Prevalence Of Tuberculosis Cases Research Articles

Medication Adherence among Drug-Resistant Tuberculosis (DR-TB) Patients at Universitas Indonesia Hospital

Background: Drug-resistant tuberculosis (TB-DR) is a deadly disease caused by infectious agents. Indonesia is one of the countries with the highest drug-resistant tuberculosis (TB-DR) rates in the world. The prevalence of tuberculosis cases in Depok City between 2019-2022 showed an increase in cases every year. This study aims to measure the level of adherence of drug-resistant tuberculosis (TB-DR) patients to their treatment using the Eight-Item Morisky Medication Adherence Scale (MMAS-8) questionnaire.Methods: This study is an observational study using a cross-sectional study design, conducted from February 2024 to March 2024 at the University of Indonesia Hospital. Eighty-seven respondents participated in this study. Respondents completed the validated Indonesian version of the MMAS-8 questionnaire after signing informed consent forms.Results: The results of the study showed that 50.6% of respondents had low adherence levels, 47.1% had moderate adherence levels, and 2.3% had high adherence levels. The data was then statistically analyzed using the SPSS version 29 statistical package with Chi-Square analysis, which resulted in a significant correlation (P<0.05) between adherence levels and gender.Conclusion: There was a significant correlation between gender and respondent adherence. More than 50% of drug-resistant tuberculosis (TB-DR) patients at the University of Indonesia Hospital still have low adherence levels to their treatment.

Epidemiology of Tuberculosis Among People Living With HIV in the African Cohort Study From 2013 to 2021.

The prevalence and incidence of tuberculosis (TB) is high among people living with HIV (PLWH) but is often underdiagnosed in HIV programmatic settings. President's Emergency Plan for AIDS Relief (PEPFAR)-supported research sites in Uganda, Kenya, Tanzania, and Nigeria. All patients underwent molecular testing at entry into a longitudinal cohort of PLWH and annually thereafter. We assessed the prevalence and incidence of TB and identified clinical and demographic factors associated with prevalent and incident TB using logistic regression and Cox proportional hazard models. From 21 January, 2013, to 1 December 2021, 3171 PLWH were enrolled with a TB prevalence of 3% (n = 93). Of the cases with prevalent TB, 66% (n = 61) were bacteriologically confirmed. The adjusted odds of prevalent TB were significantly higher among those with higher educational attainment, PLWH for 1-5 years since their HIV diagnosis, those who were underweight, and those with CD4 counts <200 cells/mm 3 . The overall TB incidence rate was 600 per 100,000 person-years (95% CI: 481-748). We found that shorter time since HIV diagnosis, being underweight, taking antiretroviral therapy <6 months, and having a CD4 count <200 cells/mm 3 were significantly associated with incident TB. PLWH on dolutegravir/lamivudine/tenofovir had a 78% lower risk of incident TB compared with those on tenofovir/lamivudine/efavirenz (hazard ratio: 0.22; 95% CI: 0.08-0.63). The prevalence and incidence of TB was notably high in this cohort sourced from PEPFAR clinics. Aggressive efforts to enhance HIV diagnosis and optimize treatment in programmatic settings are warranted to reduce the risk of HIV-TB co-occurrence in this cohort.

Screening for Pulmonary Tuberculosis among Patients with Cough Attending Different Block Public Health Centre of North Bank of Kamrup District of Assam, India: Does Location, Gender and Duration of Cough Impact on Screening?

India has 2.64 million tuberculosis (TB) cases, and this number is almost 30% of the worldwide TB burden. The aim of the study was to find out whether there is a relationship between the prevalence of TB cases with respect to gender, duration of cough and location. In this study, sputum samples were collected from the patients who reported cough in outdoor patient departments. All sputum samples were examined microscopically. Age, gender, and location-wise data were prepared for study. During the study period, total 37119 presumptive patients were attended outpatient department and 1103 (2.97%) presumptive patients reported cough. Out of 1103 presumptive cases, 5.98% were found to be sputum positive. The occurrence was highest among male patients (73.1%). The age group 16–30 years was found to be the most vulnerable one. Duration of cough was not found to be a significant factor for sputum positive pulmonary TB. However, there was a locality-wise difference in detection (P &lt; 0.05). The findings suggested that cough reported for any duration should be brought under TB screening. Although the data showed that the occurrence of TB was maximum in male patients, female TB patients should also be brought under thorough investigation. In locations showing significant TB cases, targeted interventions should be initiated by government and non-government agencies to detect the root cause.

The effect of host factors on discriminatory performance of a transcriptomic signature of tuberculosis risk.

SummaryBackgroundWe aimed to understand host factors that affect discriminatory performance of a transcriptomic signature of tuberculosis risk (RISK11).MethodsHIV-negative adults aged 18–60 years were evaluated in a prospective study of RISK11 and surveilled for tuberculosis through 15 months. Generalised linear models and receiver-operating characteristic (ROC) regression were used to estimate effect of host factors on RISK11 score (%marginal effect) and on discriminatory performance for tuberculosis disease (area under the curve, AUC), respectively.FindingsAmong 2923 participants including 74 prevalent and 56 incident tuberculosis cases, percentage marginal effects on RISK11 score were increased among those with prevalent tuberculosis (+18·90%, 95%CI 12·66−25·13), night sweats (+14·65%, 95%CI 5·39−23·91), incident tuberculosis (+7·29%, 95%CI 1·46−13·11), flu-like symptoms (+5·13%, 95%CI 1·58−8·68), and smoking history (+2·41%, 95%CI 0·89−3·93) than those without; and reduced in males (−6·68%, 95%CI −8·31−5·04) and with every unit increase in BMI (−0·13%, −95%CI −0·25−0·01). Adjustment for host factors affecting controls did not change RISK11 discriminatory performance. Cough was associated with 72·55% higher RISK11 score in prevalent tuberculosis cases. Stratification by cough improved diagnostic performance from AUC = 0·74 (95%CI 0·67−0·82) overall, to 0·97 (95%CI 0·90−1·00, p < 0·001) in cough-positive participants. Combining host factors with RISK11 improved prognostic performance, compared to RISK11 alone, (AUC = 0·76, 95%CI 0·69−0·83 versus 0·56, 95%CI 0·46−0·68, p < 0·001) over a 15-month predictive horizon.InterpretationSeveral host factors affected RISK11 score, but only adjustment for cough affected diagnostic performance. Combining host factors with RISK11 should be considered to improve prognostic performance.FundingBill and Melinda Gates Foundation, South African Medical Research Council.

Evaluation of Interferon Gamma Release Assay in the Diagnosis of Active and ‎Latent Tuberculosis among Patients and Contacts ‎

Background and study aim: To date, tuberculosis (TB) is a global health emerging disease. Early detection of TB infection is critical to start therapy and stop increasing the prevalence of TB cases. The presence of sensitive, non-invasive, rapid and cheap method for diagnosing active and latent TB is very crucial to control TB transmission‎.The current study aims to compare the results of Ziehl-Neelsen (ZN) and tuberculin skin test (TST or Mantoux) with the QuantiFERON-TB Gold in-tube Test (QFT-GIT) in the diagnosis of active TB and latent infection. Patients and method: The study included 90 participants divided into 45 clinically and microbiologically diagnosed patients with pulmonary tuberculosis (PTB) and 45 close contacts to PTB patients. Both groups examined clinically, and subjected to three diagnostic tests; ZN, Mantoux, and QFT- GIT. Results: The TST was positive in 95.6% and 42.2% of patients and contacts, respectively. Out of the screened TB patients and contacts, the positive QFT-GIT was found among 86.7% and 68.9%, respectively. The total agreement between QFT-GIT and the Mantoux was 71.11%. Positive concordant results (QFT+/TST+) were observed in 86.9%, while negative concordant results (QFT-/TST-) were detected in 37.9% of patients and contacts‎. Conclusion: The evaluation results of the QFT-GIT with ZN and Mantoux showed high sensitivities but relatively low specificities. The specificity of QFT-GIT was improved by modifying the cut off values to higher levels. Latent tuberculosis infection (LTBI) was likely to occur when both QFT-GIT and TST were positive ‎.

Profile of Pulmonary Tuberculosis Patients with Type 2 Diabetes Mellitus in Pulmonary Department Dr. Soetomo General Hospital Surabaya

Background: Pulmonary tuberculosis (TB) is the most important infectious disease, caused by Mycobacterium tuberculosis (MTB). Indonesia is the third country with the most prevalent TB cases in the world. Not all people who were exposed to MTB will become active TB, because the immune response is the main determinant. Immunocompromised person, such as patients who have type 2 diabetes mellitus (DM) as a comorbid are more prone to develop active TB infection. This study aimed to analyze the profile of pulmonary TB patients with type 2 DM in Pulmonary Department Dr. Soetomo General Hospital Surabaya.Methods: This was an observational descriptive study with a cross-sectional design. The research data were obtained from the medical records of TB patients with type 2 DM in Pulmonary Department Dr. Soetomo General Hospital Surabaya in January - December 2017.Results: Out of a total of 414 hospitalized patients, 74 patients with pulmonary TB were found with type 2 DM. Only 53 patients fulfilled the inclusion criteria. Gene Xpert results were sensitive (66.7%), previous TB treatment history (54.7%), unregulated type 2 DM (88.4%), RBG with the average of 311.83 mg/dl, PPBS with the average of 263.31 mg/dl, FBG with the average of 238 mg/dl, and HbA1C &gt; 10% (68%).Conclusion: The majority of the patients of pulmonary TB with type 2 DM have average high blood glucose and unregulated DM.

A transcriptional blood signature distinguishes early tuberculosis disease from latent tuberculosis infection and uninfected individuals in a Vietnamese cohort

Global tuberculosis (TB) control is restricted by the failure to detect an estimated 3.3 million TB cases annually. In the majority of TB endemic settings, sputum smear microscopy is used to diagnose TB, but this test is insensitive for TB in its early stages. The objective of this study is to establish a concise gene signature that discriminates between individuals with early TB disease, latent TB infection (LTBI) and those without infection. This is a case control study nested within a cluster-randomised trial of population screening for active TB using Xpert MTB/RIF. Whole blood samples from 303 participants with active TB (97), LTBI (92) and uninfected individuals (114) were subject to transcriptomic analysis of selected target genes based on a systematic review of previous studies. Analysis of 82 genes identified a pattern of differentially expressed genes in TB disease. A seven gene signature was identified that distinguished between TB disease and no TB disease with an AUC of 0.86 (95% CI: 0.80-0.91), and between TB disease from LTBI with an AUC of 0.88 (95% CI: 0.82-0.93). This gene signature accurately distinguishes early TB disease from those without TB disease or infection, in the context of community-wide TB screening. It could be used as a non-sputum based screening tool or triage test to detect prevalent cases of TB in the community.

Smoking and HIV associated with subclinical tuberculosis: analysis of a population-based prevalence survey

BACKGROUND: Despite multiple tuberculosis (TB) prevalence surveys reporting a relatively high frequency of bacteriologically confirmed, active TB among individuals reporting no typical symptoms of disease, our understanding of this phenomenon is limited.OBJECTIVE: To quantify the epidemiological burden and estimate associations between individual-level variables and this "subclinical" presentation.METHODS: We performed a secondary analysis of TB prevalence survey data from the South African communities of the Zambia, South Africa Tuberculosis and AIDS Reduction trial. Generalized estimating equations were used to estimate the association between individual-level demographic, behavioral, socio-economic, and medical variables and the risk of bacteriologically positive TB among participants not reporting any symptoms consistent with active TB.RESULTS: The crude prevalence of TB was 2222.1 cases per 100 000 population (95% CI 2053.4-2388.5); 44.7% (295/660) of all documented prevalent cases of TB were subclinical. Current tobacco smoking (OR 2.37, 95% CI 1.41-3.99) and HIV-positive status (OR 3.26, 95% CI 2.31-4.61) were significantly associated with subclinical TB.CONCLUSION: Individuals who smoke or have HIV may be at increased risk of active TB and not report typical symptoms consistent with disease. This suggests possible shortcomings of symptom-based case finding which may need to be addressed in similar settings.

Using surveillance data to simulate the impact of a hypothetical pre-entry tuberculosis screening programme in Japan.

Despite a growing burden of foreign-born tuberculosis (TB) patients, Japan does not currently practise pre-entry tuberculosis (TB) screening among foreign-born entrants. To evaluate the impact of a hypothetical pre-entry TB screening programme among new foreign-born entrants into Japan. Using publicly available sources, we estimated 1) the number of prevalent TB cases, defined as bacteriologically or clinically confirmed cases among new foreign-born entrants into Japan in 2015, and 2) the yield from a hypothetical pre-entry TB screening programme under three scenarios: Scenario A, in which screening would be required of all applicants intending to stay for 3 months; Scenario B, screening among applicants for visas for settlement purposes; and Scenario C, screening among student and technical intern visa applicants. The numbers of prevalent TB cases under Scenarios A, B and C were respectively 492, 54 and 248 out of a total of 328 791, 21 554 and 182 879 applicants, respectively 276, 29 and 137 of whom would be detected via the pre-entry screening programme, giving an yield of respectively 83.9, 134.5 and 74.9 per 100 000 screened under each scenario. The yield was the highest under Scenario B; however, the impact was greatest under Scenario A, in that it detected the greatest number of patients and thus contributed the most in reducing the burden of foreign-born TB cases in Japan.

English

The re-emergence and increase in the prevalence of tuberculosis cases and multidrug resistant strains is of public health concern. The conventional Acid Fast Bacilli detection tool is weak in the current disease trend especially in children, patients with human immunodeficiency virus (HIV) and low bacterial load. The aim of this research was to assess effectiveness of the Gene Xpert MTB/RIF assay and Microscopy in detectiing Mycobacterium tuberculosis (MTB) in sputum samples in Port Harcourt metropolis. A total of two hundred sputum samples were collected from tuberculosis (TB) suspected patients visiting the antiretroviral and directly observed short treatment clinics at Braithwaite Memorial Specialist Hospital, Port Harcourt and University of Port Harcourt Teaching Hospital, Choba. These samples were investigated to compare and evaluate the detection of M. tuberculosis using Gene Xpert MTB/RIF assay and microscopy. Results revealed that 20% (40/200) of the samples were positive for MTB. Ages 31 to 40 years had 55 samples with ten positive MTB while ages < 10 years had the least number of specimens and one MTB detected. Out of 200 samples analyzed, the percentage positive was 20% while 80% was negative for MTB. Ages < 10 years did not show any AFB positive smear whereas ages 31 to 40 years had 10 positive AFB smears. One hundred and four individuals were people living with HIV, ninety six were negative for HIV; fifteen individuals were positive for HIV as well as MTB (co-infection) and no individual that was co-infected had Rifampicin resistance. There is a significant difference in the detection of MTB across PLHIV and negative persons using AFB microscopy and Gene Xpert technique. It can be concluded that the gene xpert MTB/RIF assay is highly sensitive (98%) with a p-value of < 0.001 and specific in the detection of MTB and Rifampicin Resistance in sputum, and its use in health institutions should be encouraged to reduce exposure and spread of the disease as well correct treatment. Key words: Gene xpert, tuberculosis, Mycobacterium tuberculosis/Rifampicin (MTB/RIF), sputum, microscopy.

Small contribution of gold mines to the ongoing tuberculosis epidemic in South Africa: a modeling-based study

BackgroundGold mines represent a potential hotspot for Mycobacterium tuberculosis (Mtb) transmission and may be exacerbating the tuberculosis (TB) epidemic in South Africa. However, the presence of multiple factors complicates estimation of the mining contribution to the TB burden in South Africa.MethodsWe developed two models of TB in South Africa, a static risk model and an individual-based model that accounts for longer-term trends. Both models account for four populations — mine workers, peri-mining residents, labor-sending residents, and other residents of South Africa — including the size and prevalence of latent TB infection, active TB, and HIV of each population and mixing between populations. We calibrated to mine- and country-level data and used the static model to estimate force of infection (FOI) and new infections attributable to local residents in each community compared to other residents. Using the individual-based model, we simulated a counterfactual scenario to estimate the fraction of overall TB incidence in South Africa attributable to recent transmission in mines.ResultsWe estimated that the majority of FOI in each community is attributable to local residents: 93.9% (95% confidence interval 92.4–95.1%), 91.5% (91.4–91.5%), and 94.7% (94.7–94.7%) in gold mining, peri-mining, and labor-sending communities, respectively. Assuming a higher rate of Mtb transmission in mines, 4.1% (2.6–5.8%), 5.0% (4.5–5.5%), and 9.0% (8.8–9.1%) of new infections in South Africa are attributable to gold mine workers, peri-mining residents, and labor-sending residents, respectively. Therefore, mine workers with TB disease, who constitute ~ 2.5% of the prevalent TB cases in South Africa, contribute 1.62 (1.04–2.30) times as many new infections as TB cases in South Africa on average. By modeling TB on a longer time scale, we estimate 63.0% (58.5–67.7%) of incident TB disease in gold mining communities to be attributable to recent transmission, of which 92.5% (92.1–92.9%) is attributable to local transmission.ConclusionsGold mine workers are estimated to contribute a disproportionately large number of Mtb infections in South Africa on a per-capita basis. However, mine workers contribute only a small fraction of overall Mtb infections in South Africa. Our results suggest that curtailing transmission in mines may have limited impact at the country level, despite potentially significant impact at the mining level.

The prevalence and determinants of active tuberculosis among diabetes patients in Cape Town, South Africa, a high HIV/TB burden setting

AimsStudies addressing the association between diabetes mellitus (DM) and tuberculosis (TB) in sub–Saharan Africa are limited. We assessed the prevalence of active TB among DM patients at a primary care clinic, and identified risk factors for prevalent TB. MethodsA cross–sectional study was conducted in adult DM patients attending a clinic in Khayelitsha, Cape Town. Participants were screened for active TB (symptom screening and microbiological diagnosis) and HIV. ResultsAmong 440 DM patients screened, the active TB prevalence was 3.0% (95% CI 1.72–5.03). Of the 13 prevalent TB cases, 53.9% (n = 7; 95% CI 27.20–78.50) had no TB symptoms, and 61.5% (n = 8; 95% CI 33.30–83.70) were HIV–1 co–infected. There were no significant differences in either fasting plasma glucose or HbA1c levels between TB and non–TB participants. On multivariate analysis, HIV–1 infection (OR 11.3, 95% CI 3.26–39.42) and hemoptysis (OR 31.4, 95% CI 3.62–273.35) were strongly associated with prevalent active TB, with no differences in this association by age or gender. ConclusionsThe prevalence of active TB among DM patients was 4–fold higher than the national prevalence; suggesting the need for active TB screening, particularly if hemoptysis is reported. Our results highlight the importance of HIV screening in this older population group. The high prevalence of sub–clinical TB among those diagnosed with TB highlights the need for further research to determine how best to screen for active TB in high–risk TB/HIV population groups and settings.

Knowing how many children to find is the first step in finding them.

Over fifty years ago, large-scale studies undertaken in the United States established that following the diagnosis of tuberculosis (TB) in a source case, household contact investigations were a highly effective strategy to identify previously undiagnosed prevalent cases of TB. Six thousand households were examined, and nearly five hundred contacts had prevalent TB at baseline. Over twenty-five thousand disease-free contacts were then enrolled in a trial comparing isoniazid to placebo. The provision of isoniazid to well household contacts was demonstrated to dramatically reduce the risk of those contacts developing TB disease themselves.1 At about the same time, Katharine Hsu carried out a series of studies in Houston, evaluating TB-affected families identified either through a child with TB or through a child identified as being infected following the diagnosis of TB in an adult. She concluded in 1963 that: ‘…tuberculosis exists in “pools” involving large numbers of cases. Public health efforts should be directed to these pools of infection, and contact investigation has proved very efficient in finding pools.’2 Therefore, we have known for over fifty years that both household contact investigations and preventive therapy for high-risk contacts work effectively. In most high-burden settings, high risk is usually taken to be children aged under five years and those with immune suppression. These strategies are recommended by the World Health Organization (WHO),3,4 and the majority of national TB programmes advise that they are carried out. Yet, in the majority of countries they do not take place, and it is unclear why. Household contact investigations can be seen as time-consuming and resource-intensive. They are often not seen as a priority compared to treating cases of infectious TB. Giving daily preventive therapy for six months to well children is not always easy, and may seem unnecessary to many health care workers and families. Data on the number of household contact investigations undertaken or the number of contacts given preventive therapy are not requested by TB programmes or by the WHO, perhaps sending the message that these activities are unimportant. Finally, health care workers have no idea how many contacts they should be looking for and how many they should be finding. The study by Yuen and colleagues in this issue of Public Health Action addresses this final aspect and provides realistic and tangible targets at a global and national level for the number of children that should be screened and the number that could be expected to have prevalent Mycobacterium tuberculosis infection and disease.5 This is a significant development and one that could be used by local clinic staff, district TB managers, national TB managers and global TB experts to improve the care of children exposed to TB. Not only does knowing the expected number of children that require screening and treatment help to inform resource planning, it also allows an assessment of the programme. By comparing the numbers screened and treated with the numbers expected to need screening and treatment, shortfalls can be identified and addressed. These shortfalls can be compared between clinics, between districts or between countries so that examples of ‘good’ practice (small shortfalls) can inform those with less good practice (larger shortfalls). Yuen and colleagues estimate that seven and a half million children each year live in households with diagnosed cases of infectious pulmonary TB. These children should be screened. Although this is a large number, these children are the low-hanging fruit: the yield from screening in this context is higher than almost any other strategy for trying to find cases of M. tuberculosis infection and disease. Currently only about a third of the one million children who develop TB disease globally each year are diagnosed and treated.6 A far smaller proportion of the children who are eligible for preventive therapy receive it. It is difficult to see how we will improve on these rates without household screening; if we want to find and treat more children we really do not have any other options.

Risk of Tuberculosis Among Patients on Dialysis: The Predictive Value of Serial Interferon-Gamma Release Assay.

Patients on long-term dialysis are at high risk for tuberculosis (TB). Although latent tuberculosis infection (LTBI) is good target for TB eradication, interferon-gamma release assay-defined LTBI has a high proportion of negative conversion and lacks active TB correlation among patients on dialysis.Patients on long-term dialysis were screened in multiple centers in Taiwan. QuantiFERON-TB Gold In-tube (QFT-GIT) was used to define LTBI and was performed thrice at 6-month intervals. The primary outcome was active TB diagnosed after LTBI screening. The incidence and predictive value of QFT-GIT were analyzed.The 940 dialysis patients enrolled had an average age of 59.3 years. The initial QFT-GIT results were positive in 193, including 49.6% with persistent positive results on second check. In an average follow-up period of 3 years, 7 patients had TB. Three (319.1 per 100,000 person-yrs) and 4 (141.8 per 100,000 person-yrs) of them were prevalent and incident TB cases, respectively. Persistent positive QFT-GIT for 2 and 3 times correlated with increased hazard ratio for TB (14.44 and 20.29, respectively) compared with a single positive result (hazard ratio 10.38). Among those with 3 positive QFT-GIT results, TB development rate was 4.5% and incidence rate was 1352.3 per 100,000 person-years. In contrast, none of the incident TB occurred in those with initial positive and then negative conversion of QFT-GIT.In an area of intermediate TB incidence, dialysis patients have high TB risk. LTBI status is a good predictor of TB development, especially for those with more than 1 positive result. After excluding prevalent TB cases, serial follow-up of LTBI may narrow the target population to reduce treatment costs.

Implementation and operational research: Integrated pre-antiretroviral therapy screening and treatment for tuberculosis and cryptococcal antigenemia.

To demonstrate the feasibility of integrated screening for cryptococcal antigenemia and tuberculosis (TB) before antiretroviral therapy (ART) initiation and to assess disease specific and all-cause mortality in the first 6 months of follow-up. We enrolled a cohort of HIV-infected, ART-naive adults with CD4 counts ≤250 cells per microliter in rural Uganda who were followed for 6 months after ART initiation. All subjects underwent screening for TB; those with CD4 ≤100 cells per microliter also had cryptococcal antigen (CrAg) screening. For those who screened positive, standard treatment for TB or preemptive treatment for cryptococcal infection was initiated, followed by ART 2 weeks later. Of 540 participants enrolled, pre-ART screening detected 10.6% (57/540) with prevalent TB and 6.8% (12/177 with CD4 count ≤100 cells/μL) with positive serum CrAg. After ART initiation, 13 (2.4%) patients were diagnosed with TB and 1 patient developed cryptococcal meningitis. Overall 7.2% of participants died (incidence rate 15.6 per 100 person-years at risk). Death rates were significantly higher among subjects with TB and cryptococcal antigenemia compared with subjects without these diagnoses. In multivariate analysis, significant risk factors for mortality were male sex, baseline anemia of hemoglobin ≤10 mg/dL, wasting defined as body mass index ≤15.5 kg/m, and opportunistic infections (TB, positive serum CrAg). Pre-ART screening for opportunistic infections detects many prevalent cases of TB and cryptococcal infection. However, severely immunosuppressed and symptomatic HIV patients continue to experience high mortality after ART initiation.

A Systematic Review on TST and IGRA Tests Used for Diagnosis of LTBI in Immigrants

High immigration rates from tuberculosis (TB) endemic countries to low-incidence countries have caused new TB guidelines in these countries to reconsider latent TB infection (LTBI) screening in these immigrants. We performed a systematic review with the primary outcome of evaluating the number of cases recommended LTBI treatment with the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Secondary objectives were to examine prevalence of positive LTBI diagnostic tests stratified by age and incidence of TB in country of origin. We performed a systematic search of seven electronic databases for studies assessing TST and/or IGRA performance in immigrant populations to low incidence countries. Demographics, LTBI diagnosis, longitudinal TB development, and test result data were the primary data extracted from the studies. Prevalence of positive test data was stratified by age and country of origin. Studies were evaluated using a modified SIGN checklist for diagnostic studies. Data was compared using Fisher's exact test or χ (2) test, where appropriate. Our literature search yielded 51 studies (n = 34 TST, n = 9 IGRA, n = 8 both). Recommendation of LTBI treatment was less common in those tested with an IGRA compared to TST (p < 0.0001), while long-term development of active TB appears higher in those with a positive IGRA. There was no difference in the sensitivity and specificity of the IGRA and TST for prevalent TB (p > 0.05). Prevalence of a positive test was significantly lower in those who were <18 years of age compared to those ≥18 years of age (p < 0.0001) and those from low TB incidence countries compared to high incidence countries (p < 0.0001) for both TST and IGRA. When comparing the two tests within the 2 subgroups: age and TB incidence in country of origin, the prevalence of positive results was significantly lower for the IGRA than the TST (p < 0.0001). The number of available studies evaluating the IGRA and longitudinal active TB development in those tested limits this study. Prevalence of positive test results were significantly lower in immigrants who were tested with an IGRA, resulting in fewer immigrants being recommended for LTBI treatment compared to TST. Coupled with comparable performance for detecting prevalent TB cases, the IGRA appears to exhibit better specificity than the TST and may be preferred as the standard of care for detecting LTBI in immigrants moving to low TB incidence countries.

Symptom reporting among prevalent tuberculosis cases who smoke, are HIV-positive or have hyperglycaemia.

Data from a tuberculosis (TB) prevalence survey conducted in 24 communities in Zambia and the Western Cape, South Africa, January-December 2010, were analysed to determine the influence of smoking, hyperglycaemia and human immunodeficiency virus (HIV) infection on TB symptom reporting in culture-confirmed TB cases. Of 123 790 adults eligible for enrolment, 90 601 (73%) consented and 64 463 had evaluable sputum samples. ORs and 95%CIs were calculated using a robust standard errors logistic regression model adjusting for clustering at community level. HIV-positive TB cases were more likely to report cough, weight loss, night sweats and chest pain than non-HIV-positive TB cases. TB cases who smoked or had hyperglycaemia did not report symptoms differently from cases without these comorbidities.

A comparative study on the prevalence and risk factors of tuberculosis among the prisoners in khuzestan, South-west iran.

Background:High prevalence of Tuberculosis (TB) among prisoners is reported as an alarming public health problem in the world, especially in the developing countries.Objectives:Since there is almost no information from TB in this population in Khuzestan province, the current study aimed to assess the prevalence and identify risk factors of TB among the prisoners of this region.Patients and Methods:In a retrospective study, medical files of patients with Tuberculosis in Khuzestan Health Center (KHC), from 2005 to 2010, were studied. Patients with Pulmonary TB were placed in two groups as the Inmate Prison (IP) and Non-Inmate Prison (NIP) groups. Data extracted from the patients' records in the two groups were compared by SPSS software system using Chi square and Fisher exact tests. P-value was considered less than 0.05.Results:From the reported 4562 patients with Tuberculosis, 363 (7.9%) were prison inmates at the time of TB diagnosis. Prevalence of TB cases among the prison inmates was 403.3 per 100'000.The annual TB case rate in the general population during this period was 16.4 per 100,000. Among the TB risk factors close contact [odds ratio (OR), 95% confidence interval (CI), 19.4, 8.9-41.8, P < 001] especially in the recent 2 years, injection drug use (IDU) [OR, 95% CI, 4.61, 1.7-12.4, P = 006], and Human Immunodeficiency Virus (HIV) infection [OR, 95% CI, 2.4, 1.1-5.0, P = 025] were more frequent in the prisoners than in the general population with TB.Conclusions:In the region under study the prevalence of TB among the prisoners was higher than the general population. The main risk factors for Pulmonary TB in this population were close contact, IDU and HIV infection.

Epidemiology and control of tuberculosis in the Western Pacific Region: analysis of 2012 case notification data.

Tuberculosis (TB) control in the World Health Organization (WHO) Western Pacific Region has seen substantial progress in the last decade, with a 33% reduction in prevalent TB cases since 2000. The burden remains immense, however, and national TB programmes must evolve and adapt to build upon these gains. Through routine surveillance, countries and areas in the Region reported 1.4 million TB cases in 2012. The case notification rate increased in the early 2000s, appears to have stabilized in recent years and is in decline for all forms and new smear-positive cases. The age and sex breakdown for smear-positive TB case rates by country shows generally higher rates with increased age and declining rates over time for all age groups. Treatment success remains high in the Region, with 15 countries reaching or maintaining an 85% success rate. HIV testing among TB patients has increased gradually along with a slow decline in the number of HIV-positive patients found. The trend of TB notification is heavily influenced by programmatic improvements in many countries and rapidly changing demographics. It appears that cases are being found earlier as reflected in declining rates of smear-positive TB and steady rates of TB in all forms. WHO estimates depict a decline in TB incidence in the Region. HIV testing, while still low, has increased substantially in recent years, with essential TB/HIV services expanding in many countries. TB surveillance data, within inherent limitations, is an important source of programmatic and epidemiological information. Careful interpretation of these findings can provide useful insight for programmatic decision-making.

Therapeutic drug management: is it the future of multidrug-resistant tuberculosis treatment?

Multidrug- and extensively drug-resistant (M/XDR) tuberculosis (TB) are emerging public health concerns [1, 2]. In 2011, the World Health Organization (WHO) estimated 12 million prevalent cases of TB globally, which is equivalent to 170 cases per 100 000 population, out of these an estimated 630 000 cases were affected by MDR Mycobacterium tuberculosis strains [3]. Among the newly diagnosed patients ∼3.7% were infected by MDR-TB strains, but the worrisome fact is that the prevalence of MDR-TB among new cases in some Former Soviet Union countries exceeds 30% [4, 5], XDR-TB has been identified in 84 countries and the average proportion of MDR-TB cases with an XDR-TB pattern is 9.0% [3]. Further adding to the problem are the reports of “totally drug resistant” TB [6, 7], a term currently not recognised by WHO [8, 9]. Treatment of drug resistant TB is more expensive and more toxic if compared with that prescribed for drug-susceptible TB, and currently takes up to 2 years of therapy [10]. The cost per patient to treat MDR-TB cases is incredibly high [11, 12] and, in spite of international public health efforts, the treatment outcome is not very promising [13–15]. Diel et al. [16] showed that direct treatment-related costs of MDR-TB patients can amount to €52 259 in Germany (table 1). View this table: Table 1– Direct costs of multidrug-resistant tuberculosis (MDR-TB) therapy in a European low-income country In the largest MDR-TB cohort analysed to date [13] the proportion of cases treated successfully was 62%, with 7% failing or relapsing, 9% dying and 17% defaulting; in the XDR-TB subgroup 40% achieved treatment success, 22% failed treatment or relapsed, whereas 15% died and 16% defaulted [14, 15]. In this issue of the …