The relationship between seasonality, latitude and tuberculosis notifications in Pakistan

Peculiar hyper vascular manifestations in idiopathic multicentric castleman disease without tafro syndrome: a case report

BACKGROUND

Castleman disease affects lymph nodes with abnormal cell growth. It has unicentric (single node) Castleman disease (UCD) and multicentric (multiple nodes) Castleman disease (MCD) forms. MCD is systemic, with diverse symptoms, necessitating systemic treatment. Idiopathic MCD (iMCD) clinical subtypes are divided into iMCD- not otherwise specified (NOS) and iMCD-TAFRO (thrombocytopenia, anasarca, fever, reticular fibrosis, organomegaly). UCD, iMCD-NOS, and iMCD-TAFRO mainly exhibit histopathology of hyaline vascular type, plasma cell type, and hyper vascular type, respectively.

CASE PRESENTATION

A 21-year-old female with no comorbidities presented to the outpatient department (OPD) with left inguinal swelling, gradually growing over four years, accompanied by fever and weight loss. Her past medical history included pulmonary TB 5 years prior and miscarriages. Vitals are within normal limits. Examination revealed a tender, nonreducible inguinal lump and a smaller neck swelling. Serological tests for infections were negative. Imaging revealed enlarged lymph nodes. Biopsy confirmed Castleman disease of the hyper vascular type. We performed surgical removal of the enlarged lymph nodes followed by close regular follow-up along with potential chemotherapy for relapse.

CONCLUSION

Hyper vascular type of the lymph node histology in Idiopathic multicentric Castleman disease without TAFRO syndrome must be considered a differential diagnosis in lymphoproliferative disease.

Analyzing the seasonality of tuberculosis case notifications in the UK, 2000-2018

Globally, there is seasonal variation in tuberculosis (TB) incidence, yet the biological and behavioural or social factors driving TB seasonality differ across countries. Understanding season-specific risk factors that may be specific to the UK could help shape future decision-making for TB control. We conducted a time-series analysis using data from 152,424 UK TB notifications between 2000 and 2018. Notifications were aggregated by year, month, and socio-demographic covariates, and negative binomial regression models fitted to the aggregate data. For each covariate, we calculated the size of the seasonal effect as the incidence risk ratio (IRR) for the peak versus the trough months within the year and the timing of the peak, whilst accounting for the overall trend. There was strong evidence for seasonality (p < 0.0001) with an IRR of 1.27 (95% CI 1.23-1.30). The peak was estimated to occur at the beginning of May. Significant differences in seasonal amplitude were identified across age groups, ethnicity, site of disease, latitude and, for those born abroad, time since entry to the UK. The smaller amplitude in older adults, and greater amplitude among South Asians and people who recently entered the UK may indicate the role of latent TB reactivation and vitamin D deficiency in driving seasonality.

Spatiotemporal analysis and seasonality of tuberculosis in Pudong New Area of Shanghai, China, 2014-2023

BACKGROUND

Spatiotemporal analysis is a vital method that plays an indispensable role in monitoring epidemiological changes in diseases and identifying high-risk clusters. However, there is still a blank space in the spatial and temporal distribution of tuberculosis (TB) incidence rate in Pudong New Area, Shanghai. Consequently, it is crucial to comprehend the spatiotemporal distribution of TB in this district, this will guide the prevention and control of TB in the district.

METHODS

Our research used Geographic Information System (GIS) visualization, spatial autocorrelation analysis, and space-time scan analysis to analyze the TB incidence reported in the Pudong New Area of Shanghai from 2014 to 2023, and described the spatiotemporal clustering and seasonal hot spot distribution of TB incidence.

RESULTS

From 2014 to 2023, the incidence of TB in the Pudong New Area decreased, and the mortality was at a low level. The incidence of TB in different towns/streets has declined. The spatial autocorrelation analysis revealed that the incidence of TB was spatially clustered in 2014, 2016-2018, and 2022, with the highest clusters in 2014 and 2022. The high clustering area was mainly concentrated in the northeast. The space-time scan analysis indicated that the most likely cluster was located in 12 towns/streets, with a period of 2014-2018 and a radiation radius of 15.74 km. The heat map showed that there was a correlation between TB incidence and seasonal variations.

CONCLUSIONS

From 2014 to 2023, the incidence of TB in the Pudong New Area of Shanghai declined, but there were spatiotemporal clusters and seasonal correlations in the incidence area. Local departments should formulate corresponding intervention measures, especially in high-clustering areas, to achieve accurate prevention and control of TB within the most effective time and scope.

The Impact of the Seasonal and Geographical Distribution of Tuberculosis in Sicily: A 6-Year Retrospective Study (2018-2023)

Background: Tuberculosis (TB) continues to be a major public health issue, with high mortality rates reported worldwide. It is worth noting that most of the hospitalizations for tuberculosis in the Sicilian region involve Italian-born individuals, underscoring the need to address this problem. Recent research on the geographic area and seasonality of infectious diseases, including tuberculosis, may aid in developing effective preventive measures. Objectives: This study aimed to evaluate the impact of the season and geographical area on tuberculosis disease prevalence in the Sicilian region. Methods: A retrospective study from January 2018 to May 2023 was conducted on patients with tuberculosis in the Sicilian region by analyzing computerized records on the Infectious Diseases Information System, currently named the Italian National Notification System (NSIS), of the Epidemiology Unit at Policlinico Paolo Giaccone University Hospital of Palermo and the Regional Reference Laboratory for Tuberculosis Surveillance and Control. Results: Eastern and Western Sicily were the geographical Sicilian areas with the highest frequency of patients with tuberculosis (52.2% and 42.6%, respectively). In comparison, Central Sicily had a significantly lower frequency of patients with tuberculosis (5.2%). Regarding the season, autumn was the season with the highest number of notification cases (28.9%), while spring was the season with the lowest frequency of patients with tuberculosis (19.7%). In autumn, we found significantly fewer patients with tuberculosis from Eastern Sicily (39.3%) and Central Sicily (1.5%), while Western Sicily had more patients with tuberculosis (59.3%). In spring, we found significantly more patients with tuberculosis from Eastern Sicily (64.1%), while Western and Central Sicily had significantly fewer patients with tuberculosis (23.9% and 12%, respectively). The presence of patients with tuberculosis did not significantly differ between geographical regions in summer and winter. Conclusions: Geographical area and seasonality significantly impact the distribution of tuberculosis cases in Sicily. These factors may be linked to different climatic conditions across the various geographical areas considered. Our findings suggest that climate can play a critical role in the spread of airborne infectious diseases, such as tuberculosis.

The associations of ambient fine particles with tuberculosis incidence and the modification effects of ambient temperature: A nationwide time-series study in China

Ambient fine particulate matter (PM2.5) is a major air pollutant that poses significant risks to human health. However, little is known about the association of PM2.5 with tuberculosis (TB) incidence, and whether temperature modifies the association.This study aimed to explore the association between ambient PM2.5 exposure and TB incidence in China and the modification effects of temperature. Weekly meteorological data, PM2.5 concentrations, and TB incidence numbers were collected for 22 cities across Mainland China, from 2011 to 2020. A quasi-Poisson regression with the distributed lag non-linear model was used to assess city-specific PM2.5-TB associations. A multivariate meta-regression model was then used to pool the city-specific effect estimates, at the national and regional levels. A J-shaped PM2.5-TB relationship was observed at the national level for China. Compared to those with minimum PM2.5-TB risk, people who were exposed to the highest PM2.5 concentrations had a 26 % (RR:1.26, 95 % confidence interval [CI]: 1.05, 1.52) higher risk for TB incidence. J-shaped PM2.5-TB associations were also observed for most sub-groups, however, no significant modifying effects were found. While a trend was observed between low temperatures and increased exposure-response associations, these results were not significant. Overall, approximately 20 % of TB cases in the 22 study cities, over the period 2011-2020, could be attributed to PM2.5 exposure. Strengthening the monitoring and emission control of PM2.5 could aid the prevention and control of TB incidence.

Tuberculosis epidemiological trend in Sousse, Tunisia during twenty years (2000-2019)

Describe the epidemiology of tuberculosis in the last two decades (2000-2019) in the East region of Tunisia (city of Sousse). This was a descriptive retrospective analysis of notified incident cases of tuberculosis from 2000 to 2019 in Sousse Governorate, Tunisia. The data collection was done via the regional registry of tuberculosis. Stata software was used to characterize the socio-demographic and clinical profile of tuberculosis, to calculate its incidence, mortality and fatality rates and to determine predictive factors of mortality. R software was used to analyze the chronological trend of tuberculosis incidence and mortality. A total of 2606 incident cases of tuberculosis were declared from 2000 to 2019 in Sousse. The mean age was 39 ± 19 years with a sex ratio (male/female) of 1.19. Only one case was HIV positive among the total 2606 incident cases. Extra-pulmonary tuberculosis was the most recorded (1,534 cases, 58.9%). The mean annual case notification and deaths were 130 and four respectively. After adjusting for confounders, individuals with pulmonary tuberculosis were 1.9 significantly more likely to die from tuberculosis compared to those suffering from extra-pulmonary tuberculosis. There was a trend of increasing mortality with increasing age. The association was statistically significant only for those above 60 years' old who had 12.5 times higher odds of dying compared to those below 60 years. After adjusting for age and gender, with every year there was an increase in the total incidence rate (+0.35 per 100,000) with p = 0.005 and in the extra-pulmonary incidence (+0.27 per 100,000), with p = 0.001. This study demonstrated the increasing trend of tuberculosis in Sousse, Tunisia from 2000 to 2019. The national program against tuberculosis should enhance community knowledge and centralize the national and regional epidemiological information for better epidemiological surveillance.

[Analysis of the seasonality of tuberculosis in Brazilian capitals and the Federal District from 2001 to 2019]

The literature has few studies on the seasonality of tuberculosis (TB) in the southern hemisphere, entailing the fill of this knowledge gap. This study aims to analyze whether TB incidence in Brazilian capitals and the Federal District is seasonal. This is an ecological study of a time series (2001-2019) of TB cases, conducted with 26 capitals and the Federal District. The Ministry of Health database, with 516,524 TB cases, was used. Capitals and the Federal District were divided into five groups based on social indicators, disease burden, and the Koppen climate classification. The seasonal variation of TB notifications and group amplitude were evaluated. We found TB seasonality in Brazil with a 1% significance in all capital groups (Stability assumption and Krusall-Wallis tests, p < 0.01). In the combined seasonality test, capital groups A, D, and E showed seasonality, whereas groups B and C, its probability. Our findings showed that health service supply and/or demand - rather than climate - may be the most relevant underlying factor in TB seasonality. It is challenging to raise the other seasonal factors underlying TB seasonality in tropical regions in the Southern Hemisphere.

Estimating the Effects of the COVID-19 Outbreak on the Reductions in Tuberculosis Cases and the Epidemiological Trends in China: A Causal Impact Analysis

Objective

COVID-19 may have a demonstrable influence on disease patterns. However, it remained unknown how tuberculosis (TB) epidemics are impacted by the COVID-19 outbreak. The purposes of this study are to evaluate the impacts of the COVID-19 outbreak on the decreases in the TB case notifications and to forecast the epidemiological trends in China.

Methods

The monthly TB incidents from January 2005 to December 2020 were taken. Then, we investigated the causal impacts of the COVID-19 pandemic on the TB case reductions using intervention analysis under the Bayesian structural time series (BSTS) method. Next, we split the observed values into different training and testing horizons to validate the forecasting performance of the BSTS method.

Results

The TB incidence was falling during 2005–2020, with an average annual percentage change of −3.186 (95% confidence interval [CI] −4.083 to −2.281), and showed a peak in March–April and a trough in January–February per year. The BSTS method assessed a monthly average reduction of 14% (95% CI 3.8% to 24%) in the TB case notifications from January–December 2020 owing to COVID-19 (probability of causal effect=99.684%, P=0.003), and this method generated a highly accurate forecast for all the testing horizons considering the small forecasting error rates and estimated a continued downward trend from 2021 to 2035 (annual percentage change =−2.869, 95% CI −3.056 to −2.681).

Conclusion

COVID-19 can cause medium- and longer-term consequences for the TB epidemics and the BSTS model has the potential to forecast the epidemiological trends of the TB incidence, which can be recommended as an automated application for public health policymaking in China. Considering the slow downward trend in the TB incidence, additional measures are required to accelerate the progress of the End TB Strategy.

Tension hydrothorax in a patient with SARS-CoV-2 pneumonitis and pleural Mycobacterium tuberculosis

Unilateral pleural effusions are uncommonly reported in patients with SARS-CoV-2 pneumonitis. Herein, we report a case of a 42-year-old woman who presented to hospital with worsening dyspnoea on a background of a 2-week history of typical SARS-CoV-2 symptoms. On admission to the emergency department, the patient was severely hypoxic and hypotensive. A chest radiograph demonstrated a large left-sided pleural effusion with associated contralateral mediastinal shift (tension hydrothorax) and typical SARS-CoV-2 changes within the right lung. She was treated with thoracocentesis in which 2 L of serosanguinous, lymphocyte-rich fluid was drained from the left lung pleura. Following incubation, the pleural aspirate sample tested positive for Mycobacterium tuberculosis. This case demonstrates the need to exclude non-SARS-CoV-2-related causes of pleural effusions, particularly when patients present in an atypical manner, that is, with tension hydrothorax. Given the non-specific symptomatology of SARS-CoV-2 pneumonitis, this case illustrates the importance of excluding other causes of respiratory distress.