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Dhafer Alshehri F, Mahmood Okal F, Baeshen SK, Alharbi ZG, Khojah O, Alhawsawi WK, Alamoudi S, Bahati A, Lary AI. Outcomes of central nervous system tuberculosis in Saudi Arabia: a multi-center study. Neurol Res 2024:1-11. [PMID: 38855923 DOI: 10.1080/01616412.2024.2359262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 05/19/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES Central nervous system tuberculosis (TB) (CNS-TB) can occur in several forms, including intracranial tuberculoma, tuberculous brain abscess, TB meningitis (TBM), and spinal TB. Early treatment can save lives and prevent severe neurological complications. This study aimed to describe the characteristics and post-treatment outcomes of patients with CNS-TB and identify factors associated with poor outcomes. To the best of our knowledge, this is the largest CNS-TB study till date published in Saudi Arabia. METHODS This retrospective cohort study included all patients diagnosed with CNS-TB in three tertiary centers in Saudi Arabia (King Abdulaziz Medical City in Jeddah, King Abdulaziz Medical City in Riyadh, and Al-Noor Specialist Hospital in Makkah) between 2009 and 2019. Data of patients' demographics, co-morbidities, presenting symptoms, type of CNS-TB, medical and surgical treatments, and outcome after completion of treatment were obtained from medical records. Treatment outcomes were categorized using the modified Rankin Scale for neurological disability. RESULTS A total of 140 participants were included in this study from 2009 to 2019. Good outcomes were achieved in approximately 65% of cases, whereas 35% had poor outcomes based on the modified Rankin Scale. Glasgow Coma Scale score ≤10 at presentation and TBM/tuberculoma were significantly associated with poor outcomes. Moreover, the use of corticosteroids, more than three anti-TB medications, and surgical interventions were not significantly associated with good or poor outcomes. DISCUSSION CNS-TB is associated with a high burden of long-term neurological morbidity. Early detection and treatment are crucial to prevent serious complications and decrease morbidity and mortality.
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Affiliation(s)
- Fayez Dhafer Alshehri
- Departemnt of Neuroscience, Section of Neurosurgery, King Abdul Aziz Medical City, Ministry of the National Guard Health Affairs, King Abdullah International Medical Research Center, King Abdul Aziz Medical City, Jeddah, Saudi Arabia
| | - Fahad Mahmood Okal
- Departemnt of Neuroscience, Section of Neurosurgery, King Abdul Aziz Medical City, Ministry of the National Guard Health Affairs, King Abdullah International Medical Research Center, King Abdul Aziz Medical City, Jeddah, Saudi Arabia
| | - Salem K Baeshen
- Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Zeyad G Alharbi
- Neurosurgery Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Osama Khojah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia
- Department of Ophthalmology, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Waseem K Alhawsawi
- Department of Dermatology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Saeed Alamoudi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia
- Department of Ophthalmology, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ammar Bahati
- Neurosurgery Section, Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed I Lary
- Departemnt of Neuroscience, Section of Neurosurgery, King Abdul Aziz Medical City, Ministry of the National Guard Health Affairs, King Abdullah International Medical Research Center, King Abdul Aziz Medical City, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Jawed A, Tharwani ZH, Siddiqui A, Masood W, Qamar K, Islam Z, Jawed A, Shah M, Adnan A, Essar MY, Rackimuthu S, Head MG. Better understanding extrapulmonary tuberculosis: A scoping review of public health impact in Pakistan, Afghanistan, India, and Bangladesh. Health Sci Rep 2023; 6:e1357. [PMID: 37359409 PMCID: PMC10287908 DOI: 10.1002/hsr2.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Background and Aims South Asian countries, including Pakistan, Afghanistan, India, and Bangladesh, have a high prevalence of pulmonary and extra-pulmonary tuberculosis (EPTB). This prevalence is influenced by various risk factors such as ethnicity, nutrition, socioeconomic disparities, high out-of-pocket healthcare expenses, and specific Mycobacterium Tuberculosis (TB) lineages. The COVID-19 pandemic has likely hindered access to healthcare and led to under-reporting of EPTB cases nationally and internationally. This rapid review aimed to summarize the literature on the prevalence and disease outcomes of EPTB in the mentioned countries, compare the situations across countries, and provide recommendations for future action. Methods The review utilized PubMed and Google Scholar databases to search for literature on EPTB in South Asian countries. The search string included keywords related to different forms of EPTB and the countries of interest while excluding pulmonary tuberculosis. Results The results showed that both TB, including drug-resistant TB, and EPTB are prevalent and burdensome in South Asia. In Pakistan, pleural TB was the most commonly reported form of EPTB, followed by lymph node TB, abdominal TB, osteoarticular TB, Central Nervous System TB, and miliary TB. In India, lymph node TB(LNTB) was more common among EPTB cases. Bangladesh reported a high prevalence of EPTB involving lymph node, pleura, and abdomen, while Afghanistan had a higher prevalence of forms such as LNTB and tuberculous meningitis. Conclusion In conclusion, the prevalence of EPTB in Pakistan, Afghanistan, India, and Bangladesh is alarmingly high and negatively impacts population health. Effective measures are needed for treatment and management of this condition, along with addressing current and future challenges. Strengthening the evidence base through surveillance and research is crucial to understand the patterns and significant factors related to EPTB, requiring investment in these areas.
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Affiliation(s)
- Areesha Jawed
- Department of MedicineDow Medical CollegeKarachiPakistan
| | | | | | - Waniyah Masood
- Department of MedicineDow Medical CollegeKarachiPakistan
| | - Khulud Qamar
- Department of MedicineDow Medical CollegeKarachiPakistan
| | - Zarmina Islam
- Department of MedicineDow Medical CollegeKarachiPakistan
| | - Aleeza Jawed
- The Ziauddin Medical UniversityKarachiSindhPakistan
| | - Muzhgan Shah
- Bolan University of Medical and Health SciencesQuettaPakistan
| | | | | | | | - Michael G. Head
- Clinical Informatics Research Unit, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
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Aljohaney AA. Real time endobronchial ultrasound transbronchial needle aspiration for the diagnosis of tuberculous intrathoracic lymphadenopathy: Saudi Arabian Western region experience. Saudi Med J 2023; 44:178-186. [PMID: 36773981 PMCID: PMC9987700 DOI: 10.15537/smj.2023.44.2.20220434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/19/2023] [Indexed: 02/13/2023] Open
Abstract
OBJECTIVES To assess the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for presumptive tuberculosis (TB) patients with intrathoracic enlarged lymph nodes in a country with low to moderate TB incidence. METHODS Thirty-one patients with clinical features of TB and intrathoracic lymphadenopathy, who had EBUS-TBNA sampling and final confirmation of intrathoracic TB lymphadenopathy, were retrospectively reviewed over an 8-year period. Routine clinical and laboratory evaluations including computerized tomography scans were performed before the EBUS-TBNA. Sociodemographic characteristics, clinical profile, pathological, and microbiological findings were collected. RESULTS The EBUS-TBNA confirmed TB diagnosis in 26 (83.9%) subjects with a consistent pathological finding or positive culture of Mycobacterium tuberculosis. Pathological analysis had findings consistent with TB in 25 (80.6%) patients. Culture of the EBUS-TBNA sample was positive for Mycobacterium tuberculosis in 12 (38.7%) patients. Other supportive investigations like purified protein derivative (PPD) skin test was positive in 28 (90.3%) participants. Overall, the sensitivity of the EBUS-TBNA alone was 83.9%. No complications were recorded during the procedure. The EBUS-TBNA aspirate culture positivity was significantly related to having a larger size lymph node (p=0.048) only, while PPD positivity was significantly related to baseline and clinical features of the participants. CONCLUSION The EBUS-TBNA demonstrated effective utility and safety in the evaluation and diagnosis of intrathoracic TB lymphadenopathy among individuals with compatible symptoms in a country with low-moderate TB-incidence.
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Affiliation(s)
- Ahmed A. Aljohaney
- From the Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Ahmed A. Aljohaney, Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-2905-2344
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Melki S, Mizouni G, Chebil D, Ben Abdelaziz A. Tuberculosis epidemiological trend in Sousse, Tunisia during twenty years (2000-2019). Libyan J Med 2022; 17:2003968. [PMID: 34802395 PMCID: PMC8635596 DOI: 10.1080/19932820.2021.2003968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/04/2021] [Indexed: 10/26/2022] Open
Abstract
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.
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Affiliation(s)
- Sarra Melki
- Resident of Preventive and Community Medicine, Information System Department, University Hospital of Sahloul, SousseTunisia
| | - Ghodhbani Mizouni
- Director of the Regional Directorate of Basic Healthcare, Sousse, Tunisia
| | - Dhekra Chebil
- Associate Professor of Community and Preventive Medicine, Hospital Hygiene Service, Kairouan University Hospital, Tunisia
| | - Ahmed Ben Abdelaziz
- Professor of Preventive and Community Medicine, Information System Department, University Hospital of Sahloul, Tunisia
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Ali ZA, Al-Obaidi MJ, Sameer FO, Mankhi AA, Misha'al KI, Jassim IA, Taqi EA, Ad'hiah AH. Epidemiological profile of tuberculosis in Iraq during 2011-2018. Indian J Tuberc 2022; 69:27-34. [PMID: 35074147 DOI: 10.1016/j.ijtb.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/10/2020] [Accepted: 01/14/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Tuberculosis (TB) is one of the most progressive infectious diseases caused by Mycobacterium tuberculosis. The pathogen is the first cause of mortality linked to a single pathogen worldwide, especially in poor and developing countries. METHODS A cross-sectional descriptive study was conducted to estimate incidence rate (IR) of TB in Iraq during a period of eight years (2011-2018). TB data were extracted from the computer system of the National Specialized Center for Chest and Respiratory Diseases in Baghdad. RESULTS During 2011-2018, 65,102 confirmed TB cases were reported in Iraq; 39,640 pulmonary TB (PTB) and 25,462 extra-pulmonary TB (EPTB). The average IR (case/100,000 inhabitants) of TB was 23.4 (14.2 for PTB and 9.1 for EPTB). Annual rate of TB cases showed a gradual decline over years (from 29.2 in 2011 to 18.6 in 2018). The decline in IR was more pronounced in PTB than EPTB. However PTB/EPTB ratio showed a gradual decreasing over years (from 2.04 in 2011 to 1.56 in 2018). GIS-mapping revealed that PTB and EPTB IRs show variations between the 18 governorates of Iraq. Most of the recorded PTB cases were new (average: 90.5%), followed by relapse cases (average: 7.9%). Among the reported PTB cases, percentage of males was greater than females (average: 52.1 vs. 47.9%), whereas an opposite trend was observed in EPTB (42.9 vs. 57.1%). The frequency distribution of PTB and EPTB varied between age groups, and lowest average frequency was recorded in age groups 1-4 and 5-14 year. CONCLUSIONS TB is still a public health threat, and although a declining trend in incidence was depicted over the years 2011-2018, the disease is still out of control in Iraq, and more investments of resource are necessitated to eliminate the disease. In this context, EPTB and PTB relapse need a recognized attention.
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Affiliation(s)
- Zainab A Ali
- Biotechnology Department, College of Science, University of Baghdad, Baghdad, Iraq
| | - Mohammed J Al-Obaidi
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq
| | - Fadhaa O Sameer
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq
| | - Ahmed A Mankhi
- National Specialized Center for Chest and Respiratory Diseases, Ministry of Health and Environment, Baghdad, Iraq
| | - Khawla I Misha'al
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq
| | - Iftikhar A Jassim
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq
| | - Estabraq A Taqi
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq
| | - Ali H Ad'hiah
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq.
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Alsharani F, Zafar M, Omar EO, Muzaheed. Lifestyle Risk Factors Associated with Tuberculosis Patients in Asir Region of Saudi Arabia. Int J Prev Med 2021; 12:89. [PMID: 34584655 PMCID: PMC8428305 DOI: 10.4103/ijpvm.ijpvm_211_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Tuberculosis remains to be a major public health problem. Lifestyle factors that have indirectly influence to the burden of tuberculosis. The aim of this study is to determine the lifestyle risk factors associated with tuberculosis patients in Asir region of KSA. Methods: We conducted a case-control study at the military hospital of Asir region of KSA. A total of 135 sample which is divided into 67 cases and 67 controls. Cases were included from hospital database between 2017 and 2018. Control were selected from patient attending the same hospital with respiratory disease other than tuberculosis. Data collection done through interview using a structured questionnaire. Lifestyle factors and socio-demographic factors associated with tuberculosis were analyzed using logistic regression. Results: Mean age of study participants (cases and control) are 38.04 ± 9.66 and 40.16 ± 7.72 respectively. Most important factors associated with tuberculosis patients are overweight and obese [OR = 4.40, 95% CI 1.27-15.25 and 2.38 (1.61-9.22)], Smoker [OR = 1.34, 95% CI 0.52-3.43], abnormal sleep at night (<8 hours) [OR = 5.03, 95% CI 1.57-16.10], blue color job worker [OR = 2.69, 95% CI 1.02-7.28], physical exercise <3 days/week [OR = 1.41, 95% CI 1.21-3.47]. Conclusions: In Saudi Arabia, a person's lifestyle and socioeconomic condition are associated with tuberculosis. Interventions focused on improving the quality of life through a reduction of risky lifestyle which prevent the spread of Tuberculosis in Saudi society and improve the efficiency of Saudi national tuberculosis control programme.
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Affiliation(s)
- Faisal Alsharani
- Department of Public Health, Military Hospital Asir Region, Dammam, KSA
| | - Mubashir Zafar
- Department of Family and Community Medicine, College of Medicine, University of Hail, Dammam, KSA
| | - Eltigani Osman Omar
- Department of Public Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Muzaheed
- Department of Clinical Laboratory Science, College of Applied Science, Imam Abdulrahman Bin Faisal University, Dammam, KSA
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de Oliveira MCB, Sant'Anna CC, Raggio RL, Kritski AL. Tuberculosis among children and adolescents in Rio de Janeiro, Brazil - Focus on extrapulmonary disease. Int J Infect Dis 2021; 105:105-112. [PMID: 33596481 DOI: 10.1016/j.ijid.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To compare the socio-demographic, clinical, and diagnostic characteristics and treatment outcomes between extrapulmonary tuberculosis (EPTB) and pulmonary tuberculosis (PTB) in children and adolescents in Rio de Janeiro, a high TB-burdened Brazilian city. METHODS This retrospective study used data from patients with EPTB and PTB aged 0 - 18 years, notified on two national databases from 2014 to 2016. RESULTS Among the 1008 patients, 144 (14.2%) had EPTB. Patients with EPTB showed higher odds of hospital-based diagnosis (odds ratio (OR): 6.76 [95% confidence interval (95% CI): 4.62-9.90]; p < 0.001), no laboratory confirmation (OR: 4.9 2.14 [95% CI: 3.07 - 7.85]; p < 0.001), and being <14 years old (OR: 3.13 [95% CI: 2.18-4.49]) than those with PTB. A diagnosis without laboratory investigation was observed among 301/864 (34.8%) patients with PTB, 48/144 (33.3%) with EPTB, and among those aged under five years with EPTB (15/27 [55.6%]). TB deaths were more frequent in patients with EPTB (5/144 [3.5%]) than in those with PTB (4/864[0.5%]) (p = 0.001); 4/5 (80%) TB deaths were due to TB meningitis; 50% died within 14 days of diagnosis. CONCLUSIONS EPTB remains a clinical diagnostic challenge that needs to be addressed to fully benefit from the higher sensitivity laboratory investigations.
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Affiliation(s)
| | - Clemax Couto Sant'Anna
- Pediatrics Department, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (RJ), Brazil.
| | - Ronir Luiz Raggio
- Federal University of Rio de Janeiro, Instituto de Estudos de Saúde Coletiva, Rio de Janeiro(RJ), Brazil.
| | - Afrânio Lineu Kritski
- Academic Program of Tuberculosis, School of Medicine, Institute of Torax Disease, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro (RJ), Brazil.
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Baghbanbashi S, Mousavi SMJ, Dabiri H, Hakemi-Vala M, Goudarzi H, Hamzehloo G, Amini S, Nasiri MJ. Rifampin resistance among individuals with extrapulmonary tuberculosis: 4 years of experience from a reference laboratory. New Microbes New Infect 2021; 40:100841. [PMID: 33664961 PMCID: PMC7897986 DOI: 10.1016/j.nmni.2021.100841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
Information is limited about the drug resistance patterns in extrapulmonary tuberculosis (EPTB) in Iran. This study aimed to determine the prevalence of EPTB and to investigate the drug-resistance pattern in Mycobacterium tuberculosis strains collected from extrapulmonary samples at the Tehran regional TB reference laboratory. Extrapulmonary specimens from individuals with suspected TB referred to the TB reference laboratories in five cities of Iran were collected. Both standard conventional methods (culture and direct smear microscopy) and Xpert MTB/RIF assay were used for the identification of mycobacteria. Drug susceptibility testing was done using Xpert MTB/RIF. The proportion method on Lowenstein–Jensen medium was performed for confirmation. Between 2016 and 2020, a total of 12 050 clinical specimens from individuals with suspected TB were collected, of which 10 380 (86%) were pulmonary specimens and 1670 (14%) were extrapulmonary. Of the extrapulmonary specimens, 85 (5.0%) were positive for M. tuberculosis, and the remaining 1585 (95.0%) samples were negative by standard methods. Of 85 M. tuberculosis isolates, drug susceptibility testing was performed for 32 isolates, of which 1 (3.1%, 95% CI 0.0%–9.4%) was rifampin resistant and 31 (96.9%, 95% CI 90.1%–100%) were pan-susceptible. The rifampin-resistant isolate was also resistant to isoniazid, so was assigned as a multidrug-resistant TB. Our study indicated the frequency of drug-resistance among EPTB in Iran. Establishing rapid diagnostic methods for detection of drug-resistance in EPTB, performing drug susceptibility testing for all EPTB cases to provide effective treatment, and continuous monitoring of drug resistance, are suggested for prevention and control of drug resistance in EPTB in Iran.
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Affiliation(s)
- S Baghbanbashi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Mohammad J Mousavi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Dabiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Hakemi-Vala
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - G Hamzehloo
- Regional Tuberculosis Reference Laboratory, Tehran University of Medical Sciences, Tehran, Iran
| | - S Amini
- Regional Tuberculosis Reference Laboratory, Tehran University of Medical Sciences, Tehran, Iran
| | - M J Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mokaddas E, Ahmad S, Eldeen H. Performance Comparison of GeneXpert MTB/RIF and ProbeTec ET Tests for Rapid Molecular Diagnosis of Extrapulmonary Tuberculosis in a Low TB/MDR-TB Incidence Country. Med Princ Pract 2021; 30:277-284. [PMID: 33592621 PMCID: PMC8280443 DOI: 10.1159/000515254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/15/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This study evaluated the performance of GeneXpert MTB/RIF (Xpert) and ProbeTec ET (PTec-ET) assays in diagnosing extrapulmonary tuberculosis (EPTB) in Kuwait. MATERIALS AND METHODS We tested nonrespiratory clinical specimens (n = 3,995) collected from 3,995 patients suspected to have EPTB. These included cavitary fluids (n = 2,054), fine-needle aspirate (FNA)/pus/tissue biopsy (n = 1,461), urine (n = 302), cerebrospinal fluid (CSF, n = 118), and others (n = 60). All specimens were processed for acid-fast bacilli (AFB), culture in mycobacteria growth indicator tube 960 system, and nucleic acid detection by Xpert and PTec-ET according to manufacturer's instructions. RESULTS Of 3,995 specimens, 95 were AFB-positive, 403 were culture-positive, and an additional 86 samples had histopathology suggestive of TB. Using culture as reference, the sensitivity and specificity values were 88.33 and 97.3% for Xpert and 72.95 and 97.80% for PTec-ET, respectively. Although performance of both tests was comparable in AFB-positive samples, Xpert detected significantly more cases in culture-positive samples. Among culture-negative samples, Xpert detected 18 more cases including 16 with histopathological evidence of TB. Lowest positivity was detected for both tests in cavitary fluids. Xpert performed better than PTec-ET in culture-positive FNA/pus/tissue biopsy and CSF samples. CONCLUSIONS Although performance of both tests was suboptimal for AFB-negative/culture-positive samples, Xpert performed better than PTec-ET and also detected more cases of AFB-negative/culture-negative/histopathology-positive samples. PTec-ET was positive in 3, while Xpert was positive in all 6 culture-positive CSF specimens for rapid diagnosis of TB meningitis. Xpert was thus superior to PTec-ET or smear microscopy in rapid diagnosis of EPTB.
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Affiliation(s)
- Eiman Mokaddas
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Kuwait National TB Control Laboratory, Shuwaikh, Kuwait
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- *Correspondence to: Suhail Ahmad,
| | - Hanaa Eldeen
- Kuwait National TB Control Laboratory, Shuwaikh, Kuwait
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Alateah SM, Othman MW, Ahmed M, Al Amro MS, Al Sherbini N, Ajlan HH. A retrospective study of tuberculosis prevalence amongst patients attending a tertiary hospital in Riyadh, Saudi Arabia. J Clin Tuberc Other Mycobact Dis 2020; 21:100185. [PMID: 33024839 PMCID: PMC7527716 DOI: 10.1016/j.jctube.2020.100185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB) is a public health challenge that affects all genders and age groups and is a single leading infectious disease killer globally. We retrospectively investigated the prevalence of TB and anti-TB drug resistance among patients treated at the Prince Sultan Military Medical City (PSMMC) between the years 2000 and 2017. Patient demographic variables and drug susceptibility test results were obtained from TB notification records located in the TB laboratory at PSMMC. A total of 58,141 records were reviewed of which 1123 (2%) specimens were positive for Mycobacterium tuberculosis. Of the positive, 621 (55%) were from pulmonary specimens. Males over the age of 15 years accounted for 60% of the positive specimens. Drug resistance to at least one drug was detected in 90 (8%) of which 60 (5.3%), 24 (2%) 6 (0.5%) patients were mono-drug-resistant, poly-drug resistant and multidrug resistant (MDR-TB) respectively. Resistance to isoniazid and streptomycin were the most frequently found among first-line tuberculosis drugs, accounting for 4.5% and 3.8% of drug resistance cases respectively. Our findings show low prevalence of tuberculosis and multidrug resistant TB among patients treated at PSMMC over a 17-year period. Nationwide assessment is needed to get a clear picture of the TB burden across Saudi Arabia and inform national policies for eradication of TB.
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Affiliation(s)
- Souad M Alateah
- Prince Sultan Military Medical City, Central Military Laboratory & Blood Bank, Microbiology Laboratory, Saudi Arabia
| | - Maha W Othman
- Prince Sultan Military Medical City, Central Military Laboratory & Blood Bank, Microbiology Laboratory, Saudi Arabia
| | - Medina Ahmed
- Prince Sultan Military Medical City, Central Military Laboratory & Blood Bank, Microbiology Laboratory, Saudi Arabia
| | - Mohammed S Al Amro
- Prince Sultan Military Medical City, Central Military Laboratory & Blood Bank, Saudi Arabia
| | - Nisreen Al Sherbini
- Prince Sultan Military Medical City, Infectious Diseases Department, Saudi Arabia
| | - Hisham H Ajlan
- Prince Sultan Military Medical City, Central Military Laboratory & Blood Bank, Microbiology Laboratory, Saudi Arabia
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11
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Shirzad-Aski H, Hamidi N, Sohrabi A, Abbasi A, Golsha R, Movahedi J. Incidence, risk factors and clinical characteristics of extra-pulmonary tuberculosis patients: a ten-year study in the North of Iran. Trop Med Int Health 2020; 25:1131-1139. [PMID: 32501638 DOI: 10.1111/tmi.13452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the incidence of extra-pulmonary tuberculosis (EPTB) and examine the risk factors and the clinical features of the disease over a ten-year period. METHODS Retrospective study of records of patients who were followed and registered in the TB registry programme in the health district of Gorgan, Iran from January 1, 2008, through December 31, 2017. RESULTS Among 2280 TB records, 609 (26.71%) were EPTB. They were mostly female patients (53.7%) and residents in rural areas (56.5%) with a mean age of 40.55 years [±16]. The average age of female patients (37.55 years [±16.99]) was lower than of male patients (44.07 years [±20.59]). The median of the incidence rate was 7.5 per 100 000 inhabitants for EPTB; biopsy and pathology were the best methods for the detection of EPTB. The most frequent forms of EPTB were lymphatic TB (193/609 = 31.7%) and pleural TB (158/609 = 25.9%). In most cases (245/609 = 40.2%), one to three months elapsed between occurrence of symptoms and final confirmation of EPTB. The outcome of EPTB was weaker than of pulmonary TB (PTB). CONCLUSION Our most important finding was the increasing incidence of EPTB, which shows the importance of attention to this disease. Lymph node and pleural tissue were the most commonly infected tissues. Skeletal TB presents a challenge in the diagnosis and treatment of EPTB.
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Affiliation(s)
| | - Niloofar Hamidi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ahmad Sohrabi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdollah Abbasi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Roghieh Golsha
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Jamileh Movahedi
- Tuberculosis laboratory of Health Care Center, Golestan University of Medical Sciences, Gorgan, Iran
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Alemu A, Yesuf A, Gebrehanna E, Zerihun B, Getu M, Worku T, Bitew ZW. Incidence and predictors of extrapulmonary tuberculosis among people living with Human Immunodeficiency Virus in Addis Ababa, Ethiopia: A retrospective cohort study. PLoS One 2020; 15:e0232426. [PMID: 32374773 PMCID: PMC7202654 DOI: 10.1371/journal.pone.0232426] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/14/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Extrapulmonary tuberculosis is an emerging public health problem among HIV positives compared to the general population. This study aimed to assess the incidence and predictors of extrapulmonary tuberculosis among people living with HIV in selected health facilities in Addis Ababa, Ethiopia, from 01 January 2013 up to 31 December 2018. METHODS A retrospective cohort study design was employed based on data collected from 566 HIV positive individuals. Data were entered using EpiInfo version 7.1 and analyzed by SPSS version 20. The incidence rate was determined per 100 person-years. Kaplan-Meier estimates used to estimate survivor and the hazard function, whereas log-rank tests used to compare survival curves and hazard across different categories. Cox proportional hazard model was used to identify the predictors and 95%CI of the hazard ratio were computed. P-value<0.05 in the multivariable analysis was considered statistically significant. RESULTS Five hundred sixty-six HIV positive individuals were followed for 2140.08 person-years. Among them, 72 developed extrapulmonary tuberculosis that gives an incidence rate of 3.36/100 person-years (95%CI = 2.68-4.22). The most frequent forms of extrapulmonary tuberculosis were; lymph node tuberculosis (56%, 41) followed equally by pleural tuberculosis (15%, 11) and disseminated tuberculosis (15%, 11). The majority (70.83%) of the cases occurred within the first year of follow-up. In multivariable Cox regression analysis, baseline WHO stage III/IV (AHR = 2.720, 95%CI = 1.575-4.697), baseline CD4 count<50cells/μl (AHR = 4.073, 95%CI = 2.064-8.040), baseline CD4 count 50-200 cells/μl (AHR = 2.360, 95%CI = 1.314-4.239) and baseline Hgb<10 mg/dl (AHR = 1.979, 95%CI = 1.091-3.591) were the independent risk factors. While isoniazid prophylaxis (AHR = 0.232, 95%CI = 0.095-0.565) and taking antiretroviral drugs (AHR = 0.134, 95%CI = 0.075-0.238) had a protective benefit. CONCLUSION Extrapulmonary tuberculosis co-infection was common among HIV positive individuals, and mostly occurred in those with advanced immune suppression. The risk decreases in those taking antiretroviral therapy and took isoniazid preventive treatment. Screening of HIV positives for extrapulmonary tuberculosis throughout their follow-up would be important.
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Affiliation(s)
- Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- * E-mail:
| | - Aman Yesuf
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ewenat Gebrehanna
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Melak Getu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Teshager Worku
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
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