Smear-positive Pulmonary Tuberculosis Patients Research Articles

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 <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.

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...

Bacilli load in PTB- intestinal helminths co-infected and PTB non -infected patients at selected public health facilities in Jimma zone, Oromia, Ethiopia: comparative cross-sectional study

BackgroundTuberculosis (TB) and intestinal helminths are diseases that pose a dual burden on public health in low-income countries. Previous studies have shown that helminths can affect the shedding of bacteria or the bacterial load in the sputum of active TB patients. However, there is limited information on bacterial load in TB patients with helminth infections.ObjectiveThis study aimed to compare bacterial load in helminths-infected and non-infected pulmonary tuberculosis patients at selected public health facilities in Jimma zone, Oromia, Ethiopia.MethodsThe study was conducted in Jimma Zone, Oromia, Ethiopia. A facility-based comparative cross-sectional study was employed from August 01, 2020, to January 2021. A total of 124 (55 intestinal helminths-infected and 69 non-infected) newly diagnosed smear-positive pulmonary tuberculosis (PTB) patients were included in the study. A convenience sampling technique was employed to recruit study participants, and a semi-structured questionnaire was used to collect data regarding socio-demographic characteristics and possible risk factors for intestinal helminths co-infection. Stool examination was performed using both wet mount and Kato Katz technique. Additionally, weight and height measurements, sputum, and blood samples were taken to determine body mass index, bacilli load, and diabetic mellitus, respectively. Data were entered into Epi-Data software version 3.1 and analyzed using Statistical Packages for Social Sciences (SPSS) Version 25. A statistically significant difference was defined as a P-value of less than 0.05.ResultsIntestinal helminths reduced bacilli load 3 times more than intestinal helminths non-infected PTB (AOR = 3.44; 95% CI; 1.52, 7.79; P = 0.003) However, diabetes mellitus, HIV, drinking alcohol and cigarette smoking were not associated with bacilli load. The rate of co-infection TB with intestinal helminths was 44%. The three most prevalent parasites detected were Trichuris trichiura 29 (66%), hookworm 19 (43%), and Ascaris lumbricoides 11(25%)). Among co-infected patients about 36 (81.8%) had a single parasite infection, and 19 (43.2%) had multiple infections. A body mass index < 18.5 (AOR = 3.26; 95% CI; 1.25, 8.56;P = 0.016) and untrimmed fingernail status (AOR = 3.63; 95%CI;1.32,9.93;P = 0.012) were significantly associated with PTB- intestinal helminth –co-infection.ConclusionHelminth infection was associated with a lower bacilli load compared to helmenths non-infected PTB. The rate of co-infection TB with intestinal helminths was 44%. Trichuris trichiura was the most prevalent helminth. Untrimmed fingernail and a body mass index were associated with PTB-intestinal helminth co-infection.

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.

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, 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.

Risk factors and treatment outcome of smear positive pulmonary tuberculosis patients: A five-year study in the North of Iran.

It is essential to constantly review the risk factors and treatment outcomes of tuberculosis (TB). This study evaluated some important risk factors of TB over five years. Between 2013 and 2018, all available information and possible risk factors related to TB patients were analyzed from the TB registry program of the health district of Gorgan, Iran. Among 349 TB patients, 194 (55.59%) were males and 167 (47.85%) had at least a comorbidity. The death rate was higher in the age group more than 65 years (p < 0.001), the low-educated group (P = 0.012), and patients with underlying diseases, especially diabetes (p < 0.001). In total, univariate and multivariate statistical analyzes showed that having comorbidity (OR = 4.34; 95% CI 1.49 - 13.49), as well as, being jobless (OR = 3.07; 95% CI 1.19 - 8.59) were the main factors influencing the adverse events. According to the study, aging, underlying diseases, and cultural poverty include a higher share of the main risk factors for active TB and/or treatment outcomes. By considering these risk factors and training the medical staff continually, we can reduce the time of TB diagnosis, and prevent it from spreading.

Risk factors of treatment interruptions among drug-sensitive and drug-resistant pulmonary tuberculosis patients - A study from South Delhi, New Delhi, India

BackgroundA variety of factors influence adherence to the lengthy duration of anti-tuberculosis treatment, making it a complicated and dynamic problem. The objective of this study was to investigate the treatment interruption patterns using pre-defined criteria among a cohort of pulmonary tuberculosis patients and to elicit the associated factors. MethodsThis prospective, observational study was conducted between October 2016 to May 2018. All smear and culture positive pulmonary tuberculosis patients (age ≥ 14 years) enrolled between October 1, 2016 to March 31, 2017 across 3 Designated Microscopy Centers (DMCs) were included and followed up till end of treatment for outcome in drug-sensitive, and till interim outcome at 6 months for drug-resistant TB patients. Patterns and reasons for interruptions were recorded as per the study protocol. Results171 patients were enrolled in this study, of which 135 (78.94 %) were on Category-I and Category-II treatment (drug-sensitive tuberculosis), 23 (13 %) were multidrug-resistant (MDR) and 13 (8 %) were extensively drug resistant (XDR) tuberculosis patients. Among the drug-sensitive group, 65 (48 %) patients completed their treatment without any interruption while 70 (52 %) patients interrupted with at least one missed dose. Among the 36 MDR/XDR patients, 19 (53 %) patients did not interrupt treatment, but 17 (47 %) patients interrupted with at least one missing dose. The 87 patients in both sub-groups interrupted for 232 times/episodes of which 140 were short and 84 were long interruptions. The main reasons for interruption were found to be busy schedule in 63 (29 %) patients, adverse drug reactions in 40 (18.4 %) and comorbidities in 43 (19.8 %) patients. Feeling of early improvement/no improvement in 23 (10.5 %) patients, addictions in 27 (12.4 %) patients, lack of family support in 14 (6.4 %), unawareness of dosage and duration of treatment in 7 (3.20 %) patients were other common reasons. ConclusionThe plurality of patients studied were found to be in the younger age group i.e., 14–25 years (n = 75), constituting nearly 44 % of all the patients included and male treatment interrupters (62 %) outnumbered the females (38 %), possibly owing to work schedule or addictions. The majority of interruptions were related to patient related factors (93.5 %), followed by DOTS provided factors (6.40 %) and system related factors (3.01 %). Further studies should be conducted to classify the factors of treatment interruptions in detail and also to study the impact of these interruptions’ patterns on final outcomes.

Multi-drug-resistant tuberculosis and its associated factors among pulmonary tuberculosis patients linked to first-line anti-tuberculosis drugs in north-west Ethiopia

Introduction. Multi-drug-resistant tuberculosis (MDR-TB) is an emerging global challenge. Ethiopia is one of the 20 top countries with the highest estimated numbers of incidents of MDR-TB. Recently, the World Health Organization warned that drug-resistant TB is escalating and called for concerted action to reduce the spread of drug resistance. Hypothesis. The current study investigated MDR-TB in patients receiving first-line anti-TB drug treatment and associated factors. Aim. The study aimed to determine the prevalence of MDR-TB and its associated factors among smear-positive pulmonary TB patients receiving first-line anti-TB drug treatment. Methodology. An institution-based cross-sectional study was employed. All data were collected from laboratory result log books and information via a questionnaire. Samples from 205 smear-positive pulmonary TB patients were selected among first-line drug treatment by a systematic sampling method. Specimens were transported to Felege Hiwot referral hospital laboratory for GeneXpert testing. Factors associated with an outcome variable in binary multi-variable logistic regression analysis at P&lt;0.05 were considered statistically significant variables. An ethical approval letter was taken to the respective health facility and written consent was obtained from each participant. Results. The overall prevalence of MDR-TB was 9.3 % (95 % CI, 5.4 13.7 %). Sign and symptom experience of anti-TB drug side effects [adjusted odds ratio (AOR)=0.18, 95 % CI=0.03–0.99, P=0.049] and co-morbidity (AOR=0.03, 95 % CI=0.01–0.55, P=0.02) were statistically associated with the development of MDR-TB infection Conclusion. The prevalence of MDR-TB was high (9.3 %) and contributed highly to new cases (8.3 %). Factors associated with MDR-TB were previous treatment, co-morbidity and laboratory diagnosis method prior to TB treatment. Therefore, this finding aims to maximize early detection and treatment, strengthening TB infection control, and proper implementation of directly observed therapy short course recommendations to reduce the burden of MDR-TB.

Predictors of Change in the Anemia Status Among Pulmonary Tuberculosis Patients Following Anti-tuberculosis Treatment in Puducherry, India.

Background Pulmonary tuberculosis (PTB) is commonly associated with reversible peripheral blood abnormalities. The evolution of tuberculosis (TB)-associated anemia with anti-tuberculosis treatment (ATT) has not been well elucidated. This study aimed to compare the hematological profiles at the start and end of the ATT among new sputum smear-positive (NSP) PTB patients in Puducherry, India. Methods A prospective cohort study was conducted in the 10 urban primary health centers of Puducherry from 2017 to 2020. All the NSP PTB participants aged ≥18 years registered under the National Tuberculosis Elimination Program (NTEP) were contacted within two weeks of the start of the ATT. All eligible participants were enrolled, and they were followed up till the end of ATT (180 days). Hematological profiles and anthropometric measurements were compared at the start and end of the ATT. Binomial logistic regression analysis was used to assess the predictors of changes in the anemia status at the start and end of the ATT. Results Out of 176 NSP PTB participants, 145 were followed up after treatment. Initially, 63% (111/176) patients had anemia, which decreased to 44% (64/145) by the end of treatment. The risk factors for a negative change in hemoglobin levels were female gender, below poverty level, underweight, and reduced iron intake. The adjusted risk ratios (ARRs) were 1.53 (1.24-1.88), 1.18 (1.01-1.38), 1.29 (1.02-1.64), and 1.26 (1.05-1.51),respectively. Conclusion ATT may lead to the resolution of TB-associated anemia. Moreover, female gender, possession of a red ration card, being underweight, and reduced iron intake were identified as risk factors for negative changes in hemoglobin levels during treatment.

Comorbidity and drug resistance of smear-positive pulmonary tuberculosis patients in the yi autonomous prefecture of China: a cross-sectional study

BackgroundTuberculosis (TB) has a high morbidity and mortality rate, and its prevention and treatment focus is on impoverished areas. The Liangshan Yi Autonomous Prefecture is a typical impoverished area in western China with insufficient medical resources and high HIV positivity. However, there have been few reports of TB and drug resistance in this area.MethodsWe collected the demographic and clinical data of inpatients with sputum smear positive TB between 2015 and 2021 in an infectious disease hospital in the Liangshan Yi Autonomous Prefecture. Descriptive analyses were used for the epidemiological data. The chi-square test was used to compare categorical variables between the drug-resistant and drug-susceptible groups, and binary logistic regression was used to analyse meaningful variables.ResultsWe included 2263 patients, 79.9% of whom were Yi patients. The proportions of HIV (14.4%) and smoking (37.3%) were higher than previously reported. The incidence of extrapulmonary TB (28.5%) was high, and the infection site was different from that reported previously. When drug resistance gene detection was introduced, the proportion of drug-resistant patients became 10.9%. Patients aged 15–44 years (OR 1.817; 95% CI 1.162–2.840; P < 0.01) and 45–59 years (OR 2.175; 95% CI 1.335–3.543; P < 0.01) had significantly higher incidences of drug resistance than children and the elderly. Patients with a cough of ≥ 2 weeks had a significantly higher chance of drug resistance than those with < 2 weeks or no cough symptoms (OR 2.069; 95% CI 1.234–3.469; P < 0.01). Alcoholism (OR 1.741; 95% CI 1.107–2.736; P < 0.05) and high bacterial counts on sputum acid-fast smears (OR 1.846; 95% CI 1.115–3.058; P < 0.05) were significant in the univariate analysis.ConclusionsSputum smear-positive TB predominated in Yi men (15–44 years) with high smoking, alcoholism, and HIV rates. Extrapulmonary TB, especially abdominal TB, prevailed. Recent drug resistance testing revealed higher rates in 15–59 age group and ≥ 2 weeks cough duration. Alcohol abuse and high sputum AFB counts correlated with drug resistance. Strengthen screening and supervision to curb TB transmission and drug-resistant cases in the region.

Treatment Outcome Monitoring by Using Sputum Conversion Rate of Tuberculosis Patients in Pkd Kinta, Malaysia

Introduction: A control programme termed Directly Observed Treatment Short-Course (DOTS) is adopted to promote early TB detection and effective TB treatment. An indicator of a successful DOTS programme is the Sputum Conversion Rate (SCR) which is obtained at the end of the two-month intensive treatment to measure the treatment outcome by SCR. The present study determined the association between several factors and the SCR among TB patients attending the DOTS clinic at the Kinta District Health Office (PKD Kinta) in 2017. Methods: The factors included are sociodemographic factors, physical factors, knowledge, attitude, and practice of TB patients. All groups of 150 sputum smear positive pulmonary TB patients enrolled for treatment at PKD Kinta between January and September 2017 were recruited for this study by the cross-sectional questionnaire method. A statistical analysis was performed to determine the association between the variables and the SCR of the TB patients in the DOTS programme. Results: At the end of the two-month intensive period, an SCR of 96.0% was obtained. According to the statistical analysis of the association among sociodemographic factors and SCR, there are no statistical differences between the variables. Similarly, no association was found between the physical characteristics and SCR in the current study. Conclusion: SCR methods are perfect methods used in regular medicine to monitor TB cases’ treatment. The identification of factors influencing the DOTS programme is critical to ensuring the program’s success in eradicating TB in society.

Socio Clinical Profile of MDR TB Cases: A Study at DR –TB Center, SCB Medical College &amp; Hospital

Introduction India accounts for about one-fourth of the global burden of MDR-TB. This study aims to evaluate clinical profile and factors associated with tuberculosis drug resistance among patients from eastern India. Method All the MDR-TB cases registered under RNTCP PMDT services were included in the study between 1st April-2013 to 31st March 2014. This observational study was carried out by the Department of Pulmonary Medicine, SCB Medical College, Cuttack. Result Between April 2013 and March 2014, the IRL ATDC Center collected a total of 2205 sputum samples. Out of 2205, 245 (11%) had both INH and Rifampicin, 68 (3%), INH resistance, 359 (16.3%), and 51 (2.3%) had sputum contaminated with report awaiting. Mean age MDR TB was 35.6 (Standard deviation 13.769). The study shows 14.3% of the TB patients were illiterate. Out of 126 cases of MDR-TB presented with 140 co- morbidities at DR-TB Center. Discussion High rate of drug resistance pattern was found among the new sputum smear positive pulmonary tuberculosis patients and also high MDR tuberculosis. Risk factors such as age, sex, smoking, and alcoholism were independently associated with pulmonary MDR-TB. Our study concluded that young age, male sex, smear positivity, treatment failure, and the combination of smoking and alcoholism were identified as risk factors for Tuberculosis mortality.

Prevalence and factors associated with sputum smear non-conversion after two months of tuberculosis treatment among smear-positive pulmonary tuberculosis patients in Rwanda: a cross-sectional study

BackgroundNon-conversion of sputum smear prolongs the infectivity of pulmonary tuberculosis patients and has been associated with unfavorable tuberculosis (TB) treatment outcomes. Nevertheless, there is a limited evidence on predictors of sputum smear non-conversion among smear-positive PTB (SPPTB) patients in Rwanda. Therefore, this study aimed to determine the factors associated with sputum smear non-conversion after two months of treatment among SPPTB patients in Rwanda.MethodsA cross-sectional study was conducted among SPPTB patients registered in the national electronic TB reporting system by all health facilities countrywide (Rwanda) from July 2019 to June 2021. Eligible patients who had completed the first two months of anti-TB treatment and with smear results at the end of the second month of treatment were included in the study. Bivariate and multivariate logistic regression analyses were done using STATA version 16 to determine the factors associated with sputum smear non-conversion. Adjusted odds ratio (OR), 95% confidence interval (CI), and p-value < 0.05 was considered statistically significant.ResultsThis study included 7,211 patients. Of them, 632 (9%) patients had sputum smear non-conversion at the end of the second month of treatment. In multivariate logistic regression analysis, age groups of 20–39 years (AOR = 1.7, 95% CI: 1.0-2.8) and 40–59 years (AOR:2, 95% CI: 1.1–3.3), history of first-line TB treatment failure (AOR = 2, 95% CI: 1.1–3.6), follow-up by community health workers(CHWs) (AOR = 1.2, 95% CI: 1.0-1.5), BMI < 18.5 at TB treatment initiation (AOR = 1.5, 95% CI: 1.2–1.8), and living in Northern Province of Rwanda (AOR = 1.4, 95% CI: 1.0–2.0), were found to be significantly associated with sputum smear non-conversion after two months of treatment.ConclusionSputum smear non-conversion among SPPTB patients remains low in Rwanda compared to countries of similar health care setting. Identified risk factors for sputum smear non-conversion among SPPTB patients in Rwanda were age (20–39 years, 40–59 years), history of first-line TB treatment failure, follow up by CHWs, BMI < 18.5 at TB treatment initiation and residence (Northern province).

Development of a new cellular immunological detection method for tuberculosis based on HupB protein induced IL-6 release test.

As a virulence factor, HupB plays important roles in the survival of MTB after infection and modulates the host immune response. In the current study, we aim to explore a new cellular immunological detection method for tuberculosis infection detection based on HupB protein. HupB was used to stimulate PBMCs extracted from pulmonary tuberculosis (PTB) patients, and secreted cytokines was examined. Then, we constructed a single center and a multi-center clinical trials to collect PBMCs from PTB patients, nPTB patients, or healthy volunteers to verify our findings. Cytokine's screening illustrated that IL-6 was the only cytokine released after HupB stimulation. Single-center and multi-center clinical trials showed that HupB stimulation significantly increased the level of IL-6 in the supernatant of PBMCs from PTB patients. Then we compared the specificity and sensitivity of HupB induced IL-6 release assay with ESAT-6 and CFP10 induced interferon γ release assay (IGRA), and found in smear positive PTB patients, the specificity and sensitivity of HupB induced IL-6 release assay was better than IGRA, and in smear negative PTB patients, the sensitivity was better. Combination of both assays provided an improved specificity and sensitivity for tuberculosis diagnosis. This study explored an immunological detection method for tuberculosis infection cells based on HupB protein-induced IL-6 release test, which can be used to enhance the diagnosis diagnostic accuracy of TB.

Prevalence and associated factors of delayed sputum smear conversion in patients treated for smear positive pulmonary tuberculosis: A retrospective follow up study in Sabah, Malaysia.

Tuberculosis remains a major health problem globally and in Malaysia, particularly in the state of Sabah. Delayed sputum conversion is associated with treatment failure, drug-resistant tuberculosis and mortality. We aimed to determine the prevalence of delayed sputum conversion among smear positive pulmonary tuberculosis (PTB) patients and its associated factors in Sabah, Malaysia. A retrospective follow up study on all patients newly diagnosed with smear positive pulmonary tuberculosis from 2017 to 2019 was conducted at three government health clinics in Sabah, utilizing data from a national electronic tuberculosis database and medical records. Descriptive statistics and binary logistic regression were applied for data analysis. The outcome of the study was the sputum conversion status at the end of the two-month intensive treatment phase with either successful conversion to smear negative or non-conversion. 374 patients were included in the analysis. Our patients were generally younger than 60 years old with no medical illness and varying proportions of tuberculosis severity as judged by radiographic appearance and sputum bacillary load upon diagnosis. Foreigners constituted 27.8% of our sample. 8.8% (confidence interval: 6.2-12.2) did not convert to smear negative at the end of the intensive phase. Binary logistic regression showed that older patients ≥60 years old (adjusted odds ratio, AOR = 4.303), foreigners (AOR = 3.184) and patients with higher sputum bacillary load at diagnosis [2+ (AOR = 5.061) and 3+ (AOR = 4.992)] were more likely to have delayed sputum smear conversion. The prevalence of delayed sputum conversion in our study was considerably low at 8.8% with age ≥60 years old, foreigners and higher pre-treatment sputum bacillary load associated with delayed conversion. Healthcare providers should take note of these factors and ensure the patients receive proper follow up treatment.

МОНИТОРИНГ И ОЦЕНКА МИКРОБИОЛОГИЧЕСКОЙ ДИАГНОСТИКИ ТУБЕРКУЛЁЗА: РЕСУРСЫ И ДЕЯТЕЛЬНОСТЬ МИКРОБИОЛОГИЧЕСКИХ ЛАБОРАТОРИЙ

Significance. The system of microbiological diagnostics is of key importance for organizing microbiological diagnostics in accordance with the modern recommendations, and fulfilling political commitments of the Russian Federation within the framework of the End TB Strategy Purpose: to assess the availability, use and results of the modern methods of microbiological diagnostics of tuberculosis in Russia in 2021. Material and methods. The study has analyzed forms #7-TB, ВР-4БЛ, ВР-1Ф of official statistical observation, results of external quality assessment of laboratories (Interlaboratory comparison system “Federal System of External Quality Assessment of Clinical Laboratory Testing (FSEQA)”). Results. The share of patients with pulmonary tuberculosis with a smear positive Ziehl-Nelsen, detected in medical organizations providing primary health care (PHC) decreased to 12.8%, while the share of new smear positive pulmonary TB patients increased to 37.4%; the share of newly diagnosed patients with pulmonary tuberculosis with a positive result of sputum bacterioscopy among patients with cavities increased to 60.6%.The share of laboratories with satisfactory results of the FSEQA participation regarding smear microscopy increased to 92.8%; the share of laboratories with the confirmed quality increased to 14.3%. The culture coverage of new pulmonary TB patients equaled to 98.0%. Culture-based confirmation of the diagnosis was obtained in 55.3% of the patients; the share of smear positive new pulmonary TB patients with the negative culture result decreased to 3.8%. The share of laboratories participating in FSEQA increased to 44.5%; the share of laboratories that showed satisfactory results - up to 90.8%, the share of laboratories with the confirmed quality - up to 40.4%. The coverage with molecular genetic testing added up to 90.8%. The drug susceptibility testing (DST) coverage equaled to 97.7%. The patient coverage with rifampicin resistance DST to fluoroquinolones reached 93.2%; coverage with pre-XDR-TB DST to linezolid - 35.0%, bedaquiline - 12.4%. Conclusion. Microbiological diagnostics of tuberculosis in PHC by smear microscopy is ineffective in modern conditions; there are prospects for its use in new Russian regions. The COVID-19 pandemic failed to produce any significant negative impact on the patient coverage with microbiological examination methods. In 2020–2021, the quality of bacterioscopic and culture testing for tuberculosis increased. DST coverage for bedaquiline and linezolid is poor; this does not allow to meet the current clinical guideline requirements. The cost of consumables per patient increased 3.1 times between 2015 and 2021.In the structure of financial expenses on TB microbiological diagnostics, consumables that require import substitution prevail. Scope of application. The study results can be used by heads of health authorities, chief physicians of TB facilities, heads of microbiological laboratories in order to increase effectiveness of TB care, timely detection of people excreting bacteria and MBT drug susceptibility testing.

Impact of diabetes mellitus on treatment outcome of newly diagnosed smear-positive pulmonary tuberculosis patients: A case–Control study

Background: Tuberculosis (TB) and diabetes mellitus (DM) are major public health problems in developing countries such as India. The link of DM and TB is more prominent in these countries where TB is endemic, and the burden of DM is increasing. Studies regarding the effect of DM on smear conversion and treatment outcome of pulmonary TB (PTB) in India are limited. Aims: The study aimed to compare the conversion and treatment success among new smear-positive PTB patients with and without DM. Materials and Methods: A case–control study was conducted in the department of pulmonary medicine of a tertiary care hospital in eastern India between October 2019 and September 2020. All newly diagnosed smear-positive drug-sensitive PTB patients visiting the outdoor or being admitted were identified, and their initial smear status, history of diabetes, and glycemic status were recorded. All the patients were treated with category I regimen of the Revised National TB Control Program. Sputum smear was followed up at the end of intensive phase and at the end of treatment and compared between diabetic and nondiabetic patients. The software SPSS version 16 was used to analyze all the data. Results: Sixty newly diagnosed smear-positive PTB patients with DM and sixty smear-positive PTB without DM were included in this study. Smear conversion was seen in 24 (40%) out of 60 diabetic TB patients and 55 (91.7%) out of 60 nondiabetic TB patients. Treatment success was seen in 40 (66.7%) out of 60 diabetic TB patients and 56 (93.3%) out of the 60 nondiabetic TB patients. Conclusion: Smear conversion and treatment success rate are lower in diabetic TB patients as compared to nondiabetic TB patients.