Recurrent Tuberculosis Research Articles

Prevalence of drug-resistant recurrent tuberculosis and new multidrug-resistant tuberculosis mutations detection in Can Tho, Vietnam

Prevalence of drug-resistant recurrent tuberculosis and new multidrug-resistant tuberculosis mutations detection in Can Tho, Vietnam

HUBUNGAN PENGETAHUAN, SIKAP DAN PERILAKU PENGAWAS MINUM OBAT (PMO) TERHADAP KEJADIAN TUBERKULOSIS (TBC) BERULANG DI KABUPATEN MUARA ENIM

The discovery of repeated TB cases is a problem in TB control in Muara Enim Regency. One of the causes of failure and lack of discipline of TB patients in taking medication is influenced by the role of the drug taking supervisor (PMO). The role of PMO is very important in monitoring, reminding and ensuring regularity of treatment for TB patients in order to achieve optimal treatment results. This study aims to examine the relationship between the role of the family as a supervisor for taking medication on the incidence of recurrent tuberculosis in Muara Enim district. This study used a case-control design with a retrospective approach. The research subjects were PMO in patients with recurrent TB/MDR TB as a case group and PMO in former TB patients who recovered on schedule as a control group. The comparison of case samples (46 samples) and controls (92 samples) was one to two (1:2). Data on the level of knowledge, attitude and behavior variables were assessed using a scoring system. The analysis uses the chi square test to get the odds ratio (OR) value. The results of the analysis show that the level of PMO knowledge is still below the program's expectations. The level of knowledge, attitudes and behavior of PMO are not related to the occurrence of recurrent TB cases. To increase the role of PMO, health workers can conduct counseling by changing the extension technique using more varied and communicative extension media.

CT Appearances in Treated Abdominal Tuberculosis: A Radiologist's Dilemma

Abstract Objective To study the CT appearances of the abdomen after completion of antitubercular therapy (ATT) in adult patients. Methods Multidetector CT scan abdomen was done in 20 adults within 1 month of completing ATT. CT appearances were compared with pretreatment scans which were available in 7 cases. Results We found that residual ileocecal wall thickening and enhancement was significant (p < 0.05) after treatment in cases of ileocecal tuberculosis (TB). Mild decrease in wall thickness and diameter of the involved dilated small bowel loops was seen. Numerous large, matted nodes with necrosis persisted in the mesentery and retroperitoneum in treated TB, but reduction in the size of nodes was appreciated. Conclusion Our results help to fill the vacuum in the database of CT appearances in treated abdominal TB. Persistence of bowel changes and lymph nodes should not be mistaken for recurrence of TB or residual disease.

Epidemiological trends in tuberculosis in Ukraine at the beginning of the COVID­-19 pandemic

Objective — to examine the tendencies of the epidemiological situation on tuberculosis in Ukraine at the beginning of the COVID-19 pandemic in 2020. 
 Materials and methods. The analysis of the data of official statistics in 2015—2020, a survey of 157 medical experts and a telephone questionnaire survey of 69 residents of the Volyn region.
 Results and discussion. It was established that the disease of COVID-19 has found its imprint on the epidemiological situation of tuberculosis and on the functioning of the TB care service. In 2020, the rate of decline in the incidence of pulmonary and extrapulmonary tuberculosis was significantly more intensive than in previous years. However, the incidence of tuberculosis among contacts with bacterial excretion in tuberculosis foci increased 1.85 times in each year. The frequency of tuberculosis recurrences is steadily decreasing.The prevalence and mortality from all forms of active tuberculosis among the entire population of Ukraine has a tendency similar to a decrease in morbidity.The effectiveness of treatment of patients of all categories is proportional to the severity of the tuberculosis process, but still insufficient. Mortality in TB care institutions increased in the previous year against the decrease of this indicator in previous years. Against the background of the inaccessibility of the population to TB care, day hospitals are underused, and the sanatorium network needs to be reorganized. The surgical method of treatment of patients is extremely insufficiently realized.
 Conclusions. The dispensary contingent of TB care institutions is decreasing every year. There is a reduction in the infrastructure of the TB care service, and in each year, the largest reduction was in the bed stock of TB care institutions and sanatoriums, as well as a decrease in the number of TB doctors.

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.

1400. Pretomanid in the Treatment of Patients with Tuberculosis in the United States: the Bedaquiline, Pretomanid and Linezolid (BPaL) Accelerated Monitoring (BAM) Project

BackgroundIn August 2019 the U.S. FDA approved pretomanid as part of a 6-month all-oral BPaL (bedaquiline, pretomanid, and linezolid) regimen for treating pulmonary extensively drug-resistant (XDR) or treatment-intolerant or nonresponsive multidrug-resistant (MDR) tuberculosis (TB). In the study supporting approval, 89% of patients had a favorable outcome, and all reported ≥ 1 adverse event. We describe the reported use of BPaL in the United States.MethodsUsing the 2020 CDC Report of a Verified Case of Tuberculosis (RVCT) MDR TB supplemental form, TB programs and providers submitted data for patients who began taking BPaL between Aug 1, 2019 and May 1, 2020, for retrospective descriptive analysis.ResultsPrograms and providers reported 17 TB patients aged a mean of 41 years (range 23–76) who received BPaL: 11 (65%) were male; 15 (88%) were non-U.S. born; 15 (88%) had pulmonary TB disease only; two (12%) had both pulmonary and extrapulmonary disease. Of all patients, 16 had Mycobacterium tuberculosis isolated from sputum and 7 (44%) had cavitary disease. The preliminary drug susceptibilities were 8 MDR patterns, 8 pre-XDR, and 1 unreported. Three patients received BPaL as their only treatment; six first received treatment for drug-susceptible TB, and eight received other regimens for MDR TB before BPaL. Eleven (65%) patients had ≥ 1 side effect reported during any TB treatment, including peripheral neuropathy (n=5), depression (n=4), vestibular dysfunction (n=3), and vision changes (n=3). Timing related to specific TB drug use was not reported. Sixteen (94%) patients received less than the approved initial dose of 1200 mg linezolid daily, and 15 (88%) patients underwent monitoring of linezolid exposure. All 16 patients with M. tuberculosis in initial sputa converted to negative culture results within 6 months of starting treatment. At 12 months after BPaL initiation, all patients had completed treatment, without TB recurrences or deaths reported.ConclusionIn the early period after FDA approval, most U.S. patients received BPaL off-label with an initial linezolid dose lower than the approved 1200mg yet still achieved good outcomes. Most reported patients underwent some monitoring of linezolid exposure. Monitoring of BPaL use is important and should continue.Disclosures All Authors: No reported disclosures

LncRNA CCAT1 is overexpressed in tuberculosis patients and predicts their survival

IntroductionLncRNA CCAT1 promotes inflammatory responses, which contribute to tuberculosis. Therefore, CCAT1 may participate in tuberculosis. Therefore, we analyzed the involvement of CCAT1 in tuberculosis.MethodsPlasma samples were donated by a total of 200 patients with newly developed tuberculosis (N‐TB), 102 patients with recurrent tuberculosis (R‐TB), and 102 healthy controls on the day of admission. Plasma samples were also collected from N‐TB and R‐TB patients every month after the initiation of treatment for a total of 6 months. CCAT1 expression in these samples was detected by quantitative reverse transcription polymerase chain reaction. Levels of IFN‐γ, IL‐1β, iNOS, TNF‐α, and IL‐10 in plasma were determined by enzyme‐linked immunosorbent assay. N‐TB and R‐TB patients were monitored for 2 months to analyze their survival.ResultsOn the day of admission, the highest levels of CCAT1, IFN‐γ, IL‐1β, iNOS, and TNF‐α were detected in N‐TB patients, followed by R‐TB patients and controls, while the lowest levels of plasma IL‐10 were detected in N‐TB patients, followed by R‐TB patients and controls. Across R‐TB and N‐TB patients, CCAT1 was inversely correlated with IL‐10 but not closely correlated with other inflammatory factors. During the treatment, plasma CCAT1 levels decreased in both N‐TB and R‐TB patients. High CCAT1 levels were closely correlated with high mortality rates of both N‐TB and R‐TB patients.ConclusionCCAT1 is overexpressed in tuberculosis patients and predicts their survival. Its function in tuberculosis may be related to IL‐10.

ILC2s induce adaptive Th2-type immunity in different stages of tuberculosis through the Notch-GATA3 pathway

The study is to investigate the roles of group 2 innate lymphoid cells (ILC2s) in different courses of tuberculosis (TB). Serum and PBMCs were respectively isolated from the TST negative, LTBI (latent TB infection), ATB (active TB) and RTB (recurrent TB) patients. Flow cytometry was used to detect Th1, Th2 and ILC2s in the peripheral blood. The mRNA and protein levels of GATA3, RORα, CRTH2, Hes1, Notch1, NF-κB, and ID2 were detected by qRT-PCR and Western blotting. ILC2 cells from ATB and RTB patients were stimulated with rJagged2 or DAPT in vitro, and co-cultured with CD4+ T cells from TST negative group. ELISA was used to detect cytokine levels. The results showed that compared with the TST negative or LTBI group, Th2 cells and serum IL-4 in ATB group increased dramatically, accompanied by an increase of Th2/Th1 ratio in ATB patients, especially in RTB group. However, ILC2s in the ATB and RTB group increased significantly, along with increased GATA3, RORα, and CRTH2 levels. After rJagged2 stimulation in vitro, the levels of Hes1, Notch1, NF-κB, RORα, GATA3 and ID2 and those of IL-4, IL-5 and IL-13 were significantly increased. These effects were abrogated by DAPT treatment. Then, ILC2s, especially those from RTB patients, induced Th2-type immune response after co-culturing with CD4+ T cells. In conclusion, our results suggest that ILC2s may promote Th2-type immune response in different stages of TB via the Notch-GATA3 pathway.

AKT 3 Induced Hepatitis: Case Report

Abstract: As tuberculosis is a global health problem. Non-adherence related to treatment regimen and inappropriate prescription of tuberculosis therapy may be one of the major contributing factors in public health. Hepatotoxicity is leading adverse effect of first line anti tuberculosis medication. They do not cause hepatotoxicity in all patients but there are many reported cases which showed hepatotoxicity due to antituberculosis drugs. This adverse effect occurs due to individual drug metabolize by alternative pathways. A 24-year-old female came to respiratory department with complains of dry cough and generalized weakness since one month, pedal edema for three days, breathlessness, chest pain and weight loss. She was known case of systemic lupus erythematosus with vitamin B12 deficiency with Hypothyroidism. She had recurrent tuberculosis in the last 15 days and for that she was put on isoniazid, rifampicin, ethambutol, pyrazinamide combination (HRZE regimen). Her laboratory reports suggest she developed hepatitis for which antituberculosis drugs were suspected. She was put on alternative regimen (streptomycin, levofloxacin, ethambutol and ethambutol). After stopping potent hepatotoxic medication, she started reliving symptoms of hepatitis. The early diagnosis of reaction and close monitoring of patient prevented the seriousness of reaction in this case. Key words: Tuberculosis, Anti Koch Therapy, Hepatotoxicity, Isoniazid, Rifampin.

Single-stage posterior resection of the transversal process combined with an intervertebral foraminal approach for debridement, interbody fusion, internal fixation for the treatment of lumbar tuberculosis and psoas major abscess.

To investigate the feasibility and clinical efficacy of the treatment for lumbar tuberculosis with psoas major abscess with single-stage posterior resection of the transversal process combined with an intervertebral foraminal approach for debridement, interbody fusion, internal fixation. Thisretrospectivestudy evaluated the clinical data of 24 patients (14 males and 10 females) with lumbar tuberculosis and psoas major abscess admitted to the Comprehensive Surgery from June 2016 to June 2019.All patients were treated with the single-stage posterior approach to remove the transverse process combined with the intervertebral foramina approach for debridement, interbody fusion, internal fixation. The quadruple anti-tuberculosis drug therapy was given both pre-operatively and post-operatively. Clinical symptoms and complications were investigated and recorded. The visual analogue scale (VAS), American Spinal Injury Association (ASIA), degree of lesion fusion C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR) were evaluated. The average follow-up period was 16. 5months (from 12 to 36months). The average VAS score at threemonths post-operation was significantly declined than the pre-operative VAS score [(2.17 ± 0.87) points vs (5.46 ± 1.22) points, t = - 11.534, P < 0.01)]. At the last follow-up, the neurological function of 20 patients recovered to grade E, whereas four patients were still in grade D. The ESR and CRP returned to normal levels in all patients. Bone fusion was achieved in nine cases at sixmonths, 11 cases at ninemonths, and four cases at 12months. The incisions of 23 patients had healed nicely without chronic sinus. Poor incision healing only happened in one case at the day 12 post-operation. The bone grafts among the lesions obtained bony fusion. Besides, there was no recurrence of tuberculosis, loosening or fracture of internal fixation during the follow-up. Single-stage posterior resection of the transversal process combined with an intervertebral foramina approach for debridement, interbody fusion, internal fixation is probably an effective and safe approach of the treatment for lumbar tuberculosis combined with psoas major abscess, producing few complications. This technique provides an alternative method for the surgical treatment of lumbar tuberculosis combined with psoas major abscess.

Stroke in a Patient with Recurrent Meningeal Tuberculosis and HIV Coinfection

Recurrent tuberculous meningitis can have a non-specific clinical presentation when it presents as a co-infection with HIV and can resemble other causes of subacute and chronic meningitis, leading to unwanted outcomes; for this reason, timely diagnoses are required. The most widely used microbiological diagnostic methods can be of low sensitivity or have delayed results. The aim of this article is to present a clinical case of recurrent tuberculous meningitis with a clinical presentation of stroke due to a basal cistern ischaemic lesion in a patient co-infected with HIV, who had a microbiological confirmation and a drug sensitivity study with phenotypic and molecular tests.

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.

Short and long-term outcomes of video observed treatment in tuberculosis patients, the Republic of Moldova.

The Republic of Moldova is among the 18 high priority countries for tuberculosis (TB) in Europe. This study compared adherence and short and long-term TB treatment outcomes for TB patients who experienced asynchronous Video Observed Treatment (aVOT) during three months of outpatient treatment versus Directly Observed Treatment (DOT) in operational conditions in 2016-2017 in Chisinau. We used secondary data from the 2016-2017 Randomized Clinical Trial (RCT) that piloted the aVOT Strategy in Chisinau and data from the national TB register. Relative risk was selected as a measure of association in analysis of treatment strategies (aVOT and DOT under operational conditions) and short and long-term treatment outcomes. From 647 TB patients included in the study, 169 followed the treatment strategy in the RCT (83 in aVOT and 86 in DOT) and 478 were on DOT in operational conditions. Those in aVOT were more likely to have favourable short-term outcome than patients with DOT in operational conditions (RR 0.07; p < 0.001). TB recurrence as an indicator for the long-term outcome, was observed in group with DOT in operational conditions (40 cases, p = 0.006). This study demonstrated that the aVOT treatment strategy was associated with better adherence and both short and long-term TB treatment favourable outcomes. aVOT as a new patient-centred approach supporting TB patients on improving treatment adherence and outcomes might be recommended as an alternative to DOT strategy in the Republic of Moldova.

A Prospective Cohort Study on the Prevalent and Recurrent Tuberculosis Isolates Using the MIRU-VNTR Typing.

The study aims to describe the clustering characteristics of Mycobacterium tuberculosis (M.tb) strains circulating in eastern China and determine the ratio of relapse and reinfection in recurrent patients. We recruited sputum smear-positive pulmonary tuberculosis cases from five cities of Jiangsu Province, China, during August 2013 and December 2015. Patients were followed for the treatment outcomes and recurrence based on a cohort design. M.tb strains were isolated and genotyped using the 12-locus MIRU-VNTR. The Beijing family was identified by the extended Region of Difference (RD) analysis. The Hunter-Gaston Discriminatory Index (HGDI) was used to judge the resolution ability of MIRU-VNTR. The odds ratio (OR) together with 95% confidence interval (CI) were used to estimate the strength of association. We performed a cluster analysis on 2098 M.tb isolates and classified them into 545 genotypes and five categories (I, 0.19%; II, 0.43%; III, 3.34%; IV, 77.46%; V, 18.59%). After adjusting for potential confounders, the Beijing family genotype (OR = 118.63, 95% CI: 79.61–176.79, P = 0.001) was significantly related to the dominant strain infections. Patients infected with non-dominant strains had a higher risk of the pulmonary cavity (OR = 1.39, 95% CI: 1.01–1.91, P = 0.046). Among 37 paired recurrent cases, 22 (59.46%) were determined as endogenous reactivation, and 15 (40.54%) were exogenous reinfection. The type of M.tb strains prevalent in Jiangsu Province is relatively single. Beijing family strains infection is dominant in local tuberculosis cases. Endogenous reactivation appears to be a major cause of recurrent tuberculosis in Eastern China. This finding emphasizes the importance of case follow-up and monitoring after the completion of antituberculosis treatment.

Phenotypic and immune functional profiling of patients with suspected Mendelian Susceptibility to Mycobacterial Disease in South Africa

BackgroundMendelian Susceptibility to Mycobacterial Disease (MSMD) is a primary immunodeficiency (PID) characterised by a predisposition to infection by weakly-pathogenic mycobacteria. In countries with a high prevalence of tuberculosis (TB), individuals with MSMD are also prone to infections by Mycobacterium tuberculosis. Several MSMD-associated genes have been described, all resulting in a disruption of IL-12 and IFN-γ cytokine axis, which is essential for control of mycobacterial infections. An accurate molecular diagnosis, confirmed by phenotypic and functional immune investigations, is essential to ensure that the patient receives optimal treatment and prophylaxis for infections. The aim of this study was to implement a set of functional assays to assess the integrity of the IL-12-IFN-γ cytokine pathways in patients presenting with severe, persistent, unusual and/or recurrent TB, mycobacterial infections or other clinical MSMD-defining infections such as Salmonella.MethodsBlood was collected for subsequent PBMC isolation from 16 participants with MSMD-like clinical phenotypes. A set of flow cytometry (phenotype and signalling integrity) and ELISA-based (cytokine production) functional assays were implemented to assess the integrity of the IL-12-IFN-γ pathway.ResultsThe combination of the three assays for the assessment of the integrity of the IL-12-IFN-γ pathway was successful in identifying immune deficits in the IL-12-IFN-γ pathway in all of the participants included in this study.ConclusionsThe data presented here emphasise the importance of investigating PID and TB susceptibility in TB endemic regions such as South Africa as MSMD and other previously described PIDs relating to TB susceptibility may present differently in such regions. It is therefore important to have access to in vitro functional investigations to better understand the immune function of these individuals. Although functional assays alone are unlikely to always provide a clear diagnosis, they do give an overview of the integrity of the IL-12-IFN-γ pathway. It would be beneficial to apply these assays routinely to patients with suspected PID relating to mycobacterial susceptibility. A molecular diagnosis with confirmed functional impairment paves the way for targeted treatment and improved disease management options for these patients.

Smoking increases risk of recurrent tuberculosis: A qualitative study of Bangladesh

Smoking increases risk of recurrent tuberculosis: A qualitative study of Bangladesh

Recurrence and risk factors to the pulmonary tuberculosis patients after successful initial treatment in Beijing

Objective To analyze the recurrence and risk factors of pulmonary tuberculosis (TB) cases after successful initial treatment in Beijing. Methods A retrospective cohort study was conducted. The data of pulmonary TB cases with successful initial treatment in Beijing during 2015–2017 were collected from TB information management system. The medical records and infectious disease report cards registered or reported before December 31, 2020 were collected to find recurrent TB cases and survival analysis was performed. The recurrence of TB was estimated by using life-table method, Kaplan-Meier method was used for univariate analysis of recurrence, log-rank method was used for comparison between groups, and time-dependent Cox regression model was used for multivariate analysis. Results Of the 8 503 TB cases with successful initial treatment enrolled in Beijing, 253 (2.98%) had recurrence, with a recurrence rate density of 8.13/1000 person-years, in which 88.54% (224 cases) had recurrence within 3 years, and 3.57% had recurrence within 5 years. Multivariate analysis based on univariate analysis showed that, lung cavity (adjusted Hazard ratio, aHR =1.592, 95% CI: 1.166–2.172, P=0.003), time-dependent covariates such as age (aHR=1.004, 95% CI: 1.001–1.008, P=0.008), passive treatment (aHR=1.200, 95% CI: 1.008–1.428, P=0.040), being etiologically positive (aHR=1.154, 95% CI: 1.034–1.289, P=0.011) were the independent risk factors for TB recurrence. Conclusion We should strengthen the follow-up and management of pulmonary TB patients after successful treatment, and conduct targeted intervention for groups at high-risk for TB recurrence. Health education for the general people should be strengthened, and early detection and early treatment of TB cases should be performed to reduce TB recurrence.

Profile of HIV/AIDS Patients Coinfected with Tuberculosis in Bumi Wonorejo Health Centre and Santo Rafael Clinic Nabire, Papua

HIV-TB co-infection still becomes a health problem in Indonesia, including in Nabire district, Papua province, which has the highest number of cases. HIV and TB infections are closely related and affect the epidemiology of one another. This study aims to determine the profile description of HIV-TB co-infected patients in Nabire. This research is a descriptive study with a cross-sectional design on 90 people with HIV/AIDS selected consecutively. Data were analyzed univariately and presented in the form of a frequency distribution table. The results showed that of 55 HIV/AIDS co-infected TB patients, almost all (90.9%) were Papuan ethnic, 70.9% were female and aged 30 to 49 years (50.9%) with a mean of 31.309.36 years. The majority of HIV-TB co-infected patients were married (63.6%), holding secondary education (58.2%), working (67.3%), engaging in sexual activity after 17 years of age, only having one sexual partner, and did not use drugs or obtain blood transfusions. The clinical profile of HIV-TB patients showed that 67.3% of the patients were with baseline CD4 count ≤350 cells/mm3, 64.8% had CD4 count at the time of study &gt;350 cells/mm3, and viral load values fewer than 5000 copies/ml (87.3%). The therapy most widely received for patients with HIV-TB coinfection was the combination of ARV 3TC+EFV+TDF (76.4%). The most common clinical symptoms of HIV/AIDS patients were weight loss (56.4%), cough (40%), recurrent oral thrush (36.4%), chickenpox (32.7%), and tuberculosis lymph nodes (18.2%).

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

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

Particularities of the evolution of the patients with tuberculosis associated with the pulmonary neoplastic process

Risk factors for pulmonary tuberculosis and pulmonary neoplastic process are interdependent. Antineoplastic treatment is a contributing factor in the reactivation of latent tuberculosis infection and the recurrence of pulmonary tuberculosis. The aim of the study was to evaluate the particularities of the evolution of patients with tuberculosis associated with pulmonary neoplastic process to identify recommendations for early detection of the neoplastic process. A retrospective, selective study was performed which included 105 patients distributed in the study group that included 50 cases with diagnosed pulmonary neoplatic process and the comparison group which consisted from 65 patients with pulmonary tuberculosis without current or previous neoplasia. Th e peculiarities of patients with associated neoplastic process was age over 55 years, urban residence, incomplete level of education, disadvantaged socio-economic peculiarities, immunosuppressive treatment (in one third of cases). Th e diagnosis of tuberculosis was established by the specialist, having a low rate of positive microbiological status and a wide range of clinical manifestations. Standardized antituberculosis treatment resulted in a low rate of therapeutic success. Conclusion: the standardized management of patients with pulmonary tuberculosis associated with the pulmonary neoplastic process led to the late detection of the neoplastic process and the completion of antituberculosis treatment with therapeutic success only in every second patient.