1
|
Feyisa JW, Berhanu RD, Lema M, Desalegn M, Merdassa E, Kitila KM, Hailu WB, Beyena SD, Shama AT. Magnitude and determinants of undernutrition among tuberculosis patients in Ethiopia: systematic review and meta-analysis. BMC Public Health 2024; 24:1698. [PMID: 38918733 PMCID: PMC11201327 DOI: 10.1186/s12889-024-19220-3] [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: 05/02/2023] [Accepted: 06/21/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Undernutrition increases the risk of TB infection to be active TB, death and relapse of the disease. Undernutrition also disturbs the management process of tuberculosis. Therefore, this study aimed to estimate the pooled magnitude and determinants of undernutrition among TB patients in Ethiopia. METHODS From August 20, 2022 to January 6, 2023, the research articles were identified via the search engines Google Scholar, Medline, Pub Med, Cochrane Library, and Web of Science. Stata version 14 was used for analysis, along with a standardized data extraction checklist. The Cochrane Q test statistic and I2 statistics were used to determine heterogeneity. A random-effect model was used to assess the extent of undernutrition among TB patients. OR with a 95% CI was used to report the relationship between undernutrition and independent factors. A funnel plot and Egger's test were used to examine publication bias. RESULTS A total of 720 research articles were identified via several databases and 21 studies were included in the systematic review and meta-analysis. The pooled magnitude of undernutrition among TB patients was 48.23% (95% CI 42.84, 53.62). The current meta-analysis revealed that patients who had no formal education (OR = 2.11(95%CI: 1.09, 4.06), average monthly income < 1800 ETB (OR = 2.32 (95CI: 1.33, 4.04), unable to work (OR = 2.61(95CI:1.99, 3.43), patients who had eating disorder (OR = 2.73 (95CI: 2.09, 3.56), patients who had intestinal parasite (OR = 3.77 (95CI: 2.39, 5.94), patients of > 5 family size (OR = 3.79 (95CI: 1.06, 14.93), and patients who drank alcohol (OR = 1.47(95CI: 1.06, 2.05) were significantly associated with undernutrition. CONCLUSION This meta-analysis examined the high magnitude of undernutrition among TB patients in Ethiopia. Strategic and police-oriented intervention to prevent factors contributing to the problem is mandatory.
Collapse
Affiliation(s)
- Jira Wakoya Feyisa
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia.
| | - Robera Demissie Berhanu
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Matiyos Lema
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
| | - Markos Desalegn
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
| | - Emiru Merdassa
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
| | - Keno Melkamu Kitila
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Wase Benti Hailu
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
| | - Sidie Debelo Beyena
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
| | - Adisu Tafari Shama
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
| |
Collapse
|
2
|
Chandra H, Rahman A, Yadav P, Maurya G, Kumar Shukla S. Effect of adjunct Vitamin D treatment in vitamin D deficient pulmonary tuberculosis patients: A randomized, double blind, active controlled clinical trial. Indian J Tuberc 2024; 71:170-178. [PMID: 38589121 DOI: 10.1016/j.ijtb.2023.04.026] [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: 03/18/2023] [Revised: 04/15/2023] [Accepted: 04/28/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Since, Vitamin D [1α,25(OH)2D)] enhances antimicrobial activity of Innate immunity and modulate Adaptive immune responses, simultaneously, so it play a potential role for balanced immune activity against Mycobacterium tuberculosis and restricting tissue injuries within the TB patients.(Chun et al., 2011) 9 We aimed to determine the role of adjunct Vitamin D treatment on the outcome of pulmonary tuberculosis patients and evaluated the effect of Vitamin D administration on Differential Leucocyte Count, Erythrocyte Sedimentation Rate, serum Adenosine deaminase, serum C- reactive protein, Oxygen saturation (SpO2) and Body Weight in Vitamin D deficient pulmonary tuberculosis patients. METHODS We conducted a prospective, interventional, randomized, double blind, parallel group, active controlled clinical trial. Newly diagnosed Vitamin D deficient pulmonary tuberculosis patients were randomly assigned to intervention group (received standard anti-tubercular treatment with adjunct Vitamin D3) and control group (received standard anti-tubercular treatment without adjunct Vitamin D3). Total four doses [each dose of 2.5 mg (100000 IU)] of Vitamin D3 were given, orally. First dose was given within 7 days of starting anti-tubercular treatment and second, third, fourth dose were given at 2, 4 and 6 weeks respectively. At the time of enrollment, we measured all baseline characteristics. During follow-up, we measured the study variables and monitored adverse events at 2, 4, 6, 8 and 12 weeks. Our safety parameter was serum corrected calcium level to assess the risk of hypercalcemia. RESULTS Total 130 pulmonary TB patients, 65 patients in each group, were analyzed. Our study results showed that decrease in Neutrophil count was statistically significant with small effect sizes at every time point of measurement and increase in Lymphocyte count was statistically significant with small and moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Decrease in erythrocyte sedimentation rate was statistically significant with small effect sizes at 6 and 8 week, decrease in serum adenosine deaminase and serum C- reactive protein was statistically significant with moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Increase in Oxygen saturation was statistically significant at 4 week with small effect size and increase in body weight was statistically significant with small effect sizes for intervention group than for control group. No case of hypercalcemia was reported. CONCLUSION Our findings suggest a potential role of adjunctive Vitamin D3 to accelerate resolution of inflammatory responses and improvement in clinical outcomes of pulmonary TB patients. TRIAL REGISTRATION This trial is registered with Clinical Trials Registry - INDIA (http://ctri.nic.in) with CTRI Number - CTRI/2021/11/037914. PLACE OF STUDY Room Number 27, first floor out-patients department (OPD) and inpatient Wards, fourth floor, Department of Respiratory Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (U.P.), INDIA.
Collapse
Affiliation(s)
- Harish Chandra
- Department of Biochemistry, Academic Block, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, (U.P), 206130, India.
| | - Adil Rahman
- Department of Biochemistry, Academic Block, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, (U.P), 206130, India
| | - Prashant Yadav
- Department of Respiratory Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, (U.P.), 206130, India
| | - Geeta Maurya
- Department of Pathology, Academic Block, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, (U.P.), 206130, India
| | - Sushil Kumar Shukla
- Department of Community Medicine, Academic Block, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, (U.P.), 206130, India
| |
Collapse
|
3
|
Wagnew F, Alene KA, Kelly M, Gray D. Impacts of body weight change on treatment outcomes in patients with multidrug-resistant tuberculosis in Northwest Ethiopia. Sci Rep 2024; 14:508. [PMID: 38177234 PMCID: PMC10767082 DOI: 10.1038/s41598-023-51026-y] [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: 09/23/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024] Open
Abstract
Measuring body weight during therapy has received insufficient attention in poor resource settings like Ethiopia. We aimed to investigate the association between weight change during therapy and treatment outcomes among patients with multidrug-resistant tuberculosis (MDR-TB) in northwest Ethiopia. This retrospective cohort study analysed data from patients with MDR-TB admitted between May 2015 to February 2022 at four treatment facilities in Northwest Ethiopia. We used the joint model (JM) to determine the association between weight change during therapy and treatment outcomes for patients with MDR-TB. A total of 419 patients with MDR-TB were included in the analysis. Of these, 265 (63.3%) were male, and 255 (60.9%) were undernourished. Weight increase over time was associated with a decrease in unsuccessful treatment outcomes (adjusted hazard ratio (AHR): 0.96, 95% CI: 0.94 to 0.98). In addition, patients with undernutrition (AHR: 1.72, 95% CI: 1.10 to 2.97), HIV (AHR:1.79, 95% CI: 1.04 to 3.06), and clinical complications such as pneumothorax (AHR: 1.66, 95% CI: 1.03 to 2.67) were associated with unsuccessful treatment outcomes. The JM showed a significant inverse association between weight gain and unsuccessful MDR-TB treatment outcomes. Therefore, weight gain may be used as a surrogate marker for good TB treatment response in Ethiopia.
Collapse
Affiliation(s)
- Fasil Wagnew
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia.
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, WA, Australia.
| | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, WA, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Darren Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| |
Collapse
|
4
|
Wagnew F, Alene KA, Kelly M, Gray D. Geospatial Overlap of Undernutrition and Tuberculosis in Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7000. [PMID: 37947558 PMCID: PMC10647613 DOI: 10.3390/ijerph20217000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
Undernutrition is a key driver of the global tuberculosis (TB) epidemic, yet there is limited understanding regarding the spatial overlap of both diseases. This study aimed to determine the geographical co-distribution and socio-climatic factors of undernutrition and TB in Ethiopia. Data on undernutrition were found from the Ethiopian Demographic and Health Survey (EDHS). Data on TB were obtained from the Ethiopia national TB prevalence survey. We applied a geostatistical model using a Bayesian framework to predict the prevalence of undernutrition and TB. Spatial overlap of undernutrition and TB prevalence was detected in the Afar and Somali regions. Population density was associated with the spatial distribution of TB [β: 0.008; 95% CrI: 0.001, 0.014], wasting [β: -0.017; 95% CrI: -0.032, -0.004], underweight [β: -0.02; 95% CrI: -0.031, -0.011], stunting [β: -0.012; 95% CrI: -0.017, -0.006], and adult undernutrition [β: -0.007; 95% CrI: -0.01, -0.005]. Distance to a health facility was associated with the spatial distribution of stunting [β: 0.269; 95% CrI: 0.08, 0.46] and adult undernutrition [β: 0.176; 95% CrI: 0.044, 0.308]. Healthcare access and demographic factors were associated with the spatial distribution of TB and undernutrition. Therefore, geographically targeted service integration may be more effective than nationwide service integration.
Collapse
Affiliation(s)
- Fasil Wagnew
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra 2601, Australia;
- College of Health Sciences, Debre Markos University, Debre Markos P.O. Box 269, Ethiopia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands 6009, Australia;
| | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands 6009, Australia;
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley 6102, Australia
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra 2601, Australia;
| | - Darren Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia;
| |
Collapse
|
5
|
Kalva J, Babu SP, Narasimhan PB, Raghupathy K, Ezhumalai K, Knudsen S, Horsburgh CR, Hochberg N, Salgame P, Roy G, Ellner J, Sarkar S. Predictors of weight loss during the intensive phase of tuberculosis treatment in patients with drug-susceptible pulmonary tuberculosis in South India. J Public Health (Oxf) 2023; 45:545-552. [PMID: 36451280 PMCID: PMC10470329 DOI: 10.1093/pubmed/fdac141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/08/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is well-known for causing wasting. Patients on treatment gain weight and weight loss is associated with unfavorable treatment outcomes. There is limited description of weight loss and its predictors during intensive treatment phase. The objective of this study was to assess the predictors of weight loss during intensive phase and to see if there is any association exists with sputum conversion at the end of intensive phase of treatment. METHODS Data collected as a part of the prospective TB cohort (Regional Prospective Observational Research for TB India Phase 1) conducted in Pondicherry, Cuddalore and Viluppuram districts of Tamil Nadu were used for this study. Sputum smear and body weight comparison were made in the baseline and at the end of second month of treatment. RESULTS In all, 726 participants had weight measurements at the two time points and 18.7% had weight loss; mean weight lost being 2.3 kg (SD 3.05). Mean weight loss was more among males (2.4 kg, SD 3.2), diabetics (2.8 kg, SD 3.9) and alcoholics (2.1 kg, SD 2.4). Alcohol consumption was the only predictor of weight loss after adjusting for age, diabetes, marital status and BMI (aRR 1.52, P 0.02). Weight loss was not associated with sputum conversion at the end of second month. CONCLUSIONS Alcohol use emerged as the major predictor for weight loss during intensive phase.
Collapse
Affiliation(s)
- Jayashree Kalva
- Department of Preventive and Social Medicine, JIPMER, Puducherry 605006, India
| | - Senbagavalli P Babu
- Department of Preventive and Social Medicine, JIPMER, Puducherry 605006, India
| | | | | | - Komala Ezhumalai
- Department of Preventive and Social Medicine, JIPMER, Puducherry 605006, India
| | - Selby Knudsen
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA 02118, USA
| | - Charles R Horsburgh
- School of Public Health, Epidemiology & Biostatistics, Boston University, Boston, MA 02118, USA
| | - Natasha Hochberg
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA 02118, USA
| | - Padmini Salgame
- Department of Medicine, Rutgers University, Newark, NJ 07102, USA
| | - Gautam Roy
- Department of Preventive and Social Medicine, JIPMER, Puducherry 605006, India
| | - Jerrold Ellner
- Department of Medicine, Rutgers University, Newark, NJ 07102, USA
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, JIPMER, Puducherry 605006, India
| |
Collapse
|
6
|
Oswal N, Thangavel H, Lizardo K, Dhanyalayam D, Sidrat T, Salgame P, Nagajyothi JF. Diets Differently Regulate Pulmonary Pathogenesis and Immune Signaling in Mice during Acute and Chronic Mycobacterium tuberculosis Infection. Life (Basel) 2023; 13:228. [PMID: 36676177 PMCID: PMC9861969 DOI: 10.3390/life13010228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) infection persists as a leading cause of mortality and morbidity globally, especially in developing and underdeveloped countries. The prevalence of TB-DM (diabetes mellitus) is higher in low- and middle-income countries where TB and DM are most prevalent. Epidemiological data suggest that slight obesity reduces the risk of TB, whereas DM increases the risk of pulmonary TB. Diets can alter the levels of body fat mass and body mass index by regulating systemic adiposity. Earlier, using a transgenic Mtb-infected murine model, we demonstrated that loss of body fat increased the risk of pulmonary bacterial load and pathology. In the present study, we investigated whether increased adiposity alters pulmonary pathology and bacterial load using C57BL/6 mice infected with HN878 Mtb strain and fed a medium-fat diet (MFD). We analyzed the effects of MFD on the lung during acute and chronic infections by comparing the results to those obtained with infected mice fed a regular diet (RD). Histological and biochemical analyses demonstrated that MFD reduces bacterial burden by increasing the activation of immune cells in the lungs during acute infection and reduces necrosis in the lungs during chronic infection by decreasing lipid accumulation. Our data suggest that slight adiposity likely protects the host during active TB infection by regulating immune and metabolic conditions in the lungs.
Collapse
Affiliation(s)
- Neelam Oswal
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Hariprasad Thangavel
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Kezia Lizardo
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Dhanya Dhanyalayam
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Tabinda Sidrat
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Padmini Salgame
- Department of Medicine, Center for Emerging Pathogens, Rutgers-New Jersey Medical School, Newark, NJ 07103, USA
| | - Jyothi F. Nagajyothi
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| |
Collapse
|
7
|
Bourgi K, Ofner S, Musick B, Griffith B, Diero L, Wools-Kaloustian K, Yiannoutsos CT, Gupta SK. Weight Gain Among Treatment-Naïve Persons With HIV Receiving Dolutegravir in Kenya. J Acquir Immune Defic Syndr 2022; 91:490-496. [PMID: 36126175 PMCID: PMC9814314 DOI: 10.1097/qai.0000000000003087] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several recent studies have linked integrase strand transfer inhibitors (INSTI) with increased weight gain. SETTING The effects of sex on weight gain with dolutegravir (DTG)-based antiretroviral therapy (ART) among treatment-naïve participants in a lower-income, sub-Saharan population with high rates of pre-ART underweight and tuberculosis (TB) coinfection are unknown. METHODS Our analysis included treatment-naïve participants in Kenya and starting their first treatment regimen between January 1, 2015, and September 30, 2018. Participants were grouped into 2 cohorts based on the initial treatment regimen [DTG vs. nonnucleoside reverse transcriptase inhibitors (NNRTI)]. We modelled weight changes over time using a multivariable nonlinear mixed-effect model, with participant as a random effect. Logistic regression models were constructed to evaluate the association between different variables with extreme increase in body mass index (≥10% increase). RESULTS Seventeen thousand forty-four participants met our inclusion criteria. Sixty-two percent of participants were women, 6% were receiving active TB therapy, and 97% were on NNRTI-based regimens. Participants starting DTG-based regimens were more likely to gain weight when compared with participants starting NNRTI-based regimens. Female participants starting DTG-based regimens experienced the highest weight gain compared with other participants (mean gain of 6.1 kgs at 18 months). Female participants receiving DTG-based regimens, along with participants with lower CD4 cell counts, underweight at baseline, and those receiving active TB therapy were also at higher risk for extreme body mass index increase. CONCLUSIONS Our study in a lower-income sub-Saharan African population confirms higher weight gain with DTG-based regimens compared with traditional ART for treatment-naïve patients.
Collapse
Affiliation(s)
- Kassem Bourgi
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Susan Ofner
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Beverly Musick
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bradley Griffith
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lameck Diero
- College of Health Sciences, Moi University School of Medicine, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Constantin T Yiannoutsos
- Department of Biostatistics and Health Data Science, Indiana University R.M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Samir K. Gupta
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
8
|
Makeswaran P, Shah SA, Safian N, Muhamad NA, Harith AA. Determinants of delayed tuberculosis treatment among patients in Selangor: A study protocol. PLoS One 2022; 17:e0266746. [PMID: 35468167 PMCID: PMC9037902 DOI: 10.1371/journal.pone.0266746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/27/2022] [Indexed: 11/19/2022] Open
Abstract
The high prevalence rate and ever-increasing incidence of tuberculosis (TB) worldwide remain a significant issue in healthcare. In Malaysia, the incidence and mortality rate of TB is increasing due to the delayed presentation of TB patients to healthcare facilities. However, there is a lack of local studies on the contributing factors of delayed presentation of TB patients in Malaysia. This study aims to establish a social epidemiology framework by analysing social factors including socio-epidemiological, socio-cultural, and health-seeking behaviours associated with the delay in seeking TB treatment among patients in Selangor, Malaysia. A sequential exploratory mixed-method study design that combines qualitative and quantitative research methods will be employed. This study will recruit adult patients who have been diagnosed with TB using chest X-ray and sputum smear microscopy. Four districts with the highest recorded cases in the state of Selangor will be selected as study locations. The qualitative study will involve a Focus Group Discussion (FGD) to explore six components, namely demographic, socio-cultural, health-seeking behaviours, social support and resources, previous knowledge and experience with illness, and treatment pathway. Meanwhile, the quantitative study will incorporate a structured survey that will be developed based on the themes identified in the qualitative phase and a review of several studies in the literature. Several quality control measures will be taken while ensuring that the survey questionnaires are anonymised and participants' confidentiality is maintained. The data obtained from both qualitative and quantitative approaches will be combined to provide a more robust assessment of the study. Given that this study will focus on districts with high recorded cases of TB in Selangor, the findings might assist to address TB-related issues such as the increasing incidence and mortality rates, which are mainly attributed to the delayed presentation of TB patients to healthcare facilities.
Collapse
Affiliation(s)
- Punitha Makeswaran
- Department of Community Medicine, UKM Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Shamsul Azhar Shah
- Department of Community Medicine, UKM Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Nazarudin Safian
- Department of Community Medicine, UKM Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Nor Asiah Muhamad
- Evidence Based Healthcare Medicine Sector, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Abdul Aziz Harith
- Occupational Health Research Centre, Institute for Public Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| |
Collapse
|
9
|
Alkabab YMA, Biswas S, Ahmed S, Paul K, Nagajyothi J, Banu S, Heysell S. Differentiating transient from persistent diabetic range hyperglycemia in a cohort of people completing tuberculosis treatment in Dhaka, Bangladesh. PLoS One 2021; 16:e0260389. [PMID: 34813631 PMCID: PMC8610235 DOI: 10.1371/journal.pone.0260389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/08/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In recent non-pandemic periods, tuberculosis (TB) has been the leading killer worldwide from a single infectious disease. Patients with DM are three times more likely to develop active TB and poor treatment outcomes. Single glycemic measurements at TB diagnosis may inaccurately diagnose or mischaracterize DM severity. Data are limited regarding glycemic dynamics from TB diagnosis through treatment. METHODS Prospective study of glycemia dynamics in response to TB treatment measured glycosylated haemoglobin (HbA1c) in patients presenting to TB screening centres in Bangladesh to determine the prevalence and risk factors of hyperglycemia before and at TB treatment completion. RESULTS 429 adults with active TB disease were enrolled and divided into groups based on history of DM and initial HbA1c range: normoglycemia, prediabetes, and DM. DM was diagnosed in 37%. At treatment completion,14(6%) patients from the normoglycemia and prediabetes groups had HbA1c>6.5%, thus increasing the prevalence of DM to 39%. The number needed to screen to diagnose one new case of DM at TB diagnosis was 5.7 and 16 at treatment completion in the groups without DM. Weight gain>5% at treatment completion significantly increased the risk of hyperglycemia in the groups without DM at TB diagnosis (95% CI 1.23-26.04, p<0.05). CONCLUSION HbA1c testing prior to and at TB treatment completion found a high prevalence of prediabetes and DM, including a proportion found at treatment completion and commonly in people with a higher percentage of weight gain. Further longitudinal research is needed to understand the effects of TB disease and treatment on insulin resistance and DM complications.
Collapse
Affiliation(s)
- Yosra M. A. Alkabab
- University of Virginia Medical Center, Division of Infectious diseases and International Health, Department of Medicine, Charlottesville, VA, United States of America
| | - Samanta Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Enteric and Respiratory Infections, Infectious Diseases Division, Dhaka, Bangladesh
| | - Shahriar Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Enteric and Respiratory Infections, Infectious Diseases Division, Dhaka, Bangladesh
| | - Kishor Paul
- The Kirby Institute, University of New South Wales, Surveillance Evaluation Research Program, Kensington, NSW, Australia
| | - Jyothi Nagajyothi
- Center for Discovery and Innovation, Hackensack University Medical Center, Nutley, New Jersey, United States of America
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Enteric and Respiratory Infections, Infectious Diseases Division, Dhaka, Bangladesh
| | - Scott Heysell
- University of Virginia Medical Center, Division of Infectious diseases and International Health, Department of Medicine, Charlottesville, VA, United States of America
| |
Collapse
|
10
|
Improving tuberculosis treatment success rate through nutrition supplements and counselling: Findings from a pilot intervention in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
11
|
Muse AI, Osman MO, Ibrahim AM, Wedajo GT, Daud FI, Abate KH. Undernutrition and Associated Factors Among Adult Tuberculosis Patients in Jigjiga Public Health Facilities, Somali Region, East, Ethiopia. Res Rep Trop Med 2021; 12:123-133. [PMID: 34168515 PMCID: PMC8216752 DOI: 10.2147/rrtm.s311476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022] Open
Abstract
Background Tuberculosis and undernutrition are the public health concerns of people living in middle and low-income countries. When patient develops TB, undernutrition is not only a risk factor for progression of latent TB infection to active disease, but also intensifies the risk of drug toxicity, relapse and death. Nutritional supplementation in patients with TB is associated with faster sputum conversion, higher cure and treatment completion rates, and body-weight gain. Objective To find out the magnitude of undernutrition and associated factors among adult tuberculosis patients in jigjiga public health facilities. Methods and Materials A facility-based cross-sectional study design was applied. Data were collected using a structured questionnaire while anthropometric measurements were collected in their scale measurements. The data were entered into an Epi-data version 3.1, then were exported and analyzed using SPSS v20. Bivariate logistic regression was done to assess the association between the outcome variable and the independent variables, value <0.25 was considered as a candidate for multivariate logistic regression at 95% CI. In multivariable logistic regression analysis, the level of statistical significance was declared at a p-value less than 0.05. Results The magnitude of undernutrition was 44.3% [95% CI (38.2, 49.7)]. Sex (female) [AOR=1.769, CI=1.035, 3.024], educational status [AOR=3.939, CI=2.285, 6.792] and being Bedridden [AOR=3.718, CI=1.115, 12.394) were predictors of Undernutrition among adult tuberculosis patients. Conclusion The magnitude of undernutrition among adult patients with TB was high in the area. Overall routine appropriate nutrition assessment and support should be given to undernourished patients with TB. The level of education about nutrition should be improved by counseling on a balanced diet to all patients with TB and particularly for female patients. Appropriate nutrition support should be provided to undernourished TB patients, and more focused on those who are bedridden.
Collapse
Affiliation(s)
- Abdilahi Ibrahim Muse
- Department of Nursing, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Mohamed Omar Osman
- Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Ahmed Mohammed Ibrahim
- Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Girma Tadesse Wedajo
- Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Fuad Ismail Daud
- Department of Nursing, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | | |
Collapse
|
12
|
Peetluk LS, Rebeiro PF, Cordeiro-Santos M, Kritski A, Andrade BB, Durovni B, Calvacante S, Arriaga MB, Turner MM, Figueiredo MC, Rolla VC, Sterling TR. Lack of Weight Gain During the First 2 Months of Treatment and Human Immunodeficiency Virus Independently Predict Unsuccessful Treatment Outcomes in Tuberculosis. J Infect Dis 2021; 221:1416-1424. [PMID: 31724035 DOI: 10.1093/infdis/jiz595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Weight change may inform tuberculosis treatment response, but its predictive power may be confounded by human immunodeficiency virus (HIV). METHODS We prospectively followed up adults with culture-confirmed, drug-susceptible, pulmonary tuberculosis receiving standard 4-drug therapy (isoniazid, rifampin, pyrazinamide, and ethambutol) in Brazil. We examined median weight change 2 months after treatment initiation by HIV status, using quantile regression, and unsuccessful tuberculosis treatment outcome (treatment failure, tuberculosis recurrence, or death) by HIV and weight change status, using Cox regression. RESULTS Among 547 participants, 102 (19%) were HIV positive, and 35 (6%) had an unsuccessful outcome. After adjustment for confounders, persons living with HIV (PLWH) gained a median of 1.3 kg (95% confidence interval [CI], -2.8 to .1) less than HIV-negative individuals during the first 2 months of tuberculosis treatment. PLWH were at increased risk of an unsuccessful outcome (adjusted hazard ratio, 4.8; 95% CI, 2.1-10.9). Weight change was independently associated with outcome, with risk of unsuccessful outcome decreasing by 12% (95% CI, .81%-.95%) per 1-kg increase. CONCLUSIONS PLWH gained less weight during the first 2 months of tuberculosis treatment, and lack of weight gain and HIV independently predicted unsuccessful tuberculosis treatment outcomes. Weight, an easily collected biomarker, may identify patients who would benefit from alternative treatment strategies.
Collapse
Affiliation(s)
- Lauren S Peetluk
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Marcelo Cordeiro-Santos
- Fundação Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | - Afranio Kritski
- Universidade do Estado do Amazonas, Manaus, Brazil.,Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, Brazil
| | - Bruno B Andrade
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Bahia, Brazil.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil.,Faculdade de Tecnologia e Ciências, Salvador, Bahia, Brazil
| | - Betina Durovni
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Solange Calvacante
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil.,Secretaria Municipal de Saúde do Rio de Janeiro (Clínica da Familia Rinaldo Delamare)-Rocinha, Rio de Janeiro, Brazil
| | - María B Arriaga
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Bahia, Brazil.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Megan M Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Marina C Figueiredo
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Valeria C Rolla
- Secretaria Municipal de Saúde do Rio de Janeiro (Clínica da Familia Rinaldo Delamare)-Rocinha, Rio de Janeiro, Brazil
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| |
Collapse
|
13
|
Wondmieneh A, Gedefaw G, Getie A, Demis A. Prevalence of undernutrition among adult tuberculosis patients in Ethiopia: A systematic review and meta-analysis. J Clin Tuberc Other Mycobact Dis 2020; 22:100211. [PMID: 33458257 PMCID: PMC7797563 DOI: 10.1016/j.jctube.2020.100211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Undernutrition and tuberculosis are the major public health problems of people living in middle and low-income countries. Even though single studies have been reported from different areas of Ethiopia, there is no national-level study that estimates the overall burden of undernutrition among tuberculosis patients. Therefore, this study aimed to estimate the overall magnitude of undernutrition among adult tuberculosis patients in Ethiopia. Methods We searched out records from databases such as PubMed/MEDLINE, HINARI, EMBASE, Scopus, Google Scholar, and African journals and the online Ethiopian University repositories for published and unpublished articles. The data were extracted using a standardized data extraction format. Meta-analysis was computed using STATA version 11 software. The Cochrane Q-test and I2 with its corresponding p-value were used to assess the heterogeneity of the study. The presence of publication bias was evaluated using Egger’s test and presented with funnel plots. The random-effects meta-analysis model was computed to estimate the pooled prevalence of undernutrition among adult tuberculosis patients. Results A total of Twelve observational studies with 4963 study participants were included in this systematic review and meta-analysis. The pooled prevalence of undernutrition among tuberculosis patients in Ethiopia was 50.8% (95% CI 43.97, 57.63). The results of subgroup analysis showed that the highest prevalence of undernutrition among TB patients was observed from studies done in the Amhara region (65.63%). In this meta-analysis, the pooled prevalence of undernutrition among TB-HIV co-infected patients was 45.45% (95%CI 21.85, 56.07). Conclusion The prevalence of undernutrition among TB patients in Ethiopia was noticeably high. The result of this study showed that undernutrition is more severe in the Amhara regional state. Additionally, TB-HIV co-infected patients are highly affected by undernutrition. Therefore, the Ministry of Health in collaboration with clinicians should give special attention to provide nutritional care and support for TB patients as part of regular care. Moreover, special nutritional support should be designed for TB-HIV co-infected patients.
Collapse
Affiliation(s)
- Adam Wondmieneh
- Department of Nursing, College of Health Sciences, Woldia University, P.O.Box: 400, Woldia, Ethiopia
| | - Getnet Gedefaw
- Department of Midwifery, College of Health Sciences, Woldia University, P.O.Box: 400, Woldia, Ethiopia
| | - Addisu Getie
- Department of Nursing, College of Health Sciences, Woldia University, P.O.Box: 400, Woldia, Ethiopia
| | - Asmamaw Demis
- Department of Nursing, College of Health Sciences, Woldia University, P.O.Box: 400, Woldia, Ethiopia
| |
Collapse
|
14
|
Systematic analysis for the relationship between obesity and tuberculosis. Public Health 2020; 186:246-256. [PMID: 32866737 DOI: 10.1016/j.puhe.2020.06.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Underweight or low body mass index (BMI) is an established risk factor for active tuberculosis. Recent evidence, however, suggests that overweight is associated with lower incidence of tuberculosis. The objective of this systematic review and meta-analysis is to understand the relationship between obesity and tuberculosis and document the extent of association between the two conditions over the range of BMI from underweight to obesity. METHODS A comprehensive literature search was conducted to identify studies reporting prevalence of the different BMIs in patients with tuberculosis and controls. Thirty studies of adult humans reporting the incidence of tuberculosis at different weight categories were selected for inclusion for meta-analysis in the present study. RESULTS In tuberculosis, the prevalence of underweight was 3-fold higher than that in controls (P = 0.001) whereas the proportion of overweight and obesity was 2-fold lower (P = 0.001). One unit increase in BMI was associated with 2% reduction in tuberculosis incidence (P < 0.001). Adjusted odds ratio of tuberculosis was 4.96 (95% confidence interval: 4.87-5.05) in underweight and 0.26 in obesity. CONCLUSION This study further establishes low body weight as a risk factor for tuberculosis whilst overweight and obesity are associated with lower disease risk. Body weight can be considered as a prognostic indictor in the clinical course of tuberculosis.
Collapse
|
15
|
Chiang SS, Park S, White EI, Friedman JF, Cruz AT, Del Castillo H, Lecca L, Becerra MC, Seddon JA. Using Changes in Weight-for-Age z Score to Predict Effectiveness of Childhood Tuberculosis Therapy. J Pediatric Infect Dis Soc 2020; 9:150-158. [PMID: 30715497 DOI: 10.1093/jpids/piy138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/31/2018] [Accepted: 12/12/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND International guidelines recommend monitoring weight as an indicator of therapeutic response in childhood tuberculosis (TB) disease. This recommendation is based on observations in adults. In the current study, we evaluated the association between weight change and treatment outcome, the accuracy of using weight change to predict regimen efficacy, and whether successfully treated children achieve catch-up weight gain. METHODS We enrolled children treated for drug-susceptible TB disease (group 1) and multidrug-resistant TB disease (group 2) in Peru. We calculated the change in weight-for-age z score (ΔWAZ) between baseline and the end of treatment months 2-5 for group 1, and between baseline and months 2-8 for group 2. We used logistic regression and generalized estimating equation models to evaluate the relationship between ΔWAZ and outcome. We plotted receiver operating characteristic curves to determine the accuracy of ΔWAZ for predicting treatment failure or death. RESULTS Groups 1 and 2 included 100 and 94 children, respectively. In logistic regression, lower ΔWAZ in months 3-5 and month 7 was associated with treatment failure or death in groups 1 and 2, respectively. In generalized estimating equation models, children in both groups who experienced treatment failure or death had lower ΔWAZ than successfully treated children. The ΔWAZ predicted treatment failure or death with 60%-90% sensitivity and 60%-86% specificity in months 2-5 for group 1 and months 7-8 for group 2. All successfully treated children-except group 2 participants with unknown microbiologic confirmation status-achieved catch-up weight gain. CONCLUSIONS Weight change early in therapy can predict the outcome of childhood TB treatment.
Collapse
Affiliation(s)
- Silvia S Chiang
- Department of Pediatrics, Alpert Medical School of Brown University.,Center for International Health Research, Rhode Island Hospital, Providence
| | - Sangshin Park
- Department of Pediatrics, Alpert Medical School of Brown University.,Center for International Health Research, Rhode Island Hospital, Providence
| | - Emily I White
- Department of Pediatrics, Alpert Medical School of Brown University
| | - Jennifer F Friedman
- Department of Pediatrics, Alpert Medical School of Brown University.,Center for International Health Research, Rhode Island Hospital, Providence
| | - Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Hernán Del Castillo
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Leonid Lecca
- Instituto Nacional de Salud del Niño, Imperial College London, United Kingdom.,Socios En Salud Sucursal Perú, Lima, Imperial College London, United Kingdom
| | - Mercedes C Becerra
- Instituto Nacional de Salud del Niño, Imperial College London, United Kingdom.,Socios En Salud Sucursal Perú, Lima, Imperial College London, United Kingdom
| | - James A Seddon
- Centre for International Child Health, Imperial College London, United Kingdom
| |
Collapse
|
16
|
Phase III, placebo-controlled, randomized, double-blind trial of tableted, therapeutic TB vaccine (V7) containing heat-killed M. vaccae administered daily for one month. J Clin Tuberc Other Mycobact Dis 2019; 18:100141. [PMID: 31890902 PMCID: PMC6933248 DOI: 10.1016/j.jctube.2019.100141] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Immunotherapy of tuberculosis (TB) to shorten treatment duration represents an unmet medical need. Orally delivered, tableted TB vaccine (V7) containing heat-killed Mycobacterium vaccae (NCTC 11659) has been demonstrated in prior clinical studies to be safe and fast-acting immune adjunct. Methods The outcome of Phase III trial of V7 containing 10 µg of hydrolyzed M. vaccae was evaluated in 152 patients randomized at 2:1 ratio: V7 (N = 100), placebo (N = 52). Both arms received conventional 1st or 2nd line TB drugs co-administered with daily pill of V7 or placebo. Results After one month mycobacterial clearance was observed in 68% (P < 0.0001) and 23.1% (P = 0.04) of patients on V7 and placebo. Stratified conversion rates in V7 recipients with drug-sensitive and multidrug-resistant TB were 86.7% and 55.6% vs 27.2% and 15% in placebo. Patients on V7 gained on average 2.4 kg (P < 0.0001) vs 0.3 kg (P = 0.18) in placebo. Improvements in hemoglobin levels, erythrocyte sedimentation rate and leukocyte counts were significantly better than in controls. Liver function tests revealed that V7 can prevent chemotherapy-induced hepatic damage. Conclusion Oral M. vaccae is safe, can overcome TB-associated weight loss and inflammation, reduce hepatotoxicity of TB drugs, improve sputum conversion three-fold OR 3.15; 95%CI (2.3,4.6), and cut treatment length by at least six-fold. Longer follow-up studies might be needed to further substantiate our findings (Clinicaltrials.gov: NCT01977768).
Collapse
|
17
|
Ayyappan JP, Ganapathi U, Lizardo K, Vinnard C, Subbian S, Perlin DS, Nagajyothi JF. Adipose Tissue Regulates Pulmonary Pathology during TB Infection. mBio 2019; 10:e02771-18. [PMID: 30992360 PMCID: PMC6469978 DOI: 10.1128/mbio.02771-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/11/2019] [Indexed: 12/16/2022] Open
Abstract
Tuberculosis (TB), caused by Mycobacterium tuberculosis infection, remains a major cause of mortality and morbidity worldwide. One-third of the world population is infected with M. tuberculosis, and about 15 million people with latent tuberculosis infection (LTBI) reside in the United States. An estimated 10% of individuals with LTBI are at risk of progressing to active disease. Loss of body mass, or wasting, accompanied by a significant reduction of body fat is often associated with active TB disease and is considered to be immunosuppressive and a major determinant of severity and outcome of disease. While the lungs are the primary site of M. tuberculosis infection and TB manifestation, recent reports have shown that adipose tissue serves as an important reservoir for M. tuberculosis In this article, we investigated the association between M. tuberculosis infection, adipose tissue, and TB disease progression using a transgenic inducible "fatless" model system, the FAT-ATTAC (fat apoptosis through targeted activation of caspase 8) mouse. By selectively ablating fat tissue during M. tuberculosis infection, we directly tested the role of fat cell loss and adipose tissue physiology in regulating pulmonary pathology, bacterial burden, and immune status. Our results confirm the presence of M. tuberculosis in fat tissue after aerosol infection of mice and show that loss of fat cells is associated with an increase in pulmonary M. tuberculosis burden and pathology. We conclude that acute loss of adipose tissue during LTBI may predispose the host to active TB disease.IMPORTANCE Although the lungs are the port of entry and the predominant site of TB disease manifestation, we and others have demonstrated that M. tuberculosis also persists in adipose tissue of aerosol-infected animals and directly or indirectly alters adipose tissue physiology, which in turn alters whole-body immuno-metabolic homeostasis. Our present report demonstrates a direct effect of loss of adipocytes (fat cells) on promoting the severity of pulmonary pathogenesis during TB, advancing our understanding of the pathogenic interactions between wasting and TB activation/reactivation.
Collapse
Affiliation(s)
- Janeesh Plakkal Ayyappan
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Usha Ganapathi
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Kezia Lizardo
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Christopher Vinnard
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Selvakumar Subbian
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - David S. Perlin
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Jyothi F Nagajyothi
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| |
Collapse
|
18
|
Filate M, Mehari Z, Alemu YM. Longitudinal body weight and sputum conversion in patients with tuberculosis, Southwest Ethiopia: a retrospective follow-up study. BMJ Open 2018; 8:e019076. [PMID: 30185566 PMCID: PMC6129038 DOI: 10.1136/bmjopen-2017-019076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To describe the association between change in body weight and sputum smear conversion and to identify factors linked with body weight and sputum smear conversion in Jimma University Specialized Hospital, Southwest Ethiopia. DESIGN A retrospective follow-up study. SETTING Teaching hospital in Southwest Ethiopia. PARTICIPANTS A total of 450 patients with tuberculosis (TB) were included in the follow-up between 2011 and 2013. MAIN OUTCOME MEASURES The association between body weight and sputum conversion was measured using joint modelling. RESULTS The association between change in body weight and change in sputum conversion was -0.698 (p<0.001). A strong inverse association between change in body weight and change in sputum conversion was observed. The study variables sex, age, type of TB, HIV status, dose of anti-TB drug and length of enrolment to TB treatment were significantly associated with change in body weight of patients with TB. The study variables age, type of TB, dose of anti-TB drug and length of enrolment were significantly associated with change in sputum status of patients with TB. CONCLUSIONS Among patients with TB who were on anti-TB treatment, increase in body weight and positive sputum status were inversely related over time. TB prevention and control strategies should give emphasis on factors such as female sex, older age, non-pulmonary positive type of TB, HIV-positive, lower dose of anti-TB drug and length of enrolment to TB treatment during monitoring of trends in body weight and sputum status.
Collapse
Affiliation(s)
- Mersha Filate
- Department of Statistics, Jimma University, Jimma, Ethiopia
| | - Zelalem Mehari
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yihun Mulugeta Alemu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
19
|
Diallo A, Dahourou DL, Dah TTE, Tassembedo S, Sawadogo R, Meda N. Factors associated with tuberculosis treatment failure in the Central East Health region of Burkina Faso. Pan Afr Med J 2018; 30:293. [PMID: 30637077 PMCID: PMC6320454 DOI: 10.11604/pamj.2018.30.293.15074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/21/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Tuberculosis treatment failure results in increased risk of morbidity, drug resistance, transmission and mortality. There are few data about tuberculosis treatment outcomes in Burkina Faso. The current study investigated the factors associated with tuberculosis treatment failure in the central east health region of Burkina Faso. Methods We conducted a case-control study. All cases of pulmonary tuberculosis failing first-line treatment matched to those who were cured (controls) in the Central Eastern Region were sampled from January 2010 to December 2014. Predictors of treatment failure were determined using multiple conditional logistic regression. Results A total of 381 patients with positive microscopic pulmonary tuberculosis were included. Of these 76 cases failed first-line treatment while 305 controls were cured. Weight loss between diagnosis and first sputum-smear examination was significantly associated with the tuberculosis treatment failure [aOR: 2.5, 95% CI: 1.3-4.7]. In addition, the delay from between treatment initiation to first sputum-smear examination, and high bacillary load at the first sputum-smear examination were significantly associated with treatment failure (p<0.001). Conclusion Strengthening the relationship between health care services and local communities to improve the follow-up of tuberculosis patients, and improving adherence to tuberculosis treatment among tuberculosis patients with weight loss between treatment initiation and 2-month sputum-smear examination could be useful to reduce the risk of unsuccessful outcome.
Collapse
Affiliation(s)
- Adama Diallo
- National Tuberculosis Control Program, Ouagadougou, Burkina Faso
| | | | | | | | - Romial Sawadogo
- Central East Health Regional Direction, Tenkodogo, Burkina Faso
| | - Nicolas Meda
- Centre Muraz, Department of Clinical Research, Bobo-Dioulasso, Burkina Faso.,University of Ouagadougou, Department of Public Health, Ouagadougou, Burkina Faso
| |
Collapse
|