Tuberculosis Exposure Research Articles

Tuberculosis Contact Investigations Conducted in New York City Adult Day Care and Senior Centers, 2011-2018.

Multiple tuberculosis (TB) exposures have been reported in New York City (NYC) adult day care and senior centers. Strategies to identify TB transmission at such locations are needed. Review of the NYC TB Registry identified 12 contact investigations (CIs) at adult day care or senior centers (2011-2018). Median age of the 12 index patients was 81 years. Of 148 contacts identified who had no history of TB infection or disease, 141 (95%) were tested for TB, primarily with interferon gamma release assays; 46 (33%) tested positive. Transmission was probable (n = 3) or possible (n = 1) at 4 (33%) centers; at all of these, the index patient had an acid-fast bacilli-positive sputum smear. Transmission was not found from index patients with negative sputum smears. We found evidence of transmission of smear-positive respiratory TB disease to contacts in adult day care or senior centers, underscoring the importance of CI.

PULMONARY EPITHELIOID HEMANGIOENDOTHELIOMA: CASE REPORT

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: We present a case of a 29-year-old female with an insidious clinical presentation. At first, it was thought to be an infectious disease, but it turned out to be a very rare neoplasm. CASE PRESENTATION: 29-year-old female with healthcare-related tuberculosis exposure for working as a nurse in an emergency service and homecare. She had a 2-month history of non-productive cough and progressive dyspnea, progressing from exertion to small effort dyspnea. She visited an emergency service where a chest x-ray was obtained. It showed multiple, diffuse, bilateral, micronodular radiopacities, therefore, being referred to a Respiratory Medicine Facility for further studies. On arrival, a High-Resolution Computed Tomography (HRCT) of the lungs was performed, which showed the previously mentioned nodules as well as interlobular septal thickening. A flexible video bronchoscopy (FBO) was then performed, obtaining specimens samples of bronchial lavage for AFB, PCR for M. tuberculosis and transbronchial biopsies. The first two were reported as “negative”, and the transbronchial biopsies reported “nodular and diffuse fibrosis”, therefore proceeding to a surgical biopsy, with the following findings: “generalized micronodular pattern and multiple nodules. A surgical specimen from lingula is obtained”. Histopathology reported: “Low-grade vascular neoplasm compatible, by morphology, with Epithelioid Hemangioendothelioma. Immunohistochemistry positive to CD31 and CD 34, and negative to Actin, CK and COCKTEL.” DISCUSSION: The suspicion of an infectious disease was based on clinical findings: A young woman from a tuberculosis endemic region in México, with an important tuberculosis exposure due to her work as a healthcare professional, a clinical condition of 2-month non-productive cough, and a HRCT with micronodular hyperdensities. At first glance, Miliary Tuberculosis was suspected and accordingly approached. All tests made in fiber-optic bronchoscopy were negative for Tuberculosis and Fungi. Afterward, when a surgical biopsy was performed a neoplasm was found. Oncology assessed the case and decided expectant follow up. The patient will maintain follow up every 3 months with an HRCT. In the event of progression or worsening of the symptoms, medical therapy will be started. CONCLUSIONS: The epithelioid hemangioendothelioma is a very rare low-grade sarcoma. It appears typically in young women, with an average age of 40 years. An insidious evolution if often present, with respiratory symptoms, nodules, usually under 1cm, and interlobular septal thickening in the HRCT. The treatment consists of chemotherapy, interleukin-2 and interferon alfa-2B. The average survival of this neoplasm is 4.6 years, varying between 12 months and 26 years. Reference #1: Cronin P, Arenberg D. Pulmonary Epithelioid Hemangioendothelioma An Unusual Case and a Review of the Literature. 2nd ed. CHEST; 2004. Reference #2: Rosengarten D, Kramer M, Amir G, Fuks L, Berkman N. Hemangioendothelioma Epithelioid Pulmonary. 13th ed. IMAJ, Israel Medical Association Journal; 2011. DISCLOSURES: No relevant relationships by Paloma Barajas, source=Web Response No relevant relationships by Luis Galindo, source=Web Response No relevant relationships by Maria del Carmen Lozano Cuevas, source=Web Response No relevant relationships by Alfredo Noyola Correa, source=Web Response

Tuberculosis Exposure and Conversion Rates Can Guide Deimplementation of Annual Tuberculosis Screening

Background: The CDC recently updated recommendations on tuberculosis (TB) screening in healthcare facilities, suggesting the discontinuation of annual TB screening. However, hospitals may opt to continue based on their local TB epidemiology. We assessed TB infection control parameters in our facility to guide the implementation of the new CDC recommendations. Methods:We retrieved data for patients with an International Classification of Disease, Tenth Revision (ICD-10) code for TB treated at the University of Iowa Hospitals and Clinics during 2016–2019. We supplemented our search with microbiology data: culture or PCR for Mycobacterium tuberculosis. Based on manual chart review, we adjudicated each patient as active TB, latent TB, previously treated TB, unclear history, or no TB. We further labeled active TB cases based on their risk of transmission (pulmonary or extrapulmonary cases that underwent an aerosol generating procedure). We then calculated the number of exposure events associated with those patients and tuberculin skin test (TST) conversion rates among the exposed. Results: During 2016–2019, we identified 197 patients based on ICD-10 codes. In total, 10 additional patients were detected by microbiology data review. Of these 207 patients, 48 (23.2%) had active TB: lung, n = 24 (50%); lymph node, n = 9 (19%); bone or spine, n = 5 (10%); eye, n = 3 (6%); disseminated, n = 2 (4%); pleura, n = 2 (4%); skin abscess, n = 2 (4%); and meningitis, n = 1 (2%). Of the 24 pulmonary patients, 6 (25%) had either a positive smear or a cavity on imaging. In total, 159 patients were excluded: no TB, n = 22 (14%); latent TB, n = 27 (17%); old or treated TB, n = 93 (58%); and unclear history, n = 9 (6%). Of the 48 cases with active TB, 31 (65%) were deemed potentially infectious. Also, 10 cases (32%) led to the exposure of 204 healthcare workers (HCWs). Baseline and postexposure TST were available for 179 HCWs (88%); 72 (35%) followed up in the employee health clinic within the 8–12 weeks after exposure. Of 161 HCWs with a negative TST at baseline, no conversions occurred. Of 18 HCWs with positive TST at baseline, no HCW developed symptoms during the observation period. Conclusions: Nearly one-third of infectious TB cases led to HCW exposures in a low-incidence setting. However, no TST conversions or active TB infections were seen. Exposure and conversion rates are useful indicators of TB infection control in healthcare facilities and may help guide implementation of the new CDC TB control recommendations.Funding: NoneDisclosures: None

S1481 Isolated Pancreatic Mass: A Unique Presentation of Tuberculosis

INTRODUCTION: Malignancy is often the culprit after discovery of an isolated pancreatic mass. It is important to consider other etiologies including infectious etiologies such as tuberculosis. CASE DESCRIPTION/METHODS: A 28 year old Vietnamese immigrant with no significant medical history presented with intermittent nausea and epigastric pain for several years that acutely worsened over two days. She reported the pain radiated to her back and was exacerbated by spicy foods. She denied any fevers, weight loss, or jaundice. Lipase and liver function tests were normal. CT imaging of the abdomen showed a 4cm heterogeneous hypodense pancreatic lesion but was otherwise normal (Figure 1a). EUS was notable for hypoechoic mass in the pancreatic head with irregular margins and no vascular invasion (Figure 1b). Fine needle aspiration cytology revealed granulomatous inflammation with extensive necrosis and negative AFB/GMS stains. Quantiferon Gold testing was positive and HIV testing was negative. Chest x-ray was normal. She had no prior history of tuberculosis and no known high risk exposures. Her immigration medical testing in 2012 was reportedly normal. In light of the pathologic and serologic findings, the patient was treated for isolated pancreatic tuberculosis with RIPE therapy. Her gastrointestinal symptoms resolved on therapy and follow-up CT imaging 6 months after completion of antibiotics showed complete resolution of the pancreatic mass. DISCUSSION: The gastrointestinal tract is the 6th most common site of extrapulmonary tuberculosis and is seen in only about 5% of all tuberculosis cases; the ileocecal region is involved in the majority of cases. Isolated pancreatic tuberculosis is considered an extremely rare entity since pancreatic enzymes usually destroy any intrusive pathogens. These patients are typically immunocompromised. Abdominal pain and jaundice are well-known symptoms but weight loss and fevers and also commonly seen. Imaging will show a hypodense mass without any biliary ductal dilation or vascular invasion. EUS with fine needle aspiration is done for initial investigation while excisional biopsy is the most accurate diagnostic tool. Patients tend to respond very well to antituberculosis therapy. We present a unique case of an immunocompetent patient with dyspeptic symptoms who had no prior personal history of tuberculosis or known high risk exposure and was found to have isolated pancreatic tuberculosis.Figure 1.: Figure 1a. Initial CT abdomen/pelvis showing a multilobulated heterogeneous pancreatic mass (red circle).Figure 2.: b. EUS findings notable for a 4 cm × 4 cm pancreatic head mass with irregular outer margins.

FATAL CAVITARY PULMONARY HISTOPLASMA CAPSULATUM IN AN ELDERLY IMMUNOCOMPETENT PATIENT

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Histoplasma Capsulatum (HC) infection can present with various manifestations, such as acute pulmonary infection, chronic cavitary lung disease, fibrosing or granulomatous mediastinitis and disseminated mycotic infection. Histoplasmosis is typically more serious in immunosuppressed patients. Disease is usually self-limited or subclinical in immunocompetent patients. Clinical presentation and prognosis of HC infection is variable. We hereby present a rare case which was fatal to an elderly immunocompetent host from an endemic area. CASE PRESENTATION: A 77-year-old Caucasian, long standing Ohio resident male, with past medical history significant for heavy tobacco and alcohol use, and hepatic cirrhosis, presented to the pulmonary clinic for follow up after numerous outside hospital admissions for pneumonia. Patient served in Vietnam, however he was not aware of previous tuberculosis infection or exposure. He had been treated with prolonged antibiotics course for suspected Acinetobacter infection. However, he subsequently presented with worsening dyspnea, fatigue, loss of appetite, and 80lb unintentional weight loss within a one-year period. CT chest revealed a large progressive left upper lobe necrotic cavitary lesion, diffuse bronchiectasis, tree-in-bud inflammatory pneumonitis, a new 1.7cm right middle lobe solitary pulmonary nodule and bilateral cavitary lesions. Initial concern was for invasive Aspergillus superimposed on past Acintetobacter baummanii infection. Bronchoalveolar lavage (BAL) from six months prior during one of his previous admissions was neutrophilic but negative for tuberculosis, fungi and malignancy. Repeat bronchoscopy with BAL of the left upper lobe was performed. HC was confirmed by DNA probe identification on the BAL growth. Immunodiffusion serological testing was positive for both H and M bands of HC. Histoplasma antibody complement fixation was positive (1:256) that suggested acute infection. HC urine antigen was also detected. These reflect advanced disease course. Unfortunately, patient died prior to initiation of treatment. DISCUSSION: Clinical presentation of HC is thought to be dependent on duration of exposure and host response. In this case, the prolonged clinical presentation suggests significant dormant progressive histoplasma disease in an immunocompetent host. Despite negative initial testing, patient subsequently tested positive HC. Unfortunately, this patient died prior to initiation of antifungal treatment. CONCLUSIONS: In conclusion, this case highlights the significance of assessing for cavitary HC infection even in immunocompetent older patients. Reference #1: Evrard S, Caprasse P, Gavage P, Vasbien M, Radermacher J, Hayette MP, et al. Disseminated histoplasmosis: case report and review of the literature. Acta Clin Belg. 2018;73(5):356-63. Reference #2: Staffolani S, Buonfrate D, Angheben A, Gobbi F, Giorli G, Guerriero M, et al. Acute histoplasmosis in immunocompetent travelers: a systematic review of literature. BMC Infect Dis. 2018;18(1):673 DISCLOSURES: No relevant relationships by Batool Abuhalimeh, source=Web Response No relevant relationships by Randall Harris, source=Web Response No relevant relationships by Tanya Marshall, source=Web Response No relevant relationships by Rami Sabri, source=Web Response

BCG vaccination: An update on current Australian practices.

The Bacille Calmette-Guérin (BCG) vaccine is primarily used to prevent tuberculosis (TB) infection and disease insettings with high TB incidence. The aim of this review article is to describe the current uses of BCG vaccination in Australia, including the indications and contraindications, efficacy and other off-target effects, and the role of the general practitioner. BCG vaccination in Australia is primarily used to prevent TB in neonates and children with a high risk of TB exposure. The BCG vaccine is most effective at preventing severe disseminated TB disease in young children and has variable efficacy in preventing adult disease. The BCG vaccine is usually well tolerated; however, given the small risk of adverse effects, vaccination should be undertaken by a practitioner experienced in its administration. When indicated, the BCG vaccine is available from specialist TB or travel medicine centres.

Association of gene polymorphisms and environmental factors in tuberculosis patients and their household contacts.

Tuberculosis (TB) is an important public health problem in China and environmental and genetic factors have an impact on its occurrence and development. We explored the relationship between environmental factors, genetic susceptibility genes and gene-environment interactions and the incidence of TB, as well as their high-risk combination, which can provide a scientific basis for prevention of the disease. The 242 individuals, which included 82 TB patients, 67 family genetically related patients and 93 healthy controls, all of whom were of the Han population in Guangdong Province. The basic information of subjects was collected, including general conditions, behaviour habits, family environmental factors and blood samples. Two single nucleotides with potential functions (interleukin-10 [IL-10] rs1800896, interferon-γ [IFN-γ] rs2430561) were screened by bioinformatics tools and identified by polymerase chain reaction-restriction fragment length polymorphism. We found that gender, education, TB exposure history, fitness activities, residential areas and indoor hygiene conditions were all associated with the occurrence of TB. In the dominant model, AG+GG of IL-10 and AA of IFN-γ are high-risk genotypes. Multifactor dimensionality reduction (MDR) analysis of TB-prone families shows that a combination of male sex, IL-10 AA and AG genotypes and smoking history are elements of high risk for TB infection (prediction accuracy 62.45%, cross-validation consistency 10/10). The MDR analysis of the TB patients group and the healthy control group showed that the combination of low education level, history of TB exposure, and IFN-γ AA genotype represented a higher risk of TB infection (prediction accuracy 80.34%, cross-validation consistency 10/10). The occurrence of TB in TB-prone families in the Han population of Guangdong Province is related to environmental factors as well as cytokines IL-10 and IFN-γ. We also found high-risk combinations of genes and environmental factors, providing clues for the timely detection of high-risk groups.

Nurse Practitioner Led Emergency Clinic for Nosocomial Tuberculosis Exposure in a Level 3 NICU.

This article describes the nurse practitioner (NP) led management of a possible nosocomial exposure of tuberculosis (TB) in a level 3 NICU in Toronto, Canada. 26 babies, premature and term, were identified as being at risk and multiple emergency clinics were set up to diagnose possible infection, prescribe window prophylaxis, and monitor for adverse effects to the medication. The NICU NPs were chosen to organize, co-ordinate, and manage these emergency clinics because of their skills in leadership, diagnosing, therapeutic management, and client relationship building. The clinic was able to achieve 100 percent follow up with each at risk baby, from initial assessment through to completion of window prophylaxis with negative tuberculin skin test. Some insight in to the decision making surrounding possible TB outbreak management is provided, and special considerations around therapeutic management specific to this population are discussed. This incident demonstrates how nurse practitioners can be utilized to provide high quality care, across multiple clinical situations, to meet the needs of the health care system.

Risk stratification and management of QuantiFERON-positive solid-organ living donors.

Donor-derived disease with Mycobacterium tuberculosis (MTB) is likely to become more common as donor pools expand due to increasing transplant volume coupled with patterns of migration and global mobility. Our article reviews the current literature and provides a rational approach for clinicians managing the scenario of a living donor who has epidemiologic risk factors for tuberculosis exposure. Tuberculous bacilli, formerly thought to exist latently only in pulmonary granulomas, are now known reside dormant in nonpulmonary organs. Kidney and liver grafts are thus vectors for donor transmitted MTB disease. Donors with elevated risk for latent MTB disease can be identified with tuberculin skin testing or IFN-γ release assay screening in combination with a thorough history to identify risk factors for latent disease. Living donors with an elevated risk for prior MTB exposure provide an opportunity to treat latent disease prior to organ procurement and reduce the risk of donor transmitted disease and secondary morbidity. Improved identification of these high-risk donors can reduce both the incidence of posttransplant MTB disease and the risk of allograft compromise associated with treatment of latent and active disease in posttransplant recipients.

A Randomized Controlled Trial of Isoniazid to Prevent Mycobacterium tuberculosis Infection in Kenyan Human Immunodeficiency Virus-Exposed Uninfected Infants.

Human immunodeficiency virus (HIV)-exposed uninfected (HEU) infants in endemic settings are at high risk of tuberculosis (TB). For infants, progression from primary Mycobacterium tuberculosis (Mtb) infection to TB disease can be rapid. We assessed whether isoniazid (INH) prevents primary Mtb infection. We conducted a randomized nonblinded controlled trial enrolling HEU infants 6 weeks of age without known TB exposure in Kenya. Participants were randomized (1:1) to 12 months of daily INH (10 mg/kg) vs no INH. Primary endpoint was Mtb infection at end of 12 months, assessed by interferon-γ release assay (QuantiFERON-TB Gold Plus) and/or tuberculin skin test (TST, added 6 months after first participant exit). Between 15 August 2016 and 6 June 2018, 416 infants were screened, with 300 (72%) randomized to INH or no INH (150 per arm); 2 were excluded due to HIV infection. Among 298 randomized HEU infants, 12-month retention was 96.3% (287/298), and 88.9% (265/298) had primary outcome data. Mtb infection prevalence at 12-month follow-up was 10.6% (28/265); 7.6% (10/132) in the INH arm and 13.5% (18/133) in the no INH arm (7.0 vs 13.4 per 100 person-years; hazard ratio, 0.53 [95% confidence interval {CI}, .24-1.14]; P = .11]), and driven primarily by TST positivity (8.6% [8/93] in INH and 18.1% [17/94] in no INH; relative risk, 0.48 [95% CI, .22-1.05]; P = .07). Frequency of severe adverse events was similar between arms (INH, 14.0% [21/150] vs no INH, 10.7% [16/150]; P = .38), with no INH-related adverse events. Further studies evaluating TB preventive therapy to prevent or delay primary Mtb infection in HEU and other high-risk infants are warranted. NCT02613169.

History of household member with tuberculosis or related death in newly diagnosed patients in India.

Among new smear-positive pulmonary tuberculosis (TB) patients aged ⩾15 years from marginalised populations in India, one in four had a history of a household member with TB and one in 10 had a TB-related death in the household. This contribution of household transmission to overall TB transmission provides evidence for a potential population-level benefit of TB preventive treatment for all household contacts (without active TB). Females with TB had a significantly higher household TB exposure than males. Targeted TB preventive treatment (if implemented in a phased manner) among female household contacts may be explored after considering other factors.

Prevalence of tuberculosis in migrant children in Switzerland and relevance of current screening guidelines.

Since 2016, Swiss guidelines recommend screening of all migrant children <5 years of age for tuberculosis (TB) and to screen older children only if they have risk factors for TB. Our goals were to describe the epidemiology of latent tuberculosis (LTBI) in migrant children at the Lausanne University Hospital, to identify determinants of LTBI and tuberculosis disease (TBD), and to evaluate the risk of a false-positive tuberculin skin test (TST) when using a positivity limit of 5 mm. Newly arrived migrant children 0–18 years of age were prospectively enrolled from 31 August 2015 to 31 August 2017. Every migrant child was assessed for the risk of TB exposure and TBD and was administered a TST. A TB-spot test was performed in children ≥5 years of age when the TST was positive. Children with clinical and/or radiological signs of TBD were further investigated. Children ≥5 years of age with a positive TB-spot test and children <5 years of age with a positive TST, without clinico-radiological signs of TBD received a diagnosis of LTBI. A false-positive TST result was diagnosed in children ≥5 years of age when the TB-spot test was negative. Potential determinants of TB (LTBI and TBD) and of false-positive TSTs were identified. Student’s t-test or the Kruskal-Wallis test were used for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. All variables with a p-value <0.05 were included in a multivariate logistic regression model. Two hundred and fifty-three patients were eligible for the study. The median age of the patients was 8.1 years (interquartile range [IQR] 4.5–12.8) and 104 (41%) were female. Twenty-four percent of the patients (62/253) came from a country with a moderate–high incidence of TBD (≥80 cases per 100,000 individuals). Twenty-eight patients (11%) had positive TSTs, and TB was confirmed in 17 (6.7%) of these patients (16 with LTBI and 1 with TBD). On multivariate analysis, moderate–high incidence of TBD in the country of origin (adjusted odds ratio [aOR] 18.8, 95% confidence interval [CI] 5.1–68.6; p <0.001), older age (aOR 1.1, 95% CI 1.0–1.3; p = 0.025), and contact with a TBD patient (aOR 8, 95% CI 1.8–36.2; p = 0.007) were associated with a diagnosis of TB. Among the 23 children over 5 years of age who had a positive TST with measurement available, a measure between 5–9 mm was more frequent in case of a false-positive TST (5/9, 56% vs 0/14, 0%, p = 0.002). BCG vaccination was the only predictor of a false-positive TST (p = 0.03). Screening migrant children ≥5 years of age for TB could confer a public health benefit even in the absence of other risk factors. The limit of TST positivity could be raised from ≥5 mm to ≥10 mm to decrease the rate of false-positive results. A national assessment of migrant children between the ages of 5 and 15 should be carried out to confirm our findings.

Incidence of and risk factors for tuberculosis among people with HIV on antiretroviral therapy in the United Kingdom.

Objective:The United Kingdom has a low tuberculosis incidence and earlier combination antiretroviral therapy (cART) is expected to have reduced incidence among people with HIV. Epidemiological patterns and risk factors for active tuberculosis were analysed over a 20-year period among people accessing HIV care at sites participating in the UK CHIC observational study.Design:Cohort analysis.Methods:Data were included for individuals over 15 years old attending for HIV care between 1996 and 2017 inclusive, with at least 3 months follow-up recorded. Incidence rates of new tuberculosis events were calculated and stratified by ethnicity (white/Black/other) as a proxy for tuberculosis exposure. Poisson regression models were used to determine the associations of calendar year, ethnicity and other potential risk factors after cART initiation.Results:Fifty-eight thousand seven hundred and seventy-six participants (26.3% women; 54.5% white, 32.0% Black, 13.5% other/unknown ethnicity; median (interquartile range) age 34 (29–42) years) were followed for 546 617 person-years. Seven hundred and four were treated for active tuberculosis [rate 1.3; 95% confidence interval (CI) 1.2–1.4/1000 person-years). Tuberculosis incidence decreased from 1.3 (1.2–1.5) to 0.6 (0.4–0.9)/1000 person-years from pre-2004 to 2011–2017. The decline among people of Black ethnicity was less steep than among those of white/other ethnicities, with incidence remaining high among Black participants in the latest period [2.1 (1.4–3.1)/1000 person-years]. Two hundred and eighty-three participants [191 (67%) Black African] had tuberculosis with viral load less than 50 copies/ml.Conclusion:Despite the known protective effect of cART against tuberculosis, a continuing disproportionately high incidence is seen among Black African people. Results support further interventions to prevent tuberculosis in this group.

Case-control study to evaluate the role of smoking, alcohol abuse, intravenous drug abuse, tobacco use and biomass fuel exposure as risk factor in pulmonary tuberculosis

Background: An association between smoking and tuberculosis disease has been shown in various studies, it is less clear to what extent smoking increases the risk of Mycobacterium tuberculosis infection. Therefore the aim of this study is to evaluate the role of smoking, alcohol abuse, intravenous drug abuse, tobacco use and biomass fuel exposure as a risk factor for the development of pulmonary tuberculosis.Methods: This is a case control study and total 200 subjects will be included with 100 sputum smear positive pulmonary tuberculosis cases and 100 age and sex matched healthy subjects as controls. Data collected from both cases and controls using a proforma by enquiring smoking habits, alcohol abuse, intravenous drug abuse, biomass fuel exposure and documenting chest X-ray features.Results: The study showed significant association between tuberculosis and smoking as a risk factor with beedi smoking, early age of starting smoking, increased duration and quantity of smoking increases risk for tuberculosis. There was significant association between intravenous drug abuse, biomass fuel exposure and risk of tuberculosis. There was no significant association in the study between alcohol abuse, tobacco chewing and tuberculosis, but heavy drinking and tuberculosis showed significant association. The study also showed significant association of cavitary lesion with smoking.Conclusions: There is significant association between smoking, intravenous drug abuse, biomass fuel exposure and tuberculosis, since these risk factors impairs host immune defences that allows the development of active tuberculosis.

Tuberculosis Infection in Women of Reproductive Age: A Cross-sectional Study at Antenatal Care Clinics in an Ethiopian City.

BackgroundKnowledge on tuberculosis (TB) infection epidemiology in women of reproductive age living in TB-endemic areas is limited. We used a composite definition of TB infection in a cohort of pregnant women recruited in an Ethiopian city as a model for TB exposure patterns, and to identify factors associated with TB infection. MethodsWomen seeking antenatal care at public health facilities underwent structured interviews, physical examination, and QuantiFERON-TB Gold-Plus (QFT) testing. Women with symptoms compatible with TB disease, and all human immunodeficiency virus (HIV)–positive women, were investigated for active TB by sputum bacteriological testing. TB infection (TB+) was defined as either positive QFT (≥ 0.35 IU/mL), self-reported previous active TB, or current active TB. Associations between TB infection and clinical, demographic, and socioeconomic characteristics were tested in multiple logistic regression analysis.ResultsAmong 1834 participants, 679 (37.0%) met criteria for TB+ (80 [4.4%] previous active TB, 5 [0.3%] current active TB, and 594 [32.4%] QFT-positive without previous or current active TB). Age (annual adjusted odds ratio [AOR], 1.069 [95% confidence interval {CI}, 1.045–1.093]) and HIV infection (AOR, 1.43 [95% CI, 1.033–1.988]) were independently associated with TB+. The relationship with increasing age was only observed in HIV-negative women, and translated to an estimated annual risk of TB infection of 2.1% in HIV-negative women.ConclusionsTB infection in women of reproductive age in Ethiopia was independently associated with HIV infection and increasing age, suggesting exposure to contagious TB and continuous acquisition of TB infection in this population.

Cellular immunity evaluation of five mycobacterium tuberculosis recombinant proteins and their compositions

Objective: The cellular immunity of 5 Mycobacterium tuberculosis recombinant proteins and their compositions was evaluated. Method: A total of 88 fresh venous blood from peripheral heparin anticoagulant population, 42 of which were from tuberculosis patients treated by The Tuberculosis Prevention and Treatment Center of Changping District, Beijing, and 46 of healthy volunteers were provided by the Infection Diseases of Chinese Center for Disease Control and Prevention. Healthy volunteers without a history of tuberculosis exposure and any clinical signs and symptoms. Using the Mycobacterium tuberculosis standard strain H37Rv DNA as a template, complete genes of the selected 5 recombinant proteins Rv3874, Rv3875, Rv2031c, Rv1411c and Rv3418c by PCR amplified; 5 recombinant proteins were cloned, expressed and purified as stimulants by genetic recombination and protein purification techniques, and the effector T cell enzyme-linked immunospot assay (ELISPOT) was used to detect cellular immunity in the population. Results: The recombinant proteins Rv3874, Rv3875, Rv2031c, Rv1411c and Rv3418c were successfully cloned, expressed and purified; And the sensitivities were 50.00%, 71.43%, 69.04%, 73.81% and 76.19%, and the specificities were 86.96%, 76.09%, 71.74%, 39.13% and 36.96%. In addition, the positive predictive value, negative predictive value, area under the curve and Youden index were 52.46% to 77.78%, 62.96% to 74.47%, 0.511 to 0.754 and 0.129 to 0.475, respectively. Except for Rv1411c and Rv3418c, the number of spot-forming cell (SFC) detected by Rv3874, Rv3875 and Rv2031c in tuberculosis patients was higher than healthy volunteers, and the differences were statistically significant (P<0.001). Among the 26 compositions composed of 5 recombinant proteins, the sensitivity was 80.95% to 95.24%, and the specificity was 68.89% to 24.44%. As the number of recombinant proteins in the composition increases, the sensitivity gradually increased, but the specificity decreased. Conclusion: The recombinant proteins of Mycobacterium tuberculosis Rv3874, Rv3875 and Rv2031c have strong ability to stimulate T cells to produce immune response, and have certain antigenicity. The efficacy of Rv1411c and Rv3418c alone as diagnostic antigens is not ideal, and the composition composed of multi-component antigens has certain application value. This article provides experimental evidence for the immune diagnosis of tuberculosis and the preparation of new anti-tuberculosis vaccines.

A Neighbor-Based Approach to Identify Tuberculosis Exposure, the Kopanyo Study.

Contact investigation is one public health measure used to prevent tuberculosis by identifying and treating persons exposed to Mycobacterium tuberculosis. Contact investigations are a major tenet of global tuberculosis elimination efforts, but for many reasons remain ineffective. We describe a novel neighbor-based approach to reframe contact investigations.

Risk Factors for Adverse Events in Household Contacts Prescribed Preventive Treatment for Drug-resistant Tuberculosis Exposure.

Completion of tuberculosis (TB) preventive treatment is important to optimize efficacy; treatment-related adverse events (AEs) sometimes result in discontinuation. This study describes the occurrence of AEs and their risk factors during a 6-month, 2-drug, fluoroquinolone-based preventive treatment for household contacts of patients with drug-resistant TB in Karachi, Pakistan. The primary outcome was development of any clinical AE during preventive treatment. Adverse events were categorized using the AE grading tables of the National Institutes of Health. Time-to-event analysis with Kaplan-Meier curves and Cox proportional hazards models accounting for recurrence were used to analyze associated risk factors. Of the 172 household contacts on preventive treatment, 36 (21%) developed 64 AEs during 813 months of treatment. The incidence of AEs over 6 months of treatment was 7.9 per 100 person-months; 16 per 100 person-months with a fluoroquinolone and ethionamide, and 4.4 per 100 person-months with a fluoroquinolone and ethambutol. There were 53 (83%) grade 1 and 11 grade 2 AEs, with no grade 3 or 4 AEs. In multivariable analysis, the risk of AEs was higher in contacts prescribed ethionamide as compared to ethambutol adjusting for age, sex, and body mass index (adjusted hazard ratio, 2.1 [95% confidence interval {CI}, 1.2-3.6]). Overall, there was no notable difference in treatment completion among the contacts who experienced an AE and those who did not (crude odds ratio, 1.1 [95% CI, .52-2.5]). A fluoroquinolone-based preventive treatment regimen for drug-resistant TB exposure is well tolerated. Regimens with ethionamide are more likely to result in AEs.

Employees' knowledge and practices on occupational exposure to tuberculosis at specialised tuberculosis hospitals in South Africa.

BackgroundTo prevent the spread of infection of tuberculosis (TB), sufficient knowledge and safe practices regarding occupational exposure are crucial for all employees working in TB hospitals.ObjectivesTo explore and describe the knowledge and practices of employees working in three specialised TB hospitals in Nelson Mandela Bay, Eastern Cape, regarding occupational exposure to TB.MethodsA quantitative, descriptive and contextual study was conducted using convenience sampling to have 181 employees at the three hospitals elected to complete the self-administered questionnaire, which was distributed in December 2016. Three scores on a scale of 0–10 were calculated per participant: knowledge, personal practice and institutional practice. Descriptive and inferential statistics were utilised.ResultsApproximately, one-third (34%) of the participants were between the ages of 36 and 45 years. Most of the participants (63%) attended high school and less than one-third (28%) had a tertiary qualification. The majority of participants (62%) had not received any clinical training. Participants displayed high scores (> 6) for knowledge (75%; mean = 6.65), personal practice (68%; mean = 6.12) and institutional practice (51%; mean = 6.15). The correlation between knowledge and personal practice was found to be non-significant (r = 0.033). An analysis of variance revealed that Knowledge is significantly related to age and education level.ConclusionEmployees’ knowledge regarding occupational TB exposure was generally high, but they were not necessarily practicing what they knew. Further research is required regarding appropriate managerial interventions to ensure that employees’ practices improve, which should reduce the risk of occupational TB exposure.

No time to waste: preventing tuberculosis in children

Tuberculosis takes the life of one in five children developing the disease. 1 WHOGlobal tuberculosis report: 2019. World Health Organization, Geneva2019 Google Scholar Data from the pre-chemotherapy era suggest very young children are at highest risk for tuberculosis after exposure, and highly susceptible to the most severe forms of the disease. 2 WHOLatent tuberculosis infection: updated and consolidated guidelines for programmatic management. World Health Organization, Geneva2018 Google Scholar , 3 Marais BJ Gie RP Schaaf HS et al. The clinical epidemiology of childhood pulmonary tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis. 2004; 8: 278-285 PubMed Google Scholar As a result, tuberculosis control efforts among children in high-burden countries are focused on those below 5 years of age. 2 WHOLatent tuberculosis infection: updated and consolidated guidelines for programmatic management. World Health Organization, Geneva2018 Google Scholar One of the most important efforts is provision of tuberculosis preventive therapy after tuberculosis exposure, yet only one in four children below 5 years of age who might benefit from life-saving preventive therapy will receive it. 1 WHOGlobal tuberculosis report: 2019. World Health Organization, Geneva2019 Google Scholar In resource-constrained high-burden countries, fewer than 1% of children at least 5 years of age receive preventive therapy. 1 WHOGlobal tuberculosis report: 2019. World Health Organization, Geneva2019 Google Scholar The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysisThe risk of developing tuberculosis among exposed infants and young children is very high. Most cases occurred within weeks of contact investigation initiation and might not be preventable through prophylaxis. This suggests that alternative strategies for prevention are needed, such as earlier initiation of preventive therapy through rapid diagnosis of adult cases or community-wide screening approaches. Full-Text PDF