Previous History Of Tuberculosis Research Articles

DIVERSITY OF SPINAL TUBERCULOSIS FINDINGS ON MAGNETIC RESONANCE IMAGING: A STUDY FROM A TERTIARY CARE HOSPITAL

Objective: To determine the spectrum of findings on Magnetic Resonance Imaging (MRI) in patients with spinal tuberculosis (TB) in a tertiary care hospital. Methodology: From January 2019 to December 2020, this retrospective study was carried out at the Hayatabad Medical Complex (HMC), Peshawar, Department of Diagnostic Radiology. In total, 120 TB patients were sampled for this research. A total of 45 samples were found to be TB cases and were further investigated in this study. Results: Out of those 45 patients 19 (42.2%) were female and 26 (57%) were male. In 45 patients only 9 (20%) gave a history of previous tuberculosis. Spondylitis at a single level was observed in 3 (6.7%) patients, 37 (82.2%) patients had spondylitis at multiple levels, and 5 (11.1%) did not develop any spondylitis. Conclusion: This study concluded that magnetic resonance imaging is costly but valuable for the investigation of spinal TB. It is a variety of presentations that can cause a diagnostic dilemma so by looking into the most repetitive and common findings we can achieve diagnostic accuracy for spinal TB.

Difference and Factor Associated with Interferon Gamma Level in Pulmonary Tuberculosis Patients and Healthy Control

BACKGROUND : Interferon-gamma (INF-γ) is an important cytokine in the immune response against Mycobacterium tuberculosis. Interferon-gamma activates macrophage to kill intracellular mycobacterium. AIM: The aim of this study is to determine the difference of plasma INF-γ level in pulmonary tuberculosis (PTB) patients compared to a healthy control and factors associated with interferon-gamma level. METHODS: This is a case–control study. Fifty subjects were selected, including 25 new PTB patients with positive sputum smear, and 25 healthy control (non TB patients) with no symptoms of tuberculosis, normal chest X-Ray and no history of previous tuberculosis. Interferon-gamma concentration was determined by an ELISA technique. Data were analyzed with independent t-test and the results were statistically significant at p < 0.05. RESULTS: Interferon-gamma level was significantly higher in PTB patients compared to healthy control (p = 0.024). Mean ± SD interferon gamma level was 317.2 ± 201.97 pg/ml in PTB patients and 213.5 ± 86.43 pg/ml in healthy control. Acid fast bacilli (AFB) positivity was significantly associated with interferon gamma level (p < 0.001). Interferon gamma level in TB patients with AFB 1+ was 503.22 ± 146.15 pg/ml, AFB 2+ was 337 ± 81.61 pg/ml, and AFB 3+ was 88.27 ± 51.32 pg/ml. Sex, body mass index (BMI), and age were not associated with INF-γ level. CONCLUSIONS: Interferon gamma level was significantly higher in PTB patients than healthy control. Sex, BMI, and age were not associated with INF-γ level. Interferon-gamma level was significantly associated with AFB positivity in pulmonary tuberculosis patients.

RESISTENSI OBAT PADA PASIEN TUBERKULOSIS PARU DI PUSKESMAS BATU HORPAK KABUPATEN TAPANULI SELATAN

Tuberculosis (TB) is an infectious disease with a very high prevalence in several countries in the world. Inadequate TB treatment can cause tuberculosis bacterial resistance to OAT (Anti-Tuberculosis Medicine). The emergence ofresistance M. tuberculosis can be in the form of single drug resistance (DR-TB) or a number or all of the first-line OAT (Multidrug Resistance Tuberculosis). The purpose of this study was to determine drug resistance factors which are influenced by patient habits, medical history, drugs, and health services. This type of research is qualitative research with a case study approach method. There were 6 informants in this study who were two MDR-TB patients, two patient personal monitors, a doctor, and the person in charge of the tuberculosis section. The results showed that the patient had a smoking habit and had a previous history of tuberculosis. In terms of treatment, patients do not routinely take medicines while in health services, the puskesmas have run them well so that there are no mistakes in management. The conclusion of this study is that smoking habits, previous history of tuberculosis disease, and not routine treatment are factors that greatly influence the occurrence of resistance

Clinical Characteristics and Mortality of Non-tuberculous Mycobacterial Infection in Immunocompromised vs. Immunocompetent Hosts.

Immunosuppression and host vulnerability play a key role in non-tuberculous mycobacteria (NTM) pathogenesis. The objective of this study was to compare the clinical characteristics and mortality of NTM infections in immunocompromised and immunocompetent patients. We used a retrospective dataset obtained from our large, tertiary, urban, teaching hospital which is the medical records of hospitalized patients with NTM infections between January 1, 2013 to December 31, 2020. The information including clinical manifestations, imaging, and NTM etiological data were obtained from the hospital's clinical data system. A total of 480 patients with NTM infections completed species identification. 118 hospitalized NTM patients who met ATS/IDSA NTM diagnostic criteria and had complete medical records were included in the study. The average age was 49.4 years, 57 (48.3%) were female, and 64 (54.2%) were immunosuppressed hosts. In our study, the most common species in order of frequency were: M. intracellulare, M. abscessus, M. avium, and M. kansasii among NTM patients. The most common comorbidity was history of previous tuberculosis (30.5%). Besides malignancy, the most common immunodeficiencies were adult-onset immunodeficiency induced by anti-interferon-gamma autoantibody, SLE, and vasculitis. The immunocompromised patients with NTM had more clinical symptoms, comorbidities and lower lymphocyte counts compared to immunocompetent patients. The mortality we observed in immunocompromised patients of NTM disease was significantly higher than that of immunocompetent patients (HR 3.537, 95% CI 1.526–8.362). Immunosuppressed NTM patients with lower B and CD4+ T lymphocyte counts may more frequently present with disseminated NTM infections, clinical exacerbations, and higher mortality than immunocompetent patients.

First and second doses of Covishield vaccine provided high level of protection against SARS-CoV-2 infection in highly transmissible settings: results from a prospective cohort of participants residing in congregate facilities in India

ObjectivesThis study aimed to determine the effectiveness of Covishield vaccine among residents of congregate residential facilities.DesignA prospective cohort study in congregate residential facilities.SettingDharamshala, Himachal Pradesh, India, from December 2020 to...

Predicting the risk of active pulmonary tuberculosis in people living with HIV: development and validation of a nomogram

BackgroundDiagnosis of pulmonary tuberculosis (PTB) among people living with HIV (PLHIV) was challenging. The study aimed to develop and validated a simple, convenient screening model for prioritizing TB among PLHIV.MethodsThe study included eligible adult PLHIV participants who attended health care in Yunnan, China, from January 2016 to July 2019. Participants included before June 2018 were in the primary set; others were in the independent validation set. The research applied the least absolute shrinkage and selection operator regression to identify predictors associated with bacteriological confirmed PTB. The TB nomogram was developed by multivariate logistic regression. The C-index, receiver operating characteristic curve (ROC), the Hosmer–Lemeshow goodness of fit test (H–L), and the calibration curves were applied to evaluate and calibrate the nomogram. The developed nomogram was validated in the validation set. The clinical usefulness was assessed by cutoff analysis and decision curve analysis in the primary set.ResultThe study enrolled 766 PLHIV, of which 507 were in the primary set and 259 in the validation set, 21.5% and 14.3% individuals were confirmed PTB in two sets, respectively. The final nomogram included 5 predictors: current CD 4 cell count, the number of WHO screen tool, previous TB history, pulmonary cavity, and smoking status (p < 0.05). The C-statistic was 0.72 (95% CI 0.66–0.77) in primary set and 0.68 (95% CI 0.58–0.75) in validation set, ROC performed better than other models. The nomogram calibration was good (H–L χ2 = 8.14, p = 0.15). The area under the decision curve (0.025) outperformed the existing models. The optimal cutoff for screening TB among PLHIV was the score of 100 (sensitivity = 0.93, specificity = 0.35).ConclusionThe study developed and validated a discriminative TB nomogram among PLHIV in the moderate prevalence of TB and HIV. The easy-to-use and straightforward nomogram would be beneficial for clinical practice and rapid risk screening in resource-limited settings.

Association of weight change following smoking cessation with the risk of tuberculosis development: A nationwide population-based cohort study.

BackgroundSmoking or weight loss is a risk of tuberculosis (TB) development. However, the impact of weight change after smoking cessation on the occurrence of TB remains elusive. We aimed to determine the relationship between weight change after smoking cessation and the risk of TB development.MethodsWe conducted a population-based cohort study using the national database in Republic of Korea. Of the 10,490,491 subjects who underwent health check-up in 2009, we enrolled 9,953,124 subjects without a previous TB history and followed them until 2017. We divided all study participants into the following three groups: never, former, and current smokers. The primary endpoint was newly developed TB.ResultsAmong 9,953,124 subjects analyzed, 5,922,845 (59.5%) were never smokers, 1,428,209 (14.4%) were former smokers, and 2,602,080 (26.1%) were current smokers. The risk of TB development was significantly higher in current smokers than in never smokers (adjusted hazard ratio (aHR) 1.158; 95% confidence interval [CI] 1.131–1.186). Among current smokers, individuals who stopped smoking and maintained weight after baseline evaluation had a significantly lower risk of TB development compared with those who continued to smoke (aHR 0.771; 95% CI 0.741–0.892). However, even after smoking cessation, individuals who lost weight were at a significantly higher risk of TB development compared with those who continued to smoke (aHR 1.327; 95% CI 1.119–1.715).ConclusionsOur findings suggest that smoking is a risk factor for TB and weight maintenance (neither gaining or losing) after quitting smoking might reduce the risk of TB development.

Nasopharyngeal Tuberculosis

Tuberculosis of the nasopharynx is uncommon and may mimic malignant disease. In this study, 14 patients (17-61 years old; 12 women, 2 men) who were histologically diagnosed as having nasopharyngeal tuberculosis were described. None of them bad known previous history of tuberculosis. Half of our patients had isolated nasopharyngeal tuberculosis with no apparent pulmonary involvement. Eleven patients present with enlarged neck lymph nodes and 6 of the 14 had blood-tinged nasal discharge. A bulging mass, with or without ulceration was the most common nasopharyngeal lesion encountered in 11 patients. Clinically, it appeared to resemble cancer presenting as a nasopharyngeal mass lesion with concomitant enlarged neck lymph nodes. It is important to consider tuberculosis in the differential diagnosis of nasopharyngeal lesions and take biopsy specimens for histological and bacteriological studies.

Detection of Mycobacterium tuberculosis and rifampicin resistance by Xpert® MTB/RIF assay among presumptive tuberculosis cases at Jimma University Medical Center, Southwest Ethiopia.

BackgroundRapid diagnosis of tuberculosis (TB) and detection of drug resistance are very important for timely and appropriate management of patients. Xpert MTB/RIF assay is approved for use in TB and rifampicin-resistance diagnosis. However, data are limited on the impact of Xpert MTB/RIF assay under routine clinical settings with a heterogeneous group of patients and sample types in Ethiopia.MethodsA retrospective study was carried out in 2220 presumptive TB cases at Jimma University Medical Center. Data were gathered from the registration logbook using formatted data extraction tools and double entered to epidata version 3.1 and further transported to SPSS version 20 for analysis. Associations were determined using the Chi-square test and P-value <0.05 was considered statistically significant.ResultsOf 2220 cases enrolled, 1665 (75%) were adults and the remaining 555 (25%) were children aged less than 14 years. The majority, 1964 (88.46%), had pulmonary manifestation and 256 (11.54%) had extrapulmonary involvements. The overall, frequency of Mycobacterium tuberculosis (MTB) was 9.3% (206/2220), among this 10.27% (171/1665) and 6.3% (35/555) were adults and children, respectively. M. tuberculosis was detected from 171 (8.75%) of pulmonary patients and 35 (13.28%) of extrapulmonary manifested patients. Out of 206 M. tuberculosis positive cases, 7(3.4%) were rifampicin-resistant: four from pulmonary tuberculosis (PTB) patients and three from EPTB patients. In the Chi-square test, the age group of 15–24 years, previous history of TB, pus/lymph node sample, and being HIV positive were significantly associated with TB positivity by Xpert MTB/RIF (P-value <0.001).ConclusionThese data suggest that the overall frequency of M. tuberculosis and rifampicin resistance was found to be relatively low compared to the previous reports in Ethiopia. Nevertheless, better diagnostic tools and approaches are still vital to halt the burden of TB and drug-resistant TB in the country.

Treatment Outcomes Among Notified Pulmonary Tuberculosis Cases in 67 Refugee Health Facilities in the Eastern Africa-IGAD Region: Historical Cohort, 2014-2017

Background: Refugees are at increased risk for Tuberculosis (TB). In 2020, more than 3.9 million refugees were hosted in refugee camps/settlements in member countries of Intergovernmental Authority on Development (IGAD), East Africa. Regional evidence, therefore, on treatment outcome is important to improve the quality of TB care and strengthen the monitoring and evaluation system in the refugee settings. Objective: To assess trends of pooled TB treatment outcomes at the regional level and identify factors associated with unsuccessful treatment outcome among patients with pulmonary TB (PTB), bacteriologically confirmed pulmonary TB (BCPTB) and clinically diagnosed pulmonary TB (CDPTB) in refugee camps in IGAD region from 2014 to 2017. Methods: A retrospective cohort study was conducted in 67 refugee health facilities located in four countries (Ethiopia=25, Uganda=33, Kenya=5 and Sudan=4). Demographic and clinical data of all PTB patients registered between January 1, 2014 and December 31, 2017 were used. Descriptive analysis was done on the data and multivariate logistic regression analysis was used to identify baseline covariates associated with unsuccessful treatment. Results: A total of 4,072 TB cases (42%, 28%, 12% and 19% were from Kenya, Ethiopia, Sudan, and Uganda respectively) were included with more than half (62.4%) being BCPTB. 59.2% were males and 13.5% were HIV co-infected. The pooled treatment success rate (TSR) in the period under review was 80.7%. TSR was higher among the CDPTB compared to BCPTB cases in 2014 (86.5% vs. 81.3%), 2015 (87.5% vs. 84.8%) and 2016 (81.0 vs. 80.6%); but reversed in favour of BCPTB in 2017 (77.1% vs. 74.3%). Overall, 13.6% of the cases had unsuccessful treatment (treatment failed, died, or lost to follow-up). The factors significantly associated with unsuccessful treatment were positive HIV status (aOR 2.6[CI: 1.7 - 4.2]), male gender (aOR 1.7[CI: 1.4 - 3.8]), previous TB history (aOR 1.5[CI: 1.0 - 2.2]) and older age (aOR 1.7[CI: 1.1 - 2.8]). Conclusion: TB Treatment success rate in the refugee camps remained below the global target (≥ 90). TB-HIV co-infection, Male gender, previous history of treatment and age (15-34 &amp;old age) increased the risk for unsuccessful treatment outcomes among PTB patients in the refugee camps.

The Effect of Long-Term HAART on the Incidence of Tuberculosis Among People Living with HIV in Addis Ababa, Ethiopia: A Matched Nested Case-Control Study.

BackgroundThe introduction of antiretroviral therapy (ART) significantly decreases the incidence of tuberculosis (TB) in people living with human immunodeficiency virus (PLWHIV). However, a considerable proportion is still co-infected with TB after ART initiation. Thus, this study aimed to assess the effect of long-term HAART on the incidence of TB among PLWHIV in Addis Ababa, Ethiopia.MethodsA matched nested case–control study was conducted among PLWHIV who were enrolled in ART clinics in Addis Ababa, Ethiopia from 2013 up to 2018. Cases were HIV-TB co-infected individuals who were taking antiretroviral treatment, while controls were PLWHIV without TB who were taking antiretroviral treatment. The cases and controls are matched exactly in age and sex. Data were entered in Epi Info version 7.1 and analyzed using SPSS version 20. Bi-variable and multivariable conditional logistic regression were employed along with 95% CI. A P-value <0.05 in the multivariable analysis was considered statistically significant.ResultsFifty-seven cases were compared with 114 controls. Accordingly, previous TB history (X2; 13.790, P < 0.001), baseline functional status (X2; 9.120, P = 0.010), baseline WHO clinical stage (X2; 10.083, P = 0.001), baseline hemoglobin value (X2; 6.985, P = 0.008), baseline body mass index (X2; 3.873, P = 0.049), isoniazid preventive treatment (X2; 8.047, P = 0.005), baseline CD4 value (X2; 12.741, P < 0.001) and length of stay on ART (X2; 53.359, P < 0.001) were associated with developing TB. Length of stay on ART was found to be the statistically significant determinant of TB infection after ART initiation (aOR = 5.925, 95% CI = 2.649–13.250).ConclusionAdvanced clinical stages at the baseline, previous TB history, and not taking IPT were associated with TB infection. The long-term ART exposure significantly decreases tuberculosis incidence in PLWHIV. Thus, retaining PLWHIV on ART would be important to decrease the incidence of TB in this group of individuals.

Co-infection leprosy and tuberculosis: a systematic review.

Leprosy and tuberculosis are endemic in several countries. The aim of this study was to describe factors associated with co-infection among both diseases. A systematic review was carried out, following the Quality of Reporting of Meta-analyses, with the PubMed and Biblioteca Virtual em Saúde (BVS) portals as sources, under eligibility criteria: cross-sectional, cohort, case-control studies or case reports, published in Portuguese, English, French and Spanish, from 2015 to 2020. Studies that dealt with leprosy and tuberculosis not in the context of co-infection were excluded. The initial phase resulted in 1079 articles; 13 went on to a final stage. All were case reports. Thirteen (72.2%) participants were male, aged between 17 and 72 years. Life habits were found in 8 (44.4%) of the articles: 1 (12.5%) reported chronic alcoholism, 1 (12.5%) reported chronic smoking and alcoholism and 1(12.5%) reported chronic smoking, alcoholism and use of illicit drugs. Pathological history was mentioned by 14 (77.8%) patients; 1 (7.1%) reported HIV/AIDS. Three patients (16.6%) described previous history of tuberculosis and/or leprosy. Seven (38.9%) participants reported vaccination with Bacillus Calmette-Guérin. The pulmonary form of tuberculosis predominated and one third of the patients presented resistance to, at least, one tuberculostatic. All cases had multibacillary leprosy. The study did not highlight any comorbidity, and there was no change in the course of the conditions owing to co-infection.

Gender Disparities in Their Effects on Characteristics and Prognostics of Lung Cancer Patients in Pulmonary Ward of Dr. M Djamil Hospital, Padang

Background: Lung cancer incidence in female tends to increase in many countries. Various studies have reported the characteristics of lung cancer in female are different from male. The purpose of this study was to determine the effect of gender on characteristics of lung cancer at Dr. M Djamil Hospital, Padang.Methods: A retrospective analytic study of lung cancer patients treated in the Pulmonary Ward of Dr. M. Djamil Hospital Padang from January 1, 2004 to December 31, 2017, with recognized cancer cell types. Data were grouped according to gender.Results: This study found that 451 lung cancer patients, male-dominant 77.8%. Female were younger than male (52.97 ± 12.79 years vs. 57.81 ± 11.23 years; p = 0.00). Most of male (94.5%) were smokers and former smokers, while 93.9% of female were non-smokers (p = 0.00). Most female were having prior history of tuberculosis (TB) (21.2% vs 11.0%; p = 0.008) and also prior history of other organs cancer (10.1% vs 3.4%; p = 0.007) than in male. Squamous cells were highest in males (41.1%), while females had adenocarcinoma (55.0%); with p = 0.008. Advanced stage in female more than male (91.8% vs 82.7%; p = 0.027). The mean life expectancy of female was longer than male, respectively 8.74 ± 1.56 and 7.29 ± 0.64 months; (p = 0.95). Conclusion: There are differences in the epidemiology of lung cancer between male and female in Dr. M. Djamil Hospital Padang in the form of age, cell type and staging. Non-smokers, a previous history of TB and a history of cancer in other organs were more dominant in female.

Correlation between Measurement of Lung Diffusion Capacity Using Single Breath Methods (DLCO-SB) and COPD Group in Persahabatan Hospital Jakarta

Background: This was a preliminary study to measure DLCO-SB on COPD patients in Persahabatan Hospital to understand the prevalence of DLCO reduction among COPD patients.Methods: This was a cross sectional study of COPD patients who attended COPD-Asthma clinic in Persahabatan Hospital Jakarta. Spirometry and DLCO-SB were performed consecutively during May–July 2015. Comorbidities were also recorded.Results: Spirometry and DLCO-SB measurements were conducted on 65 COPD subjects of which 10.8% subjects were in COPD Group A, 29.2% Group B, 32.3% Group C and 27.7% Group D. The mean age was 64.15; mean FEV1% was 46.05%, mean DLCO measured was 19.42 ml/min/mmHg and the mean DLCO% was 72.00%. The proportion of DLCO decline among COPD patients was 56.92%. There were significant correlations between COPD group, GOLD COPD grade, FEV1, BMI and comorbidities with the DLCO value results. There were no significant correlation between DLCO value with sex, age, smoking history, Brinkmann Index, obstructive-restrictive criteria, comorbidities and length of COPD period. Conclusion: The proportion of DLCO decline among COPD patients was 56.92%. There were significant correlations between COPD group, GOLD COPD grade, FEV1, BMI and previous TB history with the results of DLCO.

Patient characteristics associated with different types of prison TB: an epidemiological analysis of 921\xa0TB cases diagnosed at an Ethiopian prison

BackgroundDespite incarcerated population being at an increased risk of tuberculosis (TB) and serving as a potential source of TB transmission for the general population, prison TB remains understudied. Given its adverse impact on progress towards TB elimination, World Health Organization (WHO) has identified prison TB research as a top priority to guide TB treatment/control interventions.MethodsWe retrospectively analyzed 921 notified TB cases that were diagnosed at Kality Federal Prison, Ethiopia during 2009–2017. To assess trends of microbiologically confirmed pulmonary TB (PTB), extra-pulmonary TB (EPTB), and TB-HIV co-infection, an ecological analysis of aggregated cases was used to report trends over time. Additionally, we used multivariable log binomial regression to identify patient characteristics associated with microbiologically confirmed PTB, EPTB, and TB-HIV co-infection.ResultsMicrobiologically confirmed PTB proportion increased over time. Young age was identified as an important risk factor for EPTB (adjusted prevalence ratio [aPR] = 1.74, 95% CI 0.97, 3.13) while HIV coinfection was negatively associated with EPTB (aPR = 0.73, 95% CI 0.55, 0.97). While previous TB history was associated with a lower likelihood of EPTB (aPR = 0.42, 95% CI 0.25, 0.70), it was associated with an increased risk of TB-HIV coinfection (aPR = 1.37, 95% CI 1.10, 1.71). Clinically diagnosed PTB patients were more likely to have TB-HIV coinfection compared to microbiologically confirmed PTB patients (aPR = 1.32, 95% CI 1.02, 1.72).ConclusionsIncreasing proportion of microbiologically confirmed PTB may suggest delayed access to treatment, severe disease and increased risk of intramural transmission. Associations with clinical/demographic factors varied for different types of TB and were not always consistent with what has been previously reported for the general population, necessitating the need to refocus prison TB control/treatment strategies based on context specific epidemiological factors.

Clinical Factors Associated with Cavitary Tuberculosis and Its Treatment Outcomes.

Cavitary pulmonary tuberculosis (TB) is associated with poor outcomes, treatment recurrence, higher transmission rates, and the development of drug resistance. However, reports on its clinical characteristics, associated factors, and treatment outcomes are lacking. Hence, this study sought to evaluate the clinical factors associated with cavitary pulmonary TB and its treatment outcomes. We retrospectively evaluated 410 patients with drug-susceptible pulmonary TB in a university hospital in Korea between 2014 and 2019. To evaluate the factors associated with cavitary TB, multivariable logistic regression was performed with adjustments for potential confounders. We also compared the treatment outcomes between patients with cavitary TB and those without cavitary TB. Of the 410 patients, 244 (59.5%) had non-cavitary TB and 166 (40.5%) had cavitary TB. Multivariable logistic analysis with forward selection method showed that body mass index (BMI) (adjusted OR = 0.88, 95% CI: 0.81–0.97), previous history of TB (adjusted OR = 3.45, 95% CI: 1.24–9.59), ex- or current smoker (adjusted OR = 1.77, 95% CI: 1.01–3.13), diabetes mellitus (adjusted OR = 2.72, 95% CI: 1.36–5.44), and positive results on the initial sputum acid-fast bacilli (AFB) smear (adjusted OR = 2.24, 95% CI: 1.26–3.98) were significantly associated with cavitary TB. Although treatment duration was significantly longer in patients with cavitary TB than in those with non-cavitary TB (248 (102–370 days) vs. 202 (98–336 days), p < 0.001), the recurrence rate after successful treatment was significantly higher in the patients with cavitary TB than in those with non-cavitary TB (0.4% vs. 3.0% p = 0.042). In conclusion, ex- or current smoker, lower BMI, previous history of TB, diabetes mellitus, and positivity of the initial AFB smear were associated with cavitary TB. The patients with cavitary TB had more AFB culture-positive results at 2 months, longer treatment duration, and higher recurrence rates than those with non-cavitary TB.

Safety of latent tuberculosis infection treatment in older patients with immune-mediated inflammatory diseases.

Screening and treatment of latent tuberculosis infections (LTBI) are required before starting biologics in patients with immune-mediated inflammatory diseases (IMIDs). This study aimed to assess the safety of LTBI treatment in older patients with IMIDs. The medical records of 916 patients treated for LTBI before the start of biologics for IMIDs between January 2004 and December 2018 were reviewed. The safety profiles of LTBI treatment were retrospectively compared according to age. Among the 916 patients, 201 were aged > 60years (older age group). The older age group showed female predominance, more frequent history of previous tuberculosis, and more comorbidities, and received biologics mainly for rheumatoid arthritis. Most patients (74.0%) took isoniazid and rifampicin daily for 3months. The treatment completion rate was 90.4% in the overall population and was lower in the older age group (91.9% vs. 85.1%, P = 0.005). Adverse drug events were more frequent in the older age group (22.9% vs. 9.8%, P < 0.001); however, differences were mainly observed for nausea (5.5% vs. 2.1%, P = 0.016) and flu-like syndrome (6.5% vs. 1.7%, P = 0.001), but not hepatotoxicity. LTBI treatment is generally safe in older patients with IMIDs, especially with respect to hepatotoxicity. Key points • The older age group had significantly more nausea and flu-like syndrome but not hepatotoxicity, compared to the younger age group. • LTBI treatment was acceptable and generally safe in the older age group.

Pattern of drug resistance among patients of pulmonary tuberculosis

BackgroundDrug resistant tuberculosis (DR-TB), particularly multidrug resistance (MDR-TB) and extensive drug resistance (XDR-TB) pose a serious threat to public health. This study aimed to identify drug resistance in pulmonary tuberculosis patients and to see their association with diabetes, human immunodeficiency virus (HIV), previous history of tuberculosis (TB) and family history of TB. MethodSputum specimens obtained from 11,874 pulmonary tuberculosis patients were subjected to smear microscopy, cartridge based nucleic acid amplification test (CBNAAT) and liquid culture (LC). Smear positive isolates were subjected to first line Line probe assay (FL-LPA) for isoniazid and rifampicin resistance. FL- LPA positive isolates were subjected to second line Line probe assay (SL-LPA) for fluoroquinolones and second line injectable drug resistance. ResultOut of 11,874 microbiologically confirmed cases of pulmonary tuberculosis, 976 (8.2%) had a drug resistant tuberculosis. Five patterns of drug resistance were identified monoisoniazid; 394 (3.32%), rifampicin; 461 (3.88%) (monorifampicin; 383 (3.22%)), multidrug; 73 (0.61), extensivedrug; 11 (0.09) and others; 37 (0.31). Previous history of tuberculosis was significantly associated with rifampicin resistance and MDR-TB. Family history of tuberculosis contact was strongly associated with rifampicin resistance, MDR-TB and XDR-TB. ConclusionThere has been an increasing trend in drug resistance in the recent years, particularly in retreatment cases. This study highlights the pattern of drug resistance and need to detect resistance among all tuberculosis cases, in order to interrupt transmission and control this emerging epidemic.

Magnitude of Multidrug Resistance and Associated Factors of Pulmonary Tuberculosis Among Adult Smear Positive Patients in Eastern Ethiopia.

BackgroundIn Ethiopia, multidrug resistant tuberculosis is a major public health problem. However, information is scarce regarding MDR-TB and associated factors. ObjectiveThe study was aimed to assess the magnitude of multidrug resistance and associated factors of pulmonary tuberculosis among adult smear-positive patients in Harari regional state health facilities, eastern Ethiopia.MethodsA cross-sectional study was conducted among 395 adult smear-positive pulmonary tuberculosis patients attending health facilities from March to October 2019. Smear-positive sputum samples were collected from health facilities, and transported to Harari Health Research and Regional Laboratory, and tested for drug susceptibility using a line probe assay. Data were analyzed using Statistical Package for Social Sciences version 20. Bivariate and multivariable logistic regression analyses with 95% confidence intervals were carried out to identify factors associated with multidrug-resistant tuberculosis.ResultsThe overall magnitude of multidrug-resistant tuberculosis was 3.8% (15/395) (95% CI: 2.0–5.8%). Being male (AOR = 4.9; 95% CI: 1.16, 20.5), patients with a previous history of tuberculosis (AOR = 4.9; 95% CI: 1.5, 29.6), treatment failure (AOR = 8.5; 95% CI: 1.61, 45.3), treatment default (AOR = 10.38; 95% CI: 1.86, 58.0), human immunodeficiency virus co-infection (AOR = 9.83.95% CI: 3, 21, 30.1) and a previous history of contact with multidrug-resistant tuberculosis patients (AOR = 14.4; 95% CI: 3.1, 67.6) had higher odds of multidrug-resistant tuberculosis.ConclusionThe overall magnitude of multidrug-resistant tuberculosis was high. Strengthening the tuberculosis control program by giving special attention to HIV co-infected patients, treatment failure and default, previously infected patients as well as to those individuals who have a history of contact with multidrug-resistant tuberculosis infected patients .

Impact of early chest radiography on delay in pulmonary tuberculosis case notification in Ethiopia.

Background:One-third of tuberculosis (TB) cases are missed each year and delays in the diagnosis of TB are hampering the whole cascade of care. Early chest X-ray (CXR) in patients with cough irrespective of duration may reduce TB diagnostic and treatment delays and increase the number of TB patients put into TB care. We aimed to evaluate the impact of CXR on delay in the diagnosis of pulmonary tuberculosis (PTB) among people with cough of any duration.Methods:A facility-based cross-sectional study was conducted in four selected health facilities from two regions and two city administrations of Ethiopia. Patients who sought health care were screened for cough of any duration, and those with cough underwent CXR for PTB and their sputum specimens were tested for microbiological confirmation. Delays were followed up and calculated using median and inter-quartile range (IQR) to summarize (first onset of cough to first facility visit, ≥15 days), diagnosis delay (first facility visit to date of PTB diagnosis, >7 days), and total delay (first onset of cough to date of PTB diagnosis, >21 days). Kruskal–Wallis and Mann–Witney tests were used to compare the delays among independent variables.Results:A total of 309 PTB cases were consecutively diagnosed of 1853 presumptive TB cases recruited in the study that were identified from 2647 people who reported cough of any duration. The median (IQR) of patient delay, diagnosis delay, and the total delay was 30 (16–44), 1 (0–3), and 31 (19–48) days, respectively. Patients’ delay contributed a great role in the total delay, 201/209 (96.2%). Median diagnosis delay was higher among those that visited health center, diagnosed at a facility that had no Xpert mycobacterium tuberculosis (MTB)/RIF assay, radiologist, or CXR (P < 0.05). Factors associated with patients delay were history of previous TB treatment (adjusted prevalence ratio [aPR] = 0.79, 95% confidence interval [CI]: 0.63–0.99) and history of weight loss (aPR = 1.12; 95% CI: 1.0–1.25). Early CXR screening for cough of <2 weeks duration significantly reduced the patients’ delay and thus the total delay, but not diagnostic delay alone.Conclusion:Early screening using CXR minimized delays in the diagnosis of PTB among people with cough of any duration. Patients’ delay was largest and contributed great role in the delay of TB cases. Screening by cough of any duration and/or CXR among people seeking healthcare along with ensuring the availability of Xpert MTB/RIF assay and skilled human power at primary healthcare facilities are important to reduce patient and diagnostic delays of PTB in Ethiopia.