Era of TB elimination: Growing need to understand diversities of Mycobacterium tuberculosis lineages!

INTRODUCTION: The mycobacterium tuberculosis complex (MTBC) has highly clonal population structure which made the organism spread globally mirroring human migration out of Africa and resulted in the formation of seven lineages. We conducted this study to determine the proportion of spoligotype lineages and drug susceptibility profile of Mycobacterium tuberculosis isolates among smear positive TB patients attending a tertiary care hospital in Mysore, Karnataka, India. METHODS: It is a descriptive study conducted at JSS Hospital a tertiary care centre at Mysore, India during 2018-19. The sputum smear positive samples were subjected to solid culture and drug susceptibility testing and spoligotyping for identification of lineages. RESULTS: Of the 100 samples which were culture positive, 94 isolates were clustered into five spoligotype international types with SIT-126 (EAI-5) being the largest cluster of 46 (46%) isolates, followed by SIT-62 (H1) with 24 (24%), SIT -26 (CAS 1-DELHI) with 20 (20%), SIT-53 (T1) with 03 (3%) and SIT-482 (BOV-1) with 01 (1%). Among the remaining six isolates, two had unique Cameroon spoligotypes and four were orphans CONCLUSION: The study finding reveals that a diverse pattern of genotypes is circulating in the region of which EAI-5, Harleem (H1) and CAS-DELHI pattern forms the majority (88%). It is evident that there is a wide range of MTB genetic lineages in circulation and further research is needed to understand the diversity across the country.

The prevalence of stress, stressors and coping mechanisms and the socio-demographic factors associated among the auto-rickshaw drivers in Bengaluru city, India.

CONTEXT: Socio-demographic and environmental factors attribute to stress for auto-rickshaw driver leading to compromise of driver and passenger safety. AIMS: This study assesses the prevalence and socio-demographic factors associated with stress and identifies the stressors and coping mechanisms in auto-rickshaw drivers. SETTINGS AND DESIGN: A cross-sectional study was conducted amongst 140 randomly selected auto-rickshaw drivers in Bengaluru city, India. METHODS AND MATERIAL: Data was collected at a place and time convenient to the study participants using semi-structured pre-tested tool. Stress was assessed using Cohen's Perceived Stress Scale. STATISTICAL ANALYSIS: Data was entered and analyzed using Epi Info™ software. Two sample t/ANOVA tests were used to compare the difference in means and standard deviations (SD) between the sub-groups. P <0.05 was considered statistically significant. RESULTS: Mean age of the auto-rickshaw drivers was 32.8 ± 8.3 years, majority belonged to the 25-30 years age-group. About 55.7%, 40.7% and 28.7% were consuming tobacco products, alcohol and some both, respectively. While the prevalence of self-reported stress was 76.4% (n = 107), 78.6% (n = 110) had stress based on Perceived Stress Scale (PSS) assessment. Mean PSS for participants self-reporting stress was 20.51 ± 5.25 as against 12.36 ± 4.98 who did not (P < 0.001). The mean PSS was 17.55 ± 4.13, 20.65 ± 5.23 and 23 ± 5.12 among those who self-reported having mild-, moderate- and severe-degree stress, respectively (P < 0.001). There was no significant association of any socio-demographic factors with the PSS score. Financial problems (n = 51; 47.7%) was the leading stressor, followed by road traffic (n = 49; 45.8%). Conclusions: Appropriate strategies are needed to address the high level of stress among auto-rickshaw drivers.

Sputum smear microscopy at two months into continuation-phase: should it be done in all patients with sputum smear-positive tuberculosis?

BACKGROUND: The Revised National Tuberculosis Control Program (RNTCP) of India recommends follow-up sputum smear examination at two months into the continuation phase of treatment. The main intent of this (mid-CP) follow-up is to detect patients not responding to treatment around two-three months earlier than at the end of the treatment. However, the utility of mid-CP follow-up under programmatic conditions has been questioned. We undertook a multi-district study to determine if mid-CP follow-up is able to detect cases of treatment failures early among all types of patients with sputum smear-positive TB. METHODOLOGY: We reviewed existing records of patients with sputum smear-positive TB registered under the RNTCP in 43 districts across three states of India during a three month period in 2009. We estimated proportions of patients that could be detected as a case of treatment failure early, and assessed the impact of various policy options on laboratory workload and number needed to test to detect one case of treatment failure early. RESULTS: Of 10055 cases, mid-CP follow-up was done in 6944 (69%) cases. Mid-CP follow-up could benefit 117/8015 (1.5%) new and 206/2040 (10%) previously-treated sputum smear-positive cases by detecting their treatment failure early. Under the current policy, 31 patients had to be tested to detect one case of treatment failure early. All cases of treatment failure would still be detected early if mid-CP follow-up were discontinued for new sputum smear-positive cases who become sputum smear-negative after the intensive-phase of treatment. This would reduce the related laboratory workload by 69% and only 10 patients would need to be tested to detect one case of treatment failure early. CONCLUSION: Discontinuation of mid-CP follow-up among new sputum smear-positive cases who become sputum smear-negative after completing the intensive-phase of treatment will reduce the laboratory workload without impacting overall early detection of cases of treatment failure.