High helminthic co-infection in tuberculosis patients with undernutritional status in northeastern Ethiopia

Immunological and Haematological Relevance of Helminths and Mycobacterium tuberculosis Complex Coinfection among Newly Diagnosed Pulmonary Tuberculosis Patients from Bobo-Dioulasso, Burkina Faso

The effect of helminthiasis on host immunity is a neglected area of research, particularly in tuberculosis (TB) infection. This study aimed to evaluate the effect of helminthiasis on immunological and haematological parameters in newly diagnosed TB patients in Bobo-Dioulasso. After all biological analyses, we formed three subpopulations: group 1 (n = 82), as control, were participants without helminthic or Mycobacterium tuberculosis complex infection (Mtb-/Helm-), group 2 (n = 73) were TB patients without helminthic infection (Mtb+/Helm-), and group 3 (n = 22) were TB patients with helminthic infection (Mtb+/Helm+). The proportion of helminth coinfection was 23.16% (22/95) in TB patients, and Schistosoma mansoni infection was found in 77.3% (17/22) cases of helminthiasis observed in this study. A low CD4 T cell count and a low CD4:CD8 ratio were significantly associated with concomitant infection with helminths and the Mtb complex (Mtb+/Helm+) compared to the other groups (p < 0.05). However, there was no statistically significant difference in the CD8 median among the three participating groups (p > 0.05). Lymphopenia, monocytosis, thrombocytosis, and hypochromic microcytic anaemia were the haematological defects observed in the Mtb+/Helm+ and Mtb+/Helm- patients. Exploring these types of immune-haematological biomarkers would be a valuable aid in diagnosing and a better follow-up and monitoring of the tuberculosis-helminthiasis coinfection.

Deciphering drug discovery and microbial pathogenesis research in tuberculosis during the two decades of postgenomic era using entity mining approach

We examined literature on Mycobacterium tuberculosis (Mtb) subsequent to its genome release, spanning years 1999-2020. We employed scientometric mapping, entity mining, visualization techniques, and PubMed and PubTator databases. Most popular keywords, most active research groups, and growth in quantity of publications were determined. By gathering annotations from the PubTator, we determined direction of research in the areas of drug hypersensitivity, drug resistance (AMR), and drug-related side effects. Additionally, we examined the patterns in research on Mtb metabolism and various forms of tuberculosis, including skin, brain, pulmonary, extrapulmonary, and latent tuberculosis. We discovered that 2011 had the highest annual growth rate of publications, at 19.94%. The USA leads the world in publications with 18,038, followed by China with 14,441, and India with 12,158 publications. Studies on isoniazid and rifampicin resistance showed an enormous increase. Non-tuberculous mycobacteria also been the subject of more research in effort to better understand Mtb physiology and as model organisms. Researchers also looked at co-infections like leprosy, hepatitis, plasmodium, HIV, and other opportunistic infections. Host perspectives like immune response, hypoxia, and reactive oxygen species, as well as comorbidities like arthritis, cancer, diabetes, and kidney disease etc. were also looked at. Symptomatic aspects like fever, coughing, and weight loss were also investigated. Vitamin D has gained popularity as a supplement during illness recovery, however, the interest of researchers declined off late. We delineated dominant researchers, journals, institutions, and leading nations globally, which is crucial for aligning ongoing and evolving landscape of TB research efforts. Recognising the dominant patterns offers important information about the areas of focus for current research, allowing biomedical scientists, clinicians, and organizations to strategically coordinate their efforts with the changing priorities in the field of tuberculosis research.

Prevalence and Clinical Relevance of Schistosoma mansoni Co-Infection with Mycobacterium tuberculosis: A Systematic Literature Review

Tuberculosis disease stands for the second leading cause of death worldwide after COVID-19, most active tuberculosis cases result from the reactivation of latent TB infection through impairment of immune response. Several factors are known to sustain that process. Schistosoma mansoni, a parasite of the helminth genus that possesses switching power from an immune profile type Th1 to Th2 that favors reactivation of latent TB bacteria. The aim of the study was to assess the prevalence of the co-infection between the two endemic infections. Systematic literature was contacted at the University Clinical Research Center at the University of Sciences, Techniques, and Technologies of Bamako in Mali. Original articles were included, and full texts were reviewed to assess the prevalence and better understand the immunological changes that occur during the co-infection. In total, 3530 original articles were retrieved through database search, 53 were included in the qualitative analysis, and data from 10 were included in the meta-analysis. Prevalence of the co-infection ranged from 4% to 34% in the literature. Most of the articles reported that immunity against infection with helminth parasite and more specifically Schistosoma mansoni infection enhances latent TB reactivation through Th1/Th2. In sum, the impact of Schistosoma mansoni co-infection with Mycobacterium tuberculosis is under-investigated. Understanding the role of this endemic tropical parasite as a contributing factor to TB epidemiology and burden could help integrate its elimination as one of the strategies to achieve the END-TB objectives by the year 2035.

A Wriggly Problem of Cervix

Case Summary

A 27 years old female presented to gynae OPD with foul smelling discharge per vaginum off and on for a year and was given treatment for PID (Pelvic inflammatory disease) and cervicitis. Pap smear was taken and was reported unsatisfactory due to inflammation. Colposcopy was planned later due to her bothersome complaints and suspicious looking cervix. A white worm popped out of cervix while doing colposcopy which turned out to be Trichuris trichiura. Deworming was done for the patient and her family members. Patient reported again with similar complaints and this time colposcopy and guided biopsy was done that showed Tubercular Granulomatous cervicitis hence, she was put on category I ATT (Anti-tubercular treatment) that relieved her symptoms and improved cervical findings.

Conclusion

People living in tropical and subtropical areas are at highest risk of infection by T. trichiura. This is the first case of T. trichiura in ectopic location and first case of a live worm found in female genital tract. Previous studies have shown that helminthic infection can reactivate latent TB and aggravate the disease expression.

Malnutrition assessment methods in adult patients with tuberculosis: a systematic review

OBJECTIVES

Malnutrition is associated with a twofold higher risk of dying in patients with tuberculosis (TB) and considered an important potentially reversible risk factor for failure of TB treatment. The construct of malnutrition has three domains: intake or uptake of nutrition; body composition and physical and cognitive function. The objectives of this systematic review are to identify malnutrition assessment methods, and to quantify how malnutrition assessment methods capture the international consensus definition for malnutrition, in patients with TB.

DESIGN

Different assessment methods were identified. We determined the extent of capturing of the three domains of malnutrition, that is, intake or uptake of nutrition, body composition and physical and cognitive function.

RESULTS

Seventeen malnutrition assessment methods were identified in 69 included studies. In 53/69 (77%) of studies, body mass index was used as the only malnutrition assessment method. Three out of 69 studies (4%) used a method that captured all three domains of malnutrition.

CONCLUSIONS

Our study focused on published articles. Implementation of new criteria takes time, which may take longer than the period covered by this review. Most patients with TB are assessed for only one aspect of the conceptual definition of malnutrition. The use of international consensus criteria is recommended to establish uniform diagnostics and treatment of malnutrition.

PROSPERO REGISTRATION NUMBER

CRD42019122832.

Factor Associated with Underweight among People with Tuberculosis

Background: The relationship between Tuberculosis (TB) and nutritional status is a significant one. Patients with TB who are underweight face a higher risk of death. Purpose: This research aims to analyze the factors related to the occurrence of being underweight among TB patients at the Public Health Center (PHC) in Perak Timur, Surabaya. Method: This was an analytical observational study and used a cross-sectional design. The sample for this research was 41 respondents, who were TB patients and were undergoing treatment at the PHC in Perak Timur, Surabaya. Data collection was done from March 2020 to June 2020. Primary data was collected by conducting interviews using a questionnaire. Data analysis was performed using a chi-square test. Results: The results indicated that, out of the 41 respondents, there were 21 respondents who were underweight (51.22%). Descriptively, underweight TB patients were more likely to be in the intensive phase of treatment (90%), have a low income (56.76%), have a low education status (65.38%), and be unemployed (59.38%), with PR=0.43 and 95%CI=0.76–9.38. The results of this research indicated a link between the treatment phase and TB patients being underweight (p=0.01; PR=2.33; 95% CI=1.43–3.79), the level of education attained by underweight TB patients (p=0.04; PR=0.41; 95% CI=0.17–0.99), and the income of underweight TB patients (p=0.04; PR=0.43; 95%CI=0.30–0.63). The results of this research indicated that there was a correlation between the work status and TB patients being underweight (p=0.07; PR=2.67; 95%CI=0.76–9.38). Conclusion: The treatment phase, education level and income are significantly related to TB patients being underweight.

Intestinal parasites co-infection among tuberculosis patients in Ethiopia: a systematic review and meta-analysis

Background

Tuberculosis and intestinal parasites are mostly affecting poor people. They are in a vicious since one is the risk factor for the other. However, the comprehensive report on the burden and co-incidence of intestinal parasites and tuberculosis in Ethiopia is scant. This systematic review and meta-analysis aimed to provide abridge conclusive evidence on the intestinal parasite-tuberculosis co-infection in Ethiopia.

Methods

A total of 414 articles published in English were searched from both electronic databases (CINAHL, DOAJ, Embase, Emcare, Medline, ProQuest, and PubMed, Science Direct, and Web of Science) and other sources. The qualities of the included studies were assessed using the Joanna Briggs Institute Critical Appraisal tools and the publication bias was measured using the funnel plot and Eggers regression test. Comprehensive meta-analysis (CMA) Version 3.3.07 and Review Manager software were used to estimate pooled prevalence and associations of intestinal parasites and tuberculosis infection.

Results

Eleven articles with a total of 3158 tuberculosis patients included in the analysis based on the eligibility criteria. The estimated pooled prevalence of intestinal parasites co-infection was 33% (95% CI: 23.3, 44.3) using the random-effects model. The most common intestinal parasites were Ascaris lumbricoides 10.5% (95% CI: 6.0, 17.5), Hookworm 9.5% (95% CI: 6.10, 14.4), Giardia lamblia 5.7% (95% CI: 2.90, 10.9) and Strongyloides sterocoralis 5.6% (95% CI: 3.3, 9.5). The odds of intestinal parasites infection was higher among tuberculosis patients compared to tuberculosis free individuals (OR = 1.76; 95% CI: 1.17, 2.63). A significant difference was observed among TB patients for infection with intestinal helminths (OR = 2.01; 95% CI: 1.07, 3.80) but not for intestinal protozoans when compared with their counterparts. The odds of multiple parasitic infections was higher among tuberculosis patients (OR = 2.59, 95% CI: 1.90, 3.55) compared to tuberculosis free individuals. However, intestinal parasites co-infection was not associated with HIV status among tuberculosis patients (OR = 0.97; 95% CI: 0.71, 1.32).

Conclusion

One-third of tuberculosis patients are co-infected with one or more intestinal parasites, and they are more likely to be infected with intestinal helminths and multiple intestinal parasitic infections compared to TB free individuals. We recommend routine screening of tuberculosis patients for intestinal parasites. The effect of mass deworming on tuberculosis incidence would be important to be considered in future researches.

Trial registration

Registered on PROSPERO with reference number ID: CRD42019135350.