Tuberculosis Disease In Patients Research Articles

Prior Screening for Latent Tuberculosis Among Patients Diagnosed With Tuberculosis Disease: Missed Opportunities?

California has the largest number of tuberculosis (TB) disease cases in the United States. This study in a large California health system assessed missed opportunities for latent tuberculosis (LTBI) screening among patients with TB disease. Kaiser Permanente Southern California patients who were ≥18 years old with membership for ≥24 months during the study period from 1 January 2008 to 31 December 2019 were included. Prior LTBI test (tuberculin skin test or interferon-γ release assay) or diagnosis code prior to TB disease diagnosis was assessed among patients with observed TB disease (confirmed by polymerase chain reaction and/or culture). In the absence of current treatment practices, more patients screened for LTBI may have developed TB disease. We estimated hypothetical TB disease cases prevented by multiplying LTBI progression rates by the number of LTBI-positive patients prescribed treatment. A total of 1289 patients with observed TB disease were identified; 148 patients were LTBI positive and 84 were LTBI negative. Patients not prescreened for LTBI made up 82.0% of observed TB disease cases (1057/1289). Adding the hypothetical maximum estimate for prevented cases decreased the percentage of patients who were not prescreened for LTBI to 61.7% [1057/(1289 + 424)]. One-fifth of patients were screened for LTBI prior to their active TB diagnosis. Assuming the upper bound of cases prevented through current screening, almost 62% of TB disease patients were never screened for LTBI. Future work to elucidate gaps in LTBI screening practices and to identify opportunities to improve screening guidelines is needed.

Tracing TB: Are there predictors for active TB disease in patients with Xpert Ultra trace results?

ObjectivesThe Xpert MTB/Rif Ultra (Xpert Ultra; Cepheid, USA) has increased sensitivity compared with its predecessor (Gene Xpert), due to the addition of multicopy amplification targets and a novel trace call. The World Health Organization suggests that tuberculosis (TB) treatment should be initiated in HIV, paediatric, and extra-pulmonary TB patients with trace results. However, other factors such as previous TB disease may complicate the interpretation of trace results in high-burden TB settings. This study aimed to clarify the positive predictors for active TB disease in patients with trace results and to investigate if previous TB disease influences TB culture positivity. MethodsA retrospective descriptive study was performed on 290 patients with trace results, to determine what the positive predictors for active TB are by comparing clinical factors to TB culture. ResultsThe key findings of this study were that extra-pulmonary TB samples (OR, 2.7; p=0.012), no previous TB disease (OR, 4.5; p=0.001) and symptoms suggestive of TB (OR, 6.4; p<0.001) are independent predictors for active TB disease. ConclusionThis study found readily available clinical predictors that can aid clinicians with TB management decisions in patients with trace results.

Incident tuberculosis disease in patients receiving biologic therapies in the Western Cape, South Africa from 2007 to 2018

BackgroundSouth Africa has one of the highest tuberculosis incidence rates. Biologic disease-modifying anti-rheumatic drugs are associated with an increased risk of tuberculosis. The objective of this study was to describe the tuberculosis disease incidence rate among public sector patients receiving biologic therapies in the Western Cape Province.MethodsA retrospective, descriptive analysis was undertaken using routine health data collated by the Provincial Health Data Centre from January 2007 (first use of biologic therapy in the Western Cape) to September 2018.ResultsWe identified 609 patients treated with tumour necrosis factor-alpha (TNF-α) or non-TNF-α biologic therapies. Thirty-seven (37) patients developed tuberculosis after biologic therapy exposure, of whom the majority (78%) had an immune mediated inflammatory disease and the remainder (22%) a haematologic malignancy. The incidence rate of tuberculosis per 100,000 person-years was 2227 overall [95% confidence interval (CI): 1591, 3037]. Patients treated with TNF-α inhibitors and non-TNF-α inhibitors had estimated incidence rates of 2819 [95% CI: 1669, 4480] and 1825 [95% CI: 1131, 2797], respectively (p = 0.10).ConclusionPatients exposed to both TNF-α and non-TNF-α biologic therapies may have a higher incidence of tuberculosis disease compared to the background risk of 681 cases per 100,000 per year in the Western Cape.

Risk of incident active tuberculosis disease in patients treated with non-steroidal anti-inflammatory drugs: a population-based study

BackgroundMycobacterium tuberculosis (TB) is one of the world’s most devastating public health threats. Our goal is to evaluate whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) affect the risk of new incident active TB disease.MethodsWe conducted a nested case-control analysis by using a 1 million longitudinally followed cohort, from Taiwan’s national health insurance research database. Effects of NSAIDs on active TB were estimated by conditional logistic regression and adjusted using a TB-specific disease risk score (DRS). NSAIDs exposures were defined as having a prescription record of NSAIDs ≧ 7 days that ended between 31 and 90 days prior to the index date.ResultsA total of 123,419 users of traditional NSAIDs, 16,392 users of cyclooxygenase-2 selective inhibitor (Coxibs), and 4706 incident cases of active TB were identified. Compared with nonusers, use of traditional NSAIDs was associated with an increased risk of TB in the unadjusted analysis ([RR], 1.39; 95% [CI], 1.24 – 1.57 and DRS adjusted analysis ([ARR], 1.30; 95% [CI], 1.15– 1.47). However, use of Coxibs was not associated with a significant increase in the risk of TB after DRS adjustment ([ARR], 1.23; 95% [CI], 0.89 – 1.70).ConclusionsIn this large population-based study, we found that subjects using traditional NSAIDs were associated with increased risk for active TB. We did not find evidence for a causative mechanism between traditional NSAIDs and TB, and more research is required to verify whether the association between traditional NSAIDs and TB is causal, or simply reflects an increased use of anti-inflammatory drugs in the early phases of TB onset.

Comparative Study between Polymerase Chain Reaction and Different Rapid Tests for Detection of Mycobacterium Infection.

The objective of this work is to reach a sensitive and rapid method for the laboratory diagnosis of active tuberculosis disease in patients and latent TB infection in household contacts and healthy community controls. We recruited 86 subjects divided into 3 groups: Thirty six patients with suspected active TB (Twenty four suspected pulmonary TB cased and 12 suspected extrapulmonary TB cases). 28 household contacts of confirmed pulmonary TB patients and 22 healthy community controls. Methods: For diagnosis of active tuberculosis the following tests were evaluated: Ziehl-Neelsen (Z-N) staining and culture on Lownestein-Jensen (L-j), tuberculin skin test (TST), nested polymerase chain reaction (PCR) assay on separated peripheral blood mononuclear cells (PBMCs), antibody detection by Immunchromatographic test (ICT), and JFN assay by QuantiFERON TB Gold In-Tube method for diagnosis of latent tuberculosic the following tests were evaluated: TST and Quantiferon TB Gold (In-tube method). The results showed that in pulmonary TB group, TST was the most sensitive test (92.3%), while QFT-Gold IT plus ZN was the most sensitive combined test (100%). In extrapulmonary TB group, TST, nested PCR and QFT-Gold IT were the most sensitive single tests (75%) while QFT-Gold IT plus ZN was the most sensitive combines test (100%). For diagnosis of LTBI: QFT-Gold IT was as sensitive as the TST. TST was 54.5% specific, while QFT Gold-IT was 94.5% specific TST showed that the exposure in the contacts group increased the risk of infection in the contacts group 0.9 times more than the control group (OR, 0,9m 95% Cl, 0.25-3.22; P=0.85). by QFT-Gold IT, exposure increased the risk of infection in the contacts group 8.4 times more than the control group (OR, 8.4; 95% Cl, 0.9-195.63; P=0.028). In household contacts group the concordance between TST and QFT-Gold IT was poor (64.3%, with a k value of 0.230.18). In conclusion, using QFT-Gold IT plus ZN staining is very helpful in the diagnosis of active TB disease. For diagnosis of LTBl. QuantiFERON-TB Gold In-Tube method is more helpful than Tuberculin skin test.

The increased risk of active tuberculosis disease in patients with dermatomyositis - a nationwide retrospective cohort study.

The risk of active tuberculosis (TB) in patients with dermatomyositis (DM) is poorly understood. The cohort study aimed to investigate the association between DM and the risk of active TB disease. We conducted a population based study on 4,958 patients with newly diagnosed DM and 19,832 matched controls according to age, sex, and index date between 1998 and 2008. The hazard ratios (HRs) and cumulative incidences of active TB disease between DM patients and controls were analyzed. During the study period, a total of 85 (1.7%) DM patients developed active TB disease, which was significantly higher than that of non-DM patients (0.64%). The incidence rate of active TB disease was higher among DM patients than controls (incidence rate ratio 2.95; 95% confidence interval [CI], 2.24 to 3.88). The Cox regression model demonstrated significantly higher active TB disease rate among DM patients compared with controls (adjusted HR, 2.64; 95% CI, 1.97 to 3.54; p < 0.001) after adjusting for age, sex, and underlying medical disorders. The most significant risk factors for developing active TB included male sex, diabetes mellitus comorbidity, and use of corticosteroids and azathioprine in DM patients. In conclusion, DM patients are at a greater risk for active TB disease.

Tuberculosis in patients with haematological malignancies.

Tuberculosis (TB) is an infectious disease that causes more than 1 million deaths worldwide every year. In addition, it is estimated that one third of the world population is infected with M. tuberculosis in a latent state, which involves an eventual risk of progressing to active TB disease. Patients with immunodeficiencies, such as those suffering from haematological malignancies, have a greater risk of progressing to TB disease once infected. It is estimated that the Relative Risk of TB disease in patients with hematologic malignancies is 2–40 times that of the general population. The diagnosis of TB in these patients is often challenging as they often present clinical characteristics that are distinct to those of patients without any other underlying disease. Mortality due to TB is higher. Therefore, it is recommended to diagnose latent TB infection and consider preventive therapy that could avoid the progression from a latent state to active TB disease. There are currently two methods for diagnosing latent TB infection: the Tuberculin Skin Test (TST) and the Interferon-Gamma Release Assays (IGRA). Due to the lack of sensitivity in patients with immunodeficient conditions, a combined TST-IGRA testing is probably the best way for latent TB diagnosis in order to gain sensitivity. Treatment of latent TB infection and TB disease should follow the general principles to that in the general population.

Tuberculosis Otitis Media with Disseminated Tuberculosis in a Pregnant Female

Background: Tuberculosis remains a public health problem worldwide, and tuberculosis in pregnancy in particular can have effects on both mother and infant. Findings: We report a case of a 22- year-old female presenting in preterm labor at 32 weeks gestation. Her pregnancy had been complicated by hearing loss and weight loss, and at the time of delivery, she was diagnosed with tuberculous otitis media and disseminated tuberculosis. Tuberculous otitis media is a rare form of tuberculosis disease, and in this case, had consequences for mother and infant. Conclusions: Importance of suspicion for tuberculosis disease in patients presenting with atypical symptoms but epidemiologic history is emphasized.

Latent tuberculosis infection and active tuberculosis in patients with psoriasis: a study on the incidence of tuberculosis and the prevalence of latent tuberculosis disease in patients with moderate–severe psoriasis in Spain. BIOBADADERM registry

The incidence of tuberculosis (TB) or the prevalence of latent tuberculosis infection (LTBI) in psoriasis patients has not been described in the Spanish population. We carried out a study with the objectives: (i) To describe the incidence of TB in patients with psoriasis on systemic treatment in the Spanish population; (ii) To determine the prevalence of LTBI in patients who are candidates for biological treatment; and (iii) To investigate the level of compliance with current recommendations for LTBI and TB screening. Data were obtained from BIOBADADERM (Spanish registry for systemic biological and non-biological treatments in psoriasis). An analysis was performed of the exposed cohort to determine the prevalence of LTBI and to describe compliance with the screening guidelines. A total of 1425 patients were registered in BIOBADADERM. They included 793 (56%) patients exposed to biological treatment and 632 (44%) treated with conventional systemic drug. Overall follow-up was 3720 person-years. Of the 793, 20.5% (163) were diagnosed with LTBI before starting biological treatment. The rate of active TB for the exposed cohort was 145 cases × 100,000 patient-years (95% CI 54-389). No case of TB was found in the control group. Screening for LTBI was performed in 83% of the exposed sample. Patients with psoriasis who are exposed to biological treatment appear to be at greater risk for tuberculosis. In Spain, up to 20% of patients with psoriasis who are candidates for biological therapy have LTBI. There continues to be a significant percentage of errors in compliance with clinical guidelines.

Risk factors associated with pulmonary tuberculosis

Tuberculosis (TB) remains a global emergency and continues to kill 1.4 million people every year. The interaction between noncommunicable and infectious diseases like TB has important implications with regard to the attainment of the Millennium Development Goals (MDGs). Smoking, diabetes mellitus, anti-TNFα drugs and other immunosuppressive therapies are well known major risk factors associated with TB. The purpose of this review is to summarize the recent literature on these risk factors and interventions that reduce the risk. Mathematical models and aggregate data from the field show that smoking, diabetes and anti-TNFα drugs independently increase the risk of developing active TB. There is consensus on the great need for screening for active TB disease in patients with these conditions and targeted preventive interventions through a combined multidisciplinary approach. Smoking, diabetes mellitus, anti-TNFα drugs and new immunosuppressive treatments represent important common risk factors for TB. A high degree of clinical awareness of the possibility of TB should be considered in patients with these risk factors, and active screening and prevention should be undertaken. Further operational research is needed to optimize screening for latent Mycobacterium tuberculosis infection, instituting preventive intervention measures.

Comparison of Lung graphy and thorax computed tomography findings in children with Tuberculin skin test positive

Aim: Benefit of thorax computed tomography was investigated when lung graphy remains insufficient in the diagnosis of tuberculosis. Materials and Methods: 55 patients across children with tuberculin skin test (TST) positive nonspecific symptom who applied to the tuberculosis polyclinic of our hospital were investigated between ages of 0-18, determined positivity in their TST test or with tuberculosis contact story. Age, gender, complaining, TST results, existence/number of BCG scar, underlying disease, contact status, cigarette exposure, laboratory findings, Lung graphy and thorax CT findings of patients were compared. Results: Average age of cases was 110, 38±42, 8 months. Lung graphy results of 36.4% of cases were abnormal while 63.6% were normal. Results of 30.9% (n=17) were abnormal while 69.1% (n=38) of cases were normal. No compliance is observed between results of CT and Lung graphy (p<0.05). Lung graphy was found to have a low positive true diagnosis value, a higher negative true diagnosis value. A significant difference is observed between tuberculosis sighting case and scar numbers of BCG (p<0.05). Conclusion: Taking lung graphy and thorax CT is beneficial and significant in the investigation of tuberculosis disease in patients with positivity of tuberculin skin test. Computed tomography is more sensitive method in comparison to lung graphy in terms of all findings.

Risk of Tuberculosis in Dialysis Patients: A Nationwide Cohort Study

BackgroundThe ability to identify individuals at increased risk of developing tuberculosis (TB) has important implications for public health policy and patient care. We conducted a general population historical cohort study in all Australian States and Territories to establish the risk of TB arising in people on chronic hemo- or peritoneal dialysis.Methodology/Principal FindingsCases of TB disease in patients receiving chronic dialysis were identified by record linkage using the Australia & New Zealand Dialysis and Transplant Registry (ANZDATA) and State and Territory TB notification databases 2001 to 2006. Main outcome measure was the relative risk of TB in people on dialysis, adjusted for TB incidence in country of birth, sex, age and indigenous status. A total of 6,276 cases of active TB were reported among 19,855,283 people living in Australia between 2001 and 2006. Among 14,506 patients on dialysis, 37 had a notification for TB disease after commencing dialysis, of whom 28 were culture positive. The incidence of TB was 66.8/100,000/year (95% CI 47.7 to 93.2) among people on dialysis and 5.7/100,000/year (95% CI 5.5 to 5.8) in the general population. The adjusted relative risk (aRR) of TB in people on dialysis was 7.8 (95% CI 3.3 to 18.7), and the aRR of culture positive TB was 8.6 (95% CI 3.9 to 19.3).Conclusions/SignificancePatients on dialysis are at increased risk of TB. The final decision to screen for, and to treat, LTBI in individual dialysis patients will be influenced by a cumulative assessment of the risk of reactivation of TB and by assessment of risk factors for adverse effects of treatment.

Protease inhibitor-containing antiretroviral treatment and tuberculosis: can rifabutin fill the breach? [Review article

To assess how to best manage co-administration of rifabutin (RFB) and human immunodeficiency virus 1 (HIV-1) protease inhibitor (PI) containing antiretroviral treatment (ART). Recommended for initial anti-tuberculosis treatment, rifampicin (RMP) lowers PI concentrations below therapeutic levels, posing significant challenges for ART. As RFB has little effect on PI concentrations, it could be an alternative to RMP. A review of the scientific literature on the safety and efficacy of RFB for adult tuberculosis (TB) treatment was conducted, focusing on ART-TB co-therapy. A cost comparison was performed between treatment regimens, and estimates of the burden of TB disease in patients on ART were used to model RFB demand in low- and middle-income countries (LMICs). Eleven clinical studies were identified, comprising 1543 TB patients treated with RFB; 980 (64%) were living with HIV. RFB was as safe and effective as RMP, including in 313 patients receiving co-administered ART (unboosted PIs included indinavir, nelfinavir or saquinavir; a minority received ritonavir [RTV] boosted amprenavir or saquinavir). The total cost for 6 months of all HIV and TB treatment containing RTV-boosted lopinavir (LPV) and RFB is US$410, compared to US$455 if RMP is used with LPV super-boosted with RTV. Our model suggests that demand for RFB in LMICs could be between 10,000 and 18,000 courses by 2012. RFB is effective and safe in combination with the PIs studied, cost-saving for co-therapy with currently recommended boosted PIs, and may have a pivotal role in the roll-out of ART. Further research into a daily dose of RFB to simplify dosing regimens and developing fixed-dose combinations can enhance the public sector roll-out of ART.

Application of the systematized health education in nursing for pulmonary tuberculosis disease patients

Objective To study the clinical nursing experiences for pulmonary tuberculosis patients and explore the application value of the systematization health education for the nursing measures. Methods 40 cases of pulmonary tuberculosis were selected and randomly divided into the observation group and the control group, 20 cases for each group, the control group used conventional health nursing method, while the observation group implemented the systematized health education based on control group' s nursing foundation, through multiaspect education methods as well as system' s education content (in hospital, during hospitalization, discharge from hospital), all patients should be investigated the pulmonary tuberculosis disease knowledge situation 6 months before and after discharge from hospital. Results Through the systematized health education, compared to the control group, the observation group patients had significant higher improvement in understanding pulmonary tuberculosis knowledge, obeying the doctors'advices, and the latter 6-month-long clinical curative effect after discharge from hospital. Conclusion With the systematized health education carrying on the health education to pulmonary tuberculosis patients, we may not only enhance patients' understanding pulmonary tuberculosis knowledge rate, promoting their obeying the medicaladvice,but may also raise the cure rate and their degree of satisfaction. Key words: Pulmonary tuberculosis; Systematization; Health education; Nursing

Clinical evaluation for diagnosing active TB disease and transitional change of two commercial blood tests

We compared the usefulness of TST, QFT-TB and T-SPOT.TB for the identification of patients with active tuberculosis (TB) disease and investigated transitional change in both tests during anti-tuberculous treatment. The subjects were 50 healthy volunteers and 48 patients with active TB disease between October 2005 and December 2006. Among active TB disease patients, 60% had a positive TST result, 81% had a positive QFT-TB result, and 87% had a positive T-SPOT.TB result. Indeterminate results of QFT-TB and T-SPOT.TB were recognized in 12% and 6% of patients, respectively. Negative results on QFT-TB and T-SPOT.TB were 6% each. QFT-TB had a sensitivity of 81% for active TB disease. T-SPOT.TB had a sensitivity of 88% for active TB disease. With regard to transitional changes in QFT-TB results and T-SPOT.TB results, both test results showed a positive response in over 40% of patients 12 months after anti-tuberculous treatment. In conclusion, both blood assays seemed to be more useful than TST for the identification of patients with active TB disease. However, neither of the 2 blood tests appears to provide any certainty regarding the cure of infection.

The spectrum of tuberculosis in dialysis patients

Patients receiving dialysis therapy are known to be at increased risk of tuberculosis (TB). The aim of this study was to evaluate the frequency, clinical characteristics and course of TB disease in dialysis patients treated at our institution. Medical records of 330 regular haemodialysis (n=219) and continuous ambulatory peritoneal dialysis (n=111) patients (172 male, 158 female; mean age 55+/-16 y) who were cared for at our tertiary university hospital between December 2002 and January 2006 were retrospectively evaluated. Nine cases of TB (2.7%) occurred, in the following locations: vertebra (n=3), miliary (n=3), lymph nodes (n=1), peritoneum (n=2; one as peritionitis, 1 as an abscess). Four of these 9 patients died during the follow-up (mean time from diagnosis to death, 7 months); none of the deaths appeared to be caused by the disease itself. The incidence of TB disease in patients receiving renal replacement therapy is high, and occurs primarily in extrapulmonary sites.

Cellular immune responses to ESAT-6 discriminate between patients with pulmonary disease due to Mycobacterium avium complex and those with pulmonary disease due to Mycobacterium tuberculosis.

ESAT-6 (for 6-kDa early secreted antigenic target) is a secreted antigen found almost exclusively in organisms of the Mycobacterium tuberculosis complex. We compared in vitro gamma interferon (IFN-gamma) responses by peripheral blood mononuclear cells to this antigen in patients with pulmonary disease due to either Mycobacterium avium complex (MAC) or Mycobacterium tuberculosis with those in healthy, skin test-negative, control subjects. Significant IFN-gamma responses to ESAT-6 were detected in 16 (59%) of 27 M. tuberculosis pulmonary disease patients, 0 (0%) of 8 MAC disease patients, and 0 (0%) of 8 controls. Significant IFN-gamma responses to M. tuberculosis purified protein derivative were detected in 23 (85%) of 27 M. tuberculosis disease patients, 2 (25%) of 8 MAC disease patients, and 5 (63%) of 8 healthy controls. M. avium sensitin was recognized in 24 (89%) of 27 M. tuberculosis disease patients, 4 (50%) of 8 MAC disease patients, and 1 (13%) of 8 controls. IFN-gamma responses to ESAT-6 are specific for disease due to M. tuberculosis and are not observed in patients with MAC disease or in healthy controls.