Assessing the capacity of primary health care centres to provide tuberculosis services in Kaduna State, North-Western Nigeria

Background: Despite earlier successes achieved in combating it, cases of tuberculosis in Nigeria are now on the increase, affecting more people and communities. Primary health care in Nigeria is through ward health system, designed to provide minimum health package to the communities including TB services. This study aimed to ascertain the capacity of PHC centres to provide TB services in Kaduna North senatorial district, Kaduna State, Nigeria.Methods: Four out of eight local Government areas in the district were randomly selected and one PHC per ward was recruited in the study. In each facility, questionnaires developed from the TB tracer items of the WHO service availability and readiness assessment tool were administered to the facility in-charges and TB/DOTS focal persons.Results: Forty four facilities were selected from Zaria, Sabon Gari, Makarfi and Kudan LGAs. Almost all facilities (98%) diagnosed TB clinically and 39 (90%) had anti-TB drugs available. National TB guidelines were lacking in 23 (52%) facilities and only 5 (11%) had additional capacity for sputum microscopy. While 35 (80%) TB/DOTS focal persons had received training on TB diagnosis and treatment, only 24 (55%)received training on TB/HIV co-infection and only 8 (18%) received training on multi-drug resistant TB.Conclusions: While TB services are widely available in the district, urgent need exists for all stakeholders to work together towards equipping those facilities with critical infrastructure that will improve their overall capacity, particularly with regards to comprehensive TB guidelines, laboratory diagnosis and personnel training for effective TB management.

Growth of Aspergillus and Mucor spp. in sputum culture of a post-COVID patient: fungal infection or colonization? A clinical challenge in COVID-era

Opportunistic infections, especially invasive fungal infections have emerged as an added health issue in this COVID-era. The dysregulated immune mechanisms in the pathophysiology of COVID-19, its treatment with corticosteroids and other immunomodulatory agents, invasive mechanical ventilation and other forms of ventilatory and oxygen delivery systems, prolonged hospital stay, injudicious use of antimicrobials – all have set the required stages for such infections. Aspergillus spp. and Mucorales are ubiquitous, environmental fungus; may colonize in airways and chronically damaged human lungs, without significant health effects and cause disease, especially in immunocompromized patients. We report case history of a middle aged Bangladeshi man with multiple comorbidities, who presented with fever and respiratory symptoms, four-months after recovery from COVID-19. He had Aspergillus and Mucors on sputum microscopy and cultures; but his response to antibiotics suggested these were colonozations in previously injured lungs by tuberculosis in the form of fibrosis and bronchiectasis. He is well and free of symptoms, two-months since discharge. BIRDEM Med J 2021; 11(3): 218-222

_PROGNOSTIC MARKER OF TUBERCULOSIS SEVERITY AND TREATMENT EFFECTIVENESS IN PULMONARY TUBERCULOSIS

The aim: Was to investigate human-beta-defensin-1 level in blood serum depending on tuberculosis severity and treatment effectiveness. Materials and methods: 100 patients with pulmonary tuberculosis and 20 healthy persons were included to the study. HBD-1 level was measured by ELISA in all the healthy persons and in all the patients at the treatment onset and at the end of initial phase of treatment. Additionally, the patients were examined with chest X-ray, sputum microscopy and culture, blood test and blood biochemistry. Results: HBD-1 level was higher in patients with tuberculosis (21.5 ± 2.9 μmol/L) compared with healthy individuals (8.9 ± 2.5 μmol/L). A positive correlation of middle strength was found between the size of lung lesion and the level of HBD-1 and between the level of HBD-1 and the massiveness of bacterial excretion. We found weakly negative correlations between the level of HBD-1 at the beginning of treatment and parameters of life quality rated on sf-36 scale. Patients with initially high level of HBD-1 had preservation of bacterial excretion, as well as signs of inflammatory activity. In patients with an effective intensive phase of treatment, the initial level of HBD-1. Conclusions: The larger pulmonary tuberculosis lesion, as well as the more pronounced clinical manifestations lead to the higher level of HBD-1. The possibility of using human-beta-defensin-1 as a prognostic marker of treatment effectiveness is confirmed by the fact that human-beta-defensin-1 level prevails at the beginning of treatment in patients with subsequently non-effective intensive phase of treatment.

Microbiological diagnosis of tuberculosis in Russia in 2020:achievements and challenges

SummaryMonitoring the status of microbiological diagnostics of tuberculosis is of major national and international importance for achieving tuberculosis control objectives. Objective. To study and characterize the current state, major trends and current trends in the development of microbiological diagnostics of TB in progress. Materials and methods. The study covered health care organiza-tions of the executive authorities in the field of health services of the subjects of the Russian Federation. The data of industrial and single time statistical observation, as well as answers to special enquiries were studied. Results and discussion. Detection of TB patients by means of sputum microscopy is insufficient, amount-ing to 14.9% in new cases and 10.8% in recurrent ones. The increase in the share of pulmonary TB patients with a positive sputum microscopy up to 35.1% can be as-sociated with a worsening of active detection due to a new coronavirus infection. The share of newly-detected pulmonary TB patients with a positive culture for Myco-bacterium tuberculosis has also increased to 52.8%, but this is below the target (54.0%) and will not reach the target by 2024 (60.0%). The decrease is seen at both preanalytical and analytical phases, mainly in selected regions. The coverage by rapid methods was 87.4%, including WHO-recommended was 58.0%, which is be-low the target (90%). The coverage by drug sensitivity testing (DST) was 97.1% (target 100%). The coverage by DST of patients with resistance to rifampicin and fluoro-quinolones was 93.5%, the coverage by DST of patients with resistance to linezolid was 35.0%, to bedaquiline — 8.5%, to two drugs — 6.6%. Conclusion. It is advisable to intensify the targeted supervision by specialists in microbiological diagnostics of TB with low target values, paying attention to participation in quality assessment programmes, ensuring the possibility of DST to bedaqui-line and linezolid.

Urine lipoarabinomannan (LAM) testing for all HIV patients hospitalized in the medical wards identifies a large proportion of patients with tuberculosis at risk of death

Background Diagnosing tuberculosis (TB), the leading cause of death in people with HIV, remains a challenge in resource-limited countries. We assessed TB diagnosis using a strategy that included systematic urine lipoarabinomannan (LAM) testing for all HIV patients hospitalized in the medical wards and 6-month mortality according to the LAM result. Methods This prospective, observational study included adult HIV patients hospitalized in the medical wards of a public district hospital in Malawi regardless of their TB symptoms or CD4 count. Each patient had a clinical examination and Alere Determine TB-LAM, sputum microscopy, sputum GeneXpert MTB/RIF (Xpert), chest X-ray, and CD4 count were systematically requested. Results Among 387 inpatients, 54% had a CD4<200 cells/µL, 64% had presumptive TB and 90% had ≥1 TB symptom recorded in the medical file. LAM results were available for 99.0% of the patients, microscopy for 62.8% and Xpert for 60.7%. In total, 26.1% (100/383) had LAM-positive results, 48% (48/100) of which were grades 2-4. Any TB laboratory test result was positive in 30.8% (119/387). Among patients with no Xpert result, 28.5% (43/151) were LAM-positive. Cumulative 6-months mortality was 40.1% (151/377): 50.5% (49/97) in LAM-positives and 36.2% (100/276) in LAM-negatives, p=0.013. In multivariable regression analyses, LAM-positive patients had higher risk of mortality than LAM-negatives (aOR: 2.5, 95%CI: 1.1-5.8, p=0.037). Conclusions In resource-limited hospital medical wards with high TB prevalence, a diagnostic strategy including systematic urine-LAM testing for all HIV patients is an easily implementable strategy that identifies a large proportion of patients with TB at risk of death.

A pilot study to evaluate urine LAM assay for diagnosis of pulmonary tuberculosis among non-HIV patients

There is a great need to improve diagnostic tools for tuberculosis where the majority are without HIV co-infection in resource-poor settings and high-burden areas such as India. The urine LAM assay has not hitherto been studied and may have a role to play. Our study found that, as a stand-alone diagnostic tool, the assay was suboptimal when compared to Xpert MTB/Rif. However, a combination of LAM assay along with sputum microscopy may be useful in settings where molecular testing is unavailable.