1
|
Zangpo T, Tsheten, Tenzin P, Dorji C, Nima G, Dorjee S, Sultana R. Demographic risk factors for extra-pulmonary tuberculosis: a rising public health threat in Bhutan. Indian J Tuberc 2024; 71:137-146. [PMID: 38589117 DOI: 10.1016/j.ijtb.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/16/2023] [Accepted: 04/20/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Recently, extra-pulmonary tuberculosis (EPTB) has been increasingly reported in Bhutan, rising from 26% in 2001 to 39% in 2010. In 2016, almost half (49%) of all reported TB cases were classified as EPTB. Thus, this study was conducted to understand the epidemiology and identify risk factors contributing to increasing notification of EPTB in Bhutan. METHODS A case-control study was conducted by recruiting all 110 cases of nationally notified EPTB (Extrapulmonary bacteriologically confirmed/EPBC) as cases and 235 Pulmonary TB (Pulmonary bacteriologically confirmed/PBC) as controls. Data were collected on socio-demography, clinical and diagnostic, behavioral and lifestyle and environmental exposures using a structured questionnaire between April and September, 2018. RESULTS The median age of the cases was 25 years, ranged 9-79 years. Lymphatic TB was predominant (n = 78; 70.91%) followed by genitourinary TB (n = 4 (3.64%). The likelihood of EPTB decreased with increase in age (p = 0.023). The odds of EPTB in females was 1.65 times higher than the males (p = 0.038). Increase in Body Mass Index (adjusted odds ratio (AOR): 1.1; 95% confidence interval (CI): 1.052-1.200) and urban residency were (AOR 1.6; 95% CI 1.016-2.805) were found to have higher odds of developing EPTB. CONCLUSION Females, urban residents, and those with higher BMI are at increased risk of developing EPTB. These at-risk groups can be used to target limited public health resources to control EPTB in Bhutan.
Collapse
Affiliation(s)
- Tandin Zangpo
- Communicable Disease Division, Department of Public Health, Ministry of Health, Thimphu, Bhutan.
| | - Tsheten
- Royal Centre for Disease Control, Department of Public Health, Ministry of Health, Bhutan
| | - Phurpa Tenzin
- National Tuberculosis Control Program, Department of Public Health, Ministry of Health, Bhutan
| | - Chencho Dorji
- Gidakom Hospital, Ministry of Health, Thimphu, Bhutan
| | - Gaki Nima
- Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Sithar Dorjee
- Khesar Gyalpo University of Health Sciences of Bhutan, Thimphu, Bhutan
| | | |
Collapse
|
2
|
Badawi MM, SalahEldin MA, Idris AB, Idris EB, Mohamed SG. Tuberculosis in Sudan: systematic review and meta analysis. BMC Pulm Med 2024; 24:51. [PMID: 38263137 PMCID: PMC10807179 DOI: 10.1186/s12890-024-02865-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 01/17/2024] [Indexed: 01/25/2024] Open
Abstract
Every year, 10 million people fall ill with tuberculosis (TB). Despite being a preventable and curable disease, 1.5 million people die from TB each year -making it the world's top infectious disease. TB is the leading cause of death of people with HIV and also a major contributor to antimicrobial resistance. Its presumed that TB was the cause of 1% of the total deaths among inpatients in Sudan in 2017. The current study is aimed to provide pooled prevalence of Mycobacterium tuberculosis among Sudanese as well as to determine any socio-cultural risk factors associated. A systematic review of the literature was conducted and regulated in accordance with the PRISMA Statement. After abstract and full text screening only twenty-six articles met our inclusion criteria and passed the quality assessment procedure. Pulmonary tuberculosis prevalence was assessed in sixteen included studies among participants from Khartoum, Gezira, Kassala, Blue Nile, River Nile, White Nile, Gadarif, Red sea, North Kordofan, Northern State, Sennar and West Darfur States, representing a total sample size of 11,253 participants of suspected individuals such as febrile outpatients, TB patients' contacts and other groups such as HIV/AIDS patients, hemodialysis patients, School adolescents as well as pregnant women. The pooled prevalence was 30.72% [CI: 30.64, 30.81]. Moreover, Khartoum State recorded the highest pooled prevalence as 41.86% [CI: 14.69, 69.02] based on a total sample size of 2,737 participants. Furthermore, male gender and rural residence were found to be significantly associated with TB infection. Further research with larger sample sizes targeting prevalence and risk factors of TB among Sudanese population is needed to be conducted.
Collapse
Affiliation(s)
- M M Badawi
- Higher Academy for Strategic and Security Studies, Khartoum, Sudan.
| | - M A SalahEldin
- Medical Microbiology Department, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - A B Idris
- General Surgery Resident, Medical Specialization Board, Khartoum, Sudan
| | - E B Idris
- Department of medical microbiology, Rashid Medical Complex, Riyadh, Saudi Arabia
| | - S G Mohamed
- Medical Microbiology Department, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| |
Collapse
|
3
|
Amar DN, Rao S, Bilagi R, Hiregoudar RN, Kanakpur S. Disseminated tuberculosis presenting as a tubercular sinus with myositis of forearm in an immunocompetant patient. Indian J Tuberc 2022; 69:699-701. [PMID: 36460411 DOI: 10.1016/j.ijtb.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/04/2021] [Indexed: 06/17/2023]
Abstract
Disseminated tuberculosis is a life-threatening form of tuberculosis resulting from haematogenous spread of M. tuberculosis. It is most commonly seen in an immunocompromised patient. Here we report a case of Pulmonary tuberculosis with Tubercular myositis of forearm flexors and carpal tunnel syndrome presenting as a discharging sinus in an immunocompetent patient.
Collapse
Affiliation(s)
- D N Amar
- Department of Surgery, Srinivas Institute of Medical Sciences and Research Institute (SIMS and RC), India
| | - Shobitha Rao
- Department of Respiratory Medicine, SIMS and RC, India.
| | - Rakesh Bilagi
- Department of Respiratory Medicine, SIMS and RC, India
| | | | | |
Collapse
|
4
|
Djannah F, Massi MN, Hatta M, Bukhari A, Hasanah I. Profile and histopathology features of top three cases of Extra Pulmonary Tuberculosis (EPTB) in West Nusa Tenggara: A retrospective cross-sectional study. Ann Med Surg (Lond) 2022; 75:103318. [PMID: 35242312 PMCID: PMC8857446 DOI: 10.1016/j.amsu.2022.103318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 10/28/2022] Open
|
5
|
Arega B, Mersha A, Minda A, Getachew Y, Sitotaw A, Gebeyehu T, Agunie A. Epidemiology and the diagnostic challenge of extra-pulmonary tuberculosis in a teaching hospital in Ethiopia. PLoS One 2020; 15:e0243945. [PMID: 33320897 PMCID: PMC7737896 DOI: 10.1371/journal.pone.0243945] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ethiopia reported a high rate of extra-pulmonary tuberculosis (EPTB) and the cases are increasing since the last three decades. However, diagnostic evidence to initiate TB treatment among EPTB cases is not well known. Therefore, we described the epidemiology and assessed how EPTB is diagnosed in a teaching hospital in Ethiopia. METHODS We conducted a retrospective review among all adult EPTB cases diagnosed in Yekatit 12 Hospital Medical College from 2015 to 2019. Using a standardized data abstraction sheet, we collected data from patients' medical records on sociodemographic, sites, and laboratory diagnosis of EPTB cases. RESULTS Of the 965 total TB cases, 49.8%(481) had a recorded diagnosis of EPTB during the study period. The mean age of EPTB patients was 32.9 years (SD±13.9) and 50.7% were males. Tubercular lymphadenitis (40.3%), abdominal (23.4%), and pleural TB(13.5%) were the most common sites of EPTB involvement, followed in descending order by the genitourinary, skeletal, central nervous system, abscess, breast, and laryngeal TB. We found a histopathology finding consistent with EPTB in 59.1% of cases, Acid-fast bacilli positive in 1.5%, and the rest diagnosed on radiological grounds. In the majority of cases, more than one diagnostic method was used to diagnose EPTB cases. CONCLUSIONS Nearly half of TB patients had a recorded diagnosis of EPTB that comprise heterogeneous anatomical sites. All EPTB patients were started anti-TB therapy without definitive microbiology results. This indicates the diagnostic challenge of EPTB faced in our setting and proves to be significant for TB control in Ethiopia.
Collapse
MESH Headings
- Adolescent
- Adult
- Antitubercular Agents/therapeutic use
- Ethiopia/epidemiology
- Female
- Hospitals, Teaching
- Humans
- Male
- Risk Factors
- Tuberculosis, Lymph Node/drug therapy
- Tuberculosis, Lymph Node/epidemiology
- Tuberculosis, Lymph Node/microbiology
- Tuberculosis, Lymph Node/pathology
- Tuberculosis, Pleural/drug therapy
- Tuberculosis, Pleural/epidemiology
- Tuberculosis, Pleural/microbiology
- Tuberculosis, Pleural/pathology
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/microbiology
- Tuberculosis, Pulmonary/pathology
- Young Adult
Collapse
Affiliation(s)
- Balew Arega
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Abraham Minda
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Alazar Sitotaw
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Asnake Agunie
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
6
|
Ahmed MH, Abdalla ME, Taha MH. Why social accountability of medical schools in Sudan can lead to better primary healthcare and excellence in medical education? J Family Med Prim Care 2020; 9:3820-3825. [PMID: 33110774 PMCID: PMC7586598 DOI: 10.4103/jfmpc.jfmpc_498_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/25/2020] [Accepted: 05/21/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction: Medical education in Sudan continues to evolve and progress with proliferation in the number of medical schools after 1990. Social factors and the geographical location of Sudan will increase the opportunity of success of medical schools to be socially accountable. In this analysis, we explained why social accountability is needed in Sudan and how this can enhance both excellence in medical education and primary health care, especially in rural areas. Methodology: PubMed, scopus Medline, and Google Scholar were searched for published-English literature concerning social accountability of medical schools in Sudan and worldwide were reviewed regardless of the time limit. We have also included examples of medical schools from Sudan and the Middle East to reflect on their experience in social accountability. Results: In this critical review, we have shown that social accountability will come with benefits for medical schools and the community. Implementation of social accountability in medical schools in Sudan will increase the effectiveness of medical schools' productivity, research output, and health service in urban and rural areas. There is an urgent need for social accountability alliance in Sudan to increase collaboration between medical schools. This will increase the benefits of social accountability for all stakeholders and also increases the competency in social medicine within the medical school curriculum. Conclusion: Social accountability is regarded as a sign of excellence in medical education. Primary care physicians in Sudan are expected to be the leaders in the implementation of social accountability. This analysis answered two important questions about why medical schools in Sudan should be socially accountable? And do we need a special structure of social accountability in Sudan?
Collapse
Affiliation(s)
- Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Mohamed Elhassan Abdalla
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamed H Taha
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
| |
Collapse
|
7
|
Metaferia Y, Seid A, Fenta GM, Gebretsadik D. Assessment of Extrapulmonary Tuberculosis Using Gene Xpert MTB/RIF Assay and Fluorescent Microscopy and Its Risk Factors at Dessie Referral Hospital, Northeast Ethiopia. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8207098. [PMID: 30159328 PMCID: PMC6106971 DOI: 10.1155/2018/8207098] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/07/2018] [Accepted: 07/05/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Tuberculosis is a major public health problem and extrapulmonary tuberculosis (EPTB) accounts for a significant proportion of tuberculosis cases worldwide. OBJECTIVE To determine the magnitude of EPTB, associated risk factors, and agreement of diagnostic techniques at Dessie Referral Hospital. METHODS A cross-sectional study was conducted on consecutive presumptive EPTB cases from March 1 to June 30, 2017. Sociodemographic characteristics and other variables were collected using a structured questionnaire. Clinical specimens were collected and processed using fluorescent microscopy and Gene Xpert assay. Data was analyzed using SPSS version 20. Chi-square test and logistic regression were done and a P value of ≤0.05 was taken as statistically significant. RESULTS From a total of 353 presumptive EPTB cases the overall prevalence of Gene Xpert assay and smear confirmed patients was 8.8% and 2.5%, respectively. Tuberculosis lymphadenitis was the predominant (33.3%) type followed by pleural (11.9%) and peritoneal (6.7%) tuberculosis. Previous history of pulmonary tuberculosis was significantly associated with extrapulmonary infection (AOR:2.8; 95%CI: 1.05-7.54; p=0.04); however, other variables such as age, residence, sex, marital status, occupation, level of education, and monthly income did not show any association. CONCLUSION High proportions (71%) of Gene Xpert assay confirmed EPTB patients were smear-negative. Sensitivity of microscopy should be enhanced in resource limited countries like Ethiopia where Gene Xpert machine is not easily accessible.
Collapse
Affiliation(s)
- Yeshi Metaferia
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Ethiopia
| | - Abdurahaman Seid
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Ethiopia
| | - Genet Mola Fenta
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Ethiopia
| | - Daniel Gebretsadik
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Ethiopia
| |
Collapse
|
8
|
Smear Microscopy for Diagnosis of Pulmonary Tuberculosis in Eastern Sudan. Tuberc Res Treat 2018; 2018:8038137. [PMID: 30013800 PMCID: PMC6022320 DOI: 10.1155/2018/8038137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/19/2018] [Indexed: 11/24/2022] Open
Abstract
Background In Sudan, tuberculosis diagnosis largely relies on clinical symptoms and smear microscopy as in many other low- and middle-income countries. The aim of this study was to investigate the positive predictive value of a positive sputum smear in patients investigated for pulmonary tuberculosis in Eastern Sudan. Methods Two sputum samples from patients presenting with symptoms suggestive of tuberculosis were investigated using direct Ziehl-Neelsen (ZN) staining and light microscopy between June to October 2014 and January to July 2016. If one of the samples was smear positive, both samples were pooled, stored at −20°C, and sent to the National Reference Laboratory (NRL), Germany. Following decontamination, samples underwent repeat microscopy and culture. Culture negative/contaminated samples were investigated using polymerase chain reaction (PCR). Results A total of 383 samples were investigated. Repeat microscopy categorized 123 (32.1%) as negative, among which 31 were culture positive. This increased to 80 when PCR and culture results were considered together. A total of 196 samples were culture positive, of which 171 (87.3%), 14 (7.1%), and 11 (5.6%) were M. tuberculosis, M. intracellulare, and mixed species. Overall, 15.6% (57/365) of the samples had no evidence of M. tuberculosis, resulting in a positive predictive value of 84.4%. Conclusions There was a discordance between the results of smear microscopy performed at local laboratories in the Sudan and at the NRL, Germany; besides, a considerable number of samples had no evidence of M. tuberculosis. Improved quality control for smear microscopy and more specific diagnostics are crucial to avoid possible overtreatment.
Collapse
|