Tuberculosis Research Articles

Decoding the hidden realm: Molecular pioneering unravelling osteoarticular tuberculosis diagnosis

Osteoarticular tuberculosis (TB), a form of extrapulmonary tuberculosis, refers to the involvement of Mycobacterium tuberculosis (M.tb) in the bones and joints. While pulmonary tuberculosis is the most common form, osteoarticular TB represents a relatively rare but significant manifestation, accounting for approximately 1–3% of all TB cases. Accurate and timely diagnosis plays a pivotal role in the management of osteoarticular TB. Conventional diagnostic methods for osteoarticular TB, such as acid-fast bacilli smear microscopy and culture, have limitations in terms of sensitivity, specificity, and turnaround time. The purpose of this review is to comprehensively evaluate and synthesize the existing literature on molecular pioneering in osteoarticular TB diagnosis. Molecular techniques, such as nucleic acid amplification tests and gene-based assays, have emerged as promising tools for diagnosing TB. These techniques target specific genetic sequences of M.tb, enabling rapid and sensitive detection of the pathogen. However, the diagnostic accuracy, advantages, and limitations of these molecular techniques in the context of osteoarticular TB diagnosis require further investigation and consolidation of evidence. Furthermore, this review aims to identify areas for future research and development in the field of molecular diagnostics for osteoarticular TB.

A Comprehensive Review of HIV-Associated Tuberculosis: Clinical Challenges and Advances in Management.

Human immunodeficiency virus (HIV) and tuberculosis (TB) are two of the most pressing global health issues, each contributing significantly to morbidity and mortality worldwide. This review provides a comprehensive analysis of HIV-associated TB (HIV-TB), focusing on the clinical challenges and advancements in its management. HIV-positive individuals are at a heightened risk of developing active TB due to the immunosuppressive effects of the virus, which complicates both diagnosis and treatment. The interplay between these two diseases exacerbates health outcomes, presenting unique challenges related to drug interactions, adherence to treatment regimens, and management of adverse effects. This review explores the current diagnostic approaches, including advances in testing technologies and screening strategies, and examines treatment protocols, highlighting the integration of antiretroviral therapy with TB treatment. Special considerations for managing HIV-TB in various populations, such as children, pregnant women, and the elderly, are discussed. Additionally, the review addresses public health strategies for prevention and the impact of socio-economic and healthcare system factors on disease management. Finally, it highlights recent research innovations and future directions aimed at improving outcomes for individuals with HIV-TB. By synthesizing the latest evidence and clinical practices, this review aims to enhance understanding and guide effective management of this critical co-infection, ultimately contributing to reduced global burden and improved patient care.

A Study of Clinical, Radiological, and Etiological Profiles of Patients with Cavitary Lung Disease

Abstract Background: This study aims to find out the distribution pattern of cavitary lung disease across clinical, radiological, and etiological variables. Methods: This is an observational monocentric retrospective study conducted in Apollo Hospital, Greams Road, Chennai, between August 2022 and May 2023. After excluding cases lacking follow-up and no clinical data, 50 patients with cavitary lung disease who underwent bronchoscopy were included in this study. Data such as demographics, smoking status, clinical presentation, comorbidities, and radiological features were obtained. Results: Of the 50 participants, the majority had tuberculosis (TB), fungal, and bacterial infections. Fungal cavities were common in males with uniform age distribution and had cavities with air crescent signs. Bronchoscopy was inconclusive in most of them and required either computed tomography or video-assisted thoracic surgery (VATS)-guided biopsy to establish a diagnosis. The most common malignancy was squamous cell carcinoma, and autoimmune disease was granulomatous polyangiitis. Conclusion: Our study shows that the presence of cavities points more toward TB. One of the key measures in making TB treatment and control activities a success is identifying patients at high risk of transmission and poor outcomes like patients with cavities. However, it is important to exclude other diagnoses like malignancy where the prognosis can be fatal.

Mycobacterial Targets for Thiourea Derivatives: Opportunities for Virtual Screening in Tuberculosis Drug Discovery.

Tuberculosis (TB) remains a primary global health concern, necessitating the discovery and development of new anti-TB drugs, mainly to combat drug-resistant strains. In this context, thiourea derivatives have emerged as promising candidates in TB drug discovery due to their diverse chemical structures and pharmacological properties. This review aimed to explore this potential, identifying and exploring molecular targets for thiourea derivatives in Mycobacterium tuberculosis (Mtb) and the potential application of virtual screening techniques in drug discovery. We have compiled a comprehensive list of possible molecular targets of thiourea derivatives in Mtb. The enzymes are primarily involved in the biosynthesis of various cell wall components, including mycolic acids, peptidoglycans, and arabinans, or targets in the branched-chain amino acid biosynthesis (BCAA) pathway and detoxification mechanisms. We discuss the potential of these targets as critical constituents for the design of novel anti-TB drugs. Besides, we highlight the opportunities that virtual screening methodologies present in identifying potential thiourea derivatives that can interact with these molecular targets. The presented findings contribute to the ongoing efforts in TB drug discovery and lay the foundation for further research in designing and developing more effective treatments against this devastating disease.

Synthesis, crystal structure, density functional theory, drug-likeness, and molecular docking studies of a new carbazole-pyrazole derivative: A potential inhibitor of tuberculosis

In this study, a compound combining a carbazole moiety with a pyrazole ring (4E)-4-((9-ethyl-9H-carbazol-3-yl)methyleneamino)-1,2-dihydro-2,3-dimethyl-1-phenylpyrazol-5-one was synthesized and evaluated for its potential as an effective tuberculosis (TB) inhibitor. Compound 3 was synthesized by the condensation of 9-ethylcarbazole-3-carbaldehyde (1) with 4-amino-1,2-dihydro-2,3-dimethyl-1-phenyl-1H-pyrazol-5-one (2), and its 3D pose was employed by X-ray crystallography. The crystal structure analysis revealed the precise arrangement of atoms and provided insights into the compound's three-dimensional arrangement, which is crucial for understanding its interactions with biological targets. To assess the compound's pharmacokinetic properties and potential toxicity, an absorption, distribution, metabolism, excretion, and toxicity study was implemented. The results indicated satisfactory bioavailability and showed limited toxicity risks, suggesting a favorable safety profile. To gain insights into the compound's binding interactions of the compound with the target protein involved in TB, molecular docking studies were carried out. The docking results supported its potential as a TB inhibitor by highlighting its ability to establish favorable interactions within the binding pocket.. KEYWORDS :ADMET, Carbazole cum pyrazole, Crystal structure, DFT, Docking, Drug-likeness.

Mitochondrial Transplantation Promotes Protective Effector and Memory CD4+ T Cell Response During Mycobacterium Tuberculosis Infection and Diminishes Exhaustion and Senescence in Elderly CD4+ T cells.

Tuberculosis (TB), caused by Mycobacterium tuberculosis (M.tb), is a major global health concern, particularly affecting those with weakened immune systems, including the elderly. CD4+ T cell response is crucial for immunity against M.tb, but chronic infections and aging can lead to T cell exhaustion and senescence, worsening TB disease. Mitochondrial dysfunction, prevalent in aging and chronic diseases, disrupts cellular metabolism, increases oxidative stress, and impairs T-cell functions. This study investigates the effect of mitochondrial transplantation (mito-transfer) on CD4+ T cell differentiation and function in aged mouse models and human CD4+ T cells from elderly individuals. Mito-transfer in naïve CD4+ T cells is found to promote protective effector and memory T cell generation during M.tb infection in mice. Additionally, it improves elderly human T cell function by increasing mitochondrial mass and altering cytokine production, thereby reducing markers of exhaustion and senescence. These findings suggest mito-transfer as a novel approach to enhance aged CD4+ T cell functionality, potentially benefiting immune responses in the elderly and chronic TB patients. This has broader implications for diseases where mitochondrial dysfunction contributes to T-cell exhaustion and senescence.

Nutritional Supplementation in Tuberculosis Treatment: A Mixed Methods Study of Clinical Outcomes and Patient Perceptions in Jamnagar, India.

Tuberculosis (TB) remains a significant global health challenge, with malnutrition being a key risk factor for poor outcomes. This study aimed to evaluate the impact of nutritional supplementation on treatment outcomes in drug-sensitive pulmonary tuberculosis (DS-PTB) patients and explore patient perspectives on nutrition during TB treatment. We conducted a mixed methods study in the Jamnagar district of Gujarat, India. The quantitative component was a retrospective cohort study comparing 645 DS-PTB patients who received nutritional supplements with 645 patients who did not. The primary outcomes were cure rates, mortality, and weight gain. Qualitative data were collected through in-depth interviews of 240 patients to explore their experiences and perceptions regarding nutrition during TB treatment. Patients receiving nutritional supplements had significantly higher cure rates (482/645, n=74.7% vs 328/645, n=50.9%, OR: 2.86, 95% CI: 2.26-3.61, p<0.001) and lower mortality (7/645, n=1.1% vs 37/645, n=5.7%, OR: 0.18, 95% CI: 0.08-0.41, p<0.001) compared to the non-supplemented group. The group that received nutritional supplementation showed greater weight gain over six months (6.5 kg vs 3.1 kg, p<0.001). Qualitative findings revealed that patients who received nutritional supplementation reported improved appetite, increased energy, and faster symptom resolution while control group participants faced financial constraints and reduced appetite as barriers to adequate nutrition. Nutritional supplementation significantly improved treatment outcomes in DS-PTB patients, including higher cure rates, reduced mortality, and enhanced weight gain. Patient perspectives highlighted the multifaceted impact of nutritional support. These findings suggest that integrating nutritional supplementation into standard TB care could substantially improve patient outcomes and experiences.

Intranasal vaccination with engineered BCG expressing CCL2 induces a stronger immune barrier against Mycobacterium tuberculosis than BCG

Intradermal Mycobacterium bovis Bacillus Calmette-Guérin (BCG) vaccination is currently the only licensed strategy for preventing tuberculosis (TB). It provides limited protection against pulmonary TB. To enhance the efficacy of BCG, we developed a recombinant BCG expressing exogenous monocyte chemoattractant CC chemokine ligand 2 (CCL2), termed rBCG-CCL2. Co-culturing macrophages with rBCG-CCL2 enhances their abilities in migration, phagocytosis, and effector molecules expression. In the mouse model, intranasal vaccination with rBCG-CCL2 induced greater immune cells infiltration and a more extensive innate immune responses in lung compared to vaccination with parental BCG, as determined by multiparameter flow cytometry, transcriptomic analysis, and pathological assessments. Moreover, rBCG-CCL2 induced a high frequency of activated macrophages and antigen-specific Th1 and Th17 T cells in lungs. The enhanced immune microenvironment responded more effectively to intravenous challenge with Mycobacterium tuberculosis (Mtb) H37Ra, leading to significant reductions in H37Ra burden and pathological damage to the lungs and spleen. Intranasal rBCG-CCL2 vaccinated mice rapidly initiated pro-inflammatory Th1 cytokine release and reduced pathological damage to the lungs and spleen during the early stage of H37Ra challenge. The finding that co-expression of CCL2 synergistically enhances the immune barrier induced by BCG provides a model for defining immune correlates and mechanisms of vaccine-elicited protection against TB.

Assessment of Quality of Life and Social Correlates among Drug Sensitive and Multidrug-resistant Tuberculosis Patients

Abstract Background: Tuberculosis (TB) has significant health, social, psychological, and economic impacts on patients. This study aimed to assess and compare quality of life (QOL) among multidrug-resistant (MDR) TB patients and drug-sensitive TB patients. Materials and Methods: A comparative study was conducted among 40 MDR-TB patients and 80 age- and gender-matched drug-sensitive TB patients in Chitradurga district, South India. Sociodemographic data were collected and QOL was assessed using the WHO BREF scale. Data were analyzed using SPSS v20. Results: The study population was predominantly male (65%) and aged 27–35 years. Education level and socioeconomic status differed significantly between MDR and sensitive TB groups (P &lt; 0.05). MDR-TB patients had significantly lower self-rated QOL and health satisfaction compared to sensitive TB patients (P &lt; 0.001). MDR-TB patients scored lower on all four QOL domains (physical, psychological, social relationships, and environmental), with the psychological domain most affected. The majority of both MDR and sensitive TB patients had “fair” QOL across domains. Conclusion: QOL was impaired in both MDR and sensitive TB patients, but more severely in MDR-TB. The psychological domain was most affected. Factors such as poor accessibility to health services, low socioeconomic status, and poor mental health may contribute to reduce QOL in TB patients.

Epidemiologic characteristics and risk factors of Clostridioides difficile infection in patients with active tuberculosis in the Republic of Korea: a nationwide population-based study

The relationship between anti-tuberculosis (TB) agents and Clostridioides difficile infection (CDI) remains unclear. This study aimed to investigate the epidemiological characteristics and risk factors for CDI in patients with TB. This nationwide, population-based cohort study was conducted in the Republic of Korea (ROK) between January 2018 and December 2022. Data were extracted from the National Health Insurance Service (NHIS) National Health Information Database. The risk factors for CDI in patients with TB were identified through multivariate logistic regression analysis using a 1:4 greedy matching method based on age and sex. During the study period, CDI developed in 2,901 of the 131,950 patients with TB who were prescribed anti-TB agents. The incidence of CDI in patients with TB has increased annually in the ROK from 12.31/1000 in 2018 to 33.51/1000 in 2022. Oral metronidazole (81.94%) was the most common first-line treatment for CDI. The in-hospital mortality rate of patients with concomitant CDI and tuberculosis was 9.9% compared with 6.9% in those with TB alone (P<0.0001). Multivariate logistic regression analysis found intensive care unit admission, Charlson Comorbidity Index ≥3, antibiotics exposure, standard regimen, multidrug resistant TB, and extrapulmonary TB as significant risk factors for development of CDI in patients with TB. CDI is uncommon in patients with TB, but it results in a significantly increased mortality rate. Patients being treated for TB should be carefully monitored for the development of CDI. Further clinical research is warranted to identify effective interventions for preventing and controlling CDI during TB treatment.

Therapeutic potential of Zanha africana (Radlk.) Exell: antimycobacterial activity and safety evaluation

BackgroundZanha africana (Radlk.) Exell extracts are commonly utilized in Tanzania and other countries for treating conditions associated with HIV and AIDS, including tuberculosis (TB). In Tanzania, it is listed among the most frequently traded plant species for medicinal use in different marketplaces. However, limited literature exists regarding its antimycobacterial properties and safety profile. ObjectiveThis study aimed to evaluate Z. africana ethanolic extract for safety and antimycobacterial activity. MethodsThe antimycobacterial activity of the crude extracts was assessed using the broth microdilution method against various non-pathogenic mycobacteria strains including Mycobacterium aurum (MA), Mycobacterium madagascariense (MM), and Mycobacterium indicus pranii (MIP). Bioassay-guided fractionation was employed to isolate the active compounds. The safety profile of the crude extract was investigated through cytotoxicity assay on peripheral blood mononuclear cells (PBMCs) and the brine shrimp lethality test. ResultsThe 80% ethanolic extracts of Z. africana demonstrated activity against all tested non-pathogenic mycobacteria. The antimycobacterial activity of ethanolic extract of the stem bark was 625 µg/mL, 313 µg/mL and 125 µg/mL against MA, MM, and MIP, respectively. The most potent fraction was the ethyl acetate fraction, from which two active compounds were isolated: proanthocyanidin A2; Compound (1) and its monomer epicatechin, Compound (2). Compound (1) exhibited higher antimycobacterial activity compared to compound (2) with minimum inhibitory concentrations (MICs) of 19.50 µg/mL and 12.98 µg/mL against MM and MIP respectively. The ethanolic extract did not demonstrate toxicity on PBMCs and brine shrimps. ConclusionThis study demonstrates that Z. africana extracts and the isolated compounds possess antimycobacterial activity. This provides evidence supporting the traditional use of Z. africana extracts for TB management. Further research is recommended to comprehensively evaluate the efficacy and safety of the plant constituents using different models.

Evaluating the efficacy of whole genome sequencing in predicting susceptibility profiles for first-line antituberculosis drugs

ObjectivesThis study aimed to examine the efficacy of whole genome sequencing (WGS) in accurately predicting susceptibility profiles, potentially eliminating the need for conventional phenotypic drug susceptibility testing (pDST) for first-line antituberculosis drugs in routine tuberculosis diagnosis. MethodsOver the period of 2017 to 2020, 1114 Mycobacterium tuberculosis complex isolates were collected with drug susceptibility testing conducted using the MGIT960 system and WGS performed for predicting drug resistance profiles. In addition, we implemented a new algorithm with an updated WGS workflow, omitting pan-susceptible strains from pDST. ResultsResults showed that out of 1075 analysed isolates, WGS-based genotypic sensitivity predictions for isoniazid, rifampicin, ethambutol, and pyrazinamide were 100% (95% CI, 99.6–100%), 100% (95% CI, 99.62–100%), 99.8% (95% CI, 99.26–99.94%), and 100% (95% CI, 99.63–100%), respectively. In contrast, the WGS-based genotypic resistance prediction, was 98.85% (95% CI, 93.77–99.79%) for isoniazid, 94.74% (95% CI, 82.71–98.54%) for rifampicin, 86.96% (95% CI, 67.87–95.46%) for ethambutol, and 75.7% (95% CI, 59.9–86.63%) for pyrazinamide. Moreover, WGS enabled the implementation of a new testing algorithm that made it unnecessary to perform pDST in 954 of all 1075 samples (88.7%) and in 890 of 901 pan-susceptible samples (98.8%). DiscussionIntegrating WGS into tuberculosis management offers significant potential to replace phenotypic drug susceptibility testing, especially for problematic drugs like pyrazinamide and ethambutol, potentially improving treatment outcomes.

Congenital Segmental Absence of the Bowel Muscle Layer with Duplication of then Bowel in an Adult - An Exceedingly Rare Case Report

ABSTRACT Congenital segmental absence of bowel muscle layer which is also known as Segmental absence of intestinal musculature (SAIM) is rare cause of obstruction in neonates and exceedingly rare in adults. We present 35 years old male with right iliac fossa (RIF) pain since 7 daysandnot passing stool since 3 days, was operated with suspicion of intestinal tuberculosis (TB). Our case shows two rare anomalies, SAIM and duplication in single patient which makes itunique. Histopathologically it was diagnosed as Congenital segmental absence of bowel muscle layer with duplication of bowel wall.

Is Restoration of Sagittal Spinopelvic Parameters Necessary in Spinal Tuberculosis of Lumbar and Lumbosacral Spine? Conservative versus Operative Management

The relationship of spinopelvic parameters with spondylolisthesis is widely explored. However, there is scarce evidence on correlation of tuberculosis of lumbar spine with respect to spinopelvic harmony. The current study aims to find the association between functional outcomes and spinopelvic parameters in lumbar spine tuberculosis treatment. A total of 47 patients with active tuberculosis confined to lumbar spine were prospectively analyzed and divided into 2 groups according to mode of intervention. Group A included 26 operatively managed patients and group B had 21 conservatively managed cases. Functional parameters comprising Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) along with spinopelvic radiologic parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], lumbar lordosis [LL], PI-LL, sagittal vertical axis) in both groups were analyzed at 0 and 6 months of follow-up. Both the groups showed significant improvement from initial presentation to final follow-up in ODI (Group A: 85.4 ± 12.1-12.3 ± 3.2, P= 0.02; Group B: 82.5 ± 10.06-36.8 ± 11.9, P= 0.04) and VAS (Group A: 8.1 ± 1.2-1.4 ± 0.9, P= 0.02; Group B: 8.5 ± 0.09-3.5 ± 1.1, P=0.02). Statistically significant (P < 0.05) difference was observed in both functional outcome parameters between the 2 groups at 2-month and 6-month follow-up, compared with nonsignificant difference (P > 0.05) at presentation. Better improvements of spinopelvic parameters of PT, SS, LL, PI-LL were observed in Group A and in both groups the difference of these parameters correlated with differences of functional outcome parameters, though PI showed no correlation. The spinopelvic parameters played significant role in functional outcome. There is better functional outcome when LL is adequately restored. Surgical correction offered betterment of spinopelvic parameters like PT, SS, an sagittal vertical axis, which in turn leads to improvement in functional outcome.

PreVenTB trial: protocol for evaluation of efficacy and safety of two vaccines VPM1002 and Immuvac (Mw) in preventing tuberculosis (TB) in healthy household contacts of newly diagnosed sputum smear-positive pulmonary TB patients: phase III, randomised, double-blind, three-arm placebo-controlled trial

IntroductionTuberculosis (TB) continues to be one of the deadliest infectious diseases over the centuries, killing more people worldwide than any other single infectious disease. There is an urgent need for...

Determinant of Successful Tuberculosis Treatment in UPT Puskesmas Singosari Working Areas in 2020-2022

Background: Indonesia is one of the countries that contribute the most mortality of Tuberculosis (TB) in the world. The tuberculosis treatment success rate in Indonesia is 86% which is still far from the target coverage of the TB treatment success rate (90%). This study was conducted to determine the determinant factors associated with successful TB treatment in Puskesmas Singosari.Methods: A cross-sectional design study was constructed for this study and used SITB including form TB as a research instrument. The population of this study were all drug-sensitive TB patients who had completed treatment at the Puskesmas Singosari in 2020, 2021, and QI-QII in 2022. The sample of this study was 71 people from 99 total population. The dependent variable is the success of drug-sensitive TB treatment. Independent variables are sex, age, weight, regular use of anti-tuberculosis drugs, and comorbidities. The data processing and analysis are being conducted using SPSS software.Result: Chi-square analysis showed that the variable weight changes has a significant relation to successful tuberculosis treatment (p = 0.014; OR = 9.818). This study found that the mean weight gain in patients who succeeded in TB treatment was approximately 2.19 kg.Conclusion : Puskesmas Singosari's TB Team can collaborate with the nutritionist team to optimize TB treatment through monitoring the nutritional status and weight gain of drug-sensitive TB patients.

The Impact Of Clients' Knowledge On Compliance With Anti-Tuberculosis Medication At Home

Pulmonary tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, namely acid-fast bacteria. Successful treatment of patients with tuberculosis (TB) is a problem in today's society. One of the reasons for the increase in pulmonary TB cases is the low level of education of sufferers. One of the causes of failure of tuberculosis treatment therapy is the side effects of anti-tuberculosis drugs (OAT) which can affect the adherence to medication in tuberculosis patients. The success of TB treatment is compliance in taking anti-tuberculosis medication at the prescribed dose. The aim of this research was to determine the relationship between clients' knowledge of pulmonary tuberculosis and compliance with taking anti-pulmonary tuberculosis medication at Harapan Pematang Siantar Hospital. This research was conducted at Harapan Pematangsiantar Hospital in May 2023. This type of research is descriptive quantitative correlational with a cross-sectional approach. Data collection was carried out using a questionnaire with the Gutman scale. The population of this study was all outpatient clinic patients at Harapan Pematang Siantar Hospital in October-December 2022. The sampling technique was accidental sampling, namely 58 respondents who came in May 2023. Statistical test results used the chi square test with a confidence level of 95% (α = 0.05) shows the p value = 0.001, meaning that there is a relationship between the level of knowledge of tuberculosis clients and compliance with taking anti-tuberculosis medication at Harapan Pematang Siantar Hospital in 2023

Glomerulonephritis during Mycobacterium tuberculosis infection: scoping review

IntroductionPeople with Tuberculosis (TB) infection may present with glomerulonephritis (GN). The range of presentations, renal pathologies, and clinical outcomes are uncertain. Whether clinical features that establish if GN etiology is medication or TB related, and possible benefits of immunosuppression remain uncertain.MethodsA scoping review was completed, searching MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and Conference s from Inception to December, 2023. The study population included patients with TB infection who developed GN and underwent renal biopsy. All data regarding presentation, patient characteristics, renal pathology, management of TB and GN, and outcomes were summarized.ResultsThere were 62 studies identified, with 130 patients. These cases included a spectrum of presentations including acute kidney injury, nephrotic syndrome and hypertension, and a range of 10 different renal pathology diagnoses. Cases that included immunosuppression and outcomes ranged from complete remission to long-term dialysis dependence. The presence of granulomas (4/4, 100%), anti-glomerular basement membrane disease (3/3, 100%), amyloidosis (75/76, 98.7%), and focal segmental glomerulosclerosis (2/2, 100%) were specific for GN being TB-infection related. On the other hand, minimal change disease was specific for anti-TB therapy related (7/7, 100%). While patients with more aggressive forms of GN commonly were prescribed immunosuppression, this study was unable to confirm efficacy. Only rifampin or isoniazid were implicated in drug-associated GN.DiscussionThis study provides a clear rationale for renal biopsy in patients with TB and GN, and outlines predictors for the GN etiology. Thus, this study establishes key criteria to optimize diagnosis and management of patients with TB and GN.

Initiation of Increasing Tuberculosis Medication Supervisors Roles: An Action Research Approach

Indonesia is ranked second in the number of Tuberculosis (TB) cases worldwide. TB patients and their families experience a complex burden. Hence, support and strengthening TB medication supervisors (Pengawas Minum Obat/ PMO) role is needed. The aim of this study was to enhance the Community Health Center (CHC)-based PMOs’ role by improving their knowledge and strengthening peer group support. The method used was an action research cycle with four stages. The diagnosis stage was carried out by consensus decision making group with CHC to determine priority problems, namely the need to increase basic knowledge of TB and its treatment. Optimizing peer group was also necessary, as the Self Reporting Questionnaire-20 showed that more PMOs from patient families have psychological problems than cadres. The planning stage was conducted by preparing educational sessions and creating educational media. The action stage was a quasi-experimental (without control, non-randomization)—an educational talk show provided by the TB program manager, pulmonologist, and psychiatrist. Peer groups are also activated by triggering shared media education and discussion. At the evaluation stage, knowledge was measured by giving pre and post-tests (n= 21, total sampling). The results of the analysis using the Wilcoxon's Signed Ranks Test showed that participants' knowledge had increased significantly (p=0.000; r=0.59). In conclusion, education can increase PMO knowledge as an initial step to strengthen their role in supporting the success of TB treatment. Innovation, cross-sector assistance, and support are needed to enable the PMO to succeed in the TB program.

Utility of GeneXpert in Diagnosis of Pediatric Tuberculosis and Detection of Rifampicin Resistance

Abstract Background: Tuberculosis (TB) remains a significant public health challenge in developing countries, including India, where children under 15 years account for 12% of all TB cases. The National Tuberculosis Elimination Programme (NTEP) recommends the use of GeneXpert/Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) for TB diagnosis, followed by Line Probe Assay (LPA) for detecting drug resistance. This study aimed to determine the prevalence of TB and rifampicin resistance in pediatric patients and to evaluate the utility of CBNAAT in comparison with LPA and Ziehl-Neelsen staining. Methods: This retrospective study was conducted over one year, from 1st January 2022 to 31st December 2022, at a tertiary care hospital in western Maharashtra. A total of 528 samples from pediatric patients (aged &lt;18 years) suspected of having TB were included. Samples underwent CBNAAT testing and Ziehl-Neelsen staining. Positive samples were further analyzed using LPA or Mycobacterial Growth Indicator Tube (MGIT) culture. Results: Among the 528 samples analyzed, gastric lavage accounted for 81.25% of the specimens. CBNAAT detected TB in 61 (11.55%) of the samples, with 15 (24.59%) of these showing rifampicin resistance. Samples with very low or low bacterial loads were often missed by Ziehl-Neelsen staining. Conclusion: Pediatric tuberculosis continues to be a public health concern in developing countries. The study found an 11.55% positivity rate in children under 18 years of age, with 24.59% of positive cases exhibiting rifampicin resistance. The findings underscore the importance of using advanced diagnostic techniques like CBNAAT and highlight the limitations of Ziehl-Neelsen staining in detecting low bacterial loads.