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Liu, Theresa T., Douglas Wilson, Halima Dawood, D. William Cameron, and Gonzalo G. Alvarez. "Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV Prevalence." Clinical and Developmental Immunology 2012 (2012): 1–5. http://dx.doi.org/10.1155/2012/937013.
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Despite the South African antiretroviral therapy rollout, which should reduce the incidence of HIV-associated tuberculosis (TB), the number of TB-attributable deaths in KwaZuluNatal (KZN) remains high. TB is often diagnosed clinically, without microbiologic confirmation, leading to inaccurate estimates of TB-attributed deaths. This may contribute to avoidable deaths, and impact population-based TB mortality estimates.Objectives. (1) To measure the number of cases with microbiologically confirmed TB in a retrospective cohort of deceased inpatients with TB-attributed hospital deaths. (2) To estimate the rates of multi-drug resistant (MDR) and extensively drug resistant (XDR) TB in this cohort.Results. Of 2752 deaths at EDH between September 2006 and March 2007, 403 (15%) were attributed to TB on the death certificate. 176 of the TB-attributed deaths (44%) had a specimen sent for smear or culture; only 64 (36%) had a TB diagnosis confirmed by either test. Of the 39 culture-confirmed cases, 27/39 (69%) had fully susceptible TB and 27/39 (69%) had smear-negative culture-positive TB (SNTB). Two patients had drug monoresistance, three patients had MDR-TB, and one had XDR-TB.Conclusions. Most TB-attributed deaths in this cohort were not microbiologically confirmed. Of confirmed cases, most were smear-negative, culture positive and were susceptible to all first line drugs.
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Pedrazzoli, Debora, Katharina Kranzer, H. Lucy Thomas, and Maeve K. Lalor. "Trends and risk factors for death and excess all-cause mortality among notified tuberculosis patients in the UK: an analysis of surveillance data." ERJ Open Research 5, no. 4 (2019): 00125–2019. http://dx.doi.org/10.1183/23120541.00125-2019.
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IntroductionIn the UK, several hundred patients notified with tuberculosis (TB) die every year. The aim of this article is to describe trends in deaths among notified TB patients, explore risk factors associated with death and compare all-cause mortality in TB patients with age-specific mortality rates in the general UK population.MethodsWe used 2001–2014 data from UK national TB surveillance to explore trends and risk factors for death, and population mortality data to compare age-specific death rates among notified TB patients with annual death rates in the UK general population.ResultsThe proportion of TB patients in the UK who died each year declined steadily from 7.1% in 2002 to 5.5% in 2014. One in five patients (21.3%) was diagnosed with TB post-mortem. Where information was available, almost half of the deaths occurred within 2 months of starting treatment. Risk factors for death included demographic, disease-specific and social risk factors. Age had by far the largest effect, with patients aged ≥80 years having a 70 times increased risk of death compared with those aged <15 years. In contrast, excess mortality determined by incidence ratios comparing all-cause mortality among TB patients with that of the general population was highest among children and the working-age population (15–64 years old).ConclusionsEfforts to control TB and improve diagnosis and treatment outcomes in the UK need to be sustained. Control efforts need to focus on socially deprived and vulnerable groups. There is a need for further in-depth analysis of deaths of TB patients in the UK to identify potentially preventable factors.
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Min, Jinsoo, Yoon Mi Shin, Won Jae Lee, et al. "Clinical features of octogenarian patients with tuberculosis at a tertiary hospital in South Korea." Journal of International Medical Research 47, no. 1 (2018): 271–80. http://dx.doi.org/10.1177/0300060518800597.
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Objective The growth of the older population is a great challenge for tuberculosis (TB) control in South Korea. This study was performed to investigate the clinical characteristics of and treatment outcomes among octogenarian patients with TB. Methods We retrospectively analyzed the medical records of 109 patients with TB (age of ≥80 years) from January 2014 to March 2017. Clinical, microbiologic, and radiologic findings were obtained. Results Fifty-five patients (50.5%) were male, the mean age of the patients was 83.8 years, and 75 patients (68.8%) had pulmonary TB. All patients with pulmonary TB underwent either chest X-ray or chest computed tomography examination, and the results showed that only one-third (n = 33, 39.3%) had active lesions suggestive of TB. Twenty-nine patients (26.4%) had an unfavorable outcome (21 died and 8 were lost to follow-up). Only two TB-related deaths occurred, and both were caused by respiratory failure. Among the 15 non-TB-related deaths, the progression of malignancy and sepsis were the most frequent causes of death. Conclusions A high mortality rate was observed in octogenarian patients with TB, and most of these deaths were non-TB-related. Among all causes of mortality, solid malignancy was a significant risk factor for death.
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Garcia-Basteiro, Alberto L., Juan Carlos Hurtado, Paola Castillo, et al. "Unmasking the hidden tuberculosis mortality burden in a large post mortem study in Maputo Central Hospital, Mozambique." European Respiratory Journal 54, no. 3 (2019): 1900312. http://dx.doi.org/10.1183/13993003.00312-2019.
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Sensitive tools are needed to accurately establish the diagnosis of tuberculosis (TB) at death, especially in low-income countries. The objective of this study was to evaluate the burden of TB in a series of patients who died in a tertiary referral hospital in sub-Saharan Africa using an in-house real time PCR (TB-PCR) and the Xpert MTB/RIF Ultra (Xpert Ultra) assay.Complete diagnostic autopsies were performed in a series of 223 deaths (56.5% being HIV-positive), including 54 children, 57 maternal deaths and 112 other adults occurring at the Maputo Central Hospital, Mozambique. TB-PCR was performed in all lung, cerebrospinal fluid and central nervous system samples in HIV-positive patients. All samples positive for TB-PCR or showing histological findings suggestive of TB were analysed with the Xpert Ultra assay.TB was identified as the cause of death in 31 patients: three out of 54 (6%) children, five out of 57 (9%)maternal deaths and 23 out of 112 (21%) other adults. The sensitivity of the main clinical diagnosis to detect TB as the cause of death was 19.4% (95% CI 7.5–37.5) and the specificity was 97.4% (94.0–99.1) compared to autopsy findings. Concomitant TB (TB disease in a patient dying of other causes) was found in 31 additional cases. Xpert Ultra helped to identify 15 cases of concomitant TB. In 18 patients, Mycobacterium tuberculosis DNA was identified by TB-PCR and Xpert Ultra in the absence of histological TB lesions. Overall, 62 (27.8%) cases had TB disease at death and 80 (35.9%) had TB findings.The use of highly sensitive, easy to perform molecular tests in complete diagnostic autopsies may contribute to identifying TB cases at death that would have otherwise been missed. Routine use of these tools in certain diagnostic algorithms for hospitalised patients needs to be considered. Clinical diagnosis showed poor sensitivity for the diagnosis of TB at death.
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Salim, Saema. "Prevalence, Types and Treatment of Tuberculosis: A Review." Scientific Inquiry and Review 4, no. 4 (2020): 41–48. http://dx.doi.org/10.32350/sir/2020/44/999.
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Tuberculosis (TB) has reemerged as one of the main cause of death in human beings in recent years. TB is caused by a group of species called Mycobacterium tuberculosis complex, and it causes three million deaths each year around the world. In 2010, the global estimated incidence of TB was about 8.0 million. The number of deaths from TB among HIV-negative patients was 1.0 million while the number of deaths among the HIV-positive TB was about 0.40 million. The higher incident and elevation of MDR cases demand efforts to shift focus to various control strategies against TB. According to WHO, in 2014 magnitude of TB was recorded as 126 positive cases per 0.1 million population in the world. Pakistan ranks fourth in high TB burden countries where each year approximately 297,000 TB cases are reported. Tuberculosis can be comprehensively grouped into two main types; pulmonary and extra pulmonary tuberculosis. Pulmonary tuberculosis affects the lungs and is most common type of TB. In 15 to 20 % cases of the active TB, the infection spreads from lungs to different parts of the body. This condition is called extra-pulmonary tuberculosis. Different treatment regimens are available for tuberculosis.
 
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Avoi, Richard, and Yau Chun Liaw. "Tuberculosis Death Epidemiology and Its Associated Risk Factors in Sabah, Malaysia." International Journal of Environmental Research and Public Health 18, no. 18 (2021): 9740. http://dx.doi.org/10.3390/ijerph18189740.
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Tuberculosis (TB) is a leading killer from a single infectious agent globally. In 2019, Malaysia’s TB incidence rate was 92 per 100,000 population, and the TB mortality rate was estimated at 4 cases per 100,000 population per year. However, the state of Sabah had a higher burden of TB with a notification rate of 128 per 100,000 population and a TB case fatality rate of 8% compared to the national figure. This study aims to provide a comprehensive report on TB deaths epidemiology and its associated factors at a sub-national level. This nested case-control study used Sabah State Health Department TB surveillance data from the Malaysia national case-based TB registry (MyTB) between 2014 and 2018. Cases were defined as all-cause TB deaths that occurred before anti-TB treatment completion from the time of TB diagnosis. Controls were randomly selected from TB patients who completed anti-TB treatment. The TB mortality rate had increased significantly from 9.0/100,000 population in 2014 to 11.4/100,000 population in 2018. The majority of TB deaths occurred in the first two months of treatment. TB-related deaths were primarily due to advanced disease or disseminated TB, whereas non-TB-related deaths were primarily due to existing comorbidities. Many important independent risk factors for TB deaths were identified which are useful to address the increasing TB mortality rate.
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Glaziou, Philippe, Katherine Floyd, Diana Weil, and Mario Raviglione. "TB deaths rank alongside HIV deaths as top infectious killer." International Journal of Tuberculosis and Lung Disease 20, no. 2 (2016): 143–44. http://dx.doi.org/10.5588/ijtld.15.0985.
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Kootbodien, Tahira, Kerry Wilson, Nonhlanhla Tlotleng, et al. "Tuberculosis Mortality by Occupation in South Africa, 2011–2015." International Journal of Environmental Research and Public Health 15, no. 12 (2018): 2756. http://dx.doi.org/10.3390/ijerph15122756.
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Work-related tuberculosis (TB) remains a public health concern in low- and middle-income countries. The use of vital registration data for monitoring TB deaths by occupation has been unexplored in South Africa. Using underlying cause of death and occupation data for 2011 to 2015 from Statistics South Africa, age-standardised mortality rates (ASMRs) were calculated for all persons of working age (15 to 64 years) by the direct method using the World Health Organization (WHO) standard population. Multivariate logistic regression analysis was performed to calculate mortality odds ratios (MORs) for occupation groups, adjusting for age, sex, year of death, province of death, and smoking status. Of the 221,058 deaths recorded with occupation data, 13% were due to TB. ASMR for TB mortality decreased from 165.9 to 88.8 per 100,000 population from 2011 to 2015. An increased risk of death by TB was observed among elementary occupations: agricultural labourers (MORadj = 3.58, 95% Confidence Interval (CI) 2.96–4.32), cleaners (MORadj = 3.44, 95% CI 2.91–4.09), and refuse workers (MORadj = 3.41, 95% CI 2.88–4.03); among workers exposed to silica dust (MORadj = 3.37, 95% CI 2.83–4.02); and among skilled agricultural workers (MORadj = 3.31, 95% CI 2.65–4.19). High-risk TB occupations can be identified from mortality data. Therefore, TB prevention and treatment policies should be prioritised in these occupations.
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Salazar-Austin, Nicole, David W. Dowdy, Richard E. Chaisson, and Jonathan E. Golub. "Seventy Years of Tuberculosis Prevention: Efficacy, Effectiveness, Toxicity, Durability, and Duration." American Journal of Epidemiology 188, no. 12 (2019): 2078–85. http://dx.doi.org/10.1093/aje/kwz172.
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Abstract Tuberculosis (TB) has been a leading infectious cause of death worldwide for much of human history, with 1.6 million deaths estimated in 2017. The Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health has played an important role in understanding and responding to TB, and it has made particularly substantial contributions to prevention of TB with chemoprophylaxis. TB preventive therapy is highly efficacious in the prevention of TB disease, yet it remains underutilized by TB programs worldwide despite strong evidence to support its use in high-risk groups, such as people living with HIV and household contacts, including those under 5 years of age. We review the evidence for TB preventive therapy and discuss the future of TB prevention.
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Nayeem, Jannatun, and Md Abu Salek. "Tuberculosis Endemic in Bangladesh." Malaysian Journal of Medical and Biological Research 2, no. 2 (2015): 71–76. http://dx.doi.org/10.18034/mjmbr.v2i2.392.
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Tuberculosis (TB) has been a major public concern of Bangladesh for decades. According to the World Health Organization (WHO), Bangladesh ranks sixth among the 22 high TB-burden countries. Thus in order to improve the TB status, BRAC introduced the tuberculosis control program in 1984 in collaboration with the government. In this paper is carried out on the number of reported cases and deaths from endemic of tuberculosis. Time series analysis performed on this data reveals that tuberculosis infection has been on the rise over the years. The situation is also the same as the number of deaths. Reported cases and death cases are forecasted to carry out using appropriate and reliable method that also indicates in the two related population in this research work.
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Lino Ferreira da Silva Barros, Maicon Herverton, Geovanne Oliveira Alves, Lubnnia Morais Florêncio Souza, et al. "Benchmarking Machine Learning Models to Assist in the Prognosis of Tuberculosis." Informatics 8, no. 2 (2021): 27. http://dx.doi.org/10.3390/informatics8020027.
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Tuberculosis (TB) is an airborne infectious disease caused by organisms in the Mycobacterium tuberculosis (Mtb) complex. In many low and middle-income countries, TB remains a major cause of morbidity and mortality. Once a patient has been diagnosed with TB, it is critical that healthcare workers make the most appropriate treatment decision given the individual conditions of the patient and the likely course of the disease based on medical experience. Depending on the prognosis, delayed or inappropriate treatment can result in unsatisfactory results including the exacerbation of clinical symptoms, poor quality of life, and increased risk of death. This work benchmarks machine learning models to aid TB prognosis using a Brazilian health database of confirmed cases and deaths related to TB in the State of Amazonas. The goal is to predict the probability of death by TB thus aiding the prognosis of TB and associated treatment decision making process. In its original form, the data set comprised 36,228 records and 130 fields but suffered from missing, incomplete, or incorrect data. Following data cleaning and preprocessing, a revised data set was generated comprising 24,015 records and 38 fields, including 22,876 reported cured TB patients and 1139 deaths by TB. To explore how the data imbalance impacts model performance, two controlled experiments were designed using (1) imbalanced and (2) balanced data sets. The best result is achieved by the Gradient Boosting (GB) model using the balanced data set to predict TB-mortality, and the ensemble model composed by the Random Forest (RF), GB and Multi-Layer Perceptron (MLP) models is the best model to predict the cure class.
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Floyd, Katherine, Mario Raviglione, and Philippe Glaziou. "Global Epidemiology of Tuberculosis." Seminars in Respiratory and Critical Care Medicine 39, no. 03 (2018): 271–85. http://dx.doi.org/10.1055/s-0038-1651492.
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AbstractTuberculosis (TB) was the underlying cause of 1.3 million deaths among human immunodeficiency virus (HIV)-negative people in 2016, exceeding the global number of HIV/acquired immune deficiency syndrome (AIDS) deaths. In addition, TB was a contributing cause of 374,000 HIV deaths. Despite the success of chemotherapy over the past seven decades, TB is the top infectious killer globally. In 2016, 10.4 million new cases arose, a number that has remained stable since the beginning of the 21th century, frustrating public health experts tasked to design and implement interventions to reduce the burden of TB disease worldwide. Ambitious targets for reductions in the epidemiological burden of TB have been set within the context of the Sustainable Development Goals (SDGs) and the End TB Strategy. Achieving these targets is the focus of national and international efforts, and demonstrating whether or not they are achieved is of major importance to guide future and sustainable investments. This article reviews epidemiological facts about TB, trends in the magnitude of the burden of TB and factors contributing to it, and the effectiveness of the public health response.
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Stewart, Triccas, and Petrovsky. "Adjuvant Strategies for More Effective Tuberculosis Vaccine Immunity." Microorganisms 7, no. 8 (2019): 255. http://dx.doi.org/10.3390/microorganisms7080255.
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Tuberculosis (TB) caused by Mycobacterium tuberculosis infection is responsible for the most deaths by a single infectious agent worldwide, with 1.6 million deaths in 2017 alone. The World Health Organization, through its “End TB” strategy, aims to reduce TB deaths by 95% by 2035. In order to reach this goal, a more effective vaccine than the Bacillus Calmette-Guerin (BCG) vaccine currently in use is needed. Subunit TB vaccines are ideal candidates, because they can be used as booster vaccinations for individuals who have already received BCG and would also be safer for use in immunocompromised individuals in whom BCG is contraindicated. However, subunit TB vaccines will almost certainly require formulation with a potent adjuvant. As the correlates of vaccine protection against TB are currently unclear, there are a variety of adjuvants currently being used in TB vaccines in preclinical and clinical development. This review describes the various adjuvants in use in TB vaccines, their effectiveness, and their proposed mechanisms of action. Notably, adjuvants with less inflammatory and reactogenic profiles that can be administered safely via mucosal routes, may have the biggest impact on future directions in TB vaccine design.
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Dheda, Keertan, Edson Makambwa, and Aliasgar Esmail. "The Great Masquerader: Tuberculosis Presenting as Community-Acquired Pneumonia." Seminars in Respiratory and Critical Care Medicine 41, no. 04 (2020): 592–604. http://dx.doi.org/10.1055/s-0040-1710583.
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AbstractAccording to World Health Organization estimates, tuberculosis (TB) and lower respiratory tract infections (LRTIs) are both among the top 10 global causes of death. TB and community-acquired pneumonia (CAP), if mortality estimates are combined, would rank as the third most common cause of death globally. It is estimated that each year there are approximately 10 million new cases of TB that are associated with approximately 1.2 million deaths, and almost 450 million new episodes of LRTI (synonymous with CAP) with approximately 4 million associated deaths. Globally, Streptococcus pneumoniae remains the most common cause of CAP. However, although well documented, it is not widely appreciated that in several parts of the world, including sub-Saharan Africa, Asia, and South America, Mycobacterium tuberculosis is an important cause of CAP, if not the most common organism isolated in such settings. Thus, CAP due to M. tuberculosis is not uncommon in some parts of the world with up to a third of cases being attributable to M. tuberculosis. Consequently, TB remains an important clinical entity in the intensive care unit in these settings. Despite its frequency and importance, there are very limited data about TB CAP. In this review we discussed the epidemiology, immunopathogenesis, clinical presentation, diagnosis, management, prognosis, and prevention of TB CAP. The utility of newer diagnostic approaches is highlighted.
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Talip, Balkis A., Roy D. Sleator, Colm J. Lowery, James S. G. Dooley, and William J. Snelling. "An Update on Global Tuberculosis (TB)." Infectious Diseases: Research and Treatment 6 (January 2013): IDRT.S11263. http://dx.doi.org/10.4137/idrt.s11263.
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Tuberculosis globally results in almost 2 million human deaths annually, with 1 in 4 deaths from tuberculosis being human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related. Primarily a pathogen of the respiratory system, aerobic Mycobacterium tuberculosis complex (MTBC) infects the lungs via the inhalation of infected aerosol droplets generated by people with pulmonary disease through coughing. This review focuses on M. tuberculosis transmission, epidemiology, detection methods and technologies.
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&NA;. "Reducing TB-related deaths in sub-Saharan Africa." Inpharma Weekly &NA;, no. 1288 (2001): 3. http://dx.doi.org/10.2165/00128413-200112880-00004.
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Thysen, Sanne M., Ane Baerent Fisker, Stine Byberg, et al. "Disregarding the restrictive vial-opening policy for BCG vaccine in Guinea-Bissau: impact and cost-effectiveness for tuberculosis mortality and all-cause mortality in children aged 0–4 years." BMJ Global Health 6, no. 8 (2021): e006127. http://dx.doi.org/10.1136/bmjgh-2021-006127.
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ObjectiveBCG vaccination is frequently delayed in low-income countries. Restrictive vial-opening policies, where a vial of BCG vaccine is not opened for few children, are a major reason for delay. During delays, children are unprotected against tuberculosis (TB) and deprived of non-specific effects of BCG. We assessed the potential effect and cost-effectiveness of disregarding the restrictive vial-opening policy, on TB and all-cause mortality, in children aged 0–4 years in Guinea-Bissau.MethodsUsing static mathematical models, we estimated the absolute and percentage change in TB and all-cause deaths, in children aged 0–4 years, between the current BCG vaccine restrictive-opening policy scenario, and a non-restrictive policy scenario where all children were vaccinated in the first health-facility contact. Incremental cost-effectiveness was estimated by integration of vaccine and treatment costs.FindingsDisregarding the restrictive BCG vial-opening policy was estimated to reduce TB deaths by 11.0% (95% uncertainty range (UR):0.5%–28.8%), corresponding to 4 (UR:0–15) TB deaths averted per birth cohort in Guinea-Bissau, resulting in incremental cost-effectiveness of US$ 911 per discounted life-year gained (LYG) (UR:145–9142). For all-cause deaths, the estimated reduction was 8.1% (UR: 3.3%–12.7%) corresponding to 392 (UR:158–624) fewer all-cause deaths and an incremental cost-effectiveness of US$ 9 (UR:5–23) per discounted LYG.ConclusionsDisregarding the restrictive BCG vial-opening policy was associated with reductions in TB deaths and all-cause deaths and low cost-effectiveness ratios. Our results suggest that it would be cost-effective to disregard the restrictive vial-opening policy. Other settings with similar practice are also likely to gain from disregarding this policy.
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Yadav, Sarita, Shikha Goel, and Anand Agrawal. "Burden of Tuberculosis in females in rural area at a tertiary care centre." Asian Journal of Medical Sciences 7, no. 1 (2015): 108–10. http://dx.doi.org/10.3126/ajms.v7i1.12604.
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Backgroud: Tuberculosis (TB) is the second leading cause of death worldwide amongst communicable diseases. TB kills approximately 1 million women every year and is responsible for more deaths in women in the reproductive age group.Aims and Objectives: The present study was aimed to delineate the burden of disease in women in rural area.Results: High incidence of TB is reported in females of reproductive age group.Conclusion: Routine TB screening should be incorporated into maternal and child health programs in countries where TB is endemic. Revised National Tuberculosis Control Program (RNTCP) should mobilise interventions at rural level to eliminate stigma and ultimately eliminate TB’s impact on women.Asian Journal of Medical Sciences Vol.7(1) 2015 108-110
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Lawalata, Ivy Violan, and Bellytra Talarima. "Risk Factors for Child Tuberculosis in Ambon City in 2019." Journal La Medihealtico 1, no. 3 (2020): 1–8. http://dx.doi.org/10.37899/journallamedihealtico.v1i3.123.
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The percentage of TB globally reaches 6% (530,000 TB patients children/year) while the death of children (with negative HIV status) suffering from TB reaches 74,000 deaths/year or with a percentage of about 8% of the total deaths caused by TB (TB Control Guidelines, 2014 ). The number of TB cases in children in Ambon City in 2018 was 220 cases in 22 Puskesmas, the highest cases of TB in children were in three Puskesmas including Puskesmas Ch.M. Tiahahu, 16 TB cases in children, Air Salobar Health Center with 5 TB cases for children and Rijali Health Center with 1 TB case for children. This study aims to determine whether BCG immunization, nutritional status, LBW, smoking, and household contacts are risks of TB in children in Ambon City in 2019. This type of research uses retrospective correlation analytical case control studies design that identifies patients and their effects or diseases. certain (cases) and groups without cases. The sample in this study consisted of 22 cases of TB for children under five and 64 controls for children under five. The case sampling technique was the total sampling, the comparison of cases and controls was 1: 2. The results of the analysis based on 95% CI obtained a value of OR = 0.101 with a CI 95% LL - UP 0.010-1.024, nutritional status OR = 1.761 with 95% CI LL - UP 0.524-5.921, LBW OR = 3.492 with 95% CI LL - UP 1,141-10,688, smoking behavior OR value = 0.536 with CI 95% LL - UP 0.189-1.521 and household contacts determine the value OR = 31.00 with CI 95% LL - UP 6.029-159,398.
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Torpey, Kwasi, Adwoa Agyei-Nkansah, Lily Ogyiri, et al. "Management of TB/HIV co-infection: the state of the evidence." Ghana Medical Journal 54, no. 3 (2020): 186–96. http://dx.doi.org/10.4314/gmj.v54i3.10.
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Tuberculosis (TB) and HIV are strongly linked. There is a 19 times increased risk of developing active TB in people living with HIV than in HIV-negative people with Sub-Saharan Africa being the hardest hit region. According to the WHO, 1.3 million people died from TB, and an additional 300,000 TB-related deaths among people living with HIV. Although some progress has been made in reducing TB-related deaths among people living with HIV due to the evolution of diagnostics, treatment and antiretroviral HIV treatment, multi drug resistant TB is becoming a source of worry. Though significant progress has been made at the national level, understanding the state of the evidence and the challenges will better inform the national response of the opportunities for improved patient outcomes.Keywords: Tuberculosis, management, HIV, MDR TB, GhanaFunding: None
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Patel, Anik R., Jonathon R. Campbell, Mohsen Sadatsafavi, et al. "Burden of non-adherence to latent tuberculosis infection drug therapy and the potential cost-effectiveness of adherence interventions in Canada: a simulation study." BMJ Open 7, no. 9 (2017): e015108. http://dx.doi.org/10.1136/bmjopen-2016-015108.
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ObjectivePharmaceutical treatment of latent tuberculosis infection (LTBI) reduces the risk of progression to active tuberculosis (TB); however, poor adherence tempers the protective effect. We aimed to estimate the health burden of non-adherence, the maximum allowable cost of hypothetical new adherence interventions to be cost-effective and the potential value of existing adherence interventions for patients with low-risk LTBI in Canada.DesignA microsimulation model of LTBI progression over 25 years.SettingGeneral practice in Canada.ParticipantsIndividuals with LTBI who are initiating drug therapy.InterventionsA hypothetical intervention with a range of effectiveness was evaluated. Existing drug adherence interventions including peer support, two-way text messaging support, enhanced adherence counselling and adherence incentives were also evaluated.Primary and secondary outcome measuresSimulation outcomes included healthcare costs, TB incidence, TB deaths and quality-adjusted life years (QALYs). Base case results were interpreted against a willingness-to-pay threshold of $C50 000/QALY.ResultsCompared with current adherence levels, full adherence to LTBI drug therapy could reduce new TB cases from 90.3 cases per 100 000 person-years to 35.9 cases per 100 000 person-years and reduce TB-related deaths from 7.9 deaths per 100 000 person-years to 3.1 deaths per 100 000 person-years. An intervention that increases relative adherence by 40% would bring the population near full adherence to drug therapy and could have a maximum allowable annual cost of approximately $C450 per person to be cost-effective. Based on estimates of effect sizes and costs of existing adherence interventions, we found that they yielded between 900 and 2400 additional QALYs per million people, reduced TB deaths by 5%–25% and were likely to be cost-effective over 25 years.ConclusionFull adherence could reduce the number of future TB cases by nearly 60%, offsetting TB-related costs and health burden. Several existing interventions are could be cost-effective to help achieve this goal.
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Ricks, Saskia, Claudia M. Denkinger, Samuel G. Schumacher, Timothy B. Hallett, and Nimalan Arinaminpathy. "The potential impact of urine-LAM diagnostics on tuberculosis incidence and mortality: A modelling analysis." PLOS Medicine 17, no. 12 (2020): e1003466. http://dx.doi.org/10.1371/journal.pmed.1003466.
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Background Lateral flow urine lipoarabinomannan (LAM) tests could offer important new opportunities for the early detection of tuberculosis (TB). The currently licensed LAM test, Alere Determine TB LAM Ag (‘LF-LAM’), performs best in the sickest people living with HIV (PLHIV). However, the technology continues to improve, with newer LAM tests, such as Fujifilm SILVAMP TB LAM (‘SILVAMP-LAM’) showing improved sensitivity, including amongst HIV-negative patients. It is important to anticipate the epidemiological impact that current and future LAM tests may have on TB incidence and mortality. Methods and findings Concentrating on South Africa, we examined the impact that widening LAM test eligibility would have on TB incidence and mortality. We developed a mathematical model of TB transmission to project the impact of LAM tests, distinguishing ‘current’ tests (with sensitivity consistent with LF-LAM), from hypothetical ‘future’ tests (having sensitivity consistent with SILVAMP-LAM). We modelled the impact of both tests, assuming full adoption of the 2019 WHO guidelines for the use of these tests amongst those receiving HIV care. We also simulated the hypothetical deployment of future LAM tests for all people presenting to care with TB symptoms, not restricted to PLHIV. Our model projects that 2,700,000 (95% credible interval [CrI] 2,000,000–3,600,000) and 420,000 (95% CrI 350,000–520,000) cumulative TB incident cases and deaths, respectively, would occur between 2020 and 2035 if the status quo is maintained. Relative to this comparator, current and future LAM tests would respectively avert 54 (95% CrI 33–86) and 90 (95% CrI 55–145) TB deaths amongst inpatients between 2020 and 2035, i.e., reductions of 5% (95% CrI 4%–6%) and 9% (95% CrI 7%–11%) in inpatient TB mortality. This impact in absolute deaths averted doubles if testing is expanded to include outpatients, yet remains <1% of country-level TB deaths. Similar patterns apply to incidence results. However, deploying a future LAM test for all people presenting to care with TB symptoms would avert 470,000 (95% CrI 220,000–870,000) incident TB cases (18% reduction, 95% CrI 9%–29%) and 120,000 (95% CrI 69,000–210,000) deaths (30% reduction, 95% CrI 18%–44%) between 2020 and 2035. Notably, this increase in impact arises largely from diagnosis of TB amongst those with HIV who are not yet in HIV care, and who would thus be ineligible for a LAM test under current guidelines. Qualitatively similar results apply under an alternative comparator assuming expanded use of GeneXpert MTB/RIF (‘Xpert’) for TB diagnosis. Sensitivity analysis demonstrates qualitatively similar results in a setting like Kenya, which also has a generalised HIV epidemic, but a lower burden of HIV/TB coinfection. Amongst limitations of this analysis, we do not address the cost or cost-effectiveness of future tests. Our model neglects drug resistance and focuses on the country-level epidemic, thus ignoring subnational variations in HIV and TB burden. Conclusions These results suggest that LAM tests could have an important effect in averting TB deaths amongst PLHIV with advanced disease. However, achieving population-level impact on the TB epidemic, even in high-HIV-burden settings, will require future LAM tests to have sufficient performance to be deployed more broadly than in HIV care.
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Kuzyk, Petro V., Andriy Yu Horoshchak, Bogdan Ya Serbin, Rahaina Musa-Bador, and Uchenna Uchie-Okoro. "Challenges in morphological diagnosis of tuberculosis." Biomedical update, no. 1 (March 5, 2021): 28–35. http://dx.doi.org/10.52739/bio-up.1.2021.28-35.
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TB is the seventh leading cause of death worldwide and third leading cause of death among women in the 15–44 age group1. However, in 2010, the number of multidrug-resistant tuberculosis (MDR-TB) cases rose to 650,000 worldwide, with more than 150,000 deaths. All of the well-known widely available methods such as chest X-ray, culture in liquid and solid media should be accompanied with the modern and more accurate methods such as chest CT and molecular diagnostic tests which proved the necessity of usage with high sensitivity and accuracy, especially in smear-negative pulmonary TB patients and patients with the multi drug resistant forms.
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Teixeira, Francine, Sonia M. Raboni, Clea EL Ribeiro, João CB França, Anne C. Broska, and Nathalia LS Souza. "Human Immunodeficiency Virus and Tuberculosis Coinfection in a Tertiary Hospital in Southern Brazil: Clinical Profile and Outcomes." Microbiology Insights 11 (January 2018): 117863611881336. http://dx.doi.org/10.1177/1178636118813367.
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Worldwide, the convergence of tuberculosis (TB) and human immunodeficiency virus type 1 (HIV-1) infection epidemics is a public health challenge. In Brazil, TB is the leading cause of death by infectious disease in people living with HIV (PLWH). This study aimed to report the clinical, demographic, epidemiological, and laboratory data for TB in PLWH. This cross-sectional study involved a retrospective analysis of data for patients with TB/HIV coinfection who attended from 2006 to 2015 through a review of medical records. A total of 182 patients were identified, of whom 12 were excluded. Patients were divided according to whether they had pulmonary tuberculosis (PTB; n = 48; 28%) or extrapulmonary tuberculosis (EPTB; n = 122; 72%). The diagnosis was laboratory confirmed in 75% of PTB patients and 78.7% of EPTB patients. The overall 1-year mortality rate was 37.6%, being 22.9% in PTB patients and 69% in EPTB patients; 84% of these deaths were TB-related. The CD4+ count and disseminated TB were independent risk factors for death. The frequency of resistance among Mycobacterium tuberculosis (MTB) isolates was 14%. TB in PLWH is associated with high morbidity and mortality, and severe immunosuppression is a risk factor for death. Appropriate measures for early TB detection should reduce the case fatality rate in high-burden settings.
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du Cros, Philipp, Hamidah Hussain, and Kerri Viney. "Special Issue “Innovation and Evidence for Achieving TB Elimination in the Asia-Pacific Region”." Tropical Medicine and Infectious Disease 6, no. 3 (2021): 114. http://dx.doi.org/10.3390/tropicalmed6030114.
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The World Health Organization’s (WHO) END-TB strategy has set the world on course to climb the highest of medical mountains by 2035, with a targeted peak of reductions in TB deaths by 95%, TB cases by 90%, and no burden of catastrophic expenses on families due to TB [...]
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Li, T., Y. Ma, K. Liu, et al. "Childhood TB in China: notification, characteristics and risk factors for outcomes, 2010–2017." International Journal of Tuberculosis and Lung Disease 24, no. 12 (2020): 1285–93. http://dx.doi.org/10.5588/ijtld.20.0391.
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SETTING: China National Tuberculosis Programme, 2010–2017.OBJECTIVE: To describe the epidemiology of childhood (age < 15 years) TB, including treatment outcomes and risk factors for unfavourable outcomes and death.DESIGN: We used a cross-sectional design for the descriptive component and a cohort design for treatment outcomes and their risk factors (assessed using log binomial regression).RESULTS: Of 40 561 children, 77.7% (n = 31 529) were aged 10–14 years and 19.6% (n = 7931) were bacteriologically confirmed. Around 14% (n = 5827) belonged to migrant families (internal migration) and 4.0% (n = 1,642) were actively detected. Over 8 years, annual notification was consistently very low (<1%), and notification of bacteriologically confirmed TB decreased by half. Unfavourable outcomes were seen in 6% and deaths in 0.4%; there were no significant changes over the years. The independent predictors of unfavourable outcomes were active case finding and extrapulmonary TB. Children belonging to migrant family were more likely to die. Independent predictors of unfavourable outcomes as well as death were age < 5 years and previous treatment.CONCLUSION: China needs to address the issue of under-detection of childhood TB, especially in younger age groups. The risk factors identified require attention if China is to attain zero child TB deaths.
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Veisani, Yousef, Ali Delpisheh, and Salman Khazaei. "Global strategy and targets to reach end the global tuberculosis epidemic." Biomedical Research and Therapy 4, no. 08 (2017): 1498. http://dx.doi.org/10.15419/bmrat.v4i08.204.
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Tuberculosis (TB) has the second highest death rate in the world among infectious diseases after HIV/AIDS (Wei et al., 2016). TB epidemic is more important than it was supposed to be (Raviglione and Sulis, 2016). In 2015, 10.4 million new cases were occurred worldwide, among these, 5.9 million (56%) were male, 3.5 million (34%) were female, and 1.0 million (10%) of them was the child. It should be noted that 1.2 million (11%) of all new TB cases were occurred in people that living with HIV (PWLH). Although tuberculosis deaths are declined by about 22% between 2000 to 2015, still is remained among top 10 causes of death in 2015 (Uplekar et al., 2015; WHO, 2016).
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Arinaminpathy, Nimalan, and Christopher Dye. "Health in financial crises: economic recession and tuberculosis in Central and Eastern Europe." Journal of The Royal Society Interface 7, no. 52 (2010): 1559–69. http://dx.doi.org/10.1098/rsif.2010.0072.
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The ongoing global financial crisis, which began in 2007, has drawn attention to the effect of declining economic conditions on public health. A quantitative analysis of previous events can offer insights into the potential health effects of economic decline. In the early 1990s, widespread recession across Central and Eastern Europe accompanied the collapse of the Soviet Union. At the same time, despite previously falling tuberculosis (TB) incidence in most countries, there was an upsurge of TB cases and deaths throughout the region. Here, we study the quantitative relationship between the lost economic productivity and excess TB cases and mortality. We use the data of the World Health Organization for TB notifications and deaths from 1980 to 2006, and World Bank data for gross domestic product. Comparing 15 countries for which sufficient data exist, we find strong linear associations between the lost economic productivity over the period of recession for each country and excess numbers of TB cases ( r 2 = 0.94, p < 0.001) and deaths ( r 2 = 0.94, p < 0.001) over the same period. If TB epidemiology and control are linked to economies in 2009 as they were in 1991 then the Baltic states, particularly Latvia, are now vulnerable to another upturn in TB cases and deaths. These projections are in accordance with emerging data on drug consumption, which indicate that these countries have undergone the greatest reductions since the beginning of 2008. We recommend close surveillance and monitoring during the current recession, especially in the Baltic states.
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Carroll, A., M. Vincenti-Delmas, B. Maung Maung, et al. "TB outcomes and mortality risk factors in adult migrants at the Thailand-Myanmar border." International Journal of Tuberculosis and Lung Disease 24, no. 10 (2020): 1009–15. http://dx.doi.org/10.5588/ijtld.20.0014.
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BACKGROUND: Cross-border migrants at the Thailand-Myanmar border are an underserved and vulnerable population. We aimed to identify the causes and risk factors for TB mortality at a migrant-friendly TB programme.METHODS: Routinely collected data on TB cases, treatment outcomes and causes of death were analysed for adult TB cases diagnosed between January 2013 and April 2017. Mortality in the 6 months post-diagnosis was calculated and risk factors were identified using multivariable Poisson regression.RESULTS: Of the 1344 TB cases diagnosed, 1005 started treatment and 128 died. Case fatality rate was 9.5% and the TB mortality rate was 2.4/100 person-months. The number of pre-treatment deaths (33/128) and losses to follow-up (9.0%) were high. Among cases enrolled in treatment, the treatment success rate was 79.8%. When stratified by HIV status, case fatality was higher in HIV-positive cases not on antiretroviral therapy (ART) (90.3%) or with unknown HIV status (31.8%) than those on ART (14.3%) or HIV-negative (8.6%).CONCLUSION: This TB programme achieved high treatment success rates in a population with a substantial burden of TB-HIV coinfection. Expanding access to HIV testing and ART is crucial to reduce mortality. Striving towards same-day TB diagnosis and treatment could reduce death and loss to follow-up.
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Ogunbanjo, Gboyega A. "Multi-drug-resistant tuberculosis (MDR-TB): Current situation in South Africa." South African Family Practice 59, no. 2 (2017): 5. http://dx.doi.org/10.4102/safp.v59i2.4679.
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Multi-drug-resistant tuberculosis (MDR-TB) is a form of tuberculosis (TB) infection which is resistant to treatment with at least two of the most powerful first-line anti-TB drugs, namely isoniazid and rifampicin. Globally, MDR-TB caused an estimated 480 000 new TB cases and 250 000 deaths in 2015 and accounted for 3.3% of all new TB cases worldwide.1 MDR-TB, or rifampicin-resistant TB, causes 3.9% of new TB cases and 21% of previously treated TB cases, and most MDR-TB cases occur in South America, southern Africa, India, China, and the former Soviet Union.1
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Zawedde-Muyanja, Stella, Joseph Musaazi, Yukari C. Manabe, et al. "Estimating the effect of pretreatment loss to follow up on TB associated mortality at public health facilities in Uganda." PLOS ONE 15, no. 11 (2020): e0241611. http://dx.doi.org/10.1371/journal.pone.0241611.
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Introduction Tuberculosis (TB) mortality estimates derived only from cohorts of patients initiated on TB treatment do not consider outcomes of patients with pretreatment loss to follow-up (LFU). We aimed to assess the effect of pretreatment LFU on TB-associated mortality in the six months following TB diagnosis at public health facilities in Uganda. Methods At ten public health facilities, we retrospectively reviewed treatment data for all patients with a positive Xpert®MTB/RIF test result from January to June 2018. Pretreatment LFU was defined as not initiating TB treatment within two weeks of a positive test. We traced patients with pretreatment LFU to ascertain their vital status. We performed Kaplan Meier survival analysis to compare the cumulative incidence of mortality, six months after diagnosis among patients who did and did not experience pretreatment LFU. We also determined the health facility level estimates of TB associated mortality before and after incorporating deaths prior to treatment initiation among patients who experienced pretreatment LFU. Results Of 510 patients with positive test, 100 (19.6%) experienced pretreatment LFU. Of these, we ascertained the vital status of 49 patients. In the six months following TB diagnosis, mortality was higher among patients who experienced pretreatment LFU 48.1/1000py vs 22.9/1000py. Hazard ratio [HR] 3.18, 95% confidence interval [CI] (1.61–6.30). After incorporating deaths prior to treatment initation among patients who experienced pretreatment LFU, health facility level estimates of TB associated mortality increased from 8.4% (95% CI 6.1%-11.6%) to 10.2% (95% CI 7.7%-13.4%). Conclusion Patients with confirmed TB who experience pretreatment LFU have high mortality within the first six months. Efforts should be made to prioritise linkage to treatment for this group of patients. Deaths that occur prior to treatment initation should be included when reporting TB mortality in order to more accurately reflect the health impact of TB.
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Bussi, Claudio, and Maximiliano G. Gutierrez. "Mycobacterium tuberculosis infection of host cells in space and time." FEMS Microbiology Reviews 43, no. 4 (2019): 341–61. http://dx.doi.org/10.1093/femsre/fuz006.
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ABSTRACTTuberculosis (TB) caused by the bacterial pathogen Mycobacterium tuberculosis (Mtb) remains one of the deadliest infectious diseases with over a billion deaths in the past 200 years (Paulson 2013). TB causes more deaths worldwide than any other single infectious agent, with 10.4 million new cases and close to 1.7 million deaths in 2017. The obstacles that make TB hard to treat and eradicate are intrinsically linked to the intracellular lifestyle of Mtb. Mtb needs to replicate within human cells to disseminate to other individuals and cause disease. However, we still do not completely understand how Mtb manages to survive within eukaryotic cells and why some cells are able to eradicate this lethal pathogen. Here, we summarise the current knowledge of the complex host cell-pathogen interactions in TB and review the cellular mechanisms operating at the interface between Mtb and the human host cell, highlighting the technical and methodological challenges to investigating the cell biology of human host cell-Mtb interactions.
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Oei, Welling, and Hiroshi Nishiura. "The Relationship between Tuberculosis and Influenza Death during the Influenza (H1N1) Pandemic from 1918-19." Computational and Mathematical Methods in Medicine 2012 (2012): 1–9. http://dx.doi.org/10.1155/2012/124861.
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The epidemiological mechanisms behind the W-shaped age-specific influenza mortality during the Spanish influenza (H1N1) pandemic 1918-19 have yet to be fully clarified. The present study aimed to develop a formal hypothesis: tuberculosis (TB) was associated with the W-shaped influenza mortality from 1918-19. Three pieces of epidemiological information were assessed: (i) the epidemic records containing the age-specific numbers of cases and deaths of influenza from 1918-19, (ii) an outbreak record of influenza in a Swiss TB sanatorium during the pandemic, and (iii) the age-dependent TB mortality over time in the early 20th century. Analyzing the data (i), we found that the W-shaped pattern was not only seen in mortality but also in the age-specific case fatality ratio, suggesting the presence of underlying age-specific risk factor(s) of influenza death among young adults. From the data (ii), TB was shown to be associated with influenza death (P=0.09), and there was no influenza death among non-TB controls. The data (iii) were analyzed by employing the age-period-cohort model, revealing harvesting effect in the period function of TB mortality shortly after the 1918-19 pandemic. These findings suggest that it is worthwhile to further explore the role of TB in characterizing the age-specific risk of influenza death.
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Bhowmick, Nilanjana. "Pandemic is leading to more TB deaths in India." New Scientist 248, no. 3305 (2020): 9. http://dx.doi.org/10.1016/s0262-4079(20)31863-7.
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Seid, Getachew, and Marta Ayele. "Undernutrition and Mortality among Adult Tuberculosis Patients in Addis Ababa, Ethiopia." Advances in Preventive Medicine 2020 (July 27, 2020): 1–9. http://dx.doi.org/10.1155/2020/5238010.
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Background. In developing countries, there are several adult tuberculosis (TB) patients suffering from profound undernutrition. Undernutrition is a significant risk factor for developing tuberculosis. In the world, TB is one of the top ten and leading causes of death. To appropriately intervene death of adult TB patients, it is crucial to understand the magnitude of undernutrition and its associated factors among them. The study assessed undernutrition and mortality among adult tuberculosis patients in Addis Ababa, Ethiopia. Methods. Institutional-based retrospective study was conducted in Addis Ababa, Ethiopia, from January 2019 to August 2019. The total sample size of the study was 284. The source populations were TB patients who have followed up for TB treatment at public health facilities of Addis Ababa. The sample size was allocated to the selected health facilities proportional to their size, and study subjects were enrolled to the study during the study period. Data were collected by a structured data sheet from the selected health center registration book. Data were entered into Epi Data software and analyzed by using SPSS version 20. Descriptive statistical methods were used to summarize the sociodemographic characteristics of the study participants. Survival curves were generated using the Kaplan–Meier method for all TB patients. Result. A total of 284 study participants were included in the study. It was found that 46.8% of the study population have undernutrition (BMI <18.5 kg/m2) at the time of registration for treatment. Out of undernourished patients, 54 (19.0%) had severe malnutrition and 78 (27.5%) had moderate undernutrition. At the end of the two-month intensive treatment period, the under nutrition prevalence declined to 38.7%. Of the 284 patients, 17 (6.0%) died before completing anti-TB treatment. Three quarters of all forms of TB deaths occurred within 57 days after the start of anti-TB treatment. The proportion of deaths by nutritional status at treatment initiation among normal, moderate acute malnutrition, and severe acute malnutrition TB patients was 3.1%, 8.9%, and 16.3%, respectively. Conclusion. Almost half of the TB patients were undernourished at the start of anti-TB treatment based on BMI. From the malnourished, less than 20% of the participants gained weight and moved to normal weight at the end of the two-month intensive treatment period. The high death rate was reported among severely malnourished tuberculosis patients, but it needs a larger study to further understand predictors. To enhance the increment of nutritional status during treatment, the government should give attention to support nutritional supplements for TB patients.
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Osman, Muhammad, Sue-Ann Meehan, Arne von Delft, et al. "Early mortality in tuberculosis patients initially lost to follow up following diagnosis in provincial hospitals and primary health care facilities in Western Cape, South Africa." PLOS ONE 16, no. 6 (2021): e0252084. http://dx.doi.org/10.1371/journal.pone.0252084.
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In South Africa, low tuberculosis (TB) treatment coverage and high TB case fatality remain important challenges. Following TB diagnosis, patients must link with a primary health care (PHC) facility for initiation or continuation of antituberculosis treatment and TB registration. We aimed to evaluate mortality among TB patients who did not link to a TB treatment facility for TB treatment within 30 days of their TB diagnosis, i.e. who were “initial loss to follow-up (ILTFU)” in Cape Town, South Africa. We prospectively included all patients with a routine laboratory or clinical diagnosis of TB made at PHC or hospital level in Khayelitsha and Tygerberg sub-districts in Cape Town, using routine TB data from an integrated provincial health data centre between October 2018 and March 2020. Overall, 74% (10,208/13,736) of TB patients were diagnosed at PHC facilities and ILTFU was 20.0% (2,742/13,736). Of ILTFU patients, 17.1% (468/2,742) died, with 69.7% (326/468) of deaths occurring within 30 days of diagnosis. Most ILTFU deaths (85.5%; 400/468) occurred in patients diagnosed in hospital. Multivariable logistic regression identified increasing age, HIV positive status, and hospital-based TB diagnosis (higher in the absence of TB treatment initiation and being ILTFU) as predictors of mortality. Although hospitals account for a modest proportion of diagnosed TB patients they have high TB-associated mortality. A hospital-based TB diagnosis is a critical opportunity to identify those at high risk of early and overall mortality. Interventions to diagnose TB before hospital admission, improve linkage to TB treatment following diagnosis, and reduce mortality in hospital-diagnosed TB patients should be prioritised.
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Watt, Jacqueline, and Jun Liu. "Preclinical Progress of Subunit and Live Attenuated Mycobacterium tuberculosis Vaccines: A Review following the First in Human Efficacy Trial." Pharmaceutics 12, no. 9 (2020): 848. http://dx.doi.org/10.3390/pharmaceutics12090848.
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Tuberculosis (TB) is the global leading cause of death from an infectious agent with approximately 10 million new cases of TB and 1.45 million deaths in 2018. Bacille Calmette-Guérin (BCG) remains the only approved vaccine for Mycobacterium tuberculosis (M. tb, causative agent of TB), however clinical studies have shown BCG has variable effectiveness ranging from 0–80% in adults. With 1.7 billion people latently infected, it is becoming clear that vaccine regimens aimed at both post-exposure and pre-exposure to M. tb will be crucial to end the TB epidemic. The two main strategies to improve or replace BCG are subunit and live attenuated vaccines. However, following the failure of the MVA85A phase IIb trial in 2013, more varied and innovative approaches are being developed. These include recombinant BCG strains, genetically attenuated M. tb and naturally attenuated mycobacteria strains, novel methods of immunogenic antigen discovery including for hypervirulent M. tb strains, improved antigen recognition and delivery strategies, and broader selection of viral vectors. This article reviews preclinical vaccine work in the last 5 years with focus on those tested against M. tb challenge in relevant animal models.
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Berra, Thaís Zamboni, Ivaneliza Simionato de Assis, Luiz Henrique Arroyo, et al. "Social determinants of deaths from pneumonia and tuberculosis in children in Brazil: an ecological study." BMJ Open 10, no. 8 (2020): e034074. http://dx.doi.org/10.1136/bmjopen-2019-034074.
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ObjectiveTo identify the risk areas of deaths due to unspecified pneumonia and tuberculosis (TB) in children, and to identify if there is a relationship between these events with higher TB incidence and social determinants.MethodsEcological study carried out in Brazil. All cases of TB or unspecified pneumonia deaths in children under 5 years of age reported between 2006 and 2016 were included and collected through Department of Informatics of the Unified Health System (Brazil’s electronic database). The Spatial Scan Statistics was used to identify areas at higher risk of dying from this event. The spatial association was verified through the Getis-Ord techniques. The Bivariate Moran Global Index was used to verify the spatial autocorrelation between the two events. To identify the association of TB and pneumonia deaths with endemic areas of pulmonary TB and social determinants, four explanatory statistical models were identified.ResultsA total of 21 391 cases of pneumonia and 238 cases of TB were identified. Spatial scanning analysis enabled the detection of four clusters of risk for TB (relative risk, RR, between 3.30 and 18.18) and 22 clusters for pneumonia (RR between 1.38 and 5.24). The spatial association of the events was confirmed (z-score 3.74 and 64.34) and spatial autocorrelation between events (Moran Index:0.031 (p=0.001)). The zero-inflated negative binomial distribution was chosen, and an association for both events was identified with the TB incidence rate (OR 5.3, 95% CI 2.85 to 9.84; OR 6.63, 95% CI 5.62 to 7.81), with the Gini Index (OR 1.78, 95% CI 1.12 to 2.82; OR 4.22, 95% CI 3.63 to4.92). Primary care coverage showed an inverse association for both events (OR 0.10, 95% CI 0.67 to 0.17; OR 0.18, 95% CI 0.15 to 0.21) for pneumonia). Finally, a family that benefited from the Bolsa Família Programme had an inverse association for deaths from pneumonia (OR 0.81, 95% CI 0.52 to 1.25).ConclusionsThe results do not just contribute to reduce mortality in children, but mainly contribute to prevent premature deaths through identification of critical areas in Brazil, which is crucial to qualify health surveillance services.
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Hadebe, Sabelo, Melissa Chengalroyen, Reto Guler, et al. "Intervening along the spectrum of tuberculosis: meeting report from the World TB Day nanosymposium in the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town." Gates Open Research 3 (November 12, 2019): 1491. http://dx.doi.org/10.12688/gatesopenres.13035.3.
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Tuberculosis (TB), caused by the highly infectious Mycobacterium tuberculosis, remains a leading cause of death worldwide, with an estimated 1.6 million associated deaths reported in 2017. In South Africa, an estimated 322,000 (range 230,000-428,000) people were infected with TB in 2017, and a quarter of them lost their lives due to the disease. Bacille Calmette-Guérin (BCG) remains the only effective vaccine against disseminated TB, but its inability to confer complete protection against pulmonary TB in adolescents and adults calls for an urgent need to develop new and better vaccines. There is also a need to identify markers of disease protection and develop novel drugs. It is within this backdrop that we convened a nanosymposium at the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town to commemorate World TB Day and showcase recent findings generated by early career scientists in the institute. The speakers spoke on four broad topics: identification of novel drug targets, development of host-directed drug therapies, transmission of TB and immunology of TB/HIV co-infections.
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Hadebe, Sabelo, Melissa Chengalroyen, Reto Guler, et al. "Intervening along the spectrum of tuberculosis: meeting report from the World TB Day nanosymposium in the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town." Gates Open Research 3 (May 28, 2020): 1491. http://dx.doi.org/10.12688/gatesopenres.13035.4.
Full textAbstract:
Tuberculosis (TB), caused by the highly infectious Mycobacterium tuberculosis, remains a leading cause of death worldwide, with an estimated 1.6 million associated deaths reported in 2017. In South Africa, an estimated 322,000 (range 230,000-428,000) people were infected with TB in 2017, and a quarter of them lost their lives due to the disease. Bacille Calmette-Guérin (BCG) remains the only effective vaccine against disseminated TB, but its inability to confer complete protection against pulmonary TB in adolescents and adults calls for an urgent need to develop new and better vaccines. There is also a need to identify markers of disease protection and develop novel drugs. It is within this backdrop that we convened a nanosymposium at the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town to commemorate World TB Day and showcase recent findings generated by early career scientists in the institute. The speakers spoke on four broad topics: identification of novel drug targets, development of host-directed drug therapies, transmission of TB and immunology of TB/HIV co-infections.
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Watch, Villa, Jimmy Aipit, Tina Kote-Yarong, et al. "The burden of presumed tuberculosis in hospitalized children in a resource-limited setting in Papua New Guinea: a prospective observational study." International Health 9, no. 6 (2017): 374–78. http://dx.doi.org/10.1093/inthealth/ihx043.
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Abstract Background In Papua New Guinea, TB is considered to be a major public health problem, but little is known about the prevalence and prognosis of presumed TB in children. Methods As part of a prospective hospital-based surveillance on the northern coast of mainland Papua New Guinea, the authors investigated the admission prevalence and case fatality rate associated with presumed TB over a 6-year period (2011–2016). All children admitted who were diagnosed with TB were followed-up until discharge or death. Results Of 8992 paediatric admissions, 734 patients (8.2%) were diagnosed with presumed TB and there were 825 deaths, with TB accounting for 102 (12.4%). Extrapulmonary TB was the final diagnosis in 384 admissions {prevalence 4.3% [384/8992 (95% CI 3.9–4.7)]} with a case fatality rate of 21.4% [82/384 (95% CI 17.4–25.9)]. TB meningitis, disseminated TB and pericardial TB had high case fatality rates of 29.0% (53/183), 28.9% (11/38) and 25% (4/16), respectively. Severe malnutrition was more common in patients with pulmonary compared with extrapulmonary TB (25.4% vs 15.6%; p&lt;0.01). Conclusions Improved community-based case detection strategies, routine BCG vaccinations and other effective forms of TB control need revitalization and sustainability to reduce the high case fatality rates associated with childhood TB in Papua New Guinea.
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Greifinger, Robert B., Nancy J. Heywood, and Jordan B. Glaser. "Tuberculosis in Prison: Balancing Justice and Public Health." Journal of Law, Medicine & Ethics 21, no. 3-4 (1993): 332–41. http://dx.doi.org/10.1111/j.1748-720x.1993.tb01258.x.
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During the mid-nineteenth century the annual tuberculosis (TB) mortality in the penitentiaries at Auburn, N.Y., Boston, and Philadelphia exceeded 10 percent of the inmate population. At the beginning of the sanatorium era, 80 percent of the prison deaths were attributed to TB. As the mountain air was “commonly known” to be healthful, the first prison sanatorium was opened in the mountains near Dannemora, N.Y. in 1904. It served to isolate contagious prison inmates until the advent of effective chemotherapy for the disease in the 1950’s. Early antibiotic therapy for TB was such a great success that the public health aspects of TB in prisons remained dormant for the next 40 years.In 1991, a correctional officer from Auburn Correctional Facility in Auburn, New York died as a result of multidrug-resistant TB. He had been posted to care for hospitalized patients, from whom he acquired his disease. This death, and the transmission of TB infection to health care workers in the same hospital, brought the nature and extent of modern inmate medical care into finer focus.
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Shilova, Margarita V., and Christopher Dye. "The resurgence of tuberculosis in Russia." Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences 356, no. 1411 (2001): 1069–75. http://dx.doi.org/10.1098/rstb.2001.0895.
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This paper documents and attempts to explain the epidemic spread of tuberculosis (TB) in Russia during the 1990s. After several decades of decline, the notification rate of all new TB cases among permanent residents increased by 7.5% per year from 1991–1999 and the death rate by 11% per year. Growth was quickest from 1993–1995 but increased again after the economic crisis of August 1998. Approximately 120 000 new cases and 30 000 deaths were reported in 1999. Case detection and cure rates have fallen in Russia since the mid–1980s; the fall has been accompanied by a higher frequency of severe disease among cases, and higher death and case fatality rates. With a mathematical model describing the deterioration in case finding and cure rates we could replicate the average rate of increase in incidence 1991–1999 but not the precise timing of the observed changes. Other factors that probably helped to shape the observed rise in caseload include enhanced transmission due to the mixing of prison and civilian populations, an increase in susceptibility to disease, and changes in the proportion of cases detected by surveillance. Although our explanation for the resurgence of TB is incomplete, we have identified a set of measures that can be implemented now to cut transmission, incidence and deaths.
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Gahan, Ajaya Kumar, Jyoti Ranjan Champatiray, and Saroj Kumar Satpathy. "Study of tuberculosis in HIV positive children in a tertiary care hospital of Odisha." International Journal of Contemporary Pediatrics 4, no. 4 (2017): 1374. http://dx.doi.org/10.18203/2349-3291.ijcp20172669.
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Background: Tuberculosis and HIV have been closely linked since the emergence of AIDS. Worldwide, TB is the most common opportunistic infection affecting HIV seropositive individuals and it remains the most common cause of death in patients with AIDS. HIV infection has contributed to a significant increase in the worldwide incidence of TB. So, an attempt was made in the present study to know the magnitude/extent of tuberculosis, associated clinical patterns, epidemiological factors and outcomes in HIV positive children attending the ART Centre of SCB medical college and hospital, Cuttack.Methods: A tertiary care hospital based prospective study was carried out in 50 children between 6 months to 14 years of age for a period of 2 years.Results: Most of the cases were less than 6 years old. TB was more common in male children than in females. Most cases were from rural areas. Majority belong to Class IV (Upper Lower) and Class V(Lower) socio-economic class. Most had Grade II and Grade III malnutrition as per IAP classification. Definite history of contact and recent infection was present in most. Majority (75%) had pulmonary tuberculosis. Pleural variant was predominant in extra-pulmonary form followed by TB lymphadenitis and disseminated forms. 5% had both PTB and EPTB. Most cases were un vaccinated. Common clinical features were fever, cough, FTT, chronic diarrhoea. Disseminated TB was common in unvaccinated group. Recovery pattern was almost similar in vaccinated and unvaccinated groups. Most of the PTB cases were cured of the disease with only 2 deaths in this group whereas the number of deaths, children going LAMA and development of MDR-TB was more in disseminated forms.Conclusions: Occurrence of TB is high in HIV positive cases. EPTB is common in unvaccinated cases. TB is common in rural and underprivileged children. Drug compliance is poor in disseminated forms. Mortality is high in disseminated forms. Sequele is more in disseminated forms of TB.
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Ngari, Moses, Osman Abdullahi, Deche Sanga, Geoffrey Katana, and Annie Willetts. "PO 8417 RISING TRENDS IN TB MORTALITY AMID DECLINE IN CASES NOTIFIED IN A RURAL COUNTY IN KENYA: COHORT STUDY." BMJ Global Health 4, Suppl 3 (2019): A34.3—A35. http://dx.doi.org/10.1136/bmjgh-2019-edc.89.
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BackgroundDespite introduction of rapid and accurate diagnostic tools and aggressive treatment for tuberculosis (TB), it is still a global health problem. In 2016, globally, 1.7 million people died of TB, 95% from resource-poor countries. This study aimed to estimate changing trends in all-cause mortality rate and identify features associated with mortality among suspected TB patients on treatment.MethodsA cohort study of patients registered in a TB surveillance system from 2012 to 2016 and followed up for six months during TB treatment. The outcome was all-cause mortality within six months of TB treatment. The exposures examined were demographic and clinical features at the time of starting TB treatment.ResultsA total of 10,717 participants, median (IQR) age 33 (24–45) years, of which 3163 (30%) were HIV-infected were included in the analyses. During follow-up of 5175.5 person-years (PY), 585/10,717 (5.5%) participants died; mortality rate was 12.2 (95% CI 11.3,13.3) deaths per 100PY. The yearly mortality rate increased from 7.79 (95% CI 6.35, 9.54) in 2012 to 17.73 (95% CI 14.93, 21.06) in 2016 per 100PY (Ptrend <0.001) but the number of suspected-TB notifications declined from 2610 (24%) in 2012 to 1689 (16%) in 2016 (Ptrend=0.02). 77% of all deaths occurred by month three. Mortality among HIV-infected participants was higher (325/3163; 10.3%) than among HIV-non-infected participants (251/7413; 3.4%; p<0.001). Old age, being a female, type of TB diagnosis used, body mass index (BMI) <18.5, HIV status and year of diagnosis were associated with mortality in the multivariate regression model.ConclusionThis large population level TB study identifies an alarming trend of patients dying within months of starting treatment. These early deaths could be due to late diagnosis and multidrug-resistance. The study warrants further investigation to go beyond already established indicators which remained constant (including HIV co-infection), to explore host, disease or health system related factors that may explain the observed trend.
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Hadebe, Sabelo, Melissa Chengalroyen, Reto Guler, et al. "Intervening along the spectrum of tuberculosis: meeting report from the World TB Day nanosymposium in the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town." Gates Open Research 3 (July 30, 2019): 1491. http://dx.doi.org/10.12688/gatesopenres.13035.2.
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Tuberculosis (TB), caused by the highly infectious Mycobacteriumtuberculosis, remains a leading cause of death worldwide, with an estimated 1.6 million associated deaths reported in 2017. In South Africa, an estimated 322,000 people were infected with TB in 2017, and a quarter of them lost their lives due to the disease. Bacille Calmette-Guérin (BCG) remains the only effective vaccine against disseminated TB, but its inability to confer complete protection against pulmonary TB in adolescents and adults calls for an urgent need to develop new and better vaccines. There is also a need to identify markers of disease protection and develop novel drugs. On March 25th 2019, the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town hosted the second annual World TB Day nanosymposium. The theme of the nanosymposium was “Intervening across the spectrum of TB II” and the goal was to commemorate World TB Day by showcasing research insights shared by early-career scientists and researchers in the field. The speakers spoke on four broad topics: identification of novel drug targets, development of host-directed drug therapies, transmission of TB and immunology of TB/HIV co-infections. Assistant Professor Bryan Bryson gave a highly interesting keynote address that showcased the application of engineering tools to answer fundamental biological questions, particularly in the context of TB.
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ALBUQUERQUE, M. F. P. M., D. N. ALVES, C. C. BRESANI SALVI, et al. "Predictors of immunodeficiency-related death in a cohort of low-income people living with HIV: a competing risks survival analysis." Epidemiology and Infection 145, no. 5 (2017): 914–24. http://dx.doi.org/10.1017/s0950268816003149.
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SUMMARYWe conducted a survival analysis with competing risks to estimate the mortality rate and predictive factors for immunodeficiency-related death in people living with HIV/AIDS (PLWH) in northeast Brazil. A cohort with 2372 PLWH was enrolled between July 2007 and June 2010 and monitored until 31 December 2012 at two healthcare centres. The event of interest was immunodeficiency-related death, which was defined based on the Coding Causes of Death in HIV Protocol (CoDe). The predictor variables were: sociodemographic characteristics, illicit drugs, tobacco, alcohol, nutritional status, antiretroviral therapy, anaemia and CD4 cell count at baseline; and treatment or chemoprophylaxis for tuberculosis (TB) during follow-up. We used Fine & Gray's model for the survival analyses with competing risks, since we had regarded immunodeficiency-unrelated deaths as a competing event, and we estimated the adjusted sub-distribution hazard ratios (SHRs). In 10 012·6 person-years of observation there were 3·1 deaths/100 person-years (2·3 immunodeficiency-related and 0·8 immunodeficiency-unrelated). TB (SHR 4·01), anaemia (SHR 3·58), CD4 <200 cells/mm3(SHR 3·33) and being unemployed (SHR 1·56) were risk factors for immunodeficiency-related death. This study discloses a 13% coverage by highly active antiretroviral therapy (HAART) in our state and adds that anaemia at baseline or the incidence of TB may increase the specific risk of dying from HIV-immunodeficiency, regardless of HAART and CD4.
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Bouhamed, Heni. "COVID-19 Deaths Previsions With Deep Learning Sequence Prediction." International Journal of Big Data and Analytics in Healthcare 5, no. 2 (2020): 65–77. http://dx.doi.org/10.4018/ijbdah.20200701.oa1.
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In this study, the authors use deep learning sequence prediction models for the continuous monitoring of the epidemic while considering the potential impacts of Bacille Calmette-Guérin (BCG) vaccination and tuberculosis (TB) infection rates in populations. Three models were built based on the epidemic data evolution in several countries between the date of their first case and April 1, 2020. The data was based on 14 variables for cases prediction, 15 variables for recoveries prediction, and 16 variables for deaths prediction. Prevision results were very promising, and the suspicions on the BCG vaccination and TB infections rates' implications turned out to be warranted. The model can evolve by continuously updating and enriching data, adding the experiences of all affected countries.
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Vinod, Vaishnavy S., Leyanna Susan George, Aleena Joy, et al. "Proportion of pulmonary tuberculosis cases diagnosed at different levels of health care across fourteen districts of Kerala." International Journal Of Community Medicine And Public Health 7, no. 9 (2020): 3636. http://dx.doi.org/10.18203/2394-6040.ijcmph20203935.
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Background: It is estimated that 10.4 million cases and 1.7 million deaths occur due to tuberculosis (TB) globally. More than one quarter of TB cases and TB-related deaths worldwide occur in India each year. Kerala's TB incidence is estimated to be 67 cases per 100,000. Objective was to estimate the proportion of Pulmonary TB cases diagnosed at different levels of the health care system across all the fourteen districts of Kerala from January to September 2019.Methods: A secondary data analysis was conducted on information obtained from the NIKSHAY portal from January to September 2019. Proportion of cases detected at PHC, CHC, THQ, District hospital and other tertiary care facilities was computed. Statistical analysis was performed using statistical package of social sciences (SPSS) version 23.0.Results: The maximum number of new TB cases (70.8%) was being detected at the primary care level, while 20.3% of new cases were detected from tertiary care centres and 8.9% from secondary care centres. At the primary healthcare level, the maximum number of newly diagnosed TB cases was reported from Wayanad district (88.0%) while, in the secondary and tertiary care levels, Kollam district was found to diagnose the maximum number of new TB cases (24.0% and 48.4% respectively).Conclusions: In this study, majority of the new TB cases were being diagnosed at the Primary health care level. However, in few districts the secondary and tertiary care centres were found to be diagnosing a greater number of cases.
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Giri, Om Prakash, Vishal Prakash Giri, Kirti Vishwakarma, and Debranjan Datta. "Tuberculosis and Human Immunodeficiency Virus Co-Infection: Clinico-Demographic Determinants at an Anti-Retroviral Therapy Center in Northern India." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 14, no. 2 (2018): 12–17. http://dx.doi.org/10.3126/saarctb.v14i2.19333.
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Background: In India, Tuberculosis (TB) is endemic and Human immunodefi ciency virus (HIV) infection is epidemic in few states. The risk of developing TB in people living with HIV (PLHIV) is about 19 (27-22) times greater than those without it. TB is major cause of death in HIV-TB co-infected patients. Globally 0.4 million deaths occur annually due to HIV-TB disease.Material & Methods:The present observational study was conducted at Darbhanga Medical College and Hospital ART (Antiretroviral therapy) center during period from January to June 2017. Data of HIV-TB co-infected patients was collected from HIV-TB register and entered into Microsoft Excel sheet for analysis using Statistical Package for the Social Sciences.Results:Young persons mostly from the labouring class working in other states were most affected. Pulmonary tuberculosis (sputum smear positive) was most common co-infection. Baseline CD4 cell count at the time of presentation was observed to be low (less than 200 cells/μL) in 46.64℅ HIV-TB co-infected patients.Conclusion: Rural young people working as migrant labourer need focus of health interventions. They should be educated and screened for HIV and TB. Baseline CD4 cell count should be done in all PLHIV cases to assess their immune status.SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, Vol. 14, No. 2, 2017, Page: 12-17