Impact of the COVID-19 pandemic on tuberculosis patients and tuberculosis control programs in Turkey, review and analysis.

BACKGROUND: Many infectious diseases, including Tuberculosis (TB), have been put in the background with the COVID-19 pandemic. This study aimed to evaluate the changes in the number of TB patients, the parameters of the TB patients and tuberculosis control programs in the first year of the COVID-19 pandemic in Turkey when compared to the previous year. METHODS: All TB patients who were recorded in Samsun province between March 1, 2019 and February 28, 2021 were included in this retrospective study. The data were analyzed in 2 groups as the COVID-19 period (March 2020 and February 2021) and the Pre-COVID-19 period (March 2019 and February 2020),the demographic and microbiological characteristics of the tuberculosis patients in both periods were compared according to months and years p < 0.05 was considered statistically significant. RESULTS: The total number of TB patients was 320, although it was 172 in the Pre-COVID-19 period, it was 148 in the COVID-19 pandemic period. It was found that the TB incidence rate (IR) was 15.32%, the total number of examinations performed in TB dispensary decreased 33.54%, and the total number of contact examinations decreased by 53.54% during the pandemic period. The mean age of the patients decreased significantly during the COVID-19 period (p = 0.047), and it was found that culture positivity rates and smear positivity rates increased compared to the previous year (7.97%, p = 0.166, 1.86%; p = 0.507, respectively). SARS-CoV-2 PCR test result was found to be (-) in 46 (82.1%) of the 56 TB patients who were examined. CONCLUSIONS: In the present study, it was found that the incidence of TB, the number of examinations, and the number of contact examinations decreased at significant levels. The decrease in TB patients was mostly in the first 3 months when COVID-19 precautions and restrictions were intense. As a conclusion, it was observed that the application of TB patients to the healthcare institution and TB control were affected negatively by the COVID-19 pandemic.

Investigation of Granulomatous Inflammations in Terms of Tuberculosis Diagnosis: A 5-Year Multi-center Laboratory Study.

OBJECTIVE: Granulomatous inflammation showing "caseification necrosis" is considered pathognomonic for tuberculosis. This study aimed to evaluate patients with granulomatous inflammation and some characteristics to diagnose tuberculosis. MATERIAL AND METHODS: This is a cross-sectional descriptive study. The study includes all pathology laboratories in Samsun between the years 2012 and 2017. Pathology reports that contained the term granulomatous were selected between all patient reports of these laboratories. The patient reports were examined by comparing the dispensary records and the presence of a diagnosis of tuberculosis. RESULTS: In the 703 pathology reports, it was found that 38% were only granulomatous and 33% were caseous granulomatosis lesions. When the prevalence of tuberculosis according to the presence of microscopic necrosis was observed in granulomatous tissue samples, 85% tuberculosis was found in patients with necrotic granulomatous tissue and 14% tuberculosis was found with non-necrotic lesions. The presence of tuberculosis in necrotic granulomatous tissues was statistically significantly higher (P < .00001). CONCLUSION: As a result, when examining a pathology report for the presence of tuberculosis, the existence of a granulomatous reaction should be considered first. Getting stuck on the definition of caseification necrosis will cause the case to be skipped. An indication of necrosis in the pathologic evaluation will guide the diagnosis of tuberculosis.

Characteristics of tuberculosis-related deaths and risk factors: a retrospective cohort study in Samsun province of Turkey.

OBJECTIVES: Tuberculosis (TB) remains one of the top ten leading causes of death worldwide despite effective therapy. The present study aims to examine the characteristics of TB-related deaths in Samsun Province and to determine the risk factors. METHODS: In this retrospective registry-based cohort study, the medical records of patients registered with Samsun Tuberculosis Control Dispensary between 1 January 2018 and 31 December 2019 were retrospectively reviewed. The Cox proportional-hazards model was used to determine the factors associated with the risk of death in patients with TB. RESULTS: The treatment outcomes of a total of 382 patients were reviewed. It was found that the treatment was successful in 346 patients (90.6%), and 31 patients (8.1%) died before or during TB therapy. The median survival time of patients who died during the therapy was 1.86 months (95% CI = 0.07-5.17 months), and more than 50% (13/25) of the deaths occurred in the first two months of the treatment. Age above 70 years (HR 15.06 (3.33-67.95)), male gender (HR 2.74 (1.02-7.33)), pulmonary TB (HR 2.92 (1.002-8.52)), multidrug-resistant (MDR) tuberculosis (HR 1.69 (1.22-12.75)), and a delay in the treatment of more than ten days (HR 2.71 (1.22-6.04)) were identified as risk factors associated with mortality in TB patients (p < 0.05). CONCLUSION: The majority of deaths in our cohort occurred within the first two months after starting the treatment. Advanced age, male sex, a new diagnosis of TB, pulmonary TB, MDR-TB, and a treatment delay of more than ten days after diagnosis increased the risk for mortality during antituberculosis treatment.

Evaluation of effectiveness of pathology reports in active surveillance of tuberculosis.

OBJECTIVE: Despite advancing technology, national TB surveillance systems are still inadequate in terms of patient detection around the world. It was aimed to investigate suspicious cases detected by active surveillance method in pathology laboratories and to evaluate the effectiveness of this method in terms of finding new TB cases. METHODS: This is a descriptive cross-sectional study. It was administrated in Samsun, Turkey, between January 2012-December 2017. Within the scope of active surveillance, pathology laboratories were regularly visited and reported cases with granulomatous inflammation were assessed. The obtained patient list was compared with the records of the Electronic Tuberculosis Management System (ETMS). Patients who were not included in these records were invited to the dispensary and evaluated for TB. They were also referred to the relevant hospitals for diagnosis if necessary. Frequency values and descriptive statistics were calculated using SPSS method. RESULTS: It was found that 35.6% of 703 patients with the diagnosis of granulomatous inflammation were previously diagnosed, treated or currently undergoing treatment in the ETMS registry. As a result of the assessment of remaining 453 cases, 46 patients (10.1%) were newly diagnosed with TB. Newly diagnosed TB patients were reported, and their treatment started. CONCLUSION: As a result, active surveillance method conducted in pathology laboratories are used to detect unknown or late reported TB cases and allows to start treatment without further delay.

Regional success on screening and chemoprophylaxis in contacts of patients with pulmonary tuberculosis in Turkey: a dispensary experience in 2016-2017.

BACKGROUND: Turkey has a national tuberculosis (TB) control program that follows the standards set by the World Health Organization's (WHO) global TB control program. METHODS: In this record-based retrospective study, contact screening and chemoprophylaxis of 469 TB contacts registered at the Samsun Tuberculosis Dispensary in 2016-2017 were assessed. RESULTS: On average, patients with pulmonary TB each had four contacts. Chemoprophylaxis was administered in 233 of the contacts for the following reasons: having close contact with an active TB patient (187 [80%]), being <15 y of age and tuberculin skin test (TST) positive (12 [5%]), detection of latent TB infection (27 [12%]) or not having been treated for TB before in conjunction with the discovery via radiography of a sequel lesion (7 [3%]). The remaining 236 contacts were not given chemoprophylaxis: 203 (86%) were TST negative, 10 (4%) rejected chemoprophylaxis and 23 (10%) refused to participate in an examination. Chemoprophylaxis was given to 30% of contacts in the first week and to 75% of contacts in the first month. The treatment completion rate was 80%, while the rate of chemoprophylaxis abandonment was 19.5% for males and 21.2% for females. CONCLUSIONS: The Samsun TB dispensary is successfully implementing the WHO's End TB strategy and has achieved higher treatment completion rates than other countries.