Thyroid function in multidrug-resistant tuberculosis patients with or without human immunodeficiency virus (HIV) infection before commencement of MDR-TB drug regimen

Socioepidemiological status and clinical outcome of MDR TB patients in a tertiary medical college in Southern Odisha

Introduction

India accounts for one-fourth of the global TB burden. The load of drug-resistant TB is of foremost attention and concern at international, regional, and national levels. As per estimates of TB burden in India in 2018, the MDR/RR-TB incidence was 1.30 lakhs.

Objectives

Socioepidemiological status and clinical outcome of MDR TB patients in a teaching hospital in tribal area of southern Odisha from 2012-2020.

Material and Methods

This is a retrospective observational study accepted by the Institutional Ethics Committee of this tertiary medical college & hospital to which the DRTB centre is attached with the agreement of the program administrators.

Inclusion Criteria

Patients with >15 years of age, those patients with pulmonary and extrapulmonary tuberculosis with normal liver enzymes.

Exclusion Criteria

Patients having abnormal liver enzymes before treatment, pregnant ladies and children <15 years of age.

Results

A total of 40 MDR TB patients were included. The patients' mean age was 36.65 ± 11.75 years. 65% of the patients had BMI below 18.5 kg/m2. 17.5% of patients had comorbidities. Approximately 45% had successful treatment outcomes. Poor treatment outcome includes loss to follow-up in 22.5% and mortality in 12.5%. We did not find any treatment failure.

Conclusion

Treatment success outcomes occurred in less than half of the cases. The main predictors of mortality among MDR-TB patients were the presence of comorbidities like anaemia, baseline leucocytosis or lymphopenia, hypoproteinaemia, HIV sero-positivity and smaller baseline BMI.

Thyroid Profile and Factors Associated with Hypothyroidism Among Multidrug-Resistant Tuberculosis Patients Attending Saint Peter's Specialized Hospital Addis Ababa, Ethiopia

Background

The emergence of MDR-TB is a global public health problem. Hypothyroidism is one of the severe adverse drug reactions (ADRs) in MDR-TB patients on treatment. Representative data on hypothyroidism and its associated factors among MDR-TB patients are lacking.

Objective

To determine thyroid profiles and associated risk factors among multidrug-resistant TB patients during therapy with anti-MDR-TB regimen in Saint Peter Specialized Hospital Addis Ababa, Ethiopia from January to November 2020.

Methods

A cross-sectional study was conducted in MDR-TB patients in Addis Ababa, Ethiopia. A total of 162 patients, who were older than 18 years, had bacteriologically confirmed MDR-TB and on treatment for more than one month were enrolled consecutively from the TB registration book. However, critically sick patients and those who were receiving additional drugs known to cause severe ADRs were excluded. Simple descriptive statistics were used to present the socio-demographic and clinical characteristics of the patients. A logistic regression model was used to assess the association between independent and dependent variables. A p-value <0.05 was considered as statistically significant in all analyses.

Results

Mean age of the study participant was 35.9 ± 13.6 years. The prevalence of hypothyroidism was 32 (19.8%). The presence of co-morbidity, being underweight, and prothionamide use were significantly associated with hypothyroidism in MDR-TB patients on treatment.

Conclusion

Hypothyroidism occurs commonly among MDR-TB patients. Presence of co-morbidity, being underweight, and prothionamide drug use are the factors associated with hypothyroidism. Monitoring of thyroid function test during MDR-TB treatment and factors associated with hypothyroidism require attention to prevent complication.

The pattern of comorbidity and its prevalence among drug-resistant tuberculosis patients at treatment initiation in Lagos, Nigeria

BACKGROUND

Multimorbidity is increasingly being recognized as a serious public health concern in the control of both drug-susceptible and drug-resistant tuberculosis (DR-TB). This study assessed the pattern of comorbidities and their prevalence in DR-TB patients at treatment initiation in Lagos, Nigeria.

METHODS

A cross-sectional study was conducted. The baseline laboratory records (human immunodeficiency virus [HIV] status, fasting blood sugar, audiometry, thyroid function tests, serum electrolyte, haemoglobin level and pregnancy test) of DR-TB patients initiated on treatment in Lagos, Nigeria between 1 August 2014 and 31 March 2017 were reviewed.

RESULTS

A total of 565 DR-TB patients' laboratory records were reviewed, of which 397 (70.3%) had comorbidities. The proportion with one, two, three and four comorbidities was 60.2%, 29.7%, 8.1% and 2.0%, respectively. Anaemia was the most common (48.1%) comorbid condition, while anaemia and hypokalaemia (7.3%), anaemia and hypothyroidism (6.5%) and anaemia and HIV (5%) were most common among patients with more than one comorbid condition. DR-TB patients with comorbidity were significantly older (34.8±12.3 y) than those without comorbidity (32.0±12.8 y) (p=0.038). Of the 176 females in the reproductive age group, 8 (4.5%) were pregnant at baseline.

CONCLUSIONS

The prevalence of comorbidity among DR-TB patients was high. There is a need for the national TB program to expand its DR-TB council of experts and also integrate reproductive health services into DR-TB management in Nigeria.

Tuberculosis of the thyroid in Togo: a clinicopathologic study of 11 presumed cases

Tuberculosis (TB) remains a real public health concern in Africa; thyroid localisation of the disease is a very rare form of extrapulmonary TB. We conducted a descriptive and cross-sectional study on all histologically proved cases of thyroid TB diagnosed in Togo over the last 20 years. Eleven cases of TB of the thyroid were identified, of which nine were in women, with an average age of 29.4 ± 0.2 years. The clinical signs were the presence of a nodule in seven, an abscess in three and a swelling with cutaneous fistulisation in one. Thyroid involvement alone was found in four, associated with pleuropulmonary TB in six and mammary TB in one. Human immunodeficiency virus (HIV) co-infection was present in six. All histopathology results showed inflammatory granulomata with caseous necrosis. The clinical features are often misleading and pose a real diagnostic problem, especially with differentials of simple abscess and cancer.