Smear-positive Tuberculosis Patients Research Articles

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.

Genetic polymorphism of toll-like receptors in HIV-I infected patients with and without tuberculosis co-infection.

Toll-like receptors (TLRs) are identified as one of the key components of innate immune system due to their ability to sense conserved molecular motifs associated with several pathogens. It has been implicated from several evidence that mutations in genes encoding TLRs are associated with increased or decreased susceptibility to various infectious diseases. The study was prospective, cross-sectional, as well as longitudinal in nature, which includes 223 HIV-positive patients, 150 HIV-positive patients with latent tuberculosis (TB) infection, 150 HIV-positive patients with active TB, 200 HIV-negative newly diagnosed sputum smear positive pulmonary TB patients, and 205 healthy subjects. A statistically significant difference was observed in allelic frequencies of TLR4 between healthy subjects and HIV + TB patients (P < 0.001), healthy subjects, and pulmonary TB (PTB) Category-I patients (P < 0.01) and between healthy subjects and HIV + TB patients (P < 0.001). TLR4 genotype frequencies were also significantly different between healthy subjects and PTB Cat I patients (P < 0.001) and HIV + and HIV + TB patients (P < 0.01). A statistically significant difference was also observed between HIV + and PTB Cat I patients (P = 0.04), HIV + LTBI and HIV + TB patients (P = 0.01), and between HIV + TB and PTB Cat I patients (P < 0.01). This study implicates that Asp299Gly polymorphism in TLR4 gene is associated with increased susceptibility to active TB in HIV-seropositive patients. Increased frequency of 'A' allele in TLR9 gene was also discovered at the time of active TB development in ART naïve HIV + patients, who developed active TB on follow-up.

Investigation of two general venous thromboembolism risk-stratification models in predicting venous thromboembolic events in TB patients.

Tuberculosis (TB) remains an infectious disease with a high prevalence worldwide and represents a major public health concern. It is known that TB causes a hyper-coagulable state due to its infective nature. Thus, patients are prone to higher incidence rates of venous thromboembolism (VTE) in comparison with the general population. Although there are many risk assessment models (RAMs) that estimate the risk of VTE incidence in the general population, none have been proven to show significant prognostic value in early and accurate VTE prediction among TB patients. This study aims to investigate the accuracy of general RAMs in prediction of VTE incidence in the population of TB-positive patients. The following survey is a retrospective study among patients afflicted with TB, in whom VTE had occurred either during or at the onset of admission. A total number of 865 smear-positive TB cases were recorded in hospital in a 7-year timespan, among which a total sum of 37 patients (67.6% males, age: 56.19 ± 20 years) experienced at least one episode of thromboembolic incidence. We nominated Padua and Geneva RAMs and calculated the scores with regard to their inpatient hospital records. Of 865 adult hospitalized smear-positive TB patients, 37 patients happened to develop VTE in the course of infection, after excluding the unacceptable data. The incidence of VTE was calculated at 4.27%. Of all VTEs, 73% turned out to be deep venous thromboembolism (DVT), 18.9% were pulmonary thromboembolism (PTE), and 8.1% of patients developed both DVT and PTE during the course of disease. Among all cases, 32.4% revealed Geneva score equivalent or >3. It conveys the meaning that these patients were at greater risk for VTE development and were indicated to receive prophylactic medication. Similarly, Padua model was capable of predicting 29.7% cases scoring >4, which is alarming for elevated VTE probability. 21.6% of TB patients, who had developed VTE during the course of their disease eventually passed away. Our statistics show minimal positive predictive value for Padua and Geneva RAMs, which are seemingly in sharp contrast with the excellent validation of these models verified by numerous surveys in general population. This fact could be attributable to failing to consider TB, or in general chronic infections, as independent indicators of VTE incidence. These findings indicate the need for revising the presenting RAMs or establishing a separate RAM for VTE prediction in TB patients, resembling the VTE risk assessment model for cancer patients.

Epidemiology and factors of tuberculosis treatment outcome, Bangladesh, 2012-13

Tuberculosis (TB) treatment outcome is an important indicator to improve TB control efforts. We assessed factors associated with unfavorable treatment outcomes among smear-positive pulmonary TB patients reported to the national TB program from January 2012 to December 2013 in Bangladesh. Favorable outcomes were cured and treatment completed with unfavorable outcomes as failed, defaulted, died and lost to follow-up. We retrieved 98,932 patients with outcome data; 65,458 (66%) were male and 7,956 (8%) had unfavorable outcomes (3,737 (47%) died, 1,641 (21%) defaulted, and 1,599 (20%) lost to follow-up). In multivariable analysis, male gender (adjusted odds ratio [aOR] 1.41; 95% confidence interval [CI] 1.34-1.49) and treatment at a chest disease hospital (CDH) (aOR 1.44; 95% CI 1.25-1.66) were risk factors. The association between male gender and unfavorable outcomes may result from the high smoking rates among males in Bangladesh. The association of treatment at a CDH with unfavorable outcomes may occur because complicated cases (e.g., TB with co-infections) are usually treated in a chest hospital in Bangladesh. A case-control study could further confirm and explain these findings.

Particularities of radiological lesions in smear-positive and HIV-positive tuberculosis patients in the era of triple antiretroviral therapy at Jamot Yaoundé hospital

Introduction: The aim of this work was to compare the radiological lesions during bacilliferous tuberculosis between HIV positive patients under ARV treatment and HIV negative patients. Methodology: This was a, descriptive and comparative study conducted from December 1, 2018 to May 31, 2019 (6 months) at Jamot Yaoundé Hospital. Smearpositive tuberculosis patients meeting our inclusion criteria were enrolled in the study. We split them into two groups, HIV + and HIV -. The comparison of the data was made by the Chi² test, that of the quantitative data with the Student's T test. A p-value less than 0.05 was considered significant. Results: In total, we recruited 145 patients divided into 2 groups of 63 HIV + patients and 82 HIV-patients. The radiological peculiarities found in HIV were as follows: Normal radiography was more frequent, P = 0.004. Interstitial syndrome was less common. Bilateral involvement was predominant. Right localization and upper lobe lesions were less frequent, P &lt;0.05. Micronodular lesions were more frequent, P &lt;0.05. During the alveolar syndrome, the left side was less affected and the upper lobe was the most; p &lt;0.05. Cavitary, pleural, mediastinal and bronchial syndromes did not show statistically significant differences. Conclusion: Although a normal x-ray does not exclude pulmonary tuberculosis, the x-ray lesions are multiple but are dominated by the interstitial syndrome. In patients immunocompromised to HIV, bilateral involvement predominates. The right localization and lesions of the upper lobe are less frequent. Micronodular lesions are frequent.

Examination of close contacts of smear positive tuberculosis patients in Shaanxi, 2012–2020

Objective To analyze the examination of close contacts of smear positive pulmonary tuberculosis (TB) patients and the detection of pulmonary TB patients in Shaanxi province. Methods The performance of screening of 190 542 close contacts of newly registered smear positive pulmonary TB patients in Shaanxi from 2012 to 2020 was analyzed. The relevant information of the close contacts were collected and input into Excel database. SPSS 21.0 was used for data analysis. Results The screening rate and examination rate of the close contacts of smear positive pulmonary TB patients in Shaanxi were 99.89% and 84.92%. The detection rate of TB patients and smear positive TB patients were 1.56% and 0.03%. The examination rate of close contacts, the annual detection rate of TB patients and the detection rate of smear positive TB patients showed an overall upward trend. The detection rate in family members, symptomatic patients were higher than that in non-family members and asymptomatic patients. The differences in the examination rate, detection rate of TB patients and detection rate of smear positive TB patients among all groups were significant. Conclusion It is important to conduct early detection of TB in close contacts of newly registered smear positive TB patients.

Factors Associated with the Non-Adherence of TB Screening in Children Aged &lt;15 Years with Smear-Positive TB Patients’ Close Contact

Background: TB screening in children having close contact with smear-positive TB patients is urgent to conduct to improve the case detection rate and to achieve the “End TB” target. In fact, the implementation of screening in Indonesia is still inadequate.Objective: To analyze the factors associated with the non-adherence of TB screening in children aged &lt;15 years with smear-positive TB patients’ close contact.Methods: A cross-sectional study was conducted in Semarang between February and August 2020. Subjects were children &lt;15 years old with smear-positive TB patient's close contact. Data were collected from interviewed parents or guardians of the child using a structured questionnaire. Chi-square or Fisher's exact test analysis was used to identify the factor associated with non-adherence to TB screening in children.Results: A total of 84 children were recruited into this study. The proportion of children who did not undergo the screening is still high (86,9%), and there was a significant association with children's age (OR 13,556, 95% CI=3.135-58,613), parents' age (OR 41,143, 95% CI=4,025-420,604), parents’ education level (OR 0,114, 95%CI=0.027–0.477), distance to health facilities, knowledge level, perceived barriers, and cues to action. There was no significant association between children’s gender, economic level, perceived threats with non-adherence of screening.Conclusion: Children and parents’ age, education level, distance to health facilities, knowledge level, perception of barriers, and cues to action associated with the non-adherence of TB screening in children aged &lt;15 years with smear-positive TB patients’ close contact.

Prevalence and factors associated with diabetes mellitus among tuberculosis patients in South India—a cross-sectional analytical study

ObjectiveTo determine the prevalence and determinants of diabetes mellitus (DM) among tuberculosis (TB) patients and to assess the additional yield and number needed to screen (NNS) to obtain a newly...

Clinical and radiological epidemiological features of smear-positive tuberculosis patients in the era of triple antiretroviral therapy

Introduction: The aim of this work was to compare the epidemiological, clinical and radiological aspects during bacilliferous tuberculosis between HIV positive patients under ARV treatment and HIV negative. Methodology: This was a prospective, descriptive and comparative study conducted from December 1, 2018 to May 31, 2019 (6 months) at Jamot Yaoundé Hospital. Smear-positive tuberculosis patients meeting our inclusion criteria were enrolled in the study. We split them into two groups, HIV + and HIV - Data were analyzed using SPSS 23.0 software. The comparison of the data was made by the Chi² test, that of the quantitative data with the Student's T test. A p-value less than 0.05 was considered significant. Results: For HIV positive, the mean age was 41.1 ± 14.4 years versus 39.8 ± 14.8 years in the HIV negative group. HIV + patients aged 35 to 44 were more represented [49.5 versus 17.1% (P &lt;0.0001)]. The sex radio was 1.03 for the HIV positive versus 3.31 for the HIV negative group. The HIV + group had fewer single people, had more history of tuberculosis (22.2 versus 9.8%). HIV + patients were more likely to have a WHO performans status score 4, and were more febrile [96.8 versus 85.4% (p = 0.021)]. The normal chest x-ray was more common. Interstitial and alveolar syndromes were less common. Conclusion: The proportions of both sexes were almost identical. Almost half were 35 to 44 years old They had more history of tuberculosis. A WHO score of 4 and were generally febrile. Chest x-ray was often normal.Interstitial and alveolar syndromes were less common.

Vitamin D deficiency and Tuberculosis in Basrah: The Effect of Anti-tuberculosis Drugs

Background Low vitamin D levels had been reported to be associated with a wide range of health problems, one of them is tuberculosis. the aim is to estimate vitamin D serum concentration among patients with tuberculosis at baseline, 2 and 5 months after starting anti-tuberculosis treatment. Methods The study was carried out at the TB Center and College of Medicine in Basrah (Iraq), during the period from September 2018 to June 2019. Participants were newly diagnosed tuberculosis patients, and their matched apparently healthy controls. Total 25-hydroxy vitamin D in serum was estimated using chemiluminescent microparticle immunoassay. Calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and others, were also measured. Results There were no statistically significant difference in the mean levels of vitamin D between tuberculosis patients at baseline (n=56) and control subjects (n=57). The prevalence of vitamin D deficiency was high in patients and their controls at baseline where more than 80% of them had a vitamin D level below 20 ng/ml. When patients were followed two months after starting anti-tuberculosis treatment, the mean serum vitamin D level was significantly lower than that at baseline. Despite the wide spread vitamin D deficiency among TB patients, all smear-positive pulmonary TB patients, except 3, had sputum conversion after 2 months of treatment. Conclusions The prevalence of vitamin D deficiency is high with no significant difference between tuberculosis patients at baseline and their matched normal controls. Vitamin D deficiency did not seem to affect the response of patients to anti-TB treatment.

Clinical audit of management of smear positive adult pulmonary tuberculosis in PR1 tuberculosis clinic, KK Bandar Miri.

Malaysian tuberculosis (TB) clinical practice guideline (CPG) standardises the management of TB to improve the quality of care for TB patients. Not all primary care providers adhere to this guideline, however. This audit aims to improve the management of smear positive adult pulmonary TB by identifying areas of concern and developing action plans. Data for the audit were gathered from August 2018 to August 2019 from medical records of diagnosed smear positive pulmonary TB patients. Patients were included based on inclusion and exclusion criteria. Forty-eight smear positive pulmonary TB patients were recruited. The majority of patients were male (54.2%) and Malay (33.2%). TB symptoms were assessed for 29.2% of patients at two weeks and then in 81.3% at one month, 97.9% at two months, 16.7% at three months, 95.8% at four months, 22.9% at five months and 95.8% at six months. Medication side effects were assessed at two weeks for only 2.1% of patients, then for 8.3% of patients at one month, 2.1% at two months and 0% at subsequent months. At diagnosis, 25% and 4.2% of patients had their visual acuity and colour vision, respectively, assessed. Only 6.3% of patients were referred to pre-pregnancy counselling. Weights were recorded for 87.5% of patients at diagnosis, then for 27.1% at two weeks, 81.3% at one month, 91.7% at two months, 77.1% at three months, 97.9% at four months, 79.2% at five months and 93.8% at six months. Baseline investigations and Mycobacterium tuberculosis culture and sensitivity were conducted for all patients, but only 81.3% of patients were traced. No patients were referred to pharmacy for medication counselling. This audit shows that there is a difference between current practice and the national guideline. There are some downfalls in management and proper documentation, so interventions should be carried out to improve those aspects.

How Do Smoking Status and Smoking Cessation Efforts Affect TB Recurrence After Successful Completion of Anti-TB Treatment? A Multicenter, Prospective Cohort Study With a 7-Year Follow-up in China.

Many important risk factors are associated with tuberculosis (TB) recurrence; among them, smoking is the most common and modifiable behavioral factor. We aimed to assess the association of smoking status and cessation support during anti-TB treatment with subsequent TB recurrence. A 7-year prospective cohort study was performed on 634 TB patients in China. The participants were grouped by smoking status at baseline. Cox proportional hazards models were applied to analyze the association between baseline characteristics and TB recurrence. The cumulative incidence of TB recurrence was estimated by Kaplan-Meier curves. Multivariable analysis showed that patients who continued smoking during anti-TB treatment were at higher risk for TB recurrence (hazard ratio = 3.45; 95% confidence interval: 1.54-7.73) than nonsmokers. Moreover, this risk remained significant even in those who stopped smoking during anti-TB treatment (hazard ratio = 2.75; 95% confidence interval: 1.47-5.14) than nonsmokers. The association between smoking and TB recurrence was stronger for smear-positive TB patients than for smear-negative TB patients. Among all the subgroups, patients who continued smoking had a higher TB recurrence rate over the 7-year follow-up than those who successfully quit during their anti-TB treatment (log-rank statistic, p < .01). With the increase in the number of cigarettes smoked daily, the TB recurrence risk also increased accordingly (log-rank statistic, p = .02). Our findings highlight the importance of incorporating effective smoking cessation intervention measures into TB services and call for continuous monitoring of TB recurrence. Among patients who continue smoking or have a history of smoking, special attention should be given to smear-positive patients and heavy smokers when monitoring recurrence. This study provides a comprehensive picture of the association of smoking behavior and cessation efforts with TB recurrence. It shows that patients who are nonsmokers have the lowest risk of recurrence and that ex-smokers have a lower risk of recurrence than current smokers. Moreover, patients who successfully quit smoking during TB treatment have a lower risk of recurrence than those who continue smoking. Health workers should provide cessation intervention, focus on TB patients with a history of smoking, and continuously monitor TB recurrence after the completion of anti-TB treatment, particularly for smear-positive TB patients.

Molecular characterization of multidrug-resistant tuberculosis against levofloxacin, moxifloxacin, bedaquiline, linezolid, clofazimine, and delamanid in southwest of China

ObjectivesTo explore the drug susceptibility of levofloxacin (LFX), moxifloxacin (MFX), bedaquiline (BDQ), linezolid (LZD), clofazimine (CFZ) and delamanid (DLM) against multidrug resistant tuberculosis (MDR-TB) isolates from drug resistance survey of southwest China, and to illustrate the genetic characteristics of MDR-TB isolates with acquired drug resistance.MethodsA total of 339 strains were collected from smear-positive TB patients in the drug resistance survey of southwest China between January 2014 and December 2016. The MICs for the above mentioned drugs were determined for MDR-TB by conventional drug susceptibility testing. Genes related to drug resistance were amplified with their corresponding pairs of primers.ResultsMDR was observed in 88 (26.0%; 88/339) isolates. LFX had the highest resistance rate (50.0%; 44/88), followed by MFX (38.6%; 34/88). The resistance rate to LZD, CFZ, and DLM was 4.5% (4/88), 3.4% (3/88), and 4.5% (4/88), respectively, and the lowest resistance rate was observed in BDQ (2.3%; 2/88). Of the 45 isolates resistant to LFX and MFX, the most prevalent resistance mutation was found in gyrA with the substitution of codon 94 (34/45, 75.6%). Two strains with CFZ - BDQ cross resistance had a mutation in the Rv0678 gene. Of the four LZD resistant isolates, two carried mutations in rplC gene. For the four isolates resistant to DLM, one isolate had mutations in codon 318 of fbiC gene, and two isolates were with mutations in codon 81 of ddn gene.ConclusionThis study provided evidence of the usefulness of new anti-TB drugs in the treatment of MDR-TB in China.

Era of TB elimination: Growing need to understand diversities of Mycobacterium tuberculosis lineages!

IntroductionThe mycobacterium tuberculosis complex (MTBC) has highly clonal population structure which made the organism spread globally mirroring human migration out of Africa and resulted in the formation of seven lineages. We conducted this study to determine the proportion of spoligotype lineages and drug susceptibility profile of Mycobacterium tuberculosis isolates among smear positive TB patients attending a tertiary care hospital in Mysore, Karnataka, India. MethodsIt is a descriptive study conducted at JSS Hospital a tertiary care centre at Mysore, India during 2018–19. The sputum smear positive samples were subjected to solid culture and drug susceptibility testing and spoligotyping for identification of lineages. ResultsOf the 100 samples which were culture positive, 94 isolates were clustered into five spoligotype international types with SIT-126 (EAI-5) being the largest cluster of 46 (46%) isolates, followed by SIT-62 (H1) with 24 (24%), SIT -26 (CAS 1-DELHI) with 20 (20%), SIT-53 (T1) with 03 (3%) and SIT-482 (BOV-1) with 01 (1%). Among the remaining six isolates, two had unique Cameroon spoligotypes and four were orphans ConclusionThe study finding reveals that a diverse pattern of genotypes is circulating in the region of which EAI-5, Harleem (H1) and CAS-DELHI pattern forms the majority (88%). It is evident that there is a wide range of MTB genetic lineages in circulation and further research is needed to understand the diversity across the country.

Hubungan faktor lingkungan fisik, sosial dan ekonomi dengan kejadian Tuberkulosis Paru di Kecamatan Tambang Kabupaten Kampar

Pulmonary tuberculosis is an infectious disease caused by Mycobacterium tuberculosis which mostly attacks the lungs and can also attack other organs. Tuberculosis is transmitted by smear positive tuberculosis patients, Tuberculosis germs are transmitted through the air when the patient coughs and sneezes so that the germs spread in the air in the form of droplets (sputum sparks), so people can become infected if they inhale the droplet into the respiratory tract (Ministry of Health Republic of Indonesia, 2014 ). According to Achmadi (2010) risk factors for tuberculosis transmission are environmental and behavioral factors. Environmental factors include ventilation, occupancy density, temperature, lighting and humidity. Whereas behavioral factors include smoking, spitting or sputum in any place, coughing or sneezing not closing the mouth and habit of not opening the window. Based on the results of a survey in Indonesia by the Directorate General of Communicable Disease Eradication and Environmental Health (2011), the high incidence of pulmonary TB is caused by a lack of knowledge. Knowledge of tuberculosis sufferers will affect the attitude and behavior such as throwing up spit or sputum that can be carelessly a source of transmission for people around him. Prabu in Fitriani (2013) explained that family heads who have an income below the regional minimum wage (UMR) will consume foods with nutrient levels that are not in accordance with the needs of each family member so that they have an nutritional status that is lacking and will make it easier to contract infectious diseases including Lung TB. According to WHO the number of cases of tuberculosis is ranked above HIV / AIDS. In 2016 there were an estimated 10.4 million new cases of tuberculosis or 142 cases / 100,000 population, 60% of new cases occurred in 6 (six) countries namely India, Indonesia, China, Nigeria, Pakistan and South Africa, and Indonesia ranked second (WHO Global Tuberculosis Report, 2017). Based on data on Indonesia's health profile in 2018 the number of tuberculosis cases in Indonesia in 2017 was 420,994 cases and increased in 2018 to reach 511,873 cases (Ministry of Health Republic of Indonesia, 2018). The number of pulmonary tuberculosis in Riau Province in 2018 is 11,135 cases (Ministry of Health of the Republic of Indonesia, 2018). Based on data on the health profile of Kampar Regency in 2017, tuberculosis is an environmentally-based direct infectious disease that ranks second with a total of 1,071 cases after diarrheal disease with a total of 1,076 cases. The number of positive AFB cases in 2017 in Kampar District reached 1071 cases, with the highest number of sufferers found in Tambang District, 78 cases. In 2018 the number of TB cases was 1079 cases, with the highest cases also occurring at the Tambang Health Center with a total of 67 cases and 43 new cases, followed by the Siak Hulu I Health Center with a total of 57 cases (Dinkes District Health Office, 2018). Based on this, this study aims to analyze and the risk of the relationship between the physical, social and economic environment with the incidence of pulmonary tuberculosis in Tambang District, Kampar Regency.

The simple direct slide method is comparable to indirect Lowenstein Jensen proportion culture for detecting rifampicin resistant tuberculosis.

Introduction. Drug resistant tuberculosis remains a worldwide problem that requires prompt diagnosis.Hypothesis/Gap statement. The WHO recommended direct, rapid Xpert MTB/RIF is prohibitively costly, therefore, there is a need to validate a rapid, affordable DST for use in low- and middle-income settings.Aim. The technical performance and time to results of a simple, direct microscopy-based slide DST (SDST) assay for diagnosis of rifampicin-resistant TB was evaluated in Uganda.Methodology. Sputum samples from 122 smear-positive re-treatment TB patients presenting to the TB treatment centre at Uganda's National Referral Hospital, Mulago, Kampala, Uganda were examined. The sputum samples were tested by the direct SDST which was compared to the indirect Lowenstein Jensen Proportion Method (LJDST) method as the gold standard. The time to results was defined as the time from DST setting to results interpretation. The results were further analysed for sensitivity and specificity as well as agreement between LJDST and SDST for rifampicin resistance determination.Results. A total of 117 smear positive sputum samples with valid results for both tests were compared. The median time to results for SDST was 14 days with an interquartile range (IQR) of 10-14 days compared to 60 days with IQR of 60-75 days for LJDST. The number for rifampicin resistance by the gold standard LJDST was 26. The SDST had a sensitivity of 96 % (95 %; CI 81-99 %) and a specificity of 97.8 % (95 %; CI 93-100 %). The Positive Predictive and Negative Predictive values for SDST were 92.3 % (95 %; CI 76.8-99 %) and 98.9 % (95 %; CI 94-100 %), respectively. The kappa agreement between SDST and LJDST was 92.3 %.Conclusion. The SDST was found to be a rapid and accurate direct test for the detection of rifampicin resistance among retreatment TB cases in low-income settings.

Diagnostic Performance of GeneChip for the Rapid Detection of Drug-Resistant Tuberculosis in Different Subgroups of Patients.

ObjectiveDrug-resistant tuberculosis (DR-TB) is a growing problem worldwide. The rapid drug susceptibility test (DST) of DR-TB enables the timely administration of a chemotherapy regimen that effectively treats DR-TB. GeneChip has been reported as a novel molecular diagnostic tool for rapid diagnosis but has limited data on the performance of subgroup patients with DR-TB. This study aims to assess the diagnostic value of GeneChip in patients with different sexes, ages, treatment histories, treatment outcomes, and places of residence.MethodsWe recruited newly registered sputum smear-positive pulmonary TB patients from January 2011 to September 2020 in Lianyungang City, Jiangsu Province, China. We applied both GeneChip and DST to measure drug resistance to rifampin (RIF) and isoniazid (INH). The kappa value, sensitivity, specificity, and agreement rate (AR) were calculated. We also applied a Classification and Regression Tree to explore factors related to the performance of GeneChip.ResultsWe observed that sex, age, treatment history, treatment outcomes, and drug resistance type were significantly associated with the performance of GeneChip. For RIF resistance, there was significant accordance in young patients (kappa: 0.79) and cases with the treatment failure outcome (kappa: 0.92). For multidrug resistance (MDR), there was significant accordance in young cases (kappa: 0.77). Compared with previously treated patients, the newly treated patients had a significantly higher AR in detecting RIF resistance (0.97 vs 0.92), INH resistance (0.95 vs 0.89), and MDR (0.98 vs 0.92). The overall sensitivity, specificity, AR and kappa value for the diagnosis of MDR-TB were 0.70 (95% CI: 0.63–0.70), 0.99 (95% CI: 0.98–0.99), 0.98 (95% CI: 0.97–0.98), and 0.72 (95% CI: 0.67–0.78), respectively.ConclusionWe observed a high concordance between GeneChip and DST among TB patients with different characteristics, indicating that GeneChip can be a potential alternative tool for rapid MDR-TB detection.

BARRIERS TO THE IMPLEMENTATION OF ISONIAZID PREVENTIVE THERAPY AMONG CHILDREN UNDER FIVE YEARS OLD IN CLOSE CONTACT WITH SPUTUM SMEAR-POSITIVE TB PATIENTS

Background: The implementation of isoniazid preventive therapy (IPT) among children under five years old in close contact with sputum smear-positive TB patients is still low. Only 21,7% of children implemented the IPT in Central Java in 2017. Assessment of the barriers to IPT implementation needs to be carried out in the control of child TB cases.Objective: To analyze the barriers to IPT implementation among children under five years old in close contact with sputum smear-positive TB patients.Methods: A cross-sectional study was conducted among children (age &lt;5 years) in close contact with sputum smear-positive TB patients. Data were collected from KRMT Wongsonegoro Hospital, Dr. Adhyatma, MPH Hospital, Puskesmas Kedungmundu, and Puskesmas Bandarharjo. Structured questionnaires were used to obtain sociodemographic information and to identify associated barriers to IPT implementation. The data were analyzed using Fisher’s exact test.Results: The majority (93,3%) of the total subject (75) of this study did not implement the IPT. The results of the bivariate analysis showed that distance to health facilities (p=0.024), perceived barriers (p=0.016), and cues to action (p=0.001) had a significant association as barriers to IPT implementation. Meanwhile age (p=0.622), gender (p=2.121), education level (p=0.073), economic level (p=0.521), knowledge level (p=0.166), and perceived threats (p=0.316) had no significant association as barriers to IPT implementation.Conclusion: IPT implementation rate is low. The barriers were distance to health facilities, perceived barriers, and cues to action.