scholarly journals Evaluation of the performance of clinical predictors in estimating the probability of pulmonary tuberculosis among smear-negative cases in Northern Ethiopia: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037913
Author(s):  
Mala George ◽  
Geert-Jan Dinant ◽  
Efrem Kentiba ◽  
Teklu Teshome ◽  
Abinet Teshome ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Cross Sectional Study ◽  
Clinical Suspicion ◽  
Secondary Outcome ◽  
Northern Ethiopia ◽  
Sectional Study ◽  
Cross Sectional ◽  
Smear Negative ◽  
Culture Positive ◽  
Culture Negative

ObjectivesTo evaluate the performance of the predictors in estimating the probability of pulmonary tuberculosis (PTB) when all versus only significant variables are combined into a decision model (1) among all clinical suspects and (2) among smear-negative cases based on the results of culture tests.DesignA cross-sectional study.SettingTwo public referral hospitals in Tigray, Ethiopia.ParticipantsA total of 426 consecutive adult patients admitted to the hospitals with clinical suspicion of PTB were screened by sputum smear microscopy and chest radiograph (chest X-ray (CXR)) in accordance with the Ethiopian guidelines of the National Tuberculosis and Leprosy Program. Discontinuation of antituberculosis therapy in the past 3 months, unproductive cough, HIV positivity and unwillingness to give written informed consent were the basis of exclusion from the study.Primary and secondary outcome measuresA total of 354 patients were included in the final analysis, while 72 patients were excluded because culture tests were not done.ResultsThe strongest predictive variables of culture-positive PTB among patients with clinical suspicion were a positive smear test (OR 172; 95% CI 23.23 to 1273.54) and having CXR lesions compatible with PTB (OR 10.401; 95% CI 5.862 to 18.454). The regression model had a good predictive performance for identifying culture-positive PTB among patients with clinical suspicion (area under the curve (AUC) 0.84), but it was rather poor in patients with a negative smear result (AUC 0.64). Combining all the predictors in the model compared with only the independent significant variables did not really improve its performance to identify culture-positive (AUC 0.84–0.87) and culture-negative (AUC 0.64–0.69) PTB.ConclusionsOur finding suggests that predictive models based on clinical variables will not be useful to discriminate patients with culture-negative PTB from patients with culture-positive PTB among patients with smear-negative cases.

scholarly journals Incidence, clinical implications and impact on public health of infections with Shigella spp. and entero-invasive Escherichia coli (EIEC): results of a multicenter cross-sectional study in the Netherlands during 2016–2017

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Maaike J. C. van den Beld ◽  
◽  
Esther Warmelink ◽  
Alexander W. Friedrich ◽  
Frans A. G. Reubsaet ◽  
...  
Keyword(s):  
Public Health ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Secondary Infections ◽  
Shigella Spp ◽  
Contaminated Food ◽  
Health Regulations ◽  
Culture Positive ◽  
Culture Negative

Abstract Background Shigella spp. and entero-invasive E. coli (EIEC) use the same invasive mechanism to cause diarrheal diseases. Public health regulations apply only to Shigella spp. infections, but are hampered by the lack of simple methods to distinguish them from EIEC. In the last decades, molecular methods for detecting Shigella spp. and EIEC were implemented in medical microbiological laboratories (MMLs). However, shigellosis cases identified with molecular techniques alone are not notifiable in most countries. Our study investigates the impact of EIEC versus Shigella spp. infections and molecular diagnosed shigellosis versus culture confirmed shigellosis for re-examination of the rationale for the current public health regulations. Methods In this multicenter cross-sectional study, fecal samples of patients suspected for gastro-enteritis, referred to 15 MMLs in the Netherlands, were screened by PCR for Shigella spp. or EIEC. Samples were cultured to discriminate between the two pathogens. We compared risk factors, symptoms, severity of disease, secondary infections and socio-economic consequences for (i) culture-confirmed Shigella spp. versus culture-confirmed EIEC cases (ii) culture positive versus PCR positive only shigellosis cases. Results In 2016–2017, 777 PCR positive fecal samples with patient data were included, 254 of these were culture-confirmed shigellosis cases and 32 were culture-confirmed EIEC cases. EIEC cases were more likely to report ingestion of contaminated food and were less likely to be men who have sex with men (MSM). Both pathogens were shown to cause serious disease although differences in specific symptoms were observed. Culture-negative but PCR positive cases were more likely report travel or ingestion of contaminated food and were less likely to be MSM than culture-positive cases. Culture-negative cases were more likely to suffer from multiple symptoms. No differences in degree of secondary infections were observed between Shigella spp. and EIEC, and culture-negative and culture-positive cases. Conclusions No convincing evidence was found to support the current guidelines that employs different measures based on species or detection method. Therefore, culture and molecular detection methods for Shigella spp. and EIEC should be considered equivalent for case definition and public health regulations regarding shigellosis. Differences were found regarding risks factors, indicating that different prevention strategies may be required.

scholarly journals Incidence, clinical implications and impact on public health of infections with Shigella spp. and entero-invasive Escherichia coli (EIEC): results of a multicenter cross-sectional study in the Netherlands during 2016-2017

2019 ◽  
Author(s):  
Maaike van den Beld ◽  
Esther Warmelink ◽  
Alexander W. Friedrich ◽  
Frans A.G. Reubsaet ◽  
Maarten Schipper ◽  
...  
Keyword(s):  
Public Health ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Secondary Infections ◽  
Shigella Spp ◽  
Contaminated Food ◽  
Health Regulations ◽  
Culture Positive ◽  
Culture Negative

Abstract Background: Shigella spp. and entero-invasive E. coli (EIEC) use the same invasive mechanism to cause diarrheal diseases. Public health regulations apply only to Shigella spp. infections, but are hampered by the lack of simple methods to distinguish them from EIEC. In the last decades, molecular methods for detecting Shigella spp. and EIEC were implemented in medical microbiological laboratories (MMLs). However, shigellosis cases identified with molecular techniques alone are not notifiable in most countries. Our study investigates the impact of EIEC versus Shigella spp. infections and molecular diagnosed shigellosis versus culture confirmed shigellosis for re-examination of the rationale for the current public health regulations. Methods: In this multicenter cross-sectional study, fecal samples of patients suspected for gastro-enteritis, referred to fifteen MMLs in the Netherlands, were screened by PCR for Shigella spp. or EIEC. Samples were cultured to discriminate between the two pathogens. We compared risk factors, symptoms, severity of disease, secondary infections and socio-economic consequences for (i) culture-confirmed Shigella spp. versus culture-confirmed EIEC cases (ii) culture positive versus PCR positive only shigellosis cases. Results: In 2016-2017, 777 PCR positive fecal samples with patient data were included, 254 of these were culture-confirmed shigellosis cases and 32 were culture-confirmed EIEC cases. EIEC cases were more likely to report ingestion of contaminated food and were less likely to be men who have sex with men (MSM). Both pathogens were shown to cause serious disease although differences in specific symptoms were observed. Culture-negative but PCR positive cases were more likely report travel or ingestion of contaminated food and were less likely to be MSM than culture-positive cases. Culture-negative cases were more likely to suffer from multiple symptoms. No differences in degree of secondary infections were observed between Shigella spp. and EIEC, and culture-negative and culture-positive cases. Conclusions: No convincing evidence was found to support the current guidelines that employs different measures based on species or detection method. Therefore, culture and molecular detection methods for Shigella spp. and EIEC should be considered equivalent for case definition and public health regulations regarding shigellosis. Differences were found regarding risks factors, indicating that different prevention strategies may be required.

scholarly journals Predicting smear negative pulmonary tuberculosis with classification trees and logistic regression: a cross-sectional study

2006 ◽  
Vol 6 (1) ◽  
Author(s):  
Fernanda Carvalho de Queiroz Mello ◽  
Luiz Gustavo do Valle Bastos ◽  
Sérgio Luiz Machado Soares ◽  
Valéria MC Rezende ◽  
Marcus Barreto Conde ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Pulmonary Tuberculosis ◽  
Classification Trees ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Smear Negative

scholarly journals Association of TB treatment initiation delay with clinical severity and risk of transmission among pulmonary tuberculosis patients in Tigray, Northern Ethiopia: Cross-sectional study

2020 ◽  
Author(s):  
kiros Tedla ◽  
Girmay Medhin ◽  
Gebretsadik Berhe ◽  
Afework Mulgeta ◽  
Nega Berhe
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Initiation ◽  
Family Members ◽  
Cross Sectional Study ◽  
Clinical Severity ◽  
Northern Ethiopia ◽  
Sectional Study ◽  
Cross Sectional ◽  
Tuberculosis Patients ◽  
Delayed Treatment

Abstract Background Delayed treatment initiation of tuberculosis (TB) increases disease progression and development of complications which may lead to a higher risk of transmission, clinical severity and increased mortality. But, published evidences that investigated the effect of delayed initiation of treatment on clinical severity and risk of transmission of pulmonary tuberculosis patients is scarce in Tigray, Northern Ethiopia. Objective To investigate the association of delayed treatment initiation of Pulmonary Tuberculosis with clinical severity and risk of transmission. Methods In this cross-sectional study design, a total of 875 newly diagnosed adult pulmonary tuberculosis patients were recruited from 21 health facilities from October 2018 to October 2019. Health facilities were selected by simple random sampling method and the study participants were enrolled consecutively. Data were collected using questionnaires through face-to-face interviews of patients within the first 2 weeks of treatment initiation. Clinical severity was assessed by Bandim tuberculosis score and risk of transmission was assessed by smear positivity or lung cavitations. Data were analyzed using SPSS version 21 software program. Logistic regression analysis was used to ascertain the association of delay with clinical severity and risk of transmission. P-value of less than 0.05 was reported as being statistically significant. Results Those who had initiating treatment without delay and those who were initiated treatment after a medium delay of 31 to 60 days were significantly associated with decreased clinical score compared to those who initiated treatment after a delay of more than two months. Compared with patients who were initiated treatment within one month, the risk of transmission was greater for delay of 30-60 days and above 60 days. Patients having more than 3 family members have higher risk to transmit TB as compared to those who have maximum of 3 family members. Whereas, patients having at least two rooms and being HIV negative have lower risk to transmit TB compared to their counter patients. Conclusion Narrowing the gap between initial occurrence of TB symptoms and treatment initiation is the way forward to improve clinical courses of TB patients and to reduce the risk of transmission of TB to other people from these patients.

scholarly journals Prevalence of Antibiotic Resistance to Isonicotinylhydrazide and Rifampicin in Culture Positive Pulmonary Tuberculosis Patients From 2014 to 2016 in Zahedan City, Iran

2019 ◽  
Vol 4 (2) ◽  
pp. 57-61
Author(s):  
Seyed Mohammad Hashemi Shahri ◽  
Fatemeh Fardoust ◽  
Shokoufeh Mogharabi Ostad Kalayeh ◽  
Mohammad Ghenaatpisheh Sanani
Keyword(s):  
Antibiotic Resistance ◽  
Pulmonary Tuberculosis ◽  
Positive Culture ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Tuberculosis Patients ◽  
Pulmonary Tb ◽  
The World ◽  
Culture Positive

Background: One third of the world’s population is infected with TB, and the disease is known as the second deadly global infection, even more severe than measles. The disease kills about 2 million people a year. Approximately 8 million people in the world are affected by advanced tuberculosis (TB). Objective: The current study aimed to determine the frequency of resistance to the antibiotics isoniazid and rifampin in positive culture pulmonary TB patients in Zahedan city during 2013-2016. Methods: This descriptive cross-sectional study studied 100 samples from patients who referred to Boo-Ali hospital of Zahedan city from 2014 to 2016. First, the isoniazid solution was prepared, and then the rifampin solution was prepared. After that, 200 μL of mycobacterium suspension was added to the antibiotic and antibiotic-free control. Results: Of 100 patients participating in the study, 50 (50%) were male and 50 (50%) were female. Participants had an average age of 51.69 ± 20.41 years (95-12 years), 79 (79%) were Iranians and 21 (21%) were Afghans. Of the 100 samples, 55 (55%) were from the year 2013, 21 (21%) were from 2014, 10 (10%) were from 2015, and 14 (14%) were from year 2016. The samples examined showed that 4 (4%) were resistant and 96% were sensitive. Conclusion: The results of the current study showed that out of 100 samples, 4 cases (4%) had resistance and 96% were sensitive; 2% were resistant to isoniazid, and 2% were resistant to isoniazid and rifampin.

scholarly journals Incidence, clinical implications and impact on public health of infections with Shigella spp. and entero-invasive Escherichia coli (EIEC): results of a multicenter cross-sectional study in the Netherlands during 2016-2017

2019 ◽  
Author(s):  
Maaike van den Beld ◽  
Esther Warmelink ◽  
Alexander W. Friedrich ◽  
Frans A.G. Reubsaet ◽  
Maarten Schipper ◽  
...  
Keyword(s):  
Public Health ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Secondary Infections ◽  
Shigella Spp ◽  
Contaminated Food ◽  
Health Regulations ◽  
Culture Positive ◽  
Culture Negative

Abstract Background: Shigella spp. and entero-invasive E. coli (EIEC) use the same invasive mechanism to cause diarrheal diseases. Public health regulations apply only to Shigella spp. infections, but are hampered by the lack of simple methods to distinguish them from EIEC. In the last decades, molecular methods for detecting Shigella spp. and EIEC were implemented in medical microbiological laboratories (MMLs). However, shigellosis cases identified with molecular techniques alone are not notifiable in most countries. Our study investigates the impact of EIEC versus Shigella spp. infections and molecular diagnosed shigellosis versus culture confirmed shigellosis for re-examination of the rationale for the current public health regulations. Methods: In this multicenter cross-sectional study, fecal samples of patients suspected for gastro-enteritis, referred to fifteen MMLs in the Netherlands, were screened by PCR for Shigella spp. or EIEC. Samples were cultured to discriminate between the two pathogens. We compared risk factors, symptoms, severity of disease, secondary infections and socio-economic consequences for (i) culture-confirmed Shigella spp. versus culture-confirmed EIEC cases (ii) culture positive versus PCR positive only shigellosis cases. Results: In 2016-2017, 777 PCR positive fecal samples with patient data were included, 254 of these were culture-confirmed shigellosis cases and 32 were culture-confirmed EIEC cases. EIEC cases were more likely to report ingestion of contaminated food and were less likely to be men who have sex with men (MSM). Both pathogens were shown to cause serious disease although differences in specific symptoms were observed. Culture-negative but PCR positive cases were more likely report travel or ingestion of contaminated food and were less likely to be MSM than culture-positive cases. Culture-negative cases were more likely to suffer from multiple symptoms. No differences in degree of secondary infections were observed between Shigella spp. and EIEC, and culture-negative and culture-positive cases. Conclusions: No convincing evidence was found to support the current guidelines that employs different measures based on species or detection method. Therefore, culture and molecular detection methods for Shigella spp. and EIEC should be considered equivalent for case definition and public health regulations regarding shigellosis. Differences were found regarding risks factors, indicating that different prevention strategies may be required.

scholarly journals Incidence, clinical implications and impact on public health of infections with Shigella spp. and entero-invasive Escherichia coli (EIEC): results of a multicenter cross-sectional study in the Netherlands during 2016-2017

2019 ◽  
Author(s):  
Maaike van den Beld ◽  
Esther Warmelink ◽  
Alexander W. Friedrich ◽  
Frans A.G. Reubsaet ◽  
Maarten Schipper ◽  
...  
Keyword(s):  
Public Health ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Secondary Infections ◽  
Shigella Spp ◽  
Contaminated Food ◽  
Health Regulations ◽  
Culture Positive ◽  
Culture Negative

Abstract Background Shigella spp. and entero-invasive E. coli (EIEC) use the same invasive mechanism to cause diarrheal diseases. Public health regulations apply only to Shigella spp. infections, but are hampered by the lack of simple methods to distinguish them from EIEC. In the last decades, molecular methods for detecting Shigella spp. and EIEC were implemented in medical microbiological laboratories (MMLs). However, shigellosis cases identified with molecular techniques alone are not notifiable in most countries. Our study investigates the impact of EIEC versus Shigella spp. infections and molecular diagnosed shigellosis versus culture confirmed shigellosis for re-examination of the rationale for the current public health regulations. Methods In this multicenter cross-sectional study, fecal samples of patients suspected for gastro-enteritis, referred to fifteen MMLs in the Netherlands, were screened by PCR for Shigella spp. or EIEC. Samples were also cultured to discriminate between the two pathogens. We compared, risk factors, symptoms, severity of disease, secondary infections and socio-economic consequences for (i) culture-confirmed Shigella spp. versus culture-confirmed EIEC cases (ii) culture positive versus PCR positive only shigellosis cases. Results In 2016-2017, 777 PCR positive fecal samples with patient data were included, 254 of these were culture-confirmed shigellosis cases and 32 were culture-confirmed EIEC cases. EIEC cases were more likely to report ingestion of contaminated food or water and were less likely to be men who have sex with men (MSM). Both pathogens were shown to cause serious disease although differences in specific symptoms were observed. Additionally, culture-negative but PCR positive cases were more likely report travel or ingestion of contaminated food or water and were less likely to be MSM than culture-positive cases. Culture-negative cases were more likely to suffer from multiple symptoms. No differences in degree of secondary infections were observed between both Shigella spp. and EIEC, and culture-negative and culture-positive cases.Conclusions No convincing evidence was found to support the current guidelines. Therefore, culture and molecular detection methods for Shigella spp. and EIEC should be considered equivalent for case definition and public health regulations regarding shigellosis. Differences were found regarding risks factors, indicating that different prevention strategies may be required.

scholarly journals Incidence, clinical implications and impact on public health of infections with Shigella spp. and entero-invasive Escherichia coli (EIEC): results of a multicenter cross-sectional study in the Netherlands during 2016-2017

2019 ◽  
Author(s):  
Maaike van den Beld ◽  
Esther Warmelink ◽  
Alexander W. Friedrich ◽  
Frans A.G. Reubsaet ◽  
Maarten Schipper ◽  
...  
Keyword(s):  
Public Health ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Secondary Infections ◽  
Shigella Spp ◽  
Contaminated Food ◽  
Health Regulations ◽  
Culture Positive ◽  
Culture Negative

Abstract Background Shigella spp. and entero-invasive E. coli (EIEC) use the same invasive mechanism to cause diarrheal diseases. Public health regulations apply only to Shigella spp. infections, but are hampered by the lack of simple methods to distinguish them from EIEC. In the last decades, molecular methods for detecting Shigella spp. and EIEC were implemented in medical microbiological laboratories (MMLs). However, shigellosis cases identified with molecular techniques alone are not notifiable in most countries. Our study investigates the impact of EIEC versus Shigella spp. infections and molecular diagnosed shigellosis versus culture confirmed shigellosis for re-examination of the rationale for the current public health regulations. Methods In this multicenter cross-sectional study, fecal samples of patients suspected for gastro-enteritis, referred to fifteen MMLs in the Netherlands, were screened by PCR for Shigella spp. or EIEC. Samples were also cultured to discriminate between the two pathogens. We compared, risk factors, symptoms, severity of disease, secondary infections and socio-economic consequences for (i) culture-confirmed Shigella spp. versus culture-confirmed EIEC cases (ii) culture positive versus PCR positive only shigellosis cases. Results In 2016-2017, 777 PCR positive fecal samples with patient data were included, 254 of these were culture-confirmed shigellosis cases and 32 were culture-confirmed EIEC cases. EIEC cases were more likely to report ingestion of contaminated food or water and were less likely to be men who have sex with men (MSM). Both pathogens were shown to cause serious disease although differences in specific symptoms were observed. Additionally, culture-negative but PCR positive cases were more likely report travel or ingestion of contaminated food or water and were less likely to be MSM than culture-positive cases. Culture-negative cases were more likely to suffer from multiple symptoms. No differences in degree of secondary infections were observed between both Shigella spp. and EIEC, and culture-negative and culture-positive cases. Conclusions No convincing evidence was found to support the current guidelines. Therefore, culture and molecular detection methods for Shigella spp. and EIEC should be considered equivalent for case definition and public health regulations regarding shigellosis. Differences were found regarding risks factors, indicating that different prevention strategies may be required.

scholarly journals Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e039625
Author(s):  
Jason I Chiang ◽  
John Furler ◽  
Frances Mair ◽  
Bhautesh D Jani ◽  
Barbara I Nicholl ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
General Practice ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Linear Regression Models ◽  
Sectional Study ◽  
Cross Sectional ◽  
Long Term Conditions ◽  
Australian General Practice

ObjectivesTo explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).DesignCross-sectional study.SettingAustralian general practice.Participants69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).Primary and secondary outcome measuresPrevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).ResultsMean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.ConclusionsMultimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.

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