The prevalence and predictors of tuberculin positivity in subjects screened for reasons other than contact investigation

Assessment of gender differences in some inflammatory cytokines of tuberculosis patients before and during treatment

Background

Gender variation is a feature of many physiological parameters including inflammatory cytokines. Inflammation is an obvious feature of Tuberculosis (TB) infection with changes in pro and anti-inflammatory cytokines.

Objective

To compare the levels of inflammatory cytokines between male and female TB patients before treatment, after 2-months and after 6-months anti-tuberculosis treatment.

Materials and methods

A total of 35 males and 25 females TB subjects were enlisted before initiation of therapy and followed up after 2-months and 6 months treatment and samples collected and analysed. Tumour necrosis factor-alpha (TNF-α), Interleukin 10 (IL-10, Interleukin -6 (IL-6), Interleukin-2 (IL-2), transforming growth factor-beta (TGF-β) were assayed by ELISA method.

Results

Before treatment, the median level of IL-6 (pg/ml) was significantly higher in males compared to female TB patients (P=0.046). While after 2-months treatment, TNF-α (pg/ml) and IL-10 (pg/ml) was significantly higher in males compared with females (P=0.008 and 0.045 respectively). Conversely, the median IL-6 (pg/ml) was significantly higher in female TB patients compared to the males (P=0.042). No significant differences were observed after 6-months treatment.

Conclusion

Gender differences exist in IL-6 before treatment and in IL-6, TNF-α and IL-10 at two months treatment. Thus, TB treatment contributes differentially to levels of inflammatory cytokines in male and female TB patients.

The impact of migration on tuberculosis epidemiology and control in high-income countries: a review

Tuberculosis (TB) causes significant morbidity and mortality in high-income countries with foreign-born individuals bearing a disproportionate burden of the overall TB case burden in these countries. In this review of tuberculosis and migration we discuss the impact of migration on the epidemiology of TB in low burden countries, describe the various screening strategies to address this issue, review the yield and cost-effectiveness of these programs and describe the gaps in knowledge as well as possible future solutions.The reasons for the TB burden in the migrant population are likely to be the reactivation of remotely-acquired latent tuberculosis infection (LTBI) following migration from low/intermediate-income high TB burden settings to high-income, low TB burden countries.TB control in high-income countries has historically focused on the early identification and treatment of active TB with accompanying contact-tracing. In the face of the TB case-load in migrant populations, however, there is ongoing discussion about how best to identify TB in migrant populations. In general, countries have generally focused on two methods: identification of active TB (either at/post-arrival or increasingly pre-arrival in countries of origin) and secondly, conditionally supported by WHO guidance, through identifying LTBI in migrants from high TB burden countries. Although health-economic analyses have shown that TB control in high income settings would benefit from providing targeted LTBI screening and treatment to certain migrants from high TB burden countries, implementation issues and barriers such as sub-optimal treatment completion will need to be addressed to ensure program efficacy.

Tuberculin test can be read after 24 hours in adolescent children

OBJECTIVE

To assess readability of 24-h tuberculin response in adolescent school children.

DESIGN

Prospective observational study in school.

SUBJECTS

601 healthy adolescent children.

INTERVENTIONS

Tuberculin (1TU PPD RT23 Tween80) was administered and indurations at 24 and 72 h were compared.

MAIN OUTCOME MEASURE

Tuberculin reaction at 24 h.

RESULTS

One hundred twelve children (18.6%) had a positive tuberculin reaction. Prevalence of tuberculin positivity was least (14.2%) in the 10-year age-group and maximum in the 13-year age-group (21.2%). When individual values of tuberculin reaction at 24 and 72 h were compared, a significant difference was noted irrespective of the tuberculin status (t = 8.46, p = 0.001). However, when tuberculin reaction was considered as positive or negative, this difference was not significant (t = 1.89, p > 0.05).

CONCLUSIONS

Tuberculin status in adolescents can be read as positive or negative at 24 h, irrespective of their bacillus Calmette-Guérin scar status.