Nutritional status and other associated factors of patients with TB in urban areas

Who

• Population: 314 adult (≥18 years) patients with active tuberculosis (pulmonary or extrapulmonary) enrolled in DOTS centers.

• Demographics: Mean age 35.2±15.0 years (range 18–80); 51.3% male. Most were 21–50 years old (65.9%).

• Socioeconomic profile: 12.7% had no schooling; 26.8% primary, 26.4% secondary, 34.1% higher secondary/other education. 32.5% were in service, 38.5% dependent. Over half (52.9%) had monthly family income <20,000 taka; 54.8% lived in concrete houses.

• Clinical profile: 44.9% had pulmonary TB; 55.1% extrapulmonary TB; 91.4% on anti-TB treatment <6 months; 10.8% had diabetes; 17.5% had hypertension.

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What (focus, main findings, conclusions, implications)

• Focus: To determine the prevalence of undernutrition and identify factors associated with nutritional status among adult TB patients in selected urban areas of Bangladesh.

• Nutritional status (primary outcome):

  • Underweight (BMI <18.5): 33.4%

  • Normal BMI (18.5–24.9): 45.5%

  • Overweight/obese (>24.9): 21%
    

• Key bivariate associations with nutritional status (significant):

  • Sociodemographic/clinical factors: age group, educational status, occupational status, housing condition, type of TB, TB treatment duration, and diabetes status (all p<0.05).

  • Dietary/lifestyle factors: frequency of meals per day, daily protein intake, receiving dietary counseling, safe drinking water facilities, and fortified oil intake (all p<0.05).

• Key multivariable (logistic regression) findings (underweight vs normal):

  • Age <20 years vs ≥50 years: higher odds of being underweight (OR 2.494; 95% CI 0.994–6.253; p=0.051 – borderline).

  • TB treatment duration <6 months vs ≥6 months: significantly higher odds of underweight (OR 3.639; 95% CI 1.193–11.085; p=0.023).

  • Having safe drinking water and eating three meals per day were protective against underweight (safe water OR 0.151, p=0.017; three meals/day OR 0.339, p=0.037).

• Authors’ conclusions:

  • About one-third of urban TB patients are underweight, indicating a substantial burden of undernutrition.

  • Nutritional status is closely linked with demographic, clinical, and dietary factors (e.g., age, TB type, occupation, family size, diabetes, diet, water and oil use).

  • TB programs in urban Bangladesh should integrate nutritional assessment and support, including food assistance, nutritional care guidelines, and health education on undernutrition and its consequences.

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When

• Study period/data collection: January–June 2023 (6 months).

• Contextual timeframe: Conducted against ongoing national TB control efforts in Bangladesh and the post-1993 WHO TB emergency era, but no longer-term follow-up was performed.

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Where

• Geographic setting: Selected DOTS centers in three urban city corporations in Bangladesh: Dhaka, Gazipur, and Narayanganj.

• Facilities: 12 DOTS centers in total – six in Dhaka City Corporation, three in Narayanganj, and three in Gazipur.

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Why (purpose/rationale)

• TB and malnutrition are major overlapping public health problems in Bangladesh, and malnutrition impairs cell-mediated immunity, increasing risk of TB disease and poor outcomes.

• Urban settings like Dhaka have high TB burden due to overcrowding, poor hygiene, and poverty, making nutritional problems particularly relevant.

• The study aimed to quantify undernutrition among adult TB patients in urban areas and identify associated factors in order to inform nutritional interventions within the National TB Program.

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How (design, methods, analysis)

• Study design: Descriptive cross-sectional study.

• Sampling and inclusion: Adult (≥18 years) patients with active TB confirmed by sputum microscopy and GeneXpert, enrolled in DOTS at the 12 selected centers and currently receiving anti-TB treatment. Only those present and consenting on data collection days were included.

• Data collection tools:

  • Semi-structured questionnaire (developed from prior literature, drafted in English then translated into Bangla, pretested on 10% of sample).

  • Sections on sociodemographics, lifestyle (water source, sanitation, tobacco, exercise, iodized salt and fortified oil use), health status (type of TB, treatment duration, functional status, comorbidities), dietary patterns (meal frequency, protein intake, appetite, dietary changes, counseling), and nutritional status.

• Anthropometry:

  • Weight measured with bathroom scale; height with measuring tape.

  • BMI (kg/m²) used to classify nutritional status: underweight <18.5; normal 18.5–24.9; overweight/obese >24.9.

• Statistical analysis:

  • Data entry and analysis using SPSS v25.

  • Descriptive statistics: means, standard deviations, frequencies, percentages.

  • Bivariate analysis: chi-square tests to explore associations between nutritional status and explanatory variables (sociodemographic, clinical, dietary, lifestyle).

  • Multivariable analysis: multiple logistic regression to identify independent predictors of underweight vs normal nutritional status; significance level p<0.05. 

Source: Nabi, S.G., Aziz, M.M., Uddin, M.R., Tuhin, R.A., Shuchi, R.R., Nusreen, N., Jahan, R., Afroz, F. and Islam, M.S., 2024. Nutritional status and other associated factors of patients with tuberculosis in selected urban areas of Bangladesh. Well Testing Journal, 33(S2), pp.571-590.

Association of CKD with incident TB

Who

• Adults in South Korea (≥19 years) enrolled in the National Health Insurance Service (NHIS) screening program.

• 408,873 people with predialysis CKD (stages 1–5 not on dialysis), each matched 1:1 to 408,873 controls without CKD by age, sex, smoking history, and low-income status (total ≈ 817,746 participants).

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What

• Focus: To assess whether predialysis CKD (not yet on dialysis or transplanted) is associated with higher risk of incident active tuberculosis (TB), and to examine short-term mortality after TB.

• Main findings:

  • Incidence of active TB was higher in predialysis CKD vs matched controls:

    • CKD: 1704 TB cases; 137.5 per 100,000 person-years

    • Controls: 1518 TB cases; 121.9 per 100,000 person-years

    • Adjusted hazard ratio (HR) for active TB with CKD: 1.21 (95% CI 1.13–1.30).

  • By CKD stage (vs controls, fully adjusted):

    • Stage 1 (eGFR ≥90 + albuminuria): HR ≈ 1.82

    • Stage 2 (eGFR 60–89 + albuminuria): HR ≈ 1.19 (borderline)

    • Stage 3 (eGFR 30–59): HR ≈ 1.16

    • Stage 4/5 without dialysis (eGFR <30): HR ≈ 1.85.

  • CKD was associated with higher risks of pulmonary, non-pulmonary, and miliary TB.

  • Among those who developed TB, 1-year all-cause mortality was higher in the CKD group (adjusted HR 1.68; 95% CI 1.28–2.22).

• Authors’ conclusion: Predialysis CKD is associated with increased incidence of active TB and worse short-term prognosis after TB. Particular concern is warranted for CKD stage 1 and advanced CKD (stages 4/5) not on dialysis.

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When

• Health screenings to define CKD status: 2012–2016.

• Follow-up for TB events and mortality: from each participant’s index examination date until TB, death, or December 31, 2016.

• Median follow-up: about 3.0 years in both CKD and control groups.

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Where

• Republic of Korea, using the nationwide National Health Insurance Database (NHID) and its general health screening program.

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Why

• CKD prevalence is increasing globally and in countries where TB remains endemic.

• Dialysis and kidney transplantation are known TB risk factors, but large-scale data on TB risk in predialysis CKD were lacking.

• Because CKD is associated with immune dysfunction and infection risk, the authors aimed to clarify if earlier CKD stages already confer significantly increased TB risk to guide surveillance and management.

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How

• Design: Nationwide retrospective population-based cohort study.

• Data source: Korean NHID, including:

  • General health screening data (serum creatinine, urine dipstick albuminuria, BMI, smoking, etc.).

  • Claims data with mandatory TB insurance codes and ICD-10 diagnoses to identify active TB (A15–A19).

• Population definition:

  • Included adults with ≥2 health screenings (2012–2016) using Jaffe-based creatinine.

  • Predialysis CKD: persistent CKD indicators (eGFR <60 mL/min/1.73 m² and/or dipstick albuminuria ≥1+) in two or more consecutive screenings.

  • Excluded those with prior TB, prior kidney replacement therapy, fluctuating/transient CKD labs, or (for controls) any CKD codes.

• Exposure: Presence and stage of predialysis CKD, categorized per KDIGO into stages 1, 2, 3, and 4/5 (non-dialysis) using baseline eGFR and albuminuria.

• Outcome measures:

  • Primary: Incident active TB (pulmonary, non-pulmonary, miliary) during follow-up.

  • Secondary: TB-associated mortality, defined as 1-year all-cause death after TB diagnosis.

• Analysis:

• 1:1 matching of CKD patients to controls by age, sex, smoking history, and low-income status.

• Incidence rates calculated per 100,000 person-years.

• Cox proportional hazards models with:

  • Model 1: adjusted for matching factors.

  • Model 2: additionally adjusted for BMI, residence (urban/rural), diabetes, hypertension, cancer, COPD, immunosuppressant use.

• Subgroup analyses by CKD stage and TB site; risk factor analysis for TB within the CKD cohort using multivariable Cox with backward elimination.

Source: Park, S., Lee, S., Kim, Y., Lee, Y., Kang, M.W., Cho, S., Han, K., Han, S.S., Lee, H., Lee, J.P. and Joo, K.W., 2019. Association of CKD with incident tuberculosis. Clinical Journal of the American Society of Nephrology, 14(7), pp.1002-1010.

Potential paediatric TB incidence and deaths resulting from interruption in programmes supported by international health aid, 2025–34

Who

• Population: Infants, children, and young adolescents aged 0–14 years living in 130 low-income and middle-income countries (LMICs).

• This group represents 99.5% of global paediatric TB incidence.

• Subgroups in 63 countries were further stratified by HIV status (no HIV, on ART, or not on ART).
  

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What

• Focus of the Study: Estimate how cuts to US bilateral health aid and Global Fund contributions could affect paediatric tuberculosis (TB) incidence and mortality between 2025 and 2034.

• Key Findings:

  • If US bilateral funding stops (Scenario 2):
    +2.5 million paediatric TB cases and +340,000 TB deaths.

  • If the US also withdraws from the Global Fund (Scenario 3):
    +5.9 million cases and +0.9 million deaths.

  • If non-US donors also reduce contributions by 50% (Scenario 4):
    +8.9 million cases and +1.5 million deaths—134% increase in deaths vs continued funding.

• Interpretation: Cuts could reverse decades of gains, especially in Africa and South-East Asia.

• Implication: Rapid restoration of funding (even within one year) could reduce excess deaths by ≥90%.
  

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When

• Study projection period: 2025–2034.

• Historical model base: Paediatric cohorts simulated from 2010 to allow full 0–14-year population by 2025.
  

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Where

• Geographic scope:

  • 130 LMICs across all WHO regions (largest impacts in African Region and South-East Asia Region).

  • Minimal projected impact in Europe and the Americas.
    

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Why

• Rationale:

  • Children have higher susceptibility to TB infection and mortality than adults.

  • US government cuts in early 2025 affected USAID, PEPFAR, and potentially The Global Fund.

  • Many high-burden countries rely heavily on external TB/HIV funding; disruptions risk surging transmission, reduced treatment access, and increased deaths.
    

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How

• Study Design: Mathematical modelling study.

• Methods:

  • Transmission-dynamic TB and HIV models calibrated for 130 countries.

  • Used country-specific data on funding shares, TB/HIV epidemiology, malnutrition, and BCG vaccination.

  • Created four funding scenarios, from no cuts to severe cuts involving both US and non-US donors.

  • Modelled:

    • Changes in force of infection (TB transmission risk),

    • Declines in treatment coverage (TB treatment & ART),

    • Resulting TB incidence and mortality among children.

  • Incorporated parameter uncertainty using 1000 Monte Carlo simulations.

• Validation: Compared model outputs to WHO and Global Burden of Disease estimates for recent years.
  

Source: Menzies, N.A., Brown, T.S., Imai-Eaton, J.W., Dodd, P.J., Cohen, T. and Martinez, L., 2025. Potential paediatric tuberculosis incidence and deaths resulting from interruption in programmes supported by international health aid, 2025–34: a mathematical modelling study. The Lancet Child & Adolescent Health, 9(11), pp.787-795.

Indoor environmental conditions were associated with pediatric pulmonary TB

Who

Children aged 0–14 years living in Sambas District, West Kalimantan. The study included 62 cases of pediatric pulmonary TB and 62 controls without TB.

What

The study examined how indoor environmental conditions—air circulation, natural lighting, housing density, cigarette smoke exposure, bedroom orientation, family history of pulmonary TB, and maternal knowledge—were associated with pediatric pulmonary TB.
Key findings: Significant associations were found for:

• Housing density (RR = 3.847)

• Ventilation adequacy (RR = 2.208)

• Natural lighting (RR = 3.024)

• Bedroom orientation (non-east-facing) (RR = 2.879)

• Family history of pulmonary TB (RR = 9.818)

Cigarette smoke exposure (RR = 1.245) and maternal knowledge showed no significant association.

When

Data were collected from July to October 2023.

Where

The study took place in Sambas District, located in West Kalimantan Province, Indonesia.

Why

The research aimed to evaluate whether indoor environmental conditions and household characteristics contribute to the occurrence of pulmonary TB in children, addressing a local public health concern regarding TB transmission risk factors.

How

An analytical observational study with a case-control design was conducted. Primary data were collected using observation sheets and direct measurements of air circulation, natural lighting, and housing density. Statistical analysis assessed the relationship between household environmental factors and pediatric TB incidence.

Source: Syukur, A., Yulia, Y. and Istikomah, N.R., 2024. Hubungan Kondisi Lingkungan Rumah Dengan Kejadian Tb. Paru Pada Anak Di Kabupaten Sambas. Journal of Innovation Research and Knowledge, 4(6), pp.3795-3806.

Prevalence and treatment outcomes of LTBI among older patients with COPD in Taiwan

Who

• Population: Older adults (>60 years) with COPD diagnosed per GOLD 2023 criteria (FEV₁/FVC <70%).

• Sample: 920 eligible; 819 (89.0%) underwent LTBI screening.

  • IGRA-positive: 193 (23.6%); IGRA-indeterminate: 9 (1.1%).

  • TPT recipients: 150 IGRA-positive participants (77.7% of positives).

• Demographics: Mean age ~72 years; majority male (~85%).

• Key comorbidities: Hypertension (53.8%), hyperlipidemia (33.7%), asthma (33.1%).

• Risk behaviors: 24.3% current smokers; high cumulative smoking exposure among IGRA-positive individuals.

What

• Focus: Determining the prevalence and predictors of latent tuberculosis infection (LTBI) among older COPD patients and evaluating completion and safety of various LTBI treatment regimens.

• Main findings:

  • LTBI prevalence: 23.6% via IGRA.

  • Predictors of IGRA positivity: Greater smoking pack-years, longer COPD duration, current smoking, history of cerebrovascular accident, inhaled corticosteroid (ICS) use, and cumulative prednisolone dose >210 mg in 2 years.

  • Treatment completion: Overall TPT completion 82.0%; highest in 3HP (91.2%), lowest in 9H (50.0%).

  • Safety: Adverse drug reactions (ADRs)—especially systemic drug reactions (SDRs) and hepatotoxicity—were the leading cause of discontinuation. Ten patients experienced AECOPD during treatment; four deaths occurred (three respiratory, one cardiac and unrelated to LTBI therapy).

• Implications: Older COPD patients have substantial LTBI prevalence and multiple clinical predictors; shorter rifapentine- or rifampin-based regimens showed higher completion rates but notable SDR risk.

When

• Study period: January 2021 – February 2024.

Where

• Setting: Prospective multicenter study in Taiwan at:

  • Taichung Veterans General Hospital

  • Kaohsiung Medical University Hospital

  • National Taiwan University Hospital and affiliated centers.

Why

• Rationale: COPD patients are at high risk for reactivation TB, yet LTBI prevalence, predictors, and regimen-specific outcomes in this population are insufficiently defined. Understanding these factors is essential for optimizing LTBI strategies and supporting TB elimination efforts.

How

• Design: Prospective multicenter cohort.

• Screening: IGRA using QuantiFERON-Gold or Gold-Plus.

• Treatment: WHO-recommended LTBI regimens (1HP, 3HP, 3HR, 4R, 9H) chosen via shared decision-making and administered under directly observed preventive therapy (DOPT/eDOPT).

• Monitoring:

  • Baseline labs (CBC, liver/renal panel, hepatitis, HIV).

  • Daily or dose-based ADR monitoring; monthly or biweekly biochemical testing depending on regimen.

  • ADR causality assessed using Naranjo score; severity guided management.

• Analysis: Baseline comparisons and multivariate logistic regression to identify predictors of IGRA positivity; regimen-wise assessment of completion and ADRs.

Source: Huang, H.L., Cheng, M.H., Lee, M.R., Chien, J.Y., Lu, P.L., Sheu, C.C., Wang, J.Y., Chong, I.W., Yang, J.M. and Huang, W.C., 2025. Prevalence and treatment outcomes of latent tuberculosis infection among older patients with chronic obstructive pulmonary disease in an area with intermediate tuberculosis burden. Emerging Microbes & Infections, 14(1), p.2497302.

Recurrence of TB and associated risk factors among Non-HIV patients in Taiwan

Who

• Study population: 1,875 patients with active tuberculosis (TB) who completed anti-TB treatment at a referral medical center in Taiwan.

• Subgroups:

  • 1,514 (80.7%) with pulmonary TB.

  • 1,342 culture-confirmed pulmonary TB cases.

  • 361 (19.3%) with extrapulmonary TB.

• Demographics: Median age 67 years; 67% male; comorbidities included diabetes (21.2%), malignancy (14.4%), prior TB (11.1%); 34.3% smokers; 9% had cavitary disease; 35.5% sputum smear–positive.

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What

• Focus: Determine TB recurrence rate within 6 years after treatment and identify risk factors for recurrence; evaluate annual recurrence patterns from 2012–2019.

• Major findings:

  • Overall TB recurrence rate: 2.0% (434 per 100,000 person-years).

  • Recurrence highest in the second year post-treatment.

  • Recurrence declined in patients diagnosed after 2017.

  • Independent risk factors for recurrence:

    • BMI < 20 kg/m² (aHR ~4.4–5.0)

    • Prior TB history (aHR ~4.3–4.4)

    • 2-month sputum culture non-conversion (aHR ~3.4–4.4)

  • Recurrence risk increased with cumulative risk factors (10.8% with two; 28.6% with all three).

• Implications: Early culture conversion and nutritional status are key for risk stratification; past TB history strongly predicts recurrence; supports tailored follow-up intensity and resource allocation.

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When

• Diagnosis and inclusion period: January 1, 2012 – December 31, 2019.

• Follow-up duration: Up to 6 years post-treatment, with follow-up ending December 31, 2022.

• Median follow-up: 72 months.

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Where

• Conducted at a single referral medical center in Taiwan, a region with moderate TB burden.

• Data linked with the Taiwan CDC notification database.

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Why

• To identify clinical predictors of TB recurrence to enable risk-stratified and individualized TB management, determine who may need prolonged therapy or closer monitoring, and optimize public health resource deployment.

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How

• Study design: Single-center retrospective cohort.

• Eligibility: Bacteriologically confirmed or clinically diagnosed active TB; completed ≥6 months of guideline-based treatment; excluded those who died or were lost before treatment completion, or had HIV.

• Data collected: Demographics, comorbidities, radiologic findings, microbiology including drug resistance, treatment adherence, and sputum culture conversion at 1 and 2 months.

• Outcome definitions: TB recurrence per WHO criteria (relapse or reinfection).

• Statistical approach:

• Cox proportional hazards regression for risk factor identification.

• Kaplan–Meier survival curves.

• Death treated as a censoring event; recurrence rates expressed per person-years.

• Subgroup analyses for pulmonary and culture-confirmed pulmonary TB.

Source: Hsu, C.M., Wu, C.J., Chang, C.J., Pan, S.W., Tseng, Y.H., Huang, J.R., Su, W.J., Feng, J.Y. and Chen, Y.M., 2025. Recurrence of tuberculosis and associated risk factors among Non-HIV patients in Taiwan: A retrospective cohort study. Journal of Infection and Public Health, p.102912.

Determinants of Treatment Interruption Among Drug-Resistant Tuberculosis Patients in Medan

Who

• Participants: 104 bacteriologically confirmed DR-TB patients at H. Adam Malik General Hospital, Medan.

• Groups: 34 patients lost to follow-up and 70 who continued treatment.

• Demographics of loss-to-follow-up patients:

  • 65% aged 45–65

  • 55.9% male

  • 91.2% completed high school or equivalent

  • 58.8% employed

  • 70.6% married

What

• Study focus: Association between perceived social support and perceived quality of healthcare services with loss-to-follow-up among DR-TB patients.

• Key findings:

  • Low–moderate social support significantly predicts loss-to-follow-up (PR = 14.50; p < 0.001).

  • Patients perceiving only “adequate” healthcare provider support have nearly a six-fold higher risk of loss-to-follow-up compared with those perceiving full support (p < 0.001).

• Implications: Both social and healthcare support strongly influence treatment adherence and should be integrated into patient-centered TB management strategies in Indonesia.

When

• The study was conducted over seven months; patients included had initiated treatment between 2020 and 2024.

Where

• H. Adam Malik Hospital, Medan, Indonesia. 

Why

• To fill a gap in understanding how combined social support and healthcare service quality predict loss-to-follow-up among DR-TB patients—an area with limited evidence in Medan.

How

• Design: Observational study using purposive sampling.

• Inclusion criteria: Age ≥18 years, DR-TB default or treatment completion status, treatment initiation 2020–2024, and informed consent.

• Data collection: Medical record review plus a validated questionnaire covering demographics, treatment attitude, social support, and healthcare provider support.

• Instruments: Social support assessed using adapted versions of the MSPSS (Multidimensional Scale of Perceived Social Support) questionnaire (12 items, 3 subscales).

Source: Dalimunthe, A., Sinaga, B.Y.M., Siagian, P. and Amelia, R., 2025. Social Support and Healthcare Service Quality as Determinants of Treatment Interruption Among Drug-Resistant Tuberculosis Patients in Medan, Indonesia. Jurnal Impresi Indonesia, 4(11), pp.5176-5183.

LF-LAM TB Antigen vs Xpert MTB/RIF Diagnostic Accuracy in Underweight Suspected Pulmonary TB Patients

Who

• Participants: 52 suspected pulmonary TB patients who were HIV-negative and underweight (BMI <18.5 kg/m²).

• Demographics: 42 males and 10 females; age distribution included 1 (10–19 yrs), 20 (19–43 yrs), 17 (44–60 yrs), and 14 (>60 yrs).

• Sample selection: All were newly suspected pulmonary TB cases able to produce sputum.

• Exclusions: Patients with diabetes, hepatitis, chronic renal failure, malignancy, or HIV.

• Initial enrollment: 70 patients; 52 remained after criteria applied.

What

• Study focus: Evaluation of the LF-LAM TB-Ag urine assay versus Xpert MTB/RIF sputum assay for diagnosing pulmonary TB in underweight, HIV-negative individuals.

• Key findings:

  • LF-LAM TB-Ag sensitivity: 79.59%; specificity: 100% (using Xpert as reference).

  • Significant association between the two tests (chi-square P = 0.002).

  • LF-LAM positivity higher in severely underweight patients (80%) than mildly underweight (68.1%).

  • Xpert positivity similar across underweight categories (93.33% vs. 95.45%).

• Implication: LF-LAM TB-Ag is a potentially useful, simple screening tool for pulmonary TB in severely underweight, HIV-negative patients.

When

• Data collection period: January 2023 – June 2024.

Where

• Setting: Abdul Moeloek Hospital, Lampung Province, Indonesia.

• Location type: Inpatient wards.

Why

• Rationale: To determine whether the LF-LAM TB-Ag urine test—already known as a useful tool in severe TB or HIV-associated TB—can serve as a diagnostic alternative for pulmonary TB in non-HIV, underweight patients, a population at higher risk with limited validated screening tools.

How

• Study design: Observational diagnostic evaluation.

• Procedures:

  • LF-LAM TB-Ag test: Midstream morning urine, tested within 30–60 minutes, using the Alere Determine LAM TB-Ag kit.

  • Xpert MTB/RIF: Morning sputum mixed 2:1 with reagent, shaken 10–15 minutes, then analyzed via GeneXpert cartridge system.

• Analysis: Chi-square test comparing LF-LAM and Xpert results; subgroup analysis by severity of underweight status.

Source: Eksa, D.R., Hendarto, G.S., Sinaga, F.T., Dilangga, P., Herdato, M.J.D., Infianto, A., Ekawati, D., Gozali, A. and Ajipurnomo, A., 2025. Comparative Diagnostic Accuracy of LF-LAM TB Antigen and Xpert MTB/RIF in Pulmonary Tuberculosis among Underweight Patients. Jurnal Respirologi Indonesia, 45(4), pp.272-279.

Determinants of Tuberculosis Preventive Treatment Uptake Among Pediatric Household Contacts

Who

• Participants: 364 caregiver–child pairs who were household contacts of 114 bacteriologically confirmed pulmonary TB index cases.

• Children: Mean age 10 years 4 months (range 8 months–15 years 9 months), mostly normal or obese nutritional status.

• Caregivers: Mean age 36 years (range 16–72); 49.7% ≤35 years, 67.6% biological parents, 75% below regional minimum wage income, 61% with ≥high school education, 65.7% with good TB knowledge.

• Healthcare workers: 70 staff from 16 community health centers; all had good TPT knowledge and adequate facility/drug availability.

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What

• Study focus: Determining the rate of pediatric tuberculosis preventive therapy (TPT) administration among child household contacts in Palembang and identifying associated factors.

• Major findings:

  • Only 12 of 364 children (3.3%) received TPT.

  • Younger caregiver age (≤35 years) was significantly associated with higher likelihood of child TPT receipt (OR 11.7; aOR 12.0).

  • No significant associations were found for caregiver knowledge, education, economic status, caregiver role, or distance to health center.

  • Healthcare facility factors (knowledge, drug availability, worker profession) showed no variation and thus were not associated with TPT provision.

  • Knowledge gaps persisted: nearly half of caregivers (49.5%) answered incorrectly regarding the definition of TPT.

• Authors’ conclusion: Pediatric TPT uptake in Palembang was very low, and caregiver age was the only significant determinant of TPT administration.

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When

• Data collection: May–August 2024.

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Where

• Setting: Community health centers across Palembang, Indonesia; 16 centers involved, with highest participation from Kertapati and Sako sub-districts.

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Why

• Purpose: To determine the rate of TPT administration in children who were household contacts of pulmonary TB cases, in a context where TPT coverage was unknown and TB burden was high.

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How

• Study design: Observational study.

• Participants: Included children in household contact with bacteriologically confirmed TB cases registered for treatment; excluded children with TB/HIV, recent negative TST/IGRA, incomplete questionnaires, and parental/guardian refusal.

• Data collection: Caregiver questionnaires; healthcare worker surveys; facility assessments.

• Analysis: Bivariate and multivariate analyses of caregiver, child, household, and facility factors associated with TPT administration.

Source: Ridwan, I., Sofiah, F. and Rismarini, R., 2025. Rate of administration of tuberculosis preventive treatment to pediatric household contacts and influencing factors. Paediatrica Indonesiana, 65(5):422-430.

Respiratory isolation for tuberculosis

Tuberculosis has been recognized for thousands of years, and its story reflects the evolution of medicine itself. In the early Hippocratic corpus of the 5th–4th century BCE, chronic wasting lung diseases—likely including tuberculosis—were grouped under phthisis, meaning “to waste away.” The Hippocratic school believed the illness to be hereditary, a view shaped by its appearance among cohabitating family members. The idea of contagion surfaced in Classical Greece: Isocrates acknowledged possible transmission, while Aristotle noted that scrofulous disease in livestock could spread through “foul air.” Galen, writing in the second century BCE, leaned toward a contagious explanation and recommended treatments such as fresh air, milk, and sea voyages. Yet physicians in the Galenic tradition largely favored the miasma theory—the belief that disease arose from inhaling noxious vapors—so individuals with phthisis were not stigmatized during Greek and Roman times.

By the Middle Ages, scrofula had gained a new cultural identity. Known as the “king’s evil,” it was believed curable by the royal touch of English and French monarchs, and sufferers were sometimes treated like lepers. A shift in thinking emerged toward the end of the 18th century, when physicians encouraged patients with advanced disease to remain at home, emphasizing diet, gentle physical exercise, and fresh air rather than long, arduous journeys to coastal spas or dry climates.

The sanatorium era began in 1859, when Herman Brehmer opened the first tuberculosis sanatorium in Gobersdorf, in the Silesian Mountains. These institutions originated as therapeutic rather than public health responses. Mountain air was thought to have curative power, and Brehmer believed that TB patients had abnormally small hearts; he theorized that high-altitude air would strengthen the heart and improve health. The model spread internationally. In the United States, Edward Livingston Trudeau—himself diagnosed with tuberculosis in the early 1870s—opened the nation’s first sanatorium at Saranac Lake in 1884. The first patients were housed in the modest “Little Red” cottage, and Trudeau credited the restorative Adirondack climate with extending his life until 1915.

Even as sanatoria expanded, the scientific understanding of tuberculosis advanced dramatically. In the Islamic Golden Age, Avicenna (980–1037 CE) described phthisis as contagious and recommended isolating patients. During the Renaissance, Girolamo Fracastoro (1478–1553 CE) proposed an early germ-like theory, suggesting that diseases spread through tiny “seed-like” particles. But it was not until the 19th century that definitive evidence emerged. Inspired by Pasteur’s work, Jean Antoine Villemin demonstrated in the 1860s that tuberculosis was infectious, though he could not yet identify the organism responsible. The breakthrough came on 24 March 1882, when Robert Koch announced his discovery of the tubercle bacillus—Mycobacterium tuberculosis—and established its role through what would become known as Koch’s postulates. His work also confirmed that the disease spread directly between people via airborne droplets.

Diagnostic techniques improved quickly. Paul Ehrlich refined Koch’s staining methods, and later modifications by Ziehl and Neelsen produced the famous acid-fast stain still used in much of the world today to identify tuberculosis in sputum samples.

The mid-20th century brought the true revolution: effective antibiotic therapy. In 1941, Jörgen Lehmann, working with the Swedish firm Ferrosan, showed that para-aminosalicylate (PAS) inhibited tubercle bacteria and protected infected animals. That same year, Selman Waksman and Albert Schatz at Rutgers University isolated streptomycin from Streptomyces griseus, demonstrating its lifesaving potential in both animal models and humans. Sanatoria continued to operate into the 1960s—mainly to prevent relapse—but their importance waned rapidly with the arrival of powerful drug combinations. The discovery of isoniazid in 1952 allowed near-universal cures when given alongside streptomycin and PAS. Additional breakthroughs soon followed: rifampicin in the mid-1960s, and recognition of pyrazinamide’s sterilizing activity in the early 1970s, enabling the fully oral six-month regimen that remains the standard for treating drug-susceptible TB today.

To bridge the gap between clinical efficacy and real-world adherence, public health programs adopted directly observed therapy (DOT), in which patients take medications under supervision to ensure consistent, effective treatment. This approach, used worldwide, helps prevent relapse and reduces ongoing transmission in the community.

Source: Karakousis, P.C. and Mooney, G., 2025. Respiratory isolation for tuberculosis: a historical perspective. The Journal of Infectious Diseases, 231(1), pp.3-9.