Association of Fine Particulate Matter and Residential Greenness With Risk of Pulmonary Tuberculosis Retreatment: Population-Based Retrospective Study.

Background: The evidence on the association of fine particulate matter with an aerodynamic diameter of 2.5 µm or less (PM2.5) with pulmonary tuberculosis (PTB) retreatment is limited. There are no data on whether greenness exposure protects air pollution-related PTB retreatment in patients with prior PTB. Objective: In a population-based retrospective study, we aimed to investigate the influence of PM2.5 and residential greenness on the risk of PTB retreatment. Methods: A total of 26,482 patients with incident PTB, registered in a mandatory web-based reporting system between 2012 and 2019 in Zhengzhou, China, were included in the analysis. The exposure to PM2.5 was assessed based on the China High Air Pollutants dataset, and the level of greenness was estimated using the Normalized Difference Vegetation Index (NDVI) values. The associations of PTB retreatment with exposure to PM2.5 and greenness were evaluated, respectively, considering the local socioeconomic level indicated by the nighttime light index. Results: Among the 26,482 patients (mean age 46.86, SD 19.52 years) with a median follow-up time of 1523 days per patient, 1542 (5.82%) PTB retreatments were observed between 2012 and 2019. Exposure to PM2.5 was observed to be significantly associated with the increased risk of PTB retreatment in fully adjusted models with a hazard ratio of 1.97 (95% CI 1.34-2.83) per 10 µg/m3 increase in PM2.5. Patients living in the regions with relatively high quartiles of NDVI values had a 45% lower risk of PTB retreatment than those living in the regions with the lowest quartile for the 500 m buffers (hazard ratio 0.55, 95% CI 0.40-0.77). Such a protective effect of residential greenness was more pronounced among patients living in lower nighttime light areas. The strength of the association between PM2.5 exposure and the risk of PTB retreatment was attenuated by greenness. No significant association was observed between NDVI and the incidence of drug resistance. Conclusions: Long-term exposure to PM2.5 might be a risk factor for PTB retreatment, while an increased level of residential greenness was found to be associated with reduced risks of PTB retreatment. Our results suggest strengthening the control of ambient air pollution and improving residential greenness may contribute to the reduction of PTB retreatment.

Opportunistic infections among people living with HIV/AIDS attending antiretroviral therapy clinics in Gedeo Zone, Southern Ethiopia.

INTRODUCTION: Opportunistic infections (OIs) are more common and severe among people with suppressed immunity like those living with HIV/AIDS (PLWH). This study aimed to assess the prevalence of OIs and associated factors among PLWH attending antiretroviral therapy (ART) clinics in the Gedeo zone, Southern Ethiopia. METHODS: A facility based retrospective cohort study was conducted from April to June 2018 among PLWH attending ART clinics in Gedeo zone, Ethiopia from November 2016 - November 2017. A simple random sampling method was used to select the both paper based and electronic study participants' charts. Adjusted odds ratios were calculated using multivariable logistic regression analysis for variables statistically significant at 95% confidence interval under bivariable logistic regression analysis, and significance was declared at P < 0.05. RESULTS: a total of 266 PLWH attended the selected ART clinics of Gedeo zone during the one year period were participated in the current study. The majority 104(39.1%) were within the age group 30-39, 106(60.2%) male, 184(69.2%) married, and 167(62.9%) urban residents. The study revealed the prevalence of OIs was 113(42.5%) with oral candidiasis 28(24.5%) the most prevalent followed by pulmonary tuberculosis 22(19.5%) and herpes zoster 15(13.4%). Further, study participants with ambulatory [AOR = 2.40(95% CI: 1.14, 5.03)], and bedridden [AOR = 3.27(95% CI:1.64, 6.52)] working functional status; with lower CD4 count: less than 200cells/mm3 [AOR = 9.14(95% CI: 2.75, 30.39)], 200-350cells/mm3 [AOR = 9.45(95% CI: 2.70,33.06)], 351-500cells/mm3 [AOR = 5.76(95% CI: 1.71, 19.39)]; being poor in ART adherence level [AOR = 10.05(95% CI: 4.31,23.46)]; being in stage III/IV WHO clinical stage of HIV/AIDS [AOR = 2.72(95% CI: 1.42, 5.20)]; and being chewing khat [AOR = 2.84(95% CI: 1.21, 6.65)] were found positively predicting the occurrence of OIs. CONCLUSION: This study speckled a high prevalence of OIs with several predicting factors. Therefore, the study acmes there should be interventional means which tackles the higher prevalence of OIs with focus to the predicting factors like lower CD4 count level, less/bedridden working functional status, poor ART adherence level, advanced stage of HIV/AIDS stage and chewing khat.

Xpert MTB/RIF assay in the diagnosis of pulmonary tuberculosis in children in tertiary care setting in South India.

Xpert MTB/RIF is recommended for the diagnosis of tuberculosis (TB) in children. We determined the performance of Xpert MTB/RIF in the diagnosis of pulmonary TB in children. The characteristics of children influencing Xpert MTB/RIF positivity were explored. Children aged <15 years with symptoms suggestive of pulmonary TB were prospectively enrolled from 2013 to 2019. Two sputum/early morning gastric aspirate specimens were collected for examination by smear (fluorescence microscopy), Xpert MTB/RIF, and culture [Mycobacteria growth indicator tube (MGIT)/Lowenstein-Jensen (LJ) medium]. Diagnostic performance of Xpert MTB/RIF was evaluated using LJ and or MGIT culture positivity as the reference standard. Sensitivity, specificity with 95% confidence interval (CI) were calculated. Stratified analysis was done; P < .05 was considered statistically significant. Of the total 1727 enrolled children, 1674 (97%) with complete results for at least one sputum/gastric aspirate sample were analyzed. The sensitivity of Xpert MTB/RIF was 68.5% in sputum and 53.6% in gastric aspirate while the specificity was 99% for both. The sensitivity compared to smear was 68.5% vs. 33.7% (P < .001) and 53.6% vs. 14.5%; (P < .001) in sputum and gastric aspirate, respectively. The sensitivity of Xpert MTB/RIF was 23.9% with decision to treat as reference standard. Xpert MTB/RIF positivity was significantly influenced by sex, age, nutritional status, chest X-ray abnormality, TB infection status, and symptoms suggestive of TB. Xpert MTB/RIF as an upfront test compared to smear improves diagnosis of pulmonary TB in children yet the sensitivity is suboptimal. Newer TB diagnostic tools with improved sensitivity is warranted in children.

We evaluated the performance of Xpert MTB/RIF in the diagnosis of pulmonary TB in children and explored the characteristics influencing Xpert MTB/RIF positivity. Sputum and or early morning gastric aspirate specimen was collected from children aged <15 years with symptoms suggestive of pulmonary TB. This was examined by smear (fluorescence microscopy), Xpert MTB/RIF, and culture (Mycobacteria growth indicator tube (MGIT)/Lowenstein­Jensen (LJ) medium). Diagnostic performance of Xpert MTB/RIF was evaluated using LJ and or MGIT culture positivity as the reference standard. Of the total 1727 enrolled children, 1674 (97%) with complete results for at least one sputum/gastric aspirate sample were analyzed. The sensitivity of Xpert MTB/RIF was 68.5% in sputum and 53.6% in gastric aspirate which was higher than smear and the specificity was 99%. The sensitivity of Xpert MTB/RIF was 23.9% with decision to treat for TB as reference standard. The Xpert MTB/RIF positivity was influenced by sex, age, nutritional status, chest X-ray abnormality, TB infection status, and symptoms suggestive of TB. Xpert MTB/RIF as an upfront test compared to smear improves the diagnosis of pulmonary TB in children yet the sensitivity is suboptimal. Newer TB diagnostic tools with improved sensitivity is warranted in children.

Detection of Mycobacterium tuberculosis from tongue swabs using sonication and sequence-specific hybridization capture.

Tongue swabs hold promise as a non-invasive sample for diagnosing tuberculosis (TB). However, their utility as replacements for sputum has been limited by their varied diagnostic performance in PCR assays compared to sputum. The use of silica-based DNA extraction methods may limit sensitivity due to incomplete lysis of Mycobacterium tuberculosis (MTB) cells and co-extraction of non-target nucleic acid, which may inhibit PCR. Specificity may also be compromised because these methods are labor-intensive and prone to cross-contamination. To address these limitations, we developed a sample preparation method that combines sonication for MTB lysis and a sequence-specific MTB DNA capture method using hybridization probes immobilized on magnetic beads. In spiked tongue swabs, our hybridization capture method demonstrated a 100-fold increase in MTB DNA yield over silica-based Qiagen DNA extraction and ethanol precipitation. In a study conducted on clinical samples from South Africa, our protocol had 74% (70/94) sensitivity and 98% (41/42) specificity for detecting active pulmonary TB with sputum Xpert MTB/RIF Ultra as the reference standard. While hybridization capture did not show improved sensitivity over Qiagen DNA extraction and ethanol precipitation, it demonstrated better specificity than previously reported methods and was easier to perform. With integration into point-of-care platforms, these strategies have the potential to help enable rapid non-sputum-based TB diagnosis across key underserved patient populations.

Nutritional status affects immune function and exacerbates the severity of pulmonary tuberculosis.

Aim: To comprehensively evaluate the association and impact of nutritional status and immune function on the severity of pulmonary tuberculosis (PTB). Methods: This descriptive cross-sectional study involved 952 participants who were diagnosed with active PTB. Severe PTB involves three or more lung field infections based on chest radiography. Nutritional status was evaluated using various indicators, including body mass index (BMI), the nutritional risk screening score (NRS-2002), total protein (TP), prealbumin (PA), transferrin (TRF), and serum albumin (ALB) levels and the prognostic nutritional index (PNI). Immune dysfunction was defined as a CD4+ count <500 cells/µl or a CD4+/CD8+ ratio <1. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were also calculated. Multivariate logistic and generalized linear regression were used to assess the associations between nutritional status, immune function, the severity of PTB, and the number of infected lung fields, adjusting for age, sex, and diabetes. Mediation analysis was conducted to evaluate the extent to which immune function mediated the impact of nutritional status on the severity of PTB. Sensitivity analysis was performed to enhance the robustness of the results. Results: Compared to those in the general PTB group, patients in the severe PTB group tended to be older men with diabetes. Higher nutritional risk, higher proportion of immune dysfunction and lower lymphocyte counts were observed in the severe group. BMI and the PNI were found to be protective factors, while PLR was identified as a risk factor for disease severity. Immune dysfunction and the PLR are mediators of the relationship between nutritional status and PTB severity. When BMI, the PNI, and the PLR were combined with traditional clinical indicators, these parameters showed promising diagnostic value, and the AUC reached 0.701 (95% CI: 0.668-0.734). Conclusion: The findings suggest that nutritional status is significantly associated with the severity of PTB, and immune function mediates the effects of nutritional status on the severity of PTB. Maintaining adequate BMI, PNI levels, and immune function or reducing PLR levels helps reduce the risk of severe PTB.

Modeling tuberculosis transmission flow in China, 2010-2012.

BACKGROUND: China has the third largest number of TB cases in the world, and the average annual floating population in China is more than 200 million, the increasing floating population across regions has a tremendous potential for spreading infectious diseases, however, the role of increasing massive floating population in tuberculosis transmission is yet unclear in China. METHODS: 29,667 tuberculosis flow data were derived from the new smear-positive pulmonary tuberculosis cases in China. Spatial variation of TB transmission was measured by geodetector q-statistic and spatial interaction model was used to model the tuberculosis flow and the regional socioeconomic factors. RESULTS: Tuberculosis transmission flow presented spatial heterogeneity. The Pearl River Delta in southern China and the Yangtze River Delta along China's east coast presented as the largest destination and concentration areas of tuberculosis inflows. Socioeconomic factors were determinants of tuberculosis flow. Some impact factors showed different spatial associations with tuberculosis transmission flow. A 10% increase in per capita GDP was associated with 10.2% in 2010 or 2.1% in 2012 decrease in tuberculosis outflows from the provinces of origin, and 1.2% in 2010 or 0.5% increase in tuberculosis inflows to the destinations and 18.9% increase in intraprovincial flow in 2012. Per capita net income of rural households and per capita disposable income of urban households were positively associated with tuberculosis flows. A 10% increase in per capita net income corresponded to 14.0% in 2010 or 3.6% in 2012 increase in outflows from the origin, 44.2% in 2010 or 12.8% increase in inflows to the destinations and 47.9% increase in intraprovincial flows in 2012. Tuberculosis incidence had positive impacts on tuberculosis flows. A 10% increase in the number of tuberculosis cases corresponded to 2.2% in 2010 or 1.1% in 2012 increase in tuberculosis inflows to the destinations, 5.2% in 2010 or 2.0% in 2012 increase in outflows from the origins, 11.5% in 2010 or 2.2% in 2012 increase in intraprovincial flows. CONCLUSIONS: Tuberculosis flows had clear spatial stratified heterogeneity and spatial autocorrelation, regional socio-economic characteristics had diverse and statistically significant effects on tuberculosis flows in the origin and destination, and income factor played an important role among the determinants.

Bacilli load in PTB- intestinal helminths co-infected and PTB non -infected patients at selected public health facilities in Jimma zone, Oromia, Ethiopia: comparative cross-sectional study.

BACKGROUND: Tuberculosis (TB) and intestinal helminths are diseases that pose a dual burden on public health in low-income countries. Previous studies have shown that helminths can affect the shedding of bacteria or the bacterial load in the sputum of active TB patients. However, there is limited information on bacterial load in TB patients with helminth infections. OBJECTIVE: This study aimed to compare bacterial load in helminths-infected and non-infected pulmonary tuberculosis patients at selected public health facilities in Jimma zone, Oromia, Ethiopia. METHODS: The study was conducted in Jimma Zone, Oromia, Ethiopia. A facility-based comparative cross-sectional study was employed from August 01, 2020, to January 2021. A total of 124 (55 intestinal helminths-infected and 69 non-infected) newly diagnosed smear-positive pulmonary tuberculosis (PTB) patients were included in the study. A convenience sampling technique was employed to recruit study participants, and a semi-structured questionnaire was used to collect data regarding socio-demographic characteristics and possible risk factors for intestinal helminths co-infection. Stool examination was performed using both wet mount and Kato Katz technique. Additionally, weight and height measurements, sputum, and blood samples were taken to determine body mass index, bacilli load, and diabetic mellitus, respectively. Data were entered into Epi-Data software version 3.1 and analyzed using Statistical Packages for Social Sciences (SPSS) Version 25. A statistically significant difference was defined as a P-value of less than 0.05. RESULTS: Intestinal helminths reduced bacilli load 3 times more than intestinal helminths non-infected PTB (AOR = 3.44; 95% CI; 1.52, 7.79; P = 0.003) However, diabetes mellitus, HIV, drinking alcohol and cigarette smoking were not associated with bacilli load. The rate of co-infection TB with intestinal helminths was 44%. The three most prevalent parasites detected were Trichuris trichiura 29 (66%), hookworm 19 (43%), and Ascaris lumbricoides 11(25%)). Among co-infected patients about 36 (81.8%) had a single parasite infection, and 19 (43.2%) had multiple infections. A body mass index < 18.5 (AOR = 3.26; 95% CI; 1.25, 8.56;P = 0.016) and untrimmed fingernail status (AOR = 3.63; 95%CI;1.32,9.93;P = 0.012) were significantly associated with PTB- intestinal helminth -co-infection. CONCLUSION: Helminth infection was associated with a lower bacilli load compared to helmenths non-infected PTB. The rate of co-infection TB with intestinal helminths was 44%. Trichuris trichiura was the most prevalent helminth. Untrimmed fingernail and a body mass index were associated with PTB-intestinal helminth co-infection.

Laryngeal tuberculosis, the great deceiver: A series of 10 cases.

BACKGROUND: Laryngeal involvement is rare in tuberculosis, representing around 1% of all cases of this infection worldwide. Given the larynx' location in the airway, this form of tuberculosis is of particular importance because it is highly contagious. With our hospital being in a high tuberculosis burden area, we propose to characterize the clinical presentation, evolution, and laryngoscopy findings of a series of laryngeal tuberculosis cases in order to reduce misdiagnosis. METHODS: Epidemiological and clinical data from 10 patients diagnosed with laryngeal tuberculosis in the Otorhinolaryngology department of (Blinded for manuscript) between January 2011 and December 2021 were retrieved and analyzed. RESULTS: There were eight males and two females. Seven patients had a history of smoking and alcohol abuse and four had silicosis. Hoarseness was the most reported symptom (n = 9). The most frequent site of involvement were the true vocal cords (n = 6). All patients but one had concomitant active pulmonary tuberculosis. Patients had full resolution of laryngeal symptoms between 4 and 16 weeks after initiating antituberculosis treatment. CONCLUSION: Laryngeal tuberculosis is indeed a great deceiver. On one hand it can look like a simple polypoid lesion or simulate laryngopharyngeal reflux; but on the other hand its risk factors, symptoms and appearance simulate laryngeal carcinoma like no other. Since most patients present with concomitant pulmonary tuberculosis, all suspect laryngeal lesions should perform a chest radiograph prior to rigid laryngoscopy. Antituberculosis treatment is effective in both alleviating symptoms and reducing the risk of transmission.

Sociocultural aspects of delays in diagnosis among tuberculosis-diabetes comorbid patients in Satara, India: Its implications for the implementation of the national framework for joint tuberculosis-diabetes collaborative activities.

BACKGROUND: Tuberculosis(TB) and Diabetes comorbidity is an emerging public health problem in India. Delays in diagnosing TB or Diabetes would lead to adverse outcomes among comorbid patients, and attempts must be made to reduce these delays. Against this background, the study has been undertaken to clarify the role of sociocultural factors in determining diagnostic delays for TB and Diabetes among comorbid patients. METHODS: A cross-sectional cultural epidemiological survey of the randomly selected 180 TB-Diabetes comorbid patients was carried out. The study examined sociocultural factors of delayed diagnosis of TB and Diabetes among urban and rural TB-Diabetes comorbid patients registered under TB-Diabetes collaborative activities under the National TB Elimination Programme (NTEP) in the Satara district of Maharashtra by using a semi-structured interview schedule. The patterns of distress (PDs) and perceived causes(PCs) of TB and Diabetes were compared with patients' and providers' diagnostic delays of TB and Diabetes based on prominence categories. In addition, the relationship between PDs and PCs as explanatory variables and TB and Diabetes diagnostic delays as outcome variables were assessed using stepwise multiple logistic regression. RESULTS: Of the 180 TB-Diabetes comorbid patients, the proportion of men was higher, and they were 4.7 times more likely to get a delayed Diabetes diagnosis. Those who reported side effects of drugs and stigma reduced social status as the PDs were 2-3 times more likely to delay reaching TB facilities/providers (patients' diagnostic delay). Those who perceived inadequate diet and mental-emotional stress as the causes of TB were about three times more likely to reach the TB providers/facilities after two weeks. Also, those who perceived TB as a cause of punishment for prior deeds were two times more likely to reach TB facilities/providers after two weeks. Patients who reported fever and chest pain as the symptoms of TB were two times more likely to delay the diagnosis of TB. Patients who reported tobacco consumption, unhealthy lifestyles, thoughts, worries, tension, and germs or infection as perceived causes of TB were about two times more likely to be diagnosed after two weeks. Patients who reported excessive thirst as a diabetes symptom were about two times more likely to get delayed >2 weeks to reach diabetes facilities/providers. Patients who perceived environmental/occupational exposure as the cause of Diabetes were two times more likely to reach the diabetes facilities/providers after two weeks. Patients who reported excessive thirst and stroke as the physical problems of Diabetes were 3.2 and 9.6 times more likely to get delayed in the diagnosis of Diabetes (providers' diagnostic delay). Patients who perceived violation of taboo or misbehaviour as the perceived cause of Diabetes were 6.7 times more likely to get a delayed diagnosis of Diabetes. CONCLUSIONS: The sociocultural factors associated with TB and Diabetes diagnostic delays among comorbid patients are essential considerations in the evolving context of implementing TB-Diabetes collaborative activities. Therefore, acknowledging sociocultural factors concerning delayed diagnosis and minimising delays would strengthen joint TB-Diabetes collaborative activities under the National framework locally and nationally.

Factors affecting tuberculosis treatment outcome among newly diagnosed tuberculosis patients - A longitudinal study.

BACKGROUND: Tuberculosis disease epidemiology is closely related to social and economic conditions which make its prevention, control and cure challenging. Early diagnosis and adequate treatment will help to prevent various tuberculosis related morbidities. Factors such as adverse effects of drugs, transportation cost, family support, distance to the treatment center, personal habits, co morbid conditions, and patients' multiple obligations concerning to their employment, family and society have an impact on the treatment outcomes. OBJECTIVE: To know the factors affecting tuberculosis treatment outcome among newly diagnosed tuberculosis patients. MATERIALS AND METHODS: A total of 261 Tuberculosis patients registered in NTEP under District tuberculosis centre were enrolled using universal sampling method. First follow up was done at the end of intensive phase i.e. End of 2 months. Second follow up was done after completion of treatment i.e., End of 6th month. RESULTS: Majority 59% participants were diagnosed as smear negative at 2nd month follow up and 45.21% and 28.73% participants were diagnosed as cured and treatment completed respectively at 6th month follow up. 73.95% participants had successful outcome. Multivariate logistic regression analysis showed that treatment outcomes of tuberculosis were affected by type of house (pucca house), presence of cough, past history of tuberculosis, family support, supervision by family and support of supervisor. CONCLUSION: Overall treatment success rate was 73.95%. The contributing factors for successful outcome of tuberculosis were age, past history of TB, type of house, presence of cough and fever, weight gain, family support, supervision by family and support of supervisor.

End TB strategy: Role of tobacco control.

Tobacco use and Tuberculosis (TB) presents a huge public health challenge globally. Tobacco and TB have consistent and strong epidemiological evidence with smokers having higher odds of TB infection, disease, mortality, delayed diagnosis etc. Overall, limited evidence exists about the extent of TB-tobacco integration. The aim of the current short communication is to highlight comprehensive strategy for addressing TB-tobacco comorbidities.

Enhanced diagnosis of pulmonary tuberculosis through nucleotide MALDI-TOF MS analysis of BALF: a retrospective clinical study.

To evaluate the diagnostic accuracy of matrix-assisted laser desorption ionization time-of-flight mass spectrometry based on nucleotide (nucleotide MALDI-TOF MS) on bronchoalveolar lavage fluid (BALF) from suspected pulmonary tuberculosis (PTB) patients. A retrospective study was conducted on suspected PTB patients (total of 960) admitted to Chongqing Public Health Medical Center between May 2021 and January 2022. The sensitivity, specificity, positive predictive value, negative predictive value (NPV) and area under the curve values of nucleotide MALDI-TOF MS as well as smear microscopy, Mycobacterium Growth Indicator Tube 960 culture (MGIT culture), and Xpert MTB/RIF were calculated and compared. Total of 343 presumed PTB cases were enrolled. Overall, using the clinical diagnosis as reference, the sensitivity and NPV of nucleotide MALDI-TOF MS was 71.5% and 43.1%, respectively, significantly higher than smear microscopy (22.6%, 23.2%), MGIT culture (40.6%, 18.9%), Xpert MTB/RIF (40.8%, 27.9%). Furthermore, nucleotide MALDI-TOF MS also outperformed over Xpert MTB/RIF and MGIT culture on smear-negative BALFs. Approximately 50% and 30% of patients benefited from nucleotide MALDI-TOF MS compared with smear and MGIT culture or Xpert MTB/RIF, respectively. This study demonstrated that the analysis of BALF with nucleotide MALDI-TOF MS provided an accurate and promising tool for the early diagnosis of PTB.

A study on factors influencing delayed sputum conversion in newly diagnosed pulmonary tuberculosis based on bacteriology and genomics.

Conversion of sputum from positive to negative is one of the indicators to evaluate the efficacy of anti-tuberculosis treatment (ATT). We investigate the factors associated with delayed sputum conversion after 2 or 5 months of ATT from the perspectives of bacteriology and genomics. A retrospective study of sputum conversion in sputum positive 1782 pulmonary tuberculosis (PTB) was conducted from 2021 to 2022 in Beijing, China. We also designed a case-matched study including 24 pairs of delayed-sputum-conversion patients (DSCPs) and timely-sputum-conversion patients (TSCPs), and collect clinical isolates from DSCPs before and after ATT and initial isolates of TSCPs who successfully achieved sputum conversion to negative after 2 months of ATT. A total of 75 strains were conducted drug sensitivity testing (DST) of 13 anti-TB drugs and whole-genome sequencing (WGS) to analyze the risk factors of delayed conversion and the dynamics changes of drug resistance and genomics of Mycobacterium tuberculosis (MTB) during ATT. We found TSCPs have better treatment outcomes and whose initial isolates show lower levels of drug resistance. Clinical isolates of DSCPs showed dynamically changing of resistance phenotypes and intra-host heterogeneity. Single nucleotide polymorphism (SNP) profiles showed large differences between groups. The study provided insight into the bacteriological and genomic variation of delayed sputum conversion. It would be helpful for early indication of sputum conversion and guidance on ATT.

Prognostic analysis of destroyed-lung patients with preoperative massive hemoptysis: a 20-year retrospective study.

BACKGROUND: Surgery is the main treatment option for destroyed-lung (DL) patients with life-threatening massive hemoptysis. However, short-term and long-term surgical safety and efficacy are unclear, prompting this study. METHODS: Data from 124 DL patients undergoing surgery between November 2001 and January 2022 at Beijing Chest Hospital were retrospectively analyzed. Data of the DL group (82 cases) and DL + massive hemoptysis group (42 cases) were compared with regard to clinical characteristics, long-term postoperative residual lung reinfection. RESULTS: As compared with DL group rates, The DL + massive hemoptysis group had greater incidence rates of postoperative complications, invasive postoperative respiratory support, long-term postoperative residual lung reinfection, and postoperative tuberculosis recurrence. Revealed risk factors for postoperative complications (Extent of lung lesion resection), postoperative invasive respiratory therapy (preoperative Hb < 9 g/L, severe intraoperative hemoptysis), and postoperative long-term residual lung reinfection (DL with massive hemoptysis). CONCLUSIONS: DL patients with massive hemoptysis had greater rate of invasive respiratory support therapy and postoperative complications. Extensive lesion removal, preoperative anaemia, severe intraoperative bleeding associated with recent postoperative complications for the patient.

Spatiotemporal analysis of tuberculosis in the Hunan Province, China, 2014-2022.

Background: Pulmonary tuberculosis (PTB) is a major infectious disease that threatens human health. China is a high tuberculosis-burden country and the Hunan Province has a high tuberculosis notification rate. However, no comprehensive analysis has been conducted on the spatiotemporal distribution of PTB in the Hunan Province. Therefore, this study investigated the spatiotemporal distribution of PTB in the Hunan Province to enable targeted control policies for tuberculosis. Methods: We obtained data about cases of PTB in the Hunan Province notified from January 2014 to December 2022 from the China Information System for Disease Control and Prevention. Time-series analysis was conducted to analyze the trends in PTB case notifications. Spatial autocorrelation analysis was conducted to detect the spatial distribution characteristics of PTB at a county level in Hunan Province. Space-time scan analysis was conducted to confirm specific times and locations of PTB clustering. Results: A total of 472,826 new cases of PTB were notified in the Hunan Province during the 9-year study period. The mean PTB notification rate showed a gradual, fluctuating downward trend over time. The number of PTB notifications per month showed significant seasonal variation, with an annual peak in notifications in January or March, followed by a fluctuating decline after March, reaching a trough in November or December. Moran's I index of spatial autocorrelation revealed that the notification rate of PTB by county ranged from 0.117 to 0.317 during the study period, indicating spatial clustering. The hotspot areas of PTB were mainly concentrated in the Xiangxi Autonomous Prefecture, Zhangjiajie City, and Hengyang City. The most likely clustering region was identified in the central-southern part of the province, and a secondary clustering region was identified in the northwest part of the province. Conclusion: This study identified the temporal trend and spatial distribution pattern of tuberculosis in the Hunan Province. PTB clustered mainly in the central-southern and northwestern regions of the province. Disease control programs should focus on strengthening tuberculosis control in these regions.

PneumoniaCheck, a novel aerosol collection device, permits capture of airborne Mycobacterium tuberculosis and characterisation of the cough aeromicrobiome in people with tuberculosis.

BACKGROUND: Tuberculosis (TB), a major cause of disease and antimicrobial resistance, is spread via aerosols. Aerosols have diagnostic potential and airborne-microbes other than Mycobacterium tuberculosis complex (MTBC) may influence transmission. We evaluated whether PneumoniaCheck (PMC), a commercial aerosol collection device, captures MTBC and the aeromicrobiome of people with TB. METHODS: PMC was done in sputum culture-positive people (≥ 30 forced coughs each, n = 16) pre-treatment and PMC air reservoir (bag, corresponding to upper airways) and filter (lower airways) washes underwent Xpert MTB/RIF Ultra (Ultra) and 16S rRNA gene sequencing (sequencing also done on sputum). In a subset (n = 6), PMC microbiota (bag, filter) was compared to oral washes and bronchoalveolar lavage fluid (BALF). FINDINGS: 54% (7/13) bags and 46% (6/14) filters were Ultra-positive. Sequencing read counts and microbial diversity did not differ across bags, filters, and sputum. However, microbial composition in bags (Sphingobium-, Corynebacterium-, Novosphingobium-enriched) and filters (Mycobacterium-, Sphingobium-, Corynebacterium-enriched) each differed vs. sputum. Furthermore, sequencing only detected Mycobacterium in bags and filters but not sputum. In the subset, bag and filter microbial diversity did not differ vs. oral washes or BALF but microbial composition differed. Bags vs. BALF were Sphingobium-enriched and Mycobacterium-, Streptococcus-, and Anaerosinus-depleted (Anaerosinus also depleted in filters vs. BALF). Compared to BALF, none of the aerosol-enriched taxa were enriched in oral washes or sputum. INTERPRETATION: PMC captures aerosols with Ultra-detectable MTBC and MTBC is more detectable in aerosols than sputum by sequencing. The aeromicrobiome is distinct from sputum, oral washes and BALF and contains differentially-enriched lower respiratory tract microbes.

[The expression of T cell costimulatory molecules and the proportion of NK cells in peripheral blood of patients with pulmonary tuberculosis].

Objective To investigate the levels of costimulator molecules CD28, CD152/CTLA4, PD-1 and NK cells in peripheral blood of patients with pulmonary tuberculosis (PTB), and to explore the activation of T cell subsets and function of NK cell in PTB patients, as well as the role of T cell costimulatory signaling molecules in the pathogenesis of PTB. Methods Thirty-two PTB patients (PTB group) and 15 health examiners (control group) were recruited.The expression of CD28 and CD152 on peripheral blood T lymphocytes was detected by flow cytometry. The relationship between the two group was analyzed using receiver operating characteristic (ROC) curves. The expression of PD-1 on regulatory T cells (Tregs) and the proportion of NK cells in peripheral blood were detected by flow cytometry. Results Compared with the control group, the proportions of CD8+CD28+ T cells and CD8+CD152+ T cells were significantly lower in the PTB group.The ROC curve showed that the variable CD8+CD152+ T cell proportion had some predictive value in PTB (AUC=0.800, CI=0.664-0.936). The proportions of CD4+CD28+ T cells and CD4+CD152+T cells had no predictive value. There was a positive correlation between CD4+CD28+ T cells and CD8+CD28+ T cells in PTB group (r=0.563). Compared with the control group, the proportion of NK cells was significantly reduced in the PTB group. Conclusion The proportions of CD8+CD152+ T cells, CD8+CD28+ T cells, and NK cells significantly reduced in PTB patients.

Successful Mycobacterium tuberculosis culture isolation from tongue swabs: Results from both experimentally infected and clinical swabs from pulmonary tuberculosis patients.

This study explored Mycobacterium tuberculosis (MTB) growth from tongue swabs, both experimentally infected after sampling from healthy controls, or sampled from patients with smear-microscopy confirmed pulmonary tuberculosis (PTB). For both, we evaluated the performance of NALC-NaOH/MGIT960 (MGIT), Kudoh-Ogawa (KO), and cetylpyridinium chloride-Löwenstein-Jensen (CPC/LJ) culture processing methods. Experimentally spiked swabs from 20 participants exhibited 94.4% MTB growth when inoculated within 7 days of CPC exposure, declining significantly after 14-21 days (p<0.00001). KO-processed specimens showed 100% MTB growth, with a non-significant reduction after storage (94.1%; p=0.21), and all spiked swabs yielded growth in MGIT. In the field evaluation on 99 PTB patients, MGIT isolated MTB from 89% of tongue swabs, with an 8% contamination rate, compared to 99% MGIT positivity from sputum. Solid media had lower positivity, 62% for KO and 49% for CPC/LJ, suggesting MGIT as optimal for growing MTB from tongue swabs. Further testing of presumptive PTB patients is recommended.

Initial Misdiagnosis of Lung Cancer due to Elevated Carcinoembryonic Antigen in a Patient with Tuberculosis.

BACKGROUND: Tuberculosis often presents on imaging in the form of a solitary nodule, sometimes accompanied by elevated CEA, which is clinically difficult to differentiate from lung cancer and prone to misdiagnosis. METHODS: Lung tissue taken by lung biopsy and sent for NGS and Xpert MTB/RIF finally led to the definitive diag-nosis of nodular foci in the upper lobe of the left lung caused by tuberculosis. RESULTS: Enhanced CT of the chest showed nodular foci in the upper lobe of the left lung. Initially the nodules were thought to be malignant, but after a series of tests, were finally confirmed to be tuberculosis. CONCLUSIONS: In patients with lung disease, when chest imaging reveals a space-occupying lesion accompanied by an elevated CEA level, a comprehensive analysis of the type of lung disease, the patient's age, and comorbidities should be performed before final diagnosis to avoid misdiagnosis and delay in appropriate treatment.