Factores relacionados con la adherencia al tratamiento de tuberculosis en el Departamento de Boyacá / Factors related with adherence to treatment of tuberculosis in the Department of Boyacá

Resumen Introducción: la tuberculosis es una enfermedad infecciosa crónica causada por Mycobacterium tuberculosis, capaz de afectar cualquier órgano o tejido siendo la forma más común la enfermedad pulmonar. Objetivo: identificar los factores que afectan la adherencia al tratamiento antituberculoso en pacientes del Departamento de Boyacá durante los años 2017-2019. Metodología: estudio descriptivo retrospectivo que utilizó como fuentes de información datos registrados en la base del programa departamental de Tuberculosis y SIVIGILA. Se realizó análisis univariado, determinando la distribución de las variables y análisis bivariado en el que se exploró la asociación entre la adherencia al tratamiento de tuberculosis y las variables independientes, se utilizó la prueba de Chi cuadrado. Resultados: se incluyeron 402 pacientes, la adherencia al tratamiento antituberculoso fue 96,5% y la no adherencia de 3,5%. El 66,7% eran de sexo femenino; 55,7% vivián en zona urbana; 66,5% pertenecían al régimen subsidiado; 89,7% mestizos; 91,2% correspondían a otros grupos poblacionales, seguido del 7,5% de población privada de la libertad y 1,3% habitantes de calle. Dentro de las comorbilidades la coinfección con VIH con 4,2% fue la de mayor presencia. Entre las causas de no adherencia al tratamiento fueron desinterés, cambio frecuente de domicilio, contrato finalizado con la EPS y suspensión del tratamiento por toxicidad hepática. El paciente con mayor probabilidad de abandonar el tratamiento pertenece al sexo masculino, al grupo poblacional de migrantes o habitantes de calle y se encuentra afiliado al régimen subsidiado, ​​​​se encontró una relación estadísticamente significativa entre estas variables y el resultado con la adherencia al tratamiento. Conclusiones: si bien el resultado obtenido en el presente trabajo no es elevado, es importante realizar vigilancia de la adherencia al tratamiento antituberculoso para disminuir el riesgo de complicaciones derivadas de su abandono como mayor mortalidad, desarrollo de resistencia bacteriana y un período de contagiosidad más prolongado.

Abstract Introduction: Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, capable of affecting any organ or tissue, the most common form being lung disease. Objective: Identify the factors that affect adherence to tuberculosis treatment in patients from the Department of Boyacá during the years 2017-2019. Methodology: Retrospective descriptive study that used as information sources data registered in the database of the departmental Tuberculosis program and SIVIGILA. A univariate analysis was carried out, determining the distribution of the variables and a bivariate analysis in which the association between adherence to tuberculosis treatment and the independent variables was explored, using the Chi-square test. Results: 402 patients were included, adherence to anti-tuberculosis treatment was 96.5% and non-adherence 3.5%. 66.7% were female; 55.7% lived in an urban area; 66.5% belonged to the subsidized regime; 89.7% mestizo; 91.2% corresponded to other population groups, followed by 7.5% of the population deprived of liberty and 1.3% homeless. Within the comorbidities, coinfection with HIV 4.2% was the one with the greatest presence. Among the causes of non-adherence to treatment were lack of interest; frequent change of address; Terminated contract with the EPS and suspension of treatment due to liver toxicity. The patient with the highest probability of abandoning treatment belongs to the male sex, to the population group of migrants or street dwellers and is affiliated with the subsidized regime, a statistically significant relationship was found between these variables and the result with adherence to treatment. Conclusions: Although the result obtained in this study is not high, it is important to monitor adherence to tuberculosis treatment to reduce the risk of complications derived from its abandonment, such as increased mortality, development of bacterial resistance, and a longer period of contagiousness.

Tratamiento para tuberculosis resistente a rifampicina o multirresistente: análisis comparativo de indicadores programáticos entre Buenaventura y otros municipios del Valle del Cauca, Colombia / Treatment for multidrug-resistant tuberculosis: A comparative analysis of programmatic outcome indicators between Buenaventura and other municipalities of Valle del Cauca, Colombia

Resumen Introducción. El manejo adecuado de la tuberculosis multirresistente es una estrategia priorizada para el control de la tuberculosis en el mundo. Objetivo. Evaluar las diferencias entre las características demográficas y clínicas, y los indicadores programáticos de los pacientes con diagnóstico confirmado de tuberculosis pulmonar resistente a rifampicina o multirresistente en Buenaventura, frente a la cohorte de los demás municipios del Valle del Cauca entre 2013 y 2016. Materiales y métodos. Se desarrolló un estudio analítico de cohortes para comparar los registros de pacientes mayores de 15 años con tuberculosis multirresistente, del Programa de Tuberculosis de Buenaventura (con ácido paraaminosalicílico), frente a los demás municipios del Valle del Cauca (sin ácido paraaminosalicílico). Resultados. Se registraron 99 casos con una mediana de edad de 40 años (RIC = 26 - 53); en Buenaventura, el 56 % eran mujeres; en los demás municipios, predominaron los hombres (67 %); el 95 % de los evaluados tenía aseguramiento en salud. La comorbilidad más frecuente fue diabetes (14 %). Las reacciones adversas a medicamentos antituberculosos en Buenaventura fueron 1,3 veces más frecuentes que en los demás municipios (OR = 2,3; IC95 %: 0,993 - 5,568; p = 0,04). En Buenaventura falleció el 5 % de los casos frente al 15 % reportado en los demás municipios. No hubo fracasos con el tratamiento en Buenaventura, pero se reportó un 35 % de pérdida del seguimiento. El éxito del tratamiento fue mayor en Buenaventura en el 56 %. Conclusión. El programa fortalecido de Buenaventura presentó mejores resultados programáticos que los demás municipios del Valle del Cauca. El acceso a pruebas moleculares, la disponibilidad de tratamientos acortados y el seguimiento continuo para identificar reacciones adversas a medicamentos antituberculosos son un derrotero para todos los programas de control.

Abstract Introduction. Proper management of multidrug-resistant tuberculosis is a prioritized strategy for tuberculosis control worldwide. Objective. To evaluate differences concerning demographic and clinical characteristics and programmatic indicators of Buenaventura patient cohort with confirmed diagnosis of multidrug-resistant tuberculosis, compared to those of the other municipalities from Valle del Cauca, Colombia, 2013-2016. Materials and methods. We conducted an analytical cohort study to compare records of patients older than 15 years with multidrug-resistant tuberculosis included in the Programa de Tuberculosis de Buenaventura (with para-aminosalicylic acid) versus the other municipalities of Valle del Cauca (without para-aminosalicylic). Results. Ninety-nine cases were recorded with a median age of 40 years (IQR = 26 - 53); in Buenaventura, 56% of the patients were women, while in the other municipalities, men predominated with 67%; 95% had health insurance. The most common comorbidity was diabetes (14%). Adverse reactions to antituberculosis medications in Buenaventura were 1.3 times more frequent than in the other municipalities (OR = 2.3; 95% CI = 0.993 - 5.568; p = 0.04). In Buenaventura, the mortality rate was 5% compared to the 15% reported in the other municipalities. Treatment failures were not reported in Buenaventura, but 35% did not continue with the follow-up. Treatment success was higher in Buenaventura (56 %). Conclusion. A strengthened program in Buenaventura presented better programmatic results than those from the other municipalities of Valle del Cauca. Access to molecular tests, availability of shortened treatments, and continuous monitoring to identify adverse reactions to antituberculosis medications are routes for all other control programs.

Diagnóstico de tuberculosis en pediatría / Diagnosis of tuberculosis in pediatrics

La tuberculosis sigue siendo una epidemia mundial y en Chile no ha mostrado una tendencia descendente en los últimos años, con un aumento en los casos infantiles. En los niños, el diagnóstico es un reto debido a la baja carga bacilar y las características de las lesiones, que suelen ser cerradas. Métodos tradicionales como los cultivos, considerados anteriormente como el gold standard, con frecuencia arrojan resultados negativos. Sin embargo, los avances en pruebas moleculares han permitido un progreso significativo en la confirmación bacteriológica. Otras herramientas diagnósticas, como la prueba de tuberculina (PPD) y los ensayos de liberación de interferón gamma (IGRAs), tienen sensibilidades y especificidades variables, siendo útiles como pruebas complementarias. Las imágenes juegan un papel clave en la evaluación diagnóstica de tuberculosis pulmonar y extrapulmonar en pacientes pediátricos. Esta revisión aborda la epidemiología y el proceso diagnóstico de la tuberculosis infantil.

Tuberculosis remains a global epidemic, and in Chile, it has not shown a downward trend in recent years, with an increase in pediatric cases. Diagnosing tuberculosis in children presents challenges due to the low bacillary load and the closed nature of the lesions. Traditional methods like cultures, once considered the gold standard, often yield negative results. However, advances in molecular testing have significantly improved bacteriological confirmation. Other diagnostic tools, such as the tuberculin skin test (PPD) and interferon-gamma release assays (IGRAs), offer variable sensitivities and specificities and are useful as complementary tests. Imaging plays a critical role in the diagnostic evaluation of pulmonary and extrapulmonary tuberculosis in pediatric patients. This review addresses the epidemiology and diagnostic process of pediatric tuberculosis.

Características clínico-epidemiológicas de la meningitis tuberculosa en pacientes internados en el Servicio de Clínica Médica del Centro Médico Nacional en el periodo 2015 ­ 2023 / Clinical-epidemiological characteristics of tuberculous meningitis in inpatients in the Servicio de Clínica Médica of the National Medical Center in the period 2015 ­ 2023

RESUMEN Introducción: la meningitis tuberculosa es la forma más grave de tuberculosis extrapulmonar, esto se debe a la gran mortalidad y morbilidad en los pacientes, con alta prevalencia en los países en desarrollo, lo que constituye un problema de salud pública. Su diagnóstico es difícil y la mayoría de casos se logran identificar a base de criterios clínicos y características del líquido cefalorraquídeo que la mayoría de veces son inespecíficos. Objetivo: determinar las características clínico-epidemiológicas en pacientes con tuberculosis meníngea de los pacientes internados en área de clínica médica en el Hospital Nacional en el periodo 2015-2023. Metodología: estudio observacional descriptivo de corte transversal de pacientes adultos con tuberculosis meníngea internados en el Centro Médico Nacional en el periodo 2015- 2023. Resultados: se incluyeron 32 pacientes entre 20 y 85 años (edad media: 39 años); varones 68,75 %, mujeres 32,25 %. Mayoría provenientes del interior del país. En la mayoría de los casos los pacientes presentaron un aumento de proteínas en el líquido cefalorraquídeo y celularidad predominio de mononucleares, la positividad de GeneXpert de Mycobacterium del líquido cefalorraquídeo fue 62,5 %, en ningún caso se aisló BAAR. Fueron seropositivos para VIH 37,5 % y tenían afección pulmonar concomitante a la meningitis 43,75 %. La mortalidad fue de 31,25 %. Conclusión: la meningitis tuberculosa en nuestra investigación afectó mayormente a hombres de mediana edad provenientes del interior, cuya clínica inicial es la fiebre en mayor porcentaje seguido de cefalea presentando una alta mortalidad.

ABSTRACT Introduction: tuberculous meningitis is the most serious form of extrapulmonary tuberculosis, this is due to the high mortality and morbidity in patients, its diagnosis is difficult and the majority of cases can be identified based on clinical criteria and characteristics of the cerebrospinal fluid that the majority Sometimes they are nonspecific. Objective: determine the clinical-epidemiological characteristics in patients with meningeal tuberculosis of patients admitted to the medical clinic area at the National Hospital in the period 2015-2023. Methodology: retrospective descriptive observational cross-sectional study of adult patients with meningeal tuberculosis admitted to the National Hospital in the period 2015-2023. Results: 32 patients between 20 and 80 years old (mean age: 39 years) were included; men 68.75 %, women 32.25 %. Mostly coming from the interior of the country. In most cases, patients presented an increase in proteins in the cerebrospinal fluid and predominantly mononuclear cellularity. The genxpert positivity of Mycobacterium from the cerebrospinal fluid was 62.5 %; in no case was AFB isolated. 37.5 % were seropositive for HIV and 43.75 % had pulmonary disease concomitant to meningitis. Mortality was 31.25 %. Conclusion: tuberculous meningitis in our research mainly affected middle-aged men from the interior, whose initial symptoms are fever in a higher percentage followed by headache, presenting a high mortality.

Recomendaciones para el manejo de la enfermedad pulmonar post tuberculosis / Recommendations for the Management of Post Tuberculosis Lung Disease

Introducción: Los esfuerzos de la lucha contra la tuberculosis (TB) se centran habitualmente en un diagnóstico precoz y un tratamiento eficaz y oportuno para romper la cadena de transmisión de Mycobacterium tuberculosis. Sin embargo, en los últimos años, coincidiendo con la asociación sindémica TB/COVID-19, han aparecido cada vez más evidencias sobre las graves secuelas clínicas, funcionales y psicosociales que puede ocasionar la TB, condición que se ha definido como enfermedad pulmonar post-tuberculosis (PTLD). Aproximadamente, un tercio de los pacientes que sobreviven a la TB se enfrentan a esto, incluyendo síntomas respiratorios persistentes con exacerbaciones episódicas, insuficiencia respiratoria crónica, trastornos emocionales y desafíos psico-sociales que impactan negativamente en la calidad de vida y enfrentan un alto costo catastrófico. Objetivo: Proporcionar un modelo compartido, orientador y científicamente válido para diagnosticar, evaluar y tratar en forma oportuna a los pacientes con PTLD (prevención, diagnóstico, tratamiento y posible rehabilitación). Metodología: Es una investigación documental que incluye revisiones sistemáticas, meta-análisis, estudios observacionales y de las directrices existentes en los últimos años al respecto, sumado a una evaluación por expertos en el tema, con el propósito de adaptarlas a las condiciones locales de cada país latinoamericano. Conclusiones: Considerando la carga mundial, particularmente, latinoamericana de TB, y la carga estimada de la PTLD, se considera urgente el desarrollo de un consenso sobre este tema. Creemos que las recomendaciones de ALAT proporcionarán la base para la formulación y adopción de directrices nacionales para el manejo del PTLD en Amé- rica Latina.

Introduction: Efforts to combat tuberculosis (TB) usually focus on early, rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, coinciding with the syndemic TB/COVID-19 association, more and more evidence has proved the serious clinical, functional and psycho-social sequelae that TB can cause. This condition has been defined as Post-Pulmonary Disease Tuberculosis (PTLD) and it affects approximately one-third of the patients who survive TB, facing persistent respiratory symptoms with episodic exacerbations, chronic respiratory failure, emotional disorders and psychosocial challenges that negatively impact their life quality, meaning a high catastrophic cost. Objective: Provide a shared, guiding and scientifically valid model to promptly diagnose, evaluate and treat patients with PTLD (prevention, diagnosis, treatment and possible rehabilitation). Methodology: It is documentary research that includes systematic reviews, meta-analysis, observational studies and the guidelines that have existed in recent years in this regard, added to an evaluation by experts, with the purpose of adapting them to local conditions of each Latin American country. Conclusions: Considering the global and, particularly, the Latin American burden of TB, and the estimated burden of PTLD, the development of a consensus document on this topic is urgent. Therefore, we think ALAT recommendations will provide the basis for the formulation and adoption of national specific guidelines for the management of PTLD in Latin America.

Adenitis tuberculosa: experiencia de una unidad de asistencia inmediata / Tuberculous adenitis: Experience from an immediate assistance unit

Resumen Introducción : En el consultorio de atención inmediata de clínica se concentra la atención de pacientes ambu latorios con enfermedades que requieren diagnóstico precoz, como la adenitis tuberculosa (AT). El objetivo fue describir las características clínicas, estudios com plementarios y procedimientos realizados a pacientes con diagnóstico confirmado por bacteriología o anatomía patológica de AT. Métodos : Estudio observacional, descriptivo, retros pectivo. Período: 2017-2023. Resultados : Se incluyeron 49 pacientes, con una mediana de edad de 31 años; 59% de sexo femenino, 22% con comorbilidades El 40% presentó adenopatías localizadas, la mayoría cervicales. La serología para HIV era positiva en 3 (6.1%). Al 73% se le ingresaron muestras para bacteriología, con aislamiento de M. tuberculosis en 71%. Al 79% se le realizó punción aspiración con aguja fina (PAAF) ganglionar; en el 48% los resultados de la citología fueron sugestivos de tuberculosis (TB). Al 77% se le realizó biopsia ganglionar, resultando en el 62% adenitis granulomatosa. Desde la primera consulta hasta el diagnóstico transcurrieron una mediana de 40 días. La mayoría de los tratamientos se iniciaron luego del resultado de la biopsia, seguido de cultivos, baciloscopia, PAAF y GeneXpert. Un paciente falleció. Discusión : La AT predominó en el sexo femenino en el grupo estudiado, coincidente con la experiencia local, la edad promedio de presentación fue 30 a 40 años. Puede afectar cualquier cadena ganglionar, aunque predomina la localización cervical, que coincide con los hallazgos de este trabajo. En nuestra serie, la demora diagnóstica desde la primera consulta fue menor a la referida en la bibliografía.

Abstract Introduction : In the clinical medicine's immediate assistance unit, care is focused on outpatients with dis eases that require early diagnosis, such as tuberculous adenitis (TA). The aim was to describe clinical features, complementary studies and procedures performed in patients with a diagnosis confirmed by bacteriology or pathological anatomy of TA. Methods : Observational, descriptive, retrospective. Period: 2017-2023. Results : Fourty nine patients were included, with a median age of 31 years, 59% were female, 22% with comorbidities. 40% had localized lymphadenopathy, most of them cervical. HIV serology was positive in 3 cases (6.1%). Samples for bacteriology were submitted in 73%, with isolation of M. tuberculosis in 71%. Nodal fine needle aspiration (FNA) was performed in 79%, and in 48% the cytology results were suggestive of tuberculosis. Nodal biopsy was performed in 77%, with granulomatous adenitis as result in 62%. The term between admis sion and diagnosis ranged from a median of 40 days. Most treatments were started after the biopsy result, followed by culture, bacilloscopy, FNA, and GeneXpert. One patient died. Discussion : TA predominates in the female sex in the studied group, coinciding with the local experience, the average age of presentation is 30 to 40 years, can affect any lymph node region, although the cervical location predominates, which coincides with the findings of this work. In our series, the diagnostic delay from the first consultation was shorter than reported in the literature.

Diagnóstico tardío de tuberculosis diseminada: reporte de caso / Late diagnosis of disseminated tuberculosis: A case report

Introducción Los pulmones son más afectados en la tuberculosis. La infección también puede comprometer a otros órganos a través de la diseminación linfohematógena. La presentación del cuadro clínico de la tuberculosis diseminada es variable. El diagnóstico es difícil, porque las manifestaciones clínicas son diversas. Más del 50% de los pacientes acuden tardíamente, porque las pruebas microbiológicas dependen de procedimientos invasivos para el cultivo de micobacterias y la histopatología de apoyo. Caso clínico Paciente varón de 30 años, persona privada de su libertad, sin comorbilidades, ingresó al hospital por dolor intenso en muñeca izquierda, con historia previa de haber recibido glucocorticoides sistémicos durante siete meses. Desarrolló cuadro clínico de tuberculosis pulmonar en pleura, en articulación de la muñeca izquierda y en testículo izquierdo. En los análisis se confirmó presencia de . Fue intervenido quirúrgicamente en muñeca y en el testículo. Además, recibió tratamiento para tuberculosis sensible. Concomitantemente se diagnosticó secuelas de Cushing iatrogénico, anemia crónica y proctitis crónica inactiva. Conclusiones El diagnóstico de tuberculosis diseminada fue difícil debido al cuadro clínico inespecífico, a las limitaciones de herramientas de diagnóstico confirmatorio y a las evaluaciones especializadas en forma oportuna. El uso prolongado de corticoides sistémicos habría influido en la diseminación de la tuberculosis.

Introduction The lungs are most commonly involved in tuberculosis, but infection can also involve other organs through lymphohematogenous dissemination. The clinical presentation of disseminated tuberculosis is variable. Diagnosis is difficult, because clinical manifestations are diverse, more than 50% of patients present late, because microbiological testing relies on invasive procedures for mycobacterial culture and supportive histopathology. Case report A 30-year-old male patient, deprived of his liberty, with no co-morbidities, was admitted to the hospital for severe pain in the left wrist, with a previous history of having received systemic glucocorticoids for 7 months. He developed clinical symptoms of pulmonary tuberculosis, in the pleura, in the joint of the left wrist and in the left testicle, and tests confirmed the presence of M. tuberculosis. He underwent surgery on the wrist and testicle and was also treated for susceptible tuberculosis. Concomitant sequelae of iatrogenic Cushing's disease, chronic anemia and chronic inactive proctitis were diagnosed. Conclusions Diagnosis of disseminated tuberculosis was difficult due to the non-specific clinical picture, limitations of confirmatory diagnostic tools and timely specialized evaluations. Prolonged use of systemic corticosteroids may have played a role in the dissemination of tuberculosis.

Missed opportunities in the prevention and diagnosis of pediatric tuberculosis: a scoping review

Abstract Objectives: Identify potential barriers, delays, and missed opportunities in the prevention and diagnosis of childhood TB. Methods: Scoping review according to the PRISMA extension. The definitions considered for the selection followed the acronym PCC where the population (P) is children under 18years of age with TB disease, the concept (C) refers to missed opportunities for prevention and diagnosis, and context (C) is defined as a diagnosis of TB disease. The authors searched systematically in the databases; VHL/Lilacs, Medline via PubMed, Cochrane, Scopus, and Web of Science, without date or language limitation. Results: Seven studies were included. In developed countries, with low disease burden, the main shortcoming is the delay in diagnosing bacilliferous adults in contact with young children. This problem is concentrated in the portion of the population with socioeconomic vulnerability. In underdeveloped countries, with a high burden of disease, the biggest challenge is tracking children who come into contact with bacilliferous patients. Conclusions: There are still many missed opportunities in the prevention and diagnosis of childhood TB. The positive legacy of the COVID-19 pandemic should be taken advantage of and the encouragement of scientific development in the management of infectious diseases should be taken.

Tuberculous bronchoesophageal fistula presenting with miliary tuberculosis: a case report

A 35-year-old Asian woman with no pre-existing illnesses presented with a chronic cough during eating, mucoid sputum production, low-grade fever, and significant weight loss over the past few months. She had no history of high-risk behavior, foreign body aspiration, or ingestion of toxic substances. Physical examination revealed mild pallor without other significant findings. Vital signs were normal. Laboratory tests indicated mild anemia, leukocytosis, and elevated ESR. Sputum AFB and viral/autoimmune markers were negative. The tuberculin skin test was positive. Imaging studies, including fluoroscopy with contrast and a CT scan of the thorax, identified an esophagobronchial fistula and miliary tuberculosis, with multiple diffuse lung nodules and associated changes. The CT scan showed a thick-walled fistulous tract connecting the esophagus to the right main bronchus at three points, along with miliary nodules and bronchiectatic changes. AFB staining of bronchial secretions was negative, but PCR and cultures confirmed M. tuberculosis. The patient was initiated on weight-adjusted antituberculosis therapy and nasogastric feeding. The patient showed significant symptomatic improvement after two months of antituberculosis treatment. This case underscores the importance of thorough diagnostic evaluation in atypical presentations of tuberculosis and highlights the potential for esophagobronchial fistulas to complicate pulmonary tuberculosis.

Analysis of 100 sputum positive pulmonary tuberculosis patients: a retrospective study

Background: The bacterium Mycobacterium tuberculosis causes tuberculosis (TB), a contagious, airborne infection that destroys body tissue. Pulmonary TB occurs when M. tuberculosis primarily attacks the lungs. However, it can spread from there to other organs. Pulmonary TB is curable with an early diagnosis and antibiotic treatment. Methods: The present study was conducted at Adichunchanagiri Institute of Medical Sciences, Mandya with total of 100 sputum positive TB cases. The analysis was done between January 2023 to June 2023. Results: The proportion of sputum positive pulmonary tuberculosis and sputum positivity was highest in 20 to 40 years age group. The number of sputum positive pulmonary tuberculosis was three times more common in male compares to female. Conclusions: The highest burden of sputum positive pulmonary tuberculosis and maximum sputum positivity rate was found in productive age group. The proportion of sputum positive PTB was more in male than female patients. All age group except in patient between 0-19 year抯 ratio between male and female were almost equal.

Factors associated with sputum conversion time among patients with drug-resistant tuberculosis in Kenya

Background: Drug-resistant tuberculosis (DR-TB) is a form of antimicrobial resistance that is difficult and costly to treat. It is caused by TB bacteria that are resistant to at least one of the first-line existing TB medications, resulting in fewer treatment options and increasing mortality rates. Treatment for this form of TB, known as DR-TB, requires a minimum of 18-24 months of treatment with drugs that are less effective, more toxic, and more expensive than those needed for drug-susceptible TB. Methods: This was a retrospective review of secondary data for patients diagnosed with DR-TB in Kenya from 2014 to 2019. Each patient had a two-year follow-up period to monitor sputum conversion time and the associated factors. The enrolled patients comprised all patients diagnosed with DR-TB within the 47 counties in Kenya and enrolled at any drug-resistant registered treatment center. Results: A total of 2674 patients were enrolled for review to establish factors associated with conversion and we only found out that the type of resistance a patient enrolled on gender, intensive phase regiment, modification of intensive phase, and waiting time before treatment initiation were the only significant factors that would influence when a patient would convert from being sputum positive to negative. Conclusions: Patients with resistant TB require correct diagnosis and timely start of medication with good follow-up to avoid being lost to follow-up or failing on the medication started. Additionally, healthcare workers need continuous training to gain more knowledge in case of detection for patients coming to hospitals.

Qualidade dos registros da tuberculose no sistema de informação de notificação: perspectivas de apoiadores e digitadores distritais / Quality of tuberculosis records in the notifiable diseases information: perspectives of district supporters and typists

Apesar dos múltiplos esforços realizados em todo o mundo, a tuberculose (TB) continua sendo um problema de saúde pública e um grande desafio para os países com uma carga maior da doença. O sistema de vigilância epidemiológica (VE) da TB tem papel primordial nas atividades de prevenção e controle dessa doença. Este estudo tem como objetivo conhecer a perspectiva de apoiadores técnicos e digitadores sobre o registro de dados no SINAN acerca da tuberculose de uma capital do Norte do país. Estudo qualitativo, exploratório, realizado com oito apoiadores técnicos e digitadores. Os dados foram coletados por entrevista semiestruturada no período de janeiro a junho de 2022 e submetidos à análise temática. Expressos em duas categorias: Compromisso com a qualidade dos dados e Desafios no preenchimento e busca das informações. As principais limitações dos registros de dados estão relacionadas à qualidade dos dados enviados pelas unidades básicas de saúde e à falta de articulação entre os sistemas de registro. Há fragilidades em vários pontos do sistema, apontando a necessidade de investimento para a integração dos sistemas de registro, sensibilização dos profissionais sobre preenchimento adequado das informações; e elaboração de estratégias informatizadas que otimizem o processo de registro.

Despite multiple efforts around the world, tuberculosis (TB) remains a public health problem and a major challenge for countries with a higher burden of the disease. The TB epidemiological surveillance (ES) system plays a key role in TB prevention and control activities. The aim of this study was to get to know the perspective of technical supporters and typists on the recording of tuberculosis data in SINAN in a capital city in the north of the country. This is a qualitative, exploratory study carried out with eight technical supporters and typists. The data was collected through semi-structured interviews between January and June 2022 and subjected to thematic analysis. They were expressed in two categories: Commitment to data quality and Challenges in filling in and searching for information. The main limitations of the data records are related to the quality of the data sent by the basic health units and the lack of coordination between the recording systems. There are weaknesses at various points in the system, pointing to the need for investment in integrating the recording systems, raising awareness among professionals about how to fill in the information properly, and developing computerized strategies to optimize the recording process.

Actualización en la detección de la tuberculosis a través de pruebas moleculares / An update on the detection of tuberculosis through molecular testing

La tuberculosis es una enfermedad infecciosa respiratoria que afecta a un tercio de la población mundial y es una amenaza significativa para la salud global. La detección de la tuberculosis de manera temprana es crucial para un tratamiento eficaz y prevenir su propagación. Una solución para mejorar el diagnóstico y abordar la resistencia a los medicamentos antituberculosos es el uso de pruebas moleculares de alto rendimiento para la identificación del Mycobacterium tuberculosis y su susceptibilidad. Este estudio de revisión narrativa busca describir las generalidades, la eficacia, la sensibilidad, las ventajas y las limitaciones de las principales pruebas moleculares; Truenat® MTB, MTB plus y MTB-RIF, Abbott RealTime MTB y MTB RIF/INH en el sistema m2000sp y m2000rt y FluoroType MTBDR, además, de compararlas con GeneXpert MTB/RIF o Xpert Ultra, utilizadas para la detección del patógeno resistente a medicamentos tuberculosos. Estas pruebas utilizan diversas técnicas para la detección del ADN del Mycobacterium tuberculosis y la cuantificación de la carga bacteriana con alta sensibilidad y especificidad, resultados rápidos, reducción de los errores humanos, así como la detección temprana de cepas drogo-resistentes. A pesar de que requieren infraestructura especializada y competencias profesionales para su implementación, representan avances significativos con el potencial de mejorar la atención sanitaria y la gestión de la tuberculosis. Estas pruebas moleculares, comparadas con el GeneXpert, son una alternativa viable, aunque esta última tecnología sigue siendo la preferida en áreas con recursos limitados

Tuberculosis is a respiratory infectious disease that affects one third of the world's population and is a significant threat to global health. Detecting tuberculosis early is crucial for effective treatment and preventing its spread. One solution to improve diagnosis and address antituberculosis drug resistance is the use of high-throughput molecular tests for the identification of Mycobacterium tuberculosis and its susceptibility. This narrative review study seeks to describe the generalities, efficacy, sensitivity, advantages and limitations of the main molecular tests: Truenat® MTB, MTB plus and MTB-RIF, Abbott RealTime MTB and MTB RIF/INH on the m2000sp and m2000rt system and FluoroType MTBDR, and to compare them with GeneXpert MTB/RIF or Xpert Ultra, used for the detection of the tuberculosis drug-resistant pathogen. These tests use various techniques for the detection of Mycobacterium tuberculosis DNA and quantification of bacterial load with high sensitivity and specificity, rapid results, reduction of human error, as well as early detection of drug-resistant strains

Infecção latente pelo Mycobacterium tuberculosis em trabalhadores da saúde na Bahia / Latent Infection by Mycobacterium tuberculosis in health Workers in Bahia, Brazil

Objetivo: Estimar a prevalência de positividade do Teste Tuberculínico (TT) no rastreamento da infecção latente pelo Mycobacterium tuberculosis (ILTB) e identificar fatores associados entre trabalhadores da Atenção Primária à Saúde (APS) e média complexidade no segundo maior município do Estado da Bahia. Métodos: Inquérito epidemiológico, com 370 participantes, que avaliou dados sociodemográficos, ocupacionais, consumo de tabaco, álcool e variáveis relacionadas à tuberculose (TB), no período de abril/2021 a março/2022. Aplicou-se o TT por via intradérmica, com leitura após 72h. Resultados: A prevalência de positividade do TT foi de 41,3% e 17,6% para TT ≥ 5mm e TT ≥ 10mm, respectivamente. Para TT ≥ 5mm, as variáveis associadas foram: possuir cicatriz da vacina Bacilo Calmette-Guérin (BCG) e contato prévio com pessoas com TB. Conclusão: A prevalência de positividade do TT foi elevada entre os participantes do estudo. Fazem-se necessárias medidas de proteção ambiental, coletiva e individual para redução do risco de ILTB.

Objective: To estimate the prevalence of tuberculin test (TT) positivity in screening for Latent Mycobacterium tuberculosis Infection (LTBI) and to identify associated factors in Primary Health Care (PHC) and medium complexity workers in the second largest municipality in the State of Bahia, Brazil. Methods: Epidemiological survey with 370 workers on sociodemographic and occupational data, tobacco and alcohol use and variables related to Tuberculosis (TB), during April 2021 and March 2022. TT was applied intradermally, with reading after 72 hours. Results: The prevalence of positive TT was 41.3% and 17.6% for TT ≥ 5mm and TT ≥ 10mm, respectively. For TT ≥ 5mm, the associated variables were: presence of Bacillus Calmette-Guérin (BCG) vaccine scar and previous contact with TB patients. Conclusion: The prevalence of TST positivity was high among study participants. Environmental, collective and individual protection measures are necessary to reduce the risk of LTBI.

Tuberculosis: a narrative review on epidemiology, risks, implications, preventions and treatments

Tuberculosis (TB) is an airborne disease that generally affects the pulmonary portion of the human body leading to severe coughing, fever and chest pain. It is caused by a bacterium known as Mycobacterium tuberculosis, which kills human beings each and every year globally more than the death toll of combined HIV and malaria. However, it is preventable, treatable, and curable. The world is suffering due to this dreaded disease with an approximate number of 11 million TB cases and 1.6 million deaths annually. Tuberculosis increases the public health attention because of its high mortality rates after HIV/AIDS. World Health Organisation (WHO) and Centre for Chronic Disease Control (CCDC) are the leading organizations playing an important role to combat against TB by publishing proper health guidelines and treatments through reliable awareness campaigns whenever there is sudden outbreaks of TB, COVID-19 and related diseases. A wide range of research findings, clinical reports and new treatment methods like multi-drug therapy have been developed to combat TB. It is still necessary to develop new research and innovative ideas and proper implementations of the treatment and prevention guidelines of WHO and CCDC to fight against this fatal disease. In countries having higher increase of populations due to immunosuppressed chronic diseases like HIV, diabetes and pandemics like COVID-19, eradication of TB infection is a very difficult and challenging task. This mini review is based on the critical analyses of the data available from the official websites of WHO (Global Tuberculosis Report), CCDC, and search engines like Medline, PubMed, Google Scholar, and research findings of selected articles, textbooks were used as additional sources which are cited in the reference section.

Pott’s paraplegia-satisfactory outcome in spite of poor prognostic factors, treated by a novel surgical technique of posterior spinal stabilization and anterolateral decompression with bone graft fusion: a case report

A case of Pott’s paraplegia of sudden onset and of more than two months duration in an aged female, treated by a novel surgical technique of anterior decompression and local kyphotic angle correction by spinal pedicular fixation is presented here. A 52 year female with Pott’s paraplegia, ASIA-A with sphincters involvement and with flexor spasm, was treated by surgical intervention, in a single operation of two stages, the first by provisional posterior pedicular fixation and the second stage by anterolateral decompression and correcting the local kyphotic angle by cyclic changing the rods in increments of 5 degrees in compressive mode. The paravertebral abscess of opposite side was sucked out and at the end a tricortical bone graft harvested from iliac crest was impacted in between the space created by pedicular fixation maneuver in course of correcting kyphosis. There was steady dramatic improvement of clinical and neurological status within three weeks. Kyphotic correction was maintained with anterior tricortical interbody bone graft impacted in position. The novel surgical technique that is adopted for decompression, drainage including paravertebral abscess of opposite side, debridement and local kyphotic angle correction along with interbody bone graft fusion, in this case, offered a satisfactory outcome in spite of poor prognostic factors.

Sputum positivity status for acid fast bacilli in patient attending a designated microscopy centre of a tertiary care hospital, Lucknow

Background: Tuberculosis is a contagious bacterial disease that is considered to be one of the deadliest diseases worldwide. It affects lungs and causes pulmonary TB. Today in India, every minute 3 to 4 people die of TB, more than 1000 die every day and more than 5 lakhs die every year. Demonstration of AFB in smear has a great important in control of TB, as smear positivity directly correlates with infectivity. Methods: It was a cross-sectional study. It lasted over a period of 6 months (January to June). Samples were collected from patients attending TB and Chest OPD of IIMS&R Hospital and sent for AFB examination by Ziehl-Neelsen (ZN) microscopy at microbiology lab. Patients with symptom of cough lasting for more than 2 weeks were included. Results: Out of 718 patient’s samples, 128 were smear positive by ZN staining method. Out of which 81 (63.28%) were males and 47 (36.72%) were females. According to age distribution 35 (27.35%) were <30 years of age, 68 (53.12%) were in between 30 and 60 while 25 (19.53%) were >60 years of age. 105 (82.03%) positive patients were found to be from rural area and remaining 23 (17.9%) patients belong to urban area. 29 patients were found to have a past history of TB of 1 year. Out of 128 positive patients none were smokers. 25 (19.53%) were tobacco chewers. 11 (8.56%) were contact with a case of TB. Conclusions: Demonstration of AFB in smear has a great important in control of TB, as smear positivity directly correlates with infectivity. Z-N staining method is the most commonly used worldwide.

A comparative study of clinical profile of diabetic tuberculosis patients with non diabetic tuberculosis patients of outpatient department of tertiary healthcare centre

Background: The global increase in type 2 DM is recognized re-emerging risk and challenge to TB control in India. TB-T2D association is again at the frontline of risk factors for TB, with an estimated worldwide population attributable fraction of 34.5%. T2D not only increases TB risk 3-fold, but also TB treatment failure including death. And prognosis of diabetic tuberculosis patients as compared to non diabetic ones is poorer. Methods: An comparative analytical study was done in microbiologically confirmed 50 diabetic and 50 non diabetic TB patients registered in RNTCP OPD of tertiary healthcare hospital who were followed up for 3 months. Results: In our study we found that elderly (above 65 age group) male diabetic patients were affected more with tuberculosis as compared to young patients and data was statistically significant. Extrapulmonary involvement was seen more in diabetic patients as compared to non diabetic patients. Radiologically diabetic tuberculosis patient showed predominantly lower lobe of lung involvement as oppose to non diabetic tuberculosis patients who showed upper lobe of lung involvement and data was statistically significant. Outcomes like Multidrug Resistance and prolonged sputum positivity after intensive phase treatment was seen more with diabetic tuberculosis patients but this was not statistically significant. Conclusions: Early screening of TB patients for DM and vice versa and early initiation of treatment will prevent unfavourable outcomes of these patients.

Innovative Hybrid Compounds Targeting Tuberculosis: Development, Characterization and Bioefficacy analysis of 6-substituted-2-Chloroquinoline-3-Carbaldehyde Hydrazide Ester derivatives

This study delves into the biological activity of ester compounds obtained from analogues of 6-substituted-2-chloroquinoline-3-carbaldehyde hydrazide, aiming to exploit the combined antitubercular properties of quinoline and hydrazide to create innovative hybrid compounds. The molecules underwent a meticulous multi-step synthesis process, followed by purification through recrystallization. Methodologies such as 1H NMR, 13C NMR, FTIR and Mass Spectrometry was used to confirm the molecular structures of developed derivatives. SWISSADME, an online tool, was utilized to predict the ADME properties, shedding light on their pharmacokinetic profiles. Evaluation of in vitro antitubercular activity employing the Alamar blue method highlighted compounds 4a and 4f, exhibiting noteworthy efficacy achieving threshold concentrations of 6.25 µg/ml for M. tuberculosis inhibition. These findings suggest the possibility of novel quinoline Scaffold as potential molecule for TB treatment, contributing to ongoing endeavors in TB drug discovery and potentially laying the groundwork to develop effective antitubercular therapies.

Pulmonary and Extrapulmonary Tuberculosis, An Inflammatory Disease misdiagnosed as Cancer

Introduction:Tuberculosis is a serious infection associated with a high mortality rate if not treated.The clinical and imaging presentation are usually nonspecific and can mimic malignancy; therefore, extrapulmonary TB should be considered in the differential diagnosis of any suspicious extrapulmonary masses, particularly in immunocompromised patients. Objective:This study aims to analyse 160 cases of pulmonary and extra-pulmonary tuberculosis correlate the pathological features with the clinical data and find the most common differentiation diagnosis of both pulmonary and extrapulmonary tuberculosis.Methodology: A retrospective analysis of 160 cases of pulmonary and extra-pulmonary tuberculosis was performed.The age, gender , site, and symptoms of the lesion were collected, extrapulmonary sites were detected including rare and unusual sites and the differential diagnosis of these lesions was highlighted. The data were plotted in graphs and were analyzed.Result: In our study 63.6% were male and 36.4 were females.The majority of the patients were in the age group of 21-30 years followed by 31- 40 years, cough and hemoptysis were the most common symptoms followed by cervical swelling with 39% and 33% respectively. The most common sites were lung with (39%) and cervical swelling with (33%).The main differential diagnosis for many pulmonary and all extra-pulmonary tuberculosis was malignancy. Conclusion:Tuberculosis is a serious young person's disease that can affect almost every organ and tissue of the body and should be considered in the differential diagnosis of suspicious masses, as tuberculosis is often misdiagnosed as cancer.