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Gunasekera, Kenneth S., Elisabetta Walters, Marieke M. van der Zalm, Megan Palmer, Joshua L. Warren, Anneke C. Hesseling, Ted Cohen, and James A. Seddon. "Development of a Treatment-decision Algorithm for Human Immunodeficiency Virus–uninfected Children Evaluated for Pulmonary Tuberculosis." Clinical Infectious Diseases 73, no. 4 (January 15, 2021): e904-e912. http://dx.doi.org/10.1093/cid/ciab018.
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Abstract Background Limitations in the sensitivity and accessibility of diagnostic tools for childhood tuberculosis contribute to the substantial gap between estimated cases and cases notified to national tuberculosis programs. Thus, tools to make accurate and rapid clinical diagnoses are necessary to initiate antituberculosis treatment in more children. Methods We analyzed data from a prospective cohort of children <13 years old being routinely evaluated for pulmonary tuberculosis in Cape Town, South Africa, from March 2012 to November 2017. We developed a regression model to describe the contributions of baseline clinical evaluation to the diagnosis of tuberculosis using standardized, retrospective case definitions. We included baseline chest radiographic and Xpert MTB/RIF assay results to the model to develop an algorithm with ≥90% sensitivity in predicting tuberculosis. Results Data from 478 children being evaluated for pulmonary tuberculosis were analyzed (median age, 16.2 months; interquartile range, 9.8–30.9 months); 242 (50.6%) were retrospectively classified with tuberculosis, bacteriologically confirmed in 104 (43.0%). The area under the receiver operating characteristic curve for the final model was 0.87. Clinical evidence identified 71.4% of all tuberculosis cases in this cohort, and inclusion of baseline chest radiographic results increased the proportion to 89.3%. The algorithm was 90.1% sensitive and 52.1% specific, and maintained a sensitivity of >90% among children <2 years old or with low weight for age. Conclusions Clinical evidence alone was sufficient to make most clinical antituberculosis treatment decisions. The use of evidence-based algorithms may improve decentralized, rapid treatment initiation, reducing the global burden of childhood mortality.
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Kulchavenya, E. V., S. Yu Shevchenko, D. P. Kholtobin, and A. A. Baranchukova. "Relapses of urogenital tuberculosis." Tuberculosis and Lung Diseases 98, no. 10 (November 14, 2020): 19–22. http://dx.doi.org/10.21292/2075-1230-2020-98-10-19-22.
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The objective of the study: to characterize the cases of tuberculosis relapses with lesion in urogenital organs.Subjects and methods. Out of 140 case histories of patients with urogenital tuberculosis (UGTB; tuberculosis of the urinary and male reproductive system), registered for follow-up by the phthisiourologist, all files of patients with tuberculosis relapses were picked up, totally, there were 13 of them.Results. Men prevailed among cases of relapses (61.5%). Patients at the age of 30-50 years old made 46.1%, and 53.9% were 51 years old and above. In the first episode of tuberculosis, lesions of the genitourinary system were observed in 53.9% of patients, bacterial excretion was found in 38.5%. On the average, the relapse developed in 9.1 years after successful cure of the first episode of tuberculosis: after respiratory tuberculosis – in 5.6 years and after UGTB – in 12.3 years. In 3 (23.1%) patients with relapse, mycobacteriuria was documented, in 1 of them, drug resistance (to streptomycin and isoniazid) was detected. In general, in the relapse of tuberculosis with urogenital lesions, the kidneys were most often (69.2%) affected. The treatment of relapse was effective in 12 out of 13 patients. During chemotherapy of tuberculosis, 3 (23.1%) patients developed toxic and allergic reactions that required treatment interruption or cancellation of the drug.
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Mulyati, Tatik, Endy Paryanto Prawirohartono, and Toto Sudargo. "Pengaruh pendidikan gizi kepada ibu terhadap konsumsi makanan dan status gizi anak balita penderita tuberkulosis primer di rawat jalan RSUP Dr. Kariadi Semarang." Jurnal Gizi Klinik Indonesia 1, no. 2 (November 1, 2004): 87. http://dx.doi.org/10.22146/ijcn.17399.
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Background: Tuberculosis is an infectious disease that persists as a public health problem in Indonesia. The tuberculosis infected to the under 5-years old-children namely primary tuberculosis, could decrease the children’s immunity eventually causes death, which were 100.000 death rate 75% are children’s. Conditions of children’s health were deeply depending on the quality and quantity of their food consumption. An adequate consumption is needed to increase their nutrition status. To improve the maternal behavior of children’s food consumption, it is necessary to give nutritional education.Objective: The purpose of this study is to examine the effect of nutritional education on the food consumption and nutrition status of the under 5-years old-children that infected by primary tuberculosis.Methods: The research was an experimental research using randomized controlled trial method. The subject was 1 to 5- year(s) old-children those who infected by primary tuberculosis at Unit Rawat Jalan RSUP Dokter Kariadi Semarang. Two groups chosen by randomized got different treatments, i.e. availability and unavailability of nutritional education. Each group was asked to come to Poliklinik Paru Anak every two-week for two months (4 times). The food consumption data was collected by multiple recalls before treatment and after research. The nutrition status was determined by weight per age and weight per height of Z- Score WHO NCHS.Results: The result of this study showed that after the nutritional education issued, the energy consumption average of children has increase 18.18% from necessity and the protein consumption average of children has increase 21.39% from necessity. There was a significant effect of nutritional education on increasing protein consumption of under 5-years old-children that was infected by primary tuberculosis (p<0.05). It was also showed that the Z-Score increasing (weight per age and weight per height) of children in treatment-group was higher than the control-group.Conclusion: Nutritional education has a significant effect on increasing protein consumption of under 5-years old-children that was infected by primary tuberculosis (p<0.05), or there is increasing of protein consumption about 21.39%.
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Drozdetskaya, I. V., A. V. Mordyk, and N. I. Porkulevich. "Urogenital tuberculosis in children 0 - 14 years old in the structure of other localizations of tuberculosis." Vestnik Urologii 9, no. 2 (July 10, 2021): 34–44. http://dx.doi.org/10.21886/2308-6424-2021-9-2-34-44.
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Introduction. Extrapulmonary tuberculosis (EPTB) still has many features: there is a different approach to its definition in different countries, there is no screening, diagnosis is extremely difficult and requires financial costs, and bacteriological verification does not exceed 46%, complex restorative and reconstructive operations are used in treatment. the proportion of patients with isolated extrapulmonary localizations among tuberculosis patients is low.Purpose of the study. To study the structure of tuberculosis (TB) in children with the accentuation of EPTB in the current conditions to determine the development areas of preventive and diagnostic measures.Materials and methods. A retrospective two-stage study was carried out in the period from 1989 to 2018 among in-patient children aged 0 - 14 yrs. At the first stage, the structure of clinical forms of TB was assessed in 2306 children. Three comparison groups were formed following ten-year periods. At the second stage, 4 groups were identified according to age: early age, preschool age, primary school age, prepubertal age. The data obtained in the course of the study were statistically processed using the Microsoft Office 2007 (Microsoft Corp., USA) and Biostat 2009 (AnalystSoft Inc., USA) software package. The differences between the groups were determined using the χ2 test, and significant differences were considered when the value of the p < 0.05 criterion.Results. It was found that throughout the entire observation period in the region, the predominant localization of the specific process was respiratory TB. The proportion of isolated extrapulmonary lesions in children decreased from 11.1% in the period from 1999 to 2008 to 3.4% in the period from 2009 to 2018 (p = 0.000). At the same time, the most frequent localization (60.4 - 77.8% of cases) among EPTB remains urinary TB. In the dynamics from 1989 to 2018, the number of cases of the disease with combined forms of tuberculosis increased (from 3.1% to 7.2%; p = 0.000), mainly due to the establishment of several localizations of the lesion. The frequency of bacteriological confirmation of the diagnosis was significantly different at various localizations of the specific process. In children of the compared periods of childhood, the predominant localization of the specific process was isolated respiratory TB. The isolated extrapulmonary process localizations were more common in the age groups 7 - 11 and 12 - 14 yo, where it accounted for 10.8 - 12.4% of TB cases (p = 0.000). The localization of the EPTB also depended on the children's age. So, young children often developed damage to the osteoarticular system, in preschool children - the genitourinary and lymphatic (peripheral lymphadenopathy) systems, in younger schoolchildren and preschoolers - the genitourinary system. The frequency of bacteriological confirmation of the EPTB increased with the age. The combined forms of a specific process were more often observed in the age group of 7 - 11 yo, in the other groups their share was 77.4%, 87.1%, and 95.0% of cases. Respiratory TB and TB of other organs was confirmed bacteriologically more often in the age group 7 - 11 yo (19.4%), and in the group 12 - 14 yo in 12.9%, 4 - 6 yo in 10.0%, early age in 9.7%, which is much more frequent than confirmation of isolated respiratory TB.Conclusions. EPTB in children has not lost its position and due to the widespread introduction of the recombinant TB allergen and CT into clinical practice. It has become more often detected in combination with respiratory TB. Among the EPTB, genitourinary tuberculosis prevailed, which can be verified in contrast to damage to other organs. Raising the level of awareness of paediatricians and phthisiatrician-paediatricians about the frequency of EPTB occurrence makes it possible to form alertness in terms of the possibility of their development and to timely detect the disease at an early stage.
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Kim, Jung Ho, Jin Young Ahn, Su Jin Jeong, Nam Su Ku, Jun Yong Choi, Young Keun Kim, Joon-Sup Yeom, and Young Goo Song. "Prognostic factors for unfavourable outcomes of patients with spinal tuberculosis in a country with an intermediate tuberculosis burden." Bone & Joint Journal 101-B, no. 12 (December 2019): 1542–49. http://dx.doi.org/10.1302/0301-620x.101b12.bjj-2019-0558.r1.
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Aims Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavourable outcomes are not yet established. We investigated the clinical manifestations and predictors of unfavourable treatment outcomes in patients with spinal TB. Patients and Methods We performed a multicentre retrospective cohort study of patients with spinal TB. Unfavourable outcome was defined according to previous studies. The prognostic factors for unfavourable outcomes as the primary outcome were determined using multivariable logistic regression analysis and a linear mixed model was used to compare time course of inflammatory markers during treatment. A total of 185 patients were included, of whom 59 patients had unfavourable outcomes. Results In multivariate regression analysis, the factors associated with unfavourable outcome were old age (odds ratio (OR) 2.51; 95% confidence interval (CI) 1.07 to 5.86; p = 0.034), acid-fast bacilli (AFB) smear positivity in specimens obtained through biopsy (OR 3.05; 95% CI 1.06 to 8.80; p = 0.039), and elevated erythrocyte sedimentation rate (ESR) at the end of treatment (OR 3.85; 95% CI 1.62 to 9.13; p = 0.002). Patients with unfavourable outcomes had a significant trend toward higher ESR during treatment compared with patients with favourable outcome (p = 0.009). Duration of anti-TB and surgical treatment did not affect prognosis. Conclusion Elevated ESR at the end of treatment could be used as a marker to identify spinal TB patients with a poor prognosis. Patients whose ESR is not normalized during treatment, as well as those with old age and AFB smear positivity, should be aware of unfavourable outcomes. Cite this article: Bone Joint J 2019;101-B:1542–1549
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Bagga, Rupali Verma, Sarit Sharma, RK Soni, Anurag Chaudhary, and Mahesh Satija. "Factors associated with treatment outcome in adult tuberculosis patients under directly observed treatment short course in Ludhiana city, Punjab, India: a cohort study." International Journal Of Community Medicine And Public Health 4, no. 4 (March 28, 2017): 933. http://dx.doi.org/10.18203/2394-6040.ijcmph20170900.
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Background: Tuberculosis (TB) is a communicable disease requiring prolonged treatment and poor adherence to a prescribed treatment increases the risk of morbidity, mortality and spread of disease in the community. Objective was to study factors associated with treatment outcome in adult Tuberculosis patients on directly observed treatment short (DOTS) course in Ludhiana city, Punjab, India.Methods: The present study was a community based prospective cohort study. It was conducted in the two tuberculosis units (TU) of Ludhiana city, Punjab, India. A total of 221 registered DOTS patients were taken as study subjects and were followed during the course of treatment to observe their treatment outcome. The information was collected on a pre-designed semi-structured questionnaire through personal interviews.Results: Out of 221, 183 (82.8%) subjects had favorable outcome, 35 (15.8%) had unfavourable outcome and 3 (1.4%) were transferred out. The comparison between favorable and unfavourable treatment was found be statistically significant with respect to different age groups, problems faced by subjects to reach DOTS centre, diabetes, sputum smear status, site of tuberculosis involvement and side effects of treatment.Conclusions: Elderly and diabetic patients were found to have higher unfavourable outcome. There is need for special provisions for older age groups, illiterates and for lower socio-economic status (SES) in the form of counselling for old people and health insurance for those belonging to lower SES. Keeping in mind the default rate of the present study, initial counselling, periodic motivation of patients and prompt defaulter retrieval action would be beneficial.
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Ho Kim, Jung, Jin young Ahn, Su Jin Jeong, Nam su Ku, Jun yong Choi, Young Keun Kim, Joon-Sup Yeom, and Young Goo Song. "1366. Prognostic Factors for Unfavorable Outcomes of Patients with Spinal Tuberculosis in a Country with an Intermediate Tuberculosis Burden: a Multi-Center Cohort Study." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S494—S495. http://dx.doi.org/10.1093/ofid/ofz360.1230.
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Abstract Background Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavorable outcomes are not yet known. Therefore, we investigated the clinical manifestations and predictors of unfavorable treatment outcomes in patients with spinal TB. Methods We performed a multi-center retrospective cohort study of patients with spinal TB. The clinical features, comorbidities, laboratory data, imaging findings and treatment outcomes of the patients were analyzed. The unfavorable outcome was defined according to previous studies. The prognostic factors for unfavorable outcomes as the primary outcome were determined using multivariate logistic regression analysis and a linear mixed model were used to compare time course of inflammatory markers during treatment. Results A total of 185 patients (85 males and 100 females) were included. The mean age of the patients was 57.2 years. Of them, 115 underwent surgery during treatment, with a median treatment duration of 12 months. Fifty-nine patients had unfavorable outcomes. In multivariate regression analysis, the factors associated with unfavorable outcome were old age (odds ratio [OR], 2.51; P = 0.034), acid-fast bacilli (AFB) smear positivity in specimens obtained through biopsy (OR, 3.05; P = 0.039), and elevated erythrocyte sedimentation rate (ESR) at the end of treatment (OR, 3.85; P = 0.002). Patients with unfavorable outcomes had a significant trend toward higher ESR during treatment compared with patients with favorable outcome (P = 0.009). Duration of anti-TB and surgical treatment did not affect prognosis. Conclusion Elevated ESR at the end of treatment could be used as a marker to identify spinal TB patients with a poor prognosis. Patients whose ESR are not normalized during treatment, as well as those with old age and AFB smear positivity, should be aware of unfavorable outcomes. Disclosures All authors: No reported disclosures.
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Ilievska-Poposka, Biljana, Marija Metodieva, Maja Zakoska, Cveta Vragoterova, and Dejan Trajkov. "Latent Tuberculosis Infection - Diagnosis and Treatment." Open Access Macedonian Journal of Medical Sciences 6, no. 4 (April 14, 2018): 651–55. http://dx.doi.org/10.3889/oamjms.2018.161.
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INTRODUCTION: Latent tuberculosis infection (LTBI) is defined as a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens without evidence of clinically manifested active tuberculosis (TB). Diagnosis and treatment for LTBI are important for TB, especially in high-risk populations. Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are used to diagnose LTBI.AIM: The study aims to present the first results with IGRA test compared with TST in the screening of LTBI and the treatment results in the cases with LTBI in Macedonia.MATERIAL AND METHODS: In this study 73 cases diagnosed and treated with LTBI in 2016 were included. For diagnosis of LTBI, we used TST RT -23 5T.U. and commercial IGRA test such as QuantiFERON-TB Gold In-Tube (QFT-IT).RESULTS: Out of 73 cases with LTBI, 61.64% were men, and 38.36% were women. Among all age groups, the most frequent were cases between 5 and 14 years old (54.79%). Among the evaluated risk groups for LTBI, the most frequent were children household contacts with pulmonary TB cases (61-83.65%), followed by people living with HIV (9-12.33%) and only 3 cases with other medical reasons. Positive TST had 34 cases (46.57%) and positive IGRA test 25 cases (34.25%). Regarding the treatment regimes, we use two regimes: 50 cases (68.44%) received 6 months daily regime with Isoniazid, and 23 cases (31.51%) received 3 months daily regime with Isoniazid and Rifampicin. Treatment outcomes showed that the most patients completed treatment regimes: 55 (75.34%) and only 10 (13.09%) interrupted the treatment.CONCLUSION: Despite the progress made in the last few years, several challenges remain to be addressed for better management of LTBI which will contribute to strength TB control in the country.
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Interlandi, Emanuela, Francesco Pellegrini, Carlos Pavesio, Marco De Luca, Rocco De Marco, Alessandro Papayannis, Erika Mandarà, et al. "Intraocular Tuberculosis: A Challenging Case Mimicking Wet Age-Related Macular Degeneration." Case Reports in Ophthalmology 12, no. 2 (June 11, 2021): 519–24. http://dx.doi.org/10.1159/000512578.
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An otherwise healthy 72-year-old Chinese patient diagnosed with exudative age-related macular degeneration and decreased vision in left eye was fully investigated. The retrospective analysis of past multimodal imaging revealed bilateral severe choroidal neovascularization and choroiditis associated with a positive tuberculin skin testing and interferon-gamma release assay (QuantiFERON-TB Gold – Cellestis<sup>®</sup>, Chadstone, VIC, Australia) suggestive of latent ocular tuberculosis. The variable presentation and tests’ results interpretation represent the greatest limitations in understanding and treating intraocular TB (IOTB). This may present without any other systemic symptoms, the intraocular tissues are of limited access to biopsies and other tests, including imaging and immunological tests, are of relative value. This case highlights how variable may be the presentation of IOTB, which can be easily misdiagnosed leading to a delayed treatment and worse prognosis.
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du Preez, Karen, Muhammad Osman, James A. Seddon, Pren Naidoo, H. Simon Schaaf, Zahn Munch, Rory Dunbar, Lindiwe Mvusi, Sicelo S. Dlamini, and Anneke C. Hesseling. "The Impact of the Evolving Human Immunodeficiency Virus Response on the Epidemiology of Tuberculosis in South African Children and Adolescents." Clinical Infectious Diseases 73, no. 4 (February 3, 2021): e967-e975. http://dx.doi.org/10.1093/cid/ciab095.
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Abstract Background Few studies have evaluated tuberculosis control in children and adolescents. We used routine tuberculosis surveillance data to quantify age- and human immunodeficiency virus (HIV)-stratified trends over time and investigate the relationship between tuberculosis, HIV, age, and sex. Methods All children and adolescents (0–19 years) routinely treated for drug-susceptible tuberculosis in South Africa and recorded in a de-duplicated national electronic tuberculosis treatment register (2004–2016) were included. Age- and HIV-stratified tuberculosis case notification rates (CNRs) were calculated in four age bands: 0–4, 5–9, 10–14, and 15–19 years. The association between HIV infection, age, and sex in children and adolescents with tuberculosis was evaluated using multivariable logistic regression. Results Of 719 400 children and adolescents included, 339 112 (47%) were 0–4 year olds. The overall tuberculosis CNR for 0–19 year olds declined by 54% between 2009 and 2016 (incidence rate ratio [IRR] = 0.46; 95% confidence interval [CI], .45–.47). Trends varied by age and HIV, with the smallest reductions (2013–2016) in HIV-positive 0–4 year olds (IRR = 0.90; 95% CI, .85–.95) and both HIV-positive (IRR = .84; 95% CI, .80–.88) and HIV-negative (IRR = 0.89; 95% CI, .86–.92) 15–19 year olds. Compared with 0- to 4-year-old males, odds of HIV coinfection among 15–19 year olds were nearly twice as high in females (adjusted odds ratio [aOR] = 2.49; 95% CI, 2.38–2.60) than in males (aOR = 1.35; 95% CI, 1.29–1.42). Conclusions South Africa’s national response to the HIV epidemic has made a substantial contribution to the observed declining trends in tuberculosis CNRs in children and adolescents. The slow decline of tuberculosis CNRs in adolescents and young HIV-positive children is concerning. Understanding how tuberculosis affects children and adolescents beyond conventional age bands and by sex can inform targeted tuberculosis control strategies.
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Herchline, Thomas, and Ashley Trent. "796. Treatment of Latent Tuberculosis Infection in a Refugee Population." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S286. http://dx.doi.org/10.1093/ofid/ofy210.803.
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Abstract Background As tuberculosis (TB) rates decline in the United States, many new cases are among individuals who migrated from countries with a high incidence of TB. Public Health – Dayton & Montgomery County screens incoming refugees for active and latent TB. The objective of this study was to estimate the number of active cases of TB prevented through screening and treatment of LTBI. Methods Data were collected through retrospective chart review of refugee seen between July 1, 2011 and June 30, 2015. Refugees younger than 5 years old were excluded. New cases of active TB identified from July 1, 2011 through August 31, 2017 were reviewed for cases in refugees. The number of expected new, active TB cases was 100–150 per 100,000 person-years of follow-up (McBride, MJA 2012). Results A total of 607 charts were reviewed: 373 were males, 234 females. Ages ranged from 6 to 77 years, average 27.4 years. The leading countries of origin were Kenya (79), Iraq (68), Rwanda (59), Ethiopia (55), and Nepal (52). There were three cases of active TB diagnosed on initial evaluation; there were no cases of active TB diagnosed in 2,341 person-years of follow-up. Among refugees, 23.1% had positive T-Spots; highest in the 36–45 age group (35.0%) and refugees from South to East Asia (29.6%). LTBI was diagnosed in 21.1% of refugees; highest in the 46–55 age group (33.3%) and refugees from South to East Asia (27.8%). The majority of subjects with LTBI completed treatment (78.9%). Treatment completion was highest among the 13–17 age group (100.0%), males (81.4%), and refugees from South to East Asia (92.9%); lowest in the >56 age group (40.0%) and European region (50.0%). Conclusion Based on published data, an estimated 2.3–3.5 active cases of TB were prevented through this program. Treatment completion rates were higher than reported for non-refugee populations. Results indicate the program is effective at screening for and preventing development of active TB. Disclosures All authors: No reported disclosures.
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Shrestha, Pushpa Man, Minani Gurung, and Nabin Kumar Chaudhary. "Factors Influencing Sputum Smear and Culture Conversion Time among Patients with Pulmonary Tuberculosis." Nepal Medical Journal 1, no. 01 (August 21, 2018): 41–46. http://dx.doi.org/10.37080/nmj.14.
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Introduction: Pulmonary tuberculosis is a contagious bacterial infection that involves the lungs and it may spread to other organs. Sputum smear and culture conversion are important indicators for the effectiveness of treatment and the infectivity of the patient. The present study aims to find sputum smear and culture conversion time and the factors that influence the conversion time among tuberculosis patients at National Tuberculosis Centre in Nepal.
Methods: A total of 54 patients, who were diagnosed with laboratory confirmed pulmonary tuberculosis and under antitubercular therapy were monitored for sputum smear and culture conversion time. The blood specimens from each patient were processed for hemoglobin, platelets, erythrocyte sedimentation rate and blood glucose levels. Patient’s clinical history, risk factors that prolong conversion time and sociodemographic information were also collected by direct interview.
Results: The mean sputum smear and culture conversion were found to be 54.4 days and 45.5 days respectively. Old age, smoking habit, low body mass index value, Treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate values were found to be associated with long sputum conversion time. Radiographic involvement of only left lungs, presence of fewer symptoms, aged between 15-45 years, having normal weight, without smoking habit and being married, were found to be associated with short sputum conversion time.
Conclusions: The sputum microscopy, old age, smoking habit, low body mass index value, treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate value had been found to be significantly associated with long sputum conversion time.
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Elgali, A. I., A. V. Aseev, Dmitriy S. Riasenskii, and N. A. Grishkina. "LONG-TERM OUTCOMES OF TREATMENT IN PATIENTS WITH DRUG-RESISTANT PULMONARY TUBERCULOSIS AND NON-EFFICIENCY OF PREVIOUS THERAPY." Epidemiology and Infectious Diseases (Russian Journal) 24, no. 2 (April 15, 2019): 88–91. http://dx.doi.org/10.18821/1560-9529-2019-24-2-88-91.
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In 2018 key changes were made to the recommended treatment for multi-drug resistant tuberculosis, the priority of oral medications over injectables was indicated. For the first time in history, a new, completely oral 20-month treatment regimen was proposed. The regimen recommends bedaquiline and linezolid together with levofloxacin / moxifloxacin, cycloserine / clofazimine. This treatment regimen differs from the standard 4 MDR-TB chemotherapy regimens adopted in Russia. Until recently, bedaquiline and linezolid were relatively unobtainable in the conditions of tuberculosis dispensaries, patients who needed such treatment were referred to specialized Federal tuberculosis facilities. The aim of the study was to study the long-term results of treatment of patients with drug-resistant pulmonary tuberculosis in cases of the ineffectiveness of previous therapy in an antituberculosis dispensary and referral to a specialized Federal tuberculosis institution. In 2010-2014, 143 people of both sexes in the age group from 20 to 60 years old were treated in the Tver Regional Clinical Antituberculosis Dispensary. Individual conversations, organizing communication with other patients who received effective anti-tuberculosis treatment, watching the training video “Tuberculosis: Questions and Answers”, studying the materials of the brochure “School of the Patient. A brochure for patients suffering from tuberculosis” developed by the charitable organization “Partners in the name of health” was used in the process of increasing adherence to treatment. When carrying out measures to increase adherence to treatment among patients with pulmonary tuberculosis, a positive result was obtained in 143 people. These patients agreed to possible surgical intervention in the Federal Tuberculosis Institution. Immediately after the surgical stage of treatment, cavity closure and/or abacillation were achieved in 132 (92.3%) people. In the postoperative period anti-tuberculosis therapy was continued in accordance with the drug-resistant pathogen, the discipline of patients in receiving anti-tuberculosis drugs increased significantly.
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Soedarsono, Soedarsono, Sari Mandayani, Kinasih Prayuni, and Rika Yuliwulandari. "THE RISK FACTORS FOR DRUG INDUCED HEPATITIS IN PULMONARY TUBERCULOSIS PATIENTS IN DR. SOETOMO HOSPITAL." Indonesian Journal of Tropical and Infectious Disease 7, no. 3 (October 31, 2018): 73. http://dx.doi.org/10.20473/ijtid.v7i3.8689.
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Tuberculosis (TB) is still a major public health problem in Indonesia. Anti-tuberculosis drug-induced hepatotoxicity (DIH) is common side effect leading to changes in treatment regimens, and the less effective second-line treatments. Several risk factors such as age, sex, body mass index (BMI) and acetylization status for hepatotoxicity were suggested in previous studies but in the fact, those are often not related to DIH incidence after receiving standard TB treatment regimen. The aim of this study was to asses the role of risk factors in the DIH incidence in pulmonary TB patients receiving standard TB treatment regimen in Dr. Soetomo Hospital, Surabaya. Study design was analytic observational with case control. The subjects were 30 TB DIH patients and 31 TB non-DIH patients receiving standard national TB program therapy. DIH severity was divided based on International DIH Expert Working Group. Demographic data and BMI status were taken from medical records. The age classification are ≥35 years old and <35 years old as one of the risk factors studied. DNA sequencing was used to assess single-nucleotide polymorphisms in NAT2 coding region to evaluate acetylator status from blood samples. The risk factors were evaluated using chi-square test and Mantel-Haenszel test. Significant association between low BMI and DIH in general was identified (OR=3.017; 95% CI=1.029-8.845) and more significant association between low BMI and moderate DIH (OR=15.833; 95% CI=1.792-139.922). Age, sex, and acetylization status has no significant correlation with DIH incidence in general. Significant association between slow acetylator phenotype and incidence of moderate DIH was identified (OR=7.125; 95% CI= 1.309-38.711). In conclusion, some risk factors were correlated to DIH incidence in pulmonary TB patientsreceiving standart TB treatment regimen.
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Dharmshaktu, Ganesh S., and Pankaj Singh. "Isolated Tuberculosis of Patella in a Child: A Case Report and Literature Review." International Journal of Advanced and Integrated Medical Sciences 2, no. 2 (June 2017): 101–3. http://dx.doi.org/10.5005/jp-journals-10050-10085.
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ABSTRACT The patella is an uncommon site for skeletal tuberculosis. Its incidence is limited to a few anecdotal case reports or series in the literature. The presence of this clinical entity in the pediatric age group is even rarer. A high index of suspicion and early clinicoradiological diagnosis are the mainstay of treatment coupled with compliant antitubercular treatment. The effective management also mitigates its spread to whole of the knee joint and subsequent arthrosis. A rare case of patella tuberculosis with effective management and good functional outcome in a 9-year-old male child is presented here with relevant details. How to cite this article Dharmshaktu GS, Singh P. Isolated Tuberculosis of Patella in a Child: A Case Report and Literature Review. Int J Adv Integ Med Sci 2017;2(2):101-103.
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Krajewska, Monika, Agnieszka Czujkowska, Marcin Weiner, Marek Lipiec, and Krzysztof Szulowski. "Avian tuberculosis in a captive cassowary (Casuarius casuarius)." Bulletin of the Veterinary Institute in Pulawy 59, no. 4 (December 1, 2015): 483–88. http://dx.doi.org/10.1515/bvip-2015-0072.
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AbstractThe paper describes avian tuberculosis in a captive bred cassowary. A two-and-a-half-year-old bird was obtained by a Polish zoo in 2010 from the Netherlands under conditions compliant with the recommendations of the European Association of Zoos and Aquaria. Despite being of small size for the age, the bird appeared healthy and showed no signs of the disease until the day when it was found recumbent in its pen. Later on it was euthanised due to lack of treatment possibilities. Pathological changes typical of avian tuberculosis were found in the liver and spleen. Mycobacterium avium ssp. avium was cultured from both organs.
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Firnawati, Artika Fristi, Riris Andono Ahmad, and Heni Retnowulan. "Ketahanan hidup 2 tahun pasien tuberkulosis resisten obat di RS. Moewardi Surakarta tahun 2010-2014." Berita Kedokteran Masyarakat 33, no. 8 (August 1, 2017): 371. http://dx.doi.org/10.22146/bkm.22462.
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Two year survival of drug resistant tuberculosis patients in Moewardi hospital in Surakarta in 2010-2014PurposeThe purpose of this study was to determine the two year survival rate and predictor factors of mortality in drug resistant tuberculosis patients during treatment at the Moewardi Hospital in Surakarta.MethodsThis research was a retrospective cohort study of 250 drug resistant tuberculosis patients receiving treatment in the Moewardi Hospital in January 2011-September 2014. Data were analyzed using survival analysis to find factors affecting the 2 year survival. Our variables were demographic factors, disease characteristics and treatment history. We used Cox regression test with 5% significance level.Results2-year survival rates of drug resistant patients was 74.82%. age, the type of patient, HIV status, side effects of medications and culture conversion were significant to survival rate in bivariate analysis. Cox regression test showed that aged ≥ 40 years (HR 3.221; 95% CI 1.037 to 10.001) and have HIV-positive status (HR 18.086; 95% CI 1.958 to 167.073) were related with reduction of two year survival rate in drug resistant tuberculosis patient. ConclusionAge above 40 years old and HIV positive status for drug-resistant tuberculosis patients may accelerate their death. The screening of HIV in drug resistant tuberculosis patients is needed in order to increase two year survival rate of patients during treatment.
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Slаschevа, D. M., A. D. Petrushinа, N. S. Brynzа, А. P. Chernovа, N. D. Pirogovа, and S. V. Sosnovskаya. "Vitamin D deficiency in children with latent tuberculosis infection." Tuberculosis and Lung Diseases 98, no. 6 (July 10, 2020): 27–31. http://dx.doi.org/10.21292/2075-1230-2020-98-6-27-31.
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The objective: to assess the level of vitamin D and parameters of phosphorus-calcium metabolism in children with latent tuberculosis infection.Subjects and methods. 40 children from 3 to 17 years were enrolled in the study, they all had the abnormal reaction to Mantoux test with 2 TU but no clinical, radiological and bacteriological signs of active tuberculosis; 39 of them received preventive treatment for latent tuberculosis infection during the study. The following parameters were tested: blood level of 25-hydroxycholecalciferol (calcidiol, 25(OH)D) (the level of less than 10 ng/ml was considered as pronounce severe deficiency, the level of 11-20 ng/ml as moderate deficiency, 21-29 ng/ml – minor deficiency, above 30 ng/ml – an adequate level of vitamin D); total calcium, and ionized calcium.Results: 87.5% (14/16) of children from the group of 3-6 years old and 96% (23/24) of children from the group of 7-17 years old were found to have vitamin D deficiency; p > 0.05. The blood level of total calcium and ionized calcium in all children was within the age norm.
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Jahan, Ishrat, Mehedi Parvez, and Laisha Yeasmin. "A Case of Congenital Tuberculosis in a Tertiary Care Hospital." Journal of Enam Medical College 1, no. 2 (July 29, 2012): 85–87. http://dx.doi.org/10.3329/jemc.v1i2.11469.
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Congenital tuberculosis is an unusual and severe clinical presentation of Mycobacterium tuberculosis (MTB) infection. It is usually difficult to diagnose and treat. We report a tenweek-old male infant who had presented with fever, difficulty in breathing, abdominal distension, convulsion, low weight gain since one month of his age. The diagnosis was made by demonstration of MTB bacilli in the gastric aspirate of baby and chest radiography. Treatment with the four drug regimen including streptomycin was initiated, but the baby died on the third day of ATT. This case gives an account of difficulties in diagnosis and therapeutic management of congenital tuberculosis and alerts for development of protocols that foresee these difficulties. DOI: http://dx.doi.org/10.3329/jemc.v1i2.11469 J Enam Med Col 2011; 1(2): 85-87
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Rashidov, Z. R., Sh T. Mukhtаrov, and S. I. Аzimov. "Possibilities of Therapeutic and Prophylactic Tactics in Management of Benign Prostatic Hyperplasia in Tuberculosis Patients." Tuberculosis and Lung Diseases 99, no. 7 (August 19, 2021): 26–30. http://dx.doi.org/10.21292/2075-1230-2021-99-7-26-30.
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The objective: to assess the severity of symptoms of urinary dysfunction in tuberculosis patients with benign prostatic hyperplasia (BPH) and determine the effectiveness of comprehensive therapeutic and preventive measures aimed at their elimination as well as the possibility of their combination with anti-tuberculosis therapy.Subjects and Methods. 447 men with various localizations of tuberculosis at the age from 20 to 96 years old were examined. The questionnaire we used included questions regarding lower urinary tract symptoms, urinary tract infection, involuntary urination, and male genital disorders. The assessment involved comprehensive clinical and laboratory evaluation, including objective examination, laboratory and echographic tests of genitourinary organs.Results. According to assessment results, among 447 male tuberculosis patients, 88 (19.7%) were diagnosed with benign prostatic hyperplasia which indicated a large proportion of older men with various forms of tuberculosis. Analysis of the structure of tuberculosis clinical forms showed the highest frequency of benign prostatic hyperplasia in patients with infiltrative pulmonary tuberculosis (51.1%) and bone and joint tuberculosis (26.1%). Medical treatment (tamsulosin 0.4 mg once a day for 3 months) in 66 patients was highly effective – up to 80.3%.
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Sharma, K. R., N. K. Bhatta, S. R. Niraula, R. Gurung, and P. K. Pokharel. "A Measure of Transmission of Tuberculosis Infection among Children in Household Contact." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 16, no. 1 (June 30, 2018): 33–37. http://dx.doi.org/10.3126/saarctb.v16i1.23241.
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Introduction: Tuberculosis (TB) is transmitted through droplets from patients having pulmonary TB, Young children living in the same household are at higher risk Tuberculosis, with great potential to benefit from screening and preventive treatment. This study was conducted with the objectives to estimate the prevalence of TB infection among under five years old children in household contact with pulmonary tuberculosis patients, and assess the factors associated with transmission of TB.
Methods: Pulmonary TB patients receiving treatment from the DOTS Centres in Sunsari District (Index Case-IC) were visited in their household to identify and assess contacts below five years of age. Transverse induration greater than10 mm was defined as a positive Mantoux test suggestive of tubercular infection.
Results: Among 190 household contacts, Mantoux was positive in 13.7% (95%CI: 11.2-16.2). Higher sputum bacillary load (adjusted OR=3.03; 95% CI 1.01-9.1) and spitting habits of Index Cases (aOR=3.1; 95% CI 1.2-7.7), first-degree relationship (aOR=3.5; 95%CI 1.4-8.7) and longer duration of contact (aOR- 6.7; 95% CI 1.4-32.2), were factors significantly associated with positive Mantoux test in the under-five years old household contact.
Conclusion: The prevalence of tuberculosis infection among under-five children in contact with pulmonary tuberculosis patients was 13.7%, which is nearly double than the results of first national tuberculin survey (7%), conducted by National Tuberculosis Centre. This highlights the need for a competent & functioning contact tracing mechanism to halt the chain of transmission of infection. Social and behavioral factors existing in the household were significantly associated with the transmission of Tuberculosis infection.
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Dailami, Fariz Abdul Mujib, Regina Satya Wiraharja, and Febie Chriestya. "RELATIONSHIP BETWEEN SUCCESSFUL TREATMENT OF PULMONARY TUBERCULOSIS PATIENTS WITH THE AVAILABILITY OF TREATMENT SUPPORTER IN ATMA JAYA HOSPITAL." Damianus Journal of Medicine 18, no. 2 (November 15, 2019): 67–73. http://dx.doi.org/10.25170/djm.v18i2.2221.
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Introduction: One of the biggest health problems faced by community is pulmonary tuberculosis (TB).TB is an respiratory tract infectious disease caused by Mycobacterium Tuberculosis. World Health Organization (WHO) recommends TB treatment with Directly Observed Treatment Short-course (DOTS) strategy, one of which is through the help of treatment supporter (PMO or Pengawas Minum Obat) who supervises the patient during the treatment period.
Methods: This was an analytic descriptive study with cross sectional approach.. Respondents were taken by consecutive sampling, based on medical records at Atma Jaya Hospital. We applied inclusion criteria such as newly diagnosed TB patient with positive sputum smear microscopy results, adult TB patient who has finished 6 month of treatment and patients who have done sputum smear microscopy test after finishing their TB treatment. The exclusion criteria were TB-HIV patients and Milliary TB patients. After fulfilment of those criteria, a total of 81 respondents were selected. Data was analysed by Chi Square test (Fisher Exact test).
Results: Most of patients were 15-50 years old (70,4%) with mean age at 38.49±17.83 years old),male (53.1%), had family as treatment supporter (91.4%) and had successful TB treatment (74.1%). TB patients with treatment supporter had more successful treatment (66.7%) than TB patients with no treatment supporter (7.4%), however there was no significant among the avalibility of treatment supporter and the success of TB treatment (p=0.670).
Conclusion: Despite the insignificant result, this study gives good insight to implementation of TB DOTS strategy in Atma Jaya Hospital. The implementation of this strategy contributes to imbalance number of samples between patient with and without treatment supporter, leading to overestimate results on with TB treatment supporter group.
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Ledingham, David, Shadi El-Wahsh, Cecilia Cappelen-Smith, Suzanne Hodgkinson, Alan McDougall, Michael Maley, and Dennis Cordato. "017 Paradoxical reaction in tuberculous meningitis: a tertiary referral hospital retrospective experience of concomitant immunosuppression therapy." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 6 (May 24, 2018): A8.1—A8. http://dx.doi.org/10.1136/jnnp-2018-anzan.17.
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IntroductionTuberculous meningitis (TBM) accounts for <1% of all tuberculosis (TB) presentations. Paradoxical reactions (PR) in non-HIV patients are a common manifestation of anti-tuberculosis therapy characterised by clinico-radiological deterioration. We report a case series of TBM admissions to our institution, including two cases with corticosteroid-refractory PR who responded to adjuvant cyclosporin.MethodsRetrospective review of 12 HIV-negative patients admitted to Liverpool Hospital, Sydney (2005–2017) with laboratory and/or radiologically confirmed TBM.ResultsMedian age 40 (range 22–81 years), 7 males. Eleven patients were of Asia-Pacific origin. All eleven presented with central nervous system manifestations and 1 had preceding miliary TB. Nine patients had extra-cranial TB involvement, including 8 with past or current pulmonary disease. Cerebrospinal fluid (CSF) TB PCR/culture was positive in 10 patients. One patient had multi-resistant TB. PR of TBM developed in 5 patients despite concomitant corticosteroids in 4. Two cases had refractory PR.Case 1. 22 year old Vietnamese male presented with 6 week history of progressive headache and neck stiffness. CSF demonstrated 61 WCC (75% neutrophils), protein 2.67 g/L (n<0.45), glucose 2.1 mmol/L. Despite concomitant anti-tuberculosis and high-dose corticosteroid treatment, he developed worsening headaches and altered mentation with interval MRI brain increase in size and number of tuberculomas, hydrocephalus, and left thalamic infarction. Cyclosporin was added with gradual improvement and ultimately good outcome.Case 2. 47 year old Filipino male presented with 3 week history of headache and neck stiffness and 3 day history of fever, dysarthria and diplopia. MRI brain showed basal meningitis, hydrocephalus and left putaminal infarction. CSF demonstrated 245 WCC (35% neutrophils), protein 0.68 g/L, glucose 1.8 mmol/L. Despite concomitant anti-tuberculosis and corticosteroid treatment, the patient developed PR-induced worsening hydrocephalus necessitating ventriculo-peritoneal shunting. Cyclosporin was added with gradual PR resolution.ConclusionOur case series highlights the importance of concomitant corticosteroids in TBM and the potential role of cyclosporin in refractory PR.
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Mandal, Amitabha, Mausumi Basu, Palash Das, Sujishnu Mukherjee, Sibasis Das, and Nirmalya Roy. "Magnitude and reasons of initial default among new sputum positive cases of pulmonary tuberculosis under RNTCP in a district of West Bengal, India." South East Asia Journal of Public Health 4, no. 1 (February 2, 2015): 41–47. http://dx.doi.org/10.3329/seajph.v4i1.21839.
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Under the Revised National Tuberculosis Control Programme (RNTCP), Tuberculosis services are provided free of charge in India; all diagnosed TB patients are initiated on treatment within 7 days. Initial default is a potentially serious problem, particularly in cases of smear positive patients because they may continue transmitting the disease. This study was conducted to estimate the proportion of new sputum positive pulmonary TB patients who dropped out before initiating treatment, and their reasons for not registering for treatment. A cross-sectional study was carried out at Darjeeling District from July 2011 to April 2012 among 132 initial defaulters. Initial defaulter rate was 23.5%. A majority of the defaulters were 15-29 years old (59.10%); male (70.45%); from rural areas (80.06%); literate (78.79%); employed (86.36%); married (71.97%); non-smokers (77.27%); and had a mean per capita monthly income of Rs 741.40. Age, literacy, employment, marital status, smoking habits, alcohol consumption and pre treatment counseling were associated more among males than females and the differences were statistically significant. Among busy with other jobs, 76.19 % of patients were from a rural area, 71.43%were below the mean age, 73.81% had below mean per capita income. Among temporary vocational migration, 87.8% of patients were from rural areas, 56.1% were below the mean age, 63.41% had below mean per capita income. Among idle at home, 78.57% patients were from rural areas, 60.71% were below mean age, 75% had below mean per capita income. There is a need to convince the tuberculosis patients for initiating and completing treatment.DOI: http://dx.doi.org/10.3329/seajph.v4i1.21839 South East Asia Journal of Public Health Vol.4(1) 2014: 41-47
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Klevno, N. I., V. A. Аksenova, A. V. Kazakov, and E. B. Kovalevskaya. "Short course chemotherapy in children suffering from drug resistant tuberculosis." Tuberculosis and Lung Diseases 99, no. 2 (March 10, 2021): 34–39. http://dx.doi.org/10.21292/2075-1230-2021-99-2-34-39.
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The objective: to study the effect of short course chemotherapy regimens on treatment outcomes in children with drug resistant tuberculosis.Subjects and methods. In 2017-2019, 31 children at the age from 3 to 17 years old, received short course chemotherapy which lasted for 12-15 months. Children of both genders were enrolled in the study, they all were new pulmonary tuberculosis cases with multiple drug resistance or at risk of MDR, with no history of previous treatment with reserve anti-tuberculosis drugs, and without severe concomitant diseases. Before the treatment was prescribed, all children underwent lung computed tomography additionally to general clinical and laboratory tests.Results. The chemotherapy regimen for each child consisted of 4-6 drugs selected individually with the consideration of resistance pattern of the child or suspected index case. In all cases, the combination of drugs included fluoroquinolones (levofloxacin or moxifloxacin). Amikacin (67.7%), aminosalicylic acid (80.6%) and prothionamide (74.2%) were frequently prescribed. 54.8% of children received pyrazinamide and 48.4% – cycloserine. Given the limited lesions, only 16.1% of children received linezolid and 9.7% of children received bedaquiline. The main chemotherapy course made 13.2 ± 0.5 months (from 12 to 15 months depending on the form of tuberculosis and changes during treatment). The duration of the intensive phase made 4.8 ± 0.3 on the average. 2 (6.5 ± 4.4%) of 31 children developed adverse events requiring the cancellation of the drugs causing them.Conclusion. This study has demonstrated satisfactory tolerability and good efficacy of these short course regimens for treatment of multiple drug resistant tuberculosis. No relapses of tuberculosis were reported.
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Fernando García-Goez, Jose, Juan Diego Velez, Jessica Pino-Escobar, Barbara Lucía Mora, Luis Gabriel Parra-Lara, Joan A. Caylà, and José M. Miró. "1368. Tuberculosis in Older Patients in Cali, Colombia (2011–2016): A Hospital-Based Cohort Study." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S495. http://dx.doi.org/10.1093/ofid/ofz360.1232.
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Abstract Background Tuberculosis (TB) in older adults is a public health concern worldwide. We aim to describe the outcomes of patients over 65 years old with a confirmed TB diagnosis. We furthermore assessed factors related to poor outcomes among this patient population. Methods This retrospective study included patients older than 65 years with a biological specimen positive by smear microscopy, culture, or GeneXpert. Clinical and microbiological data, information about drug-related side effects, adverse reactions, and TB treatment outcomes were reviewed. Patients were subsequently assigned to either the octogenarian group or non-octogenarian group, also the treatment success group or treatment nonsuccess group. Results A total of 108 patients were included. 59% were male, and 26% of patients were 80 years old or older. 81% of the patients presented pulmonary TB. Diagnostic delay greater than 90 days was present in 36% of the cases. There was a statistically significant difference in the rates of diabetes (P = 0.004) and COPD (P = 0.017) between the octogenarian group and non-octogenarian group. One hundred six patients started anti-TB therapy, 34% of cases were lost to follow-up, and 18% died. Patients of 65–79 years of age and those older than 80 years had similar mortality, 19% vs. 18%, respectively. When comparing treatment success (n = 45) and nonsuccess (n = 22) groups, most of the variables were found not to be statistically significant as TB risk factors, except malignancy (P = 0.013). Overall, survival of the patients was 78. 23% at 5 years follow-up; there were no differences between age groups. Conclusion The presence of baseline comorbidities as diabetes, malignancies and COPD, diagnosis delay, adverse events during anti-TB treatment and drug–drug interactions (DDI) makes this age group a different population, hence care models need to be evaluated to improve the indicators of the success of TB programs. Furthermore, the significant losses to follow-up require strict management of these patients and optimal coordination among health centers. Disclosures All authors: No reported disclosures.
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Baronova, O. D., V. A. Aksenova, N. I. Klevno, V. S. Odinets, and O. V. Pilipenko. "Safety and medical cost effectiveness of preventive treatment of children with latent tuberculosis infection." Tuberculosis and Lung Diseases 98, no. 9 (October 26, 2020): 25–31. http://dx.doi.org/10.21292/2075-1230-2020-98-9-25-31.
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The objective: to assess the safety and medical cost effectiveness of different LTBI treatment regimens in children and adolescents.Subjects and methods. 205 children in the age from 6 to 17 years old with latent tuberculosis infection were included in the study: The main (prospective) group included 31 children who were treated with isoniazid and rifapentine (HRpt). The comparison (retrospective) group included 174 pediatric patients: 128 patients received the regimen consisting of isoniazid and pyrazinamide (HZ), 14 patients received isoniazid and rifampicin (HR), and 32 patients received isoniazid and ethambutol (HE).Results. When using the HRpt regimen, the treatment was well tolerated; adverse events (eosinophilia) were documented in 6.5% of children. The medications were taken once a week and it allowed reducing the frequency of treatment interruptions for non-medical reasons. The overall cost per patient was lower with the HRpt regimen than with the other three LTBI treatment regimens.
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Bakti, Reiska Kumala, Ni Made Mertaniasih, Diah Savitri Ernawati, Bagus Soebadi, and Priyo Hadi. "Acid fast bacilli detected in the oral swab sample of a pulmonary tuberculosis patient." Dental Journal (Majalah Kedokteran Gigi) 51, no. 2 (June 30, 2018): 91. http://dx.doi.org/10.20473/j.djmkg.v51.i2.p91-94.
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Background: Tuberculosis (TB) is an infectious disease that persists as a health problem worldwide. Mycobacterium tuberculosis, as an etiological agent, is transmitted from infected to uninfected individuals via airborne droplet nuclei. Oral health care workers or dental practitioners may be at high risk of TB infection because of their close proximity to infected individuals during treatment procedures. Simple and rapid screening of mycobacterium tuberculosis in the oral cavity is necessary in order to prevent transmission of infection. Purpose: To investigate the presence of acid-fast bacilli in the buccal mucosa of pulmonary TB patients. Methods: Nineteen pulmonary TB patients of both sexes, ranging in age from 19 to 74 years old participated in this study. The diagnosis of tuberculosis was performed by clinical symptom assessment and supporting examination, including acid-fast bacilli on sputum examination. Two buccal mucosa swabs taken from pulmonary TB patients were collected for acid fast bacilli direct smear by Ziehl Neelsen staining. Results: With regard to mycobacterium tuberculosis, acid-fast bacilli presented in 10.5% of the oral buccal mucosa swabs of subjects, whereas in the sputum specimens, bacilli were found in 52.6% of subjects. Conclusion: Acid-fast bacilli can be found in the buccal epithelial mucosa of pulmonary tuberculosis patients, although its presence was very limited.
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Cojocaru, Ioana, Livia Luculescu, Daniela Negoescu, and Irina Strâmbu. "Profile of patients admitted in a pulmonology ward and developing Clostridium difficile enterocolitis." Pneumologia 68, no. 1 (June 1, 2019): 31–36. http://dx.doi.org/10.2478/pneum-2019-0010.
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Abstract Clostridium difficile is an anaerobic bacterium than can colonise the lower intestine and cause enterocolitis in susceptible patients. Clostridium difficile infection (CDI) is typically a nosocomial infection, favoured by treatment with antibiotics (especially with broad-spectrum drugs), proton pump inhibitors, but also comorbidities, old age and prolonged hospitalisation. Based on the observation that in the past years, the frequency of nosocomial CDI has increased in the Institute of Pulmonology, Bucharest, this retrospective observational study aimed to analyse the characteristics of admitted patients who develop CDI, in order to identify possible particular features and risk factors. Accordingly, medical files from 80 patients admitted from January 2015 to August 2017 were analysed for demographic data, respiratory diagnosis, comorbidities, blood tests, treatments prescribed, time of CDI onset, evolution and outcome. The number of patients studied was 29 in 2015, 16 in 2016 and 35 in 2017, with slight male predominance. Totally, 54 patients (67.5%) had tuberculosis (pulmonary or pleural), 12 had lung cancer, five had respiratory infections, two had chronic obstructive pulmonary disease and seven had other diseases. All patients but nine were receiving antibiotics: tuberculosis drugs, cephalosporins, fluoroquinolones and beta-lactams. About half of the patients received proton pump inhibitors. Most patients had several comorbidities. Mean time since admittance to onset of diarrhoea was 20 days. CDI was treated with metronidazole or vancomycin. The evolution was favourable in 90% of patients, but eight patients (10%) died This study highlights a high frequency of CDI in patients treated for tuberculosis. Due to insufficient data, no epidemiological consideration could be made. Further studies are needed to assess the relationship among tuberculosis, tuberculosis treatment and CDI.
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Sarafoleanu, Codrut, Elena Patrascu, George Bacarna, and Gabriela Violeta Melinte. "Pulmonary tuberculosis with rhinosinusal and otic manifestations - diagnostic challenge." Romanian Journal of Rhinology 9, no. 35 (September 1, 2019): 155–59. http://dx.doi.org/10.2478/rjr-2019-0019.
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Abstract BACKGROUND. Unfortunately, tuberculosis is still being diagnosed among patients, independent of their age, gender, provenance or social category. The etiologic agent of tuberculosis is Mycobacterium tuberculosis, which is known to have a period of latency between the initial infection and the clinical manifestation. The most common localization is pulmonary, but it can affect, secondarily, other organs, especially in the ENT regions, mimicking other systemic diseases. MATERIAL AND METHODS. We are presenting a case of a 51-year-old female patient, who was referred to our ENT Clinic with the suspicion of Behcet’s disease with rhinosinusal manifestations. She had a pulmonary assessment in another hospital, as she was known with left lung bronchiectasis, but the sputum samples were negative. The clinical otorhinolaryngologic examination together with the rheumato-logical assessment and the result of the nasal mucosa biopsy were suggestive for Behcet’s disease and the patient received 6 weeks of Prednisolone. The specific immunologic tests (cANCA, pANCA, HLA B51) were negative. The patient returned to our clinic after 2 months, accusing symptomatology reacutization with right otorrhea and bilateral hearing loss aggravation. Nasal and rhinopharyngeal mucosa biopsies were repeated and the anatomopathological result was specific for tuberculosis. RESULTS. She was referred to the Pneumology Service where she received the diagnosis of pulmonary tuberculosis with rhinosinusal and otic manifestations. Currently, the patient is under tuberculostatic treatment. CONCLUSION. Extrapulmonary tuberculosis symptoms might be confused with other systemic diseases with rhinosinusal manifestations. Thorough examination and multidisciplinary approach are mandatory in order to establish a correct diagnosis followed by an appropriate treatment.
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Song, Alice Tung Wan, Denise Schout, Hillegonda Maria Dutilh Novaes, and Moisés Goldbaum. "Clinical and epidemiological features of AIDS/tuberculosis comorbidity." Revista do Hospital das Clínicas 58, no. 4 (2003): 207–14. http://dx.doi.org/10.1590/s0041-87812003000400004.
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Considering the relevance of AIDS/tuberculosis comorbidity worldwide, especially in Brazil, this study was developed to describe the clinical and epidemiological features of the comorbid cases identified from 1989 to 1997 by the epidemiology service of the Hospital das Clínicas of the Universidade de São Paulo. METHODS: Databases containing information on all identified AIDS/tuberculosis cases cared for at the hospital were used to gather information on comorbid cases. RESULTS: During the period, 559 patients were identified as presenting with AIDS/tuberculosis comorbidity. Risk behavior for AIDS was primarily heterosexual contact (38.9%), followed by intravenous drug use (29.3%) and homosexual/bisexual contact (23.2%). Regarding clinical features, there were higher rates of extrapulmonary tuberculosis when compared to tuberculosis without comorbidity. There was an increase in reporting of AIDS by ambulatory units during the period. Epidemiologically, there was a decrease in the male/female ratio, a predominance in the 20 to 39 year-old age group, and a majority of individuals who had less than 8 years of schooling and had low professional qualifications. CONCLUSIONS: High rates of AIDS/tuberculosis cases at our hospital indicate the need for better attention towards early detection of tuberculosis, especially in its extrapulmonary form. Since the population that attends this hospital tends to be of a lower socioeconomic status, better management of AIDS and tuberculosis is required to increase the rates of treatment adherence and thus lower the social costs.
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Reis, Dener Carlos dos, Thiara Amanda Corrêa de Almeida, Humberto Ferreira de Oliveira Quites, and Mariana Mattar Sampaio. "Epidemiological profile of tuberculosis in the city of Belo Horizonte (MG), from 2002 to 2008." Revista Brasileira de Epidemiologia 16, no. 3 (September 2013): 592–602. http://dx.doi.org/10.1590/s1415-790x2013000300004.
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Objective: To assess the epidemiological profile of tuberculosis in Belo Horizonte, Minas Gerais State, from 2002 to 2008. Methods: For descriptive epidemiological study, the data were obtained from the municipal National Health Surveillance System, after obtaining approval from the Research Ethics Committee at the City Health Department. Incidence coefficient, average rates and stratified data analysis with significance level of p ≤ 0.05 were calculated. Results: About 7.590 new tuberculosis cases were reported between 2002 and 2008. There was a slight reduction in the number of cases throughout the historical trend, with an average annual incidence rate of 46/100,000 inhabitants. The study also showed a male gender ratio of 1.84:1, a higher incidence coefficient in the age group between 40 and 59 years old (73/100,000) and a higher incidence of tuberculosis among people who only had primary education level. Pulmonary tuberculosis was the most prevalent form in every year of the study (p < 0,001). Among the cases reported with associated diseases, alcoholism was registered in 47.9% and AIDS in 34.5%. Between 2002 and 2008, there was an increasing trend of cases treated under Directly Observed Treatment, accounting for 29.5% in total. Cure percentage rate was below the expected result (67.3%) and non-adherence to treatment showed a high total percentage (17.9%). Conclusion: The results indicated that tuberculosis control actions need to be intensified with investments on professional training, systemic audits of the information system, improved integration between AIDS/tuberculosis programs and raising awareness of the disease with the goal of mobilizing the society.
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Pinsai, Subencha. "1342. Impact of HIV Infection on Treatment Outcome of New Tuberculosis Patients Attending Tuberculosis and Antiretroviral Treatment Services in the Community-Based Hospital, Thailand: A Retrospective Cohort Study." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S485—S486. http://dx.doi.org/10.1093/ofid/ofz360.1206.
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Abstract Background Tuberculosis (TB) and HIV are one of the significant public health problems in Thailand, and an estimated 15,000 individuals have a dual infection. Both HIV and TB each disease speeds up the progression of each other. TB is the leading cause of death in HIV-infected individuals, and HIV coinfected TB patients have disease-specific, and treatment affected their treatment outcomes. There is insufficient evidence on issues of TB and HIV co-infection patients received treatment. This study aimed to assess the impact of HIV status on treatment outcome of TB patients. Methods We conducted a retrospective cohort study among TB patients who registered to service at Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand from October 1, 2017 to October 31, 2018. All patients’ demographic data, diagnosis, and treatment were retrieved. Clinical characteristics, treatment outcome, and factors associated with treatment outcome were analyzed. Results There were 49 (10.65%) HIV among 460 TB patients with a median (IQR) age of 44 (32–61) years old and 65.2% were males. Disseminated TB and extrapulmonary TB were higher in HIV coinfected group (P < 0.001). All pulmonary TB patients’ lower lobe involvement was higher in HIV coinfected group (62.50 vs. 36.00, P = 0.001). In HIV coinfected group median CD4 was 134 cell/mm3 (IQR 19–294), 66.67% were diagnosed HIV infection after TB diagnosis, the median time from TB diagnosed to antiretroviral was 29 days (IQR 21–48). The overall treatment success rate was 93.04%; the treatment success rate was similar in HIV coinfected TB patients (89.80%) and non- HIV-infected patients (93.43%) (P = 0.66).Adverse drug reactions were higher in HIV coinfected group (44.89% vs 12.41%) (P < 0.001). By multiple stepwise logistic regression, factors associated with anti-TB drug adverse reactions were having HIV infection (OR 7.99; 95% CI 3.73–17.10, P < 0.001), Age >60 years (OR 2.64; 95% CI 1.43–4.87, P = 0.002) and female sex (OR 1.97; 95% CI 1.11–3.52, P = 0.02). Conclusion There is a high TB treatment success rate among patients who have treated for TB, but adverse drug events in HIV co-infected TB patients is higher than that observed in non-HIV-infected patients. Disclosures All authors: No reported disclosures.
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Opanasenko, M. S., O. V. Tereshkovich, S. M. Shalahai, L. I. Levanda, and T. V. Kirillova. "The results of the Center for Pediatric Tuberculosis of the State Institution «National Institute of Tuberculosis and Pulmonology named after F.G. Yanovsky NAMS of Ukraine»." Paediatric Surgery. Ukraine, no. 3(68) (September 29, 2020): 21–27. http://dx.doi.org/10.15574/ps.2020.68.21.
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Pediatric surgeons often to have different indications for the diagnosis and treatment of pathology of the thoracic cavity. Often, only invasive techniques, such as a biopsy, can help diagnose and determine further treatment. One of the reasons for performing thoracic operations on children in Ukraine is tuberculosis. Object. Evaluate our own results of surgical treatment of children and adolescents with pathology of the thoracic cavity. Materials and methods. On January 1, 2019, a pediatric phthisiosurgery center was established. The results of surgical treatment of 34 children for the period from 2019 to 2020 are analyzed. Research results and their discussion. Among the operated patients, males predominated – 18 (52.9%), the average age of patients was 12.9 years (from 4 to 17 years). The majority of patients – 20 (58.8%) were operated on for pulmonary tuberculosis, pleura, intrathoracic lymph nodes. VATS were carried out – 16 (34.0%); 1 pulmonectomy with mediastinal lymph dissection in a 10-year-old girl who was diagnosed with a myofibroblastic tumor of the upper lobe of the left lung with spread to the root of the lung; 1 (2.1%) single-port VATS chest wall biopsy of a 13-year-old boy who was diagnosed with malignant fibrous histiocytoma as a result of pathological morphology. There was no postoperative mortality. Postoperative complications developed in 3 (8.8 %) patients. Conclusions. Surgical treatment makes it possible to increase the effectiveness of treatment of children with pulmonary TB in the epidemiological situation in Ukraine. The VATS lung biopsy is an effective method of diagnosis that can significantly speed up the time of the main diagnosis. If resection surgical treatment of lung pathology in children is necessary, anatomical resections should be preferred. VATS minimally invasive lung resections have advantages over traditional surgery using thoracotomy, due to less trauma and shortening the duration of postoperative inpatient treatment. Implantation of intravenous port systems for long-term infusions is an important element in the treatment of resistant forms of TB, which can improve adherence to treatment and reduce physical and psychological discomfort of the child, and prepare him for further surgery if necessary. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: Pediatric thoracic surgery, VATS, surgical treatment of children, pediatric phthisiosurgery.
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Lima, Maria Luiza Lopes Timóteo de, Fábio Lessa, Ana Maria Aguiar-Santos, and Zulma Medeiros. "Hearing impairment in patients with tuberculosis from Northeast Brazil." Revista do Instituto de Medicina Tropical de São Paulo 48, no. 2 (April 2006): 99–102. http://dx.doi.org/10.1590/s0036-46652006000200008.
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The aim of this paper is to describe the auditory profile of subjects who were given streptomycin treatment for tuberculosis in the years 2000 and 2001, in Recife, Northeast Brazil. The Injury Notification Database at the Municipal Department of Health was consulted and 78 individuals who had been on streptomycin during the period under study were selected. Forty-two individuals were excluded, of whom five were over 59 years of age and two were under 18 years. Nineteen turned out to be deceased, 13 could not be found, two were serving prison terms and one refused to participate. As a result, only 36 subjects participated in the study. These 36 individuals were interviewed and underwent meatoscopy and audiometry. The mean age of the group under study was 38.8 years old and males predominated (79.4%). Twenty-seven patients (75%) showed hearing impairment, the bilateral sensorineural type (63.9%) being the most frequent, mainly affecting the high frequencies over 4000 Hz. In the light of findings showing a high percentage of hearing impairment complaints among users of streptomycin, this issue seems to warrant an in-depth investigation, as does the implementation of an auditory follow-up routine for patients undergoing such chemotherapy for tuberculosis.
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Mortel, Maika Kamille, Ana Patricia Alcasabas, and Anna Lisa Ong-Lim. "#95: Clinical Profile and Outcome of Pediatric Acute Lymphoblastic Leukemia Patients with Tuberculosis at the Philippine General Hospital." Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (March 1, 2021): S17. http://dx.doi.org/10.1093/jpids/piaa170.054.
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Abstract Background The Philippines remains one of the countries on the WHO list of high-burden countries for tuberculosis (TB), and malignancy has long been recognized as a risk factor for this disease. This report describes the clinical profile and outcomes of pediatric patients with acute lymphoblastic leukemia (ALL) diagnosed with tuberculosis. Methods Medical records of pediatric patients with ALL consulting at the University of the Philippines – Philippines General Hospital diagnosed from January 2015 to December 2017 (excluding those with concomitant HIV infection) were reviewed. Those diagnosed with tuberculosis infection were further analyzed, obtaining demographic data, results of diagnostics, and treatment. Results Out of 102 patients, 5 were found to have tuberculosis, all of them being male, with an average age of 7.2 years old. All cases were pulmonary, with one patient having multi-drug-resistant TB. PPD was positive in 4 cases, with indurations measuring >10mm, while chest radiographs showed nonspecific findings for 3 patients. Of 3 patients who underwent sputum AFB testing, one had a positive result. While 1 patient was diagnosed with TB and ALL concurrently, majority of patients were diagnosed after entering remission. Three patients completed 6 months of TB treatment, while 1 patient is still on medication for multi-drug-resistant tuberculosis. One patient abandoned treatment. Conclusion In this group of ALL patients, malnutrition and corticosteroid use were not found to be independent risk factors for TB. As TB disease may be due to reactivation of latent TB infection (LTBI) during immunosuppression, screening for LTBI may be a worthwhile strategy to decrease morbidity. Transmission precautions are emphasized to reduce acquired TB infection in immunocompromised populations.
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Hong, Hyejeong, David W. Dowdy, Kelly E. Dooley, Howard W. Francis, Chakra Budhathoki, Hae-Ra Han, and Jason E. Farley. "Prevalence of Pre-Existing Hearing Loss Among Patients With Drug-Resistant Tuberculosis in South Africa." American Journal of Audiology 29, no. 2 (June 8, 2020): 199–205. http://dx.doi.org/10.1044/2020_aja-19-00103.
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Purpose Hearing loss, resulting from aminoglycoside ototoxicity, is common among patients with drug-resistant tuberculosis (DR-TB). Those with pre-existing hearing loss are at particular risk of clinically important hearing loss with aminoglycoside-containing treatment than those with normal hearing at baseline. This study aimed to identify factors associated with pre-existing hearing loss among patients being treated for DR-TB in South Africa. Method Cross-sectional analysis nested within a cluster-randomized trial data across 10 South African TB hospitals. Patients ≥ 13 years old received clinical and audiological evaluations before DR-TB treatment initiation. Results Of 936 patients, average age was 35 years. One hundred forty-two (15%) reported pre-existing auditory symptoms. Of 482 patients tested by audiometry, 290 (60%) had pre-existing hearing loss. The prevalence of pre-existing hearing loss was highest among patients ≥ 50 years (adjusted prevalence ratio [aPrR] for symptoms 5.53, 95% confidence interval (CI) [3.63, 8.42]; aPrR for audiometric hearing loss 1.63, 95% CI [1.31, 2.03] compared to age 13–18 years) and among those with a prior history of second-line TB treatment (aPrR for symptoms 1.73, 95% CI [1.66, 1.80]; PrR for audiometric hearing loss 1.33, 95% CI [1.03, 1.73]). Having HIV with cluster of differentiation 4 cell count < 200 cells/mm 3 and malnutrition were risk factors but did not reach statistical significance in adjusted analyses. Conclusion Pre-existing hearing loss is common among patients presenting for DR-TB treatment in South Africa, and those older than the age of 50 years or who had prior second-line TB treatment history were at highest risk.
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Azovtseva, O. V., T. S. Trofimova, G. S. Arkhipov, S. V. Ogurtsova, A. M. Panteleev, and N. A. Belyakov. "LETAL OUTCOMES IN PATIENTS WITH HIV INFECTION, PARALLELS WITH ADEQUACY OF DIAGNOSTICS, DISPENSER AND TREATMENT." HIV Infection and Immunosuppressive Disorders 10, no. 3 (October 2, 2018): 90–101. http://dx.doi.org/10.22328/2077-9828-2018-10-3-90-101.
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The goal is to consider the lethality as an indicator of the adequacy and success of timely detection, clinical examination and treatment of patients with HIV infection. Materials and methods. A retrospective analysis of 913 deaths of HIV-infected patients in the Novgorod Region was carried out for the period from 2001 to 2017. The study included patients with previously known HIV status and patients with newly diagnosed HIV infection. Age, time (from the time of detection of HIV infection to death), clinical (causes of deaths) and other characteristics were taken into account. The conclusion. Every year, the number of deaths of HIV-infected patients increases, while the number of deaths diagnosed with AIDS is increasing yearly. The structure of deaths is dominated by cases caused by severe immunosuppression, which is a characteristic feature of this stage of the epidemic. The most likely cause of increased mortality is the late onset of treatment, low coverage of therapy and a large number of late-identified patients. The age structure of the deceased is dominated by persons 30–39 years old. The main cause of death is tuberculosis. The increase in deaths from tuberculosis depends on the number of patients with unstable social status. Other common causes of death are bacterial infections (pneumonia, sepsis, etc.), malignant neoplasms, toxoplasmosis, pneumocystis pneumonia. A similar structure of deaths is associated with late diagnosis and atypical course (rapid progression) of tuberculosis. Among the causes of death not related to HIV, a significant proportion is occupied by viral hepatitis in the cirrhotic stage, cardiovascular diseases, malignant neoplasms, drug overdoses, alcohol poisoning. The annual increase in lethal outcomes in the region is due to inadequate coverage and late onset of ARVT, a low percentage of prevention of opportunistic diseases at a critically low level of CD4 cells, weak adherence to medical examination and treatment. To increase the life expectancy of HIV-infected people, it is necessary to improve and expand programs for the prevention and treatment of HIV infection.
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Kabir, Shaila, M. Tanveer Hossain Parash, Nor Amalina Emran, A. B. M. Tofazzal Hossain, and Sadia Choudhury Shimmi. "Diagnostic challenges and Gene-Xpert utility in detecting Mycobacterium tuberculosis among suspected cases of Pulmonary tuberculosis." PLOS ONE 16, no. 5 (May 20, 2021): e0251858. http://dx.doi.org/10.1371/journal.pone.0251858.
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The incidence of pulmonary tuberculosis (PTB) can be reduced by preventing transmission with rapid and precise case detection and early treatment. The Gene-Xpert MTB/RIF assay is a useful tool for detecting Mycobacterium tuberculosis (MTB) with rifampicin resistance within approximately two hours by using a nucleic acid amplification technique. This study was designed to reduce the underdiagnosis of smear-negative pulmonary TB and to assess the clinical and radiological characteristics of PTB patients. This cross-sectional study included 235 participants who went to the Luyang primary health care clinic from September 2016 to June 2017. The demographic data were analyzed to investigate the association of patient gender, age group, and ethnicity by chi-square test. To assess the efficacy of the diagnostic test, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. The area under the curve for sputum for both AFB and gene-Xpert was analyzed to compare their accuracy in diagnosing TB. In this study, TB was more common in males than in females. The majority (50.71%) of the cases belonged to the 25–44-year-old age group and the Bajau ethnicity (57.74%). Out of 50 pulmonary TB cases (smear-positive with AFB staining), 49 samples were positive according to the Gene-Xpert MTB/RIF assay and was confirmed by MTB culture. However, out of 185 smear-negative presumptive cases, 21 cases were positive by Gene-Xpert MTB/RIF assay in that a sample showed drug resistance, and these results were confirmed by MTB culture, showing resistance to isoniazid. In comparison to sputum for AFB, Gene-Xpert showed more sensitivity and specificity with almost complete accuracy. The additional 21 PTB cases detection from the presumptive cases by GeneXpert had significant impact compared to initial observation by the routine tests which overcame the diagnostic challenges and ambiguities.
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Qin, Yinyin. "The clinical analysis of pulmonary lymphoepithelioma-like carcinoma with epithelioid granuloma: Fourteen cases and literature review." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e20545-e20545. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e20545.
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e20545 Background: Pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare subtype of non-small cell lung cancer associated with Epstein-bar virus (EBV) infection. Even less reported were those with Epithelioid granuloma (EG) and were frequently misdiagnosed. Current study aimed at investigating the clinical presentation, pathological characteristics and treatments of PLELC complicated with EG to improve our understanding of this disease. Methods: Data was collected from January 2013 to December 2017. A total of 105 patients were diagnosed as PLELC, in which 14 patients were with EG. Their clinical features, pathological characteristics and treatment were analyzed. Results: The 14 patients with EG (13.3%) in our group were followed-up 15 months (10-31 months).The median age was 48.5 year-old (38-67 year-old) and 85.7% were under the age of 60, meanwhile females had a slightly higher proportion than males (1.8:1). Most patients were at early stage (71.4%) with nonspecific manifestations such as cough, expectoration and lack of rich-lewis phenomenon. EG were often located in tumor or beside the tumor (71.4%), others were located in lymph node. It was all negative in specific stain of pathology and all positive in situ hybridization of EBV-encoded RNA (EBER). In our study, two patients received palliative chemotherapy with the duration of progression-free survival in 8 and 10 months, respectively. Twelve patients underwent surgical resection including ten with adjuvant or neo-adjuvant chemotherapy. Three patients had disease relapsed in 8, 13 and 25 months after surgery, respectively. None of them had tuberculosis occurring, progression or relapse, even if anti-tuberculosis therapy were not taken. Conclusions: PLELC complicated with EG, a rare phenomenon, was lack of rich-lewis phenomenon and specific clinical characteristic compared with those without EG. The formation of EG may be caused by immunological hypersensitivity to tumor cell or EBV infection instead of tuberculosis. It was important for us to make an exact pathological diagnosis, and attention should be paid to obtain samples by biopsy and make differential diagnosis. PLELC complicated with EG could receive multimodality therapy such as chemotherapy and surgery. However, anti-tuberculosis therapy was not necessary.
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Seid, Mohammed Assen, Mohammed Biset Ayalew, Esileman Abdela Muche, Eyob Alemayehu Gebreyohannes, and Tadesse Melaku Abegaz. "Drug-susceptible tuberculosis treatment success and associated factors in Ethiopia from 2005 to 2017: a systematic review and meta-analysis." BMJ Open 8, no. 9 (September 2018): e022111. http://dx.doi.org/10.1136/bmjopen-2018-022111.
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ObjectivesThe main aim of this study was to assess the overall tuberculosis (TB) treatment success in Ethiopia and to identify potential factors for poor TB treatment outcome.DesignA systematic review and meta-analysis of published literature was conducted. Original studies were identified through a computerised systematic search using PubMed, Google Scholar and Science Direct databases. Heterogeneity across studies was assessed using Cochran’s Q test and I2statistic. Pooled estimates of treatment success were computed using the random-effects model with 95% CI using Stata V.14 software.ResultsA total of 230 articles were identified in the systematic search. Of these 34 observational studies were eligible for systematic review and meta-analysis. It was found that 117 750 patients reported treatment outcomes. Treatment outcomes were assessed by World Health Organization (WHO) standard definitions of TB treatment outcome. The overall pooled TB treatment success rate in Ethiopia was 86% (with 95% CI 83%_88%). TB treatment success rate for each region showed that, Addis Ababa (93%), Oromia (84%), Amhara (86%), Southern Nations (83%), Tigray (85%) and Afar (86%). Mainly old age, HIV co-infection, retreatment cases and rural residence were the most frequently identified factors associated with poor TB treatment outcome.ConclusionThe result of this study revealed that the overall TB treatment success rate in Ethiopia was below the threshold suggested by WHO (90%). There was also a discrepancy in TB treatment success rate among different regions of Ethiopia. In addition to these, HIV co-infection, older age, retreatment cases and rural residence were associated with poor treatment outcome. In order to further improve the treatment success rate, it is strategic to give special consideration for regions which had low TB treatment success and patients with TB with HIV co-infection, older age, rural residence and retreatment cases.
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Sweeney, Eileen, Darren Dahly, Nahed Seddiq, Mary Horgan, Dan Corcoran, and Corinna Sadlier. "761. Age-Related Incidence of TB Infection Supporting Efficacy of BCG Vaccination." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S273—S274. http://dx.doi.org/10.1093/ofid/ofy210.768.
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Abstract Background Mycobacterium tuberculosis (MTB) is a major, and potentially preventable, cause of morbidity and mortality worldwide. Bacillus Calmette-Guerin (BCG) remains the only licensed vaccine for TB, and while efficacy has been demonstrated in some populations, many uncertainties remain. Three BCG vaccination policies were implemented across bordering geographical regions in the South West of Ireland from 1972; neonatal vaccination (vaccinated region-a), vaccination of children aged 10–12 years (vaccinated region-b) and no vaccination (unvaccinated region-c). The aim of this study was to investigate the impact of BCG vaccination on incidence of MTB during the study period. Methods Surveillance data were used to identify all M. tuberculosis complex (MTC) isolates from 2003 to 2016. Residential addresses for each case were geocoded using the Google Maps API. Case locations were spatially linked to 2011 census population data and to Local Health Offices (LHO) BCG coverage data for study regions a–c. The 13-year incidence of TB was calculated assuming a steady-state population. Using SatScan (v9.4.4), spatial clusters were identified at the small area level with the spatial scan statistic based on the discrete Poisson probability distribution. Results Of 638 MTC infections identified (621 MTB, 16 M. bovis, 1 M. africanum), 510 occurred in study regions a–c (median age 42 years (4 months–94 years), 65% male and 66% Irish born). The incidence of MTB was higher in the unvaccinated population, region-c 132/100,000 (95% CI 116–150) vs. vaccinated region-a 56/100,000 (95% CI 45–69) and region-b 44/100,000 (95% CI 29–63). A single high-risk cluster of 138 cases within a population of 46,000 was identified in unvaccinated region-c (relative risk 4.94 (95% CI 4–6). The year-on-year incidence rates in the 20- to 35-year-old age range suggested a decreasing risk consistent with a beneficial impact of vaccination policies. Conclusion Prevention and treatment of TB remains a significant challenge worldwide. Our study demonstrates significant differences in incidence of MTC infection in demographically similar populations based on BCG immunization policy and thus further supports efficacy of BCG for prevention of tuberculosis infection. Disclosures All authors: No reported disclosures.
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Serra, Joao Tiago, Raquel Silva, Fernando Aldomiro, and Fernanda Paixao Duarte. "Bone Marrow Langerhans Cell Histiocytosis in Association with Kasabach-Merritt Syndrome: The Difficulty of a Differential Diagnosis." Case Reports in Oncology 13, no. 1 (April 14, 2020): 408–13. http://dx.doi.org/10.1159/000506539.
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Langerhans cell histiocytosis is a rare haematological disorder with variable clinical findings and a high mortality rate. On the other hand, Kasabach-Merritt syndrome is of rare onset at adult age, requiring the simultaneous presentation of vascular lesion, thrombocytopenia, and consumptive coagulopathy. We present the first reported case of both diseases in a single patient and highlight the difficulties of diagnostic. A 69-year-old woman with immune thrombocytopenic purpura underwent surgery for the removal of giant skin haemangiomas. During post-operative care, intravascular disseminated coagulopathy developed. After weeks of corticosteroids and immunosuppressive therapy with no clinical improvement, pulmonary tuberculosis was diagnosed and appropriate treatment initiated. Despite all the efforts, the patient’s clinical condition kept worsening and she eventually died. An autopsy revealed bone marrow Langerhans cell histiocytosis. In this case, the patient’s autoimmune background together with tuberculosis and intravascular disseminated coagulopathy masked the presentation and made the diagnosis of a rapidly progressive fatal disease very difficult.
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Guich, Abdelhafid, Fatimazahra Haddani, El Mehdi Boudhar, Soumia Oulahrir, Tarik Youssoufi, Redouane Abouqal, Lahcen Achemlal, et al. "MALE RHEUMATOID ARTHRITIS IN ALL MOROCCAN RA UNDERGOING BIOTHERAPY: PREVALENCE, CHARACTERISTICS, AND RESPONSE TO BIOLOGICAL TREATMENTS (NATIONAL REGISTRY)." International Journal of Advanced Research 9, no. 5 (May 31, 2021): 852–59. http://dx.doi.org/10.21474/ijar01/12913.
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Introduction:This study aims at reporting the RA male frequency while undergoing biotherapy and describing the epidemiological characteristics (clinical, biological and radiological) in relation to female RA. It also evaluates its impact on the response to biological treatments. Materials and methods: There are 224 patients followed for rheumatoid arthritis, responding to ACR/EULAR 2010 criteria during their biotherapy. They were included in the national RBSMR registry. The patients were divided into two groups and were compared at the basis of their gender in terms of the socio-demographic, clinical, biological, radiological parameters, and response to the treatement. Results: The average age of the patients under study is 51.94 ans±11.36 years old [20-80]. The presence of male rheumatoid arthritis under biotherapy is 12.4%. The mean age of RA male is 55.96+9 years old. The estimated duration of progression of male RA is 542 weeks with an average diagnostic deadline of 562.61 weeks. As a description of the case study, 28,6% of men are diagnosed with cormobidities (mainly tuberculosis 21.4%) while 10,7% of men are smokers. There is an average sedimentation rate (1st hour) at 52.6mm. Rheumatoid serology is found to be positive in 96.4% of cases. Radiological abnormalities are observed in 90.5% of the cases. Male rheumatoid arthritis is related to a shorter duration of progression (542 versus 768 weeks in females, p=0.01), liberal profession (p=0.00), study level (p=0.003), duration between diagnosis and the starting of biotherapy (p=0.021), EVA pain patient and physician (p=0.003, p=0.01) Tobacco (p=0.006), and pulmonary tuberculosis (p=0.029). On the other hand, it was not associated with the following parameters: age, duration of diagnosis, disease intensity, rheumatoid serology, structural damage nor with the DAS 28vs response during one year. Conclusion: The male RA rate in RBSMR study is 12.4% in that there is no significant difference between the sexes in clinical presentation, disease activity, disease severity, rheumatoid serology and response to the biotherapy. However, male RA was related to smoking, liberal profession, and history or occurrence of pulmonary tuberculosis.
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Loutet, Miranda G., Matthew Burman, Nivenka Jayasekera, Duncan Trathen, Susan Dart, Heinke Kunst, and Dominik Zenner. "National roll-out of latent tuberculosis testing and treatment for new migrants in England: a retrospective evaluation in a high-incidence area." European Respiratory Journal 51, no. 1 (January 2018): 1701226. http://dx.doi.org/10.1183/13993003.01226-2017.
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Latent tuberculosis infection (LTBI) screening is an important intervention for tuberculosis (TB) elimination in low-incidence countries and is, therefore, a key component of England's TB control strategy. This study describes outcomes from a LTBI screening programme in a high-incidence area to inform national LTBI screening in England and other low-incidence countries.We conducted a retrospective cohort study of LTBI screening among eligible migrants (from high-incidence countries and entered the UK within the last 5 years), who were identified at primary-care clinics in Newham, London between August 2014 and August 2015. Multivariable logistic regression was used to identify factors associated with LTBI testing uptake, interferon-γ release assay (IGRA) positivity and treatment uptake.40% of individuals offered LTBI screening received an IGRA test. The majority of individuals tested were 16–35 years old, male and born in India, Bangladesh or Pakistan. Country of birth, smoking status and co-morbidities were associated with LTBI testing uptake. IGRA positivity was 32% among those tested and was significantly associated with country of birth, age, sex and co-morbidities.This study identifies factors associated with screening uptake, IGRA positivity and treatment uptake, and improves understanding of groups that should be supported to increase acceptability of LTBI testing and treatment in the community.
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Boushab, Boushab Mohamed, Noukhoum Kone, and Leonardo K. Basco. "Contribution of Computed Tomography Scan to the Diagnosis of Spinal Tuberculosis in 14 Cases in Assaba, Mauritania." Radiology Research and Practice 2019 (May 2, 2019): 1–6. http://dx.doi.org/10.1155/2019/7298301.
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Background. The incidence of tuberculosis has increased in recent years in both developed and developing countries. Objective. This retrospective study aimed to review all cases of spinal tuberculosis diagnosed at the Department of Internal Medicine and Infectious Diseases in Kiffa Regional Hospital and assess the role of computed tomography (CT) scan in establishing definite diagnosis. Patients and Methods. Data were collected from clinical records of patients admitted to the hospital for rachialgia between August 2016 and July 2018. Results. Fourteen (12.2%) adults with spinal tuberculosis were found among 115 patients with all forms of tuberculosis during the study period. The mean (± standard deviation) age of our patients was 47.5 ± 22.0 years old with male:female (8/6) sex ratio of 1.3. The mean duration of evolution of the disease was 15 months. The presenting signs and symptoms included rachialgia in most patients (93%), associated with segmental spinal stiffness (50%) and/or neurological complications (50%). Diagnosis was established on the basis of clinical history, clinical examination, standard vertebral column radiography, and CT scan. Vertebral imaging showed a clear predominance of lumbar lesions (57%), followed by dorsal (36%) and cervical (7%) involvement. The evolution under treatment was favorable, with the exception of two cases of medullary compression. Conclusion. Spinal tuberculosis is the most common form of osteoarticular tuberculosis. It affects predominantly lumbar and dorsal vertebrae. In the absence of histological confirmation, the presence of back pain associated with major radiological signs of spondylosis disc disease seems to justify the use of CT scan to confirm the diagnosis of this pathology.
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Aziz, Sajid, Shazia Jehan, and Muhammad Ateeq. "NON APPENDICULAR PERFORATION PERITONITIS." Professional Medical Journal 21, no. 04 (December 9, 2018): 613–20. http://dx.doi.org/10.29309/tpmj/2014.21.04.2295.
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Objectives: To evaluate the spectrum of non-appendicular perforation peritonitisand their management outcome in a peripheral teaching hospitals. Study design: Retrospectivedescriptive, Interventional. Setting: Surgical Department Aziz Bhatti Shaheed (Teaching)Hospital Nawaz Sharif Medical College University of Gujrat& Surgical Department Islam MedicalCollege Sialkot. Study period: February 2011 to June 2013. Results: All the patients with clinicaldiagnosis of Acute Peritonitis were included, however patients with peritonitis secondary toperforated appendix and traumatic GIT perforations were excluded from study when foundpreoperatively. Total 100 patients with acute peritonitis were operated. 79 patients were male and21 were female. Mean age was 39.9 years, youngest patient was a 12 year old boy whereas oldestwas 73 year old. Perforated duodenal ulcer was the commonest cause of peritonitis seen in 42cases followed by intestinal tuberculosis 18%. Enteric gut perforation was seen in 17% cases.Mortality was 9% and sepsis and multi organ failure was the main cause of death. Conclusions:Management of perforation peritonitis is a complex and demanding. We can avoid thiscomplication by primary prevention, adequate& timely treatment of diseases like Peptic ulcer,tuberculosis and Typhoid fever which are the commonest cause of GUT perforations in Easternregion/ Tropical countries. Early diagnosis of acute peritonitis, adequate efficient resuscitationand early exploration preferable within six hours is the key to reduce both morbidity and mortalitythese patients
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Poboży, Tomasz, Wojciech Konarski, and Martyna Hordowicz. "Hip Fusion Takedown with Subsequent Hip and Knee Arthroplasty. Case Study." Ortopedia Traumatologia Rehabilitacja 22, no. 6 (December 31, 2020): 477–86. http://dx.doi.org/10.5604/01.3001.0014.6059.
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There is no uniform standard of treatment for patients with hip fusion and accompanying symptomatic osteoarthritis of the ipsilateral knee. Fusion takedown is associated with an increased risk of complications, and often the results are not satisfactory for patients. Therefore, each case should be considered individually. We present a case report regarding a 70-year-old patient with hip fusion as a result of tuberculosis at a young age who underwent hip fusion takedown with total hip arthroplasty followed by total knee arthroplasty as a second step. The 70-year-old patient with end-stage renal failure and hip fusion as a complication of tuberculosis in adolescence complained of increasing pain in the left knee. After taking into account his comorbidities and discussing with the patient possible treatment options and their limitations, he was qualified for 2-step surgery involving hip replacement and total knee replacement spaced 5 months apart. At the last follow-up visit the patient did not report any pain, with a hip joint mobility of 110° flexion and -10° extension and internal and external rotation of 35° each. The range of knee flexion was 110°. On a VAS scale, the patient’s quality of life was rated 85/100 vs. 30/100 preoperatively. In patients with hip fusion, satisfactory results can be achieved with 2-stage hip and knee replacement, even despite significant co-morbidities. However, this requires careful intraoperative planning and management of patient expectations.
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Testov, V. V., S. А. Sterlikov, I. А. Vasilyeva, I. А. Sidorova, and Yu V. Mikhaylova. "Federal Register of TB Cases as a tool for monitoring the impact of COVID-19 pandemic response activities on the TB care system." Tuberculosis and Lung Diseases 98, no. 11 (December 5, 2020): 6–11. http://dx.doi.org/10.21292/2075-1230-2020-98-11-6-11.
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The objective of the study: to analyze the impact of response activities to the COVID-19 pandemic on the system of tuberculosis care provided to the population of the Russian Federation based on the data of the Federal Register of TB Cases (FRTBC). Subjects and methods. Using regression analysis of data obtained from the forms of federal and sectoral statistical observation, regression equations were drawn up, and estimated indicators were determined for each month of 2020. The estimated indicators were compared with the data obtained from monthly reports downloaded from FRTBC from January to June 2020. Results. The shortfall in the registration of all cases of tuberculosis treatment relative to estimated indicators in May-June 2020 amounted to 24.4-24.7%, including 24.8% for new cases and relapses. That is very close to the value estimated by the World Health Organisation (25%). The number of tuberculosis cases detected post mortem increased by 37.1%. The number of detected pediatric tuberculosis cases at the age of 0-14 and 15-17 years old decreased by 31.4 and 28.2%, respectively. In June 2020, there was an increase in almost all recorded indicators that was due to the intensified tuberculosis detection activities. Conclusions. FRTBC allows performing prompt monitoring of the impact of response activities to the COVID-19 pandemic on the system of tuberculosis care provided to the population. After a period of a significant decrease in the number of registered tuberculosis patients in April and May 2020, in June, as anti-epidemic activities related to COVID-19 were slowed down, the number of registered patients tended to reach the previous level and approach their estimated values.
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McIntosh, Javardo, Nikkiah Forbes, Kevin Moss, and M. Anthony C. Frankson. "1373. Clinical Presentation, Demographics, and Outcomes of Cases of Tuberculosis (TB) at Princess Margaret Hospital, Nassau, The Bahamas 2014–2016." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S498. http://dx.doi.org/10.1093/ofid/ofz360.1237.
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Abstract Background Tuberculosis (TB) is one of the oldest diseases known to man, yet the world health organization reports that Tuberculosis is one of the top 10 causes of death worldwide. There are various factors that have made the eradication of tuberculosis in the Bahamas difficult such as high rates of HIV infection and immigrants migrating from countries with high TB prevalence. In understanding the epidemiology and risk factors of TB cases in the Bahamas, the development of protocols can improve screening procedures and decrease disease burden. Methods A retrospective chart review of cases of Tuberculosis diagnosed at the Princess Margaret Hospital, Nassau, Bahamas. 189 cases of active tuberculosis diagnosed between 2014–2016 and all cases were evaluated for demographics, risk factors, clinical manifestation, method of diagnosis, symptoms, and treatment outcomes. Results Of the 189 cases of notified tuberculosis between 2014 and 2016, 46 cases were reported in 2014, 60 cases in 2015 and 83 cases in 2016. The mean age was 37.96 (±18.20) years old. 164 (86.8%) presented with symptoms, 19 (10.1%) of cases were diagnosed by routine screening and 6 (3.2%) of cases were diagnosed by contact tracing. 109 (59.9%) were HIV negative and 73 (40.1%) were HIV positive. 144 (76.2%) presented with cough, 84 (44.7%) weight-loss, 80 (42.3%) fever, 44 (23.3%) night sweats, 43 (22.8%) chills, 32 (16.9%) fatigue, and 25 (13.2%) hemoptysis. 126(66.7%) completed the full course of antibiotic therapy, 29(15.3%) patients expired before completing treatment and 18(9.5%) of patients defaulted. Conclusion HIV is a major risk factor for Tuberculosis in the Bahamas and it is advised that all patients diagnosed with TB be tested for HIV. We also advise screening HIV-positive patients for TB. Screening other high-risk groups such as migrant populations would also benefit to reduce the amount of latent TB cases which may progress to active TB. Disclosures All authors: No reported disclosures.