Use Of Anti-tuberculosis Drugs Research Articles

Determinant of Successful Tuberculosis Treatment in UPT Puskesmas Singosari Working Areas in 2020-2022

Background: Indonesia is one of the countries that contribute the most mortality of Tuberculosis (TB) in the world. The tuberculosis treatment success rate in Indonesia is 86% which is still far from the target coverage of the TB treatment success rate (90%). This study was conducted to determine the determinant factors associated with successful TB treatment in Puskesmas Singosari.Methods: A cross-sectional design study was constructed for this study and used SITB including form TB as a research instrument. The population of this study were all drug-sensitive TB patients who had completed treatment at the Puskesmas Singosari in 2020, 2021, and QI-QII in 2022. The sample of this study was 71 people from 99 total population. The dependent variable is the success of drug-sensitive TB treatment. Independent variables are sex, age, weight, regular use of anti-tuberculosis drugs, and comorbidities. The data processing and analysis are being conducted using SPSS software.Result: Chi-square analysis showed that the variable weight changes has a significant relation to successful tuberculosis treatment (p = 0.014; OR = 9.818). This study found that the mean weight gain in patients who succeeded in TB treatment was approximately 2.19 kg.Conclusion : Puskesmas Singosari's TB Team can collaborate with the nutritionist team to optimize TB treatment through monitoring the nutritional status and weight gain of drug-sensitive TB patients.

Socialization and Evaluation of The Level of Compliance of Tuberculosis Patients to The Use Anti-Tuberculosis Drugs to Pharmacy Students of The Lubuk Pakam Medical Health Institute in 2023

The incidence of Tuberculosis (TB) is a health issue that must be paid attention to, especially at the Limapuluh Community Health Center. This health center is a health service center in the Fifty District which experiences a high incidence of TB, with the number of TB cases in 2022 increasing from the previous year. The level of patient compliance with treatment is one of the determining factors for the success of therapy. This study aims to provide an understanding of the factors that influence the level of compliance of TB patients with the use of Anti-Tuberculosis Drugs (OAT) at the Limapuluh Community Health Center. The method of service carried out is in the form of communication, information and education related to the use of Anti-Tuberculosis Drugs. The socialization was carried out online through a zoom meeting with the presentation of material and continued with a pretest and posttest as a measuring tool regarding the increase in participants' understanding of the material presented. This activity was carried out on January 06, 2024 at 10.00-12.00 WIB. The results of this service are the counseling material provided to students seen from the posttest results which show that the understanding and increase in knowledge of the participants is good compared to the results of the previous pretest points. In conclusion, students who take part in this activity can further explore the factors that affect patient compliance in taking OAT drugs so that similar activities can be carried out regularly to prevent errors in the use of Anti Tuberculosis drugs.

Evaluasi Kesesuaian Penggunaan Obat Antituberkulosis Pada Pasien Tuberkulosis Paru

Tuberculosis, caused by the bacterium Mycobacterium tuberculosis, primarily affects the lungs. This study aims to evaluate the precise use of antituberculosis drugs, focusing on factors such as patient suitability, correct indication, drug selection, dosage, administration method, and treatment duration. Sampling involved Purposive Sampling of pulmonary tuberculosis outpatients Dr. RSUD. H. Abdul Moeloek Bandar Lampung from January to December 2021, resulting in 89 patients. The data showed a majority of male patients, with 52 (58.4%) aged between 36 and 45 years, and 24 (26.9%) weighing between 46 kg and 55 kg. Additionally, 50 patients (56%) tested positive for sputum BTA and had undergone category I treatment previously. Evaluation of antituberculosis drug usage in these outpatients revealed 100% accuracy in patient suitability, indication, drug selection, dosage, and administration method, with a treatment duration of 15 days. Hence, it can be inferred that the utilization of antituberculosis drugs is appropriate.

Development and Validation of a Liquid Chromatography-Tandem Mass Spectrometry Method for Screening Potential Citrate Lyase Inhibitors from a Library of Marine Compounds.

Tuberculosis, a persistent illness caused by Mycobacterium tuberculosis, remains a significant global public health challenge. The widespread use of anti-tuberculosis drugs has resulted in the emergence of drug-resistant strains, which complicates treatment efforts. Addressing this issue is crucial and hinges on the development of new drugs that can effectively target the disease. This involves identifying novel therapeutic targets that can disrupt the bacterium's survival mechanisms in various environments such as granulomas and lesions. Citrate lyase, essential for the survival of Mycobacterium species at lesion sites and in granulomatous conditions, is a potential target for the treatment of tuberculosis. This manuscript aimed to construct an efficient enzyme inhibitor screening platform using ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry (UHPLC-QTOF MS). This system can accurately identify compounds with enzyme inhibitory activity from a library of marine terpenoids and phenolic compounds. Utilizing the screened herbal enzyme inhibitors as a starting point, we analyzed their chemical structures and skillfully built a library of marine compounds based on these structures. The results showed that all of the tested compounds from the phenolics library inhibited citrate lyase by more than 50%, and a significant portion of terpenoids also demonstrated inhibition, with these active terpenoids comprising over half of the terpenoids tested. The study underscores the potential of marine-derived phenolic and terpenoid compounds as potent inhibitors of citrate lyase, indicating a promising direction for future investigations in treating tuberculosis and associated disorders.

ANALISIS KADAR SERUM GLUTAMIC PIRUVIC TRANSAMINASE DAN SERUM GLUTAMIC OXALOACETIC TRANSAMINASE PADA PASIEN TUBERKULOSIS YANG MENJALANI PENGOBATAN OBAT ANTI TUBERKULOSIS

Introduction: Since 1995, Indonesia began to adopt the Directly Observed Treatment Shortcourse Chemotherapy (DOTS) system in controlling tuberculosis. The main drugs recommended in this system are Antituberculosis Drugs (OAT) consisting of Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), and Ethambutol (E). The use of Anti-Tuberculosis Drugs can cause side effects which are still other problems, such as liver damage which is characterized by an increase in transaminase enzymes. Therefore, monitoring liver function is very important. The routine examination carried out is a serum transaminase examination, namely SGOT (AST) and SGPT (ALT). Therefore, monitoring liver function is very important. The routine examination carried out is a serum transaminase examination, namely SGOT (AST) and SGPT (ALT). Objective: the aim of this study is to determine whether there is a difference between SGOT and SGPT levels before and after treatment with Antituberculosis Drugs . Method: The research design was cross-sectional analytic using secondary data from examination results of SGOT and SGPT levels from adult tuberculosis sufferers who were undergoing treatment at Cileungsi Regional Hospital, totaling 70 people. The research was conducted from January to August 2023. Results: There was an increase in SGOT levels by 104%, namely from 21.61 IU/L before treatment to 43.47 IU/L and SGPT levels increased by 107%, namely from 16.41 IU/L before treatment to 34.47 IU /L.. The Wilcoxon test showed a significant difference of 0.000 (p <0.05) for SGOT and SGPT levels before and after treatment.. Conclusion: there is a significant difference between SGOT and SGPT levels before and after treatment with antituberculosis drugs.

Adverse hematological and coagulability reactions to the use of antituberculosis preparations

Treatment of tuberculosis requires long-term use of antituberculosis drugs with a high risk of side effects. In recent decades, along with the frequent and detailed side effects (gastrointestinal symptoms, hepatotoxicity, neurotoxicity, allergic reactions), hematological and coagulation disorders have been described when taking antituberculosis drugs. Their main manifestations can be: iron deficiency anemia, hemolytic anemia, megaloblastic and sideroblastic anemia, thrombocytopenia, thrombocytopenic purpura, leukopenia, eosinophilia, agranulocytosis, deep vein thrombosis, thromboembolism, disseminated intravenous coagulopathy, etc. Although these side effects are rare, they require special attention because they can appear more frequently in the case of intermittent or interrupted treatment and present diagnostic difficulties.

Determinant of Successful Tuberculosis Treatment in Puskesmas Singosari in 2020-2022

Indonesia is one of the countries that contribute the most mortality of TB in the world. The tuberculosis treatment success rate in Indonesia is 86% meanwhile is still far from the target coverage of the TB treatment success rate (90%). This study conducted to determine the determinant factors of successful TB treatment in Puskesmas Singosari. A cross-sectional design study was constructed for this study and used SITB and form TB as a research instrument. The population of this study were all drug-susceptible TB patients who had completed treatment at the Puskesmas Singosari in 2020, 2021, and QI-QII in 2022. The sample of this study was 71 people from 99 total population. The dependent variable is the success of drug-susceptible TB treatment. Independent variables are sex, age, weight, regular use of anti-tuberculosis drugs, and comorbidities. The data processing and analysis are being conducted using SPSS software. Chi-square analysis showed that the variable weight changes have a significant assosiation to successful tuberculosis treatment (p = 0,014; OR = 9,818). Puskesmas Singosari's TB Team can collaborate with the nutritionist team to optimize TB treatment by monitoring nutritional status and weight gain of drug-susceptible TB patients.

Expert consensus on off-label use of antituberculosis drugs (2023 Update)

In 2018, Chinese Society of Tuberculosis, Chinese Medical Association organized and wrote the Expert consensus on off-label use of antituberculosis drugs, which covered more comprehensively the contents related to off-label use of antituberculosis drugs, and was the basis for clinical workers to exceed the drug instructions for the use of antituberculosis treatment in irreplaceable cases, and was also a good regulation for off-label use, which had a great guiding effect on clinical work. In the last four years, with the reported national and international research results, the anti-tuberculosis treatment drugs have been adjusted and there are more new advances in the use of some drugs. For this reason, Chinese Society for Tuberculosis, Chinese Medical Association has updated the expert consensus on off-label use of antituberculosis drugs. This consensus included isoniazid, rifamycins (rifampicin, rifapentine), fluoroquinolones (levofloxacin, moxifloxacin), linezolid, clofazimine, bedaquiline, delamanid, aminoglycosides (streptomycin, amikacin), and β-lactam antibacterial (imipenem/cilastatin, meropenem), and a total of 13 drugs in 9 categories were reviewed for off-label use, overdose, route of administration and patient populations. The GRADE evidence classification method was used to conduct a systematic evaluation of evidence quality and recommended strength. The revised consensus provides a reference for tuberculosis prevention and control workers in China for standardized drug use and rationalized treatment, and therefore for improved effectiveness and better patient benefits.

Bioprospective Role of Ocimum sanctum and Solanum xanthocarpum against Emerging Pathogen: Mycobacterium avium Subspecies paratuberculosis: A Review.

Mycobacterium avium subspecies paratuberculosis (MAP) is a chronic, contagious, and typically life-threatening enteric disease of ruminants caused by a bacterium of the genus Mycobacterium, but it can also affect non-ruminant animals. MAP transmission occurs through the fecal-oral pathway in neonates and young animals. After infection, animals generate IL-4, IL-5, and IL-10, resulting in a Th2 response. Early detection of the disease is necessary to avoid its spread. Many detection methods, viz., staining, culture, and molecular methods, are available, and numerous vaccines and anti-tuberculosis drugs are used to control the disease. However, the prolonged use of anti-tuberculosis drugs leads to the development of resistance. Whereas vaccines hamper the differentiation between infected and vaccinated animals in an endemic herd. This leads to the identification of plant-based bioactive compounds to treat the disease. Bioactive compounds of Ocimum sanctum and Solanum xanthocarpum have been evaluated for their anti-MAP activity. Based on the MIC50 values, Ursolic acid (12 µg/mL) and Solasodine (60 µg/mL) were found to be suitable for anti-MAP activity.

ISOLATED RETINAL VASCULITIS: Prognostic Factors and Expanding the Role of Immunosuppressive Treatment in Retinal Vasculitis Associated With Positive QuantiFERON-TB Gold Test.

To identify prognostic factors for poor visual outcomes in patients with isolated retinal vasculitis and to elucidate the outcome of immunosuppressive treatment without the use of antituberculosis drugs for patients with retinal vasculitis associated with a positive QuantiFERON-TB Gold In-Tube (QFT) test. A retrospective chart review was performed of patients presenting with retinal vasculitis. After the diagnosis of active retinal vasculitis had been confirmed by fluorescein angiography and other possible causes of retinal vasculitis had been excluded, patients were categorized into two groups by their QFT result. Potential associated factors between the poor and good visual outcome groups were statistically analyzed by the chi-square test and logistic regression model with generalized estimating equations. Seventy-three eyes (48 patients) were enrolled in this study. After univariate analysis, multivariate logistic regression analysis was performed and revealed that logMAR visual acuity at the initial visit ( P = 0.01) and outer retinal disruption ( P = 0.03) were the two factors significantly associated with poor visual outcomes. Systemic corticosteroids were administered without the use of antituberculosis drugs to all 16 cases of presumed tuberculous retinal vasculitis associated with positive QFT (26 eyes), 10 (63%) of whom were given nonsteroidal immunosuppressive drugs and achieved inflammatory control and treatment success. Risk factors leading to poor visual outcome in patients with isolated retinal vasculitis have been identified. Immunosuppressive treatment without antituberculosis drugs seems to be a promising regimen for selected patients with presumed tuberculous retinal vasculitis under vigilant care.

Regulatory effect of PINK1/Parkin axis on mitophagy in isoniazide-induced hepatocellular injury.

Patients with tuberculosis, who are treated with long-term high-dose combined use of anti-tuberculosis drugs, can cause many adverse reactions such as liver damage, but the mechanism is still unclear. Although phosphatase and tensin homolog induced kinase 1 (PINK1)/Parkin axis might participate in the process of liver damage through regulating mitochondrial autophagy and oxidative stress in liver cells. However, the association between the mitochondrial autophagy regulated by the PINK1/Parkin axis and the liver injury induced by anti-tuberculosis drugs is unknown. This study aims to explore the mechanism of PINK1/Parkin signal axis in regulating hepatocellular injury induced by anti-tuberculosis drugs through mitochondrial autophagy, and to provide new therapeutic targets for the patients with liver damage caused by anti-tuberculosis drugs. Mouse hepatocytes AML-12 were treated with isoniazide (INH) to induce liver injury. The mRNA and protein levels of PINK1, Parkin and autophagy associated factors were detected by real-time PCR and Western blotting in the normal AML-12 cells (control group), the AML-12 cells treated by INH (model group) and the AML-12 cells treated with INH and salidroside together (intervention group). Meantime, ELISA kit was used to detect the level of reactive oxygen species (ROS) in AML-12 cells, and the cell morphology and injury was observed by HE staining and transmission electron microscope (TEM). Compared with the control group, the mRNA (all P <0.01) and protein levels (all P <0.05) of PINK1, Parkin and microtubule associated protein 1 light chain 3 (LC3) were significantly decreased, the ubiquitination level was significantly decreased ( P <0.05), and the ROS level was increased ( P <0.05), and the hepatocellular cell showed obvious damage in the model group. Compared with the model group, the expression of PINK1, Parkin and LC3 were significantly increased in the intervention group (all P <0.05), as well as the ubiquitination level was also increased ( P <0.05). The ROS level mediated by mitochondria was decreased ( P <0.05). The results of HE staining and TEM showed that the cell status was improved and the damage of hepatocytes was significantly attenuated. In this study, the mechanism of mitochondrial autophagy mediated by PINK1/Parkin signal axis may be related to INH-induced injury in liver cells and it can regulate the damage state in vitro, indicating that Parkin is a potential molecular target for the prediction, diagnosis and treatment for liver injury induced by anti-tuberculosis drugs.

Multidrug Resistant Tuberculosis: Trends and Control

Multidrug resistant tuberculosis (MDR-TB) has been an area of growing concern and is posing a threat to the control of tuberculosis (TB). The exact magnitude of problem of resistance to anti-tuberculosis drugs worldwide was not known till the 1994-97 global project on anti-tuberculosis drug resistance surveillance initiated by the World Health Organization (WHO) and International Union Against Tuberculosis and Lung Diseases (IUATLD). The Global Tuberculosis Report 2014 estimated that an 3.5% of newly diagnosed and 20.5% of previously treated.TB cases had MDR-TB. It has been estimated that 480,000 cases emerged and 210,000 deaths occurred due to MDR-TB globally in 2013. In India, estimates showed that the prevalence of MDR-TB among new and previously treated patients was 2.2% and 15%, respectively. It is estimated that 99,000 cases of MDR-TB emerge every year of which 62,000 were among notified cases of TB in 2013. The MDR-TB is a human-made problem and results largely from poorly managed cases of TB. Adequate, timely diagnosis and optimal treatment of MDR-TB will help curb the epidemic. Efforts must be focused on the effective use of anti-tuberculosis drugs in every new patient, so as to prevent the emergence of MDR-TB.

Studi Pola Penggunaan Obat Anti Tuberkulosis pada Pasien Tuberkulosis Paru

Tuberculosis is one infectious disease that is still a significant problem in the health sector. This study aims to determine the pattern of anti-tuberculosis drugs in pulmonary tuberculosis patients, including the right dose, right patient, right time of administration, right route of administration, and alert for side effects based on the 2017 National Guidelines for Tuberculosis Control. The method used is descriptive with data collection systematically. Retrospectively in the form of medical record data for 2019 to 2020 at the Semarang Barat District Health Center, Semarang City, namely as many as 35 pulmonary tuberculosis patients. The study of drug side effects was traced based on the literature from several journals. The results of the univariate analysis showed that the use of anti-pulmonary tuberculosis drugs was obtained 100% at the right dose, 100% by the right patient, 100% at the time of administration, and 100% correct method of administration. Meanwhile, the side effects of using fixed-dose combination category 1 anti-tuberculosis drugs based on the literature are nausea, vomiting, redness of the urine, fever, lack of appetite, itching, and skin redness. The use of drugs in pulmonary tuberculosis patients at the Semarang Barat District Health Center, Semarang City, is in by the 2017 National Guidelines for Tuberculosis Control, a reference for the appropriate use of anti-tuberculosis drugs.

A case report of percutaneous endoscopic debridement for treating lumbar tuberculous spondylitis with large psoas abscess.

Introduction and importanceSpondylitis tuberculosis is a spinal infection characterized by bone destruction, fracture, abscess, and resulting in deformity (kyphosis and gibbus formation). Therefore, early diagnosis and management of spondylitis tuberculosis have special importance in preventing complications. Surgery is reserved for progressive deformity or where the neurological deficit is not improved by anti-tubercular treatment. The spine can be approached anteriorly or posteriorly in a minimally invasive way. We reviewed the evaluation of clinical outcome, laboratory findings, and radiological post-minimal invasive endoscopic debridement in spinal tuberculosis with psoas abscess.Case presentationWe collected data from two patients, a 24 years-old female and 27 years-old male, who was diagnosed with spondylitis tuberculosis with psoas abscess based on the history, physical, and supportive examination. Patients were given chemotherapy antituberculosis agents and performed percutaneous endoscopic debridement. The outcome was measured by clinical signs, laboratory findings, and radiology evaluation.DiscussionPatients had pre-operative symptoms of unremitting lower back and thigh pain, febrile sensation, signs of paravertebral muscle tenderness, and limitation of spine motion. Post percutaneous endoscopic debridement, patients showed good response with clinical improvement seen from significant reduction of pain, paravertebral muscle tenderness, increasing spinal motion, laboratory improvement with a decline of ESR and CRP value, and radiology findings improvement with resorption of psoas abscess. No complications were found.ConclusionTreatment of spondylitis tuberculosis remains controversial regarding optimal use of antituberculosis drugs and the approach used for surgical decompression. Patients had immediate pain relief and reduced disability in treating spinal tuberculosis after percutaneous endoscopic debridement.

The role of C-Reactive protein as an inflammatory marker to predict prolonged QTc interval in rifampicin-resistant tuberculosis patients: A case-control study

Backgroundlong-term use of anti-tuberculosis drugs (ATD) increases the risk of QTc prolongation, while C-reactive protein (CRP) can be used as an inflammatory marker of Mycobacterium tuberculosis infection.Objective: correlation of CRP on the QTc interval in Rifampicin-resistant tuberculosis (RR-TB) patients with the short regimen. MethodsAn observational study was conducted in Rifampicin-resistant tuberculosis (RR-TB) patients from 2 groups, patients on intensive phase and patients on continuation phase. CRP levels were measured from blood samples and measured automatically using the immunoturbidimetric assay. QTc interval was calculated using electrocardiography. Levels of CRP levels and QTc interval between the 2 groups were analyzed. The statistical analysis used includes the independent t-test, Mann Whitney test, and Rank Spearman test with p = 0.05. ResultsForty-five eligible RR-TB patients were included in this study. CRP levels and QTc intervals between 2 groups (intensive and continuation phase) showed significant difference with p < 0.001 but found no significant correlation of CRP levels and QTc interval in both intensive and continuation phase with p = 0.226 and 0.805, respectively. A higher level of CRP strongly indicated the inflammation caused by RR-TB infection at the early phase of the disease, but not correlated with QTc interval in RR-TB patients. ConclusionLevels of CRP and QTc interval do not correlate in RR-TB patients and can not be used to be the marker of QTc prolongation in RR-TB Patients.

EVALUASI PENGGUNAAN OBAT ANTITUBERKULOSIS (OAT) PADA PASIEN TB PARU DI RUMAH SAKIT GRANDMED LUBUK PAKAM TAHUN 2020

Tuberculosis is a disease caused by the bacterium Mycobacterium tuberculosis, a first- line anti-tuberculosis drug, namely Isoniazid (H) and Rifampicin (R). The increase in the number of Tb Lung patients from 2019 to 2020 at the RS Grandmed Lubuk Pakam encouraged researchers to conduct this study. The purpose of this study was to determine the description of the use of antituberculosis drugs and the rationality of the use of anti-tuberculosis drugs in pulmonary TB patients in RS Grandmed Lubuk Pakam in 2019. This study was a descriptive (non-experimental) study with retrospective data collection taken from patient medical records. Pulmonary tuberculosis at RS Grandmed Lubuk Pakam. Data was collected using purposive sampling technique in accordance with the inclusion criteria and exclusion criteria using the Data Collection Sheet. The number of samples used in the study is 76 medical records of patients diagnosed with pulmonary TB. Data analysis was performed using the Univariate with the help of SPSS. Results of the distribution of treatment duration data that most patients underwent treatment for &lt;6 months, as many as 31 people (19.9%). Followed by patients with exactly 6 months length of 30 people (0.39%). Whereas patients from 6 months 16 people (21.1%). And the number of Chronic Disease that suffered by Diabetes Mellitus patients was 24 patients (14.5%). All three have a significant relationship to the patient's treatment outcomes. Whereas at the age range 18-24 years, 44 people (57.9%) were affected by pulmonary TB. and The results of the evaluation of the rationality of pulmonary TB treatment are the exact indications of (97.4%), (74 patients), the right patients by 100% (76 patients), the right drugs by (97.4%) (74 patients), and the correct dosage of 100% ( 76).

Analysis of the early clinical outcomes of arthroscopic debridement in the treatment of shoulder tuberculosis

BackgroundDue to atypical clinical symptoms, it is difficult to diagnose joint tuberculosis infection, which often results in misdiagnosis and missed diagnosis. It is easy to cause joint disability. And there are few reports of using arthroscopy to diagnose and treat shoulder tuberculosis. This case series aims to introduce the clinical outcomes of arthroscopic treatment of shoulder tuberculosis.MethodsTwenty-nine patients with shoulder tuberculosis from September 2013 to February 2019 were included (10 males, 19 females; age range from 22 to 69; the average age is 37.6 years). All patients underwent arthroscopic lesion debridement, with preoperative and postoperative regular use of isoniazid, rifampicin, pyrazinamide, and streptomycin quadruple anti-tuberculosis drugs. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded before and at the last follow-up. The shoulder function was evaluated according to the visual analogue scoring method (visual analogue scale, VAS) pain score and Constant score.ResultsTwenty-nine patients were followed up from 12 months to 2 years, and the average follow-up time was 15.7 months. The pathological diagnosis of all patients after surgery was shoulder tuberculosis. No serious complications were found at the last follow-up, and the incision healed well. VAS pain score, Constant score, ESR, and CRP at the last follow-up were significantly improved compared with those before treatment (P < 0.05).ConclusionOn the basis of the standard use of anti-tuberculosis drugs before and after surgery, shoulder arthroscopy is used to treat early and mid-term shoulder tuberculosis, which can be diagnosed by direct observation under the arthroscope and postoperative pathological examination. It has the advantages of thorough lesion removal, minimal invasiveness, rapid recovery, and reliable clinical effect.

Disseminated Bacillus Calmette\u2013Gu\xe9rin (BCG) infection and acute exacerbation of interstitial pneumonitis: an autopsy case report and literature review

BackgroundIntravesical administration of Bacillus Calmette–Guérin (BCG) has proven useful for treatment and prevention of recurrence of superficial bladder cancer and in situ carcinoma. However, fatal side effects such as disseminated infections may occur. Early diagnosis and accurate therapy for interstitial pneumonitis (IP) are important because exacerbation of IP triggered by infections is the major cause of death. Although some fatality reports have suggested newly appeared IP after intravesical BCG treatment, to our knowledge, there are no reports which have demonstrated acute exacerbation of existing IP. Moreover, autopsy is lacking in previous reports. We report the case of a patient with fatal IP exacerbation after BCG instillation and the pathological findings of the autopsy.Case presentationA 77-year-old man with a medical history of IP was referred to our hospital because of fever and malaise. He had received an intravesical injection of BCG 1 day before the admission. His fever reduced after the use of antituberculosis drugs, so he was discharged home. He was referred to our hospital again because of a high fever 7 days after discharge. On hospitalisation, he showed high fever and systemic exanthema. Hepatosplenomegaly and myelosuppression were also observed. Biopsies revealed multiple epithelioid cell granulomas with Langhans giant cells of the liver and bone marrow. Biopsy DNA analyses of Mycobacterium bovis in the bone marrow, sputum, and blood were negative. His oxygen demand worsened drastically, and the ground-glass shadow expanded on the computed tomography scan. He was diagnosed with acute exacerbation of existing IP. We recommenced the antituberculosis drugs with steroid pulse therapy, but he died on day 35 because of respiratory failure. The autopsy revealed a diffuse appearance of multiple epithelioid cell granulomas with Langhans giant cells in multiple organs, although BCG was not evident.ConclusionsWe report the first case of acute exacerbation of chronic IP by BCG infection. This is also the first case of autopsy of a patient with acute exacerbation of existing IP induced by intravesical BCG treatment. Whether the trigger of acute IP exacerbation is infection or hypersensitivity to BCG is still controversial, because pathological evidence confirming BCG infection is lacking. Physicians who administer BCG against bladder cancer should be vigilant for acute exacerbation of IP.

DIAGNOSTIC USEFULNESS OF CBNAAT IN DIAGNOSING PEDIATRIC TUBERCULOSIS: A COMPARATIVE STUDY.

Introduction: Tuberculosis (TB) caused by the bacterium Mycobacterium tuberculosis, remains one of the major health problems in India. The recent introduction of Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) also known as Gene Xpert MTB/ RIF assay has significantly transformed the diagnostics of TB. The present study aimed diagnostic usefulness of CBNAAT for diagnosing pediatric tuberculosis in our hospital setting.&#x0D; Material and Methods: This study was carried out at department of Pediatric, Skmch Bihar India from oct 2018 to Nov 2019. Total 447 patients showing symptoms and signs of suspected localized and/or disseminated tuberculosis or having history of close contact with diagnosed tuberculosis patients admitted in our hospital during the study period were included in this study. Samples (pulmonary and extrapulmonary) were collected from the subjects and put to test for CBNAAT, Zeihl-Neelsen (ZN) smear and culture.&#x0D; Results: Among the pulmonary samples, CBNAAT detected MTB in 23 of the 108 sputum/induced sputum samples (21.29%), 89 of the 248 gastric lavage/aspirate samples (35.88%) and 0 of the 5 bronchoalveolar lavage samples (0%). Among the extrapulmonary samples, CBNAAT detected MTB in 9 of the 63 CSF samples (14.28%), 1 of the 13 pleural fluid samples (7.69%), 0 of the 6 ascitic fluid samples (0%) and 3 of the 4 lymph node aspirate samples obtained by FNAC(75%). Sensitivity, specificity, positive predictive value and negative predictive value of CBNAAT in reference to culture are 90.15%, 98.09%, 95.2%and 95.2%respectively. Sensitivity, specificity, positive predictive value and negative predictive value of CBNAAT in reference to ZN smear are 100%, 91.47%, 76% and 100% respectively.&#x0D; Conclusion: CBNAAT assay is a rapid test which identifies both the presence of Mycobacterium tuberculosis (MTB) (with high sensitivity, specificity, positive predictive value and negative predictive value) and rifampicin resistance associated with mutation of rpoB gene in a single test. It also helps to avoid injudicious use of anti-tuberculosis drugs.&#x0D; Keywords: CBNAAT; MTB; ZN smear; Culture

The ongoing challenge of Pulmonary Tuberculosis in Southern Tunisia: A review of a 22-year period

BackgroundDespite the wide use of anti-tuberculosis drugs, pulmonary tuberculosis (PTB) remains one of the most important causes of mortality and morbidity, particularly in developing countries. Therefore, combining clinical and epidemiological approach would be of a great benefit. Our study aimed to describe the epidemiological and clinical specificities of PTB and its recent chronological trends. MethodsWe conducted a retrospective study of all PTB new cases of any age diagnosed between 1995 and 2016 in Southern Tunisia. We applied the direct method of age-standardization using the World Standard Population to compute the age standardized incidence rate (ASIR) and the age standardized mortality rate (ASMR) per 100 000 inhabitants. ResultsWe recorded 1121 new cases with PTB among 2771 new cases of tuberculosis (40.5%). The ASIR of PTB was 5.3/100 000 inhabitants/year and didn’t change over the study period (rho=0.3; P=0.2). Patients with PTB were mainly aged between 15 and 59 years (n=861; 76.8%) and came from urban areas (n=600; 55%). The median duration of treatment was 7.6 months (IQR=[6–8 months]). Successful outcome was notified in 1075 cases (95.9%). Forty-one patients died yielding an ASMR of 0.18/100 000 inhabitants/year. Factors statistically associated with unsuccessful outcome included age≥60 years (OR=5; P<0.001) and shorter treatment duration (6.15 months vs 7.76 months; P<0.001). ConclusionIn contrast to the decline in the global PTB incidence reported worldwide and in the neighboring countries, our study revealed no significant change in the PTB rates from 1995 to 2016. Therefore, tools and strategies used to manage PTB should be strengthened by a substantial effort in both basic science and epidemiology to have better incidence curves.