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1.
Pediatr Clin North Am ; 69(1): 19-45, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34794675

RESUMO

Childhood tuberculosis (TB) has been underreported and underrepresented in TB statistics across the globe. Contributing factors include health system barriers, diagnostic barriers, and community barriers leading to an underdetected epidemic of childhood tuberculosis. Despite considerable progress in childhood TB management, there is a concerning gap in policy and practice in high-burden countries leading to missed opportunities for active case detection, early diagnosis and treatment of TB exposure, and infection and disease in children regardless of human immunodeficiency virus status. Bridging this gap requires multisectoral coordination and political commitment along with an eye to research and innovation with potential to scale.


Assuntos
Tuberculose/diagnóstico , Tuberculose/epidemiologia , Vacina BCG/uso terapêutico , Criança , Pré-Escolar , Epidemias , Feminino , Saúde Global , Política de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Fatores de Risco , Teste Tuberculínico/métodos , Tuberculose/prevenção & controle , Tuberculose Pulmonar/epidemiologia
2.
PLoS One ; 16(12): e0261688, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34962944

RESUMO

BACKGROUND: Understanding health delivery service from a patient´s perspective, including factors influencing healthcare seeking behaviour, is crucial when treating diseases, particularly infectious ones, like tuberculosis. This study aims to trace and contextualise the trajectories patients pursued towards diagnosis and treatment, while discussing key factors associated with treatment delays. Tuberculosis patients' pathways may serve as indicator of the difficulties the more vulnerable sections of society experience in obtaining adequate care. METHODS: We conducted 27 semi-structured interviews with tuberculosis patients attending a treatment centre in a suburban area of Lisbon. We invited nationals and migrant patients in active treatment to participate by sharing their illness experiences since the onset of symptoms until the present. The Health Belief Model was used as a reference framework to consolidate the qualitative findings. RESULTS: By inductive analysis of all interviews, we categorised participants' healthcare seeking behaviour into 4 main types, related to the time participants took to actively search for healthcare (patient delay) and time the health system spent to diagnose and initiate treatment (health system delay). Each type of healthcare seeking behaviour identified (inhibited, timely, prolonged, and absent) expressed a mindset influencing the way participants sought healthcare. The emergency room was the main entry point where diagnostic care cascade was initiated. Primary Health Care was underused by participants. CONCLUSIONS: The findings support that healthcare seeking behaviour is not homogeneous and influences diagnostic delays. If diagnostic delays are to be reduced, the identification of behavioural patterns should be considered when designing measures to improve health services' delivery. Healthcare professionals should be sensitised and perform continuous capacity development training to deal with patients´ needs. Inhibited and prolonged healthcare seeking behaviour contributes significantly to diagnostic delays. These behaviours should be detected and reverted. Timely responses, from patients and the healthcare system, should be promoted.


Assuntos
Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/terapia , Tuberculose/epidemiologia , Tuberculose/terapia , Adulto , Alcoolismo/complicações , Atitude Frente a Saúde , Complicações do Diabetes , Feminino , Infecções por HIV/complicações , Comportamentos Relacionados com a Saúde , Disparidades em Assistência à Saúde , Humanos , Masculino , Portugal/epidemiologia , Atenção Primária à Saúde , Pesquisa Qualitativa , Projetos de Pesquisa , Fumar , Tempo para o Tratamento , Tabagismo/complicações , Migrantes , Populações Vulneráveis
3.
PLoS One ; 16(12): e0261454, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34972122

RESUMO

BACKGROUND: Human immunodeficiency virus (HIV) infected individuals are prone to opportunistic infections (OIs) due to HIV mediated immune suppression. When opportunistic infections occur in the form of relapse or reinfection, it is said to be reoccurrence. This study was aimed to assess Incidence and predictors of reoccurrence of opportunistic infections among adult people living with HIV (PLHIV) attending ART clinics in Arba Minch Town, Southern Ethiopia. METHODS: This retrospective cohort study was conducted on 450 HIV/AIDS patients attending anti-retro viral therapy (ART) clinics in Arba Minch town, southern Ethiopia. Simple random sampling technique was used. Kaplan-Meier graph and log rank test were used for group wise comparison. Bivariate and multivariable Cox Proportional Hazard Regression model were used to identify independent predictors of reoccurrence of opportunistic infection. RESULT: One hundred nineteen HIV/AIDS patient had reoccurrence of opportunistic infection. The incidence rate was 11.5 per 1000 person months. The mean time of reoccurrence was 56 months. One of the most reoccurred OIs was pulmonary tuberculosis (PTB). Predictors that were associated significantly were recent cell differentiation 4 (CD4) count, recent body mass index (BMI), recent functional status, and duration on anti-retroviral therapy (ART). CONCLUSION: Though the incidence rate of OIs decreased from previous findings, attention should be given to HIV patients with low CD4 count, low BMI and for those bedridden patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/fisiopatologia , Antirretrovirais/uso terapêutico , Infecções por HIV/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Índice de Massa Corporal , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/citologia , Diarreia/complicações , Diarreia/epidemiologia , Etiópia/epidemiologia , Feminino , Herpes Zoster/complicações , Herpes Zoster/epidemiologia , Humanos , Incidência , Masculino , Meningite Criptocócica/complicações , Meningite Criptocócica/epidemiologia , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Classe Social , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/epidemiologia , Síndrome de Emaciação/complicações , Síndrome de Emaciação/epidemiologia
4.
Wiad Lek ; 74(10 pt 1): 2433-2438, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34897000

RESUMO

OBJECTIVE: The aim: To study the structure of clinical forms of tuberculosis (TB) which are combined with the comorbidities, to prevent the development, and to improve the diagnostics of TB among children with nonspecific diseases. PATIENTS AND METHODS: Materials and methods: A retrospective, selective research of 330 cards of children for the age group from 0 to 15 years old who were treated on local forms of pulmonary and extrapulmonary TB in a specialized pediatric department for the last 30 years was conducted. RESULTS: Results: Among 92.9 % children with comorbidities, the specific process of respiratory system was detected. Every seventh child has developed generalized forms of pulmonary TB. 43.8 % of children had extrapulmonary TB. In the structure of comorbidities among children with extrapulmonary TB were observed iron deficiency anemia, the diseases of digestive and endocrine systems, malnutrition, cachexia and rickets. The iron deficiency anemia was accompanied by TB of the peripheral LN and TB of the CNS. TB of the rare localization and TB of the CNS were combined with diseases of the digestive system. At pulmonary TB were detected infectious and parasitic diseases. The concomitant pathology of the respiratory and cardiovascular systems was often detected with the TB of intrathoracic LN, and concomitant pathology of the eyes, ears and CNS - with primary tuberculosis complex. The variety of comorbidities and extrapulmonary TB has led to the diagnostic errors and prolonged stay of children in several somatic hospitals. CONCLUSION: Conclusions: To prevent the development of TB among children with non-specific diseases, it is necessary to strengthen anti-TB measures among them.


Assuntos
Tuberculose Pulmonar , Tuberculose , Adolescente , Criança , Pré-Escolar , Comorbidade , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia
5.
Georgian Med News ; (320): 70-76, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34897048

RESUMO

Among 256 patients examined, 145 were diagnosed with multidrug-resistant pulmonary TB: 67 children and 78 teenagers from the focies with the multidrug-resistant TB (the main group), and 111 patients (35 children and 76 teenagers) from the focies with a chemosensitive TB (the control group). Molecular genetic testing of sputum, including the GeneXpert MTB / RIF method and the Hain Lifesciences linear probe analysis, was used to diagnose MRTB. It was found that the pulmonary TB was by 4.7 times more often revealed among the children under 1 year old (23.8%) and among a half of the children under 4 years old (59.6%) being from the focies with the multidrug-resistant TB (the maint group) as compared to those being from the localities with the drug-susceptible TB (the control group). At the same time, 17-year old teenagers prevailed in the main group. The teenagers from the main group were by 1.6 times more often diagnosed with MDR-TB/RifTB than the children, while the risk of MDR-TB was by 3.7 times more often detected among the children. Pre-extensive drug resistance was detected in 5.0% cases (1 child) and extensive drug resistance was also revealed in 5.0% cases (1 child), both pre-extensive drug resistance and extensive drug resistance were by 2 times more often revealed among the teenagers. The microbiological study of sputum for the susceptibility/resistance of the mycobacterium tuberculous strains showed that the resistance to HRS and HR combinations was more often revealed among the children (by 3.5 and 2.7 times correspondingly) than among the teenagers, while the resistance to HRESZ and HRES was revealed less often (by 2.7 and 1.6 times correspondingly). The children from the focies with the multidrug-resistant TB infection were diagnosed with the miliary TB (by 3.4 times), fibrous-cavernous pulmonary TB(by 2 times) and disseminated TB (by 1.4 times) more often than in the control group. Meningocephalitis (4.9% - 4) and caseous pneumonia (2.9% - 2) were detected only in the main group of children. The teenagers were statistically more often diagnosed with the fibrous-cavernous TB (by 3.5 times), miliary TB (by 2.5 times) and caseous pneumonia (by 2.3 times), while the infiltrative TB was by 1.7 times less often revealed as compared to the control group. Most of the infected children (65.6%) and teenagers (61.5%) from the main group were diagnosed after visiting their family physicians. The moderate state was evident in 35.8% cases (24 children) and the severe state was revealed in 46.3% cases (31 children) in the main group. The frequent TB forms were detected among the children (44.7%) and teenagers (59.0%), however, the moderate and severe states were revealed among the children by 1.3 times more often than among the teenagers.


Assuntos
Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose Pulmonar , Tuberculose , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Mycobacterium tuberculosis/genética , Escarro , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
6.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(12): 2164-2169, 2021 Dec 10.
Artigo em Chinês | MEDLINE | ID: mdl-34954981

RESUMO

Objective: To evaluate the detection of MDR-TB and XDR-TB patients and to provide evidence for further improvement of MDR-TB and XDR-TB screening strategy. Methods: Patients who were under drug resistance surveillance, registered and reported by the TB Management Information System of the Chinese Disease Prevention and Control Information System from 2012 to 2019 and resided in Guizhou province were retrospectively analyzed. The contribution of five high-risk subgroups to detection of MDR/XDR-TB were evaluated using population attributable risk proportion (PARP). Results: Of the 18 506 cases under drug resistance surveillance, patients who were male, aged between 25 and 54 years, with drug-resistant TB or with MDR/XDR-TB accounted for 68.65% (12 705/18 506), 47.69% (8 826/18 506), 15.90% (2 943/18 506) or 5.42% (1 003/18 506), respectively. Five high-risk subgroups made significant contributions to the detection of MDR/XDR-TB with a PARP of 57.00%. Specifically, the PARP were 21.70%, 19.49%, 11.90% and 2.30% for patients that were relapse and return, failed initial treatment, chronic/retreatment failure and smear-positive at the end of the second or third month, respectively. The detection rate of MDR/XDR-TB in high-risk groups was 15.89% (578/3 637) while in low-risk groups was 2.86% (425/14 869). Conclusions: Number of patients under drug resistance surveillance and the detection of MDR/XDR-TB trended to increase in Guizhou province from 2012 to 2019. The detection rate of MDR/XDR-TB in high-risk groups was higher than low-risk groups.


Assuntos
Tuberculose Extensivamente Resistente a Medicamentos , Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose Pulmonar , Adulto , Antituberculosos/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
7.
PLoS One ; 16(12): e0261849, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34962960

RESUMO

BACKGROUND: Tuberculosis (TB) and COVID-19 pandemics are both diseases of public health threat globally. Both diseases are caused by pathogens that infect mainly the respiratory system, and are involved in airborne transmission; they also share some clinical signs and symptoms. We, therefore, took advantage of collected sputum samples at the early stage of COVID-19 outbreak in Ghana to conduct differential diagnoses of long-standing endemic respiratory illness, particularly tuberculosis. METHODOLOGY: Sputum samples collected through the enhanced national surveys from suspected COVID-19 patients and contact tracing cases were analyzed for TB. The sputum samples were processed using Cepheid's GeneXpert MTB/RIF assay in pools of 4 samples to determine the presence of Mycobacterium tuberculosis complex. Positive pools were then decoupled and analyzed individually. Details of positive TB samples were forwarded to the NTP for appropriate case management. RESULTS: Seven-hundred and seventy-four sputum samples were analyzed for Mycobacterium tuberculosis in both suspected COVID-19 cases (679/774, 87.7%) and their contacts (95/774, 12.3%). A total of 111 (14.3%) were diagnosed with SARS CoV-2 infection and six (0.8%) out of the 774 individuals tested positive for pulmonary tuberculosis: five (83.3%) males and one female (16.7%). Drug susceptibility analysis identified 1 (16.7%) rifampicin-resistant tuberculosis case. Out of the six TB positive cases, 2 (33.3%) tested positive for COVID-19 indicating a coinfection. Stratifying by demography, three out of the six (50%) were from the Ayawaso West District. All positive cases received appropriate treatment at the respective sub-district according to the national guidelines. CONCLUSION: Our findings highlight the need for differential diagnosis among COVID-19 suspected cases and regular active TB surveillance in TB endemic settings.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Coinfecção/diagnóstico , Coinfecção/epidemiologia , Mycobacterium tuberculosis/genética , Pandemias/prevenção & controle , SARS-CoV-2/genética , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , Antibióticos Antituberculose/farmacologia , COVID-19/prevenção & controle , COVID-19/virologia , Coinfecção/virologia , Diagnóstico Diferencial , Farmacorresistência Bacteriana/efeitos dos fármacos , Feminino , Gana/epidemiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/efeitos dos fármacos , Rifampina/farmacologia , Escarro/microbiologia , Tuberculose Pulmonar/microbiologia
8.
Int J Mycobacteriol ; 10(4): 364-372, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34916453

RESUMO

Background: One-third of tuberculosis (TB) cases are missed each year and delays in the diagnosis of TB are hampering the whole cascade of care. Early chest X-ray (CXR) in patients with cough irrespective of duration may reduce TB diagnostic and treatment delays and increase the number of TB patients put into TB care. We aimed to evaluate the impact of CXR on delay in the diagnosis of pulmonary tuberculosis (PTB) among people with cough of any duration. Methods: A facility-based cross-sectional study was conducted in four selected health facilities from two regions and two city administrations of Ethiopia. Patients who sought health care were screened for cough of any duration, and those with cough underwent CXR for PTB and their sputum specimens were tested for microbiological confirmation. Delays were followed up and calculated using median and inter-quartile range (IQR) to summarize (first onset of cough to first facility visit, ≥15 days), diagnosis delay (first facility visit to date of PTB diagnosis, >7 days), and total delay (first onset of cough to date of PTB diagnosis, >21 days). Kruskal-Wallis and Mann-Witney tests were used to compare the delays among independent variables. Results: A total of 309 PTB cases were consecutively diagnosed of 1853 presumptive TB cases recruited in the study that were identified from 2647 people who reported cough of any duration. The median (IQR) of patient delay, diagnosis delay, and the total delay was 30 (16-44), 1 (0-3), and 31 (19-48) days, respectively. Patients' delay contributed a great role in the total delay, 201/209 (96.2%). Median diagnosis delay was higher among those that visited health center, diagnosed at a facility that had no Xpert mycobacterium tuberculosis (MTB)/RIF assay, radiologist, or CXR (P < 0.05). Factors associated with patients delay were history of previous TB treatment (adjusted prevalence ratio [aPR] = 0.79, 95% confidence interval [CI]: 0.63-0.99) and history of weight loss (aPR = 1.12; 95% CI: 1.0-1.25). Early CXR screening for cough of <2 weeks duration significantly reduced the patients' delay and thus the total delay, but not diagnostic delay alone. Conclusion: Early screening using CXR minimized delays in the diagnosis of PTB among people with cough of any duration. Patients' delay was largest and contributed great role in the delay of TB cases. Screening by cough of any duration and/or CXR among people seeking healthcare along with ensuring the availability of Xpert MTB/RIF assay and skilled human power at primary healthcare facilities are important to reduce patient and diagnostic delays of PTB in Ethiopia.


Assuntos
Mycobacterium tuberculosis , Tuberculose Pulmonar , Estudos Transversais , Etiópia/epidemiologia , Humanos , Radiografia , Escarro , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/epidemiologia
9.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(7): 1240-1245, 2021 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814538

RESUMO

Objective: To understand the spatiotemporal distribution of pulmonary tuberculosis (TB) and influencing factors in Beijing from 2008 to 2018. Methods: The incidence data of pulmonary TB in Beijing from 2008 to 2018 were from Tuberculosis Information Management System of Chinese Disease Prevention and Control Information System. Software ArcGIS 10.2 was used to visualize the spatiotemporal distribution of pulmonary TB incidence. Getis's Gi* statistic was applied to analyze the spatial clustering of pulmonary TB incidence at street/township scale. Bayesian spatiotemporal model was applied to analyze factors affecting its spatiotemporal distribution, including urbanization rate, GDP per capita, number of hospital beds per thousand population, permanent migrant population and population density. Results: The reported pulmonary TB incidence showed a downward trend in the past 11 years in Beijing, from 58.64/100 000 to 30.43/100 000. The incidences were higher in Tongzhou, Changping and other newly developed urban districts, with the hot spots concentrated in local areas of these districts. The incidences of pulmonary TB were lower in Dongcheng, Xicheng and other old urban districts-with the cold spots also concentrated in these area. The risk for the incidence of pulmonary TB was associated with the urbanization rate and the permanent migrant population. For every 1% increase in the urbanization rate, the relative risk of pulmonary TB would increase by 1%. For every 10 000 person increase of permanent migrant population, the relative risk of pulmonary TB would increase by 0.6%. Conclusions: In Beijing, the current pulmonary TB prevention and control needs to be focused on the newly developed urban areas. Due to the accelerated process of urbanization, it is necessary to strengthen TB prevention and control in permanent migrant population to reduce the incidence of TB in Beijing.


Assuntos
Tuberculose Pulmonar , Tuberculose , Teorema de Bayes , Pequim , China/epidemiologia , Humanos , Incidência , Análise Espaço-Temporal , Tuberculose Pulmonar/epidemiologia
10.
PLoS One ; 16(10): e0242446, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34637447

RESUMO

BACKGROUND: Mycobacterium tuberculosis (TB) is the deadliest disease that claims millions of deaths globally. Ethiopia is among the countries heavily hit by the disaster. Despite the effective directly observed treatment and TB infection control (TBIC) measures provided by the world health organization (WHO), the rate of new cases increased daily throughout the country. Healthcare workers (HCWs) are at highest risk serving without having the necessary facility in place while overcrowding of patients exacerbated TB transmission. The study aimed to assess TBIC implementation and analyze case notification rate (CNR) of smear-positive pulmonary TB in the selected health facilities at Dale district, Sidama Zone, Southern Ethiopia. METHODS: Seven health care facilities have been visited in the study area and smear-positive pulmonary TB notification rate was determined retrospectively during the years 2012 to 2014. Data on smear positive test results and demographic characteristics were collected from the TB unit registries. A structured questionnaire, facility survey, and observation checklists were used to assess the presence of TBIC plans at the health care facilities. RESULTS: The overall case notification rate of smear-positive pulmonary tuberculosis was 5.3% among all 7696 TB suspected patients. The odds of being diagnosed with smear-positive TB were 24% more in males than in females (adj OR = 1.24, 95% CI: (1.22, 1.55). Moreover, in the study area, only 28% of the facilities have been practiced TB infection control and 71% of the facilities assigned a focal person for the TBIC plan. The implementation of environmental control measures in the facilities was ranged between 16-83%. N95 particulate respirators were found only in 14% of the facilities. CONCLUSION: TB CNR in Dale district was low. Moreover, implementations of TBIC in Dale district health facilities were poor when the survey was done. Hence, urgent measures should be taken to reverse the burden of TB.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/prevenção & controle , Adolescente , Adulto , Criança , Pré-Escolar , Etiópia/epidemiologia , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/patogenicidade , Estudos Retrospectivos , Inquéritos e Questionários , Organização Mundial da Saúde , Adulto Jovem
11.
PLoS One ; 16(10): e0247245, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34610012

RESUMO

BACKGROUND: Tuberculosis (TB) prevalence surveys add to the active case detection in the community level burden of TB both national and regional levels. The aim of this study was to assess the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB) in the community. METHODS: Household community-based tuberculosis disease survey was conducted targeting 69054 population from 43 villages of 5 blocks in Tiruvallure district adopting cluster sampling methodology of ≥15 years old adult rural population of South India during 2015-2018. All eligible individuals with suspected symptoms of PTB were screened with chest X-ray. Two sputum specimens (one spot and the other early morning sample) were collected for M.tb smear and culture examination. Conversely demographical, smoking and alcohol drinking habits information were also collected to explore the risk factor. Stepwise logistic regression was employed to associate risk factors for PTB. RESULTS: A total of 62494 were screened among 69054 eligible population, of whom 6340 were eligible for sputum specimen collection. Sputum for M.tb smear and culture examination were collected in 93% of participants. The derived prevalence of PTB was 307/100000 population (smear-positive 130; culture positive 277). As expected that PTB has decreased substantially compared to preceding surveys and it showed that older age, male, low BMI, diabetes, earlier history of TB and alcohol users were significantly associated (p < .0001) with an increased risk of developing PTB. CONCLUSION: Upshot of the active survey has established a reduction in the prevalence of PTB in the rural area which can be accredited to better programmatic implementation and success of the National TB Control Programme in this district. It also has highlighted the need for risk reduction interventions accelerate faster elimination of TB.


Assuntos
Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/patogenicidade , Prevalência , Fatores de Risco , População Rural , Escarro/microbiologia , Inquéritos e Questionários , Tuberculose Pulmonar/microbiologia , Adulto Jovem
12.
Western Pac Surveill Response J ; 12(3): 25-33, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34703633

RESUMO

Objective: To determine the characteristics associated with mortality in patients with culture-positive pulmonary tuberculosis (PTB) in Airin, Osaka City, Japan. Methods: The characteristics of patients with culture-positive PTB registered between 2015 and 2018 in Airin, Osaka City, Japan, were compared between those who died of all causes before or during treatment and those who completed treatment. Results: Of the 241 culture-positive PTB patients eligible for this study, 170 completed treatment, with negative sputum culture tests, and 62 died. The all-cause case fatality rate was 26.7% (62/232). Multivariate analysis showed that mortality was associated with age 370 years, having a positive sputum smear, a body mass index of < 18.5 and serious comorbidities such as cancer and heart and renal disease. Detection of tuberculosis (TB) by screening or in an outpatient department (OPD) for other diseases was inversely associated with mortality. Discussion: Detection of PTB by chest X-ray screening and during regular visits to OPDs for other diseases was associated with non-fatal TB and might contribute to early case finding. Therefore, current active TB case finding and health education on regular visits to physicians for other diseases should be strengthened further for the urban poor population of Osaka City, Japan.


Assuntos
Tuberculose Pulmonar , Tuberculose , Idoso , Humanos , Japão/epidemiologia , Programas de Rastreamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , População Urbana
13.
BMC Infect Dis ; 21(1): 1100, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34702208

RESUMO

BACKGROUND: Tuberculosis (TB) is an airborne chronic infectious disease mainly caused by Mycobacterium tuberculosis complex bacteria. Currently, about 1.7 billion (26%) of the world's population are considered to be infected with M. tuberculosis. The risk of acquiring tuberculosis is higher on some segments of societies including people with severe mental illness. As a result, World health organization (WHO) strongly recommends screening for tuberculosis in such risk groups and setting. METHODS: A cross-sectional study was conducted to assess the prevalence of active tuberculosis and associated factors among patients with chronic psychotic disorders admitted at St. Amanuel Mental Specialized Hospital and Gergesenon Mental rehabilitation center from February to June, 2020. All admitted patients were screened for any sign of TB as recommended by WHO. Presumptive TB cases were identified. Sputum samples were collected and tested by Xpert MTB/RIF assay. Data analysis was performed using SPSS version 25.0 statistical software and Chi square analysis was used to test the statistical association. RESULTS: From a total 3600 pschotic patients screened for TB, 250 (6.94%) presumptive tuberculosis cases were detected. From these, 27 (10.8%) were positive by Xpert MTB/RIF assay. Most of the patients were males (68.4%). The mean ± SD age of the participant was 36.5 ± 9.7 years. The overall prevalence of tuberculosis was found to be 750 per 100,000 population. The number of patients per room (p = 0.039) was associated with Xpert MTB/RIF positive active tuberculosis. CONCLUSION: The prevalence of active tuberculosis among chronic psychotic patients was high. Number of admitted patients per room was identified as risk factors for Xpert MTB/RIF positive active tuberculosis. Therefore, to control TB transmission in chronic mental health treatment facilities, efforts should be directed to periodic screening for early case detection and improving the number of patients per room.


Assuntos
Transtornos Mentais , Mycobacterium tuberculosis , Transtornos Psicóticos , Tuberculose Pulmonar , Tuberculose , Adulto , Estudos Transversais , Etiópia/epidemiologia , Hospitais Especializados , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos Psicóticos/epidemiologia , Centros de Reabilitação , Sensibilidade e Especificidade , Escarro , Tuberculose/epidemiologia , Tuberculose Pulmonar/epidemiologia
14.
BMJ Open ; 11(10): e047986, 2021 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-34702728

RESUMO

BACKGROUND: Unrecognised transmission of tuberculosis is a main contributor of high epidemic of tuberculosis in low-income countries. Studies done in Ethiopia showed that delay in tuberculosis diagnosis and treatment is one of the major challenges to tuberculosis control programmes in the country. This study assessed factors which predict health system diagnostic delay of new pulmonary tuberculosis in Gurage and Siltie zones, South Ethiopia. METHODS: A health facility-based cross-sectional study was conducted among 204 adult patients with new pulmonary tuberculosis in Gurage and Siltie zones. Consecutive sampling technique was used to recruit participants. Data were collected by using a structured and pretested Amharic questionnaire. Data were entered into Epi-info V.7, processed and analysed by SPSS V.20. Health system diagnostic delay was dichotomised as either long or acceptable delay using median delay. RESULTS: Median (IQR) patient and health system diagnostic delays are almost equal which are 20 (10-34.5) and 20.5 (8.2-56.2) days, respectively. Results from logistic regression show that presence of long patient delays (adjusted OR (AOR)=2.85, 95% CI: 1.44 to 5.62; p=0.003) in seeking care, presence of sputum smear examination (AOR=0.37, 95% CI: 0.19 to 0.75; p=0.005) at the first visit to a health facility and multiple heath facility visit before diagnosis of tuberculosis (AOR=4.95, 95% CI: 1.98 to 12.40; p=0.001) were factors significantly associated with long health system diagnostic delay. CONCLUSIONS: Long patient delay and multiple health facility visits are positively associated with long health system diagnostic delay; whereas sputum smear examination at the first contact with a health facility is negatively associated with long health system tuberculosis diagnostic delay.


Assuntos
Diagnóstico Tardio , Tuberculose Pulmonar , Adulto , Estudos Transversais , Etiópia/epidemiologia , Humanos , Tempo para o Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia
15.
Sci Rep ; 11(1): 18023, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34504296

RESUMO

Similar to global trends, the incidence rate of tuberculosis (TB) in China declined from 2000 to 2018. In this study, we aimed to evaluate TB trends in northern Guizhou Province and identify risk factors associated with rifampicin-resistant (RR) and concurrent extrapulmonary TB (EPTB). We analyzed data of TB patients hospitalized in Affiliated Hospital of Zunyi Medical University from 2011 to 2018, and assessed correlations between demographic characteristics of patients and RR-TB as well as concurrent EPTB. Our results showed that numbers of new, retreated, RR-TB and concurrent EPTB cases increased gradually from 2011 to 2018. Retreated patients had the highest odds of RR-TB but a lower likelihood of concurrent EPTB compared to new patients. Patients between 21 and 40 years of age had a higher likelihood of RR-TB compared to those 20 years and younger. Female patients and patients from Bijie city as well as the Miao ethnic minority had higher odds of concurrent EPTB. In summary, our data demonstrate upward trends in new, rifampicin-resistant and concurrent extrapulmonary TB cases in northern Guizhou Province of China, which should not be overlooked especially during and post the COVID-19 pandemic because TB is a greater long-term global health threat than COVID-19.


Assuntos
Antibióticos Antituberculose/uso terapêutico , Mycobacterium tuberculosis/efeitos dos fármacos , Rifampina/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , China/epidemiologia , Farmacorresistência Bacteriana Múltipla/fisiologia , Sistemas Especialistas , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
Int J Mycobacteriol ; 10(3): 234-242, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34494561

RESUMO

Background: This study aimed to describe the spatiotemporal distribution, to build a forecasting model, and to determine the seasonal pattern of tuberculosis (TB) in Algeria. Methods: The Box-Jenkins methodology was used to develop predictive models and GeoDa software was used to perform spatial autocorrelation. Results: Between 1982 and 2019, the notification rate per 100,000 population of smear-positive pulmonary TB (SPPTB) has dropped 62.2%, while that of extrapulmonary TB (EPTB) has risen 91.3%. For the last decade, the mean detection rate of PTB was 82.6%. At around, 2% of PTB cases were yearly reported in children under 15 years old, a peak in notification rate was observed in the elderly aged 65 and over, and the sex ratio was in favor of men. Between 52% and 59% of EPTB cases were lymphadenitis TB and between 15% and 23% were pleural TB. About two-third of EPTB cases were females and around 10% were children under the age of 15. The time series analysis showed that (1,1, 2) × (1, 1, 0)4 (respectively (0, 1, 2) × (1, 1, 0)4, (3, 1, 0) × (1, 1, 0)4) offered the best forecasting model to quarterly TB (respectively EPTB, SPPTB) surveillance data. The most hit part was the Tell followed by high plateaus which accounted for 96.6% of notifications in 2017. Significant hot spots were identified in the central part for EPTB notification rate and in the northwestern part for SPPTB. Conclusions: There is a need to reframe the set objectives in the state strategy to combat TB taking into account seasonality and spatial clustering to ensure improved TB management through targeted and effective interventions.


Assuntos
Tuberculose Pleural , Tuberculose Pulmonar , Adolescente , Idoso , Argélia/epidemiologia , Criança , Feminino , Previsões , Humanos , Masculino , Análise Espaço-Temporal , Tuberculose Pulmonar/epidemiologia
17.
Int J Infect Dis ; 111: 313-321, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34481968

RESUMO

BACKGROUND: The aim of this study was to identify the differences in diversity, composition, and function of the gut microbiota between tuberculosis (TB) patients and healthy controls (HCs). METHODS: A cross-sectional study was conducted in three cities of China. Stool samples from 94 treatment-naive TB patients and 62 HCs were analyzed by 16S rRNA gene sequencing. TB patients were further divided into antibiotic-free and antibiotic-exposure according to their use of non-specific antibiotics before the TB diagnosis. RESULTS: Compared with HCs, antibiotic-free TB patients presented a different gut microbial community (P < 0.005) and decreased Shannon diversity (P < 0.005). Among TB patients, the relative abundances of short-chain fatty acid (SCFA)-producing genera such as Lachnospiraceae ND3007 group (log2(FC) = -2.74) were lower, while several conditional pathogen-related genera such as Enterococcus (log2(FC) = 12.05) and Rothia (log2(FC) = 6.322) were at higher levels. In addition, 41% of patients received antibiotics before TB diagnosis. Antibiotic exposure was correlated with an additional reduction in α diversity and depletion of SCFA-producing bacteria. Microbial functional analysis revealed that the biosynthesis capacity of amino acids and fatty acids was lower among TB patients compared to HCs. CONCLUSIONS: Significant alterations in gut microbiota composition and metabolic pathways of TB patients were observed. Antibiotic exposure could alter the gut microbiota of TB patients, which should be considered in anti-TB treatment.


Assuntos
Microbioma Gastrointestinal , Tuberculose Pulmonar , Tuberculose , Estudos Transversais , Humanos , Projetos Piloto , RNA Ribossômico 16S , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
18.
Saudi Med J ; 42(9): 1017-1023, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34470841

RESUMO

OBJECTIVES: To evaluate risk factors associated with 31-day unplanned readmission(s) for pulmonary tuberculosis (TB) in China. METHODS: This retrospective study enrolled patients (age, >14 years) with pulmonary TB who experienced 31-day unplanned readmissions to a specialized hospital for TB between January 2018 and December 2019. For each confirmed readmission, 2 control subjects were randomly selected from among patients with pulmonary TB but did not experience an unplanned readmission within 31 days. RESULTS: A total of 402 pulmonary TB patients (5.9%) experienced unplanned readmission within 31 days after discharge. In univariate analysis, readmission was associated with gender, age, insurance coverage, residing in a rural area, active smoking, chronic obstructive pulmonary disease (COPD), drug-induced hepatitis, and leaving hospital against medical advice. The final logistic regression model revealed that higher risks for unplanned readmissions were associated with male gender (odds ratio [OR] 1.44, [95% confidence interval (CI) : 1.06-1.95]), age >65 years (OR 2.94, 95%CI: 2.03-4.27), rural residence (OR 8.86, 95%CI: 6.61-11.87), active smoking (OR 2.15, 95% CI 1.37-3.40), COPD (OR 2.77, 95%CI: 1.59-4.81), and leaving hospital against physician advice (OR 4.11, 95%CI: 1.43-11.83). The median time to 31-day unplanned readmission was 24 days. Major reasons for unplanned readmission included fever, exacerbation of dyspnea, and hemoptysis. CONCLUSION: Unplanned readmission for pulmonary TB within 31 days of discharge was higher among older males residing in rural areas, active smokers, and those leaving hospital against medical advice.


Assuntos
Readmissão do Paciente , Tuberculose Pulmonar , Adolescente , Idoso , Feminino , Hospitais , Humanos , Masculino , Distribuição Aleatória , Estudos Retrospectivos , Fatores de Risco , Tuberculose Pulmonar/epidemiologia
19.
J Ayub Med Coll Abbottabad ; 33(3): 368-375, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34487640

RESUMO

BACKGROUND: COVID-19 pandemic has severely affected the entire world. However, its severity and mortality rate are lesser in developing countries, including Pakistan. This study aims to determine the association of prior pulmonary tuberculosis with COVID-19 pneumonia. METHODS: This cross-sectional study was conducted at two centres of Sindh, Pakistan. 521 HRCT chest performed from 1st May to 31st July 2020 were included and marked as "COVID-19 group". 761 HRCT chest performed during the first six months of 2019 were retrospectively evaluated to determine the prevalence of prior pulmonary tuberculosis and marked as the "pre-COVID-19 group". Previous pulmonary tuberculosis was documented as evidenced by clinical history, ATT intake and HRCT findings. Chi-square test was used to determine the association of prior pulmonary tuberculosis with COVID-19 pneumonia. A p-value of ≤0.01 was considered statistically significant. RESULTS: In the "COVID-19 group", 4.9% (n=26) patients had prior pulmonary tuberculosis. In the "pre-COVID-19 group", 9.8% (n=75) patients had prior pulmonary tuberculosis with a confirmed history of tuberculosis in 8.9% (n=68) and without documented history in 0.9% (n=7) cases. A significant p-value of 0.001 was obtained with a confidence interval of 99%. CONCLUSIONS: Prior pulmonary tuberculosis might have a protective effect against COVID-19 pneumonia which could be due to developed antibodies secondary to exposure to prior tuberculosis or BCG vaccination. Our results warrant further consideration due to the potential public-health benefits that can be achieved in our fight against the novel pandemic.


Assuntos
COVID-19 , Tuberculose Pulmonar , Estudos Transversais , Humanos , Paquistão/epidemiologia , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/epidemiologia
20.
East Mediterr Health J ; 27(8): 755-763, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34486711

RESUMO

Background: In pulmonary tuberculosis (PTB), the sputum conversion rate at 2 months is frequently used to evaluate treatment outcomes and effectiveness of a TB control programme. Aims: The study aimed to estimate the rate of delayed sputum conversion and explore its predicting factors at the end of the intensive phase among smear-positive PTB (PTB +ve) patients. Methods: A 3-year retrospective study was conducted in the government hospital in Pulau Pinang from 2016 to 2018. During the study, a standardized, data collection form was used to collect data from the patient record. Patients aged over 18 years were recruited. Multivariable logistic regression analysis was used to identify significant independent variables associated with delayed sputum conversion. Results: A total 1128 of PTB patients were recorded visiting the TB clinic, 736 (65.2%) were diagnosed as PTB +ve; of these, 606 (82.3%) PTB +ve had a record of sputum conversion at the end of the intensive phase. Age ≥ 50 years, blue-collar jobs, smoking, heavy bacillary load, relapsed and treatment interrupted were significantly (P < 0.05) associated with delayed sputum conversion. Delayed sputum conversion rate at the end of the intensive phase was 30.5%. Conclusion: The rate of sputum smear conversion in the intensive phase of treatment was independently associated with high sputum smear grading at diagnosis, relapsed and treatment interrupted categories, old age and blue-collar occupations.


Assuntos
Mycobacterium tuberculosis , Tuberculose Pulmonar , Adulto , Antituberculosos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Escarro , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
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