From Risk to Resistance

• In Aceh, Indonesia, environmental risks like poor lighting (AOR: 77.69) and contact with TB patients (AOR: 25.39) were strongly linked to TB. Behavioral factors like poor TB knowledge and smoking, along with comorbidities, also significantly increased TB risk. See also: BMRC.id
• Protective factors against TB included employment, higher income, and good nutrition, indicating socioeconomic status plays a key role. The multivariate model explained 76.7% of TB prevalence, suggesting strong predictive capacity for policy-making.
• Global analysis from GBD 2019 found TB mortality and disability from high fasting plasma glucose (HFPG) declined most in high-SDI regions. In contrast, low-SDI countries had minimal improvement, highlighting unequal progress.
• TB burden reductions varied widely by region; East Asia and wealthy nations saw improvements, while parts of Sub-Saharan Africa and Central Asia experienced worsening trends. Economic development was closely tied to lower HFPG-related TB burden.
• Males and older adults consistently had higher TB mortality and disability, especially in lower SDI areas. The slowest TB burden reductions were seen in older populations in high-SDI regions, calling for targeted interventions.
• A Myanmar study found TB patients were more likely to be male, smoke, drink, and have diabetes. Their household contacts also showed elevated behavioral risk compared to the general population.
• TB patients were seven times more likely to be underweight and had significantly lower odds of being overweight or hypertensive. Diabetes risk was 6.3 times higher, dropping to 3.4 when adjusted for BMI.
• Integrating NCD screening, especially for diabetes, into TB contact tracing helps identify undiagnosed cases. This dual approach enhances cost-effectiveness and addresses overlapping risk factors.
• Widespread undiagnosed NCDs among TB contacts and communities underscore the need for integrated community screening. Early intervention can curb both TB and NCD burdens.
• In Brazil, TB incidence is projected to increase to early-2000s levels by 2030 if trends continue. Time series models like SARIMA forecast 124,245 new cases in 2030, highlighting the need for renewed public health strategies.
• MDR-TB cases in a population-based study were mostly new and male, with lineage 2.2 (modern Beijing) being most common. Clustering was significant and linked to specific sublineages and compensatory mutations.
• Novel compensatory mutation rpoC E750D was unique to sublineage 2.1 and associated with transmission. Other mutations (e.g., rpoC D485Y, E1140D) were linked to increased spread, showing a genomic basis for MDR-TB clusters.
• A Taiwan study found fluoroquinolone (FQ)-resistant MDR-TB cases had more drug resistance and lower treatment success (71.6%) than FQ-susceptible cases (85.8%). Use of at least two new or repurposed drugs eliminated treatment failure in FQ-resistant TB.
• Despite improved outcomes with new drugs, mortality was still higher in FQ-resistant MDR-TB cases. Older age and comorbidities were key predictors of poor prognosis, indicating the need for better-targeted treatments.

References:

1. Fahdhienie, F., Mudatsir, M., Abidin, T.F. and Nurjannah, N., 2024. Risk factors of pulmonary tuberculosis in Indonesia: a case-control study in a high disease prevalence region. Narra J, 4(2), p.e943.
2. Zayar, N.N., Chotipanvithayakul, R., Bjertness, E., Htet, A.S., Geater, A.F. and Chongsuvivatwong, V., 2023. Vulnerability of NCDs and Mediating Effect of Risk Behaviors Among Tuberculosis Patients and Their Household Contacts Compared to the General Population in the Yangon Region, Myanmar. International Journal of General Medicine, pp.5909-5920.
3. 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.
4. Bian, Q., Zhang, Y., Xue, C., Lu, W., Li, W., Pan, F. and Li, Y., 2024. Global and regional estimates of tuberculosis burden attributed to high fasting plasma glucose from 1990 to 2019: emphasis on earlier glycemic control. BMC Public Health, 24(1), p.782.
5. Silva, M.T. and Galvão, T.F., 2024. Tuberculosis incidence in Brazil: time series analysis between 2001 and 2021 and projection until 2030. Revista Brasileira de Epidemiologia, 27, p.e240027.
6. Liu, K.H., Xiao, Y.X. and Jou, R., 2024. Multidrug-resistant tuberculosis clusters and transmission in Taiwan: a population-based cohort study. Frontiers in Microbiology, 15, p.1439532.
7. Huang, Y.W., Yu, M.C., Lin, C.B., Lee, J.J., Lin, C.J., Chien, S.T., Lee, C.H. and Chiang, C.Y., 2024. Mitigating treatment failure of pulmonary pre-extensively drug-resistant tuberculosis: The role of new and repurposed drugs. Journal of Microbiology, Immunology and Infection, 57(4), pp.617-628.

TBC 057