Prior History Of Tuberculosis Research Articles

Policy and programmatic directions for the Lesotho tuberculosis programme: Findings of the national tuberculosis prevalence survey, 2019.

The Kingdom of Lesotho has one of the highest burdens of tuberculosis (TB) in the world. A national TB prevalence survey was conducted to estimate the prevalence of bacteriologically confirmed pulmonary TB disease among those ≥15 years of age in 2019. A multistage cluster-based cross-sectional survey where residents ≥15 years in 54 clusters sampled from across the country were eligible to participate. Survey participants were screened using a symptom screen questionnaire and digital chest X-ray (CXR). Respondents who acknowledged cough of any duration, fever, weight loss, night sweats and/or had any CXR abnormality in the lungs were asked to provide two spot sputum specimens. All sputum testing was conducted at the National TB Reference Laboratory (NTRL), where samples underwent Xpert MTB/RIF Ultra (1st sample) and MGIT culture (2nd sample). HIV counselling and testing was offered to all survey participants. TB cases were those with Mycobacterium tuberculosis complex-positive samples with culture; and where culture was not positive, Xpert MTB/RIF Ultra (Xpert Ultra) was positive with a CXR suggestive of active TB and no current or prior history of TB. A total of 39,902 individuals were enumerated, and of these, 26,857 (67.3%) were eligible to participate; 21,719 (80.9%) participated in the survey of which 8,599 (40%) were males and 13,120 (60%) were females. All 21,719 (100%) survey participants underwent symptom screening and a total of 21,344 participants (98.3%) had a CXR. Of the 7,584 (34.9%) participants who were eligible for sputum examination, 4,190 (55.2%) were eligible by CXR only, 1,455 (19.2%) by symptom screening, 1,630 by both, and 309 by CXR exemption. A total of 6,780 (89.4%) submitted two sputum specimens, and 311 (4.1%) submitted one sample only. From the 21,719 survey participants, HIV counseling and testing was offered to 17,048, and 3,915 (23.0%) were documented as HIV-positive. The survey identified 132 participants with bacteriologically confirmed pulmonary TB thus providing an estimated prevalence of 581 per 100,000 population (95% CI 466-696) for those ≥15 years in 2019. Using the survey results, TB incidence was re-estimated to be 654 per 100,000 (95% CI 406-959), which was comparable to the 2018 TB incidence rate of 611 per 100,000 (95% CI 395-872) reported by the World Health Organization (WHO). The highest TB burden was found in those ≥55 years and among men. The ratio of prevalence to case notification was estimated at 1.22. TB/HIV coinfection was identified in 39 (29.6%) participants. Out of the 1,825 participants who reported a cough, 50% of these participants, mostly men, did not seek care. Those who sought care predominantly went to the public health facilities. The TB prevalence survey results confirmed that burden of TB and TB/HIV coinfection remains very high in Lesotho. Given that TB prevalence remains high, and there is a significant proportion of participants with confirmed TB that did not report TB suggestive symptoms. The National TB Programme will need to update its TB screening and treatment algorithms to achieve the End TB targets. A major focus will need to be placed on finding the "missing cases" i.e., undiagnosed or under-reported TB cases, or ensuring that not only TB symptomatic but also those who do not present with typical TB symptoms are promptly identified to reduce further onward transmission.

Intracranial tuberculoma masquerading as a brain tumor: A rare presentation in a healthy young adult with no prior history of tuberculosis.

Intracranial tuberculoma masquerading as a brain tumor: A rare presentation in a healthy young adult with no prior history of tuberculosis.

479. Predisposing factors and outcomes of infections due to rare yeasts: a study from an apex medical center in India (2018-2020).

Abstract Background Fungi are ubiquitous in the environment, and for patients with risk factors, they can present as pathogens. Unusual fungi often pose a diagnostic challenge and when encountered in practice, albeit infrequently, can delay diagnosis and treatment. Methods Over a period of three years (2018-2020), such cases were followed up till death or discharge and all details were noted down. All patients were diagnosed to have invasive fungal disease according to the EORTC/MSG criteria. Species identification was performed using MALDI-TOF MS and antifungal susceptibility testing (AFST) was done using standard CLSI guidelines. Results A total of 14 cases of rare yeasts were noted out of a total of 155 infections due to yeasts. Among these 5 presented with fungemia and 9 with invasive fungal infections (IFI). Of the IFI clinical isolates, there were 2 pus samples and 7 sterile fluids. The majority of these 14 patients were male (11) and belonged to extremes of age (8). The risk factors included CKD (2), prior history of tuberculosis (2), CLD (1), congenital heart disease (2), and type 2 diabetes mellitus (1). Pathogens isolated were Candida guilliermondii (2), Candida pelliculosa (2), Lodderomyces elongisporus (1) from the blood samples, and Trichosporon asahii (6), Candida guilliermondii (1), Candida kefyr (1), and Geotrichum spp. (1) from the other samples. Certain Candida species showed higher MICs to azoles and echinocandins. Trichosporon and Geotrichum showed higher MICs to azoles. Unfortunately, half of the patients (7) received no antifungals. Of those who did, 4 received mono therapy with azoles or Amphotericin B, while other 3 received combination or sequential therapy with azoles, echinocandins and Amphotericin B. Of the 14 patients, 3 patients expired. The etiological agents in these cases were Candida pelliculosa (fungemia) and Trichosporon asahii (IFI, 2 cases). Conclusion This study aims to highlight the clinical presentation of uncommon yeasts, presenting both as bloodstream infections (BSI) and as invasive disease. Improved methods of detection will help us improve our diagnostic accuracy of uncommon pathogens. The clinician should liaise closely with the laboratory, and treatment should be instituted according to the AFST data. Disclosures All Authors: No reported disclosures.

Endovascular management of hemoptysis in a known case of tetralogy of fallot and tuberculosis complicated with aspergilloma: a case report

BackgroundHemoptysis is a life-threatening complication due to bleeding either from hypertrophied bronchial arteries or enlarged non-bronchial systemic collaterals, having multiple etiologies. Bronchial artery embolization (BAE) is a minimally invasive modality of management that can effectively manage moderate-to-severe hemoptysis.Case presentationWe report the case of a 25-year-old female with moderate-to-severe hemoptysis. There was prior history of tuberculosis and treatment with anti-tubercular therapy 6 months back. There was also a background of tetralogy of Fallot(TOF) with symptoms of chronic breathlessness and palpitations. Imaging evaluation with X-ray and HRCT thorax revealed a cavity in the left upper lobe with dependent soft tissue, implying a diagnosis of aspergilloma in an old tubercular cavity. TOF and right-sided aortic arch were noted. CT bronchial angiography showed dilated and tortuous left bronchial artery, as well as non-bronchial systemic collaterals from the ipsilateral internal mammary artery. Endovascular management was achieved by super-selective catheterization and embolization of the involved branch of the left bronchial artery and selective embolization of non-bronchial systemic collaterals from the ipsilateral internal mammary artery.ConclusionsBAE has a high clinical success rate and is recommended as first-line therapy in the management of massive hemoptysis. The CT pulmonary angiography, as well as the pre-embolization angiogram, is very important to detect the source of hemoptysis from the non-bronchial systemic circulation, increasing the success rate and decreasing the incidence of recurrence. BAE is effective even in presence of underlying vascular anomalies such as Fallot of Tetralogy.

Pathogenesis and Staging of Craniovertebral Tuberculosis: Radiographic Evaluation, Classification, and Natural History.

Retrospective cohort. To radiographically evaluate Craniovertebral junction (CVJ) tuberculosis infection pathogenesis and to propose a modification to the Lifeso classification. A cohort of patients with radiologically or microbiologically identified CVJ tuberculosis treated at a single tertiary referral center in a TB endemic area was queried for characteristics about clinical presentation, treatment, and radiographic evidence of bone destruction and abscess formation were included. Disease was classified according to the Lifeso grading system and bony lesions were classified as either type 1 (preservation of underlying structure) or type 2 (damage of underlying structure). 52 patients were identified (mean age 28.5 ± 13.4yr, 48% male; 14% with a prior history of tuberculosis). All presented with neck pain at presentation, 29% with rotatory pain, and 37% with myelopathy. Comparison by Lifeso type showed Lifeso III lesions had longer symptom durations (P = .03) and more commonly had periarticular or predental abscess formation (P < .05), spinal cord compression (P < .01), and more commonly involved the C2 body and atlanto-dental joint. Underlying bony destruction was more common for lesions of the lateral atlantoaxial joints and atlanto-dental joints in Lifeso III cases than in either Lifeso I or II (all P < .05). The radiologic findings of the present series suggest CVJ TB infection may originate in the periarticular fascia with subsequent invasion into the adjacent atlanto-dental and lateral atlantoaxial joints in later disease. To reflect this proposed etiology, we present a modified Lifeso classification to describe the radiologic pathogenesis of CVJ TB.

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.

Deciphering the diagnostic dilemma of abdominopelvic tuberculosis and advanced ovarian cancer

Abdominopelvic tuberculosis often poses a diagnostic challenge due to its bizarre clinical features and inconclusive imaging features. Most such patients were categorized under advanced ovarian cancer and undergo radical cytoreductive surgery with its associated morbidity, which would otherwise resolve spontaneously with medical management. This is a retrospective study of ten patients referred to the Department of Surgical Oncology between November 2015 to October 2018 in a tertiary care centre at south Tamil Nadu, India as advanced ovarian cancer and later diagnosed to have tuberculosis.In 10 patients, the mean age was 34 years; mean CA125 was 496.6 IU/ml. abdominal pain and distension, loss of weight were seen in 70% of cases, respectively.Only one patient had a prior history of tuberculosis. The imaging findings were complex adnexal mass in 9 patients (90%), ascites in 6 patients (60%) and omental stranding in 6 patients (60%). Abdominal paracentesis was done in 6 patients (60%) and all had lymphocyte rich effusion. The diagnosis is established by laparotomy and biopsy in seven patients (70%), diagnostic laparoscopy in two patients (20%) and image-guided trucut biopsy in one patient (10%) with histopathology revealing caseating granulomas. With our patients' experience, a high index of suspicion is always needed whenever we encounter young women presenting with ascites, adnexal mass and elevated serum CA125 even when the routine investigations for tuberculosis reveal negative findings. The biopsy is the gold standard for establishing the diagnosis and to commence therapy.

The transition to Xpert MTB/RIF ultra: diagnostic accuracy for pulmonary tuberculosis in Kampala, Uganda

BackgroundThe World Health Organization (WHO) has endorsed the next-generation Xpert MTB/RIF Ultra (Ultra) cartridge, and Uganda is currently transitioning from the older generation Xpert MTB/RIF (Xpert) cartridge to Ultra as the initial diagnostic test for pulmonary tuberculosis (TB). We assessed the diagnostic accuracy of Ultra for pulmonary TB among adults in Kampala, Uganda.MethodsWe sampled adults referred for Xpert testing at two hospitals and a health center over a 12-month period. We enrolled adults with positive Xpert and a random 1:1 sample with negative Xpert results. Expectorated sputum was collected for Ultra, and for solid and liquid culture testing for Xpert-negative patients. We measured sensitivity and specificity of Ultra overall and by HIV status, prior history of TB, and hospitalization, in reference to Xpert and culture results. We also assessed how classification of results in the new “trace” category affects Ultra accuracy.ResultsAmong 698 participants included, 211 (30%) were HIV-positive and 336 (48%) had TB. The sensitivity of Ultra was 90.5% (95% CI 86.8–93.4) and specificity was 98.1% (95% CI 96.1–99.2). There were no significant differences in sensitivity and specificity by HIV status, prior history of TB or hospitalization. Xpert and Ultra results were concordant in 670 (96%) participants, with Ultra having a small reduction in specificity (difference 1.9, 95% CI 0.2 to 3.6, p=0.01). When “trace” results were considered positive for all patients, sensitivity increased by 2.1% (95% CI 0.3 to 3.9, p=0.01) without a significant reduction in specificity (− 0.8, 95% CI − 0.3 to 2.0, p=0.08).ConclusionsAfter 1 year of implementation, Ultra had similar performance to Xpert. Considering “trace” results to be positive in all patients increased case detection without significant loss of specificity. Longitudinal studies are needed to compare the benefit of greater diagnoses to the cost of overtreatment.

1652. Diagnoses of Non- Tuberculosis Mycobacterium (NTM) in patients with granuloma on lung biopsy

BackgroundThe prevalence of non-Tuberculous mycobacteria (NTM) lung disease has increased from 8.7 to 13.9/100,000 from 2008-2013 making NTM lung disease a rising public health problem. Patterns of infection include fibrocavitary, bronchiectatic or nodular. Diagnosis of NTM may be incidental after surgical resection performed during malignancy work up. We aimed to identify the proportion of NTM in resected lung lesions (both nodules and masses) with granulomas (GL) both necrotizing (NGL) and non-necrotizing (n-NGL) on pathology and to compare differences in characteristics of patients with NTM versus those without NTM.MethodsThis was a retrospective chart review of patients who underwent resection of lung nodules and/or a lung mass during malignancy work up from January 2013 through March 2019 including only those with granulomatous inflammation on pathology. 497 patients met these criteria and their electronic medical records were reviewed. Findings of culture-confirmed NTM on tissue, bronchoalveolar lavage or sputum (at time of resection) were classified as “NTM” group; and those with no NTM diagnoses were classified as “Non-NTM” group. Patients with NTM and another diagnoses were classified within the NTM group. Study variables were compared by the dichotomous NTM group using Chi-square test for categorical variables and T-test for continuous variables.ResultsAmong all patients, the most common diagnosis was lung cancer (21.93%). There were 81 (16.3%) patients with NTM (Table 1). Within the NTM group, percentage of Asians, presence of NGL, placement on airborne precautions and prior history of tuberculosis were significantly higher. The NTM group also had a higher proportion of both COPD and lung cancer as their underlying condition (Table 2). 161 patients had non-diagnostic biopsies.Table 1 Table 2 Table 2 ConclusionMycobacterial infections made up a significant percentage of resected lung nodules and/or lung masses for malignancy evaluation. NTM were isolated with greater frequency than M. Tuberculosis even with NGL on lung pathology. This reflects the changing epidemiology of NTM. The significant proportion of Asians with NTM compared with GL found during a malignancy work up without NTM is interesting and deserves further investigation.Disclosures All Authors: No reported disclosures

Novel stepwise approach to assess representativeness of a large multicenter observational cohort of tuberculosis patients: The example of RePORT Brazil

BackgroundA major goal of tuberculosis (TB) epidemiological studies is to obtain results that can be generalized to the larger population with TB. The ability to extrapolate findings on the determinants of TB treatment outcomes is also important. MethodsWe compared baseline clinical and demographic characteristics and determinants of anti-TB treatment outcomes between persons enrolled in the Regional Prospective Observational Research in Tuberculosis (RePORT)-Brazil cohort between June 2015 and June 2019, and the registry of TB cases reported to the Brazilian National TB Program (Information System for Notifiable Diseases [SINAN]) during the same time period. Multivariable regression models adjusted for the study site were performed using second-generation p-values, a novel statistical approach. Associations with unfavorable treatment outcomes were tested for both RePORT-Brazil and SINAN cohorts. FindingsA total of 1,060 culture-confirmed TB patients were enrolled in RePORT-Brazil and 455,873 TB cases were reported to SINAN. Second-generation p-value analyses revealed that the cohorts were strikingly similar with regard to sex, age, use of antiretroviral therapy and positive initial smear sputum microscopy. However, diabetes, HIV infection, and smoking were more frequently documented in RePORT-Brazil. Illicit drug use, the presence of diabetes, and history of prior TB were associated with unfavorable TB treatment outcomes; illicit drug use was associated with such outcomes in both cohorts. ConclusionsThere were important similarities in demographic characteristics and determinants of clinical outcomes between the RePORT-Brazil cohort and the Brazilian National registry of TB cases.

The burden of anxiety among people living with HIV during the COVID-19 pandemic in Pune, India

IntroductionGlobally, India has the third largest population of people living with HIV (PLHIV) and the second highest number of COVID-19 cases. Anxiety is associated with antiretroviral therapy (ART) nonadherence. It is crucial to understand the burden of anxiety and its sources among Asian Indian PLHIV during the COVID pandemic, but data are limited.MethodsDuring the first month of government mandated lockdown, we administered an anxiety assessment via telephone among PLHIV registered for care at a publicly funded antiretroviral therapy (ART) center in Pune, India. Generalized anxiety was defined as GAD-7 score ≥ 10. Sociodemographic and clinical variables were compared by anxiety status (GAD-7 score ≥ 10 vs GAD-7 score < 10). Qualitative responses to an open-ended question about causes of concern were evaluated using thematic analysis.ResultsAmong 167 PLHIV, median age was 44 years (IQR 40–50); the majority were cisgender women (60%) and had a monthly family income < 200 USD (81%). Prior history of tuberculosis and other comorbidities were observed in 38 and 27%, respectively. Overall, prevalence of generalized anxiety was 25% (n = 41). PLHIV with GAD-7 score ≥ 10 had fewer remaining doses of ART than those with lower GAD-7 scores (p = 0.05). Thematic analysis indicated that concerns were both health related and unrelated, and stated temporally. Present concerns were often also projected as future concerns.ConclusionsThe burden of anxiety was high during COVID lockdown in our population of socioeconomically disadvantaged PLHIV in Pune and appeared to be influenced by concerns about ART availability. The burden of anxiety among PLHIV will likely increase with the worsening pandemic in India, as sources of anxiety are expected to persist. We recommend the regular use of short screening tools for anxiety to monitor and triage patients as an extension of current HIV services.

Representativeness of a Large Multicenter Observational Cohort of Tuberculosis Patients: The Example of RePORT Brazil

Background: A major goal of tuberculosis (TB) epidemiologic studies is to obtain results that can be generalized to the larger population with TB. The ability to extrapolate findings on determinants of TB treatment outcomes is also important. Methods: We compared baseline clinical and demographic characteristics and determinants of anti-TB treatment outcomes between persons enrolled into the Regional Prospective Observational Research in Tuberculosis (RePORT)-Brazil cohort between June 2015 and June 2019, and the registry of TB cases reported to the Brazilian National TB Program (Information System for Notifiable Diseases [SINAN]) during the same time period. Multivariable regression models adjusted for study site were performed using second-generation p-values, a novel statistical approach. Associations with unfavorable treatment outcomes were tested for both RePORT-Brazil and SINAN cohorts. Findings: 1,060 culture-confirmed TB patients were enrolled in RePORT-Brazil and 455,873 TB cases were reported to SINAN. Second-generation p-value analyses revealed that the cohorts were strikingly similar with regard to sex, age, use of antiretroviral therapy and positive initial smear sputum microscopy. However, diabetes, HIV infection and smoking were more frequently documented in RePORT-Brazil. Illicit drug use, presence of diabetes and history of prior TB were associated with unfavorable TB treatment outcomes; illicit drug use was associated with such outcomes in both cohorts. Interpretations: There were important similarities in demographic characteristics and determinants of clinical outcomes between the RePORT-Brazil cohort and the Brazilian National registry of TB cases. Funding Statement: Fundacao Jose Silveira and Ministerio da Saude, Brazil and the National Institutes of Allergy and Infectious Diseases. Declaration of Interests: All authors: none reported. Ethics Approval Statement: All clinical investigations were conducted according to the principles of the Declaration of Helsinki. The RePORT-Brazil protocol, informed consent, and study documents were approved by the institutional review boards at each study site and at Vanderbilt University Medical Center. Participation in RePORT Brazil was voluntary, and written informed consent was obtained from all such participants. For the data extracted from SINAN, the anonymity of study subjects was preserved, and all data were de-identified.

S1481 Isolated Pancreatic Mass: A Unique Presentation of Tuberculosis

INTRODUCTION: Malignancy is often the culprit after discovery of an isolated pancreatic mass. It is important to consider other etiologies including infectious etiologies such as tuberculosis. CASE DESCRIPTION/METHODS: A 28 year old Vietnamese immigrant with no significant medical history presented with intermittent nausea and epigastric pain for several years that acutely worsened over two days. She reported the pain radiated to her back and was exacerbated by spicy foods. She denied any fevers, weight loss, or jaundice. Lipase and liver function tests were normal. CT imaging of the abdomen showed a 4cm heterogeneous hypodense pancreatic lesion but was otherwise normal (Figure 1a). EUS was notable for hypoechoic mass in the pancreatic head with irregular margins and no vascular invasion (Figure 1b). Fine needle aspiration cytology revealed granulomatous inflammation with extensive necrosis and negative AFB/GMS stains. Quantiferon Gold testing was positive and HIV testing was negative. Chest x-ray was normal. She had no prior history of tuberculosis and no known high risk exposures. Her immigration medical testing in 2012 was reportedly normal. In light of the pathologic and serologic findings, the patient was treated for isolated pancreatic tuberculosis with RIPE therapy. Her gastrointestinal symptoms resolved on therapy and follow-up CT imaging 6 months after completion of antibiotics showed complete resolution of the pancreatic mass. DISCUSSION: The gastrointestinal tract is the 6th most common site of extrapulmonary tuberculosis and is seen in only about 5% of all tuberculosis cases; the ileocecal region is involved in the majority of cases. Isolated pancreatic tuberculosis is considered an extremely rare entity since pancreatic enzymes usually destroy any intrusive pathogens. These patients are typically immunocompromised. Abdominal pain and jaundice are well-known symptoms but weight loss and fevers and also commonly seen. Imaging will show a hypodense mass without any biliary ductal dilation or vascular invasion. EUS with fine needle aspiration is done for initial investigation while excisional biopsy is the most accurate diagnostic tool. Patients tend to respond very well to antituberculosis therapy. We present a unique case of an immunocompetent patient with dyspeptic symptoms who had no prior personal history of tuberculosis or known high risk exposure and was found to have isolated pancreatic tuberculosis.Figure 1.: Figure 1a. Initial CT abdomen/pelvis showing a multilobulated heterogeneous pancreatic mass (red circle).Figure 2.: b. EUS findings notable for a 4 cm × 4 cm pancreatic head mass with irregular outer margins.

Endogenous Tuberculous Endophthalmitis and Panophthalmitis: A Systematic Review of Case Reports and Case Series.

PurposeTo systematically review the characteristics of patients with endogenous tuberculous (TB) endophthalmitis and panophthalmitis in an effort to help clinicians with diagnosis and treatment.Patients and MethodsWe conducted a systematic literature search in MEDLINE/PubMed, EMBASE and Web of Science from inception to August 2020. References and abstracts were screened independently by two authors. Included studies were case reports and case series reporting endogenous TB endophthalmitis and panophthalmitis secondary to Mycobacterium tuberculosis complex (MTBC). Available-case analysis was employed to handle missing data. ResultsA total of 1343 articles were found using the search strategy. Following abstract screening, 51 articles were selected for full text-review, from which 26 were deemed eligible for inclusion in the study. Forty-four cases from 26 articles were included in the quantitative analysis. The median age of presentation was 29.5 (range: 1 to 81), and 11/44 patients (25.0%) were pediatric. Immunosuppression was seen in 9/36 cases (25.0%). Most patients (24/38, 63.2%) had no prior history of tuberculosis. Systemic symptoms were absent in half of the patients (16/32, 50.0%). Visual acuity was poor, with 23/27 cases (85.2%) being 20/200 or worse at presentation. Poor organ and visual outcomes were reported: 36/43 cases (83.7%) resulted in enucleation/evisceration or exenteration. Intraocular tumors were suspected in 5/34 cases (14.7%). Pulmonary tuberculosis was seen in 15/35 cases (42.8%), and miliary tuberculosis was seen in 7/35 cases (20.0%). The earliest source of TB diagnosis was through histopathologic specimen after eye removal in 32/44 cases (72.7%), vitreous specimen in 6/44 cases (13.6%) and aqueous specimen in 3/44 cases (6.8%).ConclusionTB endophthalmitis is a rare and sight-threatening manifestation of ocular tuberculosis. It can occur in apparently healthy individuals and can mimic intraocular tumors and other infectious etiologies. Diagnosis remains a significant challenge, which, often delayed, leads to profound visual loss. Early detection and treatment of intraocular tuberculosis may be associated with better ocular and systemic outcomes.

Isoniazid (INH) mono-resistance and tuberculosis (TB) treatment success: analysis of European surveillance data, 2002 to 2014.

Introduction: Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment. Resistance to INH may increase the likelihood of negative treatment outcome.Aim: We aimed to determine the impact of INH mono-resistance on TB treatment outcome in the European Union/European Economic Area and to identify risk factors for unsuccessful outcome in cases with INH mono-resistant TB.Methods: In this observational study, we retrospectively analysed TB cases that were diagnosed in 2002–14 and included in the European Surveillance System (TESSy). Multilevel logistic regression models were applied to identify risk factors and correct for clustering of cases within countries.Results: A total of 187,370 susceptible and 7,578 INH mono-resistant TB cases from 24 countries were included in the outcome analysis. Treatment was successful in 74.0% of INH mono-resistant and 77.4% of susceptible TB cases. In the final model, treatment success was lower among INH mono-resistant cases (Odds ratio (OR): 0.7; 95% confidence interval (CI): 0.6–0.9; adjusted absolute difference in treatment success: 5.3%). Among INH mono-resistant TB cases, unsuccessful treatment outcome was associated with age above median (OR: 1.3; 95% CI: 1.2–1.5), male sex (OR: 1.3; 95% CI: 1.1–1.4), positive smear microscopy (OR: 1.3; 95% CI: 1.1–1.4), positive HIV status (OR: 3.3; 95% CI: 1.6–6.5) and a prior TB history (OR: 1.8; 95% CI: 1.5–2.2).Conclusions: This study provides evidence for an association between INH mono-resistance and a lower likelihood of TB treatment success. Increased attention should be paid to timely detection and management of INH mono-resistant TB.

Asthma and atopy prevalence are not reduced among former tuberculosis patients compared with controls in Lima, Peru

BackgroundAlthough there are theoretical reasons for believing that asthma and atopy may be negatively correlated with tuberculosis, epidemiological studies have had conflicting findings.ObjectiveTo determine if people with confirmed tuberculosis were less likely to be atopic and less likely to have atopic disease including asthma compared to those with no previous tuberculosis.MethodsPatients in Lima, Peru with a prior history of tuberculosis were identified from clinic records in this cohort study. A representative sample of individuals without a prior tuberculosis diagnosis was recruited from the same community. Allergen skin prick testing was performed to classify atopic status. Allergic rhinitis was identified by history. Asthma was defined by symptoms and spirometry. Eosinophilic airway inflammation was measured using exhaled nitric oxide levels.ResultsWe evaluated 177 patients with, and 161 individuals without, previous tuberculosis. There was a lower prevalence of atopy among people with prior tuberculosis on univariate analysis (odds ratio 0.57; 95% confidence interval 0.37–0.88) but, after adjustment for potential confounders, this was no longer statistically significant (aOR 0.64, 95% CI 0.41–1.01). The prevalence of allergic rhinitis (aOR 0.76, 95% CI 0.47 to 1.24 and asthma (aOR 1.18, 95% CI 0.69 to 2.00) did not differ significantly between the two groups. We also found no significant difference in the prevalence of elevated exhaled nitric oxide (aOR 1.30, 95% CI 0.78 to 2.17) or a combined index of atopic disease (aOR 0.86, 95% CI 0.54 to 1.36).ConclusionIn this urban environment in a middle-income country, prior tuberculosis may be associated with a reduced risk of atopy but does not protect against asthma and atopic disease.

757. Community Prevalence of Bacteriologically Confirmed Pulmonary Tuberculosis: A 7-Year Retrospective Study

BackgroundIt is estimated that about 40% of the Indian population is infected with Mycobacterium tuberculosis (TB), the vast majority of whom have latent TB. However, asymptomatic pulmonary carriage of the TB bacteria contributes to sustenance of the disease in the community and subsequent transmission. The present study was carried out to see the prevalence of culture positive pulmonary tuberculosis in apparently asymptomatic individuals from the community.MethodsThe study population consisted of individuals wishing to migrate to the USA/UK/Canada/Australia and submitting for the mandatory health check prior to obtaining the Visa. Chest X-ray was the initial screening test for diagnosis of tuberculosis. Individuals with any X-ray abnormalities were directed to submit three sputum samples for microscopy and culture which was done on automated culture systems (BacTALERT and MGIT). First-line drug susceptibility (INH, Rifampicin, Pyrazinamide, Ethambutol, Streptomycin) testing data were retrieved wherever available. Data were obtained for a period of 7 years from August 2010 to July 2017.ResultsA total of 140,499 individuals presented for the health check. Of these, 1,002 (0.7%) were further investigated using sputum microscopy and culture based on chest X-ray findings. Of these, 42 (0.4%) individuals were sputum culture positive for Mycobacterium tuberculosis. Except two, none had any respiratory complaints. Eleven (27.5%) of them were smear positive for acid fast bacilli. Most of the patients (30%) belonged to the age group of 18–25 years. Eighty-four percent had no prior history of tuberculosis or treatment for TB. Fifty-nine percent isolates were sensitive to all first-line drugs (Isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin). Twenty-seven percent were resistant to pyrazinamide alone. Fourteen percent were resistant to more than one first-line drug. There were no cases of multidrug resistance.ConclusionThis is a unique large-scale study which assesses prevalence of culture positive pulmonary tuberculosis in the urban Indian community. It stresses the need for more stringent public health measures to curb transmission of the disease in such a high endemic region such as India.Disclosures All authors: No reported disclosures.

Effect of bedaquiline on mortality in South African patients with drug-resistant tuberculosis: a retrospective cohort study

Addition of bedaquiline to treatment for multidrug-resistant tuberculosis was associated with an increased risk of death in a phase 2b clinical trial, resulting in caution from WHO. Following a compassionate access programme and local regulatory approval, the South African National Tuberculosis Programme began widespread use of bedaquiline in March, 2015, especially among patients with extensively drug resistant tuberculosis for whom no other effective treatment options were available. We aimed to compare mortality in patients on standard regimens with that of patients on regimens including bedaquiline. In this retrospective cohort study, we analysed patient data from the South African rifampicin-resistant tuberculosis case register (EDRweb), and identified additional mortality using the national vital statistics register. We excluded patients who started treatment before July 1, 2014, or after March 31, 2016; patients younger than 15 years or older than 75 years; patients without documented rifampicin resistance, and patients with pre-extensively drug-resistant tuberculosis (multidrug-resistant tuberculosis with further resistance to a second-line injectable or fluoroquinolone). We compared all-cause mortality between patients who received bedaquiline in treatment regimens and those who did not. Patients who did not receive bedaquiline had kanamycin or capreomycin and moxifloxacin as core medicines in their regimen. We estimated hazard ratios for mortality separately for multidrug-resistant or rifampicin-resistant tuberculosis and extensively drug-resistant tuberculosis and adjusted using propensity score quintile strata for the potential confounders of sex, age, HIV and antiretroviral therapy status, history of prior tuberculosis, valid identification number, and year and province of treatment. 24 014 tuberculosis cases were registered in the EDRweb between July 1, 2014, and March 31, 2016. Of these, 19 617 patients initiated treatment and met our analysis eligibility criteria. A bedaquiline-containing regimen was given to 743 (4·0%) of 18 542 patients with multidrug-resistant or rifampicin-resistant tuberculosis and 273 (25·4%) of 1075 patients with extensively drug-resistant tuberculosis. Among 1016 patients who received bedaquiline, 128 deaths (12·6%) were reported, and there were 4612 deaths (24·8%) among 18 601 patients on the standard regimens. Bedaquiline was associated with a reduction in the risk of all-cause mortality for patients with multidrug-resistant or rifampicin-resistant tuberculosis (hazard ratio [HR] 0·35, 95% CI 0·28-0·46) and extensively drug-resistant tuberculosis (0·26, 0·18-0·38) compared with standard regimens. Our retrospective cohort analysis of routinely reported data in the context of high HIV and extensively drug-resistant tuberculosis prevalence showed that bedaquiline-based treatment regimens were associated with a large reduction in mortality in patients with drug-resistant tuberculosis, compared with the standard regimen. None.

Characteristics and outcome of multidrug-resistant tuberculosis in a low-incidence area

ObjectivesTo characterize multidrug-resistant tuberculosis (MDR-TB) patients treated in a low endemic area in France and to determine risk factors for resistance. We also analyzed the efficacy and tolerability of tuberculosis (TB) treatment. MethodsBetween 2002–2013, all MDR-TB patients diagnosed in western France (hospitals belonging to the GERICCO group) were retrospectively included, with a follow-up period running until 2016. A case-control study (1:2), matched according to age, sex, and year of diagnosis, was performed to assess socio-demographic and clinical data, treatment strategies, and outcomes for the MDR-TB patients and controls treated for drug-susceptible tuberculosis during the same period. ResultsOf 134 TB patients, 44 were MDR-TB and 90 were drug-susceptible TB. Of the 44 MDR-TB patients (35 MDR and nine extensively drug-resistant [XDR]), 33 (75%) were males; the median age was 33 years; and 27 (61%) were born in Eastern Europe. Prior treatment failure was more frequently reported for XDR-TB (8/9) in Georgian patients. In multivariate analysis, risk contacts and prior TB history were associated with MDR-TB. Treatment failure was associated with MDR/XDR-TB and miliary TB. ConclusionIn western France, MDR-TB more frequently occurred in recent migrants from high-risk countries with a previous history of at-risk contact with other MDR-TB patients or previous TB treatment failure.

Plasma Cytokine Predictors of Tuberculosis Recurrence in Antiretroviral-Treated Human Immunodeficiency Virus-infected Individuals from Durban, South Africa.

Immune correlates of tuberculosis (TB) risk in populations infected with human immunodeficiency virus (HIV) remain understudied, despite HIV being associated with a high burden of TB disease. Here we describe plasma cytokine correlates of TB recurrence in a well-characterized cohort of HIV-infected individuals on antiretroviral therapy (ART) with a history of prior TB cure. Study participants were drawn from a prospective cohort study initiated at the conclusion of a randomized clinical trial in which individuals presented with untreated HIV infection and active pulmonary TB. At baseline, ART was initiated, and TB successfully cured. Participants were screened for TB recurrence quarterly for up to 4 years. TB recurrent cases (n = 63) were matched to controls (n = 123) on sex, study arm assignment in the original trial, and month of enrollment with a subset of cases sampled longitudinally at several time-points. Three cytokines were associated with increased rates of TB recurrence in univariate models: interleukin 6 (IL6) (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.34-5.28, P = .005), IP10 (OR 4.62, 95% CI 1.69-12.65, P = .003), monokine induced by IFN-γ (MIG) (OR 3.11, 95% CI 1.10-8.82, P = .034). Conversely, interferon β (IFNβ) was associated with decreased TB risk (OR 0.34, 95% CI 0.13-0.87, P = .025). Following multivariate analyses adjusting for covariates IL6, interleukin 1β (IL1β), and interleukin 1Rα (IL1Rα) were associated with increased risk and IFNβ with decreased TB risk. Longitudinal analysis showed that levels of many TB-associated markers, including IL6, IP10, sCD14, and interferon γ (IFNγ) are reduced following TB treatment. These data show that TB recurrence, in HIV-infected individuals on ART is predicted by biomarkers of systemic inflammation, many of which are implicated in more rapid HIV disease progression. NCT 01539005.