scholarly journals Plasma chemokines are baseline predictors of unfavorable treatment outcomes in pulmonary tuberculosis

2020 ◽  
Author(s):  
Nathella P Kumar ◽  
Kadar Moideen ◽  
Arul Nancy ◽  
Vijay Viswanathan ◽  
Kannan Thiruvengadam ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Outcomes ◽  
Validation Cohort ◽  
High Sensitivity ◽  
Sputum Smear ◽  
Newly Diagnosed ◽  
Characteristic Analysis ◽  
Increased Risk ◽  
Culture Positive ◽  
Culture Conversion

Abstract Background Plasma chemokines are biomarkers of greater disease severity, higher bacterial burden and delayed sputum culture conversion in pulmonary tuberculosis (PTB). Whether plasma chemokines could also serve as biomarkers of unfavorable treatment outcomes in PTB is not known. Methods A cohort of newly diagnosed, sputum smear and culture positive adult individuals with drug-sensitive PTB were recruited under the Effect of diabetes on Tuberculosis Severity study in Chennai, India. Plasma chemokine levels measured before treatment initiation were compared between 68 cases with unfavorable outcomes (treatment failure, death or recurrence) and 136 control individuals who had recurrence-free cure. A second validation cohort comprising of newly diagnosed, culture positive adults with drug-sensitive TB was used to measure plasma chemokine levels in 20 cases and 40 controls. Findings Six chemokines (CCL2, CCL3, CCL4, CXCL8, CXCL10 and CX3CL1) were associated with increased risk, while CXCL1 was associated with decreased risk of unfavorable outcomes in unadjusted and adjusted analyses in the test cohort. Similarly, CCL3, CXCL8 and CXCL10 were associated with increased risk of unfavorable treatment outcomes in the validation cohort. Receiver operating characteristic analysis revealed combinations of CCL3, CXCL8 and CXCL10 exhibited very high sensitivity and specificity in differentiating cases versus controls. Conclusions Our study reveals a plasma chemokine signature that can be used as a novel biomarker for predicting adverse treatment outcomes in PTB.

scholarly journals Factors Influencing Sputum Smear and Culture Conversion Time among Patients with Pulmonary Tuberculosis

2018 ◽  
Vol 1 (01) ◽  
pp. 41-46
Author(s):  
Pushpa Man Shrestha ◽  
Minani Gurung ◽  
Nabin Kumar Chaudhary
Keyword(s):  
Pulmonary Tuberculosis ◽  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Smoking Habit ◽  
Sputum Smear ◽  
Erythrocyte Sedimentation ◽  
Sputum Conversion ◽  
Conversion Time ◽  
Index Value ◽  
Culture Conversion

Introduction: Pulmonary tuberculosis is a contagious bacterial infection that involves the lungs and it may spread to other organs. Sputum smear and culture conversion are important indicators for the effectiveness of treatment and the infectivity of the patient. The present study aims to find sputum smear and culture conversion time and the factors that influence the conversion time among tuberculosis patients at National Tuberculosis Centre in Nepal. Methods: A total of 54 patients, who were diagnosed with laboratory confirmed pulmonary tuberculosis and under antitubercular therapy were monitored for sputum smear and culture conversion time. The blood specimens from each patient were processed for hemoglobin, platelets, erythrocyte sedimentation rate and blood glucose levels. Patient’s clinical history, risk factors that prolong conversion time and sociodemographic information were also collected by direct interview. Results: The mean sputum smear and culture conversion were found to be 54.4 days and 45.5 days respectively. Old age, smoking habit, low body mass index value, Treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate values were found to be associated with long sputum conversion time. Radiographic involvement of only left lungs, presence of fewer symptoms, aged between 15-45 years, having normal weight, without smoking habit and being married, were found to be associated with short sputum conversion time. Conclusions: The sputum microscopy, old age, smoking habit, low body mass index value, treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate value had been found to be significantly associated with long sputum conversion time.

scholarly journals Delay to initiate treatment is associated with unsuccessful treatment outcome among new pulmonary tuberculosis patients in Tigray, Northern Ethiopia: a follow up study

2021 ◽  
Author(s):  
kiros Tedla ◽  
Girmay Medhin ◽  
Gebretsadik Berhe ◽  
Afework Mulugeta ◽  
Nega Berhe
Keyword(s):  
Treatment Outcome ◽  
Pulmonary Tuberculosis ◽  
Treatment Outcomes ◽  
Treatment Initiation ◽  
Statistical Significance ◽  
Northern Ethiopia ◽  
Follow Up Study ◽  
Unsuccessful Treatment ◽  
Increased Risk

Abstract Background : Previous studies in Ethiopia indicated that tuberculosis (TB) patient’s elapse long time before treatment initiation. However, there is very limited evidence on the association of delay to initiate treatment with treatment outcome. Objective : To investigate the association of time to treatment initiation delay with treatment outcomes of new adult TB patients in Tigray region of Ethiopia. Methods : We conducted a follow up study from October 2018 to April 2020 by recruiting 875 newly diagnosed Pulmonary Tuberculosis (PTB) patients from 21 randomly selected health facilities. Study participants were selected using simple random sampling technique during treatment initiation from October 1/2018 to October 30/2019. Delay to initiate treatment and treatment outcome were collected using standardized questionnaire and laboratory investigation. Adherence of TB patients to their treatment was collected using a 10 points linear visual analogue scale (VAS) at the end of treatment. The association of delay to initiate treatment with treatment outcome was modeled using log binomial regression model. Statistical significance was reported whenever p-value was less than 0.05. Data was analyzed using SPSS software version 21. Result : The median total delay to treatment initiation was 62 days with inter-quartile range of 16-221 days. A unite increase in a day to initiate treatment results in increment of risk of unsuccessful treatment outcome by 2.3. Other factors associated with unsuccessful treatment outcomes were being less adherent to the treatment, HIV co infection, being smear positive at initiation of treatment and after 2 months of treatment initiation. Conclusion : delay in a day to initiate treatment is associated with increased risk of unsuccessful treatment outcome. Any effort targeted towards reducing the negative effects of PTB should target on strategies that reduces the length of delay to initiate treatment and strengthen community engagement to improve treatment adherence of patients that have started treatment.

scholarly journals 792. Number and Volume of Cavitary Lesions on Chest Computed Tomography Associated With Prolonged Time to Culture Conversion in Drug-Susceptible Pulmonary Tuberculosis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S284-S284
Author(s):  
Alfonso Hernandez
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Chest Roentgenogram ◽  
Sputum Smear ◽  
Chest Computed Tomography ◽  
Median Difference ◽  
Cox Proportional Hazards Models ◽  
Culture Conversion

Abstract Background Cavitary lesions (CLs) may be a marker of poor treatment response in pulmonary tuberculosis (PTB). Identification of CLs by chest roentgenogram (CXR) has important limitations. Chest computed tomography (CT) is more sensitive than CXR to detect CLs but the clinical relevance of CLs identified by CT remains understudied. We compared detection of CLs between CT and CXR and assessed their association with time to sputum culture conversion (tSCC). We hypothesized that increasing number and volume of CLs on CT would be associated with prolonged tSCC. Methods Retrospective cohort study of 141 culture confirmed PTB patients who underwent chest CT. We used multivariate Cox proportional hazards models to evaluate the association between chest radiological features and tSCC. Results Seventy-five (53%) patients had one or more CLs on CT. CT identified cavities in 31% of patients without a CL on CXR. Detection of cavity on CT was associated with an increased median [IQR] time to culture conversion (15 [7–35] days among noncavitary CT vs. 39 [25–55] days among cavitary CT; P < 0.0001). Among patients without CL on CXR, detection of CL on CT was associated with prolonged tSCC (median difference (CI): 16 (7–25) days, P = 0.0008). Similar results were observed among patients with 3–4+ sputum smear (median difference: 19.5 (8–31) days, P = 0.001). Adjusted Kaplan–Meier curves of number and volume of CLs and tSCC are shown in Figure 1. After confounder adjustment patients with single and multiple CL had a prolonged tSCC relative to patients without CLs on CT (adjusted Hazard Ratio [aHR] 0.56 (0.32–0.97) and 0.31 (0.16–0.60), respectively). Similarly, patients with CL volume 25 mL or more had a prolonged tSCC (aHR 0.39 (0.21–0.72)). CXR CL was not associated with prolonged tSCC. Conclusion We observed a dose–response relationship between increasing number and volume of CLs on CT and delayed tSCC independent of sputum bacillary load. Our findings highlight a role for CT in a clinical research setting to predict shorter time to culture conversion. Disclosures All authors: No reported disclosures.

scholarly journals Impact of smoking on sputum culture conversion and pulmonary tuberculosis treatment outcomes in Brazil: a retrospective cohort study

2018 ◽  
Vol 44 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Michelle Cailleaux-Cezar ◽  
Carla Loredo ◽  
José Roberto Lapa e Silva ◽  
Marcus Barreto Conde
Keyword(s):  
Cohort Study ◽  
Relative Risk ◽  
Pulmonary Tuberculosis ◽  
Treatment Outcomes ◽  
Retrospective Cohort ◽  
Sputum Culture ◽  
Sputum Culture Conversion ◽  
Poor Treatment ◽  
Never Smokers ◽  
Culture Conversion

ABSTRACT Objective: To evaluate the impact of smoking on pulmonary tuberculosis (PTB) treatment outcomes and the two-month conversion rates for Mycobacterium tuberculosis sputum cultures among patients with culture-confirmed PTB in an area with a moderate incidence of tuberculosis in Brazil. Methods: This was a retrospective cohort study of PTB patients diagnosed and treated at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro between 2004 and 2012. Results: Of the 298 patients diagnosed with PTB during the study period, 174 were included in the outcome analysis: 97 (55.7%) were never-smokers, 31 (17.8%) were former smokers, and 46 (26.5%) were current smokers. Smoking was associated with a delay in sputum culture conversion at the end of the second month of TB treatment (relative risk = 3.58 &091;95% CI: 1.3-9.86&093;; p = 0.01), as well as with poor treatment outcomes (relative risk = 6.29 &091;95% CI: 1.57-25.21&093;; p = 0.009). The association between smoking and a positive culture in the second month of treatment was statistically significant among the current smokers (p = 0.027). Conclusions: In our sample, the probability of a delay in sputum culture conversion was higher in current smokers than in never-smokers, as was the probability of a poor treatment outcome.

scholarly journals How Soon Should Patients with Smear-Positive Tuberculosis Be Released from Inpatient Isolation?

2010 ◽  
Vol 31 (1) ◽  
pp. 78-84 ◽  
Author(s):  
David J. Horne ◽  
Catherine O. Johnson ◽  
Eyal Oren ◽  
Christopher Spitters ◽  
Masahiro Narita
Keyword(s):  
Survival Analysis ◽  
Confidence Interval ◽  
Pulmonary Tuberculosis ◽  
Patient Characteristics ◽  
Hazard Ratio ◽  
Bivariate Analysis ◽  
Sputum Smear ◽  
Patient Counseling ◽  
Factors Associated ◽  
Culture Conversion

Objective.In patients with smear-positive pulmonary tuberculosis who are hospitalized or reside in congregate settings, guidelines recommend airborne infection isolation until sputum smear results are negative. Studies have identified factors associated with delayed sputum smear and culture conversion in patients with tuberculosis. Because these studies did not use methods of survival analysis, estimates of time to sputum smear conversion that are based on initial patient characteristics are not available. The ability to predict time to sputum smear conversion could be useful for programmatic planning and patient counseling.Methods.We performed a cohort study using survival analysis to identify factors associated with time to sputum smear and culture conversion. We defined the time to sputum smear conversion as the time elapsed from the start of treatment to the first date of sustained conversion.Results.Ninety-eight patients had sputum smear samples positive for acid-fast bacilli. Lower initial smear grade (on 1+ to 4+ scale) and absence of cavitation on chest radiograph were associated with earlier sputum smear conversion in bivariate analysis. In multiple regression analysis, initial smear grade (hazard ratio, 0.45; 95% confidence interval, 0.35-0.57) and drug resistance (hazard ratio, 2.30; 95% confidence interval, 1.08-4.89) remained statistically significant; a model comprising only initial smear grade performed almost as well. Predictors of sputum culture conversion were similar.Conclusions.Initial smear grade was the strongest predictor of time to sputum smear and culture conversion in patients with pulmonary tuberculosis and may be a useful predictor for programmatic planning and patient counseling.

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