History Of TB Research Articles

Chest X-ray scoring to screen for chronic pulmonary aspergillosis in patients with a history of pulmonary TB.

Chest X-ray scoring to screen for chronic pulmonary aspergillosis in patients with a history of pulmonary TB.

P-552. Viral load non-suppression among adults living with HIV on antiretroviral treatment in Sughd Region, Tajikistan, 2013-2022

Abstract Background Unlike many other regions, Central Asia has an increasing incidence of HIV. Viral load suppression among people living with HIV (PLHIV) is a key strategy for reducing HIV transmission. We conducted a study to identify factors associated with viral load non-suppression among PLHIV on antiretroviral treatment (ART). Methods We conducted a retrospective study of adults (≥18 years old) newly diagnosed with HIV from 2013 to 2022 who received ART for 6+ months in the Sughd region. Data were abstracted from the national electronic registry of PLHIV and cross-checked with paper medical and laboratory records. Viral load non-suppression was defined as anyone with >1000 copies per ml after being on 6+ months of treatment. Descriptive statistics were performed to summarize the characteristics of the study participants. Bivariable and multivariable logistic regression was used to identify factors associated with viral load non-suppression. We present adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).Table 2.Factors associated with non-viral load suppression among adults with HIV who received antiretroviral treatment (n=1871), Sughd, Tajikistan, 2013-2022 Results Of 1,871 people who were on ART for at least 6 months from 2013 to 2022, 11% did not achieve viral suppression. Of people on ART, 57% were male, 38% were migrants, and 68% lived in a rural area. The mean age was 31 years (range: 18-74) and 8% had a history of TB. One-third (32%) had late HIV diagnosis (23% in stage 3 and 9% in stage 4). The majority (94%) were on tenofovir lamivudine/dolutegravir (TDF/3TC/DTG) (Table 1). People diagnosed with stage 4 disease vs stage 1 (aOR=2.4, 95%CI=1.5–3.8; p< 0.01), males vs females (aOR=1.5, 95%CI=1.1-2.0; p=0.03), people who migrated after HIV diagnosis vs non-migrants (aOR=1.4, 95%CI=1.1-2.0; p=0.02), or were not married (single) vs married (aOR = 2.0, 95%CI=1.3–3.2; p=< 0.01) had increased odds of viral load non-suppression. People diagnosed in 2019-2022 had lower odds of viral load non-suppression compared to people diagnosed in 2013-2018 (aOR=0.5, 95%CI=0.4-0.7; p< 0.01) (Table 2). Conclusion Level of viral load suppression among people on ART in Sughd region of Tajikistan is below the global target of 95%. Increasing early detection and providing treatment support for groups with higher odds of non-suppression, especially males, migrants and people in later stages of the disease, can help with achieving global targets. Disclosures All Authors: No reported disclosures

Special Case Study of Exploratory Thoracotomy in Pneumothorax Patients et causa Rupture of Giant Bullae

Background: Pneumothorax is an accumulation of extrapulmonary air in the chest usually due to air leakage from the lungs. Air leaks can be primary or secondary and can be spontaneous, traumatic, iatrogenic, or catamenial. Pneumothorax may occur with pneumonia, usually with empyema; it can also occur secondary to lung abscess, gangrene, infarction, rupture of an emphysematous cyst or bleb (in asthma), or a foreign body in the lung. In infants with staphylococcal pneumonia, the incidence of pneumothorax is relatively high. Case Description: Baby patient with the initials ZKP, female, aged 0 years 3 months, treated in the emergency room at Dr. RSUD. Chasbullah Abdulmadjid Bekasi City on September 29 2024 with complaints of shortness of breath. The patient was brought by his mother to the emergency room at CAM Bekasi Hospital on September 29 2024 with complaints of shortness of breath. According to the patient's family, complaints of shortness of breath had been felt since 1 day at SMRS. The patient had a WSD installed one week ago. The patient denied complaints of fever and cough. Family history of TB was denied. The patient's immunization is incomplete, the patient has not received the BCG vaccine. Post-inpatient patient at Hermina Jatinegara Hospital with the same complaint with a primary diagnosis of Empyema and secondary diagnoses of Bronchopneumonia, sepsis e.c Staphylococcus capitis MDR, and Diarrhea. Conclusion: Open thoracotomy provides several advantages in the management of pneumothorax. First, it allows direct visualization and assessment of the underlying pathology. This is especially useful in cases where there is suspicion of significant lung or pleural disease, such as bullae, blebs, or bronchopleural fistulas. By accessing the chest cavity directly, surgeons can identify and address any specific abnormalities that contributed to the pneumothorax, facilitating targeted treatment and reducing the risk of recurrence Keywords: pneumothorax, thoracotomy, lung disease, shortness of breath

Predictors of treatment delay among drug resistant tuberculosis patients in Uganda

BackgroundDrug resistant tuberculosis (DR-TB) continues to be a significant global public health concern despite the availability of effective TB medicines. Equally, delayed DR-TB treatment initiation is associated with increased morbidity, amplified resistance, transmission risk and poor treatment outcomes. This study aimed to investigate treatment delays and identify predictors of delayed treatment initiation among DR-TB patients in Uganda.MethodA retrospective study was conducted using routine DR-TB national case registration data between January 2012 and December 2019. Stata version 15 was used to run uni-variate analysis to describe patient characteristics using frequencies and percentages; bivariate analysis to identify significant differences in median times to treatment initiation; and logistic regression model was fitted, and adjusted odds ratio (AOR) with 95% confidence interval was used to identify factors associated with DR-TB treatment delay.ResultsA total of 2,166 DR-TB patients were included in this study. The median treatment initiation delay was 10 days. Approximately 57% of DR-TB patients experienced delays in starting their treatment beyond the acceptable 7-day timeframe. Being diagnosed as RR-TB [AOR = 1.22; 95% CI: 1.08–1.37], and being a recurrent TB patient [AOR = 1.22; 95% CI: 1.01–1.47] were associated with treatment delays. Patients with previous history of ‘lost to follow-up’ (LTFU), failure and being diagnosed as Pre-XDR-TB were less inclined to delay DR-TB treatment.ConclusionSeveral DR-TB patients experienced treatment delay. The delay was significant among patients diagnosed as RR-TB and those with TB treatment history of recurrent TB. This highlights the need for heightened vigilance among healthcare workers when managing DR-TB patients with a history of past TB treatment and those diagnosed as RR-TB to minimize delays. Furthermore, future research should investigate a comprehensive list of variables influencing the timing of treatment initiation after diagnosis. An in-depth understanding of the effects of these factors can inform targeted interventions to optimize treatment strategies for improved DR-TB patient outcomes.

Development and evaluation of a scoring system for early diagnosis of bone and joint tuberculosis in a resource-limited setting: a cross-sectional study

PurposeBone and joint tuberculosis (BJTB) presents a significant challenge in high TB burden countries, leading to serious complications and increased mortality. Early and accurate diagnosis is critical but often difficult due to limited access to deep tissue samples and low bacterial loads in lesion sites. This study proposes and evaluates a scoring system aimed at improving early diagnosis and management of BJTB.Please confirm if the author names are presented accurately and in the correct sequencecheckedMethodsA cross-sectional study was conducted in a public sector hospital in Karachi, Sindh. Patients with clinical suspicion of BJTB, excluding those with severe underlying diseases or HIV infection, were enrolled. The scoring system included major criteria (joint pain, swelling/effusion, restricted range of motion, X-ray findings) and minor criteria (fever, weight loss, joint redness, current pulmonary TB, raised ESR, history or family history of TB). Patients were categorized as highly suspicious (score > 7), suspicious (score 5–7), or less suspicious (score < 5). Treatment was initiated based on these categories, and outcomes were monitored over a 6-month follow-up period.ResultsOf the 78 patients, 37 (47.43%) were classified as highly suspicious, 26 (33.33%) as suspicious, and 15 (19.23%) as less suspicious. Initial anti-tuberculosis treatment (ATT) was effective in 94.59% of highly suspicious cases, 84.61% of suspicious cases, and 60% of less suspicious cases. The scoring system demonstrated a sensitivity of 94.6%, 84.6%, and 73.3%, specificity of 75.0%, 69.2%, and 84.6%, and positive predictive value (PPV) of 87.2%, 84.6%, and 84.6%, and negative predictive value (NPV) of 88.5%, 83.3%, and 74.7% for highly suspicious, suspicious, and less suspicious categories, respectively.ConclusionThe proposed scoring system is a valuable tool for diagnosing BJTB, especially in resource-limited settings. It promotes early identification and treatment, potentially improving patient outcomes. Further studies are needed to validate its widespread applicability.Affiliations: Journal instruction requires a city/country for affiliations; however, this is missing in affiliation [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]. Please verify if the provided city/country is correct and amend if necessary.checked

The Relationship Between Intrinsic, Extrinsic Factors, and Socio Economic Status With the Level of Pneumonia Among Toddlers at Paal V Health Center, Jambi City

ABSTRACT Pneumonia is the most significant trigger of infections leading to death in children globally. Every year, an estimated 921,000 children under the age of 5 die due to pneumonia. This study aims to determine the relationship between intrinsic, extrinsic, and socioeconomic factors with the level of pneumonia in toddlers at the Paal V Community Health Center in Jambi City. This study uses an analytical quantitative research method, with a cross-sectional study design. The respondents in this study were 87 toddlers (aged 0-59 months). Data analysis was conducted using chi-square statistical analysis. The research results show the p-value of intrinsic factors, namely age PR 0.447 (p=0.339), gender PR 0.747 (p=0.668), Exclusive Breastfeeding PR 4.474 (p=0.000), low birth weight PR 2.364 (p=0.064), nutritional status PR 5.250 (p=0.000), history of Vitamin A supplementation PR = 3.897 (p=0.002), history of ARI PR 3.687 (p=0.003), history of asthma PR 5.647 (p=0.008), history of tuberculosis TB 2.514 (p=0.033). Extrinsic factors such as household crowding density PR 5.778 (p=0.000), smoking behavior indoors PR 0.763 (p=0.11). Socioeconomic factors such as mother's education PR 3.055 (p=0.025), mother's occupation PR 0.753 (p=0.036), and household income PR 2.703 (p=0.04). There is a relationship between Exclusive Breastfeeding, nutritional status, history of Vitamin A supplementation, history of ARI, history of asthma, history of Tuberculosis, household crowding density, mother's education, mother's occupation, and household income with the level of pneumonia in toddlers in Jambi City in 2023. Meanwhile, there is no relationship between age, gender, history of low birth weight, and indoor smoking behavior with the level of pneumonia in toddlers in Jambi City in 2023. Keywords: Pneumonia, Toddlers, Intrinsic, Extrinsic, Socioeconomic

Revisiting tuberculosis as a cause of gastric outlet obstruction: Insights from a case report.

Gastroduodenal tuberculosis (GD-TB) is exceptionally rare. The clinical manifestations of gastrointestinal TB are diverse and non-specific, which makes diagnosis difficult, leading to delayed diagnosis and high mortality. As a peer-reviewer of World Journal of Clinical Cases, I would like to share my opinion on the article published by this journal. The patient had no family history of TB or contact with people with TB. Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient. The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.

Epidemiological and genetic aspects of pulmonary tuberculosis in Kazakhstan

ObjectiveTuberculosis is a major health problem in many countries, including Kazakhstan. Host genetics can affect TB risk, and epidemiological and social factors may contribute to disease progression. Due to the high incidence of pulmonary tuberculosis in the country, our research aimed to study the epidemiological and genetic aspects of pulmonary tuberculosis in Kazakhstan. Material and methods1026 participants of Central Asian origin were recruited in the study: 342 individuals diagnosed with active PTB, 342 household contacts, and 342 controls without a family history of TB. Genetic polymorphisms of selected genes were determined by real-time polymerase chain reaction. The association between the risk of pulmonary TB and polymorphisms was evaluated using logistic regression and assessed with the ORs and their corresponding 95 % CIs, and the significance level was determined as p < 0.05. ResultsEpidemiological data revealed that underweight BMI (χ² = 89.97, p < 0.001), employment (χ² = 39.28, p < 0.001), and diabetes (χ² = 12.38, p < 0.001) showed a significant association with PTB. A/T polymorphism of the IFG gene showed a lower risk, and A/A polymorphism showed an increased risk of susceptibility to TB. A/A polymorphism of the IFG gene was associated with an almost 3-fold increased risk of PTB, and A/T polymorphism of the IFG gene was associated with a decreased risk of PTB (OR = 0.67, 95 % CI = 0.49–0.92, p = 0.01). The analysis revealed a decreased risk of PTB for A/A polymorphism of the VDR ApaI (OR = 0.67, 95 % CI = 0.46–0.97, p < 0.05). A/A polymorphism of the TLR8 gene was associated with a 1.5-fold increased risk of PTB (OR = 1.53, 95 % CI = 1.00–2.33, p < 0.05). ConclusionResults showed that gender, employment, underweight BMI and diabetes are associated with PTB incidence in our study cohort. The A/A genotype of the IFG (rs2430561) and an A/A genotype of the TLR8 (rs3764880) genes were associated with an increased risk of PTB. A/T polymorphism of the IFG (rs2430561) and A/A polymorphism of the VDR ApaI were associated with a decreased risk of PTB.

Demographic and socioeconomic disparity in knowledge, attitude, and practice towards tuberculosis in Northwest, China: evidence from multilevel model study

BackgroundTuberculosis (TB) remains a serious global public health problem in China. The right knowledge, attitude, and practice (KAP) towards TB are indispensable to appropriate healthcare-seeking behaviors and treatment services timely. However, there are few studies that addressed the KAP towards TB in high-risk and under-developing regions in China. This study aims to evaluate the KAP towards TB in Ningxia Northwest, China, and identify factors that influence it. The findings can guide future health education and promotion interventions.MethodsA stratified multistage random sampling method was used to conduct a face-to-face questionnaire survey with 33 items for selected residents. The composite score of Knowledge, Attitudes, and Practices (KAP) was divided into two groups, which are poor (scores below the average) and good (scores above the average). A two-level logistic model with a random intercept equation accounted for the similarity of residents within communities to examine the association between individual-level KAP and demographic and socioeconomic factors.ResultsA total of 2,341 residents were recruited, the mean age was 50, and 41.2% were female. The percentages of residents who were total awareness of TB knowledge and had positive attitudes and behavior toward TB were 51.9%, 75.3%, and 76.2%, respectively. The two-level logistic model demonstrated that residents with a high annual family income, urban living, primary school education or higher, occupation of teacher or doctor, a very good self-perceived status, medical insurance, knowing DOTS, and family members or friends with TB history had better knowledge of TB (P < 0.05). Residents living in urban areas, with junior and senior high school education, a very good self-perceived status, health insurance, knowing DOTS, and family members or friends with TB history had positive attitude of TB (P < 0.05). Residents living in urban areas, a primary school education or higher, occupation of teacher, doctor and workers, a very good self-perceived status, medical insurance, knowing DOTS, and family members or friends with TB history had positive practice of TB (P < 0.05).ConclusionsFavorable demographic (higher education levels, teachers or doctors) and socioeconomic (high income, living in urban area) factors are associated to better knowledge, attitudes and practices toward TB in Northwest China. Interventions to improve KAP at the community level are required to speed up the TB reduction rate, which may benefit to ensure the End TB Strategy will be achieved.

Diabetes Mellitus as a Risk Factor for Tuberculosis: A Community Based Case Control Study.

Prevention of diabetes in the general population can help reduce the incidence of tuberculosis. Hence it is necessary to document that diabetes is strongly associated with tuberculosis as a risk factor. To study if diabetes is associated with tuberculosis compared to controls. A community based case-control study was carried out. 215 newly diagnosed cases of tuberculosis on treatment for not more than three months were selected randomly from the randomly selected tuberculosis unit. 215 neighbourhood controls were selected. They were matched for the age group of ± 10 years and sex. Fasting blood sugar (FBS) was estimated using a glucometer. Tobacco chewing, residence and family history of TB were significantly more in cases (P < 0.05). Mean BMI was significantly lower in cases compared to controls. The proportion of TB cases among the known cases of diabetes was 67% compared to 33% in controls, which was statistically significant. Mean FBS was significantly higher in cases compared to controls (P < 0.05). The odds of cases being diabetic was 2.456 times more than those of controls. On binary logistic regression, diabetes was an independent risk factor for tuberculosis. Other independent risk factors were tobacco chewing, and family history of TB. Family history of tuberculosis, and tobacco chewing were positively associated with tuberculosis whereas body mass index was negatively associated with tuberculosis. Diabetes was significantly associated with tuberculosis.

PRIMARY TUBERCULAR OTITIS MEDIA PRESENTING AS BEZOLD’S ABSCESS WITH FACIAL NERVE PARALYSIS

Introduction: Tuberculosis of the middle ear cleft is a rare extra-pulmonary manifestation. Signs and symptoms of tuberculous otitis media are indistinguishable from that of non-tuberculous otitis media making early diagnosis difficult. Material &amp; Methods: Here we present 14 years old, case of malnourished male with a history of poor immunisation and contact TB in neighbourhood was admitted in our hospital in December 2023 with right ear otorrhea, hearing loss, fever with Bezold’s abscess post aurally and peripheral facial nerve paralysis.Ear Discharge was from childhood, the recent episode of fever with post aural swelling developed over 1 week. Examination of right ear showed copious amount of mucopus which was cleaned to visualise granulation tissue with retracted tympanic membrane Conclusion: Tuberculosis should be suspected in all cases of chronic otitis media unresponsive to conventional treatment particularly in endemic areas. Histopathological examination and AFB staining of tissue removed during mastoid surgery are reliable diagnostic methods. Keywords: tubercular, otitis media, facial paralysis, Bezold’s abscess, mastoidectomy

June 2024 Pulmonary Case of the Month: A Pneumo-Colic Association

No abstract available. Article truncated after 150 words. History of Present Illness: The patient is a 57-year-old woman who presented to the emergency department with increasing cough and shortness of breath over several days. She has a history of ulcerative colitis complicated by toxic megacolon with subsequent colectomy. Past Medical History, Family History and Social History • Ulcerative colitis with history of toxic megacolon (4 years prior), s/p total colectomy • History of recent respiratory failure thought secondary to ustekinumab (Stelara). The respiratory failure responded well to steroid therapy. • She has a history of latent Tb treated with rifampin • Anxiety Medications • Clonazepam 1.0 mg daily at bedtime • Gabapentin 300 mg TID • Pantoprazole 40 mg BID • Prednisone 5 mg daily Physical Examination • Mild-moderate respiratory distress • Afebrile. SpO2 87% on room air. Oxygen saturation 94% on 2 lpm supplemental oxygen. • Chest: crackles noted at left base • Cardiovascular: regular rhythm, no murmur • Extremities: scarring and erythema on both ankles consistent with resolving pyoderma …

Modelling Time to Recovery from Multidrug Resistant Tuberculosis in Southern Ethiopia

Introduction: Multidrug resistant tuberculosis (MDR-TB) is a global heath threat, resistant to key anti-TB drugs. It is ranked among the top 10 causes of death worldwide. Therefore, the current study investigated time to recovery from MDR-TB in southern Ethiopia. Data, Materials and Methods: Restrospective data from selected hospitals in SNNPR (January 2016 to December 2021) were analyzed. A cluster sample of 301 MDR-TB patients (131 NEMMCH, 121 BH, 49 AGH) was considered. Results: Among the 301 cases, 116 (38.5%) were censored. While 185 (61.5%) were recovered. Parametric shared frailty models were employed to account unobserved heterogeneity among the Hospitals and patients and AFT models were employed. the median recovery time of MDR-TB is 22 months. The clustering effect of frailty model was hospitals. Weibull-gamma shared frailty model was appropriate for this data. Conclusion: The final model showed that males have higher recovery rates than females. Extra pulmonary MDR-TB and Urban residency correleted with longer recovery times. The recovery rate increases with increasing baseline weight, education level, and occupation. But, the recovery rate decreases with smoking, co-morbidities, previous drug history, history of TB, and alcohol use Recommendation: All concerned bodies should be cognizant on the risk factors of MDR-TB in SNNP region By providing on early case detection and appropriate treatment of drug-susceptible MDR-TB, since it is essential to shorten the recovery time of MDR-TB patients in line with WHO guidelines

Impact and cost-effectiveness of the 6-month BPaLM regimen for rifampicin-resistant tuberculosis in Moldova: A mathematical modeling analysis.

Emerging evidence suggests that shortened, simplified treatment regimens for rifampicin-resistant tuberculosis (RR-TB) can achieve comparable end-of-treatment (EOT) outcomes to longer regimens. We compared a 6-month regimen containing bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) to a standard of care strategy using a 9- or 18-month regimen depending on whether fluoroquinolone resistance (FQ-R) was detected on drug susceptibility testing (DST). The primary objective was to determine whether 6 months of BPaLM is a cost-effective treatment strategy for RR-TB. We used genomic and demographic data to parameterize a mathematical model estimating long-term health outcomes measured in quality-adjusted life years (QALYs) and lifetime costs in 2022 USD ($) for each treatment strategy for patients 15 years and older diagnosed with pulmonary RR-TB in Moldova, a country with a high burden of TB drug resistance. For each individual, we simulated the natural history of TB and associated treatment outcomes, as well as the process of acquiring resistance to each of 12 anti-TB drugs. Compared to the standard of care, 6 months of BPaLM was cost-effective. This strategy was estimated to reduce lifetime costs by $3,366 (95% UI: [1,465, 5,742] p < 0.001) per individual, with a nonsignificant change in QALYs (-0.06; 95% UI: [-0.49, 0.03] p = 0.790). For those stopping moxifloxacin under the BPaLM regimen, continuing with BPaL plus clofazimine (BPaLC) provided more QALYs at lower cost than continuing with BPaL alone. Strategies based on 6 months of BPaLM had at least a 93% chance of being cost-effective, so long as BPaLC was continued in the event of stopping moxifloxacin. BPaLM for 6 months also reduced the average time spent with TB resistant to amikacin, bedaquiline, clofazimine, cycloserine, moxifloxacin, and pyrazinamide, while it increased the average time spent with TB resistant to delamanid and pretomanid. Sensitivity analyses showed 6 months of BPaLM to be cost-effective across a broad range of values for the relative effectiveness of BPaLM, and the proportion of the cohort with FQ-R. Compared to the standard of care, 6 months of BPaLM would be expected to save Moldova's national TB program budget $7.1 million (95% UI: [1.3 million, 15.4 million] p = 0.002) over the 5-year period from implementation. Our analysis did not account for all possible interactions between specific drugs with regard to treatment outcomes, resistance acquisition, or the consequences of specific types of severe adverse events, nor did we model how the intervention may affect TB transmission dynamics. Compared to standard of care, longer regimens, the implementation of the 6-month BPaLM regimen could improve the cost-effectiveness of care for individuals diagnosed with RR-TB, particularly in settings with a high burden of drug-resistant TB. Further research may be warranted to explore the impact and cost-effectiveness of shorter RR-TB regimens across settings with varied drug-resistant TB burdens and national income levels.

Latent Tuberculosis Infection Management in Solid Organ Transplantation Recipients: A National Snapshot.

Latent tuberculosis infection (LTBI) screening is strongly recommended in the pre-transplant evaluation of solid organ transplant (SOT) recipients, although it remains inadequate in many transplant centers. We decided to investigate pre-transplant TB risk assessment, LTBI treatment, and registry rates in Turkey. Adult SOT recipients who underwent tuberculin skin test (TST) and/or interferon-gamma release test (IGRA) from 14 centers between 2015 and 2019 were included in the study. An induration of ≥5 mm on TST and/or probable/positive IGRA (QuantiFERON-TB) was considered positive for LTBI. Demographic features, LTBI screening and treatment, and pre-/post-transplant TB history were recorded from the electronic database of transplantation units across the country and pooled at a single center for a unified database. TST and/or IGRA were performed in 766 (33.8%) of 2266 screened patients most of whom were kidney transplant recipients (n= 485, 63.4%). LTBI screening test was positive in 359 (46.9%) patients, and isoniazid was given to 203 (56.5%) patients. Of the patients treated for LTBI, 112 (55.2%) were registered in the national registry, and 82 (73.2%) completed the treatment. Tuberculosis developed in 6 (1.06%) of 563 patients who were not offered LTBI treatment. We determined that overall, only one-third of SOT recipients in our country were evaluated in terms of TB risk, only 1 of the 2 SOT recipients with LTBI received treatment, and half were registered. Therefore, we want to emphasize the critical importance of pretransplant TB risk stratification and registration, guided by revised national guidelines.

Assessing Tuberculosis and Risk Factors: Population Study in Rivers State, Nigeria's Niger Delta Region, Nigeria

Mycobacterium tuberculosis (MTB), an infectious airborne bacterium primarily impacting the lungs and instigating a chronic inflammatory response, persists as an enduring menace. This study aims to evaluate the interplay between MTB infection and associated risk factors in Rivers State, Nigeria. The study involved 392 participants from three local government areas (LGAs): Eleme, Obio/Akpor, and PHALGA. Data collection involved a structured questionnaire covering socio-demographics variables and associated risk factors. A stratified random sampling method was employed. Statistical analysis, including descriptive statistics and Spearman's correlation coefficient, was performed using SPSS version 25. Correlation analysis of socio-demographic variables revealed no significant associations with MTB, as indicated by non-significant p-values of (p=0.27), (p=0.83), (p=0.42), (p=0.35), (p=0.49), (p=0.28) for age, sex, education, occupation, marital status and geographical area respectively. However, significant positive weak correlations emerged between MTB infection and cough (p=0.00), hepatitis (p=0.01), coughing blood (p=0.00), and fever (p=0.00). Conversely, family TB history (p=0.93), cough lasting 2 weeks (p=0.84), weight loss (p=0.19), contact with a person who has been coughing for 2 weeks (p=0.93), and alcohol consumption (p=0.55) did not show significant associations. While demographic characteristics alone may not be strong predictors of MTB infection, this study highlights the complex interplay between various risk factors Addressing these risk factors through targeted interventions and raising awareness can contribute to reducing the TB burden in Rivers State and the Niger Delta region.

Determinants of Treatment Delay in Drug-Resistant Tuberculosis Patients in Banten Province in 2020

Indonesia is currently ranked 2nd with the most tuberculosis cases in the world, after India and China. is ranked 2nd with the most tuberculosis sufferers in the world, after India and China.&#x0D; Tuberculosis control in Indonesia faces many challenges, one of which is the increase in patients&#x0D; with drug-resistant tuberculosis (DR TB). In 2019, the number of tuberculosis sufferers in Indonesia&#x0D; reached 543,874 cases, with drug-resistant tuberculosis cases reaching 11,463 (2.1%). Banten is&#x0D; one of the provinces with the highest number of Tuberculosis sufferers in Java, which is 223 people&#x0D; per 100,000 population, with a national TB rate of 203 people per 100,000 population, of which&#x0D; only 58.3% take medication regularly. This study aims to determine the determinants of treatment&#x0D; delay in drug-resistant tuberculosis patients in Banten province in 2020. The study design was a&#x0D; retrospective cohort. The sampling technique was a total sampling of the list of DR TB cases at&#x0D; South Tangerang city General Hospital and dr. Drajat Prawiranegara Serang. Secondary data&#x0D; search was carried out on the TB Information System (SITB) and patient medical records. The study&#x0D; population was 114 respondents, obtained 90 respondents who fit the inclusion and exclusion&#x0D; criteria. Univariate, bivariate analysis with chi-square test and multivariate with logistic regression&#x0D; statistical test were performed to obtain a fit final model. The results of the bivariate analysis&#x0D; showed a significant relationship between age (p=0.030) and employment status (p=0.003). The&#x0D; final multivariate model, showing employment status with delayed treatment (p = 0.008), with OR&#x0D; 18,788 (95% CI: 2,122 – 166.329), meaning that respondents who have jobs have 18.8 times risk for&#x0D; late treatment compared to respondents who do not have jobs after being controlled by variables&#x0D; of age, gender, history of TB, and education level. The researcher concludes that the determinants&#x0D; of delay in treatment of DR TB patients in Banten province in 2020 are employment status and age.&#x0D; It is recommended that the Banten Provincial Health Office can coordinate cross sectors, to ensure the treatment of DR TB patients until they are cured.&#x0D; Keywords: epidemiology, tuberculosis, drug-resistant

Clinical and Imaging Characteristics of Smear Negative Pulmonary Tuberculosis Patients: A Comparative Study.

Prevalence surveys in Ethiopia indicate smear negative pulmonary tuberculosis (SNPTB) taking the major share of the overall TB burden. It has also been a diagnostic dilemma worldwide leading to diagnostic delays and difficulty in monitoring treatment outcomes. This study determines and compares the clinical and imaging findings in SNPTB and smear positive PTB (SPPTB). Methodology. A case-control study was conducted on 313 PTB (173 SNPTB) patients. Data and sputum samples were collected from consented patients. Smear microscopy, GeneXpert, and culture analyses were performed on sputum samples. Data were analyzed using Stata version 17; a P value < 0.05 was considered statistically significant. Of the 173 SNPTB patients, 42% were culture positive with discordances between test results reported by health facilities and Armauer Hansen Research Institute laboratory using concentrated smear microscopy. A previous history of TB and fewer cavitary lesions were significantly associated with SNPTB. Though overall clinical presentations of SNPTB patients resemble those seen in SPPTB patients, a prior history of TB was strongly associated with SNPTB. Subject to further investigations, the relatively higher discrepancies seen in TB diagnoses reflect the posed diagnostic challenges in SNPTB patients, as a higher proportion of these patients are also seen in Ethiopia.

Socio-demographic factors & adherence of newly diagnosed pulmonary tuberculosis patients to the newly introduced daily regimen: A hospital survey based follow up study

IntroductionPoor adherence to anti-tuberculosis medication is a major barrier to its global control. Patient adherence to the standard anti-TB therapy (ATT) in developing countries has been estimated to be as low as 40%. Multiple factors influencing adherence to treatment are:Economic and structural factors such as homelessness, unemployment and poverty; patient related factors like ethnicity, gender, age, knowledge about TB, cultural belief systems, mental state etc. Aims & objectivesThis study was planned with the aim to study the association between various socio-demographic factors with level of adherence to the daily regimen amongst newly diagnosed pulmonary TB patients at a tertiary care hospital in metropolitan city of Maharashtra. Additionally, we tried to determine the type of non-adherence along with reasons for it. Methodology: An interview based pre-tested and validated questionnaire was developed & used as data collection tool. Total 181 newly diagnosed, FDC naïve, drug sensitive pulmonary TB patients from DOT center of a tertiary care hospital were enrolled & interviewed for sociodemographic, treatment & adherence details. They were followed up at 2nd & 6th month of their treatment, i.e., IP & CP follow up. Their Nikshay portal data & TB treatment cards were accessed for information on treatment adherence. ResultsOut of 181 patients, 110 (60.8%) were found to be adherent whereas 71 (39.2%) were found to be non-adherent. Among those non-adherent, 64 (90.9%) had treatment gaps (intermittent missed doses) & 7 (9.9%) showed discontinuation of treatment. Majority of these patients reported personal obligations & starting to feel better as the main reason for non-adherence (p < 0.0001). The sociodemographic factors that had significant impact on level of adherence were patients’ age (p = 0.013); level of education (p = 0.035); family size (p = 0.018); family history of TB (p = 0.0001) & current smoking habit (p = 0.025). ConclusionIt is evident from the study that socio-demographic factors do have a major impact on patients’ levels of adherence to treatment. Family history of TB as well as sputum conversion at end of treatment/CP have been identified as independent risk factors among pulmonary TB patients who are non-adherent to treatment. Thus, ensuring robust availability of DBT & intensive tobacco cessation sessions for all diagnosed patients as well as strengthening system for making prophylaxis available for household & close contacts of patients can help in reducing impact of socio-demographic factors & improving adherence levels. RecommendationsIn-patient care option specifically during IP; regular dietary counseling to improve nutrition & help reduce drug side effects & use of alternate adherence technologies like facility-based DOT or Video Observed Therapy (VOT) wherever feasible can help to improve adherence levels for TB patients from all walks of life.

CD8+ T cell response in QuantiFERON-TB Gold Plus testing was associated with tuberculosis recurrence: a 2-year prospective study

Background Recurrence posed an important challenge to pulmonary tuberculosis (PTB) control in China. The prospective study aimed to identify potential risk factors and to explore the value of QuantiFERON-TB Gold Plus (QFT-Plus) in identifying at-risk individuals with treated prior PTB history. Methods All eligible individuals aged ≥18 years who had been diagnosed with PTB before 2016 in Zhongmu County, where with an average level of TB prevalence in China, were included and received baseline survey including chest radiography, QuantiFERON-TB Gold In-Tube (QFT-GIT) and QFT-Plus, then PTB recurrence was tracked through a 2-year follow-up. Results Half of 1068 (52.34%, 559/1068) included eligible participants were QFT-Plus positive at baseline and 21 of them recurred active TB in 2-year follow-up. Individuals aged ≥ 60 years, who had a recent history of TB and smokers were associated with increased risk of TB recurrence with an adjusted odds ratio (aOR) of 3.97 (95% confidence interval (CI): 1.29–12.24), 7.71 (95% CI: 1.74–34.25) and 4.56 (95% CI: 1.62–12.83), respectively. Compared to QFT-Plus negatives, those who were TB2+/TB1- (aOR = 15.34) exhibited stronger association with the risk of TB recurrence than those who were TB1+/TB2+ (aOR = 6.06). A dose response relationship was also found between the risk of TB recurrence with the baseline level of TB2-TB1 (p for trend < 0.001). Conclusions High burden of TB infection and high risk of PTB recurrence were observed in the study population. Those with recent onset of prior TB, elderly smokers and QFT-Plus positives especially with TB2 single positive deserved further attention in active TB surveillance.