Tuberculosis Comorbidity Research Articles

Tuberculosis and AIDS co-morbidity in Brazil: linkage of the tuberculosis and AIDS databases

This study evaluated differences in AIDS patients with and without tuberculosis (TB) in Espírito Santo State, Brazil. Standard regional AIDS (SINAN, SISCEL, SICLOM and SIM) and tuberculosis (SINAN) databases were used. TB and AIDS databases were linked using Reclink software, version 3, with SPSS software support to identify co-infected cases. Data from July 2000 to June 2006 in Espírito Santo State were linked. The results showed 3,523 adult AIDS cases and 9,958 adult TB cases resulted in 430 co-infected patients, who were compared to 1,290 AIDS patients who never developed TB. Among 430 co-infected patients, TB was diagnosed first in 223 (51.9%), AIDS was first in 44 (10.2%), and AIDS and TB were diagnosed concurrently in 163 (37.9%). Median age did not differ between co-infected cases (36 years (interquartile range [IQR] 29-43) and non-co-infected cases (34 years; IQR 28-42). Pulmonary tuberculosis was diagnosed in 239 (55.6%); 109 (25.3%) had extra-pulmonary TB and 82 (19.1%) had both presentations. In the final logistic regression model, living in a metropolitan area [Odds Ratio (OR)=1.43 (95% Confidence Interval (CI) 1.05-1.95)], education < 3 years [OR=3.03 (95%CI 1.56-5.88)] and CD4 counts < 200/mm(3) [OR=1.14 (95%CI 1.09-1.18)] were associated with co-infection. This report emphasizes the significance of tuberculosis among AIDS cases in Brazil, and highlights the importance of evaluating secondary data for purposes of improving data quality and developing public health interventions.

Co-morbidity of tuberculosis, alcoholism and drug dependence

One of the reasons of growing incidence of tuberculosis (TB) is spread of AIDS, drug dependence, and alcoholism. To investigate their mutual influence the authors examined 185 lung TB patients (of them, 124 males) admitted to TB hospitals of St-Petersburg in 2003-2005. Inclusive criteria were age of 18 to 79 yrs, recent admission to the hospital, the patient's consent to participate the study. Patients were excluded if they were severely ill or had psychiatric disorders. The lung TB was evaluated using medical history, physical, clinic, laboratory, radiologic, and bacteriologic data. Alcohol and drug abuse was assessed with Addiction Severity Index (ASI), retrospective analysis of alcohol and substance use for previous 90 days, Michigan Alcohol Screening Test (MAST), measurement of alcohol in exhaled air and detection of substances in urine. Somatic and psychic health was evaluated using ASI, Beck Depression Inventory, and Spielberger Trait Anxiety Inventory. Risk of HIV-infection was determined in a test of HIV risk assessment and with HIV risk questionnaire developed at Johns Hopkins University. The average age of the participants was 40.5 yrs. More than 60 % of them had abuse-related disorders: alcohol abuse in 51.9 %, alcoholism plus drug dependence in 8.6 %, and drug dependence in 3.8 %. Alcohol dependence facilitated development of TB multiple drug resistance (21 % vs 7.6 % in patients without alcohol dependence, p < 0.05), extensive (73.9 % and 40.9 %, respectively, p < 0.001) and chronic (28.6 % and 16.7 %, respectively) forms of TB. Most of TB patients with abuse-related disorders tended to have psychiatric disorders (depression, anxiety). The risk of HIV-infection was significantly higher in TB patients with drug abuse (3.51 vs 0.07). Thus, it is necessary to consider co-morbidity in TB patients for more effective treatment of lung tuberculosis.

What Is Tuberculosis Surveillance in the European Union Telling Us?

Today's European Union (EU) encompasses countries with diverse patterns of tuberculosis epidemiology. We explored national tuberculosis data for 1999-2003 reported to the EuroTB surveillance network. We analyzed only complete, representative data for drug resistance (from 15 countries) and treatment outcomes (from 19 countries). Between 1999 and 2003, overall tuberculosis notification rates in the 25 EU countries decreased by 4% each year, down to 14 cases per 100,000 population in 2003, but Italy and the United Kingdom registered increases because of tuberculosis in immigrants. In 2003, EU countries reported 62,743 tuberculosis cases; of these, 76% were in persons who were previously untreated, 22% were in persons >64 years old, and 30% were in foreigners (the percentage in individual countries ranged from 2% to 75%). In Estonia, Latvia, and Lithuania, resistance to isoniazid and rifampicin occurred in 15%-23% of cases in which resistance testing was performed, but it was uncommon elsewhere (median resistance, 1%). Among previously untreated culture-positive patients with pulmonary tuberculosis, 76% had successful outcome (the percentage in individual countries ranged from 54% to 100%); among these patients, the probability of successful outcome diminished with advancing age. Of 9414 patients with AIDS reported in the EU, 2207 (23%) had tuberculosis as the initial defining illness, representing 3% of all tuberculosis cases notified that year (the percentage in individual countries ranged from 0% to 10%). The prevalence of HIV infection among patients with tuberculosis was highest in Portugal (16.1%) and Spain (9.6%), but it increased in Estonia (from 0.1% to 2.9%) and in Latvia (from 0.5% to 2.3%) between 1999 and 2003. Surveillance data would be more comparable if more countries reported exhaustive and representative data. Drug resistance is low in most EU countries other than former Soviet states. HIV infection and tuberculosis comorbidity is important in certain countries. Prevention and control of tuberculosis in the EU should target groups at higher risk of infection or death, including foreigners and the elderly population.

Management of advanced HIV disease in patients with tuberculosis or hepatitis co-infection

Advanced human immunodeficiency virus (HIV) disease can be defined as a cluster of differentiation 4 (CD4) count <50 cells/mm(3) or the presence of an acquired immunodeficiency syndrome (AIDS)-defining illness. In the UK and Ireland, the number of patients who present with advanced HIV disease is increasing, with 301/977 (31%) of patients presenting late (<200 CD4 cells/mm(3)). Many patients who present with advanced HIV disease will have comorbid conditions, such as hepatitis B or C or tuberculosis (TB), which complicates the choice of therapy. This article reviews the evidence and some clinical scenarios for specific patient groups who may present with advanced HIV disease: those with comorbid TB, hepatitis B or hepatitis C. The aim is to offer practical advice on therapeutic options for treatment-naïve patients who present with advanced HIV disease on the basis of available clinical evidence.

THE DEGREE OF CO-MORBIDITY OF SILICOSIS AND PULMONARY TUBERCULOSIS AMONG EX-MINEWORKERS OF THE FORMER HOMELAND OF TRANSKEI, SOUTH AFRICA. AN X-RAY BASED STUDY

PURPOSE: This study was done to determine the degree of co-morbidity of silicosis and pulmonary tuberculosis in ex-mineworkers, measure distribution of the conditions in different age groups and to determine the length of service in the mines in relation to the disease states.

HIV and tuberculosis in the former Soviet Union

HIV and tuberculosis in the former Soviet Union

Treatment of Comorbid Tuberculosis and Depression.

Tuberculosis (TB) remains a leading infectious cause of mortality worldwide. While the overall prevalence of TB in the United States has declined in the general population, certain groups remain at high risk, including the homeless, those who are HIV seropositive, individuals with a history of alcohol or drug abuse, and immigrants from a country in which TB is endemic. Many recipients of psychiatric services possess 1 or more of these risk factors, and consequently TB may be overrepresented in this population. Conversely, psychiatric illness may develop subsequent to TB infection. Mood disorders seem to be particularly common in TB patients compared with those with other medical diagnoses. It is important that primary care physicians understand the high prevalence of mental illness in TB patients so that proper treatment provisions can be implemented. Likewise, it is important for psychiatrists to understand the clinical manifestations of TB so that when a patient presents with symptoms of TB proper precautions can be taken and appropriate referrals can be made. This article integrates information concerning mental illness in TB patients with diagnostic and treatment guidelines for TB. Brief suggestions are offered for the treatment of TB patients with comorbid mental illness.

Clinically significant drug interactions with antituberculosis agents

Tuberculosis (TB) has, until recently, been considered to be primarily of historical importance in the United States, but in the past 10 years the number of reported cases has increased. As a result of mismanaged patients and poor treatment outcomes, a strain of Mycobacterium tuberculosis resistant to both of the most effective antitubercular agents, isoniazid (INH) and rifampin has emerged and necessitates the use of more toxic and less effective drugs for longer periods of time. Compounding the problem is the treatment of HIV/ AIDS patients with TB, which also requires several medications during treatment (1,2). Psychiatric populations are at greater risk for developing TB, and are often treated with multiple medications that have the potential to interact adversely with antitubercular agents. Rifampin is a well-known potent inducer of both cytochrome P450 (CYP) 2C and CYP3A and has the majority of clinically significant drug interactions. INH inhibits the metabolism of many drugs due to a mechanism other than CYP enzyme involvement. Drug interactions involving these and other antitubercular drugs can result in either therapeutic failure or toxicity of antitubercular and/or psychoactive agents. Additionally psychosis has occurred, although rarely, as a direct result of the use of antitubercular treatment in TB patients with no history of psychiatric symptoms (3). Prevention of these drug-induced adverse events as well as education and medication compliance are essential factors in the optimal treatment of psychiatric patients with comorbid TB.

Effect of HIV infection and tuberculosis on hospitalizations and cost of care for young adults in the United States, 1985 to 1990.

To evaluate the effect of human immunodeficiency virus (HIV) infection and tuberculosis on hospitalizations and the cost of care. National Hospital Discharge Survey, a nationally representative survey of discharges from U.S. nonfederal short-stay hospitals, and statewide billing information. Patients 15 to 44 years of age with a listed diagnosis of HIV infection (n = 418,200) or active tuberculosis (n = 77,700) during 1985-1990. During 1985-1990, hospitalizations related to HIV infection increased sixfold, from 18 to 102 per 100,000 persons; during 1988-1990, hospitalizations related to tuberculosis increased twofold, from 8 to 16 per 100,000 persons. The prevalence of tuberculosis among HIV-infected patients increased from 2.4% in 1985-1988 to 5.1% in 1989-1990 (P = 0.003). The prevalence of HIV infection among patients with tuberculosis increased from 11% in 1985-1988 to 28% in 1989 to 39% in 1990 (P < 0.001). Infection with HIV was more prevalent among patients with extrapulmonary tuberculosis (31%) than among those with pulmonary tuberculosis (18%) (P = 0.01). An increase in the duration of hospital stay was associated with both tuberculosis and HIV infection. From 1985 to 1990, inpatient care costs increased 7.7-fold and 3.2-fold for HIV and tuberculosis hospitalizations, respectively. During this period, HIV and tuberculosis hospitalizations resulted in 5,793,000 and 1,107,900 days of care, respectively, with an estimated direct cost of $5.7 to $7.4 billion and $0.89 to $1.07 billion, respectively. Estimated national costs of inpatient care for HIV infection or tuberculosis or both totaled $6.4 to $8.1 billion, 5% of which was for patients with both HIV infection and tuberculosis. This is the first study to use a nationally representative sample of hospitals, combined with cost data, to estimate hospitalizations and their costs for HIV and tuberculosis care. Our findings suggest that the convergence of the HIV and tuberculosis epidemics has had an increasing effect on morbidity and the cost of care among young adults in the United States. The increasing prevalence of comorbidity of HIV infection and tuberculosis in inpatients underscores the need for strict infection control of tuberculosis on the part of hospitals, increased attention to prevention, and early identification and treatment of HIV infection, and tuberculosis to reduce morbidity, hospitalizations, and the cost of care.

Drug reactions

Tuberculosis and mental illness share common risk factors including homelessness, HIV positive serology, alcohol/substance abuse and migrant status leading to frequent comorbidity. We sought to generate a comprehensive literature review that examines the complex relationship between tuberculosis and mental illness.A literature search was conducted in MedLine, Ovid and Psychinfo, with further examination of the references of these articles. In total 316 articles were identified. It was not possible to conduct a formal meta-analysis due to the absence of randomised controlled data.Rates of mental illness of up to 70% have been identified in tuberculosis patients. Medications used in the treatment of common mental illnesses, such as depression, may have significant interactions with anti-tuberculosis agents, especially isoniazid and increasingly linezolid. Many medications used in the treatment of tuberculosis can have significant adverse psychiatric effects and some medications such as rifampicin may reduce the effective doses of anti-psychotics y their enzyme induction actions. Treatment with agents such as cycloserine has been associated with depression, and there have been reported cases of psychosis with most anti-tuberculous agents. Mental illness and substance abuse may also affect compliance with treatment, with attendant public health concerns.As a result of the common co-morbidity of mental illness and tuberculosis, it is probable that physicians will encounter previously undiagnosed mental illness among patients with tuberculosis. Similarly, psychiatrists are likely to meet tuberculosis among their patients. It is important that both psychiatrists and physicians are aware of the potential for interactions between the drugs used to treat tuberculosis and psychiatric conditions.