Smear Conversion Research Articles

Ефективність лікування хворого на вперше діагностований туберкульоз легень із супутньою патологією в залежності від способу введення антимікобактеріальних препаратів

Resume. The use of antimycobacterial therapy in its majority leads to a positive dynamics of the TB disease, smear and sputum cultures conversion and cure of the patient. The lack of an expected positive response to the therapy happens in a limited number of patients. One of the most common reason for the lack of a positive response, in the conditions of the appointment of therapeutic agents in accordance with the identified sensitivity and controlled use of chemotherapy, may be the presence of concomitant pathology and malabsorption / maldigestia syndrome. Your attention is given to the clinical case of the progression of pulmonary tuberculosis on the background of oral administration of antimycobacterial drugs. During the treatment, the presence of chronic pancreatitis and malabsorption syndrome of oral forms of drugs was confirmed, which allowed changing the treatment tactics and reaching the patient's cure.

Treatment outcome of multidrug-resistant tuberculosis with modified DOTS-plus strategy: A 2 years' experience.

Background:Multidrug-resistant tuberculosis (MDR-TB) is a global health problem with notoriously difficult and challenging treatment. This study determined treatment outcome in patients of MDR-TB with modified DOTS-Plus strategy.Methods:Ninety-eight consecutive MDR-TB patients treated with standardized regimen according to modified DOTS-Plus strategy aligned to the existing national DOTS-Plus guidelines with relevant modifications proposed by Chennai consensus were analyzed prospectively. Treatment included monthly follow-up with clinical, radiological, and bacteriological assessment (sputum smear advised monthly till conversion then quarterly; culture for Mycobacterium tuberculosis at 0, 4, 6, 12, 18, and 24 months), ensuring adherence, intense health education, and monitoring of adverse events (AEs). Patients' outcome was considered as cure when at least two of the last three cultures (all three or last two) were negative and as failure when the same were positive.Results:Favorable and unfavorable outcomes in this cohort were reported to be 71/98 (72.4%) and 27/98 (27.6%) (failure – 10 [10.2%], default – 7 [7.1%], and expiry – 10 [10.2%]), respectively. Sputum smear and culture conversion rate were 75/81 (92.5%) and 71/81 (87.7%), respectively. Major AEs were experienced in only 17.4% of patients.Conclusions:MDR-TB can be cured successfully with modified DOTS-Plus strategy and requires much effort from both the patients and health-care workers. It can be an alternative model for treating MDR-TB patients in private sector.

Serum isoniazid concentration in the patients as an indicator of the effectiveness and toxicity of tuberculosis treatment

Introduction The low serum concentration of the anti-tuberculosis (TB) drugs in TB patients is observed quite often, but the significance of this phenomenon remains controversial. Aim The aim of the presented research was to clarify the association between isoniazid concentration and TB-treatment outcomes. Material and methods Blood samples were obtained from 86 patients with newly diagnosed pulmonary TB at Odessa Regional TB Hospital in 2015. The level of isoniazid in blood was measured 2 h, 4 h, 6 h, and 24 h after the administration of isoniazid. The medical records of the enrolled patients at the beginning and at the end of the in-patient treatment, and the activity of the biochemical indices were considered. Results and discussion At the end of the in-patient treatment in patients with a serum isoniazid concentration of more than 2 µg/mL (HIC), 4 h after the drug administration, the resorption of TB infiltrates in lungs occurred 1.3 times more frequently than in patients with an isoniazid concentration of less than 2 µg/mL (LIC). According to the culture method, the smear conversion occurred 3.1 times more often in patients with HIC than in the LIC ones. A positive correlation was found between the isoniazid serum level with the bilirubin level, thymol probe, and the AsAT activity, which proved the higher risk of hepatotoxicity in patients with HIC. Conclusions Thus, the measurement of the isoniazid concentration after 4 h of isoniazid administration can predict the outcome of the TB-treatment. It is postulated that the recommended concentration of isoniazid in blood 4 h after its administration > 2 µg/mL.

Pulmonary tuberculosis in the immunocompromised patients

Background/Aim. During the last few decades, immunocompromising diseases led to an increase in the number of tuberculosis cases. The aim of this study was to examine the influence of immunocompromising diseases on the course of tuberculosis. Methods. The research included two groups, each consisting of 40 subjects with tuberculosis, who were treated at the Institute for Pulmonary Diseases of Vojvodina during 2010 and 2011. The first group had no immunocompromising diseases (the kontrol group), whereas the second group contained patients with accompanying immunocompromising diseases. The data from the patients? medical history, from the Center for Microbiology and from the Radiology Center were used. The two groups were compared according to the following characteristics: age, sex, bacteriological status, radiological presence of the disease, presence of adverse effects of drugs, presence of resistance to drugs, duration of the therapy regimen and the duration of hospitalization. Results. The group of immunocompromised patients was older in average than the control group and included a higher percentage of males. The immunocompromised group had statistically important longer average time required for the sputum smear conversion (p = 0.000) and for the conversion of sputum cultures to M. tuberculosis (p = 0.010), more frequent presence of cavity (p = 0.030), longer average therapy regimen duration (p = 0.000) and higher average number of hospital days (p = 0.000) compared to the control group. The most frequent localization of changes in the immunocompromised patients was in all lobes of both lungs (32.5%) whereas the changes in the control group were mostly localized in the upper lung lobes (62.5%). There was no statistically important difference in the finding of sputum smear positive acidfast bacilli on direct micoscropy, the presence of adverse effects of drugs and M. tuberculosis resistance to drugs between the two groups of patients. Conclusion. The immunocompromising diseases change the course of tuberculosis, primarily by affecting bacteriological status, radiological presentation, the length of therapy regimen and the duration of hospitalization.

A PROSPECTIVE SINGLE-BLINDED STUDY ON THE SAFETY AND EFFICACY OF ZINC SUPPLEMENTATION IN PULMONARY TUBERCULOSIS

Aim and Objectives: The aim of the study was to study the serum zinc (Zn) levels, safety, and efficacy of Zn supplementation in pulmonary tuberculosis (PTB) patients.Methods: A randomized single-blinded study of two groups: Group A received conventional TB therapy while Group B received conventional TB therapy along with 15 mg of Zn tablet. 40 patients were assigned in each group by randomized permuted blocks.Results: After 8 weeks of treatment in Group A 27 patients and Group B 36 patients were found to be sputum negative with p=0.0421 and 0.0629. After 24 weeks of treatment in Group A 37 patients and Group B 40 patients were found to be sputum negative with p=0.00976 and 0.00971. By this, the given treatment was effective in the patients with PTB.Conclusion: Zn supplementation improves the effect of TB medication treatment and results in earlier sputum smear conversion.

FIXED-DOSE COMBINATION VERSUS SEPARATE ANTITUBERCULOSIS FORMULATIONS IN PULMONARY TUBERCULOSIS PATIENTS: EVALUATION OF EFFECTIVENESS AND SAFETY

Objective: This study aimed to compare the effectiveness and safety of fixed dose combination (FDC) versus separate (separate formulation [SF])antituberculosis (TB) formulations in patients with bacteriologically confirmed pulmonary TB.Methods: Data were collected retrospectively from patient records, which included all newly diagnosed bacteriologically confirmed pulmonaryTB patients treated with first category FDC or SF between January 2014 and January 2017 at the Dr. Esnawan Antariksa Hospital. The efficacy ofthe formulations was determined according to acid-fast bacilli (AFB) sputum smear conversion at the end of the intensive phase (month 2), after6 months of therapy, and after the extended treatment phase (month 3). Adverse drug reactions (ADRs) during treatments were recorded as safetyoutcomes. Chi-square tests were used to analyze the differences between the groups.Results: On comparing patients treated with FDC (n=33) and SF (n=30), rates of sputum conversions did not differ significantly after 2 months(83.3% vs. 78.7%, p=0.693) and the intensive phase was extended by 1 month for patients with conversion failures at this time point. One of sevenpatients in the FDC group did not achieve sputum conversion during the extended phase and was recorded as a medication failure. At the end ofcontinuation phase, all other subjects achieved sputum conversion. The overall frequencies of ADRs were not significantly higher in the FDC groupthan that in the SF group (36.4% vs. 23.3%, p=0.260).Conclusion: No differences in effectiveness and safety profiles were identified between first category FDC and separate anti TB formulations.

Mycobacterium africanum (Lineage 6) shows slower sputum smear conversion on tuberculosis treatment than Mycobacterium tuberculosis (Lineage 4) in Bamako, Mali.

ObjectiveAncestral M. tuberculosis complex lineages such as M. africanum are underrepresented among retreatment patients and those with drug resistance. To test the hypothesis that they respond faster to TB treatment, we determined the rate of smear conversion of new pulmonary tuberculosis patients in Bamako, Mali by the main MTBc lineages.MethodsBetween 2015 and 2017, we conducted a prospective cohort study of new smear positive pulmonary tuberculosis patients in Bamako. Confirmed MTBc isolates underwent genotyping by spoligotyping for lineage classification. Patients were followed at 1 month (M), 2M and 5M to measure smear conversion in auramine (AR) and Fluorescein DiAcetate (FDA) vital stain microscopy.ResultAll the first six human MTBc lineages were represented in the population, plus M. bovis in 0.8% of the patients. The most widely represented lineage was the modern Euro-American lineage (L) 4, 57%, predominantly the T family, followed by L6 (M. africanum type 2) in 22.9%. Ancestral lineages 1, 5, 6 and M. bovis combined amounted to 28.8%. Excluding 25 patients with rifampicin resistance, smear conversion, both by AR and FDA, occurred later in L6 compared to L4 (HR 0.80 (95% CI 0.66–0.97) for AR, and HR 0.81 (95%CI 0.68–0.97) for FDA). In addition we found that HIV negative status, higher BMI at day 0, and patients with smear grade at baseline ≤ 1+ were associated with earlier smear conversion.ConclusionThe six major human lineages of the MTBc all circulate in Bamako. Counter to our hypothesis, we found that patients diseased with modern M. tuberculosis complex L4 respond faster to TB treatment than those with M. africanum L6.

794. Infectivity of Smear-Positive Pulmonary TB After 2 Weeks of Rifampicin-based Anti-Tuberculous Therapy

BackgroundPulmonary tuberculosis (TB) remains one of the leading infectious causes of morbidity and mortality worldwide. Most data showed that infectiousness of pulmonary TB diminishes rapidly after 2 weeks of effective anti-tuberculous therapy and the bacilli seen in the smear after 2 weeks are most likely nonviable. We aim to assess this hypothesis by doing sputum culture after 2 weeks of therapy to assess the viability of the bacilli in the smear.MethodsA prospective cohort study was conducted on patients admitted to Communicable Disease Centre (CDC), Qatar with smear positive pulmonary tuberculosis during the period November 2013–November 2014. We repeated sputum smear and culture after 2 weeks of rifampicin based regimen to assess the infectivity. Demographic and clinical characteristics of patients was evaluated and compared with smear and culture conversion rate.ResultsNinety-five cases were included in the study. All had sputum smear and culture after 2 weeks of supervised rifampicin based therapy (Table 1). Sputum culture at two weeks of treatment was positive in 91 cases (95.7%) and only four cases were culture negative after 2 weeks. Demographic and clinical characteristics were compared with the culture status after 2 weeks, found Patient from Indian subcontinent and symptoms duration more than 1 month are less likely to clear infection after 2 weeks with P-value 0.01 and 0.009, respectively (Table 2). The calculated mean for sputum smear and culture conversion rate was 4 and 8 weeks, respectively. The presence of cough and the duration of symptoms were associated significantly with rapid sputum conversion (P < 0.05); however, the presence of cavity on CXR had no statistical significant effect (Table 3). ConclusionMajority of our patients in the study have positive TB culture after two weeks of rifampicin based anti-tuberculosis therapy. So, discontinuation of the isolation after 2 weeks of treatment assuming that bacilli in the smear are nonviable may not be safe.Disclosures All authors: No reported disclosures.

Gender differences in tuberculosis treatment outcomes: a post hoc analysis of the REMoxTB study

BackgroundIn the REMoxTB study of 4-month treatment-shortening regimens containing moxifloxacin compared to the standard 6-month regimen for tuberculosis, the proportion of unfavourable outcomes for women was similar in all study arms, but men had more frequent unfavourable outcomes (bacteriologically or clinically defined failure or relapse within 18 months after randomisation) on the shortened moxifloxacin-containing regimens. The reason for this gender disparity in treatment outcome is poorly understood.MethodsThe gender differences in baseline variables were calculated, as was time to smear and culture conversion and Kaplan-Meier plots were constructed. In post hoc exploratory analyses, multivariable logistic regression modelling and an observed case analysis were used to explore factors associated with both gender and unfavourable treatment outcome.ResultsThe per-protocol population included 472/1548 (30%) women. Women were younger and had lower rates of cavitation, smoking and weight (all p < 0.05) and higher prevalence of HIV (10% vs 6%, p = 0.001). They received higher doses (mg/kg) than men of rifampicin, isoniazid, pyrazinamide and moxifloxacin (p ≤ 0.005). There was no difference in baseline smear grading or mycobacterial growth indicator tube (MGIT) time to positivity. Women converted to negative cultures more quickly than men on Lowenstein-Jensen (HR 1.14, p = 0.008) and MGIT media (HR 1.19, p < 0.001). In men, the presence of cavitation, positive HIV status, higher age, lower BMI and ‘ever smoked’ were independently associated with unfavourable treatment outcome. In women, only ‘ever smoked’ was independently associated with unfavourable treatment outcome. Only for cavitation was there a gender difference in treatment outcomes by regimen; their outcome in the 4-month arms was significantly poorer compared to the 6-month treatment arm (p < 0.001). Women, with or without cavities, and men without cavities had a similar outcome on all treatment arms (p = 0.218, 0.224 and 0.689 respectively). For all other covariate subgroups, there were no differences in treatment effects for men or women.ConclusionsGender differences in TB treatment responses for the shorter regimens in the REMoxTB study may be explained by poor outcomes in men with cavitation on the moxifloxacin-containing regimens. We observed that women with cavities, or without, on the 4-month moxifloxacin regimens had similar outcomes to all patients on the standard 6-month treatment. The biological reasons for this difference are poorly understood and require further exploration.

Decentralized, Community-Based Treatment for Drug-Resistant Tuberculosis: Bangladesh Program Experience

Bangladesh is a highly populous country where the prevalence of drug-resistant tuberculosis (DR-TB) is growing. With the rapid increase in DR-TB notifications through GeneXpert technology, it was imperative to come up with a new treatment strategy that could keep up with the increase of patients diagnosed. Intervention was designed to support national transition of DR-TB management of World Health Organization-approved long course (20-to-24-month regimen) treatment from a hospital-based approach to the decentralized model of community-based programmatic management of DR-TB (cPMDT). In close coordination with the Ministry of Health and Family Welfare and National TB Program, patients were initiated into treatment at hospitals and then transferred to community-based care. A cadre of directly observed therapy providers supported treatment at the household level, supervised by the outpatient DR-TB teams. We conducted a descriptive pre- and post-intervention study of all 1,946 DR-TB patients enrolled in treatment nationwide between May 2012 and June 2015. Data were collected from hospitals, patient cards, district records, and diagnostic laboratories through the National TB Program. Intervention results were assessed in comparison with the baseline (2011) indicators. During the intervention period, treatment enrollment of 1,946 diagnosed DR-TB patients through the national program increased from 50% in 2011 to 100% in 2015. The delay between diagnosis and treatment initiation decreased from 69 days in 2011 to 6 days in 2014. Most (95%) of the patients completed all scheduled follow-up smear and culture tests. By the sixth month of treatment, 99% of patients had negative smear conversion and 98% had negative culture conversion. The treatment success rate increased from 70% in 2011 to 76% in 2015 at the end of the intervention period. The results also indicate a decline between baseline and end line from 14% to 9% for patients died, 14% to 10% for loss to follow-up, and 1.7% to 0% for treatment failure. Community-based management is an effective approach for increasing access to quality-assured DR-TB treatment. Using existing structures and resources, the intervention demonstrated that favorable treatment outcomes can be achieved and sustained by treating patients with DR-TB at their homes.

Longitudinal body weight and sputum conversion in patients with tuberculosis, Southwest Ethiopia: a retrospective follow-up study

ObjectivesTo describe the association between change in body weight and sputum smear conversion and to identify factors linked with body weight and sputum smear conversion in Jimma University Specialized Hospital,...

Factors Influencing Sputum Smear and Culture Conversion Time among Patients with Pulmonary Tuberculosis

Introduction: Pulmonary tuberculosis is a contagious bacterial infection that involves the lungs and it may spread to other organs. Sputum smear and culture conversion are important indicators for the effectiveness of treatment and the infectivity of the patient. The present study aims to find sputum smear and culture conversion time and the factors that influence the conversion time among tuberculosis patients at National Tuberculosis Centre in Nepal.&#x0D; Methods: A total of 54 patients, who were diagnosed with laboratory confirmed pulmonary tuberculosis and under antitubercular therapy were monitored for sputum smear and culture conversion time. The blood specimens from each patient were processed for hemoglobin, platelets, erythrocyte sedimentation rate and blood glucose levels. Patient’s clinical history, risk factors that prolong conversion time and sociodemographic information were also collected by direct interview.&#x0D; Results: The mean sputum smear and culture conversion were found to be 54.4 days and 45.5 days respectively. Old age, smoking habit, low body mass index value, Treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate values were found to be associated with long sputum conversion time. Radiographic involvement of only left lungs, presence of fewer symptoms, aged between 15-45 years, having normal weight, without smoking habit and being married, were found to be associated with short sputum conversion time.&#x0D; Conclusions: The sputum microscopy, old age, smoking habit, low body mass index value, treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate value had been found to be significantly associated with long sputum conversion time.

Fixed-dose combination associated with faster time to smear conversion compared to separate tablets of anti-tuberculosis drugs in patients with poorly controlled diabetes and pulmonary tuberculosis in Qatar

BackgroundDiabetes is associated with increased risk of tuberculosis (TB) treatment failure, death, and relapse compared to patients without diabetes. Current TB regimens are available as fixed dose combination (FDC) and separate tablets (ST), in which using the former is purported to make it easier to adhere and complete treatment. So far there are no studies assessing the performance of FDC compared to ST in diabetic patients with pulmonary TB.MethodologyA retrospective cohort study was conducted, and included eight hospitals in Qatar in which patients diagnosed with pulmonary TB received rifampin, isoniazid, pyrazinamide, and ethambutol (as FDC or ST) given as directly observed therapy. Sputum smears for acid fast bacilli were tested weekly. We included patients admitted between December 2012 and December 2015, ≥18 years old, diagnosed with TB with pretreatment positive sputum smears, and having diabetes. Patients with Mycobacterium tuberculosis that was resistant to any first-line drug were excluded. Blood glucose was monitored closely and controlled to < 180 md/dL using oral hypoglycemic agents and/or insulin. We assessed the effectiveness of TB regimens by comparing time to confirmed negative smears between those treated with FDC or ST, and the impact of adding metformin.Results103 patients met inclusion criteria. Mean age and body mass index were 45.6 ± 9.1 years and 22.1 ± 3.6 kg/m2, respectively. Fifty-four (52%) patients received the FDC. There was no difference between groups in baseline characteristics and sputum bacillary loads. Patients prescribed FDC showed faster times to sputum smear conversion compared to ST (32 ± 19 vs. 46 ± 31 days, p = 0.01). The difference was greater among patients with pretreatment bacillary load of 3+ (FDC 36.6 ± 19.5 vs. ST 56.1 ± 28.8, p = 0.008). Receipt of metformin≥2000 mg/day altered the difference in time to smear conversion (FDC 30.7 ± 13.4 vs. ST 62 ± 35.5, p = 0.016), which was of greatest difference in those with pretreatment bacillary load 3+ and who received metformin≥2000 mg/day (FDC 36 ± 12.1 vs. ST 92.2 ± 26 days, p = 0.001).ConclusionPatients with diabetes and prescribed FDC showed faster smear conversion during treatment for pulmonary TB compared to ST which was more pronounced in those with 3+ bacillary load pretreatment and which appeared to be modified by higher dose metformin.

Therapeutic effects of recombinant human interleukin 2 as adjunctive immunotherapy against tuberculosis: A systematic review and meta-analysis.

BackgroundInterleukin 2 (IL-2) is a cytokine secreted by activated T cells. Studies exploring recombinant human interleukin 2 (rhuIL-2) as an adjunctive immunotherapeutic agent to treat tuberculosis (TB) have shown variable results; however, the true therapeutic efficacy of rhuIL-2 administration in TB patients has not been determined.MethodsA systematic review to identify publications exploring the association between rhuIL-2-based immunotherapy for TB and outcomes (sputum culture conversion, sputum smear conversion, radiographic changes, and leukocyte phenotype changes) in patients with pulmonary TB published before June 8, 2018 was performed. Data were extracted and analyzed by two investigators independently.ResultsA total of 2,272 records were screened. Four randomized controlled trials (RCTs) comprising 656 pulmonary TB patients were finally included. The rhuIL-2 treatment could significantly improve the sputum culture conversion of TB (RR, 1.18; 95%CI: 1.03–1.36; I2 < 0.01; P = 0.019) after at least 3 months of anti-TB therapy and the sputum smear conversion of TB during anti-TB therapy. Treating multidrug-resistant tuberculosis (MDR-TB) with rhuIL-2 could improve the sputum culture conversion (RR, 1.28; 95%CI: 1.05–1.57; I2 < 0.01; P = 0.016) and smear conversion (RR, 1.28; 95%CI: 1.09–1.51; I2 < 0.01; P = 0.003) at the end of anti-TB treatment. Meanwhile, rhuIL-2-based adjunctive immunotherapy could expand the proliferation and conversion of CD4+ and natural killer (NK) cells. Three of the included studies suggested that radiographic changes could not be improved by the use of rhuIL-2 as adjunctive immunotherapy. Publication bias did not exist.ConclusionsBased on this first meta-analysis, rhuIL-2-based adjunctive immunotherapy appears to expand the proliferation and conversion of CD4+ and NK cells, as well as improve the sputum culture (at 3 months and later) and smear conversion of TB patients.

Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies.

BackgroundIncomplete adherence to tuberculosis (TB) treatment increases the risk of delayed culture conversion with continued transmission in the community, as well as treatment failure, relapse, and development or amplification of drug resistance. We conducted a systematic review and meta-analysis of adherence interventions, including directly observed therapy (DOT), to determine which approaches lead to improved TB treatment outcomes.Methods and findingsWe systematically reviewed Medline as well as the references of published review articles for relevant studies of adherence to multidrug treatment of both drug-susceptible and drug-resistant TB through February 3, 2018. We included randomized controlled trials (RCTs) as well as prospective and retrospective cohort studies (CSs) with an internal or external control group that evaluated any adherence intervention and conducted a meta-analysis of their impact on TB treatment outcomes. Our search identified 7,729 articles, of which 129 met the inclusion criteria for quantitative analysis. Seven adherence categories were identified, including DOT offered by different providers and at various locations, reminders and tracers, incentives and enablers, patient education, digital technologies (short message services [SMSs] via mobile phones and video-observed therapy [VOT]), staff education, and combinations of these interventions. When compared with DOT alone, self-administered therapy (SAT) was associated with lower rates of treatment success (CS: risk ratio [RR] 0.81, 95% CI 0.73–0.89; RCT: RR 0.94, 95% CI 0.89–0.98), adherence (CS: RR 0.83, 95% CI 0.75–0.93), and sputum smear conversion (RCT: RR 0.92, 95% CI 0.87–0.98) as well as higher rates of development of drug resistance (CS: RR 4.19, 95% CI 2.34–7.49). When compared to DOT provided by healthcare providers, DOT provided by family members was associated with a lower rate of adherence (CS: RR 0.86, 95% CI 0.79–0.94). DOT delivery in the community versus at the clinic was associated with a higher rate of treatment success (CS: RR 1.08, 95% CI 1.01–1.15) and sputum conversion at the end of two months (CS: RR 1.05, 95% CI 1.02–1.08) as well as lower rates of treatment failure (CS: RR 0.56, 95% CI 0.33–0.95) and loss to follow-up (CS: RR 0.63, 95% CI 0.40–0.98). Medication monitors improved adherence and treatment success and VOT was comparable with DOT. SMS reminders led to a higher treatment completion rate in one RCT and were associated with higher rates of cure and sputum conversion when used in combination with medication monitors. TB treatment outcomes improved when patient education, healthcare provider education, incentives and enablers, psychological interventions, reminders and tracers, or mobile digital technologies were employed. Our findings are limited by the heterogeneity of the included studies and lack of standardized research methodology on adherence interventions.ConclusionTB treatment outcomes are improved with the use of adherence interventions, such as patient education and counseling, incentives and enablers, psychological interventions, reminders and tracers, and digital health technologies. Trained healthcare providers as well as community delivery provides patient-centered DOT options that both enhance adherence and improve treatment outcomes as compared to unsupervised, SAT alone.

Time to sputum smear and culture conversions in multidrug resistant tuberculosis at University of Gondar Hospital, Northwest Ethiopia.

BackgroundSputum smear and culture conversions are an important indicator of treatment efficacy and help to determine treatment duration in multidrug resistant tuberculosis (MDR-TB) patients. There are no published studies of sputum smear and culture conversion of MDR-TB patients in Ethiopia. The objective of this study is to evaluate and compare time to initial sputum smear and culture conversion and to identify factors influencing time to culture conversion.MethodsA retrospective cohort study was conducted among all culture positive and rifampicin mono resistant (RR) or MDR-TB patients from September 2011 to August 2016 at University of Gondar Hospital. Sputum cultures were collected monthly and conversion was defined as two consecutive negative cultures taken at least 30 days apart. Data were entered using EpiData and exported to SPSS software for analysis. Cox proportional hazard model was used to determine the predictor variables for culture conversion.ResultsOverall, 85.5% (201/235) of the patients converted their cultures in a median of 72 days (inter-quartile range: 44–123). More than half (61.7%) of patients achieved culture conversion within three months. The median time for sputum smear conversion was 54 days (inter-quartile range: 31–72). The median time to culture conversion among HIV positive patients was significantly shorter at 67 days (95% CI, 55.4–78.6) compared to HIV negative patients, 77 days (95% CI, 63.9–90, p = 0.005). Independent predictors of significantly longer time to sputum culture conversion were underweight (aHR = 0.71, 95% CI, 0.52–0.97), HIV negative (aHR = 0.66, 95% CI, 0.47–0.94) and treatment regimen composition (aHR = 0.57, 95% CI, 0.37–0.88). Significantly higher rate of culture conversion was observed in 2015 (aHR = 1.86, 95% CI, 1.1–3.14) and in 2016 (aHR = 3.7, 95% CI, 1.88–7.35) years of treatment compared to 2011.ConclusionsMajority of patients achieved sputum culture conversion within three months and smear conversion within two months. Patients with identified risk factors were associated with delayed culture conversion. These factors should be considered during management of MDR-TB patients.

A cross-sectional study of tuberculosis drug resistance among previously treated patients in a tertiary hospital in Accra, Ghana: public health implications of standardized regimens

BackgroundMycobacterium tuberculosis drug resistance is a major challenge to the use of standardized regimens for tuberculosis (TB) therapy, especially among previously treated patients. We aimed to investigate the frequency and pattern of drug resistance among previously treated patients with smear-positive pulmonary tuberculosis at the Korle-Bu Teaching Hospital Chest Clinic, Accra.MethodsThis was a cross-sectional survey of mycobacterial isolates from previously treated patients referred to the Chest Clinic Laboratory between October 2010 and October 2013. The Bactec MGIT 960 system for mycobactrerial culture and drug sensitivity testing (DST) was used for sputum culture of AFB smear-positive patients with relapse, treatment failure, failure of smear conversion, or default. Descriptive statistics were used to summarize patient characteristics, and frequency and patterns of drug resistance.ResultsA total of 112 isolates were studied out of 155 from previously treated patients. Twenty contaminated (12.9%) and 23 non-viable isolates (14.8%) were excluded. Of the 112 studied isolates, 53 (47.3%) were pan-sensitive to all first-line drugs tested Any resistance (mono and poly resistance) to isoniazid was found in 44 isolates (39.3%) and any resistance to streptomycin in 43 (38.4%). Thirty-one (27.7%) were MDR-TB. Eleven (35.5%) out of 31 MDR-TB isolates were pre-XDR. MDR-TB isolates were more likely than non-MDR isolates to have streptomycin and ethambutol resistance.ConclusionsThe main findings of this study were the high prevalence of MDR-TB and streptomycin resistance among previously treated TB patients, as well as a high prevalence of pre-XDR-TB among the MDR-TB patients, which suggest that first-line and second-line DST is essential to aid the design of effective regimens for these groups of patients in Ghana.

Treatment responses in multidrug-resistant tuberculosis in Germany.

Excellent treatment outcomes have recently been reported for patients with multi/extensively drug-resistant tuberculosis (M/XDR-TB) in settings where optimal resources for individualised therapy are available. To ascertain whether differences remain in treatment responses between patients with M/XDR-TB and those with non-M/XDR-TB. Patients with TB were prospectively enrolled between March 2013 and March 2016 at five hospitals in Germany. Treatment was conducted following current guidelines and individualised on the basis of drug susceptibility testing. Two-month and 6-month sputum smear and sputum culture conversion rates were assessed. A clinical and radiological score were used to assess response to anti-tuberculosis treatment. Non-M/XDR-TB (n = 29) and M/XDR-TB (n = 46) patients showed similar rates of microbiological conversion: 2-month smear conversion rate, 90% vs. 78%; culture conversion rate, 67% vs. 61%; time to smear conversion, 19 days (IQR 10-32) vs. 31 days (IQR 14-56) (P = 0.066); time to culture conversion, 39 days (IQR 17-67) vs. 39 days (IQR 6-85) (P = 0.191). Both clinical and radiological scores decreased after the introduction of anti-tuberculosis treatment. There were no significant differences in scores between the two groups until 6 months of treatment. Under optimal clinical conditions, with the availability of novel diagnostics and a wide range of therapeutic options for individualised treatment, patients with M/XDR-TB achieved 6-month culture conversion rates that were compatible with those in patients with non-M/XDR-TB.

The Role Of Zinc Sulphate and Omega 3 On The Improvement Of Weight and Speed Conversion Conversion on Tuberculosis Parent Patients at Surabaya Park Hospital, 2015

Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, can affect almost all organs of the body with the most locations in the lungs. Immunity and high nutrients such as vitamin C, zinc and other antioxidants have shown good effects for infections, including tuberculosis. One effort to help accelerate sputum conversion of people with pulmonary tuberculosis is by supplementation of Zinc Sulphate and Omega 3.Objective: Analyze the role of Zinc Sulphate and Omega 3 on sputum conversion acceleration in patients with pulmonary tuberculosis at Surabaya Paru Hospital 2015.Method: This research use Randomized Pre Post Test Post Control Group Design design. In patients with pulmonary tuberculosis with Zinc Sulphate and Omega 3 in the treatment and placebo group in the control group. A sample of 20 patients consisting of 10 treatment patients and 10 control patients. Statistical test using paired T-Test, Friedman test and Mann whitney.Results: Friedman test showed that in the treatment group showed significant difference in the number of BTA between before and after supplementation (p=0,001), while in the control group significance of 0.141. Mann-Whitney test showed no significant difference in the amount of reduction of BTA between the treatment group and the control group (p = 0.080). This means that statistically does not show any significant difference.Conclusions: Zinc Sulphate and Omega 3 play a role in accelerating sputum smear conversion of respondents. The results of smear test in pulmonary TB patients with Zinc Sulphate and Omega 3 supplementation showed positive results

A study on role of sputum conversion rate in management of tuberculosis in South Indian population

Background: Directly observed treatment short course (DOTS) is the currently recommended control strategy for tuberculosis. Even after intensive phase of directly observed treatment short course, there is delayed sputum smear conversion in some patients due to multiple factors. The present study was undertaken to study the role of sputum conversion in management of tuberculosis.Methods: A total of 229 patients with smear positive Tuberculosis cases of both Category-I and Category-II from DOTS centre in tuberculosis, S.V.R.R. Government General Hospital, Tirupati, A.P were enrolled and registered for the present study. Consent was taken from the patients to study the role of Sputum conversion rate importance in management of Tuberculosis in South Indian population.Results: The sputum conversion rate has been found to be higher in Category I (93.2%) compared to that of Category II (80.8%) and the difference is also found to be statistically significant. The sputum conversion rate has been found to be higher in those who were one + initial grade of sputum 96.1% followed by scanty grading 93.3%.Conclusions: The present study suggests that special attention should be given to patients enrolled for DOTS II regimen to improve sputum conversion rate in management of tuberculosis.