The link between tuberculosis and body mass index

Patterns of Quetelet Index (Body Mass Index) Improvement and Associated Clinical Factors During Initial Tuberculosis Treatment: A Prospective Analysis of Newly Diagnosed Tuberculosis Patients

Introduction Tuberculosis (TB) and malnutrition form a detrimental synergistic relationship, with malnutrition weakening the immune system and increasing susceptibility to TB, while TB, in turn, worsens the nutritional status through increased metabolic demands and decreased appetite. The nutritional recovery is expected during treatment, but the extent and rate of improvement may vary based on patient characteristics, disease severity, and presence of comorbidities. This study aimed to assess the nutritional status changes in newly diagnosed TB patients by evaluating and comparing their body mass index (BMI) at treatment initiation and after the completion of intensive phase (two months) while also analysing the influence of various factors (age, gender, bacterial load, drug sensitivity, and comorbidities) on BMI variations during this period. Methods A prospective longitudinal study was conducted among 116 newly diagnosed pulmonary TB patients at a tertiary medical college hospital in Tamil Nadu between August and October 2021. Baseline assessments included demographic data, sputum microscopy for bacterial load, drug sensitivity testing via the Cartridge-Based Nucleic Acid Amplification Test (CBNAAT)/TrueNat, and screening for diabetes mellitus and chronic kidney disease (CKD). Anthropometric measurements (weight and BMI) were recorded at treatment initiation and after the completion of a two-month intensive phase treatment using standardized protocols. Data analysis was performed using IBM SPSS Statistics for Windows, V. 23.0 (IBM Corp., Armonk, NY, USA), with descriptive statistics for demographic and clinical characteristics, comparative analyses using independent t-test and one-way ANOVA for subgroup BMI improvements, and McNemar's test and paired t-test for assessing changes in BMI from baseline to post-two-month treatment (p < 0.05 considered significant). Results Among 116 pulmonary TB patients, mean (SD) BMI significantly increased from 16.17 (4.15) to 16.96 (4.01) kg/m² during the intensive phase treatment (p < 0.001). Of 89 initially malnourished patients, 9% achieved normal BMI status. Younger patients (<30 years) showed higher BMI improvement (1.12 ± 0.51 kg/m²) compared to the elderly (>70 years: 0.56 ± 0.49 kg/m²). Lower BMI improvements were observed in rifampicin-resistant cases (0.48 ± 0.22 vs 0.80 ± 0.50 kg/m²) and patients with comorbidities (diabetes: 0.74 ± 0.53 vs 0.85 ± 0.46 kg/m²; CKD: 0.65 ± 0.51 vs 0.83 ± 0.49 kg/m²), though these differences were not statistically significant. Conclusion Significant improvements in nutritional status were observed during the intensive phase treatment, with younger age associated with better BMI gains. Though not statistically significant, drug resistance and the presence of comorbidities appeared to negatively influence nutritional recovery, suggesting the need for enhanced nutritional monitoring and support in these vulnerable subgroups.

Prevalence of bronchiectasis in adults: a meta-analysis

BACKGROUND

Bronchiectasis, once considered an orphan disease, is receiving attention globally owing to its increasing prevalence, healthcare burden, and associated morbidity. However, the prevalence of bronchiectasis is unclear. This meta-analysis estimates the prevalence of bronchiectasis in adults, providing a valuable reference for future research.

METHODS

PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception to May 31, 2024 for studies reporting the prevalence of bronchiectasis. Study selection, data extraction, and overall analysis of risk of the retrieved studies were conducted independently by two authors. The tool for assessing the risk of bias in prevalence studies was used to evaluate overall risk. Stata software (version 15.1) was used to performed the meta-analysis. Subgroup and sensitivity analyses were conducted to identify the source of heterogeneity. Funnel plots combined with Egger's test were used to detect publication bias.

RESULTS

The pooled prevalence of bronchiectasis in adults from 15 studies covering 437,851,478 individuals was 680 per 100,000 (95% CI: 634-727 per 100,000). Subgroup analysis showed that the prevalence of bronchiectasis in the United States, Korea, and China was 478 per 100,000 (95% CI: 367-588 per 100,000), 886 per 100,000 (95% CI: 778-993 per 100,000), and 759 per 100,000 (95% CI: 35-2399 per 100,000), respectively; 467 per 100,000 (95% CI: 416-518 per 100,000) in males and 535 per 100,000 (95% CI: 477-592 per 100,000) in females; 3958 per 100,000 (95% CI: 117-12637 per 100,000), 4677 per 100,000 (95% CI: 427-8928 per 100,000), and 3630 per 100,000 (95% CI: 158-7103 per 100,000) among never-smokers, ever-smokers, and current smokers, respectively; 430 per 100,000 (95% CI: 411-450 per 100,000), 380 per 100,000 (95% CI: 374-386 per 100,000), and 351 per 100,000 (95% CI: 342-360 per 100,000) among individuals with body mass index<18.5, 18.5-24.9, and ≥ 25, respectively. Sixteen comorbidities were evaluated in patients with bronchiectasis, revealing a high rate.

CONCLUSION

Bronchiectasis is not a rare disease and requires more attention from scientific researchers.

TRIAL REGISTRATION

The protocol for this review was registered with PROSPERO: CRD42023409216. Registered 26 June 2023.

Lack of weight gain and increased mortality during and after treatment among adults with drug-resistant tuberculosis in Georgia, 2009-2020

Background

While low body mass index (BMI) is associated with poor tuberculosis (TB) treatment outcomes, the impact of weight gain during TB treatment is unclear. To address this knowledge gap, we assessed if lack of weight gain is associated with all-cause mortality during and after TB treatment.

Methods

We conducted a retrospective cohort study among adults with newly diagnosed multi- or extensively drug-resistant (M/XDR) pulmonary TB in Georgia between 2009-2020. The exposure was a change in BMI during the first 3-6 months of TB treatment. All-cause mortality during and after TB treatment was assessed using the National Death Registry. We used competing-risk Cox proportional hazard models to estimate adjusted hazard ratios (aHR) between BMI change and all-cause mortality.

Results

Among 720 adult participants, 21% had low BMI (<18.5 kg/m2) at treatment initiation and 9% died either during (n=16) or after treatment (n=50). During the first 3-6 months of TB treatment, 17% lost weight and 14% had no weight change. Among 479 adults with normal baseline BMI ( ≥18.5-24.9 kg/m2), weight loss was associated with an increased risk of death during TB treatment (aHR=5.25; 95%CI: 1.31-21.10). Among 149 adults with a low baseline BMI, no change in BMI was associated with increased post-TB treatment mortality (aHR=4.99; 95%CI: 1.25-19.94).

Conclusions

Weight loss during TB treatment (among those with normal baseline BMI) or no weight gain (among those with low baseline BMI) was associated with increased rates of all-cause mortality. Our findings suggest that scaling up weight management interventions among those with M/XDR TB may be beneficial.

Effects of diabetes mellitus on retreatment of Tuberculosis: A multi-centered case-control study from Bangladesh

Objectives

Several studies suggested that diabetes mellitus (DM) worsens the tuberculosis (TB) treatment outcome. But information regarding the association of DM with retreatment of TB is very scarce in Bangladesh. Present study aimed to assess the effects of DM on retreatment of TB.

Methods

This case-control study was conducted among 254 patients (127 cases and 127 controls) from January 2022 - December 2022. Patients were recruited by purposive sampling from 92 centers of the Diabetic Association of Bangladesh (BADAS). Data were collected by face-to-face interview and record reviewing with the help of semi-structured questionnaire and checklist respectively. Quality of data was maintained in all stages of the study. Data were analyzed by using IBM SPSS software. Informed written consent was taken from each patient prior to the study. Ethical issues were maintained strictly.

Results

Present study matched the age and sex of cases and controls. The study revealed that majority of case (89.0) and controls (97.6) were married. Among cases 78.0 % had DM and among controls 64.6 % had DM. Among diabetic patients, 78.8 % cases' and 64.6 % controls' HbA1C level was not within normal range. The study found that, the number of episodes of previous TB (AOR = 3.088, ρ = 0.019), presence of DM (AOR = 2.817, ρ = 0.012) and uncontrolled HbA1C level (AOR = 2.500, ρ = 0.028) were independently associated with retreatment of TB.

Conclusion

The study found that presence of DM, uncontrolled HbA1C level and multiple episodes of previous TB were the risk factors for retreatment of TB. So, a separate guideline for treatment of TB-DM patients should be established to prevent retreatment cases.

Association of serum cathelicidin and Vitamin D levels with infectiousness in patients with pulmonary tuberculosis: A prospective cohort study

BACKGROUND

The immunomodulatory effects of Vitamin D expand to induce the synthesis of an antimicrobial peptide, cathelicidin. There is evidence showing altered levels of cathelicidin in tuberculosis (TB). It has been suggested that Vitamin D-mediated antimicrobial activity depends on its ability to induce cathelicidin. The present study was designed to assess the alterations in serum anti-microbial peptide cathelicidin and 25-hydroxy Vitamin D levels in patients with newly diagnosed pulmonary TB at different treatment times and to study the association between serum Vitamin D levels and cathelicidin.

METHODS

Serum 25-hydroxyvitamin D and cathelicidin levels were estimated in 147 patients with newly diagnosed pulmonary TB at different times: at the start of anti-tubercular treatment, end of the intensive phase of treatment, and at the end of treatment.

RESULTS

There was a statistically significant difference between the levels of serum 25-hydroxyvitamin D and serum cathelicidin at different treatment periods. However, no significant correlation was found between serum Vitamin D and cathelicidin levels or between serum Vitamin D and cathelicidin levels with infectiousness in patients with pulmonary TB.

CONCLUSION

Serum Vitamin D levels and serum cathelicidin levels were significantly reduced at diagnosis, and there was an incremental increase following treatment. However, there was no correlation between the levels of serum cathelicidin and serum Vitamin D or with the infectiousness of the illness.

Prevalence and Predictors of Pulmonary Tuberculosis among Prison Inmates in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Introduction

Prisoners in Sub-Saharan Africa (SSA) are at a high risk of tuberculosis (TB) infection due to overcrowding and poor ventilation. Consequently, TB is a leading cause of morbidity and mortality in prison, and many inmates face a number of barriers to TB control and had limited information in the region. Thus, the aim of this systematic review and meta-analysis was to estimate the overall pooled prevalence of pulmonary TB and predictors among prison inmates in SSA.

Methods

From 2006 to 2019, a systematic review and meta-analysis was conducted using various databases, including PubMed, Embase, Web of Science, and Scopus. The data were extracted in Microsoft Excel using a standardized data extraction format, and the analysis was carried out with STATA version 14. To detect heterogeneity across studies, the I² and the Cochrane Q test statistics were computed. To determine the overall prevalence of TB and predictors among prison populations, a random effect meta-analysis model was used.

Results

Of the 3,479 retrieved articles, 37studies comprising 72,844 inmates met the inclusion criteria. The pooled prevalence of pulmonary TB among prison inmates in SSA was 7.74% (95% CI: 6.46-8.47). In the subgroup analysis, the highest prevalence was found in the Democratic Republic Congo (DRC) (19.72%) followed by Zambia (11.68%) and then Ethiopia (9.22%). TB/HIV coinfection (OR 4.99 (95% CI: 2.60-9.58)), Body mass index (BMI < 18.5) (OR 3.62 (95% CI: 2.65-6.49)), incarceration (OR 4.52 (95% CI: 2.31-5.68)), and previous TB exposure (OR 2.43 (95% CI: 1.61-3.56)) had higher odds of pulmonary TB among inmates.

Conclusion

The prevalence of pulmonary TB among SSA prison inmates was found to be high as compared to total population. TB/HIV coinfection, BMI, incarceration duration, and TB exposure were all predictors with pulmonary tuberculosis in prison inmates. As a result, emphasizing early screening for prisoners at risk of pulmonary TB is an important point to achieving global TB commitments in resource-limited settings.

Diets Differently Regulate Pulmonary Pathogenesis and Immune Signaling in Mice during Acute and Chronic Mycobacterium tuberculosis Infection

Tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) infection persists as a leading cause of mortality and morbidity globally, especially in developing and underdeveloped countries. The prevalence of TB-DM (diabetes mellitus) is higher in low- and middle-income countries where TB and DM are most prevalent. Epidemiological data suggest that slight obesity reduces the risk of TB, whereas DM increases the risk of pulmonary TB. Diets can alter the levels of body fat mass and body mass index by regulating systemic adiposity. Earlier, using a transgenic Mtb-infected murine model, we demonstrated that loss of body fat increased the risk of pulmonary bacterial load and pathology. In the present study, we investigated whether increased adiposity alters pulmonary pathology and bacterial load using C57BL/6 mice infected with HN878 Mtb strain and fed a medium-fat diet (MFD). We analyzed the effects of MFD on the lung during acute and chronic infections by comparing the results to those obtained with infected mice fed a regular diet (RD). Histological and biochemical analyses demonstrated that MFD reduces bacterial burden by increasing the activation of immune cells in the lungs during acute infection and reduces necrosis in the lungs during chronic infection by decreasing lipid accumulation. Our data suggest that slight adiposity likely protects the host during active TB infection by regulating immune and metabolic conditions in the lungs.

Factors Associated with Emergency Department Visits and Consequent Hospitalization and Death in Korea Using a Population-Based National Health Database

We aim to investigate common diagnoses and risk factors for emergency department (ED) visits as well as those for hospitalization and death after ED visits. This study describes the clinical course of ED visits by using the 2014–2015 population data retrieved from the National Health Insurance Service. Sociodemographic, medical, and behavioral factors were analyzed through multiple logistic regression. Older people were more likely to be hospitalized or to die after an ED visit, but younger people showed a higher risk for ED visits. Females were at a higher risk for ED visits, but males were at a higher risk for ED-associated hospitalization and death. Individuals in the highest quartile of income had a lower risk of ED death relative to lowest income level individuals. Disabilities, comorbidities, and medical issues, including previous ED visits or prior hospitalizations, were risk factors for all ED-related outcomes. Unhealthy behaviors, including current smoking, heavy alcohol consumption, and not engaging in regular exercise, were also significantly associated with ED visits, hospitalization, and death. Common diagnoses and risk factors for ED visits and post-visit hospitalization and death found in this study provide a perspective from which to establish health polices for the emergency medical care system.

Risk factors associated with tuberculosis recurrence in South Korea determined using a nationwide cohort study

Objective

Prevention of tuberculosis (TB) recurrence is an important issue in TB control. South Korea, a country with a high average income, has been challenged with an intermediate burden of TB. We aimed to estimate the TB recurrence rate after successful completion of the first anti-TB chemotherapy, and to identify the risk factors for the TB recurrence by focusing on co-morbidities and behavioral factors.

Methods

This is a population-based cohort study using data from the National Health Insurance (NHI) database between 2002 and 2013. Newly diagnosed TB patients were identified using the classification of disease codes and prescription records. Final analytical subjects included people who successfully completed the first anti-TB chemotherapy. The primary outcome measure was recurrent TB 6-month after the first treatment completion. A set of associated risk factors, including demographic characteristics, co-morbidities, and health behavior factors were analyzed using Cox regression analysis.

Results

Among 5,446 TB patients, 2,226 (40.1%) completed the first anti-TB treatment. During the follow-up period, 150 (6.7%) patients had TB recurrence, and the crude recurrent rate was 22.6 per 1000 person-years. The majority of recurrence cases (89%) occurred within the first 2-year period. The major findings show that participants who are male (adjusted HR (aHR) = 1.81, at a 95% CI, range: 1.11–2.94), older in age (aHR = 1.07, at a 95% CI, range: 1.00–1.14), have a lower income (aHR = 1.96, at a 95% CI, range: 1.10–3.48) and who are underweight (aHR = 1.92, at a 95% CI, range 1.15–3.20) were at higher risks for TB recurrence.

Conclusion

People who have risk factors for recurrent TB need to improve treatment compliance through more effective TB management, and follow-up observation for one or two years after the treatment completion.

Female Reproductive Factors and the Risk of Bronchiectasis: A Nationwide Population-Based Longitudinal Study

Although the oestrogen level is thought to be involved in the occurrence of bronchiectasis, limited data are available on the relationship between female reproductive factors and the risk of bronchiectasis. We performed a population-based retrospective cohort study of 959,523 premenopausal women and 1,362,401 postmenopausal women without a previous history of bronchiectasis who participated in a health screening exam in 2009 in South Korea. In premenopausal women, compared with a later age at menarche (≥16 years), an earlier menarche (<12 years) was associated with a reduced risk of bronchiectasis with an adjusted hazard ratio (aHR) (95% confidence interval (CI)) of 0.74 (0.67–0.81). However, there were no significant associations between other reproductive factors (breastfeeding, parity, or oral contraceptive use) and the risk of bronchiectasis. In postmenopausal women, the risk of bronchiectasis (aHR (95% CI)) was lower in those with an earlier menarche (0.79 (0.72–0.87) for <12 years vs. ≥16 years), a later menopause (0.90 (0.84–0.96) ≥55 years vs. <40 years), and a longer reproductive period (0.90 (0.86–0.94) for ≥40 years vs. <30 years). There was no significant relationship between parity and the risk of bronchiectasis. Although breastfeeding <1 year (aHR (95% CI) = 0.92 (0.87–0.97) for <0.5 years and 0.93 (0.88–0.97) for 0.5–1 years) and oral contraceptive use <1 year (0.97 (0.94–0.99)) reduced the risk of bronchiectasis, hormone replacement therapy ≥5 years increased the risk of bronchiectasis (1.24 (1.18–1.30)). Female reproductive factors are risk factors for developing bronchiectasis, showing a higher risk associated with shorter endogenous oestrogen exposure regardless of the menopausal status.

Being Underweight Increases the Risk of Non-Cystic Fibrosis Bronchiectasis in the Young Population: A Nationwide Population-Based Study

Although body mass index (BMI) is a potential risk factor for bronchiectasis in young adults, the association between BMI and incident bronchiectasis has not been well elucidated. This study included 6,329,838 individuals aged 20-40 years from the Korean National Health Insurance Service database 2009-2012 who were followed up until the date of the diagnosis of bronchiectasis, death, or 31 December 2018. We evaluated the incidence and risk of bronchiectasis according to the BMI category. The incidence rate of bronchiectasis increased as BMI decreased in a dose-dependent manner (p for trend <0.01). In multivariable Cox regression analysis, being underweight was an independent risk factor for the development of bronchiectasis, with a hazard ratio of 1.24 (95% confidence interval, 1.19-1.30) compared to being normal weight. In subgroup analysis, the effect of being underweight on the development of bronchiectasis was more evident in males and older individuals (30-40 years) than females and younger individuals (20-29 years), respectively (p for interaction <0.01 for both). These results remained significant in subgroup analysis in which subjects with comorbidities related to being underweight were excluded. Being underweight may be a novel risk factor for the development of bronchiectasis in young adults.

Discovery of serum biomarkers for diagnosis of tuberculosis by NMR metabolomics including cross-validation with a second cohort

Background

Tuberculosis (TB) is a disease with worldwide presence and a major cause of death in several developing countries. Current diagnostic methodologies often lack specificity and sensitivity, whereas a long time is needed to obtain a conclusive result.

Methods

In an effort to develop better diagnostic methods, this study aimed at the discovery of a biomarker signature for TB diagnosis using a Nuclear Magnetic Resonance based metabolomics approach. In this study, we acquired ¹H NMR spectra of blood serum samples of groups of healthy subjects, individuals with latent TB and of patients with pulmonary and extra-pulmonary TB. The resulting data were treated with uni- and multivariate statistical analysis.

Results

Six metabolites (inosine, hypoxanthine, mannose, asparagine, aspartate and glutamate) were validated by an independent cohort, all of them related with metabolic processes described as associated with TB infection.

Conclusion

The findings of the study are according with the WHO Target Product Profile recommendations for a triage test to rule-out active TB.

Association of gene polymorphisms and environmental factors in tuberculosis patients and their household contacts

BACKGROUND

Tuberculosis (TB) is an important public health problem in China and environmental and genetic factors have an impact on its occurrence and development. We explored the relationship between environmental factors, genetic susceptibility genes and gene-environment interactions and the incidence of TB, as well as their high-risk combination, which can provide a scientific basis for prevention of the disease.

METHODS

The 242 individuals, which included 82 TB patients, 67 family genetically related patients and 93 healthy controls, all of whom were of the Han population in Guangdong Province. The basic information of subjects was collected, including general conditions, behaviour habits, family environmental factors and blood samples. Two single nucleotides with potential functions (interleukin-10 [IL-10] rs1800896, interferon-γ [IFN-γ] rs2430561) were screened by bioinformatics tools and identified by polymerase chain reaction-restriction fragment length polymorphism.

RESULTS

We found that gender, education, TB exposure history, fitness activities, residential areas and indoor hygiene conditions were all associated with the occurrence of TB. In the dominant model, AG+GG of IL-10 and AA of IFN-γ are high-risk genotypes. Multifactor dimensionality reduction (MDR) analysis of TB-prone families shows that a combination of male sex, IL-10 AA and AG genotypes and smoking history are elements of high risk for TB infection (prediction accuracy 62.45%, cross-validation consistency 10/10). The MDR analysis of the TB patients group and the healthy control group showed that the combination of low education level, history of TB exposure, and IFN-γ AA genotype represented a higher risk of TB infection (prediction accuracy 80.34%, cross-validation consistency 10/10).

CONCLUSIONS

The occurrence of TB in TB-prone families in the Han population of Guangdong Province is related to environmental factors as well as cytokines IL-10 and IFN-γ. We also found high-risk combinations of genes and environmental factors, providing clues for the timely detection of high-risk groups.

Diagnosis Based on Detection of CXCL10 in Urine as Biomarker for The Determining Diagnosis of Active Lung Tuberculosis

Tuberculosis diagnosis is an important component in decreasing TB incidence and prevalence. Because of the difficulty to collect sputum in some cases, urine specimens are used as it is easier to garner. One of the biomarkers in urine that can be used to diagnose pulmonary TB is IP-10, which can be represented by the CXCL10 gene. The study aims to determine the accuracy of diagnosis based on detection of the CXCL10 gene in urine as a biomarker for the patients with suspected pulmonary TB in Dr. Soetomo Hospital in Surabaya from November 2019 until March 2020. Thus, this is an observative laboratory research with a cross-sectional study. CXCL10 gene was examined using PCR for 36 urine samples, and then, the data, together with the medical records of clinical manifestations of pulmonary TB, GeneXpert MTB /RIF, blood count, and thorax radiograph, were processed using IBM SPSS Statistics 26. The results of the GeneXpert MTB/RIF and thorax radiograph criteria show positive results of pulmonary TB, which were 44.4% and 69.4% respectively. CXCL10 gene was not found in all urine of healthy people (negative), while 2.8% (1/36 samples) positive CXCL10 gene was found in a patient with positive GeneXpert, also with negative clinical manifestations and urine culture. In this study, the accuracy of diagnosis based on detection of the CXCL10 gene in urine for diagnosis of active pulmonary TB was 2.8%. Future research is needed to improve the methods, among them are bigger size of urine samples and clearer medical history of patients. 

Changes in Nutritional Status in Pulmonary Tuberculosis: Longitudinal Changes in BMI According to Acid-Fast Bacilli Smear Positivity

Malnutrition is closely associated with pulmonary tuberculosis (PTB). However, changes before and after treatment remain unclear. We aimed to investigate the longitudinal changes in nutritional status from treatment to follow-up of TB in 215 PTB cases in South Korea. First, we evaluated the trend in body mass index (BMI) from the time of diagnosis to a 2-year follow-up. Second, we compared the BMIs of our cases with 5694 controls who participated in a Korean national survey after treatment. During the treatment period, the BMI of the smear-positive group (n = 72) significantly increased compared with that of the smear-negative group (n = 143) (+1.9 kg/m² vs. +0.4 kg/m², p = 0.001). Almost all the changes occurred in the early phase, with unremarkable differences in the rest of the treatment period and up to the 2-year follow-up period. When compared with controls, the smear-positive PTB group also had a lower BMI than the smear-negative PTB group, which, however, was lower than that of the general population, though all the participants regained their BMIs during treatment. These results clarify the nutritional aspects of PTB and enable better strategies to support patients with PTB.

Evaluation of underweight status may improve identification of the highest-risk patients during outpatient evaluation for pulmonary tuberculosis

BACKGROUND

When evaluating symptomatic patients for tuberculosis (TB) without access to same-day diagnostic test results, clinicians often make empiric decisions about starting treatment. The number of TB symptoms and/or underweight status could help identify patients at highest risk for a positive result. We sought to evaluate the usefulness of BMI assessment and a count of characteristic TB symptoms for identifying patients at highest risk for TB.

METHODS

We enrolled adult patients receiving pulmonary TB diagnoses and a representative sample with negative TB evaluations at four outpatient health facilities in Kampala, Uganda. We asked patients about symptoms of chronic cough, night sweats, chest pain, fever, hemoptysis, or weight loss; measured height and weight; and collected sputum for mycobacterial culture. We evaluated the diagnostic accuracy (for culture-positive TB) of two simple scoring systems: (a) number of TB symptoms, and (b) number of TB symptoms plus one or more additional points for underweight status (body mass index [BMI] ≤ 18.5 kg/m2).

RESULTS

We included 121 patients with culture-positive TB and 370 patients with negative culture results (44 of whom had been recommended for TB treatment by evaluating clinicians). Of the six symptoms assessed, the median number of symptoms that patients reported was two (interquartile range [IQR]: 1, 3). The median BMI was 20.9 kg/m2 (IQR: 18.6, 24.0), and 118 (24%) patients were underweight. Counting the number of symptoms provided an area under the Receiver Operating Characteristic curve (c-statistic) of 0.77 (95% confidence interval, CI: 0.72, 0.81) for identifying culture-positive TB; adding two points for underweight status increased the c-statistic to 0.81 (95%CI: 0.76, 0.85). A cutoff of ≥3 symptoms had sensitivity and specificity of 65% and 74%, whereas a score of ≥4 on the combined score (≥2 symptoms if underweight, ≥4 symptoms if not underweight) gave higher sensitivity and specificity of 69% and 81% respectively. A sensitivity analysis defining TB by Xpert MTB/RIF status produced similar results.

CONCLUSION

A count of patients' TB symptoms may be useful in clinical decision-making about TB diagnosis. Consideration of underweight status adds additional diagnostic value.

Association of the Clinico-Demographic and Laboratory Profile with Treatment Outcomes in Patients with Drug-Resistant Pulmonary Tuberculosis

Background:

Drug-resistant tuberculosis (DR-TB) is a significant public health problem, especially in the developing and underdeveloped countries; its treatment is relatively expensive, of longer duration, and associated with more adverse effects.

Objective:

The objective of this study was to report the treatment outcomes in patients with DR-TB and determine if a few selected clinico-demographic parameters and baseline laboratory values, done as part of the pre-treatment evaluation, have any impact on sputum culture conversion and outcomes. The aim was to identify the potential factors associated with unfavourable outcomes prior to starting the treatment.

Methods:

A retrospective analysis of data of patients diagnosed with DR-TB admitted at our centre from January 2015 to May 2016 was done. Of the 114 patients included, culture reports were available in 85 and 72 patients at the end of the third and sixth month, respectively. The clinicodemographic and laboratory parameters were compared with the sputum culture report at the end of the third and sixth month and final treatment outcomes.

Results:

Favorable outcome (cured) was seen in 33.3% (38/114) patients. Female gender was associated with delayed sputum culture conversion at three months (P = 0.020). A positive culture at the end of the sixth month was significantly associated with unfavourable outcomes (P = 0.002). A low body mass index (BMI) (15.86 [IQR, 14.10-18.11]) and a higher platelet count (358 × 109/L [IQR, 282-4.85]) at the initiation of treatment were independently and significantly associated with unfavorable outcomes.

Conclusion:

Patients with a low BMI and high platelet count are more likely to have unfavourable treatment outcomes. Identifying patients with these risk factors during the pre-treatment phase, more intensive follow-up during the treatment course could be advocated.

Reece S, R. Martineau A, P. Kateete D. Detection of Mycobacterium tuberculosis DNA in CD34 + peripheral blood mononuclear cells of Ugandan adults with latent infection: a cross-sectional and nested prospective study

Background: Tuberculin skin test and interferon gamma release assay (IGRA) show limitations in diagnosing latent tuberculosis infection (LTBI) and poorly predict progression to active tuberculosis. This study will explore detection of Mycobacterium tuberculosis ( M.tb) DNA in CD34 + peripheral blood mononuclear cells (PBMCs) as a biomarker for LTBI and monitoring chemoprophylaxis response. Methods: In a cross-sectional study, 120 household contacts (60 HIV positive and 60 HIV negative) will be recruited. Also, 10 patients with sputum positive pulmonary tuberculosis and 10 visitors from low incidence countries with no history of TB treatment will be recruited as positive and negative controls, respectively. Participants will donate 100 ml (50 ml for TB patients) of blood to isolate PBMCs using density gradient centrifugation. Isolated PBMCs will be separated into CD34 + and CD34 - enriched cellular fractions. DNA from each fraction will be purified, quantified and subjected to droplet digital PCR targeting IS6110 (a M.tb Complex multi-copy gene) and rpoB, a single copy gene. Also, 4 ml of blood will be drawn for IGRA. In a nested prospective study, 60 HIV positive participants will be given 300 mg of Isoniazid Preventive Therapy (IPT) daily for six months, after which they will donate a second 100 ml blood sample that will be processed as described above. Data from the cross-sectional study will be analysed to determine the proportion of individuals in whom M.tb DNA is detectable in CD34 + and CD34 - fractions and number of M.tb genomes present. Data from the prospective study will be analysed to compare the proportion of individuals with detectable M.tb DNA in CD34 + and CD34 - fractions, and median M.tb genome copy number, post vs pre-IPT. Discussion: This study will determine whether detection of M.tb DNA in CD34 + PBMCs holds promise as a biomarker for LTBI and monitoring chemoprophylaxis response.

The implementation of health <em> istithaah </em> to the pilgrims with tuberculosis: a cross-sectional study in Jakarta, Indonesia

BACKGROUND Based on the regulation of the Indonesian Ministry of Health No. 15 of 2016 about health istithaah for the Hajj, patients with tuberculosis (TB) can be categorized into ineligible or temporarily ineligible pilgrims. This study aimed to know the characteristics of pilgrims with TB and determined their level of fitness for fulfilling the health istithaah. METHODS A cross-sectional study of pilgrims from Jakarta who were receiving TB treatment during the Hajj in 2018 was conducted with consecutive sampling. The secondary data was collected from the Hajj Integrated Computer Health System 2018, TB registered form, and six-minute walk test (the fitness level data) conducted by the District Hajj Health Team at district health centers in DKI Jakarta and Pondok Gede before the Hajj embarkation in June–July 2018. The questionnaire to the Indonesian Hajj Health Team during pilgrimage was also included as additional data. RESULTS Thirty-one pilgrims received TB treatment and completed the intensive phase of TB treatment, but 29 pilgrims had no symptoms. Among them, 2 patients had MDR-TB. Most of them were male aged ≥40 years old. Twelve pilgrims with TB have a sufficient fitness. All pilgrims were able to run the pillars of the Hajj. CONCLUSIONS Pilgrims with TB, including MDR-TB, who had completed the intensive phase with a negative sputum smear test were declared eligible for the Hajj with assistance.

Intrinsic and extrinsic factors associated with sputum characteristics of presumed tuberculosis patients

BACKGROUND

Sputum remains the most preferred specimen for detection of Mycobacterium tuberculosis due to its non-invasive method of production. Good quality sputum specimen is essential for accurate diagnosis of pulmonary tuberculosis (PTB). It is therefore imperative to assess factors that are related to the production of sputum that is of the best quality.

OBJECTIVE

We assessed the intrinsic and extrinsic characteristics of presumed tuberculosis patients and the quality of sputum they produced.

METHODS

This was a cross-sectional study in which consenting enrolled presumed tuberculosis patients were subjected to medical examination and a structured questionnaire administered to collect clinical history, demographic information, environmental and behavioral characteristics. The enrolled participants were instructed on how to collect spot and morning sputum specimens for macroscopic and microscopic assessment to determine any association.

RESULTS

A total of 309 patients were enrolled into the study with an even distribution on gender (50.5% males). Of these, 202 (65.3%) submitted both a spot and a morning specimen for analysis. On macroscopic examination, 70% spot and 68% morning sputum were characterized as good quality (Purulent/mucoid). The factors associated (p<0.05) with quality specimen included both intrinsic and extrinsic factors. The intrinsic factors included: difficulty in breathing, presence of conjunctivitis and knowledge of the disease whereas the only extrinsic factor associated with production of good quality sputum for tuberculosis diagnosis was time taken by patient to seek tuberculosis treatment after occurrence of any of the TB symptoms.

CONCLUSION

Both intrinsic and extrinsic factors affected the quality of sputum produced by presumed tuberculosis patients. Clinical and behavioral characteristics including conjunctivitis, difficulty in breathing and delay in seeking treatment were important factors that determined the production of good quality sputum specimens, while knowledge of tuberculosis disease did not compel presumed tuberculosis patients to produce good quality sputum for diagnosis of the disease.