Tuberculosis

The inflammasome adaptor pycard is essential for immunity against Mycobacterium marinum infection in adult zebrafish

Inflammasomes regulate the host response to intracellular pathogens including mycobacteria. We have previously shown that the course of Mycobacterium marinum infection in adult zebrafish (Danio rerio) mimics the course of tuberculosis in human. To investigate the role of the inflammasome adaptor pycard in zebrafish M. marinum infection, we produced two zebrafish knockout mutant lines for the pycard gene with CRISPR/Cas9 mutagenesis. Although the zebrafish larvae lacking pycard developed normally and had unaltered resistance against M. marinum, the loss of pycard led to impaired survival and increased bacterial burden in the adult zebrafish. Based on histology, immune cell aggregates, granulomas, were larger in pycard-deficient fish than in wild-type controls. Transcriptome analysis with RNA sequencing of a zebrafish haematopoietic tissue, kidney, suggested a role for pycard in neutrophil-mediated defence, haematopoiesis and myelopoiesis during infection. Transcriptome analysis of fluorescently labelled, pycard-deficient kidney neutrophils identified genes that are associated with compromised resistance, supporting the importance of pycard for neutrophil-mediated immunity against M. marinum. Our results indicate that pycard is essential for resistance against mycobacteria in adult zebrafish.

Delayed diagnosis of pulmonary tuberculosis with pleuritis due to ampicillin/sulbactam: A case report

BACKGROUND

Tuberculosis (TB) remains a global health concern despite decreasing incidence. Delayed TB diagnosis can exacerbate patient outcomes and lead to broader public health issues such as mass infections. Differentiation between TB and bacterial pneumonia is often complicated by variable clinical and radiological manifestations of TB, leading to diagnostic delays.

CASE SUMMARY

An 89-year-old, Japanese male patient with a history of diabetes mellitus, hypertension, and hypothyroidism presented with right-sided chest pain. Based on the elevated inflammatory response, right pleural effusion, and infiltrating shadow in the lung field, the diagnosis of right pleurisy was made and the antibiotic, ampicillin/sulbactam, was administered. The patient’s condition, inflammatory reaction, and right pleural effusion temporarily improved. However, persistent low-grade fever and malaise prompted further evaluation, revealing repeated right pleural effusion and inflammatory response. A right thoracentesis was performed; the patient was diagnosed with tuberculous pleurisy as a result of exudative effusion with lymphocyte predominance, elevated adenosine deaminase levels, and positive Mycobacterium TB polymerase chain reaction test. Anti-TB treatment, including isoniazid, rifampicin, and ethambutol was initiated, leading to significant clinical improvement. The patient successfully completed a 12-month course of TB therapy without recurrence or deterioration.

CONCLUSION

There are cases of TB wherein temporary improvement apparently could be shown through treatment with antimicrobial agents other than anti-TB drugs, necessitating careful evaluation in atypical cases of bacterial pneumonia.

Clinical characteristics and outcomes of tuberculosis and non-tuberculous mycobacteria infections: a population-based study of concurrent and sequential infections

BACKGROUND

Co-infection with Tuberculosis (TB) and non-tuberculous mycobacteria (NTM) poses significant diagnostic and therapeutic challenges. This study investigates the demographic, clinical, and survival characteristics of these patients.

METHODS

This retrospective study included patients diagnosed with TB, NTM, or TB + NTM co-infection at the Shanghai Public Health Clinical Center (2019-2022). Clinical, imaging, and survival data were collected and analyzed.

RESULTS

A total of 400 patients were included: 33 in the TB + NTM group, 167 in the NTM-only group, and 200 in the TB-only group. Chest pain was more common in the TB + NTM group than the TB-only group (P = 0.006). The TB + NTM group exhibited a significantly lower body mass index (19.95 ± 3.51) and serum albumin level (36.09 ± 4.93 g/l), as well as a higher prevalence of hilar lymphadenopathy (45.5%) and cavitary lesions (39.4%), compared to the TB-only or NTM-only groups (P < 0.05). Miliary nodules were more frequent in the TB + NTM group (24.2%) compared to the TB-only group (11.0%, P = 0.048). A higher proportion of TB + NTM patients were from Central and Western China (P = 0.005). Survival analysis showed worse outcomes for the TB + NTM group (P = 0.038 vs. NTM-only, P = 0.008 vs. TB-only). Cox regression further identified a higher mortality risk in the TB + NTM group (adjusted hazard ratios = 2.468, 95% CI: 1.079-5.642, P = 0.032).

CONCLUSION

TB + NTM co-infection is associated with distinct clinical features and worse survival outcomes, emphasizing the need for early diagnosis and tailored treatment.

CLINICAL TRIAL NUMBER

Not applicable.

The correlation between serum 25-hydroxyvitamin D3 and oxidative balance score in patients with tuberculosis infection

BACKGROUND

Previous study had reported the imbalance of pro- and anti-oxidants in tuberculosis (TB), which was involved in the TB progression. This study aimed to identify the key oxidative stress indicator associated with oxidative balance in patients with TB infection.

METHODS

Overall, 339 participants with TB were included in this study. The oxidative balance score (OBS) was composed of scores of dietary and lifestyle factors. Trend regression analysis, generalized additive model, polynomial regression, and threshold effect analysis, were used to examine the relationship between the serum 25-hydroxyvitamin D3 25(OH)D3 and OBS. Moreover, the correlation between serum 25(OH)D3 and OBS components was explored via Pearson analysis, and mediation analysis was used to explore the function of OBS components.

RESULTS

Linear regression analysis showed that among 6 oxidative stress indicators, only serum 25(OH)D3 was independently related to the OBS. A positive association between them was then found (P for trend<0.05) in a non-linear relationship (all P<0.05). The 25(OH)D3 concentration of 51.9nmol/L was identified as the key turning point by threshold effect analysis, and their association was only found when it <51.9nmol/L. Further, we revealed that 25(OH)D3 mainly correlated with 2 OBS components including BMI and riboflavin. Moreover, BMI and riboflavin were found to mediate the association of serum 25(OH)D3 with OBS by mediation analysis (all P<0.05).

CONCLUSIONS

In summary, our study revealed relationship between the serum 25(OH)D3 and OBS in patients with TB, which provided a piece of evidence that vitamin D can assist the treatment of TB.

Functional and mechanistic insights into the stealth protein full-length CpsY is conducive to understanding immune evasion mechanisms by Mycobacterium tuberculosis

Mycobacterium tuberculosis (Mtb) is a crucial and destructive intracellular pathogen responsible for causing tuberculosis (TB), a disease of substantial morbidity and mortality. Mtb capsular polysaccharides can misdirect the host's immune response pathways, resulting in additional challenges in TB treatment. These capsule polysaccharides are biosynthesized by a series of stealth proteins including CpsY. Our prior investigations elucidated the structural and functional information of the central domain (aa 201-520) of CpsY within Mtb. However, within the host milieu, it is the full-length iteration of CpsY, rather than its truncated form CpsY201-520, that assumes pivotal roles in immune evasion. Consequently, investigating the functional mechanism of full-length CpsY is extremely important. Here, we found that the indispensable role of four conserved regions (CR1-CR4) in governing the phosphotransferase activity of full-length CpsY. Notably, the deletion of S2 (ΔS2) dramatically increased the activity compared to the wild-type (WT) full-length CpsY, thereby revealing S2 in the regulatory dynamics governing the inactivation and activation of full-length CpsY. The gene cpsY helps Mtb to survive in macrophages. Our findings were useful for the development of vaccines and immunotherapies targeting Mtb.

Risk factors for the progression from pulmonary tuberculosis to spinal tuberculosis: a logistic regression analysis

PURPOSE

This study aims to identify the risk factors for the progression from pulmonary tuberculosis (PTB) to spinal tuberculosis (STB), which is crucial for early disease intervention, optimizing treatment strategies, and improving patient prognosis.

METHODS

A retrospective analysis was conducted on 326 patients diagnosed with PTB between January 2017 and October 2024. Demographic, clinical, and socioeconomic data were collected, including age, gender, body mass index (BMI), Karnofsky Performance Status (KPS), Nutritional Risk Screening 2002 (NRS-2002) score, diabetes, per capita income, smoking status, alcohol consumption, and a history of recurrent PTB. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for the progression to STB, and interaction effect analysis and risk stratification based on the NRS-2002 score were conducted to assess its predictive value.

RESULTS

Univariate logistic regression revealed that the NRS-2002 score (OR = 2.762, p < 0.001), recurrent PTB (OR = 15.370, p < 0.001), and living in relative poverty (OR = 10.000, p = 0.002) were significant risk factors for the progression from PTB to STB. Multivariate logistic regression confirmed that the NRS-2002 score (OR = 11.22, p < 0.001), recurrent PTB (OR = 5.08, p < 0.001), and living in relative poverty (OR = 2.58, p < 0.001) were independently associated with increased likelihood of STB progression. Stratified analysis revealed a clear dose-response relationship between higher NRS-2002 scores and the risk of progression to STB, with those having scores ≥ 6 exhibiting the highest odds (OR = 91.59, p < 0.001).

CONCLUSIONS

This study highlights critical risk factors for the progression from PTB to STB, particularly the NRS-2002 score, recurrent PTB, and socioeconomic status (living in relative poverty). The NRS-2002 score was identified as the most significant predictor, demonstrating a strong dose-response relationship with disease progression. Clinically, early identification of patients with elevated NRS-2002 scores, alongside timely nutritional interventions and efforts to alleviate poverty, can significantly reduce the risk of STB development. These findings can inform clinical decision-making, enhance early intervention strategies, and guide public health policies aimed at preventing STB, particularly in high-risk populations.

Association of urbanization-related factors with tuberculosis incidence among 1992 counties in China from 2005 to 2019: a nationwide observational study

BACKGROUND

Most high tuberculosis (TB) burden countries are in low- and middle-income regions undergoing rapid urbanization. We aimed to assess the association between urbanization factors and TB incidence in China.

METHODS

We evaluated urbanization at the county level in China from 2005 to 2019 using a composite index integrating population density, gross domestic product (GDP, per capita), hospital beds per 1000 population, nighttime light (NTL), and normalized difference vegetation index (NDVI). The annual incidence rate and number of TB cases were obtained from the national Tuberculosis Information Management System, maintained by the Chinese Center for Disease Control and Prevention. Fixed-effects models were used to examine the association between urbanization factors and TB incidence. A subgroup analysis was performed by dividing counties into four regions: northeast, eastern, central, and western.

RESULTS

A total of 1992 counties in China were included in this study. Overall, urbanization scores were associated with reduced TB incidence (β = - 0.0114, P < 0.001), corresponding to a 1.1% reduction in TB incidence per unit score. Quadratic models presented a U-shaped relationship between urbanization and TB incidence with an inflection point at 52.94 urbanization units. For each indicator of urbanization, population density and the number of hospital beds were positively associated with TB incidence, with incidence rate ratios of 11.384 [95% confidence interval (CI): 9.337 to 13.881], and 1.015 (95% CI: 1.011 to 1.019), respectively, while GDP, NTL, and NDVI exhibited protective effects. Central China displayed an increase trend that urbanization score was linked to a 1.8% rise in TB incidence.

CONCLUSIONS

Urbanization-related factors, including GDP, NTL and NDVI, were inversely associated with TB incidence. Central China's contrasting results highlighted region-specific challenges. Therefore, governments in developing countries should adopt integrated approaches that promote both economic growth and sustainable development of environment during urbanization to optimize TB control efforts.

Indications and contraindications to platelet-rich plasma injections in musculoskeletal diseases in case of infectious, oncological and haematological comorbidities: A 2025 formal consensus from the GRIIP (International Research Group on Platelet Injections)

PURPOSE

Platelet-rich plasma (PRP) could be a vector for certain diseases, and its composition may vary by pathologic condition. The main comorbidities that could affect PRP composition are infectious, oncologic and haematologic. In addition to potential alteration of clinical response, these pathologies could have a significant impact on the local tolerance of PRP as well as a risk of disease dissemination to the injection site. To date, there are few specific recommendations related to these comorbidities to guide clinicians. Therefore, the International Research Group on Platelet Injections (GRIIP) supported a consensus project to develop these recommendations.

METHODS

Following the 'recommendations by formal consensus' methodology, a steering committee performed a literature review and drafted an initial set of recommendations. They were evaluated by an international rating group (15 specialists in musculoskeletal [MSK] diseases, five haematologists, four oncologists, three infectiologists and four scientists specialising in platelet physiology). From this rating, the first set of recommendations was discussed in a plenary meeting and then modified by the steering committee. Finally, four overarching principles and 23 recommendations were re-evaluated by the rating group. Recommendations were classified as appropriate or not, with strong or relative agreement, or uncertain.

RESULTS

From the 23 recommendations, 10 concerned infectious diseases (viral and bacterial infections; dialysis; immunosuppressive drugs; dental care…), five oncologic diseases (local tumour; cured, active or in remission cancer…) and eight haematologic diseases (cytopenia; cured, active or stabilised cured hemopathy; monoclonal gammopathy…). All were considered appropriate by the experts (median = 9; range = 8-9), with strong or relative agreement. Due to the paucity of literature data, the recommendations are mainly based on expert opinion (Grade D).

CONCLUSION

This consensus project provides four overarching principles and 23 recommendations related to contraindications of PRP injections in case of infectious, oncologic or hematologic diseases, validated by an international expert group.

LEVEL OF EVIDENCE

Level I.

The dual missions of FoxO3a in inflammatory diseases: Regulation of antioxidant enzymes and involvement in programmed cell death

The transcription factor FoxO3a plays a crucial role in the process of cells adapting to various stress conditions. Multiple post - translational modifications and epigenetic mechanisms work together to precisely regulate the activity of FoxO3a, influencing its subcellular localization, stability, interactions with other proteins, DNA - binding affinity, and transcriptional regulatory capacity. Under different chemical signal stimuli and subcellular environments, the activation of FoxO3a triggered by oxidative stress can initiate diverse transcriptional programs, which are essential for the body to resist oxidative damage. In the development and progression of inflammatory diseases, FoxO3a exerts an important function by regulating the expression levels of antioxidant enzymes and participating in key physiological processes such as programmed cell death. This article comprehensively reviews the structural characteristics, mechanism of action of FoxO3a, as well as its functions in regulating antioxidant enzymes and programmed cell death. The aim is to deeply explore the potential of FoxO3a as a potential therapeutic target for preventing and treating damages such as inflammatory diseases caused by cellular stress.

Bibliometric analysis and knowledge mapping of diabetes mellitus combined with tuberculosis research: trends from 1995 to 2023

Background

The synergistic epidemic of diabetes mellitus and tuberculosis (DM-TB) has created a dual disease burden, challenging global health systems with complex pathophysiological interactions and suboptimal treatment outcomes. To decode the evolving research landscape, this study presents the latest comprehensive bibliometric analysis mapping the intellectual architecture of DM-TB research over three decades.

Methods

We systematically analyzed 791 peer-reviewed articles from the Web of Science Core Collection (1995-2023) using CiteSpace, VOSviewer, and Bibliometrix. Advanced metrics including co-citation networks, keyword burst detection, and institutional collaboration patterns were employed to identify paradigm-shifting trends.

Results

Three distinct growth phases were observed: initial stagnation (1995-2007, <10 annual publications), exponential growth (2008-2019), and research diversification (2020-2023). The United States dominated scientific output (27.3% of total publications), while the London School of Hygiene & Tropical Medicine emerged as the central hub for international collaborations (TLS=176). Keyword evolution revealed three transformative phases: (1) Pathomechanistic exploration (1995-2016): Focused on hyperglycemia-immunity interplay and epidemiological surveillance; (2) Translational innovation (2017-2020): Shifted to preclinical models, pharmacokinetic optimization, and multidrug resistance; (3) Precision medicine era (2021-2023): Emerging hotspots in latent TB screening (burst strength=6.82), metformin-mediated immunomodulation, and AI-driven diagnostic biomarkers.

Conclusion

Beyond delineating historical trajectories, this study identifies critical knowledge gaps in inflammation-resolution mechanisms and insulin resistance pathways, proposing a roadmap for targeted biomarker discovery and global health policy formulation. The constructed knowledge framework empowers strategic resource allocation for combating the DM-TB syndemic.

Real-world data on combination treatment with bedaquiline in patients with multidrug-resistant pulmonary tuberculosis in Japan: An interim analysis of post-marketing surveillance

BACKGROUND

An observational post-marketing surveillance (PMS) is being conducted to evaluate the long-term safety and effectiveness of bedaquiline as part of combination therapies in treating pulmonary multidrug-resistant tuberculosis (MDR-TB) in Japan.

METHODS

This interim analysis includes patients with MDR-TB who started bedaquiline-containing anti-tuberculosis (TB) drugs in Japan between January 2018 and September 2022. Outcomes include the incidence of adverse drug reactions (ADRs) and negative sputum cultures.

RESULTS

In total, 112 patients were included in the safety analysis. All patients were receiving anti-TB drugs in addition to bedaquiline at baseline; 96.4 % were receiving ≥3 drugs. The most commonly used concomitant anti-TB drugs were delamanid, cycloserine, linezolid, and levofloxacin hydrate. At 24 weeks after bedaquiline initiation, in the effectiveness analysis set, 19/20 (95.0 %) had negative sputum mycobacteria growth indicator tube cultures and 9/12 (75.0 %) have negative solid medium cultures. Patients received bedaquiline for a median of 186.0 days, during which 85 ADRs occurred in 45 patients (40.2 %). The top three ADRs were electrocardiogram QT prolonged (9.8 %), nausea (7.1 %), and hepatic function abnormal (4.5 %).

CONCLUSIONS

This interim analysis of a PMS supports the long-term safety and effectiveness of bedaquiline for MDR-TB in Japan. ADRs were consistent with previous reports and no new safety signals were detected. The final analysis of this ongoing PMS will be expected to confirm these findings.

Clinical value of serum miRNA-206 in pulmonary tuberculosis

OBJECTIVE

This study sought to investigate the diagnostic value and the effect of microRNA (miR)-206 on drug resistance in pulmonary tuberculosis (TB) patients.

METHODS

This study included 88 TB patients (TB group) as study subjects, 80 healthy subjects as control 1 (Control group), and 85 latent TB infection (LTBI) patients as control 2 (LTBI group). The drug resistance of TB patients after standard anti-TB treatment was recorded. TB patients were assigned into the pan-sensitive and drug-resistance groups, with miR-206 level in drug-resistant TB patients analyzed. The correlation coefficients between inflammatory indicators (TNF-α, IgG, IL-4, IFN-γ, IP-10) and drug resistance in TB patients were analyzed, and the independent correlation between miR-206 levels and drug resistance was analyzed.

RESULTS

Compared to the Control and LTBI groups, serum miR-206 and IP-10 were highly-expressed in TB group. The miR-206 levels positively correlated with IP-10 levels. miR-206 had potential diagnostic value for TB. Levels of TNF-α, IgG, IFN-γ, and IL-4 were elevated in TB group and positively-correlated with miR-206 levels. Moreover, miR-206 levels were higher in the Drug-resistance group than the pan-sensitive group. The low-expression group had a lower incidence of drug resistance than the high-expression group (χ2 = 16.84, P < 0.0001). miR-206 was the most significant indicator affecting drug resistance in TB patients (β = 0.516, P = 0.013). miR-206 was an independent risk factor for drug resistance.

CONCLUSION

High miR-206 expression helps TB diagnosis and may predict drug-resistance incidence. miR-206 may be an independent risk factor for drug resistance in TB patients.

Unrecognized Tuberculosis: Risk Factors for Smear-Positive/Cavitary Asymptomatic Cases

Background

Screening patients with asymptomatic active tuberculosis (TB) is crucial as they can transmit the disease. Identifying the risk factors for transmission is essential for targeted screening. Understanding how the infectiousness of asymptomatic patients with TB affects disease outcomes is crucial for developing strategies to control TB spread.

Methods

We analyzed the national Korean TB cohort data to determine the factors associated with transmission risk and clinical outcomes in patients with asymptomatic pulmonary TB. The primary outcome was the factors associated with a risk factor for transmission, while the secondary outcome was mortality in asymptomatic patients with pulmonary TB stratified by transmission risk.

Results

Among 20 455 patients with pulmonary TB, 7434 (36.4%) were asymptomatic, while 1520 (25.5%) had potential transmission risks, indicated by a positive sputum acid-fast bacillus smear test or cavitation on chest radiographs. The factors associated with a higher transmission risk included male sex (odds ratio [OR], 1.385; 95% CI, 1.172-1.636; P < .001), low body mass index (BMI; OR, 1.687; 95% CI, 1.420-2.004; P < .001), current smoking (OR, 1.443; 95% CI, 1.213-1.716; P < .001), diabetes (OR, 1.399; 95% CI, 1.201-1.629; P < .001), and autoimmune disease (OR, 2.233; 95% CI, 1.295-3.850; P = .004). The mortality rate was higher in patients with a risk factor for transmission risk than in those without (9.3 vs 7.1%; P = .008).

Conclusions

Lean, smoking men with asymptomatic TB who have DM and/or autoimmune diseases have higher transmission and mortality risk. Asymptomatic populations with these risk factors warrant targeted screening.

Extrapulmonary tuberculosis in Morocco: A systematic review of observational studies

BACKGROUND

Tuberculosis remains a major global health concern and a leading cause of mortality. In Morocco, various forms of extrapulmonary tuberculosis are prevalent. This systematic review examines research findings on the prevalence, risk factors, and treatment outcomes of extrapulmonary tuberculosis in Morocco.

METHODS

We conducted searches for observational studies on extrapulmonary tuberculosis in Morocco, published between January 1991 and February 2023, using Scopus, ScienceDirect, and PubMed databases. Medical Subject Heading keywords were used to guide the search.

RESULTS

This review included 18 studies focusing on different forms of extrapulmonary tuberculosis, such as cold abscesses, lymph nodes, meningeal, cutaneous, osteoarticular, genital, breast, and gastrointestinal tuberculosis. These studies provided insights into the clinical, diagnostic, and therapeutic aspects of these extrapulmonary tuberculosis forms. Prevalence data were limited, and treatment outcomes varied considerably across studies. The only study providing prevalence data for all forms of extrapulmonary tuberculosis reported a prevalence of 43.5% among tuberculosis cases in Larach Province. Treatment success rates ranged from 64.7% to 100%. Common risk factors included low socioeconomic status, diabetes mellitus, pulmonary tuberculosis exposure, and HIV co-infection.

CONCLUSIONS

This review highlights a lack of comprehensive on the prevalence of extrapulmonary tuberculosis in Morocco, with inconsistent findings on risk factors and treatment outcomes. Further controlled studies are recommended to obtain more robust evidence and inform more effective management strategies for extrapulmonary tuberculosis.

Tuberculosis

Tuberculosis is a leading cause of death globally. Given the airborne transmission of tuberculosis, anybody can be infected, but people in high-incidence settings are more exposed. Risk of progression to disease is higher in the first years after infection, and in people with undernourishment, immunosuppression, or who smoke, drink alcohol, or have diabetes. Although cough, fever, and weight loss are hallmark symptoms, people with tuberculosis can be asymptomatic, so a high index of suspicion is required. Prompt diagnosis can be made by sputum examination (ideally with rapid molecular tests), but chest radiography can be helpful. Most people with disease can be treated with regimens of 6 months or less; longer regimens may be necessary for those with drug resistance. Central to successful treatment is comprehensive, person-centred care including addressing key determinants, such as undernourishment, smoking, and alcohol use, and optimising management of comorbidities, such as diabetes and HIV. Care should continue after treatment ends, as long-term sequelae are common. Prevention relies mostly on treatment with rifamycin-based regimens; current vaccines have limited efficacy. Ongoing research on shorter and safer regimens for infection and disease treatment, and simpler and more accurate diagnostic methods will be key for tuberculosis elimination.

Genetic variations underlying aminoglycoside resistance in antibiotic-induced Mycobacterium intracellulare mutants

Mycobacterium avium complex (MAC) is an emerging pathogen leading to public health concerns in developing and developed countries, particularly among immunocompromised individuals and patients with structural lung diseases. Current clinical guidelines recommend combination antibiotic therapy for treating MAC pulmonary disease (MAC-PD). However, the rising prevalence of antibiotic resistance poses significant challenges, including treatment failure and clinical recurrence. A deeper understanding of the mechanisms underlying MAC antibiotic resistance is essential to improve treatment outcomes. This study investigates the genetic variations associated with aminoglycoside resistance in an antibiotic-induced Mycobacterium intracellulare mutant derived from a clinical strain. Whole-genome analysis identified seven mutations in the aminoglycoside-resistant mutant, including single nucleotide polymorphisms (SNPs) and insertions/deletions (InDels). Key genetic alterations included a frameshift variant in a gene encoding a secreted protein antigen, missense mutations in rpsL and rsmG, and synonymous and in-frame deletion variants in srfAB and mtrB, respectively. These findings highlight the complex genetic landscape of aminoglycoside resistance in M. intracellulare. Understanding these resistance determinants provides valuable insights for developing diagnostic tools to detect drug-resistant MAC strains and optimizing therapeutic strategies for managing MAC infections in clinical practice.

Impact of WHO-recommended tuberculosis control measures on occupational tuberculosis risk among healthcare workers in a high-burden tertiary hospital in Brazil: a 24-year retrospective analysis

BACKGROUND

Tuberculosis (TB) remains a significant public health concern, particularly in low-to-middle-income countries. Healthcare workers (HCWs) are at a higher risk due to prolonged exposure. The World Health Organization (WHO) has proposed guidelines focusing on administrative interventions, structural interventions, and personal protective equipment (PPE) usage to mitigate this risk.

AIM

To evaluate the effectiveness of the WHO-recommended measures regarding the risk of developing TB among the HCWs.

METHODS

This was a retrospective analysis of TB incidence among patients admitted to a tertiary public emergency department (ED) compared with HCWs from 2000 to 2023. TB notifications were extracted among HCWs and the general population of Ribeirão Preto from a public database.

FINDINGS

From 2000 to 2023, the ED handled an average of 148,496 patients per quadrennium, with 202 TB patients per quadrennium. The prevalence ratio of TB per 100,000 patients increased from 80 to 170 (P = 0.035) and the incidence rates rose from 39 to 157 per 100,000 patients (P = 0.046). The incidence rate of TB among HCWs started at 412.0 (85.0; 1201.0) and decreased to 179.0 (20.0; 619.0). In total, 11 HCWs were diagnosed with TB. The relative risk of having TB between HCWs and the general population was significantly higher before the programme implementation and became equivalent after it.

CONCLUSION

Implementing WHO-recommended TB control measures was demonstrated to be effective in reducing the incidence rate ratios between HCWs and the general population in a high-burden tertiary hospital in Brazil.

Ferritinophagy: multifaceted roles and potential therapeutic strategies in liver diseases

Ferritinophagy, the selective autophagic degradation of ferritin to release iron, is emerging as a critical regulator of iron homeostasis and a key player in the pathogenesis of various liver diseases. This review comprehensively examines the mechanisms, regulation, and multifaceted roles of ferritinophagy in liver health and disease. Ferritinophagy is intricately regulated by several factors, including Nuclear Receptor Coactivator 4 (NCOA4), Iron regulatory proteins and signaling pathways such as mTOR and AMPK. These regulatory mechanisms ensure proper iron utilization and prevent iron overload, which can induce oxidative stress and ferroptosis. In liver diseases, ferritinophagy exhibits dual roles. In liver fibrosis, promoting ferritinophagy in hepatic stellate cells (HSCs) can induce cell senescence and reduce fibrosis progression. However, in non-alcoholic fatty liver disease (NAFLD), chronic ferritinophagy may exacerbate liver injury through iron overload and oxidative stress. In hepatocellular carcinoma (HCC), ferritinophagy can be harnessed as a novel therapeutic strategy by inducing ferroptosis in cancer cells. Additionally, ferritinophagy is implicated in drug-induced liver injury and sepsis-associated liver damage, highlighting its broad impact on liver pathology. This review also explores the crosstalk between ferritinophagy and other selective autophagy pathways, such as mitophagy and lipophagy, which collectively influence cellular homeostasis and disease progression. Understanding these interactions is essential for developing comprehensive therapeutic strategies targeting multiple autophagy pathways. In summary, ferritinophagy is a complex and dynamic process with significant implications for liver diseases. This review provides an in-depth analysis of ferritinophagy's regulatory mechanisms and its potential as a therapeutic target, emphasizing the need for further research to elucidate its role in liver health and disease.

Multimodal machine learning-based model for differentiating nontuberculous mycobacteria from mycobacterium tuberculosis

Objective

To develop and evaluate the effectiveness of multimodal machine learning approach for the differentiation of NTM from MTB.

Methods

The clinical data and CT images of 175 patients were retrospectively obtained. We established clinical data-based model, radiomics-based model, and multimodal (clinical plus radiomics) model gradually using 5 machine learning algorithms (Logistic, XGBoost, AdaBoost, RandomForest, and LightGBM). Optimal algorithm in each model was selected after evaluating the differentiation performance both in training and validation sets. The model performance was further verified using external new MTB and NTM patient data. Performance was also compared with the existing approaches and model.

Results

The clinical data-based model contained age, gender, and IL-6, and the RandomForest algorithm achieved the optimal learning model. Two key radiomics features of CT images were identified and then used to establish the radiomics model, finding that model from Logistic algorithm was the optimal. The multimodal model contained age, IL-6, and the 2 radiomics features, and the optimal model was from LightGBM algorithm. The optimal multimodal model had the highest AUC value, accuracy, sensitivity, and negative predictive value compared with the optimal clinical or radiomics models, and its' favorable performance was also verified in the external test dataset (accuracy = 0.745, sensitivity = 0.900). Additionally, the performance of multimodal model was better than that of the radiologist, NGS detection, and existing machine learning model, with an increased accuracy of 26, 4, and 6%, respectively.

Conclusion

This is the first study to establish multimodal model to distinguish NTM from MTB and it performs well in differentiating them, which has the potential to aid clinical decision-making for experienced radiologists.

Comparison of Al[18F]-NOTA-FAPI-04 PET/CT and [18F]-FDG PET/CT in a patient with lung cancer and pulmonary tuberculosis: a case report and literature review

Background

The coexistence of lung cancer and pulmonary tuberculosis (TB) makes differential diagnosis even more complicated. The purpose of the study is to explore superiority of [18F]-NOTA-FAPI-04 PET/CT in distinguishing TB from malignant lesions and accurately detecting inflammatory lymph nodes than [18F]-FDG PET/CT.

Case summary

Herein, we described a case report of a patient with both lung cancer and tuberculosis underwent [18F]-FDG and Al[18F]-NOTA-FAPI-04 positron emission tomography/computed tomography (PET/CT) to determine staging. Additionally, a literature review was conducted to discuss the potential clinical applications of FAPI PET/CT. We reported a 70-year-old man with newly diagnosed lung squamous cell carcinoma underwent [18F]-FDG and Al[18F]-NOTA-FAPI-04 PET/CT to determine staging. The avid uptake of [18F]-FDG in old pulmonary TB and the right hilar inflammatory lymph nodes (<1 cm) were not found on Al [18F]-NOTA-FAPI-04 PET/CT. After 2 months of follow-up, the small lymph node was finally confirmed to be inflammatory.

Conclusion

Al[18F]-NOTA-FAPI-04 PET/CT may perform better in distinguishing TB from malignancy and may offer greater specificity than [18F]-FDG PET/CT for the diagnosis inflammatory lymph nodes.

Efficacy of nintedanib as a host-directed therapy candidate in the treatment of tuberculosis

BACKGROUND

The lengthy duration and high frequency of drug resistance associated with currently used antimycobacterial drug treatments have intensified the need for alternative therapies against Mycobacterium tuberculosis, the causative agent of TB.

METHODS

MICs and intracellular macrophage cfu counts were tested to evaluate the antibacterial activity of nintedanib and pirfenidone against drug-susceptible and -resistant M. tuberculosis. A chronic murine model of pulmonary infection was used to assay the therapeutic efficacy of nintedanib. Macrophage transcriptome deep sequencing, a confocal assay, siRNA knockdown, Western blotting, quantitative RT-PCR and a cfu assay were used to investigate the antibacterial mechanism of nintedanib.

RESULTS

The MIC90 of nintedanib against M. tuberculosis standard strain H37Rv was 23.56-40.51 mg/L. TB murine model studies showed that nintedanib, coadministered with isoniazid, rifampicin and pyrazinamide, shortened treatment duration, and ameliorated pulmonary inflammation and fibrosis. In mechanism studies, transcriptome sequencing analysis revealed that nintedanib may eliminate M. tuberculosis through up-regulating macrophage autophagy. Furthermore, inhibition of autophagy by using siRNA targeting ATG5 or the autophagy inhibitor 3-methyladenine almost completely abolished nintedanib-mediated suppression of M. tuberculosis. Nintedanib induced autophagy by the JAK2/STAT3/Beclin1 pathway. When JAK2 or Beclin1 were knocked down through siRNA, nintedanib no longer inhibited M. tuberculosis. JAK2 activator coumermycin A1 and STAT3 agonist colivelin also reversed this phenotype.

CONCLUSIONS

In vitro activity of nintedanib against drug-susceptible and -resistant M. tuberculosis and efficacy in murine infections warrant the continued clinical evaluation of nintedanib as a new adjuvant therapy for standard treatment of TB.

Differences analysis between spinal tuberculosis and brucella spondylitis with preoperative non-invasive differential diagnosis

OBJECTIVE

Spinal tuberculosis (STB) and Brucella spondylitis (BS) represent two types of granulomatous infections affecting the spine, which exhibit significant similarities that often result in misdiagnosis and overlooked diagnoses during preoperative evaluations. This study aims to identify non-invasive evaluative indicators that facilitate the differentiation between STB and BS.

METHODS

This study conducted a retrospective collection of clinical features, laboratory tests, and imaging characteristics from 89 patients diagnosed with STB and 66 patients diagnosed with BS. Differences were assessed utilizing χ² tests, independent non-parametric tests, Mann-Whitney U tests, or Fisher's exact tests. Binary logistic regression analysis was employed to identify independent predictive factors for differential diagnosis, and receiver operating characteristic (ROC) curves were generated to assess the effectiveness by calculating the area under the curve (AUC).

RESULTS

Root symptoms (including limb pain and numbness) and necrosis formation exhibited statistically significant differences, with P values of 0.024 and 0.045, respectively. Furthermore, gender, decreased A/G ratio, involvement of thoracic vertebrae, number of damaged vertebrae, and straightening of spinal curvature were identified as independent predictive factors for differentiating between STB and BS, with P values of 0.009, 0.003, < 0.001, 0.005, and 0.014, respectively. ROC analysis revealed that the AUC and 95% confidence intervals (CIs) for these five evaluative indicators were 0.626 (0.537-0.714), 0.621 (0.533-0.709), 0.694 (0.612-0.777), 0.597 (0.508-0.686), and 0.631 (0.540-0.722), respectively. The predictive model exhibited an AUC and 95% CI of 0.854 (0.796-0.911), indicating strong predictive performance.

CONCLUSION

Statistically significant differences were observed between STB and BS regarding root symptoms and necrosis formation. In cases where the patient is male, presents with a decreased A/G ratio, does not have thoracic vertebra involvement, number of vertebral body destructions < 2.5, and exhibits straightening of spinal curvature, the likelihood of diagnosing BS is significantly greater than that of STB.

YY1 Contributes to the Inflammatory Responses of Mycobacterium tuberculosis-Infected Macrophages Through Transcription Activation-Mediated Upregulation TLR4

Tuberculosis (TB) is a chronic respiratory infectious disease and is induced by Mycobacterium tuberculosis (M.tb) infection. Macrophages serve as the cellular home in immunoreaction against M.tb infection, which is tightly regulated through Toll-like receptor 4 (TLR4) expression. Therefore, this study is designed to explore the role and mechanism of TLR4 in mycobacterial injury in human macrophages (THP-1 cells) after M.tb infection. Cell proliferation and apoptosis were assessed using MTT, EdU, and flow cytometry assays. ELISA kits were utilized to assess the levels of Interleukin-6 (IL-6), IL-1β, and tumor necrosis factor α (TNF-α). The binding between Yin-Yang-1 (YY1) and TLR4 promoter was predicted by JASPAR and verified using Chromatin immunoprecipitation (ChIP) and dual-luciferase reporter assays. M.tb infection might repress THP-1 cell proliferation, and induce cell apoptosis and inflammatory response in a multiplicity of infection (MOI)-dependent manner. Moreover, M.tb infection increased the expression of TLR4 in HTP-1 cells in an MOI-dependent way, and its downregulation might overturn M.tb infection-mediated HTP-1 cell damage and inflammatory response. At the molecular level, YY1 was a transcription factor of TLR4 and promoted TLR4 transcription via binding to its promoter region. Besides, YY1 might activate the NF-kB signaling pathway via regulating TLR4. Meanwhile, TLR4 inhibitor BAY11-7082 might overturn the repression effect of TLR4 on M.tb-infected HTP-1 cell damage. YY1-activated TLR4 might aggravate mycobacterial injury in human macrophages after M.tb infection by the NF-kB pathway, providing a promising therapeutic target for TB treatment.

Avian tuberculosis identified as the potential disease in an outbreak in wild migratory birds in China

This study identifies avian tuberculosis as a potential cause of mass mortality in wild migratory birds in Inner Mongolia, China. Combining meta-transcriptomic sequencing and histopathological analysis, it reveals one of the rare instances of tuberculosis-associated outbreaks in avian populations. These findings underscore the importance of surveillance on wildlife diseases to mitigate the risk of interspecies transmission of the disease associated pathogens and their broader implications for biodiversity and public health.

In silico development of potential InhA inhibitors through 3D-QSAR analysis, virtual screening and molecular dynamics

Tuberculosis is one of the most ancient infectious diseases known to mankind predating upper Paleolithic era. In the current scenario, treatment of drug resistance tuberculosis is the major challenge as the treatment options are limited, less efficient and more toxic. In our study we have developed an atom based 3D QSAR model, statistically validated sound with R2 > 0.90 and Q2 > 0.72 using reported direct inhibitors of InhA (2018-2022), validated by enzyme inhibition assay. The model was used to screen a library of 3958 molecules taken from Binding DB and candidates molecules with promising predicted activity value (pIC50) > 5) were selected for further analyzed screening by using molecular docking, ADME profiling and molecular dynamic simulations. The lead molecule, ZINC11536150 exhibited good docking score (glideXP = -11.634 kcal/mol) compared to standard triclosan (glideXP =  -7.129 kcal/mol kcal/mol) and through molecular dynamics study it was observed that the 2nv6-complex of ZINC11536150 with Mycobacterium tuberculosis InhA (PDB entry: 2NV6) complex remained stable throughout the entire simulation time of 100 ns.Communicated by Ramaswamy H. Sarma.

Two-centers machine learning analysis for predicting acid-fast bacilli results in tuberculosis sputum tests

Background

Tuberculosis (TB) is a chronic respiratory infectious disease caused by Mycobacterium tuberculosis, typically diagnosed through sputum smear microscopy for acid-fast bacilli (AFB) to assess the infectivity of TB.

Methods

This study enrolled 769 patients, including 641 patients from the First Affiliated Hospital of Guangxi Medical University as the training group, and 128 patients from Guangxi Hospital of the First Affiliated Hospital of Sun Yat-sen University as the validation group. Among the training cohort, 107 patients were AFB-positive, and 534 were AFB-negative. In the validation cohort, 24 were AFB-positive, and 104 were AFB-negative. Blood samples were collected and analyzed using machine learning (ML) methods to identify key factors for TB diagnosis.

Results

Several ML methods were compared, and support vector machine recursive feature elimination (SVM-RFE) was selected to construct a nomogram diagnostic model. The area under the curve (AUC) of the diagnostic model was 0.721 in the training cohort and 0.758 in the validation cohort. The model demonstrated clinical utility when the threshold was between 38% and 94%, with the NONE line above the ALL line in the decision curve analysis.

Conclusion

We developed a diagnostic model using multiple ML methods to predict AFB results, achieving satisfactory diagnostic performance.

In silico evaluation of snake venom proteins against multidrug-resistant Mycobacterium tuberculosis: A molecular dynamics study and simulation dynamic

Background

Mycobacterium tuberculosis (Mtb), a pathogen that belongs to the M. tuberculosis complex, causes tuberculosis (TB), an infectious bacterial disease. Although it usually affects the lungs and results in pulmonary TB, it can also lead to extra-pulmonary TB by affecting other regions of the body. TB, which ranks first on the list of infectious diseases that kill the most people, affects one-third of the world's population and has a high mortality and morbidity rate. The clinical treatment of active TB infection mainly relies on the use of Isoniazid (INH) in combination with three other drugs-rifampin, pyrazinamide, and ethambutol. However, the situation is getting worse due to the rise of extensively drug-resistant tuberculosis (XDR-TB) and multidrug-resistant tuberculosis (MDR-TB). Finding more effective drugs is always a top priority. In this regard, animal venoms, such as snake toxins, contain antibacterial chemicals that have significant therapeutic properties and prevent bacterial infections and disease progression. This suggests that snake venom is a good natural source of promising novel anti-TB drugs.

Aim

This study examines the snake venom protein's capacity in silico to interrupt the intracellular enzymes of Mtb, which is responsible for the development of MDR-TB in humans.

Methods

From Research Collaboratory for Structural Bioinformatics (RCSB)-Protein Data Bank, the active protein structure of catalase-peroxidase, RNA polymerase, and snake venom proteins was derived. Using molecular docking software such as PyRx, PyMOL, and Ligplot analyzers the interactions between those proteins and the targeted intracellular proteins were evaluated.

Results

Our findings reveal fascinating affinities and interaction patterns between snake venom proteins and MDR-TB intracellular enzymes. Analysis of the effects of these interactions and their capacity to impair catalase-peroxidase and RNA polymerase showed that Russell's viper venom proteins were active against the catalase-peroxidase system, whereas Bothrops jararaca venom proteins were active against the RNA polymerase system.

Conclusion

This study highlights a prospective approach for advancing anti-TB agents by using snake venom proteins to inhibit the growth, replication, and transmission of MDR-TB. This will provide a basis for exploring pharmacophore-based drugs to combat MDR-TB infections.

Estimating Mycobacterium tuberculosis transmission in a South African clinic: Spatiotemporal model based on person movements

The risk of Mycobacterium tuberculosis (Mtb) transmission can be high in crowded clinics. We developed a spatiotemporal model of airborne Mtb transmission based on the Wells-Riley equation. We collected environmental, clinical and person-tracking data in a South African clinic during COVID-19, when community or surgical masks were compulsory and ventilation was increased. We matched person movements with clinical records to identify the spatiotemporal location of infectious TB patients. We modeled the concentration of infectious doses (quanta) and estimated the individual risk of infection. Over five days, video sensors tracked 1,438 clinic attendees. CO2 levels were low (median 431 ppm, IQR 406 ppm-458 ppm); the quanta concentration was higher in the morning than in the afternoon, and highest in the waiting room. The estimated risk of infection per clinic attendee was 0.05% (80%-credible interval (CrI) 0.01%-0.06%). It increased with the number of close contacts with infectious patients and the time spent in the clinic, and was 1.3-fold (95%-CrI 1.2-1.4) higher in scenarios without mask use and 2.1-fold (95%-CrI 0.9-5.0) higher with pre-pandemic ventilation rates, emphasizing the importance of ventilation. Spatiotemporal modeling can identify high-risk areas and evaluate the impact of infection control measures in clinics.

Inhibitors of NADH-O-methylquinone compound a class of antitubercular drugs

Disruption of the mycobacterial redox homeostasis leads to irreversible stress induction and cell death. Hydroquinone scaffolds, as a new type of redox cycling anti-tuberculosis chemotypes, exhibit potent bactericidal activity against non-replicating, nutrient-deprived phenotypically drug-resistant bacteria. Evidences from microbiological, biochemical, and genetic studies indicate that the redox-driven mode of action relies on the reduction of quinones by type II NADH dehydrogenase (NDH2), generating reactive oxygen species (ROS) of bactericidal level. This study demonstrates that (S)-Peniphenone D possesses significant resistance to Mycobacterium marinum (M. marinum) infection, as it enables redox cycling within M. marinum cells, ROS production, and reduction of intracellular NADH levels. The results suggest that hydroquinone compounds, due to their distinctive biological activities, could serve as novel sources for antibacterial drugs, particularly in developing scaffolds for new anti-tuberculosis agents.

Identification of core biomarkers for tuberculosis progression through bioinformatics analysis and in vitro research

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains a significant global public health issue with high mortality rates and challenges posed by drug-resistant strains, emphasizing the continued need for new therapeutic targets and effective treatment strategies. Transcriptomics is a highly effective tool for the development of novel anti-tuberculosis drugs. However, most studies focus only on changes in gene expression levels at specific time points. This study screened for genes with altered expression patterns from available transcriptomic data and analysed their association with the TB progression. Initially, a total of 1228 genes with altered expression patterns were identified through two-way analysis of variance (ANOVA). We define genes with a P-value less than 0.05 for the combined effect of infection and time on gene expression as those with altered expression patterns. Gene Ontology (GO) enrichment analysis revealed that the biological functions of these genes mainly involve DNA translation, RNA processing, and transcriptional regulation. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis indicated that these genes are primarily associated with fatty acid degradation, pyruvate metabolism, arginine and proline metabolism, as well as cholesterol metabolism signaling pathways. Subsequent Protein-protein interaction (PPI) analysis and Receiver Operating Characteristic (ROC) curve analysis identified four core genes closely associated with TB progression, namely Rac Family Small GTPase 1 (RAC1), Ring-Box 1 (RBX1), Mitochondrial Ribosomal Protein L33 (MRPL33), and ELAV Like RNA Binding Protein 1 (ELAVL1). Q-PCR experiments confirmed that Mtb infection led to changes in the gene expression patterns of RAC1, RBX1, MRPL33, and ELAVL1 in THP-1 cells. These four genes may serve as core biomarkers for TB progression and can be utilized in the development of more effective anti-tuberculosis drugs and host therapy.

Assessment of public literacy in TB prevention and control in the National 13th Five-Year plan for Tuberculosis Prevention and Control (2016-2020) in China

BACKGROUND

China has always been a country with a high burden of tuberculosis. In order to end TB, the Chinese government launched three plans for TB prevention and control. The Chinese government implemented the National 13th Five-Year plan for Tuberculosis Prevention and Control (2016-2020) to promote TB prevention and control from policy, technology, health promotion and other aspects from 2016 to 2020. The objective of this study was to assess public TB literacy in health promotion in the National 13th Five-Year plan for Tuberculosis Prevention and Control (2016-2020), and provide a basis for the next plan. Compared with previous studies on TB literacy, this study increased the sample size to cover all provinces in China, which is more representative.

METHODS

A cross-sectional study covering all provinces in China was conducted in 2020. 47,728 questionnaires were collected. Logistic regression was used to analyze the overall awareness of TB health literacy among people with different demographic characteristics. Multicollinearity and outliers were checked using VIF and box plots, respectively.

RESULTS

In the TB key information, the total awareness rate of TB key information was 82.51%. Participants had poor awareness that TB is a chronic infectious disease, and if the whole course of treatment is standardized, the vast majority of patients can be cured and can avoid infecting others. Participants who received public education on TB had better awareness of TB key information. Participants who were over 60 years old, had a primary school or below degree, students, and did not receive public education on TB were less likely to know all TB key information. In the public education methods, participants were more likely and preferred to receive public education on TB through television or radio (67.93%) and Internet (33.85%) more and preferred television or radio (65.39%) and Internet (54.60%). Compared with participants aged below 60, participants aged 60 and above were more likely to receive public education on TB through relatives or friends (16.80%) (P < 0.001) and preferred to receive public education on TB through television or radio (68.15%), doctor consultation (42.19), relatives or friends (16.15%) (P < 0.001). Participants were more likely to query health-related information through self-media platforms (41.55%) and search engines (31.41%) on the Internet, but the elderly (60 years old and above) and participants with primary school or below degree were more likely to not to query health-related information (56.27%, 59.30%) on the Internet. In the public education materials, participants preferred audiovisual (40.69%), text and images (39.51%) public education materials. Participants preferred video (60.12%), text and image (51.78%) health-related information on the Internet.

CONCLUSIONS

The overall public TB literacy was considered high, but the awareness of some TB key information did not reach the target, and it is necessary to strengthen public education on TB for the elderly, people with low education and students. In the future, audiovisual media and the Internet should be the main methods of public education on TB for all people. Relatives or friends dissemination and doctor consultation are also suitable public education methods for older people. More health-related information should be promoted on the Internet, especially on self-media and search engine. TB public education materials and health-related information should use more audio-visual types.

Diagnostic accuracy of Mycobacterium tuberculosis-specific triple-color FluoroSpot assay in differentiating tuberculosis infection status in febrile patients with suspected tuberculosis

Objective

This study aims to evaluate the diagnostic accuracy of a Mycobacterium tuberculosis (MTB)-specific triple-color FluoroSpot assay (IFN-γ/IL-2/TNF-α) in the differentiation of tuberculosis (TB) infection status in febrile patients.

Method

Febrile patients with suspected active TB (ATB) were consecutively enrolled. The frequencies and proportions of MTB-specific T cells secreting IFN-γ, IL-2, and TNF-α were detected at the single-cell level by triple-color FluoroSpot assay. The diagnostic index was fitted with a binary logistic regression model, and the diagnostic accuracy was evaluated according to the receiver operating characteristic (ROC) curve. The sensitivity, specificity, predictive values (PV), and likelihood ratios (LR) were calculated.

Result

A total of 210 febrile patients were enrolled, 53 patients were diagnosed with ATB (28 pathogen-confirmed vs. 25 clinically diagnosed) and 157 patients were non-ATB (84 with latent tuberculosis infection (LTBI) vs. 73 uninfected with MTB). Additionally, 30 pathogen-confirmed ATB patients were assembled. When diagnosing ATB, the area under the ROC curve (AUROC) of the MTB-specific triple-color FluoroSpot assay was significantly better than that of T-SPOT.TB (0.882 vs. 0.811, p = 0.017). With the fitted diagnostic index at a cutoff value of 0.378, the sensitivity, specificity, LR+, and LR- were 74.7%, 93.0%, 10.66, and 0.27, respectively. When differentiating ATB from LTBI, the AUROC of the FluoroSpot assay and T-SPOT.TB was 0.878 and 0.692, respectively (p < 0.001). With a diagnostic index of 0.413, the sensitivity, specificity, LR+, and LR were 77.1%, 85.7%, 5.40, and 0.27, respectively.

Conclusion

The MTB-specific triple-color FluoroSpot (IFN-γ/IL-2/TNF-α) might be helpful for the differentiation of TB infection status in febrile patients.

Global cell-free DNA methylation in patients with active tuberculosis and tuberculosis contacts with latent tuberculosis infection

INTRODUCTION

To investigate whether the methylation of circulating cell-free DNA (cfDNA) differentiates active tuberculosis (TB) from latent TB infection (LTBI).

METHODS

Patients with pulmonary TB, contacts with LTBI, and healthy controls were enrolled (2018-2021). Plasma cfDNA was extracted, and using a 5-methylcytosine (5mC) DNA ELISA kit, the global methylation of cfDNA (5mC-cfDNA) was measured.

RESULTS

59 TB, 63 LTBI, 39 healthy controls were included. The 5mC-cfDNA level was higher in TB (6.4 %) than LTBI (4.1 %) and healthy controls (4.9 %) (both p<0.05). Independent TB factors were 5mC-cfDNA ≥6.6 % and CRP ≥0.32 mg/dL (adjusted odds ratio (aOR) 4.594 [95 % CI:1.628-12.965], p=0.004 and 5.338 [1.659-17.176], p=0.005). Having one or both factors increased TB odds 8- and 16-fold (aOR 8.688 [3.229-23.378], p <0.001 and 16.080 [3.092-83.632], p =0.001).

CONCLUSION

The global cfDNA methylation level was higher in TB than contacts without TB and helped differentiate patients with TB from contacts with LTBI.

Burden of Tuberculosis in Western Sudan During the Sudan Armed Conflict

BACKGROUND

Tuberculosis remains the leading cause of death from infectious diseases worldwide. This study assesses the impact of tuberculosis in western Sudan during armed conflict in 2023-2024.

METHODOLOGY

This study was conducted by the respiratory department of El-Obeid Teaching Hospital in North Kordofan State, Sudan. The study encompassed 751 patients with tuberculosis. Data were collected in August 2024. A data collection sheet was developed to compile all pertinent information.

RESULTS

Of the 751 patients, 659 (87.7%) were classified as new cases, 85 (11.3%) as recurrent cases, and seven (9.3%) as multidrug-resistant (MDR). Of the 659 new cases, 470 (86.2%) were male patients, and 206 (91.7%) were female. The majority of patients were aged 26-35 years with 166 (22.1%), followed by those aged 19-25 years at 160 (21.3%) and 36-45 years at 127 (16.9%), totaling 127 individuals.

CONCLUSION

The incidence rate of tuberculosis rose markedly during the armed conflict in Sudan from 54 per 100,000 to 63 per 100,000 people. During wartime, there was an increase in recurrent disease, non-compliance with treatment methods, and multidrug resistance. The demographics most affected include men, laborers, and individuals employed in gold mining. Extrapulmonary tuberculosis is increasingly detected in lymph nodes, pleura, and abdominal areas. Immediate enhancements to the healthcare system are necessary to prevent the widespread transmission of tuberculosis in Sudan.

Engineering Stimuli-Responsive Materials for Precision Medicine

Over the past decade, precision medicine has garnered increasing attention, making significant strides in discovering new therapeutic drugs and mechanisms, resulting in notable achievements in symptom alleviation, pain reduction, and extended survival rates. However, the limited target specificity of primary drugs and inter-individual differences have often necessitated high-dosage strategies, leading to challenges such as restricted deep tissue penetration rates and systemic side effects. Material science advancements present a promising avenue for these issues. By leveraging the distinct internal features of diseased regions and the application of specific external stimuli, responsive materials can be tailored to achieve targeted delivery, controllable release, and specific biochemical reactions. This review aims to highlight the latest advancements in stimuli-responsive materials and their potential in precision medicine. Initially, we introduce disease-related internal stimuli and capable external stimuli, elucidating the reaction principles of responsive functional groups. Subsequently, we provide a detailed analysis of representative pre-clinical achievements of stimuli responsive materials across various clinical applications, including enhancements in the treatment of cancers, injury diseases, inflammatory diseases, infection diseases, and high-throughput microfluidic biosensors. Finally, we discuss some clinical challenges, such as off-target effects, long-term impacts of nano-materials, potential ethical concerns, and offer insights into future perspectives of stimuli-responsive materials.

The identification and spatial distribution of hotspots of tuberculosis occurrence in South Africa

OBJECTIVE

Prior research has shown strong evidence of spatial clustering of tuberculosis across a range of contexts. Identifying the spatial patterning of infectious diseases such as tuberculosis is crucial as it allows for targeted intervention strategies, directing healthcare resources efficiently to areas where tuberculosis incidence is concentrated. This is especially true for low- and middle-income countries that typically experience greater resource constraints relative to their Global North counterparts. In this study, we extend existing literature by investigating the spatial patterning of tuberculosis among vulnerable communities in South Africa, notably in the relatively under-researched provinces of the North-West and Gauteng.

RESULTS

Data for this study were collected from several locations implementing community-oriented primary care in the country. Community health workers used AitaHealth™, a custom-built mobile information management application, to obtain data on tuberculosis status and environmental conditions of households. We find notable clusters of tuberculosis in these provinces which we speculate could be associated with urban formal and informal settlement densification and overcrowding, the incidence of mining activities prevalent in sampled locations and poor access to healthcare.

Clinical features of Tibetan adolescent tuberculosis at high altitudes: a retrospective study

BACKGROUND

Adolescent pulmonary tuberculosis (TB) is considered inadequately recognized and underreported at high altitudes. This study aimed to investigate the clinical features of adolescent pulmonary TB patients at high altitudes in China.

METHOD

A retrospective analysis was performed at Linzhi People's Hospital. Patients recruited were newly diagnosed with pulmonary TB. Detailed information, including demographics, medical history, presenting symptoms, laboratory results and pulmonary images, was collected. Sputum samples were collected to detect Mycobacterium tuberculosis via the GeneXpert MTB/RIF assay.

RESULT

A total of 63 adolescents and 192 adults were recruited. Compared with those in the adult group, typical TB-related manifestations were significantly less common in the adolescent group (all P < 0.05). The adolescent group had significantly more subclinical TB (23.8% vs. 8.3%, P = 0.001) and a higher previous tuberculosis exposure rate (38.8% vs. 8.3%, P < 0.001) than did the adult group. The erythrocyte sedimentation rate was significantly higher in the adolescent group than in the adult group (P = 0.026). Compared with adult patients, adolescent patients presented a lower rate of pleural thickening (P < 0.01). Compared with active adolescent patients, there were more female than male in the adolescent subclinical TB group (12/15 vs 27/48) and the positive rate of the sputum GeneXpert test was higher in subclinical TB group (6/15 vs 8/48).

CONCLUSION

Adolescent patients with pulmonary TB at high altitudes were prone to subclinical TB and have a higher previous TB exposure rate. Sputum GeneXpert test and ESR were important for the diagnosis of subclinical pulmonary TB.

Surgical treatment of spinal tuberculosis: an updated review

Tuberculosis (TB) is a worldwide disease which seriously affects the global public health. Spinal TB is the most common extra-pulmonary TB and may cause vertebral bone destruction, collapse, kyphosis and even paralysis. Anti-TB chemotherapy is considered the cornerstone treatment of spinal TB and surgery is often required for patients with severe kyphosis, impaired neurological function or spinal instability. Debridement of TB lesions, bone grafting and internal fixation are the key procedures of spinal TB surgery. However, the selection of surgical approach, the extent of TB lesion debridement, the choice of bone graft materials, and the method and extent of internal fixation are all remain controversy. The aim of this updated review is to evaluate current literature for advances in management of spinal TB, with particular focus on surgical techniques.

NIR-II AIEgens for Infectious Diseases Phototheranostics

Pathogenic infectious diseases have persistently posed significant threats to public health. Phototheranostics, which combines the functions of diagnostic imaging and therapy, presents an extremely promising solution to block the spread of pathogens as well as the outbreak of epidemics owing to its merits of a wide-spectrum of activity, high controllability, non-invasiveness, and difficult to acquire resistance. Among multifarious phototheranostic agents, second near-infrared (NIR-II, 1000-1700 nm) aggregation-induced emission luminogens (AIEgens) are notable by virtue of their deep penetration depth, excellent biocompatibility, balanced radiative and nonradiative decay and aggregation-enhanced theranostic performance, making them an ideal option for combating pathogens. This minireview provides a systematical summary of the latest advancements in NIR-II AIEgens with emphasis on the molecular design and nanoplatform formulation to fulfill high-efficiency in treating bacterial and viral pathogens, classified by disease models. Then, the current challenges, potential opportunities, and future research directions are presented to facilitate the further progress of this emerging field.

Prognostic nutritional index and naples prognostic score as biomarkers for the prognosis of incisional wound healing after thoracolumbar tuberculosis surgery

OBJECTIVES

This study aimed to evaluate and compare the clinical predictive value of prognostic nutritional index (PNI) and naples prognostic score (NPS) as biomarkers for the prognosis of incisional wound healing in patients who underwent thoracolumbar tuberculosis surgery through the posterior approach.

METHODS

From January 2019 to October 2021, a total of 124 patients with thoracolumbar tuberculosis who underwent posterior approach debridement and internal fixation were included in this study. We retrospectively analyzed the clinical data, including PNI and NPS. They were divided into poor wound healing (PWH) and non-PWH groups according to whether PWH developed after the operation. And according to the receiver operating characteristic curve, patients were divided into two groups through the threshold value. Risk factors were found using logistic regression analysis.

RESULTS

The unfavorable outcome group had lower hemoglobin, serum albumin, Pre-albumin, PNI, and higher estimated blood loss, instrumented segments, neutrophil count, and NPS (P < 0.05). Both PNI and NPS were strongly correlated with PWH (r = 0.373, P < 0.05; r = -0.306, P < 0.05, respectively). The area under the curve (AUC) of PNI for predicting unfavorable outcomes was 0.764 (95% CI 0.662-0.865, P < 0.001), which was similar to NPS (0.808, 95% CI: 0.719-0.897, P < 0.001). Multivariate stepwise logistic regression analysis showed that PNI, NPS, the neutrophil count, the level of serum albumin, and the number of instrumented segments were independent risk factors for PWH.

CONCLUSION

Both PNI and NPS might be novel independent biomarkers and predictors of poor outcomes in incisional wound healing after STB surgery.

Research Trends of Ocular Tuberculosis: A Bibliometric Analysis

PURPOSE

Ocular tuberculosis (OTB), an extrapulmonary manifestation of tuberculosis (TB), significantly impacts vision acuity and presents challenges in diagnosis and treatment. With ongoing research efforts, new insights into its pathogenesis and treatment have emerged. This study employed bibliometric methods to investigate key research areas and emerging trends, aiming to provide a comprehensive overview of the field.

METHODS

The documents about OTB from January 1, 2003 to December 31, 2023, were retrieved from the Web of Science Core Collection (WoSCC). VOSviewer, CiteSpace, R package bibliometrix, and GraphPad were utilized to analyze the data and visualize the network of the country, organization, author, journal, and keyword related to the field of OTB.

RESULTS

300 articles in the past 21 years were included in this research. The overall number of annual publications exhibits an upward trend. The most productive country, institution, author, and journal were India, Post Graduate Institute of Medical Education & Research (PGIMER), Gupta Vishali, and Ocular Immunology and Inflammation. The main keywords focused on ocular tuberculosis, intraocular tuberculosis, and uveitis. The time trend of keyword occurrences indicated that "T cells" and "aqueous humor" have become new hotspots. Burst detection analysis of keywords shows that "pattern" and "standardization" have emerged as new focal points.

CONCLUSIONS

This study represents the first bibliometric analysis on OTB, offering insights into hot topics and emerging trends within this field. T cells and aqueous humor are identified as novel directions for ongoing research endeavors. The latest research focus is on the standardization of OTB in diagnosis, treatment, and other aspects.

Replacement of the essential nitro group by electrophilic warheads towards nitro-free antimycobacterial benzothiazinones

Nitrobenzothiazinones (BTZs) are undergoing late-stage development as a novel class of potent antitubercular drug candidates with two compounds in clinical phases. BTZs inhibit decaprenylphosphoryl-β-d-ribose oxidase 1 (DprE1), a key enzyme in cell wall biosynthesis of mycobacteria. Their mechanism of action involves an in-situ-reduction of the nitro moiety to a reactive nitroso intermediate capable of covalent binding to Cys387 in the catalytic cavity. The electron-deficient nature of the aromatic core is a key driver for the formation of hydride-Meisenheimer complexes (HMC) as main metabolites in vivo. To mimic the electrophilic character of the nitroso moiety, bioisosteric replacement with different electrophilic warheads was attempted to reduce HMC formation without compromising covalent reactivity. Herein, we synthesized and characterized various covalent warheads covering different reaction principles. Covalent inhibition was confirmed for most active antimycobacterial compounds by enzymatic inhibition assays and peptide fragment analysis.

Evaluating the effectiveness of self-attention mechanism in tuberculosis time series forecasting

BACKGROUND

With the increasing impact of tuberculosis on public health, accurately predicting future tuberculosis cases is crucial for optimizing of health resources and medical service allocation. This study applies a self-attention mechanism to predict the number of tuberculosis cases, aiming to evaluate its effectiveness in forecasting.

METHODS

Monthly tuberculosis case data from Changde City between 2010 and 2021 were used to construct a self-attention model, a long short-term memory (LSTM) model, and an autoregressive integrated moving average (ARIMA) model. The performance of these models was evaluated using three metrics: root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE).

RESULTS

The self-attention model outperformed the other models in terms of prediction accuracy. On the test set, the RMSE of the self-attention model was approximately 7.41% lower than that of the LSTM model, MAE was reduced by about 10.99%, and MAPE was reduced by approximately 9.87%. Compared to the ARIMA model, RMSE was reduced by about 28.86%, MAE by about 32.22%, and MAPE by approximately 29.89%.

CONCLUSION

The self-attention model can effectively improve the prediction accuracy of tuberculosis cases, providing guidance for health departments optimizing of health resources and medical service allocation.

Identification of diagnostic biomarkers and molecular subtype analysis associated with m6A in Tuberculosis immunopathology using machine learning

Tuberculosis (TB), ranking just below COVID-19 in global mortality, is a highly complex infectious disease involving intricate immunological molecules, diverse signaling pathways, and multifaceted immune processes. N6-methyladenosine (m6A), a critical epigenetic modification, regulates various immune-metabolic and pathological pathways, though its precise role in TB pathogenesis remains largely unexplored. This study aims to identify m6A-associated genes implicated in TB, elucidate their mechanistic contributions, and evaluate their potential as diagnostic biomarkers and tools for molecular subtyping. Using TB-related datasets from the GEO database, this study identified differentially expressed genes associated with m6A modification. We applied four machine learning algorithms-Random Forest, Support Vector Machine, Extreme Gradient Boosting, and Generalized Linear Model-to construct diagnostic models focusing on m6A regulatory genes. The Random Forest algorithm was selected as the optimal model based on performance metrics (area under the curve [AUC] = 1.0, p < 0.01), and a clinical predictive model was developed based on these critical genes. Patients were stratified into distinct subtypes according to m6A gene expression profiles, followed by immune infiltration analysis across subtypes. Additionally, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses elucidated the biological functions and pathways associated with the identified genes. Quantitative real-time PCR (RT-qPCR) was used to validate the expression of key m6A regulatory genes. Analysis of the GSE83456 dataset revealed four differentially expressed m6A-related genes-YTHDF1, HNRNPC, LRPPRC, and ELAVL1-identified as critical m6A regulators in TB through the Random Forest model. The diagnostic significance of these genes was further supported by a nomogram, achieving a high predictive accuracy (95% confidence interval [CI]: 0.87-0.94). Consensus clustering classified patients into two m6A subtypes with distinct immune profiles, as principal component analysis (PCA) showed significantly higher m6A scores in Group A than in Group B (p < 0.05). Immune infiltration analysis highlighted significant correlations between key m6A genes and specific immune cell infiltration patterns across subtypes. This study highlights the potential of key m6A regulatory genes as diagnostic biomarkers and immunotherapy targets for TB, supporting their role in TB pathogenesis. Future research should aim to further validate these findings across diverse cohorts to enhance their clinical applicability.

Dissecting regional variability in Pyrazinamide prescribing practices for tuberculosis treatment in Japan

Objectives

To investigate regional variations in pyrazinamide (PZA) prescribing across Japan's 47 prefectures and associated influential factors.

Methods

This study utilized the Standardized Claim Ratio (SCR) for PZA from Japan's National Database of Health Insurance Claims in 2018. Pearson's correlation coefficients assessed relationships between SCR and tuberculosis (TB) incidence, patient characteristics (age, liver disease), and healthcare resources (specialists, TB beds). Multiple regression analysis identified independent predictors of SCR.

Results

Median SCR for PZA was 90.0 (range 40.2-187.1), with a 3-fold difference between top and bottom prefectures. In univariate analysis, SCR correlated positively with TB incidence (r = 0.42), respiratory/infectious disease/TB specialists, and negatively with elderly TB patients (r = -0.33) and liver disease per TB case. Multiple regression revealed higher SCR associated with higher TB incidence (β = 0.44, p < 0.001), lower elderly patients (β = -0.33, p = 0.005), and more respiratory specialists (β = 0.41, p < 0.001).

Conclusions

Regional PZA prescription patterns are multifaceted, significantly influenced by TB prevalence, elderly patient ratios, and the availability of respiratory specialists. To enhance PZA prescribing conformity and TB management, fostering respiratory expertise across Japan is imperative.

Recent Cutting-Edge Designing Strategies for Mtb-DHFR Inhibitors as Antitubercular Agents

Tuberculosis (TB) is an obstinate and infectious disease requiring a relatively longer treatment duration than other bacterial infections. The current treatment regime is prolonged and cumbersome, with adverse effects, often leading to nonadherence. The upsurge in TB's multidrug-resistant and extensively drug-resistant strains with evolved resistance to existing drugs has compounded the problems. The last two decades witnessed unprecedented progress in developing TB drugs with better efficacy and reduced toxicity. Of late, inhibitors targeting the dihydrofolate reductase (DHFR) enzyme were being explored and developed as antitubercular drugs. A plethora of diverse molecular cores, such as pteridines, diamino heterocycles, diamino triazoles, and nontraditional cores, were developed recently as Mtb-DHFR targets. Besides the characteristic binding pockets of Mtb-DHFR, an extended hydrophilic binding pocket was also studied for intermolecular interactions with the designed compounds to assess the enzyme specificity. In this study, prominent DHFR inhibitors developed in the last two decades were reported. Key features of the designed compounds, such as the structural similarities with existing pharmacophores, interactions with binding pockets, enzyme selectivity and specificity, and percentage of inhibition, were evaluated. The authors hope the study will help streamline the pharmacological pipeline of Mtb-DHFR inhibitors and bring the investigators one step closer to success.

Clinical diagnostic value of CRISPR-Cas13a-based molecular technology for tuberculosis

OBJECTIVE

To address the clinical diagnostic value of CRISPR-Cas13a-based molecular technology for tuberculosis (TB).

METHODS

The 189 suspected TB patients were simultaneously sent for acid-fast staining smear of bronchoalveolar lavage fluid, MGIT 960 cultures, Xpert MTB/RIF assay, and CRISPR-Cas13a assay. Using the final clinical diagnosis as the gold standard, the TB and non-TB groups were determined, and the diagnostic values of the four assays and the combined test in TB were compared. Using MGIT 960 culture as the gold standard, the diagnostic value of CRISPR-Cas13a assay was explored in TB, and the concordance between the CRISPR-Cas13a assay and MGIT 960 culture was compared.

RESULTS

The 189 preliminary diagnosed patients with suspected TB were diagnosed, with 147 in the TB group and 42 in the non-TB group. Taking the final clinical diagnosis as the gold standard, the sensitivity, negative predictive value, and accuracy of CRISPR-Cas13a assay, MGIT 960 culture, and XpertMTB/RIF assay were higher than those of acid-fast staining smear; by comparing the area under the ROC curve, the diagnostic value of the CRISPR-Cas13a assay, MGIT 960 culture, and XpertMTB/RIF assay was superior to that of acid-fast staining smear (all P < 0.05). Using the MGIT 960 culture results as the gold standard, there was a moderate concordance between the CRISPR-Cas13a assay and the MGIT 960 culture (kappa = 0.666).

CONCLUSION

Bronchoalveolar lavage fluid CRISPR-Cas13a assay has high application value in the clinical diagnosis of TB and can be recommended for the initial screening of patients with suspected TB.

The identification of essential cellular genes is critical for validating drug targets

Accurately identifying biological targets is crucial for advancing treatment options. Essential genes, vital for cell or organism survival, hold promise as potential drug targets in disease treatment. Although many studies have sought to identify essential genes as therapeutic targets in medicine and bioinformatics, systematic reviews on their relationship with drug targets are relatively rare. This work presents a comprehensive analysis to aid in identifying essential genes as potential targets for drug discovery, encompassing their relevance, identification methods, successful case studies, and challenges. This work will facilitate the identification of essential genes as therapeutic targets, thereby boosting new drug development.

Pharmacology of emerging drugs for the treatment of multi-drug resistant tuberculosis

Mycobacterium tuberculosis (TB) remains the leading cause of infection-related mortality worldwide. Drug resistance, need for multiple antimycobacterial agents, prolonged treatment courses, and medication-related side effects are complicating factors to TB cure. The introduction of treatment regimens containing the novel agents bedaquiline, pretomanid, and linezolid, with or without moxifloxacin (BPaL-M or BPaL, respectively) have substantially reduced TB-related morbidity and mortality and are associated with favorable rates of treatment completion and cure. This review summarizes key information on the pharmacology and treatment principles for moxifloxacin, bedaquiline, delamanid, pretomanid, linezolid, and tedizolid in the treatment of multi-drug resistant TB, with recommendations provided to address and attenuate common adverse effects during treatment.

Machine learning-enabled virtual screening indicates the anti-tuberculosis activity of aldoxorubicin and quarfloxin with verification by molecular docking, molecular dynamics simulations, and biological evaluations

Drug resistance in Mycobacterium tuberculosis (Mtb) is a significant challenge in the control and treatment of tuberculosis, making efforts to combat the spread of this global health burden more difficult. To accelerate anti-tuberculosis drug discovery, repurposing clinically approved or investigational drugs for the treatment of tuberculosis by computational methods has become an attractive strategy. In this study, we developed a virtual screening workflow that combines multiple machine learning and deep learning models, and 11 576 compounds extracted from the DrugBank database were screened against Mtb. Our screening method produced satisfactory predictions on three data-splitting settings, with the top predicted bioactive compounds all known antibacterial or anti-TB drugs. To further identify and evaluate drugs with repurposing potential in TB therapy, 15 screened potential compounds were selected for subsequent computational and experimental evaluations, out of which aldoxorubicin and quarfloxin showed potent inhibition of Mtb strain H37Rv, with minimal inhibitory concentrations of 4.16 and 20.67 μM/mL, respectively. More inspiringly, these two compounds also showed antibacterial activity against multidrug-resistant TB isolates and exhibited strong antimicrobial activity against Mtb. Furthermore, molecular docking, molecular dynamics simulation, and the surface plasmon resonance experiments validated the direct binding of the two compounds to Mtb DNA gyrase. In summary, our effective comprehensive virtual screening workflow successfully repurposed two novel drugs (aldoxorubicin and quarfloxin) as promising anti-Mtb candidates. The verification results provide useful information for the further development and clinical verification of anti-TB drugs.