Tuberculosis Symptoms Research Articles

Comparison of Tuberculosis Cases in Military Personnel Versus Civilians: A Retrospective Descriptive Study.

Tuberculosis (TB) remains a leading cause of death from infectious diseases worldwide. Military personnel are particularly vulnerable to TB because of the factors like deployments to endemic regions and close-quarters living. This study aims to compare the characteristics and outcomes of symptomatic TB cases between military and civilian patients treated at 2 French military hospitals, with a specific focus on diagnostic delay. This retrospective observational study included patients over 18 years old with culture-confirmed symptomatic TB treated between 2008 and 2021. Military patients (Group A) were compared to civilian patients (Group B), matched by age and sex. Data collected included demographic details, diagnostic delay, clinical presentations, and treatment outcomes. Statistical analyses were performed using chi-squared tests and Mann-Whitney tests, with significance set at P < .05. A total of 17 military and 38 civilian patients were included in the study. The median diagnostic delay was shorter for military patients at 49 days, compared to 64 days for civilians, although this difference was not statistically significant (P = .42). In the military group, 59% had been deployed to TB endemic regions, with 35% showing symptoms during operational missions. Clinical presentations and microbiological findings were similar between the two groups. Notably, two military patients were infected with Mycobacterium canettii, likely linked to deployments in Djibouti, where this strain is endemic. The military population showed a significant burden of physical sequelae, with 25% experiencing lasting physical impairments post-treatment. Tuberculosis presentation and outcomes in military and civilian patients were generally comparable. Early diagnosis remains essential to minimize disease severity and operational impact, particularly in military settings.

“Cough was Extremely Excruciating”: A Qualitative Study of Pre-Diagnosis Experience among Individuals with Tuberculosis in Samarinda, Indonesia

Tuberculosis (TB) is a global public health challenge. It's critical to comprehend how an infected person lives with the disease for TB control initiatives to be successful. Identifying the experiences before being diagnosed with tuberculosis needs to be done. This study aimed to explore the pre-experiences among individual that survive from TB. The qualitative method of descriptive phenomenology was utilized in this study. Purposive sampling was used in the sample process, and 16 tuberculosis survivors were included. This study found two themes that were pre-diagnosis symptoms (cough symptom, nutrition problem, hyperthermia and breathing problem) and health seeking behavior prior to being diagnosed with tuberculosis (visit health services, treatment behavior and ignore the symptoms felt). This study revealed that some individuals were still unable to identify the signs of tuberculosis and seek inappropriate treatment before receiving a diagnosis. Particularly for those who are at high risk, interventions aimed at enhancing the community's capacity to identify tuberculosis symptoms and adopt appropriate treatment-seeking behavior must be refined and implemented.

COMMUNITY VIEWS ON PULMONARY TUBERCULOSIS: A STUDY OF KNOWLEDGE AND BEHAVIOR

Inadequate understanding of tuberculosis (TB) may impact patients' inclination to seek medical care and perpetuate the spread of the disease among the community. This study aimed to evaluate the understanding and perspective of individuals who appear to be in good health regarding pulmonary tuberculosis (PTB)). Objectives: To explore the knowledge and behavior of the population about pulmonary TB. Methods: The study was conducted using a cross-sectional design. A survey using a questionnaire was done on 165 randomly selected healthy individuals after obtaining verbal agreement from all participants. SPSS 23 was used to analyze the data. The chi-square test was applied to obtain the required results. Results: The findings indicated that the average age of the participants was 45.33 ± 1.49 years, ranging from 19 to 67 years. Out of the total, 42 individuals (25.46%) were females, while 123 individuals (74.54%) were males. Out of the respondents, 70 (42.42%) acknowledged that they were aware of the bacterial cause of TB. Eighty percent of individuals are aware that tuberculosis can be treated. The most prevalent symptom of tuberculosis (TB) was the presence of blood in the sputum, accounting for 101 cases (61.21%). In health institutions, contemporary pharmaceuticals were the favored treatment option, chosen in 70 cases (42.42%). Conclusion: The results suggest that communities possessed basic knowledge about the disease. However, it is essential to provide health education to change their traditional beliefs and views of the condition into factual knowledge.

Africa Health Research Institute (AHRI) Household Contact study: a study protocol, statistical analysis and modelling plan

Household case-contact studies are an established method to estimate the relative infectiousness of people with pulmonary tuberculosis. Testing of child household contacts with a QuantiFERON TB Gold plus (QFT) assay provides a proxy measure of M. tuberculosis infection in exposed household members. This study aims to generate data about the effect of antiretroviral treatment (ART) and of tuberculosis symptoms on risk of intra-household M. tuberculosis transmission to children and investigate the conditions under which symptom-agnostic screening should be considered, which could provide evidence to support a paradigm shift in tuberculosis screening strategy. Index people diagnosed with bacteriologically-confirmed pulmonary tuberculosis who have been identified by routine health services and starting tuberculosis treatment at one of the 12 health facilities serving the population of the Africa Health Research Institute health and demographic surveillance area will be eligible for recruitment. For each consenting index participant, we will enroll all household members aged 2-14 years who will undergo a symptom screen and provide a blood sample for a QFT and HIV test. We will compare the proportion of child contacts who are QFT-positive in households of (i) index adults who are living with HIV and taking ART vs not taking ART and (ii) index adults engaged in ART care who report no symptoms vs those who report symptoms. We will use a novel mathematical model, incorporating new insights into TB natural history and transmission, to determine the circumstances under which screening for TB, regardless of reported symptoms, would have most impact on tuberculosis incidence and mortality, and explore comparative cost-effectiveness of interventions along the diagnostic pathway at different levels of the health system. Estimates of relative risk of intra-household M. tuberculosis transmission, combined with healthcare utilisation and cost data, will allow us to generate mathematical model estimates of the potential epidemiological impact and relative cost-effectiveness of different approaches to tuberculosis case-finding including symptom-agnostic tuberculosis screening at different levels of the health system.

Time Motion Study of Tuberculosis Patients Attending a Hospital in an Indian State

Abstract Objectives: To analyse the time taken in availing various services by a patient of cardinal symptoms of Tuberculosis in TB Hospital, Bhopal, India and to determine the satisfaction of patients regarding care. Methods: This is a time–motion observational study of patients who came with symptoms of TB. A sample of 210 was calculated using Cochran’s formula. Results: Amongst the 210 patients studied, the majority were males, i.e. 123 (58.6%). A striking feature was found during this study that reports of sputum were given 2–5 days after collection. Conclusion: This busy hospital dedicated to providing comprehensive healthcare pertaining to TB had multiple patient queues, long clinical visits and short clinical encounters. Although the patients were satisfied with the clinical consultations from the doctors, they found difficulty in availing laboratory and X-ray services.

New admissions and asymptomatic TB cases seem to fuel TB epidemic in prisons, a cross sectional survey in Tanzania.

There is an increased risk for tuberculosis (TB) infection and disease progression in prison settings. TB prevalence in prisons in low- and middle-income countries have been measured to be up to 50 -times higher than in the general population. The aim of the study was to perform active TB screening and estimate the burden of TB in central prisons in Tanzania mainland. We performed TB active case finding in five central prisons, Keko, Segerea, Ukonga, Butimba and Ruanda prison in Tanzania, using the Xpert on early morning or spot sputum sample from inmates and new entries between April 2014 and July 2015. A questionnaire that asked about the symptoms and risk factors for TB was administered before a sputum sample was collected. Out of 13,868 incarcerated individuals tested, 13,763 had valid results. TB prevalence among tested was 1550 per 100,000 population (214/13,763); new admissions contributed to the majority (61.68%) of TB cases, but prevalence was higher among inmates (1.75%) compared to new admissions (1.45%). Ukonga, an urban prison which incarcerates long-term convicted inmates had the highest prevalence of 4.02%. Male gender (OR = 2.51, p<0.001), repeated incarcerations (OR = 2.85, p<0.001), history of TB treatment (OR = 1.78, p = 0.002), TB symptoms (OR = 2.78, p = 0.006) and HIV infection (OR = 2.86, p = 0.002) were associated with positive TB results. New admissions could be the driving force of the TB epidemic in the penitentiary system. However, prison environments remain a major risk factor for developing active TB disease.

APERFEIÇOAMENTO SOBRE O RASTREIO DA TUBERCULOSE PARA OS AGENTES COMUNITÁRIOS DE SAÚDE DA ESTRATÉGIA DE SAÚDE DA FAMÍLIA DO NASCENTE I E II EM ARARIPINA-PE.

Tuberculosis (TB), a disease formerly described as typhus, was known in the 19th century as the white plague, decimating hundreds of thousands of people around the world. TB can be caused by any of the seven species that make up the Mycobacterium tuberculosis complex: M. tuberculosis, M. bovis, M. africanum, M. canetti, M. microti, M. pinnipedi and M. caprae. M. tuberculosis is transmitted by air, from a person with pulmonary or laryngeal TB, who eliminates bacilli in the environment (source case), to another person, by inhaling aerosols from coughing, talking or sneezing. Primary pulmonary TB usually occurs after the individual's first contact with the bacillus and is therefore more common in children. Its main characteristic is a dry or productive cough. Evening fever, without chills, does not usually exceed 38.5ºC. Night sweats and anorexia are common. Tuberculosis is a serious disease, but it is curable in the vast majority of cases, as long as the treatment is followed correctly. In Brazil, treatment is standardized and free of charge, provided by the National Tuberculosis Control Program (PNCT) in Health Units. In Brazil, tuberculosis treatment is standardized and consists of two phases: intensive and maintenance. The basic regimen recommended by the Ministry of Health (BRASIL, 2019) for adults and adolescents aged 10 and over includes rifampicin, isoniazid, pyrazinamide and ethambutol (RHZE). Directly Observed Treatment (DOT) is a fundamental strategy for ensuring patient adherence to tuberculosis treatment and reducing abandonment rates. Adopted by the Ministry of Health (MoH) based on WHO recommendations, DOT consists of direct observation of drug intake by health professionals. Community health workers (CHWs) are essential for tuberculosis control, from diagnosis to the outcome of cases. Their duties include Spreading the word to their community about tuberculosis as an important current public health problem. Educate the population about airborne transmission of tuberculosis and the preventive measures that can be adopted. To be aware of the main symptoms of tuberculosis (cough, fever, weight loss and night sweats) at all meetings with the community, as well as publicizing them, and referring suspected cases to the health unit.

Profile of Clinical, Radiological and Laboratory Pattern in TB-HIV Coinfection in National Infection Centre of Indonesia

Background: The study aims to map TB (Tuberculosis) – HIV (Human Immunodeficiency Virus) patients based on clinical, radiological, and laboratory patterns. Objective: This study is expected to provide previous research investigating radiologic and laboratory examinations in TB-HIV patients. Method: We conducted a cross-sectional study based on medical records of TB-HIV patients at RSPI Sulianti Saroso from January 2004 - March 2017. Samples were 240 TB-HIV patients from a population of 1014 People Living with HIV/AIDS (PLWHA). Inclusion criteria were PLWHA, aged over 18 years, diagnosed with TB with completed medical record status. Result: Characteristics of the majority of patients were in the productive age group (99.2%) with an average age of 33 years and male sex (78%). The main symptom is cough (91.7%) and cough with phlegm (59.1%). Most patients (83.37%) have not received ART (Anti-Retroviral Therapy). Pulmonary physical examination showed that most patients had Ronchi (95.8%) while others got wheezing (5%). Laboratory tests revealed an initial CD4 cell count of 71.6 cells/ml and a negative Acid-Fast Bacillus (AFB) smear (59.2%). The patient's radiology was mainly with an infiltrate (82.5%); most infiltrate was presented in apex (52.4%). Conclusion: The majority of TB-HIV coinfected patients are young males, presenting with common TB symptoms, low CD4 counts, and negative AFB smears, complicating diagnosis. Radiological findings frequently show infiltrates, particularly in the apex. These findings emphasize the importance of early diagnosis and ART initiation to improve outcomes in TB-HIV coinfected patients

Real-world diagnostic accuracy of lipoarabinomannan in three non-sputum biospecimens for pulmonary tuberculosis disease

Development of a non-sputum test using readily-obtainable biospecimens remains a global priority for tuberculosis (TB) control. We quantified lipoarabinomannan (LAM) concentrations, a pathogen biomarker for Mycobacterium tuberculosis, in urine, plasma and serum for real-world diagnostic accuracy of pulmonary TB among people living with and without HIV. We conducted a prospective diagnostic study among adults with TB symptoms in South Africa. We measured LAM concentrations in time-matched urine, plasma and serum with an electrochemiluminescence immunoassay using two capture antibodies (FIND 28 and S4-20). From the completed cohort, we randomly selected 210 participants (2 cases: 1 control) based on sensitivity estimates, and we compared diagnostic accuracy of LAM measurements against the microbiological reference standard. Urine and blood specimens from 210 of 684 adults enrolled were tested for LAM. Among 138TB-positive adults (41% female), median urine LAM was 137pg/mL and 52pg/mL by FIND 28 and S4-20, respectively. Average LAM concentrations were highest in HIV-positive participants with CD4+ T cells <200cells/mm3. Urine LAM by S4-20 achieved diagnostic sensitivity of 62% (95% CI: 53%-70%) and specificity of 99% (95% CI: 96%-100%). Plasma and serum LAM by FIND 28 showed similar sensitivity (70%, 95% CI: 62%-78%) and comparable specificities (90%, 95% CI: 82%-97%; 94%, 95% CI: 88%-99%). Diagnostic sensitivity of urine LAM by S4-20 was higher among participants without HIV (41%, 95% CI: 24%-61%) compared to HIV-positive participants with CD4 ≥200cells/mm3 (20%, 95% CI: 8%-39%). Detection of LAM was achievable in non-sputum specimens for pulmonary TB, but additional analyte concentration or signal amplification may be required to achieve diagnostic accuracy targets. Bill and Melinda Gates Foundation.

Evaluating Pericardiectomy Outcomes and Determinants; an 8-Year Retrospective Study at Tertiary Teaching Hospitals in Ethiopia

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: Constrictive pericarditis has a variety of etiologies which leads to severe symptoms and heart failure which affects the quality of life. So far the main modality of treatment is pericardiectomy. &amp;lt;i&amp;gt;Objective&amp;lt;/i&amp;gt;: The aim of this research was to know pericardiectomy outcomes and determinants among constrictive pericarditis patients who were operated at Tikur Anbessa Specialized Hospital from 2014 - 2022. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: A retrospective study was done among 65 patients. Data was presented using frequencies with percentages, mean (±standard deviation) and/ or median (interquartile range) as required. Perioperative mortality and complications were summarized using incidence density with 95% confidence interval (CI). &amp;lt;i&amp;gt;Result&amp;lt;/i&amp;gt;: Most patients were in their 20s (53.8%) and where male are (84.6%). The commonest presenting symptom was shortness of breath (100%), fatiguability (96.9%), and coughs (66.2%). The median time of presentation was 12.3 months (IQR, 7.0-25.5). There were also cases with clinical symptoms of tuberculosis (13.8%). The etiology of constrictive pericarditis was infectious in 83.1% of cases. The mean length of surgery was 3.3 ± 0.6 hours. The median duration of hospital stay is 9.0 days (IQR, 7.0-12.0). The incidence rate (IR) of perioperative death was 7.9 per 1000 person-days (PD) of observation (94% CI = 3.3 – 19.2) and the incidence rate of complication was 4.8 per 1000 PD (95% CI = 1.5 -14.9). &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Pericardiectomy is the best treatment for patients with constrictive pericarditis. The majority of patients had a good outcome, with an improvement in symptoms and functional status. The mortality rate was low, and the complication rate was acceptable. However, this study is based on relatively small sample size, and it is a retrospective study from a single center. Hence, further prospective studies are needed to confirm the findings of this study.

Scientific Achievements of The Department of Phthisiology and Pulmonology of the Bogomolets National Medical University (on the Occasion of the 100th Anniversary of the Founding of the Department)

Department of Phthisiology and Pulmonology of O.O. Bogomoletsa was founded in the distant past (1924). The department was initially established as an associate professorship in tuberculosis at the Kyiv Medical Institute (KMI), later became a course on tuberculosis, and eventually developed into a full department of tuberculosis. During its existence, the department changed its name several times (Department of Phthisiology, Department of Phthisiology with a Course of Pulmonology, Department of Phthisiology and Pulmonology).The direction of the work of the associate professorship on tuberculosis of the KMI (head A.I. Sobkevych) is the scientific analysis of the symptoms of tuberculosis and the development of recommendations for the rational nutrition of patients. The direction of the tuberculosis course (head D.Ya. Epshtein) is to improve the method of treating tuberculosis with the help of an artificial pneumothorax.The field of work of the Department of Tuberculosis (head V.P. Rudin) is the analysis of age-related reactivity of the body of tuberculosis patients, features of pathogenesis, clinic, diagnosis and treatment of tuberculosis in young people and the elderly; study of tuberculous meningitis and new methods of climate therapy for tuberculosis.The field of work of the Department of Phthisiology (head M.S. Pylypchuk) is the development of methods of diagnosis and improvement of treatment of patients with tuberculosis and non-specific lung diseases (use of heparin, donors of sulfhydryl groups, galascorbin and proteolytic enzymes; establishment of hemosorption, endolymphotherapy, aerosol therapy and intravenous administration of antituberculosis drugs drugs, lung resection with pneumoperitoneum) and treatment of tuberculosis patients with chronic alcoholism. Study of the surfactant system of the lungs, the mucociliary apparatus and the aerogematic barrier; animal lung transplantation experiments.The field of work of the department of phthisiology and pulmonology since 1997 (head — V.I. Petrenko) — improvement of existing and development of new methods of antimycobacterial and pathogenetic therapy (Tri-vi-plus, Dufalak®, Kagocel®, Glutargin, ademethionine, Livolin Forte and Immunofan) in patients with pulmonary tuberculosis; application of biocorrective technologies in emergency conditions in pulmonology and the latest technologies in diagnostics (dopplerography) and treatment (information-wave therapy «IHT-Threshold») of tuberculosis; environmental problems in phthisiology and pulmonology (cigarette smoking, ionizing radiation).The student circle at the Department of Phthisiology and Pulmonology has been operating since 1960. Students have been actively engaged in scientific research. They take part in the implementation of the Department’s National Development Program and make presentations at scientific and practical conferences, congresses and forums (they receive diplomas and certificates). Active student participation is noted during the «April Student Scientific Sessions» (Ukraine) and Olympiads (Ukraine, Uzbekistan).

Accessibility of Finding Tuberculosis Case Actively, Separate Safely and Treat Effectively (FAST) Strategy for Early Detection of Suspected and Symptomatic Tuberculosis Patients: A Hospital Based Quantitative Study

Introduction: Tuberculosis is a contagious disease which has always been a challenge over the course of human history. It is known to spread mostly from persons with undiagnosed and suspected tuberculosis cases. Diagnosing tuberculosis in an early stage with effective treatment is one of the best ways to reduce the burden of tuberculosis. Finding cases Actively, Separate safely and Treat effectively (FAST) Strategy in Nepal, is a rapid diagnostic tool for rapid tuberculosis case detection. Aims: To access tuberculosis case Actively, Separate safely and Treat effectively (FAST) strategy for suspected and symptomatic tuberculosis patients coming to the hospital for early case detection and also to identify patient’s health care behaviour, technical barrier during surveillance. Methods: An observational quantitative study of active cough surveillance was carried at an entry point of FAST corner of Nepalgunj Medical College Teaching Hospital, Banke from April 2023 to December 2023. Scrutinized data was obtained by purposive sampling method with sample size 128 from FAST corner. Results: Maximum cases belonged to the aged group 65 and above having lower middle to lower socioeconomic status. Most of them were from joint family with contact history of tuberculosis in 35 (27.3) % of total cases. Out of total cases, 72 (56.25) % were confirmed with tuberculosis. Among those confirmed tuberculosis cases, multi drug resistance TB was found in 6 (4.7) %. Uses of mask was found significant (P&lt; 0.05) in our study although number of these health care behaviour were less appropriate. Pneumonia was a significant association 17 (P = 0.004) with tuberculosis patient. Insufficient volunteers, and limited Gene xpert machine were major barriers to implement FAST strategy screening in Hospital. Conclusion: FAST strategy is feasible tool in high tuberculosis burden healthcare settings in Nepal. However, the technical and behavioral factors should be managed to ensure an effective approach.

Knowledge, attitudes and practices towards tuberculosis: results of a community-based survey in the Karamoja subregion, North Eastern Uganda

BackgroundThe Karamoja subregion in north-eastern Uganda has very high Tuberculosis (TB)case notification rates and, until recently, had suboptimal treatment completion rates among patients diagnosed with TB. We evaluated community knowledge, attitudes and practices towards Tuberculosis in order to identify barriers to TB control in this region.MethodsFrom September to October 2022, we conducted a community-based survey in four districts in the Karamoja subregion. We collected data on TB knowledge, attitudes, and practices using a structured electronic questionnaire. We generated knowledge, attitude and practice scores. We used a survey-weighted zero-truncated modified Poisson model to assess the association between knowledge/attitude scores and respondents’ characteristics and a complementary log-log model to assess the association between practice scores and respondents’ characteristics. Data analysis was carried out using STATA version 14.ResultsA total of 1927 respondents were interviewed. Of these, 55.5% were female, and 1320 (68.6%) had no formal education. Overall, 68.5% 95% CI (59.6–76.7%) had knowledge scores of ≥ 60%. Higher TB knowledge scores were associated with being employed (adjusted prevalence ratio, aPR = 1.22, 95% CI 1.04–1.42, p = 0.01) while being a wife in a household was associated with lower TB knowledge (aPR = 0.90, 95% CI 0.82–0.99, p = 0.03). Being 25–34 years old was associated with a positive attitude towards TB (PR = 1.06, 1.01–1.11, p = 0.01). Over 85% of respondents would go to the health facility immediately if they had TB signs and symptoms. Almost all respondents (98.6%) would start TB treatment immediately if diagnosed with the disease.ConclusionMore than two thirds of patients had good knowledge and practices towards TB which can be leveraged to improve uptake of TB control interventions in the region. Additional interventions to improve TB knowledge and practice should focus on specific segments within the communities e.g., older women in the households.

Exhaled breath analysis: A promising triage test for tuberculosis in young children

The diagnosis of paediatric pulmonary tuberculosis is difficult, especially in young infants who cannot expectorate sputum spontaneously. Breath testing has shown promise in diagnosing respiratory tract infections, but data on paediatric tuberculosis are limited.We performed a prospective cross-sectional study in Kenya in children younger than five years with symptoms of tuberculosis. We analysed exhaled breath with a hand-held battery-powered nose device. For data analysis, machine learning was applied using samples classified as positive (microbiologically confirmed) or negative (unlikely tuberculosis) to assess diagnostic accuracy.Breath analysis was performed in 118 children. The area under the curve of the optimal model was 0.73. At a sensitivity of 86 % (CI 62–96 %), this resulted in a specificity of 42 % (95 % CI 30–55 %).Exhaled breath analysis shows promise as a triage test for TB in young children, although the WHO target product characteristics were not met.

Effectiveness of Systematic Screening and Treatment of Tuberculosis in Prison in Thailand.

The global incidence of tuberculosis (TB) in prison is 5 to 70 times greater than that in the general population. The systematic screening and treatment of TB in prison benefit TB control and treatment outcomes. However, no study has supported this in Thailand. Here, we evaluated the effectiveness of long-term, continuous, systematic screening for TB control. We conducted a retrospective study in Suratthani Central Prison, Thailand, using annual TB screening from 2016 to 2020. A positive TB screening was defined as having any TB symptoms or chest radiography abnormality. We collected sputum smear and Xpert® Mycobacterium tuberculosis/rifampicin (MTB/RIF) results from those inmates with positive screening results. Bacteriologically confirmed TB was defined as a positive sputum smear or M. tuberculosis detected by Xpert assay. Inmates with clinically diagnosed TB were also eligible for this study. Those inmates diagnosed with active TB were sent to an isolation zone in prison and received anti-TB medicine using directly observed therapy and were monitored by pulmonologists during the treatment course via telemedicine. Of 18,965 TB screening events, 175 patients were diagnosed with TB. The 5-year prevalence was 922 per 100,000 inmates. The relative reduction in TB prevalence was 60.5% from 2016 to 2020. Overall, 94.3% of TB patients were successfully treated (sum of patients cured and treatment completed). Three TB patients died during the 5-year study period. All occurred in 2016. The systematic screening and treatment of TB in inmates effectively reduced the prevalence and mortality in Suratthani Central Prison. The success rate of treatment in this prison has been consistently high.

Cost-effectiveness analysis with surrogate endpoint: mobile targeted active case detection for early detection of tuberculosis

Abstract Objective This study aimed to determine cost-effectiveness analysis with the surrogate endpoint of mobile targeted active case detection (MTACD) programmes in the early detection of tuberculosis (TB) cases. Methods A cross-sectional study to determine the cost-effectiveness with the surrogate endpoint of MTACD as compared with passive case detection (PCD) from the provider’s perspective. Data were gathered on the costs and significant dates (TB screening date, first TB symptoms date, TB diagnosis date, and TB treatment starting date) for 904 patients from five Sabah districts in 2022. A combined step-down and activity-based costing method was used to estimate provider costs. The health outcome measures used were the time taken by the day to detect TB cases. Cost-effectiveness analysis with surrogate endpoint was assessed using cost per TB screening by MTACD and PCD, and the mean of the time taken by the day to detect TB cases. Key findings The total cost for a patient to be screened by MTACD was Malaysian Ringgit (MYR) 96.6 (MYR 1 = USD 0.22), while the cost by PCD was MYR 43.1. The MTACD generally costs MYR 1727.1 to detect a case of TB, compared with MYR 586.9 for PCD. However, MTACD used a shorter mean time to detect TB cases (52.7 days) than PCD (98.9 days). Conclusions Despite the higher costs per screening, MTACD may shorten the days of diagnosis from the onset of TB symptoms when compared with PCD. This study is beneficial when budgeting for TB programmes since MTACD can detect TB cases earlier and lead to early treatment.

Elevated Plasma Matrix Metalloproteinases Are Associated With Mycobacterium tuberculosis Bloodstream Infection and Mortality in Human Immunodeficiency Virus-Associated Tuberculosis.

Mortality from human immunodeficiency virus (HIV)-associated tuberculosis (TB) is high, particularly among hospitalized patients. In 433 people with HIV hospitalized with symptoms of TB, we investigated plasma matrix metalloproteinases (MMP) and matrix-derived biomarkers in relation to TB diagnosis, mortality, and Mycobacterium tuberculosis (Mtb) bloodstream infection (BSI). Compared to other diagnoses, MMP-8 was elevated in confirmed TB and in Mtb-BSI, positively correlating with extracellular matrix breakdown products. Baseline MMP-3, -7, -8, -10, and PIIINP were associated with Mtb-BSI and 12-week mortality. These findings implicate MMP dysregulation in pathophysiology of advanced HIV-TB and support MMP inhibition as a host-directed therapeutic strategy for HIV-TB.

Sequential and parallel testing for microbiological confirmation of tuberculosis disease in children in five low-income and middle-income countries: a secondary analysis of the RaPaed-TB study

Despite causing high mortality worldwide, paediatric tuberculosis is often undiagnosed. We aimed to investigate optimal testing strategies for microbiological confirmation of tuberculosis in children younger than 15 years, including the yield in high-risk subgroups (eg, children younger than 5 years, with HIV, or with severe acute malnutrition [SAM]). For this secondary analysis, we used data from RaPaed-TB, a multicentre diagnostic accuracy study evaluating novel diagnostic assays and testing approaches for tuberculosis in children recruited from five health-care centres in Malawi, Mozambique, South Africa, Tanzania, and India conducted between Jan 21, 2019, and June 30, 2021. Children were included if they were younger than 15 years and had signs or symptoms of pulmonary or extrapulmonary tuberculosis; they were excluded if they weighed less than 2 kg, had received three or more doses of anti-tuberculosis medication at time of enrolment, were in a condition deemed critical by the local investigator, or if they did not have at least one valid microbiological result. We collected tuberculosis-reference specimens via spontaneous sputum, induced sputum, gastric aspirate, and nasopharyngeal aspirates. Microbiological tests were Xpert MTB/RIF Ultra (hereafter referred to as Ultra), liquid culture, and Löwenstein-Jensen solid culture, which were followed by confirmatory testing for positive cultures. The main outcome of this secondary analysis was categorising children as having confirmed tuberculosis if culture or Ultra positive on any sample, unconfirmed tuberculosis if clinically diagnosed, and unlikely tuberculosis if neither of these applied. Of 5313 children screened, 975 were enrolled, of whom 965 (99%) had at least one valid microbiological result. 444 (46%) of 965 had unlikely tuberculosis, 282 (29%) had unconfirmed tuberculosis, and 239 (25%) had confirmed tuberculosis. Median age was 5·0 years (IQR 1·8-9·0); 467 (48%) of 965 children were female and 498 (52%) were male. 155 (16%) of 965 children had HIV and 110 (11%) children had SAM. 196 (82%) of 239 children with microbiological detection tested positive on Ultra. 110 (46%) of 239 were confirmed by both Ultra and culture, 86 (36%) by Ultra alone, and 43 (18%) by culture alone. 'Trace' was the most common semiquantitative result (93 [40%] of 234). 481 (50%) of 965 children had only one specimen type collected, 99 (21%) of whom had M tuberculosis detected. 484 (50%) of 965 children had multiple specimens collected, 141 (29%) of whom were positive on at least one specimen type. Of the 102 children younger than 5 years with M tuberculosis detected, 80 (78%) tested positive on sputum. 64 (80%) of 80 children who tested positive on sputum were positive on sputum alone; 61 (95%) of 64 were positive on induced sputum, two (3%) of 64 were positive on spontaneous sputum, and one (2%) was positive on both. High rates of microbiological confirmation of tuberculosis in children can be achieved via parallel sampling and concurrent testing procedures. Sample types and choice of test to be used sequentially should be considered when applying to groups such as children younger than 5 years, living with HIV, or with SAM. European and Developing Countries Clinical Trials Partnership programme, supported by the EU, the UK Medical Research Council, Swedish International Development Cooperation Agency, Bundesministerium für Bildung und Forschung, the German Center for Infection Research, and Beckman Coulter.

Combination of exhaled breath condensate samples with lipoarabinomannan point of care assay for pulmonary tuberculosis (TB) diagnosis: protocol for a diagnostic accuracy study

IntroductionThe WHO estimates a gap of about 30% between the incident (10.6 million) and notified (7.5 million) cases of tuberculosis (TB). Combined with the growing recognition in prevalence surveys of...

Evaluation of C-Reactive Protein and Computer-Aided Analysis of Chest X-rays as Tuberculosis Triage Tests at Health Facilities in Lesotho and South Africa.

To improve tuberculosis case-finding, rapid, non-sputum triage tests need to be developed according to the World Health Organization target product profile (TPP) (>90% sensitivity, >70% specificity). We prospectively evaluated and compared artificial intelligence-based, computer-aided detection software, CAD4TBv7, and C-reactive protein assay (CRP) as triage tests at health facilities in Lesotho and South Africa. Adults (≥18 years) presenting with ≥1 of the 4 cardinal tuberculosis symptoms were consecutively recruited between February 2021 and April 2022. After informed consent, each participant underwent a digital chest X-ray for CAD4TBv7 and a CRP test. Participants provided 1 sputum sample for Xpert MTB/RIF Ultra and Xpert MTB/RIF and 1 for liquid culture. Additionally, an expert radiologist read the chest X-rays via teleradiology. For primary analysis, a composite microbiological reference standard (ie, positive culture or Xpert Ultra) was used. We enrolled 1392 participants, 48% were people with HIV and 24% had previously tuberculosis. The receiver operating characteristic curve for CAD4TBv7 and CRP showed an area under the curve of .87 (95% CI: .84-.91) and .80 (95% CI: .76-.84), respectively. At thresholds corresponding to 90% sensitivity, specificity was 68.2% (95% CI: 65.4-71.0%) and 38.2% (95% CI: 35.3-41.1%) for CAD4TBv7 and CRP, respectively. CAD4TBv7 detected tuberculosis as well as an expert radiologist. CAD4TBv7 almost met the TPP criteria for tuberculosis triage. CAD4TBv7 is accurate as a triage test for patients with tuberculosis symptoms from areas with a high tuberculosis and HIV burden. The role of CRP in tuberculosis triage requires further research. Clinicaltrials.gov identifier: NCT04666311.