Clinicoradiological Profile of Patients Having Drug-Sensitive Pulmonary Tuberculosis With and Without Diabetes Mellitus in a Tertiary Care Hospital in Ahmedabad, Gujarat, India.

Background A significant effect of diabetes mellitus (DM) on the clinical and radiological features of tuberculosis (TB) has been reported. However, conflicting results have also been reported. Hence, a conclusion is yet to be drawn. This study aimed to analyze and compare the clinical and radiological features of drug-sensitive pulmonary TB with DM and without DM. Methodology A comparative, observational study was conducted between August and October 2023. Patients with drug-resistant TB, extrapulmonary TB, those on immunosuppressive drugs, and human immunodeficiency virus-positive individuals were excluded from this study. Pulmonary TB patients with DM were classified as the case group and those without DM were classified as the control group. Demographic details, clinical symptoms, detailed past and family histories of comorbid conditions, laboratory investigations, sputum acid-fast bacilli results, and chest X-ray findings were noted. The diagnosis of TB and grading of sputum smear results were done by following the National Tuberculosis Elimination Program guidelines. Results A total of 40 patients, 20 (50%) cases and 20 (50%) controls, were enrolled in this study. Clinical symptoms were almost similar in both groups except for dyspnea (80% vs. 40%) and hemoptysis (75% vs. 35%), which were significantly predominant in the case group. Lower zone involvement in chest X-ray was significantly (p = 0.0079) more in the case group (75%) compared to the control group (40%). Cavitary lesions were also significantly higher in the TB with DM group (p = 0.031). Bilateral lesions and multiple zone involvement were also more common in the case group, although no statistically significant difference was seen. Additionally, the hematological parameters of the two groups differed; however, the findings were not statistically significant. Conclusions Based on our findings, we recommend screening all TB patients for DM. Similarly, all high-risk DM patients should be screened for TB for early diagnosis and management, thereby reducing morbidity and mortality. Physicians should be aware that people with DM may present with pulmonary TB in an atypical manner.

Quabodepistat in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary tuberculosis: protocol for a multicenter, phase 2b/c, open-label, randomized, dose-finding trial to evaluate safety and efficacy.

BACKGROUND: Delamanid and bedaquiline are two of the most recently developed antituberculosis (TB) drugs that have been extensively studied in patients with multidrug-resistant TB. There is currently a need for more potent, less-toxic drugs with novel mechanisms of action that can be used in combination with these newer agents to shorten the duration of treatment as well as prevent the development of drug resistance. Quabodepistat (QBS) is a newly discovered inhibitor of decaprenylphosphoryl-ß-D-ribose-2'-oxidase, an essential enzyme for Mycobacterium tuberculosis to synthesize key components of its cell wall. The objective of this study is to evaluate the safety, efficacy, and appropriate dosing of a 4-month regimen of QBS in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary TB in comparison with the 6-month standard treatment (i.e., rifampicin, isoniazid, ethambutol, and pyrazinamide). METHODS: This phase 2b/c, open-label, randomized, parallel group, dose-finding trial will enroll approximately 120 participants (including no more than 15% with human immunodeficiency virus [HIV] coinfection) aged ≥ 18 to ≤ 65 years at screening with newly diagnosed pulmonary drug-sensitive TB from ~8 sites in South Africa. Following a screening period of up to 14 days, eligible participants will be randomized in a ratio of 1:2:2:1 to one of four arms. Randomization will be stratified by HIV status and the presence of bilateral cavitation on a screening chest x-ray. After the end of the treatment period, participants will be followed until 12 months post randomization. The primary efficacy endpoint is the proportion of participants achieving sputum culture conversion in Mycobacteria Growth Indicator Tube by the end of the treatment period. The safety endpoints consist of adverse events, clinical laboratory tests, vital signs, physical examination findings, and electrocardiographic changes. DISCUSSION: QBS's potent bactericidal activity and distinct mechanism of action (compared with other TB drugs currently available for human use) may make it an ideal candidate for inclusion in a novel treatment regimen to improve efficacy and potentially prevent resistance to concomitant TB drugs. This trial will assess the effectiveness, safety, and dosing of a new, shorter, QBS-based, combination anti-TB treatment regimen. TRIAL STATUS: ClinicalTrials.gov NCT05221502. Registered on February 3, 2022.

Role for Linezolid in drug sensitive tuberculosis.

Tuberculosis (TB) continues to be a global challenge. Reducing the duration of TB treatment for drug-sensitive TB (DSTB) has direct and distinct advantages. We ventured into the aspect of utilizing linezolid as a pivotal drug in shortening therapy in DSTB. Linezolid has gained prominence as it is faring well in resistant TB management. Only a few studies use the strategy of Linezolid in DS-TB but it seems a lucrative approach, the bactericidal effects have been reported favourably in the studies. There have been concerns about the potential adverse drug effects of Linezolid reported but clinical trials have demonstrated safety and tolerability when administered for shorter periods. If the safety and efficacy of giving Linezolid for a shorter period along with standard drugs for DSTB is established it could lead to newer avenues using Linezolid for shortening the duration of treatment for DSTB as an alternative to treat DSTB.

Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia.

BACKGROUND: Non-adherence to tuberculosis treatment increases the risk of poor treatment outcomes. Digital adherence technologies (DATs), including the smart pillbox (EvriMED), aim to improve treatment adherence and are being widely evaluated. As part of the Adherence Support Coalition to End TB (ASCENT) project we analysed data from a cluster-randomised trial of DATs and differentiated care in Ethiopia to examine individual-factors for poor engagement with the smart pillbox. METHODS: Data were obtained from a cohort of trial participants with drug-sensitive tuberculosis (DS-TB) whose treatment started between 1 December 2020 and 1 May 2022, and who were using the smart pillbox. Poor engagement with the pillbox was defined as (i) > 20% days with no digital confirmation and (ii) the count of days with no digital confirmation, and calculated over a two evaluation periods (56-days and 168-days). Logistic random effects regression was used to model > 20% days with no digital confirmation and negative binomial random effects regression to model counts of days with no digital confirmation, both accounting for clustering of individuals at the facility-level. RESULTS: Among 1262 participants, 10.8% (133/1262) over 56-days and 15.8% (200/1262) over 168-days had > 20% days with no digital confirmation. The odds of poor engagement was less among participants in the higher stratum of socio-economic position (SEP) over 56-days. Overall, 4,689/67,315 expected doses over 56-days and 18,042/199,133 expected doses over 168-days were not digitally confirmed. Compared to participants in the poorest SEP stratum, participants in the wealthiest stratum had lower rates of days not digitally confirmed over 168-days (adjusted rate ratio [RRa]:0.79; 95% confidence interval [CI]: 0.65, 0.96). In both evaluation periods (56-days and 168-days), HIV-positive status (RRa:1.29; 95%CI: 1.02, 1.63 and RRa:1.28; 95%CI: 1.07, 1.53), single/living independent (RRa:1.31; 95%CI: 1.03, 1.67 and RRa:1.38; 95%CI: 1.16, 1.64) and separated/widowed (RRa:1.40; 95%CI: 1.04, 1.90 and RRa:1.26; 95%CI: 1.00, 1.58) had higher rates of counts of days with no digital confirmation. CONCLUSION: Poorest SEP stratum, HIV-positive status, single/living independent and separated/ widowed were associated with poor engagement with smart pillbox among people with DS-TB in Ethiopia. Differentiated care for these sub-groups may reduce risk of non-adherence to TB treatment.

Effectiveness and Pharmacokinetic Exposures of First-Line Drugs Used to Treat Drug-Susceptible Tuberculosis in Children: A Systematic Review and Meta-Analysis.

BACKGROUND: Optimal doses of first-line drugs for treatment of drug-susceptible tuberculosis in children and young adolescents remain uncertain. We aimed to determine whether children treated using World Health Organization-recommended or higher doses of first-line drugs achieve successful outcomes and sufficient pharmacokinetic (PK) exposures. METHODS: Titles, abstracts, and full-text articles were screened. We searched PubMed, EMBASE, CENTRAL, and trial registries from 2010 to 2021. We included studies in children aged <18 years being treated for drug-susceptible tuberculosis with rifampicin (RIF), pyrazinamide, isoniazid, and ethambutol. Outcomes were treatment success rates and drug exposures. The protocol for the systematic review was preregistered in PROSPERO (no. CRD42021274222). RESULTS: Of 304 studies identified, 46 were eligible for full-text review, and 12 and 18 articles were included for the efficacy and PK analyses, respectively. Of 1830 children included in the efficacy analysis, 82% had favorable outcomes (range, 25%-95%). At World Health Organization-recommended doses, exposures to RIF, pyrazinamide, and ethambutol were lower in children than in adults. Children ≤6 years old have 35% lower areas under the concentration-time curve (AUCs) than older children (mean of 14.4 [95% CI 9.9-18.8] vs 22.0 [13.8-30.1] µg·h/mL) and children with human immunodeficiency virus (HIV) had 35% lower RIF AUCs than HIV-negative children (17.3 [11.4-23.2] vs 26.5 [21.3-31.7] µg·h/mL). Heterogeneity and small sample sizes were major limitations. CONCLUSIONS: There is large variability in outcomes, with an average of 82% favorable outcomes. Drug exposures are lower in children than in adults. Younger children and/or those with HIV are underexposed to RIF. Standardization of PK pediatric studies and individual patient data analysis with safety assessment are needed to inform optimal dosing.

Active case finding of pulmonary tuberculosis and HIV infection among prisoners of South Gujarat: A cross sectional study.

BACKGROUND: In a close knit congregation such as prison, Tuberculosis (TB) and HIV can be major health problems. However, their prevalence in Indian prisons is under reported. This study aimed at adopting a camp based, active case finding approach to identify cases of TB, HIV and at risk prisoners in a central prison of South Gujarat. METHODS: A multidisciplinary team of public health experts, pulmonologists, social workers and lab technicians conducted a week-long camp to screen 1665 prisoners for TB using clinical examination, sputum smear for AFB, CBNAAT and Chest X-Ray and for HIV through Rapid Antigen Testing. RESULTS: Majority of participants (1392, 84%) were under trail prisoners, having spent an average of 1.4 years in prison. About 2.9% of participants had previous history of TB, of whom only 59% had completed treatment. About 14% of participants were underweight. Weight reduction was found to be significant in first five years of imprisonment. Of all participants, 3.6% were found to have diabetic range of blood sugar. Seven new active, drug sensitive pulmonary TB cases and three new cases of HIV infection were identified. All new cases of TB, HIV and increased blood sugar levels were linked to treatment. CONCLUSION: Camp based approach is effective in active case finding of pulmonary TB and predisposing factors such as malnourishment, Diabetes and HIV among prisoners. Routine screening of all prisoners at the time of entry and monthly thereafter in a camp based approach should be adopted to identify TB and at risk prisoners.

Factors predicting self-report adherence (SRA) behaviours among DS-TB patients under the "Integrated model": a survey in Southwest China.

BACKGROUND: China is one of 30 countries with a high tuberculosis (TB) burden, and poor adherence to TB treatment is one of the biggest challenges for TB control. We aimed to explore the barriers and facilitators of treatment adherence among drug-sensitive tuberculosis (DS-TB) patients under the "Integrated model" in Western China, to provide evidence-based treatment and control regimens for DS-TB patients to improve adherence behaviours. METHODS: Both qualitative and quantitative research methods were used to explore the factors associated with self-reported adherence (SRA) behaviours. Questionnaire surveys with DS-TB patients and in-depth interviews with leaders from the Centers for Disease Control and Prevention (CDC) and community health sectors (CHCs), healthcare workers (HCWs) from CHCs, and DS-TB patients were conducted. RESULTS: A total of 459 eligible patients were included in the quantitative survey, and two patients and 13 healthcare providers were included in the in-depth interviews. The percentage of patients who experienced a missed dose, lack of follow-up sputum examination, and interrupted treatment were 19.0%, 11.3%, and 9.2%, respectively. Patients aged 20-39 had a higher risk of missed dose [OR (95% CI): 2.302 (1.001-5.305)] and a lower risk of interrupted treatment [OR (95% CI): 0.278 (0.077-0.982)] than patients more than 60 years. Patients who were of Han ethnicity (OR [95% CI]: 0.524 [0.301-0.912]) received psychological support (OR [95% CI]: 0.379 [0.144-0.998]) from their family and had a lower risk of missed doses. Patients who had drug side effects had a higher risk of interrupted treatment (OR [95% CI]: 2.587 [1.237-5.412]). Patients who possessed higher knowledge had a lower risk of lack of follow-up sputum examination [OR (95% CI): 0.817 (0.673-0.991)]. The results of the qualitative study also reported that patients' poor TB knowledge was the main reason for their non-SRA behaviours. CONCLUSIONS: Patient-centred strategies should be implemented to improve health literacy and strengthen psychological support. More effective case management should be designed and implemented based on different patient characteristics to improve adherence behaviours in further studies.

Chest X-ray findings in drug-sensitive and drug-resistant pulmonary tuberculosis patients in Uganda.

Background: Tuberculosis (TB) is one of the leading causes of death worldwide. Radiology has an important role in the diagnosis of both drug-sensitive (DS) and rifampicin-resistant (RR) pulmonary TB (PTB). This study aimed to compare the chest x-ray (CXR) patterns of microbiologically confirmed DS and RR PTB cases stratified by HIV serostatus in Uganda. Methods: We conducted a hospital-based retrospective study at the Mulago National Referral Hospital (MNRH) TB wards. All participants had a microbiologically confirmed diagnosis of PTB. CXR findings extracted included infiltrates, consolidation, cavity, fibrosis, bronchiectasis, atelectasis, and other non-lung parenchymal findings. All films were examined by two independent radiologists blinded to the clinical diagnosis. Results: We analyzed CXR findings of 165 participants: 139 DS- and 26 RR-TB cases. The majority (n = 118, 71.7%) of the participants were seronegative for HIV. Overall, 5/165 (3%) participants had normal CXR. There was no statistically significant difference in the proportion of participants with consolidations (74.8% versus 88.5%; p = 0.203), bronchopneumonic opacities (56.1% versus 42.3%, p = 0.207) and cavities (38.1% versus 46.2%, p = 0.514), across drug susceptibility status (DS versus RR TB). Among HIV-infected participants, consolidations were predominantly in the middle lung zone in the DS TB group and in the lower lung zone in the RR TB group (42.5% versus 12.8%, p = 0.66). HIV-infected participants with RR TB had statistically significantly larger cavity sizes compared to their HIV uninfected counterparts with RR TB (7.7 ± 6.8 cm versus 4.2 ± 1.3 cm, p = 0.004). Conclusions: We observed that a vast majority of participants had similar CXR changes, irrespective of drug susceptibility status. However, HIV-infected RR PTB had larger cavities.The diagnostic utility of cavity sizes for the differentiation of HIV-infected and non-infected RR TB could be investigated further.

The Cavity as a Lasting Abode for Tuberculous Bacilli: An Observational Study.

The aim of this study was to determine the factors associated with persistent sputum positivity at the end of 2 months of treatment in patients presenting with (drug-susceptible) pulmonary tuberculosis at a tertiary care hospital in Karachi. A cross-sectional study was conducted at the Department of Chest Medicine (Ward 12), Jinnah Postgraduate Medical Center (JPMC), Karachi, over 6 months. A sample of 73 consenting, newly diagnosed, smear-positive drug-susceptible pulmonary tuberculosis patients was studied. Demographic (age, gender, height, weight and duration of tuberculosis, BMI, socioeconomic, occupational, marital, educational and residential statuses) and clinical factors (chest X-ray extent and cavities, initial smear results, diabetic and smoking statuses) which may be associated with sputum non-conversion were entered in a proforma. Patients were followed up at 2 months of treatment with a sputum smear. Data analysis was done on SPSS (Statistical Package for Social Sciences-version 20.0). Rate of sputum positivity after 2 months of anti-tubercular drug treatment was 17.8%. None of the above-mentioned demographic and clinical factors was associated with persistence of sputum positivity except for the presence of CXR cavities, which made it 5.5 times more likely that the patient would remain smear-positive at 2 months (p = 0.035). The finding of chest radiograph cavities makes it highly likely that a pulmonary tuberculosis patient may remain infectious or have an unfavorable outcome despite taking treatment for 2 months. Clinicians and national policy-makers should thus bear in mind the implications this can have with regard to disease control and therefore pay particular attention to such patients in terms of stringent monitoring and directly observed treatment short-course (DOTS) provision. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42399-021-01098-6.

Changes of cytokine levels before and after anti-tuberculosis treatment / 中国热带医学

@#Abstract： Objective　To analyze the changes of cytokine levels in patients with sensitive pulmonary tuberculosis and drug-resistant pulmonary tuberculosis before and after anti-tuberculosis treatment. Methods　The clinical data of 213 pulmonary tuberculosis patients admitted to the Eighth Affiliated Hospital of Xinjiang Medical University from August 2019 to October 2020 were collected, and divided into a sensitive pulmonary tuberculosis group and a drug-resistant pulmonary tuberculosis group, of which 141 were in the sensitive group and 72 in the drug-resistant group , and the pro-inflammatory factors tumor necrosis factor-α (TNF-α), IL-6, IL-17, interferon-γ (IFN-γ) and anti-inflammatory factors IL-10 and IL-4 in plasma before treatment, 3 months and 6 months after treatment were compared. Results　Compared with the healthy group, the levels of plasma IL-6 in the sensitive group and the resistant group were significantly increased, difference was statistically significant (P<0.01). The plasma levels of IFN-γ and IL-17 in the sensitive group were increased, and the difference was statistically significant (P<0.05). Compared with before treatment, the levels of IL-6 and IL-4 in the plasma of the sensitive group after 6 months of treatment were lower than those after 3 months of treatment, and the difference was statistically significant (P<0.05), and IFN-γ was significantly decreased (P<0.001). After 6 months of treatment, the IL-10 content was lower than that before treatment, and the difference was statistically significant (P<0.05), and the IFN-γ decreased significantly (P<0.000 1). The levels of IFN-γ at 3 months were higher than those in the resistant group, and the difference was statistically significant (P<0.01). After 6 months of treatment, there was no significant difference in the content of IFN-γ between the sensitive group and the resistant group. The effective rate of CT absorption was 70% in the sensitive group and only 43.33% in the resistant group at 3 months of treatment, and there was no significant difference in the effective rate between the two groups after 6 months of treatment. Conclusions　Detection of pro-inflammatory cytokines and anti-inflammatory cytokines in plasma can provide reference for host-directed therapy of pulmonary tuberculosis. Understanding this important feature of cytokines on pathogen-host interactions can provide new insights into the study of virulence mechanisms and may provide new approaches for immune intervention in pulmonary tuberculosis.

Recent Advances in Diagnosis and Management of Female Genital Tuberculosis.

Female genital tuberculosis (FGTB) is an important cause of significant morbidity and infertility. Gold-standard diagnosis by demonstration of acid fast bacilli on microscopy or culture or detection of epithelioid granuloma on histopathology of endometrial or peritoneal biopsy is positive in only small percentage of cases due to its paucibacillary nature. Use of gene Xpert on endometrial or peritoneal biopsy has improved sensitivity of diagnosis. Composite reference standard (CRS) is a significant landmark in its diagnosis in which combination of factors like AFB on microscopy or culture, positive gene Xpert, epithelioid granuloma on endometrial or peritoneal biopsy, demonstration of definite or probable findings of FGTB on laparoscopy or hysteroscopy. There have been many advances and changes in management of FGTB recently. The program is now called National Tuberculosis Elimination Program (NTEP), and categorization of TB has been stopped. Now, patients are divided into drug-sensitive FGTB for which rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) are given orally daily for 2 months followed by three drugs (rifampicin, isoniazid and ethambutol (RHE) orally daily for next 4 months. Multi-drug-resistant FGTB is treated with shorter MDR TB regimen of 9-11 months or longer MDR TB regimen of 18-20 months with reserved drugs. In vitro fertilization and embryo transfer have good results for blocked tubes and receptive endometrium, while surrogacy or adoption is advised for severe grades of Asherman's syndrome.

Determinants of drug resistant & drug sensitive tuberculosis patients from North India-a case control study.

BACKGROUND AND OBJECTIVE: The burden of drug resistant tuberculosis (DRTB) has posed a huge challenge to for the governments, throughout the world. India has 27% of the global DRTB burden with incidence of 130,000 cases. India has kept an ambitious target of elimination of tuberculosis by 2025 which requires understanding and mitigating various determinants of DRTB. METHODS: The retrospective case control study was undertaken from May to September 2019 among drugresistant (cases) and drug sensitive (controls) tuberculosis patients from two districts of Himachal Pradesh, India. A total of 211 participants were recruited in the study, which includes all 102 cases and randomly selected, age and sex matched 109 controls. A semi structured questionnaire, adapted from a study by Lobo et al, was used for assessing the determinants of DRTB and DSTB. The data collection was undertaken from district and block level health care facilities followed by home visits to patients. Multivariate logistic regression was used to determine risk factors associated with DRTB. RESULTS: Diagnostic delay (aOR-7.72, p value 0.000), history of treatment default (aOR-2.97, self history of tuberculosis (aOR 1.42, p value 0.01), migration (aOR-4.84, p value 0.000), smoking (aOR-2.70, p value 0.014), and belonging to rural area (aOR-2.62, p value- 0.013) were found as independent risk factors for the occurrence of DRTB. CONCLUSION: The risk factors identified in the study should be prioritized by the policy makers, implementators and educators for framing appropriate policies in TB control programme in India. The diagnostic delay as a risk factor merits active case finding of TB patients and educating health care staff and community.

Serum zinc level and its association with multidrug-resistant tuberculosis.

Background: Zinc deficiency is evident in chronic diseases, but little is known about its association with multi-drug resistant tuberculosis (MDRTB). We aimed to measure serum zinc level in MDRTB patients and explore its association with MDRTB compared to drug-sensitive tuberculosis (DSTB). Methods: We recruited 107 MDRTB and 87 DSTB patients from a tuberculosis referral hospital in Bangladesh. After overnight fasting, 5 ml venous blood was collected from each patient to measure serum zinc level through graphite furnace atomic absorption spectrophotometry method. Multivariate logistic regression was done to measure its association with MDRTB. Results: The mean age of all patients was 36 years, where 70% were male. About 27% MDRTB patients and 2.3% DSTB patients had low serum zinc level (P < 0.0001). An inverse correlation was observed between serum zinc level and duration of anti-TB therapy (r-value: -0.252, P < 0.01). Reduced serum zinc level (odds ratio, 0.957; 95% confidence interval 0.923-0.992) was found as a significant associating factor for MDRTB after adjusted with age, sex, occupation, residence, tobacco consumption, Bacillus Calmette-Guérin-vaccination, and duration of anti-TB therapy. Conclusion: A lower serum zinc level is significantly associated with MDRTB. The tuberculosis control program should address this in the MDRTB control strategy.

Knowledge about tuberculosis, treatment adherence and outcome among ambulatory patients with drug-sensitive tuberculosis in two directly-observed treatment centres in Southwest Nigeria.

BACKGROUND: Tuberculosis (TB) remains one of the most common infectious diseases worldwide. Although TB is curable provided the treatment commenced quickly, appropriately and uninterrupted throughout TB treatment duration. However, high default rate, treatment interruption and therapy non-adherence coupled with inadequate disease knowledge significantly contribute to poor TB treatment outcome, especially in developing countries. This study therefore assessed knowledge about TB and possible reasons for treatment non-adherence among drug-sensitive TB (DS-TB) patients, as well as evaluated treatment outcomes for the DS-TB managed within a 5-year period. METHODS: A mixed-method design comprising a cross-sectional questionnaire-guided survey among 140-ambulatory DS-TB patients from January-March 2019, and a retrospective review of medical-records of DS-TB managed from 2013 to 2017 in two WHO-certified TB directly-observed-treatment centres. Data were summarized using descriptive statistics, while categorical variables were evaluated with Chi-square at p < 0.05. RESULTS: Among the prospective DS-TB patients, males were 77(55.0%) and females were 63(45.0%). Most (63;45.0%) belonged to ages 18-34 years. A substantial proportion knew that TB is curable (137;97.9%) and transmittable (128;91.4%), while 107(46.1%) accurately cited coughing without covering the mouth as a principal mode of transmission. Only 10(4.0%) mentioned adherence to TB medications as a measure to prevent transmission. Inaccessibility to healthcare facility (33;55.0%) and pill-burden (10,16.7%) were topmost reasons for TB treatment non-adherence. Of the 2262-DS-TB patients whose treatment outcomes were evaluated, 1211(53.5%) were cured, 580(25.6%) had treatment completed, 240(10.6%) defaulted, 54(2.3%) failed treatment and 177(7.8%) died. Overall, the treatment success rate within the 5-year period ranged from 77.4 to 81.9%. CONCLUSIONS: Knowledge about TB among the prospective DS-TB patients is relatively high, especially with respect to modes of TB transmission and preventive measures, but a sizeable number lacks the understanding of ensuring optimal TB medication-adherence to prevent TB transmission. Inaccessibility to healthcare facility largely accounts for treatment non-adherence. Outcomes of treatment within the 5-year period show that nearly half were cured, while almost one-tenth died. Overall treatment success rate is about 12% below the WHO-defined target. There is generally a need for concerned stakeholders to step-up efforts in ensuring consistent TB enlightenment, while improving access to TB care is essential for better treatment outcome.

Comparison of the yield of tuberculosis among contacts of multidrug-resistant and drug-sensitive tuberculosis patients in Ethiopia using GeneXpert as a primary diagnostic test.

OBJECTIVES: This study compared the yield of tuberculosis (TB) among contacts of multidrug-resistant tuberculosis (MDR-TB) index cases with that in drug-sensitive TB (DS-TB) index cases in a program setting. METHODS: A comparative cross-sectional study was conducted among contacts of sputum smear-positive new DS-TB index cases and MDR-TB index cases. After contacts were screened, GeneXpert was used for the diagnosis of TB. RESULTS: The study included 111 MDR-TB and 119 DS-TB index cases. A total of 340 and 393 contacts of MDR-TB and DS-TB index cases, respectively, were traced, of whom 331 among MDR-TB contacts and 353 among DS-TB contacts were screened. There were 20 (6%) presumptive TB cases for MDR-TB contacts and 41 (11%) for DS-TB contacts. The prevalence of TB among MDR-TB contacts was 2.7% and among DS-TB contacts was 4.0%. The majority of the MDR-TB contacts diagnosed with TB had MDR-TB; the reverse was true for DS-TB. CONCLUSIONS: The yield of TB among contacts of MDR-TB and DS-TB patients using GeneXpert was high as compared to the population-level prevalence. The likelihood of diagnosing rifampicin-resistant TB among contacts of MDR-TB index cases was higher in comparison with contacts of DS-TB index cases. The use of GeneXpert in DS-TB contact investigation has the added advantage of diagnosing rifampicin-resistant TB cases when compared to the use of the nationally recommended acid-fast bacillus (AFB) microscopy for DS-TB contact investigation.

Chest X-Ray Findings Comparison between Multi-drug-resistant Tuberculosis and Drug-sensitive Tuberculosis.

BACKGROUND: Imaging has a big role in tuberculosis (TB) diagnosis and chest X-ray is preferable because it is available in primary health care and can point out the location, area, and morphology of lesions, such as cavity, consolidation, pleural effusions, and fibrosis. We aimed to compare the chest X-ray findings in multi-drug resistant TB (MDR-TB) and in drug-sensitive TB (DS-TB) cases. METHODS: This is a retrospective cross-sectional study which compares chest X-ray findings of two groups of patients, involving 183 DS-TB patients and 183 MDR-TB patients. Radiologic findings that we analyzed were infiltrate, consolidation, cavity, ground glass opacity, fibrosis, bronchiectasis, calcification, node, atelectasis, bullae, emphysema, and other nonlung parenchymal findings. RESULTS: MDR-TB group have 177 (96%) patients with large lesions, 6 (4%) with medium lesions, and no small lesions. DS-TB group have 55 (30%) patients with small lesions, 78 (43%) with medium lesions, and 50 (27%) with large lesions. Active TB lesions in the forms of infiltrate and ground-glass opacity were more dominant in DS-TB group, whereas consolidation, cavity, fibrosis, bronchiectasis, calcification, node, atelectasis, bullae, emphysema, and other nonlung parenchymal findings, were more dominant in MDR-TB. CONCLUSIONS: There were significant differences in chest X-ray findings between MDR-TB and DS-TB in terms of lesion size and morphology. Recognition of chest X-ray findings could help the physician to differentiate patient with suspected MDR-TB.

Caracterización de la tuberculosis sensible en el Ecuador: una visión epidemiológica a un antiguo y latente problema de salud / Characterization of sensitive tuberculosis in Ecuador: an epidemiological view of an ancient and latent health problem

Contexto: se calcula que en el año 2013, nueve millones de sujetos contrajeron tuberculosis y 1,5 millones fallecieron, de éstos, 360.000 sujetos fueron VIH positivos. Material y métodos: se realizó un estudio descriptivo transversal, en pacientes con diagnóstico de tuberculosis sensible en el Ecuador durante el período enero 2009 a diciembre 2013. El universo comprende el 100% de la población afectada por tuberculosis sensible. Resultados: predomina el sexo masculino, con una razón media de 1,8 hombres por mujer, con un intervalo de 15-54 años, la provincia de Guayas concentra un poco más del 50% de los casos de Tb; el 75% de casos se concentró en 5 provincias que son Guayas, Los Ríos, Pichincha, El Oro y Manabí. Los fracasos terapéuticos, en el 2011 en Ecuador alcanza una media 6,6%, el abandono terapéutico fue de 9,9% con un paulatino descenso, la tasa de mortalidad muestra una reducción superior al 50%. Conclusión: los resultados reflejan la necesidad de definir una estrategia para de incrementar el porcentaje de identificación de sintomáticos respiratorios, lo que aumentará el número de casos diagnosticados para aproximarse como país a la estimaciones de la OMS. Adicionalmente deberá fortalecerse la estrategia DOT con el fin de mejorar el éxito terapéutico y recudir los fracasos y abandonos. (AU)

Context: It is estimated that in 2013, nine million subjects contracted tuberculosis and 1.5 mil-lion died, of which 360,000 subjects were HIV positive. Material and methods: A cross-sectional descriptive study was performed in patients diagnosed with tuberculosis in Ecuador during the period January 2009 to December 2013. The universe comprises 100% of the population affected by sensitive tuberculosis. Results: men predominate, with an average ratio of 1.8 men per woman, with an interval of 15-54 years, the province of Guayas concentrates a little more than 50% of the cases of Tb; 75% of cases were concentrated in 5 provinces that are Guayas, Los Ríos, Pichincha, El Oro and Manabí. The therapeutic failures, in 2011 in Ecuador reaches a mean of 6.6%, the thera-peutic abandonment was 9.9% with a gradual decrease, the mortality rate shows a reduction of more than 50%. Conclusion: the results reflect the need to define a strategy to increase the per-centage of symptomatic respiratory identification, which will increase the number of cases diag-nosed to approximate the WHO country estimates. In addition, the DOT strategy should be strengthened in order to improve therapeutic success and recuse failures and dropouts. (AU)

Efectividad de la consejer¡a en enfermería en la adherencia al tratamiento farmacológico en pacientes con tuberculosis de la microred de salud Jaime Zubieta Calderón en San Juan de Lurigancho, Lima, Perú / Effectiveness of the counseling in nursing adherence to drug treatment in patients with tuberculosis of the micro red de salud Jaime Zubieta Calderón in San Juan de Lurigancho, Lima, Perú

Objetivos: determinar la efectividad de la consejería en enfermería en la adherencia al tratamiento farmacológico en pacientes nuevos con tuberculosis sensible al tratamiento, en la Micro red de salud Jaime Zubieta Calderón perteneciente a la DISA IV de Lima Este en San Juan de Lurigancho durante los meses de octubre 2013 hasta agosto 2014. Material y Métodos: estudio cuasi experimental con grupo control histórico. La muestra estuvo conformada por 30 pacientes nuevos con diagnóstico tuberculosis sensible, los controles se tomaron teniendo los mismos criterios de inclusión y el periodo de tiempo durante los meses de octubre 2012-setiembre 2013 obteniendo 72 controles. La recolección de datos se realizó a través de la tarjeta de control de asistencia y administración de medicamentos de cada uno. Los resultados se tabularon en el programa Excel 2010, posteriormente analizados en el programa SPSS versión 22. Resultados: se realizó un cuadro de homogeneidad donde se evidenció un nivel de significancia estadística 4.62, siendo el valor de p=0.032. El grupo intervenido obtuvo 100% de adherencia; a diferencia del grupo control histórico que tuvo una adherencia 86 %, se evidenció un incremento del 14% a lo esperado. Conclusiones: la consejería de enfermería es efectiva en la mejora de la adherencia al tratamiento antituberculoso en pacientes con TB sensible. Además, favorece a la asistencia diaria a la toma del tratamiento, citas médicas, nutrición y enfermería.

Objectives: to determine the effectiveness of counseling in nursing adherence to drug treatment in new patients with tuberculosis in “Micro red de salud Jaime Zubieta Calderon” belongs to the DISA IV Lima Este in San Juan de Lurigancho district during the months of October 2013 to August 2014. Material and Methods: a quasi-experimental research design with historical control. The sample was conducted with 30 patients new sensitive diagnosed with tuberculosis, where evaluated over a period of two months-a period greater risk to non-adherence- issues about the disease, treatment is addressed, and the particular needs of each user is identified. Controls were taken to have the same inclusion criteria and the period during the months of October 2012 to September 2013 obtaining 72 controls. The results are tabulated in the Excel 2010 program subsequently analyzed in SPSS version 22. Results: Homogeneity box where a level of statistical significance was performed evidenced 4.62, the value of p = 0.032. The interview group the percentage of adherence was 100%; than the history control group had a 86 % adherence is achieved a 14% increased the percentage expected. Conclusions: Nursing counseling is effective in improving adherence to tuberculosis treatment in patients with sensitive TB. Furthermore, fauvors the daily attendance taking treatment, medical appointments, nutrition and nursing.

Transitioning to daily treatment for drug-sensitive TB in India.

World Health Organization in its treatment guideline for tuberculosis 2010 recommended daily dosing as the preferred regimen in treatment of drug-sensitive TB patients. The Revised National Tuberculosis Control Program took a decision to implement daily regimen in five states of India in 2015. This article describes the policy-making chronology, evidences used, stakeholders involved, and process of decision making.