Prevalence Of Tuberculosis In India Research Articles

A study of analysis on prevalence, serological marker and prognosis of tuberculosis in tertiary care hospital

BackgroundTuberculosis is an infectious disease responsible for a significant cause of ill health. According to the WHO global tuberculosis report 2021. 9.9 million cases fell sick with TB in 2020. Significantly, the prevalence of tuberculosis in India is 25%. ObjectiveTo analyze the prevalence of tuberculosis in the suburban areas of the metropolitan city in South India. To analyze the serological marker and prognosis of tuberculosis among males and females. To determine the importance of molecular testing - PCR confirmation on TB after AFB smear. MethodsA retrospective study to analyze 462 patients enrolled by the respiratory medicine department on suspecting pulmonary- 356 (M−264 & F-92) and extra-pulmonary-106 (M-73&F-33) patients and diagnosed Zhiel-Neelsen staining, Mantoux test, Chip-based RT-PCR test, Erythrocyte sedimentation rate, and analyzed serological test such as C-Reactive Protein, Chemiluminescence immune assay. Results23 patients were positive in Ziehl-Neelsen staining, 65 were positive in molecular True-Nat PCR test, Mantoux skin test induration in 10 patients, 98 TB Positive patients examined in the serological analysis, 1 & 3 patients reacted in HIV/HBsAg, and HBsAg test respectively, by chemiluminescence immunoassay, 8 PTB and 4 EPTB and 47 non-TB patients were positive in C-reactive protein, 46 TB and 94 non-TB patients detected abnormal values out of these 160 patients in ESR test. ConclusionThe Prevalence of tuberculosis is significantly rising, especially in the middle-aged population. The rapid molecular diagnostics to detect TB are highly sensitive and specific. Serological markers are essential for the analysis of disease prognosis and need to focus on the guidance of DOTS and RNTCP to End TB.

Clinico-Epidemiological Study of Pericardial Effusion in Northern India

Background: Pericardial effusions may be discovered incidentally or as life-threatening scenario of cardiac tamponade. Hence, etiological identification of pericardial effusion proves crucial in-patient management. Aim: To assess the clinical presentation and etiology of pericardial effusion at a tertiary-care centre in India. Methods: This was a retrospective, observational, single-centre one-year hospital-based study. Data from 70 diagnosed cases of pericardial effusion from our tertiary-care centre in India from August 2016 to July 2017 was retrospectively reviewed. A diagnosis of pericardial effusion was confirmed based on findings from clinical history, examination, specific laboratory investigations, and radiological investigations. Pericardial fluid analysis was also performed. Results: The mean age of the patients was 46.87±14.40 years. Almost equal frequencies of men 36 (51.4%) and women 34 (48.6%) were observed. The most commonly observed signs/symptoms of patients diagnosed with pericardial effusion was raised jugular venous pulse in 39 (55.7%) patients, breathlessness in 36 (51.4%) patients, and tachypnea and tachycardia (heart rate >100 beats per minute) in 33 (47.1%) patients each. An etiology of tubercular effusion was common in 32 (44.4%) patients. On analyzing data according to the underlying etiology, the most frequent sign/symptom was raised jugular venous pulse in 20 (62.5%) patients diagnosed with tubercular effusion, tachypnea in 10 (52.6%) patients diagnosed with hypothyroidism and tachycardia in 12 (63.2%) patients with a diagnosis other than pericardial effusion or hypothyroidism. Conclusions: The high prevalence of tuberculosis in India warrants increased control and awareness of this infection.

Potential effect of household environment on prevalence of tuberculosis in India: evidence from the recent round of a cross-sectional survey

BackgroundTuberculosis (TB) has been a major health problem globally since ages, and even today, it is a major cause of morbidity in millions of people each year. In 2015 alone, TB accounted for about 1.4 million deaths globally, with India carrying the biggest burden of the disease. The physical environment of the household, an individual living in, has a significant influence on the incidence of TB. Thus, an understanding of the socio-economic, demographic and environmental factors that individuals are exposed to is of importance. The objective of present study is to examine the association of household environment with the prevalence of Tuberculosis in India.MethodsThe study utilizes data from the fourth round of National Family Health Survey (NFHS-4), 2015-16, which was collected from self-reported information pertaining to Tuberculosis in the household questionnaire. The specific question was, “Does any usual resident of your household suffer from tuberculosis?” the response to which helped in the detection of Tuberculosis. Binary Logistic regression was performed from which appropriate inferences are drawn on the association of household environment with Tuberculosis.ResultsPrevalence of TB was found to be the highest among elderly people (0.9%), no education (0.4%) and people belonging to the poorest wealth quintile (0.53%). Family members who were regularly (daily) exposed to smoke (second-hand smoke) inside the house were more prone to getting tuberculosis (OR = 1.49; CI = 1.39-1.61) as compared with households where people do not smoke inside the house. Further, households having a finished wall (OR = 0.7; CI = 0.6-0.8) are less likely to get TB than the households with mud walls. Households that shared their toilets with other households are more likely to get hold of Tuberculosis (OR = 1.2; CI = 1.1-1.4).ConclusionsResults strongly suggest that a contaminated household environment increases the risk of tuberculosis in India. There are multiple risk factors that are strongly associated with Tuberculosis: smoke inside house, type of cooking fuel, separate kitchen, floor, roofing and wall material, number of persons sleeping in a room, sharing toilet and potable water with other households; and individual characteristics such as age, sex, educational attainment, marital status, place of residence and wealth index.

Levamisole as an Adjuvant to Short-Course Therapy in Newly Diagnosed Pulmonary Tuberculosis Patients.

Background:The estimated incidence and prevalence of tuberculosis in India are 2.1 and 2.6 million cases respectively. Immunotherapy may shorten tuberculosis treatments and improve the immunity of individuals as well. Hence we study the efficacy of levamisole (LVM) (immunomodulator) as an adjuvant to chemotherapy of pulmonary tuberculosis patients.Materials and Methods:A randomized, double-blind, placebo-controlled clinical trial was conducted for 21 months in newly diagnosed sputum positive pulmonary tuberculosis patients. Patients were subjected initially to clinical examination, sputum acid-fast bacilli smear and culture, tuberculin skin test and weight record. During follow-up, above investigations were repeated. Sixty-five patients were randomly assigned into two groups to receive either tab LVM 100 mg once in a day or matching placebo, orally as a single dose, thrice a week, for 2 months with short-course antituberculosis chemotherapy.Results:Sputum negativity at 1 week was observed in 11 (44%) patients in LVM group whereas only 3 (12%) in placebo group. All the patients 25 (100%) in LVM group were sputum negative compared to 14 (56%) in placebo group by the end of 3 weeks. In LVM group, 24 (96%) and 11 (44%) patients in placebo group show radiological improvement at 2 months. A direct correlation existed between quantum of immune response and weight gain with LVM. LVM rendered all anergic patients to positive tuberculin reactors. In LVM group, patients with initial Mantoux ≥20 mm and advanced cavitary disease, there was decrease in tuberculin reaction size.Conclusion:Adjuvant immunomodulation with levamisole has the potential of shortening the total duration of antitubercular therapy.

Cross sectional study of 39 Cases of Tuberculous Meningitis in North Bihar

Abstract Background: Tuberculous meningitis (TBM) is the most severe manifestation of extrapulmonary tuberculosis with a high mortality and morbidity rates. Exact prevalence of Central nervous system tuberculosis in India is not known, but it accounts for an estimated 1% of all cases of TB, which equates to around 17000 cases in India in 2014. The aims of the study are (1) to review the clinical, laboratory, disease staging and radiological findings of 39 TBM cases at a single center. (2) to present the local epidemiological data from our cases. Methods: Thirty -nine patients admitted to our tertiary hospital with symptoms and signs of meningitis were selected and on the basis of adopted criteria labeled as tuberculous meningitis. Clinical profile, disease staging and cerebrospinal fluid (CSF) findings noted in each patient. adenosine deaminase (ADA) level in CSF estimated. Cut off value of ADA kept at or above 10 IU/L for tubercular meningitis. Comparative study done with 23 patients of pyogenic meningitis. Results: The mean age of patients with tubercular meningitis was 39.07 ± 16.67 years. The symptom duration range from 7 to 98 days with a median of 28 days. Clinically fever was present in 37 (94.8 %), headache in 29 (74.3 %), and vomiting in 22 (56.4 %) patients. Six (15.38 %) patients had seizure. On CSF cytological and biochemical analysis the mean total white blood cell count was 256.74 ± 184.03 /cmm, mean protein 182.22 ± 113.12 mg/ dl and mean sugar 52.85 ± 19.3. The CSF / Blood glucose ratio in TBM case was 0.41. Out of 39 TBM patients, 33 patients were found to be having CSF ADA at or above the cutoff value of 10 IU/L while six had below cutoff value. On comparison between two groups, the CSF ADA level found to be highly significant (P < 0.001). On cranial CT or MRI 28.2 % patients had hydrocephalous, 7.6 % with tuberculoma and 5.1 % with spinal arachnoiditis. About one third patients had evidence of active tuberculosis on chest X-ray. Conclusions: Any patient presenting either acutely or chronically with signs and symptoms of meningitis, urgent CSF examination should be done to diagnose tuberculous meningitis on the basis of CSF lymphocytic pleocytosis, decreased glucose, increased protein, and ADA more than 10 IU/L. Because of high mortality and morbidity early initiation of antitubercular drugs may prevent sequel.

Logistic Regression Approach for Prediction of Gender Bias in the Prevalence of Tuberculosis in India

Objectives: India is one of major contributors to global burden of tuberculosis which alone accounted for an estimated one quarter (26%) of all tuberculosis cases worldwide. The estimation of disease burden of tuberculosis is a challenge, considering its varied epidemiology and dynamics of transmission. As true disease burden cannot be estimated with count data therefore, statistical modelling techniques have been employed to analyze the disease burden in terms of prevalence of tuberculosis among males and females. Methods: An attempt has been made to predict gender bias in the prevalence of tuberculosis. The statistical models for both male and female tuberculosis positivity are developed on the information taken from NHFS (2015-16). The gender wise prevalence of tuberculosis has been compared by considering different indicators. In our analysis, the binary logistic regression model has been used by considering some factors to know their impact on prevalence of the tuberculosis. Results: Some of the variables under socioeconomic factors, Demographic Factors, Cultural factors and Health factors have shown decline their impact on prevalence of tuberculosis in males as compared females. However rests of the variables have the impact on the prevalence of tuberculosis without any variation. Conclusion: The study reveals that there are some factors which are responsible for prevalence of tuberculosis in India among male as well as in females and these factors are continuously contributing in increasing the prevalence of tuberculosis. Hence it is suggested that there is a need to redesign the policies to minimize the risk factors generated on the part of the factors having same impact on the prevalence of tuberculosis to avoid gender bias.

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

BackgroundIndia has 23% of the global burden of active tuberculosis (TB) patients and 27% of the world’s “missing” patients, which includes those who may not have received effective TB care and could potentially spread TB to others. The “cascade of care” is a useful model for visualizing deficiencies in case detection and retention in care, in order to prioritize interventions.Methods and FindingsThe care cascade constructed in this paper focuses on the Revised National TB Control Programme (RNTCP), which treats about half of India’s TB patients. We define the TB cascade as including the following patient populations: total prevalent active TB patients in India, TB patients who reach and undergo evaluation at RNTCP diagnostic facilities, patients successfully diagnosed with TB, patients who start treatment, patients retained to treatment completion, and patients who achieve 1-y recurrence-free survival. We estimate each step of the cascade for 2013 using data from two World Health Organization (WHO) reports (2014–2015), one WHO dataset (2015), and three RNTCP reports (2014–2016). In addition, we conduct three targeted systematic reviews of the scientific literature to identify 39 unique articles published from 2000–2015 that provide additional data on five indicators that help estimate different steps of the TB cascade. We construct separate care cascades for the overall population of patients with active TB and for patients with specific forms of TB—including new smear-positive, new smear-negative, retreatment smear-positive, and multidrug-resistant (MDR) TB.The WHO estimated that there were 2,700,000 (95%CI: 1,800,000–3,800,000) prevalent TB patients in India in 2013. Of these patients, we estimate that 1,938,027 (72%) TB patients were evaluated at RNTCP facilities; 1,629,906 (60%) were successfully diagnosed; 1,417,838 (53%) got registered for treatment; 1,221,764 (45%) completed treatment; and 1,049,237 (95%CI: 1,008,775–1,083,243), or 39%, of 2,700,000 TB patients achieved the optimal outcome of 1-y recurrence-free survival.The separate cascades for different forms of TB highlight different patterns of patient attrition. Pretreatment loss to follow-up of diagnosed patients and post-treatment TB recurrence were major points of attrition in the new smear-positive TB cascade. In the new smear-negative and MDR TB cascades, a substantial proportion of patients who were evaluated at RNTCP diagnostic facilities were not successfully diagnosed. Retreatment smear-positive and MDR TB patients had poorer treatment outcomes than the general TB population. Limitations of our analysis include the lack of available data on the cascade of care in the private sector and substantial uncertainty regarding the 1-y period prevalence of TB in India.ConclusionsIncreasing case detection is critical to improving outcomes in India’s TB cascade of care, especially for smear-negative and MDR TB patients. For new smear-positive patients, pretreatment loss to follow-up and post-treatment TB recurrence are considerable points of attrition that may contribute to ongoing TB transmission. Future multisite studies providing more accurate information on key steps in the public sector TB cascade and extension of this analysis to private sector patients may help to better target interventions and resources for TB control in India.

Tubercular liver abscess: A rare presentation of a common disease

Tubercular liver abscess is one of the rarest forms of extra pulmonary tuberculosis. Despite high prevalence of tuberculosis in India hepatic involvement is rare. Here we present an interesting case of hepatic liver abscess with atypical presentation. Patient was managed successfully with anti tubercular therapy.

Tuberculosis at unusual sites: A case series from a tertiary care center in North Karnataka, India

Tuberculosis (TB) has long been a common and major public health problem in India. Pulmonary infection is the commonest form of the disease, though the bacteria can cause systemic infection in virtually any organ. The increased global incidence of acquired immune deficiency syndrome (AIDS) has led to a resurgence of TB, with reports of unusual sites being affected by the disease. Due to a very high incidence and prevalence of pulmonary TB in India, different forms of extrapulmonary TB are also relatively high. It can present in many diverse ways at unusual sites, which can be confused with many treatable and nontreatable conditions. Here, we present a case series of primary and secondary forms of TB at unusual sites.

Restrictive cardiomyopathy a missed cause of cardioembolic stroke in young patients

Restrictive cardiomyopathy is characterized by restrictive filling and reduced diastolic volume of either or both ventricles with normal or near-normal systolic function and wall thickness. Here, author reports a case of 18-year-old boy who presented with cardioembolic stroke. On further workup, restrictive physiology was identified and possibility of constrictive pericarditis (CP) could not be ruled out on two-dimensional echocardiographic examination, which was subsequently ruled out by 64 slice cardiac computed tomography scan. The identification of the condition is important for the point of diagnosis and management; rheumatic valvular diseases are prevalent most commonly and are a source of embolism for ischemic stroke in young patients. CP is also common due to high prevalence of tuberculosis in India, which poses diagnostic difficulties.

Systemic lupus erythematosus and tuberculosis

Infections, renal failure and cardiovascular disease account for the majority of mortality in systemic lupus erythematosus (SLE). Although most infections are caused by Gram-positive or Gram-negative bacteria, there is an increase in the incidence of Mycobacterium tuberculosis and other opportunistic infections that also account for increased mortality. The higher prevalence of tuberculous infections in SLE is attributed to multiple immune abnormalities seen in these patients. SLE and tuberculosis (TB) interact in complicated ways - they may have similar presentation and may mimic each other. In an individual patient, it becomes important to differentiate one from the other. In this review, we have highlighted the complex interactions of these diseases, the impact of one on the other and the various modalities available for the evaluation and management and their shortcomings. Considering the high prevalence of TB in India, it becomes all the more important for us to be aware of this interaction in our population.

Nosocomial Tuberculosis in India

Most high-income countries implement tuberculosis (TB) infection control programs to reduce the risk for nosocomial transmission. However, such control programs are not routinely implemented in India, the country that accounts for the largest number of TB cases in the world. Despite the high prevalence of TB in India and the expected high probability of nosocomial transmission, little is known about nosocomial and occupational TB there. The few available studies suggest that nosocomial TB may be a problem. We review the available data on this topic, describe factors that may facilitate nosocomial transmission in Indian healthcare settings, and consider the feasibility and applicability of various recommended infection control interventions in these settings. Finally, we outline the critical information needed to effectively address the problem of nosocomial transmission of TB in India.

Biomass cooking fuels and prevalence of tuberculosis in India

Objectives: To examine the relation between use of biomass cooking fuels (wood or dung) and prevalence of active tuberculosis in India. Methods: The analysis is based on 260,162 persons age 20 and over in India's 1992–1993 National Family Health Survey. Logistic regression is used to estimate the effects of biomass fuel use on prevalence of active tuberculosis, as reported by household heads, after controlling for a number of potentially confounding variables. Results: Persons living in households that primarily use biomass for cooking fuel have substantially higher prevalence of active tuberculosis than persons living in households that use cleaner fuels (odds ratio [OR] = 3.56; 95% confidence interval [Cl] = 2.82−4.50). This effect is reduced somewhat when availability of a separate kitchen, house type, indoor crowding, age, gender, urban or rural residence, education, religion, caste or tribe, and geographic region are statistically controlled (OR = 2.58; 95% Cl = 1.98−3.37). Fuel type also has a large effect when the analysis is done separately for men (OR = 2.46; 95% Cl = 1.79−3.39) and women (OR = 2.74; 95% Cl = 1.86−4.05) and separately for urban areas (OR = 2.29; 95% Cl = 1.61−3.23) and rural areas (OR = 2.65; 95% Cl = 1.74−4.03). The analysis also indicates that, among persons age 20 years and over, 51% of the prevalence of active tuberculosis is attributable to cooking smoke. Conclusions: Results strongly suggest that use of biomass fuels for cooking substantially increases the risk of tuberculosis in India.

Notes on the Prevalence of Tuberculosis in India

Notes on the Prevalence of Tuberculosis in India