Tuberculosis Burden Countries Research Articles

Safety profile of BCG revaccination for COVID prevention among elderly individuals in India

BCG vaccination is known to be safe in infants and a part of immunization schedule in high tuberculosis (TB) burden countries. In the conquest to bring down the severity of the COVID 19 pandemic, many drugs were repurposed in research mode including BCG vaccination /revaccination in various populations. We did a study among the elderly population (> 60 years of age) to assess the role of BCG revaccination in preventing the severity of COVID 19 disease. Live attenuated BCG vaccine was given to the willing participants and were followed up for 6 months to estimate COVID19 incidence, understand severity and immunogenicity profile. A total of 48 serious adverse events (SAE) were reported among 1566 elders, none of them had more than one SAE. None of the SAEs were related to the BCG revaccination. Among the 372 adverse events reported, 96% were local reactions at the vaccine site and resolved on its own. BCG revaccination appeared to be safe and could be explored further if repurposing studies were planned for other diseases.

Bridging the gap: evaluating high TB burden country data needs to support the potential introduction of TB vaccines for adolescents and adults: a workshop report

High tuberculosis (TB) burden countries (HBCs) need to prepare for TB vaccine implementation alongside licensure, to ensure rapid rollout. WHO policy/implementation frameworks have been created to support this effort. Using WHO frameworks, we convened a workshop to ask HBC experts about what epidemiological, impact, feasibility and acceptability data they anticipated they would need to guide TB vaccine introduction. For required data, we asked HBC and global experts which data were already available, data collection planned, or gaps. HBC experts expressed high demand for epidemiological, impact, feasibility and acceptability data, reported variable availability of existing epidemiological data, and low availability for impact, feasibility, and acceptability data. Global experts reported additional knowledge of existing data on impact, upcoming collection of infection prevalence, acceptability and feasibility data, and potential epidemiological data collection on adolescents, adults, people living with HIV, and underweight individuals. HBC and global experts made key recommendations for: a coordinated data collation, collection, analysis and sharing system; updating existing HBC health and economic impact estimates and extending impact analyses to other HBCs; demand/market forecasting; resource gap mapping; aligning delivery strategies; addressing manufacturing, procurement, delivery, and regulatory barriers; sharing potential vaccine licensure timing; incorporating TB vaccine introduction strategies into NSPs, immunization programs, and health services; collecting vaccine hesitancy, mistrust, and misinformation data; collecting adolescent/adult vaccine demand generation data, and identifying funding. Experts recommended expanding this analysis to other areas of the WHO frameworks, including more HBC stakeholders, and repeating this analysis after country and community advocacy and socialization around different vaccine candidates.

Profile of non-tuberculous mycobacteria amongst tuberculosis presumptive people in Cameroon

BackgroundCameroon is a tuberculosis (TB) burden country with a 12% positivity among TB presumptive cases. Of the presumptive cases with a negative TB test, some are infected with Non-tuberculous Mycobacteria (NTM). However, the diagnosis of NTM infections remains difficult due to the lack of tools in many laboratories, particularly in resource limited laboratories and remote setting. The present study was undertaken to determine NTM profile and associated comorbidities among TB presumptive people.MethodsA retrospective study was conducted from December 2018 to December 2019 in the Tuberculosis-National Reference Laboratory (TB-NRL) for Bacteriological analysis of samples and Jamot Hospital of Yaounde (JHY) for clinical evaluation of confirmed NTM patients.We included in this study data of 5267 TB presumptive people previously diagnosed using three consecutive samples and having culture and SD Bioline results with or without Microscopy and reverse hybridization-based Line Probe Assay(LPA) results. The data on co-morbidities or history of people infected with NTM were then collected from the three participants with available clinical data.ResultsWe collected data of 5267 presumptive TB people. Among them, 3436 (65.24%), have a positive culture with 3200 (60.75%) isolates belong to Mycobacterium tuberculosis Complex (MBTC) and 236 (4.48%) to NTM. Our results showed that, 123 (52.11%) NTM were isolated from people with negative microscopy and 113 (47.88%) from people with positive microscopy. Among the 236 NTM, 108 (45.8%) isolates were identified using LPA. M. fortuitum was the most represented species (32.41%) followed by M. intracellulare (19.44%). Sputum had the highest proportion of NTM (56%), followed by bronchial aspirations (31%). The extra-pulmonary samples presented lower proportions of isolates compared to pulmonary samples. Some patients affected with NTM presented comorbidities as HIV infection, Pulmonary tuberculosis, Type 2 diabetes, Chronic bronchitis and Alveolar pneumonia.ConclusionsOur study showed the presence of NTM strains among presumptive TB people with a predominance of M. fortuitum and M. intracellulare. It is important to implement a surveillance system of NTM in TB burden country and also to develop a point-of-care test for NTM identification in limited-resource settings.

A systematic review and meta-analysis of intraarterial chemotherapy for non muscle invasive bladder cancer: Promising alternative therapy in high tuberculosis burden countries.

Local therapies for high risk non-muscle-invasive bladder cancer (NMIBC) such as intravesical chemotherapy (IVC) have shown a high rate of progression and recurrence. Intravesical Bacillus Calmette-Guérin (BCG) for local therapies has been shown to reduce progression and recurrence in patient with NMIBC. However, its potential role is limited in high burden countries for tuberculosis (TB) due to its low specificity that can cause wrong diagnosis or false positive in patients with clinically diagnosed tuberculosis. BCG vaccine that has to be given for most people in tuberculosis endemic countries will induce trained immunity that could reduce the effectivity of intravesical BCG for NMIBC. Moreover, intravesical BCG is contraindicated in patient with or previous tuberculosis. The potential clinical benefit of intraarterial chemotherapy (IAC) in delaying the recurrence and progression of high-risk NMIBC have been investigated with promising results. We aimed to conduct a meta-analysis to evaluate the potential anti-tumor effect of IAC in NMIBC. We conducted a comprehensive search of published articles in Cochrane Library, Pubmed, and Science-Direct to identify relevant randomized controlled trials (RCTs) and observational studies comparing IAC alone or combined with IVC versus IVC/BCG alone in NMIBC. The protocol of preferred reporting items for systematic review and meta-analysis (PRISMA) was applied to this study. Four RCTs and 4 cohort observational studies were eligible in this study and 5 studies were included in meta-analysis. The risk ratio of tumor recurrence was reduced by 35% (RR = 0.65; 95% CI 0.49-0.87; p = 0.004) in IAC plus IVC, while recurrence-free survival (RFS) was prolonged by 45% (HR: 0.55; 95% CI, 0.44-0.69; p < 0.001). The risk of tumor progression was reduced by 45% (RR = 0.55; 95% CI 0.41-0.75; p = 0.002) and tumor progression-free survival (PFS) was also prolonged by 53% (HR: 0.47; 95% CI, 0.34-0.65; p<0.001). Some RCT's had high or unclear risk of bias, meanwhile 4 included cohort studies had overall low risk of bias, therefore the pooled results need to be interpreted cautiously. Subgroup analysis revealed that the heterogeneity outcome of tumour recurrence might be attributed to the difference in NMIBC stages and grades. The IAC alone or combined with IVC following bladder tumor resection may lower the risk of tumor recurrence and progression. These findings highlight the importance of further multi institutional randomized controlled trials with bigger sample size using a standardized IAC protocol to validate the current results.

Catch them young: Knowledge gaps about drug resistant tuberculosis among Homoeopathy college interns: Apre and post-test study

Background: India is the highest Tuberculosis (TB) burden country in the world. It also has the second highest burden of Multidrug-resistant TB globally. Many precious lives are lost due to Drug-resistant TB (DR TB) every day. To achieve the goal of TB elimination in India, robust primary health care is mandatory. Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) practitioners provide a quarter of primary health care in India. Since interns working at Homoeopathic Medical college will be the future primary care providers, their awareness about DR TB will help reach the target of End TB by 2025. Objective:The study objective was to assess the knowledge gained by Homoeopathy college interns in the diagnosis and treatment of DR TB following a single-day training session. Materials and methods: This cross-sectional study was carried out among 33 interns of Bharati Vidyapeeth (Deemed to be University) Homoeopathic Medical College, Pune. Aquestionnaire was given in the form of a pre-test before the training session. The training comprised the epidemiology of DR TB, its diagnosis,treatment, counseling, and need for referral. After completion of training, a post-test was given, and scores were calculated. A two-tailed paired sample t-test was used to assess gain in knowledge. The proportion of participants with correct responses for every question was determined and compared before and after training using the McNemar test. P&lt;0.05 was considered statistically significant. Result: The mean pre-test score was 2.30 ± 1.24, while the mean post-test score was 4.24 ± 2.00 (p&lt;0.001). There was less knowledge about the regime for DR TB, pre-treatment evaluation, gene Xpert method, and empirical Anti-tuberculosis Treatment. Conclusion: This study highlights that there are significant gaps in knowledge about DR TB among Homoeopathy college interns. It also showed that a short training session significantly improved their knowledge.

Laboratory Diagnosis of Genital Tuberculosis: A Narrative Review

Genital tuberculosis is a leading cause of infertility in high tuberculosis burden countries like Bangladesh. Diagnosing this condition can be challenging due to the diverse ways it can present, which requires a physician to have a high level of suspicion. The fallopian tubes are mainly affected, and the endometrium in 50% of cases1. Diagnostic modalities usually include histopathology, microscopy, solid and liquid culture tests, Polymerase Chain Reaction (PCR) tests, immunohistochemistry tests, radiology imaging and laparoscopic and hysteroscopic procedures.&#x0D; Bangladesh Journal of Infectious Diseases, December 2023;10(2):92-100

2511. Screening for Hepatitis B Virus (HBV) and Tuberculosis (TB) Infection among Non-U.S.-Born Adults from High HBV and TB Burden Countries

Abstract Background Hepatitis B virus (HBV) infection and tuberculosis (TB) infection both disproportionately affect non-U.S.–born persons from countries with hepatitis B surface antigen (HBsAg) seroprevalence ≥2% or TB incidence rates ≥20/100,000 population. Early identification and treatment of chronic HBV and TB infection are critical to reduce morbidity and mortality, but little is known about HBV and TB screening among non-U.S.–born persons in the United States. Methods In a cross-sectional study using electronic health record data, we assessed HBV and TB infection screening practices among Kaiser Permanente Northern California eligible members aged ≥18 years born in countries with intermediate to high burdens of both HBV and TB infection. HBV screening was defined as testing for HBV surface antigen and HBV core antibody. TB infection screening was defined as testing with interferon gamma release assay or tuberculin skin test. We calculated the proportion of individuals from intermediate and high HBV-TB burden countries who had HBV or TB infection screening and the proportion of patients positive for HBV or TB infection. Results Of 498,339 non-U.S.–born adults, 275,708 (55.3%) were born in intermediate or high HBV-TB burden countries. Most patients were aged ≥50 years (65.3%) and 23.5% had diabetes. Among persons born in intermediate or high HBV-TB burden countries, 67.1% were screened for HBV infection, 29.4% were screened for TB infection, and only 23.7% were screened for both HBV and TB infection. Among all persons born in intermediate or high HBV-TB burden countries (both screened and unscreened), 3.7% had HBV infection and 10.1% had TB infection. Among 231,431 persons born in intermediate or high HBV-TB burden countries without current or prior HBV infection, 72.9% had received at least one HBV vaccine dose. Conclusion Among non-U.S.–born adults from intermediate or high HBV-TB burden countries, we found low screening proportions, intermediate prevalence of chronic HBV infection and high prevalence of TB infection. Given the large population of persons from intermediate or high HBV-TB burden countries in Kaiser Permanente Northern California, screening for both infections at the same time could improve early diagnosis and treatment for both conditions. Disclosures Jacek Skarbinski, MD, Genentech: Grant/Research Support|Gilead Sciences: Grant/Research Support Robert J. Wong, MD, MS, Gilead Sciences: Grant/Research Support

Genotypic and phenotypic comparison of drug resistance profiles of clinical multidrug-resistant Mycobacterium tuberculosis isolates using whole genome sequencing in Latvia

BackgroundMultidrug-resistant tuberculosis (MDR–TB) remains a major public health problem in many high tuberculosis (TB) burden countries. Phenotypic drug susceptibility testing (DST) take several weeks or months to result, but line probe assays and Xpert/Rif Ultra assay detect a limited number of resistance conferring gene mutations. Whole genome sequencing (WGS) is an advanced molecular testing method which theoretically can predict the resistance of M. tuberculosis (Mtb) isolates to all anti-TB agents through a single analysis.MethodsHere, we aimed to identify the level of concordance between the phenotypic and WGS-based genotypic drug susceptibility (DS) patterns of MDR–TB isolates. Overall, data for 12 anti-TB medications were analyzed.ResultsIn total, 63 MDR–TB Mtb isolates were included in the analysis, representing 27.4% of the total number of MDR–TB cases in Latvia in 2012–2014. Among them, five different sublineages were detected, and 2.2.1 (Beijing group) and 4.3.3 (Latin American-Mediterranean group) were the most abundant. There were 100% agreement between phenotypic and genotypic DS pattern for isoniazid, rifampicin, and linezolid. High concordance rate (> 90%) between phenotypic and genotypic DST results was detected for ofloxacin (93.7%), pyrazinamide (93.7%) and streptomycin (95.4%). Phenotypic and genotypic DS patterns were poorly correlated for ethionamide (agreement 56.4%), ethambutol (85.7%), amikacin (82.5%), capreomycin (81.0%), kanamycin (85.4%), and moxifloxacin (77.8%). For capreomycin, resistance conferring mutations were not identified in several phenotypically resistant isolates, and, in contrary, for ethionamide, ethambutol, amikacin, kanamycin, and moxifloxacin the resistance-related mutations were identified in several phenotypically sensitive isolates.ConclusionsWGS is a valuable tool for rapid genotypic DST for all anti-TB agents. For isoniazid and rifampicin phenotypic DST potentially can be replaced by genotypic DST based on 100% agreement between the tests. However, discrepant results for other anti-TB agents limit their prescription based solely on WGS data. For clinical decision, at the current level of knowledge, there is a need for combination of genotypic DST with modern, validated phenotypic DST methodologies for those medications which did not showed 100% agreement between the methods.

Lineage classification and antitubercular drug resistance surveillance of Mycobacterium tuberculosis by whole-genome sequencing in Southern India.

Whole-genome sequencing has created a revolution in tuberculosis management by providing a comprehensive picture of the various genetic polymorphisms with unprecedented accuracy. Studies mapping genomic heterogeneity in clinical isolates of Mycobacterium tuberculosis using a whole-genome sequencing approach from high tuberculosis burden countries are underrepresented. We report whole-genome sequencing results of 242 clinical isolates of culture-confirmed M. tuberculosis isolates from tuberculosis patients referred to a tertiary care hospital in Southern India. Phylogenetic analysis revealed that the isolates in our study belonged to five different lineages, with Indo-Oceanic (lineage 1, n = 122) and East-African Indian (lineage 3, n = 80) being the most prevalent. We report several mutations in genes conferring resistance to first and second line antitubercular drugs including the genes rpoB, katG, ahpC, inhA, fabG1, embB, pncA, rpsL, rrs, and gyrA. The majority of these mutations were identified in relatively high proportions in lineage 1. Our study highlights the utility of whole-genome sequencing as a potential supplemental tool to the existing genotypic and phenotypic methods, in providing expedited comprehensive surveillance of mutations that may be associated with antitubercular drug resistance as well as lineage characterization of M. tuberculosis isolates. Further larger-scale whole-genome datasets with linked minimum inhibition concentration testing are imperative for resolving the discrepancies between whole-genome sequencing and phenotypic drug sensitivity testing results and quantifying the level of the resistance associated with the mutations for optimization of antitubercular drug and precise dose selection in clinics. IMPORTANCE Studies mapping genetic heterogeneity of clinical isolates of M. tuberculosis for determining their strain lineage and drug resistance by whole-genome sequencing are limited in high tuberculosis burden settings. We carried out whole-genome sequencing of 242 M. tuberculosis isolates from drug-sensitive and drug-resistant tuberculosis patients, identified and collected as part of the TB Portals Program, to have a comprehensive insight into the genetic diversity of M. tuberculosis in Southern India. We report several genetic variations in M. tuberculosis that may confer resistance to antitubercular drugs. Further wide-scale efforts are required to fully characterize M. tuberculosis genetic diversity at a population level in high tuberculosis burden settings for providing precise tuberculosis treatment.

Analytical performances of the Xpert MTB/RIF assay using stool specimens to improve the diagnosis of pulmonary tuberculosis in Burkina Faso, a tuberculosis endemic country.

Timely diagnosis of Pulmonary Tuberculosis (PTB) is associated with good prognosis, but remains difficult in primary healthcare facilities and particularly in children and patients living with HIV. The aim of this study was to compare the GeneXpert ® MTB/RIF assay (Xpert) performed using a stool sample (3-5 g) and using the first Respiratory Tract Sample (RTS; i.e., sputum, bronchoalveolar or gastric aspirate; as normally done) concomitantly collected from 119 patients with suspected PTB to improve PTB diagnosis in Burkina Faso, a high tuberculosis burden country with limited resources. Overall, microbiological, microscopic and molecular analysis of the 119 first RTS and 119 stool specimens led to Mycobacterium tuberculosis complex detection in 28 patients (23 positive RTS cultures and 5 negative RTS cultures-RTS Xpert positive). When using the 28 clinical confirmed cases as reference standard, the sensitivities of the stool-based and RTS-based Xpert assays were not different (24/28, 85.7%, versus 26/28, 92.86%; p > 0.30), and 22 results were fully concordant. Considering the first RTS culture as the gold standard, the sensitivities of the stool-based and RTS-based Xpert assays to detect PTB in patients with positive RTS culture were 100% (23/23) and 91.3% (21/23), respectively (p >0.05). The stool-based Xpert assay specificity for excluding PTB was 99% (95/96) (compared with 95%, 91/96, when using RTS) and its negative and positive predictive values were 100% (95/95) and 96% (23/24), respectively. Compared with the 23 positive RTS cultures, the incremental yield rates of the RTS-based and stool-based Xpert assays were 4.2% (5/119) and 0.84% (1/119), respectively. Overall, our findings support using the stool-based Xpert assay as an alternative method for earlier PTB diagnosis, when RTS are difficult to obtain.

Interferon-γ release assay and mantoux response in infants with tuberculous meningitis in low and intermediate burden countries

AimUntil now, the performance of interferon-γ release assay (IGRA) and Mantoux tests remains unclear in infant tuberculous meningitis (TBM). Therefore, a systematic review is performed to evaluate the sensitivity of IGRA and Mantoux tests for the diagnosis of infant TBM in low and intermediate tuberculosis (TB) burden countries, while following PRISMA.MethodsSeveral databases, including PubMed, EBSCO, Embase, Scopus, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials, were searched. Articles describing the results of IGRA or Mantoux tests among infant TBM were included for analysis. Data, such as age, sex, Mantoux test or IGRA, and cerebrospinal fluid (CSF) microbiological examinations (such as acid-fast bacilli (AFB) smear, TB PCR, and TB culture), were extracted from each study.ResultsA total of 31 articles were enrolled for further analysis, including 48 cases. The mean age was 9.4 ± 5.8 months and boys accounted for 57.1% of infants (24/42). Mantoux test was positive in 57.4% (27/47) of tested infants and IGRA was positive in 77.8% (7/9) of infants. In addition, among the infants with confirmed TB, 18 (52.9%, 18/34) of them have positive Mantoux responses and 7 (20.0%, 7/35) have positive IGRA results.ConclusionsIn low or intermediate TB burden countries, the Mantoux test has a poor performance for diagnosing TBM among infants, and IGRAs appear to have a moderate sensitivity for the diagnosis of infant TBM.

Integrating tuberculosis and COVID-19 molecular testing in Lima, Peru: a cross-sectional, diagnostic accuracy study

Integrated molecular testing could be an opportunity to detect and provide care for both tuberculosis and COVID-19. Many high tuberculosis burden countries, such as Peru, have existing GeneXpert systems for tuberculosis testing with GeneXpert Xpert MTB/RIF Ultra (Xpert Ultra), and a GeneXpert SARS-CoV-2 assay, GeneXpert Xpert Xpress SARS-CoV-2 (Xpert Xpress), is also available. We aimed to assess the feasibility of integrating tuberculosis and COVID-19 testing using one sputum specimen with Xpert Ultra and Xpert Xpress in Lima, Peru. In this cross-sectional, diagnostic accuracy study, we recruited adults presenting with clinical symptoms or suggestive history of tuberculosis or COVID-19, or both. Participants were recruited from a total of 35 primary health facilities in Lima, Peru. Participants provided one nasopharyngeal swab and one sputum sample. For COVID-19, we tested nasopharyngeal swabs and sputum using Xpert Xpress; for tuberculosis, we tested sputum using culture and Xpert Ultra. We compared diagnostic accuracy of sputum testing using Xpert Xpress with nasopharyngeal swab testing using Xpert Xpress. Individuals with positive Xpert Xpress nasopharyngeal swab results were considered COVID-19 positive, and a positive culture indicated tuberculosis. To assess testing integration, the proportion of cases identified in sputum by Xpert Xpress was compared with Xpert Xpress on nasopharyngeal swabs, and sputum by Xpert Ultra was compared with culture. Between Jan 11, 2021, and April 26, 2022, we recruited 600 participants (312 [52%] women and 288 [48%] men). In-study prevalence of tuberculosis was 13% (80 participants, 95% CI 11-16) and of SARS-CoV-2 was 35% (212 participants, 32-39). Among tuberculosis cases, 13 (2·2%, 1·2-3·7) participants were concurrently positive for SARS-CoV-2. Regarding the diagnostic yield of integrated testing, Xpert Ultra detected 96% (89-99) of culture-confirmed tuberculosis cases (n=77), and Xpert Xpress-sputum detected 67% (60-73) of COVID-19 cases (n=134). All five study staff reported that integrated molecular testing was easy and acceptable. The diagnostic yield of Xpert Xpress on sputum was moderate, but integrated testing for tuberculosis and COVID-19 with GeneXpert was feasible. However, systematic testing for both diseases might not be the ideal approach for everyone presenting with presumptive tuberculosis or COVID-19, as concurrent positive cases were rare during the study period. Further research might help to identify when integrated testing is most worthwhile and its optimal implementation. Canadian Institutes of Health Research and International Development Research Centre. For the Spanish translation of the abstract see Supplementary Materials section.

Patient-reported usability and satisfaction with electronic medication event reminder and monitor device for tuberculosis: a multicentre, randomised controlled trial

The success of a tuberculosis digital adherence technology relies on patients' satisfaction with and the usability of the technology. This study aimed to evaluate treatment satisfaction and usability of a digital medication event reminder and monitor (MERM) device for patients with tuberculosis to address the prespecified secondary endpoint of the SELFTB trial. In this multicenter, randomised controlled trial, adults (≥18 years) with new or previously treated, bacteriologically-confirmed, drug-sensitive pulmonary tuberculosis who were eligible to start anti-tuberculosis therapy were recruited from 10 healthcare facilities in Ethiopia. With a computer-generated random number sequence, participants were randomly assigned 1:1 to receive a 15-day tuberculosis medication supply dispensed with an evriMED500® MERM device to self-administer and return every 15 days or the standard in-person DOT. Both arms were followed throughout the standard two-month intensive treatment phase. Treatment was based on the WHO-recommended two-month fixed-dose-combination of first-line anti-tuberculosis drug delivered as a single daily dose (2RHZE). Treatment Satisfaction Questionnaire for Medication version 4 (TSQM 1.4©) was used to measure and compare treatment satisfaction between arms. Adapted System Usability Scale (SUS) was used to assess the usability of the device, with emphasis on ease of use, challenges, benefits, motivation, popularity, and recommendation. The findings were correlated with adherence and clinical endpoints including sputum smear conversion and IsoScreen urine isoniazid test results. This trial is registered with ClinicalTrials.gov, NCT04216420. Between June 2, 2020, and June 15, 2021, 337 patients were screened for eligibility, of whom 109 participants enrolled and completed the satisfaction [control (n=57) and intervention (n=52) arms] and usability [intervention arm (n=52)] questionnaires. TSQM 1.4© geometric mean scores were: Effectiveness 73.25 [geometric standard deviation (GSD) 1.28], Side Effects 100, Convenience 63.31 (GSD 1.45), and Global Satisfaction 77.29 (GSD 1.25). TSQM score was significantly higher in the intervention vs the control: Effectiveness [85.78 vs 63.43, 95% CI 1.35 (1.26-1.45), p<0.001], Convenience [85.41 vs 48.18, 95% CI 1.77 (1.63-1.93), p<0.001], and Global Satisfaction [90.19 vs 67.11, 95% CI 1.34 (1.26-1.43), p<0.001]. There were significant associations between Global Satisfaction and medication adherence (p=0.017). Average SUS score was 97.45%, which was close to the best imaginable SUS value of 100%. Likelihood to Recommend (LTR) value was ≥9, on a scale of 0-10, for 90.4% of MERM users, yielding higher net promoters. There was no significant association between usability and medication adherence (p=0.691). Our findings suggested that treatment satisfaction scores were superior in the intervention vs control arms and across the domains of Effectiveness, Convenience, and Global Satisfaction. There was excellent usability of the MERM device and a significantly higher number of users likely to promote the device. High tuberculosis burden countries may transform patient-centered care through ongoing evaluation and scale-up of digital health innovations. U.S. National Institute of Health (NIH) Fogarty International Center and National Institute of Allergy and Infectious Diseases (D43 TW009127) and the Emory Center for AIDS Research (P30 AI050409).

Tuberculosis and HIV coinfection and rifampicin-resistant tuberculosis among patients living with HIV in Northern part of West Bengal, India

Background: India is one of the top most country among the high tuberculosis (TB) burden countries and ranks the third highest human immunodeficiency virus (HIV) burden country in the world contributing to 23% of the total global load. Mycobacterium tuberculosis (MTB) and HIV are known to act synergistically and result in higher mortality rates. TB-HIV coinfection and emergence of drug resistant forms of MTB can impact positively on treatment outcomes. Aims and Objectives: The aim of this study was to determine of the prevalence of TB-HIV co-infection among MTB and to determine the prevalence of rifampicin (RIF) resistant TB among HIV seropositive patients. Materials and Methods: It was a retrospective and observational study carried out in the Department of Microbiology, Malda Medical College, Malda, West Bengal. Records of all patients that tested using CBNAAT during March 2016–December 2019 in the CBNAAT laboratory of Malda Medical College were assessed. Data generated during this period were collected and analyzed. The statistical analysis was done in tabulation form and different charts and tables were used for displaying data. Results: A total of 6503 samples were tested in CBNAAT laboratory during March 2016–December 2019. Out of 6503, 3098 samples were positive for CBNAAT (MTB detected).Of 3098 MTB, 8.91% (276/3098) were RIF resistant. Among 3098 MTB, 91.22% (2826/3098) were pulmonary TB (PTB) and 8.78% (272/3098) were extra PTB. Out of 6503 total samples, 664 were reported patients living with HIV. The prevalence of TB-HIV coinfection was 3.91% (121/3098) among MTB positive cases. Of all TB-HIV coinfected cases, most of the patients (67.77%) were in the age group of 20–39 years and males (77.69%) contributed to more than females. Of 121 TB-HIV coinfected, 88.43% (107/121) were sensitive to RIF and 11.57% (14/121) were resistant to RIF. Conclusion: The present study reported that the prevalence of TB-HIV coinfection was 3.91% and the prevalence of RIF resistant TB in HIV seropositive patients was higher than HIV seronegative patients. Thus, all TB patients should be screened for HIV and all HIV-positive individuals should be screened for TB along with drug resistance for better management.

Uncommon manifestation of disseminated tuberculosis with metastatic skin abscesses in an immunocompromised adult patient: A case report

Background: Cutaneous lesions account for less than 2% of all extrapulmonary manifestations of tuberculosis (TB). Metastatic tuberculous abscesses (tuberculous gummas), uncommon forms of cutaneous TB, typically result from the bacillus spreading hematogenously from the main site of infection to the subcutaneous tissue when the body's cell mediated immunity is compromised and present with one or more non-tender and fluctuant subcutaneous nodules. Case Presentation: A 51-year-old male presented with dry cough of one month duration associated with loss of appetite, easy fatigability and vomiting of ingested matter. He had left armpit and lower back skin swellings of similar duration. Physical findings were remarkable for whitish coat over the dorsal part of the tongue, crepitation over the lower two-third of bilateral posterior chest, and non-tender fluctuant masses over the left axilla and lower back region. Chest X-ray revealed multiple bilateral air space nodules and abdominopelvic U/S showed numerous hypoechoic splenic lesions. Urine lipoarabinomannan and Xpert MTB/RIF (mycobacterium tuberculosis/rifampicin) assay from the axillary skin abscess were positive for MTB. He was started on anti-tuberculous therapy and showed marked improvement after a month of follow up. Conclusion: It is worth considering the uncommon manifestations of tuberculosis including metastatic skin abscesses in the appropriate clinical context, to avoid misdiagnosis and underreporting in high tuberculosis burden countries. We strongly advise the utilization of Xpert MTB/RIF assay and/or urine lipoarabinomannan for the diagnosis of different forms of tuberculosis including cutaneous TB in HIV positive patients, especially in the absence of sputum for microbiologic tests, like in our patient

PREVALENCE OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS IN PUNJAB POPULATION OF PAKISTAN

Tuberculosis, being one of the top 10 death causing diseases worldwide, is still widespread in developing countries. Pakistan is currently ranked fifth among the high tuberculosis burden countries and 5 % of the total patients worldwide are from this country. The study was conducted on 633 tuberculosis patients involving both pulmonary and extrapulmonary tuberculosis from Punjab population of Pakistan. Male to female ratio was found to be 0.96 in this population. Most of the individuals infected from this disease were found to be of age group 15-34 where 38.38% males and 46.43% females were infected. Among pulmonary tuberculosis, age group &lt;15 was most infected with 31.11% males and 39.84% females while among extra pulmonary tuberculosis age group 15-34 was found most infected with 51.53% males and 56.31% females. Significant difference in MFR and age groups prevalence of this disease was noted when compares with neighbor countries India and Iran.

Progress towards the 2020 milestones of the end TB strategy in Cambodia: estimates of age and sex specific TB incidence and mortality from the Global Burden of Disease Study 2019

BackgroundCambodia was recently removed from the World Health Organization’s (WHO’s) top 30 high tuberculosis (TB) burden countries. However, Cambodia’s TB burden remains substantial, and the country is on the WHO’s new global TB watchlist. We aimed to examine the levels and trends in the fatal and non-fatal TB burden in Cambodia from 1990 to 2019, assessing progress towards the WHO End TB interim milestones, which aim to reduce TB incidence rate by 20% and TB deaths by 35% from 2015 to 2020.MethodsWe leveraged the Global Burden of Disease 2019 (GBD 2019) analytical framework to compute age- and sex-specific TB mortality and incidence by HIV status in Cambodia. We enumerated TB mortality utilizing a Bayesian hierarchical Cause of Death Ensemble modeling platform. We analyzed all available data sources, including prevalence surveys, population-based tuberculin surveys, and TB cause-specific mortality, to produce internally consistent estimates of incidence and mortality using a compartmental meta-regression tool (DisMod-MR 2.1). We further estimated the fraction of tuberculosis mortality among individuals without HIV coinfection attributable to the independent effects of alcohol use, smoking, and diabetes.ResultsIn 2019, there were 6500 (95% uncertainty interval 4830–8680) deaths due to all-form TB and 50.0 (43.8–57.8) thousand all-form TB incident cases in Cambodia. The corresponding age-standardized rates were 53.3 (39.9–69.4) per 100,000 population for mortality and 330.5 (289.0–378.6) per 100,000 population for incidence. From 2015 to 2019, the number of all-form TB deaths decreased by 11.8% (2.3–21.1), while the age-standardized all-form TB incidence rate decreased by 11.1% (6.3–15.6). Among individuals without HIV coinfection in 2019, alcohol use accounted for 28.1% (18.2–37.9) of TB deaths, smoking accounted for 27.0% (20.2–33.3), and diabetes accounted for 12.5% (7.1–19.0). Removing the combined effects of these risk factors would reduce all-form TB deaths by 54.2% (44.2–62.2).DiscussionDespite significant progress in reducing TB morbidity and mortality since 1990, Cambodia is not on track to achieve the 2020 WHO End TB interim milestones. Existing programs in Cambodia can benefit from liaising with risk factor control initiatives to accelerate progress toward eliminating TB in Cambodia.

Isolated Chest Wall Tuberculosis Presenting As an Abscess

Lebanon is a relatively low Tuberculosis burden country but has a high proportion of extrapulmonary tuberculosis. Tuberculosis involving the chest wall is found in around 1% of all skeletal tuberculosis cases. We present the case of an 81-year-old immunocompetent patient who presented with 3 months history of a painful lump in the anterior chest wall. PCR for MTB (mycobacterium tuberculosis) was positive and a diagnosis of the tubercular abscess of the chest wall was made mimicking a pyogenic abscess.

Trends of Tuberculosis Disease from 2013-2018 in Bale Zone, Oromia Region, Ethiopia. Retrospective Review.

Tuberculosis is a common global public health problem. Ethiopia is among the thirty top Tuberculosis burden countries. Trends of tuberculosis disease in general and at the district level in the Bale Zone have not been assessed and no adequate information existed for informed decision-making. This study was to describe the trends and physical distribution of the tuberculosis disease in the Bale Zone from 2013 to 2018. We reviewed the reported data of tuberculosis from 2013 to 2018 in March 2019 and extracted data of tuberculosis from the Bale Zone health information system database. Analysis of the six-year data of tuberculosis was conducted after the data was cleaned and checked for completeness. We recruited a total of 11, 268 tuberculosis cases. The proportions of sputum smear-positive tuberculosis (SS+), sputum smear-negative tuberculosis (SS-), and extra-pulmonary tuberculosis (EPTB) cases were 40.4%, 29.6% and 30%, respectively. Of all cases, 81.9% are aged greater than 15 years. Prevalence of all types of tuberculosis was 0.005%, 0.127%, 0.133%, 0.136%, 0.131% and 0.093% in 2013, 2014, 2015, 2016, 2017 and 2018, respectively. The death rate from positive pulmonary tuberculosis was 0%. 2.74, 2.10, 2.06, 1.04, and 2.75 in 2013, 2014, 2015, 2016, 2017 and 2018, respectively. The highest average prevalence rate was 198, 152 and 142 per 100,000 populations in Berbere, Rayitu, and Gura-Dhamole Woreda, respectively. The proportion of sputum smear-positive tuberculosis was high in the Bale Zone. Bale Zone should give more attention to the Tuberculosis program to tackle sputum smear positive. We recommended researchers investigate further research to identify determinants in districts with a high prevalence rate of tuberculosis.

Chronic obstructive pulmonary disease as a comorbidity in pulmonary tuberculosis patients in Manjeri, Kerala

Chronic obstructive pulmonary disease as a comorbidity among pulmonary tuberculosis patients is less studied in south India. To determine the proportion of Pulmonary tuberculosis patients in Manjeri Tuberculosis Unit who have COPD as a co-morbidity. Study design -Cross sectional study. Study setting -Manjeri Tuberculosis unit of Malapuram district. Study population -All diagnosed Pulmonary Tuberculosis patients registered in the Manjeri Tuberculosis unit of Malapuram district. Sample size-178 patients satisfying inclusion criteria. Study tools- Questionnaire – A structured questionnaire used for collecting the basic demographic data and patient characteristics. COPD screener tool to be applied at the start of treatment. Pulmonary function test at end of intensive phase in patients or when patients are sputum smear negative, whichever is later. Of the total 181 persons who participated in the study 114[62.98%] were males. 35[19.34%] were smokers. 70 persons reported to have some form of chronic respiratory illness in the past. By using the COPD screener tool, 70 persons [38.89%] had score from 5 to 10 implying that they had high chance of having COPD. Spirometry was done for 174 persons. 31(17.81%) persons showed evidence of obstructive airway disease. The prevalence of COPD among pulmonary tuberculosis patients was 17.81%. In a high tuberculosis burden country like India, more studies are needed to find out how COPD in tuberculosis patients adversely affects the disease progression, morbidity, and mortality.