Capture - recapture based study on the completeness of smear positive pulmonary tuberculosis reporting in southwest Iran during 2016

Background Tuberculosis (TB) is one of the ten leading causes of death in infectious diseases and one of the ten leading causes of death in the world. For any TB control program, a valid surveillance is essential. In order to assess the status of the assessment, the quality of the record and the completeness of reporting should be assessed. The purpose of this study was to investigate the completeness of smear positive pulmonary tuberculosis reporting in Ahvaz, south west of Iran. Methods This cross-sectional study was conducted in 2016 in Ahvaz, southwest Iran. The study was conducted through a three-source Capture recapture method by collecting laboratory, hospital, physician prescription data; including patient referral to the health care center, prescriptions of patients receiving anti-tuberculosis drugs and prescriptions of medical TB diagnostic laboratories, and laboratory prescriptions. Percentage, mean and standard deviation were used to describe the variables. Data analysis was performed using log-linear model in Rcapture package R software. Results Generally, 134 new cases of smear-positive pulmonary tuberculosis patients were reported through three sources from urban and rural regions during 2016. Pulmonary tuberculosis was reported through three sources from urban and rural regions during 2016. The most common age group was 25 to 44 years and 79.1% of the patient were man. The overall prevalence of new cases of smear-positive pulmonary tuberculosis was in persons that lived urban areas (97.8%). The completeness of reporting the disease estimated by log-linear model was 87.5% and the incidence rate was estimated to be 11.8 disease per 100,000 persons. Completeness of reporting of laboratory, hospital and physician resources were 79%, 30% and 16.3%, respectively. Conclusions The present study shows the necessity of evaluating the quality, completeness and linkage between data. Linking between data sources can improve the accuracy and completeness of TB surveillance.

Effectiveness of a case management model in newly treated smear-positive pulmonary tuberculosis patients

Introduction: To investigate the effectiveness of the case management mode on the application of smear-positive pulmonary tuberculosis patients. Methodology: This was a randomized control trial. A total of 70 newly diagnosed smear-positive pulmonary tuberculosis patients were recruited and been randomly divided into experimental group and control group, with 35 participants in each group. In the experimental group, patients received the tuberculosis case management mode based on the conventional management mode. In the control group, patients received the routine management mode. We compared the knowledge, attitude, and practice score; sputum-negative conversion rate, effective imaging rate of the two groups at the time of initial admission, discharge, and one month after discharge. Results: The results showed that there was no significant difference in baseline data between the two groups (p > 0.05); at the time of discharge and one month after discharge, the knowledge, belief, behavior, sputum-negative conversion rate, and imaging examination effective rate of the experimental group were higher than those of the control group (p < 0.05). Conclusions: The case management mode can improve the knowledge, attitude, and practice level; sputum-negative conversion rate; and imaging efficiency of newly treated smear-positive pulmonary tuberculosis patients.

Sputum Smears Conversion in Daily Versus Intermittent Treatment Regimen in New Sputum Smear Positive Pulmonary Tuberculosis Patients - A Retrospective Study

BACKGROUND Sputum smear conversion is the negative conversion of the sputum smear at the end of the second month of treatment regimen under the National Tuberculosis Elimination Program (NTEP). When the acid-fast bacillus (AFB) smear comes negative at the end of an intensive phase, the treatment regimen can shift to the continuation phase that indicates bacillary load is a minimum. Although some authors consider the conversion of cultures when the AFB smear is negative, two potent drugs in the continuation phase are sufficient to kill the remaining bacilli. The drug that can kill bacteria in the first 2 days of treatment is called early bactericidal activity (EBA). This can be assessed by the percentage of negative conversion of cultures at the end of the intensive phase of the treatment regimen. EBA is very essential because it reduces the transmission in the community and chances of patient death. When the purpose is to kill as many bacilli as possible in the first few days and weeks of treatment, it is very important to include bactericidal drugs in the treatment regimen so that it reduces the chances of patient death and infectiousness and the negative conversion of the cultures after 2-month treatment regimen is an indication of the bactericidal capacity of the drug. The purpose of this study was to compare sputum smear conversion in daily versus intermittent treatment regimens in diagnosed cases of new sputum smear-positive pulmonary tuberculosis patients. METHODS This retrospective observational study was carried out in the Department of Respiratory medicine and nodal drug resistance tuberculosis centre (DR-TB) at the Government medical college and hospital, Akola. In this study, a total of 120 new patients were taken. 60 patients were given daily and intermittent regimens respectively under NTEP. RESULTS Out of 120 patients, 56 (93.33 %) patients in intermittent and 53 (88.33 %) patients in daily regimen were sputum smear-negative at the end of 2nd month (intensive phase) and at the end of 6th month (continuation phase). 1 patient (1.6 %) remained sputum smear-positive after the intensive phase. That patient was given 1 month of extension of anti-tuberculosis treatment (AKT) in the intensive phase and the patient became sputum negative after 1 month of extension. CONCLUSIONS It was concluded in this study, daily regimens and intermittent regimens were equally effective in negative conversion of the sputum smear at the end of the intensive phase and the end of the continuation phase. Negative conversion of the sputum smear is quite important because the bacillary load will be so low at the end of 2nd month that reduces the chances of patient death and transmission in the community. KEY WORDS Pulmonary Tuberculosis (PTB), Drug-Resistant TB (DR-TB), National Tuberculosis Programme (NTP), Revised National TB Control Program (RNTCP), Intensive Phase (IP), continuation Phase (CP), National Tuberculosis Elimination Program (NTEP).

A Prospective Cohort Study on the Prevalent and Recurrent Tuberculosis Isolates Using the MIRU-VNTR Typing

The study aims to describe the clustering characteristics of Mycobacterium tuberculosis (M.tb) strains circulating in eastern China and determine the ratio of relapse and reinfection in recurrent patients. We recruited sputum smear-positive pulmonary tuberculosis cases from five cities of Jiangsu Province, China, during August 2013 and December 2015. Patients were followed for the treatment outcomes and recurrence based on a cohort design. M.tb strains were isolated and genotyped using the 12-locus MIRU-VNTR. The Beijing family was identified by the extended Region of Difference (RD) analysis. The Hunter-Gaston Discriminatory Index (HGDI) was used to judge the resolution ability of MIRU-VNTR. The odds ratio (OR) together with 95% confidence interval (CI) were used to estimate the strength of association. We performed a cluster analysis on 2098 M.tb isolates and classified them into 545 genotypes and five categories (I, 0.19%; II, 0.43%; III, 3.34%; IV, 77.46%; V, 18.59%). After adjusting for potential confounders, the Beijing family genotype (OR = 118.63, 95% CI: 79.61–176.79, P = 0.001) was significantly related to the dominant strain infections. Patients infected with non-dominant strains had a higher risk of the pulmonary cavity (OR = 1.39, 95% CI: 1.01–1.91, P = 0.046). Among 37 paired recurrent cases, 22 (59.46%) were determined as endogenous reactivation, and 15 (40.54%) were exogenous reinfection. The type of M.tb strains prevalent in Jiangsu Province is relatively single. Beijing family strains infection is dominant in local tuberculosis cases. Endogenous reactivation appears to be a major cause of recurrent tuberculosis in Eastern China. This finding emphasizes the importance of case follow-up and monitoring after the completion of antituberculosis treatment.

Socio-clinico-radiological profile of smear-positive pulmonary tuberculosis patients in association with sputum conversion and baseline hsCRP levels

Our was an observational follow-up study where the aim was to assess the baseline high-sensitivity C-reactive protein levels in 50 smear-positive pulmonary tuberculosis patients in association with socio-clinico-radiological profile and microbiological conversion. Smear and culture conversion of sputum samples at the end of intensive phase of anti-tubercular treatment were recorded. Baseline serum high-sensitivity C-reactive protein estimation was done by ELISA. Mean high-sensitivity C-reactive protein levels at baseline, smear/culture converted and delayed converters were 68.1 ± 22.2 mg/l, 66.7 ± 22.0 mg/l and 91.6 ± 6.7 mg/l, respectively; high-sensitivity C-reactive protein levels were significantly higher in delayed converters as compared to sputum converters. Significantly higher baseline high-sensitivity C-reactive protein levels were seen in patients with bilateral chest X-ray lesions, cavitations, evening rise of temperature, haemoptysis and dyspnoea as compared to those without these features. high-sensitivity C-reactive protein, being a non-specific inflammatory marker could be an adjunct tool for TB prognosis.

Molecular epidemiology of tuberculosis in northeastern Ethiopia

Background: Tuberculosis (TB) is a major public health threat causing the highest morbidity and mortality in Ethiopia. However, there is shortage of information on the species and strains of mycobacteria that cause TB in Ethiopia. The objective of this study is to investigate the diversity of Mycobacterium tuberculosis (M. tb) isolated from TB patients in northeastern Ethiopia. Methods: A total of 384 smear positive pulmonary and extra-pulmonary TB cases were recruited on the basis of clinical examination and ZiehlNeelsen staining for further investigation. Mycobacterial culturing, region of difference (RD) 9-based polymerase chain reaction (PCR), spoligotyping and mycobacterial interspersed repetitive unit-variable-number tandem repeat (MIRU-VNTR) typing were used for the identification the species and strains. Descriptive statistical analysis was used for the expression of the results while proportions were compared using c2 test. Statistical significance was considered when p<0.05.Results: Smear positive pulmonary tuberculosis accounted for 74.5% (286/384). The disease proportion was highest in age group of 18–37 years. Culture positivity was confirmed only in 29.2% (112/384). Speciation of the culture positive isolates using RD9 indicated that 77.7% (87/112) were M. tuberculosis. Further identification of the isolates using spoligotyping indicated 92.9% (104/112) interpretable spoligotyping patterns of which 20.2% (21/104) were grouped under 10 clustered patterns. Further grouping of the spoligotypes indicated that 86.5% (90/104) of the isolates as orphan types. Grouping of the isolates into the major lineages showed 52.9%, 27.9% and 19.2% of the isolates as Euroamerican, Indio-oceanic and East African Indian lineages, respectively. Typing of 69 isolates using 24-loci MIRU-VNTR typing gave interpretable results for 56 isolates each of them having distinct MIRU-VNTR profile and were considered as 56 different genotypes (strains).Conclusion: M. tuberculosis was identified as the main cause of TB in northeastern Ethiopia and its strains were highly diversified.