Treatment Of Tuberculosis Patients Research Articles

Therapeutic issues with, and long-term outcomes of, pulmonary mycobacterial tuberculosis treatment in patients with autoimmune rheumatic diseases

Real-world data on treatment safety and outcome of pulmonary tuberculosis (PTB) in patients with rheumatic diseases (RDs) are scarce. This study explored the therapeutic issues of standard first-line anti-tuberculosis (TB) medication in patients in whom PTB complicated autoimmune RDs. Observational, retrospective study was conducted in an intermediate TB burden area, South Korea. We evaluated the safety profile of, and adherence to, standard first-line anti-TB medication in PTB patients with systemic RD and assessed the long-term treatment outcomes, up to 84 months after treatment completion. We included 37 patients suffering from PTB with RD (case group) and 191 without RD (control group). Rheumatoid arthritis (RA) was the most common RD (24 PTB patients, 64.9%). The frequency of severe adverse drug reactions (ADRs) was significantly higher in the case group than in the control group (36.1% vs. 12.5%, P=0.003). Severe gastrointestinal problems were the most commonly observed ADRs, with a high frequency consistently noted in both groups. Changes in first-line anti-TB medication because of severe ADRs were significantly more frequent in the case group, compared with the control group (19.4% vs. 8.3%, P=0.046). No significant between-group difference was evident in terms of long-term unfavorable outcomes (including relapse and mortality) (5.7% cases vs. 1.2% controls, P=0.146). Clinicians may encounter difficulties when treating PTB in patients with RD. Despite the favorable long-term outcomes of RD patients, the outcomes of individual patients such as those with systemic lupus erythematosus (SLE) should be interpreted with caution during post-therapy follow-up.

Management of intracranial tuberculous mass lesions: how long should we treat for?

Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting Mycobacterium tuberculosis ( M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3 rd International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected with M.tb strains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions.

Management of intracranial tuberculous mass lesions: how long should we treat for?

Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infectingMycobacterium tuberculosis(M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3rdInternational Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected withM.tbstrains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions.

Tuberculosis as a socially significant disease. The organization of medical care for patients with tuberculosis in Khanty-Mansiysk Autonomous District – Ugra

Introduction. In the world (and in the Russian Federation) the situation caused by the increase in the number of socially significant diseases continues to be quite tense. The most important in this group is tuberculosis, which causes significant damage to society, due to the loss of temporary and permanent disability, an increase in the number of disabled people and destabilization of the demographic situation in the country. In this regard, an integrated approach to the implementation of therapeutic and preventive measures in patients suffering from tuberculous lesions is a priority in addressing the spread of this pathology. Purpose of the study. Analysis of data on the epidemiological situation, morbidity, prevalence, mortality, prevention and treatment of tuberculosis patients in the Khanty-Mansiysk Autonomous District – Ugra in 2017, comparing the figures for the first half of 2017 and 2018. Materials and methods. To assess the parameters characterizing the organization of early diagnosis of tuberculosis, hospitalization of patients of the relevant cohort of the population, the effectiveness of therapeutic measures taken, the quality of preventive measures among the population of the Khanty-Mansiysk Autonomous District – Ugra, the data of annual reports of relevant medical organizations for 2017–2018 are used. Results. In 2017, the coverage of examinations for tuberculosis of the population with the use of all survey methods amounted to 78,6%, while the target indicator of the state program «Health Development 2014–2020» was 78,0%. The number of patients effectively treated at the studied stages was more than 50% of cases for each. Conclusion. In the Autonomous District – Ugra, the work of all services and institutions for the treatment and prevention of tuberculosis is recognized as systematic and effective according to the results of events held.

Long-term Prognosis of Tuberculosis Infection and Disease in Swedish Children

Reports of the outcome of treatment of tuberculosis (TB) disease and infection (TBI) in children are scarce. Since 2010, we routinely use interferon-gamma release assays in addition to clinical history for the exclusion of TBI, although the safety of this approach has been questioned. We present the frequency of recurrent TB or progression to TB after treatment for TB disease or TB infection, respectively, and progression to disease in children considered TB uninfected at our pediatric TB clinic. We included 4707 patients from 1990 to 2017. At the initial assessment, 96 (2.0%) had previously received TB treatment, 253 (5.4%) had TB disease, 1625 (35%) had TBI and 2733 (58%) children were considered uninfected. Patients were passively followed at our clinic, at the adult TB clinics in Stockholm and at the Swedish national TB registry. During a median follow-up time of 8.4 years, we found 36 cases of TB disease, with true relapses in 3/243 (1.2%) successfully treated TB patients. Preventive treatment of TBI reduced the risk of progression to TB by 85%, from 4.3% (15/349) to 0.6% (8/1262). In children considered uninfected, the risk of later developing TB was 0.07% (2/2733). The effectiveness of TB management was acceptable. Our routine procedures for the exclusion of TBI appear safe.

Prevalence and factors associated with multidrug/rifampicin resistant tuberculosis among suspected drug resistant tuberculosis patients in Botswana

BackgroundTo investigate the prevalence and factors associated with the prevalence of multidrug/rifampicin-resistant tuberculosis among suspected drug resistant tuberculosis patients in Botswana.MethodsA retrospective review of medical records of suspected drug resistant tuberculosis patients receiving care at public health facilities in Botswana was conducted from January, 2013 and December, 2014. Patient characteristics and drug susceptibility data were abstracted from 2568 medical records on to a pre-tested checklist form. The prevalence of multidrug/rifampicin resistance was computed. Bivariate and multivariate logistic regression was carried out to determine the factors associated with the prevalence of multidrug/rifampicin in the study population.ResultsOverall, multidrug/ rifampicin - resistance among suspected drug resistant tuberculosis patients in Botswana were found in 139 (5.4%) cases with 1.3% among new cases and 7.7% among previously treated tuberculosis patients. Being a previously treated tuberculosis patient and having a positive smear were found to be factors associated with the prevalence of multidrug/rifampicin-resistant tuberculosis (p < 0.05). However, age, sex, living in urban area and HIV status were not associated with this disease (p > 0.05).ConclusionThis study highlights a low burden of multidrug/rifampicin resistant tuberculosis among suspected drug resistant tuberculosis patients receiving care at public health facilities in Botswana. Strategies in controlling MDR/RR-TB should emphasize on effective implementation of Directly Observation Treatment – short course strategy, continuous surveillance of drug resistance cases, prevention of the development of new cases of MDR/RR-TB and to treat existing patients. Further interventions should focus on strengthening TB infection control activities.

Quality of TB services assessment: The unique contribution of patient and provider perspectives in identifying and addressing gaps in the quality of TB services

Ambitious efforts to detect and treat tuberculosis (TB) are required to reduce the burden of disease in low resource settings, and the provision of high quality TB services is critical to reaching global TB targets. The quality of TB services assessment (QTSA) is a facility-based approach aimed at identifying gaps in TB services and prioritizing interventions to improve care across multiple countries with high TB burden. Randomly sampled facilities are assessed with standardized instruments to collect data on structures, processes, and outcomes of TB care, with adaption for local diagnostic and treatment algorithms. The sampling strategy is modified to ensure representation of all levels of the health system where TB services are provided, as well as inclusion of private sector or other facility types relevant to the context. Instruments include a facility audit, provider and patient interviews, and a review of TB registers. A recent QTSA in the Philippines generated important data on provider and patient perspectives on quality of care, showing that providers are more likely to report that they counseled current TB patients on key aspects of TB diagnosis and treatment than patients are to report having received the information. These comparisons highlight areas where refresher training or interpersonal communication and counseling skills may be needed.

Clinical Significance of the Plasma Protein Binding of Rifampicin in the Treatment of Tuberculosis Patients.

Clinical Significance of the Plasma Protein Binding of Rifampicin in the Treatment of Tuberculosis Patients.

Recurrence Is a Noticeable Cause of Rifampicin-Resistant Mycobacterium tuberculosis in the Elderly Population in Jiangxi, China.

Setting: Rifampicin-resistant tuberculosis (RR-TB) in elderly people in Jiangxi Province, China.Objective: To investigate the incidence of RR-TB and risk factors in elderly people within a hospital setting in China.Design: Retrospective cohort study.Methods: A comparative study was performed to analyze RR-TB and rifampicin-susceptible TB (RS-TB). The 15-locus mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) method was used to distinguish between relapse and reinfection.Results: Twenty-three recurrent cases occurred in 151 elderly patients with RR-TB, and 24 recurrent cases occurred in 466 elderly patients with RS-TB during this period. TB recurrence was significantly different in the RR-TB and RS-TB groups (OR = 0.35, 95% CI: 0.14–0.88; χ2 = 5.28, P = 0.03). Comparing the risk factors for RR-TB and RS-TB, we found that educational level, age, and pulmonary cavity were inextricably linked to RR-TB in elderly patients. Furthermore, pulmonary cavity, HIV status, and alcohol consumption were associated with recurrence in elderly RR-TB patients.Conclusions: Recurrence is an important source of RR-TB in the elderly population. It is necessary to promptly treat tuberculosis patients, prevent the spread of AIDS, and reduce alcohol intake to control recurrent RR-TB in the elderly population.

Pulmonary and intestinal tuberculosis in a kidney transplant recipient

Introduction. Tuberculosis is one of the most common infections in the general population, as well as among the recipients of solid organs. In kidney transplant recipients, the diagnosis of tuberculosis is often extremely difficult to make because of unclear clinical and radiological symptoms, and a highly frequent atypical (extrapulmonary) localization. The tuberculosis treatment in patients on drug immunosuppression is a significant problem.Clinical case. At five years after renal transplantation, the patient noted the onset of fever up to 38 degrees C. It was suspicious of respiratory infection. Chest X-ray, computed tomography, and ultrasound examination of the graft revealed no pathology. Antibacterial and antiviral therapy brought stable improvement. A repeated computer tomography demonstrated an enhanced pulmonary pattern in S6 of the left lung with visualization of small grouped lesions located peribronchially, the terminal ileitis in the abdominal cavity: (an intensive contrast accumulation in the mucosa of the affected part of the small intestine, the mesentery hypervascularity at this level). A colonoenteroscopy with a ileum intestine biopsy was performed; the findings were highly consistent with a tuberculous process. A targeted treatment of tuberculosis was carried out, which had a marked positive trend.Conclusion. Thus, the diagnosis of tuberculosis in kidney transplant recipients is complex; the clinical signs and instrumental test results are often ambiguous, which greatly complicates the timely diagnosis. An integrated approach with the use of modern diagnostic methods is required.

L-Histidine, arachidonic acid, biliverdin, and l-cysteine-glutathione disulfide as potential biomarkers for cured pulmonary tuberculosis

Lack of laboratory standards for cured tuberculosis (TB) can lead to early discharge of untreated TB patients from the hospital, resulting in increased risk of TB spread and of developing drug resistant Mycobacterium tuberculosis (Mtb). We used ultra-high performance liquid chromatography coupled with mass spectrometry (LC–MS) to detect heparin anticoagulant in plasma of untreated TB patients, two-month treated TB patients, cured TB subjects, and healthy controls. Screening of differentially expressed metabolites resulted in identification of four differentially expressed metabolites such as, l-Histidine, Arachidonic acid (AA), Biliverdin, and l-Cysteine-glutathione disulfide after 6 months of TB treatment. Among them, l-Cysteine-glutathione disulfide and AA could be identified after 2 months of TB treatment. We established a cured TB model with an area under the curve (AUC) of 0.909 (95% CI, 0.802–0.970), 86.2% sensitivity, and 85.2% specificity. The diagnostic model fitted from the four differential metabolites in combination (l-Histidine, AA, Biliverdin, and l-Cysteine-glutathione disulfide) can be used as potential biomarkers for cured TB. Our study provided laboratory standards for hospital discharge of TB patients, as well as experimental basis for evaluating the efficacy of anti-TB drugs.

Pharmacokinetics of isoniazid: The good, the bad, and the alternatives

Although isoniazid (INH) has been successful in treating Tuberculosis (TB) since its introduction in 1952, there has been continual reports of drug-associated hepatotoxicity in TB patients. These toxic side effects may reveal more about the recipient of the drug, than the drug itself. A combination of pharmacogenetic and pharmacokinetic studies have identified polymorphisms within enzymes involved in INH metabolism and detoxification. These essential metabolic enzymes include N-acetyltransferase 2, Cytochrome P450 2E1, and glutathione S transferases. Different phenotypes of these enzymes can affect the rate of INH metabolism, resulting in production of hepatotoxic metabolites. This review is intended to elucidate the pharmacokinetics of INH by examining its Administration, Distribution, Metabolism, and Elimination, while suggesting potential alternatives within INH personalized treatment to help reduce hepatotoxicity.

PO 8182 INVESTIGATING TREATMENT RESPONSE OF PATIENTS WITH CONFIRMED DRUG-RESISTANT TUBERCULOSIS IN AN HIV-1-ENDEMIC POPULATION IN WESTERN KENYA

BackgroundIn 2015, 10.4 million people worldwide had tuberculosis (TB) and 1.4 million deaths occurred, 400 000 of whom were HIV-positive. Sub-Saharan Africa accounted for 81% of these cases. In western Kenya, current data on the distribution of rifampicin (RIF) and isoniazid (INH) mutations is not available. The association of gene mutations with HIVinfection and the treatment response of HIV-infected and -uninfected patients with TB are not known. This study „determined the proportion of drug-resistant Mycobacterium tuberculosis in sputum isolates and investigated the association of RIF and INH gene mutations with HIV status and monitored the treatment response of TB/HIV-co-infected patients.MethodsThe present study was longitudinal, and enrolment was done between 2012 and 2014 after the revision of the TB treatment regimen. Patients with confirmed drug-resistant TB were followed up for one year to establish the TB treatment response as confirmed by sputum smear microscopy.ResultsA total of 1381 new and 18 previously treated TB patients were enrolled. Sputum samples were cultured on Mycobacteria-growth indicator tubes; drug susceptibility tests and line probe assay were performed to identify drug resistance and specific mutations on the rpo B, kat G and inh A’genes. Discordant samples were sequenced. Conversion rate was calculated by finding the percentage of smear-negative and -positive patients at follow-up and initial visit, respectively. Regression analysis showed that RIF resistance was associated with HIV status (p=0.025). Mann-Whitney tests revealed that the conversion time of HIV-infected and -uninfected patients with TB drug mutations was comparable (p=0.180).ConclusionThe study showed that INH mono-resistance was common. Detection of INH mono-resistance in TB-endemic areas should be scaled-up as well as TB contact investigation studies to increase early detection of resistant strains.

Peer Group Support on the Treatment Adherence of Pulmonary Tuberculosis Patients

In recent years, pulmonary tuberculosis attracts the global concern as about 1.2 million people died of the disease by 2014. Treatment disobedience is one of the most factors causing the increase in mortality and morbidity rates. This study aimed to identify the effect of peer-group support towards treatment adherence in pulmonary tuberculosis patients. The study used quasi-experimental research with pre-test and post-test groups. The sample was 36 people selected with purposive sampling method. The independent variable was peer group support, while the dependent variable was the treatment adherence. The data were analyzed by Chi-square test and McNemar‘s test. The results of Chi-square test showed that the peer group support had significant effect to treatment adherence in taking medication time sub-variable (p=0.005) and the McNemar‘s showed a significant difference between pre-test and post-test in mentioned sub-variable (p=0.004). The results proved that peer group support could affect the medication time adherence on pulmonary tuberculosis patients. It can be concluded that peer group support can be used as an optional intervention to increase the obedience of pulmonary tuberculosis treatment in patients.

Tuberculosis knowledge, attitude and practice among healthcare workers during the 2016 Hajj.

BackgroundGiven the inherent characteristics of the Hajj pilgrimage, the event is a risk for tuberculosis (TB) infection. Early diagnosis and appropriate management of TB cases by knowledgeable and skilled healthcare workers (HCWs) are key in improving patients’ outcome and preventing transmission during the Hajj mass gathering and globally.MethodWe conducted a cross-sectional study to assess knowledge, attitude and practice (KAP) of HCWs deployed during the 2016 Hajj regarding TB and its management using an anonymous self-administered questionnaire.ResultsData was collected from 540 HCWs from 13 hospitals. HCWs originated from 17 countries and included physicians, nurses and other non-administrative HCWs. Nearly half of HCWs declared having experience dealing with TB patients. In general, HCWs had average knowledge (mean knowledge score of 52%), above average attitude (mean attitude score of 73%) and good practice (mean practice score of 85%) regarding TB, based on our scoring system and cut-off points. Knowledge gaps were identified in relation to the definition of MDR-/XDR-TB and LTBI, smear microscopy results, length of standard TB treatment for drug-sensitive TB, 2nd line anti-TB drugs, BCG vaccination, and appropriate PPE to be used with active PTB patients. Poor attitudes were found in relation to willingness to work in TB clinic/ward and to the management and treatment of TB patients. Poor practices were reported for commencing anti-TB treatment on suspected TB cases before laboratory confirmation and not increasing natural ventilation in TB patients’ rooms. Age, gender, nationality, occupation, length of work experience and experience dealing with TB patients were associated with knowledge scores. Age and occupation were associated with attitude scores while length of work experience and occupation were associated with practice scores. There was a weak but statistically significant positive correlation between score for knowledge and attitude (rs = 0.11, p = 0.009) and attitude and practice (rs = 0.13, p = 0.002).ConclusionsWhile the results of the study are encouraging, important knowledge gaps and some poor attitudes and practices regarding TB were identified among HCWs during Hajj. This calls for multifaceted interventions to improve HCWs KAP regarding TB including tailored, periodic TB education and training aimed at boosting knowledge and improving behaviour.

Development and validation of a risk score to predict mortality during TB treatment in patients with TB-diabetes comorbidity

BackgroundMaking an accurate prognosis for mortality during tuberculosis (TB) treatment in TB-diabetes (TB-DM) comorbid patients remains a challenge for health professionals, especially in low TB prevalent populations, due to the lack of a standardized prognostic model.MethodsUsing de-identified data from TB-DM patients from Texas, who received TB treatment had a treatment outcome of completed treatment or died before completion, reported to the National TB Surveillance System from January 2010–December 2016, we developed and internally validated a mortality scoring system, based on the regression coefficients.ResultsOf 1227 included TB-DM patients, 112 (9.1%) died during treatment. The score used nine characteristics routinely collected by most TB programs. Patients were divided into three groups based on their score: low-risk (< 12 points), medium-risk (12–21 points) and high-risk (≥22 points). The model had good performance (with an area under the receiver operating characteristic (ROC) curve of 0.83 in development and 0.82 in validation), and good calibration. A practical mobile calculator app was also created (https://oaa.app.link/Isqia5rN6K).ConclusionUsing demographic and clinical characteristics which are available from most TB programs at the patient’s initial visits, our simple scoring system had good performance and may be a practical clinical tool for TB health professionals in identifying TB-DM comorbid patients with a high mortality risk.

Path Analysis on the Determinants of Adherence to Anti Tuberculosis Drug Treatment in Kaur District, Bengkulu, Indonesia

Background: Drug treatment compliance was the behavior of patients to take medication and undergo treatment according to the rules determined by professional health personnels. Many factors influenced the compliance with treatment for tuberculosis patients. This study aimed to examine determinants of drug treatment compliance among tuberculosis patients. Subject s and Method: This was an analytic observational study with a cross-sectional design. The study was conducted at 16 community health centers in Kaur Regency, Bengkulu, Indonesia, from January to February 2019. A sample of 206 study subjects was selected by purposive sampling. The dependent variable was drug treatment adherence. The indepen­dent variables were age, gender, education, income, knowledge, role of drug taking supervisor, side effect of drug treatment, distance to health service, drug availability, family support, and tenure. The data were collected by questionnaire and analyzed by path analysis. Results : Adherence to anti tuberculosis treatment was directly and positively affected by age (b= 2.96; CI 95%= 1.12 to 4.79; p= 0.002), gender (b= 1.48; CI 95%= 0.02 to 2.95; p= 0.047), education (b= 2.18; CI 95%= 0.24 to 4.11; p= 0.027), income (b= 0.85; CI 95%= 0.76 to 2.45; p= 0.031), knowledge (b= 2.27; CI 95%= 0.32 to 4.22; p= 0.023), the role of drug taking supervisor (b= 3.46; CI 95%= 1.57 to 5.36; p<0.001), drug availability (b= 0.04; CI 95%= -6.07 to 6.16; p= 0.989), and family support (b= 2.97; CI 95%= 1.30 to 4.64; p<0.001). It was negatively affected by the side effects of the drug (b= -3.07; CI 95%= -4.90 to -1.24; p= 0.001), distance to health service (b= -1.86; CI 95%= -3.61 to -0.11; p= 0.037), and tenure (b= -2.16; CI 95%= -3.95 to -0.38; p= 0.017). Adherence to anti tuberculosis treatment was indirectly affected by income, knowledge, and role of drug treatment supervisor. Conclusion: Adherence to anti tuberculosis treatment is directly and positively affected by age, gender, education, income, knowledge, the role of drug taking supervisor, drug availability, and family support. It is negatively affected by the side effects of the drug, distance to health service, and tenure. Keywords : treatment adherence, tuberculosis, determinants, path analysis Correspondence: Surahman Hamidi. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: surahmanhamidi@student.uns.ac.id. Mobile: 085267­456713. Journal of Epidemiology and Public Health (2019), 4(3): 205-214 https://doi.org/10.26911/jepublichealth.2019.04.03.08

Blood cytokine responses to early secreted protein antigen-6/culture filtrate protein-10 tuberculosis antigens 2 months after antituberculosis treatment among patients with drug-susceptible pulmonary tuberculosis.

Human tuberculosis is a chronic inflammatory disease caused by mycobacterium tuberculosis. Pulmonary tuberculosis is the result of the failure of host immune system to control mycobacterium tuberculosis. The aim of the study was to asses the changes of the cytokines in active pulmonary tuberculosis patients before and after the use of anti-TB therapy. Multiple cytokine responses in active tuberculosis (TB) patients were investigated in this study following anti-TB drug therapy after 2 months. Ninety-six participants with pulmonary TB were engaged in the study between May 2018 and October 2018. Samples of blood were taken early before treatment at 0 and 2 months after using anti-TB therapy. The levels of interferon-gamma (IFN)-γ, interleukin-4 (IL-4), IL-6, IL-10, and tumor necrosis factor (TNF)-α in whole blood plasma collected from the QuantiFERON-TB Gold Plus were measured. Compared with baseline levels, TNF-α, IL6 and IL10 were significantly lower following treatment whereas the IFN-γ and IL-4 increased significantly after treatment. The responses of five cytokines varied significantly after treatment (P < 0.0001) where IFN-γ was highest compared to other cytokines with 123.6%, AUC=0.757 and P < 0001, TNF-α AUC: 0.529 and P = 0.743, IL-4 AUC:0.557 and P = 0.514, IL-6 AUC:0.629 and P = 0.047, IL-10 AUC:0.549 and P = 0.581. It is concluded that changes of cytokines that observed during the treatment of TB patients play a very important role in monitoring pulmonary TB and can be suitable biomarkers to assess the effectiveness of anti-TB therapy in patients with TB.

Rifampicin-Induced Thrombocytopenia: A Rare Complication

Extensive clinical experience has shown that rifampicin is well tolerated, but on rare occasions, it can cause life-threatening adverse reactions such as acute renal failure and thrombocytopenia. Throbocytopenia is mostly encountered with isoniazid and pyrazinamide. Rifampicin is an essential component of the treatment regimen for tuberculosis. We are reporting a case of rifampicin-induced thrombocytopenia which was being treated for pulmonary tuberculosis. The physician treating tuberculosis patients must be aware of this rare life-threatening complication.

Knowledge about tuberculosis and infection prevention behavior: A nine city longitudinal study from India.

BackgroundImproving patients’ tuberculosis (TB) knowledge is a salient component of TB control strategies. Patient knowledge of TB may encourage infection prevention behaviors and improve treatment adherence. The purpose of this study is to examine how TB knowledge and infection prevention behaviors change over the course of treatment.MethodsA matched patient-health worker dataset (n = 6,031) of publicly treated TB patients with NGO-provided treatment support health workers was compiled in nine Indian cities from March 2013 to September 2014. At the beginning and end of TB treatment, patients were asked about their knowledge of TB symptoms, transmission, and treatment and infection prevention behaviors.ResultsPatients beginning TB treatment (n = 3,424) demonstrated moderate knowledge of TB; 52.5% (50.8%, 54.2%) knew that cough was a symptom of TB and 67.2% (65.6%, 68.7%) knew that TB was communicable. Overall patient knowledge was significantly associated with literacy, education, and income, and was higher at the end of treatment than at the beginning (3.7%, CI: 3.02%, 4.47%). Infection prevention behaviors like covering a cough (63.4%, CI: 61.2%, 65.0%) and sleeping separately (19.3%, CI: 18.0%, 20.7%) were less prevalent. The age difference between patient and health worker as well as a shared language significantly predicted patient knowledge and adherence to infection prevention behaviors.ConclusionsSocial proximity between health worker and patients predicted greater knowledge and adherence to infection prevention behaviors but the latter rate remains undesirably low.