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Introduction: tuberculosis remains a major public health problem, with continuing high levels of prevalence, and mortality. In Niger, the incidence of tuberculosis remains high. This study aims to investigate the epidemiology of pulmonary tuberculosis at the National Anti-Tuberculosis Center of Niamey in Niger. Methods: this study used a quantitative approach with a retrospective and descriptive design. Data were obtained from positive pulmonary tuberculosis cases detected by microscopy on Ziehl-Neelsen stained sputum at the National Anti-Tuberculosis Center (NATC) in Niamey, Niger covered the period between June 2017 and January 2020. 955 pulmonary TB patients were recorded whose diagnosis was based either on clinical-radiological arguments (thus negative microscopy) or positive microscopy. This form was used to collect data recorded in the clinical case registers, registers, and Excel files of the GeneXpert platform of the NATC laboratory. Results: eighty-nine-point eleven percent (89.11%) of the patients were microscopy-positive. Among the study population, men were the most affected by tuberculosis with 80.03%. The 25-34 age group, representing 23.77%, was the most affected. 6.93% of patients were co-infected with tuberculosis and HIV. All patients were put on treatment, with a therapeutic success rate of 72.38% and a therapeutic failure rate of 10.95%. Among the cases of therapeutic failure, 80.90% had Mycobacterium tuberculosis complex detected and 27.14% were resistant to Rifampicin. Conclusion: Niger continues to have a tuberculosis epidemic which requires monitoring. Improving the diagnostic system for more effective management of the disease is important for appropriate diagnosis and treatment.
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Antituberculosos , Mycobacterium tuberculosis , Tuberculosis Pulmonar , Humanos , Estudios Retrospectivos , Masculino , Niger/epidemiología , Femenino , Adulto , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/diagnóstico , Antituberculosos/farmacología , Antituberculosos/administración & dosificación , Adulto Joven , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/efectos de los fármacos , Adolescente , Resultado del Tratamiento , Niño , Infecciones por VIH/epidemiología , Infecciones por VIH/tratamiento farmacológico , Preescolar , Anciano , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Esputo/microbiología , Prevalencia , Coinfección/epidemiología , Coinfección/tratamiento farmacológico , Lactante , IncidenciaRESUMEN
Introduction. Proper management of multidrug-resistant tuberculosis is a prioritized strategy for tuberculosis control worldwide. Objective. To evaluate differences concerning demographic and clinical characteristics and programmatic indicators of Buenaventura patient cohort with confirmed diagnosis of multidrug-resistant tuberculosis, compared to those of the other municipalities from Valle del Cauca, Colombia, 2013-2016. Materials and methods. We conducted an analytical cohort study to compare records of patients older than 15 years with multidrug-resistant tuberculosis included in the Programa de Tuberculosis de Buenaventura (with para-aminosalicylic acid) versus the other municipalities of Valle del Cauca (without para-aminosalicylic). Results. Ninety-nine cases were recorded with a median age of 40 years (IQR = 26 - 53); in Buenaventura, 56% of the patients were women, while in the other municipalities, men predominated with 67%; 95% had health insurance. The most common comorbidity was diabetes (14%). Adverse reactions to antituberculosis medications in Buenaventura were 1.3 times more frequent than in the other municipalities (OR = 2.3; 95% CI = 0.993 - 5.568; p = 0.04). In Buenaventura, the mortality rate was 5% compared to the 15% reported in the other municipalities. Treatment failures were not reported in Buenaventura, but 35% did not continue with the follow-up. Treatment success was higher in Buenaventura (56 %). Conclusion. A strengthened program in Buenaventura presented better programmatic results than those from the other municipalities of Valle del Cauca. Access to molecular tests, availability of shortened treatments, and continuous monitoring to identify adverse reactions to antituberculosis medications are routes for all other control programs.
Introducción. El manejo adecuado de la tuberculosis multirresistente es una estrategia priorizada para el control de la tuberculosis en el mundo. Objetivo. Evaluar las diferencias entre las características demográficas y clínicas, y los indicadores programáticos de los pacientes con diagnóstico confirmado de tuberculosis pulmonar resistente a rifampicina o multirresistente en Buenaventura, frente a la cohorte de los demás municipios del Valle del Cauca entre 2013 y 2016. Materiales y métodos. Se desarrolló un estudio analítico de cohortes para comparar los registros de pacientes mayores de 15 años con tuberculosis multirresistente, del Programa de Tuberculosis de Buenaventura (con ácido paraaminosalicílico), frente a los demás municipios del Valle del Cauca (sin ácido paraaminosalicílico). Resultados. Se registraron 99 casos con una mediana de edad de 40 años (RIC = 26- 53); en Buenaventura, el 56 % eran mujeres; en los demás municipios, predominaron los hombres (67 %); el 95 % de los evaluados tenía aseguramiento en salud. La comorbilidad más frecuente fue diabetes (14 %). Las reacciones adversas a medicamentos antituberculosos en Buenaventura fueron 1,3 veces más frecuentes que en los demás municipios (OR = 2,3; IC95 %: 0,993 - 5,568; p = 0,04). En Buenaventura falleció el 5 % de los casos frente al 15 % reportado en los demás municipios. No hubo fracasos con el tratamiento en Buenaventura, pero se reportó un 35 % de pérdida del seguimiento. El éxito del tratamiento fue mayor en Buenaventura en el 56 %. Conclusión. El programa fortalecido de Buenaventura presentó mejores resultados programáticos que los demás municipios del Valle del Cauca. El acceso a pruebas moleculares, la disponibilidad de tratamientos acortados y el seguimiento continuo para identificar reacciones adversas a medicamentos antituberculosos son un derrotero para todos los programas de control.
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Rifampin , Tuberculosis Resistente a Múltiples Medicamentos , Humanos , Colombia/epidemiología , Adulto , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Rifampin/uso terapéutico , Masculino , Femenino , Persona de Mediana Edad , Antituberculosos/uso terapéutico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Estudios de Cohortes , Ácido Aminosalicílico/uso terapéutico , Adulto Joven , Antibióticos Antituberculosos/uso terapéuticoRESUMEN
Culturing and genomic sequencing of Mycobacterium tuberculosis (MTB) from tuberculosis (TB) cases is the basis for many research and clinical applications. The alternative, culture-free sequencing from diagnostic samples, is promising but poses challenges to obtain and analyse the MTB genome. Paradoxically, culture is assumed to impose a diversity bottleneck, which, if true, would entail unexplored consequences. To unravel this paradox we generate high-quality genomes of sputum-culture pairs from two different settings after developing a workflow for sequencing from sputum and a tailored bioinformatics analysis. Careful downstream comparisons reveal sources of sputum-culture incongruences due to false positive/negative variation associated with factors like low input MTB DNA or variable genomic depths. After accounting for these factors, contrary to the bottleneck dogma, we identify a 97% variant agreement within sputum-culture pairs, with a high correlation also in the variants' frequency (0.98). The combined analysis from five different settings and more than 100 available samples shows that our results can be extrapolated to different TB epidemic scenarios, demonstrating that for the cases tested culture accurately mirrors clinical samples.
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Variación Genética , Mycobacterium tuberculosis , Esputo , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/aislamiento & purificación , Esputo/microbiología , Humanos , Tuberculosis/microbiología , Tuberculosis/diagnóstico , Genoma Bacteriano , ADN Bacteriano/genética , Tuberculosis Pulmonar/microbiología , Tuberculosis Pulmonar/diagnósticoRESUMEN
Tuberculosis (TB) is the leading cause of mortality among infectious diseases globally. Effectively managing TB requires early identification of individuals with TB disease. Resource-constrained settings often lack skilled professionals for interpreting chest X-rays (CXRs) used in TB diagnosis. To address this challenge, we developed "DecXpert" a novel Computer-Aided Detection (CAD) software solution based on deep neural networks for early TB diagnosis from CXRs, aiming to detect subtle abnormalities that may be overlooked by human interpretation alone. This study was conducted on the largest cohort size to date, where the performance of a CAD software (DecXpert version 1.4) was validated against the gold standard molecular diagnostic technique, GeneXpert MTB/RIF, analyzing data from 4363 individuals across 12 primary health care centers and one tertiary hospital in North India. DecXpert demonstrated 88% sensitivity (95% CI 0.85-0.93) and 85% specificity (95% CI 0.82-0.91) for active TB detection. Incorporating demographics, DecXpert achieved an area under the curve of 0.91 (95% CI 0.88-0.94), indicating robust diagnostic performance. Our findings establish DecXpert's potential as an accurate, efficient AI solution for early identification of active TB cases. Deployed as a screening tool in resource-limited settings, DecXpert could enable early identification of individuals with TB disease and facilitate effective TB management where skilled radiological interpretation is limited.
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Programas Informáticos , Humanos , India/epidemiología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Diagnóstico por Computador/métodos , Tuberculosis/diagnóstico , Tuberculosis/diagnóstico por imagen , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/diagnóstico , Sensibilidad y Especificidad , Adulto Joven , Adolescente , Radiografía Torácica/métodos , AncianoRESUMEN
OBJECTIVE: To evaluate the effectiveness of a machine learning based on computed tomography (CT) radiomics to distinguish nontuberculous mycobacterial pulmonary disease (NTM-PD) from pulmonary tuberculosis (PTB). METHODS: In this retrospective analysis, medical records of 99 individuals afflicted with NTM-PD and 285 individuals with PTB in Zhejiang Chinese and Western Medicine Integrated Hospital were examined. Random numbers generated by a computer were utilized to stratify the study cohort, with 80% designated as the training cohort and 20% as the validation cohort. A total of 2153 radiomics features were extracted using Python (Pyradiomics package) to analyse the CT characteristics of the large disease areas. The identification of significant factors was conducted through the least absolute shrinkage and selection operator (LASSO) regression. The following four supervised learning classifier models were developed: random forest (RF), support vector machine (SVM), logistic regression (LR), and extreme gradient boosting (XGBoost). For assessment and comparison of the predictive performance among these models, receiver-operating characteristic (ROC) curves and the areas under the ROC curves (AUCs) were employed. RESULTS: The Student's t-test, Levene test, and LASSO algorithm collectively selected 23 optimal features. ROC analysis was then conducted, with the respective AUC values of the XGBoost, LR, SVM, and RF models recorded to be 1, 0.9044, 0.8868, and 0.7982 in the training cohort. In the validation cohort, the respective AUC values of the XGBoost, LR, SVM, and RF models were 0.8358, 0.8085, 0.87739, and 0.7759. The DeLong test results noted the lack of remarkable variation across the models. CONCLUSION: The CT radiomics features can help distinguish between NTM-PD and PTB. Among the four classifiers, SVM showed a stable performance in effectively identifying these two diseases.
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Aprendizaje Automático , Infecciones por Mycobacterium no Tuberculosas , Tomografía Computarizada por Rayos X , Tuberculosis Pulmonar , Humanos , Estudios Retrospectivos , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Masculino , Femenino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/diagnóstico por imagen , Infecciones por Mycobacterium no Tuberculosas/microbiología , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Diagnóstico Diferencial , Anciano , Adulto , Algoritmos , Curva ROC , Máquina de Vectores de Soporte , RadiómicaRESUMEN
INTRODUCTION: The WHO estimates a gap of about 30% between the incident (10.6 million) and notified (7.5 million) cases of tuberculosis (TB). Combined with the growing recognition in prevalence surveys of the high proportion of cases identified who are asymptomatic or paucisymptomatic, these data underscore how current symptom screening approaches and use of diagnostic tests with suboptimal performance on sputum miss large numbers of cases. Thus, the development of sputum-free biomarker-based tests for diagnosis is becoming necessary, which the WHO has already identified as a priority for new TB diagnostics.The objective of this study is to evaluate a combination of exhaled breath condensate (EBC) samples and mycobacterial lipoarabinomannan (LAM) as point-of-care (POC) assays to identify TB patients. METHODS AND ANALYSIS: This prospective diagnostic accuracy study is conducted at the TB Screening and Treatment Centre of International Center for Diarrhoeal Disease Research, Bangladesh, on a cohort of adults and adolescents >11 years of age. A total of 614 individuals with presumptive pulmonary TB based on TB signs, symptoms and radiography are being recruited from 28 August 2023. Spot sputum is collected for standard reference testing (L-J culture, GeneXpert MTB/Rif, acid-fast Bacilli microscopy) to fine-tune categorisation of TB disease status for each participant, defined as (1) definite TB (at least one positive standard reference test); (2) probable TB (not microbiologically confirmed but under TB treatment); (3) possible TB (no TB treatment but signs, symptoms and radiography suggestive of TB); (4) other respiratory disease (microbiologically not confirmed and no radiography presenting abnormalities compatible with TB); and (5) unknown (no microbiological evidence with normal/no TB abnormalities with radiography). Urine and EBC specimens will be subjected to LAM POC testing and biobanked for further investigation. Statistical analyses will include an assessment of diagnostic accuracy by constructing receiver operating curves and calculating sensitivity and specificity, as well as post-test probabilities. ETHICS AND DISSEMINATION: The study protocol was approved by the Research Review Committee as well as the Ethical Review Committee of icddr,b and recorded under a protocol reference number, PR-2301. Results will be submitted to open-access peer-reviewed journals, presented at academic meetings, and shared with national and international policymaking bodies.
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Pruebas Respiratorias , Lipopolisacáridos , Tuberculosis Pulmonar , Humanos , Lipopolisacáridos/análisis , Tuberculosis Pulmonar/diagnóstico , Pruebas Respiratorias/métodos , Estudios Prospectivos , Biomarcadores/análisis , Bangladesh , Adulto , Pruebas en el Punto de Atención , Sensibilidad y Especificidad , Sistemas de Atención de Punto , Masculino , Femenino , Adolescente , Mycobacterium tuberculosis/aislamiento & purificación , Esputo/microbiologíaRESUMEN
Introduction: Tuberculosis (TB) remains a significant health concern in India, and its complexity is exacerbated by the rising occurrence of non-communicable diseases such as diabetes mellitus (DM). Recognizing that DM is a risk factor for active TB, the emerging comorbidity of TB and PDM (TB-PDM) presents a particular challenge. Our study focused on the impact of PDM on cytokine and chemokine profiles in patients with pulmonary tuberculosis TB) who also have PDM. Materials and methods: We measured and compared the cytokine (GM-CSF, IFN-γ, IL-1α/IL-1F1, IL-1ß/IL-1F2, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p70, IL-13, IL-17/IL-17A, IL-18/IL-1F4, TNF-α) and chemokine (CCL1, CCL2, CCL3, CCL4, CCL11, CXCL1, CXCL2, CXCL9, CXCL10, and CXCL11) levels in plasma samples of TB-PDM, only TB or only PDM using multiplex assay. Results: We observed that PDM was linked to higher mycobacterial loads in TB. Patients with coexisting TB and PDM showed elevated levels of various cytokines (including IFNγ, TNFα, IL-2, IL-17, IL-1α, IL-1ß, IL-6, IL-12, IL-18, and GM-CSF) and chemokines (such as CCL1, CCL2, CCL3, CCL4, CCL11, CXCL1, CXCL9, CXCL10, and CXCL11). Additionally, cytokines such as IL-18 and GM-CSF, along with the chemokine CCL11, were closely linked to levels of glycated hemoglobin (HbA1c), hinting at an interaction between glycemic control and immune response in TB patients with PDM. Conclusion: Our results highlight the complex interplay between metabolic disturbances, immune responses, and TB pathology in the context of PDM, particularly highlighting the impact of changes in HbA1c levels. This emphasizes the need for specialized approaches to manage and treat TB-PDM comorbidity.
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Citocinas , Estado Prediabético , Tuberculosis Pulmonar , Humanos , Tuberculosis Pulmonar/inmunología , Tuberculosis Pulmonar/sangre , Citocinas/sangre , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estado Prediabético/inmunología , Estado Prediabético/sangre , Quimiocinas/sangre , Biomarcadores/sangre , Mycobacterium tuberculosis/inmunología , India/epidemiologíaRESUMEN
Tuberculosis (TB) remains one of the most widespread infectious diseases in the world, with high mortality and morbidity rates, contributing to a significant disease burden, particularly in developing countries. The aim of this study was to determine the risk factors of TB among the population aged 17 years (late adolescent) and above in one of the high TB prevalence countries, Indonesia. A case-control study was conducted in Banda Aceh, Indonesia, involving newly diagnosed pulmonary TB patients who visited one of the eleven community health centers in Banda Aceh. The controls were individuals matched by age and sex who lived near the cases and had no TB infection. A total of 16 risk factors were assessed. Hierarchical multivariable logistic regression models were used to examine the association between the risk factors and the occurrence of TB. A total of 196 cases and 196 controls were included in the study. Multivariable logistic regression analysis identified 11 independent predictors for the occurrence of TB after controlling possible confounders. Patients who lived in houses with insufficient light exposure were 77 times more likely to develop TB compared to those living in houses with sufficient light exposure (adjusted odds ratio (AOR): 77.69; 95%CI: 27.09, 222.79). The study also showed that people who had close contact with TB patients (AOR: 25.39; 95%CI: 2.10, 306.52), had poor knowledge of TB (AOR: 24.2; 95%CI: 6.89, 85.17), had comorbidities (AOR: 4.49; 95%CI: 1.35, 14.89), insufficient food utilization (AOR: 3.41; 95%CI: 1.51, 7.71), negative preventive behavior (AOR: 3.39; 95%CI: 1.49, 7.72), low education level (AOR: 3.08; 95%CI: 1.26, 7.55), and insufficient housing humidity (AOR: 2.89; 95%CI: 1.18, 7.12) were associated with increased the odds of having TB. Being employed, having income above minimum wage, and having good nutritional intake were protective factors for developing TB. In conclusion, the determinants of TB among people aged 17 years and older are a clear indication of the need for TB prevention programs targeting not only individual risk factors but also environmental risk factors, particularly providing adequate housing conditions. This study provided useful information that might help to develop and adopt effective policies for TB control in Indonesia.
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Tuberculosis Pulmonar , Humanos , Indonesia/epidemiología , Estudios de Casos y Controles , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/transmisión , Masculino , Factores de Riesgo , Femenino , Adulto , Prevalencia , Adolescente , Persona de Mediana Edad , Adulto Joven , Modelos LogísticosRESUMEN
Background: microRNAs (miRNAs) were recognized as a promising source of diagnostic biomarker. Herein, we aim to evaluate the performance of an ultrasensitive method for detecting serum miRNAs using single molecule arrays (Simoa). Methods: In this study, candidate miRNAs were trained and tested by RT-qPCR in a cohort of PTB patients. Besides that, ultrasensitive serum miRNA detection were developed using the Single Molecule Array (Simoa) platform. In this ultra-sensitive sandwich assay, two target-specific LNA-modified oligonucleotide probes can be simply designed to be complementary to the half-sequence of the target miRNA respectively. We characterized its analytical performance and measured miRNAs in the serum of patients with pulmonary tuberculosis and healthy individuals. Results: We identified a five signature including three upregulated (miR-101, miR-196b, miR-29a) and two downregulated (miR-320b, miR-99b) miRNAs for distinguishing PTB patients from HCs, and validated in our 104 PTB patients. On the basis of Simoa technology, we developed a novel, fully automated digital analyser, which can be used to directly detect miRNAs in serum samples without pre-amplification. We successfully detected miRNAs at femtomolar concentrations (with limits of detection [LODs] ranging from 0.449 to 1.889 fM). Simoa-determined serum miR-29a and miR-99b concentrations in patients with PTB ((median 6.06 fM [range 0.00-75.22]), (median 2.53 fM [range 0.00-24.95]), respectively) were significantly higher than those in HCs ((median 2.42 fM [range 0.00-28.64]) (P < 0.05), (median 0.54 fM [range 0.00-9.12] (P < 0.0001), respectively). Serum levels of miR-320b were significantly reduced in patients with PTB (median 2.11 fM [range 0.00-39.30]) compared with those in the HCs (median 4.76 fM [range 0.00-25.10]) (P < 0.001). A combination of three miRNAs (miR-29a, miR-99b, and miR-320b) exhibited a good capacity to distinguish PTB from HCs, with an area under the curve (AUC) of 0.818 (sensitivity: 83.9%; specificity: 79.7%). Conclusions: This study benchmarks the role of Simoa as a promising tool for monitoring miRNAs in serum and offers considerable potential as a non-invasive platform for the early diagnosis of PTB.
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Biomarcadores , MicroARNs , Tuberculosis Pulmonar , Humanos , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/sangre , Tuberculosis Pulmonar/genética , Masculino , Femenino , MicroARNs/sangre , MicroARNs/genética , Persona de Mediana Edad , Adulto , Biomarcadores/sangre , Anciano , MicroARN Circulante/sangre , MicroARN Circulante/genéticaRESUMEN
Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease with multi-system involvement. It involves the upper respiratory tract, lungs and kidneys. A 36-year-old female patient presented to a tertiary care referral hospital in Central India in 2023 with complaints of low-grade fever, dry cough and loss of appetite initially followed by dyspnoea, purpuric skin lesions, right lower limb swelling with pain and redness. Her chest radiograph revealed right upper lobe cavitary lesion with consolidation in the right lower lobe. Mycobacterium tuberculosis was detected in sputum and broncho alveolar lavage via cartridge based nucleic acid amplification assay. Later, computed tomography pulmonary angiography revealed bilateral pulmonary artery thromboembolism. Furthermore, her cytoplasmic-antineutrophil cytoplasmic antibody test was positive, serum creatinine was rising, urine microscopy had red cell casts and lower limb venous doppler revealed deep venous thrombosis. Histopathological examination of the skin lesion revealed vasculitis. Based on these findings, the patient was diagnosed with GPA. The patient improved with pulse steroids, cyclophosphamide, anticoagulants and anti-tuberculous therapy.
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Granulomatosis con Poliangitis , Embolia Pulmonar , Tuberculosis Pulmonar , Humanos , Femenino , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiología , Embolia Pulmonar/complicaciones , Adulto , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/tratamiento farmacológico , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/diagnóstico , India , Ciclofosfamida/uso terapéuticoRESUMEN
The aim of this study was to explore the related factors linked to the development and infectivity of tuberculosis. This was achieved by comparing the clinical characteristics of patients with pulmonary tuberculosis (TB) who tested positive in smear Mycobacterium tuberculosis tests with this who tested negative in smear mycobacterium tests but positive in sputum Gene Xpert tests. We gathered clinical data of 1612 recently hospitalized patients diagnosed with pulmonary tuberculosis who tested positive either in sputum Gene-Xpert test or sputum smear Mycobacterium tuberculosis tests. The data was collected from January 1, 2018 to August 5, 2023, at Sichuan Provincial People's Hospital. We conducted separately analyzes and comparisons of the clinical characteristics between the two groups of patients, aiming to discussed the related factors influencing the development and infectivity of tuberculosis. In comparison to the GeneXpert positive group, the sputum smear positive group exhibited a higher proportion of elderly patients (aged 75-89) and individuals classified as underweight (BMI < 18.5 kg/m2). Furthermore, this group was more prone to experiencing symptoms such as weight loss, coughing and sputum production, hemoptysis, shortness of breath, and difficulty breathing. Moreover, they are also more likely to develop extrapulmonary tuberculosis, such as tuberculous meningitis, tuberculous pleurisy, and tuberculous peritonitis. These clinical features, when present, not only increase the likelihood of a positive result in sputum smear tests but also suggest a high infectivity of pulmonary tuberculosis. Elderly individuals (aged 75 to 89) who are underweight (BMI < 18.5 kg/m2), display symptom of cough, expectoration, hemoptysis and dyspnea-particularly cough and expectoration-and those with extra pulmonary tuberculosis serve as indicators of highly infectious pulmonary tuberculosis patients. These patients may present with more severe condition, carrying a higher bacteria, and being more prone to bacterial elimination. Identification of these patients is crucial, and prompt actions such as timely and rapid isolation measures, cutting off transmission routes, and early empirical treatment of tuberculosis are essential to control the development of the disease.
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Mycobacterium tuberculosis , Esputo , Tuberculosis Pulmonar , Humanos , Esputo/microbiología , Masculino , Femenino , Mycobacterium tuberculosis/aislamiento & purificación , Anciano , Persona de Mediana Edad , Tuberculosis Pulmonar/microbiología , Tuberculosis Pulmonar/diagnóstico , Adulto , Anciano de 80 o más Años , Adulto Joven , AdolescenteRESUMEN
We investigated the value of plasma cytokine levels as markers of pathogenesis and treatment response in patients with non-tuberculous mycobacteria (NTM) pulmonary disease. Plasma cytokine levels were measured and compared among patients with NTM pulmonary disease (n=111), tuberculosis (TB) patients (n=50), and healthy individuals (n=40). Changes during treatment were monitored at 3 and 6 months after treatment. According to the treatment response, NTM patients were classified as 'resistance' or 'sensitivity' responders. The results revealed that five out of twelve cytokines exhibited significantly higher levels in NTM patients compared to controls. Among these, interleukin (IL)-6 demonstrated the strongest discriminating capacity for NTM. Furthermore, when combined with IL-1ß, they efficiently distinguished between NTM drug-resistant and drug-sensitive patients, as well as between NTM and TB groups. Additionally, IL-6 levels initially rose and then decreased in the NTM drug-resistant group during the six months of treatment, similar to the behavior of IL-1ß in the NTM drug-sensitive group. Subgroup analyses of the sensitive group with differential treatment responses revealed an increase in IL-10 levels in the six-month treatment responders. A high IL-6/IL-10 ratio was associated with increased disease severity of NTM and TB. Collectively, combinations of various plasma cytokines, specifically IL-1ß, IL-6, and IL-10, effectively distinguished NTM patients with varying mycobacterial burdens, with IL-6 and IL-10 emerging as potential biomarkers for early treatment response. The combination of IL-6 and IL-1ß demonstrated the highest discriminatory value for distinguishing between NTM-resistant and NTM-sensitive groups as well as between NTM and TB groups.
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Biomarcadores , Citocinas , Infecciones por Mycobacterium no Tuberculosas , Humanos , Femenino , Masculino , Biomarcadores/sangre , Infecciones por Mycobacterium no Tuberculosas/sangre , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Citocinas/sangre , Persona de Mediana Edad , Adulto , Estudios de Casos y Controles , Anciano , Resultado del Tratamiento , Tuberculosis Pulmonar/sangre , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología , Micobacterias no Tuberculosas , Interleucina-6/sangre , Interleucina-1beta/sangreRESUMEN
BACKGROUND: The objective is to assess lung compliance and identify the optimal positive end-expiratory pressure (PEEP) levels in patients with tuberculosis-associated Acute Respiratory Distress Syndrome (TB-ARDS) compared to non-TB-ARDS patients. METHODS: This observational case-control study utilized electrical impedance tomography to evaluate lung mechanics in 20 TB-ARDS and 20 non-TB-ARDS patients. Participants underwent PEEP titration from 23 to 5 cm H2O in 2 cm H2O decrements. Lung compliance and the rates of hyperdistention and collapse were assessed at each PEEP level. RESULTS: Delta impedance values showed higher amounts in a PEEP range of 11-17 cm H2O and in patients with TB-ARDS (P > 0.05). In addition, both hyperdistention and collapse rates were nonsignificantly higher in TB-ARDS patients (P > 0.05), and the compromised levels of hyperdistention and collapse rates were at 15-17 cm H2O, indicating the most favorable PEEP level. CONCLUSIONS: The observed patterns of hyperdistention and collapse rates across various PEEP levels provide valuable insights into the susceptibility of TB-ARDS patients to barotrauma. Notably, the identified optimal PEEP range between 15 and 17 cm H2O may guide ventilator management strategies in mitigating both hyperdistention and collapse; nonetheless, due to the high variability of lung compliances within groups, we strongly recommend individualized consideration for tailored respiratory support and evaluation.
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Respiración con Presión Positiva , Síndrome de Dificultad Respiratoria , Humanos , Síndrome de Dificultad Respiratoria/terapia , Síndrome de Dificultad Respiratoria/fisiopatología , Masculino , Estudios de Casos y Controles , Femenino , Persona de Mediana Edad , Adulto , Impedancia Eléctrica , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/fisiopatología , Tuberculosis/complicaciones , Anciano , Pulmón/fisiopatología , Rendimiento PulmonarRESUMEN
BACKGROUND: Pyrazinamide is one of the antitubercular drugs used for 2 months in the intensive phase. One of the adverse effects of pyrazinamide is hyperuricemia, with a symptom of arthralgia. This study aims to analyze the incidence of hyperuricemia and arthralgia and their causality in pulmonary tuberculosis (TB) patients undergoing treatment in the intensive phase. METHODS: It was an analytic observational study with a prospective cohort design. Three ml of blood from each pulmonary TB patient was withdrawn to examine uric acid levels before and after 2 months of treatment with pyrazinamide. The Wilcoxon test was used to analyze changes in uric acid levels and the Chi-square test to analyze the association between uric acid levels and arthralgia. Naranjo algorithm is used to analyze the causality of hyperuricemia. RESULTS: Twenty pulmonary TB patients met the inclusion criteria in this study. Eight out of 12 (60%) TB patients showed uric acid levels ≥7 mg/dl and 8 of them (66.6%) showed symptoms of arthralgia. The median uric acid level increased significantly before (5.14 mg/dl) and after 2 months of treatment (7.74 mg/dl), P-value = 0.001. Uric acid levels ≥7 mg/dl were significantly associated with arthralgia (P-value = 0.017; odds ratio 14.00; 95% confidence interval 1.25-156.61). Based on the Naranjo algorithm, those with hyperuricemia, eight and four patients had a total score of 7 and 8, respectively, which are classified as probable. CONCLUSION: Uric acid levels significantly increased during the intensive phase. Pulmonary TB patients with hyperuricemia are a risk factor for arthralgia.
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Antituberculosos , Hiperuricemia , Pirazinamida , Tuberculosis Pulmonar , Ácido Úrico , Humanos , Hiperuricemia/inducido químicamente , Hiperuricemia/complicaciones , Pirazinamida/efectos adversos , Pirazinamida/uso terapéutico , Masculino , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/complicaciones , Femenino , Antituberculosos/efectos adversos , Estudios Prospectivos , Adulto , Persona de Mediana Edad , Ácido Úrico/sangre , Artralgia/inducido químicamente , Anciano , Incidencia , Adulto JovenRESUMEN
BACKGROUND: Tuberculosis (TB) is a leading cause of death in patients with human immunodeficiency virus (HIV)/AIDS. About 60% of HIV-positive individuals with latent TB infection (LTBI) develop active TB. Isoniazid preventive therapy (IPT) is recommended by the World Health Organization to prevent the progression of active TB in people living with HIV/AIDS (PLWHA). However, IPT implementation has been limited in some countries like Indonesia. The objective of this study was to assess the effect of IPT administration on the incidence of active TB in HIV patients with latent TB. METHODS: This was a quasi-experimental prospective cohort study conducted in an academic hospital in Indonesia. Interferon-gamma release assay-positive HIV-TB patients were randomly divided into an IPT group (received 6 months of IPT) and a non-IPT group. The incidence of active pulmonary TB was compared between the two groups after 6 months of follow-up. RESULTS: Of the 23 eligible patients, 22 were enrolled (10 in the IPT group, 12 in the non-IPT group). The incidence of active pulmonary TB was 0% in both groups. Factors associated with the absence of TB in both groups were the use of antiretroviral therapy for >4 years and a CD4+ T lymphocyte count >200 cells/µL. IPT was found to be safe with minimal adverse effects. CONCLUSIONS: In this setting, the use of long-term antiretroviral therapy and higher CD4+ counts, rather than just IPT, were the key factors associated with preventing active TB in latent HIV-TB patients. These findings suggest that comprehensive HIV management may be more important than IPT alone for TB control in PLWHA. Further research is needed to optimize TB prevention strategies in this high-risk population.
Asunto(s)
Antituberculosos , Infecciones por VIH , Isoniazida , Tuberculosis Latente , Tuberculosis Pulmonar , Humanos , Isoniazida/uso terapéutico , Isoniazida/administración & dosificación , Tuberculosis Latente/complicaciones , Masculino , Antituberculosos/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Adulto , Femenino , Estudios Prospectivos , Tuberculosis Pulmonar/prevención & control , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/tratamiento farmacológico , Indonesia/epidemiología , Incidencia , Persona de Mediana Edad , Ensayos de Liberación de Interferón gammaRESUMEN
Sarcoidosis and tuberculosis (TB) are two granulomatous diseases that often share overlapping clinical features, including uveitis. We measured 368 inflammation-related proteins in serum in both diseases, with and without uveitis from two distinct geographically separated cohorts: sarcoidosis from the Netherlands and TB from Indonesia. A total of 192 and 102 differentially expressed proteins were found in sarcoidosis and active pulmonary TB compared to their geographical healthy controls, respectively. While substantial overlap exists in the immune-related pathways involved in both diseases, activation of B cell activating factor (BAFF) signaling and proliferation-inducing ligand (APRIL) mediated signaling pathways was specifically associated with sarcoidosis. We identified a B-lymphocyte activation signature consisting of BAFF, TNFRSF13B/TACI, TRAF2, IKBKG, MAPK9, NFATC1, and DAPP1 that was associated with sarcoidosis, regardless of the presence of uveitis. In summary, a difference in B-lymphocyte activation is a key discriminative immunological feature between sarcoidosis/ocular sarcoidosis (OS) and TB/ocular TB (OTB).
Asunto(s)
Linfocitos B , Activación de Linfocitos , Sarcoidosis , Humanos , Sarcoidosis/inmunología , Sarcoidosis/sangre , Sarcoidosis/diagnóstico , Linfocitos B/inmunología , Femenino , Masculino , Persona de Mediana Edad , Adulto , Países Bajos/epidemiología , Tuberculosis Pulmonar/inmunología , Tuberculosis Pulmonar/sangre , Tuberculosis Pulmonar/diagnóstico , Uveítis/inmunología , Uveítis/sangre , Uveítis/diagnóstico , Factor Activador de Células B/sangre , Indonesia , Biomarcadores/sangre , Tuberculosis/inmunología , Tuberculosis/sangre , Tuberculosis/diagnósticoRESUMEN
OBJECTIVE: Pulmonary tuberculosis (PTB) is a critical challenge worldwide, particularly in China. This study aimed to explore the spatiotemporal transmission patterns and socioeconomic factors of PTB in Dongguan city, China. METHODS/DESIGN: An ecological study based on the reported new PTB cases between 2011 and 2020 was conducted in Dongguan city, China. The spatiotemporal analysis methods were used to explore the long-term trend, spatiotemporal transmission pattern and socioeconomic factors of PTB. MAIN OUTCOME MEASURES: The number of new PTB cases. PARTICIPANTS: We collected 35 756 new PTB cases, including 23 572 males and 12 184 females. RESULTS: The seasonal-trend decomposition indicated a significant downward trend for PTB with a significant peak in 2017 and 2018, and local spatial autocorrelation showed more and more high-high clusters in the central and north-central towns with high incidence. The multivariate spatial time series analysis revealed that the endemic component had a leading role in driving PTB transmission, with a high total effect value being 189.40 (95% CI: 171.65-207.15). A Bayesian spatiotemporal model revealed that PTB incidence is positively associated with the agricultural population ratio (relative risk (RR) =1.074), gender ratio (RR=1.104) and the number of beds in medical institutions (RR=1.028). CONCLUSIONS: These findings revealed potential spatiotemporal variability and spatial aggregation of PTB, so targeted preventive strategies should be made in different towns based on spatiotemporal transmission patterns and risk factors.
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Factores Socioeconómicos , Análisis Espacio-Temporal , Tuberculosis Pulmonar , Humanos , Tuberculosis Pulmonar/epidemiología , China/epidemiología , Femenino , Masculino , Adulto , Incidencia , Persona de Mediana Edad , Teorema de Bayes , Adulto Joven , Factores de Riesgo , Adolescente , AncianoRESUMEN
BACKGROUND: Respiratory microbiota is closely related to tuberculosis (TB) initiation and progression. However, the dynamic changes of respiratory microbiota during treatment and its association with TB progression remains unclear. METHODS: A total of 16 healthy individuals and 16 TB patients (10 drug-sensitive TB (DS-TB) and 6 drug-resistant TB (DR-TB)) were recruited. Sputum samples were collected at baseline for all anticipants and after anti-TB treatment at Month-6 for TB patients. High throughput 16 S RNA sequencing was used to characterize the respiratory microbiota composition. RESULTS: Compared to the healthy individuals, TB patients exhibited lower respiratory microbiota diversity (p < 0.05). This disruption was alleviated after anti-TB treatment, especially for DS-TB patients. Parvimonas spp. numbers significantly increased after six months of anti-TB treatment in both DS-TB and DR-TB patients (p < 0.05). Rothia spp. increase during treatment was associated with longer sputum-culture conversion time and worse pulmonary lesion absorption (p < 0.05). Besides, Moraxella spp. prevalence was associated with longer sputum-culture conversion time, while Gemella spp. increase was associated with worsening resolving of pulmonary lesions (p < 0.05). CONCLUSION: Dynamic changes of respiratory microbiota during anti-TB treatment is closely related to TB progression. The involvement of critical microorganisms, such as Parvimonas spp., Rothia spp., Moraxella, and Gemella spp., appears to be associated with pulmonary inflammatory conditions, particularly among DR-TB. These microorganisms could potentially serve as biomarkers or even as targets for therapeutic intervention to enhance the prognosis of tuberculosis patients.
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Antituberculosos , Microbiota , Esputo , Tuberculosis Resistente a Múltiples Medicamentos , Tuberculosis Pulmonar , Humanos , Esputo/microbiología , Masculino , Femenino , Antituberculosos/uso terapéutico , Microbiota/efectos de los fármacos , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología , Adulto , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Persona de Mediana Edad , Resultado del Tratamiento , Bacterias/efectos de los fármacos , Bacterias/genética , Bacterias/clasificación , Bacterias/aislamiento & purificación , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/genética , ARN Ribosómico 16S/genéticaRESUMEN
BACKGROUND: Some pulmonary tuberculosis patients may require lung resection surgery. Postoperative pulmonary rehabilitation is essential to restore the lung function and maintain quality of life. We aimed to study the pulmonary rehabilitation outcomes and complications of step-by-step Baduanjin exercise under a doctor-nurse-patient integration mode in patients after lobectomy due to pulmonary tuberculosis. METHODS: We performed a randomized controlled clinical trial in patients undergoing lobectomy due to pulmonary tuberculosis between September 2017 and August 2021. Eligible patients were randomly assigned into the control group or interventional group. The control group received routine postoperative care. The interventional group received step-by-step Baduanjin exercise based on the doctor-nurse-patient integration mode in addition to the routine care. The primary outcomes were the pulmonary functions, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC. The secondary outcomes were the maximum walking distance in a 6-min walk test and postoperative pulmonary complications, including atelectasis, pneumonia, and respiratory failure. RESULTS: A total of 100 patients were enrolled into the study, with 50 patients in the control and interventional groups. There were 60 female patients (60%). The mean patient age was 37.9 (± 2.8) years old. At the one- and two-month postoperative follow-ups, pulmonary function tests showed statistically significantly better performances in FEV1/prediction, FVC/prediction, and FEV1/FVC in the interventional group than the control group. The 6-min walk test also revealed longer walking distances in the interventional group than the control group. There were no statistically significant differences in postoperative complications between the two groups. CONCLUSIONS: A step-by-step Baduanjin exercise regimen under the doctor-nurse-patient integration mode could safely improve pulmonary rehabilitation in patients after lobectomy due to pulmonary tuberculosis.
Asunto(s)
Neumonectomía , Tuberculosis Pulmonar , Humanos , Femenino , Masculino , Tuberculosis Pulmonar/cirugía , Neumonectomía/efectos adversos , Adulto , Persona de Mediana Edad , Resultado del Tratamiento , Terapia por Ejercicio/métodos , Complicaciones Posoperatorias/prevención & control , Qigong/métodos , Pruebas de Función Respiratoria , Calidad de Vida , Volumen Espiratorio Forzado , Pulmón/cirugía , Pulmón/fisiopatología , Capacidad VitalRESUMEN
A man in his early 50s with previously treated pulmonary tuberculosis (TB) presented with a 3-month history of cough, expectoration and progressive breathlessness, accompanied by significant weight loss. Examination revealed tachycardia, tachypnoea, hypoxaemia and unilateral diminished breath sounds. Investigations showed anaemia, leucocytosis and a homogeneous opacity on the left side of the CXR. ECG and echocardiography suggested pulmonary thromboembolism (PTE). A CT pulmonary angiogram confirmed a chronic embolus and a severely fibrosed left lung. A comprehensive thrombophilia workup yielded normal results and the PTE was attributed to his history of TB. Sputum analysis confirmed reactivated TB, leading to the initiation of antitubercular therapy. The patient improved clinically with plans for a repeat CT pulmonary angiography to assess the need for pulmonary thromboendarterectomy after completing TB treatment. This case highlights the possible association of TB and PTE, its management and why it should be considered as a differential diagnosis in patients with a history of TB presenting with exacerbated breathlessness.