Smear-positive Patients Research Articles

Evaluation of Patients with Pulmonary Tuberculosis Attending at DOTS Center of Chattagram Maa Shishu-O-General Hospital

Background: Pulmonary Tuberculosis (TB) is a contagious bacterial infection that mainly involves the lungs, but may spread to other organs caused by Mycobacterium tuberculosis. To evaluate the age and gender characteristics of pulmonary tuberculosis patients as well as outcome of tuberculosis control. Materials and methods: A retrospective study was conducted at DOTS center at a tertiary, teaching hospital in the Chattogram region of Bangladesh. by evaluating the medical records of 133 patients with pulmonary tuberculosis. Age, gender, sputum smear status and Gene-Xpert test results were among the variables examined. Patients with comorbid conditions were not considered. Other information was not evaluated. Results: The male-to-female ratio in patients with pulmonary tuberculosis was 1.4:1. A large proportion of patients (44%) were in the young and reproductive age group. Approximately, one-fifth of patients were in the pediatric age group and onesixth of patients were in the geriatric age group. Conclusion: The finding suggests that two-thirds of all female smear-positive patients were of reproductive age has significant implications for tuberculosis control strategies due to increased chances of mother-to-newborn transmission. Because of the increased risk of default, difficulties, inconvenience, and the presence of other concomitant diseases, pediatric and geriatric patients are a large category. Chatt Maa Shi Hosp Med Coll J; Vol.23 (1); January 2024; Page 38-41

Contezolid Harbored Equivalent Efficacy to Linezolid in Tuberculosis Treatment in a Prospective and Randomized Early Bactericidal Activity Study.

Contezolid (CZD) is an analog of Linezolid (LZD) that has demonstrated potent in vitro and in vivo activity against tuberculosis (TB) while presenting a safer side-effect profile. In this study, we evaluated the early bactericidal activity (EBA) of CZD compared to LZD, with LZD serving as a control. Naive, smear-positive pulmonary TB patients were enrolled and randomly assigned to receive either a 14-day monotherapy regimen of 600 mg LZD once daily (QD) or 800 mg CZD twice daily (BID). Sputum samples were collected daily starting one day before treatment initiation and continuing throughout the treatment period. Each sample was processed for the enumeration of acid-fast bacilli (AFB) colonies, and time-to-positivity (TTP) during MGIT960 liquid culture was recorded. A total of 10 eligible patients were enrolled in each treatment group, although one patient in the CZD group was later excluded from the analysis. The early bactericidal activity (EBA0-14) was 0.08 ± 0.12 log CFU/mL/day (95% CI: -0.02 to 0.18 CFU/mL/day) in the CZD group, compared to 0.03 ± 0.10 log CFU/mL/day (95% CI: -0.05 to 0.10 CFU/mL/day) in the LZD group. The increase in time-to-positivity (TTP0-14) was 38.6 ± 43.69hours (95% CI: -1.85 to 79hours) in the CZD group and 27.7 ± 78.21hours (95% CI: -28.15 to 83.75hours) in the LZD group. LZD showed rapid bacterial reduction in sputum during the first two days of treatment, whereas CZD demonstrated superior efficacy after a few days of treatment. 800 mg BID contezolid exhibited comparable efficacy to 600 mg QD LZD in treating pulmonary TB in this EBA study. While CZD showed slower initial bactericidal action compared to LZD, its efficacy surpassed that of LZD after a few days of treatment. Given its similar efficacy and superior safety profile, contezolid may serve as an alternative to linezolid for the treatment of tuberculosis.

Diagnostic delay among the patients attending DOTS centers in Pokhara: A cross-sectional study

Introduction: Delay in diagnosis not only increases the chances of transmission of tuberculosis in the community but also increases medical costs and mortality. This study aimed to identify the diagnostic delay among patients with pulmonary tuberculosis in Pokhara. Methods: An institution-based cross-sectional study was conducted from June 10 to September 16, 2019. A total of 146 respondents with new smear-positive pulmonary tuberculosis patients above 15 years or older were selected consecutively. Data were collected using a structured questionnaire through face-to-face interviews. A cut-off point of 28 days was considered acceptable for the diagnostic delay. Pearson chi-square test was used to test the association between outcome variables with different categorical independent variables. Results: Among the 146 tuberculosis patients, 79.5% had diagnostic delays. The mean diagnostic delay was 52.48 (SD=31.79) whereas the median diagnostic delay was 47 days, the minimum delay was five days, and the maximum delay was 180 days. The median age of the respondents was 30 years; 87 were male and 59 were female. Age above 40 years (p=002), marital status (p=0.004), education (p=0.030), occupation (p=0.002), economic status (p=0.006), contact with tuberculosis patients (p=0.040) and smoking habit (p=0.008) were associated with longer total delayed diagnosis. Conclusions: This study concluded that nearly one-third of tuberculosis patients experienced a diagnostic delay. Patients' demographic factors, family economic conditions, and distance were identified as the key factors for delayed tuberculosis diagnosis. Therefore, public awareness regarding the symptoms of tuberculosis and the importance of seeking early care is essential. Additionally, improving accessibility to healthcare could mitigate these delays and enhance tuberculosis management outcomes.

Prevalence of non-tuberculous mycobacteria among people with acid-fast positive presumptive tuberculosis in Mali.

Non-tuberculous mycobacteria (NTM) are environmental agents that can cause opportunistic pulmonary disease in humans and animals, often misdiagnosed as tuberculosis (TB). In this study, we describe the cases of NTM identified during the first national anti-TB drug resistance survey conducted in Mali and explore associated risk factors. Sputum was collected from people presenting for pulmonary TB diagnosis from April to December 2019, regardless of age. Microscopy-positive patients were enrolled and tested using the Xpert MTB/RIF assay. A patient who tested negative for the Mycobacterium tuberculosis complex (MTBC) was tested for the presence of mycobacteria by amplification of the IS6110 and 16SrRNA (16S) genes through double quantitative real-time PCR, followed by nested PCR and Sanger sequencing of the IS6110-negative samples for NTM species identification. 1,418 sputum smear-positive patients were enrolled, including 1,199 new cases, 211 previously treated cases, and 8 whose previous treatment history was unknown. Based on the results of Xpert MTB/RIF assay and in-house PCR methods, 1,331 (93.9%) patients were positive for MTBC, 48 (3.4%) for NTM, and no species identification was possible for 39 (2.7%). Advanced age of 65 and over with an OR 8.8 (95% CI 2.3-33.2 and p = 0.001) and previous TB treatment with an OR 3.4 (95% CI 1.2-9.6 and p = 0.016) were the risk factors statistically associated with NTM detection. M. avium complex (MAC) was the predominant NTM species, detected in 20 cases. Detection of NTM in people presumed to have TB is an ongoing challenge, confounding correct TB diagnosis. Concomitant use of microscopy and GeneXpert testing among at-risk individuals could improve patient management.

Frequency and Predictors of Diabetes Mellitus in Smear-Positive Pulmonary Tuberculosis Patients: A Cross-Sectional Study.

Introduction Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Various studies have established an association between diabetes mellitus (DM) and pulmonary TB. This study describes the prevalence of DM and its predictors in smear-positive TB patients. Methods This descriptive cross-sectional study was conducted at the Department of Chest Medicine at Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan, from December 2015 to June 2016. The inclusion criteria were as follows: drug-sensitive pulmonary TB patients of either gender, age ≥ 18 years, registered at the TB clinic JPMC, who consented to participate in the study. Pregnant/lactating patients, drug-resistant TB patients, and those who did not consent to participate in the study were excluded. Fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) were done for all patients included in the study. Sociodemographic data, along with FBS, random blood sugar (RBS), and HbA1c, were entered in a pre-designed proforma. A sedentary lifestyle was recorded as a subjective measure of the proforma. Diabetes was diagnosed if FBS was ≥126 mg/dL or HbA1c was ≥6.5%. Results Out of 100 TB patients included in the study, 18 (18%) were diagnosed with diabetes. Patients who were smokers, had a sedentary lifestyle, and had a family history of diabetes had a significantly high prevalence of diabetes (p-value < 0.0001). Age, gender, and body mass index (BMI) did not influence the prevalence of diabetes in TB patients. Conclusion The study revealed an increased occurrence of diabetes among patients with smear-positive pulmonary TB. Diabetes is more common in TB patients who smoke, have a sedentary lifestyle, and those who have a family history of diabetes. A comprehensive management plan shall be in place to cater to TB and diabetes comorbidity, including effective management of TB and optimal glycemic control.

Factors associated with time to relapse in pulmonary tuberculosis patients using penalized Cox models

BackgroundPulmonary tuberculosis (TB) is a contagious bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs. Despite advances in treatment, TB remains a major public health challenge, particularly in developing countries. This retrospective cohort study aimed to identify factors that influence the time to relapse in patients with pulmonary tuberculosis.MethodsAll smear-positive pulmonary tuberculosis patients (1548 patients) whose data were recorded in the tuberculosis registration system of Golestan University of Medical Sciences and Health Services from March 2014 to March 2019, and followed up until February 2021. To analyze the data, we applied LASSO, MCP, and SCAD penalized Cox models.ResultsBased on the AIC and BIC criteria, the MCP penalized model was better than the LASSO and SCAD penalized models. The variables of age at diagnosis (> 35 vs. ≤\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\le$$\\end{document} 35, HR = 2.77), marital status (married vs. single, HR = 8.49), chronic renal failure (Yes vs. No, HR = 5.36), and pre-treatment smear test results (+ 1 vs. 1-9Basil, HR = 0.65 and + 2 vs. 1-9Basil, HR = 0.96) influenced time to relapse according to the MCP penalized Cox regression model.ConclusionsHealth care systems should focus on identification of factors that influence time to relapse and developing interventions to reduce relapse rates.

Mapping the distribution of tuberculosis cases and associated factors identified through routine program implementation and community-based active screening in Central Ethiopia.

Smear-positive TB patients greatly contribute to community-level transmission of this disease. Locating hotspots would make it easier to prioritize and target control interventions. This study aimed to assess the spatial distribution of smear-positive index TB cases and their secondary cases and the predictors of clustering of smear-positive TB cases. This study was conducted in the Silti Zone of Central Ethiopia from 2020 to 2022. The data of smear-positive index TB patients were collected from the unit TB registries of healthcare facilities. Contacts of all index TB patients were screened in the community and tested to identify secondary TB patients. We performed spatial analysis, including Moran's I statistic, the Getis-Ord Gi* statistic and geographically weighted regression (GWR), to assess the global distribution, local clustering and predictors of clustering of smear-positive TB patients, respectively. Additionally, we used inverse distance weighting (IDW) interpolation to predict the distribution of smear-positive TB cases and develop a continuous raster map for places with no data. Spatial autocorrelation analysis revealed that the distribution of smear-positive TB patients exhibited significant clustering (Moran's I = 0.70029; p value < 0.000). The Getis-Ord Gi* output indicated the presence of statistically significant hotspots as well as cold spots in the study area. Significant hotspots were found in 11 Kebeles of the Silti, Dalocha and Misrak Silti districts. Significant coldspots were also found in five kebeles of the Silti and Misrak districts. GWR analysis revealed that no education, primary education, family size and thatched roof houses were significant predictors of the spatial clustering of smear-positive TB cases. We also found that the majority of the secondary TB cases were found in hotspots identified through spatial analysis. The study revealed a heterogenous distribution of smear positive TB in the study area and it could act as a model that can be replicated in other regions. The identified hotspots of TB could be targeted through location-based interventions such as systematic active screening in the form of outreach programs to improve the performance of TB prevention and control, including reducing the transmission of TB. Educational status, family size and housing type were some of the factors that significantly influenced the spatial distribution of smear-positive TB in the study area. The distribution of secondary TB cases found through household contact screening coincided with the identified hotspots, indicating greater transmission of the disease in these places.

Does the Third Sputum Exam has an Added Value in the Diagnosis of Pulmonary Tuberculosis?

Abstract Introduction/Objective Introduction: Current practice of examining three sputum for the diagnosis of pulmonary tuberculosis (PTB) has tended to overburden the already scarce human resources in all-purpose laboratories, and to increase the turn- around- time for patients seeking treatment. Therefore, assessing the added value of the third sputum in the diagnosis of PTB in resource-limited country with less functional External Quality Assurance (EQA) system is critical. Methods/Case Report Materials and methods: Data on patients diagnosed with smear-positive PTB during 2012- 2016 was collected retrospectively from laboratory register of nine hospitals in Eritrea. The data was extracted and analyzed for incremental yield of three sputum samples. Results (if a Case Study enter NA) Results: Data from 2,484 microscopically confirmed acid-fast bacilli (AFB) smear positive PTB patients were reviewed. AFB was detected in the first sputum in 87.5% of patients, and 99.1% for the combined first and second sputum specimens. The incremental yield of the third sputum specimen as a diagnostic value was only 0.9%. No significant variation was detected by region, residence, gender or HIV. Background information Number of cases Percent Region Maekel 649 26.10% Anseba 293 11.80% Gash-Barka 815 32.80% Debub 297 12.00% Northern Red Sea 337 13.60% Southern Red Sea 93 3.70% Sex Male 1,251 50.40% Female 1,233 49.60% Residence Urban 1,296 52.20% Rural 1,188 47.80% Age group &amp;lt;15 35 1.40% 15 + 2,449 98.60% Total 2,484 100 Conclusion Conclusion: The added value of the third sputum is so minimal that its omission will reduce patient visits, workload and cost for patients and health services. Therefore, even countries like Eritrea, with limited EQA, should consider limiting the number of sputum examinations to improve quality.

Prevalence and Associated Risk Factors of Tuberculosis among Smear Positive Contact Individuals in Port Sudan

Background: Tuberculosis is a necrotizing granulomatous multisystem infectious disease that caused by mycobacterium, mainly mycobacterium tuberculosis, It is a serious global health problem that represent the commonest infectious cause of death. Many risk factors contribute in spread of tuberculosis, these factors include environmental factors, host factors and factors related to organism. Contact with smear positive patients is a major risk factors as every infectious patient can transmit the organism to ten to fifteen persons; therefore, contact tracing being an important element in DOTS (Direct Observed Therapy Strategy), because early detection and early management of cases prevent complication and improve the outcome. Objectives: This study aims to determine the prevalence and assess risk factors of tuberculosis among TB smear positive contact whose registered in Port Sudan chest hospital TBMU center during third and fourth quarters; June to December 2023. Methodology: This is a descriptive cross sectional community base study, Port Sudan, eastern Sudan, from June 2023 to December 2023. Result: The study shows that prevalence of tuberculosis among smear positive contact individual is 4.6%s. And it shows other associated risk factors has a role in spread of the disease. Conclusion: The prevalence of tuberculosis among smear positive contact individuals in Port Sudan is low comparing to literature and other studies due to strong tuberculosis program and stigma also play a role in this reduction. Tuberculosis spread more among female and elder contact as the spend more time in the home. And immunosuppression, poor ventilation and crowded household play an essential role in spread of tuberculosis.

PreVenTB trial: protocol for evaluation of efficacy and safety of two vaccines VPM1002 and Immuvac (Mw) in preventing tuberculosis (TB) in healthy household contacts of newly diagnosed sputum smear-positive pulmonary TB patients: phase III, randomised, double-blind, three-arm placebo-controlled trial

IntroductionTuberculosis (TB) continues to be one of the deadliest infectious diseases over the centuries, killing more people worldwide than any other single infectious disease. There is an urgent need for...

A time-to-event modelling of sputum conversion within two months after antituberculosis initiation among drug-susceptible smear positive pulmonary tuberculosis patients: Implementation of internal and external validation

Delayed sputum conversion has been associated with a higher risk of treatment failure or relapse among drug susceptible smear-positive pulmonary tuberculosis patients. Several contributing factors have been identified in many studies, but the results varied across regions and countries. Therefore, the current study aimed to develop a predictive model that explained the factors affecting time to sputum conversion within two months after initiating antituberculosis agents among Malaysian with drug-susceptible smear-positive pulmonary tuberculosis patients. Retrospective data of pulmonary tuberculosis patients followed up at a tertiary hospital in the Northern region of Malaysia from 2013 until 2018 were collected and analysed. Nonlinear mixed-effect modelling software (NONMEM 7.3.0) was used to develop parametric survival models. The final model was further validated using Kaplan-Meier-visual predictive check (KM-VPC) approach, kernel-based hazard rate estimation method and sampling-importance resampling (SIR) method. A total of 224 patients were included in the study, with 34.4 % (77/224) of the patients remained positive at the end of 2 months of the intensive phase. Gompertz hazard function best described the data. The hazard of sputum conversion decreased by 39 % and 33 % for moderate and advanced lesions as compared to minimal baseline of chest X-ray severity, respectively (adjusted hazard ratio (aHR), 0.61; 95 % confidence intervals (95 % CI), (0.44–0.84) and 0.67, 95 % CI (0.53–0.84)). Meanwhile, the hazard also decreased by 59 % (aHR, 0.41; 95 % CI, (0.23–0.73)) and 48 % (aHR, 0.52; 95 % CI, (0.35–0.79)) between active and former drug abusers as compared to non-drug abuser, respectively. The successful development of the internally and externally validated final model allows a better estimation of the time to sputum conversion and provides a better understanding of the relationship with its predictors.

Clinical perspective and outcome of culture-negative microbial keratitis: A retrospective study.

To study the risk factors, clinical features, and treatment outcomes of patients with culture-negative keratitis (CNK). A retrospective data review of 933 patients with CNK was performed from January 2018 to December 2020. The variables such as the history of injury, visual acuity, slit-lamp findings with measurements of size and depth of ulcer, microbiological evaluation, duct patency, blood glucose levels, and treatment were considered, and clinical outcome was analyzed. Of the 933 patients with CNK, 763 (81.8%) were medically managed, with a mean treatment duration of 2.08 ± 1.7 weeks. Among them, 622 (66.7%) were both smear and culture-negative, and 311 (33.3%) showed only smear positivity. Smear-positive patients showed a positive correlation with the history of injury. A higher incidence of fungal growth on repeat culture was observed. Surgical interventions were done only in 18.2% of the patients; the rest were treated with topical medications alone. High clinical suspicion, differentiation of causative organisms based on clinical findings, and initiating empirical therapy with broad-spectrum antibiotics and antifungals improve the ultimate prognosis in patients with CNK, even though a standard protocol for empirical medical treatment may differ among institutions and surgeons based on their clinical experience and geographical variations.

Risk factors for tuberculosis among close IGRA-negative contacts of persons with infectious tuberculosis in Singapore

ObjectivesContacts of patients with infectious tuberculosis (TB) testing positive on interferon-gamma release assay (IGRA) are followed up to exclude active disease. However, identifying factors that predispose IGRA-negative contacts to TB could improve screening and follow-up strategies in a medium TB burden country such as Singapore. MethodsWe conducted a retrospective study of IGRA-negative contacts aged ≥2 years identified during contact investigation between January 2014 and December 2022. We examined the risk factors associated with developing active TB among contacts previously testing IGRA-negative, using univariate and multivariable logistic regression and odds ratios with 95% confidence intervals. ResultsOf 60,377 IGRA-negative contacts, 150 developed TB disease, and half were notified within 23 months of index patient diagnosis. IGRA-negative contacts of a smear-positive index patient were more likely to develop TB. Independent risk factors for TB were age >50 years, Malay ethnicity, having diabetes or end-stage renal failure, a “family” relationship with the index patient, or exposure in a dormitory or nursing home. ConclusionsIdentifying risk factors could help optimise follow-up strategies and preventive treatment in IGRA-negative individuals. The incidence rate of TB in this group was 150 per 100,000 population, substantially higher than in the community, with a median 92 weeks to develop disease. Findings suggest that follow-up should be extended to 24 months for contacts with these risk factors.

Progress Toward Tuberculosis Elimination and Tuberculosis Program Performance - National Tuberculosis Indicators Project, 2016-2022.

Elimination of tuberculosis (TB) is defined as reducing TB disease incidence in the United States to less than 1 case per million persons per year. In 2022, TB incidence in the United States was 2.5 TB cases per 100,000 persons. CDC's TB program developed a set of national TB indicators to evaluate progress toward TB elimination through monitoring performance of state and city TB program activities. Examining TB indicator data enables state- and city-level TB programs to identify areas for program evaluation and improvement activities. These data also help CDC identify states and cities that might benefit from technical assistance. The 5-year period for which the most recent data were available for each of five indicators: 1) overall TB incidence (2018-2022), 2) TB incidence among non-U.S.-born persons (2018-2022), 3) percentage of persons with drug susceptibility results reported (2018-2022), 4) percentage of contacts to sputum acid-fast bacillus (AFB) smear-positive TB patients with newly diagnosed latent TB infection (LTBI) who completed treatment (2017-2021), and 5) percentage of patients with completion of TB therapy within 12 months (2016-2020). The National TB Indicators Project (NTIP) is a web-based performance monitoring tool that uses national TB surveillance data reported through the National TB Surveillance System and the Aggregate Reports for TB Program Evaluation. NTIP was developed to facilitate the use of existing data to help TB program staff members prioritize activities, monitor progress, and focus program improvement efforts. The following five indicators were selected for this report because of their importance in Federal TB funding allocation and in accelerating the decline in TB cases: 1) overall TB incidence in the United States, 2) TB incidence among non-U.S.-born persons, 3) percentage of persons with drug susceptibility results reported, 4) percentage of contacts to sputum AFB smear-positive TB cases who completed treatment for LTBI, and 5) percentage of patients with completion of TB therapy within 12 months. For this report, 52 TB programs (50 states, the District of Columbia, and New York City) were categorized into terciles based on the 5-year average number of TB cases reported to National TB Surveillance System. This grouping allows comparison of TB programs that have similar numbers of TB cases and allocates a similar number of TB programs to each category. The following formula was used to calculate the relative change by TB program for each indicator: [(% from year 5 - % from year 1 ÷ % from year 1) × 100]. During the 5-year period for which the most recent data were available, most TB programs had improvements in reducing overall TB incidence (71.2%) and increasing the percentage of contacts receiving a diagnosis of LTBI who completed LTBI treatment (55.8%); the majority of programs (51.0%) also had improvements in reducing incidence among non-U.S.-born persons. The average percentage of persons with drug susceptibility results reported in most jurisdictions (28 of 52, [53.9%]) met or exceeded the 5-year national average of 97% (2018-2022). The percentage of contacts to sputum acid-fast bacillus (AFB) smear-positive TB patients with newly diagnosed latent TB infection (LTBI) who completed treatment increased in 29 of 52 (55.8%) jurisdictions from 2017 to 2021, signifying that, for most jurisdictions, steps have been taken to enhance performance in this area. The average percentage of patients with completion of TB therapy within 12 months was at or above the national average of 89.7% in approximately two-thirds (32 of 52 [61.5%]) of jurisdictions. This report is the first to describe a 5-year relative change for TB program performance. These results suggest that TB programs are making improvements in activities that help identify persons with TB and LTBI and ensure patients complete treatment in a timely manner. Use of NTIP data from individual TB programs enables a more detailed examination of trends in program performance and identification of areas for program improvement. Assessing indicator trends by TB program provides an opportunity to gain a better understanding of program performance in comparison to other programs. It can also facilitate communication between programs regarding successes and challenges in program improvement. This information is valuable for TB programs to allocate resources effectively and provide additional context on TB control for public health policymakers.

Mental Health Impacts of Multidrug-Resistant Tuberculosis in Patients and Household Contacts: A Mixed Methods Study.

Multidrug-resistant tuberculosis (MDR-TB) patients experience disproportionately worse mental health, with implications for adherence, outcomes, and families. Comprehensive assessments of comorbid depression/anxiety and related factors remain limited. This study aimed to assess the prevalence, predictors, and qualitative experiences of depression and anxiety in MDR-TB patients and household contacts. A sequential explanatory mixed methods study was conducted in Gujarat, India, with 403 smear-positive MDR-TB patients and 403 contacts. The quantitative phase administered structured questionnaires on sociodemographic factors, clinical history, depression/anxiety symptoms, and psychosocial stressors (like stigma and social support). Logistic regression models were used. The qualitative phase included in-depth interviews with 30 purposively sampled patients for thematic content analysis. Results were integrated to contextualize quantitative findings. High rates of depression (37.5%, n = 151) and anxiety (45.2%, n = 182) were documented among the MDR-TB patients, significantly greater than household contacts (20.1%, n = 81and 25.1%, n = 101, respectively). For depression, older age (adjusted odds ratio (AOR) 2.03, 95% CI 1.01-4.05), female gender (AOR 2.5, 95% CI 1.1-6.0), divorced/widowed status (AOR 3.8, 95% CI 1.1-8.0), financial constraints, substance abuse (AOR 1.7, 95% CI 1.1-2.7), greater disease severity (AOR 1.8, 95% CI 1.5-2.2), medication side effects (AOR 2.4, 95% CI 1.2-4.6), and perceived stigma (AOR 3.2, 95% CI 1.1-5.3) emerged as significant risk factors. For anxiety, significant predictors were less social support (AOR 0.81, 95% CI 0.71-0.86), higher perceived stigma (AOR 2.2, 95% CI 1.1-6.3), greater disease severity (AOR 2.6, 95% CI 1.3-4.0), and more medication side effects (AOR 3.3, 95% CI 1.1-5.5). Prominent themes included psychological impacts like depression and anxiety, experiences of stigma and caretaking challenges, and recommendations for comprehensive patient support services. MDR-TB patients experience a substantially higher dual disease burden of depression and anxiety, elevating the risk for adverse outcomes and transmission. Improving psychosocial support is vital to patient-centric care pathways for vulnerable groups. Mixed methods provide comprehensive evidence to inform integrated physical and mental health services.

Bayesian estimation of the time-varying reproduction number for pulmonary tuberculosis in Iran: A registry-based study from 2018 to 2022 using new smear-positive cases

IntroductionTuberculosis (TB) is one of the most prevalent infectious diseases in the world, causing major public health problems in developing countries. The rate of TB incidence in Iran was estimated to be 13 per 100,000 in 2021. This study aimed to estimate the reproduction number and serial interval for pulmonary tuberculosis in Iran. Material and methodsThe present national historical cohort study was conducted from March 2018 to March 2022 based on data from the National Tuberculosis and Leprosy Registration Center of Iran's Ministry of Health and Medical Education (MOHME). The study included 30,762 tuberculosis cases and 16,165 new smear-positive pulmonary tuberculosis patients in Iran. We estimated the reproduction number of pulmonary tuberculosis in a Bayesian framework, which can incorporate uncertainty in estimating it. Statistical analyses were accomplished in R software. ResultsThe mean age at diagnosis of patients was 52.3 ± 21.2 years, and most patients were in the 35–63 age group (37.1%). Among the data, 9121 (56.4%) cases were males, and 7044 (43.6%) were females. Among patients, 7459 (46.1%) had a delayed diagnosis between 1 and 3 months. Additionally, 3039 (18.8%) cases were non-Iranians, and 2978 (98%) were Afghans. The time-varying reproduction number for pulmonary tuberculosis disease was calculated at an average of 1.06 ± 0.05 (95% Crl 0.96–1.15). ConclusionsIn this study, the incidence and the time-varying reproduction number of pulmonary tuberculosis showed the same pattern. The mean of the time-varying reproduction number indicated that each infected person is causing at least one new infection over time, and the chain of transmission is not being disrupted.

Knowledge and Practices of Airborne Infection Control at the Household Level among Pulmonary Tuberculosis Patients Attending a Tertiary Care Teaching Hospital in Central Karnataka, India

Abstract Background: Airborne transmission of tuberculosis (TB) is a major route of spread. Household contacts of TB patients are at high risk of infection. However, there is limited evidence on airborne infection control knowledge and practices among TB patients in India. This study was done to assess the knowledge and practices related to airborne infection control among pulmonary TB (PTB) patients at the household level and determine associated factors. Subjects and Methods: A cross-sectional study was conducted among 157 smear-positive PTB patients at a tertiary care hospital in Karnataka, India, using a pretested questionnaire. Knowledge and self-reported practices regarding airborne precautions were assessed. Bivariate analysis was done to determine associated factors. P &lt;0.005 was considered significant. Results: Major gaps were found in knowledge about ventilation (50.3%), avoiding visitors (39.5%), and sputum disposal (33.8%). Suboptimal practices were reported for using tissues (19%), handwashing (25%), ventilation (66%), sputum handling (54%), and waste disposal (30%). Good knowledge was associated with younger age, higher education, Hindu religion, family history of TB, intensive phase treatment, and presence of symptoms (P &lt; 0.05). Participants with good knowledge had significantly better preventive practices (P &lt; 0.00001). Conclusion: Tailored education on airborne precautions focusing on identified knowledge gaps and risky practices can help improve the adoption of infection control measures among TB patients at the household level. A multifaceted approach is required to translate improved awareness into optimal preventive behaviors.

Prevalence and Associated Risk Factors of Tuberculosis among Smear positive Contact Individuals in Port Sudan

Background: Tuberculosis is a necrotizing granulomatous multisystem infectious disease that caused by mycobacterium, mainly mycobacterium tuberculosis, It is a serious global health problem that represent the commonest infectious cause of death. Many risk factors contribute in spread of tuberculosis, these factors include environmental factors, host factors and factors related to organism. Contact with smear positive patients is a major risk factors as every infectious patient can transmit the organism to ten to fifteen persons; therefore, contact tracing being an important element in DOTS (Direct Observed Therapy Strategy), because early detection and early management of cases prevent complication and improve the outcome. Objectives: This study aims to determine the prevalence and assess risk factors of tuberculosis among TB smear positive contact whose registered in Port Sudan chest hospital TBMU center during third and fourth quarters; June to December 2023. Methodology: This is a descriptive cross sectional community base study, Port Sudan, eastern Sudan, from June 2023 to December 2023. Result: The study shows that prevalence of tuberculosis among smear positive contact individual is 4.6%s. And it shows other associated risk factors has a role in spread of the disease. Conclusion: The prevalence of tuberculosis among smear positive contact individuals in Port Sudan is low comparing to literature and other studies due to strong tuberculosis program and stigma also play a role in this reduction. Tuberculosis spread more among female and elder contact as the spend more time in the home. And immunosuppression, poor ventilation and crowded household play an essential role in spread of tuberculosis.

Prevalence, treatment outcomes and determinants of TB/HIV coinfection: A 4-year retrospective review of national tuberculosis registry in a country in a MENA region

BackgroundThe co-occurrence of tuberculosis (TB) and AIDS (HIV) has emerged as a significant public health challenge. This study investigated the epidemiological factors and treatment outcomes of TB in individuals based on their HIV status in Iran. MethodsThe current study was a descriptive-analytical cross-sectional study that focused on new patients diagnosed with TB in Iran between 2018 and 2021. Patients’ data were sourced from the National Tuberculosis Registry database of Iran. A multiple logistic regression model was used to investigate the relationship between the most important influencing factors and TB/HIV coinfection. ResultsOver a 4-year period, a study was conducted on 25,011 new TB patients out of 30,762 registered in the national database. TB and HIV were coinfected in 672 cases (2.68%). The highest number of coinfection cases were found in patients with smear-negative pulmonary tuberculosis (249 patients, 37.05%) and extrapulmonary tuberculosis (123 patients, 18.19%). TB patients with coinfection had a median TB treatment duration of three months longer than others. The success rate of TB treatment was lower in patients with coinfection (437 patients, 65.02%) than in non-coinfection patients (20,302 patients, 83.41%). Treatment success probability in smear-positive pulmonary tuberculosis patients with and without coinfection was lower than other types of TB. Logistic regression analysis showed that having a TB risk factor was the strongest predictor of coinfection, with an odds ratio of 29.73 (95% CI: 22.05–40.07), followed by having an HIV risk factor with an odds ratio of 17.52 (95% CI: 13.68–22.45). ConclusionsThe findings of this research offer significant insights into the potential causes of HIV coinfection in individuals with TB, which could be used to inform the development of policies and strategies aimed at enhancing the identification and treatment of TB patients who are at risk of TB/HIV coinfection and to promote optimal health status for patients with TB.

Prevalence of Rifampicin resistance tuberculosis among presumptive tuberculosis patients in Egypt-2021: a national health facility-based survey

BackgroundThe magnitude of MDR-TB cases was noticeable in Egypt. However, the last national survey was 11-years ago. The current survey was conducted to determine the prevalence of rifampicin resistance among sputum smear-positive pulmonary tuberculosis patients in Egypt.MethodsA national health facility-based cross-sectional study was conducted in 14 randomly selected governorates in Egypt between August 2020 and September 2021. All presumptive TB cases, either new or previously treated according to WHO definitions, with no gender, age, or nationality limitations, and provided informed consent were included in the study. Each patient completed a case report form (CRF). The CRF included socio-demographic and clinical data. Sputum samples were collected according to standard techniques and cultured on Lowenstein-Jensen (L-J) medium. Gene X-pert test was carried out first on the samples for simultaneous identification of MTB and rifampicin resistance. The prevalence of RR was calculated using crude, cluster, and weighted methods. Factors associated with RR were analyzed by bivariate and multivariate techniques.ResultsAmong the total 849 presumptive TB patients enrolled in the study, 710 (83.6%) patients were subjected to Gene X-pert testing (MTB/RIF). The crude prevalence of RR was 3.32% (95% CI: 1.89–4.76%) among the new cases and 9.46% (95% CI: 2.63–16.29%) among the retreated cases with an overall estimate of 3.99%; (95% CI: 2.51–5.47%). By cluster analysis the overall prevalence of RR was 5.01% (95% CI: 2.90–7.13). Factors associated with the prevalence of RR were co-morbidity with bronchial asthma, drug abuse and history of contact with a family member with TB.ConclusionThe prevalence of RR among either new or retreated cases TB patients was lower than the previous Egyptian rates in 2010–2012. The strongest predictor associated with RR was comorbidity with bronchial asthma.