Treatment Of Tuberculosis Patients Research Articles

Screening and identification of four serum miRNAs as novel potential biomarkers for cured pulmonary tuberculosis

Rapid and efficient methods for the determination of cured pulmonary tuberculosis (TB) are lacking. We screened serum miRNAs using the Solexa sequencing method among untreated TB patients, two‐month treated TB patients, cured TB patients, and healthy controls. A total of 100 differentially expressed miRNAs were identified in cured TB patients, including 37 up‐regulated (fold change >1.50, P<0.05) and 63 down‐regulated (fold change <0.60, P<0.05) miRNAs. Gene ontology (GO) enrichment analysis revealed that most of the predicted genes were present in the nucleus with a strong protein binding function. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis strongly suggested alterations in the metabolic pathways. Following quantitative real time chain reaction (qRT‐PCR), significantly reduced expression levels of miR‐21‐5p (0.59, P=0.039), miR‐92a‐3p (0.46, P=0.038), and miR‐148b‐3p (0.96, P=0.049) were found in the cured TB patients compared with the untreated TB patients. Also, significantly increased expression levels of miR‐92a‐3p (2.82, P<0.001), miR‐125a‐5p (5.09, P<0.001), and miR‐148b‐3p (4.25, P<0.001) were found in the untreated TB patients compared with the healthy controls. We established a cured TB model with 73.08% accuracy by four miRNAs (miR‐21‐5p, miR‐92a‐3p, miR‐148b‐3p, and miR‐125a‐5p), and also established a diagnostic model with 71.43% accuracy. Our study provides experimental data for establishing objective indicators of cured TB, and also provides a new experimental basis to understand the pathogenesis and prognosis of TB.Support or Funding InformationThis work was supported by grants from the National Natural Science Foundation of China (No. 81573709), the Zhejiang Provincial Natural Science Foundation of China (No. LQ18H040009), and Zhejiang Provincial Medical Science and Technology Foundation of China (2017KY550).This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Treatment of drug-resistant tuberculosis in patients with HIV-1 infection

Treatment of drug-resistant tuberculosis in patients with HIV-1 infection

Differences in rpoB, katG and inhA mutations between new and previously treated tuberculosis cases using the GenoType MTBDRplus assay

Drug resistance in new cases reflects primary transmission of resistant strains, while drug resistance in previously treated patients is more likely to reflect acquired resistance during previous tuberculosis (TB) treatment. In this study from a rural hospital in South India, we compared molecular differences between new and previously treated TB patients who had isoniazid or rifampicin resistance-conferring mutations using the GenoType MTBDRplus assay. Out of 2112 TB patients, 245 (11.6%) had rpoB mutations and 338 (16%) had isoniazid resistance-conferring mutations. Among patients with rpoB mutations, the proportion of new and previously treated cases with no isoniazid resistance-conferring mutations was 41.2% and 26% (P-value = 0.02; risk ratio [RR] 1.58, 95% confidence interval [CI] 1.09–2.31; risk difference [RD] 15.2%, 95% CI 18.2–28.6), respectively. Among patients with isoniazid resistance-conferring mutations, the proportion of new and previously treated cases with no rpoB mutations was 71.8% and 33.2% (P-value < 0.0001; RR 2.17, 95% CI 1.73–2.71; RD 38.7%, 95% CI 28.8–48.6), and the proportion with single inhA mutations (versus having katG mutations) was 33.1% and 20.9% (P-value = 0.012; RR 1.58, 95% CI 1.11–2.27; RD 12.2%, 95% CI 2.57–21.8), respectively. The most common resistance mutations were S531 L in the rpoB gene, S315T1 in the katG gene and C15T in the inhA gene, and there were no significant differences between new and previously treated patients. In conclusion, new TB cases were less likely to have combined isoniazid and rifampicin resistance-conferring mutations and, in cases with isoniazid resistance, they were more likely to have single inhA mutations than katG mutations. Taking into account that previous research has shown katG mutations precede mutations in the rpoB gene in most cases of rifampicin resistant TB, our results suggest a negative epistatic association between katG and rpoB mutations.

T Cell Profile was Altered in Pulmonary Tuberculosis Patients with Type 2 Diabetes.

BackgroundStudies have suggested that type 2 diabetes (T2D) increases the risk of active pulmonary tuberculosis (TB) infection. T2D might exacerbate TB severity and adversely impact the treatment of TB patients by suppressing the immune response of TB. However, how the immune cell profiles are changed in Chinese TB patients with coincident of T2D compared with TB patients without T2D is still unclear.Material/MethodsTo explore the immune cell profile alteration in TB patients with T2D, we collected blood samples from 46 TB patients with or without T2D and measured the profiles of T cell subsets.ResultsWe found TB patients with coincident of T2D had higher percentages of Th2 and Th17 cells after TB antigens stimulation, while they had unchanged Th1 cells and decreased CD8+ cytotoxic T cells compared to TB patients without T2D. However, no significant difference in baseline percentages of these T cells subsets was observed.ConclusionsT2D has important impacts on regulating anti-TB immunity by increasing Th2 and Th17 cell differentiation, but reducing the activity of CD8+ T cells. Our study supports the need to perform longitudinal studies to evaluate the roles of immunological interaction between T2D and TB in TB development.

ОРГАНІЗАЦІЯ НАВЧАЛЬНОГО ПРОЦЕСУ НА КАФЕДРІ ФТИЗІАТРІЇ ДЗ “ДНІПРОПЕТРОВСЬКА МЕДИЧНА АКАДЕМІЯ МОЗ УКРАЇНИ”

Мета роботи – проаналізувати методи та засоби навчання, направлені на поліпшення викладання предмета “Фтизіатрія”, які застосовуються на кафедрі фтизіатрії ДЗ “Дніпропетровська медична академія МОЗ України”.Основна частина. В умовах несприятливої епідемічної ситуації та надання переваг амбулаторним моделям лікування хворих на туберкульоз в Україні виникає необхідність вдосконалювати викладання навчального матеріалу студентам-медикам на кафедрах вищих навчальних закладів.Типовий навчальний план і навчальні програми виділяють обмежену кількість годин для оволодіння дисципліною “Фтизіатрія”, віддаючи перевагу самостійній аудиторній та позааудиторній роботі студентів. Тому викладачі кафедри фтизіатрії ДЗ “Дніпропетровська медична академія МОЗ України” проводять постійний пошук сучасних методів викладання дисципліни, які сприятимуть покращенню засвоєння теоретичного і практичного матеріалу. Під час практичних занять застосовуються інтерактивні методики у вигляді рольових ігор, дискусій, роботи в групах, та допоміжний матеріал, який заохочував студентів до вивчення дисципліни. Студенти із задоволенням беруть участь в обговоренні різних ситуаційних задач, що дозволяє поглибити їх клінічне мислення та оцінити засвоєний теоретичний матеріал. Для індивідуальної роботи розроблені практикуми з самостійної роботи для студентів 4 курсу, які включають клінічні задачі з рентгенограмами, тести різного ступеня складності, задачі, малюнки та кросворди. Завдання вимагають від студента пошуку відповідей у додатковій літературі, таким чином покращуючи знання з предмета.Висновок. Підвищення зацікавлення студентів-медиків у вивченні дисципліни “Фтизіатрія” поліпшить якість надання медичної допомоги пацієнтам у майбутньому.

Factors affecting the side effects of anti-tuberculosis drugs

Side effects of Anti-Tuberculosis Drugs is a problem in the treatment of tuberculosis patients. In Barru Regency, the number of pulmonary TB patient visits in the outpatient and inpatient units in 2014–2016 was still high. Based on these data, it is deemed necessary to conduct research on the causes of cure rates in only 73% of the total users of pulmonary TB drugs, in terms of the side effects of anti-tuberculosis drugs, pulmonary disorders and gastric disorders. This study was conducted on Agustus, 2017 to January, 2018; using cross sectional approach. Subject of this study were 75 tuberculosis patients with BTA+ and side effects of Anti-Tuberculosis Drugs on the lungs and stomach, selected by total sampling. Data were obtained through interview, then analyzed by using path analysis. It is known that the pathways of influence were significant (T-value> 1.96) were knowledge on immune system, type of drug on immune system, knowledge on side effect of drug and type of drug on side effect of drug. Thus, the level of knowledge and types of drugs directly affect the immune system, as well as the side effects of drugs. Several factors that directly affect the side effects of anti-tuberculosis drugs are the level of knowledge and type of drug. Increased knowledge will reduce the side effects of the drug, because the patient makes an effort to neutralize the effect.

Feasibility and yield of screening for non-communicable diseases among treated tuberculosis patients in Peru.

The increasing prevalence of non-communicable diseases (NCDs) poses a major challenge to low- and middle-income countries. Patients' engagement with health services for anti-tuberculosis treatment provides an opportunity for screening for NCDs and for linkage to care. We explored the feasibility and yield of screening for NCDs in patients treated for tuberculosis (TB) in Lima, Peru, as part of a study focused on chronic respiratory sequelae. A representative sample of community controls was recruited from the same geographical area. Screening entailed taking a medical history and performing ambulatory blood pressure measurement and urinalysis. A total of 177 participants with previous TB (33 with multidrug-resistant TB) and 161 community controls were evaluated. There was an almost four-fold increased prevalence of self-reported diabetes mellitus (DM) in the TB group (adjusted prevalence ratio 3.66, 95%CI 1.68-8.01). Among those without self-reported DM, 3.3% had glycosuria, with a number needed to screen (NNS) of 31. The NNS to find one (new) case of hypertension or proteinuria in the TB group was respectively 24 and 5. Patient-centred care that includes pragmatic NCD screening is feasible in TB patients, and the treatment period provides a good opportunity to link patients to ongoing care.

ВЛИЯНИЕ ПИРИДОКСИНА И ПРЕПАРАТОВ ГИДРОЗИДА ИЗОНИКОТИНОВОЙ КИСЛОТЫ НА НЕРВНУЮ СИСТЕМУ ПРИ ЛЕЧЕНИИ ТУБЕРКУЛЕЗА

When treating tuberculosis patients with multi-component chemotherapy it is necessary to use medications in order to manage or minimize side effects. The review presents research findings on the effect of pyridoxine and its derivatives on the nervous system and their interaction with the agents of isonicotinic acid hydrazide. The review tells about combination drugs containing pyridoxine and pyridoxine hydrochloride used for treatment of tuberculosis.

ОПЫТ ПРИМЕНЕНИЯ НОВЫХ РЕЖИМОВ ЛЕЧЕНИЯ ТУБЕРКУЛЕЗА С МНОЖЕСТВЕННОЙ И ШИРОКОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ ВОЗБУДИТЕЛЯ В РЕСПУБЛИКЕ БЕЛАРУСЬ

The objective of the study: to describe the efficiency and safety of new ant i-t uberculosis drugs when treating tuberculosis patients with drug resistance. Subjects and methods. In Belarus, the retrospective and prospective analyses were performed in the cohort of 300 patients with multiple drug resistance and high rates of extensive drug resistance, who were treated with new drugs and drugs which were started to be used for the treatment of tuberculosis. In order to describe the cohort, blocks of variables were used to specify the efficiency and safety profiles of new ant i-t uberculosis drugs. Results of the study. The high level of therapeutic efficiency of new regimens and their fairly favorable safety profile were demonstrated in the cohort.

A comparison of intradermal test with recombinant tuberculosis allergen (diaskintest) with other immunologic tests in the diagnosis of tuberculosis infection

The WHO strategy for eradication of tuberculosis (TB) by 2035 (The End TB Strategy) is aimed at an early and precise diagnosis and subsequent effective treatment of TB patients. Currently, there is no gold standard for the diagnosis of latent TB infection. This study evaluated the diagnostic capabilities of a new intradermal test using recombinant TB allergen (Diaskintest) compared with tuberculin skin test (TST) and commercial TB interferon-gamma release assays (IGRAs). A post-hoc data analysis that involved examining 860 HIV-negative, bacillus Calmette-Guérin (BCG)-vaccinated persons aged 1-65 years who visited the TB health-care institutions of Saint Petersburg to rule out or confirm an active TB was conducted from 2011 to 2016. A high degree of consistency of the Diaskintest results with the enzyme-linked immunospot and QuantiFERON-TB Gold In-Tube test (ELISPOT and QFT) results was observed in the examined pediatric population (n = 696), with a Diaskintest cutoff ≥5 mm: the kappa consistency indices were 1.000 and 0.937, for ELISPOT and QFT, respectively. A high sensitivity of Diaskintest, comparable with the IGRA tests, was observed in patients with a confirmed TB diagnosis in all age groups. The sensitivity of Diaskintest in patients of the TB/MTB + group aged 18 years and older was 88.7%; of ELISPOT, 90.6%; of QFT, 87.0%. The conducted analysis has shown a high concordance of results of the commercial TB tests in adult HIV-negative patients (n = 164) with a Diaskintest cutoff ≥5 mm: the kappa indices were 0.805 and 0.636 (Diaskintest vs. ELISPOT and QFT, respectively) among BCG-vaccinated people. According to the WHO recommendations, replacing the TST by IGRAs is not recommended as a public health intervention in resource-constrained settings because the IGRA tests are more costly and technically complex to conduct than the TST. Diaskintest has comparable complexity to the TST and its performance is close to that of IGRA in a BCG-vaccinated population. Thus, our study demonstrates that replacing the TST by Diaskintest can be recommended as a public health intervention in resource-constrained and universal BCG vaccination settings.

Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India

ABSTRACTBackground: The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016–2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India.Objectives: The objectives of the study were among the newly diagnosed and previously treated tuberculosis (TB) patients, to (a) estimate patient costs during diagnosis and intensive phase of treatment, (b) determine the proportion of households experiencing catastrophic costs, and (c) explore coping strategies.Methods: An explanatory mixed methods design comprising both quantitative cost description and qualitative descriptive component was used. Catastrophic cost was defined as total TB care costs exceeding 20% of annual household income.Results: Of 102 TB patients included, two-thirds (69%) were male, 6% were HIV positive, and 45% reported at least one episode of hospitalization for TB care. The median (IQR) total cost of TB care was US$195 (52.1, 492.9) with a direct cost of US$65.3 (22.3, 156.5) and indirect cost of US$50.2 (0.9, 295.1). Overall, 32.4% of households experienced catastrophic costs due to TB care, significantly higher in patients with HIV coinfection (p = 0.009) and hospitalization (p = 0.009). Pledging jewels and borrowing money were major coping strategies. Cash assistance was the expected remedy from the patient perspective.Conclusion: Despite free TB care under NTP, more than a third incurred catastrophic costs towards TB care.

ТОРАКОПЛАСТИКА С ПРИМЕНЕНИЕМ ПОЛИПРОПИЛЕНОВОЙ СЕТКИ В ЛЕЧЕНИИ ТУБЕРКУЛЕЗА ЛЕГКИХ

The article presents the comparative analysis of various types of thoracoplasty in treatment of tuberculosis patients with big cavities (more than 4 cm). Subjects and methods : 63 patients were enrolled into the study (each of 3 groups included 21 patients depending on the type of thoracoplasty). Results. Cavity healing and sputum conversion were achieved faster in the patients who had thoracoplasty by the method offered by the authors with use of the mesh transplant of Surgipro– SPMM-1 49. This method allowed avoiding mediastinal hernias and provided the highest rate of cavity healing – 81.0 ± 8.6%.

The outdoor thermal climate conditions at a historical mountainous tuberculosis sanatorium site in Greece

This work deals with the assessment of the outdoor environment of a sanatorium site in mountainous conditions which were historically considered favourable in the treatment of tuberculosis patients in the pre‐antibiotic era. Thermal climate conditions are estimated through application of the thermal climate index (THI) to site‐specific air temperature and relative humidity data along with kata‐thermometer data recorded at the balconies outside of patients’ rooms. Results show that the cold conditions dominate throughout the winter period at all observation times, whereas conditions of comfort prevail during summer, in morning and evening hours, and occur frequently in spring and autumn at noon.

Determinants of multidrug resistance among previously treated tuberculosis patients in Zimbabwe, 2014.

Zimbabwe. To investigate the determinants of multidrug-resistant tuberculosis (MDR-TB) among previously treated TB patients. A 1:3 case-control study with bivariate analysis and logistic regression. Risk factors for MDR-TB were history of nursing an MDR-TB patient (adjusted OR [aOR] 4.46, 95%CI 2.02-9.88), history of hospitalisation for 3 days (aOR 2.91, 95%CI 1.62-5.23) and history of foreign travel and stay outside Zimbabwe (aOR 2.68, 95%CI 1.46-4.91). Protective factors were previous successful treatment (aOR 0.05, 95%CI 0.02-0.11), history of supervision by a health worker/village health worker (aOR 0.34, 95%CI 0.19-0.60) and having been treated not more than once previously for TB (aOR 0.18, 95%CI 0.08-0.38). No association between human immunodeficiency virus (HIV) infection and MDR-TB (aOR 1.00, 95%CI 0.53-1.88) was observed. However, among HIV-infected patients, those with CD4 <200 cells/mm3 were more likely to develop MDR-TB (aOR 4.62, 95%CI 2.49-8.53). Individual, service-related, social and demographic factors interact to determine multidrug resistance among previously treated TB patients. Infection control, treatment adherence, reduction of side effects and drug susceptibility testing must be strengthened to reduce the MDR-TB burden in Zimbabwe.

Screening and Treatment of Tuberculosis in Patients With Inflammatory Bowel Disease in a Community-Based, Safety Net Hospital

Screening and Treatment of Tuberculosis in Patients With Inflammatory Bowel Disease in a Community-Based, Safety Net Hospital

Are global tuberculosis control targets overlooking an essential indicator? Prolonged delays to diagnosis despite high case detection rates in Yunnan, China.

Delay in treating active tuberculosis (TB) impedes disease control by allowing ongoing transmission, and may explain the unexpectedly modest declines in global TB incidence. Even though China has achieved TB control targets under the global Directly Observed Treatment, Short course (DOTS) strategy, TB prevalence in western provinces, including Yunnan, is not decreasing. This cross-sectional study investigates whether prolonged delay in identifying and correctly treating TB patients, which is not routinely monitored, persists even when there is a well-functioning TB control programme and global targets are being met. Records of adult smear-positive pulmonary TB patients diagnosed with between 2006 and 2013 were extracted from the Yunnan Centre for Disease Control electronic database, which contains information on the entire population of TB patients managed across 129 diagnostic centres. Delay was investigated at three stages: delay to DOTS facility (period between symptom onset and first visit to at a CDC unit providing standardized treatment); delay to TB confirmation (period between reaching a CDC unit and confirmation of smear-positive TB) and delay to treatment (period between confirmation of TB and initiation of treatment). Data from 76 486 patients was analysed. Delay to reaching a DOTS facility was by far the largest contributor to total delay to treatment initiation. The median delay to reaching a DOTS facility, to TB confirmation and to treatment was 57 days (IQR 25-112), 2 days (IQR 1-6) and 1 day (IQR 0-1) respectively. Prolonged delays to reaching a facility providing standardized TB care occurred in a substantial subset of the population despite all TB control targets being met; overall, 32% (24 676) of patients experienced a delay of more than 90 days to reaching a DOTS facility. Policies that focus on reducing delays in accessing appropriate health services, rather than only on increasing overall case-detection rates, may result in greater progress towards reducing TB incidence.

Screening and identification of four serum miRNAs as novel potential biomarkers for cured pulmonary tuberculosis

Rapid and efficient methods for the determination of cured pulmonary tuberculosis (TB) are lacking. We screened serum miRNAs using the Solexa sequencing method among untreated TB patients, two-month treated TB patients, cured TB patients, and healthy controls. A total of 100 differentially expressed miRNAs were identified in cured TB patients, including 37 up-regulated (fold change >1.50, P < 0.05) and 63 down-regulated (fold change <0.60, P < 0.05) miRNAs. Gene ontology (GO) enrichment analysis revealed that most of the predicted genes were present in the nucleus with a strong protein binding function. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis strongly suggested alterations in the metabolic pathways. Following quantitative real time chain reaction (qRT-PCR), significantly reduced expression levels of miR-21-5p (0.30, P < 0.001), miR-92a-3p (0.63, P < 0.001), and miR-148b-3p (0.17, P < 0.001) were found in the cured TB patients compared with the untreated TB patients, while significantly increased expression levels of miR-21-5p (2.09, P = 0.001), miR-92a-3p (1.40, P = 0.005), and miR-148b-3p (4.80, P = 0.003) were found in the untreated TB patients compared with the healthy controls. And significantly increased level of miR-125a-5p was found between two-month treated TB patients and untreated TB patients (1.81, P = 0.004). We established a cured TB model with 83.96% accuracy by four miRNAs (miR-21-5p, miR-92a-3p, miR-148b-3p, and miR-125a-5p), and also established a diagnostic model with 70.09% accuracy. Our study provides experimental data for establishing objective indicators of cured TB, and also provides a new experimental basis to understand the pathogenesis and prognosis of TB.

Transmission is a Noticeable Cause of Resistance Among Treated Tuberculosis Patients in Shanghai, China

It is generally believed that drug resistance among treated tuberculosis (TB) patients is as a result of acquired drug resistance due to inappropriate treatment. Previous studies have shown that primary drug resistance caused by transmission also plays a role among treated cases. Differentiating the two types of drug resistance will help in developing appropriate strategies for control of drug resistant tuberculosis. In this study, we tested the hypothesis that drug resistance among treated TB patients is mainly caused by primary resistance rather than acquired resistance. Defining resistance profiles by molecular drug susceptibility test, we used Unit Variable Number Tandem Repeats (VNTR) to genotype and Whole Genome Sequencing (WGS) to confirm the accordance of the first and last Mycobacterium tuberculosis isolates from treated pulmonary TB patients in Shanghai from 2009–2015. Among 81 patients with increasing drug resistance, out of 390 patients enrolled, paired isolates from 59.3% (48/81) had different VNTR patterns indicating primary drug resistance. Our results have demonstrated that primary resistance due to exogenous reinfection is the major cause of drug resistance among treated TB patients in Shanghai; thus, strategies aimed at preventing and interrupting transmission are urgently needed to effectively reduce the epidemic of drug resistant tuberculosis.

Methodology for Electronic Monitoring of Quality Drug Prescriptions in Phthisiopulmonology

Significance of quality improvement of health care substantiates the need for developing electronic databases and software to support decision making in selection of drug interventions and to monitor the quality of clinical results. The purpose of the work was to apply system approach to structure information about basic characteristics of personal clinical diagnosis and concordant drug interventions in treatment of tuberculosis patients. Materials included federal standards of medical care in phthisiopulmonology, national clinical recommendations for diagnosis and treatment of pulmonary tuberculosis, scientific literature and patients’ charts. The system approach methodology to structure information about basic characteristics of personal clinical diagnosis according to the principle of discreteness of information vectors have been used. The study shows that basic characteristics of clinical diagnosis (stage, phase, severity, additional factors of causes and conditions affecting prognosis of clinical developments and choice of drug interventions, severity degree of clinical situation) still lack common definitions. Structure for basic characteristics of clinical diagnosis was presented and definitions were formulated. Each characteristic was represented by a discrete information vector making it possible to use digital codes to store personalized clinical diagnosis in electronic databases. The quality models made by the experts and the real prescriptions of drugs at definite clinical situations were saved in databases for monitoring the quality of clinical decisions. The system approach methodology for structuring information space of clinical situations and implementation of discrete information vectors of basic clinical diagnosis characteristics help to realize the enormous potential of information technologies to monitor quality of clinical decisions and enrich evidence-based data about quality treatment in phthisiopulmonology.

Changes in Host Immune-Endocrine Relationships during Tuberculosis Treatment in Patients with Cured and Failed Treatment Outcomes.

A bidirectional communication between the immune and endocrine systems exists and facilitates optimum responses in the host during infections. This is in part achieved through changes in secretion patterns of hypothalamic hormones induced by inflammatory cytokines. The aim of this study was to elucidate the immune–endocrine alterations during tuberculosis (TB) treatment in patients with cured and failed TB treatment outcomes. Blood samples were collected from 27 cured and 10 failed patients and hormone as well as cytokine concentrations quantified at baseline, week 4, and month 6 of TB treatment. Hormone profiles of the two treatment outcome groups were different from each other prior to as well as during TB treatment. Treatment response effects were observed for cortisol, estradiol, T3, T4 ghrelin, leptin, amylin, adiponectin, and dehydroepiandrosterone (DHEA). Trends suggest that T4, amylin, and DHEA concentrations were different between treatment outcomes, although these did not reach statistical significance. Relationships between endocrine and inflammatory markers and the biological pathways involved differed between cured and failed treatment patients. These results highlight the complex interaction between the endocrine and immune system during active TB disease and throughout treatment and suggest that endocrine markers in conjunction with inflammatory markers may be useful in predicting unfavorable treatment outcomes.