Diagnostic Overview and Management of Adult Pulmonary Tuberculosis Patients Inpatient at RSU Royal Prima Medan in 2020

Tuberculosis is an inflammatory disease of the lung parenchyma caused by infection with Mycobacterium tuberculosis. This research aims to find out the description of the diagnosis and management of adult pulmonary TB patients hospitalized at RSU Royal Prima Medan in 2020. This study is a descriptive study. This study is based on medical record data on inpatients with a diagnosis of pulmonary TB at the Royal Prima General Hospital Medan in 2020. The youngest patient was 18 years old and the oldest was 82 years old. The main complaint was shortness of breath (53%), additional complaints were cough (48%), symmetrical physical examination of the thorax (91%), positive sputum smear examination (72%), combined medical management of pulmicort + fumadryl + paracetamol + levofloxacin + OAT category I (72%), the longest length of stay was 7-8 days (38%), the shortest was 11-12 days (1%). In conclusion, pulmonary TB occurs more in men in the 37- 45 year age group (22%), the most complaints are shortness of breath (53%), and the most widely used combination treatment is pulmicort + fumadryl + paracetamol + levofloxacin + drugs anti tuberculosis category I (72%).

Prevalence and Clinical Profiling of Dysglycemia and HIV infection in Persons with Pulmonary Tuberculosis in Brazil

Background: There are scarce data on the prevalence and disease presentation of HIV in patients with tuberculosis (TB) and dysglycemia (diabetes [DM] and prediabetes [PDM]), especially in TB-endemic countries. Methods: We assessed the baseline epidemiological and clinical characteristics of patients with culture-confirmed pulmonary TB, enrolled in a multicenter prospective cohort in Brazil (RePORT-Brazil) during 2015-2019. Dysglycemia was defined by elevated glycated hemoglobin and stratified as PDM or DM. Additionally, we used data from TB cases obtained through the Brazilian National Notifiable Diseases Information System (SINAN), during 2015-2019. In SINAN, diagnosis of diabetes was based on self-report. Logistic regression models were performed to test independent associations between HIV, dysglycemia status, and other baseline characteristics in both cohorts. Results: In the RePORT-Brazil cohort, the prevalence of DM and of PDM was 23.7% and 37.8%, respectively. Furthermore, the prevalence of HIV was 21.4% in the group of persons with TB-dysglycemia and 20.5% in that of patients with TBDM. In the SINAN cohort, the prevalence of DM was 9.2%, and among the TBDM group the prevalence of HIV was 4.1%. Logistic regressions demonstrated that aging was independently associated with PDM or DM in both the RePORT-Brazil and SINAN cohorts. In RePORT-Brazil, illicit drug use was associated with PDM, whereas a higher body mass index (BMI) was associated with DM occurrence. Of note, HIV was not associated with an increased risk of PDM or DM in patients with pulmonary TB in both cohorts. Moreover, in both cohorts, the TBDM-HIV group presented with a lower proportion of positive sputum smear and a higher frequency of tobacco and alcohol users. Conclusion: There is a high prevalence of dysglycemia in patients with pulmonary TB in Brazil, regardless of the HIV status. This reinforces the idea that DM should be systematically screened in persons with TB. Presence of HIV does not substantially impact clinical presentation in persons with TBDM, although it is associated with more frequent use of recreational drugs and smear negative sputum samples during TB screening.

Risk Factors for Unfavorable Treatment Outcomes among the Human Immunodeficiency Virus-Associated Tuberculosis Population in Tashkent City, Uzbekistan: 2013–2017

Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical challenge. People living with HIV have a higher chance of developing TB, and once the disease has progressed, are at greater risk of having unfavorable TB treatment outcomes. Data on TB treatment outcomes among the HIV-associated TB population in Uzbekistan are limited. Thus, we conducted a cohort study among 808 adult patients with HIV-associated TB registered at the Tashkent TB referral hospital from 2013–2017 to document baseline characteristics and evaluate risk factors for unfavorable TB treatment outcomes. The data were collected from medical records and ambulatory cards. About 79.8% of the study population had favorable treatment outcomes. Antiretroviral therapy (ART) coverage at the admission was 26.9%. Information on CD4-cell counts and viral loads were largely missing. Having extrapulmonary TB (aOR 2.21, 95% CI: 1.38–3.53, p = 0.001), positive sputum smear laboratory results on admission (aOR 1.62, 95% CI: 1.07–2.40), diabetes (aOR 5.16, 95% CI: 1.77–14.98), and hepatitis C (aOR 1.68, 95% CI: 1.14–2.46) were independent risk factors for developing unfavorable TB treatment outcomes. The study findings provide evidence for targeted clinical management in co-infected patients with risk factors. Strengthening the integration of TB/HIV services may improve availability of key data to improve co-infection management.

Tuberculosis Contact Investigations Conducted in New York City Adult Day Care and Senior Centers, 2011–2018

Objectives: Multiple tuberculosis (TB) exposures have been reported in New York City (NYC) adult day care and senior centers. Strategies to identify TB transmission at such locations are needed. Method: Review of the NYC TB Registry identified 12 contact investigations (CIs) at adult day care or senior centers (2011–2018). Results: Median age of the 12 index patients was 81 years. Of 148 contacts identified who had no history of TB infection or disease, 141 (95%) were tested for TB, primarily with interferon gamma release assays; 46 (33%) tested positive. Transmission was probable ( n = 3) or possible ( n = 1) at 4 (33%) centers; at all of these, the index patient had an acid-fast bacilli–positive sputum smear. Transmission was not found from index patients with negative sputum smears. Discussion: We found evidence of transmission of smear-positive respiratory TB disease to contacts in adult day care or senior centers, underscoring the importance of CI.

Mobile health to improve adherence to tuberculosis treatment in Khartoum state, Sudan

Although tuberculosis is a treatable disease, the high frequency of treatment default remains a challenge. The use of mobile phones structurally in a TB program has the potential to lower the frequency of default. However, it’s impact on treatment outcome in Sudan has not yet been evaluated. The aim is to evaluate the potential use of cell phones for lowering treatment default. We conducted a controlled intervention pilot study during the period from 1st of May 2017 to 31st of March 2018, in eight TB treatment units in Khartoum state, Sudan. Newly diagnosed patient with positive sputum smear on DOTS therapy were enrolled in intervention and control groups. SMS reminder were sent to the intervention group.Assessments were done at the beginning and at the end of the treatment. One hundred and forty-eight patients were enrolled, seventy-four patients in each group.The participants in the two groups were similar in demographic characteristics and behavioral and knowledge related factors about TB disease at baseline. The patients in the intervention group had a lower default rate (6.8%), higher documented cure rate (78.4%), better knowledge compared to control group. SMS reminder was useful and facilitated good interaction between patients and health personnel. Mobile texting seemed useful and was highly accepted by participants. Further evaluation of it’s potential benefit was warranted.

The Prevalence of Absolute and Functional Iron Deficiency Anemia in New Cases of Smear-positive Pulmonary Tuberculosis and Their Sputum Conversion Rate at the End of Intensive Tuberculosis Treatment Phase

About one third of the population is infected with tuberculosis (TB). On the other hand, iron deficiency is the most common micronutrient deficiency in the world. A number of studies have documented anemia in patients with TB, however, this study aimed to assess the prevalence of iron deficiency anemia (IDA) in patients with acid-fast bacilli (AFB) sputum smear-positive, and sputum conversion in these two groups of patients with absolute and functional IDA at the end of the second month of anti-TB therapy in Zahedan, Iran. The results of this study revealed that 91 out of 198 (45.9%) sputum positive pulmonary TB patients were anemic, and among those 72 (79.1%) had iron deficiency anemia. The overall prevalence of IDA in this study was 36.3%. In 72 patients with IDA, 54 (75%) had functional while the remainder had absolute IDA 18 (25%). Twenty-one out of 72 (29.2%) of patients with IDA remained sputum positive and among 126 non IDA patients 47 (37.3%) had positive sputum smear at the end of intensive TB treatment phase (p=0.278). Approximately, less than half of patients with tuberculosis had anemia among them 79% had iron deficiency anemia. The frequency of functional IDA was three times more than absolute IDA. There was no statistically significant difference in sputum conversion between two groups of IDA and non-IDA patients after intensive phase of anti-TB therapy.

Factors associated with delay in treatment initiation for pulmonary tuberculosis

BackgroundDelays in treatment initiation for tuberculosis (TB) may lead to worse clinical outcomes and increased transmission. We aimed to determine factors associated with treatment delays, to guide public health action.MethodsWe extracted data on clinical characteristics and documented potential barriers to treatment from all pulmonary TB cases with clinical case review data from 2011 to 2015 and linked these to TB surveillance data. We described the distribution of delays from symptom onset to first presentation (“presentation delay”) and from presentation to treatment (“healthcare delay”). We calculated time ratios (TRs) to determine the association between sociodemographic and clinical factors and delay outcomes.ResultsMedian presentation delay was 30 days (interquartile range (IQR) 11–72 days). Language barriers were associated with 40% longer presentation delay (TR 1.40, 1.01–1.94). Median healthcare delay was 40 days (IQR 13–89 days), and mostly consisted of the time taken before deciding to refer to TB specialists (median 26 days, IQR 4–73 days). Shorter healthcare delay was associated with positive sputum smear (TR 0.58, 0.47–0.70), UK residency <2 years (TR 0.47, 0.32–0.67), male sex (TR 0.74, 0.60–0.91) and secondary care referral (TR 0.63, 0.51–0.78).ConclusionsOur findings support continued initiatives to enable access to care for migrant populations to minimise presentation delay. Multifaceted approaches to increase clinician awareness of TB clinical presentations, to implement systems enabling early case recognition, to maximise the yield from sputum smear investigations and to ensure rapid diagnosis of smear negative cases are required to achieve further TB control.

CORRELATION BETWEEN IFN-ɤ LEVELS, CHEST RADIOGRAPHY AND THE POSITIVITY OF SMEAR SPUTUM IN NEW TB CASES AT THE DR.SOETOMO HOSPITAL

Tuberculosis is an infectious disease attacking lungs, triggering damage, and pulmonary dysfunction. Host cytokine responses will influence tuberculosis manifestations. The main host immune response is cellular immunity, and Delayed-Type Hypersensitivity (DTH). IFN-γ produced by Th-1, is a major cytokine acting to eliminate TB bacteria through macrophage activation. Chest radiography has an important value for the diagnosis of TB, especially in negative sputum smears. Radiological manifestations depend on several factors including host prior to TB exposure, age, and immune status. Sputum smear is also important in diagnosing, and assessing response to treatment of adult pulmonary TB. A cross-sectional study, comprising a total of 36 new pulmonary TB cases at the Dr.Soetomo Hospital who met the inclusion, and exclusion criteria, were establish. Plasma IFN-γ was examined by ELISA. Chest radiography was divided into three categories based on the National Tuberculosis Association of USA. Sputum smear data were taken from medical records. There were significant correlations between IFN-γ plasma levels with chest radiography (r= 0.365; ρ=0.029), IFN-γ with positive sputum smear (r= 0.447; ρ=0.006), positive sputum smear with chest radiography (r=0.674; ρ=0.001) IFN-γ plasma levels could reflect lesion area on chest radiography, and sputum smear positivity. IFN-γ plasma levels, chest radigraphy, and sputum positivity may reflect a Th-1immune response, so the more severe level of diseases, an immune response Th-1 become more activated.

FEATURES OF ADOLESCENTS TUBERCULOSIS AT A REFERRAL TB'S HOSPITAL IN TEHRAN, IRAN

OBJECTIVE: To identify the pattern of the clinical, radiological, diagnostic procedures and loss to follow -up of the diagnosed cases of active tuberculosis (TB) adolescents.METHODS: This study was a retrospective analysis of the medical records of 143 adolescents aged 10 to 18 years with tuberculosis who were admitted TB wards of National Research Institute of Tuberculosis and Lung Disease (NRITLD) in Tehran, Iran, between March 2006 and March2011. RESULTS: Of the 143 patients identified, 62.9% were females. Median age of the patients was 16 years. The contact source was identified in 47.5%.The most common presenting symptom was cough (86%).Isolated pulmonary TB (PTB) was detected in 113 patients (79%), 21 patients (14.7%) had extrapulmonary TB(EPTB), and 9 patients (6.3%) had PTB and EP TB .The most common site of EPTB was pleural (14%) .The most common radiographic finding was infiltration (61%).Positive acid fast smears were seen in 67.8%.Positive cultures for Mycobacterium tuberculosis(M. TB) were seen in 31.6%. Positive PCR results were seen in 60%.The adolescents aged 15 to 18 years were more likely to lose weight (p=0.001), smear positive (p=0.002)and have positive PCR results (p=0.009). The type of TB (p=0.017) was a significant factor influencing loss to follow-up.CONCLUSIONS: Adolescents with the high rate of positive sputum smear results and the high treatment default rate are more likely to increase risk for TB transmission to the community. The TB control programs should pay more attention to prevention and treatment of TB in adolescents. Key words: adolescents, tuberculosis, Lost to follow-up, prevention

Identifikasi Bakteri Tahan Asam (BTA) pada Pasien Suspek Tuberculosis di Puskesmas Ngronggot, Kabupaten Nganjuk, Jawa Timur

Tuberculosis (TB) is an infectious disease caused byMycobacterium tuberculosis that can invade the lungs as a primary infection which is a major health problem in developing countries. The purpose of this study to identification Acid Resistant Bacteria in patients with symptoms of tuberculosis in the region Ngronggot health center, district Nganjuk. This type of study was a descriptive study. The sample in this study is the sputum of patients with suspected tuberculosis. The study was conducted in district health centers Nganjuk Ngronggot on May 14 to June 30, 2012 were 116 patients with symptoms of cough for more than three weeks and gained 7.76% or 9 people who suffer from tuberculosis with positive sputum smear examination. And the obtained results of 92.24% or 107 people with negative sputum smear examination.