Trend Of TB Research Articles

Tuberculosis control programme for the elderly with special focus on early detection

1. Epidemiological trend of TB and its diagnosis among the elderly: Masako OHMORI (Research Institute of Tuberculosis, JATA). It is estimated that over 10,000 TB patients will occur among the elderly aged over 75 years of age during 2010 and 2020. Though the new TB patients among the elderly over 65 years of age decreased in number from 1987 to 2001, sputum smear positive patients, which are highly infectious increased by 1.3 times for the same age group, and 2.3 times for that of over 80 years of age. 17.6% of those elderly patients were detected in institutions, either hospitals or nursing homes. These indicate that the elderly will become higher risk of TB for causing early death and infection to others during their admission in the hospitals or nursing homes. 2. Clinical characteristics of TB among the elderly: Nobuhiko NAGATA (Department of Internal Medicine, National Ohmuta Hospital). Analysis of the 93 elderly TB patients shows that TB diagnosis was delayed among the elderly. For TB diagnosis, 43.2% took over 1 month, and 27.3% over 2 months among the patients over 75 years of age, compared to 22.9% and 9.7% respectively for the patients under 65 years. The prognosis was also poor. Of all who died in the hospital during TB treatment, 40.9% (mostly complicated with other diseases) was among the elderly over 75 years, while it was 6.5% among those under 65 years. Complication of dementia delayed the diagnosis. 79.4% of the smear positive patients over 75 years were diagnosed while admitted in a general ward, and 40% had been admitted 2 weeks or more before diagnosis. 3. Use of serological tests for the diagnosis of TB among the elderly: Atsuyuki KURASHIMA (Department of Clinical Research, National Tokyo Hospital). As TB diagnosis is difficult for the elderly due to non-specific appearances of signs/symptoms, X-ray shadows or negative tuberculin reaction, some serological tests, which have been recently developed, can be useful as a supplementary diagnostic tool. One of them is anti-lipoarabinomannan antibody. 74.3% was positive to this among 148 bacteriologically confirmed TB cases; 77.8% for those aged 65 years and above, and 71.1% for those under 65 years. To anti TBGL antibody, 78% of 170 confirmed TB cases were positive; 75% for those aged 65 years and above, 79.8% for those less than 65 years. Multi-lipo antibody developed by Japan BCG Laboratory showed higher sensitivity of 91.5%. GPL-core antibody may increase the sensitivity. 4. Mode of TB detection in nursing homes: Shinji SHISHIDO (Research Institute of Tuberculosis, JATA). 15 elderly TB patients who had been diagnosed in 23 nursing homes in the last 5 years were analyzed. The average age was 80.7 years. 10 were male and 5 were female. 11 were sputum smear positive. The symptoms were fever (8), cough (7), wheezing (2), hemoptysis (1), chest pain (1), body weight loss (1), appetite loss (1). Number of patients by time durations before consulting a doctor of within 2 weeks, 2 weeks to 1 month, 1 to 2 months, 2 to 3 months, 3 to 6 months, and more than 6 months were 6, 1, 1, 3, 2, 2 respectively. The prognosis: 4 died within 10 days after diagnosis, 4 needed examinations for the symptoms but were delayed in diagnosis as they were not admitted due to dementia or disability. The orientation and training to the staff of the nursing homes are needed for early TB diagnosis. 5. Programme for the early detection of TB among the elderly: Tadayuki AHIKO (Murayama Public Health Center, Yamagata Prefecture). Based on the analysis of 138 confirmed TB cases registered in Yamagata Prefecture in 1998, services for early TB detection among the elderly should be 1) periodical chest X-ray examinations by the patients home doctors when underlying high risk diseases such as diabetes or cancer exist, and 2) -sputum examination for the symptomatic patients. A survey to 31 local governments conducting special TB services showed the special screening programme for the bedridden elderly in nursing homes was not so efficient due to low quality of the available X-ray facilities and low case detection rate. But these X-ray films can be utilized for comparison with those when any symptom arises.

New insights into TB from the 2010 European Respiratory Society annual conference

More than 22,000 people attended the 2010 European Respiratory Society conference. Numerous scientific sessions discussed TB themes (e.g., European and global epidemiology, management of drug-resistant TB, TB in vulnerable populations, and bacteriological and immunological diagnosis). In particular, several authors emphasized the increasing trend of TB in Europe, highlighting the need for public health programs focused on vulnerable populations: frequently, these populations are infected with drug-resistant strains and their clinical and treatment outcomes could be poor, with the consequence of increasing the risk of ongoing mycobacterial transmission. Other interesting reports were focused on IFN-γ release assays, which show a good diagnostic performance in different clinical conditions, even though their role needs to be clarified in well-designed analytic studies.

Modeling Transmission of Tuberculosis with MDR and Undetected Cases

This paper presents a novel mathematical model with multidrug‐resistant (MDR) and undetected TB cases. The theoretical analysis indicates that the disease‐free equilibrium is globally asymptotically stable if R0 < 1; otherwise, the system may exist a locally asymptotically stable endemic equilibrium. The model is also used to simulate and predict TB epidemic in Guangdong. The results imply that our model is in agreement with actual data and the undetected rate plays vital role in the TB trend. Our model also implies that TB cannot be eradicated from population if it continues to implement current TB control strategies.

Radiative signature of increasing atmospheric carbon dioxide in HIRS satellite observations

We examine the cause and implications of decadal trends observed in the High‐Resolution Infrared Radiation Sounder (HIRS) CO2 channels over the period 1980–1999 in conjunction with Microwave Sounding Unit (MSU) O2 channel measurements and climate model simulations. Simulated HIRS brightness temperatures (TBs) from the climate model with constant carbon dioxide indicate a global warming trend (∼0.2 K/decade) consistent with the corresponding MSU observations. By contrast, simulations with observed time‐varying CO2 concentration result in a global decreasing TB trend (∼−0.3 K/decade), indicating a greater influence of increased CO2 on the HIRS radiances compared to the tropospheric warming. Moreover, comparison between observation and simulations suggests that there may be important regional variations in the CO2 trends, particularly over the northern hemisphere midlatitudes downstream from major CO2 sources (U.S. and China). Thus the HIRS CO2 radiances may provide one opportunity to supplement existing surface networks by constraining regional patterns of decadal CO2 variability.

Extensively Drug-Resistant Tuberculosis in the United States, 1993-2007

Worldwide emergence of extensively drug-resistant tuberculosis (XDR-TB) has raised global public health concern, given the limited therapy options and high mortality. To describe the epidemiology of XDR-TB in the United States and to identify unique characteristics of XDR-TB cases compared with multidrug-resistant TB (MDR-TB) and drug-susceptible TB cases. Descriptive analysis of US TB cases reported from 1993 to 2007. Extensively drug-resistant TB was defined as resistance to isoniazid, a rifamycin, a fluoroquinolone, and at least 1 of amikacin, kanamycin, or capreomycin based on drug susceptibility test results from initial and follow-up specimens. Extensively drug-resistant TB case counts and trends, risk factors for XDR-TB, and overall survival. A total of 83 cases of XDR-TB were reported in the United States from 1993 to 2007. The number of XDR-TB cases declined from 18 (0.07% of 25 107 TB cases) in 1993 to 2 (0.02% of 13 293 TB cases) in 2007, reported to date. Among those with known human immunodeficiency virus (HIV) test results, 31 (53%) were HIV-positive. Compared with MDR-TB cases, XDR-TB cases were more likely to have disseminated TB disease (prevalence ratio [PR], 2.06; 95% confidence interval [CI], 1.19-3.58), less likely to convert to a negative sputum culture (PR, 0.55; 95% CI, 0.33-0.94), and had a prolonged infectious period (median time to culture conversion, 183 days vs 93 days for MDR-TB; P < .001). Twenty-six XDR-TB cases (35%) died during treatment, of whom 21 (81%) were known to be HIV-infected. Mortality was higher among XDR-TB cases than among MDR-TB cases (PR, 1.82; 95% CI, 1.10-3.02) and drug-susceptible TB cases (PR, 6.10; 95% CI, 3.65-10.20). Although the number of US XDR-TB cases has declined since 1993, coinciding with improved TB and HIV/AIDS control, cases continue to be reported each year.

U.S. TB trends reflect global influence

Journal Article U.S. TB trends reflect global influence Get access Jane L. Miller Jane L. Miller Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 56, Issue 19, 1 October 1999, Pages 1915–1916, https://doi.org/10.1093/ajhp/56.19.1915a Published: 01 October 1999

Epidemiology of drug-resistant tuberculosis in New Jersey from 1991 to 1995.

In a nationwide survey in 1991, the proportion of Mycobacterium tuberculosis isolates resistant to both isoniazid and rifampin (MDR-TB) in New Jersey (6.6%) was ranked second highest in the United States. The objectives of this study were to describe drug-resistant TB trend and to investigate risk factors for TB patients with isolates resistant to isoniazid or rifampin or both. TB surveillance data in New Jersey from 1991-1995 were analysed. Data on Mycobacterium tuberculosis culture and drug susceptibility testing of all TB isolates were obtained from public health and clinical laboratories. Logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals (CI) and to adjust for potential confounders. From 1991 to 1995, the proportion of MDR-TB was 5.7%, 4.1%, 2.7%, 3.3% and 2.6%, respectively. There was 10.6% isoniazid resistance and 4.3% rifampin resistance among TB patients in 1993-1995. As expected, recurrent TB was the most important risk factor for resistance to isoniazid (OR = 4.5, 95% CI: 2.6-7.6), rifampin (OR = 5.5, 95% CI: 2.8-11) or both (OR = 6.1, 95% CI: 2.9-13). HIV infection was significantly associated with MDR-TB (OR = 3.6, 95% CI: 1.5-8.8). Drug resistance was not found to be significantly associated with homelessness, injecting drug use and excess alcohol use. The proportion of MDR-TB in New Jersey declined significantly from 1991 to 1993, but remained at a plateau from 1993-1995. The results suggest that continuous efforts should be directed at the prevention of MDR-TB among people infected with HIV and at improving the proportion who complete chemotherapy among those with TB.

MDR TB Trends in US

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The Effect of Changes in the Complexly Defined Thermal Environment on Body and Skin Temperature and Energy Metabolism in Piglets

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