Knowledge about tuberculosis among tribal population in Kerala in the backdrop of TB elimination goal by 2025

INTRODUCTION

Kerala is one among the States in India with least prevalence of tuberculosis and is reportedly aiming to be the first State to reach the target of 'Zero TB' by 2025. But knowledge about TB among the vulnerable groups plays a critical role in controlling the spread and achieving the target of eliminating TB.

MATERIALS AND METHODS

Drawing on a collaborative research program in India to estimate the burden of TB among tribal population, the level of knowledge and its possible links between life style of tribals, their customs and practices is examined Multi stage cluster sampling technique was adopted and 3 wards were selected in three districts in Kerala: Wayanad, Idukki and Palakkad which encompasses major share of the tribal population by probability proportional to size sampling method to draw a sample of 2600 individuals.

RESULTS

Awareness about TB among Tribal population in Kerala is impressive. However, in-depth knowledge on how TB is caused and spread, the symptoms, place of treatment and the cost are not so appreciable. Misconceptions and also lack of knowledge still prevail on who is prone to TB, how TB is spread and the causative agent. The IEC activities have had its effect in sensitizing the tribal population on how to identify the symptoms of TB. The average knowledge score was 5.06 points (72.2 percent, SD: 1.81) out of a total possible score of 7 points. The individual mean knowledge score is 0.65 overall considering all the knowledge domains where the maximum value is 1 and minimum is 0. The mean knowledge score among the Malayarayan Christians and Hindus is relatively higher but poor among Kattunayaka and Irular tribes. Mean knowledge score decreases significantly with increasing age. Gender differential in mean knowledge score is absent but greater educational attainment is associated with higher knowledge scores. However knowledge is not translated to practice of all preventive aspects of TB.

CONCLUSION

Knowledge deficit poses challenges in the efforts to eliminate TB in Kerala because the State is progressing towards zero TB target. Hence spreading awareness on these vital aspects need better focus among the tribal population.

Evaluation of TB elimination strategies in Canadian Inuit populations: Nunavut as a case study

Tuberculosis (TB) continues to disproportionately affect Inuit populations in Canada with some communities having over 300 times higher rate of active TB than Canadian-born, non-Indigenous people. Inuit Tuberculosis Elimination Framework has set the goal of reducing active TB incidence by at least 50% by 2025, aiming to eliminate it by 2030. Whether these goals are achievable with available resources and treatment regimens currently in practice has not been evaluated. We developed an agent-based model of TB transmission to evaluate timelines and milestones attainable in Nunavut, Canada by including case findings, contact-tracing and testing, treatment of latent TB infection (LTBI), and the government investment on housing infrastructure to reduce the average household size. The model was calibrated to ten years of TB incidence data, and simulated for 20 years to project program outcomes. We found that, under a range of plausible scenarios with tracing and testing of 25%–100% of frequent contacts of detected active cases, the goal of 50% reduction in annual incidence by 2025 is not achievable. If active TB cases are identified rapidly within one week of becoming symptomatic, then the annual incidence would reduce below 100 per 100,000 population, with 50% reduction being met between 2025 and 2030. Eliminating TB from Inuit populations would require high rates of contact-tracing and would extend beyond 2030. The findings indicate that time-to-identification of active TB is a critical factor determining program effectiveness, suggesting that investment in resources for rapid case detection is fundamental to controlling TB.

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TB elimination in Inuit populations would likely extend beyond timelines outlined in action plans.

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Rapid case findings combined with testing of frequent contacts are fundamental to TB control.

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Reducing average household size has minimal effect on rates of TB incidence.

Predictors for tuberculosis co-infection in people living with HIV/AIDs

Background/aim

Tuberculosis (TB) is one of the most common chronic infectious conditions causing mortality and severe outcomes, particularly in people living with HIV/AIDS (PLWHA). In this study, we aimed to determine the prevalence and predictors of TB among PLWHA.

Materials and Methods

We conducted a retrospective and single-center study of adults (≥18 years) PLWHA registered at our tertiary teaching and research hospital between 2000 and 2016.

Results

A total of 711 PLWHA were included. Of whom, 633 (89.0%) were male. Mean age was 36.53 ±11.55 years (range, 17–79). Thirty-eight (5.3%) patients were diagnosed with active TB. TB development was associated with low CD4+ lymphocyte count (p<0.001), high viral load (p=0.040) and alcohol consumption (p=0.004) but no association with age (p=0.392), gender (p=0.928) and duration since anti-retroviral therapy initiation (p=0.788) was found. Also, a receiver operating characteristic analysis showed that the area under the curves of CD4+ lymphocyte count as a predictor for TB development in PLWHA was 0.717 (p<0.001).

Conclusion

There are still clinical challenges to predict TB diagnosis. However, CD4+ lymphocyte count and viral load may be considered as valuable predictors for TB development. Also, community strategies to reduce harmful effect of alcohol use should be developed.

Genetic variation of ABCB1 (rs1128503, rs1045642) and CYP2E1 rs3813867 with the duration of tuberculosis therapy: a pilot study among tuberculosis patients in Indonesia

Objective

The risk of contracting tuberculosis (TB) and the efficacy of TB therapy are affected by several factors, including genetic variation among populations. In the Indonesian population, data on the genes involved in drug transport and metabolism of TB therapy are limited. The aim of this study was to identify the genetic profile of the ABCB1 gene (rs1128503 and rs1045642) and CYP2E1 gene (rs3813867) in Indonesians with TB. This study was a cross-sectional study of 50 TB outpatients in Jambi city, Indonesia. Sociodemographic characteristics were obtained from medical records. Whole blood was collected, and genomic DNA was isolated. Single nucleotide polymorphisms were determined using polymerase chain reaction-restriction fragment length polymorphism with HaeIII, MboI, and PstI for rs1128503, rs1045642 (ABCB1), and rs3813867 (CYP2E1), respectively.

Result

The frequency of alleles of each gene was analyzed by Hardy–Weinberg equilibrium. The genetic profiles of ABCB1 rs1128503 and rs1045642 were varied (CC, CT, TT), while CYP2E1 rs3813867 was present in CC (wild type). The genetic variations of ABCB1 and CYP2E1 may have no significant correlation with the duration of TB therapy. Nevertheless, this study may provide as preliminary results for the genetic profiles of ABCB1 (rs1128503, rs1045642) and CYP2E1 (rs3813867) in the Indonesia population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05711-8.

Smoking and COVID-19: What we know so far

The ongoing COVID-19 pandemic has placed a spotlight on infectious diseases and their associations with host factors and underlying conditions. New data on the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus are entering the public domain at a rapid rate such that their distillation often lags behind. To minimise weak associations becoming perceived as established paradigms, it is imperative that methodologies and outputs from different studies are appropriately critiqued and compared. In this review, we examine recent data on a potential relationship between smoking and COVID-19. While the causal role of smoking has been firmly demonstrated in regard to lung cancer and chronic obstructive pulmonary disease, such associations have the benefit of decades' worth of multi-centre epidemiological and mechanistic data. From our analysis of the available studies to date, it appears that a relationship is emerging in regard to patients with a smoking history having a higher likelihood of developing more severe symptoms of COVID-19 disease than non-smokers. Data on whether COVID-19 has a greater incidence in smokers than non-smokers is thus far, contradictory and inconclusive. There is therefore a need for some caution to be exercised until further research has been conducted in a wider range of geographical settings with sufficient numbers of patients that have been carefully phenotyped in respect of smoking status and adequate statistical control for confounding factors.

Prevalence of invasive aspergillosis in suspected pulmonary tuberculosis at a referral tuberculosis hospital in Shandong, China

Although the progression of invasive aspergillosis (IA) shares some risk factors in the development of active pulmonary tuberculosis (PTB), however, the prevalence of IA in suspected PTB remains unclear. During a period of 1 year (from January 2016 to December 2016), consecutive patients with suspected PTB were included in a referral TB hospital. Data, including demographic information and underlying diseases, were collected from medical records. PTB were all confirmed by mycobacterial culture (Lowenstein–Jensen medium). IA were diagnosed as proven or probable according to the criteria of the 2008 EORTC/MSG definitions. A descriptive analysis was performed to estimate the corresponding prevalence. During the study year, 1507 patients have a positive mycobacterial culture, with a mean age of 45.6 (s.d. 19.9) years old and a female:male ratio of 1:4. Among the 82 patients with non-tuberculous mycobacterial diseases, two patients (2.44%, 95% CI 0.67–8.46%) were diagnosed as IA (one proven and one probable); two probable IA patients (0.15%, 95% CI 0.04–0.55%) were diagnosed in PTB patients (n = 1315), and all were retreatment cases. In addition, all four IA patients (100%) exhibited cavities in both lobes on radiograph. In China, the prevalence of IA is low in active PTB patients. However, when high-risk factors for IA are encountered in PTB patients, further investigations are required and empirically treatment for IA might be warranted.

Association between indoor air pollution, tobacco smoke and tuberculosis: an updated systematic review and meta-analysis

OBJECTIVE

This study aims to further quantify evidence of the association between exposure to indoor air pollution (IAP), tobacco smoke etc., on the one hand and the risk of contracting tuberculosis (TB) on the other.

STUDY DESIGN

This was a systematic review and meta-analysis of articles published between June 2014 and February 2020 in PubMed, Web of Science, among others.

METHODS

We only included studies that controlled for confounders, screened both the exposed and unexposed study participants, and passive smoking studies that limited the study population to non-smokers. Quality of studies was assessed using the Newcastle-Ottawa scale. The analysis was conducted using STATA, and pooled effect sizes were calculated using the random-effects model, and heterogeneity was tested for using the Cochran Q test and I2 statistic.

RESULTS

A total of 26 articles were included in the final analysis. There was an increased risk of contracting TB among people exposed to IAP (risk ratio [RR] = 1.68, 95% confidence interval [CI] 1.108-2.542). We also observed a two-fold increase in the risk of contracting TB from exposure to secondhand tobacco smoke (RR = 2.15, 95%CI 1.419-3.242). Tobacco smoking doubled the risk of contracting TB (RR = 2.67, 95%CI 2.017-3.527). Furthermore, studies that used microbiological tests showed a higher RR compared to those that used other TB diagnostic methods.

CONCLUSION

Exposure to IAP and secondhand tobacco smoke increases the risk of contracting TB. Various disease prevention campaigns should include IAP awareness and encourage a shift to cleaner sources of energy.

Impact of nicotine replacement therapy as an adjunct to anti-tuberculosis treatment and behaviour change counselling in newly diagnosed pulmonary tuberculosis patients: an open-label, randomised controlled trial

We evaluated the impact of intensive smoking cessation activities as an adjunct to anti-tuberculosis treatment on patient-related treatment outcomes. In this open-label, randomised controlled trial, self-reporting smokers with pulmonary tuberculosis who initiated standard anti-tuberculosis treatment were randomised to either nicotine replacement therapy and behaviour change counselling (n = 400) or counselling alone (n = 400) provided at baseline and two follow-up visits. The primary outcomes were change in TBscore at 24-weeks and culture conversion at 8-weeks. Biochemical smoking quit rates defined as serum cotinine levels <10 ng/mL and/or exhaled carbon monoxide levels <6 ppm (47·8% vs 32·4%, p-value =< 0·001) and self-reported quit rates (69.3% vs 38·7%, p-value =< 0·001) were significantly higher in the intervention arm at 24-weeks. Though the TBscores at 24 weeks (95% CI) were lower in the intervention arm [2·07 (1·98, 2·17) versus 2.12 (2·02, 2·21)], the difference was not clinically meaningful. Patients in the control arm required treatment extension more often than intervention arm (6·4% vs 2·6%, p-value = 0·02). Combining nicotine replacement therapy with behaviour change counselling resulted in significantly higher quit rates and lower cotinine levels, however, impact on patient-related (TBscore) or microbiological outcomes (culture conversion) were not seen.

A comparative study of the socio-economic risk factors for pulmonary tuberculosis in the Saharia tribe of Madhya Pradesh, India

Background

To determine the socio-economic risk factors for pulmonary tuberculosis (PTB) in the Saharia tribal community in Madhya Pradesh, Central India.

Methods

PTB cases detected during the year 2013-14 through a community active TB prevalence survey in the Shivpuri district, Madhya Pradesh were included in the study. For each case, three controls were selected randomly among the non-cases from the same village and the data on socio-economic risk factors were collected. Using logistic regression analysis, the risk factors for PTB disease were identified.

Results

A total of 220 cases and 660 controls participated in the study. Of the 13 risk factors studied, on multivariate analysis the risk of PTB was found to be significantly associated with malnutrition (adjusted odds ratio [AOR] 2.02 [95% confidence interval {CI} 1.46 to 2.79]), living in a kaccha (built of naturally occurring materials) house (AOR 2.72 [95% CI 1.44 to 5.11]) and tobacco smoking (mostly beedis; AOR 1.59 [95% CI 1.12 to 2.18]).

Conclusions

The findings highlight that malnutrition, poor living conditions in a Kaccha house (built of naturally occurring materials) and tobacco smoking are the major risk factors for PTB among Saharias, which need to be studied among other tribal populations in the country. There is a need to strengthen health and nutrition programmes in this community.

Prevalence of latent tuberculosis infection among coal workers' pneumoconiosis patients in China: a cross-sectional study

BACKGROUND

Little is known about the prevalence of latent tuberculosis infection (LTBI) among coal workers' pneumoconiosis (CWP) patients. To estimate the prevalence of LTBI and identify its associated risk factors among CWP patients.

METHODS

A cross-sectional study was conducted to assess the prevalence of LTBI. Participants were screened for active TB or a history of TB by X-ray and those that underwent QuantiFERON-TB Gold In-Tube (QFT) test. A standardized questionnaire was completed and risk factors were assessed for acquiring TB. Log-binomial regression was used to estimate the LTBI prevalence ratio (PR) in relation to risk factors.

RESULTS

Of 244 individuals with CWP (median age 67 years; all male), 162 (66.4%) were QFT positive. In Multivariate analysis, poor workplace ventilation (adjusted prevalence ratio [APR] = 1.26) and intake of fruits regularly (≥4 days of every week) (APR = 0.81) (all p < 0.05) were associated with a decreased risk of QFT.

CONCLUSIONS

This study showed a high prevalence of LTBI among individuals with CWP in China. Poor workplace ventilation may be an important contributing factor for LTBI. Regular monitoring and dust control measures need to be improved in workplaces to ensure the safety of workers. Moreover, intake of fruits regularly may be a protective factor for LTBI. However, the effect of fruits should be further studied.

Effect of smoking on acute phase reactants, stress hormone responses and vitamin C in pulmonary tuberculosis

BACKGROUND

Chronic inflammation, possibly exacerbated by cigarette smoking, is considered to be the primary cause of pulmonary damage in patients with tuberculosis (TB). However, the mechanisms which underpin these harmful inflammatory responses, have not been well documented.

OBJECTIVES

The current study was undertaken to determine possible associations between systemic biomarkers of inflammation (acute phase reactants, stress hormones, leukocyte vitamin C) and smoking status in patients (n=71, 20 smokers) with newly-diagnosed pulmonary TB presenting at a tertiary hospital, Johannesburg, South Africa.

METHODS

Plasma concentrations of C-reactive protein (CRP), ferritin, cortisol, epinephrine, norepinephrine, dopamine and leukocyte vitamin C were measured using a combination of immunonephelometric, radioimmunoassay, immunochromatographic and spectrophotometric procedures. Demographic, clinical and laboratory data was captured and analysed by parametric and non-parametric analyses where appropriate.

RESULTS

Smokers were predominantly males (P<0.0001), of older age (P<0.0003) with a significantly lower body mass index (P<0.03). Plasma levels of CRP, ferritin and dopamine were higher in the group of smokers in the setting of lower levels of epinephrine, and leukocyte vitamin C, with CRP and vitamin C attaining statistical significance (P<0.04 and P<0.02 respectively). Those of cortisol and norepinephrine were comparable to those of non-smokers, as were radiographic changes and clinical indices of disease activity.

CONCLUSION

Cigarette smoking is associated with an exaggerated systemic inflammatory response in pulmonary TB in the setting of decreased concentrations of leukocyte vitamin C. Although no significant associations with radiographic changes and most clinical indices of disease activity were evident on presentation, these pro-inflammatory interactions may have prognostic significance.

Prevalence and Patterns of Multimorbidity among Human Immunodeficiency Virus Positive People in Odisha, India: An Exploratory Study

INTRODUCTION

Improved and efficient Anti-Retroviral Therapy (ART) has turned HIV positive into a chronic disorder. The increase in life expectancy and quality of life comes with an increased risk of multimorbidity from the traditional risk factors.

AIM

To explore the prevalence of multimorbidity among People Living with HIV (PLHIV).

MATERIALS AND METHODS

An exploratory cross-sectional study was carried out in an ART center of Odisha, India, from November 2013 to December 2013. A systematic random sampling was done to include 197 adult HIV positive patients receiving ART at least for one year or more. A structured questionnaire was used to collect data on socio-demographic profile, ART status, multimorbidity and opportunistic infections.

RESULTS

The prevalence of multimorbidity was 47.7% (95% CI 41% to 55%). Among them, the most common chronic conditions were pulmonary tuberculosis (28.4%), gastro-intestinal conditions (7.1%), neural disorders (5.1%) and hypertension (2.5%). In total, 48.7% had opportunistic infections; with 36% bacterial, 25% fungal and 21% viral infections.

CONCLUSION

The prevalence of multimorbidity was high among HIV positive patients. Further research should explore the epidemiology of multimorbidity among HIV positive patients to formulate proper clinical practice guidelines to enhance long-term outcomes of PLHIV in the current treatment era.

Impact of HIV infection and smoking on lung immunity and related disorders

HIV-infected persons not only have higher rates of smoking than the general population, but are also unusually vulnerable to the associated adverse health effects, both infective and noninfective in origin. Indeed, in the setting of well-organised care and availability of highly active antiretroviral therapy, HIV-infected smokers lose more life-years to smoking than to HIV infection per se, presenting a major challenge to healthcare providers. Not surprisingly, the respiratory system is particularly susceptible to the damaging interactive chronic inflammatory and immunosuppressive effects of HIV and smoking, intensifying the risk of the development of opportunistic infections, as well as lung cancer and obstructive lung disorders. The impact of smoking on the immunopathogenesis and frequencies of these respiratory conditions in the setting of HIV infection, as well as on the efficacy of antiretroviral therapy, represent the primary focus of this review.