Tuberculosis problems in the Asia-Pacific region

Chronic respiratory disease mortality and its associated factors in selected Asian countries: evidence from panel error correction model

Background

Chronic Respiratory Diseases (CRDs) in Asian countries are a growing concern in terms of morbidity and mortality. However, a systematic understanding of the increasing age-adjusted mortality rate of chronic respiratory disease (CRD) and its associated factors is not readily available for many Asian countries. We aimed to determine country-level factors affecting CRD mortality using a panel error correction model.

Methods

Based on data from the Global Burden of Disease Study 2017, we estimated the trends and distribution of CRD mortality for selected Asian countries from 2010 to 2017. Furthermore, we evaluated the relationship between CRD mortality and Gross Domestic Product (GDP) per capita, average years of schooling, urbanization, and pollutant emission (PM2.5 concentration) using a fixed-effect model. We corrected the estimates for heteroscedasticity and autocorrelation through Prais-Winsten adjustment along with robust standard error.

Results

Between 2010 and 2017, approximately 21.4 million people died from chronic respiratory diseases in the countries studied. Age-standardized crude mortality rate from CRDs in the period had minimum and maximum values of 8.19 (Singapore in 2016) and 155.42 (North Korea in 2010) per 100,000 population, respectively. The coefficients corrected for autocorrelation and heteroskedasticity based on the final model of our study (Prais-Winsten), showed that all explanatory variables were statistically significant (p < 0.001). The model shows that the 1% increase in GDP per capita results in a 20% increase (0.203) in the CRD mortality rate and that a higher concentration of air pollution is also positively associated with the CRD deaths (0.00869). However, an extra year of schooling reduces the mortality rate by 4.79% (− 0.0479). Further, rate of urbanization is negatively associated with the CRD death rate (− 0.0252).

Conclusions

Our results indicate that both socioeconomic and environmental factors impact CRD mortality rates. Mortality due to CRD increases with rising GDP per capita and decreases with the percentage of the total population residing in urban areas. Further, mortality increases with greater exposure to PM2.5. Also, higher years of schooling mitigate rising CRD mortality rates, showing that education can act as a safety net against CRD mortality. These results are an outcome of sequential adjustments in the final model specification to correct for heteroscedasticity and autocorrelation.

Vaginal tuberculosis as differential diagnosis of cancer: A case report

Tuberculosis remains a worrying public health problem. But if pulmonary tuberculosis’s symptomatology is well known by the medical profession, this is not the case of genital tuberculosis. We take advantage of a case of vaginal tuberculosis to review the international literature about clinical diagnosis, further tests, and treatment of this extremely rare tuberculosis localization.

Respiratory health issues in the Asia-Pacific region: an overview

The Asia–Pacific region is home to a large heterogeneous population whose respiratory health is influenced by diverse social, economic and environmental factors. Despite this variability, the most prevalent causes of respiratory morbidity and mortality are tobacco smoking, infection, and air pollution. This review aims to summarize current respiratory health issues in the region including smoking‐related diseases especially COPD, lung cancer and infectious problems such as pandemic influenza, the severe acute respiratory syndrome coronavirus, bacterial pneumonia and tuberculosis, as well as the contribution of air pollution to respiratory disease. Published data on trends in the epidemiology and management of respiratory diseases and are summarized; finally, the limitations of available data and projections for the future of respiratory health in the region are discussed.

Predicting results of mycobacterial culture on sputum smear reversion after anti-tuberculous treatment: a case control study

Background

Little is currently known regarding sputum smear reversion (acid-fast smear becomes positive again after negative conversion) during anti-tuberculous treatment. This study aimed to evaluate its occurrence in patients with pulmonary tuberculosis (TB) and identify factors predicting results of mycobacterial culture for smear-reversion of sputum samples.

Methods

The retrospective review was performed in a tertiary referral center and a local teaching hospital in Taiwan. From 2000 to 2007, patients with smear-positive culture-confirmed pulmonary TB experiencing smear reversion after 14 days of anti-tuberculous treatment were identified.

Results

The 739 patients with smear-positive pulmonary TB had 74 (10%) episodes of sputum smear reversion that grew Mycobacterium tuberculosis in 22 (30%) (Mtb group). The remaining 52 episodes of culture-negative sputum samples were classified as the non-Mtb group. The anti-tuberculous regimen was modified after confirming smear reversion in 15 (20%). Fourteen episodes in the Mtb group and 15 in the non-Mtb group occurred during hospitalization. All were admitted to the negative-pressure rooms at the time of smear reversion. Statistical analysis showed that any TB drug resistance, smear reversion within the first two months of treatment or before culture conversion, and the absence of radiographic improvement before smear reversion were associated with the Mtb group. None of the smear reversion was due to viable M. tuberculosis if none of the four factors were present.

Conclusions

Sputum smear reversion develops in 10% of patients with smear-positive pulmonary TB, with 30% due to viable M. tuberculosis bacilli. Isolation and regimen modification may not be necessary for all drug-susceptible patients who already have radiographic improvement and develop smear reversion after two months of treatment or after sputum culture conversion.

Epidemiological trend in tuberculosis in the Italian region of Liguria: impact of immigration and AIDS

BACKGROUND

Tuberculosis (TB) uniformly decreased in all industrialized countries from 1950 to 1985. However, since 1985 an upsurge of the disease has been observed, probably due to the increases in AIDS and immigration. It is for this reason that in the last decade all industrialized countries have intensified their controls on TB and a new reduction has been recently observed.

METHODS

In this study we collected epidemiological data (mortalities and reported cases) for the region of Liguria over the last 15 years. We then calculated the incidence rate of TB per 100,000 residents according to age, HIV infection and nationality, making a distinction between European Union (EU) citizens and immigrants coming from countries outside the EU.

RESULTS

The rate of mortality, after the last peak at the end of the Second World War, has progressively decreased from 1946 to today, so much so that presently we record fewer than two cases per 100,000 people. We observed a consistent downward trend in the incidence rate up to 1987, but from 1988 onwards this trend stopped and, in subsequent years, we detected an increase in the incidence rate, which peaked in 1996. This led to increased interventions, which has resulted in a considerably decreased overall rate of cases of TB during the last few years. The number of TB cases specifically among foreigners increased considerably during the last 5 years, whereas there was a drastic reduction in the number of total TB cases, as well as an interesting reduction in AIDS cases. During the same period there was a progressive decrease in tuberculin skin positivity in all school classes.

CONCLUSIONS

The reduction in TB notifications is probably due to an increase in surveillance and control of social and health conditions. These results show that immigrant workers are considered to be a high-risk group, whereas the risk has progressively decreased in the HIV group.