and other crowding diseases is increasing in vulnerable populations worldwide. Limited resources, shared environments, and densely populated areas are factors in the spreading of disease. Method Via case study analysis, the author explores how the presence of tuberculosis-positive patients is handled in the emergency room and their journey to the operating room. Results A solutions-oriented approach is suggested along with a discussion of the value and importance of adequate personal protective equipment and the consideration of using an augmented technology to aid in the prevention of environmental contamination.