Sputum Smear-positive Patients Research Articles

Prevalence of Rifampicin resistance tuberculosis among presumptive tuberculosis patients in Egypt-2021: a national health facility-based survey

BackgroundThe magnitude of MDR-TB cases was noticeable in Egypt. However, the last national survey was 11-years ago. The current survey was conducted to determine the prevalence of rifampicin resistance among sputum smear-positive pulmonary tuberculosis patients in Egypt.MethodsA national health facility-based cross-sectional study was conducted in 14 randomly selected governorates in Egypt between August 2020 and September 2021. All presumptive TB cases, either new or previously treated according to WHO definitions, with no gender, age, or nationality limitations, and provided informed consent were included in the study. Each patient completed a case report form (CRF). The CRF included socio-demographic and clinical data. Sputum samples were collected according to standard techniques and cultured on Lowenstein-Jensen (L-J) medium. Gene X-pert test was carried out first on the samples for simultaneous identification of MTB and rifampicin resistance. The prevalence of RR was calculated using crude, cluster, and weighted methods. Factors associated with RR were analyzed by bivariate and multivariate techniques.ResultsAmong the total 849 presumptive TB patients enrolled in the study, 710 (83.6%) patients were subjected to Gene X-pert testing (MTB/RIF). The crude prevalence of RR was 3.32% (95% CI: 1.89–4.76%) among the new cases and 9.46% (95% CI: 2.63–16.29%) among the retreated cases with an overall estimate of 3.99%; (95% CI: 2.51–5.47%). By cluster analysis the overall prevalence of RR was 5.01% (95% CI: 2.90–7.13). Factors associated with the prevalence of RR were co-morbidity with bronchial asthma, drug abuse and history of contact with a family member with TB.ConclusionThe prevalence of RR among either new or retreated cases TB patients was lower than the previous Egyptian rates in 2010–2012. The strongest predictor associated with RR was comorbidity with bronchial asthma.

Mutational analysis in drug resistant Mycobacterium tuberculosis in Western Uttar Pradesh

BackgroundMulti-drug resistant tuberculosis (MDR-TB) results in treatment failure and poor clinical outcomes. This study was carried out with the aim to determine the pattern of drug resistance against Mycobacterium tuberculosis towards first line ATT (anti-tubercular treatment) in sputum smear–positive patients using Line Probe Assay (LPA). MethodsA cross sectional prospective study was carried out in a tertiary care Hospital of Meerut. A total of 898 sputum samples (on spot and early morning) collected from 449 suspected pulmonary tuberculosis patients as per RNTCP guidelines were screened by microscopy. Decontamination was done by N-acetyl-l-cysteine and sodium hydroxide. Then smear positive samples were subjected to 1st line drug susceptibility testing (DST) using LPA GenoType® MTBDRplus (HAIN Life Science) assay, a molecular method which allows rapid detection of Rifampicin (Rif) and Isoniazid (INH) resistance. ResultsThe overall burden of MDR TB in this geographical area was 7.9 %. Mono-resistance with Rif alone was around 2.8 %. However, the mono-resistance with INH (inhA gene) and INH (katG gene) was 2.8 % and 1.1 % respectively. Drug resistance of Rif was due to mutations in rpoB gene while resistances to INH were more commonly due to mutation in inhA gene followed by katG gene. TB was more commonly seen in the age group of 30–59 years (43.8 %) and predominantly in males. ConclusionTuberculosis positivity rate is high in Western Uttar Pradesh. Burden of MDR TB in Western Uttar Pradesh was similar to National data. Line probe assay can be used as a primary method to diagnose multi drug resistant TB as done in present study which can help in earlier initiation of correct therapy.

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

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

Evaluation of polymorphism of Mycobacterium tuberculosis complex and its association with age group and HIV sero-status in Ngaoundéré-Cameroon

Pulmonary tuberculosis is a millennial scourge that is still current, and considered one of the most communicable diseases in the world. This study aimed to assess the genetic diversity of isolates of the Mycobacterium tuberculosis complex (MTBC) from pulmonary tuberculosis patients in Ngaoundéré. We estimates it from newly diagnosed sputum smear-positive patients by spoligotyping method. In total we obtained 21 different profiles including 9 orphan profiles and 12 clusters grouping from 2 to 54 strains. The comparison of the profiles of the strains of Ngaoundéré studied here with those of the strains of the genetically known families and listed in the SpolDB4 database reveals 14 profiles. Of these, 73 (45.6%) isolates belong to the LAM10_CAM family while 67 (41.9%) were non LAM10_CAM strains. Strains classified into non LAM10_CAM family included strains from the T family 38 (23.75%), Uganda family 15 (9.37%), Haarlem family 10 (6.25%), and others. Among the Shared Types, ST 61 member of the LAM10_CAM represented 54 (36.98%) and ST 53 member of the T family represented 24 (16.49%). No correlation was found between the genotypes identified and both the serological status and sex. The results show that M. tuberculosis was the only species incriminated with a strong predominance of ST 61 clones from the LAM 10_CAM family and ST53 from the T family.

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.

Diagnosis of the Sputum Smear Positive and Sputum Smear Negative Pulmonary Tuberculosis - The Role of High - Resolution Computed Tomography of Chest

BACKGROUND&#x0D; Mycobacterium tuberculosis complex causes pulmonary tuberculosis (PT) which is a major public health problem worldwide and endemic in India. PT diagnosis is done by high-resolution computed tomography (HRCT) which has high sensitivity and specificity.&#x0D; METHODS&#x0D; At a tertiary hospital, this cross-sectional study was conducted for 3 years. Patients presenting with productive cough with or without haemoptysis, shortness of breath, fever with night sweats or weight loss were suspected of having tuberculosis and underwent HRCT. PT was defined as the presence of consolidation, centrilobular nodules, and branching nodules with a tree in bud appearance with or without lymphadenopathy and pleural effusion on HRCT.&#x0D; RESULTS&#x0D; In this study, a total of 118 patients with a mean age of 51.85 ± 16.86 years were included. 64 (54.2%) were males and 54 (45.76%) were females out of 118 patients. Sputum smear was negative in a total of 66 (55.9%) patients and positive in 52(44.06%) patients. 84.26% was the diagnostic accuracy of HRCT in diagnosing PT with sensitivity, specificity, PPV and NPV of 84.28%, 83.33%, 78.98%, and 99.02%, respectively. HRCT had diagnostic accuracy, sensitivity, specificity, PPV and NPV of 86.40%, 89.46%, 83.42%, 94.14% and 72.43%, respectively in sputum smear positive patients. Whereas it was 83.87%, 91.54%, 75.40%, 64.57%, and 92.14%, respectively in sputum smear negative patients.&#x0D; CONCLUSIONS&#x0D; In diagnosing sputum smear-positive and sputum smear-negative PT, HRCT has high sensitivity. The specificity of HRCT was high in diagnosing sputum smear-positive PT, whereas in case of sputum smear-negative PT it was slightly low.

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.

Association Between Genetic Polymorphisms of lncRNA NEAT1 and Pulmonary Tuberculosis Risk, Clinical Manifestations in a Chinese Population.

BackgroundRecent studies have shown that abnormal expression of lncRNA NEAT1 is associated with the progression of pulmonary tuberculosis (PTB). The aim of our study was to analyze the relationship between single nucleotide polymorphisms (SNPs) of NEAT1 gene and susceptibility to PTB.MethodsFour SNPs (rs2239895, rs3741384, rs3825071, rs512715) in NEAT1 gene were genotyped in 479 patients with PTB and 476 controls by improved multiple ligase detection reaction (iMLDR) in a Chinese population.ResultsWe found no significant differences in allele and genotype frequencies of NEAT1 gene rs2239895, rs3741384, rs3825071, rs512715 between PTB patients and controls (all P > 0.05). There was no statistically significant association between genotype frequency distribution of dominant model, as well as recessive model, and genetic susceptibility to PTB patients (all P > 0.05). The TT genotype, T allele frequencies of rs3825071 were significantly increased in sputum smear-positive PTB patients when compared to sputum smear-negative PTB patients (P = 0.010, P = 0.003, respectively). Haplotype analysis shown that NEAT1 haplotype frequency was not associated with PTB susceptibility.ConclusionNEAT1 gene polymorphisms were not associated with the risk of PTB in Chinese population, and rs3825071 polymorphism might be related to sputum smear-positive in PTB patients.

Serum adenosine deaminase activity: A novel test for early diagnosis of pulmonary tuberculosis - What about efficacy?

Background: Pulmonary tuberculosis is a tremendous public health problem, increasing significantly, especially in developing countries. Getting a TB-free globe appears to be not more than a dream. Mycobacterial culturing is the gold standard for precise diagnosis but requires six-week time, in the meantime, patients remain a source of inadvertent disease dissemination in the community. The unavailability of sputum also poses a challenge several times. As adenosine deaminase level measurement is easy, rapid and independent of a sputum sample, this study was conducted to determine the diagnostic efficacy of adenosine deaminase activity for pulmonary tuberculosis.Patients and methods: This prospective study was conducted at Pulmonology-OPD, Gulab Devi Chest Hospital, Lahore, from 01-01-2019 to 30-06-2019. A total of 300 sputum smear-positive patients with clinical and radiological evidence consistent with diagnosis of pulmonary tuberculosis and 30 normal participants without any clinical, radiological or haematological evidence of tuberculosis were included. While, smear-negative patients and those having any evidence of hepatic disease, hematopoietic malignancy, infectious mononucleosis, typhoid or pregnancy were excluded. The serum ADA level of each participant was determined. All patients were subjected to AFB culture. Diagnostic accuracy was determined by considering sputum culture as a gold standard.Results: At cut-off value of &gt;15 IU/L, a sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 98.30%, 100.00%, 100.00%, 85.71%, 98.46% respectively were defined. Conclusion: Serum ADA level, having excellent sensitivity and specificity, can diagnose pulmonary tuberculosis even if sputum sample is not available.

English

BACKGROUND Sputum smear conversion is the negative conversion of the sputum smear at the end of the second month of treatment regimen under the National Tuberculosis Elimination Program (NTEP). When the acid-fast bacillus (AFB) smear comes negative at the end of an intensive phase, the treatment regimen can shift to the continuation phase that indicates bacillary load is a minimum. Although some authors consider the conversion of cultures when the AFB smear is negative, two potent drugs in the continuation phase are sufficient to kill the remaining bacilli. The drug that can kill bacteria in the first 2 days of treatment is called early bactericidal activity (EBA). This can be assessed by the percentage of negative conversion of cultures at the end of the intensive phase of the treatment regimen. EBA is very essential because it reduces the transmission in the community and chances of patient death. When the purpose is to kill as many bacilli as possible in the first few days and weeks of treatment, it is very important to include bactericidal drugs in the treatment regimen so that it reduces the chances of patient death and infectiousness and the negative conversion of the cultures after 2-month treatment regimen is an indication of the bactericidal capacity of the drug. The purpose of this study was to compare sputum smear conversion in daily versus intermittent treatment regimens in diagnosed cases of new sputum smear-positive pulmonary tuberculosis patients. METHODS This retrospective observational study was carried out in the Department of Respiratory medicine and nodal drug resistance tuberculosis centre (DR-TB) at the Government medical college and hospital, Akola. In this study, a total of 120 new patients were taken. 60 patients were given daily and intermittent regimens respectively under NTEP. RESULTS Out of 120 patients, 56 (93.33 %) patients in intermittent and 53 (88.33 %) patients in daily regimen were sputum smear-negative at the end of 2nd month (intensive phase) and at the end of 6th month (continuation phase). 1 patient (1.6 %) remained sputum smear-positive after the intensive phase. That patient was given 1 month of extension of anti-tuberculosis treatment (AKT) in the intensive phase and the patient became sputum negative after 1 month of extension. CONCLUSIONS It was concluded in this study, daily regimens and intermittent regimens were equally effective in negative conversion of the sputum smear at the end of the intensive phase and the end of the continuation phase. Negative conversion of the sputum smear is quite important because the bacillary load will be so low at the end of 2nd month that reduces the chances of patient death and transmission in the community. KEY WORDS Pulmonary Tuberculosis (PTB), Drug-Resistant TB (DR-TB), National Tuberculosis Programme (NTP), Revised National TB Control Program (RNTCP), Intensive Phase (IP), continuation Phase (CP), National Tuberculosis Elimination Program (NTEP).

Molecular Epidemiology of Mycobacterium tuberculosis strains isolated from pulmonary tuberculosis patients in south Ethiopia.

Introduction:Understanding the epidemiology of tuberculosis is limited by lack of genotyping data. We sought to characterize the drug susceptibility testing patterns and genetic diversity of M. tuberculosis isolates in southern Ethiopia.Methodology:A cross-sectional study was conducted among newly diagnosed sputum smear positive patients with tuberculosis visiting nine health facilities in southern Ethiopia from June 2015 to May 2016. Three consecutive sputum samples (spot-morning-spot) per patient were examined using acid-fast bacilli smear microscopy with all smear positive specimens having acid-fast bacilli cultures performed. M. tuberculosis isolates had drug susceptibility testing performed using indirect proportion method and were genotyped with RD9 deletion analysis and spoligotyping. Mapping of strain was made using geographic information system.Results:Among 250 newly diagnosed patients with tuberculosis, 4% were HIV co-infected. All 230 isolates tested were M. tuberculosis strains belonging to three lineages: Euro-American, 187 (81%), East-African-Indian, 31 (14%), and Lineage 7 (Ethiopian lineage), 8 (4%); categorized into 63 different spoligotype patterns, of which 85% fell into 28 clusters. M. tuberculosis strains were clustered by geographic localities. The dominant spoligotypes were SIT149 (21%) and SIT53 (19%). Drug susceptibility testing found that 14% of isolates tested were resistant to ≥ 1 first line anti- tuberculosis drugs and 11% to INH. SIT 149 was dominant among drug resistant isolates.Conclusions:The study revealed several clusters and drug resistant strains of M. tuberculosis in the study area, suggesting recent transmission including of drug resistant tuberculosis. Wider monitoring of drug susceptibility testing and geospatial analysis of transmission trends is required to control tuberculosis in southern Ethiopia.

Evaluation of patient's experiences with daily DOTS

Background/aimsPast few decades have seen major revisions in the Tuberculosis (TB) control programs time and again with a goal to strengthen the delivery of services and achieve elimination of the disease. Daily Directly Observed Treatment, Short-course (DOTS) Fixed dose combination (FDC) was one such major leap and aimed to simplify the treatment regimen, reduce pill burden, avoid drug monotherapy, improve compliance, reduce chances of drug resistance, decrease stigma and make the treatment more patient friendly.We intended to study the impact and acceptance of this changed FDC daily DOTS at the grass root level. Clinical and microbiological parameters were also studied alongwith. MethodsProspective study was conducted in the Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh from October, 2018 to October, 2020.138 sputum smear positive patients were enrolled at the time of initiation of treatment and studied till end of intensive phase (IP). Baseline socio-demographic and clinical details, any adverse drug reactions (ADR's), their subsequent management and sputum smear conversion at end IP were noted. Various patient and disease related factors were studied in relation to sputum smear conversion and ADR's. At end IP, experiences of the patients with the newly introduced daily regimen were assessed by using a structured questionnaire. The data was tabulated and statistically analyzed. ResultsMean age of the patients was 39.31 ± 1.5 years. Majority were males, literate, married, employed, from urban background and moderately built.During IP, 59 (42.8%) patients experienced ADR's. 31/59 patients needed admission while 28/59 patients were managed on outpatient basis. 31/59 patients improved with symptomatic management, while 28/59 patients required change in anti tubercular drugs for a short period of time. All the patients were shifted back to FDC daily DOTS after a few days. Though 59 patients reported ADR's, only 44/59 patients missed their doses. Rest 15/59 patients continued with the treatment despite mild ADR's and reported for management without missing any dose. Follow-up smear at end IP was negative in 130/138 patients (94.2%).93.5% patients preferred their family member as the DOTS provider. More than 90% of the patients were satisfied with basic provisions like treatment room privacy, cleanliness, safe drinking water and sign boards at DOTS centre. Satisfaction with the health care worker (HCW) (assessed by enquiring about the behavior of the HCW, explanation given about the disease and treatment, pre-treatment counseling, occurrence of ADR's, consequences of irregular treatment, warning signs for consultation, advise on nutrition requirement and follow-up information) was reported by 97.8% patients.Sputum conversion rates were significantly higher in unemployed (p = 0.043). Non-adherence to treatment was significantly associated with ADR's (p < 0.001). Sputum conversion rates and ADR's were unaffected by education, rural/urban background, BMI, co-morbidities, addiction and previous history of anti-tubercular treatment. ConclusionDaily DOTS achieved appreciable sputum conversion rates at end IP. Non-adherence to treatment and ADR's were managed well with adequate psychosocial support, counseling, timely monitoring and treatment. FDC daily DOTS emerged as a highly acceptable regimen owing to various comprehensive measures adopted at the grass root level.

Smear-positive pulmonary tuberculosis patients with previously abnormal chest radiographs: missed opportunities for early diagnosis.

It is vital to diagnose and treat pulmonary tuberculosis (PTB) early, in the interests of the patient and public health. At the Singapore Tuberculosis Control Unit (TBCU), it was not uncommon to discover abnormal chest radiographs (CXRs) predating their PTB diagnosis by months to years in the electronic medical records (EMRs) of sputum acid-fast bacilli smear-positive patients. Our study explored this observation. The EMRs of sputum smear-positive PTB patients treated at the TBCU from January to July 2014 were viewed for abnormal CXRs preceding their PTB diagnosis. Information in the EMRs pertaining to the indication for the CXRs, radiological reports (including whether the possibility of PTB was stated) and action taken was captured. Of the 254 sputum smear-positive patients, 108 had previous CXRs in their EMRs, of whom 39 (36.1%) had previous CXRs compatible with PTB. Most of these were performed in tertiary institutions and for reasons unrelated to PTB. No action was taken in response to these CXRs in 24 (61.5%) patients. 27 (69.2%) patients had abnormal CXRs dating back more than six months, with 12 (30.8%) dating back more than 30 months before the PTB diagnosis. Patients aged ≥ 55 years were significantly more likely to have previous CXRs that were compatible with PTB. PTB patients may be asymptomatic or have chronic indolent disease and remain undiagnosed for years. There is a need for vigilance within our healthcare system to seize opportunities for early diagnosis and treatment to prevent the spread of this infectious disease in Singapore.

Predictive utility of fluorescent microscopy for detection of drug resistance in patient of pulmonary tuberculosis

Tuberculosis (TB) is a global health problem with 480000 new cases being reported annually, 9 percent of which exhibit extensive drug resistant TB. With 9.6 cases per lac population early detection of drug resistance at peripheral levels is must. The study was planned to use Fluorescent microscopy (FM) with Fluorescein Diacetate Ethidium Bromide (FDA/EB) stain to evaluate the viability of the mycobacteria to predict the drug resistance. This cross-sectional analytical study was carried out on all sputum smear positive patients after obtaining the Institutional Ethics Committee clearance over a period of 3 months. Samples were obtained on day 0, 3, 7 and 14. After staining with the working solution, observation was made by two independent observers for viable verses non-viable mycobacteria. FDA will stain the live bacilli and fluoresce green whereas dead bacilli lack the esterase activity and are counterstained by ethidium bromide and appear red. Data was maintained in MS Excel and analysed using tests of proportion and significance. A total of 30 participants were included based on the inclusion criteria. There was a loss of follow up from 14 patients. 4/16 (25%) patients were found be harbor drug resistant mycobacteria strains bases on decreasing ratio of viable to non-viable bacteria on followup. Results when compared with gold standard of Line Probe Assay (LiPA) was found to be highly significant with Chi square value of 11.73 and p value &amp;#60;0.001This study establishes the utility of fluorescent microscopy using FDA and EB to detect drug resistance in patients of pulmonary tuberculosis by evaluation of viable and non-viable at peripheral microscopic centers Fluorescent Microscopy with FDA/EB staining holds a potential to predict drug resistance in sputum smear positive patients at peripheral designated microscopic centers which will reduce financial as well as human resource burden.

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.

Difference in persistent tuberculosis bacteria between in vitro and sputum from patients: implications for translational predictions

This study aimed to investigate the number of persistent bacteria in sputum from tuberculosis patients compared to in vitro and to suggest a model-based approach for accounting for the potential difference. Sputum smear positive patients (n = 25) provided sputum samples prior to onset of chemotherapy. The number of cells detected by conventional agar colony forming unit (CFU) and most probable number (MPN) with Rpf supplementation were quantified. Persistent bacteria was assumed to be the difference between MPNrpf and CFU. The difference in persistent bacteria between in vitro and human sputum prior to chemotherapy was quantified using different model-based approaches. The persistent bacteria in sputum was 17% of the in vitro levels, suggesting a difference in phenotypic resistance, whereas no difference was found for multiplying bacterial subpopulations. Clinical trial simulations showed that the predicted time to 2 log fall in MPNrpf in a Phase 2a setting using in vitro pre-clinical efficacy information, would be almost 3 days longer if drug response was predicted ignoring the difference in phenotypic resistance. The discovered phenotypic differences between in vitro and humans prior to chemotherapy could have implications on translational efforts but can be accounted for using a model-based approach for translating in vitro to human drug response.

Analysis of the economic burden of diagnosis and treatment on patients with tuberculosis in Bao'an district of Shenzhen City, China.

Illness-related costs experienced by tuberculosis patients produce a severe economic impact on households, especially poor families. Few studies have investigated the full costs, including direct and indirect costs, at the patient and household levels in south-east China. A case follow-up study was conducted in the Bao'an district of Shenzhen City, China. Eligible new and previously treated individuals with pulmonary tuberculosis (TB) during January 1st 2013 to June 30th 2013 were enrolled. Medical and non-medical costs as well as income loss were calculated in diagnosis and treatment periods, respectively. Factors associated with costs due to TB diagnosis, treatment and TB care (diagnosis + treatment) were explored respectively with a linear regression model. Of the total 514 TB patients enrolled, 95% were from the migrant population, and 65% were males, with a mean age of 32.25 (±10.11). The median costs due to TB diagnosis and TB treatment were 79 United States dollar (USD), 748USD (6.2897 China Yuan (CNY) = 1USD, 2013) per patient, respectively. The median costs due to TB care (diagnosis and treatment) per patient was 1218USD, corresponding to 26% of patients' annual income pre-illness. Those who visited more times to health facilities, hospitalized, received higher education, or occupied in national civil servant/services/retired staff might expense more before diagnosis. Costs due to TB treatment was significantly higher among migrant patients, sputum smear positive patients, and widowed/divorced population. Factors associated with less total costs were native patients, fewer times of visiting to health-care facilities and those with no hospitalization history due to TB. Although a free TB control policy is in force, patients with TB are still facing a heavy economic burden. More available interventions to reduce the financial burden on tuberculosis patients are urgently needed.

Is International Travel an Emerging Issue on Transmission of Beijing Lineage Mycobacterium tuberculosis?

Mycobacterium tuberculosis belonging to Beijing sublineage (BL) is associated with high tuberculosis (TB) transmission, multidrug resistance, and adverse treatment outcomes. Sri Lanka experiences an increase in the number of travellers/workers to and from high TB-burden countries, and there is risk of getting BL strains imported into the country. In this context, a cohort study was conducted to assess the prevalence of BL strains among pulmonary tuberculosis (PTB) patients in the Kandy district of Sri Lanka (a popular tourist destination) and its association with patients' sociodemographic and clinical characteristics. The study population included sputum smear-positive PTB patients diagnosed from February 2018–July 2019. Fresh sputum samples were collected for culturing and conducted polymerase chain reaction using BL-specific primers. Among the 101 patients recruited, presence of BL strains could be ascertained in 94 patients of which 24 (26%; 95% CI: 18%–35%) had BL strains. Prevalence of BL strains was higher among those with high sputum smear grades (2+ and 3+) (P < 0.05) and those who had travelled abroad (P < 0.05). The prevalence was also higher among young people (aged <35 years). Treatment success rates were similar in patients with (83%) and without BL strains (83% vs. 81%; P value = 0.8375). The prevalence of BL strains in Kandy, Sri Lanka, was high compared to previously reported figures in Sri Lanka, and the percentage drives closer to the countries in South East Asia. International travel raises itself as an emerging issue in BL transmission urging the need of policies and practices in immigration/emigration strategies. The study findings have the potential to alter the TB epidemiology in the country and might represent the situation in other underexplored countries as well. Therefore, it is important to monitor the trends and factors related to the prevalence of Beijing strains globally and make decisions as a whole.

Diagnostic Accuracy of High-Resolution Computed Tomography of Chest in Diagnosing Sputum Smear Positive and Sputum Smear Negative Pulmonary Tuberculosis.

IntroductionPulmonary tuberculosis (PTB) is caused by species of organisms in the Mycobacterium tuberculosis complex. It is a major public health problem worldwide and is endemic in Pakistan. Various clinical and biochemical markers exist for its diagnosis. Radiology has an important role in the diagnosis of PTB. Initially, a chest radiograph is warranted for PTB evaluation. High-resolution computed tomography (HRCT) also has high sensitivity and specificity for PTB diagnosis. Features of primary TB include consolidation, lymphadenopathy, pleural effusion and miliary nodules whereas post-primary TB include apical consolidation, nodules and cavitation. The aim of this study was to determine the diagnostic accuracy of HRCT chest in diagnosing sputum smear positive and smear negative PTB.MethodsA cross-sectional study was conducted at a large tertiary care teaching hospital. A retrospective review of medical records of patients who underwent HRCT chest and sputum acid-fast bacillus (AFB) direct smear and AFB culture for suspicion of PTB was undertaken. All HRCT chest examinations were performed on multislice computed tomography (CT) scanner. On HRCT, PTB was defined as the presence of consolidation, centrilobular nodules, branching nodules with tree in bud appearance with or without lymphadenopathy and pleural effusion. Diagnostic accuracy of HRCT including sensitivity, specificity, positive and negative predictive values was calculated using 2 x 2 table, taking findings of AFB culture as a gold standard.ResultsA total of 108 patients were included in this study with a mean age of 51.85 ± 16.86 years. Diagnostic accuracy of HRCT in diagnosing PTB was found to be 84.26% with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 89.09%, 79.25%, 81.67%, and 87.50%, respectively. In sputum smear positive patients, HRCT has diagnostic accuracy, sensitivity, specificity, PPV and NPV of 87.50%, 88.57%, 84.62%, 93.94%, and 73.33%, respectively. In sputum smear negative patients, HRCT has diagnostic accuracy, sensitivity, specificity, PPV and NPV of 81.67%, 90.00%, 77.50%, 66.67%, and 93.94%, respectively.ConclusionHRCT has high sensitivity in diagnosing sputum smear positive and sputum smear negative PTB. The specificity of HRCT in diagnosing sputum smear positive PTB was high, whereas it was slightly low in diagnosing sputum smear negative PTB. Overall diagnostic accuracy of HRCT was high in diagnosing PTB.

Impact of Smoking and Diabetes Mellitus on Clinico-Bacterio-Radiological Profile of Pulmonary Koch’s Patients

Background: Both smoking and diabetes are attributed to be strongly linked with pulmonary tuberculosis. The significance of the study lies in assessing severity of manifestations in pulmonary tuberculosis patients due to smoking and diabetes. Subjects and Methods:This is a cross sectional observational study among patients presenting to Department of Tuberculosis and Chest Diseases, Government Medical College, Patiala. 200 Patients were enrolled in this study who are sputum smear positive pulmonary kochs patients already on ATT and admitted in this department were evaluated by clinical history, blood and radiological investigations and the data was statistically analyzed.Results:Non smoker non diabetic group had maximum of females, n=28(56%), whereas purely diabetic study group has maximum of males, n=30(60%).The total number of patients whose sputum showed bacterial culture was 19 (9.5%). In the patients having both diabetes and smoking as risk factor there was maximum culture positivity, n=6 (31.5%)and most common organism isolated was klebsiella pneumonia, n=3 (50%), Klebsiella was also the most common organism isolated overall, n=10 (62.5%).Conclusion: The combination of smoking and diabetes can lead to serious disease, sputum positivity and complications.&#x0D;