Recurrent Tuberculosis Research Articles

Характеристика рецидивов туберкулеза мочеполовой системы

Introduction Tuberculosis is an infectious disease, which can result in self-cure, chronic process or relapse course. Aim To analyze the incidence of recurrence of urogenital tuberculosis and to identify the features of patients with recurrent disease. Materials and methods Specially developed questionnaires on the structure of the incidence of extrapulmonary tuberculosis in the Siberian Federal District and the Far Eastern Federal District were analyzed. We also studied 140 outpatient medical records of patients with tuberculosis of the urinary tract and male reproductive system, who was followed at the Novosibirsk Regional TB Outpatient Department. The medical records of patients with recurrent disease were analyzed in detail. Results In 2019, 563 patients with isolated extrapulmonary tuberculosis in the Siberian Federal District and the Far Eastern Federal District were identified, and 14.4% of them had urogenital tuberculosis. In 99 (17.6%) patients, the present state was a relapse, while urogenital tuberculosis occupied 8.1%, and all patients were HIV-negative. In the Novosibirsk Region, 127 out of 140 patients were diagnosed with urogenital tuberculosis for the first time, and in 13 (9.3%) had recurrent disease. Among patients with relapse, male predominated (61.5%). The primary focus of tuberculosis was located in the genitourinary system in 53.9% of patients, which supports the theory of reactivation of dormant foci. In addition, 38.5% of patients with primary episode of tuberculosis were smear-positive. The average relapse time after successful cure of tuberculosis was 9.1 years. Among patients with recurrent urogenital tuberculosis, mycobacteriuria was recorded in 23.1% of cases, and in one case drug resistance of the pathogen to streptomycin and isoniazid was seen. In general, the kidneys were the most susceptible to relapses and were involved in 69.2% of cases. Conclusions Nearly 8.1-9.3% of patients with genitourinary tuberculosis had previously tuberculosis and were successfully cured. When urogenital tuberculosis recurs, the kidneys are affected in 69.2% of cases. The overwhelming majority (61.5%) of patients with recurrent genitourinary tuberculosis are men, therefore gender can be considered a predictor of recurrence. HIV infection was found in isolated cases in patients with both newly diagnosed and recurrent urogenital tuberculosis.

Clinical study of movable external fixation for elbow tuberculosis

To compare clinical effect of movable external fixation and fusion fixation for the treatment of elbow tuberculosis. From October 2013 to June 2019, 52 patients with elbow tuberculosis treated with standard antituberculosis therapy were divided into movable external fixation group and fusion fixation group according to treatment methods. In group A, there were 25 patients, including 11 males and 14 females, aged from 24 to 75 years old with an average of (42.81± 9.01) years old; the courses of diseases ranged from 2 to 9 months with an average of (3.96±1.45) months. In group B, there were 27 patients, including 15 males and 12 females, aged from 23 to 77 years old with an averageof (44.08±7.44) years old; the courses of diseases ranged from 2 to 7 months with an average of (3.88±1.67) months. All patients were performed focus debridement. Intraoperative blood loss, operative time were compared between two groups. VAS score before operation, 2 weeks and 12 months after operation were applied to evaluate pain relieve;Mayo elbow performance score (MEPS) before operation, 1 and 12 months after operation were used to evaluate clinical effect;changes of erythrocyte sedimentation rate (ESR) and Creactive protein, CRP) before operation, 3 weeks after antituberculosis therapy, 1 week and 6 months after operation were compared between two groups. All patients were followed up from 12 to 20 months with an average of (13.50±4.85) months. No mixed infection and recurrence of tuberculosis occurred. There were no statistical differences in intraoperative blood loss and operative time(P>0.05). There was difference in postoperative VAS score at 2 weeks between movable external fixation group (5.15±0.95) and fusion fixation group (4.04±0.84)(P<0.01);while no difference in postoperative VAS score at 12 months between two groups (P>0.05). No difference in ESR and CRP level between two groups before and after operation (P>0.05). Postoperative Mayo score at 1 and 12 months in movable external fixation group were (78.15±7.83) and (90.19±7.13);in fusion fixation group were (70.40±7.61) and (82.60±8.38);there were differences in Mayo score at different time points between two groups(P<0.01). For elbow tuberculosis, movable external fixation and fusion fixation have equal effect in operative time, amount of bleeding and control of tuberculosis infection indicator. Movable external fixation need earlier functional exercise, not conducive to pain relief at early stage, which may be better than fusion fixation, it is worth clinical promoting.

Risk factors for recurrent tuberculosis after successful treatment in a high burden setting: a cohort study

BackgroundPeople successfully completing treatment for tuberculosis remain at elevated risk for recurrent disease, either from relapse or reinfection. Identifying risk factors for recurrent tuberculosis may help target post-tuberculosis screening and care.MethodsWe enrolled 500 patients with smear-positive pulmonary tuberculosis in South Africa and collected baseline data on demographics, clinical presentation and sputum mycobacterial cultures for 24-loci mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. We used routinely-collected administrative data to identify recurrent episodes of tuberculosis occurring over a median of six years after successful treatment completion.ResultsOf 500 patients initially enrolled, 333 (79%) successfully completed treatment for tuberculosis. During the follow-up period 35 patients with successful treatment (11%) experienced a bacteriologically confirmed tuberculosis recurrence. In our Cox proportional hazards model, a 3+ AFB sputum smear grade was significantly associated with recurrent tuberculosis with a hazard ratio of 3.33 (95% CI 1.44–7.7). The presence of polyclonal M. tuberculosis infection at baseline had a hazard ratio for recurrence of 1.96 (95% CI 0.86–4.48).ConclusionOur results indicate that AFB smear grade is independently associated with tuberculosis recurrence after successful treatment for an initial episode while the association between polyclonal M. tuberculosis infection and increased risk of recurrence appears possible.

Recurrent Tuberculosis in the Netherlands – A 24 Year Follow-Up Study

Background: Reactivation rates reflect the effectiveness of TB treatment. This study aimes to estimate the rates of reactivation and reinfection in TB patients in the Netherlands, after completed or interrupted treatment. Additionally, risk factors for reactivation and reinfection are analysed. Methods: Retrospective cohort study of all culture-positive TB patients with available DNA-fingerprint data, registered in the Netherlands Tuberculosis register (NTR) between 1993 until 2016. Reactivation was defined as an identical, and reinfection as a non-identical Mycobacterium tuberculosis strain in sequential episodes. Findings: The rate of reactivation was 45 per 100,000 person years (py) for patients who completed, and 219 per 100,000 py for patients who interrupted their treatment. The rate of reinfection was 12 per 100,000 py. Among patients who completed treatment; males and patients with poly/mono rifampicin resistance had a significantly higher risk of reactivation. Among patients who interrupted their treatment, directly observed treatment (DOT) and alcohol/drugs abuse were significantly associated with reactivation. Extra-pulmonary TB was significantly associated with a lower risk in all patients. The incidence rate of reactivation was >50/100,000 py in the first five years after treatment. Interpretation: Ex-TB patients who completed or interrupted their treatment should be considered as potential risk groups for reactivation for at least five years after treatment. Good monitoring of these patients is indicated, and guidelines should be in place to enhance early detection of recurrent TB. Funding Statement: This work was carried out as an internship and therefore no specific funding was used. Declaration of Interests: None of the authors has conflicts of interest to declare. Ethics Approval Statement: Permission to use the NTR data for this study was obtained from the NTR registration committee. The matching process was done by a third party at RIVM and only anonymized data was provided from the NTR for the analysis.

Prevalence of extra pulmonary tuberculosis among patients registered under a district TB centre in North East India

Background: Worldwide, tuberculosis (TB) is one of the top 10 causes of death and the leading cause from a single infectious agent (above human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS)). Extra pulmonary tuberculosis (EPTB) is TB outside of the lungs. In general, EPTB is more difficult to diagnose than pulmonary TB (PTB), invasive methods are often needed to obtain samples for microbiological and histological testing and in some locations treatment should be extended to avoid the appearance of relapses. The purpose of this study was to find out the prevalence of EPTB among all registered TB patients in a capital city in northeast India.Methods: A retrospective study conducted at district TB Centre (Aizawl) from data collected from patient’s treatment cards. The study period was 1 year from January 2019 to December 2019. All the registered TB patients except those registered under the programmatic management of drug-resistant TB (PMDT) were included in the study and patients registered under PMDT were excluded. All the analysis was performed using simple percentage method.Results: Out of 1502 patients, 48.8% were PTB and 51.2% were EPTB. Male comprised of 54.3% and 45.7% were Female. Majority of them (87.5%) were new patients and 10.91% were recurrent cases. History of contacts was given by 8.25% of the patients. Of the 769 EPTB cases, pleural effusion was the most common finding (350) followed by lymph nodes TB (196). Among PTB, majority of them (72.71%) were microbiologically confirmed whereas majority of the patients (84.66%) were clinically diagnosed in EPTB patients.Conclusions: This study found a high prevalence of HIV-TB co-infections, recurrent TB infection and extra pulmonary tuberculosis.

Comparative analysis of the drug-drug interaction between immunosuppressants, safety and efficacy of rifabutin from rifampicin-based Anti-TB treatment in living donor liver transplant recipients with active tuberculosis

BackgroundThe Interaction between anti-tuberculous and immunosuppressive drugs which may increase the risk of graft rejections is a major challenge in managing transplant recipients with tuberculosis (TB). Instead of rifampicin (RFM), most guidelines recommended the use of rifabutin (RFB) because of its reduced capacity to induce immunosuppressant metabolism while maintaining the same efficacy as RFM against TB. However, there has been no available data directly comparing the outcome of RFB from RFM-based anti-TB regimens in liver transplant patients with TB. This study aimed to compare the effects of RFB from RFM-based treatment in terms of the drug interaction with immunosuppressants, as well as the safety, efficacy and clinical outcomes of living donor liver transplant (LDLT) recipients with active TB. MethodsA retrospective study was conducted on all adult LDLT recipients diagnosed with active TB from June 1994 to May 2016 that had concurrently and continuously received either RFB or RFM-based treatment and immunosuppressants. ResultsTwenty-two patients were included. Twelve (55%) patients were in the RFM group. Ten (45%) patients were in the RFB group. RFB group showed a lesser rate of immunosuppressant trough level reduction (20% vs 50%, p = 0.009) during TB treatment. There was no TB recurrence and no significant change in platelet or leukocyte count in either group. Acute cellular rejection (ACR), rate of TB-treatment completion and overall survival, rates were excellent and statistically similar in both groups. ConclusionThe use of RFB in LDLT recipients with active TB, had a lesser drug interaction than when RFM was used. However, RFB did not significantly reduced the rate of ACR. RFB and RFM are both effective and safe to use in LDLT recipients with active TB.

Application of the Ilizarov technique for knee joint arthrodesis as a treatment for end-stage tuberculosis of the knee

BackgroundWith the global determination to eliminate tuberculosis (TB), the treatment for end-stage TB of the knee joint is still a great clinical challenge. This study aims to retrospectively determine the clinical and radiographic outcomes after use of the Ilizarov technique for knee joint arthrodesis as a treatment for end-stage knee TB.MethodsTwenty-six patients with end-stage knee TB treated by external fixation with the Ilizarov fixator between 2012 and 2017 were examined. Anti-TB drugs were administered preoperatively, intraoperatively, and postoperatively. Clinical and radiologic examinations were performed for comprehensive evaluations, and these include C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), flexion and valgus angle of the knee, leg-length discrepancy, and Lysholm score.ResultsTwenty-four patients were followed up for an average of 5.8 years (2.2–7 years). All patients achieved bone fusion within a mean of 6.4 months (4–16 months). The ESR and CRP concentrations were observed to return to normal within 5.1 ± 1.1 months postoperatively. There was no recurrence of TB. At last follow-up, the mean leg-length discrepancy was 2.7 ± 1.4 cm, and the mean alignment was 8.7 ± 2.6° flexion and 5.3 ± 1.0° valgus. No patient had a significant rotational deformity. The average Lysholm score was seen to improve significantly from 36.8 ± 18.4 preoperatively to 79.5 ± 5.9 at final follow-up (p < 0.0001).ConclusionThis study has demonstrated that the Ilizarov technique for knee joint arthrodesis as a treatment of end-stage knee TB achieved promising outcomes with minimal complications.

Cost-effectiveness of post-treatment follow-up examinations and secondary prevention of tuberculosis in a high-incidence setting: a model-based analysis

In settings of high tuberculosis incidence, previously treated individuals remain at high risk of recurrent tuberculosis and contribute substantially to overall disease burden. Whether tuberculosis case finding and preventive interventions among previously treated people are cost-effective has not been established. We aimed to estimate costs and health benefits of annual post-treatment follow-up examinations and secondary preventive therapy for tuberculosis in a tuberculosis-endemic setting. We developed a transmission-dynamic mathematical model and calibrated it to data from two high-incidence communities of approximately 40 000 people in suburban Cape Town, South Africa. We used the model to estimate overall cost and disability-adjusted life-years (DALYs) associated with annual follow-up examinations and secondary isoniazid preventive therapy (IPT), alone and in combination, among individuals completing tuberculosis treatment. We investigated scenarios under which these interventions were restricted to the first year after treatment completion, or extended indefinitely. For each intervention scenario, we projected health system costs and DALYs averted with respect to the current status quo of tuberculosis control. All estimates represent mean values derived from 1000 epidemic trajectories simulated over a 10-year period (2019-28), with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values. We estimated that a single follow-up examination at the end of the first year after treatment completion combined with 12 months of secondary IPT would avert 2472 DALYs (95% UI -888 to 7801) over a 10-year period and is expected to be cost-saving compared with current control efforts. Sustained annual follow-up and continuous secondary IPT beyond the first year after treatment would avert an additional 1179 DALYs (-1769 to 4377) over 10 years at an expected additional cost of US$18·2 per DALY averted. Strategies of follow-up without secondary IPT were dominated (ie, expected to result in lower health impact at higher costs) by strategies that included secondary IPT. In this high-incidence setting, post-treatment follow-up and secondary preventive therapy can accelerate declines in tuberculosis incidence and potentially save resources for tuberculosis control. Empirical trials to assess the feasibility of these interventions in settings most severely affected by tuberculosis are needed. National Institutes of Health, Günther Labes Foundation, Oskar Helene Heim Foundation.

Factors associated with diagnostic delay in recurrent TB

BackgroundRecurrent tuberculosis (TB) contributes to the burden of TB. The study was designed to explore the time of diagnostic delay and risk of delay in patients with recurrent TB in China.MethodsA total of 13,334 patients with new and recurrent TB registered in Yulin a city in China were included. The Kaplan-Meier survival curve was employed to estimate the median delay time. The mixed-effects survival model was used to identify the correlates associated with diagnostic delay. The outcome of interest in the model was"being diagnosed".ResultsWe found that 6.5% of cases with TB were attributed to recurrence. The median delay time of recurrent TB cases (73 days) was more than twice as long as that of new TB (35 days). Individuals with recurrent TB had a higher risk of diagnostic delay than new TB (HR, 0.5, 95%CI, 0.5–0.6). Factors associated with diagnostic delay differed between new TB and recurrent TB cases. Immigrants (HR, 0.5, 95%CI, 0.3–0.9), cases notified by way of recommendation (HR, 0.6, 95%CI, 0.4–0.9) and diagnosed at TB dispensary (HR, 0.4, 95%CI, 0.3–0.6) were associated with a higher risk of a longer delay for recurrent TB cases.ConclusionsThe proportion of TB cases attributed to recurrence was high. Patients with recurrent TB had a longer delay time and a higher risk of diagnostic delay. Further interventions to improve diagnostic delay should focus on screening for TB in immigrants, improving public health services at the lowest healthcare level and update of TB diagnosis and management model.

TELAAH SISTEMATIK: HUBUNGAN MEROKOK DAN PRILAKU MEROKOK TERHADAP KEJADIAN TUBERKULOSIS PARU

&#x0D; Tuberculosis (TB) is one of the leading causes of death in the world especially in developing countries. Indonesia as an developing country with the second largest TB case in the world. The association of smoking and tuberculosis has been proven in numerous studies with different ethnic backgrounds. This literature review aims to discuss the relationship between smoking and TB infection. In this article the methodology used is the literature review with two databases are Pubmed and Google Scholar. In addition, study is uses a reference list in the literature with article selected from 2010 to 2020 with quantitative design. This article shows smoking and tuberculosis have a significant relationship. Some literatures show tuberculosis progression rate is proportional to the length of smoking and the number of cigarettes smoked. Another fact that smoking increases the incidence of clinical tuberculosis is the cause of half the deaths occurring in one country, of which about a quarter of a tobacco smoker died at the age of 25-69 years. Smoking is one of the risk factors for TB that has implications for the increase in the number of TB cases, recurrence, impaired treatment and mortality in patients with pulmonary tuberculosis. To take risk factors that potentially lead to infection and TB disease, such as tobacco smoking, which should be targeted by using appropriate interventions.

Admiral Nelson’s illnesses and injuries

Horatio Nelson is one of the greatest English heroes. His key exploits at the battles of the Nile and Trafalgar, which led to Britain’s maritime supremacy, are well known and celebrated in the 5.5m statue at the summit of Nelson’s column in Trafalgar Square, London. The statue also showcases his most famous injuries, the injury to his right eye and arm amputation. However, as well as these he had a number of other battle injuries and afflictions including recurrent malaria, yellow fever, scurvy, tuberculosis and dysentery, which, although he bore with stoicism, may have affected his professional performance at different times in his career. The exact cause of his death was probably a combination of blood loss, lung injury and spinal shock.

Diagnostic Performance of Xpert MTB/RIF in Bronchoalveolar Lavage of Sputum-Scarce Recurrent Pulmonary Tuberculosis Cases

Abstract Introduction Xpert MTB/RIF has greater sensitivity and specificity than smear microscopy. Bronchoalveolar lavage (BAL) is safe and valuable tool in sputum-scarce and sputum-negative tuberculosis (TB) patients. Our study evaluated the performance of Xpert in BAL specimen of sputum-scarce recurrent TB cases exclusively. Materials and Methods Sputum-scarce recurrent TB patients who underwent BAL between July 2018 and July 2019 were included. The diagnostic performance of Xpert and acid-fast bacilli (AFB) smear examination in BAL specimen was compared with liquid culture Mycobacterium TB (MTB) and composite reference standard. Results A total of 126 patients were included in the study. MTB culture was positive in 70 cases and nontuberculous mycobacteria were seen in five cases. Xpert was positive was in 63 patients. Sensitivity of Xpert and AFB smear was 84.29% (95% confidence interval [CI]: 73.62–91.89) and 18.57% (95% CI: 10.28–29.66), respectively, with p &lt; 0.001 proving the superiority of Xpert. Xpert had a specificity of 97.96 (89.15–99.95), positive predictive value of 93.65% (95% CI 85.19–97.42), and negative predictive value of 80.36% (95% CI: 70.26–87.63). Smear had a specificity of 91.84% (95% CI: 80.21–97.58) against 97.96 (89.15–99.95) of Xpert, and smear was positive in nontuberculous mycobacterium cases as well. Xpert showed no cross-reactivity between mycobacterial species. Rifampicin resistance was seen in 8 (12.69%) cases, and 21 patients had other diagnoses. Conclusion Xpert has greater sensitivity in comparison to AFB smear in BAL specimen. Sputum-scarce recurrent TB cases have a similar chance of rifampicin resistance as sputum smear-positive cases should undergo BAL for Xpert analysis routinely.

EVALUATION OF TUBERCULOSIS RECURRENCE CASES IN NORTH JUZEIRO CITY

Abstract: Tuberculosis is an infectious disease and according to the World Health Organization, the number of deaths due to the disease may be related to the renunciation of treatment, as it favors maintenance of the transmission chain and increases the bacterial resistance to the first drugs choice. This study aimed to evaluate the recurrence of tuberculosis in the city of Juazeiro do Norte-CE in the period from 2015 to 2018 regarding the sociodemographic profile of patients, comorbidities, number of contacts, sputum smear, sputum culture. This is a cross-sectional retrospective, descriptive study. Twenty-two cases of recidivism, with a higher prevalence of males, were observed in brown individuals with low educational level. The most prevalent form was pulmonary. The prevalence of Tuberculosis is still a challenge for public health, recidivist cases deserve to be evaluated with more criteria taking into account socioeconomic and demographic aspects. Keywords: Recidivism. Resistance. Tuberculosis.

An exploratory mixed method study on the follow up status and quality of life among recurrent tuberculosis patients in South India

IntroductionAfter completion of treatment of Tuberculosis (TB), many patients can have long-term physical sequelae, which in some cases results in life-long impairment and further stigma. ObjectivesTo determine the follow up status and quality of life of post-treatment among Category 2 TB patients under RNTCP and to explore the factors affecting the Quality of Life. Material and methodsThe present study was done in urban area of Villupuram district of Tamil Nadu using Exploratory mixed methods study design. In the first phase case–control study was conducted with 100 post treatment category 2 TB patients (cases) and 100 non-TB patients (controls) matched for age and gender. The quality of life of the respondents was assessed by (WHOQOL-BREF) questionnaire (Quantitative), followed by five in-depth interviews among cases with extreme scores (Qualitative). ResultsThe mean scores of “perceived physical health” and “perceived psychological health” among cases after completion of treatment was significantly lower than the mean scores in controls. The determinants for perceived physical health were age, years of education and marital status. The determinants for psychological health were age, marital status and associated comorbidities. In-depth interview explored that major perspectives of cases affecting quality of life were side effects of drugs, loss of social support, loss of employment and psychological factors like anxiety, depression. ConclusionsHR-QOL among post treatment TB patients was reduced. Efforts should be made to counsel TB patients, family members, relatives and their workplace regarding their care, support and challenges to have a reasonable QOL.

Effect of AIDS-defining events at initiation of antiretroviral therapy on long-term mortality of HIV/AIDS patients in Southwestern China: a retrospective cohort study

ObjectiveTo evaluate the impact of AIDS-defining events (ADE) on long-term mortality of HIV positive individuals on antiretroviral therapy (ART), a retrospective HIV/AIDS treatment cohort study performed in Southwestern China.MethodsThe retrospective cohort was conducted among 6757 HIV/AIDS patients on ART (2NRTIs + 1NNRTI, 2NRTIs + 1PI and Single or two drugs) recruited in Guigang city, Guangxi, China, from January 2004 to December 2018. Participants were divided into ADE and non-ADE groups, and were followed-up every six months to observe treatment outcomes. Comparison of mortality between groups was performed using the log-rank test and Kaplan–Meier analysis. Cox proportional hazard regression was used to explore the risk factors of mortality. 1:1 propensity score matching (PSM) was used to balance confounding factors and adjust the mortality risk.ResultsOf 6757 participants with 29,096.06 person-years of follow-up, 16.86% (1139/6757) belonged to ADE group while the others (83.14%) belonged to the non-ADE group. The most common cause of death by ADE was disseminated mycosis (31.65%), followed by recurrent severe bacterial pneumonia (28.48%), herpes zoster (17.72%), and extra-pulmonary tuberculosis (8.86%). The mortality of the ADE group was significantly higher than that of the non-ADE group [3.45/100 person-years (95% CI 2.92–3.97) vs. 2.34/100 person-years (95% CI 2.15–2.52), P<0.001]. The death risk of the ADE group was also higher than that of the non- ADE group [adjusted hazard ratio (aHR) = 1.291, 95% CI 1.061–1.571, P = 0.011], which was confirmed by PSM analysis (aHR = 1.581, 95% CI 1.192–2.099, P = 0.002). Cox analysis indicated that ADE, older age, male gender, previous non-use of cotrimoxazole, advanced WHO clinical stage, and low baseline CD4+ cell count were the risk factors for death.ConclusionsEven on ART, the mortality risk of HIV positive individuals with ADE was higher than those without ADE. Active testing, earlier diagnosis, and timely therapy with ART may reduce the death risk of ADE.

Tuberculosis relapse is more common than reinfection in Beijing, China

Background Recurrent tuberculosis (TB) is a major health problem in countries with a high TB burden. It is very necessary to elucidate the situation of recurrent TB in Beijing, capital of China. Objective To determine the proportion of recurrent tuberculosis (TB) cases and to identify relapsed or reinfected cases, as well as risk factors associated with recurrence in Beijing. Methods We conducted a retrospective study that included all TB cases in Beijing that were successfully treated from 2013 to 2015. Recurrence due to relapse or reinfection was determined using the variable number of tandem repeats (VNTR) method. Risk factors associated with recurrence were analysed. Results Tuberculosis recurred in 275 of the 4043 successfully treated TB patients, giving a recurrence rate of 6.8% (275/4043). 190 of the 275 cases were culture positive in both instances, and genotyping results for both episodes were available for 58 of these patients. The cultured isolates from 40 of the 58 recurrent cases (69%) had identical genotypic patterns in both episodes, indicating a relapse. 31% (18/58) had different genotypes, indicating reinfection by a new strain and suggested recent transmission. Those people in the 30–59 age group (p < .001), and those retreated for pulmonary TB (p < .001) were more likely to have TB recurrence. Conclusion Our results indicate that relapse was more common than reinfection in recurrent TB cases in Beijing from 2013 to 2015. Age and retreatment were found to be risk factors for TB recurrence.

A study on the impact of elective diagnostic laparoscopy in diagnosing chronic abdominal pain

Background: Chronic idiopathic pain syndromes are amongst the most challenging and demanding conditions to treat across the whole age spectrum. Despite these patients having undergone numerous diagnostic work ups, their pain remains a challenge to all known diagnostic and treatment methods. Aims and Objectives: We aim to evaluate the diagnostic and therapeutic efficacy of laparoscopy in the management of such patients in this prospective study. Materials and methods: Thirty five patients with chronic pain abdomen were included in this study. The pain in all these patients was either of unclear etiology or not responding to the treatment given after clinical assessment and lasting for more than 3 months duration. Pain of shorter duration and patients less than 14 years of age were excluded from the study. All patients were subjected to diagnostic laparoscopy and procedure. The results were tabulated and analyzed. Results: Females were more affected by this condition and the most common site of pain being the peri -umbilical region. A definitive diagnosis was made per operatively in 29 patients (82.85%) while in the remaining 6 (17.14%), no obvious pathology was detected. The most common findings in our study was post-operative adhesions (50%), followed by recurrent appendicitis (13.33%), Carcinoma (5.71%), Mesenteric lymphadenopathy and Tuberculosis (2.85% each). Pain assessment done at 1 month follow up showed pain relief in 80.55% and 3 month follow up showed pain relief in 70% of patients. Conclusion: Post-operative adhesions form a majority of cause for causing chronic pain abdomen. Diagnostic laparoscopy is a safe and effective modality for the diagnostic and therapeutic management of such patients.

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.

Treatment of cervical lymph node tuberculosis: When surgery should be performed? A retrospective cohort study

Backgroundlymph node tuberculosis is the most common form of extra pulmonary tuberculosis. Although diagnosis is usually difficult, therapeutic management remains a challenge and a subject of national and international debate. Materials and methodsthe medical records of patients with cervical lymph node tuberculosis who were treated at 20 August Hospital, Casablanca, Morocco, between May 2017 and November 2018 were reviewed. The results of the treatment were analyzed retrospectively.The aim of our work was to identify all causes of medical treatment failure in cervical lymph node tuberculosis, and to propose indications for the use of surgery in cervical lymph node tuberculosis in Morocco. ResultsOut of a total of 104 patients, the mean age was 24 years, the sex ratio was 0.51 (women: 66.3%), twenty (19.2%) patients received medical treatment alone, and 84 (80.8%) patients required medical and surgical treatment. Surgery was required when the size of the lymphadenopathies was greater than or equal to 3 cm (p = 0.005), when the patient presented with an abscess and/or fistula(p = 0.005), when the patient presented with resistance to antibacillary drugs(p = 0.032), or developed a paradoxical upgrading reactions (p = 0.001), or when the patient had a recurrence of lymph node tuberculosis(p = 0.008) on multivariate analysis. Conclusionantibiotic therapy remains the main treatment for all patients in lymph node tuberculosis, but the results of our work show the value of surgery in some indications.

High Rates of Recurrent Tuberculosis Disease: A Population-level Cohort Study.

BackgroundRetreatment tuberculosis (TB) disease is common in high-prevalence settings. The risk of repeated episodes of recurrent TB is unknown. We calculated the rate of recurrent TB per subsequent episode by matching individual treatment episodes over a period of 13 years.MethodsAll recorded TB episodes in Cape Town between 2003 and 2016 were matched by probabilistic linkage of personal identifiers. Among individuals with a first episode notified in Cape Town and who completed their prior treatment successfully we estimated the recurrence rate stratified by subsequent episode and HIV status. We adjusted person-time to background mortality by age, sex, and HIV status.ResultsA total of 292 915 TB episodes among 263 848 individuals were included. The rate of recurrent TB was 16.4 per 1000 person-years (95% CI, 16.2–16.6), and increased per subsequent episode (8.4-fold increase, from 14.6 to 122.7 per 1000 from episode 2 to 6, respectively). These increases were similar stratified by HIV status. Rates among HIV positives were higher than among HIV negatives for episodes 2 and 3 (2- and 1.5-fold higher, respectively), and the same thereafter.ConclusionsTB recurrence rates were high and increased per subsequent episode, independent of HIV status. This suggests that HIV infection is insufficient to explain the high burden of recurrence; it is more likely due to a high annual risk of infection combined with an increased risk of infection or progression to disease associated with a previous TB episode. The very high recurrence rates would justify increased TB surveillance of patients with >1 episode.