TB TW ID etc.

TB loss to follow-up (LTFU) refers to patients who begin TB treatment but do not complete it or fail to attend follow-up appointments. According to the WHO, TB LTFU includes patients who stop treatment for more than eight consecutive weeks after undergoing at least four weeks of treatment. Several socioeconomic factors contribute to TB LTFU, such as low education levels, short-term migration, particularly across provinces, and lack of access to healthcare. Community support, alcohol consumption, and smoking habits also increase the likelihood of LTFU. Men, individuals with lower incomes, and the unemployed are at higher risk of discontinuing TB treatment. Those whose household heads are self-employed tend to default more often compared to households led by government employees. Having health insurance and access to travel support reduces the risk of LTFU. Decentralizing treatment to facilities closer to patients' homes has also been shown to reduce treatment default rates. Alcoholi

In 2021, 4 million of the estimated 10 million new TB cases were not accounted for, and high rates of pre-treatment loss to follow-up hindered those identified. A major reason for this is the failure to address economic barriers faced by patients, which prevents them from completing the TB diagnostic evaluation process.  TB disproportionately affects the poorest and most vulnerable populations, leading to significant losses in productivity—3 to 4 months of work for individuals, 30% of yearly household earnings for families, and 4 to 7% of GDP for countries. Accessing TB diagnostic services further threatens individuals' and households' socioeconomic status. Person-centred approaches that address the underlying social determinants of TB are essential. Cash transfers, whether used as incentives or as part of a broader social protection strategy, represent a promising person-centred approach to improving TB outcomes. These transfers can play a crucial role in enhancing TB treatmen

·   Focus on TB Screening in Diabetics : Targeting individuals with diabetes (DM) and a high diabetes severity score for TB screening may be feasible and beneficial in clinical practice, especially in resource-limited settings. ·   Parameters to Define Diabetes Severity : Use of insulin and/or multiple oral hypoglycemic agents (OHAs) Duration of diabetes ≥ 5 years Presence of cardiovascular disease (CVD) Presence of chronic kidney disease (CKD) These parameters are easily obtainable in clinical practice and do not require laboratory testing. ·   Association Between Diabetes Severity and TB Risk : A significant association exists between the number of diabetes severity parameters and the increased risk of tuberculosis (TB). Those with more severe diabetes are at higher risk of developing TB. ·   FBG Concentration and TB Risk : The fasting blood glucose (FBG) level is crucial for managing diabetes and ensuring good glycemic c

One in every ten adults is a diabetic (DM) patient. Long-term hyperglycemia in DM patients leads to decreased immune cell numbers and function, increasing the incidence of tuberculosis (TB). Chronic hyperglycemia severely impairs the function of innate immune cells, affecting processes such as monocyte differentiation into macrophages and dendritic cells. This impairs the recruitment, recognition, phagocytosis, and antigen presentation functions of macrophages and reduces the frequency of dendritic cells and natural killer cells. Additionally, hyperglycemia increases the inflammatory response of neutrophils, which exacerbates bacterial load. Chronic hyperglycemia may delay the activation of adaptive immune cells, including CD4+ and CD8+ T cells. CD4+ T cells are crucial in anti-tuberculosis immunity, promoting the proliferation of T lymphocytes and macrophage activation via interferon-gamma (IFN-γ) secretion. However, high blood glucose levels can delay CD4+ T cell activation, reducing

Latent tuberculosis infection (LTBI) is characterized by an infection with Mycobacterium tuberculosis (M.tb) without symptoms of active TB. M.tb's success lies in its ability to remain asymptomatic in a latent state, reactivating only in a minority over months, years, or even decades. The risk of reactivation varies with age at infection and any concurrent health conditions that promote TB progression. With about one-fourth of the global population estimated to have LTBI, this large pool serves as a reservoir for TB re-emergence. See also:  https://tbreadingnotes.blogspot.com/2024/07/population-health-impact-and-cost.html Effective control of M.tb involves T cells, which aid macrophages in granuloma formation, tackling M.tb antigens. CD4+ T cells, in particular, release cytokines and chemokines with macrophage assistance, also supporting CD8+ T cell, DURT, and B cell activities. Both lymphoid and myeloid innate immune cells are crucial for the host’s defense against M.tb. However,

TB patients with diabetes or hyperglycemia face a higher likelihood of experiencing more severe disease and unfavorable treatment outcomes compared to those without co-morbidities. Long-term elevated blood glucose levels can impair immune cells crucial for combating TB bacteria, weakening the immune response and enabling TB bacteria to multiply and spread throughout the body, thereby increasing the risk of developing active TB. Additionally, diabetes and hyperglycemia can reduce the body's ability to effectively treat TB infections. See also:  https://tbreadingnotes.blogspot.com/2024/07/exposure-to-secondhand-smoke-and-risk.html In China, the age-standardized mortality rates (ASMRs) for TB related to hyperglycemia were lower than the global average. Although men showed higher TB mortality rates, the reduction in mortality was smaller in men compared to women. Notably,  high fasting plasma glucose (HFPG) -related TB mortality initially increased and then decreased with age, with the

In low and moderate TB incidence countries, TB often concentrates in specific groups, notably those with diabetes. In Taiwan, diabetes mellitus (DM) is the leading risk factor for pulmonary TB. After adjusting for confounders, type 2 DM is an independent risk factor for TB nationwide, though the association is stronger for type 1 DM. Poor glycemic control can increase the hazard ratio for TB in adults under 65, with men and individuals aged 55–64 at greater risk. TB patients with heart failure, ischemic heart disease, stroke, hypertension, dyslipidemia, chronic kidney disease, and liver disease are more likely to have DM. Interestingly, obesity does not increase TB risk despite its link to diabetes. TB incidence and mortality have decreased in Taiwan, yet DM remains the fifth leading cause of death. In newly diagnosed TB patients, those with DM experience higher mortality rates. Proper TB treatment has been shown to improve glycemic control, possibly due to TB-induced hyperglycemia thr

·   Standard DS-TB Treatment : The traditional DS-TB treatment consists of a 2-month intensive phase with rifampicin, isoniazid, and pyrazinamide, followed by a 4-month continuation phase with rifampicin and isoniazid. Recently, a 4-month regimen including rifapentine, isoniazid, pyrazinamide, and moxifloxacin was conditionally recommended by WHO for eligible patients aged 12 and above. See also:  https://tbreadingnotes.blogspot.com/2024/07/the-effect-of-type-2-dm-on-presentation.html ·   Isoniazid-Resistant TB : WHO recommends a 6-month regimen of rifampicin, ethambutol, pyrazinamide, and levofloxacin for isoniazid-resistant but rifampicin-susceptible TB. Adjustments, such as limiting pyrazinamide to the first 2 months, may be made based on individual factors, although evidence for these variations is limited. ·   Shortened MDR/RR-TB Treatment : WHO recommends a shorter 9–12 month all-oral regimen for MDR/RR-TB without fluoroquinolone resistance, using bedaquiline and potentially line

The annual incidence rate of LTBI in health-care workers in the government sector in Brunei Darussalam ranged from 8.1 to 24.6, with an average of 14.6 over the 4-year period. When comparing treatment acceptance among subgroups, only gender showed statistical significance, with females demonstrating significantly higher treatment acceptance. Syafiq, N.J.M., Trivedi, A.A., Lai, A., Fontelera, M.P.A. and Lim, M.A., 2023. Latent tuberculosis infection in health-care workers in the government sector in Brunei Darussalam: A cross-sectional study. Journal of Integrative Nursing, 5(3), pp.197-202. https://journals.lww.com/jinm/fulltext/2023/05030/latent_tuberculosis_infection_in_health_care.6.aspx