Therapeutic effect of cycloserine combined with anti-tuberculosis drugs in the treatment of multidrug-resistant tuberculosis

Purpose: The present study analyzes the comprehensive therapeutic effect of cycloserine, in combination with anti-tuberculosis drugs using chest X-ray and chest CT (computed tomography) scan techniques. Methods: A total of 90 patients, diagnosed with multidrug resistant tuberculosis (MDR TB) were subjected to chest x-ray and CT scan before and after treatment in the two groups. Different views such as sagittal, coronal, lung window and multiplanar imaging of mediastinal window were taken. Some parameters such as case detection rate (CDR) in chest X-ray and CT scan and comprehensive curative effect were observed in two groups. Further, the changes in chest CT signs in addition to absorption of focus, cavity closure and changes in CT extra pulmonary signs were also observed. Results: The clinical profile of the patients and the course of disease were statistically insignificant (p > 0.05). Total effectiveness rate and case detection rate (CDR) values exhibited a significant difference between the groups (p < 0.05). Lung consolidation, nodules and cavities significantly improved in both groups before and after the treatment (p < 0.05). Both groups showed significant improvements in extrapulmonary signs in CT scan (p < 0.05) after the treatment. Conclusion: Based on the study outcomes, the CT scan method has good potentials for diagnosing and treating MDR TB at the early stages. Further, it can clarify the signs and outcomes of the disease at early stages, thus providing the medical fraternity a great opportunity to cure the disease.

An Evaluation of Childhood Tuberculosis Program in Chegutu District, Zimbabwe, 2020: A Descriptive Cross-Sectional Study

Background Childhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the national 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu. Methods We conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7TM to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge. Results The majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW’s negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair childhood TB notification knowledge. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400mg was out of stock and adult 800mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions. Conclusion The childhood TB program failed to meet its targets due to inadequate inputs and suboptimal HW childhood TB knowledge. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.

Delay of TB patients in diagnosis in a conflict setting of Mogadishu, Somalia - a cross-sectional study

BBackground. The TB case detection rate in Somalia is 42%, which is much lower than the WHO target of detecting 70% of new TB cases. Understanding the factors contributing to the delay of TB patients in the diagnosis, and reducing the time between the onset of TB symptoms to diagnosis, is a prerequisite to increase the case detection rate and to ultimately bring the TB epidemic in Somalia under control. The aim of this study is to examine the duration of delay, and factors associated with the delay among patients in TB management centers in Mogadishu, Somalia. Methods. An institution-based, cross-sectional study was conducted in TB management clinics providing directly observed treatments (DOTS) programs in Mogadishu. A total of 276 patients were interviewed using a structured questionnaire from June-October 2018. We analyzed data using descriptive statistics and different logistic regression models. Results. Approximately 78% of study participants were male. Nearly a third (36.5%) came from a household of nine individuals or more, while 73% were unemployed. The median patient and provider delays were 50 days and one day, respectively. The median total delay was 55 days, with an inter-quartile range of 119 days. Patients who had a poor knowledge of the symptoms of TB had 3.16 times higher odds of delay over 50 days than their counterparts. Furthermore, a poor knowledge of the symptoms of TB (aOR 4.22, CI 2.13-8.40), not making ones own decisions in seeking TB treatment (aOR 2.43, CI 1.22-4.86) and a poor understanding of the fact that TB can be treated with biomedical treatment, as opposed to traditional treatment (aOR 2.07, CI 1.02-4.16), were predictors of a patient delay over 120 days. Conclusions. The duration in the delay of TB patients under diagnosis in Mogadishu is one of the highest reported in developing countries, exceeding two years in some patients. Training local community health workers to detect suspected TB cases, and referring the cases of prolonged cough over three weeks for TB care centers for diagnosis, is imperative to help break the transmission and reduce the infectious pool in the population of Mogadishu. This may not only increase the community awareness of TB disease, but it may also facilitate the early referral of TB patients to diagnostic and treatment care centers.

Breaking the paradigm: Optimized Case Finding multiplies tuberculosis detection among key populations in Ukraine

Introduction: In 2018, there were 3 million “missed” tuberculosis (TB) cases globally, much of which was disproportionally concentrated among key populations. To enhance TB case-finding, an Optimized Case Finding (OCF) strategy involving all contacts within the social network of an index TB case was introduced in five regions of Ukraine. We assessed TB detection and linkage to TB treatment using OCF in key populations. Methodology: A cohort study using routine programme data (July 2018 – March 2020). OCF empowers the index TB case to identify and refer up to eight close contacts within his/her social network for TB investigations. Results: Of 726 index TB cases in key populations, 6998 close contacts were referred for TB investigations and 275 were diagnosed with TB (183 drug-sensitive and 92 drug-resistant TB). The TB case detection rate was 3930/100,000 and the Numbers Needed to Investigate to detect one TB case was 25. TB was most frequent among people who inject drugs and homeless groups. Compared to TB detection using routine household case finding within the general population (1090/100,000), OCF was 3.6-fold more effective and when compared to passive case finding in the general population (60/100,000), OCF was 66 times more effective. 99% (273) of TB patients were linked to care and initiated TB treatment. Conclusions: The OCF strategy among key populations is highly effective in detecting TB cases and linking them to care. We advocate to scale-up this case finding strategy in Ukraine and beyond.

Measuring endemicity and burden of leprosy across countries and regions: A systematic review and Delphi survey

Background Leprosy is a chronic infectious disease caused by Mycobacterium leprae, the annual new case detection in 2019 was 202,189 globally. Measuring endemicity levels and burden in leprosy lacks a uniform approach. As a result, the assessment of leprosy endemicity or burden are not comparable over time and across countries and regions. This can make program planning and evaluation difficult. This study aims to identify relevant metrics and methods for measuring and classifying leprosy endemicity and burden at (sub)national level. Methods We used a mixed-method approach combining findings from a systematic literature review and a Delphi survey. The literature search was conducted in seven databases, searching for endemicity, burden and leprosy. We reviewed the available evidence on the usage of indicators, classification levels, and scoring methods to measure and classify endemicity and burden. A two round Delphi survey was conducted to ask experts to rank and weigh indicators, classification levels, and scoring methods. Results The literature review showed variation of indicators, levels, and cut-off values to measure leprosy endemicity and/or burden. The most used indicators for endemicity include new case detection rate (NCDR), new cases among children and new cases with grade 2 disability. For burden these include NCDR, MB cases, and prevalence. The classification levels ‘high’ and ‘low’ were most important. It was considered most relevant to use separate scoring methods for endemicity and burden. The scores would be derived by use of multiple indicators. Conclusion There is great variation in the existing method for measuring endemicity and burden across countries and regions. Our findings contribute to establishing a standardized uniform approach to measure and classify leprosy endemicity and burden at (sub)national level, which would allow effective communication and planning of intervention strategies.

Innovative tracking, active search and follow-up strategies for new leprosy cases in the female prison population

Background Regarding the leprosy transmission through the upper airways, overcrowded locations such as prisons can become a risk to get sick. Like the leprosy hidden endemic demonstrated in male prison population, being interesting to assess the leprosy scene also among confined women. Methods A prospective descriptive study conducted at Female Penitentiary, Brazil. Leprosy Suspicion Questionnaire (LSQ) were applied to the participants, and submitted to specialized dermatoneurological exam, peripheral nerve ultrasonography, and anti-PGL-I serology. Findings 404 female inmates were evaluated, 14 new cases were diagnosed (LG-leprosy group), a new case detection rate (NCDR) of 3.4%, 13 multibacillary, while another 390 constituted the Non-Leprosy group (NLG). Leprosy cases were followed up during multidrug therapy with clinical improvement. The confinement time median was 31 months in LG, similar to NLG, less than the time of leprosy incubation. Regarding LSQ, the neurological symptoms reached the highest x2 values as Q1–numbness (5.6), Q3–anesthetizes areas in the skin (7.5), Q5–Stinging sensation (5.8), and Q7–pain in the nerves (34.7), while Q4-spots on the skin was 4.94. When more than one question were marked in the LSQ means a 12.8-fold higher to have the disease than a subject who marked only one or none. The high 34% rate of anti-PGL-I seropositivity in the penitentiary, higher levels in LG than NLG. Three additional leprosy cases each were diagnosed on the second (n = 66) and third (n = 14) reevaluations 18 and 36 months after the initial one. Semmes-Weinstein monofilaments demonstrated lower limbs (32.2%) more affected than the upper limbs (25%) with improvement during the follow-up. Interpretation The NCDR in this population showed an hidden endemic of leprosy as well as the efficacy of a search action on the part of a specialized team with the aid of the LSQ and anti-PGL-I serology as an auxiliary tracking tools.

Leprosy: The challenges ahead for India

In India and rest of the world, there has been a tremendous decline in the number of leprosy patients over the last four decades. However, one of the major challenges faced by India is the continued occurrence of new leprosy cases, evidenced by almost a static new case detection rate (NCDR) over the last decade. The article discusses the challenges faced by the country and the solutions available for achieving the target of ‘Zero Leprosy’.

Active search strategies, clinicoimmunobiological determinants and training for implementation research confirm hidden endemic leprosy in inner São Paulo, Brazil

Background This study evaluates implementation strategies for leprosy diagnosis based on responses to a Leprosy Suspicion Questionnaire (LSQ), and analyzes immunoepidemiological aspects and follow-up of individuals living in a presumptively nonendemic area in Brazil. Methodology/Principal findings Quasi-experimental study based on LSQ throughout Jardinópolis town by community health agents, theoretical-practical trainings for primary care teams, dermatoneurological examination, anti-PGL-I serology, RLEP-PCR, and spatial epidemiology. A Leprosy Group (LG, n = 64) and Non-Leprosy Group (NLG, n = 415) were established. Overall, 3,241 LSQs were distributed; 1,054 (32.5%) LSQ were positive for signs/symptoms (LSQ+). Among LSQ+ respondents, Q2-Tingling (pricking)? (11.8%); Q4-Spots on the skin? (11.7%); Q7-Pain in the nerves? (11.6%); Q1-Numbness in your hands and/or feet? (10.7%) and Q8-Swelling of hands and feet? (8.5%) were most frequently reported symptoms. We evaluated 479 (14.8%) individuals and diagnosed 64 new cases, a general new case detection rate (NCDR) of 13.4%; 60 were among 300 LSQ+ (NCDR-20%), while 4 were among 179 LSQ negative (NCDR-2.23%). In LG, Q7(65%), Q2(60%), Q1(45%), Q4(40%) and Q8(25%) were most frequent. All 2x2 crossings of these 5 questions showed a relative risk for leprosy ranging from 3 to 5.8 compared with NLG. All patients were multibacillary and presented hypochromatic macules with loss of sensation. LG anti-PGL-I titers were higher than NLG, while 8.9% were positive for RLEP-PCR. The leprosy cases and anti-PGL-I spatial mappings demonstrated the disease spread across the town. Conclusions/Significance Implementation actions, primarily LSQ administration focused on neurological symptoms, indicate hidden endemic leprosy in a nonendemic Brazilian state.

Evaluasi Sistem Surveilans Tuberkulosis (TB) di Kabupaten Jember Berdasarkan Atribut Sistem Surveilans

Selama tahun 2016-2018 Kabupaten Jember memiliki capaian Case Detection Rate (CDR) dibawah target nasional, sehingga perlu mendapat perhatian khusus. Oleh karena itu, diperlukan upaya yang memadai dan komprehensif guna mendukung sistem surveilans TB dalam rangka memecahkan masalah TB. Tujuan dari penelitian ini adalah untuk menggambarkan kualitas sistem surveilans TB berdasarkan penilaian atribut sistem surveilans untuk memberikan rekomendasi yang tepat. Metode Penelitian ini menggunakan desain studi deskriptif dengan rancangan studi evaluasi. Penelitian evaluasi dilakukan pada sistem surveilans TB yang diimplementasikan di Dinas Kesehatan Kabupaten Jember selama tahun 2018. Responden adalah pengelola program TB di Dinas Kesehatan dan di 24 Puskesmas. Analisis data dilakukan dengan menggambarkan atribut sistem surveilans, serta membandingkan dengan Updated Guidelines for Evaluating Public Health Surveillance Sistems dari Central of Disease Control (CDC). Informasi yang diperoleh disampaikan dalam bentuk tabel dan dinarasikan. Hasil Penelitian menunjukan bahwa sistem surveilans tuberculosis di Dinkes Jember tahun 2019 sudah memenuhi atribut fleksibilitas, kualitas data tinggi, akseptabilitas, ketepatan waktu, kerepresentatifan, dan stabilitas yang tinggi. Sedangkan atribut sistem surveilans TB yang belum terpenuhi adalah keserderhanaan. Saran yang dapat diberikan adalah perlu meningkatakan kapasitas kualitas petugas TB dan Petugas Report/Record (RR) melalui berbagai pelatihan serta melakukan monitoring secara terus menerus.

Diagnostic performance of GeneXpert in tuberculosis–HIV co–infected patients at Asella Teaching and Referral Hospital, Southeastern Ethiopia: A cross sectional study

Background GeneXpert is a new introduction in the diagnostic modality to fight tuberculosis (TB) among people living with HIV (PLHIV) under the program of intensified TB case finding. This study aimed to evaluate the diagnostic performance of GeneXpert under the program of intensified TB cases finding among PLHIV. Methods Cross-sectional study was conducted by recruiting individuals attending an HIV clinic from February 2018 to January 2019. Data on clinical parameters were collected using a standardized tool. Two-morning sputum samples were collected and processed for smear microscopy and GeneXpert. SPSS 21 used for data analysis. Proportion, percentage, and mean with SD were used to describe variables. Univariate and multivariable logistic regressions were used to assess factors associated with the GeneXpert. Values for which the 95% CI interval not includes 1 and for which P<0.05 were considered significant. Result A total of 384 presumptive TB-HIV co-infection cases were included, of which 166 (43%) were diagnosed to have TB. Fifty-four (32.5%) TB cases were smear AFB positive while 79 (47.7%) TB cases were GeneXpert positive. The GeneXpert detection rate was almost two-fold of that of smear microscopy and all smear positive TB cases were detected by GeneXpert. Moreover, GeneXpert was able to detect an additional third of TB confirmed cases among smear AFB negative cases. Advanced stage of the disease, high viral load and presence of anemia were significantly associated with TB. The WHO TB screening tool remained least sensitive with the lowest positive predictive value. Conclusion GeneXpert demonstrated two-fold case detection rate compared to the sputum smear microscopy and additional third TB case detection rate among smear AFB negative cases. Clinical screening tool for evaluation of TB-HIV co-infection showed poor performance in TB case notification.