Tuberculosis Infection In Patients Research Articles

Mycobacterium tuberculosis complex bacteremia among HIV and non-HIV patients in a Mexican tertiary care center

ObjectivesTo determine the factors associated with Mycobacterium tuberculosis complex-positive blood culture. MethodsCase-control study. Sociodemographic, clinical and laboratory data were collected from 2000 to 2015. ResultsWe reviewed medical records of 533 patients with culture-proven tuberculosis, of whom 27.2% (145/533) had blood culture available. Patients with mycobacteremia presented more frequently with abdominal tuberculosis, body mass index <18kg/m2, and had lower hemoglobin and albumin levels. No differences were observed regarding HIV status. ConclusionsFew studies have reported on the characteristics associated with Mycobacterium tuberculosis complex bacteremia, especially among Human Immunodeficiency Virus-negative patients. Out of 145 tuberculosis-infected patients with blood culture results available, 21 turned out positive. Anemia, hypoalbuminemia, and a body mass index<18kg/m2 were associated with mycobacteremia.

Screening for latent tuberculosis infection in patients who are candidate for biological therapies in Spain? A multidisciplinary survey

IntroductionTreatment with biological therapies increases the incidence of tuberculous disease. The introduction of systematic screening for latent tuberculosis infection in patients who are to receive these therapies has reduced this risk. In 2016, the consensus document on the prevention and treatment of tuberculosis in patients who are candidates for biological treatment was published in Spain. The main objective of this study was to evaluate adherence to these guidelines. MethodsMulticenter, descriptive, observational study via an anonymous online survey sent to medical societies involved in biologics. ResultsWe received 747 responses. Most respondents performed screening at the right time in the right patients (93.7%). Only 36.6% of respondents requested the appropriate diagnostic test, while 56.3% correctly recommended chemoprophylaxis. Up to 96% were familiar with the recommended chemoprophylaxis regimens, while only 63.9% initiated them at the right time. The specialist area that participated most and screened most patients for latent tuberculosis infection was rheumatology (54%). In most cases, pulmonologists were involved in an advisory capacity. ConclusionsThis study shows poor overall adherence to recommendations, with only 56% of respondents reporting appropriate compliance. The incidence of tuberculous disease in patients who are to receive biological therapies could be reduced further by emphasizing the importance of the right diagnostic test and use of the diagnostic algorithm for latent tuberculosis infection.

Etiologic agents of lower respiratory tract infections among patients attending tuberculosis clinic in Benin City, Nigeria

The emergence of HIV has reawakened the tuberculosis (TB) scourge and infected patients are prone to opportunistic infections, this study was carried out to determine the HIV status and etiologic agents of Lower respiratory tract infections (LRTI) among tuberculosis suspected patients in Benin City, Nigeria. The study was cross sectional. A total of 276 patients attending tuberculosis clinic were recruited. Questionnaires were filled for each patient. Blood and sputum specimens were collected in plain and sterile containers respectively and transported immediately to the laboratory. Blood samples were screened for the presence of HIV antibodies. The sputum specimens were then cultured following standard microbiological procedure, and thereafter processed using the GeneXpert MTB/RIF assay. Emergent bacterial colonies were identified and susceptibility testing was carried out following standard microbiological techniques. A total of 118 (42.8%) non-mycobacterial bacterial agents were recovered from the patients. Patients were more likely to be culture positive for LRTI in comparison with TB infection (p < 0.0001). There was no association between TB and HIV status (OR = 0.6161, 95%CI = 0.226, 1.648, p = 0.4474). HIV positive patients were more likely to be culture positive for bacterial agents and Klebsiella pneumoniae was more likely to be recovered (p = 0.0338). The fluoroquinolones, gentamicin and ceftriaxone-sulbactam were the most active antibacterial agents against bacterial isolates. The prevalence of LRTI in this study was 52.2%. The study draws attention on the need for physicians to request for bacteriological culture (non-mycobacterial) alongside the TB diagnostic algorithm in suspected TB cases. Keywords: Tuberculosis, HIV, opportunistic infections, patients, bacteria

Early tuberculosis infection in patients with severe aplastic anemia after antithymocyte globulin therapy: two cases report and literatures review

Early tuberculosis infection in patients with severe aplastic anemia after antithymocyte globulin therapy: two cases report and literatures review

TST, QuantiFERON-TB Gold test and T-SPOT.TB test for detecting latent tuberculosis infection in patients with rheumatic disease prior to anti-TNF therapy.

Before starting tumour necrosis factor (TNF)-α blocking agents, standard tests should be used for the diagnosis of tuberculosis infection. The specificity of traditional tuberculin skin test (TST) is low in immunosuppressed patients due to prior Bacille Calmette Guérin (BCG) vaccination, non-tuberculous mycobacteria infections, false positive and negative results. In this study, we aimed to compare TST and Interferon-Gamma Release Assay (IGRA) tests for detecting latent tuberculosis infection in patients with rheumatic disease planned to receive TNF-α blocking agents. One hundred and nine patients (45 male, 64 female) with the diagnosis of rheumatoid arthritis (RA) (n= 70) and ankylosing spondylitis (AS) (n= 39) were included in the study. Age, sex, number of BCG scar, results of TST (using the Mantoux method), QuantiFERON-TB Gold test and T-SPOT.TB test were recorded for all patients. Correlation between the tests was assessed by Pearson correlation coefficient. The mean age of RA and AS patients were 50 ± 13 (19-78 years). The prevalence of latent tuberculosis was 43.1% for TST, 39.4% for QuantiFERON-TB Gold test and 13.8% for T-SPOT.TB test, compared with the evaluation using the composite criteria such as close contact with active tuberculosis infection and/or suspicious fibrotic/calcific lesions on chest X-Ray without active tuberculosis infection. There was a moderate correlation between BCG scar number and TST (p< 0.001, r= 0.495), T-SPOT.TB test and QuantiFERON-TB Gold test (p= 0.007, r= 0.406), T-SPOT.TB test and composite criteria (p= 0.024, r= 0.343). The specificity of QuantiFERON-TB Gold test was 85.7%, and sensitivity was 73.9% for all patients with rheumatic disease. It was 73.5% and 66.7% for T-SPOT.TB test, respectively. The specificity of TST was 60.3% and sensitivity was 47.8% for TST. IGRA tests are not affected prior vaccination and useful for detecting latent tuberculosis infection in patients treated with corticosteroid due to lack of correlation between test negativity and corticosteroid therapy. Also, they are useful tests for diagnosis of latent tuberculosis infection as an alternative to TST due to their specificity and sensitivity.

¿Cómo realizamos el cribado de infección tuberculosa latente en pacientes candidatos a terapias biológicas en España? Una encuesta multidisciplinar

IntroductionTreatment with biological therapies increases the incidence of tuberculous disease. The introduction of systematic screening for latent tuberculosis infection in patients who are to receive these therapies has reduced this risk. In 2016, the consensus document on the prevention and treatment of tuberculosis in patients who are candidates for biological treatment was published in Spain. The main objective of this study was to evaluate adherence to these guidelines. MethodsMulticenter, descriptive, observational study via an anonymous online survey sent to medical societies involved in biologics. ResultsWe received 747 responses. Most respondents performed screening at the right time in the right patients (93.7%). Only 36.6% of respondents requested the appropriate diagnostic test, while 56.3% correctly recommended chemoprophylaxis. Up to 96% were familiar with the recommended chemoprophylaxis regimens, while only 63.9% initiated them at the right time. The specialist area that participated most and screened most patients for latent tuberculosis infection was rheumatology (54%). In most cases, pulmonologists were involved in an advisory capacity. ConclusionsThis study shows poor overall adherence to recommendations, with only 56% of respondents reporting appropriate compliance. The incidence of tuberculous disease in patients who are to receive biological therapies could be reduced further by emphasizing the importance of the right diagnostic test and use of the diagnostic algorithm for latent tuberculosis infection.

The Global Burden of Acquired Immune Deficiency Syndrome (AIDS) in Tuberculosis Infected Patients and Related Financial Aspects

The acquired immune deficiency syndrome (AIDS) is an infectious disease caused by human immunodeficiency virus (HIV). Approximately about 37 million people are infected by this virus with the rate of 1.2 million deaths per year. The mortality rate is high among HIV infected patients in the first 6 months of treatment.1 Immune deficient cases are at the high risk of any opportunistic infection. AIDS has been closely linked with tuberculosis (TB) disease, so almost one third of total mortality is related to this co-infection. In this regard, tuberculosis is used as a diagnostic index for AIDS.2 AIDS is not only associated with high mortality and morbidity, but it affects social life with related stresses and anxieties.3 Considering vast influence of HIV-TB over peoples’ lives, the present study aimed to estimate direct global burden of HIV infection on the patients with TB in a one-year period in 2014.

Outcomes of Treatment for Latent Tuberculosis Infection in Patients With Inflammatory Bowel Disease Receiving Biologic Therapy.

Treatment for latent tuberculosis infection (LTBI) is of particular concern in patients with inflammatory bowel disease (IBD) initiating biologic therapies to prevent tuberculosis (TB) reactivation. This study aimed to evaluate the effectiveness of LTBI treatment in IBD patients receiving biologic therapy. There was a retrospective review of all IBD patients diagnosed with LTBI following a tuberculin skin test (TST) and/or interferon gamma release assay (IGRA) and who received biologic therapy between 2002 and 2016. The primary outcome was tuberculosis reactivation after completion of LTBI treatment. Three-hundred twenty-nine IBD patients were identified, and 35 (27 Crohn's disease; 8 ulcerative colitis) met the study inclusion criteria. The mean age was 38.3 years, and 68.6% were male. The most common LTBI treatment regimen was isoniazid (INH) for 9 months (74%). Biologic therapies used were infliximab (40%), adalimumab (29%), vedolizumab (20%), and certolizumab pegol (11%). Combination therapy with an immunomodulator was administered in 57% of cases. The median time from initiation of LTBI treatment to biologics was 43 days. The mean duration of follow-up was 2.9 years. The estimated median annual risk of TB reactivation without treatment was 0.52% by a prediction formula. Only 1 patient taking adalimumab monotherapy developed reactivation of TB several years after completing 6 months of isoniazid therapy. The estimated TB reactivation rate was 0.98 cases per 100 patient-years of follow-up in our cohort. Treatment for LTBI in patients with IBD treated with biologics is effective but does not eliminate the risk of reactivation. 10.1093/ibd/izy133_video1izy133.video15776720675001.

Knowledge, attitude and perception of tuberculosis management among tuberculosis-infected patients in resource constraint setting: field experience from Oyo state, South-West, Nigeria

Background: Inadequate knowledge and misconceptions about tuberculosis (TB) contribute to the burden of the disease by influencing patients’ behavior and attitude towards the disease and undermining infection control efforts. This study assesses the level of knowledge, attitude and perception of TB and its management among TB-infected patients.Methods: A descriptive cross-sectional was used to interview 712 TB patients using a semi-structured questionnaire between June and October 2016. Bivariate and multivariate analyses were performed with SPSS version 20.Results: About 70% had a good knowledge of TB. Patients’ perception of stigma was high (37.5%). A high proportion of the patients had a poor perception of their illness (88%). Healthcare workers attitude was rated as satisfactory by 97.2% of respondents. Patients who had good knowledge about TB experienced high self-stigma (42%) compared to those who had poor knowledge (27.2%), p&lt;0.05. Poor knowledge of TB was highest among relapse TB cases. Respondents with poor TB knowledge were less likely to be male (OR: 0.66; 95% CI: 0.46, 0.95), married (OR: 0.24; 95% CI: 0.10, 0.55; p=0.001) and have tertiary education (OR: 0.06; CI: 0.37, 0.87; p=0.010). Patients with good knowledge about HIV and in the richest wealth status were 91% less likely to have high perceived stigma (OR: 0.09, 95%CI: 0.02, 0.35; p=0.001).Conclusions: The level of knowledge of TB among patients is satisfactory, however perception of illness is poor. Tuberculosis diagnosis can create self-stigma because of the fear of being isolated and discriminated which may determine the success of treatment.

Prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya

BackgroundThe double burden of diabetes mellitus (DM) and pulmonary tuberculosis (TB) is one of the global health challenges. Studies done in different parts of the world indicate that 12%-44% of TB disease is associated with DM. In Kenya TB-DM co-morbidity data is scarce and is not readily available. In this study we set to determine the difference in treatment outcomes among TB and TB/DM comorbidity patients and their respective clinical and socio-demographic characteristics. ObjectiveTo determine prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya. MethodsWe carried out a prospective cohort study of non-pregnant patients aged 15 years and above that tested positive for TB in two peri‑urban counties in Kenya between February 2014 and August 2015. Clinical and socio demographic data were obtained from a questionnaire and medical records of the National TB program patient data base at two, three, five and six months. The data consisted of TB status, HIV status, TB lineage, County, (Glucose, %HbA1c, creatinine) weight, height, BMI, regimen, sex, level of education, employment status, distance from health facility, number of cigarettes smoked, home size, and diet. Univariate analysis was then used to compare each potential risk factor in the TB and TB/DM patients by the Pearson x2 test of proportions or fisher exact test, as appropriate. ResultsDM prevalence (HbA1c > 6%) among TB infected patients was 37.2%. Regimen, employment status, alcohol intake, smoking, age and household size were some of the factors associated with DM among TB patients at p-value < 0.05. The number of cigarettes smoked per day and the value of the BUN were significant risk factors of developing DM among TB patients (p values = 0.045). Mean time to conversion from positive to negative was slightly higher for the TB-DM patients compared to the TB patents, though not statistically significant (p = 0.365). ConclusionPatients regimen, employment status, alcohol intake, smoking, age and are associated with DM among TB patients.

Rates of latent tuberculosis infection in patients treated with TNF inhibitors for psoriasis: a retrospective chart review

Background: Although tuberculosis screening guidelines for psoriasis patients on TNF inhibitors exist, few studies have reported the prevalence of latent tuberculosis infection (LTBI) and conversion rates in this population.Objective: To determine the incidence of LTBI and active tuberculosis in patients with psoriasis receiving TNF inhibitor therapy.Methods: A total of 138 patients were included in our retrospective study of patients treated from September 2004 to September 2017. Tuberculin skin test was considered positive with an induration of greater than 5 mm. History of Bacillus Calmette-Guérin vaccination, follow-up tests and prophylaxis were recorded.Results: Among 99 biologic-naïve patients, 14 had LTBI before starting biologic therapy and five developed LTBI during TNF inhibitor therapy. One biologic-naïve patient developed LTBI, then active tuberculosis. Among 39 non-biologic-naïve patients, three had LTBI before starting any biologic therapy, and one developed LTBI during treatment.Limitations: Limitations include small sample size and limited information documented in the medical chart.Conclusions: LTBI appears to be prevalent among psoriasis patients. Screening for LTBI in patients on biologics may reduce risk of active tuberculosis; however, current methods may not be fully effective. Clinicians may need to use other tools including risk factor assessment to fully evaluate risk.

Recent advances of imidazole-containing derivatives as anti-tubercular agents

Tuberculosis still remains one of the most common, communicable, and leading deadliest diseases known to mankind throughout the world. Drug-resistance in Mycobacterium tuberculosis which threatens to worsen the global tuberculosis epidemic has caused great concern in recent years. To overcome the resistance, the development of new drugs with novel mechanisms of actions is of great importance. Imidazole-containing derivatives endow with various biological properties, and some of them demonstrated excellent anti-tubercular activity. As the most emblematic example, 4-nitroimidazole delamanid has already received approval for treatment of multidrug-resistant tuberculosis infected patients. Thus, imidazole-containing derivatives have caused great interests in discovery of new anti-tubercular agents. Numerous of imidazole-containing derivatives were synthesized and screened for their in vitro and in vivo anti-mycobacterial activities against both drug-sensitive and drug-resistant Mycobacterium tuberculosis pathogens. This review aims to outline the recent advances of imidazole-containing derivatives as anti-tubercular agents, and summarize the structure-activity relationship of these derivatives. The enriched structure-activity relationship may pave the way for the further rational development of imidazole-containing derivatives as anti-tubercular agents.

Household contact non-attendance of clinical evaluation for tuberculosis: a pilot study in a high burden district in South Africa

BackgroundIn 2012, the World Health Organization launched guidelines for systematically investigating contacts of persons with infectious tuberculosis (TB) in low- and middle-income countries. As such, it is necessary to understand factors that would influence successful scale-up. This study targeted household contacts of newly-diagnosed infectious TB patients in the Mangaung Metropolitan district to explore factors associated with non-attendance of clinical evaluation.MethodIn September–October 2016, a pilot study of household contacts was conducted. At each of the 40 primary health care (PHC) facilities in the district, at least one out of four types of TB index cases were purposefully selected. These included children <5 years, smear-positive cases, HIV co-infected cases, and multidrug-resistant TB (MDR-TB) cases. Trained fieldworkers administered questionnaires and screened contacts for TB symptoms. Those with TB symptoms as well as children <5 years were referred for clinical evaluation at the nearest PHC facility. Contacts’ socio-demographic and clinical characteristics, TB knowledge and perception about TB-related discrimination are described. Logistic regression analysis was used to investigate factors associated with non-attendance of clinical evaluation.ResultsOut of the 259 participants, approximately three in every five (59.5%) were female. The median age was 20 (interquartile range: 8–41) years. While the large majority (87.3%) of adult contacts correctly described TB aetiology, almost three in every five (59.9%) thought that it was hereditary, and almost two-thirds (65.5%) believed that it could be cured by herbal medicine. About one-fifth (22.9%) of contacts believed that TB patients were subjected to discrimination. Two in every five (39.4%) contacts were referred for clinical evaluation of whom more than half (52.9%) did not attend the clinic. Non-attendance was significantly associated with inter alia male gender (AOR: 3.4; CI: 1.11–10.24), prior TB diagnosis (AOR: 5.6; CI: 1.13–27.90) and sharing of a bedroom with the index case (AOR: 3.4: CI: 1.07–10.59).ConclusionThe pilot study identified gaps in household contacts’ knowledge of TB. Further research on important individual, clinical and structural factors that can influence and should be considered in the planning, implementation and scale-up of household contact TB investigation is warranted.

Mathematical model and intervention strategies for mitigating tuberculosis in the Philippines

Tuberculosis (TB) is the sixth leading cause of morbidity and mortality in the Philippines. Although significant progress has been made in the detection and cure of TB under the Directly Observed Treatment Short Course, battling against the disease is still a burdensome task. It demands a concerted effort for specific and effective interventions. In this work, a mathematical TB model fitted to the Philippine data is developed to understand its transmission dynamics. Different control strategies such as distancing, latent case finding, case holding, active case finding controls, and combinations thereof are investigated within the framework of optimal control theory. This study proposes optimal control strategies for reducing the number of high-risk latent and infectious TB patients with minimum intervention implementation costs. Results suggest that distancing control is the most efficient control strategy when a single intervention is utilized. However, full scale employment of the distancing control measure is a daunting task. This burden can be circumvented by the combination of other control interventions. Our noble finding in this study is that enhancing active case finding control instead of case holding control together with distancing and latent case finding control is shown to have significant potential for curtailing the spread of TB in the Philippines.

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 1: risk assessment.

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised 2 parts: risk of TB infection Recommendaduring anti-TNF therapy, and screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 2: management.

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised 3 parts: management of latent TB in preparation for anti-TNF therapy, monitoring during anti-TNF therapy, and management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Screening for Latent Tuberculosis Infection in Patients with Autoimmune Diseases Before Initiating TNF-α Inhibitors Therapy.

Introduction:QFT-GIT is more sensitive than TST in patients under immunosuppressive therapy, but TST detects more cases of LTBI. TST remains an inexpensive test worldwide, which does not need laboratory equipment.Material and Methods:Overall, 457 patients having autoimmune diseases were referred. Of those referred, 158 patients were screened with QFT-GIT and TST. No patient in the present study was known to be HIV positive, or had a history of tuberculosis contact the last year. Additionally, neither of the two methods distinguish latent from active TB, and neither one is better at recognizing patients with autoimmune diseases who could avail from preventive chemoprophylaxis.Results:QFT-GIT is more sensitive than TST in patients under immunosuppressive therapy, but TST detects more cases of LTBI. TST remains an inexpensive test worldwide, which does not need laboratory equipment.Conclusion:Since the literature for the economic evaluation of LTBI screening has not clearly defined which test is ultimately more cost-effective, low income countries like Greece should continue using TST as the primary method for diagnosis of LTBI.

Hematological profiling of tuberculosis-infected and co-morbid patients: A study carried out in central Punjab, Pakistan

Tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB) is a chronic bacterial infection affecting many organs of the body particularly the lungs. Another organ seriously affected by TB is the hematopoietic system. TB patients co-infected with other disorders are more prone to death than TB alone. This study was aimed to investigate the variations in hematological profile of pulmonary tuberculosis (PTB) patients co-infected with chronic infectious and metabolic disorders. The study population (n = 366) include PTB patients (positive control) and PTB patients co-infected with hepatitis C virus (HCV) infection, human immunodeficiency virus (HIV) infection, diabetes, and myocardial infarction (MI). Healthy individuals (n = 95) were also included as normal control. All the study subjects were screened for PTB, diabetes, HCV infection, MI, and HIV infection. Polymerase chain reaction (PCR) was performed to confirm MTB infection at molecular level. Among 366 Ziehl–Neelsen positive cases, 258 (70.5%) were confirmed PTB positive by PCR. Among them, 36.8% were infected with PTB only, while 24% were co-morbid with diabetes, 17.8% co-infected with HCV, 11.2% with diabetes and HCV, 4.2% with HIV, 2.3% with both HCV and HIV, and 3.4% co-morbid with MI. Significant ( P &lt; 0.01) variations were observed in hematological profile of different study groups. The study concluded that significant increase in PTB patients co-infected with HCV, HIV, diabetes, and MI suggests the investigation of co-morbidities to rule out PTB co-infection with infectious and metabolic disorders before the start of anti-TB drug therapy.

Genetic polymorphism of rare mutations in Mycobacterium tuberculosis-infected patients in Delhi

Background: There is a wide variation in existing Mycobacterium tuberculosis strains across the globe, and false results in line probe assay (LPA) can occur due to the presence of unique genetic mutations in different settings. Objectives: An attempt was made to observe uncommon mutations in multidrug-resistant tuberculosis (MDR-TB) strains and determination of genetic diversity by spoligotyping and to study the treatment outcome in patients with uncommon mutations. Materials and Methods: Band pattern analysis of LPA strips was performed as per manufacturer's instructions. DNA sequencing was performed to confirm the presence of uncommon mutations in Intermediate Reference Laboratory in Delhi state. Results: Four uncommon mutations were recognized along with 12 unique spoligotype patterns which serve as an update to worldwide databases. The noteworthy presence of a spoligotype previously rarely seen in India was the SIT53/T1 pattern. Central Asian (CAS) spoligotype was highly associated with MDR followed by Beijing type. During follow-up, the treatment outcomes of cases showing uncommon mutations were considered as cured, after completion of their treatment. Conclusion: The rifampicin resistance appears to be an effective marker of MDR-TB. The presence of uncommon mutations confirms genetic polymorphism that may require treatment targeted at both drug-resistant and drug-susceptible phenotypes for the better management of patients with MDR-TB.

Asian Organization for Crohn's and Colitis and Asian Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 1: Risk assessment.

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asian Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection, and prevention of latent TB infection and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from nine Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised two parts: (i) risk of TB infection during anti-TNF therapy and (ii) screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.