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Romaszko-Wojtowicz A, Malinowska E, Doboszyńska A. Unmasking Pott Disease: A Diagnostic Challenge Mimicking Metastatic Lung Cancer - A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943578. [PMID: 39118308 PMCID: PMC11330941 DOI: 10.12659/ajcr.943578] [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: 12/21/2024] [Revised: 07/03/2024] [Accepted: 06/04/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Tuberculosis spondylitis, also known as Pott disease, is a rare form of the ancient infectious disease tuberculosis. It bears a complex clinical and radiological profile, often necessitating an extensive differential diagnostic approach for accurate identification. The disease was named in honor of the first diagnosed patient, highlighting its historical significance. CASE REPORT We report a case involving a 69-year-old male initially admitted to the Pulmonology Department under the suspicion of a left lung tumor, as indicated by a chest X-ray. A subsequent CT scan revealed a tumor-hilar mass, enlarged subcarineal lymph nodes, and a pathological mass at the C6/C7 vertebral level. Despite negative tuberculosis tests, the patient was misdiagnosed with disseminated lung cancer with spinal metastases. Following radiotherapy targeting the cervical and thoracic spine, the definitive diagnosis of spinal tuberculosis was confirmed via histopathological examination from an open biopsy of the C6 and C7 vertebrae. CONCLUSIONS Tuberculosis can present with an insidious and misleading clinical picture, often mimicking other diseases such as cancer. Early and accurate diagnostic processes are crucial for effective treatment. This case underscores the importance of considering tuberculosis in the differential diagnosis, especially when clinical presentations are ambiguous.
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Mohan M, Thangaraj JWV, Pandey S, Sri Lakshmi Priya G, Arunachalam S, Sharma R, Shewade HD, Aishwarya B, Afeeq K, Khatoon A, Gokulvijay B, Sireesha G, Chandra K, Nandhakumar S, Samuel P, Nanditha Viswanathan C, Shanmugasundaram D, Rao R, Murhekar MV, Jeyashree K. Need for operational simplicity and timely disbursal of benefits-a qualitative exploration of the implementation of a direct benefit transfer scheme for persons with tuberculosis in India. Infect Dis Poverty 2024; 13:36. [PMID: 38783334 PMCID: PMC11112885 DOI: 10.1186/s40249-024-01206-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Ni-kshay Poshan Yojana (NPY) is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB (PwTB). Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states, reported a 70% coverage and high median delay in benefit credit. We undertook a qualitative study between January and July 2023, to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY scheme. METHODS We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources. We conducted 36 in-depth interviews of national, district and field-level staff of the National Tuberculosis Elimination Programme (NTEP) and NPY beneficiaries from 30 districts across nine states of India, selected using theoretical sampling. An analytical framework developed through inductive coding of a set of six interviews, guided the coding of the subsequent interviews. Categories and themes emerged through constant comparison and the data collection continued until theoretical saturation. RESULTS Stakeholders perceived NPY as a beneficial initiative. Strong political commitment from the state administration, mainstreaming of NTEP work with the district public healthcare delivery system, availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation. However, the complex, multi-level benefit approval process, difficulties in accessing banking services, perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and utilization. CONCLUSION The optimal utilization of NPY is enabled by strong political commitment and challenged by its lengthy implementation process and delayed disbursal of benefits. We recommend greater operational simplicity in NPY implementation, integrating NTEP activities with the public health system to reduce the burden on the program staff, and revising the benefit amount more equitably.
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Affiliation(s)
- Malu Mohan
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Jeromie W V Thangaraj
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sumit Pandey
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - G Sri Lakshmi Priya
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | | | - Rahul Sharma
- TB Support Network, WHO Country Office for India, New Delhi, India
| | - Hemant Deepak Shewade
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - B Aishwarya
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - K Afeeq
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Afsana Khatoon
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - B Gokulvijay
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Gude Sireesha
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Kavita Chandra
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - S Nandhakumar
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Prince Samuel
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - C Nanditha Viswanathan
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Devika Shanmugasundaram
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Raghuram Rao
- Central Tuberculosis Division, Government of India, New Delhi, India
| | - Manoj V Murhekar
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Kathiresan Jeyashree
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India.
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Izudi J, Bajunirwe F, Cattamanchi A. Negative effects of undernutrition on sputum smear conversion and treatment success among retreatment cases in Uganda: A quasi-experimental study. J Clin Tuberc Other Mycobact Dis 2024; 35:100422. [PMID: 38434999 PMCID: PMC10907175 DOI: 10.1016/j.jctube.2024.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Rationale The causal relationship between undernutrition and response to anti-tuberculosis (TB) treatment and TB treatment outcomes among people with retreatment TB is understudied. Objective To evaluate the effect of undernutrition on treatment success and sputum smear conversion among people with retreatment drug-susceptible TB in Kampala, Uganda. Methods We conducted a quasi-experimental study utilizing propensity score weighting among people with retreatment drug-susceptible TB aged ≥ 15 years treated between 2012 and 2022 in Kampala. The primary exposure was undernutrition assessed using the mid-upper arm circumference at the time of TB diagnosis. The primary outcome was treatment success defined as cure or treatment completion at month 6. Sputum smear conversion was the secondary outcome and was measured as a change in sputum smear status from positive to negative at months 2, 5, and 6. We estimated the causal effect of undernutrition on the outcomes using a propensity-score weighted modified Poisson regression model with robust error variance. Measurements and main results Of the 605 participants, 432 (71.4 %) were male, 215 (35.5 %) were aged 25-34 years, 427 (70.6 %) had bacteriologically confirmed pulmonary TB, 133 (22.0 %) were undernourished and 398 (65.8 %) achieved treatment success. Of participants with bacteriologically confirmed pulmonary TB, 232 (59.0 %), 327 (59.3 %), and 360 (97.6 %) achieved sputum smear conversion at months 2, 5, and 6, respectively. Undernutrition reduced treatment success (RR 0.42, 95 % CI 0.32-0.55) as well as sputum smear conversion at months 2 (RR 0.45, 95 % CI 0.42-0.49) and 5 (RR 0.46, 95 % CI 0.43-0.51) but not month 6 (RR 0.99, 95 % CI 0.97-1.02). Conclusion Undernutrition negatively impacts treatment outcomes. Therefore, nutritional assessment should be an integral component of TB care, with nutritional counseling and support offered to those undernourished to optimize their TB treatment response and outcomes.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adithya Cattamanchi
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA, USA
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
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Iswanti FC, Handayani KM, Kusumaningrum A, Yamazaki T, Handayani D, Sadikin M. Lysosomal enzymes and the oxygen burst capability of monocyte-derived macrophages in active drug-resistant tuberculosis patients in relation to cell attachment. Tuberculosis (Edinb) 2024; 146:102498. [PMID: 38461765 DOI: 10.1016/j.tube.2024.102498] [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: 09/20/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 03/12/2024]
Abstract
Drug resistance to tuberculosis (TB) has become an obstacle in eliminating tuberculosis. The transmission of drug-resistant TB from patients increases the incidence of primary drug-resistant (DR) TB in individuals who are in close contact. Therefore, it is necessary to incorporate an immunological approach into preventive therapy. This study focuses on the activity of lysosomal enzymes, oxygen bursts, and the attachment ability of macrophages among individuals diagnosed with active drug-resistant TB compared with close contacts with latent TB or healthy cases. We measured macrophage oxygen burst ability (Water-soluble tetrazolium salt (WST) test, Nitric Oxide production, and myeloperoxidase activity) and the degradative ability of lysosomes (activity of the β-glucuronidase and acid phosphatase enzymes). Six active DR-TB patients and 18 close-contact cases (8 Latent Tuberculosis Infection (LTBI); 10 healthy) were recruited at Universitas Indonesia Hospital. The macrophage attachment of the LTBI group was higher than in the other groups. NO production, myeloperoxidase activity, β-glucuronidase, and acid phosphatase were higher in the active DR-TB group. A negative correlation was uncovered between phagocytosis and NO production, myeloperoxidase activity, and lysosomal enzymes. The difference in macrophage function is expected to be a further reference in active DR-TB treatment or preventive therapy.
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Affiliation(s)
- Febriana Catur Iswanti
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Indonesia, 10430, Indonesia; Center of Hypoxia and Oxidative Stress Studies, Indonesia.
| | - Kurnia Maidarmi Handayani
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, 10430, Indonesia; Faculty of Medicine, Universitas Baiturrahmah, 25172, Indonesia.
| | - Ardiana Kusumaningrum
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia, Universitas Indonesia Hospital, 10430, Indonesia.
| | - Tomohiko Yamazaki
- Research Center for Macromolecules and Biomaterials, National Institute for Materials Science (NIMS), Tsukuba, 305-0047, Ibaraki, Japan.
| | - Diah Handayani
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Universitas Indonesia Hospital, 10430, Indonesia.
| | - Mohamad Sadikin
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Indonesia, 10430, Indonesia; Center of Hypoxia and Oxidative Stress Studies, Indonesia.
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Lajore BA, Aweke YH, Ayanto SY, Ayele M. Exploring health care providers' engagement in prevention and management of multidrug resistant Tuberculosis and its factors in Hadiya Zone health care facilities: qualitative study. BMC Health Serv Res 2024; 24:542. [PMID: 38678263 PMCID: PMC11056065 DOI: 10.1186/s12913-024-10911-6] [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: 02/27/2023] [Accepted: 03/27/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Engagement of healthcare providers is one of the World Health Organization strategies devised for prevention and provision of patient centered care for multidrug resistant tuberculosis. The need for current research question rose because of the gaps in evidence on health professional's engagement and its factors in multidrug resistant tuberculosis service delivery as per the protocol in the prevention and management of multidrug resistant tuberculosis. PURPOSE The purpose of this study was to explore the level of health care providers' engagement in multidrug resistant tuberculosis prevention and management and influencing factors in Hadiya Zone health facilities, Southern Ethiopia. METHODS Descriptive phenomenological qualitative study design was employed between 02 May and 09 May, 2019. We conducted a key informant interview and focus group discussions using purposely selected healthcare experts working as directly observed treatment short course providers in multidrug resistant tuberculosis treatment initiation centers, program managers, and focal persons. Verbatim transcripts were translated to English and exported to open code 4.02 for line-by-line coding and categorization of meanings into same emergent themes. Thematic analysis was conducted based on predefined themes for multidrug resistant tuberculosis prevention and management and core findings under each theme were supported by domain summaries in our final interpretation of the results. To maintain the rigors, Lincoln and Guba's parallel quality criteria of trustworthiness was used particularly, credibility, dependability, transferability, confirmability and reflexivity. RESULTS Total of 26 service providers, program managers, and focal persons were participated through four focus group discussion and five key informant interviews. The study explored factors for engagement of health care providers in the prevention and management of multidrug resistant tuberculosis in five emergent themes such as patients' causes, perceived susceptibility, seeking support, professional incompetence and poor linkage of the health care facilities. Our findings also suggest that service providers require additional training, particularly in programmatic management of drug-resistant tuberculosis. CONCLUSION The study explored five emergent themes: patient's underlying causes, seeking support, perceived susceptibility, professionals' incompetence and health facilities poor linkage. Community awareness creation to avoid fear of discrimination through provision of support for those with multidrug resistant tuberculosis is expected from health care providers using social behavioral change communication strategies. Furthermore, program managers need to follow the recommendations of World Health Organization for engaging healthcare professionals in the prevention and management of multidrug resistant tuberculosis and cascade trainings in clinical programmatic management of the disease for healthcare professionals.
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Affiliation(s)
| | - Yitagesu Habtu Aweke
- Department of Health informatics, Hossana College of Health Sciences, Hossana, Ethiopia
- College of Health Sciences, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Samuel Yohannes Ayanto
- Department of Midwifery, Hossana College of Health Sciences, Hossana, Ethiopia
- College of Health Sciences, Institute of Public Health, Department of -Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Menen Ayele
- Department of Clinical Nursing, Hossana College of Health Sciences, Hossana, Ethiopia
- Hossana College of Health Sciences, Hosanna, SNNPR, Ethiopia
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Vinhaes CL, Fukutani ER, Santana GC, Arriaga MB, Barreto-Duarte B, Araújo-Pereira M, Maggitti-Bezerril M, Andrade AM, Figueiredo MC, Milne GL, Rolla VC, Kristki AL, Cordeiro-Santos M, Sterling TR, Andrade BB, Queiroz AT. An integrative multi-omics approach to characterize interactions between tuberculosis and diabetes mellitus. iScience 2024; 27:109135. [PMID: 38380250 PMCID: PMC10877940 DOI: 10.1016/j.isci.2024.109135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/02/2024] [Accepted: 02/01/2024] [Indexed: 02/22/2024] Open
Abstract
Tuberculosis-diabetes mellitus (TB-DM) is linked to a distinct inflammatory profile, which can be assessed using multi-omics analyses. Here, a machine learning algorithm was applied to multi-platform data, including cytokines and gene expression in peripheral blood and eicosanoids in urine, in a Brazilian multi-center TB cohort. There were four clinical groups: TB-DM(n = 24), TB only(n = 28), DM(HbA1c ≥ 6.5%) only(n = 11), and a control group of close TB contacts who did not have TB or DM(n = 13). After cross-validation, baseline expression or abundance of MMP-28, LTE-4, 11-dTxB2, PGDM, FBXO6, SECTM1, and LINCO2009 differentiated the four patient groups. A distinct multi-omic-derived, dimensionally reduced, signature was associated with TB, regardless of glycemic status. SECTM1 and FBXO6 mRNA levels were positively correlated with sputum acid-fast bacilli grade in TB-DM. Values of the biomarkers decreased during the course of anti-TB therapy. Our study identified several markers associated with the pathophysiology of TB-DM that could be evaluated in future mechanistic investigations.
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Affiliation(s)
- Caian L. Vinhaes
- Laboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 41810-710, Brazil
- Programa de Pós-Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador 40290-150, Brazil
- Departamento de Infectologia, Hospital Português da Bahia, Salvador 40140-901, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade de Tecnologia e Ciências, Salvador 41741-590, Brazil
| | - Eduardo R. Fukutani
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 41810-710, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade de Tecnologia e Ciências, Salvador 41741-590, Brazil
- Centro de Integração de Dados e Conhecimentos para Saúde, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Gabriel C. Santana
- Laboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 41810-710, Brazil
- Curso de Medicina, Universidade Salvador, Salvador, Brazil
| | - María B. Arriaga
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Beatriz Barreto-Duarte
- Laboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 41810-710, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade de Tecnologia e Ciências, Salvador 41741-590, Brazil
- Curso de Medicina, Universidade Salvador, Salvador, Brazil
- Programa Acadêmico de Tuberculose. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Araújo-Pereira
- Laboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 41810-710, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade de Tecnologia e Ciências, Salvador 41741-590, Brazil
- Faculdade de Medicina, Univerdidade Federal da Bahia, Salvador, Brazil
| | - Mateus Maggitti-Bezerril
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 41810-710, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade de Tecnologia e Ciências, Salvador 41741-590, Brazil
| | - Alice M.S. Andrade
- Laboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 41810-710, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade de Tecnologia e Ciências, Salvador 41741-590, Brazil
| | - Marina C. Figueiredo
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ginger L. Milne
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Valeria C. Rolla
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Afrânio L. Kristki
- Programa Acadêmico de Tuberculose. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Cordeiro-Santos
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Universidade Nilton Lins, Manaus, Brazil
| | - Timothy R. Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bruno B. Andrade
- Laboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 41810-710, Brazil
- Programa de Pós-Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador 40290-150, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade de Tecnologia e Ciências, Salvador 41741-590, Brazil
- Curso de Medicina, Universidade Salvador, Salvador, Brazil
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Faculdade de Medicina, Univerdidade Federal da Bahia, Salvador, Brazil
| | - Artur T.L. Queiroz
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 41810-710, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade de Tecnologia e Ciências, Salvador 41741-590, Brazil
- Centro de Integração de Dados e Conhecimentos para Saúde, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - for the RePORT Brazil Consortium
- Laboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 41810-710, Brazil
- Programa de Pós-Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador 40290-150, Brazil
- Departamento de Infectologia, Hospital Português da Bahia, Salvador 40140-901, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade de Tecnologia e Ciências, Salvador 41741-590, Brazil
- Centro de Integração de Dados e Conhecimentos para Saúde, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Curso de Medicina, Universidade Salvador, Salvador, Brazil
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Programa Acadêmico de Tuberculose. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Faculdade de Medicina, Univerdidade Federal da Bahia, Salvador, Brazil
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Universidade Nilton Lins, Manaus, Brazil
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7
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Dana NINDREAR, Rika SUSANTI, M INDIKAP, Alexander MAISAB, Muthia SUKMA, Linda ROSALINA, Astri WIDYA, Zuhrah TAUFIQA, Rahman AGUSTIAND, Rahmi FITHRIA, Nomira PUTRI, Setia NINGSIHDAW, Arif LUBISBL, Ainil MARDIAH, Octarini EZEDDINM, Nova LINDA, Tamia MARISAY, Sri RAHMIA, Permata SARIA, Mimin OKTAVIANA, Puspa HUMANIF, Fariz AMSALM. MODIFIABLE AND NON-MODIFIABLE RISK FACTORS FOR TUBERCULOSIS AMONG ADULTS IN INDONESIA: A SYSTEMATIC REVIEW AND META-ANALYSIS. Afr J Infect Dis 2024; 18:19-28. [PMID: 38606192 PMCID: PMC11004781 DOI: 10.21010/ajidv18i2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 04/13/2024] Open
Abstract
Background Controlling tuberculosis (TB) determinant factors in Indonesia is one way to control TB in the community. A review is needed to explore risk factors for TB in Indonesia as the key strategies for accelerating the TB preventive program.The purpose of this review was to determine modifiable and non-modifiable risk factors for TB among adults in Indonesia. Materials and Methods A meta-analysis was undertaken to review current studies related to modifiable and non-modifiable risk factors for TB among adults in Indonesia. A search of PubMed, ProQuest, and Google Scholar for related articles published (January 2000 until December 2023). The Pooled Odds Ratio (POR) from the acquired data were calculated with a 95% CI. The fixed and random effects analysis was performed. The results were presented as forest plots, and Begg's test and Egger's test were used to examine study bias. Review Manager (RevMan) 5.4 and Stata 14.2 were used to process and analyze all of the data. Results This study results revealed the POR of non-modifiable risk factor (family history of TB) for TB among adults in Indonesia was 6.08 (95% CI 2.99-12.34). Based on modifiable risk factors, it is known that household contact have the highest POR (6.01, 2.57-14.04), followed by malnutrition (5.86, 2.50-13.69), inappropriate ventilation (5.57, 1.74-17.86), diabetes mellitus (4.92, 3.04-7.96), smoking behavior (3.24, 2.22-4.72), and low-income level (2.34, 1.42-3.87). Conclusion Based on significant factors that are related to TB incidence, the results of this review may be valuable to the government in identifying the optimal strategy for TB prevention among adults.
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Affiliation(s)
- NINDREA Ricvan Dana
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - SUSANTI Rika
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
- Department of Forensic and Medicolegal, Faculty of Medicine, Universitas Andalas, Padang, Indonesia, 25127
| | - INDIKA Pudia M
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - MAISA Benny Alexander
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - SUKMA Muthia
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - ROSALINA Linda
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - WIDYA Astri
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - TAUFIQA Zuhrah
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - AGUSTIAN Dede Rahman
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - FITHRIA Rahmi
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - PUTRI Nomira
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | | | | | - MARDIAH Ainil
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - EZEDDIN Maudy Octarini
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - LINDA Nova
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - MARISA Yosa Tamia
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - RAHMI Afriyeni Sri
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - SARI Anggun Permata
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - OKTAVIANA Mimin
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - HUMANI Flori Puspa
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
| | - AMSAL Mochammad Fariz
- Department of Medicine, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, 26181, Indonesia
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Franke MA, Emmrich JV, Ranjaharinony F, Ravololohanitra OG, Andriamasy HE, Knauss S, Muller N. A cross-sectional analysis of the effectiveness of a nutritional support programme for people with tuberculosis in Southern Madagascar using secondary data from a non-governmental organisation. Infect Dis Poverty 2024; 13:13. [PMID: 38303047 PMCID: PMC10835822 DOI: 10.1186/s40249-024-01182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND There is a strong, bi-directional link between tuberculosis (TB) and undernutrition: TB often causes undernutrition, and undernourished people are more likely to contract TB and experience worse outcomes. Globally, several TB nutritional support programmes exist; however, evidence on their effectiveness is limited and contested. This study evaluates the effect of a nutritional support programme implemented for people with TB in the Atsimo-Andrefana region, Madagascar in 2022. Within this programme, undernourished people with TB [with a body mass index (BMI) of < 18.5 kg/m2] receive 0.6 L of vegetable oil and 6.0 kg of a soy-wheat blend per month throughout their TB treatment. METHODS We analysed secondary non-governmental organisation data collected between January and November 2022 in the Atsimo-Andrefana region, Southern Madagascar, including information on an individual's medical conditions (e.g., type of TB, treatment outcomes) and nutritional status measured prior to, during, and after completion of treatment (e.g., height, weight, mid-upper arm circumference). We conducted descriptive analyses of patient baseline characteristics and outcomes to assess the impact of the provided nutritional support on the BMI of people with TB. RESULTS A total of 1310 people with TB were included in the study [9.9% (130) children under the age of 5, 32.1% (420) children between 5 and 18 years, 58.0% (760) adults]. 55.4% of children under 5, 28.1% of children between ages 5 and 18, and 81.3% of adults were undernourished at treatment initiation. 42.3% (55/130) of children under 5 experienced severe acute malnutrition at treatment uptake. While the average BMI of adults with TB receiving food support increased over time, from 17.1 kg/m2 (interquartile range: 15.8-18.3, range: 10.3-22.5) to 17.9 kg/m2 (interquartile range: 16.6-19.1, range: 11.9-24.1), most adults remained undernourished even after completing TB treatment. CONCLUSIONS The current TB nutritional support programme falls short of sufficiently increasing the BMI of people with TB to overcome malnutrition. There is an urgent need to revise the nutritional support available for people with TB, particularly for children under 5.
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Affiliation(s)
- Mara Anna Franke
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- London School of Hygiene and Tropical Medicine, London, UK.
- Ärzte Für Madagaskar E.V., Leipzig, Germany.
| | - Julius Valentin Emmrich
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Harizaka Emmanuel Andriamasy
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Doctors for Madagascar, Antananarivo, Madagascar
| | - Samuel Knauss
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nadine Muller
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Speciality Network: Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Jeyashree K, Shanmugasundaram P, Shanmugasundaram D, Priya G SL, Thangaraj JWV, Ts S, Pandey S, Ramasamy S, Sharma R, Arunachalam S, Shah V, Janagaraj V, Sundari S S, Chadwick J, Shewade HD, Chowdhury A, Iyer S, Rao R, Mattoo SK, Murhekar MV. Direct benefit transfer for nutritional support of patients with TB in India-analysis of national TB program data of 3.7 million patients, 2018-2022. BMC Public Health 2024; 24:299. [PMID: 38273246 PMCID: PMC10811802 DOI: 10.1186/s12889-024-17777-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Patients with TB have additional nutritional requirements and thus additional costs to the household. Ni-kshay Poshan Yojana(NPY) is a Direct Benefit Transfer (DBT) scheme under the National Tuberculosis Elimination Programme(NTEP) in India which offers INR 500 monthly to all notified patients with TB for nutritional support during the period of anti-TB treatment. Five years after its implementation, we conducted the first nationwide evaluation of NPY. METHODS In our retrospective cohort study using programmatic data of patients notified with TB in nine randomly selected Indian states between 2018 and 2022, we estimated the proportion of patients who received at least one NPY instalment and the median time to receive the first instalment. We determined the factors associated (i) with non-receipt of NPY using a generalised linear model with Poisson family and log link and (ii) with time taken to receive first NPY benefit in 2022 using quantile regression at 50th percentile. RESULTS Overall, 3,712,551 patients were notified between 2018 and 2022. During this period, the proportion who received at least one NPY instalment had increased from 56.9% to 76.1%. Non-receipt was significantly higher among patients notified by private sector (aRR 2.10;2.08,2.12), reactive for HIV (aRR 1.69;1.64,1.74) and with missing/undetermined diabetic status (aRR 2.02;1.98,2.05). The median(IQR) time to receive the first instalment had reduced from 200(109,331) days in 2018 to 91(51,149) days in 2022. Patients from private sector(106.9;106.3,107.4days), those with HIV-reactive (103.7;101.8,105.7days), DRTB(104.6;102.6,106.7days) and missing/undetermined diabetic status (115.3;114,116.6days) experienced longer delays. CONCLUSIONS The coverage of NPY among patients with TB had increased and the time to receipt of benefit had halved in the past five years. Three-fourths of the patients received at least one NPY instalment, more than half of whom had waited over three months to receive the first instalment. NTEP has to focus on timely transfer of benefits to enable patients to meet their additional nutritional demands, experience treatment success and avoid catastrophic expenditure.
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Affiliation(s)
- Kathiresan Jeyashree
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India.
| | - Prema Shanmugasundaram
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Devika Shanmugasundaram
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sri Lakshmi Priya G
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Jeromie W V Thangaraj
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sumitha Ts
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sumit Pandey
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sabarinathan Ramasamy
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Rahul Sharma
- TB support network, WHO Country Office for India, New Delhi, India
| | | | - Vaibhav Shah
- TB support network, WHO Country Office for India, New Delhi, India
| | | | - Sivakami Sundari S
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Joshua Chadwick
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Hemant Deepak Shewade
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Aniket Chowdhury
- TB support network, WHO Country Office for India, New Delhi, India
| | - Swati Iyer
- TB support network, WHO Country Office for India, New Delhi, India
| | | | | | - Manoj V Murhekar
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
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Bai W, Ameyaw EK. Global, regional and national trends in tuberculosis incidence and main risk factors: a study using data from 2000 to 2021. BMC Public Health 2024; 24:12. [PMID: 38166735 PMCID: PMC10759569 DOI: 10.1186/s12889-023-17495-6] [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: 06/26/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Despite the significant progress over the years, Tuberculosis remains a major public health concern and a danger to global health. This study aimed to analyze the spatial and temporal characteristics of the incidence of tuberculosis and its risk factors and to predict future trends in the incidence of Tuberculosis. METHODS This study used secondary data on tuberculosis incidence and tuberculosis risk factor data from 209 countries and regions worldwide between 2000 and 2021 for analysis. Specifically, this study analyses the spatial autocorrelation of Tuberculosis incidence from 2000 to 2021 by calculating Moran's I and identified risk factors for Tuberculosis incidence by multiple stepwise linear regression analysis. We also used the Autoregressive Integrated Moving Average model to predict the trend of Tuberculosis incidence to 2030. This study used ArcGIS Pro, Geoda and R studio 4.2.2 for analysis. RESULTS The study found the global incidence of Tuberculosis and its spatial autocorrelation trends from 2000 to 2021 showed a general downward trend, but its spatial autocorrelation trends remained significant (Moran's I = 0.465, P < 0.001). The risk factors for Tuberculosis incidence are also geographically specific. Low literacy rate was identified as the most pervasive and profound risk factor for Tuberculosis. CONCLUSIONS This study shows the global spatial and temporal status of Tuberculosis incidence and risk factors. Although the incidence of Tuberculosis and Moran's Index of Tuberculosis are both declining, there are still differences in Tuberculosis risk factors across countries and regions. Even though literacy rate is the leading risk factor affecting the largest number of countries and regions, there are still many countries and regions where gender (male) is the leading risk factor. In addition, at the current rate of decline in Tuberculosis incidence, the World Health Organization's goal of ending the Tuberculosis pandemic by 2030 will be difficult to achieve. Targeted preventive interventions, such as health education and regular screening of Tuberculosis-prone populations are needed if we are to achieve the goal. The results of this study will help policymakers to identify high-risk groups based on differences in TB risk factors in different areas, rationalize the allocation of healthcare resources, and provide timely health education, so as to formulate more effective Tuberculosis prevention and control policies.
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Affiliation(s)
- Wentao Bai
- School of Graduate Studies, Lingnan University, Tuen Mun, New Territories, Hong Kong.
| | - Edward Kwabena Ameyaw
- School of Graduate Studies, Lingnan University, Tuen Mun, New Territories, Hong Kong
- L & E Research Consult Ltd, Upper West Region, Ghana
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Chung C, Jeong D, Sohn H, Choi H, Kang YA. Low household income increases the risk of tuberculosis recurrence: a retrospective nationwide cohort study in South Korea. Public Health 2024; 226:228-236. [PMID: 38091811 DOI: 10.1016/j.puhe.2023.11.014] [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: 08/15/2023] [Revised: 10/14/2023] [Accepted: 11/08/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES We assessed the impact of household income on tuberculosis (TB) recurrence and the long-term impact of TB on household income. STUDY DESIGN This was a retrospective nationwide cohort study of patients with drug-susceptible TB (DS-TB) and TB recurrence. METHODS Using the South Korean national TB cohort database, we identified a sub-set cohort of patients with newly diagnosed drug-susceptible TB between 2013 and 2016 and tracked their TB recurrence and longitudinal income data from 2007 to 2018. Income levels were evaluated as 'Medical aid' and quintile categories. To assess risk factors associated with TB recurrence, we used a sub-distribution hazard model, adjusting for the competing risks of death. RESULTS Of 66,690 patients successfully treated with DS-TB, 2095 (3.1 %) experienced recurrence during a median follow-up of 39 months. The incidence of TB recurrence was 982.1/100,000 person-years, with 50.3 % of the recurrences occurring within 1 year of treatment completion. The risk of TB recurrence increased with decreasing income levels, with the highest risk observed in the lowest income group. The effect of income on TB recurrence was prominent in males but not in females. Overall, patients with TB recurrence experienced a linear decline in income levels, compared with those without recurrence. CONCLUSIONS Household income during the initial TB episode was an important risk factor for TB recurrence, particularly in males.
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Affiliation(s)
- C Chung
- Department of Pulmonary and Critical Care Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - D Jeong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H Sohn
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H Choi
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Y A Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Republic of Korea.
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12
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Yasaratna NR, Weerasinghe MC. Risk Factors for Latent Tuberculosis among Health-care Workers in Sri Lanka. WHO South East Asia J Public Health 2024; 13:9-15. [PMID: 39167130 DOI: 10.4103/who-seajph.who-seajph_42_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/02/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Management of latent tuberculosis infection (LTBI) was introduced as a national policy in Sri Lanka in 2022, targeting high-risk groups, including health-care workers (HCWs). This study aimed to identify the potential risk factors for LTBI among HCWs in government hospitals. METHODS A case-control study was conducted. Cases and controls were identified by a screening survey conducted among those tested by the tuberculin skin test (TST). The survey was conducted among HCWs of eight government hospitals in Colombo in 2022. LTBI cases were defined as TST positives (≥10 mm) without a history of pulmonary tuberculosis (TB) and controls were those rated as negative. The cases-to-control ratio was 1:1, with a sample size of 128 cases and 128 controls. Multiple logistic regression analysis was conducted to identify the risk factors. RESULTS The significant risk factors identified included age ≥40 years (adjusted odds ratio [AOR] - 2.4, 95% confidence interval [CI]: 1.28-4.47) having a service duration of ≥6 years (AOR - 2.92, CI: 1.469-5.82), not maintaining distance (AOR - 2.83, CI: 1.43-5.58) and not wearing face masks when dealing with suspected or diagnosed TB patients (AOR - 3.55, CI: 1.80-7.00), and settings with inadequate TB infection control practices (AOR - 3.47, CI: 1.85-6.47). CONCLUSION Improving infection control measures, training HCWs on TB prevention, providing adequate personal protective equipment, and initiating screening for LTBI among HCWs are recommended.
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Zayar NN, Chotipanvithayakul R, Bjertness E, Htet AS, Geater AF, Chongsuvivatwong V. Vulnerability of NCDs and Mediating Effect of Risk Behaviors Among Tuberculosis Patients and Their Household Contacts Compared to the General Population in the Yangon Region, Myanmar. Int J Gen Med 2023; 16:5909-5920. [PMID: 38106977 PMCID: PMC10725691 DOI: 10.2147/ijgm.s439141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose We investigated the association of TB patients and their household contacts with diabetes mellitus (DM) and hypertension compared to the general population, and the mediating effects of risk behaviors including current smoking, alcohol drinking, and poor diet quality. Patients and Methods A cross-sectional study on screening for DM, hypertension, and risk behaviors among newly diagnosed TB patients (n = 221) and their household contacts (n = 257) aged 25-74 years in Yangon in 2018. Health data of the general population (n = 755) were obtained from an NCD risk factor survey in Yangon. A directed acyclic graph is used to identify possible pathways of association between variables. Associations are presented as adjusted odds ratios (aOR). Results Compared to the general population, both TB patients and their household contacts were associated with current smoking and drinking, and TB patients were more likely to be underweight. Without considering mediating effects, TB patients had higher odds of DM (aOR = 6.3, 95% CI: 3.8-10.6), but both TB patients and household contacts had lower odds of hypertension (aOR = 0.54; 95% CI: 0.33-0.87) and (aOR = 0.68; 95% CI: 0.47-0.98), respectively. The body mass index-mediated pathway reduced the odds of DM and hypertension among TB patients (aOR = 3.4; 95% CI: 2.2-5.3) and (aOR = 0.3; 95% CI: 0.2-0.5), respectively. Conclusion The shared risk behaviors among TB patients and household contacts with high burden of DM in TB patients endorse screening of risk behaviors and strengthening the integration of NCD services among TB patients and household contacts in this dual-burden country.
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Affiliation(s)
- Nyi Nyi Zayar
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Rassamee Chotipanvithayakul
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aung Soe Htet
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alan Frederick Geater
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Virasakdi Chongsuvivatwong
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Rathored J, Sharma SK, Chauhan A, Singh B, Banavaliker JN, Sreenivas V, Srivastava AK. Low serum vitamin D in North Indian multi-drug resistant pulmonary tuberculosis patients: the role of diet and sunlight. Ann Med 2023; 55:2291554. [PMID: 38079515 PMCID: PMC10880569 DOI: 10.1080/07853890.2023.2291554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Background: Tuberculosis (TB) and malnutrition are major global health problems, with multidrug-resistant (MDR) TB complicating international efforts. The role of vitamin D in susceptibility to and as an adjunctive treatment for TB is being studied extensively, although no study has included MDR-TB patients in context to dietary profile with vitamin D levels and sunlight exposure.Objective: This study aimed to estimate vitamin D serum levels and examine their association with dietary intake of vitamin D and sun exposure in patients with MDR-TB.Methods: North Indian participants were enrolled in three groups: MDR-TB, drug-susceptible pulmonary TB (DS-PTB), and healthy controls. All consenting participants underwent the estimation of macro- and micronutrient intake and sunlight exposure using structured questionnaires. Serum biochemistry, including 25-hydroxyvitamin D and calcium levels, was measured, and the correlation between variables was determined.Results: 747 participants were enrolled. Significant differences among the three groups were found in mean serum 25-hydroxyvitamin D levels, body mass index, macronutrient intake, dietary vitamin D and calcium content, and sun exposure index (SEI). All except sun exposure (SEI was highest in DS-PTB patients) were found to follow the trend: MDR-TB < DS-PTB < healthy controls. The mean serum vitamin D levels of all groups were deficient and correlated positively with dietary intake and SEI.Conclusion: In this study's we found significant association of serum vitamin D concentrations, dietary intake and sunlight exposure in MDR-TB, DS-PTB patients and healthy controls. Dietary intake may be more important than sun exposure in determining serum levels. However, the significance of this finding is uncertain. Further studies are required to confirm the association, direction, and potential for vitamin D supplementation to treat or prevent MDR-TB infection.
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Affiliation(s)
- Jaishriram Rathored
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
- Department of ‘School of Allied Health Sciences’, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha, India
| | | | - Aarti Chauhan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bhagteshwar Singh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jayant Nagesh Banavaliker
- Department of Tuberculosis and Respiratory Diseases, Rajan Babu Institute of Pulmonary Medicine and Tuberculosis (RBIPMT), New Delhi, India
| | - V. Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Pant A, Das B, Arimbasseri GA. Host microbiome in tuberculosis: disease, treatment, and immunity perspectives. Front Microbiol 2023; 14:1236348. [PMID: 37808315 PMCID: PMC10559974 DOI: 10.3389/fmicb.2023.1236348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Tuberculosis (TB), an airborne pulmonary disease caused by Mycobacterium tuberculosis (M. tb), poses an unprecedented health and economic burden to most of the developing countries. Treatment of TB requires prolonged use of a cocktail of antibiotics, which often manifest several side effects, including stomach upset, nausea, and loss of appetite spurring on treatment non-compliance and the emergence of antibiotic resistant M. tb. The anti-TB treatment regimen causes imbalances in the composition of autochthonous microbiota associated with the human body, which also contributes to major side effects. The microbiota residing in the gastrointestinal tract play an important role in various physiological processes, including resistance against colonization by pathogens, boosting host immunity, and providing key metabolic functions. In TB patients, due to prolonged exposure to anti-tuberculosis drugs, the gut microbiota significantly loses its diversity and several keystone bacterial taxa. This loss may result in a significant reduction in the functional potency of the microbiota, which is a probable reason for poor treatment outcomes. In this review, we discuss the structural and functional changes of the gut microbiota during TB and its treatment. A major focus of the review is oriented to the gut microbial association with micronutrient profiles and immune cell dynamics during TB infection. Furthermore, we summarize the acquisition of anti-microbial resistance in M. tb along with the microbiome-based therapeutics to cure the infections. Understanding the relationship between these components and host susceptibility to TB disease is important to finding potential targets that may be used in TB prevention, progression, and cure.
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Affiliation(s)
- Archana Pant
- Molecular Genetics Lab, National Institute of Immunology, New Delhi, India
| | - Bhabatosh Das
- Functional Genomics Laboratory, Infection and Immunology Division, Translational Health Science and Technology Institute, Faridabad, India
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Tekese D, Dawit D, Hawulte B, Mohammed H, Asefa F, Oljira L. Incidence and predictors of tuberculosis among children receiving antiretroviral therapy in the Wolaita Zone: A retrospective cohort study. PLoS One 2023; 18:e0291502. [PMID: 37733689 PMCID: PMC10513190 DOI: 10.1371/journal.pone.0291502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Tuberculosis is the leading cause of morbidity and mortality among children living with the human immunodeficiency virus (HIV), mainly in sub-Saharan Africa, including Ethiopia. Tuberculosis remains a significant health concern for HIV-positive children in Ethiopia. There is a paucity of data on the incidence and predictors of tuberculosis among children living with HIV on antiretroviral therapy in the Wolaita zone. Hence, this study aimed to assess the incidence and predictors of tuberculosis among children living with HIV on antiretroviral therapy in the Wolaita zone between January 2010 to December 2020. METHODS A retrospective cohort study was conducted among 389 children receiving antiretroviral therapy in Wolaita zone health facilities between January 2010 to December 2020. The checklist was adapted from the standardized antiretroviral treatment (ART) follow-up form currently used by the institutions' ART clinics. The Kaplan-Meier survival function and Log-rank were used to estimate the survival for each categorical variable to compare the survival between different exposure groups. Both bivariable and multivariable parametric survival Gompertz models were fitted to identify predictors of tuberculosis among HIV-positive children. The association was summarized using an adjusted hazard ratio (AHR), and statistical significance was declared at 95% CI and p-value < 0.05. The goodness of the model fit was assessed using a Cox-Snell residual plot. RESULTS The incidence rate of tuberculosis among children living with HIV was 3.5 (95% CI 2.7-4.5) per 100 child years. World Health Organization clinical stage III or IV (AHR = 2.31, 95% CI [1.26, 4.22]), hemoglobin level <10 g/dL (AHR = 2.87, 95% CI [1.51, 5.45]), fair or poor ART adherence (AHR = 4.4, 95% CI[2.18, 9.05]), underweight (AHR = 2.55, 95% CI [1.45, 4.51]), age >10 years (AHR = 3.62; 95% CI [1.29, 10.0]), and cotrimoxazole preventive therapy (AHR = 0.23; 95% CI [0.08, 0.60]) were among the independent predictors of TB occurrence. CONCLUSION The incidence of tuberculosis among children on ART was high. HIV-positive children presenting with advanced disease staging (III and IV), anemia, "fair" and "poor" ART adherence, underweight, age above ten years, and not receiving cotrimoxazole preventive therapy were at higher risk of TB. Therefore, counseling on ART adherence, early diagnosis, and prompt treatment of anemia and malnutrition are recommended to avert tuberculosis.
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Affiliation(s)
- Daneil Tekese
- Wolaita Zone Health Department, Wolaita Sodo, Wolaita Zone, Ethiopia
| | - Desalegn Dawit
- Departemt of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Behailu Hawulte
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hussein Mohammed
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekede Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Pediatrics, The University of Tennessee Health Science Center (UTHSC)—Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, College of Medicine, Memphis, TN, United States of America
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Schwalb A, Bergstrom M, Woodd S, Rehman AM, PrayGod G, Kasonka L, Koethe JR, Filteau S, Houben RMGJ. Impact of micro- and macronutrient status on the incidence of tuberculosis: An examination of an African cohort initiating antiretroviral therapy. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002007. [PMID: 37440476 DOI: 10.1371/journal.pgph.0002007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 07/15/2023]
Abstract
Macronutrient and micronutrient deficiencies are associated with tuberculosis (TB) incidence. However, evidence is limited on the impact of micronutrient (vitamins and minerals) supplementation among underweight individuals. We conducted a secondary data analysis of a randomised controlled trial of lipid nutritional supplements with and without high-dose vitamin and mineral supplementation (LNS-VM vs LNS) for underweight (Body Mass Index [BMI] <18.5 kg/m2) adults with human immunodeficiency virus (HIV) initiating antiretroviral therapy (ART) in Tanzania and Zambia (2011-2013). Incident TB disease diagnoses were extracted from trial records. We used multivariable Cox regression to estimate hazard ratios (HR) for the impact of receiving LNS-VM on TB incidence, and the dose-response relationship between baseline BMI and TB incidence. Overall, 263 (17%) of 1506 participants developed TB disease. After adjusting for age, sex, CD4 count, haemoglobin, and C-reactive protein, receiving LNS-VM was not associated with TB incidence (aHR [95%CI] = 0.93 [0.72-1.20]; p = 0.57) compared to LNS alone. There was strong evidence for an association between lower BMI and incident TB (aHR [95%CI]: 16-16.9kg/m2 = 1.15 [0.82-1.62] and <16kg/m2 = 1.70 [1.26-2.30] compared to 17-18.5kg/m2; linear trend p<0.01). There was strong evidence that the rate of developing TB was lower after initiating ART (p<0.01). In conclusion, the addition of micronutrient supplementation to LNS was not associated with lower TB incidence in this underweight ART-naive population.
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Affiliation(s)
- Alvaro Schwalb
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Malin Bergstrom
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susannah Woodd
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andrea M Rehman
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | | | - John R Koethe
- Vanderbilt Institute of Global Health, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Suzanne Filteau
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rein M G J Houben
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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18
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Nguyen TH, Nguyen THN, Le Xuan H, Nguyen PT, Nguyen KC, Le Thi TN. Nutritional status and dietary intake before hospital admission of pulmonary tuberculosis patients. AIMS Public Health 2023; 10:443-455. [PMID: 37304581 PMCID: PMC10251045 DOI: 10.3934/publichealth.2023031] [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: 12/14/2022] [Revised: 04/13/2023] [Accepted: 05/14/2023] [Indexed: 06/13/2023] Open
Abstract
Conducting research on nutritional status and dietary intake of pulmonary tuberculosis patients is essential for developing interventions in clinical nutrition practice and treatment during hospitalization, which can improve the quality of patients life. This cross-sectional descriptive study aimed to determine nutritional status and some related factors (such as geography, occupation, educational level, economic classification, etc.) of 221 patients with pulmonary tuberculosis who were examined and treated at the Respiratory Tuberculosis Department, National Lung Hospital in July 2019-May 2020. The results showed that the risk of undernutrition: According to BMI (Body Mass Index): 45.8% of patients were malnourished, 44.2% normal and 10.0% overweight/obese. According to MUAC (Mid-Upper Arm Circumference): 60.2% of patients were malnourished, 39.8% of patients were normal. According to SGA (Subjective Global Assessment): 57.9% of patients were at risk of undernutrition, of which 40.7% were at moderate risk of undernutrition and 17.2% risk of severe undernutrition. Classification of nutritional status according to serum albumin index: 50% of patients were malnourished, the rate of undernutrition of mild, moderate and severe levels was 28.9%, 17.9% and 3.2%, respectively. Most patients eat with others and eat less than four meals a day. The average dietary energy of patients with pulmonary tuberculosis in was 1242.6 ± 46.5 Kcal and 1084 ± 57.9 Kcal, respectively. 85.52% of patients did not eat enough food, 4.07% had enough, 10.41% consumed excess energy. The ratio of energy-generating substances in the diet (Carbohydrate:Protein:Lipid) was on average 54:18:28 for males and 55:16:32 for females. Most of the study population had diets that did not meet the experimental study in terms of micronutrient content. Specifically, more than 90% do not meet the requirements for magnesium, calcium, zinc, and vitamin D. The water-soluble and fat-soluble vitamins respond poorly, only about 30-40%. Selenium is the mineral with the best response rate, above 70%. Our findings revealed that the majority of the study subjects had poor nutritional status, as evidenced by diets lacking in essential micronutrients.
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Anwar MC, Budiono I, Putriningtyas ND, Nisa AA, Santjaka A, Suswandany DL. The efficacy of Bloso fish (Glossogobius giuris sp.) in improving hemoglobin, hematocrit, platelet, and albumin levels of Wistar rats with hypoalbuminemia. POTRAVINARSTVO 2023. [DOI: 10.5219/1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Tuberculosis (TB) is an infectious disease worldwide that causes death. Common clinical manifestations of patients with TB include anemia, hypoalbuminemia, and malnutrition. Most patients with TB are infected with coccus bacteria, such as Staphylococcus aureus, that commonly attack the respiratory tract. However, the consumption of heme protein sources could improve the nutritional status of patients with TB. Fish comprise one of the most widely consumed sources of heme. The bloso fish (Glossogobius giuris sp.), considered a fish without economic value is a new alternative source of heme protein. This study aimed to develop supplements using bloso fish (Glossogobius giuris sp.). This study used an experimental pretest-post-test control group design. Seven male Wistar rats were used as the negative control group. Twenty- eight male Wistar rats were administered S. aureus, fed a protein-deficient diet, and divided into the positive control group, the K1 group, which received up to 675 mg/200 g of bloso fish flour, the K2 group, which received up to 67.5 mg/200 g of bloso fish oil, and the K3 group, which received up to 675 mg/200 g of bloso fish fluor from oil extraction dregs. Treatment was administered for 28 days. The hemoglobin (Hb), hematocrit (Ht), platelet, and albumin levels in blood serum from the retroorbital vein were measured. Data were processed using a paired t-test and one-way analysis of variance. The results showed differences in Hb, Ht, platelet, and albumin levels were observed before and after treatment. Additionally, differences in Hb, Ht, platelet, and albumin levels were observed in the groups that received bloso fish flour and bloso fish oil. Bloso fish flour and bloso fish oil increased the Hb, Ht, platelet, and albumin levels of rats with hypoalbuminemia.
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Ho ATN, Gorthi R, Lee R, Chawla M, Patolia S. Solitary Lung Nodule: CT-Guided Transthoracic Biopsy vs Transbronchial Biopsy With Endobronchial Ultrasound and Flexible Bronchoscope, a Meta-Analysis of Randomized Controlled Trials. Lung 2023; 201:85-93. [PMID: 36695890 DOI: 10.1007/s00408-023-00596-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Transbronchial lung biopsy with radial endobronchial ultrasound (rEBUS-TBB) and Computed tomography (CT) scan-guided transthoracic biopsy (CT-TTB) are commonly used to investigate peripheral lung nodules but high-quality data are still not clear about the diagnostic and safety profile comparison of these two modalities. METHOD We included all randomized controlled trials (RCT) comparing rEBUS-TBB with a flexible bronchoscope and CT-TTB for solitary lung nodules. Two reviewers extracted data independently on diagnostic performance and complication rates. RESULTS 170 studies were screened, 4 RCT with a total of 325 patients were included. CT-TTB had a higher diagnostic yield than rEBUS-TBB (83.45% vs 68.82%, risk difference - 0.15, 95% CI, [- 0.24, - 0.05]), especially for lesion size 1-2 cm (83% vs 50%, risk difference - 0.33, 95% CI, [- 0.51, - 0.14]). For malignant diseases, rEBUS-TBB had a diagnostic yield of 75.75% vs 87.7% of CT-TTB. rEBUS-TBB had a significant better safety profile with lower risks of pneumothorax (2.87% vs 21.43%, OR = 0.12, 95% CI [0.05-0.32]) and combined outcomes of hospital admission, hemorrhage, and pneumothorax (8.62% vs 31.81%, OR 0.21, 95% CI, [0.11-0.40]). Factors increasing diagnostic yield of rEBUS were lesion size and localization of the probe but not the distance to the chest wall and hilum. CONCLUSION CT-TTB had a higher diagnostic yield than rEBUS-TBB in diagnosing peripheral lung nodules, particularly for lesions from 1 to 2 cm. However, rEBUS-TBB was significantly safer with five to eight times less risk of pneumothorax and composite complications of hospital admission, hemorrhage, and pneumothorax. The results of this study only apply to flexible bronchoscopy with radial ebus without navigational technologies. More data are needed for a comparison between CT-TTB with rEBUS-TBB combined with advanced navigational modalities.
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Affiliation(s)
- An Thi Nhat Ho
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 425 E 67th St, New York, NY, 10065, USA.
| | - Ramya Gorthi
- Department of Pulmonary and Critical Care, St Louis University Hospital, St. Louis, MO, USA
| | - Robert Lee
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 425 E 67th St, New York, NY, 10065, USA
| | - Mohit Chawla
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 425 E 67th St, New York, NY, 10065, USA
| | - Setu Patolia
- Department of Pulmonary and Critical Care, St Louis University Hospital, St. Louis, MO, USA
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Arinaminpathy N, Rade K, Kumar R, Joshi RP, Rao R. The potential impact of vaccination on tuberculosis burden in India: A modelling analysis. Indian J Med Res 2023; 157:119-126. [PMID: 37202930 PMCID: PMC10319376 DOI: 10.4103/ijmr.ijmr_328_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Indexed: 05/20/2023] Open
Abstract
Background & objectives Vaccination will play an important role in meeting the end tuberculosis (TB) goals. While certain vaccine candidates in advanced stages of clinical trials raise hope for the future availability of new tools, in the immediate term, there is also increasing interest in Bacille Calmette-Guérin revaccination among adults and adolescents as a potential strategy. Here, we sought to estimate the potential epidemiological impact of TB vaccination in India. Methods We developed a deterministic, age-structured, compartmental model of TB in India. Data from the recent national prevalence survey was used to inform epidemiological burden while also incorporating a vulnerable population who may be prioritized for vaccination, the latter consistent with the burden of undernutrition. Using this framework, the potential impact on incidence and mortality of a vaccine with 50 per cent efficacy was estimated, if rolled out in 2023 to cover 50 per cent of the unvaccinated each year. Simulated impacts were compared for disease- vs. infection-preventing vaccines, as well as when prioritizing vulnerable groups (those with undernutrition) rather than the general population. A sensitivity analyses were also conducted with respect to the duration, and efficacy, of vaccine immunity. Results When rolled out in the general population, an infection-preventing vaccine would avert 12 per cent (95% Bayesian credible intervals (Crl): 4.3-28%) of cumulative TB incidence between 2023 and 2030, while a disease-preventing vaccine would avert 29 per cent (95% Crl: 24-34%). Although the vulnerable population accounts for only around 16 per cent of India's population, prioritizing this group for vaccination would achieve almost half the impact of rollout in the general population, in the example of an infection-preventing vaccine. Sensitivity analysis also highlights the importance of the duration and efficacy of vaccine-induced immunity. Interpretation & conclusions These results highlight how even a vaccine with moderate effectiveness (50%) could achieve substantial reductions in TB burden in India, especially when prioritized for the most vulnerable.
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Affiliation(s)
- Nimalan Arinaminpathy
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Kirankumar Rade
- WHO India Country Office, Ministry of Health & Family Welfare, New Delhi, India
| | - Ravinder Kumar
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, India
| | - Rajendra P. Joshi
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, India
| | - Raghuram Rao
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, India
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Vander-Pallen R, Domfeh EA, Hayford FEA, Asante M, Amoah AGB, Asare GA, Wiredu EK. Nutritional status and effect of highly active anti-retroviral therapy (HAART) on selected trace elements in people living with HIV in Ghana. SCIENTIFIC AFRICAN 2023. [DOI: 10.1016/j.sciaf.2023.e01586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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23
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Elfaky IO, Merghani TH, Elmubarak IA, Ahmed AH. Nutritional status and patterns of anemia in sudanese adult patients with active pulmonary tuberculosis: A cross-sectional study. Int J Mycobacteriol 2023; 12:73-76. [PMID: 36926766 DOI: 10.4103/ijmy.ijmy_14_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
Background Malnutrition increases the risk of developing tuberculosis (TB) and causes reactivation of latent pulmonary TB. On the other hand, TB is a recognized cause of malnutrition. Evaluation of the nutritional status and anemia of tuberculous patients with active disease is an important step toward TB management. The objectives of the study were to determine the nutritional status and patterns of anemia in adult patients with active pulmonary TB. Methods A. cross-sectional hospital-based study was performed on newly diagnosed patients with sputum-positive pulmonary TB. The nutritional status, total percentage of body fat (BF%), anemia, and general health of each patient were assessed with measurements of the body mass index (BMI), skin fold thickness, complete blood counts, and biochemical tests. Results Patients' ages ranged from 16- to 74-year old, with the majority between 20- and 40-year old. Male: female ratio was 2:1. The majority of males and females (91.2% and 84.5%, respectively) had low BF%. Underweight (BMI < 18.5) was 62%, whereas overweight (BMI ≥25.0) was 4%. BMI showed a significant decline with chronicity of the illness (P < 0.001). Eighty participants showed anemia, 90% microcytic hypochromic, and 10% normocytic normochromic. Serum albumin was low in 21%, with no relation to renal disease and insignificant association with proteinuria. Conclusion Patients with active pulmonary TB are likely to have microcytic hypochromic anemia, low BF%, and low BMI, especially with a long duration of the disease.
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Affiliation(s)
- Iman Osman Elfaky
- Department of Respiratory Medicine, Ministry of Health, Omdurman Teaching Hospital, Omdurman, Sudan
| | - Tarig H Merghani
- Department of Physiology, RAK College of Medical Sciences, RAK Medical and Health Sciences University, Ras Al-Khaimah, United Arab Emirates
| | | | - Alaeldin H Ahmed
- Department of Internal Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Ji F, Yang Y, Xu L, Cai J, Ni M, Wang Q, Zhao S, Ma A. Poor diet quality evaluated with the China Healthy Diet Index in Chinese tuberculosis patients. J Hum Nutr Diet 2022; 35:1192-1201. [PMID: 34962001 DOI: 10.1111/jhn.12985] [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: 10/15/2021] [Accepted: 12/16/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to compare and evaluate the diet quality of tuberculosis patients and healthy adults by using the China Healthy Diet Index (CHDI) and to provide guidance for the diet of tuberculosis patients in the future. METHODS A case-control study of 1241 patients and 1241 healthy individuals matchedfor sex and age. The CHDI was used to score the overall diet quality of patients in the casegroup and the control group. RESULTS The CHDI score of tuberculosis patients was 61.61 and that of healthy controls was 63.97. After adjustment for confounders, participants with >80 on CHDI were 73.5% less likely to develop tuberculosis than participants with <51 (OR: 0.265, 95% CI: 0.086, 0.813, p < 0.05). In the original model, the CHDI scores in the highest range were inversely associated with tuberculosis risk compared with the lowest range (OR: 0.687, 95% CI: 0.420,1.122, p < 0.001). After adjusting for confounders, the CHDI score was significantly associated with a reduced risk of tuberculosis (OR: 0.265, 95% CI: 0.086, 0.813, p < 0.001). After adjusting for confounders, a high-quality diet was positively correlated with anti-tuberculosis treatment outcomes (OR:0.957, 95% CI: 0.918,0.998, p = 0.039). CONCLUSION Compared with healthy adults, tuberculosis patients have poor diet quality with unreasonable diet structure. The insufficient intake of whole grains, vegetables, beans, aquatic products, meat and eggs and the excessive intake of pure energy food and solid fat suggests that the dietary structure of tuberculosis patients was unreasonable. This study provides an idea of the diet structure of tuberculosis patients.
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Affiliation(s)
- Fangfei Ji
- Department of Nutrition and Health, College of Public Health, Qingdao University, Qingdao, China
| | - Yuexin Yang
- Department of Nutrition and Health, College of Public Health, Qingdao University, Qingdao, China.,National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lei Xu
- Huai'an Center for Disease Control and Prevention, Huai'an, China
| | - Jing Cai
- Department of Nutrition and Health, College of Public Health, Qingdao University, Qingdao, China
| | - Mingde Ni
- Linyi People's Hospital East Branch, Linyi, China
| | - Qiuzhen Wang
- Department of Nutrition and Health, College of Public Health, Qingdao University, Qingdao, China
| | | | - Aiguo Ma
- Department of Nutrition and Health, College of Public Health, Qingdao University, Qingdao, China.,Institute of Nutrition and Health, Qingdao University, Qingdao, China
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Taye K, Tolesa N, Tadewos A, Ketema W. Patterns of Childhood Tuberculosis Diagnosis in Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama Regional State, Ethiopia. Pediatric Health Med Ther 2022; 13:349-359. [PMID: 36386042 PMCID: PMC9657258 DOI: 10.2147/phmt.s380092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Because of the pauci bacillary nature of childhood tuberculosis and the difficulties in obtaining proper sputum samples from young children, diagnosing childhood tuberculosis (TB) is difficult. Childhood TB needs early identification and care since it advances swiftly to more advanced stages. This study was aimed to determine the patterns of all forms of childhood tuberculosis diagnosis at Hawassa University Comprehensive Specialized Hospital in Hawassa, Ethiopia. Methods A retrospective cross-sectional study was conducted from February 1, 2017 to January 30, 2021 among 175 children diagnosed and treated for tuberculosis in the pediatric ward. Children medical charts and pediatrics ward logbook were used to extract pertinent data by structured checklists. SPSS version 23.0 was used for data entry and statistical analysis. Results Of 175 children, fever was the leading clinical symptoms and diagnosed in 166 (94.9%) children followed by weight loss (154, 88%), and cough (136, 77.7%). In twenty seven out of 88 (30.6%) children, gastric aspirate was positive for TB infection by Xpert MTB/Rif, while 3/40 (7.5%) were positive for TB using fine needle aspiration cytology (FNAC), 19/66 (28.8%) had suggestive TB by cerebrospinal fluid analysis (CSF), 10/29 (34.5%) were smear positive for TB and 70/162 (43.2%) were suspected for TB by chest X-ray. Conclusion Despite recent breakthroughs in quick microbiological detection, such as Xpert MTB/Rif, this study revealed that more than half of the children, 89/175 (51%), were treated for TB diseases solely based on clinical criteria. This will significantly underestimate the true nature of the illness or disease and make them vulnerable to mistreatment. As a result, in order to appropriately treat the disease and manage patients in our settings, getting a microbiological diagnosis of childhood tuberculosis requires improvement, and we call for expanded availability and use of a more sensitive and specific diagnostic technique to circumvent these concerns.
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Affiliation(s)
- Kefyalew Taye
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Nagasa Tolesa
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Dembi Dollo University, Dembi Dollo, Ethiopia
| | - Agete Tadewos
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Worku Ketema
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Correspondence: Worku Ketema, Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia, Email
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B K, Singla R, Singla N, V V, Singh K, Choudhury MP, Bhattacherjee N. Factors affecting the treatment outcome of injection based shorter MDR-TB regimen at a referral centre in India. Monaldi Arch Chest Dis 2022. [DOI: 10.4081/monaldi.2022.2396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/27/2022] [Indexed: 02/19/2023] Open
Abstract
Rifampicin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) is a significant burden on global tuberculosis (TB) prevention and eradication efforts. MDR-TB can be treated, but it is expensive, takes a long time (typically two years), and contains potentially toxic drugs. Under certain conditions, the WHO recommends standard regimens lasting 9 to 11 months rather than individual regimens lasting at least 18-20 months. The current study sought to identify factors associated with treatment outcome in RR/MDR-TB patients receiving an injection-based regimen for 9-11 months. This ambispective (prospective and retrospective) observational study was conducted at a tertiary tuberculosis institute in New Delhi, India. Between February 2021 and March 2022, patients with RR/MDR-pulmonary TB who received an injection-based shorter regimen were enrolled. Factors related to treatment outcome were investigated and compared in patients who had a successful outcome versus those who did not. A total of 55 patients were enrolled, with 50.91% being successful (cured/treatment completed) and 49.09% failing (including failure, lost to follow up, death, and regimen changed). The following factors were significantly associated with the unsuccessful outcome, according to univariate analysis: BMI (18.5 kg/m2), anaemia, previous anti-TB treatment, bilateral chest X-ray involvement, and far advanced disease on chest X-ray BMI (18.5 kg/m2), anaemia, and far advanced disease on chest X-ray were all significantly associated with mortality. Anaemia was associated with an unsuccessful outcome (p=0.049) and mortality (p=0.048) in the multiple logistic regression analysis. Early treatment initiation, improved nutrition and anaemia, and regular monitoring can all improve RR/MDR-TB patients' outcomes and prognoses.
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Shah S, Khan A, Shahzad M, Mokhtar JA, Harakeh S, Kibria Z, Mehr A, Bano B, Ali A, Yousafzai YM. Determinants of Response at 2 Months of Treatment in a Cohort of Pakistani Patients with Pulmonary Tuberculosis. Antibiotics (Basel) 2022; 11:1307. [PMID: 36289965 PMCID: PMC9598398 DOI: 10.3390/antibiotics11101307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 04/06/2024] Open
Abstract
Mycobacterium tuberculosis infection continues to be a major global challenge. All patients with pulmonary tuberculosis are treated with a standard 6-month treatment regimen. Historical data suggest that even with shortened treatment, most patients achieve long-term remission. Risk stratification is a goal for reducing potentially toxic prolonged treatment. This study aimed to determine the factors associated with the early clearance of sputum acid-fast bacilli (AFB). A total of 297 freshly diagnosed patients with pulmonary tuberculosis were included and enrolled in this study. Information related to their ethno-demographic and anthropometric characteristics was collected. We also assessed their complete blood counts, and blood iron, folate, and vitamin B12 levels. We found that the presence of higher levels of acid-fast bacilli (AFB) in diagnostic sputum microscopy was the single most significant prognostic factor associated with early clearance of sputum AFB after 2 months of treatment. All of our patients achieved treatment success after 6 months of treatment and were disease free. Our results support the data obtained from previous studies indicating that AFB clearance at 2 months is unlikely to be a clinically useful biomarker or indicator for therapeutic stratification. Furthermore, demographic, anthropometric, and nutritional factors are not clinically useful biomarkers.
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Affiliation(s)
- Saeed Shah
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25120, Pakistan; (S.S.); (A.K.); (A.A.)
| | - Asghar Khan
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25120, Pakistan; (S.S.); (A.K.); (A.A.)
| | - Muhammad Shahzad
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25120, Pakistan; (M.S.); (A.M.); (B.B.)
- School of Biological Sciences, Health and Life Sciences Building, University of Reading, Whiteknights, Reading RG6 6AX, UK
| | - Jawahir A. Mokhtar
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Vaccine and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Steve Harakeh
- King Fahd Medical Research Center and Yousef Abdullatif Jameel Chair of Prophetic Medicine Application, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Zeeshan Kibria
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar 25120, Pakistan;
| | - Aneela Mehr
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25120, Pakistan; (M.S.); (A.M.); (B.B.)
| | - Bushra Bano
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25120, Pakistan; (M.S.); (A.M.); (B.B.)
| | - Asif Ali
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25120, Pakistan; (S.S.); (A.K.); (A.A.)
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Yasar Mehmood Yousafzai
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25120, Pakistan; (S.S.); (A.K.); (A.A.)
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8QQ, UK
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Nikitushkin V, Shleeva M, Loginov D, Dyčka F. F, Sterba J, Kaprelyants A. Shotgun proteomic profiling of dormant, ‘non-culturable’ Mycobacterium tuberculosis. PLoS One 2022; 17:e0269847. [PMID: 35944020 PMCID: PMC9362914 DOI: 10.1371/journal.pone.0269847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/27/2022] [Indexed: 11/19/2022] Open
Abstract
Dormant cells of Mycobacterium tuberculosis, in addition to low metabolic activity and a high level of drug resistance, are characterized by ‘non-culturability’–a specific reversible state of the inability of the cells to grow on solid media. The biochemical characterization of this physiological state of the pathogen is only superficial, pending clarification of the metabolic processes that may exist in such cells. In this study, applying LC-MS proteomic profiling, we report the analysis of proteins accumulated in dormant, ‘non-culturable’ M. tuberculosis cells in an in vitro model of self-acidification of mycobacteria in the post-stationary phase, simulating the in vivo persistence conditions—the raw data are available via ProteomeXchange with identifier PXD028849. This approach revealed the preservation of 1379 proteins in cells after 5 months of storage in dormancy; among them, 468 proteins were statistically different from those in the actively growing cells and bore a positive fold change (FC). Differential analysis revealed the proteins of the pH-dependent regulatory system PhoP and allowed the reconstruction of the reactions of central carbon/glycerol metabolism, as well as revealing the salvaged pathways of mycothiol and UMP biosynthesis, establishing the cohort of survival enzymes of dormancy. The annotated pathways mirror the adaptation of the mycobacterial metabolic machinery to life within lipid-rich macrophages: especially the involvement of the methyl citrate and glyoxylate pathways. Thus, the current in vitro model of M. tuberculosis self-acidification reflects the biochemical adaptation of these bacteria to persistence in vivo. Comparative analysis with published proteins displaying antigenic properties makes it possible to distinguish immunoreactive proteins among the proteins bearing a positive FC in dormancy, which may include specific antigens of latent tuberculosis. Additionally, the biotransformatory enzymes (oxidoreductases and hydrolases) capable of prodrug activation and stored up in the dormant state were annotated. These findings may potentially lead to the discovery of immunodiagnostic tests for early latent tuberculosis and trigger the discovery of efficient drugs/prodrugs with potency against non-replicating, dormant populations of mycobacteria.
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Affiliation(s)
- Vadim Nikitushkin
- A.N. Bach Institute of Biochemistry, Federal Research Centre ‘Fundamentals of Biotechnology’ of the Russian Academy of Sciences, Moscow, Russia
- * E-mail: (VN); (FDF)
| | - Margarita Shleeva
- A.N. Bach Institute of Biochemistry, Federal Research Centre ‘Fundamentals of Biotechnology’ of the Russian Academy of Sciences, Moscow, Russia
| | - Dmitry Loginov
- Faculty of Science, University of South Bohemia, Branišovská, Czech Republic
- BioCeV—Institute of Microbiology of the CAS, Vestec, Czech Republic
- Orekhovich Institute of Biomedical Chemistry, Moscow, Russia
| | - Filip Dyčka F.
- Faculty of Science, University of South Bohemia, Branišovská, Czech Republic
- * E-mail: (VN); (FDF)
| | - Jan Sterba
- Faculty of Science, University of South Bohemia, Branišovská, Czech Republic
| | - Arseny Kaprelyants
- A.N. Bach Institute of Biochemistry, Federal Research Centre ‘Fundamentals of Biotechnology’ of the Russian Academy of Sciences, Moscow, Russia
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Prevalence of modifiable risk factors of tuberculosis and their population attributable fraction in Iran: A cross-sectional study. PLoS One 2022; 17:e0271511. [PMID: 35926063 PMCID: PMC9352083 DOI: 10.1371/journal.pone.0271511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background
The mycobacterium tuberculosis (Mtb) is necessary for the morbidity of tuberculosis (TB), but it is insufficient. Many risk factors increase the risk of disease among infected people. We aimed to estimate the prevalence of modifiable risk factors of TB and their related population attributable fraction (PAF) in the marginal population of Markazi province in Iran.
Design
In this cross-sectional study, the prevalence of the modifiable risk factors of TB was estimated. We designed and validated a questionnaire to determine the risk factors. The measures of association for the modifiable risk factors of TB were obtained via the review of published literature. We calculated the PAF for each modifiable risk factor.
Results
Out of the 1275 calculated sample size, 1146 people participated in this study, and the participation rate was 89.9%. The mean age was 39.26. Out of 1146 participants, 76% did not know anything regarding TB. The highest prevalence was related to the lack of physical activity (58.73%), lack of fish consumption (50.79%), lack of red meat consumption (21.20%), and secondhand smoke (19.02%). The highest PAF was related to secondhand smoke; this value based on the crude relative risk (RR) and crude odds ratio (OR) was 24.54% and 23.44%, respectively. Based on crude hazard ratio (HR) and crude OR, the PAF for smoking was 14.81% and 11.19%, respectively. PAF for lack of BCG vaccination based on the crude OR was 14.79%.
Conclusion
Based on this study’s results, poor nutrition, secondhand smoke, smoking, lack of BCG vaccination, and diabetes are the main prevalent modifiable risk factors for TB. The highest PAF for TB was related to secondhand smoke, smoking, lack of BCG vaccination, and diabetes.
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Zhang W. Deterministic and stochastic in-host tuberculosis models for bacterium-directed and host-directed therapy combination. MATHEMATICAL MEDICINE AND BIOLOGY : A JOURNAL OF THE IMA 2022; 39:126-155. [PMID: 35235658 DOI: 10.1093/imammb/dqac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
Mycobacterium tuberculosis (TB) infection can involve all immune system components and can result in different disease outcomes. The antibiotic TB drugs require strict adherence to prevent both disease relapse and mutation of drug- and multidrug-resistant strains. To overcome the constraints of pathogen-directed therapy, host-directed therapy has attracted more attention in recent years as an adjunct therapy to enhance host immunity to fight against this intractable pathogen. The goal of this paper is to investigate in-host TB models to provide insights into therapy development. Focusing on therapy-targeting parameters, the parameter regions for different disease outcomes are identified from an established ODE model. Interestingly, the ODE model also demonstrates that the immune responses can both benefit and impede disease progression, depending on the number of bacteria engulfed and released by macrophages. We then develop two Itô SDE models, which consider the impact of demographic variations at the cellular level and environmental variations during therapies along with demographic variations. The SDE model with demographic variation suggests that stochastic fluctuations at the cellular level have significant influences on (1) the T-cell population in all parameter regions, (2) the bacterial population when parameters located in the region with multiple disease outcomes and (3) the uninfected macrophage population in the parameter region representing active disease. Further, considering environmental variations from therapies, the second SDE model suggests that disease progression can slow down if therapies (1) can have fast return rates and (2) can bring parameter values into the disease clearance regions.
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Affiliation(s)
- Wenjing Zhang
- Department of Mathematics and Statistics, Texas Tech University Lubbock, TX 79409-1042, USA
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Watumo D, Mengesha MM, Gobena T, Gebremichael MA, Jerene D. Predictors of loss to follow-up among adult tuberculosis patients in Southern Ethiopia: a retrospective follow-up study. BMC Public Health 2022; 22:976. [PMID: 35568853 PMCID: PMC9107690 DOI: 10.1186/s12889-022-13390-8] [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: 08/22/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Loss to follow-up (LTFU) from tuberculosis (TB) treatment and care is a major public health problem as patients can be infectious and also may develop a multi-drug resistant TB (MDR-TB). The study aimed to assess whether LTFU differs by the distance TB patients travelled to receive care from the nearest health facility. Methods A total of 402 patient cards of TB patients who received care were reviewed from March 1–30, 2020. The Kaplan-Meir curve with the Log-rank test was used to compare differences in LTFU by the distance travelled to reach to the nearest health facility for TB care. The Cox proportional hazard regression model was used to identify predictors. All statistical tests are declared significant at a p-value< 0.05. Results A total of 37 patients were LTFU with the incidence rate of 11.26 per 1000 person-months of observations (PMOs) (95% CI: 8.15–15.53). The incidence rate ratio was 12.19 (95% CI: 5.01–35.73) among the groups compared (those who travelled 10 km or more versus those who travelled less than 10 km). Age ≥ 45 years (aHR = 7.71, 95% CI: 1.72, 34.50), educational status (primary schooling, aHR = 3.54, 95% CI: 1.49, 8.40; secondary schooling, aHR = 2.75, 95% CI: 1.08, 7.03), lack of family support (aHR = 2.80, 95% CI: 1.27, 6.19), nutritional support (aHR = 3.40, 95% CI:1.68, 6.89), ≥ 10 km distance to travel to a health facility (aHR = 6.06, 95% CI: 2.33, 15.81) had significantly predicted LTFU from TB treatment and care. Conclusions LTFU from adult TB care and treatment was 12 times higher among those who travelled ≥10 km to reach a health facility compared to those who travelled less. To retain adult TB patients in care and ensure appropriate treatment, health professionals and other stakeholders should give due attention to the factors that drive LTFU. We suggest identifying concerns of older patients at admission and those who travel long distance and establish social support platforms that could help people to complete TB treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13390-8.
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Affiliation(s)
| | - Melkamu Merid Mengesha
- Epidemiology and Biostatistics Unit, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Tesfaye Gobena
- Department of Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mathewos Alemu Gebremichael
- Epidemiology and Biostatistics Unit, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Degu Jerene
- KNCV Tuberculosis Foundation, Hague, The Netherlands
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Jiang G, Zhu Y, Luo W, Zhang W, Qin W, Ou Y. What Level Should Preoperative Albumin of Thoracic and Lumbar Tuberculosis Patients Be Reached: A Case-Controlled Study. Front Nutr 2022; 9:740459. [PMID: 35571899 PMCID: PMC9097765 DOI: 10.3389/fnut.2022.740459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To explore the risk factors of hypoalbuminemia in patients with thoracic and lumbar tuberculosis and develop a scoring scale, according to which the patients with thoracic and lumbar tuberculosis were divided into 2 groups to, respectively calculate the perioperative albumin changes and to find out the preoperative albumin recommended value. Methods A total of 166 patients with thoracic and lumbar tuberculosis, who underwent spinal focus debridement between January 2012 to May 2020, were identified into 2 groups: with and without postoperative hypoalbuminemia (n = 131 and n = 35, respectively), recording and analyzing clinical characteristics by multivariate analysis to establish a scoring scale. Using this scale, patients with spinal tuberculosis were divided into a high-risk group and a low-risk group, and then, calculated the average decrease of postoperative albumin in both groups. Combined with the diagnostic threshold of hypoalbuminemia, we proposed the preoperative albumin safe values of the patients with thoracic and lumbar tuberculosis. Results A total of 131 of 166 patients experienced postoperative hypoalbuminemia after spinal focus debridement. Multivariate binary logistic regression analysis identified pulmonary tuberculosis (adjusted odds ratio = 0.270, p = 0.012), pre-operative serum albumin value (adjusted odds ratio = 0.754, p < 0.001), and operation time (adjusted odds ratio = 1.017, p = 0.002) as independent risk factors for the occurrence of postoperative hypoalbuminemia in patients with thoracic and lumbar tuberculosis. According to the OR value, the risk factors are assigned to make the scoring scale, the receiver operating characteristic (ROC) curve indicates that postoperative hypoalbuminemia rises when the score is greater than or equal to 4 points. The scoring scale is tested in the derivation set (166 patients) showed: sensitivity-51.9%, specificity-91.4%, and in the validation set (102 patients) showed: sensitivity-63.6% and specificity-86.1%. The perioperative albumin decreased value is 4.71 ± 2.66 g/L in the low-risk group and 8.99 ± 3.37 g/L in the high-risk group (p < 0.001). Conclusion Complicated with pulmonary tuberculosis, low preoperative albumin value and long operation time can lead to postoperative hypoalbuminemia in patients with thoracic and lumbar tuberculosis. The scoring scale can effectively assist physicians to evaluate whether patients with thoracic and lumbar tuberculosis develop hypoalbuminemia after surgery. The scale is simple and reliable and has clinical guiding significance. For low-risk patients and high-risk patients, preoperative albumin values should reach 40 and 44 g/L, respectively, to effectively avoid postoperative hypoalbuminemia.
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Sharan Kumar VG, Pajanivel R, Boratne AV, Vimal Raj R. Impact of dietary counselling on the nutritional status and quality of life among pulmonary tuberculosis patients - A randomized control trial. Indian J Tuberc 2022; 69:201-206. [PMID: 35379402 DOI: 10.1016/j.ijtb.2021.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND & AIM Undernutrition and TB have a bidirectional relationship, which is especially relevant in the Indian context. Undernutrition is an established risk factor for the progression of latent TB infection to active TB. Undernutrition at the population level contributes to an estimated 55% of annual TB incidence in India. TB leads to weight loss, wasting, and worsening of nutritional status. Hence, the present study aimed to determine the impact of dietary counselling on the nutritional status and the health-related quality of life of PTB patients. MATERIALS & METHOD This was an interventional study (randomized controlled trial) that involved patients with PTB. 46 patients (23 patients as experimental and 23 patients as a control group) were enrolled in the study from June 2019 to February 2020 and they were divided into 2 categories based on BMI (underweight and normal weight). The special dietary counselling was given to the experimental group patients and the normal protocol was followed with the control group. The patients were followed up, till completion of treatment i.e., 6 months from enrolment. RESULTS In our study, nearly half of the patients were underweight and DM was the predominant comorbidity. The BMI increased after dietary counselling in the experimental group than the control group (P = 0.0053) in underweight individuals. Total protein (P = 0.0025), and serum albumin (P = 0.0048) levels were found to be significantly improved in the experimental group. SGRQ symptom score (P = 0.0036) has significantly reduced in the experimental group in underweight individuals than the control group. CONCLUSION Personalized dietary counselling was found to have a positive impact on BMI, total protein, and albumin levels in the experimental group, especially in underweight individuals. Besides, the quality of life measured using SGRQ showed that symptom score were also significantly reduced in the experimental group than the control group.
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Affiliation(s)
- V G Sharan Kumar
- Department of Pulmonary Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth - Deemed to Be University, Pillayarkuppam, Puducherry, 607402, India.
| | - R Pajanivel
- Department of Pulmonary Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth - Deemed to Be University, Pillayarkuppam, Puducherry, 607402, India
| | - Abhijit V Boratne
- Department of Community Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth - Deemed to Be University, Pillayarkuppam, Puducherry, 607402, India
| | - R Vimal Raj
- Department of Pulmonary Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth - Deemed to Be University, Pillayarkuppam, Puducherry, 607402, India
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Bogale L, Tenaw D, Tsegaye T, Abdulkadir M, Akalu TY. A Score to Predict the Risk of Major Adverse Drug Reactions Among Multi-Drug Resistant Tuberculosis Patients in Southern Ethiopia, 2014–2019. Infect Drug Resist 2022; 15:2055-2065. [PMID: 35480059 PMCID: PMC9037729 DOI: 10.2147/idr.s351076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Adverse events (AE) contribute to poor drug adherence and withdrawal, which contribute to a low treatment success rate. AE are commonly reported among multi-drug resistance tuberculosis (MDR-TB) patients in Ethiopia. However, predictors of AE among MDR-TB patients were limited in Ethiopia. Thus, the current study aimed to develop and validate a score to predict the risks of major AE among MDR-TB patients in Southern Ethiopia. Methods A retrospective follow-up study design was employed among MDR-TB patients from 2014–2019 in southern Ethiopia at selected hospitals. A least absolute shrinkage and selection operator algorithm was used to select the most potent predictors of the outcome. The adverse event risk score was built based on the multivariable logistic regression analysis. Discriminatory power and calibration were checked to evaluate the performance of the model. Bootstrapping method with 100 repetitions was used for internal model validation. Results History of baseline khat use, long-term drug regimen use, and having coexisting disorders (co-morbidity) were predictors of AEs. The score has a satisfactory discriminatory power (AUC = 0.77, 95% CI: 0.68, 0.82) and a modest calibration (Prob > chi2 = 0.2043). It was found to have the same c-statistics after validation by bootstrapping method of 100 repetitions with replacement. Conclusion A history of baseline khat use, co-morbidity, and long-term drug regimen use are helpful to predict individual risk of major adverse events in MDR-TB patients with a satisfactory degree of accuracy (AUC = 0.77).
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Affiliation(s)
- Lemlem Bogale
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Denekew Tenaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tewodros Tsegaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohamed Abdulkadir
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Temesgen Yihunie Akalu, Tel +251929390709, Email
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Benjamin SR, Mohammad A, Shankar R, Kuruvilla KT, Philip MA, Thankachen R, Gnanamuthu BR, Kesavan P. Does tuberculosis affect surgical outcomes following pericardiectomy for chronic constrictive pericarditis? Twelve years’ experience from a tertiary care center in India. Indian J Thorac Cardiovasc Surg 2022; 38:241-250. [PMID: 35529004 PMCID: PMC9023633 DOI: 10.1007/s12055-021-01313-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and purpose Tuberculosis (TB) is the commonest cause of chronic constrictive pericarditis (CCP) in India, unlike in the western countries. Pericardiectomy is the treatment of choice for CCP. Surgery in TB CCP is considerably more difficult than it is for other etiologies. The role of TB as an independent predictor for adverse surgical outcomes had not been properly evaluated in the Indian scenario. Hence, the aim of this study was to retrospectively analyze our results of surgery for CCP and the pre-operative factors that influenced post-operative outcomes. Methods The data of all adult patients who underwent pericardiectomy for CCP, between the years 2009 and 2020, maintained in a live database in our institute, were retrieved and analyzed. Results There were 124 patients in the study. The average age was 32 years. The male to female ratio was 3:1. TB was the commonest cause of CCP, identified in 64 (51.6%) patients. Complete anterior pericardiectomy (CAP) was possible in 122 (98.3%) patients. All the patients had significant drop in their central venous pressure (CVP) (10.25 ± 3.47 mmHg) after surgery. The operative time (p = 0.008), intra-operative blood loss (p = 0.02), intensive care unit (ICU) stay (p = 0.03), and hospital stay (p = 0.028) were significantly higher in the TB group. Apart from TB, the other pre-operative variables that predicted adverse outcomes were male sex, presence of pleural effusion or ascites, and advanced New York Heart Association (NYHA) class. There were 7 (5.6%) post-operative complications and 3 (2.4%) in-hospital deaths. Conclusion The high incidence of TB CCP makes a pericardiectomy in developing countries technically more challenging resulting in increased operative time, more blood loss, and prolonged ICU and hospital stay, but did not affect in-hospital mortality or morbidity.
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Affiliation(s)
- Santhosh Regini Benjamin
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Aamir Mohammad
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Ravi Shankar
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Korah Thomas Kuruvilla
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Madhu Andrew Philip
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Roy Thankachen
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Birla Roy Gnanamuthu
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Premprasath Kesavan
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
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Appiah PK, Osei B, Amu H. Factors associated with nutritional status, knowledge and attitudes among tuberculosis patients receiving treatment in Ghana: A cross-sectional study in the Tema Metropolis. PLoS One 2021; 16:e0258033. [PMID: 34648547 PMCID: PMC8516225 DOI: 10.1371/journal.pone.0258033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background Nutritional deficiencies are generally associated with increased risk and severity of tuberculosis. This study investigated the nutritional status, knowledge, and attitudes of tuberculosis (TB) patients receiving treatment in the Tema Metropolis. Method A cross-sectional design was used to collect data on the nutritional knowledge, attitude, and status of TB patients. Nutritional status was analysed using World Health Organization’s formula for body mass index. Pearson’s chi-square and logistic regression models were used to assess associations between predictor and outcome variables. All statistical analyses were considered significant at p-values < 0.05. Result The prevalence of malnutrition among TB patients was 39.7%, 14.4%, and 4.8% for underweight, overweight, and obesity respectively. There was a high (61.0%) knowledge of nutrition among the patients. Also, 65.8% had good attitude towards nutrition. There were significant associations between normal nutritional status and age of the TB patients (p = 0.041), highest educational level attained (p = 0.036), employment status (p = 0.019), status of alcohol intake (p = 0.031), number of months on TB treatment (p = 0.021), and attitude towards nutrition (p = 0.028). Conclusion There was a reasonable nutrition-related knowledge and attitude towards nutrition among the TB patients. However, that did not reflect on their nutritional status. We recommend continuing education on smoking cessation, avoidance of harmful use of alcohol, and the establishment of food aid and other livelihood intervention programs for TB patients.
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Affiliation(s)
- Prince Kubi Appiah
- Department of Family and Community Health, School of Public Health (Hohoe Campus), University of Health and Allied Sciences, Ho, Ghana
- Department of Medical Law and Ethics, Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, South Korea
- * E-mail: ,
| | - Bright Osei
- Department of Family and Community Health, School of Public Health (Hohoe Campus), University of Health and Allied Sciences, Ho, Ghana
| | - Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health (Hohoe Campus), University of Health and Allied Sciences, Ho, Ghana
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Bandiara R, Sukesi L, Indrasari A, Kulsum ID, Rudiansyah M. The Relationship between Nutritional Status and Latent Tuberculosis in Routine Hemodialysis. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Malnutrition in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) interferes with the natural and adaptive immune response, consequently, increasing the latent tuberculosis (TB) reactivation.
AIM: This study therefore aims to determine the relationship between nutritional status and latent TB in routine HD, using interferon gamma release assays (IGRA), to screen for latent TB.
METHODS AND STUDY DESIGN: This study has an analytical observation cross-sectional design, and was conducted on 120 CKD-HD patients aged 18 years and above, and has been undergoing HD twice weekly for over 3 months, without malignancy, human immunodeficiency virus/acquired immunodeficiency syndrome, history of TB, or radiological evidence at the HD Unit of the Dr. Hasan Sadikin Hospital, Bandung, Indonesia, between March and May 2020, and not currently receiving immunosuppressant or TB therapy. In addition, the age, gender, history of Bacille Calmette-Guerin vaccine, CKD etiology, length of HD, HD adequacy, TB contact history, number of family members, smoking status, body mass index, albumin, malnutrition inflammation score, triceps skinfold thickness (TST), biceps skinfold thickness, suprailiac skinfold thickness (SIST), mid-upper arm circumference (MAC), and normalized protein catabolic rate between positive and negative IGRA groups, of each patient, were determined.
RESULTS: In this study, all the patients met the inclusion and exclusion criteria. Based on the IGRA test, 47 patients (39.17%) tested positive, and 68 (56.67%) tested negative, while the results for the remaining 5 (4.16%) were indeterminate. The malnutrition inflammation score (MIS) score with positive IGRA 23.3 (20.0–26.7) was discovered to differ insignificantly (p value of 0.252) from the negative counterpart 20.0 (16.7–28.4). Meanwhile, in the HD adequacy assessment based on urea reduction rate, a statistically significant difference (p = 0.042) occurred between the positive 70.45 (65.70–76.61) and negative 74.15 (70.71–77.33) IGRA groups. In the smoking status, the positive and negative IGRA were discovered to differ significantly (30 (63.8% vs. 28 (41.2% p = 0.017) OR 2.521 (1.172–5.425). However, in the history of contact with TB patients, the positive and negative IGRA did not differ significantly (4.3% vs. 11.8% p = 0.160). Furthermore, there was a significant difference in TST and MAC, between MIS >5 and MIS ≤5 (p < 0.05).
CONCLUSION: The assessment of nutritional status level, TST, MAC, smoking status, and adequate HD is crucial for CKD patients with routine HD, as these factors present risks of latent TB.
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Hussien B, Ameni G. A Cross-sectional Study on the Magnitude of undernutrition in Tuberculosis Patients in the Oromia Region of Ethiopia. J Multidiscip Healthc 2021; 14:2421-2428. [PMID: 34511925 PMCID: PMC8421325 DOI: 10.2147/jmdh.s326233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/10/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To estimate the magnitude of undernutrition in tuberculosis (TB) patients and evaluate its association with selected sociodemographic and clinical characteristics of the patients. PATIENTS AND METHODS A health facility-based cross-sectional design was used. Four hundred and fifty pulmonary TB (PTB) patients were recruited between September 2017 and August 2018. Data were collected by structured questionnaire and anthropometric measurements. Data were analyzed using SPSS 20. Descriptive statistics was used for the analysis and expression of the data. Regression model was used to determine the association between undernutrition and selected factors. RESULTS The magnitude of underweight was 51.6%, (95%CI: 47.15-56.2). Binary logistic regression indicated that previous treatment with anti-TB (crude odds ratio, COR=1.68, 95%CI: 1.08-2.63; p<0.023), duration of illness greater than two months (COR=2.11, 95%CI: 1.26-3.55, p<0.005), positive HIV serum status (COR=3.83, 95%CI: 1.63-9.02, p<0.002) and history of resistance to any anti TB drug (COR=2.76, 95%CI: 1.29-5.91, p<0.009) were associated with underweight. Multiple logistic regression analysis of the association of the aforementioned variables with undernutrition indicated that HIV positivity (adjusted odds ratio, AOR=0.26, 95%CI: 0.104-0.65, p<0.004) and resistance to any anti-TB drug (AOR=0.39, 95%CI: 0.173-0.90, p<0.026) were the associated factors. CONCLUSION A significant proportion of TB patients in the Oromia Region were malnourished. Therefore, nutritional counseling and nutritional supplementation are required for the effective treatment of TB patients in the Region.
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Affiliation(s)
- Bedru Hussien
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, Robe Bale, Oromia, Ethiopia
| | - Gobena Ameni
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Lin HS, Lin MS, Chi CC, Ye JJ, Hsieh CC. Nutrition Assessment and Adverse Outcomes in Hospitalized Patients with Tuberculosis. J Clin Med 2021; 10:jcm10122702. [PMID: 34207380 PMCID: PMC8235651 DOI: 10.3390/jcm10122702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Malnutrition in patients with tuberculosis (TB) is associated with poor outcomes. This study assessed the validity of the patient-generated subjective global assessment (PG-SGA) in adult TB patients and examined the association of the PG-SGA score with adverse outcomes. Methods: This is a retrospective chart review study compared with the well-nourished and malnourished TB patients. The nutritional status was determined using the PG-SGA for adult patients (n = 128). Clinical outcomes included liver injury and mortality. Adverse outcomes included hepatitis during anti-tuberculosis therapy. Results: By comparing nutritional status using global assessment, well-nourished patients had a significantly higher body weight index (p = 0.002), a lower PG-SGA score (p < 0.001), and lower diabetic rate (p = 0.029). Malnourishment was a risk factor (p = 0.022) for liver injury and fatal outcomes (p < 0.001). A higher PG-SGA score was a risk factor for liver injury (p = 0.002) and an independent risk factor for fatal outcomes (p = 0.031). ROC analysis for outcome prediction showed that a PG-SGA score of 5.5 points yielded the most appropriate sensitivity (61.5%) and specificity (64.7%). Conclusion: Both global assessment and the total PG-SGA score were related to tuberculosis outcome and liver injury during anti-TB treatment.
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Affiliation(s)
- Huang-Shen Lin
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan; (C.-C.C.); (C.-C.H.)
- Correspondence: ; Tel.: +88-63-3621-000 (ext. 2573); Fax: +88-63-3623-002
| | - Ming-Shyan Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Ching-Chi Chi
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan; (C.-C.C.); (C.-C.H.)
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan
| | - Jung-Jr Ye
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 204, Taiwan;
| | - Ching-Chuan Hsieh
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan; (C.-C.C.); (C.-C.H.)
- Department of Nutrition, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
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Anantharam P, Emerson LE, Bilcha KD, Fairley JK, Tesfaye AB. Undernutrition, food insecurity, and leprosy in North Gondar Zone, Ethiopia: A case-control study to identify infection risk factors associated with poverty. PLoS Negl Trop Dis 2021; 15:e0009456. [PMID: 34166403 PMCID: PMC8277044 DOI: 10.1371/journal.pntd.0009456] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 07/13/2021] [Accepted: 05/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Ethiopia has over 3,200 new cases of leprosy diagnosed every year. Prevention remains a challenge as transmission pathways are poorly understood. Susceptibility and disease manifestations are highly dependent on individual host-immune response. Nutritional deficiencies, such as protein-energy malnutrition, have been linked to reduced cell-mediated immunity, which in the case of leprosy, could lead to a higher chance of active leprosy and thus an increased reservoir of transmissible infection. METHODOLOGY/PRINCIPAL FINDINGS Between June and August 2018, recently diagnosed patients with leprosy and individuals without known contact with cases were enrolled as controls in North Gondar regional health centers. Participants answered survey questions on biometric data, demographics, socioeconomic situation, and dietary habits. Descriptive statistics, univariate, and multivariate logisitic regression examined associations between undernutrition, specifically body mass index (BMI), middle upper arm circumference (MUAC), and leprosy. Eighty-one participants (40 cases of leprosy, 41 controls) were enrolled (75% male) with an average age of 38.6 years (SD 18.3). The majority of cases were multibacillary (MB) (90%). There was a high prevalence of undernutrition with 24 (29.6%) participants underweight (BMI <18.5) and 17 (21%) having a low MUAC. On multivariate analysis, underweight was significantly associated with leprosy (aOR = 9.25, 95% CI 2.77, 30.81). Also found to be associated with leprosy was cutting the size of meals/skipping meals (OR = 2.9, 95% CI 1.0, 8.32) or not having enough money for food (OR = 10, 95% CI 3.44 29.06). CONCLUSIONS/SIGNIFICANCE The results suggest a strong association between leprosy and undernutrition, while also supporting the framework that food insecurity may lead to undernutrition that then could increase susceptibility to leprosy. In conclusion, this study highlights the need to study the interplay of undernutrition, food insecurity, and the manifestations of leprosy.
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Affiliation(s)
- Puneet Anantharam
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Lisa E. Emerson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Kassahun D. Bilcha
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jessica K. Fairley
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Annisa B. Tesfaye
- University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
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Mortality in relation to profiles of clinical features in Ghanaian severely undernourished children aged 0-59 months: an observational study. Br J Nutr 2021; 125:1157-1165. [PMID: 32873346 DOI: 10.1017/s0007114520003396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Severe acute malnutrition (SAM) is associated with a complex pattern of various clinical conditions. We investigated how risk factors cluster in children with SAM, the relationship between clusters of risk factors and mortality as well as length of stay in children with SAM. A prospective observational study design was used. Data were extracted from medical records of 601 infants and children aged 0-59 months admitted and treated for SAM in three Ghanaian referral hospital between June 2013 and June 2018. Among the 601 medical records extracted, ninety-nine died. Three clusters of medical features clearly emerged from data analyses. Firstly, an association was defined by eye signs, pallor, diarrhoea and vomiting with gastrointestinal infections and malaria. In this cluster, pallor and eye signs were related to 2- to 5-fold increased mortality risk. Secondly, HIV, oedema, fast pulse, respiratory infections and tuberculosis; among those features, HIV increased child mortality risk by 2-fold. Thirdly, shock, convulsions, dermatitis, cold hands and feet, weak pulse, urinary tract infections and irritability were clustered. Among those features, cold hands and feet, dermatitis, convulsions and shock increased child mortality risk in a range of 2- to 9-fold. Medical conditions and clinical signs in children diagnosed with SAM associate in patterns and are related to clinical outcomes.
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Magassouba AS, Touré AA, Diallo BD, Camara LM, Touré D, Conté N, Diaby M, Camara SN, Camara G, Bangoura AM, Kamano TA, Tounkara AF. Malnutrition prevalence and associated biochemical factors among drug-resistance tuberculosis (DR-TB) patients at key treatment sites in Conakry City, Republic of Guinea. Pan Afr Med J 2021; 38:279. [PMID: 34122706 PMCID: PMC8179982 DOI: 10.11604/pamj.2021.38.279.27270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/31/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction drug-resistant tuberculosis is a major global health problem and a threat to health security given the increase in the number of cases and the challenges associated with care. Besides, the relationship between poor nutritional status and tuberculosis is clearly established. For relevant and evidence-based public health decision-making regarding the management of malnutrition in patients with drug-resistant tuberculosis in the initial phase, it is essential to estimate the prevalence of malnutrition and understand the risk factors associated with it. Methods we performed a retrospective cohort study in drug-resistant tuberculosis patients aged 18 years and older, among which the nutritional status was assessed through BMI. All predictors were included in a prediction model using the multivariate logistic model according to the lowest Akaike criterion. Discrimination and model calibration was evaluated using receiver performance analysis, and the Hosmer and Lemeshow test. Results this study revealed a prevalence of malnutrition of 64.7% in drug-resistant tuberculosis patients in our 218-patient series. The factors associated with malnutrition were: unsuccessful treatment, the active presence of mycobacterium tuberculosis, increased bacteriological conversion time, increased serum creatinine, increased transaminase SGPT of the liver, and anaemia. Some of the factors not associated with malnutrition included the history of anti-tuberculosis treatment, vomiting, hepatic SGPT, initial AFB count, smear and culture conversion time, depression, and chest X-ray. Conclusion malnutrition remains a concern among drug-resistant tuberculosis patients in Guinea as it affects more than half of them with a negative impact on the outcome of treatment. Implementing specific interventions for these high-risk patients, including nutritional supplementation, psychosocial support, and treatment for tuberculosis, can improve management for better treatment outcomes.
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Affiliation(s)
| | - Almamy Amara Touré
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea
| | - Boubacar Djelo Diallo
- Faculty of Health Science and Technology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Lansana Mady Camara
- Faculty of Health Science and Technology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea.,Pneumo Physiology Department, Conakry University Hospital Ignace Deen, Conakry, Guinea
| | - Demba Touré
- Faculty of Health Science and Technology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea.,Pneumo Physiology Department, Conakry University Hospital Ignace Deen, Conakry, Guinea
| | - Nfanly Conté
- Faculty of Health Science and Technology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Macka Diaby
- Faculty of Health Science and Technology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Soriba Naby Camara
- Faculty of Health Science and Technology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Gnoume Camara
- Faculty of Health Science and Technology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
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Sahile Z, Tezera R, Haile Mariam D, Collins J, Ali JH. Nutritional status and TB treatment outcomes in Addis Ababa, Ethiopia: An ambi-directional cohort study. PLoS One 2021; 16:e0247945. [PMID: 33651842 PMCID: PMC7924797 DOI: 10.1371/journal.pone.0247945] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Remaining underweight during Tuberculosis (TB) treatment is associated with a higher risk of unsuccessful TB treatment outcomes and relapse. Previous studies conducted in Ethiopia found that bodyweight not adjusted for height at the start of treatment is associated with poor treatment outcomes. However, the association of body mass index (BMI) and weight change during treatment with treatment outcomes has not been studied. We aimed to investigate the association of BMI at the time of diagnosis and after two months of treatment and TB treatment outcomes. METHODS Using an ambi-directional cohort study design (retrospective and prospective), a total of 456 participants were enrolled among 30 randomly selected public health centers residing within six sub-cities of Addis Ababa, Ethiopia. Data were collected using medical chart abstraction and face to face interviews. We compared TB treatment outcomes in persons with a body mass index (BMI) <18.5kg/m2 (underweight) versus persons with BMI ≥18.5kg/m2 (normal or overweight) at treatment initiation and after two months of treatment. Treatment was classified as successful in persons who were free of symptoms and had a negative sputum smear for acid-fast bacilli at the end of the 6-month treatment course. We analysed outcomes using univariable and multivariable logistic regression with 95% CI and p value< 0.05. RESULTS Of enrolled study participants, 184 (40.4%) were underweight and 272 (59.6%) were normal or overweight. Body mass index (BMI ≥18.5kg/m2) at the start and second month of treatment were independent predictors for successful treatment outcome (AOR = 2.15; 95% CI: 1.05, 4.39) and (AOR = 3.55; 95% CI: 1.29, 9.73), respectively. The probability of treatment success among patients with BMI≥18.5kg/m2 at the start and second month of treatment was 92.9% and 97.1%, respectively versus 86.5% and 91.7% in patients with BMI<18.5kg/m2. Bodyweight not adjusted for height and change in the bodyweight after the second and sixth months of treatment were not significantly associated with treatment success. CONCLUSION In persons treated for TB disease, being underweight at baseline and after two months of treatment was a predictor for unsuccessful treatment outcomes. Nutritional assessment, counselling, and management are important components of TB treatment programs with the potential to improve treatment outcomes.
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Affiliation(s)
- Zekariyas Sahile
- Department of Public Health, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
- * E-mail:
| | - Robel Tezera
- Department of Radiology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damen Haile Mariam
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jeffrey Collins
- School of Medicine, Emory University, Georgia, Atlanta, United States of America
| | - Jemal Haider Ali
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Peetluk LS, Rebeiro PF, Cordeiro-Santos M, Kritski A, Andrade BB, Durovni B, Calvacante S, Arriaga MB, Turner MM, Figueiredo MC, Rolla VC, Sterling TR. Lack of Weight Gain During the First 2 Months of Treatment and Human Immunodeficiency Virus Independently Predict Unsuccessful Treatment Outcomes in Tuberculosis. J Infect Dis 2021; 221:1416-1424. [PMID: 31724035 DOI: 10.1093/infdis/jiz595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Weight change may inform tuberculosis treatment response, but its predictive power may be confounded by human immunodeficiency virus (HIV). METHODS We prospectively followed up adults with culture-confirmed, drug-susceptible, pulmonary tuberculosis receiving standard 4-drug therapy (isoniazid, rifampin, pyrazinamide, and ethambutol) in Brazil. We examined median weight change 2 months after treatment initiation by HIV status, using quantile regression, and unsuccessful tuberculosis treatment outcome (treatment failure, tuberculosis recurrence, or death) by HIV and weight change status, using Cox regression. RESULTS Among 547 participants, 102 (19%) were HIV positive, and 35 (6%) had an unsuccessful outcome. After adjustment for confounders, persons living with HIV (PLWH) gained a median of 1.3 kg (95% confidence interval [CI], -2.8 to .1) less than HIV-negative individuals during the first 2 months of tuberculosis treatment. PLWH were at increased risk of an unsuccessful outcome (adjusted hazard ratio, 4.8; 95% CI, 2.1-10.9). Weight change was independently associated with outcome, with risk of unsuccessful outcome decreasing by 12% (95% CI, .81%-.95%) per 1-kg increase. CONCLUSIONS PLWH gained less weight during the first 2 months of tuberculosis treatment, and lack of weight gain and HIV independently predicted unsuccessful tuberculosis treatment outcomes. Weight, an easily collected biomarker, may identify patients who would benefit from alternative treatment strategies.
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Affiliation(s)
- Lauren S Peetluk
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Marcelo Cordeiro-Santos
- Fundação Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | - Afranio Kritski
- Universidade do Estado do Amazonas, Manaus, Brazil.,Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, Brazil
| | - Bruno B Andrade
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Bahia, Brazil.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil.,Faculdade de Tecnologia e Ciências, Salvador, Bahia, Brazil
| | - Betina Durovni
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Solange Calvacante
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil.,Secretaria Municipal de Saúde do Rio de Janeiro (Clínica da Familia Rinaldo Delamare)-Rocinha, Rio de Janeiro, Brazil
| | - María B Arriaga
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Bahia, Brazil.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Megan M Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Marina C Figueiredo
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Valeria C Rolla
- Secretaria Municipal de Saúde do Rio de Janeiro (Clínica da Familia Rinaldo Delamare)-Rocinha, Rio de Janeiro, Brazil
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis. BMC Infect Dis 2021; 21:1. [PMID: 33390160 PMCID: PMC7780691 DOI: 10.1186/s12879-020-05706-z] [Citation(s) in RCA: 195] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/11/2020] [Indexed: 01/04/2023] Open
Abstract
Background Undernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. In Sub-Saharan Africa (SSA), the impacts of these often inter-related conditions appear in a series of fragmented and inconclusive studies. Thus, this review examines the pooled effects of undernutrition on mortality and morbidities among adults living with HIV in SSA. Methods A systematic literature search was conducted from PubMed, EMBASE, CINAHL, and Scopus databases. All observational studies reporting the effects of undernutrition on mortality and morbidity among adults living with HIV in SSA were included. Heterogeneity between the included studies was assessed using the Cochrane Q-test and I2 statistics. Publication bias was assessed using Egger’s and Begg’s tests at a 5% significance level. Finally, a random-effects meta-analysis model was employed to estimate the overall adjusted hazard ratio. Results Of 4309 identified studies, 53 articles met the inclusion criteria and were included in this review. Of these, 40 studies were available for the meta-analysis. A meta-analysis of 23 cohort studies indicated that undernutrition significantly (AHR: 2.1, 95% CI: 1.8, 2.4) increased the risk of mortality among adults living with HIV, while severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% CI: 1.9, 2.8) as compared to mildly undernourished adults living with HIV. Furthermore, the pooled estimates of ten cohort studies revealed that undernutrition significantly increased the risk of developing tuberculosis (AHR: 2.1, 95% CI: 1.6, 2.7) among adults living with HIV. Conclusion This review found that undernutrition has significant effects on mortality and morbidity among adults living with HIV. As the degree of undernutrition became more severe, mortality rate also increased. Therefore, findings from this review may be used to update the nutritional guidelines used for the management of PLHIV by different stakeholders, especially in limited-resource settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05706-z.
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Wang A, MacNeil A, Maloney S. Comparison and lessons learned from neglected tropical diseases and tuberculosis. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000027. [PMID: 36962087 PMCID: PMC10022365 DOI: 10.1371/journal.pgph.0000027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Currently, tuberculosis (TB) is the leading cause of death from a single infectious agent and accounts for over one-third of all HIV-related deaths. However, research and programmatic funding have lagged far behind investments for many other diseases. For about a century, the current Bacillus Calmette-Guérin vaccine has been the only effective vaccine and is only effective in preventing severe disease in children; the first new therapeutic drug for TB in over 40 years was brought to market a few years ago; and until 10 years ago, diagnosis of TB depended on a century-old testing technique. This paper relates TB to neglected tropical diseases (NTDs) and highlights shared characteristics. The aim is to elevate awareness of TB within the framework of NTDs and gain insights from successes in addressing NTDs and how these lessons can be applied to help global health programs change the trajectory of the TB epidemic. A literature review was conducted to compare TB to NTDs and highlight lessons learned from NTD control that can be applied to the TB epidemic. Common features of NTDs include underlying burden of disease, influence and effect on poverty and development, and neglect through political will and funding. There are overarching principles for the design and implementation of NTD control programs that could be applied to ending TB.
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Affiliation(s)
- Alice Wang
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Adam MacNeil
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Susan Maloney
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Hagan Seneadza NA, Antwi S, Yang H, Enimil A, Dompreh A, Wiesner L, Peloquin CA, Lartey M, Lauzardo M, Kwara A. Effect of malnutrition on the pharmacokinetics of anti-TB drugs in Ghanaian children. Int J Tuberc Lung Dis 2021; 25:36-42. [PMID: 33384043 PMCID: PMC8259402 DOI: 10.5588/ijtld.20.0301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Anti-TB drugs dosing based on weight alone may contribute to suboptimal drug concentrations and poor treatment outcomes in malnourished children. We examined the effect of malnutrition on the pharmacokinetics (PK) of first-line anti-TB drugs in children.METHODS: Drug concentrations were measured in Ghanaian children during the intensive phase of TB treatment. Weight-for-age (WFA), height-for-age (HFA), weight-for-height (WFH) and body mass index-for-age (BFA) were calculated and children with Z-scores < -2 SD (standard deviations) were considered as having malnutrition. PK differences of anti-TB drugs were compared by nutritional status.RESULTS: Of 100 participants, 24/48 (50.0%) of those younger than 5 years had wasting, 58/86 (67.4%) were underweight, and 56/99 (56.6%) had stunting; 22/51 (43.1%) children aged ≥5 years had low BFA. Children with stunting were more likely than controls to have lower mean peak concentration (Cmax) and area under the curve (AUC0-8h) of rifampin (RIF) and pyrazinamide (PZA), as well as a higher frequency of Cmax below the normal range. Wasting and underweight were associated with lower mean ethambutol (EMB) Cmax and AUC0-8h.CONCLUSIONS: The current WHO-recommended dosages were associated with lower plasma exposure of RIF, PZA and EMB in children with stunting, wasting and underweight. Anti-TB drugs dosing models for children may need to include height.
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Affiliation(s)
- Nana Ayegua Hagan Seneadza
- Department of Epidemiology, University of Florida
- Department of Community Health, University of Ghana Medical
School
| | - Sampson Antwi
- Directorate of Child Health, Komfo Anokye Teaching
Hospital, Kumasi, Ghana
- Department of Child Health, School of Medicine and
Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Hongmei Yang
- Department of Biostatistics and Computational Biology,
University of Rochester School of Medicine and Dentistry, Rochester, NY, United
States
| | - Anthony Enimil
- Directorate of Child Health, Komfo Anokye Teaching
Hospital, Kumasi, Ghana
- Department of Child Health, School of Medicine and
Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Dompreh
- Directorate of Child Health, Komfo Anokye Teaching
Hospital, Kumasi, Ghana
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine,
University of Cape Town, Cape Town, South Africa
| | - Charles A Peloquin
- Deaprtment of Pharmacotherapy and Translational Research,
College of Pharmacy, University of Florida, Gainesville, FL
| | - Margaret Lartey
- Department of Medicine and Therapeutics, University of
Ghana Medical School, Accra, Ghana
- Fevers Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Michael Lauzardo
- Division of Infectious Diseases and Global Medicine,
College of Medicine, University of Florida, Gainesville, FL
| | - Awewura Kwara
- Division of Infectious Diseases and Global Medicine,
College of Medicine, University of Florida, Gainesville, FL
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48
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Alzahabi KH, Usmani O, Georgiou TK, Ryan MP, Robertson BD, Tetley TD, Porter AE. Approaches to treating tuberculosis by encapsulating metal ions and anti-mycobacterial drugs utilizing nano- and microparticle technologies. Emerg Top Life Sci 2020; 4:581-600. [PMID: 33315067 PMCID: PMC7752053 DOI: 10.1042/etls20190154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 01/19/2023]
Abstract
Tuberculosis (TB) is caused by a bacterial infection that affects a number of human organs, primarily the lungs, but also the liver, spleen, and spine, causing key symptoms of fever, fatigue, and persistent cough, and if not treated properly, can be fatal. Every year, 10 million individuals become ill with active TB resulting with a mortality approximating 1.5 million. Current treatment guidelines recommend oral administration of a combination of first-line anti-TB drugs for at least 6 months. While efficacious under optimum conditions, 'Directly Observed Therapy Short-course' (DOTS) is not without problems. The long treatment time and poor pharmacokinetics, alongside drug side effects lead to poor patient compliance and has accelerated the emergence of multi-drug resistant (MDR) organisms. All this, combined with the limited number of newly discovered TB drugs to treat MDR-TB and shorten standard therapy time, has highlighted the need for new targeted drug delivery systems. In this respect, there has been recent focus on micro- and nano-particle technologies to prepare organic or/and metal particles loaded with TB drugs to enhance their efficacy by targeted delivery via the inhaled route. In this review, we provide a brief overview of the current epidemiology of TB, and risk factors for progression of latent stage tuberculosis (LTBI) to the active TB. We identify current TB treatment regimens, newly discovered TB drugs, and identify studies that have used micro- or nano-particles technologies to design a reliable inhalation drug delivery system to treat TB more effectively.
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Affiliation(s)
- Khaled H Alzahabi
- National Heart and Lung Institute, Imperial College London, London, U.K
| | - Omar Usmani
- National Heart and Lung Institute, Imperial College London, London, U.K
| | - Theoni K Georgiou
- Department of Materials and London Centre for Nanotechnology, Imperial College London, London, U.K
| | - Mary P Ryan
- Department of Materials and London Centre for Nanotechnology, Imperial College London, London, U.K
| | - Brian D Robertson
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, U.K
| | - Teresa D Tetley
- National Heart and Lung Institute, Imperial College London, London, U.K
| | - Alexandra E Porter
- Department of Materials and London Centre for Nanotechnology, Imperial College London, London, U.K
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49
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Li Q, Chen H, Liu T, He L, Liu P, Zhao Y, Du J, Zou P, Zhang Z, He B, Yang J, Hao D. [Polymethylmethacrylate-augmented screw fixation in treatment of senile thoracolumbar tuberculosis combined with severe osteoporosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1526-1532. [PMID: 33319530 DOI: 10.7507/1002-1892.202006014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the safety and effectiveness of polymethylmethacrylate-augmented screw fixation (PASF) in the treatment of elderly thoracolumbar tuberculosis combined with severe osteoporosis. Methods The clinical data of 20 elderly patients with thoracolumbar tuberculosis and severe osteoporosis who underwent PASF after anterior or posterior debridement and bone grafting and met the selection criteria between December 2012 and December 2014 were retrospectively analyzed. There were 8 males and 12 females with an average age of 68.5 years (range, 65-72 years). T value of bone mineral density was -4.2 to -3.6, with an average of -3.9. There were 12 cases of thoracic tuberculosis, 3 cases of thoracolumbar tuberculosis, and 5 cases of lumbar tuberculosis. The diseased segments involved T 3-L 4, including 11 cases of single-segment disease, 6 cases of double-segment disease, and 3 cases of multi-segment disease. The disease duration was 3-9 months, with an average of 6 months. The preoperative spinal nerve function of the patients was evaluated by the American Spinal Injury Association (ASIA) grading. There were 2 cases of grade A, 5 cases of grade B, 6 cases of grade C, 4 cases of grade D, and 3 cases of grade E. Postoperative imaging examination was used to evaluate the bone graft fusion and paravertebral abscess absorption, and to measure the Cobb angle of the segment to evaluate the improvement of kyphosis. The levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested. The visual analogue scale (VAS) score, Oswestry disability index (ODI), and ASIA grading were used to evaluate the effectivreness before operation, at 1 month after operation, and at last follow-up. The clinical cure of tuberculosis was also evaluated. Results All operation successfully completed. The operation time was 154-250 minutes, with an average of 202 minutes; the intraoperative blood loss was 368-656 mL, with an average of 512 mL. All 20 patients were followed up 18-42 months, with an average of 26.8 months. The postoperative pain and symptoms of tuberculosis in all patients relieved, and the paravertebral abscess was absorbed, reaching the cure standard for spinal tuberculosis. All bone grafts fusion achieved within 1 year after operation. Only 1 case had asymptomatic bone cement leakage into the paravertebral veins, and the remaining patients had no serious complications such as bone cement leakage in the spinal canal, pulmonary embolism, and neurovascular injury. At last follow-up, spinal cord nerve function significantly improved when compared with preoperative one. Among them, ASIA grading were 7 cases of grade C, 8 cases of grade D, and 5 cases of grade E, showing significant difference when compared with preoperative one ( Z=2.139, P=0.000). VAS score, ODI score, segmental Cobb angle, ESR, and CRP at 1 month after operation and at last follow-up were significantly improved when compared with preoperative ones ( P<0.05); there was no significant difference between 1 month after operation and last follow-up ( P>0.05). During the follow-up, no complications such as failure of internal fixation, proximal junctional kyphosis, or tuberculosis recurrence occurred. Conclusion For elderly patients with thoracolumbar tuberculosis and severe osteoporosis, PASF treatment is safe and effective.
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Affiliation(s)
- Qingda Li
- Yan'an University, Yan'an Shaanxi, 716000, P.R.China;Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Hao Chen
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Tuanjiang Liu
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Limin He
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Peng Liu
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Yuanting Zhao
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Jinpeng Du
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Peng Zou
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Zhengping Zhang
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Baorong He
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Junsong Yang
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Dingjun Hao
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
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50
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Understanding how geographic, demographic and treatment history impact health outcomes of patients with multi-drug-resistant tuberculosis in Pakistan, 2014-2017. Epidemiol Infect 2020; 148:e253. [PMID: 32993828 PMCID: PMC7689600 DOI: 10.1017/s0950268820002307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB) is one of the top 10 leading causes of morbidity and mortality worldwide [1]. In 2017, approximately 10 million people were infected with TB and 1.3 million patients faced mortality [1]. Patients with active TB can infect up to 10–15 people over a year. There is a greater risk of transmission in overcrowded areas with limited air ventilation including large family units, prisons and slums [1, 2]. Without proper diagnosis and treatment, roughly 45% of non-HIV positive TB patients face mortality [1]. With the help of global organizations and national TB treatment and control programmes, the global incidence of TB is declining by approximately 2% each year [1]. The World Health Organization (WHO) TB-strategy aims to end the TB epidemic and encourages partners to fund national TB programmes to improve diagnosis and treatment of TB. The goal is to ultimately decrease death rates by 90% and decrease incidence rates by 80% [1]. To achieve these goals, the decline in TB incidence needs to reach approximately 4–5% per year [1]. The WHO 2018 TB report identified multidrug resistant TB (MDR-TB) as the leading factor hindering that goal [1]. The incidence and spread of MDR-TB has drastically increased, where approximately 558 000 new cases of MDR-TB were diagnosed in 2017 causing more than 230 000 deaths globally [1]. MDR-TB is identified by resistance to the two most powerful anti-TB treatment drugs including isoniazid and rifampicin [3]. Patients with MDR-TB are required to start second-line anti-TB drugs (SLDs), which are limited, expensive, less effective and more toxic [1,2]. Therapy duration is one of the major limitations of second-line treatments, which may require up to two years of consistent use. Since TB affects mostly developing countries, long treatment durations and associated costs become a major challenge. In 2015, 15% of new TB cases were reported as MDR-TB, which drastically increased to 24% by 2017 [1]. Even with significant improvements in molecular tests and diagnostic methods, MDR-TB is still on the rise where the success rate of treatments is between 50 and 60% [1]. Additional characteristics including socioeconomic and sociocultural factors need to be considered when targeting and treating patients with MDR-TB.
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