Recurrent Pulmonary Tuberculosis Research Articles

Diagnostic and Treatment Challenges of Recurrent Tuberculosis in Patient with Drug-Induced Hepatotoxicity: A Case Report

Introduction: Pulmonary tuberculosis (TB) remains one of the most significant global health challenges, especially complicated by cases with incomplete treatment histories. The recurrence of TB poses diagnostic and therapeutic dilemmas that significantly impact patient outcomes. Case Presentation: We report a case of a 57-year-old female patient presenting with recurrent pulmonary TB after an incomplete treatment course. The patient's history revealed gaps in adherence to the prescribed TB regimen, leading to multiple relapses. In this study, we found that patients undergoing TB treatment may experience liver damage as a result of the TB medication, also known as DIH. Comprehensive diagnostic procedures, including chest radiography, sputum culture, and molecular testing, confirmed recurrent TB. The patient's clinical manifestations, treatment plan, and response to therapy are detailed. Conclusion: Recurrent TB is common, particularly in older adults, and is influenced more by environmental factors than occupation. Additionally, ATT poses risks of hepatotoxicity, especially in malnourished patients, underscoring the importance of managing side effects and addressing factors like malnutrition to prevent complications and improve outcomes. This case underscores the importance of complete adherence to TB treatment regimens and highlights the challenges in managing recurrent TB. It emphasizes the need for robust follow-up, patient education strategies, early diagnosis, and prompt intervention to prevent recurrence and enhance patient outcomes.

Consequences of Disintegrated Care for Dual Tuberculosis and Diabetes in Tanzania: A Case Report on Recurrent Tuberculosis with Severe Haemoptysis in a Patient with Dysregulated Diabetes

Diabetes is known to be a risk factor for active pulmonary tuberculosis (TB) and the reactivation of latent or previous TB. It is also associated with poor TB treatment outcomes. Conversely, TB infection in itself can worsen glycaemic control temporarily and possibly lead to diabetes, among other non-communicable comorbidities. Post-TB lung disease decreases life expectancy and increases the risk of recurrent TB infection. There are efforts in low- and middle-income countries to integrate TB and diabetes healthcare services, as encouraged by the WHO and other international health organisations. However, integration measures, including bidirectional screening and coordinated care for both diseases in low- and middle-income countries, are scarce. This may lead to a lack of control over either condition. The authors present the journey of a 48-year-old man with Type 2 diabetes and previous pulmonary TB. He presented with a 2-week history of productive coughing and massive haemoptysis amounting to 500 mL in total. Recurrent pulmonary TB was confirmed by Gene Xpert, a chest X-ray, and CT of the chest. Glycaemic control improved while on TB treatment after counselling on adherence. The difficulties and dilemmas in managing and following up on a communicable and non-communicable disease traditionally cared for can be improved upon with the integration of TB/diabetes healthcare services.

Tuberculosis in otherwise healthy adults with inherited TNF deficiency

Severe defects in human IFNγ immunity predispose individuals to both Bacillus Calmette–Guérin disease and tuberculosis, whereas milder defects predispose only to tuberculosis1. Here we report two adults with recurrent pulmonary tuberculosis who are homozygous for a private loss-of-function TNF variant. Neither has any other clinical phenotype and both mount normal clinical and biological inflammatory responses. Their leukocytes, including monocytes and monocyte-derived macrophages (MDMs) do not produce TNF, even after stimulation with IFNγ. Blood leukocyte subset development is normal in these patients. However, an impairment in the respiratory burst was observed in granulocyte–macrophage colony-stimulating factor (GM-CSF)-matured MDMs and alveolar macrophage-like (AML) cells2 from both patients with TNF deficiency, TNF- or TNFR1-deficient induced pluripotent stem (iPS)-cell-derived GM-CSF-matured macrophages, and healthy control MDMs and AML cells differentiated with TNF blockers in vitro, and in lung macrophages treated with TNF blockers ex vivo. The stimulation of TNF-deficient iPS-cell-derived macrophages with TNF rescued the respiratory burst. These findings contrast with those for patients with inherited complete deficiency of the respiratory burst across all phagocytes, who are prone to multiple infections, including both Bacillus Calmette–Guérin disease and tuberculosis3. Human TNF is required for respiratory-burst-dependent immunity to Mycobacterium tuberculosis in macrophages but is surprisingly redundant otherwise, including for inflammation and immunity to weakly virulent mycobacteria and many other infectious agents.

Recurrent Pulmonary Tuberculosis in China, 2005 to 2021

Despite posing a significant challenge to global tuberculosis (TB) elimination efforts, recurrent TB remains understudied due to the challenges of long-term observation. To investigate the burden of recurrent TB using data from patients with pulmonary TB (PTB) in China. This retrospective cohort study included all bacteriologically confirmed or clinically diagnosed PTB cases reported to the Tuberculosis Information Management System with completed or successful treatment outcomes from January 1, 2005, to December 31, 2021. Data were analyzed from July 15, 2022, to October 28, 2023. Newly diagnosed PTB was classified into primary, hematogenous disseminated, or secondary PTB. The primary outcome was the annual recurrence rate, stratified by disease classification, over the 17-year observation period. The recurrence rate for year n was calculated by dividing the number of patients with recurrent TB in year n by observed person-years in year n. The secondary outcome was the annual proportion of recurrent TB among reported cases and associated risk factors. Of 13 833 249 patients with TB reported to the Tuberculosis Information Management System, 10 482 271 with PTB met the inclusion criteria. Of these, 68.9% were male, 22.3% were 65 years or older, 89.6% were of Han ethnicity, and 68.4% were agricultural workers. A total of 413 936 patients experienced a recurrent TB episode after successful treatment, resulting in an overall recurrence rate of 0.47 (95% CI, 0.47-0.48) per 100 person-years. The recurrence rate for patients with primary PTB was 0.24 (95% CI, 0.22-0.26) per 100 person-years; for hematogenous disseminated PTB, 0.37 (95% CI, 0.36-0.38) per 100 person-years; and for secondary PTB, 0.48 (95% CI, 0.47-0.48) per 100 person-years. The cumulative proportion of recurrences within the first 2 years accounted for 48.9% of all recurrent cases. The proportion of recurrent cases among notified incident cases increased 1.9-fold from 4.7% in 2015 to 8.8% in 2021. Among other factors, ages 45 to 64 years (adjusted hazard ratio, 1.77 [95% CI, 1.65-1.89]) and having completed treatment (adjusted hazard ratio, 1.16 [95% CI, 1.14-1.18]) were identified as associated with recurrence. In this retrospective cohort study, the PTB recurrence rate was substantially higher than the incidence, and the proportion of recurrent cases increased. Almost half of the recurrence occurred within the first 2 years, suggesting that routine posttreatment follow-up may represent an important strategy for accelerating TB elimination.

Acute phase proteins in patients with recurrent pulmonary tuberculosis

Objective. Study of initial levels of acute phase proteins in patients with pulmonary tuberculosis with and without relapse as predictors of unfavorable disease progression. Materials and methods. 2 groups of patients were examined: the base group - 55 patients with pulmonary tuberculosis with relapse and the control group - 55 patients with pulmonary tuberculosis without relapse. Acute phase protein content was studied in patients before and after the intensive phase of treatment. The content of complement factors C3 and C4, haptoglobin, ceruloplasmin, properdin, C-reactive protein, IL-6, VSH, leukocyte content was studied. Results. The obtained results reveal that acute phase proteins can be considered basic predictors of ineffective antituberculosis treatment: the high indices of leukocyte, C-reactive protein, IL-6, ESR, and haptoglobin.

Nutrition optimisation of young tuberculosis patient with poor oral intake

ABSTRACT A 19-year-old female teenager, Chinese, admitted to medical ward on 30 April 2023 with the reason of admission of recurrent disseminated pulmonary tuberculosis (TB) and presented with fever (2/12), cough (3/7), loose stool (1/12), shortness of breath (6/12), lethargy (2/52) and poor oral intake. She had underlying diseases of hypochromic microcytic anemia anaemia 2° iron-deficiency anaemia and folate deficiency, severe hypoalbuminaemia, hospital-acquired pneumonia due to Pseudomonas infection and persistent fever despite being on anti-TB medication. In this case, the patient had already been referred to a dietitian, but a follow-up was needed as she had a loss of appetite and inadequate oral nutrition for a few days. Her calculated body mass index is 16.1 kg/m2 (underweight) and Subjective Global Assessment (SGA) was rated with Grade B (mild-moderate malnutrition) with a history of severe weight loss for the past 1 month. The biochemical data showed abnormal readings of renal profile, albumin and haemoglobin levels.

Rapid Diagnosis of Recurrent Paucibacillary Tuberculosis.

The rapid diagnosis of tuberculosis recurrence can be challenging due to persistently positive detection of Mycobacterium tuberculosis-specific DNA from sputum and bronchopulmonary samples in the absence of active disease. We compared the diagnostic accuracy of the detection of M. tuberculosis-specific DNA by either Xpert (January 2010-June 2018) or Xpert Ultra (July 2018-June 2020) and M. tuberculosis-specific ELISPOT in bronchoalveolar lavage (BAL) samples with M. tuberculosis culture results from sputum or bronchopulmonary samples in patients with suspected recurrence of pulmonary tuberculosis. Among 44 individuals with previous tuberculosis and a presumptive diagnosis of recurrent pulmonary tuberculosis, 4/44 (9.1%) were diagnosed with recurrent tuberculosis by culture. DNA of M. tuberculosis was detected by Xpert in BAL fluid in 1/4 (25%) individuals with recurrent tuberculosis and in 2/40 (5%) cases with past tuberculosis without recurrence, while BAL-ELISPOT with a cut-off of >4,000 early secretory antigenic target-6-specific or culture filtrate protein-10-specific interferon-γ-producing lymphocytes per 1 million BAL-lymphocytes was positive in 4/4 (100%) individuals with recurrent tuberculosis and in 2/40 (5%) cases of past tuberculosis without recurrence. M. tuberculosis-specific BAL-ELISPOT is more accurate than BAL-Xpert for the diagnosis of paucibacillary tuberculosis recurrence.

Endogenous relapse and exogenous reinfection in recurrent pulmonary tuberculosis: A retrospective study revealed by whole genome sequencing.

Tuberculosis may reoccur due to reinfection or relapse after initially successful treatment. Distinguishing the cause of TB recurrence is crucial to guide TB control and treatment. This study aimed to investigate the source of TB recurrence and risk factors related to relapse in Hunan province, a high TB burden region in southern China. A population-based retrospective study was conducted on all culture-positive TB cases in Hunan province, China from 2013 to 2020. Phenotypic drug susceptibility testing and whole-genome sequencing were used to detect drug resistance and distinguish between relapse and reinfection. Pearson chi-square test and Fisher exact test were applied to compare differences in categorical variables between relapse and reinfection. The Kaplan-Meier curve was generated in R studio (4.0.4) to describe and compare the time to recurrence between different groups. p < 0.05 was considered statistically significant. Of 36 recurrent events, 27 (75.0%, 27/36) paired isolates were caused by relapse, and reinfection accounted for 25.0% (9/36) of recurrent cases. No significant difference in characteristics was observed between relapse and reinfection (all p > 0.05). In addition, TB relapse occurs earlier in patients of Tu ethnicity compared to patients of Han ethnicity (p < 0.0001), whereas no significant differences in the time interval to relapse were noted in other groups. Moreover, 83.3% (30/36) of TB recurrence occurred within 3 years. Overall, these recurrent TB isolates were predominantly pan-susceptible strains (71.0%, 49/69), followed by DR-TB (17.4%, 12/69) and MDR-TB (11.6%, 8/69), with mutations mainly in codon 450 of the rpoB gene and codon 315 of the katG gene. 11.1% (3/27) of relapse cases had acquired new resistance during treatment, with fluoroquinolone resistance occurring most frequently (7.4%, 2/27), both with mutations in codon 94 of gyrA. Endogenous relapse is the main mechanism leading to TB recurrences in Hunan province. Given that TB recurrences can occur more than 4 years after treatment completion, it is necessary to extend the post-treatment follow-up period to achieve better management of TB patients. Moreover, the relatively high frequency of fluoroquinolone resistance in the second episode of relapse suggests that fluoroquinolones should be used with caution when treating TB cases with relapse, preferably guided by DST results.

Epidemiology of recurrent pulmonary tuberculosis by bacteriological features of 100 million residents in China

BackgroundRecurrence continues to place significant burden on patients and tuberculosis programmes worldwide, and previous studies have rarely provided analysis in negative recurrence cases. We characterized the epidemiological features of recurrent pulmonary tuberculosis (PTB) patients, estimated its probability associated with different bacteriology results and risk factors.MethodsUsing 2005–2018 provincial surveillance data from Henan, China, where the permanent population approximately were 100 million, we described the epidemiological and bacteriological features of recurrent PTB. The Kaplan–Meier method and Cox proportional hazard models, respectively, were used to estimate probability of recurrent PTB and risk factors.ResultsA total of 7143 (1.5%) PTB patients had recurrence, and of 21.1% were bacteriological positive on both laboratory tests (positive–positive), and of 34.9% were negative–negative. Compared with bacteriological negative recurrent PTB at first episodes, the bacteriological positive cases were more male (81.70% vs 72.79%; P < 0.001), higher mortality risk (1.78% vs 0.92%; P = 0.003), lower proportion of cured or completed treatment (82.81% vs 84.97%; P = 0.022), and longer time from onset to end-of-treatment. The probability of recurrence was higher in bacteriological positive cases than those in bacteriological negative cases (0.5% vs 0.4% at 20 months; P < 0.05).ConclusionsBased on patient’s epidemiological characteristics and bacteriological type, it was necessary to actively enact measures to control their recurrent.

МЕДИКО-СОЦИАЛЬНАЯ СТРУКТУРА ПАЦИЕНТОВ С ВПЕРВЫЕ ВЫЯВЛЕННЫМ И РЕЦИДИВИРУЮЩИМ ТУБЕРКУЛЕЗОМ ОРГАНОВ ДЫХАНИЯ, ВЫЯВЛЕННЫМ В ЯКУТИИ В 2020 ГОДУ

The article presents the structure of newly diagnosed and recurrent pulmonary tuberculosis registered in the districts of the Sakha Republic (Yakutia) in 2020, based on the analysis of medical records of 146 new cases of respiratory tuberculosis, including 110 newly diagnosed and 36 relapses. When distributing patients by age and sex, it was found that men (61.8-77.8 %, respectively) of the most able-bodied age of 30-49 years predominate both among newly diagnosed patients and among relapses. According to the place of residence, both among the newly diagnosed and among the relapses, rural residents prevailed at 69.2 %, with urban residents making 30.8 %. When distributing the patients by districts of the republic, agricultural regions (50.7 %), industrial (28.8 %) and Arctic regions (20.5 %) prevailed. When examining the timing of the passage of a fluorographic (FLG) study, it was revealed that 58.2 % of those newly diagnosed underwent annual FLG, with a relapse – 91.7 %. Missing FLG for 2-3 or more years among newly diagnosed patients was observed in non-working working-age people with alcohol dependence. It was noted that the cases of newly diagnosed tuberculosis were more often detected during FLG examination – 60.9 %, and the relapses much – more often (in 72.2 %) when seeking treatment, with complaints mainly about prolonged cough, fever, shortness of breath. Infiltrative and disseminated tuberculosis occurs equally in newly diagnosed patients (44.5 % and 28.2 %) and patients with relapse (50 % and 19.4 %). Bacterial excretion was detected in the majority of the patients equally in both newly diagnosed (69.1 %) and relapses (70.5 %). At the same time, drug-susceptible (DS) and drug-resistant (DR) MBT occurred in equal proportions in newly diagnosed patients – 51.3 % and 48.7 %. Among those newly diagnosed, resistance to HR+ reserve drugs was more common in 40.5 % of patients; in the patients with relapses, resistance to HR+ of the main and reserve anti-TB drugs prevailed in 51.9 % of thecases. XDR MBT were detected in isolated cases (2.7-7.4 %) both among newly diagnosed and patients with relapses.

Diagnostic utility of chest computerized tomography in the diagnosis of recurrence among sputum scarce and sputum negative previously treated pulmonary tuberculosis suspects.

Objective:The objective was to study the sensitivity, specificity, and diagnostic accuracy of various computed tomography (CT) chest findings in diagnosing recurrence among pulmonary tuberculosis (PTB) suspects.Materials and Methods:A prospective observational study was conducted in a tertiary care hospital in New Delhi. A total of 130 suspects with a past history of treatment for PTB, who presented with any of the symptoms suggestive of recurrence were included. Sputum-positive, HIV-positive patients, pregnant females, and patients aged <18 years were excluded. Patients underwent CT chest followed by bronchoalveolar lavage (BAL).Results:A total of 62 patients were there in the final analysis. The median age of the patients with recurrent PTB was 27.5 years. Cough was the universal symptom in all these patients (>90%). Hemoptysis was the predominant symptom among patients with chronic pulmonary aspergillosis (66.6%). Necrotic mediastinal lymph nodes had good diagnostic accuracy of 88.71% with area under the curve of 0.806, P < 0.001 in diagnosing recurrent TB. BAL GeneXpert and mycobacteria growth indicator tube had good sensitivity (83.33% and 84.62%, respectively), specificity (100% for both), and excellent diagnostic accuracy (95.16% and 96.36%, respectively) for diagnosing recurrence in sputum negative and sputum scarce patient, (P < 0.001) when compared with composite reference standard. For culture-positive cases, BAL GeneXpert MTB/RIF had 100% sensitivity and 97.73% specificity in diagnosing recurrent PTB patients.Conclusion:The presence of mediastinal necrotic lymph node is the most accurate CT finding that can differentiate recurrent TB from post-TB sequelae. No other single chest CT scan finding had reliable diagnostic accuracy in comparison to microbiological tools in diagnosing recurrence among sputum negative or scarce previously treated PTB suspects.

Distinguishing Relapse From Reinfection With Whole-Genome Sequencing in Recurrent Pulmonary Tuberculosis: A Retrospective Cohort Study in Beijing, China.

Background: Tuberculosis recurrence is still a major problem for the control of tuberculosis, and the cause of the recurrence is still unclear.Methods: We retrospectively recruited 68 pairs of samples of Mycobacterium tuberculosis (MTB) from recurrent TB cases in Beijing Chest Hospital between January 2008 and December 2019. The whole-genome sequencing was conducted to analyze single-nucleotide polymorphism (SNP) and to identify whether recurrent disease was due to relapse or reinfection. The BACTEC MGIT was performed to compare differences in drug susceptibility profiles between two episodes.Results: 62 (91.2%) out of 68 confirmed recurrence were due to relapse, whereas the remaining six (8.8%) were due to reinfection. And there was a strong association between earlier relapse and underlying chronic diseases. In addition, the MTB isolates from non-diabetic patients had a higher mutation rate than those from diabetic patients. A community transmission was also identified in our cohort. Levofloxacin resistance was the most frequently observed drug resistance for 12.9% relapse cases.Conclusion: The relapse of a previous episode in Beijing. The underlying chronic diseases are associated with an earlier TB relapse. MTB isolates were more prone to develop levofloxacin resistance than moxifloxacin resistance after FQ exposure. The patients at high-risk for relapses deserve more careful investigation.

Recurrent pulmonary tuberculosis after treatment success: a population-based retrospective study in China

ObjectivesPost-treatment recurrence remains a challenge for the global control of tuberculosis (TB). This study investigated longitudinal data on pulmonary TB recurrence rates and risk factors for recurrence among successfully treated smear-positive tuberculosis cases in China. MethodsBetween 1st January 2009 and 31st December 2016 we evaluated 33 441 treatment-naïve patients diagnosed with sputum-smear-positive, non-multidrug-resistant TB in Hangzhou, China. We included the data of 9828 patients with TB who were treated successfully. ResultsA total of 4.9% of the cases were recurrent (479/9828), identified within a median observation period lasting 1565 days. Altogether, 51.1% (245/479) of the recurrences occurred within 1 year. The cumulative 2- and 5-year recurrence rates were 3.90% (95% confidence interval (CI) 3.3–4.5%) and 5.4% (95%CI 4.8–6.0%), respectively. Prolonged treatment (over 7 months) occurred in 64.7% (6363/9828), with a median treatment duration of 242 days (interquartile range 195–348 days). Male sex (adjusted hazard ratio (aHR) (95%CI) 1.61 (1.30–2.00), p < 0.001), age 60 years old or older (aHR (95%CI) 2.03 (1.70–2.44), p < 0.001), pulmonary cavity (aHR (95%CI) 1.51 (1.25–1.82), p < 0.001) and sputum positivity at 2 months (aHR (95%CI) 1.39 (1.05–1.81), p 0.02) all increased the risk of TB recurrence. Prolonged treatment was associated with reduced TB recurrence (aHR (95%CI) 0.73 (0.61–0.88), p 0.001). ConclusionsRecurrence remains a problem for successfully treated patients with sputum-smear-positive pulmonary TB, especially those with independent risk factors. Further analysis of prolonged treatment is required.

Recurrent Pulmonary Tuberculosis in Low Prevalence Settings: Case Report from Louisiana

Recurrent Pulmonary Tuberculosis in Low Prevalence Settings: Case Report from Louisiana

Clinical and Imaging Features of Adults with Recurrent Pulmonary Tuberculosis - A Prospective Case-Controlled Study

BackgroundRecurrent pulmonary tuberculosis (RPTB) is a growing, important and neglected problem affecting treated TB patients and TB health services across the world, particularly in sub-Saharan Africa. Analyses and identification of differences in clinical features between recurrent PTB and newly diagnosed PTB may lead to improved management recommendations. MethodsBetween September 1st 2019 and January 31st 2020, we performed a prospective case controlled study of clinical and imaging features of patients with recurrent pulmonary tuberculosis and compared them with those of newly diagnosed PTB cases. Recurrent PTB was defined as a patient with bacteriologically confirmed active PTB who was previously successfully treated for PTB and was cured. A control was defined as a patient who presents for the first time with bacteriologically confirmed PTB. Clinical and radiological features were assessed and documented. Chi-square and t-test were used to test the difference between proportion and continuous data, respectively. Logistic regression analysis was done to determine factors associated with RPTB using SPSS version 23 software. ResultsA total of 312 patients with PTB were enrolled (104 RPTB cases and 208 newly diagnosed controls). Clinically hemoptysis was more common in RPTB compared to controls 28/104 (26.9%) vs 35/208 (16.8%), P = 0.036. Chest pain was significantly less common among patients with RPTB compared to controls 33 (31.7%) vs 92 (44.2%), P = 0.034. A higher proportion of RPTB presented with cavitation 34/104 (32.7%) compared to control 44/208 (21.2%) P = 0.027. The median score for lung pathology was higher among patients with RPTB (50) compared to controls (30); P = 0.001. Lung function of patients with RPTB at diagnosis of index TB were more likely to show mixed restrictive and obstructive pattern 36/104 (34.6%) compared to controls 31/208 (14.9%). p<0.001. Multivariate analysis showed that patients older than 45 years of age (adjusted odds ratio [aOR]: 3.59, 95% CI: 1.38 – 9.32), those with hemoptysis (aOR 1.96, 95% CI: 1.04 – 3.69) p=0.04) and fibrosis on chest x rays (aOR 2.18, 95% CI: 1.16 – 4.10) were significantly associated with recurrent PTB. ConclusionsHemoptysis, lung parenchymal damage, and patients being older than 45 years of age are significant features of RPTB. Management should focus on risk factors for recurrence, and a more holistic model of care to prevent long term lung injury.

РЕЦИДИВЫ ТУБЕРКУЛЕЗА ЛЕГКИХ: СОЦИАЛЬНАЯ И МЕДИЦИНСКАЯ ХАРАКТЕРИСТИКИ

Currently, a new grouping of contingents is being developed that are registered at dispensary in anti- tuberculosis organizations, where a place will be reserved for patients with relapses of tuberculosis, taking into account data from social and medical characteristics, and complex rehabilitation measures. Objective of the study: to study the social and medical characteristics of patients with recurrent pulmonary tuberculosis and the possibility of early diagnosis and successful treatment of tuberculosis. The paper presents data from a study of social and medical characteristics of 460 patients with recurrent pulmonary tuberculosis. It is shown that the bulk of the contingents are persons who are not engaged in labor activities, with bad habits and numerous risk factors for the reactivation of a specific process in the lungs. Relapses of tuberculosis more often occur after patients are removed from dispensary registration (76.2 %) and less often during the period of being registered (23.8 %) in the form of infiltrative (80.0 %) and disseminated (12.2 %) processes (p &lt; 0.001). Treatment was found to be successful in 42.4 % of patients with relapse of multidrug-resistant tuberculosis and in 81.0 % of patients with relapse of drug-sensitive tuberculosis (p &lt; 0.001).

Comparison of the effectiveness of treatment of patients with pulmonary tuberculosis in conditions of TB system restructuring

Objective — to study the dynamics of the effectiveness of the treatment of patients with pulmonary tuberculosis in the Sumy region for 2011—2018.Materials and methods. The authors analyzed the effectiveness of the treatment of two groups of patients. Group I included 2973 patients with new cases of pulmonary tuberculosis with bacterial excretion, which was confirmed by microscopy of sputum smear or by bacteriological method. The second group consisted of 998 patients with relapses of pulmonary tuberculosis with bacterial excretion, which was confirmed by microscopy of sputum smear or bacteriological method. Each group has divided into subgroups «a», which includes patients registered during 2011—2014 and subgroup «b» registered during 2015—2018.Results and discussion. Over the past eight years, the effectiveness of treating patients with the first diagnosed bacillary tuberculosis has decreased from 72.3 % in 2011 to 58.1 % in 2018. Among the patients of the Ia subgroup died 75 (5.5 %) patients, which is less than 1.2 times than in the Ib subgroup — 106 (6.5 %) — (p &gt; 0.05). Unsuccessful treatments (by smear or clinical and radiological findings) in patients with Ia and Ib subgroups were 8.7 and 8.9 % respectively (p &gt; 0.05). The percentage of first identified patients transferred to category 4 increased from 6.5 % in 2011 to 25.7 % in 2018 (p &lt; 0.05). Among 432 patients with recurrent bacillary tuberculosis of the IIa subgroup, effective treatment had recorded in 169 (39.1 %) people. In the studied group IIb, the effectiveness of treatment had established in 198 (35.0 %) (p &gt; 0.05). Unsuccessful treatment (according to microbiological and clinical, radiological studies) among patients of IIa and IIb subgroups had recorded in 9.7 and 6.7 %, respectively (p &gt; 0.05). In the IIa subgroup, 128 (29.6 %) patients had transferred to 4 categories, and four years later, 270 (47.7 %) in the IIb subgroup (p &lt; 0.001).Conclusions. The effectiveness of the treatment of the first detected bacillary patients with pulmonary tuberculosis in the Sumy region in 8 years decreased by 1.2 times. The effectiveness of the treatment of patients with recurrent bacterial pulmonary tuberculosis has fluctuated within 40 % over the last decade. In the structure of «effective treatment» of patients with newly diagnosed tuberculosis and relapse of tuberculosis, the results of «treatment completed» prevail every year, which means that patients are transferred to category 5.1 only because they have just received all doses of drugs. Due to the increase of Mycobacterium tuberculosis resistance to anti tuberculosis drugs, patients are transferred to 4 categories of observation four times more often with the first detected tuberculosis, with recurrent — 1.9 times.It is evidence of a decrease in the effectiveness of the treatment of patients with newly discovered and recurrent bacillary tuberculosis in recent years.

Drug Resistance and Distribution of NAT2 Variants in Newly Diagnosed and Recurrent Vietnamese Pulmonary Tuberculosis Patients

Drug resistant TB is currently a global challenge causing high risk of death and expanding the disease. This study explores the prevalence of drug resistance in newly diagnosed and recurrent TB patients and identifies the association between NAT2 gene polymorphism distribution and acetylator phenotype of NAT2 gene and the two study groups. The study results show that the newly diagnosed TB had l lower male ratio and younger age in comparison to the recurrent TB. Newly diagnosed group was more sensitive to first line TB drugs. However, both groups had significant resistance ratio in relation to INH and SM. Finally, the allele and acetylator phenotype frequency of NAT2 showed the significant association with TB status. The study concludes that the newly diagnosed and recurrent TB patients expressed differently in their profiles concerning patient’s background, drug resistance and NAT2 allele distribution.&#x0D; Keywords&#x0D; Drug resistance, INH, NAT2 polymorphism, newly diagnosed TB, recurrent TB1.&#x0D; References&#x0D; [1] WHO, Global Tuberculossi report, https://www.who.int/tb/publications/global_report/en/, 2018 (accessed 16 April 2019).[2] Hoàng Thị Phượng, Nghiên cứu đặc điểm lâm sàng, cận lâm sàng, tính kháng thuốc của vi khuẩn ở bệnh nhân lao phổi mới kết hợp bệnh đái tháo đường, Luận văn tiến sĩ Y học, trường Đại học Y Hà Nội, 2009.[3] S. Guaoua, I. Ratbi, F.Z. Laarabi, S.A. Elalaoui, IC. Jaouad, A. Barkat, A. Sefiani, Distribution of allelic and genotypic frequencies of NAT2 and CYP2E1 variants in Moroccan population, BMC Genet. 15 (2014) 156.[4] A. Toure, M. Cabral, A. Niang, C. Diop, A. Garat, L. Humbert, M. Fall, A. Diouf, F. Broly, M. Lhermitte, D. Allorge, Prevention of isoniazid toxicity by NAT2 genotyping in Senegalese tuberculosis patients, Toxicol Rep. 3 (2016) 826-831.[5] M. Majumder, N. Sikdar, S. Ghosh, B. Roy, Polymorphisms at XPD and XRCC1 DNA repair loci and increased risk of oral leukoplakia and cancer among NAT2 slow acetylators, Int J Cancer. 120(10) (2007) 2148-2156.[6] S. Morita, M. Yano, T. Tsujinaka, Y. Akiyama, M. Taniguchi, K. Kaneko, H. Miki, T. Fujii, K. Yoshino, H. Kusuoka, M. Monden, Genetic polymorphisms of drug-metabolizing enzymes and susceptibility to head-and-neck squamous-cell carcinoma, Int J Cancer. 80(5) (1999) 685-688.[7] Hoàng Hà, Nghiên cứu một số đặc điểm lâm sàng, cận lâm sàng, sinh học của vi khuẩn ở bệnh nhân lao phổi điều trị lại, Luận án tiến sỹ Y học, Trường Đại học Y Hà Nội, 2009.[8] S. Wattanapokayakit, T. Mushiroda, H. Yanai, N. Wichukchinda, C. Chuchottawon, S. Nedsuwan, A. Rojanawiwat, S. Denjanta, T. Kantima, J. Wongyai, W. Suwankesawong, W. Rungapiromnan, R. Kidkeukarun, W. Bamrungram, A. Chaiwong, S. Suvichapanich, S. Mahasirimongkol, K. Tokunaga, NAT2 slow acetylator associated with anti-tuberculosis drug-induced liver injury in Thai patients, Int J Tuberc Lung Dis. 20(10) (2016) 1364-1369.[9] Đinh Ngọc Sỹ, Chiến lược quản lý bệnh lao đa kháng thuốc tại Việt Nam, Tạp chí khoa học Hội Phổi Pháp - Việt. 2(3) (2011) 40-42.[10] Nguyễn Thu Hà, Trần Văn Sáng, Đinh Ngọc Sỹ, Lâm sàng, cận lâm sàng và tính kháng thuốc của vi khuẩn lao ở bệnh nhân lao phổi tái phát, JFran Viet Pneu. 2(3) (2011) 63-67.[11] D. Tu, L. Zhang, J. Su, Resistance and efficacy of treatment in relapse pulmonary tuberculosis, Zhonghua Jie He He Hu Xi Za Zhi. 23 (11) (2000) 666-668&#x0D; &#x0D;

Predictors of recurrent TB in sputum smear and culture positive adults: a prospective cohort study.

To explore simple inexpensive non-culture based predictors of recurrent pulmonary tuberculosis (PTB). HIV-infected and uninfected adults with the first episode of smear positive, culture-confirmed pulmonary tuberculosis in a high tuberculosis burden country. A nested prospective cohort study of participants with pulmonary tuberculosis (PTB) presenting to a hospital out-patient clinic. A total of 630 TB culture confirmed participants were followed up for eighteen months of which 57 (9%) developed recurrent recurrent TB. On univariate analysis,4.7% low grade(1+) pre-treatment sputum smear participants developed recurrent tuberculosis Vs 8.8% with high grade(3+) smears (OR=0.31,95%CI: 0.10-0.93, p=0.037).On multivariate analysis: participants with extensive fibro-cavitation had a high risk of recurrent TB Vs minimal end of treatment fibro-cavitation (18%Vs12%, OR=2.3,95%CI:1.09-4.68, p=0.03). Weight gain with HIV infection was assosciated with a high risk of recurrent TB Vs weight gain with no HIV infection(18%Vs 6%, OR=6.8,95%CI:165-27.83, p=0.008) where as weight gain with a low pre-treatment high bacillary burden was assosciated with a low risk of recurrent TB Vs weight gain with a high pre-treatmentbacillary burden(6.5%Vs7.9%, OR=0.2,95%CI:0.05-0.79, p=0.02). Extensive end of treatment pulmonary fibro-cavitation, high pre-treatment bacillary burden with no weight gain and HIV infection could be reliable predictors of recurrent tuberculosis.

A Case of Pulmonary Cryptococcosis Suspected of Being Recurrent Pulmonary Tuberculosis Diagnosed by Bronchial Lavage

A Case of Pulmonary Cryptococcosis Suspected of Being Recurrent Pulmonary Tuberculosis Diagnosed by Bronchial Lavage