Detection of splenic microabscesses with ultrasound as a marker for extrapulmonary tuberculosis in patients with HIV: a systematic review

Background. In 2015, 1.2 million new cases of tuberculosis (TB) were diagnosed in patients with HIV. Diagnostic limitations and resource shortages in endemic areas can delay diagnosis and treatment, particularly with extrapulmonary TB (EPTB). Research suggests that ultrasound can identify splenic microabscesses caused by EPTB, but data are limited on the frequency of this finding in patients with culture-proven EPTB. Objectives. To estimate the frequency of splenic EPTB microabscesses detected with ultrasound in patients with HIV and TB co-infection. Methods. Studies published in six major databases as of November 2017 were systematically reviewed based on the PRISMA guidelines. Cohen's kappa test was used to determine inter-rater agreement. Articles included for data abstraction passed the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) evaluation. Freeman-Tukey transformation was used to calculate weighted proportions. Heterogeneity was evaluated by Forest plot and I2 calculation. Results. After abstract screening, article review and QUADAS-2 evaluation, five studies were selected for data extraction. A total of 774 patients in these studies were infected with HIV. Splenic lesions were seen with ultrasound in 21.0% of patients with HIV (95% confidence interval (CI) 10.6 - 33.8). TB diagnosed by culture, biopsy, smear, or molecular methods was found to be the cause of 88.3% (95% CI 72.3 - 97.9) of splenic microabscesses seen on ultrasound in patients with HIV. Conclusions. Ultrasound evaluation of the spleen in patients with HIV and symptoms suggestive of TB in endemic regions is a viable diagnostic adjunct. Ultrasound detection of splenic microabscesses in HIV patients is probably sufficient indication to initiate TB treatment prior to obtaining culture data. Strong conclusions cannot be drawn owing to the high heterogeneity of this small number of studies

Aspects épidémiologiques et histologiques des tuberculoses extra-pulmonaires au Bénin

Les tuberculoses extra-pulmonaires (TEP) représentent une proportion élevée de toutes les formes de tuberculose et leurs manifestations cliniques polymorphes rendent le diagnostic souvent difficile. L'objectif de notre étude était de décrire les caractéristiques épidémiologiques et histologiques des TEP diagnostiquées dans deux laboratoires d'anatomie pathologique de Cotonou. Nous avons mené une étude transversale descriptive portant sur 53 dossiers de patients atteints de tuberculose extra-pulmonaire dans les laboratoires d'anatomie pathologique de la Faculté des Sciences de la Santé et de la Cité Houéyiho à Cotonou sur une période de 10 ans (juin 2007 - juin 2018). L'âge moyen était de 46,5 ans avec une prédominance féminine (54,7 %). Les principales localisations étaient : la tuberculose ganglionnaire à 71,7 %, suivie par la tuberculose digestive (17 %) et de la tuberculose urogénitale (9,4%). Dans les différentes formes, le type histologique le plus fréquent était le type caséo-folliculaire. Notre travail a montré une fréquence élevée de l'atteinte ganglionnaire avec le type caséo-folliculaire comme le type histologique dominant

Tuberculosis and HIV co-infection in Congolese children: risk factors of death

Introduction: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the prevalence of HIV infection among children treated for TB in Directly Observed Treatment Short-Course (DOTS) clinics in Lubumbashi and to identify risk of death during this co-infection.Methods: this is a cross-sectional study of children under-15, treated for tuberculosis from January 1, 2013 to December 31, 2015. Clinical, paraclinical and outcome data were collected in 22 DOTS of Lubumbashi. A statistical comparison was made between dead and survived HIV-infected TB children. We performed the multivariate analyzes and the significance level set at p-value <0.05.Results: a total of 840 children with TB were included. The prevalence of HIV infection was 20.95% (95% CI: 18.34-23.83%). The mortality rate was higher for HIV-infected children (47.73%) compared to HIV-uninfected children (17.02%) (p<0.00001). Age <5 years (aOR=6.50 [1.96-21.50]), a poor nutritional status (aOR=23.55 [8.20-67.64]), and a negative acid-fast bacilli testing (aOR=4.51 [1.08-18.70]) were associated with death during anti-TB treatment. Conclusion: TB and HIV co-infection is a reality in pediatric settings in Lubumbashi. High mortality highlights the importance of early management

Patient-led active tuberculosis case-finding in the Democratic Republic of the Congo

Objective To investigate the effect of using volunteer screeners in active tuberculosis case-finding in South Kivu, the Democratic Republic of the Congo, especially among groups at high risk of tuberculosis infection. Methods:To identify and screen high-risk groups in remote communities, we trained volunteer screeners, mainly those who had themselves received treatment for tuberculosis or had a family history of the disease. A non-profit organization was created and screeners received training on the disease and its transmission at 3-day workshops. Screeners recorded the number of people screened, reporting a prolonged cough and who attended a clinic for testing, as well as test results. Data were evaluated every quarter during the 3-year period of the intervention (2014­2016). Findings : Acceptability of the intervention was high. Volunteers screened 650 434 individuals in their communities, 73 418 of whom reported a prolonged cough; 50 368 subsequently attended a clinic for tuberculosis testing. Tuberculosis was diagnosed in 1 in 151 people screened, costing 0.29 United States dollars (US$) per person screened and US$ 44 per person diagnosed. Although members of high-risk groups with poorer access to health care represented only 5.1% (33 002/650 434) of those screened, they contributed 19.7% (845/4300) of tuberculosis diagnoses (1 diagnosis per 39 screened). The intervention resulted in an additional 4300 sputum-smear-positive pulmonary tuberculosis diagnoses, 42% (4 300/10 247) of the provincial total for that period. Conclusion:Patient-led active tuberculosis case-finding represents a valuable complement to traditional case-finding, and should be used to assist health systems in the elimination of tuberculosis

Knowledge, attitude, and practice and service barriers in a tuberculosis programme in Lakes State, South Sudan: a qualitative study

Background: The World Health Organisation (WHO) estimates the incidence of tuberculosis (TB) in South Sudan to be 79 per 100,000 for new sputum smear positive TB and 140 per 100,000 for all forms of TB cases. The case detection rate of 53% for all forms of TB in South Sudan is below the WHO target of 70%.Objective: To explore knowledge, attitude, and practice barriers as well as service barriers to implementing TB programme in Lakes State, South Sudan.Method: This was a qualitative study conducted in May 2015.Results: Despite some understanding of the symptoms, causes, and consequences of TB, the stigma for TB and lack of disclosure of the disease, is very high among the local community. The limited network of TB facilities for case detection, lack of community distribution of TB drugs and lack of food at hospitals when patients were admitted for treatment, are key barriers to TB service delivery.Conclusion: To overcome barriers it is recommended that the local community worldview should be incorporated into TB awareness, testing, and treatment, and attention should be paid to areas where traditional practices, such as elimination of maize, clash with modern treatments

Knowledge of tuberculosis and factors responsible for low case detection in the Amansie Central District, Ghana

Background:Tuberculosis (TB) case detection rate has remained consistently low in the Amansie Central District despite the implementation of the National TB Programme (NTP).Objective:To assess the factors influencing this low case detection of TB.Method:Information was collected from 120 individuals and 40 health workers were randomly selected from four health facilities that provided TB treatment. Results:All patients had a good knowledge of TB. There was no statistical association between patients knowledge and educational level (p>0.05). However, knowledge on the causes of TB was strongly associated with occupation (p<0.05). 53% of patients indicated health facilities as the first place of visit when sick and how they are received was dependent on education (p=0.005) and marital status (p<0.05); 60% of health workers were not trained on the NTP despite 93% being aware of the programme, and 62.5% reported not initiating contact tracing after disease confirmation. Only 34 of the 120 patients reported health workers visiting them regarding TB. Conclusion: Development of interventions such as HCW training on TB treatment and care, and establishing referral networks that bring TB information and services closer to community members can contribute to improved TB case notification

Tuberculosis among individuals with community-acquired pneumonia presenting to emergency in Gaborone, Botswana

Delays in diagnosing Tuberculosis (TB) are associated with increased transmission. TB may present as a clinical syndrome that mimics community-acquired pneumonia (CAP). The aim of this paper was to determine frequency of TB among patients with CAP at a referral hospital in Gaborone, Botswana. We performed a retrospective study of adults presenting with CAP from April 2010-October 2011 to the Emergency Department (ED);we matched this cohort to the National Botswana Tuberculosis Registry (NBTR) to identify individuals subsequently diagnosed with TB. We assessed demographics, time to TB diagnosis, clinical outcomes and performed logistic regressions to identify factors associated with TB diagnosis. We identified 1305 individuals presenting with CAP;TB was subsequently diagnosed in 68 (5.2%). The median time to TB diagnosis was 9.5 days. Forty percent were AFB sputum smear positive and 87% were identified as being HIV-positive. Subsequent diagnosis of TB is common among individuals with CAP at our ED, suggesting that TB may be present at the time of CAP presentation. Given the lack of distinguishing clinical factors between pulmonary TB and CAP, adults presenting with CAP should be evaluated for active TB in Botswana

Déterminants de la réponse à l'intradermoréaction à la tuberculine à Kisangani, RDC

Introduction: Le diagnostic de la primo-infection tuberculeuse de l'enfant est difficile en situation de ressources limitées et c'est généralement à la tuberculine qu'on a recours. Le but de cette étude est de déterminer les facteurs qui peuvent influencer la réponse positive de l'intradermoréaction à la tuberculine en situation d'endémie Matériel et Méthode: Etude transversale analytique réalisée à Kisangani du 05 mars 2012 au 27 décembre 2013 chez 593 enfants d'âge compris entre 6 mois et 15 ans suivis au «Village de Pédiatrie». Chacun a subi l'intradermoréaction à la tuberculine et la lecture était faite 72 heures après. Le Chi-carré de tendance et le Test exact de Ficher, où c'est approprié, ont été utilisés Résultat: A Kisangani, le taux de prévalence de l'intradermoréaction positive (IDR+) s'élève à 31,53%. Il est identique dans les deux sexes. Celui-ci décroit significativement avec l'âge (p<0,0002): 38,0% entre 6 et 11mois, 26,4% entre 12 et 24mois, 21,4% entre 6 et 10ans puis remonte à partir de 11ans (47,0%). La positivité de l'IDR augmente avec la notion de BCG dans 69,7% de cas (p<0,0017) et avec la notion de contage tuberculeux (p<0,006) Conclusion: A Kisangani, le taux de prévalence de l'intradermoréaction positive est similaire à celui décrit en situation d'endémie. Le taux de positivité décroit avec l'âge. La cicatrice BCG et la notion de contage augmentent la positivité de l'IDR+

Sputum Smear-Positive Tuberculosis among Previously Treated Individuals in the Western Cape Province; South Africa

A considerable share of South Africa's tuberculosis burden affects those people who have previously been treated for tuberculosis - many of them successfully. In a retrospective cohort study that was conducted using tuberculosis treatment register data from two communities in suburban Cape Town; it was found that the hazard rate of re-treatment for smear-positive tuberculosis was between 3- and 5.26-times higher in tuberculosis cases who had defaulted from treatment compared to successfully treated cases. But although the rate of re-treatment was substantially higher among defaulters; cases after treatment success account for the vast majority of smear-positive re-treatment cases due to the fact that far more tuberculosis cases were successfully treated than had defaulted

Knowledge and Perception on Tuberculosis Transmission in Tanzania: Multinomial Logistic Regression Analysis of Secondary Data

Tuberculosis (TB) is one of the most important public health problems in Tanzania and was declared as a national public health emergency in 2006. Community and individual knowledge and perceptions are critical factors in the control of the disease. The objective of this study was to analyze the knowledge and perception on the transmission of TB in Tanzania. Multinomial Logistic Regression analysis was considered in order to quantify the impact of knowledge and perception on TB. The data used was adopted as secondary data from larger national survey 2007-08 Tanzania HIV/AIDS and Malaria Indicator Survey. The findings across groups revealed that knowledge on TB transmission increased with an increase in age and level of education. People in rural areas had less knowledge regarding tuberculosis transmission compared to urban areas [OR=0.7]. People with the access to radio [OR=1.7] were more knowledgeable on tuberculosis transmission compared to those who did not have access to radio. People who did not have telephone [OR=0.6] were less knowledgeable on tuberculosis route of transmission compared to those who had telephone. The findings showed that socio-demographic factors such as age; education; place of residence and owning telephone or radio varied systematically with knowledge on tuberculosis transmission

Influence des parcours de soins sur le debut du traitement antituberculeux a Conakry (Guinee)

Les parcours de soins sont souvent complexes et peuvent induire des retards de traitement; avec des effets particulierement deleteres en cas de tuberculose. Nous avons cherche a identifier de facon retrospective; les parcours de soins des patients avant le diagnostic de tuberculose et l'influence de ces parcours sur les delais de traitement a Conakry-Guinee.Nous avons interroge 112 nouveaux patients a leur enregistrement pour tuberculose pulmonaire a bacilloscopie positive. Ont ete distingues les parcours conventionnels (recours aux seules structures sanitaires) et mixtes (associant structures sanitaires; automedication et medecine traditionnelle). L'influence des caracteristiques des patients sur le type de parcours a ete testee en analyses uni et multivariees et les delais de mise sous traitement ont ete compares pour les deux types de parcours. Deux patients sur trois ont suivi un parcours mixte. Ce type de parcours n'etait lie; en analyse multivariee; qu'au niveau de scolarisation (p=0;02). Les delais moyens de traitement etaient similaires (respectivement 13;4 et 12;8 semaines pour les parcours conventionnels etmixtes; p=0;68). La proportion de parcours comportant plus de trois recours aux structures sanitaires etait significativement plus elevee pour les parcours conventionnels que pour les parcours mixtes (72vs 30; p0;001). Les principales raisons invoquees pour l'utilisation tardive des structures sanitaires etaient l'ignorance des signes de la tuberculose (26) et le cout eleve des soins (12). Les parcours des patients sont multiples et peuvent induire des retards a la mise sous traitement antituberculeux. Une sensibilisation de la population et des soignants est necessaire

Evaluation of the national tuberculosis surveillance and response systems, 2018 to 2019: national tuberculosis, leprosy and buruli-ulcer control programme, Abuja, Nigeria

Introduction: Nigeria is among the countries with high Tuberculosis (TB) burden by global rating signifying the relevance of TB surveillance system evaluation in improving performance and capacity of the existing system. Hence, this evaluation was conducted in order to determine the gaps and proffer solution to enhance the TB surveillance system performance. Methods: eight questionnaires were administered to key informants using face-to-face interview method; data obtained was analyzed. Total number of TB cases and estimated number of cases for year 2018 was obtained. Percentage of positive cases using the GeneXpert test for 6 months (January to June 2019) was obtained. Available documents and publications on the National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP) were also sought for information. Results: the NTBLCP has over 5,300 TB service points and 1,602 microscopy Centre's distributed across the country. Acceptance for the standard TB case definition was 100%, forms used are easy to fill and diagnosis is laboratory-based requiring specialized trainings for laboratory personnel. The system had 25% sensitivity, high data quality with 100% timeliness. The TB surveillance system is representative of all ages. The system was first designed as TB and leprosy control programme but later Buruli Ulcer was incorporated into the programme. First quarter supervisory visits are skipped due to late funding and delayed budget approval. Major share of the funding comes from donor partners.Conclusion: the system is useful, representative, acceptable, has good data quality, timely, and sensitive. The system is stable but needs to be funded more by the government. There is need for early funding and budget approval to avoid skipping the first quarter supervisory visits. The system is not simple due the various test that need to be conducted before, during and after treatment to detect and verify that the patient is cured. We recommend continuous training of health workers, routine monitoring and evaluation, integration of TB care and prevention into other health services programmes like HIV/AIDS and active case search at all levels to increase the sensitivity of the system. Speed up the process of integration of NTBLCP surveillance system with IDSR for data harmonization in the country

Evaluation of Dot-Blot and Phage Replication Techniques for Detection of Drug Resistant Mycobacterium Tuberculosis

We have assessed the utility of two new methods; dot-blot and bacteriophage replication techniques; for use in a routine diagnosis laboratory in poor resource settings in the screening of drug resistant Mycobacteria tuberculosis by comparing with the conventional proportion method. A total of 145 M. tuberculosis clinical isolates were tested for resistance to rifampicin; isoniazid; streptomycin and ethambutol. The dot blot had sensitivities of 91.7; 100; 93.5and 85.7 and specificities of 99.2; 99.2; 99.1and 99.2 for rifampicin; streptomycin; isoniazid and ethambutol; respectively. The phage technique had sensitivities of 92and 84.6and specificities of 99.2and 99.2for rifampicin and streptomycin; respectively. Both techniques yielded results within 48 hours of receipt of the culture on solid media.The high sensitivity and specificity coupled with rapidity of results indicate that these methods are potentially useful tools for screening resistance to anti-tuberculosis drugs in our setting. However; the phage replication technique; which is simpler and technically less demanding; seems the most suitable for routine screening of drug resistant mycobacteria in resource deprived countries such as Tanzania. We are recommending further field evaluation of the phage replication method so that it can complement; and possibly replace; the conventional proportion method in drug susceptibility testing

Le Programme National de Lutte contre la Tuberculose dans la Province de l'Ouest; Cameroun. Evaluation apres un an de fonctionnement

Objectifs: Evaluer de la mise en oeuvre du programme national de lutte contre la tuberculose (PNLT) dans la Province de l'Ouest du Cameroun a partir des indicateurs epidemiologiques et operationnels classiques. Methode : pour la periode entre le premier octobre 1996 et le 30 septembre 1997; on a recueilli des informations sur le type de la tuberculose et les resultats du traitement a partir des registres et des cartes des patients des 15 centres de diagnostic et de traitement (CDT). Des informations supplementaires sur la clinique; le statut social et l'itineraire therapeutique ont ete recueillies a partir de questionnaires. Resultat : on a enregistre 582 cas de tuberculose; dont 383 hommes et 199 femmes. 529 (91 pour cent) des cas sont bacilliferes (TPM+) dont 455 des nouveaux cas (NC). 90 pour cent des patients sont des jeunes adultes entre 15 et 44 ans. D'une premiere cohorte de six mois; 163 (78 pour cent) des patients sont gueris ou ont fini leur traitement; 21 (10 pour cent) sont decedes. Chez les 455 NC TPM+ on note : un delai moyen de 4 mois avant la prise en charge correcte; un itineraire therapeutique tres varie et incluant dans plus de 50 pour cent des cas le guerisseur;pas de difference entre sexe pour la clinique; le delai; l'itineraire therapeutique ou le resultat du traitement. Le cout par patient traite s'est eleve a 90 US $. Conclusion : La province de l'Ouest a reussi a implanter le PNLT. Les principaux problemes se resument a l'accessibilite geographique et socioculturelle des services competents

Proposition d'algorithmes de prise en charge de la tuberculose pour le Programme de Lutte contre la Tuberculose au Cameroun

La facon la plus fiable d'etablir le diagnostic de la tuberculose pulmonaire est de trouver des BK a l'examen microscopique direct d'un frottis de crachat. C'est une erreur majeure de diagnostiquer une tuberculose pulmonaire sur la radiographie et de ne pas examiner l'expectoration. La phase initiale du traitement doit se faire en hospitalisation. Les medicaments doivent etre pris sous la supervision directe d'un personnel de sante. La phase de continuation du traitement doit se faire sous surveillance au centre de sante le plus proche du malade