The global, regional, and national burden of tuberculosis in 204 countries and territories, 1990-2019

The role of circular RNA in immune response to tuberculosis and its potential as a biomarker and therapeutic target

Circular RNA (circRNA) is a new type of non-coding RNA that has gained significant attention in recent years, especially in tuberculosis research. Tuberculosis poses a major global public health threat. Its complex pathological mechanisms and worsening drug resistance urgently necessitate new research breakthroughs. The role of circRNA in mycobacterium tuberculosis infection is being gradually revealed, highlighting its importance in regulating gene expression, immune response, and inflammation. Additionally, researchers are interested in circRNA because of its potential for early tuberculosis diagnosis and its role as a biomarker. This article systematically analyzes existing literature to provide new insights into early tuberculosis diagnosis and personalized treatment. We also emphasize the need for future research to enhance the application of circRNA in tuberculosis prevention and control.

Tuberculosis incidence, deaths and disability-adjusted life years in children and adolescence, 1990-2021: Results from the Global Burden of Disease Study 2021

BACKGROUND

For a long time, eliminating tuberculosis (TB) has been an enormous challenge in global health. We aim to use the 2021 Global Burden of Disease Study (GBD 2021) to systematically analyze the TB burden in children and adolescents.

METHODS

We used the 2021 GBD to retrieve TB incidence, mortality, and disability-adjusted life years (DALYs) data among people aged 0 to19 years in 204 countries and regions between 1990 to 2021. The data are reported as counts and ratios per 100,000 people and are analyzed by age, sex, location and socio-demographic index (SDI). To quantify the uncertainty of the estimations, we include 95% confidence interval (CI) for each indicator.

RESULTS

Globally, the TB burden among people under the age of 20 has decreased significantly between 2019 and 2021. The overall incidence of TB among children and adolescents fell by 37.4%, from 2.21(95% UI:1.71-2.76) million in 1990 to 1.38(95% UI:1.06-1.76) million in 2021. Sub-Saharan Africa had the highest increase in TB incidence (302.88, 95% UI: 227.85-385.33). The age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of TB in females decreased faster than males. The incidence was higher in children under 5 years old and adolescents aged 15 to 19, showing a bimodal pattern. In addition, mortality caused by multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) have increased dramatically in several areas. The mortality rates for MDR-TB and XDR-TB in Eastern Europe are 0.04(95% UI:0.02-0.05) and 0.02(95% UI:0.01-0.03) respectively.

CONCLUSION

Although the burden of TB in children and adolescents has decreased globally, the disease remains a major public health concern, especially in countries with low SDI. To accomplish the ultimate aim of TB elimination, we should continue to invest in TB prevention and control, expand health-care infrastructure construction, and advance TB diagnostic, preventive, and treatment technologies.

Age-period-cohort analysis and prediction of tuberculosis trends in China-based on the Global Burden of Disease 2021 data

Background

This study explores the epidemic trend of tuberculosis (TB) in China from 1990 to 2021, analyzes its relationship with age-period-cohort factors from 1992 to 2021, and predicts the development trend of TB in China from 2022 to 2046.

Methods

Annual Percent Change (APC), Average Annual Percent Change (AAPC) and 95% confidence interval (CI) were calculated by Joinpoint regression model to describe the epidemic trend of TB in China. The Age-Period-Cohort (APC) model was used to explore the effects of age, period and cohort effects on the trend of TB incidence rate, mortality and DALYs rate. APC model and Bayesian Age-Period-Cohort (BAPC) model were used to predict the epidemic trend of TB in China from 2022 to 2046.

Results

In 2021, it is estimated that there are 617,700 incidence cases of TB, 37,300 deaths and 1,375,500 DALYs cases in China, and the corresponding number of male cases is higher than that of female cases. From 1990 to 2021, the number of TB incidence, deaths and DALYs, as well as ASIR, ASDR and ASR of DALYs in China decreased year by year. The AAPC of ASIR, ASDR and ASR of DALYs were -3.33, -7.28% and -6.77%, respectively, all p < 0.05, indicating that the overall trend showed a significant decrease. With the increase of age, the incidence rate of TB first decreased, then increased and then decreased, while the mortality and DALYs rate first decreased rapidly and then decreased slowly, and both reached the highest value in the <5 years age group. The period effect showed that the risk of the total population, male and female population decreased overall. The cohort effect showed that the risk of TB incidence rate, mortality and DALYs rate decreased significantly. The ASIR, ASDR and ASR of DALYs of TB in China are predicted to decrease year by year from 2022 to 2046. The BAPC model predicts that the number of incidence, deaths and DALYs will reach 177,100,077,000 and 181,700 in 2046, respectively.

Conclusion

The APC model shows that the earlier the contemporary people are born, the older the age, the higher the risk of disease. APC and BAPC models predict that the ASR of TB in China will decrease year by year, but men and the older adult are still at high risk of TB burden in China. It is recommended to strengthen the screening of TB patients in key populations, especially in the older adult.

Evaluation of pulmonary tuberculosis disease burden in Shenyang, China, 2023

BACKGROUND

Pulmonary tuberculosis (PTB) is one of the most serious infectious diseases worldwide and poses a great threat to people's health. China has a vast territory with substantial regional disparities in the PTB disease burden. However, there have been no studies conducted to evaluate the PTB disease burden in Shenyang. The aim was to elucidate the magnitude, composition, and distribution of PTB disease burden in Shenyang.

METHODS

The disability-adjusted life years (DALYs) calculated based on Global Burden of Disease (GBD) framework was used to assess the disease burden of PTB in Shenyang in 2023, and descriptive epidemiological methods were employed to elucidate the magnitude, composition, and distribution characteristics of PTB disease burden in Shenyang.

RESULTS

In 2023, 4,169 PTB cases were reported in Shenyang, including 2,901 males and 1,268 females. The incidence of PTB was 45.50/105, of which 64.29/105 for males and 27.30/105 for females. The incidence among males was higher than that among females (X2 = 688.56, p<0.001). The highest incidence was 107.00/105 in the group of the population aged 80 and above (X2 = 1171.75, p<0.001). In 2023, 189 PTB deaths were reported in Shenyang, including 156 males and 33 females. The mortality of PTB was 2.06/105 of which 3.46/105 for males and 0.71/105 for females. The mortality among males was higher than that among females (X2 = 83.69, p<0.001). The highest mortality was 16.04/105 in the group of the population aged 80 and above (X2 = 285.61, p<0.001). The PTB DALYs rate was 58.25/105, of which 91.73/105 for males and 21.22/105 for females. The DALYs rate among males was higher than that among females (X2 = 44.04, p<0.001). The highest DALYs rate was 149.86/105 in the group of the population aged 80 and above (X2 = 305.35, p<0.001). Years of life lost (YLLs) due to PTB accounted for 71.38% of total DALYs, of which 74.33% for males and 52.89% for females.

CONCLUSION

The PTB DALYs rate in Shenyang was 58.25/105, which was lower than that in China, equivalent to 80% of the national PTB disease burden rate. The disease burden showed a characteristic of increasing with age, and the PTB DALYs rate for males was higher than that for females, being equivalent to 4 times the female rate. The predominant disease burden of PTB was attributed to YLLs, accounting for as much as 71.38%, indicating that PTB primarily results in premature mortality rather than disability. Therefore, the focus should be shifted towards early intervention to reduce transmission, especially for the aged males.

Infectious Causes of Death: An Autopsy-Based Study of 546 Cases

Background

Diagnostic accuracy in cases of infectious diseases is crucial for appropriate patient management and public health interventions. This retrospective study aimed to evaluate the most common causes of death caused by infectious diseases and the rate of agreement between clinical diagnoses and autopsy findings in individuals diagnosed with infectious diseases in Mashhad, Iran.

Methods

Autopsy reports from March 2009 to February 2018 were analyzed for patients diagnosed with infectious diseases. Demographic data, clinical diagnoses, and autopsy results were collected and compared. Discrepancies between clinical and autopsy diagnoses were assessed, and potential predictors of diagnostic discrepancy were examined.

Results

Among 28 451 autopsied cases, 546 (1.9%) were diagnosed with infectious diseases. Pleuropulmonary infections were the most common cause of death (69.8%) as determined by autopsy, followed by bloodstream infections (14.1%) and intra-abdominal infections (10.0%). Discrepancies between clinical and autopsy diagnoses were identified in 22.4% of cases. Pleuropulmonary infections had the highest frequency of diagnostic discrepancies (29.1%), followed by central nervous system (CNS) infections (15.8%).

Conclusions

This study underscores the importance of autopsy in identifying diagnostic discrepancies and improving clinical practice in cases of infectious diseases. They also highlight the need for ongoing efforts to enhance diagnostic capabilities, particularly in challenging cases such as pleuropulmonary and CNS infections, to reduce the burden of misdiagnosis and improve patient outcomes.

Global, regional and national burdens of occupational injuries, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

OBJECTIVES

Occupational injuries pose a significant challenge to global health and development. This study aimed to quantify the international and regional burdens of occupational injuries from 1990 to 2019, stratified by specific causes.

METHODS

We analysed global trends in deaths, disability-adjusted life years (DALYs), age-standardised mortality rates (ASMR) and age-standardised DALY rates (ASDR) related to occupational injuries. Specific injuries, including animal contact, drowning, mechanical forces, falls, fire, heat, hot substances, foreign bodies, poisoning and road injuries, were evaluated. Age-stratified and regional analyses were also performed.

RESULTS

Globally, the number of deaths, DALYs, ASMR and ASDR related to occupational injuries declined from 1990 to 2019. The middle Socio-demographic Index (SDI) region exhibited the highest burden, whereas the high SDI region showed the least burden. China and India had the highest occupational injury-related death rates in 2019. Males, particularly those aged 25-44 years, were found to be more vulnerable. Road injuries were the leading cause of death in all age groups. Compared with 1990, mortality numbers and rates decreased significantly by 2019, with the highest burdens experienced in East Asia, South Asia and Southeast Asia.

CONCLUSION

The global decline in occupational injuries is promising; however, certain regions and demographics remain disproportionately affected. Targeted interventions in high-burden areas are crucial to further reduce the impact of occupational injuries.

Structure-guided identification and characterization of potent inhibitors targeting PhoP and MtrA to combat mycobacteria

Mycobacteria are causative agents of tuberculosis (TB), which is a global health concern. Drug-resistant TB strains are rapidly emerging, thereby necessitating the urgent development of new drugs. Two-component signal transduction systems (TCSs) are signaling pathways involved in the regulation of various bacterial behaviors and responses to environmental stimuli. Applying specific inhibitors of TCSs can disrupt bacterial signaling, growth, and virulence, and can help combat drug-resistant TB. We conducted a comprehensive pharmacophore-based inhibitor screening and biochemical and biophysical examinations to identify, characterize, and validate potential inhibitors targeting the response regulators PhoP and MtrA of mycobacteria. The constructed pharmacophore model Phar-PR-n4 identified effective inhibitors of formation of the PhoP-DNA complex: ST132 (IC50 = 29 ± 1.6 µM) and ST166 (IC50 = 18 ± 1.3 µM). ST166 (KD = 18.4 ± 4.3 μM) and ST132 (KD = 14.5 ± 0.1 μM) strongly targeted PhoP in a slow-on, slow-off manner. The inhibitory potency and binding affinity of ST166 and ST132 for MtrAC were comparable to those of PhoP. Structural analyses and molecular dynamics simulations revealed that ST166 and ST132 mainly interact with the α8-helix and C-terminal β-hairpin of PhoP, with functionally essential residue hotspots for structure-based inhibitor optimization. Moreover, ST166 has in vitro antibacterial activity against Macrobacterium marinum. Thus, ST166, with its characteristic 1,2,5,6-tetrathiocane and terminal sulphonic groups, has excellent potential as a candidate for the development of novel antimicrobial agents to combat pathogenic mycobacteria.

The temporal trend of tuberculosis burden in an aging population in China: a secondary data analysis from the GBD 2019

BACKGROUND

The rapid population aging in China has been a big challenge to achieve the goal of ending the global tuberculosis (TB) epidemic. This study aimed to describe the temporal trend of TB burden in China during 1990 ∼ 2019 and to evaluate the effect of age, period, and birth cohort on domestic TB burden, with a specific focus on the elderly.

METHODS

The trends of incidence, mortality, and disability-adjusted life years (DALYs) of TB among human immunodeficiency virus (HIV) negative people were described using the data from the Global Burden of Disease 2019 study. Join-point regression model was applied to calculate the average annual percentage change (AAPC) of TB burden for different age groups. Age-period-cohort (APC) model was fitted for incidence and mortality, and relative risks (RR) were computed for each age group.

RESULTS

In 2019, the highest TB deaths (5.23 thousand, 95% uncertainty interval [UI]: 4.38 ∼ 6.17) and DALYs (155.18 thousand, 95%UI: 126.47 ∼ 190.55) were observed in the HIV-negative population aged 70 ∼ 74 years in China. The proportion of those aged ≥ 60 years in newly diagnosed TB patients without HIV coinfection increased from 23.82% in 1990 to 37.54% in 2019, while TB deaths rose from 48.70 to 68.64%. During the past 30 years, the AAPC of age-standardized mortality (-7.77, confidence interval [CI]: -8.44∼ -7.10) and DALYs (-7.48, 95% CI: -7.98∼ -6.97) among HIV-negative individuals have shown a decrease, while much slower in the age groups above 70-year-old. The period effect and cohort effect contributed to the decline of TB incidence and mortality, but the age effect led to increasing TB mortality, especially among the ages of 85 ∼ 89 years (RR = 4.59, 95% CI: 4.25 ∼ 4.95).

CONCLUSIONS

The burden of TB remains considerable in the elderly population in China. More actions should be taken to improve case finding and the quality of TB healthcare for this high-risk population.

Host Cell Death and Modulation of Immune Response against Mycobacterium tuberculosis Infection

Mycobacterium tuberculosis (Mtb) is the causative agent of tuberculosis (TB), a prevalent infectious disease affecting populations worldwide. A classic trait of TB pathology is the formation of granulomas, which wall off the pathogen, via the innate and adaptive immune systems. Some key players involved include tumor necrosis factor-alpha (TNF-α), foamy macrophages, type I interferons (IFNs), and reactive oxygen species, which may also show overlap with cell death pathways. Additionally, host cell death is a primary method for combating and controlling Mtb within the body, a process which is influenced by both host and bacterial factors. These cell death modalities have distinct molecular mechanisms and pathways. Programmed cell death (PCD), encompassing apoptosis and autophagy, typically confers a protective response against Mtb by containing the bacteria within dead macrophages, facilitating their phagocytosis by uninfected or neighboring cells, whereas necrotic cell death benefits the pathogen, leading to the release of bacteria extracellularly. Apoptosis is triggered via intrinsic and extrinsic caspase-dependent pathways as well as caspase-independent pathways. Necrosis is induced via various pathways, including necroptosis, pyroptosis, and ferroptosis. Given the pivotal role of host cell death pathways in host defense against Mtb, therapeutic agents targeting cell death signaling have been investigated for TB treatment. This review provides an overview of the diverse mechanisms underlying Mtb-induced host cell death, examining their implications for host immunity. Furthermore, it discusses the potential of targeting host cell death pathways as therapeutic and preventive strategies against Mtb infection.

Global burden of MDR-TB and XDR-TB attributable to high fasting plasma glucose from 1990 to 2019: a retrospective analysis based on the global burden of disease study 2019

PURPOSE

High fasting plasma glucose (HFPG) has been identified as a risk factor for drug-resistant tuberculosis incidence and mortality. However, the epidemic characteristics of HFPG-attributable multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) remain unclear. We aimed to analyze the global spatial patterns and temporal trends of HFPG-attributable MDR-TB and XDR-TB from 1990 to 2019.

METHODS

Utilizing data from the Global Burden of Disease 2019 project, annual deaths and disability-adjusted life years (DALYs) of HFPG-attributable MDR-TB and XDR-TB were conducted from 1990 to 2019. Joinpoint regression was employed to quantify trends over time.

RESULTS

From 1990 to 2019, the deaths and DALYs due to HFPG-attributable MDR-TB and XDR-TB globally showed an overall increasing trend, with a significant increase until 2003 to 2004, followed by a gradual decline or stability thereafter. The low sociodemographic index (SDI) region experienced the most significant increase over the past 30 years. Regionally, Sub-Saharan Africa, Central Asia and Oceania remained the highest burden. Furthermore, there was a sex and age disparity in the burden of HFPG-attributable MDR-TB and XDR-TB, with young males in the 25-34 age group experiencing higher mortality, DALYs burden and a faster increasing trend than females. Interestingly, an increasing trend followed by a stable or decreasing pattern was observed in the ASMR and ASDR of HFPG-attributable MDR-TB and XDR-TB with SDI increasing.

CONCLUSION

The burden of HFPG-attributable MDR-TB and XDR-TB rose worldwide from 1990 to 2019. These findings emphasize the importance of routine bi-directional screening and integrated management for drug-resistant TB and diabetes.

Global prevalence and burden of multidrug-resistant tuberculosis from 1990 to 2019

BACKGROUND

Tuberculosis(TB) remains a pressing public health challenge, with multidrug-resistant tuberculosis (MDR-TB) emerging as a major threat. And healthcare authorities require reliable epidemiological evidence as a crucial reference to address this issue effectively. The aim was to offer a comprehensive epidemiological assessment of the global prevalence and burden of MDR-TB from 1990 to 2019.

METHODS

Estimates and 95% uncertainty intervals (UIs) for the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized disability-adjusted life years rate (ASR of DALYs), and age-standardized death rate (ASDR) of MDR-TB were obtained from the Global Burden of Disease (GBD) 2019 database. The prevalence and burden of MDR-TB in 2019 were illustrated in the population and regional distribution. Temporal trends were analyzed by using Joinpoint regression analysis to calculate the annual percentage change (APC), average annual percentage change (AAPC) and its 95% confidence interval(CI).

RESULTS

The estimates of the number of cases were 687,839(95% UIs: 365,512 to 1223,262), the ASPR were 8.26 per 100,000 (95%UIs: 4.61 to 15.20), the ASR of DALYs were 52.38 per 100,000 (95%UIs: 22.64 to 97.60) and the ASDR were 1.36 per 100,000 (95%UIs: 0.54 to 2.59) of MDR-TB at global in 2019. Substantial burden was observed in Africa and Southeast Asia. Males exhibited higher ASPR, ASR of DALYs, and ASDR than females across most age groups, with the burden of MDR-TB increasing with age. Additionally, significant increases were observed globally in the ASIR (AAPC = 5.8; 95%CI: 5.4 to 6.1; P < 0.001), ASPR (AAPC = 5.9; 95%CI: 5.4 to 6.4; P < 0.001), ASR of DALYs (AAPC = 4.6; 95%CI: 4.2 to 5.0; P < 0.001) and ASDR (AAPC = 4.4; 95%CI: 4.0 to 4.8; P < 0.001) of MDR-TB from 1990 to 2019.

CONCLUSIONS

This study underscored the persistent threat of drug-resistant tuberculosis to public health. It is imperative that countries and organizations worldwide take immediate and concerted action to implement measures aimed at significantly reducing the burden of TB.

Disseminated tuberculosis in a migrant child

Tuberculosis (TB) poses a major global health threat, substantially affecting children, who contribute notably to new cases and deaths. Diagnosing TB in kids is challenging due to collection issues and the paucibacillary nature of the disease. Disseminated TB, uncommon in children in low TB incidence countries, remains a significant cause of morbidity in migrant populations. We illustrate a rare case of disseminated TB in a middle-childhood boy who migrated from Angola to France, displaying chronic cough, fatigue, weight loss and persistent fever. Investigations revealed widespread TB affecting several organs (lungs, heart, bones and lymph nodes). Prompt diagnosis led to a treatment regimen of four antibiotics (isoniazid, rifampin, pyrazinamide, ethambutol) and corticosteroids, resulting in substantial improvement after 2 months. Subsequent treatment involved two antibiotics (isoniazid and rifampin) for 10 more months. This case underscores the criticality of early identification and comprehensive treatment for disseminated TB, ensuring improved outcomes and reduced risks.