Previous History Of Tuberculosis Research Articles

Prior COVID-19 infection among newly diagnosed tuberculosis patients in a tertiary care center in Tehran: A case-control study.

To assess the risk of developing pulmonary tuberculosis (TB) in accordance with prior history of COVID-19 infection. Since the advent of the COVID-19 pandemic much discussion has been had on the possible role it might play on global efforts to combat TB; most, focusing on the pandemic's impact on health care systems' capabilities to manage TB cases. Mechanisms have also been proposed by which the COVID-19 infection may directly affect individuals' chance of developing TB infection. Cases have been reported with a history of COVID-19 infection preceding a diagnosis of TB, evidencing its possible role as a risk factor for the disease. A case-control study was conducted enrolling patients diagnosed with pulmonary TB in the absence of major risk factors previous history of TB, (HIV) human immunodeficiency virus infection), end-stage renal disease, organ transplants, and use of immunosuppressive agents) for developing TB. Each patient was age and sex matched with one healthy control. Data regarding prior COVID-19 infection, diabetes, and smoking status as well as the use of corticosteroids and Tocilizumab for the treatment of COVID-19 infection was obtained. Bivariate analysis was conducted and variables with a likely association with TB status were entered in a multivariate model. Bivariate analysis demonstrated a significant relationship between prior COVID-19 infection and TB (95% confidence interval = 1.1-22.8, odds ratio [OR] = 5). Among other variables the severity of COVID-19 infection was found to have a likely association with TB status (p = .125). In a multivariate model, prior COVID-19 infection per se, was not found to be significantly associated with TB (p = .12, OR = 4.5). There seems to be an association between prior history of COVID-19 and a future diagnosis of TB partially linked to the severity of disease. The findings of the current study may serve as a basis for further studies to determine the need for and efficacy of measures to follow-up COVID-19 patients at an increased risk for developing TB.

Prevalence and risk factors for chronic pulmonary aspergillosis in chronic obstructive pulmonary disease patients with acute exacerbations.

Chronic obstructive pulmonary disease (COPD) patients often experience acute exacerbations requiring hospitalization. Recently, attention has focused on Aspergillus sensitization in the airways of these COPD patients. This study aimed to assess the prevalence of chronic pulmonary aspergillosis (CPA) in COPD patients with acute exacerbations and identify associated risk factors. A cross-sectional descriptive study was conducted at the Jawaharlal Institute of Postgraduate Medical Education and Research from January 2021 to June 2022. Sixty-one COPD patients presenting with acute exacerbations were included. Demographic details, blood investigations, and sputum examinations were performed for all patients. A high-resolution computed tomography thorax was conducted for eligible patients. The prevalence of CPA among patients with an acute exacerbation of COPD was found to be 9.8%, with chronic cavitary pulmonary aspergillosis being the most common presentation (50%). Among post-tubercular COPD patients, the prevalence of CPA was significantly higher at 22.7%. Hemoptysis (p<0.001) and a previous history of tuberculosis (p=0.008) were associated with Aspergillus sensitization. This study highlights the substantial prevalence of CPA in COPD patients with acute exacerbations, particularly in those with a history of tuberculosis. Early recognition and targeted management of CPA in COPD patients may improve outcomes and reduce hospitalization rates. Further large-scale multi-center studies are needed to validate these findings and comprehensively address the impact of CPA on all COPD patients.

Clinical and Imaging Characteristics of Smear Negative Pulmonary Tuberculosis Patients: A Comparative Study.

Prevalence surveys in Ethiopia indicate smear negative pulmonary tuberculosis (SNPTB) taking the major share of the overall TB burden. It has also been a diagnostic dilemma worldwide leading to diagnostic delays and difficulty in monitoring treatment outcomes. This study determines and compares the clinical and imaging findings in SNPTB and smear positive PTB (SPPTB). Methodology. A case-control study was conducted on 313 PTB (173 SNPTB) patients. Data and sputum samples were collected from consented patients. Smear microscopy, GeneXpert, and culture analyses were performed on sputum samples. Data were analyzed using Stata version 17; a P value < 0.05 was considered statistically significant. Of the 173 SNPTB patients, 42% were culture positive with discordances between test results reported by health facilities and Armauer Hansen Research Institute laboratory using concentrated smear microscopy. A previous history of TB and fewer cavitary lesions were significantly associated with SNPTB. Though overall clinical presentations of SNPTB patients resemble those seen in SPPTB patients, a prior history of TB was strongly associated with SNPTB. Subject to further investigations, the relatively higher discrepancies seen in TB diagnoses reflect the posed diagnostic challenges in SNPTB patients, as a higher proportion of these patients are also seen in Ethiopia.

Assessing Treatment Efficacy and Determinants of Outcome in Isoniazid Mono-resistant Tuberculosis Patients: A Prospective Observational Study in Gujarat

Introduction: There is a high number of isoniazid-resistant tuberculosis (TB) in India; estimates imply that over 25% of TB patients there are isoniazid-resistant. Hence, the study aimed to evaluate the effectiveness of therapy for patients with isoniazid-mono-resistant TB and the negative effects of the H-mono-resistant TB Regime. Materials and Methods: It was a hospital-based prospective observational study from September 2021 to August 2022. Hence, 100 patients diagnosed with isoniazid mono-resistance TB enrolled in this study. After obtaining the prior informed consent of all patients willing to approve the collection and publication of their data, including extensive clinical history and radiological, microbiological, and biochemical investigations, this study included all diagnosed cases of isoniazid mono-resistant TB. A descriptive statistical analysis was done for continuous and categorical variables. Differences in characteristics between participants were tested with logistic regression and cross-tabulation. P &lt;0.05 was considered significant. Results: Among 100 patients participated, their mean age was 50.8 ± 3.2 years. About 72 (72%) participants have successful treatment outcomes (cure). Only about 25 (25%) patients had minor adverse drug reactions. Body mass index (16.6 [3.6–74]), substance addiction history (9.5 [3.3–26.9]), previous history of TB (9 [3.3–24.0]), type of lesion (5.3 [1.6–17]), and extent of the lesion (2.6 [1.03–6.07]) in chest X-ray were associated statistically with the treatment outcome. Conclusion: The findings suggest that the H-mono-resistance regime is generally well-tolerated, with only a small percentage of patients experiencing nonserious adverse drug reactions, and the overall successful treatment outcome in H-mono patients was 72%. The study also highlights the importance of monitoring drug resistance patterns, particularly for levofloxacin and moxifloxacin, and the need for effective treatment regimens for isoniazid mono-resistant pulmonary TB.

Non-Tuberculous Mycobacteria Infections based on 16S rRNA detections in patients with Suspected Chronic Tuberculosis at a Tertiary Referral Hospital in Indonesia

This study identified non-tuberculous mycobacteria (NTM) isolates from the clinical respiratory specimen of patients suspected of chronic tuberculosis at a tertiary referral hospital in Indonesia. In this study, 20 clinical non-tuberculous mycobacteria (NTM) isolates were obtained from respiratory samples examined in the tuberculosis section of the Clinical Microbiology laboratory at Dr Soetomo General Hospital. The isolates were identified using TB Ag MPT 64 (SD Bioline) and targeting 16S rRNA genes sequence for analysis at the species level. Data on clinical features were collected and chest radiographs were evaluated. The highest bacterium found in the isolates was Mycobacterium kansasii (12 strains, 60%.), followed by Mycobacterium gordonae (2 strains, 5%), Mycobacterium parascofulaceum (2 strains, 5%), Mycobacterium avium (1 strain, 2.5%), Mycobacterium simiae (1 strain, 2.5%). Mycobacterium abcessus (1 strain, 2.5%), and Mycobacterium paraterrae (1 strain, 2.5%). Males dominated patients with Mycobacterium kansasii. Clinical symptoms include cough, dyspneu, hemoptysis, chest pain, and sweats. Half of the patients had a history of previous tuberculosis and other comorbid diabetes mellitus. Non-tuberculous mycobacteria (NTM) species identified were dominated by Mycobacterium kansasii. The predominance of non-tuberculous mycobacteria (NTM) species from clinical respiratory can be a reference to determine prudent treatment for patients in high-burden TB countries.

Tuberculosis manifesting as bilateral acute parotid swelling with unilateral lower motor neuron facial palsy: an unusual presentation

A 41-year-old female presented to the otorhinolaryngology department with a history of painful swelling over the bilateral parotid region, low-grade fever for the past one month and progressively worsening left-side facial weakness for the last 15 days. She had received multiple courses of antibiotics elsewhere, which did not result in any improvement except pain. She had no past history of any comorbidities or any previous history of tuberculosis. Examination revealed that she had a non-tender, circumscribed, solitary, 3×3 cm size, firm swelling over the bilateral parotid region. Clinical signs of grade V facial nerve palsy (House and Brackmann classification) were noted. There was a severe grade left lower motor neuron facial nerve palsy (left side) seen. There was no cervical lymphadenopathy. The rest of the head and neck examination was unremarkable. Fine needle aspiration cytology (FNAC) from the most prominent part of the swelling was suggestive of granulomatous inflammation. The patient was initially treated with intravenous antibiotics, supportive care and started on antitubercular drugs (once the diagnosis was established) under the National Tuberculosis Eradication Program (NTEP) to which she responded well and after three months of therapy, her swelling and facial weakness improved significantly. In addition to reporting a completely rare kind of presentation, this paper reviews relevant literature and stresses the need for a high degree of suspicion for tuberculous parotitis in a patient with bilateral parotid swelling. The use of fine needle aspiration is important so that this curable condition can be diagnosed early and medically treated. In this way, surgical intervention can be avoided and further complications can be prevented.

Risk adjustment model for tuberculosis compared to non-tuberculosis mycobacterium or latent tuberculosis infection: Center for Personalized Precision Medicine of Tuberculosis (cPMTb) cohort database

BackgroundThe Center for Personalized Precision Medicine of Tuberculosis (cPMTb) was constructed to develop personalized pharmacotherapeutic systems for tuberculosis (TB). This study aimed to introduce the cPMTb cohort and compare the distinct characteristics of patients with TB, non-tuberculosis mycobacterium (NTM) infection, or latent TB infection (LTBI). We also determined the prevalence and specific traits of polymorphisms in N-acetyltransferase-2 (NAT2) and solute carrier organic anion transporter family member 1B1 (SLCO1B1) phenotypes using this prospective multinational cohort.MethodsUntil August 2021, 964, 167, and 95 patients with TB, NTM infection, and LTBI, respectively, were included. Clinical, laboratory, and radiographic data were collected. NAT2 and SLCO1B1 phenotypes were classified by genomic DNA analysis.ResultsPatients with TB were older, had lower body mass index (BMI), higher diabetes rate, and higher male proportion than patients with LTBI. Patients with NTM infection were older, had lower BMI, lower diabetes rate, higher previous TB history, and higher female proportion than patients with TB. Patients with TB had the lowest albumin levels, and the prevalence of the rapid, intermediate, and slow/ultra-slow acetylator phenotypes were 39.2%, 48.1%, and 12.7%, respectively. The prevalence of rapid, intermediate, and slow/ultra-slow acetylator phenotypes were 42.0%, 44.6%, and 13.3% for NTM infection, and 42.5%, 48.3%, and 9.1% for LTBI, respectively, which did not differ significantly from TB. The prevalence of the normal, intermediate, and lower transporter SLCO1B1 phenotypes in TB, NTM, and LTBI did not differ significantly; 74.9%, 22.7%, and 2.4% in TB; 72.0%, 26.1%, and 1.9% in NTM; and 80.7%, 19.3%, and 0% in LTBI, respectively.ConclusionsUnderstanding disease characteristics and identifying pharmacokinetic traits are fundamental steps in optimizing treatment. Further longitudinal data are required for personalized precision medicine.Trial registrationThis study registered ClinicalTrials.gov NO. NCT05280886.

Comparison of Xpert MTB/RIF Ultra with Xpert MTB/RIF for the detection of Mycobacterium tuberculosis and rifampicin resistance in a primary-level clinic in rural China

The Xpert MTB/RIF Ultra (Ultra) is not yet used for the diagnosis of tuberculosis (TB) in China. We compared the performance of the Xpert and Ultra for detecting Mycobacterium tuberculosis and rifampicin resistance in a primary-level clinic in rural China. Sputum samples from suspected pulmonary TB patients were collected and subjected to smear microscopy, liquid culture, Xpert and Ultra tests. We then compared the sensitivity and specificity of Xpert and Ultra for diagnosing TB against liquid culture. Whole-genome sequencing was performed to predict rifampicin resistance and the results were compared with the Xpert and Ultra tests. The sensitivities of Xpert and Ultra were 88.1% and 95.1%, and the specificities were 91.9% and 84.4%, respectively. Among the 61 smear-negative culture-positive patients, the sensitivities of Xpert and Ultra were 80.3% and 91.8%. All Xpert-positive patients were Ultra-positive. Among culture-negative Xpert or Ultra-positive patients, 69.6% were taking anti-TB drugs or had a previous history of TB. Of the samples that Ultra classified as trace, nearly 25% were probably false-positives. Both Xpert and Ultra accurately detected all rifampicin-resistant patients. In conclusion, Ultra was more sensitive than Xpert, especially for smear-negative patients but had decreased specificity with more false-positives, especially with Ultra trace results.

Pulmonary Tuberculosis in Post COVID-19 Patients: Occurrence and Clinical Profile

Background: Tuberculosis continues to be a major public health disease to date. The mortality of this disease, which was reducing till 2019, was reversed in 2020 and 2021, as per the global tuberculosis report 2022. The novel coronavirus disease 2019(COVID-19) pandemic has af-fected tuberculosis management in various aspects. The transient immunosuppression associated with the disease and the treatment modality has been speculated to activate latent tuberculosis infec-tion as well as increase the infection risk with Mycobacterium Tuberculosis. Objective: The aim of this study was to analyze the clinical characteristics of post-COVID-19 pul-monary tuberculosis patients. Methods: We conducted a retrospective descriptive analysis of post-COVID-19 patients admitted from January 2021 to May 2022 with persistent or new-onset respiratory symptoms. The occurrence of pulmonary tuberculosis in these patients and their clinico- demographic details are summarized. Results: About 31(19.4%) of 160 post-COVID-19 patients with respiratory symptoms were diag-nosed to have pulmonary tuberculosis. About 21(67.7%) had comorbidities, of which the predomi-nant was diabetes mellitus in 14(45%) patients, and the majority (85%) had poorly controlled blood sugar levels. None of the patients had a history of contact with a pulmonary tuberculosis patient in the previous 2 years, but 4(13%) patients had a previous history of tuberculosis. Moreover,.66% of cases had a history of moderate and severe COVID-19 disease, and 70% had received systemic cor-ticosteroids and other immunosuppressive drugs like tocilizumab during the COVID-19 illness treatment. More than 50% of the patients had negative smears for acid-fast bacilli and were diag-nosed using rapid molecular methods like CBNAAT and LPA. Drug-resistant tuberculosis was seen in 6(19%) patients. 4(13%) patients died during the hospitalized course of treatment, and the re-maining 27(87%) were discharged with antituberculous treatment, but their final outcome is un-known. Conclusion: A high index of suspicion and use of rapid molecular diagnostic methods is indicated in post-COVID-19 patients with respiratory symptoms for early diagnosis of tuberculosis and pre-vention of community transmission. Identification of post-COVID-19 patients with latent tuberculo-sis infection and the feasibility of advocation of tuberculosis preventive therapy in such patients, es-pecially those with other risk factors like diabetes mellitus, need to be considered.

Prevalence And Risk Factors Of Multi Drug Resistant Tuberculosis In Children.

To assess the prevalence of drug-resistant tuberculosis and to identify possible risk factors in children. The descriptive, interview-based study was conducted at the Pulmonology outdoor clinic of Jinnah Hospital, Lahore, Pakistan, from January to August 2019, and comprised children aged up to 14 years who were either contacts of a multi-drug resistant tuberculosis patients or non-contacts. Data related to their demography as well as clinical and social characteristics was collected using a questionnaire. Data was analysed using SPSS version 22. Of the 202 subjects, 115(56.9%) were girls and 87(43.1%) were boys. There were 70(34.7%) subjects aged >13 years, followed by 45(22.3%) aged 9-12 years, 44(21.8%) aged £4 years and 43(21.3%) aged 5-8 years. Overall, there were 26(12.9%) cases positive for multi-drug resistant tuberculosis; 16(61.5%) girls and 10(38.5%) boys. In terms of age, 17(65.4) cases were positive in those aged >13 years. Age, previous history of tuberculosis, co- infection with any immune-compromising disease and close contact with patients of multi-drug resistant tuberculosis were significant risk factors identified. The prevalence of multi-drug resistant tuberculosis was high in contacts of multi-drug resistant pulmonary tuberculosis patients, more prevalent in children aged 13-14 years.

Pitutary tuberculoma: A verycommon pathology in a very uncommon location

Pituitary Tuberculoma is extremely rare, even in developing countries where tuberculosis is endemic with total reported cases in the literature fewer than a hundred. Misdiagnosis as pituitary adenoma is common and late diagnosis can result in a permanent endocrine dysfunction and/or long-term neurologic sequela. Pituitary Tuberculoma, and mimicking adenomas are very unusual. We report a small case series of a patient with sellar/ suprasellar mass, who presented with severe headache, all these patients didn’t have any previous history of tuberculosis and radiological and microbiological evidence of Tuberculosis elsewhere in the body. All these patients underwent endoscopic transsphenoidal resection of the mass and histo pathological examination was suggestive of pituitary Tuberculoma. Antituberculous therapy was started and continued for one year, all three patients had good control of the disease and hormonal profile was normal at the end of one year, though all three patients required a small dose of steroid (Prednisolone 5mg) for the initial three months after surgery.

Transudative Tuberculous Pleural Effusion Mimicking Massive Pericardial Effusion: A Case Report

The presentation of a patient with a pleural effusion can range from an incidental finding to a serious condition, which can lead to being hemodynamically compromised. Here, we discuss a 24-year-old male with a history of childhood tuberculosis who presented with shortness of breath (SOB), a non-productive cough, and recent weight loss. On examination, he was dyspnoeic but alert. On echocardiographic evaluation, a massive effusion that looked like a massive pericardial effusion was seen, while a further CT scan of the thorax showed a massive unilateral left-sided pleural effusion. Although no tuberculosis (TB) was seen in the sample of thoracocentesis, the patient was referred to a TB centre because of a history of previous tuberculosis and recent weight loss. Pleural effusion and pericardial effusion can be differentiated using echocardiography. In conditions where it is impossible, further imaging, like computer tomography, may be needed to differentiate between them. Keywords:Pleural effusion; Tuberculosis; Pericardial effusion; Cardiac tamponade

Operationalising targeted next-generation sequencing for routine diagnosis of drug-resistant TB.

Phenotypic drug susceptibility testing (pDST) for Mycobacterium tuberculosis can take up to 8 weeks, while conventional molecular tests identify a limited set of resistance mutations. Targeted next-generation sequencing (tNGS) offers rapid results for predicting comprehensive drug resistance, and this study sought to explore its operational feasibility within a public health laboratory in Mumbai, India. Pulmonary samples from consenting patients testing Xpert MTB-positive were tested for drug resistance by conventional methods and using tNGS. Laboratory operational and logistical implementation experiences from study team members are shared below. Of the total number of patients tested, 70% (113/161) had no history of previous TB or treatment; however, 88.2% (n = 142) had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB). There was a high concordance between resistance predictions of tNGS and pDST for most drugs, with tNGS more accurately identifying resistance overall. tNGS was integrated and adapted into the laboratory workflow; however, batching samples caused significantly longer result turnaround time, fastest at 24 days. Manual DNA extraction caused inefficiencies; thus protocol optimisations were performed. Technical expertise was required for analysis of uncharacterised mutations and interpretation of report templates. tNGS cost per sample was US$230, while for pDST this was US$119. Implementation of tNGS is feasible in reference laboratories. It can rapidly identify drug resistance and should be considered as a potential alternative to pDST.

Determinants of tuberculosis in Central Region of Eritrea: a matched case-control study

Background: The WHO has recommended the need for holistic approach towards TB, including addressing the underlying socio-economic determinants in conjunction with direct observed treatment short-course (DOTS). However, there is lack of epidemiological data in Eritrea regarding factors that are associated with TB and this study aimed to assess such factors. Methods: A matched case-control study was used to assess factors that are associated with TB in the Central Region of Eritrea. A structured questionnaire was used to collect data about socio-demographic characteristics, living status, housing conditions, and medical history of the study participants. All TB patients in the eight DOTS treatment centers and two age-and-sex-matched controls for each case were included. Bivariate and multivariable conditional logistic regression models were used to identify the main risk factors of TB. Results: The study recruited 67 cases and 134 controls. Bivariate analyses indicated that BCG vaccination scar, past alcohol drinking habit, history of hospital admission, previous history of TB, and family history of TB were found to be factors associated with TB. Moreover, results of multivariable analysis showed that, absence of BCG vaccination scar, family history of TB, past drinking habit, and history of hospital admission were found to be factors associated with TB among the study participants. Conclusions: This is the first study in the Central Region of Eritrea that assessed the determinant of tuberculosis. Absence of BCG vaccination scar, family history of TB, past alcohol consumption and history of hospital admission were found to be independent risk factors for TB.c

VERTEBRAL TUBERCULOSIS FOLLOWED BY TRAUMATIC SPINE FRACTURE IN A CHILD -RARE CASE REPORT

Background Vertebral tuberculosis following a spinal trauma is a rare identity presenting as extrapulmonary TB associated with high degree of morbidity in a growing children. The objective of this report is to describe a paediatric case of traumatic spine fracture on the lower thoracic spine with tuberculosis disease. And thus show the importance of identifying the disease as soon as possible, because it is a rare and severe condition that can leave to serious sequelae. Case summery A adolescent boy presents to the orthopaedic OPD with the complaints of unable to walk, evening raise of temperature, loss of weight, deformity of spine since 3 months. Upon detail history, 3 months back child had a traumatic event following which he developed weakness of both the lower limbs. In the subsequent time he started developing evening rise of temperature, lethargy and loss of weight. His mother observed postural alteration, with constant pain in the middle back region with a deformity formation, unable to walk, inability to ex the lumbodorsal spine and pain on touching surrounding skin area. Clinical examination revealed that the child was pale, emaciated and afebrile with weight of 25 kgs. A tender gibbus was present over the dorso-lumbar region. Sensation of perianal region was intact with spasticity of both lower limbs. The bladder and bowel function were spared. No other external signs of inammation were detected. The rest of the physical examination was non-contributory. No prior history of contact with the tuberculosis patient. Mantoux test and Sputum examination was done. Radiologic evaluation done in the form of radiograph and magnetic resonance imaging. ConclusionSpinal tuberculosis is haematogenous in origin, and usually follows pulmonary tuberculosis. The two conditions may occur concomitantly, as is commonly seen in young children. Spinal tuberculosis is usually associated with a poor nutritional status and a depleted immune response. In our patient the source of infection might have been from a latent focus in the hilar nodes of the lung, although the patient denied any previous history of tuberculosis. Possibly after severe trauma the patient's immunity was lowered this has led to spread of the tuberculosis infection and the vertebral fracture hematoma could have provided a nidus for infection.

Epidemiology and factors associated with Extra-pulmonary tuberculosis in a Low-prevalence area

BackgroundTuberculosis is a global public health problem. Extra-pulmonary tuberculosis accounts for an increasing proportion of cases worldwide, although information about epidemiological, clinical, or microbiological factors is lacking. MethodsWe conducted a retrospective observational study of tuberculosis cases diagnosed between 2016 and 2021, classified into Pulmonary and Extra-pulmonary tuberculosis. Univariable and multivariable logistic regression models were used to investigate risk factors of Extra-pulmonary tuberculosis. Results20.9% of overall cases were classified as Extra-pulmonary tuberculosis, with a rising trend from 22.6% in 2016 to 27.9% in 2021. Lymphatic tuberculosis accounted for 50.6% of cases, followed by pleural tuberculosis (24.1%). 55.4% of cases belonged toforeign-born patients. Microbiological culture tested positive in 92.8% of Extra-pulmonary cases. Logistic regression analysis showed that women were more predisposed to develop Extra-pulmonary tuberculosis (aOR 2.46, 95% CI 1.45–4.20) as well as elderly patients (aged ≥ 65 years) (aOR 2.47, 95% CI 1.19–5.13) and persons with previous history of tuberculosis (4.99, 95% CI 1.40–17.82). ConclusionsExtra-pulmonary Tuberculosis have increased within our study period. A profound decline occurred in 2021 tuberculosis cases, probably due to COVID-19. Women, elderly population, and persons with previous history of tuberculosis are at higher risk of developing Extra-pulmonary tuberculosis in our setting.

A rare presentation of multifocal tuberculosis in an immunocompetent patient

Introduction: Multifocal tuberculosis (MT) is an uncommon presentation in immunocompetent patients. It’s associated more with an immune-depression like Human Immunodeficiency Virus infection. We report a case of MT with presternal cold abscess, mediastina and cervical adenopathy, bone, and vertebral location that occurred in an apparently immunocompetent patient. Case presentation: A 19-year old woman with no previous history of tuberculosis (TB) exposure was admitted for chronic chest pain lasting for 13 months. She presented with a history of fever, night sweat and weight loss (09 kg). The first clinical examination noticed a voluminous presternal abscess. The chest X-Ray showed an enlargement of the middle mediastinum associated to pleural effusion opacity, but any active pulmonary lesions. A computed chest tomography revealed the presence of a parietal mass centered on the sternum, with extension in the soft parts, bone lies of the sternal manubrium, lies of the vertebral hemi-bodies of T10 and T11, cervical lymph nodes, phrenic mediastina and sub-pectoral nodes with peritoneal and mesenteric involvement. Magnetic resonance imaging of the spine showed tiered thoracic lumbar and sacral spondylitis with paravertebral and anterior epidural collections responsible for spinal cord compression next D10 without signs of spinal cord pain. The draining of the cold abscess revealed some whitish pus, in which acid-alcohol resistant bacilli were identified. There was no history of diabetes, renal failure, or long-term treatment with corticosteroids or immunosuppressant’s: HIV serology and viral hepatitis were negative. The blood glucose was normal. The patient was treated with anti-tuberculosis regimen based on: Ethambutol, Rifampicin, Isoniazid, and Pyrazinamide for two months, and then rifampicin and isoniazid for seven months. The outcome was good with the disappearance of the abscess and all the radiological signs. Conclusion: Multifocal TB such as the case reported are uncommon and confined mostly to immunocompromised patients especially those with HIV infection. Because of the clinical polymorphic features of multifocal TB, the diagnosis is usually difficult to make, resulting into delay before beginning of the adequate treatment.

Factors associated with loss to follow-up before and after treatment initiation among patients with tuberculosis: A 5-year observation in China.

Loss to follow-up (LTFU) is a significant barrier to the completion of anti-tuberculosis (TB) treatment and a major predictor of TB-associated deaths. Currently, research on LTFU-related factors in China is both scarce and inconsistent. We collected information from the TB observation database of the National Clinical Research Center for Infectious Diseases. The data of all patients who were documented as LTFU were assessed retrospectively and compared with those of patients who were not LTFU. Descriptive epidemiology and multivariable logistic regression analyses were conducted to identify the factors associated with LTFU. A total of 24,265 TB patients were included in the analysis. Of them, 3,046 were categorized as LTFU, including 678 who were lost before treatment initiation and 2,368 who were lost afterwards. The previous history of TB was independently associated with LTFU before treatment initiation. Having medical insurance, chronic hepatitis or cirrhosis, and providing an alternative contact were independent predictive factors for LTFU after treatment initiation. Loss to follow-up is frequent in the management of patients with TB and can be predicted using patients' treatment history, clinical characteristics, and socioeconomic factors. Our research illustrates the importance of early assessment and intervention after diagnosis. Targeted measures can improve patient engagement and ultimately treatment adherence, leading to better health outcomes and disease control.

Characteristics of Tuberculosis Patients at the Kauman Public Health Center, District of Ngawi

Objective: The objective of this research is to identify the characteristics of Tuberculosis (TB) patients at the Kauman Public Health Center. Methods: This research employed an analytical descriptive methodology and analyzed patient medical records from 2020 to 2022 as well as data from SITB. In this research, 42 patients made up the sample. Results: The results showed that of the 42 patients with TB, 60% were male, and 40% were female. The age range of most TB sufferers is 45-60 years (36%), while the lowest is the age range 0-18 (7%). Most TB cases were new (98%) compared to those with a history of previous TB (2%). TB patients who are sensitive to drugs are 93%, while those who are not are only 7%. And the diagnosis of Lung TB (93%) is the majority compared to Extra Lung TB, only 7%. Conclusion: The results showed that most TB patients were male (60%), the age range of most TB patients was 45-60 years (36%), most TB cases were new (98%), most TB patients were drug-sensitive (93%), and the diagnosis the most was lung TB (93%). This research suggests that further research be carried out to discover other characteristics of TB patients with a larger sample size and more complex research methods.

Prevalence of tuberculosis in homes for the aged and orphanages of a district in Kerala, India

BackgroundIndia accounts for one fourth of the TB burden globally. One of the objectives of the National Strategic Plan is to achieve 90% notification rate of all TB cases. Screening of high risk groups is one of the important components towards achieving this objective. Inmates of homes for the aged and orphanages are at higher risk of having TB infection and disease. Hence this study was conducted with the objective of identifying the prevalence of TB among inmates of homes for the aged and orphanages. MethodsA cross sectional study was done in homes for the aged and orphanages of Kollam district of Kerala in India. Sample size was estimated as 466. Cluster sampling using probability proportionate to size was used. There were 32 homes for the aged, from which 5 were selected. Out of 43 orphanages 8 were selected. Inmates were screened using a questionnaire. Those with any of the symptoms suggestive of TB were examined by a pulmonologist in a camp conducted at the institute. Those who needed further evaluation were brought to Government Medical College, Kollam/other nearest government health setting. All those who were detected to be having tuberculosis, were guided and given the care as per the NTEP treatment protocol. Permission was taken from the Collector of Kollam district. Informed written consent from the study subjects/legally accepted representative and assent were taken. Results533 inmates were assessed from homes for the aged. The mean age was 56.70 (SD - 17.40). Five new TB patients were identified during the study. Of this three patients had extra-pulmonary and two were pulmonary TB. Eight patients were receiving treatment for TB at the time of study already, seven of which were pulmonary and one was extra-pulmonary. So the prevalence of TB in homes for the aged was 13/533 ie 2.43% (95%CI – 1.36 to 4.03%) or 2430/lakh. A higher percentage of inmates with tuberculosis were females, stayed in dormitory, had only primary education, had history of contact with TB and were undernourished compared to inmates without tuberculosis.We screened 478 children in orphanages of Kollam district. There were no children less than 5 years. Most of the children were in the age group of 10–15 years (62.1%). Nine children (1.9%) had history of contact with TB. One child had a previous history of TB. There was only one child who was suspected to have Tuberculosis, She was evaluated by a pediatrician and Tuberculosis was ruled out. ConclusionThe prevalence of TB in inmates of homes for the aged is much higher than the general population. This highlights the need for a more active case detection in such institutions, especially in the context of the country marching towards TB elimination. The absence of tuberculosis among children in orphanages is a positive indicator that the community is moving in the direction of TB elimination.