Smear-positive Pulmonary Tuberculosis Research Articles

Diagnostic accuracy of high resolution computed tomography (HRCT) of chest in diagnosing sputum smear positive and sputum smear negative pulmonary tuberculosis (PTB).

Objective: To assess the diagnostic accuracy of high resolution computed tomography (HRCT) of chest in diagnosing sputum smear positive and negative pulmonary tuberculosis (PTB). Study Design: Cross-sectional study. Setting: Tertiary Care Hospital, Kharian Cantt. Period: Oct 2021 to April 2022. Methods: The retrospective reviews of medical records of patients undergone HRCT chest and sputum for AFB smear and culture due to pulmonary tuberculosis (PTB) suspicion were included. The HRCT and AFB findings for sample size of 220 was compared. SPSS was used to stratify outcomes on basis of sputum smear results. Diagnostic accuracy of HRCT chest was calculated by taking AFB as gold standard. The AFB findings and HRCT outcomes were compared through correlation analysis and paired t-test with p value < 0.05 considered as significant. Results: The sensitivity was found to be 86.23% with specificity of 86.48%, positive predictive value of 86.23%, negative predictive value of 86.48% and diagnostic accuracy of 86.36% for HRCT for diagnosing pulmonary tuberculosis (PTB). Conclusion: HRCT chest affirms high diagnostic potential for pulmonary tuberculosis (PTB) and should be used as a routine diagnostic tool for the disease.

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, 9,121 (56.4%) cases were males, and 7,044 (43.6%) were females. Among patients, 7,459 (46.1%) had a delayed diagnosis between 1 and 3 months. Additionally, 3,039 (18.8%) cases were non-Iranians, and 2,978 (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.

Pre-treatment Loss to Follow-up in Patients with Confirmed Pulmonary Tuberculosis in Niamey, Niger

Aims and Scope: Pre-treatment loss to follow-up (PTLFU) represents a major problem that hinders the management of tuberculosis. This paper focuses on determining the prevalence of lost to follow-up patients diagnosed with smear-positive pulmonary tuberculosis (SPPT) who are referred to other TB screening and treatment centers (TBSTC). Methods: This was a prospective, descriptive, and analytical study conducted over a six-month period between March and August 2019, in patients diagnosed with smear-positive pulmonary tuberculosis at NCFATRD and referred to Niamey and Tillaberi centers. A chi-square test was used with a significance level of P ≤ 0.05. Findings: 743 patients were diagnosed with SPPT, and 346 were referred to the TBSTC located in Niamey and Tillaberi cities. The prevalence of loss to follow-up before treatment in both Niamey and Tillaberi cities was 14.45% (50/343). Males represented 82% (41) of the cases with a sex ratio of 4.55. The mean age of the patients was 41.04 years. Patients not attending school, as well as those with primary school education, represented the majority of cases, accounting for 30% each. The majority of PTLFU (95.66%) were new cases of TB. Nearly half (42%) of PTLFU had traveled a distance of 6 to 15 km to receive TB screening. During the phone call follow up, only 12 patients (24%) were reached, of whom 7 (14%) were deceased. Conclusion: The prevalence of PTLFU remains high. Therefore, reinforcing the research of lost to follow-up patients is necessary to enhance tuberculosis control and management.

Integrating systemic immune-inflammation index, fibrinogen, and T-SPOT.TB for precision distinction of active pulmonary tuberculosis in the era of mycobacterial disease research.

The clinical challenge of differentiating suspected tuberculosis with positive T-SPOT.TB results persist. This study aims to investigate the utility of the Systemic Immune-Inflammation Index (SII), Fibrinogen, and T-SPOT.TB in distinguishing between active pulmonary tuberculosis (PTB) and non-tuberculous lung diseases. A retrospective analysis included 1,327 cases of active PTB with positive T-SPOT.TB results and 703 cases of non-tuberculous lung diseases from May 2016 to December 2020 at Meizhou People's Hospital. These were designated as the case group and the control group, respectively. The detection indicators of T-SPOT.TB: Early Secreted Antigenic Target 6 (ESAT-6), Culture Filtrate Protein 10 (CFP-10), as well as SII and Fibrinogen levels-were compared and analyzed for association and joint diagnostic value between the two groups. The case group showed higher values of ESAT-6, CFP-10, SII, and Fibrinogen compared to the control group (all p < 0.001). In the case group, SII and Fibrinogen did not correlate with ESAT-6 and CFP-10 (∣rs∣ all < 0.3) but were positively correlated with C-reactive protein (CRP; rs all > 0.3). SII and Fibrinogen values in smear-positive pulmonary tuberculosis were higher than in smear-negative cases (all p < 0.05). The optimal diagnostic thresholds for ESAT-6, CFP-10, SII, and Fibrinogen in differentiating between active PTB and non-tuberculous lung diseases were 21.50 SFCs/106 PBMC, 22.50 SFCs/106 PBMC, 2128.32, and 5.02 g/L, respectively. Regression logistic analysis showed that ESAT-6 < 21.5 (OR: 1.637, 95% CI: 1.311-2.043, p < 0.001), CFP-10 < 22.5 (OR: 3.918, 95% CI: 3.138-4.892, p = 0.025), SII < 2128.32 (OR: 0.763, 95% CI: 0.603-0.967, p < 0.001), and FIB < 5.02 (OR: 2.287, 95% CI: 1.865-2.806, p < 0.001) were independent risk factors for active PTB. The specificity for ESAT-6 + CFP-10, ESAT-6 + CFP-10 + SII, ESAT-6 + CFP-10 + FIB, and ESAT-6 + CFP-10 + SII + FIB was 82.5%, 83.2%, 95.8%, and 80.1%, respectively, while sensitivity was 52.6%, 53.0%, 55.8%, and 44.7%, and positive predictive values were 85.0%, 85.6%, 84.1%, and 89.6%, respectively. SII and Fibrinogen are positively correlated with the degree of tuberculosis inflammation and the bacterial load of Mycobacterium tuberculosis. The combined detection of SII, Fibrinogen, and T-SPOT.TB is significant in distinguishing between active PTB with positive T-SPOT.TB results and non-tuberculous lung diseases.

Anaemia of chronic disease among pulmonary tuberculosis patients is associated with inflammatory marker at the start of intensive phase

ABSTRACT Background: Tuberculosis (TB) disrupts iron balance through systemic inflammation. Pulmonary tuberculosis (PTB) is linked to diverse anaemia types, necessitating intricate haematological and biochemical assessments for diagnosis. This study aims to describe the prevalence of anaemia of chronic disease (ACD), iron deficiency anaemia (IDA) among PTB patients and factors associated with these types of anaemia. Methods: A cross-sectional analysis was conducted from community-based cohort study involving sputum-positive PTB patients from 2018 to 2020 in urban Puducherry. Participants were enrolled from 10 primary health centres within 2 weeks of initiating anti-tubercular treatment (ATT). Blood samples were collected for assessing haematological and biochemical parameters. The sTfR/log ferritin ratio was used to distinguish between ACD and IDA. Data were captured using Epicollect5 and analysed using STATA V14. Result: Of the 176 PTB patients included, 63.07% (111/176) had anaemia, with ACD being the predominant type (84.6%, 94/111). The C-reactive protein (CRP) levels were higher among the anaemic group [40.77 (16.66-58.51) mg/dl vs 24.65 (14.23-47.26) mg/dl] and higher among the ACD as compared to IDA [46.9 (22.3-61.2) vs 20.8 (13.0-39.1) mg/dl]. Undernourished [adjusted prevalence ratio (APR) =3.43; confidence interval (CI): 1.21-9.69] and patients having low risk of dependence on tobacco [APR = 1.52; CI: 1.10-2.11] had higher risk of ACD. Female patients had higher risk of IDA [APR = 4.95, P &lt; 0.01]. Conclusion: The largest proportion of the PTB participants with anaemia had ACD. Acute-phase reactant and inflammatory marker are increased among newly diagnosed new sputum smear-positive (NSP) PTB participants at the start of ATT. Addressing inflammation is needed for combating anaemia in PTB patients.

Late Diagnosis and Treatment of Pulmonary Tuberculosis in Ziguinchor, Southern Region of Senegal

Background: Untreated smear-positive pulmonary tuberculosis constitutes the main source of transmission of the disease in the community. Aims: The aim of our study was to determine the diagnosis delays of smear-positive pulmonary tuberculosis in adults and to identify the factors associated with the diagnosis delay in Ziguinchor, Senegal. Methodology: This is a prospective descriptive and analytical study carried out from January 1, 2019 to December 31, 2022, in cases of pulmonary tuberculosis whose diagnosis was confirmed by the identification of AFB in sputum after Ziehl Nielsen staining and/or detection of Mycobacterium tuberculosis by Genexpert. Delay was defined as a diagnosis confirmed after 36 days. Logistic regression was performed to determine factors associated with diagnosis delay. Results: A total of 141 patients were included. They had an average age of 40 years ± 16 years, (16 years - 86 years). The peak age group was 16-30 years (34.04%). The sex ratio (M/F) was 1.8. The main characteristics of the patients were: a low level of education (34.8%), work in the informal sector (70.2%) and smoking (25.5%). More than half of the patients (78.44%) had their home less than 5 km from the anti-tuberculosis dispensing center. The patients’ initial symptoms were dominated by cough (90.0%), fever (78%) and weight loss (59.6%). The traditional healer was the first source of care in 40.4%, followed by the health post (37.7%), the health center (16%) and regional hospitals (5.8%). HIV serology was positive in 13.5% of cases. The average time between the beginning of symptoms and the tuberculosis diagnosis was 36± 9.22 days (15 - 58 days). The median time to treatment initiation was 1.8± 1.6 days (1 - 6 days). A diagnosis delay was noted in 53.19%. In multivariate analysis with linear regression, age &gt; 50 years (p = 0.021), use of herbal medicine (p = 0.036) and monthly income &lt; 58 USD (p = 0.039) were the factors associated with late diagnosis of tuberculosis. Conclusion: The diagnostic delay in smear-positive tuberculosis cases is significant in our context. To shorten this mean delay period, it is necessary to both strengthen the professional abilities and skills of caregivers in the health posts and involve after training the traditional healers in the screening and sensitizing process of the population

PREDICTORS OF ATYPICAL CHEST IMAGING IN PATIENTS WITH PULMONARY TUBERCULOSIS

This study aimed to identify the risk factors associated with abnormal chest imaging in patients diagnosed with pulmonary tuberculosis. A retrospective study was conducted between December 2022 and December 2023 in the Radiology Department of Mayo Hospital, Lahore. The study included 100 patients who were diagnosed with smear-positive pulmonary tuberculosis and had undergone chest computed tomography (CT) within two weeks before or after hospital admission. Patients' performance status was assessed on a scale of 0-4. CT scans were performed on all patients, and radiologists were unaware of the patient's data. They examined the scans to determine the presence of lung involvement (upper, middle, and lower) and cavity. Out of 100 patients, 48 (48%) had non-cavity disease. Univariate analysis revealed that patients with non-cavity disease were most likely to be female, older, and have low estimated glomerular filtration rate (eGFR) and C-reactive protein (CRP) levels compared to patients with cavities. In multivariate analysis, low CRP levels were found to be the most potent risk factor for non-cavity disease after adjusting for co-variables. Additionally, 70 patients (70%) presented with non-upper predominant lung disease. Univariate analysis revealed that the majority of patients in this group were women and had high CRP levels, low albumin levels, and poor performance status. Poor performance status was the most potent risk factor for non-upper predominant lung disease. Based on the study findings, low C-reactive protein levels and poor performance status are the most substantial risk factors for non-cavity and non-upper predominant lung disease, respectively, in patients with pulmonary tuberculosis.

Prevalence of Smear-Positive, Rifampicin-Resistant Mycobacterium tuberculosis and Related Factors Among Residents with Cough in Northern Ethiopian Refugee Health Facilities.

To ascertain the prevalence of Mycobacterium tuberculosis (M.tb) among refugees suspected of tuberculosis (TB) and related risk factors, including smear-positive and Rifampicin-resistant M.tb. A cross-sectional study was conducted between January 2020 and May 2020 among 384 refugees in four refugee camps in Northwest Tigray, Ethiopia. Socio-demographic and clinical data were collected from refugees with a history of cough for more than two weeks prospectively. Spot-spot sputum samples were collected and transported in an ice box to the Shire Suhul Hospital Microbiology laboratory; and then examined using a Fluorescent Microscope. All smear-positive samples were further processed by GeneXpert to detect Rifampicin-resistant MTB. Data were analyzed using SPSS version 21 and a p-value <0.05 was considered statistically significant. The overall prevalence of smear-positive PTB infection was 5.5% (21/384), but No TB case was resistant to Rifampicin detected by GeneXpert MTB/RIF assay. About 70% of the smear-positive pulmonary TB identified were females. Five (23.8%) of the smear-positive pulmonary tuberculosis cases were co-infected by HIV. Sharing of drink and food materials (AOR = 4.36, 95% CI = 1.19-15.89), active TB contact (AOR 7.24, 95% CI = 1.62-32.125), BMI (AOR = 5.23, 95% CI = 1.28-21.29), opening window practice (AOR = 4.32, 95% CI = 1.02-18.30) and HIV status (AOR = 9.36, 95% CI = 1.64-53.35) were statistically significant predisposing factors. The prevalence of smear-positive pulmonary TB among northwest Tigray refugee camps was still high. The prevalence of TB/HIV co-infection was also high. Minimizing close contact with active TB cases, reducing malnutrition, rapid TB/HIV screening, and establishing a ventilation system can reduce the transmission of TB among refugees.

Pre-Treatment Loss to Follow-up of Patients with Bacilloscopy-Confirmed Pulmonary Tuberculosis in the National Center for the Fight Against Tuberculosis and Respiratory Diseases in Niamey

Context: Pre-treatment loss of follow-up (PTLFU) represents a major problem that hinders the management of tuberculosis. The objective of this study is to determine the prevalence of lost to follow-up patients diagnosed with smear-positive pulmonary tuberculosis (SPPT) and referred to other TB screening and treatment centers (TBSTC). Method: This was a prospective, descriptive and analytical study conducted over a six month between March and August 2019, in patients diagnosed with smear-positive pulmonary tuberculosis at NCFATRD and referred to Niamey and Tillaberi centers. The chi-square text was used with a significance level of P ≤ 0.05. Results: 743 patients were diagnosed with SPPT, and 346 were referred to the TBSTC located in Niamey and Tillaberi cities. The prevalence of loss of follow-up before treatment in both Niamey and Tillaberi cities was 14.45% (50/343). Male represented 82% (41) of the cases with a sex ratio of 4.55. The mean age of our patients was 41.04 years. Patients not attending school and those with primary education represented the majority with 30% each. The majority of PTLFU (95.66%) were new cases of TB. Nearly half (42%) of PTLFU had traveled a distance of 6 to 15 km to get the TB screening. During the phone call follow up, we were able to reach only 12 patients (24%) of which 7 (14%) were deceased. Conclusion : the prevalence of PTLFU is high, therefore there is a need to reinforce the research of lost to follow up patients in order to improve tuberculosis control and management.

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.

Impact of diabetes mellitus on tuberculosis treatment outcomes: a cohort study in Bengaluru, India

Background: Tuberculosis (TB) remains a significant global health challenge, particularly in regions with a high prevalence of diabetes mellitus (DM). This study aims to evaluate the impact of DM on the treatment outcomes of TB patients in Bengaluru, India. Methods: In this cohort study, we examined 592 patients with smear-positive pulmonary TB, half of whom had a comorbid diagnosis of DM. Conducted in the Bruhat Bengaluru Mahanagara Palike area, the study included patients registered under the national TB elimination programme (NTEP). Data were collected on demographic characteristics, treatment adherence, sputum positivity, and treatment outcomes over six months. Results: The study revealed a high prevalence of DM among TB patients. Significant associations were observed between DM and various challenges, including higher rates of sputum positivity, poor adherence to anti-TB and anti-diabetic medications, increased adverse drug reactions (ADRs), and a higher default rate. TB patients with DM had a 1.5 times higher risk of unsuccessful treatment outcomes compared to non-diabetics. Furthermore, the risk of poor outcomes, particularly relapse, increased substantially in the TB-DM group during the six-month follow-up. Conclusions: Our findings highlight the crucial need for integrated TB and DM management strategies. This includes routine DM screening for TB patients, personalized treatment regimens, and enhanced patient education and support. These measures are essential for improving treatment outcomes in TB patients with comorbid DM.

Modelling of tuberculosis dynamics incorporating indirect transmission of contaminated environment and infectivity of smear-negative individuals: A case study for Xinjiang, China

Xinjiang has been one of the high incidence areas of pulmonary tuberculosis (PTB) in China. Besides being infected by direct contacting with active PTB individuals (direct infection), the susceptible would be infected because of the exposure to the environment contaminated by Mycobacterium tuberculosis (indirect infection). Active PTB individuals include not only the smear-positive PTB (PTB+) but also the smear-negative PTB (PTB–) who are infectious due to their ability to release tiny Mycobacterium tuberculosis particles even in the absence of visible Mycobacterium tuberculosis in sputum. By taking account of direct/indirect infection and the difference between PTB+ and PTB– individuals in transmission capability, a periodic dynamical PTB transmission model is proposed. The model is fitted to the newly monthly PTB+ and PTB– cases in Xinjiang from 2008 to 2017 by Markov Chain Monte Carlo algorithm. Moreover, global sensitivity analysis is constructed to address the uncertainty of some key parameters by using Latin hypercube sampling and partial rank correlation coefficient methods. Basic reproduction number R0 for PTB transmission in Xinjiang is estimated to be 2.447 (95% CrI:(1.203, 3.844)), indicating that PTB has been prevalent in Xinjiang over the study period. Our results suggest that reducing the direct/indirect transmission rates, early screening, isolating and treating the latent, PTB+ and PTB– individuals, and enhancing the clearance of Mycobacterium tuberculosis in the environment could more effectively control PTB transmission in Xinjiang. The model fits the reported PTB data well and achieves acceptable prediction accuracy. We believe that our model can provide heuristic support for controlling PTB transmission in Xinjiang.

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.

Racial and Ethnic Disparities in Tuberculosis Incidence, Arkansas, USA, 2010-2021.

We conducted an epidemiologic assessment of disease distribution by race/ethnicity to identify subpopulation-specific drivers of tuberculosis (TB). We used detailed racial/ethnic categorizations for the 932 TB cases diagnosed in Arkansas, USA, during 2010-2021. After adjusting for age and sex, racial/ethnic disparities persisted; the Native Hawaiian/Pacific Islander (NHPI) group had the highest risk for TB (risk ratio173.6, 95% CI 140.6-214.2) compared with the non-Hispanic White group, followed by Asian, Hispanic, and non-Hispanic Black. Notable racial/ethnic disparities existed across all age groups; NHPI persons 0-14 years of age were at a particularly increased risk for TB (risk ratio888, 95% CI 403-1,962). The risks for sputum smear-positive pulmonary TB and extrapulmonary TB were both significantly higher for racial/ethnic minority groups. Our findings suggest that TB control in Arkansas can benefit from a targeted focus on subpopulations at increased risk for TB.

Burden of type 2 diabetes among pulmonary and extra pulmonary tuberculosis patients diagnosed in a tertiary care institute in Puducherry

Background: Most often diabetes and tuberculosis present together and complicate each other at many levels. Studies show people with diabetes were at three times higher risk of developing tuberculosis. Study done in Kerala have reported that the prevalence of diabetes is higher among males and among smear positive pulmonary tuberculosis cases. Objective was to measure the burden of type 2 diabetes mellitus among pulmonary and extra pulmonary tuberculosis patients diagnosed in a tertiary care institute in Puducherry. Methods: Data was obtained from National tuberculosis elimination programme (NTEP) referral register of Pondicherry Institute of Medical Science. All the patients who have diagnosed to have tuberculosis from January 2022 to July 2022 were included. Diabetic status among pulmonary and extrapulmonary tuberculosis patients was also collected. Results: Among the patients with tuberculosis, 67% of patients were males. A total of 38.8% of cases were found to have diabetes and out of these cases, 23.8% of patients were known case of diabetes and 16.4%of cases were patients with newly diagnosed diabetes. It is observed that, among patients with pulmonary tuberculosis, 32.8% of cases and among patients with extrapulmonary tuberculosis 5.9% of cases were found to have diabetes. Conclusions: The present study showed that burden of type 2 diabetes mellitus was more among pulmonary tuberculosis.

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.

CLINICAL PHARMACIST INTERVENTIONS ON MILIARY KOCH’S PATIENT WITH ANTITUBERCULAR THERAPY-INDUCED HEPATOTOXICITY AND PSYCHOSIS: A RARE CASE REPORT

Psychosis and hepatotoxicity are the dangerous side effects of the antitubercular drugs directly observed treatment short course (DOTS) therapy. Hematological spreading of tubercular bacteria in the lungs is also known as miliary tuberculosis. In this case study, 45-year-old man, weighing 55 kg was brought to the hospital with the chief complaints of vomiting (multiple episodes), fever, pain in abdomen, difficulty in breathing, mucoid cough, and disturbed sleep for the past 1 week. He had a known case of smear-positive pulmonary tuberculosis (in the past 1 month), but at that time, patient was not taking regular antitubercular treatment (ATT) medications (DOTS therapy). After 3th week of irregular antitubercular drug treatment, patient developed with the problems such as vomiting (multiple episodes), fever, pain in abdomen, difficulty in breathing, cough with expectorations, disturbed in sleep, and delirium. Pulmonologists had found the provisional and final diagnosis on the bases of subjective and objective observations miliary KOCH’S with antitubercular drugs induced hepatotoxicity and psychosis. Patients recovered from psychosis and hepatotoxicity withdrawn the first line ATT medication and tablet pyridoxine, antipsychotic medicines, and modified ATT were added in the therapy. Psychotic in a patient on ATT can be one of the complications of tablet isoniazid. As a clinical pharmacologist, we prevent and minimize drugs-induced complications and adverse drug reactions. Proper patients counseling and patients’ education are important for the better management of patients.

Pulmonary Tuberculosis Prevalence and Associated Factors Among Adult Patients Visiting Finchwa Health Center, West Guji Zone, Southern Ethiopia

Background: Mycobacterium tuberculosis is the name of the microorganism that causes tuberculosis. The bacteria typically affect the lungs, but if not adequately treated, it can affect any part of the body, such as the kidney, spine, and brain. In Ethiopia, tuberculosis is a significant public health issue. However, no epidemiological research in the study area has been recorded. Objective: The study was undertaken to assess the prevalence of pulmonary tuberculosis and associated risk factors PTB presumptive patients who visited the Finchawa Health Center from November 2022 to February 2023. Methods: A cross-sectional study was conducted among 273 study participants. Structured questionnaire was used to gather sociodemographic and risk factor information. Sputum samples were taken from the study participants and analyzed under a microscope. Data were analyzed by using SPSS Version-25 software. Binary logistic regression analysis adjusted odds ratio (AOR) with respective 95% confidence interval (CI) and the threshold for statistical significance was set at p 0.05. Result: The prevalence of smear-positive Tb among presumptive patients was 4.8% with 95% CI (2.24–7.29). Prevalence of PTB with HIV co-infections, and PTB with diabetes mellitus (DM) comorbidity were 38.5%, and 27.3%, respectively. In comparison to their counterparts, having a family size greater than five (AOR = 5.15, 95% CI. = 1.46- 18.29), having a history of family contact (AOR = 6.7, 95% CI. = 1.78-22.99) and having a history of Tb infection (AOR = 4.76, 95% CI. I = 1.05-21.62) were all found to be predictors for developing smear-positive pulmonary tuberculosis. Conclusion: The prevalence of smear-positive pulmonary tuberculosis in the Finchawa health center was found to be high. Therefore, zonal and town health departments should emphasize detailed tracing of presumptive, regular assessment of PTB suspects and refer to public health care institutions for early diagnosis and initiation of anti-TB treatment.

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.