Retreatment Of Pulmonary Tuberculosis Research Articles

Time to detection of Mycobacterium tuberculosis using culture filtrate H37rv supplementation on MGIT 960 System

Background: The fundamental priority program for controlling Tuberculosis (TB) is accurate and rapid diagnosis. Variable Mycobacterium tuberculosis (MTB) phenotypes were discovered in sputum samples from pulmonary TB (PTB) patients. Active replicating bacteria and differentially culturable tubercle bacteria (DCTB) are present in the sputum. Differentially culturable tubercle bacilli did not grow on the standard medium. Culture filtrate (CF) H37Rv supplementation containing resuscitation-promoting factors (Rpfs) has the potential to increase sensitivity and reduce time to detection (TTD) on culture-based diagnostics. Methods: This study was a true experimental laboratory. A clinical sample was taken from the sputum of 15 PTB patients, which was "MTB detected" by Xpert MTB/RIF assay. Sputum samples were divided into two groups and inoculated on MGIT 960 in one group with CF-H37Rv supplementation and without in the other as standard MGIT medium. Results: On both standard MGIT medium and MGIT+CF H37Rv, the recovery rate was 100%. Seven samples (47%) show a growth promotion effect with CF H37Rv supplementation (ΔTTD > 10 hours), while eight samples (53%) show no change in TTD (ΔTTD < 10 hours). There is no evidence that CF H37Rv supplementation inhibits growth. Six of the seven samples with ΔTTD > 10 jam (85,7%) were dominated by samples with acid-fast bacilli (AFB) grading 1+, which could be an assumption related to re-treatment PTB cases, chronic cases, treatment stages, TB-HIV, or follow up of treatments. Conclusion: There was no difference in recovery rate or TTD between standard MGIT medium and MGIT+CF H37Rv. The supplementation of culture filtrate H37Rv has a greater advantage on samples with low bacterial load (AFB 1+).

Rate of Patient Delay among Students with Pulmonary Tuberculosis in China: A Meta-Analysis

Objective: To systematically review the rate of patient delay of pulmonary tuberculosis (PTB) patients among students in China. Methods: Databases including Web of Science Core Collection, PubMed, The Cochrane Library, CBM, CNKI, VIP, and WANFANG DATA were electronically searched to collect cross-sectional studies on the incidence of delayed consultation in students with PTB in China from January 1, 2000, to November 15, 2022. Two researchers independently screened studies, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by Stata 16.0 software. Results: In total, 60 cross-sectional studies with 260,707 cases involving 136,701 delayed consultation PTB patients were included. The results of meta-analysis showed that the rate of patient delay was 46.4% (95% CI 44.3% to 48.4%) among students with PTB in China. Results of subgroup analyses showed that: 1) The rates were 46.8% and 50.4% for male and female students, respectively. 2) The rates for the East, Central and West parts of China were 42.3%, 45.6% and 50.5%, respectively. 3) The rates were increased first and then decreased during 2007 to 2020. 4) The rates of students from primary school, junior high school, senior high school and university were 50.3%, 49.8%, 40.7% and 44.9%, respectively. 5) The rates for the Han and the other nationalities were 50.3% and 53.9%, respectively. 6) The rates for local and non-local students were 47.2% and 50.5%, respectively. 7) The rates of patients detected by consultation due to symptoms, recommendation due to symptoms, referral, tracking and healthy physical examination were 50.5%, 51.6%, 46.6%, 55.6% and 16.2%, respectively. 8) The rates of patients with initial PTB and retreatment PTB were 53.1% and 59.6%, respectively. 9) The rates of patients with positive etiology, negative etiology and without etiological results were 55.9%, 47.0% and 51.6%, respectively. 10) The rates of severe and non-severe patients were 59.4% and 52.9%, respectively. Conclusion: The patient delay rate for Chinese students with PTB is generally at a high level. There are substantial differences in the patient delay rate for students with PTB among different genders, regions, study stages, nationalities, household registration types, detection methods, and treatment classifications.

Effect of Whole-course Nursing Intervention on Treatment Compliance of Retreatment Pulmonary Tuberculosis Patients

Effect of Whole-course Nursing Intervention on Treatment Compliance of Retreatment Pulmonary Tuberculosis Patients

Improvement cues of lesion absorption using the adjuvant therapy of traditional Chinese medicine Qinbudan tablet for retreatment pulmonary tuberculosis with standard anti-tuberculosis regimen

BackgroundChina is the second highest pulmonary tuberculosis (PTB) burden country worldwide. However, retreatment of PTB has often developed resistance to at least one of the four first-line anti-TB drugs. The cure rate (approximately 50.0–73.3%) and management of retreatment of PTB in China needs to be improved. Qinbudan decoction has been widely used to treat PTB in China since the 1960s. Previously clinical studies have shown that the Qinbudan tablet (QBDT) promoted sputum-culture negative conversion and lesion absorption. However, powerful evidence from a randomized controlled clinical trial is lacking. Therefore, the aim of this study was to compare the efficacy and safety of QBDT as an adjunct therapy for retreatment of PTB.MethodsWe conducted a multicenter, randomized, double-blind, placebo-controlled clinical trial in China. People diagnosed with PTB were enrolled who received previous anti-TB treatment from April 2011 to March 2013. The treatment group received an anti-TB regimen and QBDT, and the control group was administered an anti-TB regimen plus placebo. Anti-TB treatment options included isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin for 2 months (2HRZES), followed by isoniazid, rifampicin, ethambutol for 6 months (6HRE), daily for 8 months. Primary outcome was sputum-culture conversion using the MGIT 960 liquid medium method. Secondary outcomes included lung lesion absorption and cavity closure. Adverse events and reactions were observed after treatment. A structured questionnaire was used to record demographic information and clinical symptoms of all subjects. Data analysis was performed by SPSS 25.0 software in the full analysis set (FAS) population.ResultsOne hundred eighty-one cases of retreatment PTB were randomly divided into two groups: the placebo group (88 cases) and the QBDT group (93 cases). A total of 166 patients completed the trial and 15 patients lost to follow-up. The culture conversion rate of the QBDT group and placebo group did not show a noticeable improvement by using the covariate sites to correct the rate differences (79.6% vs 69.3%; rate difference = 0.10, 95% confidence interval (CI): - 0.02–0.23; F = 2.48, P = 0.12) after treatment. A significant 16.6% increase in lesion absorption was observed in the QBDT group when compared with the placebo group (67.7% vs 51.1%; rate difference = 0.17, 95% CI: 0.02–0.31; χ2 = 5.56, P = 0.02). The intervention and placebo group did not differ in terms of cavity closure (25.5% vs 21.1%; rate difference = 0.04, 95% CI: - 0.21–0.12; χ2 = 0.27, P = 0.60). Two patients who received chemotherapy and combined QBDT reported pruritus/nausea and vomiting.ConclusionsNo significant improvement in culture conversion was observed for retreatment PTB with traditional Chinese medicine plus standard anti-TB regimen. However, QBDT as an adjunct therapy significantly promoted lesion absorption, thereby reducing lung injury due to Mycobacterium tuberculosis infection.Trial registrationThis trial is registered at ClinicalTrials.gov, NCT02313610.

Effect of Xpert MTB/RIF on the treatment of multi-drug-resistant or rifampicin-resistant tuberculosis screened out from re-treatment pulmonary tuberculosis patients, a prospective cohort study.

Re-treatment pulmonary tuberculosis (PTB) has a high risk of being multi-drug- or rifampicin-resistant tuberculosis (MDR/RR-TB). The Xpert MTB/RIF assay possesses high efficacy for the evaluation of rifampicin resistance. The aim of the present study was to assess the benefit of the Xpert MTB/ RIF assay in the screening and treatment of MDR/RR-TB in re-treatment PTB patients. Patients with suspected re-treatment PTB were prospectively enrolled and divided into Xpert MTB/RIF and mycobacterial tuberculosis (MTB) culture groups. No Xpert MTB/RIF assay was carried out in the MTB culture group. The diagnostic performance and turn-around time (TAT) of MDR/RRTB detection and the culture results of MDR/RR-TB patients following two-month chemotherapy in two groups were calculated and compared. Using phenotypic DST as a reference standard, the positive predictive value of Xpert MTB/RIF for the detection of RR-TB and MDR-TB among re-treatment PTB patients was 90.72% and 77.32%, respectively. The Xpert MTB/RIF group had a significantly shorter interval for the initiation of anti-MDR/ RR-TB treatment {1 [1-1] vs. 52 [47-57] days, P<0.0001}; and following two-month chemotherapy, the percentage of positive culture MDR/RR-TB patients in the Xpert MTB/RIF group was significantly reduced (24.18% vs. 50%, P=0.0003). Xpert MTB/RIF can accurately screen MDR/RR-TB among re-treatment PTB patients, reducing both the turn-around time for therapy initiation and the percentage of positive culture MDR/ RR-TB patients following two-month chemotherapy. This is not only beneficial for treatment but also for reducing MDR-TB transmission. We recommend that re-treatment PTB patients receive anti-RR/TB chemotherapy following a positive RFP resistance result in the Xpert MTB/RIF assay.

The effectiveness of individualized treatment regimen on smear-positive retreatment pulmonary tuberculosis with mono- and poly-drug resistance

Objective: To analyze and evaluate the effectiveness of individualized treatment regimen in the therapy of smear-positive retreatment pulmonary tuberculosis with mono-and poly-drug resistance, and therefor to provide information on how to develop rational individualized regimen for retreatment tuberculosis cases with drug resistance. Methods: This was a multi-centered, prospective cohort study. Totally 254 cases of sputum positive tuberculosis with previous treatment history during the period from July 1, 2009 to August 30, 2016 were included in the analysis. All the cases were randomly divided into 3 groups and received therapy after randomization into treatment groups. After 3 months, cases with multidrug resistant tuberculosis, extensively drug-resistant tuberculosis, non-tuberculosis mycobacterial infection and those with smear-positive but culture-negative tuberculosis were excluded according to result of sputum culture and drug susceptibility test (DST). In treatment group A (individualized treatment group), 86 cases with an average age of (42.1±13.7) years for men and (38.5±12.8) years for women, were treated with individualized regimen, which allowed drug replacement on the basis of standard regimen (2SHRZE/6HRE) according to DST result. Treatment duration was recalculated after drug replacement and the total length should be 12 months or more. If the DST result did not show drug resistance, the patients would continue the 8 months' standard treatment. In treatment group B (intensified retreatment regimen group), 86 cases with an average age of (43.2±14.2) years for man and (37.9±14.1) years for women, received intensified retreatment regimen (2HL(2)EZS/2HL(2)EZS(3)/4HL(2)E). The dose for H was 0.3 g/d for patients with body weight <50 kg, and 0.4~0.5 g/d for higher body weight (≥50 kg); The doses for L(2,)E and Z were 0.6 g, 2/w; 0.75, 1/d and 0.5g, 3/d. In treatment group C (standard treatment group), 82 cases with an average of (42.5±11.9) years for man and (38.6±12.8) years for women, were treated with standardized regimen recommended by national tuberculosis program (2HREZS/6HRE). In both group B and C, the total treatment duration was 8 months and the drugs were not replaced for mono-and poly-drug resistance. Treatment outcomes of the 3 groups were analyzed, the status of drug replacement in group A was analyzed, and the adjustment of dose of H and R according to patients' body weight was observed. SPSS 19.0 was used for data analysis. Results: The treatment cure rates for group A, B and C were 73.3%(63/86), 76.7%(66/86) and 50%(41/82), and the treatment success rates were 80.2%(69/86), 84.9%(73/86) and 62.2%(51/82) respectively. Treatment failure was 8.1%(7/86), 4.7%(4/86) and 19.5%(16/82) in 3 groups. There were significant differences in the above indicators for group A and B in comparison with group C(χ(2)=13.127, P=0.001). However, there was no difference observed between group A and B(χ(2)=0.646, P=0.422). In group A, tuberculosis specialized hospitals using regular doses for R was only 38.7%(12/31). After 3 years' follow-up, no-relapse-success for group A was 66.7% (10/15). Conclusions: Inappropriate individualized treatment would increase treatment failure for retreatment tuberculosis. Higher doses of H and R and prolonged extensive therapy phase could contribute to increased treatment success.

The application of expanded nursing management in improving the medication compliance of re-treatment patients with pulmonary tuberculosis

Objective To ananlyze the application effect of expanded nursing management in improving the medication compliance of re-treatment patients with pulmonary tuberculosis. Methods A total of 92 cases of re-treatment patients with pulmonary tuberculosis treated in our hospital were selected and were randomly divided into experimental group and control group, 46 cases in each group. The control group received routine nursing management, while the experimental group received expanded nursing management. After 3 months' intervention, the relevant observed indicators of the pulmonary tuberculosis patients of the two groups were compared. Results The score of master degrees of medication knowledge and the medication adherence rate of the re-treatment pulmonary tuberculosis patients of the experimental group was significantly higher than that of the control group(P<0.05). Conclusion To implement expanded nursing management for the re-treatment pulmonary tuberculosis patients to carry out drug intervention can improve the patients' medication adherence, so as to promote the rehabilitation of disease. Key words: Extensification; Nursing; Re-treat pulmonary tuberculosis; Medication; Adherence

Assessment of diagnostic accuracy of Gene Xpert MTB/RIF in diagnosis of suspected retreatment pulmonary tuberculosis patients

BackgroundRetreatment cases of tuberculosis are reemerging as public and global health concerns, not only for dissemination of infection but for their multidrug resistant behavior as well, comprising an important challenge for National Tuberculosis Control Programs. Gene Xpert MTB/RIF is an automated molecular test for synchronized detection of tuberculosis and rifampicin resistance, recommended by the World Health Organization. This study was designed to assess the performance of single-sputum Gene Xpert MTB/RIF assay against the Ziehl–Neelsen smear, traditional culture and MGIT 960 in diagnosing suspected retreatment pulmonary tuberculosis cases and rifampicin resistance. Subjects and methodsFifty-eight patients were enrolled in this cross-sectional study from two Egyptian tertiary care hospitals. The patients were selected fulfilling clinical criteria of suspected retreatment TB. Early-morning sputum specimens were collected, decontamination liquefaction technique was done, the specimen was divided into four portions, the first and second portions were for the Ziehl–Neelsen smear and cultivation on the Löwenstein Jensen media. The third portion was processed in Gene Xpert MTB/RIF. The fourth part was used for confirmation of rifampicin susceptibility testing results by MGIT 960. ResultsGene Xpert MTB/RIF showed sensitivity, specificity and accuracy of 98.15%, 75% and 96.55% respectively in detection of mycobacterium tuberculosis. Regarding rifampicin mono-resistance, it carried the best sensitivity and specificity of 100% equal to that of reference test MGIT 960. ConclusionGene Xpert MTB/RIF is a sensitive, specific and accurate test for both diagnosis of retreatment MTB and rifampicin resistance. Finally the authors recommend restandardization of reference test with Gene Xpert MTB/RIF to obtain more valid results.

The value of initial cavitation to predict re-treatment with pulmonary tuberculosis.

ObjectivePulmonary cavitation is the classic hallmark of pulmonary tuberculosis (PTB) and is the site of very high mycobacterial burden associated with antimycobacterial drug resistance and treatment failure. The objective of this study was to investigate the relationship between re-treatment PTB and initial pulmonary cavitation coordinated with other clinical factors.MethodsWe conducted a case–control study of 291 newly diagnosed cases of pulmonary TB in The Infectious Hospital of Wuxi from Dec 2009 to Dec 2011 with complete follow-up information until December 31st of 2014. 68 patients were followed-up with PTB re-treatment; the rest of the PTB patients (n = 223) had completed anti-TB treatment, and cured without re-treatment were selected as controls.ResultsThe univariate analysis [hazard ratio (HR) 1.885, 95 % CI 1.170–3.035, P = 0.009] and the multivariable analysis (HR 2.242, 95 % CI 1.294–3.882, P = 0.004) demonstrated that the initial pulmonary cavitation was a prognostic predictor for TB re-treatment. Additionally, the re-treatment rates in PTB patients with cavitation and no-cavitation were 27.1 and 15.5 %, respectively, with significant difference (log-rank test; P = 0.010). Other factors, age of ≥60 and history of smoking, were also prognostic variables.ConclusionInitial pulmonary cavitation of chest X-ray was a significant predictor for PTB re-treatment

Predictors of Treatment Outcome for Retreatment Pulmonary Tuberculosis Cases among Tribal People of an Eastern India District: A Prospective Cohort Study.

Objective. The study was conducted to assess the treatment outcome of different category retreatment cases with the aim of finding out the important predictors of unfavorable outcomes. Methodology. This hospital based prospective cohort study was conducted in three tuberculosis units (TUs) of west Midnapore (a district of Eastern India), covering mostly the tribal populated areas. Patients who were registered for Category II antituberculosis treatment between 1st quarter of 2013 (Jan to Mar) and 4th quarter of 2013 (Oct to Dec) were considered as our study cohort and they were followed up till December 2014. The study was started with 177 patients but ultimately ended with 165 patients. Results. Unfavorable outcome was observed among 24.8% patients. Among them mostly 51.2% were defaulter, 22% were failure case, and 26.8% died during treatment. Patients, who were minority by religion, were found 4 times more vulnerable for unfavorable outcome. Unfavorable outcome was found 7 times more common among retreatment TB cases who remain sputum positive after completion of initiation phase of Category II treatment. Conclusion. Programmatic approach should be specified to address the minority by religion population and to reduce the load of sputum positive cases after completion of initiation phase treatment by tracking them.

PECULIARITIES OF CHEMIORESISTANT TUBERCULOSIS SPREAD IN TERNOPIL REGION IN RECENT YEARS

&lt;p&gt;&lt;em&gt;The article presents the&lt;/em&gt;&lt;em&gt; results of the study of susceptibility of M. tuberculosis isolated from patients with pulmonary tuberculosis in 2007 to -2013 in the Ternopol region (Ukraine)&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;The positive tendency of increasing the rate&lt;/em&gt;&lt;em&gt; of susceptibility of M. tuberculosis anti-TB drugs in 2013 in comparison 2007 in patients with new tuberculosis and other cases of tuberculosis but not recidivation was marked in Ternopil region&lt;/em&gt;&lt;em&gt;.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;I&lt;/em&gt;&lt;em&gt;n&lt;/em&gt;&lt;em&gt; patients with new tuberculosis the number of pathogens which were susceptible to anti-TB drugs of the first line I for this period increased on 12,6%, while in patients with re-treatment of pulmonary tuberculosis, except recidivation - increased in 1,7 times, and in patients&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;with&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;of&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;pulmonary&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;tuberculosis relapses this index fluctuated between &lt;/em&gt;&lt;em&gt;27,1-47,6&lt;/em&gt;&lt;em&gt;%. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;T&lt;/em&gt;&lt;em&gt;he&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;relative&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;amount&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;of&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;multiresistant&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;strains&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;during&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;this&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;period&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;has deeply increased&lt;/em&gt;&lt;em&gt;. Thus, &lt;/em&gt;&lt;em&gt;in&lt;/em&gt;&lt;em&gt; patients with new pulmonary tuberculosis twofold increase of the rate of multidrug-resistant strains in 2012 compared to 2010-2011 years was revealed. The same trend was observed in patients with tuberculosis recidivation. &lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;The attention was paid to &lt;/em&gt;&lt;em&gt;the &lt;/em&gt;&lt;em&gt;priority of the introduction of modern&lt;/em&gt;&lt;em&gt; express methods of tuberculosis diagnosis and examination of susceptibility of its causative agents to antimycobacterial drugs. It will permit to correct antimycobacterial treatment in time, and reduce the number of relapses and appearance of chronic pulmonary tuberculosis in patients with multiresistant pathogens.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;

Pyrosequencing for rapid detection of tuberculosis resistance in clinical isolates and sputum samples from re-treatment pulmonary tuberculosis patients.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is a major public health problem. Early diagnosis of MDR-TB patients is essential for minimizing the risk of Mycobacterium tuberculosis (MTB) transmission. The conventional drug susceptibility testing (DST) methods for detection of drug-resistant M.tuberculosis are laborious and cannot provide the rapid detection for clinical practice.MethodsThe aim of this study was to develop a pyrosequencing approach for the simultaneous detection of resistance to rifampin (RIF), isoniazid (INH), ethambutol (EMB), streptomycin (SM), ofloxacin (OFL) and amikacin (AMK) in M. tuberculosis clinical isolates and sputum samples from re-treatment pulmonary tuberculosis (PTB) patients. We identified the optimum conditions for detection mutation of rpoB, katG, rpsl, embB, gyrA and rrs gene by pyrosequencing. Then this approach was applied to detect 205 clinical isolates and 24 sputum samples of M. tuberculosis from re-treatment PTB patients.ResultsThe mutations of rpoB and gyrA gene were detected by pyrosequencig with the SQA mode, and the mutations of katG, rpsl, embB, gyrA and rrs gene were detected by pyrosequencing with SNP mode. Compared with the Bactec MGIT 960 mycobacterial detection system, the accuracy of pyrosequencing for the detection of RIF, INH, EMB, SM, AMK and OFL resistance in clinical isolates was 95.0%, 79.2%, 70.3%, 84.5%, 96.5% and 91.1%, respectively. In sputum samples the accuracy was 83.3%, 83.3%, 60.9%, 83.3%, 87.5% and 91.7%, respectively.ConclusionsThe newly established pyrosequencing assay is a rapid and high-throughput method for the detection of resistance to RIF, INH, SM, EMB, OFL and AMK in M.tuberculosis. Pyrosequencing can be used as a practical molecular diagnostic tool for screening and predicting the resistance of re-treatment pulmonary tuberculosis patients.

Patient and health system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi

BackgroundTuberculosis (TB) control remains a challenge in Malawi despite the National TB Control Program since 1984. This study aimed at measuring patient and health system delays and identifying factors associated with these delays.MethodsA cross-sectional survey of 588 pulmonary TB patients was conducted in three TB centres in Blantyre, Lilongwe, and Mzuzu, between July and December 2011 using a semi-structured questionnaire. Patient delay was defined as the time interval between the onset of TB symptom(s) (a common symptom being coughing) to the first visit to any health provider. Health system delay was the interval from the first care-seeking visit at any health provider to the initiation of anti-tuberculosis treatment. Participants were invited to participate in the study during intensive phase of treatment. The characteristics associated with patient and health system delays were analyzed.ResultsThe median patient delay was 14 days for both new and retreatment TB cases (interquartile range [IQR] 14 – 28 and 7 – 21, respectively). The median health system delay was 59 days (IQR 26 – 108) for new and 40.5 days (IQR 21–90) for retreatment cases. Factors associated with longer patient delay in new cases included primary education (adjusted odds ratio [AOR] 2.2, 95% CI 1.3 – 3.9) and knowledge that more than three weeks of coughing is a sign of TB (AOR 1.9, 1.1 – 3.3). In retreatment cases, distance >10 Km (AOR 3.3, 1.1 – 9.6) and knowledge that more than three weeks of coughing is a sign of TB (AOR 3.7, 1.3 – 10.7; p < 0.05) were significant factors. Making the first visit to a health centre (OR 1.9, 0.9 – 3.8) or a drug store/ traditional healer (OR 5.1, 1.1 – 21.7) in new TB cases were associated with a longer health system delay (p < 0.05) while smear negative (OR 6.4, 1.5 – 28.3), and smear unknown or not done (OR 6.1, 1.3 – 26.9) among retreatment cases were associated with a longer health system delay (p < 0.05).ConclusionsEffective management and new diagnostic techniques are needed especially among retreatment cases. It is also needed to address geographic barriers to accessing care and increasing TB awareness in the community.

A Study On Sociodemographic Pattern And Side Effects Of Anti-Tubercular Drugs Among Tuberculosis Patients In Pokhara Valley

Introduction: Tuberculosis is an infectious disease that mainly affects the lungs. Tuberculosis is one of the leading causes of morbidity and mortality in most developing countries. The SAARC region accounts more than 32% of global burden with 0.6 million deaths every year and 2.5 million new cases annually. The main aim of our study was to determine the socio-demographic patterns among tuberculosis patients in Pokhara Valley and side effects of anti tubercular drugs. Methodology: This study was conducted among 199 tuberculosis patients at Western Regional Tuberculosis Center, Pokhara, Nepal. These patients diagnosed as new as well as retreatment pulmonary tuberculosis cases were interviewed. Study variables such as age, gender, ethnicity, side effect encountered during the treatment, smoking and alcohol habit, socioeconomic status were statistically analyzed. Results: Among the 199 patient enrolled, 167(84%) patients were found to have one or more side-effects. Signifi cant relation was found between smoking and alcohol intake, socioeconomic status and disease occurrence. Prevalence of tuberculosis was higher among Gurungs. Conclusion: Socio-demographic factors also signifi cantly infl uence the occurrence of tuberculosis. The side effects of anti-tuberculosis drugs are more prevalent among the age group 19 to 65 years as compared to age group of 66 years and above. SAARC Journal of Tuberculosis, Lung Diseases &amp; HIV/AIDS; 2013; X(2); 41-44 DOI: http://dx.doi.org/10.3126/saarctb.v10i2.9712

Pulmonary resection can improve treatment outcome in re-treatment pulmonary tuberculosis and its complications

BackgroundPulmonary tuberculosis (TB) is a widely spread disease, usually treated by multidrug therapy, nevertheless there are increasing number of cases in which medical treatment fails and requires surgical intervention specially those with large cavitary lesions or persistent sputum positive for Ziehl Neelsen (ZN) stain. Our objective was to assess the role of pulmonary resection in treating certain cases of pulmonary TB and its outcome and morbidity. MethodsIn this study 45 tuberculous patients were selected for pulmonary resection (patients with large cavitary lesions and persistent sputum positive for ZN stain, massive hemoptysis, relapsed TB and treatment failure patients). Twenty-eight lobectomies (18 lobectomy for patients with relapsed TB with large cavities, persistent sputum positive and 10 lobectomy for patients with massive hemoptysis). Fourteen elective pneumonectomy for patients with symptomatic destroyed lung and 3 completion pneumonectomy were carried out. ResultsThirty-five patients (78%) were sputum positive preoperatively and 31 patients (69%) had cavitary lesions radiologically, MDR-TB was found retrospectively in 16 patients. Mortality was 4.4%, and postoperative complications were encountered in 44.4% of the participants. Forty-three patients (95.5%) became sputum negative 3–9months after surgery. Male sex, HCV infection, operation time, and intraoperative bleeding were predictive of bad outcome in this study. ConclusionsSurgery is effective when medical therapy fails to control pulmonary TB and its complications. MDR-TB patients are among those who benefit from pulmonary resection. Postoperative medical therapy is important to improve results and in achieving negative sputum conversion in TB patients including MDR-TB patients.

The profile and treatment outcomes of sputum smear positive pulmonary tuberculosis re-treatment cases, in a district medical college of West Bengal, India

Background: In a high tuberculosis (TB) burden county like India with different regional demography, knowledge about patient profile has a pivotal role in determining and identifying the factors associated with poor treatment outcomes among TB re-treatment cases. Aim: The aim was to describe the demography and clinical characteristics of TB re-treatment cases and to evaluate the factors associated with poor treatment outcomes among those patients. Settings and Design: A prospective longitudinal cohort study was carried out at chest medicine outdoor from February, 2011 to 2014 in a district medical college of West Bengal, India. Materials and Methods: Sputum smear positive re-treatment pulmonary TB patients attending our chest medicine outdoor during the 3 years study period were evaluated for demographic and clinical characteristics on the basis of previous treatment history and records at the beginning of the study. Patients were followed-up during the 8 months treatment period (Category II treatment regimen under Revised National TB Control Program). At the end of the study period, treatment outcomes were analyzed and factors associated with poor treatment outcomes were identified. Statistical Analysis: All variables were described by proportions, and differences between independent groups were compared using the Chi-square test and Fisher's exact test, as applicable. Results: Among 74 patients, re-treatment was successful in 75.7% of relapse case, 66.7% of loss to follow-up cases and 53.8% of failure cases. Re-treatment failure was higher (38.5%) in treatment failure cases compare to relapse cases (10.8%) and initial loss to follow-up cases (16.7%). Young age, male, unmarried, employed who work outside appears to be the risk factors for loss to follow-up. Low body mass index, treatment from the private sector, history of alcoholism, radiological cavitory lesion, larger duration of previous treatment, lesser gap from previous treatment has unfavorable outcome. Conclusion: Patients relapses after a single course of anti-TB treatment are likely to be cured with the Category II re-treatment regimen and failure cases have a high risk of re-treatment failure. Loss to follow-up patients should be educated, and extra care must be taken to prevent further loss to follow-up during re-treatment.

Contributions of culture and antimicrobial susceptibility tests to the retreatment of patients with pulmonary tuberculosis

This study evaluated the efficacy of retreatment of pulmonary tuberculosis (TB) with regard to treatment outcomes and antimicrobial susceptibility testing (ST) profiles. This retrospective cohort study analyzed 144 patients treated at a referral hospital in Brazil. All of them had undergone prior treatment, were smear-positive for TB and received a standardized retreatment regimen. Fisher’s 2-tailed exact test and the χ² test were used; RRs and 95% CIs were calculated using univariate and multivariate binary logistic regression. The patients were cured in 84 (58.3%) cases. Failure was associated with relapsed treatment and abandonment (n=34). Culture tests were obtained for 103 (71.5%) cases; 70 (48.6%) had positive results. ST results were available for 67 (46.5%) cases; the prevalence of acquired resistance was 53.7%. There were no significant differences between those who achieved or not therapeutic success (p=0.988), despite being sensitive or resistant to 1 or more drugs. Rifampicin resistance was independently associated with therapeutic failure (OR: 4.4, 95% CI:1.12-17.37, p=0.034). For those cases in which cultures were unavailable, a 2nd model without this information was built. In this, return after abandonment was significantly associated with retreatment failure (OR: 3.59, 95% CI:1.17-11.06, p=0.026). In this cohort, the general resistance profile appeared to have no influence on treatment outcome, except in cases of rifampicin resistance. The form of reentry was another independent predictor of failure. The use of bacterial culture identification and ST in TB management must be re-evaluated. The recommendations for different susceptibility profiles must also be improved.

Prevalence of multidrug resistance among retreatment pulmonary tuberculosis cases in a tertiary care hospital, Hyderabad, India

Background:India is one of the high tuberculosis (TB) burden countries in the world. India ranks second in harboring multi drug resistant (MDR)-TB cases. About 50,000 of MDR cases are recorded in retreatment pulmonary TB cases. This study was conducted in a tertiary care facility (Government General and Chest Hospital) in Hyderabad, India.Objectives:Toassess: Proportion of the TB patients having MDR-TB at the initiation of retreatment regimen; the prevalence of isoniazid (INH) resistance in this geographical area.Materials and Methods:An analytical, observational, prospective cohort study of patients attending the out-patient department from December 2010 to March 2011.Results:Sputum samples from 100 patients were subjected to acid fast bacilli (AFB) culture and drug sensitivity testing. Of these, 28 (28%) were MDR-TB, 42 (42%) were non-MDR-TB and 39% being INH resistance.Conclusions:In conclusion, one third of the retreatment pulmonary TB cases attending a tertiary care institute for TB will be MDR-TB at the initiation of treatment and there is a need to include ethambutol in the continuation phase of new TB case treatment in view of high INH resistance.

Diagnostic performance of multiplex cytokine and chemokine assay for tuberculosis

Simultaneous detection of multiple biomarkers might lead to improved diagnostic performance for Mycobacterium tuberculosis infection. In this study, we screened soluble biomarkers that had significant differences in patients with active tuberculosis and healthy controls and evaluated the diagnostic performance of the multiplex cytokine/chemokine assay. Overall, 178 patients with active pulmonary tuberculosis, 156 healthy individuals and 35 patients with bacterial pneumonia or lung cancer were evaluated. Among the 16 soluble biomarkers screened by the microbead-based multiplex assay, five cytokines/chemokines including IFN-γ, IP-10, MIG, TNF-α and IL-2 that showed most significant differences between active pulmonary tuberculosis patients and healthy controls were selected for further analysis. When analyzed individually, both IP-10 and MIG had sensitivity and specificity comparable to IFN-γ in detection of active TB. Combined detection of IFN-γ, IP-10 and MIG had significantly improved sensitivity and specificity as compared with individual cytokine and chemokine detection. The responsive levels of IFN-γ, IP-10, MIG, TNF-α and IL-2 were significantly lower in re-treatment pulmonary tuberculosis patients than in new tuberculosis patients. It is concluded that combined IFN-γ, IP-10, MIG multiplex detection had better diagnostic performance for tuberculosis than the individual cytokine/chemokine assays. The re-treatment pulmonary tuberculosis patients had poor responses to ESAT-6/CFP-10 peptides stimulation.

Changes and significance of peripheral blood T cell subsets, soluble interleukin-2 receptor and interferon-gamma in patients with retreatment pulmonary tuberculosis and initial treatment tuberculosis

The aim of this study was to compare the expression of peripheral blood T cell subsets, soluble interleukin-2 receptor (sIL-2R) and interferon-gamma (IFN-γ) in patients with retreatment pulmonary tuberculosis, initial treatment pulmonary and extra-pulmonary tuberculosis, and therefore to explore the cellular immune changes and the significance among different types and severity of tuberculosis. A total of 170 patients with tuberculosis in Pulmonary Hospital of Shanghai from December 2009 to January 2011, including 98 males and 72 females, aged from 16 to 70 years (average 40 years), were included in this study. The patients were divided into retreatment pulmonary tuberculosis group (47 cases), initial treatment pulmonary tuberculosis group (62 cases) and initial treatment extra-pulmonary tuberculosis group (61 cases). Furthermore, the 109 patients with pulmonary tuberculosis were divided into different subgroups according to cavity formation and the lung fields involved: patients without lung cavity (52 cases) vs those with lung cavity (57 cases), patients with involvement of 1 - 2 lung fields (48 cases), vs 3 - 4 lung fields (26 cases) and 5 - 6 lung fields (35 cases). Peripheral blood T cell subsets (by flow cytometry doubled-labeled antibody), sIL-2R and IFN-γ (by ELISA) were determined in 170 patients. Differences between means of 2 groups were tested by t test, differences among multiple groups were tested by analysis of variance (ANOVA), and multiple comparisons among multiple groups were tested by LSD-t test or χ² test. Linear regression equation was used to analyze the correlations. The levels of peripheral blood CD₄/CD₈ in patients with retreatment pulmonary tuberculosis and initial treatment extra-pulmonary tuberculosis patients were significantly lower than that in initial treatment pulmonary tuberculosis patients, [(1.7 ± 0.7), (1.6 ± 0.7) and (2.0 ± 0.7) respectively (F = 4.380, P < 0.05)]. The levels of serum sIL-2R in patients with retreatment pulmonary tuberculosis and initial treatment extra-pulmonary tuberculosis were significantly higher than that in initial treatment pulmonary tuberculosis patients [(224 ± 89) pmol/L, (209 ± 98) pmol/L, (167 ± 73) pmol/L, (F = 6.402, P < 0.01)]. The levels of serum IFN-γ in patients with retreatment pulmonary tuberculosis and initial treatment extra-pulmonary tuberculosis were significantly higher than that in initial treatment pulmonary tuberculosis patients [(37 ± 23) ng/L, (37 ± 24) ng/L, (29 ± 16) ng/L, (F = 2.799, P < 0.05)]. The levels of peripheral blood CD₄/CD₈ in initial treatment and retreatment cavity pulmonary tuberculosis patients were lower than that in pulmonary tuberculosis patients without cavity, but the results of sIL-2R and IFN-γ were the opposite [(1.7 ± 0.6) vs (2.0 ± 0.8), (214 ± 93) pmol/L vs (167 ± 68) pmol/L and (38 ± 22) ng/L vs (27 ± 14) ng/L, t = -2.813 to 3.076, P < 0.05 or P < 0.01]. The level of serum sIL-2R was negatively correlated with peripheral blood CD₄/CD₈ level in all the patients (r = -0.380, P < 0.01). Patients with retreatment pulmonary tuberculosis and initial treatment extra-pulmonary tuberculosis had lower cellular immune function as compared to those with initial treatment pulmonary tuberculosis, and the cellular immune function was significantly correlated with the extent and cavity formation of pulmonary lesions.