Smear-positive Tuberculosis Patients Research Articles

Treatment outcome in smear-positive pulmonary tuberculosis patients treated with a fixed-dose drug combination regimen in comparison with a separate regimen

Context The number of tuberculosis (TB) patients and multidrug-resistant species of Mycobacterium tuberculosis are increasing worldwide. Effective treatment is still the key factor to control TB in the society. Aims The aim of the study was to compare the efficacy of fixed-dose combination (FDC) and separate drug (SD) in the treatment of TB. Settings and design The study was a randomized, clinical trial carried out on 331 smear-positive TB patients in the Golestan province, Iran. Patients and methods Diagnosis and monitoring method was direct observation of sputum smears under a light microscope, which was used at the end of the second, third, fourth, fifth, or sixth months during the treatment. Statistical analysis used Sputum smear conversion rate at the end of second months and therapy outcome at the end of the treatment period were compared in both groups of the study by using the Poisson regression model and calculation incidence rate ratio. Results Sputum smear conversion rate at the end of the second month of the treatment had no significant difference between two groups. Success rate at the end of the treatment period was 89.36% in the intervention group and 95.65% in the nonintervention group which had significant difference (P=0.03). Adverse event incidence rate was 5.44% in all studied cases during the period of treatment. It had significant difference between the group who received FDC (8.93%) and the other who received SD (1.86%). Conclusion SD had better efficacy than FDC drugs in the treatment of TB patients.

Transient Impact of Dysglycemia on Sputum Conversion among Smear-Positive Tuberculosis Patients in a Tertiary Care Facility in Ghana.

BACKGROUNDApart from increasing the risk of tuberculosis (TB), diabetes may be associated with more severe disease and lower rates of sputum conversion among TB patients.METHODSWe conducted a baseline cross-sectional study with a longitudinal follow-up of newly diagnosed smear-positive TB patients for 6 months. Sputum conversion rates between those with dysglycemia and those without were compared at 2 months (end of the intensive phase) and 6 months (end of the treatment). Descriptive statistics and logistic regression were computed to assess factors associated with dysglycemia as well as sputum conversion.RESULTSA significantly higher proportion of normoglycemic patients had negative sputum compared with those with dysglycemia (83% vs 67%, P-value < .05) at 2 months but not at 6 months (87% vs 77%, P-value > .05). After controlling for age group and adjusting for other covariates, patients with dysglycemia were 66% less likely to convert sputum than those with normoglycemia. Females were at least 7 times more likely than males and those with high waist-to-hip ratio (WHR) of 88% were less likely compared with those with low WHR for sputum conversion at 2 months, respectively. At 6 months, females (compared with males) and those with high WHR (compared with those with normal WHR) were at over 9 times increased odds and 89% less likely for sputum conversion, respectively.CONCLUSIONA significantly lower proportion of smear-positive TB patients with dysglycemia converted to smear negative after 2 months of treatment but not at the end of the treatment, thus suggesting a transient impact of dysglycemia on sputum conversion.

First molecular-based anti-TB drug resistance survey in Eritrea.

BACKGROUND: In the absence of reliable data on drug-resistant TB in Eritrea, a national survey was conducted in 2018 using molecular-based methods, bypassing the need for culture.METHODS: A cross-sectional study was conducted in all 77 TB microscopy centres in the country. All 629 newly registered sputum smear-positive pulmonary TB patients were enrolled over 12 months. Sputum samples were tested using the Xpert® MTB/RIF assay and targeted next-generation sequencing (Deeplex Myc-TB) to identify resistance and explore the phylogenetics of Mycobacterium tuberculosis complex strains.RESULTS: Drug resistance profiles were obtained for 555 patients (502 new, 53 previously treated). The prevalence of rifampicin-resistant TB (RR-TB) was respectively 2.0% and 7.6% among new and previously treated cases. All RR-TB isolates that were susceptible to isoniazid displayed a phylogenetic marker conferring capreomycin resistance, confirming circulation of a previously described resistant TB sub-lineage in the Horn of Africa. Only one case of fluoroquinolone resistance was detected.CONCLUSION: The prevalence of rifampicin resistance among TB patients is encouragingly low. The scarcity of fluoroquinolone resistance bodes well for the success of the recommended all-oral treatment regimen. Surveillance based on molecular approaches enables a reliable estimation of the burden of resistance and can be used to guide appropriate treatment and care.

Risk factors for death during treatment in pulmonary tuberculosis patients in South India: A cohort study

ObjectiveIdentifying the risk factors for deaths during tuberculosis (TB) treatment is important for achieving the vision of India's National Strategic Plan of ‘Zero Deaths’ by 2025. We aimed to determine the proportion of deaths during TB treatment and its risk factors among smear positive pulmonary TB patients aged more than 15 years. Study designWe performed a cohort study using data collected for RePORT India Consortium (Regional Prospective Observational Research in Tuberculosis). SettingRevised TB Control Program (RNTCP) in three districts of South India. ParticipantsThe cohort consisted of newly diagnosed drug sensitive patients enrolled under the Revised National TB Control Program during 2014–2018 in three districts of southern India. Information on death was collected at homes by trained project staff. Primary outcome measuresWe calculated ‘all-cause mortality’ during TB treatment and expressed this as a proportion with 95% confidence interval (CI). Risk factors for death were assessed by calculating unadjusted and adjusted relative risks with 95% CI. ResultsThe mean (SD) age was of the 1167 participants was 45 (14.5) years and 79% of them were males. Five participants (0.4%) were HIV infected. Among the males, 560 (61%) were tobacco users and 688 (75%) reported consuming alcohol. There were 47 deaths (4%; 95% CI 3.0–5.3) of which 28 deaths (60%) occurred during first two months of treatment. In a bi-variable analysis, age of more than 60 years (RR 2.27; 95%CI: 1.24–4.15), male gender (RR 3.98; 95% CI: 1.25–12.70), alcohol use in last 12 months (RR 2.03; 95%CI: 1.07–3.87), tobacco use (RR 1.87; 95%CI: 1.05–3.36) and severe anaemia (RR 3.53: 95%CI: 1.34–9.30) were associated with a higher risk of death. In adjusted analysis, participants with severe anaemia (<7gm/dl) had 2.4 times higher risk of death compared to their counterparts. ConclusionThough deaths during TB treatment was not very high, early recognition of risk groups and targeted interventions are required to achieve zero TB deaths.

Tubercular infection in children living with adults receiving Directly Observed Treatment Short Course (DOTS): a follow up study

BackgroundChildren living with sputum smear-positive adult tuberculosis (TB) patients are vulnerable to acquire tubercular infection. Contact tracing is an important strategy to control tubercular infection in the community. This study was done to find out prevalence of tuberculosis and tubercular infection in children living with sputum smear-positive adult patients receiving DOTS at recruitment and to find out incidence of tubercular infection and disease in these children on follow up.MethodChildren (< 15 years) living in contact with adults on DOTS were grouped as < 6 years and 6–14 years. They were further sub grouped as being - uninfected, infected, diseased and on prophylaxis and were followed at 3, 6 and 9 months. Tuberculin skin test (TST) and chest X-ray were done.ResultsAt recruitment 152 children were enrolled and 21.1% (n = 32) had TB. On follow up, 4.3% (n = 5), 5.8% (n = 6) and 11.6% (n = 11) children developed TB after 3, 6 and 9 months respectively.9 children did not come for the last follow up so the overall prevalence of TB disease at 9 months was 37.7% (n = 54). Out of the 128 children with TST reading 23.4% (n = 30) child contacts were found to be infected already at recruitment. The incidence of TST conversion was 20.7% (n = 18), 26.9% (n = 18) and 16.3% (n = 7) respectively. The overall prevalence of tubercular infection in the children, who were in contact with TB patients for 9 months was 74.5% (n = 73).ConclusionAbout half the children were either suffering from TB or tubercular infection on recruitment. During 9 months follow up 22 unaffected children developed disease and 43acquired infection.

Treatment outcome of tuberculosis patient of Samtse General Hospital, Bhutan.

BackgroundTuberculosis (TB) is one of the major public health problems in Bhutan. Evaluation of treatment outcomes of TB and identification of the risk factors are important components for the success of National TB control program. Therefore, this study was undertaken to assess the TB treatment outcome and factors associated with it in Samtse General Hospital.MethodsThis was a retrospective, cross sectional study using the TB data from Samtse General Hospital from 2008–2019. A univariate and multiple logistic regression was used to check for associations between the outcome and other independent variables.ResultsThe study included a total of 634 TB patients. Of this, 44.0% (279) were smear positive TB (PTB+), 36.1% (229) were extra pulmonary TB (EPTB) and 19.9% (126) were smear negative TB (PTB-). During the study period, 56.2% (356) of them completed treatment, 33.3% (211) were declared cured, 0.2% (1) had defaulted, 5.1% (32) died and 5.4% (34) had treatment failure. The mean treatment success rate (TSR) was 89.4% (567). The TSR was highest for EPTB with 96.9% (222/229), followed by PTB- at 88.1% (111/126) and lowest for PTB+ with 83.9% (234/279). Successful treatment outcome was observed in EPTB patients (AOR: 7.3; 95% CI: 2.46-21.36), patients in age 15-28 years (AOR: 3.4; 95% CI: 1.59-7.46) and 29-42 years (AOR: 9.1; 95% CI: 2.44-33.61).ConclusionThe treatment outcome of TB in Samtse General Hospital is satisfactory and at par with the national level. Since, smear positive TB and elderly patients are prone to develop poor treatment outcome, they need to be monitored and followed up adequately.

Prevalence of Tuberculosis among bedside contacts of Smear Positive Tuberculosis Patients at The University Teaching Hospital, Lusaka, Zambia

Background: Screening of contacts of tuberculosis (TB) patients is not routinely done in resourcelimited countries like Zambia despite the World Health Organization (WHO) recommendations, leading to missed opportunities for prevention, early diagnosis and high mortality.Objective: Main objective was to establish the prevalence of latent and active tuberculosis in bedside contacts of smear-positive index patients and associated risk factors.Methods: The study was carried at the University Teaching Hospital, a tertiary level facility. We conducted a cross sectional analytical study. We included 64 TB-unexposed and 69 TB-exposed contacts in this analysis. We recruited bedside contacts of smear-positive TB patients (TB Exposed group) in medical wards and contacts of surgical patients (TB Unexposed group) as a comparison group. A structured questionnaire was used to collect data on demographic, laboratory and clinical parameters among them being, age, gender, residence, relationship index patient's sputum grades BMI and HIV status. Active TB was diagnosed microbiologically and radiologically, while latent tuberculosis infection (LTBI) by tuberculin skin test (TST). Collected data was analysed using STATA 13 to determine the prevalence of TB and LTBI and the associated factors. A p value of &lt; 0.05 was considered statistically significant.Results: The mean age for TB unexposed and that of TB exposed was of 41.2 [±13.5] years and 40.2 [±14.7] years respectively. The Prevalence of active TB in TB exposed and in TB unexposed was 13.0% and 0% respectively. The prevalence of LTBI among TB exposed and TB unexposed was 83.1% and 38.3% respectively. Active TB in TB exposed bedside contact was associated with duration of hospital stay (AOR 2.45, 95% CI 1.0 – 5.9, p = 0.03) and index patient's sputum grade of 2+ (AOR 4.4, 95% CI 1.07 -18.3, p = 0.04).Conclusion: Bedside contacts of active TB patients are at an increased risk of contracting both latent and active TB. Further, our findings suggest a significant prevalence of LTBI in the general population of Lusaka. Bedside contact tracing is an effective approach to finding the missing TB patients our setting of a high TB burden country/community. The findings call for an urgent need to institute effective TB control/preventive measures with active case finding as a priority and LTBI screening finding and treatment.

Prevalence of Tuberculosis among bedside contacts of Smear Positive Tuberculosis Patients at The University Teaching Hospital, Lusaka, Zambia

background &#x0D; Screening of contacts of TB patients is not routinely done in resource-limited countries like Zambia despite WHO recommendations, leading to missed opportunities for prevention, early diagnosis and high mortality.&#x0D; OBJECTIVES &#x0D; Main objective was to establish the prevalence of latent and active tuberculosis in bedside contacts of smear-positive index patients and associated risk factors.&#x0D; METHODS &#x0D; We recruited bedside contacts of smear-positive TB patients in medical wards and contacts of surgical patients as a comparison group using a questionnaire to collect data on various variables. Active TB was diagnosed microbiologically and radiologically, while LTBI by TST.&#x0D; RESULTS &#x0D; We had 64 TB-unexposed and 70 TB-exposed, with a mean age of 41.2 [±13.5] years and 40.2 [±14.7] years respectively. Prevalence of active TB in the two groups was 10.0% and 0% respectively while that of LTBI was 83.1% and 38.3% respectively. TB exposure was significantly associated with active TB (p=0.014), LTBI (p&lt;0.001) and type of contact (p&lt;0.001)] but not duration of exposure (p=0.057). &#x0D; CONCLUSION &#x0D; Bedside contacts were at increased risk of contracting both latent and active TB. Given the significant burden of LTBI in the general population without documented TB exposure, there is an urgent to institute preventive measures to protect/treat contacts of TB patients.

Delay in diagnosis of tuberculosis and related factors from a district in Kerala, India

BackgroundEarly diagnosis and treatment of tuberculosis is of vital importance both to cure patients and to reduce transmission for effective control of tuberculosis, It is important to know whether tuberculosis is diagnosed in time and also what causes delay if any. ObjectivesThe study was conducted with the objective of knowing the time taken to diagnose tuberculosis from the onset of symptoms and to identify the causes for delay if any. MethodsA study was conducted in the District of Malapppuram Kerala, South India among newly diagnosed smear positive tuberculosis patients. 489 patients were interviewed soon after diagnosis and their socio-demographic characteristics and details from onset of symptoms to diagnosis were collected using a structured format. ResultsThe mean time taken by the patient for consultation after onset was 36 days and the mean time for diagnosis was 42 days and total time until diagnosis was 78 days. 72.8% patients consult within 6 weeks of onset and 74.7% are diagnosed within 6 weeks of consultation. The delay for diagnosis was more with private institutions. Diagnosis took less time when government facilities are consulted and when cough was a prominent symptom. Socio demographic factors are seen not affecting the time. ConclusionsThere is delay in diagnosing tuberculosis especially with private health providers and more efforts are required to reduce the same.

Fluorescein diacetate and rapid molecular testing for the early identification of rifampicin resistance in Mali.

BACKGROUND: Non-conversion on auramine smear microscopy indicates a lack of treatment response, possibly associated with initial rifampicin-resistant tuberculosis (RR-TB). However, dead bacteria still stain positive and may be detected. Fluorescein diacetate smear microscopy (FDA) shows live mycobacteria only. Therefore, we studied the potential of 2-month (2M) FDA for the identification of initial RR-TB.METHODS: Between 2015 and 2018, we enrolled new smear-positive pulmonary TB patients from five local centres in Bamako, Mali. After baseline screening, sputum samples were collected at 1M, 2M, 5M and 18M. We used rpoB sequencing to identify initial RR-TB.RESULTS: Of 1359 patients enrolled, 1019 (75%) had rpoB sequencing results. Twenty-six (2.6%, 95%CI: 1.7-3.7) had mutations conferring rifampicin resistance. Most frequent rpoB mutations were located at the codons Asp435Val (42.4%) and Ser450Leu (34.7%). Among patients with initial RR-TB, 72.2% were FDA-negative at 2M (P = 0.2). The positive and negative predictive value of 5M FDA for culture-based failure was respectively 20.0% and 94.7%.CONCLUSION: FDA did not identify the majority of patients with initial RR-TB or culture-based failure. As the full spectrum of mutations identified on sequencing was identified using Xpert, our data support its rapid universal implementation in Mali.

English

This assessment aims to identify the increasing number of morbidity of drug susceptible tuberculosis (TB) and its treatment outcomes, government cost of medicines as well as the economic impact on society. A retrospective observational study had been conducted in a government hospital using a patient&rsquo;s record from 2013 to 2017, treated under the Direct Observed Therapy Short Course (DOTS) program in Karachi, Pakistan. Altogether, 3872 drug-susceptible TB patients were included in the study. All data had been analyzed using SPSS version 16 software. It had been found from the data that each year number of new smear-positive TB patients remained same, that is, 85% in 2013, 90% in 2014, 89.5% in 2015, 91% in 2016 and 92.3% in 2017 while slight decrease in relapse cases, that is, 15, 10, 10.4, 9 and 7.6% in 2013 to 2017, respectively. The single factor analysis of variance (ANOVA) shows that there is no significant difference between the gender of TB patient throughout the duration with the p-value=0.3769. During the years of study, cost of medicine increased due to rapid rise of inflation in the region which inturn caused the significant financial constraint on patients and their families. moral and financial support are important to render an individual productive again in the society. Key words: Drug-susceptible tuberculosis (DS-TB), anti-tubercular therapy, cost of medicine. &nbsp

Factors associated with delays in seeking tuberculosis treatment among patients at Muhima district hospital, Rwanda

Background: Few studies exist in Rwanda to establish the reasons behind delays in seeking treatment in the health institutions which further affected timely diagnosis and case detection. The study investigated factors associated with delays in seeking treatment among tuberculosis (TB) patients at Muhima District Hospital, Rwanda.Methods: The study adopted descriptive cross- sectional study of 49 smear-positive TB patients derived using proportion estimation of case registry (November 2016 to January 2017) newly- diagnosed patients, first and second months treatment. Systematic sampling technique used to select 60 TB patients from target population. Data collected by researcher and trained research assistant, using a close- ended questionnaire through a translation in local dialect.Results: About 49% (24) of the smear- positive TB patients experienced delayed in seeking treatment for more than 180 days (6 months). Also 53% (26) were within the 36-45 age-cohort, while majority 75.5% (37) of the respondents was male. About 57% (28) of the respondents have poor knowledge of TB transmission. Similarly, about 51% (25) were the results on the perception of taking anti- TB medication, while median time interval from onset of symptoms and initiation of treatments was 45 days, average 71 days between 15 -180 days.Conclusions: Statistically significant relationship exist between initial source of treatment using home remedies (p=0.0) and private insurance cover (p=0.0) in relation to delay, which further contributed to delay among majority. Recommendations of the study are strengthening medical services utilization, improving case detection, medical infrastructures and collaboration with non- formal healthcare practices.

Predictors of Loss to Follow-Up among Men with Tuberculosis in Puducherry and Tamil Nadu, India.

.Identifying predictors of loss to follow-up (LTFU; treatment lapse ≥ 2 months) among people with tuberculosis (TB) may assist programmatic efforts in controlling the spread of TB. Newly diagnosed smear-positive TB patients were enrolled in the Regional Prospective Observational Research for TB study in Puducherry and Tamil Nadu, India. Treatment records were used to identify LTFU of those who were enrolled from May 2014 through December 2017. This nested case–control study evaluated male TB patients. Predictors were assessed using multivariable logistic regression. Of 425 men with TB, 82 (19%) were LTFU. In the adjusted analyses of males, divorced/separated marital status (adjusted odds ratio [aOR] 3.80; 95% CI: 1.39–10.38) and at-risk alcohol use (aOR 1.92; 95% CI: 1.12–3.27) were significant predictors for increased risk of LTFU, and diabetes was a significant predictor for decreased risk of LTFU (aOR 0.52; 95% CI: 0.29–0.92). Of 53 men with recorded date of last treatment visit, 23 (43%) and 43 (81%) had LTFU within the first 2 and first 4 months of treatment, respectively. Addressing at-risk alcohol use and providing more intensive follow-up could lead to improved treatment completion.

Three decades History of Tuberculosis Control in Kerbala/Iraq

Objective: To assess tuberculosis control between 1988 and 2017 and evaluate the outcomes of treatment among the October patients put on DOTS in Karbala governorate since the initiation of DOTS strategy in 2000.&#x0D; Material and methods: Data on tuberculosis incidence between 1988 and 2017 were assessed. In addition, all quarterly reports were collected in addition to the annual reports to estimate the outcome indices of DOTS in the governorate. Evaluation indices included the incidence and death rates; case detection rate for smear positive and total tuberculosis patients; cure rate; treatment success rate; default rates; treatment failure rates; drug resistance rates; contact tracing during the study period between 2005 and 2014. These indices were compared to the available national indices in the whole country. The indices of treatment success and failure rates were compared to the available previous reported rates in the governorate and in Iraq. Analysis used SPSS-20 and Excel data sheet.&#x0D; Discussion with experts working for decades in TB control programs revealed some defect in determining these indices.&#x0D; Results: Between 1988 and 2017 there was a total of 8665 TB patients, while between 2005 and 2017 the total was 4055: 2592 pulmonary TB patients (62%) and 1541 extra-pulmonary tuberculosis patients (38%). Gender distribution showed male predilection (60.3%) and a mean age of patients was 41.88±19.74 year and one half of the patients were above 44 year of age, but the most frequent age group was 25-34 year.&#x0D; Positive smear Case Detection rates were below the WHO planned goals ranging from 11.5% and 29.1%. The total reported deaths during the study period were 78 deaths. Defaulters were 97 patients at a rate of 2.39, while treatment failure cases amounted to 33 patients (a rate of 0.81%). Drug sensitivity test was introduced to country in 2010 and was done only in Baghdad till the introduction of Genexpert MTB/RIF test in January 2014 and a total of 72 patients were MDR cases. Case detection rate among contacts was 0.31%.&#x0D; Conclusions: The success in DOTS in Karbala is similar to the results in the whole country and in most developing countries and approaching the WHO set goals, while the case detection rates were behind. However, some defect areas need further support to prevent failure and aid continuous tuberculosis control and stop TB.

Pre-treatment lost to follow up among presumptive tuberculosis patients in a tertiary care centre, South India

Background: At tertiary care centres, presumptive tuberculosis (TB) patients who come from far off places and are more likely to drop out during diagnosis or before treatment initiation. We aimed to describe the proportion lost during diagnosis or before treatment and also assessed the reasons for the loss to follow up.Methods: We did a hospital based descriptive study, reviewing laboratory register and referral register to assess the status of submission of second sputum and referral letter, respectively, for patients visiting a designated microscopy centre at a teaching hospital. Reasons for lost to follow up were assessed through telephonic interviews.Results: Out of a total 2025 presumptive TB patients, 315 (15.6%, 95% CI 14.0-17.2) did not provide a second sputum sample. ‘Symptoms had reduced or subsided’ (30%), ‘not aware that second sample needs to be given’ (23%) and ‘visited other hospital’ (14%) were the common reasons reported for the same. A total of 270 (13.3%) patients were sputum smear positive; of them 92 (34.1% CI 28.4-40.1) did not collect referral letter. Among those who were referred, 66% were referred within a week. Deaths, ‘busy in routine work’ and treatment at other government hospitals were the common reasons reported for not collecting referral letter.Conclusions:One out of seven patients did not submit a second sputum sample and one third of sputum smear positive TB patients did not collect the referral letter. Follow up mechanisms needs to be strengthened in the national program to reduce this pre-treatment lost to follow up.

Comparison of Clinical, Radiological and Laboratory Parameters Between Elderly and Young Patient With Newly Diagnosed Smear Positive Pulmonary Tuberculosis: A Hospital-Based Cross Sectional Study.

IntroductionTo compare clinical, radiological and haematological manifestations among newly diagnosed smear positive tuberculosis patients between Group I (Elderly >60 yrs) and Group II (Younger age between 13 and 60 years).MethodologyThis was a hospital-based cross-sectional study conducted at the out-patient department of pulmonary medicine, between March 2014 and December 2017. There were 61 patients in Group I (Elderly > 60 yrs) and 110 patients in Group II (Younger age between 13 and 60 years). Continuous variables were compared using student’s t-test and Mann-Whitney test. Chi square test and Fischer test was used for analysing categorical variables. All statistics were two-tailed, and a p-value of 0.05 was considered to be statistically significant.ResultsThe mean age for Group I (Elderly >60 yrs) was 65 ± 2 years and for the Group II (Younger age between 13 and 60 years) was 40 ± 1 years. There was a statistically significant association of cavitation with infiltrates (p = 0.007) in younger age group. Bilateral multiple zone (48, 64.86%) involvements were commonly observed in both the age groups. There was no significant difference between two groups with regard to haematological and clinical parameters.ConclusionWe did not find any difference in the presentation of tuberculosis in both the groups. Radiologically, there was more of cavitating lesion in younger age group. So, they should be isolated and followed up at regular intervals.

First-line tuberculosis treatment with double-dose rifampicin is well tolerated.

OBJECTIVE: To compare the occurrence of unfavourable treatment and safety outcomes of double-dose rifampicin (RMP; 20 mg/kg/d, intervention) with standard dose (10 mg/kg/d, control) in a first-line tuberculosis (TB) treatment regimen for smear-positive TB patients in Bangladesh.DESIGN: This was a randomised clinical trial. The primary efficacy and safety endpoints were the occurrence of an unfavourable treatment outcome (death, failure, relapse or loss to follow-up) and the occurrence of any serious drug-related adverse event (SAE).RESULTS: In primary efficacy analysis, among 343 control and 347 intervention patients, respectively 15.5% and 11.8% had an unfavourable outcome. In safety analysis, among 349 intervention and 352 control patients, respectively 4.3% and 2.6% experienced an SAE. These differences were not significant. There was a significantly lower occurrence of SAEs, explained by a lower occurrence of hepatic toxicity, in a RMP double-dosed but erroneously HZE (isoniazid+pyrazinamide+ethambutol) under-dosed subgroup.CONCLUSIONS: Our findings show that there is no statistically significant difference in terms of efficacy and safety between standard and double-dose RMP. An accidental finding (related to dosage levels of the standard regimen) suggests that high-dose RMP is potentially a lesser cause of hepatotoxicity. Larger trials with more power, or trials with at least a triple-dose might be needed to clearly see the effect of high-dose RMP on unfavourable outcomes.

Comparison of neurocognitive changes among newly diagnosed tuberculosis patients with and without dysglycaemia

BackgroundDiabetes often occurs together with tuberculosis (TB) and both may affect each other negatively. Diabetes may be associated with neurocognitive dysfunctioning in affected patients and may negatively impact treatment adherence and outcomes. This study compared the neurocognitive status between newly diagnosed smear positive tuberculosis patients with dysglycaemia and those with normoglycaemia.MethodsThe current study was a cross-sectional study involving one hundred and forty-six (146) newly diagnosed smear positive TB patients. Oral glucose tolerance test (OGTT) was performed and the results were categorized as either normoglycaemia, impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or diabetes.Neurocognitive functioning among study participants was assessed at the time of TB diagnosis using Cognitive Failure Questionnaire (CFQ), Montreal Cognitive Assessment tool (MoCA), California Verbal Learning Test (CVLT), Brief Symptom Inventory (BSI) and the Spitzer Quality of Life Index (QLI).ResultsThe mean age of the participants (n = 146) was 38.7 years with 78.8% being males and 21.2% females. Using the fasting blood glucose test, the prevalence of impaired fasting glucose and diabetes were 5.5 and 3.4% respectively, both representing a total of 13 out of the 146 participants; whilst the prevalence of impaired glucose tolerance and diabetes using 2-h post-glucose values were 28.8 and 11.6% respectively, both representing a total of 59 out of the 146 participants.There were no significant differences in the mean scores on the neurocognitive measures between the dysglaycaemia and normoglycamic groups using fasting plasma glucose (FPG). However, there were significant differences in the mean scores between the dysglycaemia and normal groups using 2-h postprandial (2HPP) glucose values on Phobic Anxiety (Normal, Mean = 0.38 ± 0.603; dysglycaemia, Mean = 0.23 ± 0.356; p = 0.045), and Montreal Cognitive Assessment (MoCA) scores (17.26 ± 5.981 vs. 15.04 ± 5.834, p = 0.037).ConclusionNewly diagnosed smear positive patients with dysglycaemia were associated with significantly lower mean cognitive scores and scores on phobic anxiety than those with normoglyacaemia. The latter finding must be further explored.

Determining Mycobacterium tuberculosis Drug Resistance and Risk Factors for Multidrug-Resistant Tuberculosis in Sputum Smear-Positive Tuberculosis Outpatients in Anhui Province, China, 2015-2016.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is currently a major problem in China. The prevention and treatment work for MDR-TB patients started late in Anhui province. To determine the prevalence of MDR-TB in sputum smear-positive TB patients (SSPTBPs) and analyze the risk factors for MDR-TB in Anhui province, we conducted an investigation of drug resistance among SSPTB outpatients from September 2015 to August 2016.MethodsA stratified cluster-randomized sampling method was used to obtain a representative sample. It was estimated that 2290 new cases and 440 previously treated cases of SSPTBPs needed to be recruited from 40 survey sites. Isolates were tested for resistance to six first-line and second-line anti-TB drugs. Information from patient questionnaire survey was used to identify factors linked to MDR-TB.ResultsFinally, a total of 3047 SSPTBPs were recruited from 40 survey sites; of these, 2530 specimens were successfully cultured and had drug susceptibility testing done. The proportions of rifampin resistant (RR)-TB were 11.42% (289/2530, 95% CI: 10.18–12.66%), 7.64% (163/2133, 95% CI: 6.38–8.62%) and 31.74% (126/397, 95% CI: 27.38–36.60%) in all cases, new cases and previously treated cases, respectively, and the proportions of confirmed MDR-TB were 7.63% (193/2530, 95% CI: 6.59–8.66%), 4.97% (106/2133, 95% CI: 4.05–5.89%) and 21.91% (87/397, 95% CI: 17.83–26.00%), respectively. The ofloxacin resistance rate in previously treated SSPTBPs reached 21.66% (95% CI: 17.33–26.75%). Patients who had received two or more anti-TB treatment courses were significantly associated with MDR-TB compared to patients who have received one anti-TB course.ConclusionMDR-TB prevalence was high among SSPTBPs in Anhui province, and past anti-TB treatment course was associated with MDR-TB.

A Cross Sectional Survey on Tissue Transglutaminase Auto-Antibodies in Patients with Pulmonary and Extra Pulmonary Tuberculosis

Background: Mycobacterium tuberculosis (TB) is a widespread life-threatening infection worldwide. There is an uncertainty in the association between the emergence of autoimmune antibodies and TB. Objectives: We hereby aimed to screen anti-tissue transglutaminase (anti-tTG) IgA in patients with TB in an Iranian population. Methods: This was a cross sectional study conducted on smear positive TB patients admitted to the Respiratory Diseases Management Center of the city of Zabol, Sistan and Baluchestan Province of Iran during 2017 - 2018. Anti-tTG IgA level was determined using an ELISA kit (Pars Azmoun, Iran). Statistical analyses were performed in SPSS 19 software. Results: Overall, 162 patients were evaluated. Females and males constituted 87 (53.7%) and 75 (46.3%) of the patients respectively. The mean age was 51.7 ± 22.3 years (range of 1 - 83). Afghan patients constituted 16 (9.9%) and the remaining were Iranians. The therapy course was successfully completed in 78 (48.1%) patients, and 67 (41.4%) improved following treatments. Overall, 5 patients had active TB with 2 drug-resistant cases. Pulmonary tuberculosis was diagnosed in 127 (78.4%) while 35 (21.6%) had extra-pulmonary disease. The mean titer of anti-tTG IgA was 22.59 ± 107.7 (range of 0.8 - 940). Overall, 19 (11.9%) of the patients showed elevated levels of the antibody. There was no significant association between anti-tTG IgA titer with neither demographic nor clinical variables. Conclusions: Although anti-tTG IgA antibody test was positive in a relatively high ratio of our patients with TB, the clinical implications of this phenomenon were not significant.