Co-infection and risk factors of tuberculosis in a Mexican HIV+ population

Whole genomic sequencing as a tool for diagnosis of drug and multidrug-resistance tuberculosis in an endemic region in Mexico

Background

Whole genome sequencing (WGS) has been proposed as a tool for diagnosing drug resistance in tuberculosis. However, reports of its effectiveness in endemic countries with important numbers of drug resistance are scarce. The goal of this study was to evaluate the effectiveness of this procedure in isolates from a tuberculosis endemic region in Mexico.

Methods

WGS analysis was performed in 81 tuberculosis positive clinical isolates with a known phenotypic profile of resistance against first-line drugs (isoniazid, rifampin, ethambutol, pyrazinamide and streptomycin). Mutations related to drug resistance were identified for each isolate; drug resistant genotypes were predicted and compared with the phenotypic profile. Genotypes and transmission clusters based on genetic distances were also characterized.

Findings

Prediction by WGS analysis of resistance against isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin showed sensitivity values of 84%, 96%, 71%, 75% and 29%, while specificity values were 100%, 94%, 90%, 90% and 98%, respectively. Prediction of multidrug resistance showed a sensitivity of 89% and specificity of 97%. Moreover, WGS analysis revealed polymorphisms related to second-line drug resistance, enabling classification of eight and two clinical isolates as pre- and extreme drug-resistant cases, respectively. Lastly, four lineages were identified in the population (L1, L2, L3 and L4). The most frequent of these was L4, which included 90% (77) of the isolates. Six transmission clusters were identified; the most frequent was TC6, which included 13 isolates with a L4.1.1 and a predominantly multidrug-resistant condition.

Conclusions

The results illustrate the utility of WGS for establishing the potential for prediction of resistance against first and second line drugs in isolates of tuberculosis from the region. They also demonstrate the feasibility of this procedure for use as a tool to support the epidemiological surveillance of drug- and multidrug-resistant tuberculosis.

Social determinants of pulmonary tuberculosis in Brazil: an ecological study

Background

Social determinants may influence the incidence and control of tuberculosis (TB). The aim of this study was to evaluate the correlation between social determinants and pulmonary TB (PTB) incidence and treatment outcomes in different regions in Brazil.

Methods

In this ecological study, PTB incidence and treatment outcome rates as well as HIV incidence for all 5560 Brazilian cities as reported to the Brazilian Tuberculosis Program in 2010 were correlated with two social indicators, the Human Development Index (HDI) and Gini Index (GI). Cities were stratified into six groups based on location (metropolitan region or not) and size (small, medium, and large cities), and according to the regions of the country to which they belong. The Spearman correlation coefficient was used to assess the association between variables.

Results

In 2010, 68,729 new PTB cases were reported in Brazil, with an incidence rate of 36 cases per 100,000 inhabitants. Incidence rates and PTB mortality demonstrated a weak negative correlation with HDI and a positive correlation with GI. The correlation between HDI and GI with cure, relapse, and lost to follow-up of treatment greatly varied in the different groups of cities and regions of the country evaluated.

Conclusions

There is a weak correlation between HDI and GI and PTB incidence and mortality rate. However, there is great variation between the HDI and GI and cure, relapse, and lost to follow-up in the different groups of cities and regions of the country. This suggests that for TB determination, these outcome variables might be more related to the quality of healthcare provided by services than to social determinants in the general population.

[Access to diagnosis of tuberculosis in Brazilian medium-sized municipality]

OBJETIVO

Evaluating access to tuberculosis diagnosis, from the perspective of patients.

METHODS

Cross-sectional study with 108 tuberculosis patients. Data were collected using the brazilian instrument Primary Care Assessment Tool - PCAT-Brazil, adapted for attention to tuberculosis, including socio-economic and demographic indicators, location of diagnosis and diagnostic access tuberculosis. The analysis of the data was of frequency, average, standard deviation, confidence interval and Chi-square test.

RESULTS

Most cases were diagnosed in hospitals (52.8%). The patient sought the Health Unit on average three times until receiving medical care. The indicators of difficulty of displacement, expenditure on motorized transport and consultation within 24 hours to discover the disease were not satisfactory and regular. The chi-square test showed a statistical association between diagnosis location and seeking the nearest health unit from home.

CONCLUSIONS

There are weaknesses in the early diagnosis of tuberculosis in primary care. There are many challenges to be faced to strengthen this level of health care, with organizational capacity to overcome the shortcomings related to the patient and the service that make it difficult to access the diagnosis of the disease.

Integrating tuberculosis screening in Kenyan Prevention of Mother-To-Child Transmission programs

BACKGROUND

Tuberculosis (TB) screening in Prevention of Mother-To-Child Transmission (PMTCT) programs is important to improve TB detection, prevention and treatment.

METHODS

As part of a national PMTCT program evaluation, mother-infant pairs attending 6-week and 9-month immunization visits were enrolled at 141 maternal and child health clinics throughout Kenya. Clinics were selected using population-proportion-to-size sampling with oversampling in a high human immunodeficiency virus (HIV) prevalence region. The World Health Organization (WHO) TB symptom screen was administered to HIV-infected mothers, and associations with infant cofactors were determined.

RESULTS

Among 498 HIV-infected mothers, 165 (33%) had a positive TB symptom screen. Positive maternal TB symptom screen was associated with prior TB (P = 0.04). Women with a positive TB symptom screen were more likely to have an infant with HIV infection (P = 0.02) and non-specific TB symptoms, including cough (P = 0.003), fever (P = 0.05), and difficulty breathing (P = 0.01). TB exposure was reported by 11% of the women, and 15% of the TB-exposed women received isoniazid preventive therapy.

CONCLUSIONS

Postpartum HIV-infected mothers frequently had a positive TB symptom screen. Mothers with a positive TB symptom screen were more likely to have infants with HIV or non-specific TB symptoms. Integration of maternal TB screening and prevention into PMTCT programs may improve maternal and infant outcomes.

Risk factors for developing active tuberculosis after the treatment of latent tuberculosis in adults infected with human immunodeficiency virus

Tuberculosis is the leading cause of death among adults infected with human immunodeficiency virus (HIV), and rates of tuberculosis remain high even after preventive therapy. Among 908 HIV-infected adults in a trial of preventive treatment, we found self-reported alcohol consumption, low baseline CD4 count, high baseline viral load, and tuberculin skin test size >15 mm as independent risk factors for incident tuberculosis.

Clinical and epidemiological profile and prevalence of tuberculosis/HIV co-infection in a regional health district in the state of Maranhão, Brazil

OBJECTIVE

To describe the clinical and epidemiological profile, as well as the prevalence, of tuberculosis/HIV co-infection in the Regional Health District of Tocantins, which serves 14 cities in the state of Maranhão, Brazil.

METHODS

This was a descriptive epidemiological study based on secondary data obtained from individual tuberculosis reporting forms in the Brazilian Case Registry Database. We included all reported cases of tuberculosis/HIV co-infection, by city, between January of 2001 and December of 2010.

RESULTS

In the district, 1,746 cases of tuberculosis were reported. Of those tested for HIV, 100 had positive results, which corresponded to a tuberculosis/HIV co-infection prevalence of 39%. Of the co-infected patients, 79% were male, 42% were Mulatto, and 64% were in the 20- to 40-year age bracket, 31% had had < 4 years of schooling, and 88% resided in the city of Imperatriz. Cases of pulmonary tuberculosis and new cases of tuberculosis predominated (in 87% and 73%, respectively). Of the co-infected patients, 27% had positive sputum smear microscopy results, and 89% had chest X-ray findings suggestive of tuberculosis. Sputum culture was performed in only 7% of the cases.

CONCLUSIONS

Our results show that, because of its clinical and epidemiological profile, tuberculosis/HIV co-infection is still a major public health problem in the southwestern region of Maranhão. This situation calls for better coordination between tuberculosis and sexually transmitted disease/AIDS control programs, as well as a political commitment and greater involvement on the part of administrators and health care professionals in the planning of interventions and the functioning of health care facilities.

Quality of life aspects of patients with HIV/tuberculosis co-infection

AIM: To investigate the quality of life of patients with HIV and tuberculosis co-infection and grasping the changes imposed in order to live with both transmissible diseases simultaneously. METHODS: Qualitative-quantitative research, undertaken at a specialized outpatient clinic in Fortaleza, Brazil, between 2009 and 2010, involving 34 co-infected patients. For data collection, a quality of life scale called HAT-QoL was used, which consists of 42 items, as well as open questions to perceive the changes the disease causes. RESULTS: Most participants suffered from pulmonary tuberculosis, were male and their education level was low. Quality of life was impaired in those domains related to economic, sexual and secrecy issues. It was also evidenced that the co-infection imposes changes in daily life that underline and further harm quality of life. CONCLUSION: Experiencing co-infection, despite appropriate treatment, causes changes in the patients' lives, whose repercussions can be mitigated through health-promoting interventions.