Smear-positive Tuberculosis Patients Research Articles

The Assessment of Serum Fibronectin Levels as a Potential Biomarker for the Severity of Drug-Sensitive Pulmonary Tuberculosis: A Pilot Study.

Tuberculosis (TB) is a global health burden caused by Mycobacterium tuberculosis (Mtb) infection. Fibronectin (Fn) facilitates Mtb attachment to host cells. We studied the Fn levels in smear-positive TB patients to assess its correlation with disease severity based on sputum smears and chest X-rays. Newly detected consecutive sputum AFB-positive pulmonary TB patients (n = 78) and healthy control subjects (n = 11) were included. The mycobacterial load in the sputum smear was assessed by IUATLD classification, ranging from 0 to 3. The severity of pulmonary involvement was assessed radiologically in terms of both the number of zones involved (0-6) and as localized (up to 2 zones), moderate (3-4 zones), or extensive (5-6 zones). The serum human fibronectin levels were measured by using a commercially available enzyme-linked immunosorbent assay (ELISA) kit (Catalogue No: CK-bio-11486, Shanghai Coon Koon Biotech Co., Ltd., Shanghai, China). The PTB patients showed lower Fn levels (102.4 ± 26.7) compared with the controls (108.8 ± 6.8), but they were not statistically significant. Higher AFB smear grades had lower Fn levels. The chest X-ray zones involved were inversely correlated with Fn levels. The Fn levels, adjusted for age and gender, decreased with increased mycobacterial load and the number of chest radiograph zones affected. A Fn level <109.39 g/mL predicted greater TB severity (sensitivity of 67.57% and specificity of 90.38%), while a level <99.32 pg/mL predicted severity based on the chest radiology (sensitivity of 84.21% and specificity of 100%). The Fn levels are lower in tuberculosis patients and are negatively correlated with severity based on sputum mycobacterial load and chest radiographs. The Fn levels may serve as a potential biomarker for assessing TB severity, which could have implications for early diagnosis and treatment monitoring.

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.

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.

No impact of helminth coinfection in patients with smear positive tuberculosis on immunoglobulin levels using a novel method measuring Mycobacterium tuberculosis-specific antibodies

Helminth/tuberculosis (TB)-coinfection can reduce cell-mediated immunity against Mycobacterium tuberculosis (Mtb) and increase disease severity, although the effects are highly helminth species dependent. Mtb have long been ranked as the number one single infectious agent claiming the most lives. The only licensed vaccine for TB (BCG) offers highly variable protection against TB, and almost no protection against transmission of Mtb. In recent few years the identification of naturally occurring antibodies in humans that are protective during Mtb infection has reignited the interest in adaptive humoral immunity against TB and its possible implementation in novel TB vaccine design. The effects of helminth/TB coinfection on the humoral response against Mtb during active pulmonary TB are however still unclear, and specifically the effect by globally prevalent helminth species such as Ascaris lumbricoides, Strongyloides stercoralis, Ancylostoma duodenale, Trichuris trichiura. Plasma samples from smear positive TB patients were used to measure both total and Mtb-specific antibody responses in a Peruvian endemic setting where these helminths are dominating. Mtb-specific antibodies were detected by a novel approach coating ELISA-plates with a Mtb cell-membrane fraction (CDC1551) that contains a broad range of Mtb surface proteins. Compared to controls without helminths or TB, helminth/TB coinfected patients had high levels of Mtb-specific IgG (including an IgG1 and IgG2 subclass response) and IgM, which were similarly increased in TB patients without helminth infection. These data, indicate that helminth/TB coinfected have a sustained humoral response against Mtb at the level of active TB only. More studies on the species-specific impact of helminths on the adaptive humoral response against Mtb using a larger sample size, and in relation to TB disease severity, are needed.

The elevated expression of LAG-3 on CD8+T cells correlates with disease severity of pulmonary TB

ObjectiveLymphocyte-activation gene 3 (LAG-3) plays an important role in regulating T-cell responses and inducing peripheral tolerance. Our aim in this study was to investigate the relationship between LAG-3 and active tuberculosis (ATB) and the impact of LAG-3 blockade on CD8+T cells. MethodsFlow cytometry was used to detect the expression of LAG-3 on CD4+T and CD8+T cells in the peripheral blood and bronchoalveolar lavage fluid from ATB patients and to explore the relationship between LAG-3 and ATB. ResultsThe expression of LAG-3 on CD4+T and CD8+T cells in ATB patients was increased (P < 0.001), and CD8+T cells with high expression of LAG-3 were associated with sputum culture results (P < 0.05). We further analyzed the relationship between the expression of LAG-3 in CD8+T cells and the severity of tuberculosis and found that the expression of LAG-3 on CD8+T cells in smear-positive tuberculosis patients was significantly higher than that in sputum smear-negative tuberculosis patients (P < 0.05). LAG-3 expression on CD8+T cells was negatively correlated with the presence of lung lesions (P < 0.05). After stimulation with a tuberculosis-specific antigen, the expression of LAG-3 on tuberculosis-specific CD8+T cells was also upregulated, and LAG-3-expressing CD8+T cells showed reduced production of IFN-γ, decreased activation, and lower proliferation, while the function of CD8+T cells was restored when LAG-3 signaling was blocked. ConclusionsThis study further explored the relationship between immune exhaustion caused by LAG-3 and immune escape of Mycobacterium tuberculosis and revealed that the elevated expression of LAG-3 on CD8+T cells correlates with functional defects of CD8+T cells and the severity of pulmonary TB.

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.

Status of universal drug-susceptibility testing among sputum smear-positive tuberculosis patients diagnosed at a tertiary care centre.

This study was aimed at estimating the proportion among sputum smear-positive tuberculosis (TB) patients diagnosed at a tertiary care centre in India, who did not undergo universal drug-susceptibility testing (UDST), assessing the sociodemographic and morbidity-related factors associated with it, ascertaining the reasons for not getting tested and estimating the proportion with any drug resistance (DR). TB Notification Register and TB Laboratory Register, maintained in Designated Microscopy Centre and Intermediate Research Laboratory, respectively were used to obtain the patient details and information regarding UDST and DR-TB status. Under UDST, the TB patients had undergone rapid molecular tests to check for any DR. TB patients who dropped out of this strategy (those who did not submit a sputum sample for DR testing even after being instructed) were telephonically contacted and asked regarding reasons for not getting themselves tested. Of the 215 patients, 74 [34.4%, 95% confidence interval (CI): 28.1-41.2] did not undergo UDST. Of these 74 participants, 60 per cent reported the reason that they were not informed regarding the drug-susceptibility test. Among the 141 patients who underwent UDST, six (4.3%, 95% CI: 1.58-9.03) had DR. Non-UDST patients were significantly more in percentage among TB patients who were aged <30 years (adjusted prevalence ratio 2.36; 95% CI: 1.19-4.68) compared to >60 years. The present findings point towards a need to sensitize healthcare workers and TB patients to improve UDST.

Status of Universal Drug Susceptibility Testing in Pulmonary Tuberculosis Patients Initiated on Treatment in an Urban Setting, South India.

Early initiation of drug susceptibility testing (DST) guided anti-tuberculosis treatment benefits the patient in terms of better treatment outcomes and possibly reduces the transmission of tuberculosis (TB) disease in the community. To determine the status of universal DST (UDST) coverage in smear-positive pulmonary TB patients (PTB) initiated on treatment under the TB program in Greater Chennai Corporation. In addition, the barriers and facilitators for UDST were explored. The data of PTB patients who were initiated on anti-TB treatment from July to December 2019 was abstracted from the NI-KSHAY database of TB Program. The barriers and facilitators for UDST were explored in 5 focus group discussions (FGDs) among the TB program healthcare workers (HCW). UDST coverage was based on the availability of Cartridge-based Nucleic Acid Amplification test (CBNAAT) results in the NI-KSHAY database. The CBNAAT result was available for 1628 (82.6%) of the 1970 smear-positive PTB patients. Non-availability of CBNAAT results was significantly higher among the older age group (>50 years), in female PTB patients, and the Private Sector. Issues with sputum collection, transport of specimens, and receipt of results were highlighted by the HCWs for the non-availability of UDST results. Universal DST coverage in smear-positive PTB patients initiated on treatment in 2019 in Chennai was optimal as per National Strategic Plan for TB elimination UDST target of 80% for the year 2020 but with scope for improvement. The low UDST coverage in the private sector, among female patients and older age groups, needs to be addressed.

Diabetes Mellitus and its Association with Body Mass Index in Sputum Positive Tuberculosis Patients in a Tertiary Health Care Centre

Background: Tuberculosis is a chronic infectious disease that causes pulmonary tuberculosis and also affectsother tissues of the body. People with diabetes mellitus and those who are underweight have an increased risk ofgetting active tuberculosis. The objectives of the study were to estimate the prevalence of diabetes mellitus and todetermine its association with Body Mass Index in tuberculosis patients.Methods: In the present record-based cross-sectional study, 100 sputum smear positive tuberculosis patients 18years and older who attended the out-patient department of Pulmonary Medicine from 1/6/2020 to 31/12/2022were included and sputum smear negative patients were excluded. Data entry and analysis was done in MicrosoftExcel. Percentages were calculated and association between diabetes mellitus and Body Mass Index of the studypopulation was assessed by chi square test.Conclusion: The prevalence of diabetes mellitus in tuberculosis patients was almost double than that of thegeneral population of India and its association with underweight was found to be statistically significant. Soproper screening of all patients of tuberculosis for diabetes mellitus is necessary for early diagnosis and treatment.Health education and counselling are equally important

Household symptomatic contact screening of sputum smear positive tuberculosis patients at the DOTS clinic of SGT hospital, Gurugram

Background: Contact screening was conducted under ICMR (REFERENCE ID: 2019-07811) programme in villages near SGT hospital, Gurugram. Objective: To evaluate risk factors, extent of spread of tuberculosis among household contacts of tuberculosis cases and to create awareness. Methods and Material: Address of TB cases were taken from RNTCP register at DOTS clinic, SGT medical college. Then all household contacts of positive cases were screened, counselled and advised to approach ASHA Workers if such symptoms appear. Data was analysed using appropriate statistical methods. Results:21 Index cases along with 94 household contacts were screened. 61.90% families still use chullahs for cooking. 76.1% families have overcrowding. 3) 61.90% families had inadequate ventilation 4) 19.05%families were aware about the spread of this disease. 5)Only 23.80% families practised adequate sanitation methods and precautions6) 42.8% Index cases had a history of smoking. 7) 44.4% 4 continue to smoke with infection. The association of adequate sanitation with presence of awareness was found to be statistically significant. (p-value&lt;0.05). Other factors were not significantly associated with level of awareness regarding prevention of tuberculosis spread among study participants. Conclusions: Contact screening is an effective tool and it gives the real-time picture of TB in India.

Rifampicin Resistance in Primary Pulmonary Tuberculosis at HMC Hospital Peshawar Department of Pulmonology a Multi Center Study

Background: According to estimates from the World Health Organization, TB afflicted about 12 million people in 2019 and claimed nearly 1.7 million lives. Pakistan is rated fifth worldwide for the prevalence of TB and fourth among developing nations for the emergence of treatment resistance. In Pakistan, there are around 525,000 new cases of TB each year, and 20,000 people develop medication resistance. A high mortality rate is caused by drug resistance. Before treating the patient for medication resistance and for a cure, it should be confirmed with a drug susceptibility test. Objective: To determine the prevalence of rifampicin resistance in patients with primary pulmonary TB using a drug susceptibility test. Methodology: In this Multi Center study, all patients who attended the pulmonology department of the HMC Hospital in Peshawar between 2018 and 2020 were included. The study comprised 296 smear-positive TB patients who attended the pulmonology department and had no prior history of ATT consumption. Further testing of the patient's sputum for rifampicin resistance and Mycobacterium TB was done using the PCR-based Gene Expert assay. Results: In the current study, 296 TB patients in total were included. According to our statistics, there were 200, 205, and 140 TB patients in the most recent three years 2018,19,2020, correspondingly (Figure 2). The study's participant population consisted of 157 men (52%) and 139 women (48%) (Table 1). The ratio of men to women was 01.11:12. 192 (64%) of the population lived in Peshawar, 33 (11%) in Khurram Agency, swat 25 (10%) and 45 (18%) in Charsadda (Figure 3). The findings revealed that Peshawar City was home to the bulk of the TB sufferers. 95 (07%) of the TB patients had extremely excellent socioeconomic standing, followed by 106 (36%) patients with average socioeconomic standing, and 166 (57%) patients with poor socioeconomic standing. Rifampicin resistance was found in 18 (06%) of these 296 TB patients (Table 2). It's important to note that 20 (60%) of the positive rifampicin resistance cases were in men and 13 (40%) were in women (Table 1). Additionally, the data we gathered indicated that rifampicin resistance was stronger in patients with low socioeconomic level (17%) and was lower in patients with high socioeconomic status (3%) for TB patients. Table 2. Conclusion: This study demonstrates a clear relationship between patient socioeconomic level and rifampicin resistance. Although TB is curable, a patient's chances of being cured are decreased and they become more resistant to other medications when they develop resistance to one or more treatments, particularly rifampicin. Keywords: Rifampicin, Tuberculosis,GeneXpertassay,drugsusceptibility.

Dietary Intake and Nutritional Status of Patients with Pulmonary Tuberculosis in Puducherry, South India

A bidirectional relationship exists between tuberculosis (TB) and nutrition. To examine the dietary intakes of tuberculosis (TB) patients and to identify the factors associated with dietary deficiencies. In this cross-sectional study, 173 newly diagnosed sputum smear-positive TB patients, and taking treatment in the National Tuberculosis Elimination Programme (NTEP) were included. Nutrient intakes were evaluated through one day 24-h dietary recall and compared with the Recommended Dietary Allowance (RDA). Data on dietary intake was analyzed using DietSoft software. The mean (SD) age of the study participants was 45.5 (18.7) years with majority male (73.4%). More than one-third (35.3%) didn’t receive any formal education and 28% were unemployed. Nearly half (47%) had diabetes mellitus, 45.1% were alcoholics, 39.3% were smokers, and 36% underweight. The mean (SD) daily intake of energy was 1414.33 (458.45) kcal and the median (Interquartile Range) of protein was 43.15 (30.00-60.26) gms. The daily energy and protein intake were lower than the national guidelines for RDA. The intake of micronutrients was found to be much lower than recommended. The intake of macronutrients and selected micronutrients in TB patients were grossly inadequate. Along with vitamin supplementation, dietary counseling also is needed in this population. Keywords: Dietary intake, Nutritional status, Risk behaviors, Tuberculosis

Prevalence of Multidrug-Resistant TB Among Smear-Positive Pulmonary TB Patients in Banadir, Somalia: A Multicenter Study.

Tuberculosis (TB) is an infectious disease that is the second most common cause of death from a single infectious agent. TB infection affects anyone, regardless of age, gender, and ethnicity. Drug-resistant TB is a serious public health problem, which needs treatment with a second-line anti-TB drug and it includes poly-drug resistance (PDR), multi-drug resistance (MDR), and extensive drug resistance (XDR). The goal of this research is to find out the prevalence of MDR TB among pulmonary TB patients in Banadir, Somalia. This was a multicenter retrospective review of data involving 1732 smear-positive pulmonary TB patients visiting Banadir TB centers between July 1, 2019 and June 30, 2020. Demographic, clinical, and drug susceptibility data were retrieved from TB treatment cards. The data were analyzed using Statistical Package for Social Sciences (SPSS) software(IBM SPSS Statistics version 26). All 1732 pulmonary TB cases were previously diagnosed by the Gene Xpert MTB/RIF test. Among them, 70.4% (1219/1732) were males. The mean age was 31.77 years. Overall, the prevalence of drug resistance TB was 10.56% (183/1732). The MDR TB was 1.96%, poly-drug resistance (PDR) was 0.12%, and extensive drug resistance was 0.06%. This study showed a prevalence of MDR-TB among pulmonary TB patients, which is similar to some of the eastern African countries.

Distinct and shared B cell responses of tuberculosis patients and their household contacts.

This study was aimed at identifying the B cell responses which could distinguish between 'latent tuberculosis infection (LTBI)' and active TB disease. Study subjects were smear-positive TB patients (n = 54) and their disease-free household contacts (HHCs, n = 120). The sera were used for determination of antibody levels (ΔOD values) against Mycobacterium tuberculosis membrane (MtM) antigens by ELISA and for visualisation of seroreactive MtM antigens by immunoblotting. B cell subsets in whole blood samples were determined by flow cytometry. In TB sera, levels of IgG antibodies were significantly higher than IgM and IgA whereas IgM and IgA antibody levels were comparable. Conversely, HHC sera had significantly higher IgM antibody levels than IgG and IgA. The ratio of IgM to IgG antibodies in HHCs were also significantly higher than in patients. Immunoblotting revealed that some of the MtM antigens (<10, ~12 and ~25 kDa) reacted with TB as well as HHC sera whereas some other antigens (~16, ~36, ~45 and ~60 kDa) reacted with most of TB and a subset of HHC sera. Frequencies of classical memory B cells (cMBCs, CD19+CD27+) were significantly higher, and of IgG+ cMBCs were significantly lower in HHCs than in patients. Frequencies of IgA+ cMBCs in HHCs and patients were comparable but both were significantly higher than the corresponding frequencies of IgG+ cMBCs. Frequencies of IgA+ atypical MBCs (aMBCs, CD19+CD27-) in HHCs and patients were also comparable and significantly higher than the IgG+ aMBCs. The plasmablast (CD19+CD27++CD38++) frequencies in HHCs and patients were comparable. These results suggest that the IgM/IgG antibody ratio, antibody binding to selected MtM antigens and relative frequencies of MBC subsets could indicate protective or pathogenic immune responses following the primary infection with Mtb. Responses that orchestrate protection leading to a 'quiescent' LTBI may provide clues to an effective vaccination strategy against TB.

The second national anti-tuberculosis drug resistance survey in Tanzania, 2017-2018.

To determine the levels and patterns of resistance to first- and second-line anti-tuberculosis (TB) drugs among new and previously treated sputum smear positive pulmonary TB (PTB) patients. We conducted a nationally representative cross-sectional facility-based survey in June 2017-July 2018 involving 45 clusters selected based on probability proportional to size. The survey aimed to determine the prevalence of anti-TB drug resistance and associated risk factors among smear positive PTB patients in Tanzania. Sputum samples were examined using smear microscopy, Xpert MTB/RIF, culture and drug susceptibility testing (DST). Logistic regression was used to account for missing data and sampling design effects on the estimates and their standard errors. We enrolled 1557 TB patients, including 1408 (90.4%) newly diagnosed and 149 (9.6%) previously treated patients. The prevalence of multidrug-resistant TB (MDR-TB) was 0.85% [95% confidence interval (CI): 0.4-1.3] among new cases and 4.6% (95% CI: 1.1-8.2) among previously treated cases. The prevalence of Mycobacterium tuberculosis strains resistant to any of the four first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) was 1.7% among new TB patients and 6.5% among those previously treated. Drug resistance to all first-line drugs was similar (0.1%) in new and previously treated patients. None of the isolates displayed poly-resistance or extensively drug-resistant TB (XDR-TB). The only risk factor for MDR-TB was history of previous TB treatment (odds ratio=5.7, 95% CI: 1.9-17.2). The burden of MDR-TB in the country was relatively low with no evidence of XDR-TB. Given the overall small number of MDR-TB cases in this survey, it will be beneficial focusing efforts on intensified case detection including universal DST.

Evaluation of endometrial tuberculosis among subjects undergoing endometrial biopsy at our teritiary care centre

Background: Female genital tuberculosis (FGTB) is known to cause severe tubal disease leading to infertility and its incidence closely parallels with the overall prevalence of tuberculosis (TB) in a community. Objectives of the study: To study the prevalence of endometrial tuberculosis among the infertility subjects undergoing endometrial biopsy. Materials and Methods: Demographic data regarding age, Socioeconomic status based on the Modified Kuppuswamy scale, menstrual pattern, type of infertility, past-history of TB in any part of the body or history of TB contact (living in the same household or in frequent contact with a sputum smear positive TB patient in last 2 years). Body Mass Index/ BMI was calculated. All the subjects were evaluated for GTB by CXR, CBNAAT, USG, Culture AFB, Biopsy, and histopathological examination. Results and Discussion: We performed various investigations which include CXR, USG, CBNAAT and CS for AFB, we found that all the subjects had normal CXR, 132 had tubo-ovarian mass on USG, 36 had CBNAAT positive and culture for AFB was positive in 23 subjects.

Experience on the first national anti-TB drug resistance survey (DRS) in Timor-Leste

BackgroundA national drug resistance survey (DRS) was implemented for the first time in Timor-Leste (TL) in 2019. The primary objective of the survey was to assess the prevalence of drug resistance among new and previously treated pulmonary TB patients in the country.MethodsThis nation-wide cross-sectional survey was conducted in 2019 targeting all new and previously treated sputum smear-positive pulmonary TB patients. Sputum samples were submitted to the National TB Reference Laboratory for confirmation of TB and to determine resistance to rifampicin by Xpert MTB/RIF. Culture was performed on solid media, and culture isolates of confirmed TB cases were shipped to the WHO Supranational TB Reference Laboratory in Chennai, India for whole genome sequencing (WGS). Survey summary statistics, data cross-tabulations and analysis of potential risk factors of rifampicin-resistant TB (RR-TB) were conducted using R statistical software (version 3.5.2).ResultsA total of 953 sputum-smear positive patients were enrolled, of which 917 were confirmed as positive for TB by either Xpert MTB/RIF or culture. An electronic web-based system was used for entry and storage of the data. Rifampicin resistance was detected among 0.6% (95% CI 0.2–1.3) of new cases and 2.7% (95% CI 0.5- 8.2) of previously treated cases. WGS was conducted for validation purposes on 65 randomly selected isolates (29% of RR-TB (2/7) and 7% of RS-TB (63/910) by Xpert MTB/RIF or pDST). The original test results agreed with the WGS validation results for 62/64 isolates (97%).ConclusionThe prevalence of RR-TB in Timor-Leste is relatively low compared to the estimated proportions of RR-TB in the WHO South-East Asia Region (2.5% [95% CI 1.9–3.3] among new cases and 14% [95% CI 7.7–21] among previously treated cases). The rapid sputum collection and transportation mechanism implemented in the survey demonstrates its feasibility in low resource settings and should be replicated for routinely transporting TB specimens from microscopy labs to GeneXpert sites. Establishment of in-country capacity for rapid molecular diagnostics for both first- and second-line DST is an immediate need for achieving universal drug susceptibility testing (DST) to guide appropriate patient management.

Hubungan Kondisi Lingkungan Rumah dengan Kejadian Tuberkulosis (TB) Paru

Pulmonary tuberculosis, or pulmonary TB, is an infectious disease caused by Mycobacterium tuberculosis (M. Tuberculosis). Pulmonary TB bacteria spread to other people through transmission or airflow (sputum of smear-positive pulmonary TB patients) when the patient coughs or sneezes. In addition, it impacts the individual and the sufferer's family, namely the psychological effect in the form of decreased support, anxiety, or low self-confidence. The World Health Organization (WHO), in its 2018 Annual report on global TB Control, stated that there were ten countries categorized as high-burden countries for pulmonary tuberculosis, namely Indonesia in third place with 842,000 TB cases. According to the WHO 2018, the incidence of tuberculosis in Indonesia in 2017 was 319 per 100,000 population, and the death rate for tuberculosis patients was 40 per 100,000 population. The condition of the home environment is very influential on the transmission of pulmonary TB disease. These include roofs, floors, walls, availability of windows, ventilation, lighting, and occupancy density. Objective: The purpose of this study was to determine the relationship between home environment conditions and the incidence of pulmonary TB. Using the literature review method. Search journals using an academic database, namely Google Scholar, published in 2018-2020 using Indonesian and English. The research analysis results showed that six research journals had a relationship with the relationship between home environmental conditions and the incidence of pulmonary tuberculosis. Based on the results of research using the literature review method, there is a relationship between home ecological conditions, including ventilation, occupancy density, and lighting, with the incidence of pulmonary tuberculosis (TB).

Weight Changes and its Determinants among Sputum Positive Pulmonary TB Patients in Bengaluru – A Prospective Study

Background and Objectives Underweight indicating undernutrition has a bidirectional relationship with Tuberculosis TB and is an established prognostic risk factor. It contributes to an estimated 55 of annual TB incidence in India. Positive weight changes among Indian patients without additional nutritional support are in the range of 3ndash4 kg. Undernourished patients with TB get into a vicious cycle of worsening disease and undernutrition which is detrimental. With this background we intend to assess the weight changes and its determinants among newly diagnosed drug sensitive smear positive pulmonary TB patients and estimate the prevalence of undernutrition.Methodology A prospective study was conducted among 121 newly diagnosed drug sensitive smear positive pulmonary TB patients ge 18 years registered in selected tuberculosis units in Bangalore. A pretested questionnaire was administered weight and height were measured at recruitment. Patients were followed up for weight assessment at the end of two and six months. Repeated ANOVA measures were applied to see statistical differences in the weight changes between the start of treatment end of two months and six months.Results Mean weight at the start of the treatment end of two months and six months was 55.72plusmn8.9 56.7plusmn8.5 and 58.2plusmn8.2 kg respectively. The weight changes between the groups was found to be statistically significant p value lt0.001. Mean weight gain in the study subjects was 2.3plusmn1.4 kg. An average of 4 positive weight change was seen at the end of the treatment. Positive weight change was significantly associated with higher socio economic status absence of alcohol consumption absence of tobacco use absence of clubbing and pallor in TB patients while only absence of pallor OR-16.169.3-3.7 and tobacco use OR-12.6 43.9-3.5 in multivariate analysis showed a p value lt 0.05.Conclusion Monitoring the weight regularly in TB patients during the course of treatment with proper nutritional counselling is essential for treatment support and success of National TB Elimination Program NTEP as the nutritional status has a bidirectional relationship with TB acting as an important determinant factor for treatment success

Process evaluation of chest camps for increased tuberculosis case finding in Punjab, Pakistan.

To contribute to the World Health Organization's End TBStrategy, the active tuberculosis (TB) case-finding approach has been proven effective. A total of 66 chest camps were organised for patients in 15 selected districts in Punjab, Pakistan, in 2017. A mixed-method process evaluation was conducted in four randomly selected districts to evaluate the use of chest camps for active TB case finding to reach the maximum number of people with TB and to assess the implementation outcomes, such as effectiveness, feasibility, fidelity, and costs. Results indicated that 1458 attendees visited 24 chest camps in four selected districts. Among attendees, 297 presumptive cases were found and smear-tested; and 34 of the smear-tested were diagnosed as smear-positive TB patients. The prevalence of smear-positive TB patients among the chest camp participants was found to be 2.3%. The findings from interviews showed that preparation of chest camp activities, especially the involvement of community leaders, was found to be effective in achieving the desired level of attendance. The respondents found attending the chest camps for TB symptoms feasible and acceptable. The chest camp costs approximately US$280, including the pre-camp mobilisation events, whereas the cost per TB-positive patient was found to be US$197.64. The higher number of attendees without TB symptoms, the low proportion of smear-negative case registrations; and relatively high unit cost (per patient detected) were the areas identified for further attention. The study supports the continuation of chest camp activity, with further attention required for quality and efficiency concerns.