Holistic care of complicated tuberculosis in healthcare settings with limited resources

Mistaken identity: Reporting two cases of rare forms of extrapulmonary tuberculosis in Solomon Islands

INTRODUCTION AND IMPORTANCE

Extrapulmonary tuberculosis (EPTB) is a relatively rare and difficult-to-diagnose manifestation of Myobacterium tuberculosis (TB) infection.

CASE PRESENTATION

This study reports the cases of a 47-year-old male and a 35-year old female with rare forms of EPTB who sought medical care in Solomon Islands. Both patients presented with nondescript symptoms and a chief complaint of pain. Initial diagnosis for the male and female patient was an abacterial colon polypoid mass and a urinary tract infection (UTI) respectively. Following unsuccessful treatment for UTI and further investigation, the surgical team diagnosed the female patient with a tuberculosis spondylitis and a bilateral psoas abscess. The male patient was subsequently diagnosed with isolated colonic tuberculosis. After starting medication, the patients were discharged and prescribed 9-month treatment regimens. During outpatient treatment both patients reported suboptimal adherence. The female patient resumed treatment and showed improvement while the male patient discontinued treatment, experienced worsening symptoms, and ultimately died.

CLINICAL DISCUSSION

The nonspecific symptoms of extrapulmonary TB infection make it difficult to diagnose. Cases of rare forms of EPTB are particularly challenging to identify. Misdiagnosis may further increase the likelihood of mortality and morbidity in these cases. Intensive medication counseling, patient outreach, and regularly scheduled follow-up visits may reduce the incidence of poor adherence and reduce the risk of developing drug-resistant TB.

CONCLUSION

Medical practitioners in tuberculosis-endemic countries like Solomon Islands should maintain a high clinical index of suspicion in diagnosing EPTB. Future research should investigate the prevalence of TB and EPTB in the Solomon Islands.

Post-tuberculosis sequelae in children and adolescents: a systematic review

In 2020, an estimated total of 155 million people had survived tuberculosis. Among this number, a sizable proportion have considerable post-tuberculosis morbidity, as shown for the adult population. This systematic review aims to identify the spectrum and prevalence of post-tuberculosis sequelae in children and adolescents. Four databases were systematically searched from database inception to Feb 7, 2022, for literature on post-treatment outcomes of tuberculosis acquired during childhood. Of the 4613 identified publications, 71 studies were included in this systematic review. Studies on cohorts with comparably rare (most of which were extrapulmonary) tuberculosis presentations, such as spinal tuberculosis and tuberculous meningitis were over-represented; however, no study assessed long-term sequelae in a cohort with an average childhood tuberculosis spectrum. The descriptive analysis includes long-term outcomes of 3529 paediatric patients 1 month to 36 years after confirmed (47%) or clinical (53%) tuberculosis. In a considerable proportion of children, a broad spectrum of post-tuberculosis sequelae were identified, ranging from radiological residua after pulmonary tuberculosis, to disabling deformities after musculoskeletal and cutaneous tuberculosis, to somatic and psychosocial impairment after tuberculous meningitis. A better understanding and comprehensive assessment of post-tuberculosis sequelae in children are needed to improve tuberculosis care beyond antituberculous treatment.

Experience and Perception of Healthcare Workers on the Challenges of Follow-Up and Treatment of Tuberculosis Patients in Southern Ethiopia: An Exploratory-Descriptive Qualitative Study

Background

There is a scarcity of research evidence on TB follow-up and treatment challenges from a healthcare worker's perspective in Ethiopia. Therefore, this study aimed to explore and describe the experience and perception of healthcare workers on the challenges of follow-up and treatment of TB patients in Southern Ethiopia.

Material and Methods

A qualitative exploratory-descriptive study was employed among 26 purposely selected Healthcare Workers (HCWs) from Wolaita Sodo University-Comprehensive Specialized Hospital and Achura, Boloso Sore, and Tida Health Centers in December 2021 and January 2022. Initially, the maximum variation purposive sampling technique was employed, then based on the data requirement of the study it was enriched by a theoretical sampling method. The required data were collected through one-on-one face-to-face audio-taped in-depth interviews. Data analysis was conducted by using a qualitative data analysis framework for the applied research method. NVivo Software Version 11 was used to ease data organization and analysis. Detailed textual narration of subthemes, and themes was done using direct verbatim quotations in the respective headings and subheadings.

Results

In the current study, three major themes and eleven sub-themes emerged from the data. The three major themes include the experience of healthcare workers, perceived challenges, and suggestions for improvement of TB patients' follow-up and treatment. Healthcare worker's experience, compliance with infection prevention protocols, fear of contracting and/or spreading TB, public awareness of TB, socio-economic burdens, providers-related problems, shortage of medical supplies, unconducive physical work environment, provision of holistic support for the patients, provision of in or out of service training, and supportive supervision were the sub-themes.

Conclusion

This study explored the multidimensional challenges adjoining follow-up and treatment of TB patients. Regular monitoring and supportive supervision accompanied by appropriate and timely decisions and feedback are vital to ensure effective follow-up and treatment of TB patients in Ethiopia.

Oral anti-tuberculosis drugs: An urgent medication reconciliation at hospitals in Indonesia

Background: Four oral anti-tuberculosis drugs are conceived to be the most effective ones to eradicate Mycobacterium tuberculosis bacteria and to obviate the resistant organisms. However, the patients’ adherence and medication discrepancies are obstacles to achieving the goal. This study aimed to define the anti-tuberculosis drugs used in the hospitals and to detect the discrepancies in the continuity of the tuberculosis treatment.

Design and Methods: This retrospective cross-sectional study was based on medical records of adult patients, and was conducted in two district tertiary care hospitals. Only 35 out of 136 patient records from Hospital A and 33 out of 85 records from Hospital B met the inclusion criteria.

Results: The most common systemic anti-infective drugs in the study were ceftriaxone (51.80 DDD/100 patient-days) used in Hospital A and isoniazid (59.53 DDD/100 patient-days) used in Hospital B. The number of rifampicin prescriptions was less than that of isoniazid. Each patient received an average of two DDD/100 patient-days, which is an under dosage for an effective treatment.

Conclusion: This study showed a medication discrepancy of tuberculosis therapy. Tuberculosis patients’ medical histories are not under the full attention of treating physicians wherever they are admitted. Thus, medication reconciliation is needed to accomplish the goal of a Tuberculosis-free world in 2050.

A luminescent Zn(II)-Containing Complex: Selective Sensing of Cr(VI) Anion and Application Values on Tuberculosis Care Through Increasing the Antibacterial Response of Macrophages

A new Zn(II)-bearing metal-organic framework (MOF), namely, {[Zn₂(L)₂(H₂O)]·8H₂O·DMF}_n (1) has been generated via applying 4,4'-([2,3'-bipyridine]-4,6-diyl) dibenzoic acid (H₂L), a pyridine-carboxylic acid ligand under the solvothermal reaction conditions. In the aqueous solution, complex 1 could be utilized as the fluorescent sensor for the simultaneous detection of Cr₂O₇^2- ion and CrO₄^2- ion with low limits of detection and high sensitivity. It is important that this luminescent material can be regenerated quickly and the sensing ability of this luminescent material can be reused for three times. Furthermore, the assessment of the compound's application values against the Tuberculosis care was carried out and simultaneously its relevant mechanism was investigated. First of all, the bacterial burden in the lung macrophages was measured with plate micro-dilution method. Besides, the signaling pathway of JAK/STAT activation was evaluated with real time RT-PCR. Molecular docking simulation reveals that the polar oxygens are the active sites that could form binding interactions the protein.

Demographic, socio-economic and behavior as risk factors of tuberculosis in Malaysia: a systematic review of the literature

Background Tuberculosis (TB) is making a comeback and has remained one of the main causes of mortality among the list of infectious diseases in Malaysia. Objective To evaluate the burden and demographic, socio-economic and behavior as risk factors of TB among communities in Malaysia. Method A comprehensive search of Scopus, Sciencedirect, PubMed, DOAJ, CINAHL Plus, MyJournal, BIREME, BMC Public Health, Medline, CAB, EMBASE (Excerpta Medica dataBASE), and Web of Science (WoS) was undertaken from the articles published from 1st January 2008 to 31st December 2017 using medical subject heading (MeSH) key terms. Results Of 717 papers screened, 31 eligible studies met our inclusion criteria. Gender, age, marriage status, ethnicity, area of living, being in prison and immigrant were evaluated as demographic factors, while educational level, occupation and household income were evaluated as socio-economic factors. For behavioral factors, smoking, drug abuse, alcohol consumption and other lifestyle practices were evaluated. However, not all the studies were statistically significantly associated with these risk factors. Studies on household income were few and too small to permit a conclusion. We also did not find any study that investigated TB infection among sex workers. Conclusion Immigrant in high density settings may increase the progression of disease infection in Malaysia. The risk factors for the development of TB, specifically in a high-risk population, should be targeted through the implementation of specialized interventions. Further research into the role of indoor and outdoor physical environments is required to better understand the association between the physical environment and the social environment with TB infection.