TB TW ID etc.

Hamada, Y., Quartagno, M., Law, I., Malik, F., Bonsu, F.A., Adetifa, I.M., Adusi-Poku, Y., D'Alessandro, U., Bashorun, A.O., Begum, V. and Lolong, D.B., 2023. Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys. EClinicalMedicine, 63. [TB0042] ·        WHO recommends systematic screening for active TB in specific populations or settings. ·        Screening aims to identify both symptomatic and asymptomatic TB cases. ·        Males are more likely to have TB but are underrepresented in screenings. ·        Surveys should systematically collect NCD-related variables to develop TB risk prediction models. ·        History of TB, HIV, self-reported diabetes, and current smoking can indicate higher TB risk. ·        The risk magnitude is approximately 1.5-fold for current smoking and self-reported diabetes. ·        S

Taylor, J., Bastos, M.L., Lachapelle-Chisholm, S., Mayo, N.E., Johnston, J. and Menzies, D., 2023. Residual respiratory disability after successful treatment of pulmonary tuberculosis: a systematic review and meta-analysis. EClinicalMedicine, 59. [TB0041] ·        There are an estimated 155 million tuberculosis (TB) survivors worldwide, equating to 1 in every 50 people alive in 2020. ·        Rifampin was approved by the FDA in 1971, and pyrazinamide (PZA) was widely used starting in 1980. ·        Even after successful treatment for pulmonary tuberculosis (PTB), many individuals experience chronic respiratory issues, including abnormal lung function, bronchiectasis, and an increased risk of lung cancer. ·        More than half of all individuals who completed PTB treatment showed abnormal spirometry results. ·        Post-PTB participants showed significantly lower scores on exercise capacity (6MWT) and physical disability due to breathlessness (MRC dyspnea scale) compared to

Murray, M., Oxlade, O. and Lin, H.H., 2011. Modeling social, environmental and biological determinants of tuberculosis. The International Journal of Tuberculosis and Lung Disease, 15(6), pp.S64-S70. [TB0040] Mathematical models have improved understanding of infectious disease dynamics and are useful for comparing control scenarios when interventional studies are not feasible or ethical. HIV has significantly impacted TB incidence rates over the past decades. Among HIV-infected individuals, low CD4 counts and high viral loads increase TB risk, while highly active antiretroviral therapy reduces it. Tobacco-associated illness and premature death create major economic burdens in low- and middle-income countries (LMICs). Higher rates of TB infection, disease, and mortality are observed among smokers. There is a potential increased risk of TB among solid-fuel users. Patients with diabetes mellitus (DM) are more than three times more likely to have TB than controls. TB disease rates are abou

TB0039 Lu, J.W., Mao, J.J., Zhang, R.R., Li, C.H., Sun, Y., Xu, W.Q., Zhuang, X., Zhang, B. and Qin, G., 2023. Association between long-term exposure to ambient air pollutants and the risk of tuberculosis: A time-series study in Nantong, China. Heliyon, 9(6). Increased concentrations of PM2.5, PM10, and NO2 are associated with increased TB risk after adjusting for various factors. No modifying effect of sex and age on the association between air pollutants and TB risk. PM2.5 and PM10 share mechanisms that enable M. tb to colonize deep lung tissues and disrupt iron balance in respiratory cells. PM exposure can lead to senescence of alveolar type II epithelial cells, downregulate antimicrobial peptides (HBD-2 and HBD-3), and increase intracellular M. tb growth. PM exposure can damage antibacterial T-cell immune function. NO2 exposure can damage airway mucosa and mucosal ciliary clearance, facilitating pathogen entry to the lungs. Prolonged NO2 exposure reduces host resistance to M. tb by

TB0038 Mendelsohn, S.C., Fiore-Gartland, A., Awany, D., Mulenga, H., Mbandi, S.K., Tameris, M., Walzl, G., Naidoo, K., Churchyard, G., Scriba, T.J. and Hatherill, M., 2022. Clinical predictors of pulmonary tuberculosis among South African adults with HIV. EClinicalMedicine, 45. CD4 count and antiretroviral initiation are associated with Mtb sensitization and TB disease. Lower CD4 cell counts are associated with reduced IGRA positivity due to the loss or dysfunction of Mtb-specific T-cell memory responses in HIV. Clinical prediction models are inadequate for detecting incipient and subclinical TB among people with HIV. Subclinical TB cases missed by symptom screening may perpetuate Mtb transmission. There is a need for more sensitive TB screening tools to find “missing” TB cases in high-incidence settings. Novel active case-finding approaches are needed that do not rely on the presence of symptoms. Simple clinical prediction models could be used as triage tools in resource-limited setti

[TB0037] Menzies, N.A., Cohen, T., Lin, H.H., Murray, M. and Salomon, J.A., 2012. Population health impact and cost-effectiveness of tuberculosis diagnosis with Xpert MTB/RIF: a dynamic simulation and economic evaluation. PLoS medicine, 9(11), p.e1001347. ·        TB diagnosis in high-burden settings mainly relies on sputum smear microscopy, which has limited sensitivity, especially among HIV-infected patients. ·        Traditional culture-based diagnosis and drug sensitivity testing are costly and slow, with many resource-limited settings lacking the capacity for high-volume testing. ·        The Xpert MTB/RIF automated DNA test provides rapid and sensitive detection of TB and rifampicin resistance, using a cartridge-based system that integrates sample processing and real-time PCR. ·        Xpert can be used by relatively unskilled healthcare workers and delivers results in less than 2 hours. ·        WHO recommended Xpert for initial diagnosis in suspected cases of multidrug-

TB0036 Bhatia V, Srivastava R, Reddy KS, et al. Ending TB in Southeast Asia: current resources are not enough. BMJ Global Health 2020;5:e002073. doi:10.1136/ bmjgh-2019-002073 In 2018, TB incidence declined but remained high in the WHO Southeast Asia Region (WHO SEAR). WHO SEAR consists of 11 member states: Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste. The region accounts for nearly half of all new TB cases and over 50% of TB deaths globally (excluding TB-HIV coinfection). Thailand is the only high-burden country in the region with high domestic spending on TB. Increased spending on TB is necessary to prevent it from remaining a serious threat by 2030. Bangladesh, India, and Indonesia need to increase their health sector allocations due to currently low public health spending. Rapid expansion of future funding requires strengthening the capacity to absorb and efficiently spend funds across th

Cegielski, J.P. and McMurray, D.N., 2004. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. The international journal of tuberculosis and lung disease, 8(3), pp.286-298. Malnutrition increases the risk of tuberculosis (TB) due to weakened cell-mediated immunity (CMI). Malnourished individuals are more likely to progress from primary or latent TB infection to active disease. Poverty links poor nutrition and higher TB risk, with malnutrition and TB rates rising together in such populations. Case Study 1: Denmark during WWI Denmark exported most protein-rich foods during the war, causing a rise in TB rates. After a German blockade in 1918, local food availability improved, and TB rates dropped. TB rates continued to rise in neighboring warring countries without improved nutrition. Case Study 2: Trondheim, Norway Naval Training School High TB rates due to crowded and unhygienic conditions. TB rates did not decline with better

Lin, H.H., Chiang, Y.T., Chuang, J.H., Yang, S.L., Chang, H.Y., Ezzati, M. and Murray, M., 2013. Exposure to secondhand smoke and risk of tuberculosis: prospective cohort study. PloS one, 8(10), p.e77333. After adjusting for potential confounders, no association was found between secondhand smoke exposure and active TB. No significant association was found between secondhand smoke and TB in the overall study population. Subgroup analysis indicated that adolescents and young adults might be particularly vulnerable to the effects of secondhand smoke on TB. The immune response related to TB protection, such as macrophage function and the IL-12/IFN-gamma circuit, matures in adolescence and should be similar across all age groups in the study. One hypothesis for differential susceptibility is that tobacco smoke might increase the risk of primary progression rather than reactivation from remote infection. The increased relative risk in adolescents suggests that the hazard of tobacco smoke is

Lee, P.H., Lin, H.C., Huang, A.S.E., Wei, S.H., Lai, M.S. and Lin, H.H., 2014. Diabetes and risk of tuberculosis relapse: nationwide nested case-control study. PloS one, 9(3), p.e92623. Presence of diabetes mellitus (DM) during anti-TB treatment was linked to a higher risk of TB relapse. The association between DM and TB relapse decreased in individuals older than 60 years. DM was independently related to an increased risk of TB relapse in the national cohort of TB patients. Strengthen follow-up strategies for DM-TB patients after anti-TB treatment to detect relapse early. TB programs should focus on rigorous glucose control for DM-TB patients.

Lin, H.H., Suk, C.W., Lo, H.L., Huang, R.Y., Enarson, D.A. and Chiang, C.Y., 2014. Indoor air pollution from solid fuel and tuberculosis: a systematic review and meta-analysis. The International journal of tuberculosis and lung disease, 18(5), pp.613-621. Low Evidence for TB Link : The association between the use of solid fuels in households and tuberculosis (TB) is supported by very low levels of evidence. Health Risks from Toxic Pollutants : Burning solid fuels can be hazardous, particularly when stoves are inefficient and ventilation is poor, leading to health issues such as acute lower respiratory infections in children under five, chronic obstructive pulmonary disease, and lung cancer. Factors Affecting Pollutant Levels : The concentration of pollutants from burning solid fuels varies based on the stove type, burning location, and ventilation at the site. These factors help in quantifying pollutant concentrations. Need for More Research : High-quality studies are required to bett

Alisjahbana, B., Sahiratmadja, E., Nelwan, E.J., Purwa, A.M., Ahmad, Y., Ottenhoff, T.H., Nelwan, R.H., Parwati, I., Meer, J.W.V.D. and Crevel, R.V., 2007. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clinical infectious diseases, 45(4), pp.428-435. Historical Context and Re-Emergence : Diabetes mellitus (DM) was historically known as a risk factor for tuberculosis (TB) but gained less attention in the latter half of the 20th century with advancements in treatment. However, with the recent global increase in type 2 DM, the association between DM and TB has resurfaced, impacting 10%–30% of TB patients. Epidemiological Data from Indonesia : Indonesia is ranked third worldwide for TB incidence and fourth for DM prevalence. Recent studies have highlighted the significant linkage between DM and TB within this demographic. Impact of Insulin on TB Outcomes : Before the introduction of insulin in 1922, DM patients frequently succ

Chen, C.C., Chiang, C.Y., Pan, S.C., Wang, J.Y. and Lin, H.H., 2015. Health system delay among patients with tuberculosis in Taiwan: 2003–2010. BMC infectious diseases, 15, pp.1-9. TB diagnosis in Taiwan largely relies on detecting symptomatic patients, enhanced by contact tracing and active screening in high-risk groups. Health care workers might miss TB due to its non-specific symptoms, increasing the risk of delayed diagnosis and transmission. The decline in TB incidence and less frequent encounters with TB cases might make clinicians less proficient in recognizing the disease. Health System Delay (HSD) is the time from the first consultation for respiratory issues to the start of TB treatment. HSD has potentially increased from 2003 to 2008 due to various factors like the complexity of diagnosing TB and changes in the health care system. Factors affecting HSD include the patient’s age, gender, type of health faci

Lin, H.H., Murray, M., Cohen, T., Colijn, C. and Ezzati, M., 2008. Effects of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis in China: a time-based, multiple risk factor, modelling study. The Lancet, 372(9648), pp.1473-1483. Tobacco smoking and indoor air pollution from solid-fuel use are primary global risk factors for chronic obstructive pulmonary disease (COPD) and lung cancer. These factors significantly contribute to mortality from these diseases in developing countries. Smoking is an independent risk factor for tuberculosis, exacerbating the spread and severity of the disease. Implementing moderate to complete reductions in smoking and solid-fuel use through tobacco taxation, advertising bans, and fuel pricing could decrease deaths from COPD and lung cancer. Reduction in these risk factors would also significantly decrease tuberculosis incidence by minimizing the duration of infectiousness through effective treatment. These diseases pose substantial economic bu

Hamada, Y., Lugendo, A., Ntshiqa, T., Kubeka, G., Lalashowi, J.M., Mwastaula, S., Ntshamane, K., Sabi, I., Wilson, S., Copas, A. and Velen, K., 2024. A pilot cross-sectional study of non-communicable diseases in TB household contacts. IJTLD OPEN, 1(4), pp.154-159. Integrating NCD screening, care, and prevention within TB contact tracing can leverage resources and enhance value for money. Household contacts (HHCs) may have a higher prevalence of NCDs than the general population due to shared risk factors. Screening for NCDs during TB contact investigations helps identify individuals unaware of their NCDs. Early identification and treatment of contacts with diabetes (DM) might reduce TB incidence. High prevalence of NCDs was found in both HHCs and neighborhood controls, suggesting the need for community-wide screening. The high prevalence of undiagnosed NCDs, particularly DM, among TB contacts and community members highlights the potential benefits of NCD screening during TB contact inve

Houben, R.M., Menzies, N.A., Sumner, T., Huynh, G.H., Arinaminpathy, N., Goldhaber-Fiebert, J.D., Lin, H.H., Wu, C.Y., Mandal, S., Pandey, S. and Suen, S.C., 2016. Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models. The Lancet Global Health, 4(11), pp.e806-e815. Aggressive scaling of a single intervention is not enough to meet the post-2015 End TB Strategy targets globally. In South Africa: A combination of targeted interventions could substantially reduce tuberculosis: Continuous isoniazid preventive therapy for individuals on antiretroviral therapy. Expanded facility-based screening for tuberculosis symptoms at health centers. Enhanced tuberculosis care. Using these interventions, significant reductions in tuberculosis are feasible, and meeting the 2025 targets is possible. For other high-burden countries like China and India, additional country-specific interventions are required: In Chin

Menzies, N.A., Gomez, G.B., Bozzani, F., Chatterjee, S., Foster, N., Baena, I.G., Laurence, Y.V., Qiang, S., Siroka, A., Sweeney, S. and Verguet, S., 2016. Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models. The Lancet global health, 4(11), pp.e816-e826. Health Outcomes : Substantial health gains were observed in India, China, and South Africa following expanded access to tuberculosis care. Cost-Effectiveness : Most intervention approaches were highly cost-effective compared to current practices and conventional cost-effectiveness thresholds. Efforts to improve access to care proved to be notably beneficial and cost-effective in each setting analyzed. Policy Considerations : Significant differences in the effectiveness and efficiency of various approaches necessitate careful planning in service expansion. Implementing expanded services effectively would require substantial new funding.

Pan S-C, Chen Y-C, Wang J-Y, Sheng W-H, Lin H-H, Fang C-T, et al. (2015) Tuberculosis in Healthcare Workers: A Matched Cohort Study in Taiwan. PLoS ONE 10(12): e0145047. Tuberculosis (TB) is considered a significant occupational hazard for healthcare workers (HCWs) in Taiwan. The incidence of active TB among HCWs in the study hospital was higher than that of the general population in Taiwan when adjusted for age, sex, and diagnosis year. The outcomes of TB in HCWs were notably better compared to non-HCW patients treated in the same setting. Factors such as the healthy worker effect, more rapid diagnosis, and less delay in treatment contributed to lower TB mortality among HCWs.  

Lai, T.C., Chiang, C.Y., Wu, C.F., Yang, S.L., Liu, D.P., Chan, C.C. and Lin, H.H., 2016. Ambient air pollution and risk of tuberculosis: a cohort study. Occupational and environmental medicine, 73(1), pp.56-61. Respirable risk factors such as active and passive smoking, and indoor air pollution from biomass, potentially impair airway defense mechanisms, increasing TB risk. High levels of ambient air pollution in developing countries correlate with continued high tuberculosis rates, necessitating further investigation into its impact on global TB control. Fine particles and traffic-related pollutants like nitrogen dioxide, nitrogen oxides, and carbon monoxide are linked to a higher risk of active tuberculosis. Laboratory and ecological studies suggest a positive association between ambient air pollution and TB incidence. The true relationship between ambient air pollution and TB might be underestimated due to potential residual confounding by area-level socioeconomic factors.  

Oliveira Hashiguchi, L., Cox, S.E., Edwards, T. et al. How can tuberculosis services better support patients with a diabetes co-morbidity? A mixed methods study in the Philippines. BMC Health Serv Res 23, 1027 (2023). https://doi.org/10.1186/s12913-023-10015-7 TB and diabetes are usually treated in separate facilities, which is a significant challenge in low- and middle-income countries (LMICs). Financial constraints, including loss of employment due to TB and the out-of-pocket costs for diabetes medications, pose major barriers to diabetes self-management. Financial incentives, such as participation allowances, are important for encouraging diabetes self-care and improving glycaemic control outcomes. Health education about diabetes management offered through TB programs is beneficial but needs further enhancement with supportive resources. There is a need for culturally appropriate messaging and information about the use of phytotherapies in diabetes management. Often, individuals see

Lee, M.R., Huang, Y.P., Kuo, Y.T., Luo, C.H., Shih, Y.J., Shu, C.C., Wang, J.Y., Ko, J.C., Yu, C.J. and Lin, H.H., 2017. Diabetes mellitus and latent tuberculosis infection: a systemic review and metaanalysis. Clinical Infectious Diseases, 64(6), pp.719-727. Individuals who do not clear Mycobacterium tuberculosis initially can develop latent tuberculosis infection (LTBI). LTBI treatment is aimed at preventing the progression to active TB, particularly recommended in low TB-burden countries for high-risk groups: People living with HIV Contacts of pulmonary tuberculosis cases Patients beginning anti-tumor necrosis factor treatments Dialysis patients Patients awaiting organ or hematological transplants Patients with silicosis A cohort study indicated a non-significant increased risk of LTBI in diabetics (risk ratio, 4.40; 95% CI, 0.50–38.55). Cross-sectional studies showed a pooled odds ratio of 1.18 (95% CI, 1.06–1.30), suggesting limited benefit from targeting diabetics for LTBI screeni

Lee, P.H., Fu, H., Lee, M.R., Magee, M. and Lin, H.H., 2018. Tuberculosis and diabetes in low and moderate tuberculosis incidence countries. The International Journal of Tuberculosis and Lung Disease, 22(1), pp.7-16. TB presents a public health challenge in both low- and middle-income countries and high-income countries, but in different ways. In countries with a generalized TB epidemic, prompt diagnosis and effective treatment of active TB are essential for control and prevention. As TB prevalence and incidence decline, a higher proportion of TB cases are expected to come from remote latent tuberculous infection (LTBI). In moderate-to-low burden settings, the TB epidemic is concentrated in specific high-risk and vulnerable populations. There is a need for an adaptive approach at the country level based on local epidemiology. There is increasing interest in the role of social determinants and risk factors of TB. Diabetes mellitus (DM) increases the risk of active TB, is associated with

Lo, H.Y., Yang, S.L., Lin, H.H., Bai, K.J., Lee, J.J., Lee, T.I. and Chiang, C.Y., 2016. Does enhanced diabetes management reduce the risk and improve the outcome of tuberculosis?. The International Journal of Tuberculosis and Lung Disease, 20(3), pp.376-382. Diabetic TB patients face higher risks of treatment failure, death, and recurrent TB compared to non-diabetic TB patients. Patients with diabetes mellitus (DM) enrolled in an enhanced case management program for DM had a lower likelihood of developing TB. If they developed TB, patients in the enhanced DM management program experienced better outcomes than those not enrolled in the program.  

Lin, H.H., Wu, C.Y., Wang, C.H., Fu, H., Lönnroth, K., Chang, Y.C. and Huang, Y.T., 2018. Association of obesity, diabetes, and risk of tuberculosis: two population-based cohorts. Clinical Infectious Diseases, 66(5), pp.699-705. Obesity and Tuberculosis Paradox : Despite the association between obesity (high BMI) and diabetes, and diabetes being a risk factor for tuberculosis (TB), epidemiological data shows that higher BMI actually correlates with a reduced risk of TB. Study Cohort Characteristics : Higher BMI in the study cohorts was associated with male gender, older age, current use of tobacco and alcohol, lower educational attainment, higher prevalence of diabetes, and lower household income (in the NHIS cohort). Mediation and Pathway Analyses : Higher BMI significantly increased the odds of diabetes; diabetes increased the odds of active TB; however, obesity directly correlated with a reduced TB risk: 71.9% reduced odds in the NHIS cohort and 67.3% in the NTC cohort. Inverse Asso

Fu, H., Lin, H.H., Hallett, T.B. and Arinaminpathy, N., 2018. Modelling the effect of discontinuing universal Bacillus Calmette-Guérin vaccination in an intermediate tuberculosis burden setting. Vaccine, 36(39), pp.5902-5909. Discontinuing the BCG vaccine could increase the tuberculosis (TB) burden, requiring careful consideration against the costs and adverse effects of the vaccination program. In regions with high vaccine efficacy (VE), stopping BCG could negatively impact health more than it would reduce side effects, due to the increased TB burden. Improving early TB detection and starting treatment promptly might be more effective than BCG vaccination in controlling TB. The immunity provided by BCG may wane over time, making the elderly less protected or not protected at all, even if they were vaccinated at birth. Even in scenarios where BCG offers strong protection for up to 40 years, older adults are least affected by the cessation of the BCG vaccination program. Instead of comp

Chidambaram, V., Gupte, A., Wang, J.Y., Golub, J.E. and Karakousis, P.C., 2021. The impact of hypertension and use of calcium channel blockers on tuberculosis treatment outcomes. Clinical Infectious Diseases, 73(9), pp.e3409-e3418. Non-dihydropyridine calcium channel blockers (non-DHP-CCBs) like verapamil enhance the effectiveness of bedaquiline against Mycobacterium tuberculosis by inhibiting efflux pumps, reducing bacillary load in macrophages. Hypertensive patients show higher all-cause mortality compared to normotensive patients, with a hazard ratio (HR) of 1.57 (95% CI, 1.23–1.99) after adjusting for factors like sex, BMI, sputum acid-fast bacilli (AFB) smear positivity, cavitary disease, past transplantation history, and Charlson Comorbidity Index (CCI). Increased 9-month all-cause mortality is also associated with male sex, lower BMI, positive sputum AFB smear, and higher CCI score. Patients with hypertension also have a significantly higher hazard of infection-related mortality

Fu, H., Lin, HH., Hallett, T.B. et al. Explaining age disparities in tuberculosis burden in Taiwan: a modelling study. BMC Infect Dis 20, 191 (2020). https://doi.org/10.1186/s12879-020-4914-2 Increasing Need for TB Control Among Elderly : As countries near TB elimination goals, prioritizing TB control measures for the elderly becomes critical due to age disparities in TB burden. Immune Senescence : Older individuals with latent TB infections are at higher risk of developing active TB as their immune systems weaken with age. Declining Transmission : TB transmission has significantly decreased in recent decades due to improved living conditions and health services, with older generations more likely exposed to TB. Age-specific Assortativity : Elders primarily interact within their own age group, leading to TB infections that rarely spread to younger people. Control Strategies : Focus on preventing disease progression in the elderly by addressing immune senescence and controlling transmis

Bao, J., Hafner, R., Lin, Y., Lin, H.H. and Magee, M.J., 2018. Curbing the tuberculosis and diabetes co-epidemic: strategies for the integration of clinical care and research. The International Journal of Tuberculosis and Lung Disease, 22(10), pp.1111-1112. Progress in reducing TB incidence and mortality has been slow. TB control strategies are being threatened by diabetes mellitus (DM), a non-communicable disease. DM increases the risk of developing active TB. The prevalence of DM has risen most quickly in low- and middle-income regions with significant TB burdens. Current estimates suggest DM contributes to as many cases of active TB as HIV/AIDS. The DM epidemic continues to increase steadily. Patients with both TB and DM experience worse clinical outcomes, including increased risk of treatment failure, relapse, and death. Resources for TB-DM research and treatment programs are limited. Large-scale clinical trials have not been conducted to find better treatment and management method

Lin HH, Shin SS, Contreras C, Asencios L, Paciorek CJ, Cohen T. Use of spatial information to predict multidrug resistance in tuberculosis patients, Peru. Emerg Infect Dis. 2012 May;18(5):811-3. doi: 10.3201/eid1805.111467.    Improved prediction of multidrug-resistant (MDR) TB can lead to earlier diagnosis, better treatment outcomes, and reduced transmission risk. Univariable analysis identified age at diagnosis, history of TB treatment, and sputum smear–negative disease as significant risk factors for MDR TB. Multivariable analysis confirmed age at diagnosis, history of TB treatment, sputum smear-negative disease, and HIV-positive status as independent predictors of MDR TB. Including information about the location of diagnosis or patient residence enhanced the prediction of MDR TB among those tested. Implementing less strict criteria for ordering drug susceptibility testing (DST) at health centers with a high risk of MDR TB might be a practical strategy when resources are constrained

Lin, H.H., Wang, L., Zhang, H., Ruan, Y., Chin, D.P. and Dye, C., 2015. Tuberculosis control in China: use of modelling to develop targets and policies. Bulletin of the World Health Organization, 93, pp.790-798. MDR tuberculosis often results from person-to-person transmission, not just unsuccessful hospital treatments. China likely cannot meet the current global targets for tuberculosis control. By 2010, China achieved older global targets of halving tuberculosis prevalence and mortality between 1990 and 2015. This success was driven by shifting tuberculosis treatment from hospitals to Chinese CDC public health centers. Future reductions in tuberculosis incidence and mortality are expected to be much slower. The most optimistic scenario predicts only an 18% reduction in incidence and a 28% reduction in mortality between 2015 and 2025. Current targets will not be met by 2025 with passive surveillance alone. Active and enhanced surveillance may accelerate declines in tuberculosis but wi

Shu, CC., Wei, YF., Yeh, YC. et al. The impact on incident tuberculosis by kidney function impairment status: analysis of severity relationship. Respir Res 21, 51 (2020). https://doi.org/10.1186/s12931-020-1294-5 LTBI screening is highly recommended for patients with end-stage renal disease on long-term dialysis; however, the TB risk in patients with chronic kidney disease (CKD) not requiring dialysis remains less clear. With the worldwide increase in CKD burden, understanding its correlation with TB infection is gaining importance. The study focused on patients aged ≥20 years from January 2008 to December 2013, using serum creatinine data to estimate kidney function via the MDRD equation, categorizing CKD into stages based on eGFR values. Exclusions were made for patients with active tuberculosis prior to or shortly after initial kidney function assessment and those with short follow-up periods. Incidence of TB among participants was analyzed by average number per 100,000 person-years

Van Wyk, S.S., Lin, H.H. and Claassens, M.M., 2017. A systematic review of prediction models for prevalent pulmonary tuberculosis in adults. The International Journal of Tuberculosis and Lung Disease, 21(4), pp.405-411. Many presumptive TB cases are not identified promptly, leading to diagnostic and treatment delays. Studies focused on developing models using clinical predictors such as history, physical examination, and chest radiography (CXR) to estimate PTB probability; more advanced imaging technologies were excluded due to lack of availability in high TB burden settings. Exclusion criteria for studies involved settings like inpatients, specific populations (e.g., TB contacts, pregnant women, drug users), to reduce heterogeneity. Only six studies met these criteria, developing and validating models to improve PTB detection using additional factors like CD4 count, BMI, and duration on antiretroviral therapy (ART). Addition of the tuberculin skin test (TST) to the WHO symptom screen

Chiang CY, Bai KJ, Lin HH, Chien ST, Lee JJ, Enarson DA, et al. (2015) The Influence of Diabetes, Glycemic Control, and Diabetes-Related Comorbidities on Pulmonary Tuberculosis. PLoS ONE 10(3): e0121698. doi:10.1371/journal. pone.0121698. Summary: Study Overview and Patient Demographics : Data were collected from three teaching hospitals across Taiwan, examining culture-positive pulmonary TB patients registered from 2005–2010. The study involved 1,473 patients (705 with diabetes, 768 without) who initiated treatment within three months of sputum collection. Exclusion Criteria : Patients with transient hyperglycemia at the start of anti-TB treatment were excluded. TB Treatment Outcomes : Outcomes were classified as successful, failed, lost-to-follow-up, or death. Diabetic patients were less likely to achieve treatment success and had higher risks of death and being lost-to-follow-up. Symptoms and Associations with Diabetes : Diabetic patients exhibited a higher prevalence of symptoms su

Shu, C.C., Hsu, C.L., Wei, Y.F., Lee, C.Y., Liou, H.H., Wu, V.C., Yang, F.J., Lin, H.H., Wang, J.Y., Chen, J.S. and Yu, C.J., 2016. Risk of tuberculosis among patients on dialysis: the predictive value of serial interferon-gamma release assay. Medicine, 95(22), p.e3813. Epidemiology and Diagnostics: Tuberculosis (TB) incidence was reported at 319.1 per 100,000 persons. QuantiFERON-TB Gold In-Tube (QFT-GIT) test had no predictive role for TB. Risk Factors for TB in Dialysis Patients: Factors such as current smoking, brief dialysis duration, active radiographic lesions, and fever were linked with prevalent TB. Reasons for increased TB risk in individuals with renal failure include enhanced immune cell apoptosis, lymphocyte depletion, and dysfunction of polymorphonuclear leukocytes, all exacerbated by oxidative stress and uremic toxins from the blood. TB Risk and Management in the Dialysis Population: The dialysis population has a high TB risk; a positive QFT-GIT test indicates a high TB

Pan, S.C., Chen, C.C., Chiang, Y.T., Chang, H.Y., Fang, C.T. and Lin, H.H., 2016. Health care visits as a risk factor for tuberculosis in Taiwan: a population-based case–control study. American journal of public health, 106(7), pp.1323-1328. TB transmission risk is heightened by inadequate ventilation and environmental cleaning, allowing TB droplets to persist in health care settings. Crowded and poorly ventilated outpatient areas significantly increase transmission risks, particularly from unsuspected and untreated TB cases. A higher frequency of health care visits is directly correlated with increased TB incidence rates; visiting a facility with an untreated TB patient on the same day notably raises the risk. Despite adjusting for medical comorbidities, the association between frequent health care visits and increased TB risk remains statistically significant. TB patients frequently visit services like family medicine, internal medicine, and general practice during potentially infect

Lee P-H, Fu H, Lai T-C, Chiang C-Y, Chan C-C, Lin H-H (2016) Glycemic Control and the Risk of Tuberculosis: A Cohort Study. PLoS Med 13(8): e1002072. doi:10.1371/journal.pmed.1002072  Diabetes Mellitus (DM) increases the risk of active tuberculosis (TB) and is associated with higher rates of treatment failure, relapse, and mortality in TB patients. A community-based screening service in New Taipei City (2005-2008) followed adults aged 30 years and older until 2012, screening for chronic diseases and cancers. The study classified DM into: no DM, DM with good glycemic control (FPG ≤ 130 mg/dl), and DM with poor glycyclic control (FPG > 130 mg/dl). Of the 122,042 participants with fasting plasma glucose (FPG) data, 11,260 (9.2%) had DM at baseline, and 71.2% of those with DM had poor glycemic control. Incidence rates of TB per 100,000 person-years were: 54.2 for nondiabetic individuals, 65.1 for DM patients with good control, and 155.5 for those with poor control. The Kaplan-Meier anal

Ko, T.H., Chang, Y.C., Chang, C.H., Liao, K.C.W., Magee, M.J. and Lin, H.H., 2023. Prediabetes and risk of active tuberculosis: a cohort study from Northern Taiwan. International Journal of Epidemiology, 52(3), pp.932-941. - Numerous studies and systematic reviews confirm diabetes mellitus (DM) as a major risk factor for active TB disease and latent TB infection. - Incident cases of active TB were identified from the National Tuberculosis Registry in Taiwan. - TB is a notifiable disease in Taiwan; presumptive TB cases must undergo sputum smear examinations at least twice and sputum cultures. - All confirmed TB cases are registered in the National Tuberculosis Registry and receive standardized and free treatment. - In this study, patients with smear-positive or culture-positive results are defined as active TB cases. -  Prediabetes is associated with a 27% reduced risk of active TB disease compared to normoglycaemia. - The biological mechanism of this inverse association and its implica

Magee, M.J., Salindri, A.D., Gujral, U.P., Auld, S.C., Bao, J., Haw, J.S., Lin, H.H. and Kornfeld, H., 2018. Convergence of non-communicable diseases and tuberculosis: a two-way street?. The International Journal of Tuberculosis and Lung Disease, 22(11), pp.1258-1268. https://doi.org/10.5588/ijtld.18.0045 In 2016, there were 10.4 million global TB cases and 1.7 million TB deaths; over 85% occurred in LMICs. None of the LMICs are projected to meet the 2030 TB-related Sustainable Development Goals. Chronic illness from TB is recognized as a risk factor for NCDs, but empirical evidence on post-TB NCD risk is limited. TB disease can temporarily increase blood glucose levels, potentially leading to hyperglycemia. Antituberculosis treatment may lower blood glucose levels. Active TB may induce hyperglycemia or DM via acute stress response, involving pro-inflammatory cytokines and regulatory hormones. Reactive oxidative species and pro-inflammatory cytokines from TB may increase liver glucose

Basham CA, Smith SJ, Romanowski K, Johnston JC (2020). Cardiovascular morbidity and mortality among persons diagnosed with tuberculosis: A systematic review and meta-analysis. PLoS ONE, 15(7), e0235821. https://doi.org/10.1371/journal.pone.0235821 Only including paper from: Denmark Egypt Estonia France Israel Peru Russia South Korea Taiwan Tanzania United States A diagnosis of TB indicates an elevated risk of cardiovascular disease (CVD). This finding has significant implications for TB research and patient care. Physicians treating patients with active TB should consider them at higher risk for CVD. Prospective studies could explore the mechanisms leading to increased CVD risk in individuals diagnosed with TB. Additionally, TB programs and healthcare providers might consider offering cardiovascular health assessments to those with active TB, following current CVD screening guidelines.

Salindri, A.D., Wang, J.Y., Lin, H.H. and Magee, M.J., 2019. Post-tuberculosis incidence of diabetes, myocardial infarction, and stroke: retrospective cohort analysis of patients formerly treated for tuberculosis in Taiwan, 2002–2013. International Journal of Infectious Diseases, 84, pp.127-130. https://doi.org/10.1016/j.ijid.2019.05.015 Methods A cohort study using data from the Taiwan National Health Insurance Research Database (NHIRD) during 2002–2013. The NHIRD, maintained by the National Health Research Institute, includes original registration and insurance claim data from the national health insurance system covering 99.9% of the Taiwanese population. Include patients formerly treated for non-pediatric active TB disease. Apply age criteria: ≥15 years old for the diabetes mellitus (DM) study and ≥25 years old for the acute myocardial infarction (AMI) and stroke studies. Confirm TB disease using ICD-9 codes (010-018) and prescriptions of anti-TB drugs for ≥28 days within a year. D