The WHO Global Tuberculosis 2021 Report - not so good news and turning the tide back to End TB

Coumarin-Triazole-Thiazole hybrids: A new avenue in Antitubercular agents

The present work reports the design and synthesis of a series of 2-(4-(((2-oxo-2H-chromen-4-yl)oxy)methyl)-1H-1,2,3-triazol-1-yl)-N-(thiazol-2-yl)acetamide derivatives (4a-4k), which were investigated for their potential against tubercular activities. The well-known click cycloaddition reaction of azido derivatives (3a-3k) and 4-(prop-2-yn-1-yloxy)-2H-chromen-2-one (2) in the presence of catalytic amount of CuSO4 in H2O and DMF was employed. Notably, compounds 4c, 4d, and 4g showed the most promising results with MIC values against tuberculosis are 7.81 μg/mL, 2.61 μg/mL, and 7.81 μg/mL, respectively. Compounds (4a-4k) exhibited moderate to excellent antioxidant activities and low cytotoxicities. In addition, molecular docking studies were performed to investigate the binding interaction modes of the compounds (4a-4k) with various proteins and ligand sites.

Approaches and results of intersectoral actions for tuberculosis control in the world: A scoping review

BACKGROUND

Tuberculosis is a neglected disease with a wide global scope that overcomes public health challenges, also constituting an obstacle to social development. In the effort to control the disease, Tuberculosis Control Programs around the world have aligned their actions with the World Health Organization End TB Strategy, which emphasizes intersectorality as a fundamental component for effective disease control.

OBJECTIVE

To map the approaches and results of intersectoral tuberculosis control actions at the global scenario.

METHODOLOGY

This scoping review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Joanna Briggs Institute manual, ensuring methodological rigor and transparency. The review protocol was registered in the Open Science Framework. Searches were carried out in indexed databases and in the gray literature. Data collection took place by two independent reviewers, with results stored and organized in spreadsheets.

RESULTS

Three hundred and ninety-six (396) studies were identified, of which 60 were analyzed in full, resulting in the inclusion of 11 studies for the final review. It was evidenced that intersectoral articulation is fundamental in tuberculosis control, involving sectors such as health, education, social assistance and justice, to ensure adequate health care and social support, particularly for vulnerable populations. Community education and awareness played a central role in treatment adherence and reducing stigma, while resource mobilization was needed to maintain health services, especially in contexts of scarcity.

CONCLUSION

The integration of intersectoral services, involvement of non-governmental organizations and active community participation are essential elements for effective tuberculosis control. The findings reinforce the importance of addressing the social determinants of health to achieve the objectives of the End TB strategy, promoting an environment conducive to the prevention, early detection and effective treatment of the disease.

Households of tuberculosis (TB) patients face high TB-related costs in Somalia

BACKGROUND

The out-of-pocket spending and costs incurred by households affected by tuberculosis (TB) while accessing TB services in Somalia remain unclear. This study is the first of its kind in Somalia, estimating the proportion of TB-affected households that experience catastrophic costs among individuals with TB.

METHODS

A nationally representative, descriptive, cluster-sampled cross-sectional survey was conducted among individuals receiving TB care within the Somali National TB network from December 28, 2023, to February 3, 2024. It utilized retrospective data collection to gather information on participants' sociodemographic and clinical characteristics, including care models, self-reported income and expenses, and the costs (out-of-pocket expenses and indirect) associated with a single episode of TB. The survey also examined risk factors for incurring these costs and mechanisms for dissaving. TB catastrophic cost is defined as the total costs (both direct and indirect) incurred during TB illness and treatment that exceed 20% of a household's annual income.

RESULTS

Overall, 68% (95% CI: 64%-71%) of households affected by TB in Somalia faced costs exceeding 20% of their household income. Among patients receiving first- and second-line drug treatment, the percentages were 69% (95% CI: 65%-73%) and 62% (95% CI: 52%-71%), respectively. Individuals with TB living in the Southwest states were the most likely to incur catastrophic costs associated with the disease. Self-reported monthly household income decreased by 43%, dropping from US $176 before contracting TB to US $101 during the interview. A total of 75.4% (364) of households facing TB-related catastrophic costs reported a decline in their financial situation while seeking TB services. To cope with the economic burden of TB-related catastrophic expenses, 42% (375) of individuals with TB and their households relied on one or more dis-saving strategies, such as taking out loans or selling assets.

CONCLUSIONS

This study found that almost three out of four patients in TB care and their households experience a substantive economic burden accessing TB services in Somalia, particularly during the continuation phase of their treatment, and mainly driven by the direct nonmedical costs. A sustainable and equitable social protection program is required to reduce the proportion of households facing economic burdens due to TB in Somalia.

High-throughput screening of small molecules targeting Mycobacterium tuberculosis in human iPSC macrophages

New treatments are still necessary to eradicate tuberculosis disease. Macrophages derived from human induced pluripotent stem cells (hiPSC-Macs) offer a physiological niche to identify potential new drugs in the context of Mycobacterium tuberculosis (Mtb) infection. Here, we describe the scale-up of hiPSC-Macs production in 5-stack chambers for high-throughput drug screening against Mtb. A rate of approximately 100 million hiPSC-Macs was generated with optimal quality for a period of up to 12 weeks. Moreover, the infection model was optimized using a luminescence-based Mtb reporter strain. The assay showed enough sensitivity to identify compounds that could target host-pathogen interactions during Mtb infection. We interrogated a library of 200,000 compounds in Mtb-infected hiPSC-Macs with a Z-score above 0.3 in all plates analyzed. After secondary assays, 223 qualified hits were selected for further progression.

Safety of interleukin-17A inhibitors in 306 patients with psoriasis with or without latent tuberculosis: a dual-centre retrospective study in China

BACKGROUND

New interleukin (IL)-17A inhibitors seem to demonstrate smaller effects on tuberculosis (TB) reactivation than expected.

OBJECTIVES

To evaluate the risk of TB reactivation, to assess serial interferon (IFN)-γ levels, and to weigh up the risks and benefits of TB chemoprophylaxis in patients with psoriasis treated with IL-17A inhibitors.

METHODS

This dual-centre study included patients with psoriasis who were treated with IL-17A inhibitors. The incidence of active TB, serial IFN-γ levels tested by IFN-γ release assays (IGRAs), adverse events (AEs) and effectiveness were evaluated through 1 year in patients with psoriasis treated with IL-17A inhibitors. According to the chemoprophylaxis treatment regimen, patients with latent TB infection (LTBI) were classified into three groups: a complete chemoprophylaxis dose regimen (CCP), an incomplete chemoprophylaxis (ICCP) or no chemoprophylaxis (NCP).

RESULTS

In 220 IGRA-negative patients, 17 of 220 (7.3%) became IGRA positive after receiving a mean of 69.1 weeks of IL-17A inhibitor treatment. Only one case of new-onset TB was observed after 52 weeks of ixekizumab therapy. Significant changes in IFN-γ levels were observed in IGRA-negative patients. Similarly, IFN-γ levels [listed as the mean (SD)] significantly increased at 1 year compared with baseline among IGRA-positive patients in the NCP [105 (68.7) vs. 236 (80.8) pg mL-1, P < 0.01] and ICCP [75.3 (48.3) vs. 608 (249) pg mL-1, P < 0.001] groups, whereas the changes were not significant [125 (26.6) vs. 131 (21.7) pg mL-1, P = 0.70] in the CCP group.

CONCLUSIONS

During IL-17A inhibitor therapy, there is a need for increased awareness of annual screening and assessment of individual risk for early detection of TB infection. LTBI treatment is generally well tolerated and is effective in preventing increased IFN-γ responses in patients with psoriasis treated with IL-17A inhibitors.

SEIRS model for TB transmission dynamics incorporating the environment and optimal control

Tuberculosis (TB) remains a significant global health challenge, claiming more than 2 million lives annually, predominantly among adults. Existing studies often neglect the environment, reinfection, relapse/reactivation, and model calibration, thus limiting their applicability. This study presents a novel data-driven model that incorporates these factors to analyze the dynamics of TB transmission. Using the next-generation matrix approach, a basic reproduction number ( R 0 ) of 1.737266 was calculated, indicating that active TB disease will persist in the human population without robust public health interventions. The model equations were numerically solved using fourth- and fifth-order Runge-Kutta methods. The model was calibrated to the historical TB incidence data for Kenya, spanning 2000 to 2022, using least squares curve fitting. The fitting algorithm yielded a mean absolute error (MAE) of 0.01% when comparing the actual data points with the results of the simulated model. This finding indicates that the proposed mathematical model closely aligns with the recorded TB incidence data. The optimal values of the model parameters were estimated from the fitting algorithm, and future TB transmission dynamics was projected for the next two decades. Key findings indicate that a 10% decrease in transmission rate, while maintaining other parameters constant, would result in a 10% reduction in TB transmission in Kenya. In addition, the incidence of tuberculosis in Kenya is expected to decrease to an estimated 35 cases per 100,000 people by 2045 with sustained efforts in Bacillus Calmette-Guérin (BCG) vaccination programs and public awareness campaigns. BCG vaccination emerges as the most cost-effective strategy to combat TB transmission in Kenya. Policymakers should prioritize investing in BCG vaccination programs to achieve optimal public health outcomes and economic benefits, aligning with Kenya's Vision 2030.

Tuberculous and Malignant Pleural Effusions With Adenosine Deaminase Levels of 40-70 IU/L: Trends in New Cases Over Time and Differentiation Between Groups

BACKGROUND

The diagnosis of tuberculous pleural effusion (TPE) often relies on pleural fluid adenosine deaminase (ADA) levels. The diagnostic utility of ADA, however, is influenced by the prevalence of tuberculosis (TB) in local populations. Malignant pleural effusion (MPE) cases can exhibit moderately elevated ADA levels comparable to those seen in TPE. As population aging potentially impacts ADA levels, global TB incidence is decreasing whereas the burden of malignancy is on the rise. Consequently, epidemiological shifts and temporal changes in ADA distribution complicate the differential diagnosis between TPE and MPE when ADA levels are within the 40-70 IU/L range. Nonetheless, data specific to this subset are scarce.

METHODS

This retrospective study included consecutive patients aged > 18 years with confirmed TPE and MPE, spanning from 2012 to 2023. ADA levels in pleural fluid were categorized into three groups: < 40 IU/L, 40-70 IU/L, and > 70 IU/L. The study examined annual trends in the frequency of new cases and ADA level distributions over time and identified discriminating factors between TPE and MPE in cases with ADA levels of 40-70 IU/L.

RESULTS

In total, 297 TPE and 369 MPE cases were included in this study. Over the study period, the frequency of TPE progressively declined, while that of MPE increased. In the most recent four-year period, new TPE and MPE cases with ADA levels of 40-70 IU/L occurred at comparable numbers. Multivariable analysis identified pleural fluid carcinoembryonic antigen (CEA) levels and the number of focal pleural nodules as independent predictors for MPE. Specifically, the presence of either CEA levels > 15.7 ng/mL or more than eight pleural nodules yielded the highest diagnostic accuracy with a sensitivity of 88%, specificity of 100%, and an area under the curve of 0.95.

CONCLUSION

The differential diagnosis between TPE and MPE with pleural ADA levels of 40-70 IU/L has become increasingly critical due to evolving epidemiological patterns and ADA distribution changes over time. Pleural fluid CEA levels and the characteristics of pleural nodules may offer valuable guidance in distinguishing between TPE and MPE within this diagnostic gray zone.

A Longitudinal Prospective Study of Active Tuberculosis Among Patients in Tétouan, Morocco

BACKGROUND

Tuberculosis (TB) continues to be a significant global health challenge, particularly in developing countries. Tétouan, Morocco, is among the most affected cities in the country; however, limited information is available on the impact of TB and its treatment on various aspects of patients' lives. This study aims to comprehensively analyze the clinical, microbiological, nutritional, and psychosocial characteristics of patients undergoing intensive pulmonary TB treatment in Tétouan.

METHODS

We conducted a 1.5-year prospective study on patients with bacteriologically confirmed pulmonary TB during the intensive treatment phase. Clinical, social, psychological, and nutritional data were collected, and bacteriological monitoring was performed. Statistical analysis was conducted using SPSS software (IBM Corp., Armonk, NY), with a 95% significance level.

RESULTS

Among the 125 surveyed patients (mean age: 37.5 years, male-to-female ratio: 3.8), 91 (73.2%) resided in urban areas, 19 (15.4%) had difficulties reaching a healthcare center, and 89 (71%) were newly diagnosed. Side effects were reported by 121 patients (97%), primarily muscle and joint pain. A balanced diet was maintained by 80 patients (63.9%) during treatment. Anxiety was observed in 102 patients (82%) and correlated with female gender, retreatment cases, smoking, side effects, and living in urban areas. Depression was experienced by 113 patients (91%), significantly associated with smoking, side effects, and retreatment cases. The sputum conversion rate was low (62.4%) and showed a significant correlation with symptom progression after two months of intensive treatment.

CONCLUSION

Consistent patient support throughout the entire treatment period is crucial to preventing dropout and treatment failure. Greater efforts are needed to strengthen economic, social, and psychological support for patients. Healthcare educational units play a key role in informing patients about nutrition, potential side effects, and nicotine withdrawal symptoms. These interventions are essential to enhancing adherence and improving overall treatment outcomes in Tétouan.

Prevalence and Clinical Implications of Pyrazinamide Resistance in Newly Diagnosed TB Patients in Uganda

Background

Globally, 10.8 million people were diagnosed with tuberculosis during 2023 causing approximately 1.3 million deaths. This study aimed to assess the prevalence and characterization of pyrazinamide resistance by detecting the pncA gene among newly diagnosed Mycobacterium tuberculosis patients attending Bombo General Military Hospital, Central Uganda.

Methods

Cross-sectional study looking at newly diagnosed TB patients in Bombo General Military Hospital. The sputum samples were confirmed TB positive using GeneXpert PCR technology, DNA extraction using the CTAB method, DNA amplification, and finally gel electrophoresis for pncA gene detection.

Results

A total of 166 sputum-positive tuberculosis samples were analyzed. Males were 91/166 (55%), while 115 (70%) of the positive sputum samples were positive HIV status. The majority (96%) of the newly diagnosed Mycobacterium tuberculosis patients showed no detection of rifampicin resistance, while the rest 6/160 (4%) showed indeterminate rifampicin resistance. Of the 52 (31%) patients with positive pncA gene, 29 (56%) had HIV positive status 18 (34%) had unknown HIV status and 5 (10%) had negative HIV status. It was observed that only one patient 1 (2%) showed both rifampicin and pyrazinamide resistance and was a female patient aged 42 years of age with positive HIV status and positive pncA gene status.

Conclusion

This study reveals the important trends regarding drug resistance and its relationship with HIV status. The majority of patients (96%) did not exhibit rifampicin resistance, suggesting that multi-drug-resistant tuberculosis is not widespread among the newly diagnosed cases. The majority (56%) of the patients with the pncA gene mutation, were HIV-positive. This highlights the potential vulnerability of HIV-positive TB patients to multidrug resistance though the overall pyrazinamide resistance rate remains low.

Cytolytic γδ T-cells and IFNγ-producing CD4-lymphocytes characterise the early response to MTBVAC tuberculosis vaccine

Infection with Mycobacterium tuberculosis (Mtb) can produce a wide spectrum of clinical manifestations, ranging from active tuberculosis (TB) to asymptomatic latent infection. Although CD4 T-cells are key immune effectors to control TB, early after infection, the innate immune response must play a role in tackling the disease. Here, we performed in-depth analyses of the acute immune response to MTBVAC, a candidate vaccine engineered from Mtb with the aim of protecting adults from pulmonary TB disease, still a major global challenge. scRNA-seq shows expansion of CD4+ and cytotoxic γδ T-cells, data confirmed by flow cytometry. CD4 T-cells exhibited lower HLA-DR and higher L-selectin expression, compared to BCG-stimulation, indicating differential activation or dynamics. Importantly, MTBVAC-activated γδ T-cells had a unique cytotoxic CD16+GZMB+ phenotype, reminiscent of effector cells found in Mtb positive individuals controlling infection. IFN-γ and TNF-α were released in cultures, while IL-17A/F were almost undetectable.

Interactions among tuberculosis, geographic environment and aerosols: evidence from the Kashgar region of China

Background

Aerosols can affect human health through mechanisms like inflammation, oxidative stress, immune dysregulation, and respiratory impairment. In high-pollution areas, airborne particles may promote the transmission of pathogens such as Mycobacterium tuberculosis. This study investigates the spatiotemporal distribution of tuberculosis, its association with air pollution, and potential sources in the geographically unique Kashgar region of Xinjiang, encircled by mountains and desert.

Methods

Kriging interpolation and time series observation were used to analyze spatiotemporal trends and identify hot and cold spots of tuberculosis (TB) incidence and air quality in Xinjiang from 2011 to 2023. Kruskal-Wallis and multiple comparisons were applied to assess regional differences. Meteorological clustering and trajectory analysis identified pollutant pathways and potential source areas, with hypotheses proposed for TB transmission routes.

Results

The interaction between tuberculosis, the geographic environment, and aerosols in Xinjiang reveals a consistent spatial distribution of air quality index (AQI) and TB incidence, with overlapping hotspots and cold spots. The incidence rate of tuberculosis is "n/100,000."Southern Xinjiang, shows higher TB incidence (235.31 ± 92.44) and poorer air quality (AQI: 64.19 ± 11.73) compared to Northern Xinjiang (TB: 83.82 ± 21.43, AQI: 53.90 ± 6.48). Significant regional differences in TB incidence (p < 0.0001) were confirmed, with post-hoc analyses indicating higher TB rates and worse air quality in Southern Xinjiang. Trajectory and concentration-weighted trajectory (WCWT) analysis identified dust from the Taklimakan Desert as a major contributor to PM2.5 and PM10 pollution, with values exceeding 150 μg/m3 for PM2.5 and 400 μg/m3 for PM10 in key areas like Aksu and Kashgar. The Kunlun and Tianshan mountain ranges serve as barriers that trap migrating dust, while meteorological patterns indicate that dust-laden trajectories extend further into the mountainous areas. This phenomenon exacerbates the spread of tuberculosis (TB) in the high-risk regions of southern Xinjiang.

Conclusion

The study highlights a distinct interaction between TB, the geographic environment, and aerosols in southern Xinjiang. Poor air quality and elevated TB incidence overlap, particularly in Kashgar. Here, dust from the Taklimakan Desert, trapped by the Kunlun and Tianshan mountains, intensifies PM2.5 and PM10 pollution, further contributing to TB transmission in high-risk areas.

Application of the metagenomic next-generation sequencing technology to identify the causes of pleural effusion

Background

Pleural effusion (PE), frequently encountered in clinical practice, can arise from a variety of underlying conditions. Accurate differential diagnosis of PE is crucial, as treatment and prognosis are heavily dependent on the underlying etiology. However, diagnosing the cause of PE remains challenging, relying on mycobacteriological methods that lack sensitivity and are time-consuming, or on histological examinations that require invasive biopsies. The recent advancements in metagenomic next-generation sequencing (mNGS) have shown promising applications in the diagnosis of infectious diseases. Despite this, there is limited research on the utility of mNGS as a comprehensive diagnostic tool for simultaneously identifying the causes of PE, particularly in cases of tuberculosis or malignancy.

Methods

This study aimed to assess the efficacy of mNGS in detecting tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE). A total of 35 patients with PE were included, and their PE samples were analyzed using mNGS.

Results

Among the participants, 8 were ultimately diagnosed with TPE, and 10 were diagnosed with MPE, with lung adenocarcinoma being the most prevalent pathological type (50%, 5/10), according to established diagnostic criteria. Additionally, 7 patients were diagnosed with non-infectious PE. However, mNGS identified only 2 cases of TPE and 8 cases of MPE. The sensitivity of mNGS for detecting Mycobacterium tuberculosis was 25% (2/8), while the specificity was 100%. For tumor detection, mNGS demonstrated a sensitivity of 80%, a specificity of 92.6%, and an AUC of 0.882.

Conclusion

mNGS is effective in distinguishing MPE from non-MPE, but is not suitable for diagnosing TPE.

Global perspectives on tuberculosis in prisons and incarceration centers - Risk factors, priority needs, challenges for control and the way forward

Tuberculosis (TB) remains a prominent cause of illness and mortality worldwide. Prisons are hotspots for TB transmission worldwide. We reviewed the literature on TB in prisons worldwide, including TB risk factors, delays in diagnosis including drug resistance, the treatment accorded, and operational and logistical issues of TB care in prison. The quantity and quality of data on TB in prisons varies worldwide. The TB incidence rate in prisons varies by World Health Organization region, with African countries having the highest rates of TB and TB/HIV co-infection. Its incidence rate among inmates is about 10 times higher than that of the general population. The growing prevalence of multidrug-resistant TB is particularly concerning, as it may affect high-risk settings and disproportionately affects vulnerable populations, such as prisoners and incarcerated individuals who go undiagnosed for extended periods of time. Factors that drive the high TB rates in prisons include limited access to health services such as TB care, overcrowding, poor ventilation, malnutrition, HIV, alcohol use disorders, illegal drug use, smoking, and other comorbidities, compounded by limited access to healthcare. Addressing TB in prisons requires a multifaceted approach, that includes improving living conditions, enhancing healthcare services, and developing innovative detection methods. The ongoing conflicts in Europe, the Middle East, Asia, and Africa further complicated TB prevention and control efforts in prisons, emphasizing the need for targeted interventions to address TB in these high-risk settings. Structured interventions tailored to the specific risk factors present in each environment should be investigated to effectively focus measures aimed at diminishing the overall burden of TB in prisons. Electronic record-keeping worldwide will allow for accurate data to be collected and shared.

Discovery of potent dihydro-oxazinoquinolinone inhibitors of GuaB for the treatment of tuberculosis

Tuberculosis is the leading cause of death from an infectious disease, and is caused by Mycobacterium tuberculosis (M.tb). More than 1 billion people worldwide are thought to harbor an M.tb infection. The multidrug therapy that represents the current standard of care requires a minimum of four months of dosing and drug resistant Mycobacterium tuberculosis treatment regimens are significantly longer. Inosine-5'-monophosphate dehydrogenase (GuaB) is the enzyme that performs the rate-limiting step in de novo guanine nucleotide biosynthesis that is critical for growth and viability of bacteria including M.tb. The development of a novel antibiotic that inhibits GuaB could combine with existing therapies in novel ways and thereby contribute to effective therapeutic regimens for the treatment of tuberculosis. Here we describe the discovery of structurally distinct small molecule GuaB inhibitors that are potent against M.tb H37Ra and H37Rv strains and have desirable safety and ADME profiles.

In-silico development of a novel TLR2-mediating multi-epitope vaccine against Mycobacterium tuberculosis

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), still remains one of the leading causes of mortality worldwide. The elusive nature of this pathogen and its ability to develop drug resistance makes it a serious threat to global health. BCG, the only preventive vaccine for TB, has a limited efficacy and provides partial protection against the disease. A new effective recombinant vaccine capable of producing a stronger and more comprehensive immune response is required to address this global threat. In the present study, we adopted an in-silico approach to develop a multi-epitope vaccine by screening 198 "regulatory proteins" of Mtb H37Rv strain. Epitopes generated from these proteins were screened on the basis of antigenicity, cytokine profile, allergenicity, toxicity, conservancy and population coverage. Selected epitopes were docked with predominant MHC alleles that were used to develop a vaccine construct using suitable linkers and adjuvant. The construct was subjected to homology modelling, tertiary structure validation and refinement and was eventually docked with Toll-like receptor 2 receptor. Molecular dynamic simulation studies revealed stable interactions between the vaccine construct and TLR-2 receptor. The construct also displayed a high probability to elicit a protective immune response involving both humoral and cell-mediated components. In conclusion, the findings suggest that the constructed vaccine has the potential to induce a robust immune response against Mtb. However, further in-vitro and in-vivo studies are required to assess the safety, efficacy, and long-term protective effects of the vaccine construct.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40203-025-00322-8.

From ancestor to pathogen: Expansion and evolutionary adaptations of multidrug resistance causing MFS efflux pumps in mycobacteria

Multidrug resistance (MDR) in Mycobacterium tuberculosis (Mtb) is a growing threat. Efflux pumps, particularly those belonging to the Major Facilitator Superfamily (MFS), play a key role in MDR. This study investigated MFS transporters across Mycobacterium spp. to understand their evolution and role in drug resistance. We conducted a proteome-wide analysis of MFS proteins in Mtb, Mycobacterium smegmatis (non-pathogenic), and Mycobacterium canettii (closely related ancestor of Mtb). Mtb, known for its MDR, possessed the highest abundance of MFS drug efflux pumps, while Mycobacterium smegmatis had the least. This suggests a link between MFS drug efflux pump abundance and MDR phenotypes. Interestingly, Mycobacterium canettii displayed an intermediate level, possibly indicating the presence of these pumps before the emergence of Mtb as a pathogen. Further analysis of Mtb proteome revealed 31 putative MFS transporters and 3 proteins from expanded MFS subfamilies. Phylogenetic analysis categorized them into thirteen distinct families based on structural features. These findings highlight the potential importance of MFS transporters in MDR and the pathogenicity of Mtb. Overall, this study highlights the evolutionary role of MFS transporters in bacterial adaptation to antibiotics. The observed correlation between efflux pump abundance and MDR suggests MFS transporters as promising targets for future anti-tuberculosis therapies. Further research on specific transporter functions within MFS subfamilies can pave the way for novel therapeutic strategies.

New volatile organic compounds from the exhaled breath of active tuberculosis patients

Tuberculosis (TB) remains a leading global cause of mortality, necessitating the development of innovative diagnostic approaches for early and accurate detection. Existing diagnostic methods are invasive, time-intensive, and contribute to delays in diagnosis, thereby exacerbating disease progression in patients and facilitating community transmission. To address these limitations, this study investigated human breath samples to identify volatile organic compounds (VOCs) associated with active TB as potential non-invasive biomarkers. VOCs were analysed using gas chromatography-mass spectrometry (GC-MS), supported by AMDIS and OpenChrom software for compound identification. The findings revealed the presence of previously unreported VOCs associated to breath samples from patients with active TB and multidrug-resistant TB (MDR-TB), which were absent in control participants without TB symptoms. Furthermore, the results suggest the feasibility of differentiating MDR-TB from active TB based on breath VOC profiles, marking a novel observation. These findings underpin the development of a non-invasive breathalyser diagnostic device for TB, with the potential to enhance disease management and reduce transmission.

Artificial intelligence: a useful tool in active tuberculosis screening among vulnerable groups in Romania - advantages and limitations

Introduction

Despite advances in diagnostic technologies for tuberculosis (TB), global control of this disease requires improved technologies for active case finding in selected vulnerable populations. The integration of artificial intelligence (AI) into imaging modalities has been anticipated to assume a pivotal position in conjunction with traditional bacteriological diagnostic approaches, especially in the active diagnosis of vulnerable groups.

Methods

The study was conducted as a prospective investigation spanning from November 2019 to October 2023, in Romania's national TB screening project. From total of 92,368 tested participants, 404 patients were included in the study, with 202 individuals diagnosed with TB and 202 individuals serving as controls. The initial interpretation of radiological images was performed by AI X-Vision software and patients with suspicious findings were confirmed to have TB using GeneXpert testing. The objective of this study is to discover a threshold at which the AI score can accurately assess the risk of TB, regardless of the patient's medical background.

Results

The study involved a number of 404 people, among whom 202 were diagnosed with TB out of a total of 92,368 participants, and the remaining 202 patients represent the control group. The current study highlighted, at an AI threshold value of 0.4, that 89% of the screened people benefited from a correct assessment using the AI associated with the radiological examination. ROC curve analysis indicates an AUC of 0.923 (95% CI:0.893-0.947; significance level p < 0.0001) which shows that the test has a high capacity to accurately detect individuals with TB and also to rule out those who do not have the disease, with sensitivity 87.1, specificity 91.6 and criterion >0.3585.

Conclusion

Our study brings to the fore the significance of integrating AI software X-vision with bacteriological diagnosis in detecting TB among vulnerable groups in Romania. This underscores the imperative at the global level to develop solutions in the prompt diagnosis of TB, particularly within vulnerable groups.

Association of Altered Baseline Hematological Parameters with Adverse Tuberculosis Treatment Outcomes

Tuberculosis (TB) treatment monitoring is an essential tool for effective TB treatment management. Identifying parameters that predict adverse TB treatment outcomes could significantly improve clinical management. The association of hematological parameters with poor TB treatment outcomes is not well defined. To study the relationship of hematological parameters with TB treatment outcomes, we examined data from pulmonary tuberculosis (PTB) patients with successful (controls) and unsuccessful (cases) treatment outcomes. We enrolled 68 cases and 133 controls through a nested 1:2 case-control study, matching for age, sex, body mass index, diabetes status, alcohol and smoking. Hematological profiling showed significant difference in the absolute counts of white blood cells, lymphocytes, neutrophils and monocytes between cases and controls. In addition, increased neutrophil to lymphocyte ratio (NL) ratio and monocyte to lymphocyte (ML) ratio were present in cases in comparison to controls. Similarly, decreased hematocrit and red blood cell counts were detected in cases when compared with controls. Univariate and multivariate analysis demonstrated a significant association of absolute counts of WBC, neutrophils, monocytes, NL and ML ratios with poor treatment outcomes. The altered baseline hematological parameters are clearly associated with the poor TB treatment outcomes, showing potential for clinical prediction to enhance management of at-risk cases.

Elucidating the knowledge, attitude, and stigma associated with tuberculosis: a community based descriptive study in Wau and Jur River, South Sudan

BACKGROUND

Tuberculosis (TB) is a major public health problem in South Sudan. Inadequate knowledge, negative attitudes and perceived stigma may complicate the prevention efforts. This study describes knowledge, attitude, and stigma associated with TB among communities in Wau and Jur River, South Sudan.

METHODS

From March to May 2023, a cross-sectional study was conducted among 352 community members randomly selected from residential blocks. A validated structured questionnaire was used to collect the required data. Descriptive, bivariate and multivariate analyses were performed.

RESULTS

Out of 352 respondents, 51% (n = 180) were males and 49% (n = 172) were females. Majority 227 (64.5%) had poor knowledge about TB, meanwhile hearing about TB, age and level of education were associated factors. Fear of having TB was the major negative attitude (57.1%; n = 218), and most of the respondents (n = 327; 92.9%) had a perceived stigma towards TB, voicing that they disliked drinking or eating with people with TB and/or felt uncomfortable and kept their distance from people with TB.

CONCLUSIONS

Communities have little knowledge, negative attitude and perceived stigma towards people with TB. Hence, tailored health messages using local languages, training of community volunteers to reach villages without accessibility and communication network are essential to improve TB prevention and control in South Sudan.

Mycobacterium tuberculosis Rv3435c gene regulates inflammatory cytokines and is involved in lung injury and mycobacterial survival in mice

Mycobacterium tuberculosis enters the body through the respiratory tract, produces and releases virulence proteins through a variety of mechanisms, regulates the host immune mechanism through a variety of ways, and then survives in the body for a long time. These depend on virulence genes encoded by Mycobacterium tuberculosis. Previous studies found that the Rv3435c gene of Mycobacterium tuberculosis is highly conserved in pathogenic mycobacterium, but not conserved in non-pathogenic mycobacterium, which may be a potential virulence gene, and inhibit the secretion of inflammatory factors in RAW264.7 cells and inhibit cell apoptosis. Based on previous studies, the function of Rv3435c gene in mice was studied by infecting mice with recombinant strains. In vivo infection experiments showed that overexpression of Rv3435c significantly promoted the survival of Ms in the lung. Ms-pMV361-Rv3435c specifically inhibits the secretion of inflammatory cytokines, including TNF-α, IL-6, IL-1β, IL-12, and IFN-γ. Rv3435c can inhibit lung cell apoptosis and cause pathological damage to lung. Therefore, Rv3435c enhances the survival of mycobacterium in mice and promotes the pathogenicity and spread of Mycobacterium tuberculosis by inhibiting the production of cytokines.

Fitness costs of Mycobacterium tuberculosis resistant to rifampicin is compensated by rapid Th2 polarization mediated by early and high IL-4 production during mice infection

It was a general belief that drug resistance in Mycobacterium tuberculosis (Mtb) was associated with lesser virulence, particularly rifampicin resistance, which is usually produced by mutations in the RNA polymerase Beta subunit (RpoB). Interestingly, this kind of bacterial mutations affect gene transcription with significant effects on bacterial physiology and metabolism, affecting also the bacterial antigenic constitution that in consequence can produce diverse immune responses and disease outcome. In the present study, we show the results of the Mtb clinical isolate A96, which is resistant to rifampicin and when used to infect BALB/c mice showed hypervirulence, apparently by rapidly polarization of the Th2 immune response through early and high production of IL-4. The 2D-PAGE analysis of the secretome of Mtb A96 showed 204 spots, and by immunoproteome, seven proteins that were differentially recognized with the sera of infected mice on day 28 were identified by LC-MS/MS. The proteins correspond to surface antigens, virulence factors, and energy metabolism enzymes. Some of them are immunodominant antigens, such as LpqH lipoprotein that induces IL-4 secretion in cell suspensions from the lung and spleen of mice infected with Mtb A96 at 28 days postinfection, suggesting that LpqH could be one of the main antigens involved in the Th2 polarization. The reduction of Mtb A96 hypervirulence in IL-4Rα-/- BALB/c mice highlights the importance of IL-4 induction and Th2 response polarization and the immunopathological response. Thus, high and rapid bias to Th2 response is a mechanism of Mtb virulence, which could be mediated by rifampicin-resistant Mtb isolates, probably by high production and secretion of specific antigens.

Prevalence of pulmonary tuberculosis and associated factors among adults living with HIV/AIDS in Ethiopia, systematic review and meta-analysis

BACKGROUND

Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), remains a global health crisis, especially in sub-Saharan Africa, where high human immune virus (HIV) prevalence exacerbates the problem. The co-infection of TB and HIV creates a deadly combination, increasing susceptibility and complicating disease progression and treatment. Ethiopia, classified as a high-burden country, faces significant challenges despite efforts to reduce co-infection rates. The rise of multidrug-resistant TB further complicates diagnosis and management, highlighting the urgent need for intensified efforts to combat this dual epidemic.

METHODS

Studies searched through the search engine of Cochrane Library, PubMed, Web of Science, Google Scholar. Data from included studies was extracted, organized in Excel, and then analyzed using STATA 17. The overall effect across all studies was calculated using a random-effect model. Potential publication bias and heterogeneity in the results between studies were assessed using Egger's test, forest plot, and I² statistic, respectively.

RESULTS

According to this systematic review and meta-analysis, the overall prevalence of pulmonary tuberculosis(PTB) among adults living with human immune virus /aquered immune deficieciency syndrome(HIV/AIDS) in Ethiopia was 15% (95% CI: 8-23%). Several factors were independently associated with pulmonary tuberculosis, including CD4 count below 200 cells/mm³ (OR = 4.491, 95% CI: 1.0001-8.132), WHO clinical stage III (OR = 4.487, 95% CI: 2.264-6.710)), WHO clinical stage IV (OR = 6.905, 95% CI: 5.239-8.571), smokers (AOR = 3.749, 95% CI: 2.626-5.271), ambulatory adults (AOR = 1.887, 95% CI: 1.439-2.335).

CONCLUSION

This systematic review and meta-analysis found a significant 15% pooled prevalence of pulmonary tuberculosis (PTB) among adults living with HIV/AIDS in Ethiopia. The prevalence was notably higher in individuals with lower CD4 counts, advanced HIV stages (III and IV), and in smokers. These findings underscore the need for early detection, targeted interventions, and integrated TB control programs with HIV care to mitigate the burden of PTB in this population.

Tuberculosis healthcare service disruptions during the COVID-19 pandemic in Brazil, India and South Africa: A model-based analysis of country-level data

Tuberculosis (TB) is the leading infectious disease cause of death worldwide. In recent years, stringent measures to contain the spread of SARS-CoV-2 have led to considerable disruptions of healthcare services for TB in many countries. The extent to which these measures have affected TB testing, treatment initiation and outcomes has not been comprehensively assessed. We aimed to estimate TB healthcare service disruptions occurring during the COVID-19 pandemic in Brazil, India, and South Africa. We obtained country-level TB programme and laboratory data and used autoregressive integrated moving average (ARIMA) time-series models to estimate healthcare service disruptions with respect to TB testing, treatment initiation, and treatment outcomes. We quantified disruptions as the percentage difference between TB indicator data observed during the COVID-19 pandemic compared with values for a hypothetical no-COVID scenario, predicted through forecasting of trends during a three-year pre-pandemic period. Annual estimates for 2020-2022 were derived from aggregated monthly data. We estimated that in 2020, the number of bacteriological tests conducted for TB diagnosis was 24.3% (95% uncertainty interval: 8.4%;36.6%) lower in Brazil, 27.8% (19.8;3 4.8%) lower in India, and 32.0% (28.9%;34.9%) lower in South Africa compared with values predicted for the no-COVID scenario. TB treatment initiations were 17.4% (13.9%;20.6%) lower than predicted in Brazil, 43.3% (39.8%;46.4%) in India, and 27.0% (15.2%;36.3%) in South Africa. Reductions in 2021 were less severe compared with 2020. The percentage deaths during TB treatment were 13.7% (8.1%; 19.7%) higher than predicted in Brazil, 1.7% (-8.9%;14.0%) in India and 21.8% (7.4%;39.2%) in South Africa. Our analysis suggests considerable disruptions of TB healthcare services occurred during the early phase of the COVID-19 pandemic in Brazil, India, and South Africa, with at least partial recovery in the following years. Sustained efforts to mitigate the detrimental impact of COVID-19 on TB healthcare services are needed.

Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition

The lack of clear definition and classification for "moderate ulcerative colitis (UC)" creates ambiguity regarding the suitability of step-up versus top-down treatment approaches. In this paper, experts address crucial gaps in assessing and managing moderate UC. The Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition comprised 24 experts who convened to share, discuss and vote electronically on management recommendations for moderate UC. Experts emphasized that the goal of treating UC is to attain clinical, biomarker, and endoscopic remission using cost-effective strategies such as 5-aminosalicylates (5-ASAs), well-tolerated therapy that can be optimized to improve outcomes. Experts agreed that 5-ASA therapy could be optimized by maximizing dosage (4 g/day for induction of remission), combining oral and topical administration, extending treatment duration beyond 8 weeks, and enhancing patient adherence through personalized counselling and reduced pill burden. Treatment escalation should ideally be reserved for patients with predictors of aggressive disease or those who do not respond to 5-ASA optimization. Premature treatment escalation to advanced therapies (including biologics and oral small molecules) may have long-term health and financial consequences. This paper provides consensus-based expert recommendations and a treatment algorithm, based on current evidence and practices, to assist decision-making in real-world settings.

Mapping Drug-Resistant Tuberculosis Treatment Outcomes in Hunan Province, China

BACKGROUND

Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in China, with varying treatment outcomes across different regions. Understanding the spatial distribution of DR-TB treatment outcomes is crucial for targeted interventions to improve treatment success in high-burden areas such as Hunan Province. This study aimed to map the spatial distribution of DR-TB treatment outcomes at a local level and identify sociodemographic and environmental factors associated with poor treatment outcomes in Hunan Province, China.

METHODS

A spatial analysis was conducted using DR-TB data from the Tuberculosis Control Institute of Hunan Province, covering the years 2013 to 2018. The outcome variable, the proportion of poor treatment outcomes, was defined as a composite measure of treatment failure, death, and loss to follow-up. Sociodemographic, economic, healthcare, and environmental variables were obtained from various sources, including the WorldClim database, the Malaria Atlas Project, and the Hunan Bureau of Statistics. These covariates were linked to a map of Hunan Province and DR-TB notification data using R software version 4.4.0. The spatial clustering of poor treatment outcomes was analyzed using the local Moran's I and Getis-Ord statistics. A Bayesian logistic regression model was fitted, with the posterior parameters estimated using integrated nested Laplace approximation (INLA).

RESULTS

In total, 1381 DR-TB patients were included in the analysis. An overall upward trend in poor DR-TB treatment outcomes was observed, peaking at 14.75% in 2018. Deaths and treatment failures fluctuated over the years, with a notable increase in deaths from 2016 to 2018, while the proportion of patients lost to follow-up significantly declined from 2014 to 2018. The overall proportion of poor treatment outcomes was 9.99% (95% credible interval (CI): 8.46% to 11.70%), with substantial spatial clustering, particularly in Anxiang (50%), Anren (50%), and Chaling (42.86%) counties. The proportion of city-level indicators was significantly associated with higher proportions of poor treatment outcomes (odds ratio (OR): 1.011; 95% CRI: 1.20 December 2024 001-1.035).

CONCLUSIONS

This study found a concerning increase in poor DR-TB treatment outcomes in Hunan Province, particularly in certain high-risk areas. Targeted public health interventions, including enhanced surveillance, focused healthcare initiatives, and treatment programs, are essential to improve treatment success.

Microfluidic Chip-based Enrichment and Nucleic Acid Extraction for Quantitative Detection of Mycobacterium Smegmatis in Aerosols

Tuberculosis (TB) is ranked as the third most prevalent infectious disease globally. Early detection and treatment are crucial for effective management. Conventional diagnostic methods primarily rely on sputum samples, which present challenges in accessibility and have limited accuracy in certain populations such as children, individuals with HIV, and those with extrapulmonary TB. To address the need for point-of-care diagnostics, this study introduces a rapid diagnostic approach for TB using exhaled breath aerosol as a more easily obtainable specimen. Mycobacterium smegmatis, a non-pathogenic bacterium genetically similar to Mycobacterium tuberculosis, is used as a surrogate organism. The method involves the use of microfluidic chips for concentrating and electrolyzing mycobacteria in the aerosol, followed by extracting and quantifying nucleic acids using real-time fluorescence quantitative PCR. Notably, successful enrichment and quantification of bacterial content were achieved even at a minimal bacterial aerosol concentration of 104 CFU/mL. The developed chips are characterized by their cost-effectiveness, ease of use, high bacterial enrichment, efficient nucleic acid extraction, and low detection threshold (4.4 × 10-18 mol/L). This innovative approach offers a promising method for early TB screening and opens avenues for the rapid identification of other aerosol-transmitted diseases.

Enhanced Rapid Screening for Multidrug-resistant tuberculosis through combined cardiometabolic and inflammatory indices: a cross-sectional study

Multidrug-resistant tuberculosis (MDR-TB) remains a global public health challenge. We aimed to investigate the utility of combining the cardiometabolic index (CMI) and systemic inflammation response index (SIRI) as biomarkers for rapid MDR-TB screening. Data were collected from 2,620 TB patients in Zibo city from 2018 to 2021. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate the associations and diagnostic performance of CMI and SIRI with MDR-TB. The prevalence of MDR-TB was 5.0% in new TB patients and 20.5% in recurrent TB patients. Both CMI and SIRI were significantly associated with MDR-TB in all models (P < 0.05). In new TB patients, the area under the curve (AUC) values of the ROC curves for SIRI, CMI, and their combination were 0.845, 0.806, and 0.910, respectively. In recurrent TB patients, the AUC values were 0.730, 0.875, and 0.902, respectively. The optimal cut-off points for SIRI and CMI were 0.72 and 1.81 in new TB patients, and 1.05 and 1.48 in recurrent TB patients, respectively. In conclusion, combining CMI and SIRI shows promise as a low-invasive, cost-effective tool for early MDR-TB screening, warranting further validation in diverse populations and TB subtypes.

Stealing survival: Iron acquisition strategies of Mycobacteriumtuberculosis

Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis (TB), faces iron scarcity within the host due to immune defenses. This review explores the importance of iron for Mtb and its strategies to overcome iron restriction. We discuss how the host limits iron as an innate immune response and how Mtb utilizes various iron acquisition systems, particularly the siderophore-mediated pathway. The review illustrates the structure and biosynthesis of mycobactin, a key siderophore in Mtb, and the regulation of its production. We explore the potential of targeting siderophore biosynthesis and uptake as a novel therapeutic approach for TB. Finally, we summarize current knowledge on Mtb's iron acquisition and highlight promising directions for future research to exploit this pathway for developing new TB interventions.

Mycobacterium tuberculosis hijacks host macrophages-derived interleukin 16 to block phagolysosome maturation for enhancing intracellular growth

The discovery of promising cytokines and clarification of their immunological mechanisms in controlling the intracellular fate of Mycobacterium tuberculosis (Mtb) are necessary to identify effective diagnostic biomarkers and therapeutic targets. To escape immune clearance, Mtb can manipulate and inhibit the normal host process of phagosome maturation. Phagosome maturation arrest by Mtb involves multiple effectors and much remains unknown about this important aspect of Mtb pathogenesis. In this study, we found that interleukin 16 (IL-16) is elevated in the serum samples of Tuberculosis (TB) patients and can serve as a specific target for treatment TB. There was a significant difference in IL-16 levels among active TB, latent TB infection (LTBI), and non-TB patients. This study first revealed that macrophages are the major source of IL-16 production in response to Mtb infection, and elucidated that IL-16 can promote Mtb intracellular survival by inhibiting phagosome maturation and suppressing the expression of Rev-erbα which can inhibit IL-10 secretion. The experiments using zebrafish larvae infected with M. marinum and mice challenged with H37Rv demonstrated that reducing IL-16 levels resulted in less severe pathology and improved survival, respectively. In conclusion, this study provided direct evidence that Mtb hijacks the host macrophages-derived interleukin 16 to enhance intracellular growth. It is suggesting the immunosuppressive role of IL-16 during Mtb infection, supporting IL-16 as a promising therapeutic target.

The Long-Term Journey of a Tuberculosis Patient With Triple Organ Involvement and Rheumatological Disease: A Case Study and Literature Review

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria, which is more prevalent among immunocompromised individuals. According to the distribution of affected organs, this infection can be categorized as either pulmonary or extrapulmonary TB. Immunodeficiency states resulting from rheumatological disorders and the use of immunosuppressive medications, such as in Behçet's disease (BD), are potential predisposing factors for TB, particularly in cases involving multiple organs. These situations can introduce challenges in both the diagnosis and treatment of patients. We describe a 43-year-old man with a history of BD who presented with symptoms of weight loss, abdominal pain, and shortness of breath. His chest X-ray revealed cavities and calcifications, while an abdominal X-ray demonstrated signs of intestinal obstruction and adhesions. Subsequent TB diagnosis led to a 6-month course of a TB treatment regimen. Despite treatment initiation, the patient developed a brain abscess 1 year later, necessitating surgical intervention. Following the procedure, he received another 1-year course of a TB treatment regimen and experienced full recovery without any complications during a 2-year follow-up period. Notably, the patient recently received a Sinopharm COVID-19 vaccine and subsequently developed seizures that are currently being managed with anticonvulsant therapy. This case report emphasizes the significance of including pulmonary TB in complex medical cases, especially in individuals with autoimmune diseases. Early diagnosis and treatment are crucial for improving outcomes and reducing the risk of complications. Furthermore, it highlights the possible correlation between TB and BD, along with the potential adverse reactions to COVID-19 vaccines in this population, which necessitate special consideration by healthcare professionals.

Pulmonary tuberculosis related diffuse cystic lung disease with recurrent pneumothorax mimicking pulmonary lymphangioleomyomatosis in Ethiopia: A review and case report

Millions of individuals worldwide are afflicted by the fatal infectious disease tuberculosis, which accounts for thousands of avoidable deaths. The literature has provided a good description of the clinical manifestation and radiologic features of pulmonary tuberculosis. However, the parenchymal complication of pulmonary tuberculosis presenting as cystic lung disease, has not been widely documented in the literature and is one of the incredibly uncommon causes of diffuse cystic lung disease. It is very uncommon to have a patient with possible pulmonary lymphangioleomyomatosis to be superinfected with bacteriologically confirmed tuberculosis. This report describes a young female patient who was admitted to the hospital, had repeated chest tube insertions and drainage of recurrent spontaneous pneumothoraxes secondary to likely diffuse cystic lung disease related to pulmonary tuberculosis. First, it was thought that the most likely diagnosis was pulmonary lymphangioleomyomatosis. The patient ultimately diagnosed with diffuse cystic lung disease associated with pulmonary tuberculosis as the most likely cause of her clinical presentation considering the high index of suspicion and her sputum gene xpert results. For drug-susceptible tuberculosis, the patient was finally started on anti-tuberculosis medication. She had both clinical and radiological improvement after completion of her anti tuberculosis treatment. Thus, it is reasonable to conclude that tuberculosis may contribute to diffuse cystic lung disease (DCLD) in tuberculosis endemic settings such as Ethiopia, and that appropriate diagnostic efforts should be undertaken to make the diagnosis. A high index of clinical suspicion is crucial to prevent delays in the diagnosis of diffuse cystic lung disease associated with pulmonary tuberculosis.

Construction of circRNA-miRNA-mRNA ceRNA regulatory network and screening of diagnostic targets for tuberculosis

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis (Mtb), which threatens human health and safety all over the world. Hundreds of thousands of people die from TB every year. Timely early diagnosis and treatment of patients is the most important measure to control the source of infection and curb the epidemic of tuberculosis. The existing diagnostic methods have the disadvantages of poor sensitivity and long culture time. Competitive endogenous RNAs (ceRNAs) can regulate the expression of corresponding target genes by competing for the same microRNA (miRNA) response elements (MREs) as mRNA. Recent studies have found that circRNA has the advantages of long half-life, good stability and tissue specificity, and can be used as a biomarker for predicting, diagnosing and treating various diseases, and is an ideal candidate for biomarkers in body fluid biopsy. In this study, transcriptome sequencing was performed on whole blood samples to screen out TB-related mirna and mRNA differential expression, and to construct the ceRNA regulatory network. Through the analysis of ceRNA regulatory network, it was found that circRNA could competitively bind has-miR-607 and induce down-regulation of has-miR-607, thereby inhibiting the expression of IFNG. The hsa_circ_0000566, hsa_circ_0001844, hsa_circ_0005408, hsa_circ_0007587, hsa_circ_0086710, IFNG and has-miR-607 couble be used as new diagnostic targets for TB. The results of this study not only provide a new perspective for studying the potential role of ceRNA regulatory network in tuberculosis, but also provide a new target and method for the diagnosis of tuberculosis.

The clinical features and prognostic factors of miliary tuberculosis in a high tuberculosis burden area

BACKGROUND

Miliary Tuberculosis (TB) remains an important infectious disease that threatens human health. The clinical characteristics and prognostic factors of miliary TB are summarized in this study.

METHODS

The clinical information of miliary TB patients between 2010 and 2022 was retrospectively analyzed. Patients with miliary TB were characterized and compared to adverse outcomes cases. Factors independently associated with adverse outcomes were determined via multivariate logistic regression analysis.

RESULTS

A total of 288 patients were analyzed, including 181 with adverse outcomes. The clinical manifestations are atypical. 88.54% Of them experienced systemic symptoms, whilst 69.79% manifested respiratory symptoms. 40.97% Presented with neurologic symptoms, while 35.07% reported gastrointestinal symptoms. The major comorbidities were pharmacological immunosuppression (21.53%), pneumoconiosis (15.28%), diabetes (10.76%), and pregnancy or postpartum (7.29%). Regarding microbiology, most patients were diagnosed via sputum or Bronchoalveolar Lavage Fluid (BALF), pleural effusion, ascites, cerebrospinal fluid, urine TB-DNA, and tuberculosis culture. Meanwhile, 2.43% of patients were diagnosed via cerebrospinal fluid NGS. Independent risk factors predictive of adverse outcomes were current smoking, leukocytosis, elevated alanine aminotransferase (ALT) levels, and the combination of lymphopenia with bone marrow tuberculosis or tuberculous lymphadenitis. The accuracy of the model was validated by an area under the ROC curve of 0.753 (95% IC 0.697-0.810).

CONCLUSIONS

The clinical manifestations of miliary TB are atypical, and early diagnosis is challenging. The major comorbidities in miliary TB patients were pharmacological immunosuppression, pneumoconiosis, diabetes, pregnancy, and postpartum. Regarding etiological detection, multi-site and multi-type specimens should be collected for a timely diagnosis. Cerebrospinal fluid mNGS test may be a viable choice in some cases. Finally, current smoking, leukocytosis, elevated ALT levels, and the combination of lymphopenia with bone marrow tuberculosis or tuberculous lymphadenitis were identified as independent risk factors for adverse outcomes.

A chemiluminescent sensor based on CRISPR-HCR technology for the hypersensitive detection of Mycobacterium tuberculosis

Tuberculosis is a highly infectious bacterial disease caused by Mycobacterium tuberculosis. The spread of this agent has caused serious health problems worldwide, and the rapid and accurate detection of M. tuberculosis is essential for controlling the spread of infection and for preventing the emergence of multidrug-resistant strains. In this study, the trans cleavage ability of CRISPR-Cas12a against single-stranded DNA was combined with hybridization chain reaction and chemiluminescent signal to establish an imaging sensor for the hypersensitive detection of M. tuberculosis DNA. We observed linear relationships between the concentration of M. tuberculosis DNA and the output signal over the ranges of 10 to 200 pM and 200 to 800 pM DNA. The equations of the standard curves were y = 56.08x + 3303, with R2 = 0.9916 for the lower range and y = 15.69x + 10 685, with R2 = 0.9929 for the higher range. The limit of detection was as low as 0.83 pM for genomic DNA, and a plasmid containing an M. tuberculosis-specific sequence was detected at 1 copy per μL. A detection accuracy of 100% was achieved in the analysis of DNA isolated from sputum of hospitalized tuberculosis patients. The sensitivity and specificity of the proposed sensor is combined with a long shelf-life and a low cost of materials. This study introduces a new method for tuberculosis detection and broadens the application of CRISPR-Cas12a-based sensors in clinical diagnosis.

Five-year tuberculosis trends analysis in eight districts of Mwanza region, Tanzania; (2017-2021)

BACKGROUND

In Tanzania like other developing countries, TB detection is hindered by totally missed, late notification, and delayed diagnosis of active cases. Apart from having TB control strategies and interventions to detect patients and put them on treatment to cut down the chain of transmission, TB remains a health concern. Limited data exist on the burden and trends of tuberculosis in Mwanza, which includes fishing communities and living conditions that are associated with high TB transmission like overcrowding. This study aimed to determine tuberculosis trends in the Mwanza region of Tanzania for five years, from 2017 to 2021.

METHODS

We extracted routine TB diagnostic data from 2017 to 2021 from eight districts of the Mwanza region of Tanzania from the electronic TB database. Data were captured in Microsoft Office Excel 2007 with district TB and leprosy coordinators and then imported into STATA 13 (Stata Corp LLC, College Station, TX, USA) for analysis. We estimated the TB case detection rate per 100,000 population.

RESULTS

A total of 6,414 laboratory-confirmed tuberculosis cases were detected in eight districts of the Mwanza region in Tanzania from 2017 to 2021. The average tuberculosis detection rate in five years was 34.7 per 100,000 population. Overall, the TB detection rate was two times higher in people without HIV (30.5) compared to those infected with HIV; 13.4 per 100,000 population. Of the 15 rifampicin-resistant TB cases detected in the year 2018, 66.7% (10/15) were HIV-negative compared to 33.3% (5/15) infected with HIV.

CONCLUSION

The TB case detection rate decreased in Mwanza region from 43.9 in 2017 to 21.4 per 100,000 population in 2021. Other parameters were missing in the database, which indicates remarkable gaps in the established database to monitor TB management in the region. The program may consider investigating and improving the documentation of information necessary to attain its goals.

Fluorescent and colorimetric dual-readout platform for tuberculosis point-of-care detection based on dual signal amplification strategy and quantum dot nanoprobe

Rapid and accurate diagnosis of tuberculosis (TB) is of great significance to control the spread of this devastating infectious disease. In this work, a sensitive and low-cost point-of-care testing (POCT) detection platform for TB was developed based on recombinase polymerase amplification (RPA)-catalytic hairpin assembly (CHA)-assisted dual signal amplification strategy. This platform could achieve homogeneous fluorescent and visual diagnosis of TB by using CdTe quantum dots (QDs) signal reporter. In the presence of target DNA (IS1081 gene fragment), RPA amplicons blocked by short oligonucleotide strands could trigger CHA signal amplification, leading to the Ag+ releasing from C-Ag+-C structure and the fluorescence quenching of CdTe QDs by the released Ag+. Furthermore, the detection performance of CdTe QDs modified by 3-mercaptopropionic acid (MPA) or thiomalic acid (TMA) (MPA-capped QDs and TMA-capped QDs) was systematically compared. Experimental results demonstrated that TMA-capped QDs exhibited better detection sensitivity due to their stronger interaction with Ag+. The limits of detection (LODs) of fluorescence and visual analysis were as low as 0.13 amol L-1 and 0.33 amol L-1. This method was successfully applied to the clinical sputum samples from 36 TB patients and 20 healthy individuals, and its quantitative results were highly consistent with those obtained by real-time fluorescent quantitative polymerase chain reaction (RT-qPCR). The proposed approach has the advantages of high sensitivity and specificity, simple operation and low cost, and is expected to be applied in clinical TB screening and diagnosis.

Knowledge, attitude, and practice regarding tuberculosis in a labor-intensive industrial district

Background

In China, tuberculosis (TB) is a major contributor to deaths caused by infectious diseases, with a significant number of cases remaining undetected. Lack of knowledge could heighten the chances of infecting TB. Due to the lack of information on the knowledge, attitudes, and practices (KAP) related to TB among labor-intensive businesses, the study aimed to evaluate the TB KAP within this demographic.

Methods

A descriptive cross-sectional survey was conducted among 1,007 participants from March 1 to 28, 2023. A survey was created for assessing knowledge, attitudes, and practices related to tuberculosis, and was sent to employees within the company. We utilize t-tests, ANOVA, and multiple linear regression to investigate the relationship between TB knowledge, attitudes, and practices and various influencing factors.

Results

The mean good scores rate for TB KAP were 43.5, 23.5, and 75.3%, respectively. Native, female, and workers living in their own houses had a higher score in TB knowledge. Native, non-operators, and workers with a history of TB contact had higher scores in TB practice. Regarding the multivariable linear regression analysis, sex, seniority, birthplace, marital status, and sources of information were associated with greater knowledge; monthly income categories were associated with greater attitude; and position, birthplace, and contact history were associated with greater practice.

Conclusion

The survey results lead to the assumption that the level of KAP toward TB is not high among manufacturing workers in Songjiang district. Therefore, it is crucial to enhance tuberculosis knowledge, attitudes, and practices within this demographic.

IFNγ-secreting T cells that highly express IL-2 potently inhibit the growth of intracellular M. tuberculosis in macrophages

Cytokine of interferon-gamma (IFNγ) plays a vital role in the immune response against Mycobacteria tuberculosis (Mtb) infection, yet the specific function of T cells producing IFNγ in this process remains unclear. In this study, we first isolated IFNγ+CD3+ T cells induced by Mtb antigens using surface staining assays. which showed a strong ability to inhibit the growth of intracellular mycobacteria in macrophages. Peripheral blood mononuclear cells (PBMCs) from healthy individuals were then challenged with Bacillus Calmette-Guérin (BCG) or Mtb, respectively, to sort IFNγ-secreting T cells for mRNA sequencing to analyze the gene expression patterns. The results of the integrated data analysis revealed distinct patterns of gene expression between IFNγ+CD3+ T cells induced by the BCG vaccine and those induced by Mtb pathogens. Further, unlike Mtb-induced cells, BCG-induced IFNγ+CD3+ T cells expressed high levels of interleukin-2 (IL-2), which increased the frequencies of these cells and the production of effector cytokines IFNγ and IL-2. Our findings suggested that IFNγ+CD3+ T cells with high IL-2 expression presented potent effector functions to inhibit intracellular Mtb growth, while Mtb infection impaired IL-2 expression in IFNγ+CD3+ T cells.

The catalogue of Mycobacterium tuberculosis mutations associated with drug resistance to 12 drugs in China from a nationwide survey: a genomic analysis

BACKGROUND

WHO issued the first edition catalogue of Mycobacterium tuberculosis complex (MTBC) mutations associated with drug resistance in 2021. However, country-specific issues might lead to arising complex and additional drug-resistant mutations. We aimed to fully reflect the characteristics of drug resistance mutations in China.

METHODS

We analysed MTBC isolates from the nationwide drug-resistant tuberculosis surveillance with 70 counties in 31 provinces, municipalities, and autonomous regions in China. Three types of MYCOTB plates were used to perform drug susceptibility testing for 12 antibiotics (rifampicin, isoniazid, ethambutol, levofloxacin, moxifloxacin, amikacin, kanamycin, ethionamide, clofazimine, linezolid, delamanid, and bedaquiline). Mutations were divided into five groups according to their odds ratios, positive predictive values, false discovery rate-corrected p values, and 95% CIs: (1) associated with resistance; (2) associated with resistance-interim; (3) uncertain significance; (4) not associated with resistance-interim; and (5) not associated with resistance. The Wilcoxon rank-sum and Kruskal-Wallis tests were used to quantify the association between mutations and minimum inhibitory concentrations (MICs). Our dataset was compared with the first edition of the WHO catalogue.

FINDINGS

We analysed 10 146 MTBC isolates, of which 9071 (89·4%) isolates were included in the final analysis. 744 (8·2%) isolates were resistant to rifampicin and 1339 (14·8%) to isoniazid. 208 (1·9%) of 11 065 mutations were classified as associated with resistance or associated with resistance-interim. 33 (97·1%) of 34 mutations in group 1 and 92 (52·9%) of 174 in group 2 also appeared in groups 1 or 2 of the WHO catalogue. Of 81 indel mutations in group 2, 15 (18·5%) were in the WHO catalogue. The newly discovered mutation gyrA_Ala288Asp was associated with levofloxacin resistance. MIC values for rifampicin, isoniazid, moxifloxacin, and levofloxacin corresponding to resistance mutations in group 1 were significantly different (p<0·0001), and 12 high-level resistance mutations were detected. 61 mutations in group 3 occurred as solo in at least five phenotypically susceptible isolates, but with MIC values moderately higher than other susceptible isolates. Among 945 phenotypically resistant but genotypically susceptible isolates, 433 (45·8%) were mutated for at least one efflux pump gene.

INTERPRETATION

Our analysis reflects the complexity of drug resistance mutations in China and suggests that indel mutations, efflux pump genes, protein structure, and MICs should be fully considered in the WHO catalogue, especially in countries with a high tuberculosis burden.

FUNDING

National Key Research and Development Program of China and the Science and Technology Major Project of Tibetan Autonomous Region of China.

Hyb_SEnc: An Antituberculosis Peptide Predictor Based on a Hybrid Feature Vector and Stacked Ensemble Learning

Tuberculosis has plagued mankind since ancient times, and the struggle between humans and tuberculosis continues. Mycobacterium tuberculosis is the leading cause of tuberculosis, infecting nearly one-third of the world's population. The rise of peptide drugs has created a new direction in the treatment of tuberculosis. Therefore, for the treatment of tuberculosis, the prediction of anti-tuberculosis peptides is crucial. This paper proposes an anti-tuberculosis peptide prediction method based on hybrid features and stacked ensemble learning. First, a random forest (RF) and extremely randomized tree (ERT) are selected as first-level learning of stacked ensembles. Then, the five best-performing feature encoding methods are selected to obtain the hybrid feature vector, and then the decision tree and recursive feature elimination (DT-RFE) are used to refine the hybrid feature vector. After selection, the optimal feature subset is used as the input of the stacked ensemble model. At the same time, logistic regression (LR) is used as a stacked ensemble secondary learner to build the final stacked ensemble model Hyb_SEnc. The prediction accuracy of Hyb_SEnc achieved 94.68% and 95.74% on the independent test sets of AntiTb_MD and AntiTb_RD, respectively.

A review on the development of bacterial multi-epitope recombinant protein vaccines via reverse vaccinology

Bacterial vaccines play a crucial role in combating bacterial infectious diseases. Apart from the prevention of disease, bacterial vaccines also help to reduce the mortality rates in infected populations. Advancements in vaccine development technologies have addressed the constraints of traditional vaccine design, providing novel approaches for the development of next-generation vaccines. Advancements in reverse vaccinology, bioinformatics, and comparative proteomics have opened horizons in vaccine development. Specifically, the use of protein structural data in crafting multi-epitope vaccines (MEVs) to target pathogens has become an important research focus in vaccinology. In this review, we focused on describing the methodologies and tools for epitope vaccine development, along with recent progress in this field. Moreover, this article also discusses the challenges in epitope vaccine development, providing insights for the future development of bacterial multi-epitope genetically engineered vaccines.

Forecasting the trend of tuberculosis incidence in Anhui Province based on machine learning optimization algorithm, 2013-2023

Tuberculosis has been one of the most common communicable diseases raising global concerns. Accurately predicting the incidence of Tuberculosis remains challenging. Here we constructed a time-series analysis and fusion tool using multi-source data, and aimed to more accurately predict the incidence trend of tuberculosis of Anhui Province from 2013 to 2023. Random forest algorithm (RF), Feature Recursive Elimination (RFE) and Least absolute shrinkage and selection operator (LASSO) were implemented to improve the derivation of features related to infectious diseases and feature work. Based on the characteristics of infectious disease data, a model of RF-RFE-LASSO integrated particle swarm optimization multiple inputs long short term memory recurrent neural network (RRL-PSO-MiLSTM) was created to perform more accurate prediction. Results showed that the PSO-MiLSTM achieved excellent prediction results compared with common single-input and multi-input time-series models (test set MSE:42.3555, MAE: 59.3333, RMSE: 146.7237, MAPE: 2.1133, R2: 0.8634). PSO-MiLSTM enriches and complements the methodological research content of calibrating the time-series predictive analysis of infectious diseases using multi-source data, and can be used as a brand-new benchmark for the analysis of influencing factors and trend prediction of infectious diseases at the public health level in the future, as well as providing a reference for incidence rate prediction of infectious diseases.

Differential Host Gene Expression in Response to Infection by Different Mycobacterium tuberculosis Strains-A Pilot Study

Tuberculosis (TB) represents a global public health threat and is a leading cause of morbidity and mortality worldwide. Effective control of TB is complicated with the emergence of multidrug resistance. Yet, there is a fundamental gap in understanding the complex and dynamic interactions between different Mycobacterium tuberculosis strains and the host. In this pilot study, we investigated the host immune response to different M. tuberculosis strains, including drug-sensitive avirulent or virulent, and rifampin-resistant or isoniazid-resistant virulent strains in human THP-1 cells. We identified major differences in the gene expression profiles in response to infection with these strains. The expression of IDO1 and IL-1β in the infected cells was stronger in all virulent M. tuberculosis strains. The most striking result was the overexpression of many interferon-stimulated genes (ISGs) in cells infected with the isoniazid-resistant strain, compared to the rifampin-resistant and the drug-sensitive strains. Our data indicate that infection with the isoniazid-resistant M. tuberculosis strain preferentially resulted in cGAS-STING/STAT1 activation, which induced a characteristic host immune response. These findings reveal complex gene signatures and a dynamic variation in the immune response to infection by different M. tuberculosis strains.

Toward a Clinical Decision Support System for Monitoring Therapeutic Antituberculosis Medical Drugs in Tanzania (Project TuberXpert): Protocol for an Algorithm' Development and Implementation

BACKGROUND

The end tuberculosis (TB) strategy requires a novel patient treatment approach contrary to the one-size-fits-all model. It is well known that each patient's physiology is different and leads to various rates of drug elimination. Therapeutic drug monitoring (TDM) offers a way to manage drug dosage adaptation but requires trained pharmacologists, which is scarce in resource-limited settings.

OBJECTIVE

We will develop an automated clinical decision support system (CDSS) to help practitioners with the dosage adaptation of rifampicin, one of the essential medical drugs targeting TB, that is known for large pharmacokinetic variability and frequent suboptimal blood exposure. Such an advanced system will encourage the spread of a dosage-individualization culture, including among practitioners not specialized in pharmacology. Thus, the objectives of this project are to (1) develop the appropriate population pharmacokinetic (popPK) model for rifampicin for Tanzanian patients, (2) optimize the reporting of relevant information to practitioners for drug dosage adjustment, (3) automate the delivery of the report in line with the measurement of drug concentration, and (4) validate and implement the final system in the field.

METHODS

A total of 3 teams will combine their efforts to deliver the first automated TDM CDSS for TB. A cross-sectional study will be conducted to define the best way to display information to clinicians. In parallel, a rifampicin popPK model will be developed taking advantage of the published literature, complemented with data provided by existing literature data from the Pan-African Consortium for the Evaluation of Antituberculosis Antibiotics (panACEA), and samples collected within this project. A decision tree will be designed and implemented as a CDSS, and an automated report generation will be developed and validated through selected case studies. Expert pharmacologists will validate the CDSS, and finally, field implementation in Tanzania will occur, coupled with a prospective study to assess clinicians' adherence to the CDSS recommendations.

RESULTS

The TuberXpert project started in November 2022. In July 2024, the clinical study in Tanzania was completed with the enrollment of 50 patients to gather the required data to build a popPK model for rifampicin, together with a qualitative study defining the report design, as well as the CDSS general architecture definition.

CONCLUSIONS

At the end of the TuberXpert project, Tanzania will possess a new tool to help the practitioners with the adaptation of drug dosage targeting complicated TB cases (TB or HIV, TB or diabetes mellitus, and TB or malnutrition). This automated system will be validated and used in the field and will be proposed to other countries affected by endemic TB. In addition, this approach will serve as proof of concept regarding the feasibility and suitability of CDSS-assisted TDM for further anti-TB drugs in TB-burdened areas deprived of TDM experts, including second-line treatments considered important to monitor.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/58720.

Individual, community and health systems factors influencing time to notification of tuberculosis: situating software and hardware bottlenecks in local health systems

BACKGROUND

Despite several global interventions, tuberculosis (TB) remains a leading cause of death affecting millions of people globally. Many TB patients either have no access to quality care or go undetected by national health systems. Several multilevel factors account for under-detection of persons with TB. This study sought to explore patient-related software, community and health systems software and hardware factors influencing time to notification of TB in Lusaka District, Zambia.

METHODS

This was an exploratory qualitative case study that adopted a software and hardware lens of conceptualizing health systems. Data were collected from across three sites - urban and peri-urban areas: Chongwe, Kafue, and Lusaka - within Lusaka Province, Zambia. Sixteen key informants - TB corner nurses, community TB treatment supporters, and TB program managers - were interviewed. Six focus groups were held with TB patients. Data were analyzed using thematic analysis.

RESULTS

The study identified factors influencing timely TB notification, categorized into software and hardware elements. Patient-related software elements, including TB knowledge and awareness, and health-seeking behavior, are crucial for prompt notification among TB patients. In the community health system, software elements like social stigma and undesirable community attitudes towards contact tracing, and hardware elements such as unbalanced schedules, excessive workload and limited capacity of community TB treatment supporters contribute to delayed TB notification. In the formal health system, software elements like negative attitudes of health providers towards TB patients and demotivation of TB staff, and hardware elements such as high diagnostics and transportation costs, outdated diagnostics in primary care facilities, and slow referral mechanisms, can also delay TB notification.

CONCLUSION

Delays in time to TB notification are influenced by a combination of software (attitudinal and behavioral) and hardware (resource-related) elements across TB patients, community health systems, community TB treatment supporters, health providers, and TB staff. Addressing these factors, particularly social stigma, negative attitudes, and resource constraints, is crucial to improving timely TB detection and treatment.

Model for predicting drug resistance based on the clinical profile of tuberculosis patients using machine learning techniques

Tuberculosis (TB) is a disease caused by the bacterium Mycobacterium tuberculosis and despite effective treatments, still affects millions of people worldwide. The advent of new treatments has not eliminated the significant challenge of TB drug resistance. Repeated and inadequate exposure to drugs has led to the development of strains of the bacteria that are resistant to conventional treatments, making the eradication of the disease even more complex. In this context, it is essential to seek more effective approaches to fighting TB. This article proposes a model for predicting drug resistance based on the clinical profile of TB patients, using machine learning techniques. The model aims to optimize the work of health professionals directly involved with tuberculosis patients, driving the creation of new containment strategies and preventive measures, as it specifies the clinical data that has the greatest impact and identifies the individuals with the greatest predisposition to develop resistance to anti-tuberculosis drugs. The results obtained show, in one of the scenarios, a probability of development of 70% and an accuracy of 84.65% for predicting drug resistance.

ZnI2-Mediated cis-Glycosylations of Various Constrained Glycosyl Donors: Recent Advances in cis-Selective Glycosylations

An efficient and versatile glycosylation methodology is crucial for the systematic synthesis of oligosaccharides and glycoconjugates. A direct intermolecular and an indirect intramolecular methodology have been developed, and the former can be applied to the synthesis of medium-to-long-chain glycans like that of nucleotides and peptides. The development of a generally applicable approach for the stereoselective construction of glycosidic bonds remains a major challenge, especially for the synthesis of 1,2-cis glycosides such as β-mannosides, β-L-rhamnosides, and β-D-arabinofuranosides with equatorial glycosidic bonds as well as α-D-glucosides with axial ones. This review introduces the direct formation of cis-glycosides using ZnI2-mediated cis-glycosylations of various constrained glycosyl donors, as well as the recent advances in the development of stereoselective cis-glycosylations.

Association Between Mycobacterium tuberculosis Sensitization and Insulin Resistance Among US Adults Screened for Type 2 Diabetes Mellitus

Background

Type 2 diabetes mellitus (T2DM) may be a long-term sequela of infection with Mycobacterium tuberculosis (Mtb) by mechanisms that remain to be fully explained. We evaluated the association between Mtb sensitization and T2DM and, via mediation analysis, the extent to which it is mediated by insulin resistance and/or β-cell failure.

Methods

Adults were assessed for T2DM by fasting plasma glucose, 2-hour oral glucose tolerance testing, and hemoglobin A1c; β-cell dysfunction and insulin resistance by homoeostasis model assessment 2; and Mtb sensitization by tuberculin skin testing. Associations between Mtb sensitization and T2DM were modeled with probit regression and decomposed into indirect effects of β-cell dysfunction and insulin resistance. Analyses were adjusted for sociodemographic, behavioral, and clinical characteristics.

Results

We included 1843 adults. Individuals with Mtb sensitization were older than those without Mtb (median [IQR], 54 [39-64] vs 47 [33-62] years). As compared with being uninfected, Mtb sensitization was associated with T2DM (adjusted absolute risk difference, 9.34% [95% CI, 2.38%-15.0%]; P < .001) and increased insulin resistance (adjusted median difference, 0.16 [95% CI, .03-.29]; P = .014) but not β-cell dysfunction (adjusted median difference, -3.1 [95% CI, -10.4 to 4.3]; P = .42). In mediation analyses, insulin resistance mediated 18.3% (95% CI, 3.29%-36.0%; P = .020) of the total effect of the association between Mtb sensitization and T2DM.

Conclusions

Definitive prospective studies examining incident T2DM following tuberculosis are warranted. Notwithstanding, our findings suggest that exposure to Mtb may be a novel risk factor for T2DM, likely driven by an increase in insulin resistance.