TB TW ID etc.

·   Tuberculosis (TB) is present in all countries and affects all age groups. ·   The five main risk factors for progression to TB disease are: Undernourishment HIV infection Alcohol use disorders Smoking (especially among men) Diabetes mellitus (DM) ·   It is unknown how many people suffer from a combination of TB, HIV, and DM. ·   The risk of TB is much higher in people living with HIV (PLWH) than in those with DM, and is strongly associated with the level of immunodeficiency. ·   Soon after HIV infection, the risk of TB disease increases 2–5-fold compared to non-HIV-infected individuals. ·   With progression to HIV-induced severe immunodeficiency, the risk of TB increases at least 20-fold compared to the general population. ·   Antiretroviral therapy (ART) for HIV-1 does not fully restore the baseline level of TB risk. ·   Glycaemic control is likely to be an important factor in reducing the risk of TB. ·   The clinical presentation of TB in PLWH va

Chaw L, Jeludin NH, Thu K. Prevalence and risk factors associated with tuberculosis mortality in Brunei Darussalam. Asian Pac J Trop Med 2023; 16(1): 9-15. It is generally assumed that a country’s TB burden status is positively associated with its TB-related mortality rate. However, previous reports do not fully support this assumption. Over a 5-year study period, we observed an overall TB mortality rate of 8.9% (95% CI: 7.4%-10.8%) in Brunei Darussalam. Significant risk factors for TB mortality included advancing age, female gender, renal disease, and cancer. Our finding that female gender was positively associated with TB mortality contrasts with other studies, where male gender was reported as a risk factor. Furthermore, most TB deaths were not directly related to TB itself, underscoring the importance of clinicians considering non-TB aspects of a patient's history, such as the presence of comorbidities.  

Smoking is recognized as a significant risk factor for tuberculosis and a major public health concern in Pakistan. Surprisingly, this study did not find a statistical association between tuberculosis and diabetes comorbidity. Diabetic patients face a substantial risk of developing tuberculosis compared to non-diabetic individuals. The rising prevalence of diabetes mellitus (DM) poses a potential threat to tuberculosis control measures, particularly in middle- and low-income countries. Khalid N, Ahmad F, Qureshi FM. Association amid the comorbidity of Diabetes Mellitus in patients of Active Tuberculosis in Pakistan: A matched case control study. Pak J Med Sci. 2021;37(3):816-820. === Another study: Meghji, J., Kon, O.M. and Ainley, A., 2023. Clinical tuberculosis.  Medicine ,  51 (11), pp.768-773. Thirty high-TB-burden countries account for 87% of global cases, with incident rates exceeding 150/100,000. Two-thirds of these cases occur in just eight countries: India, Indonesia, China, th

Sanchini, A., Lanni, A., Giannoni, F. and Mustazzolu, A., 2024. Exploring Diagnostic Methods for Drug-Resistant Tuberculosis: A Comprehensive Overview.  Tuberculosis , p.102522. Laboratories are well-equipped to test resistance to established drugs like fluoroquinolones (FQs), linezolid (LZD), and second-line injectable drugs (SLIDs) such as amikacin (AMK) and kanamycin (KAN). However, they are less prepared for novel drugs, like bedaquiline (BDQ), which are crucial for treating multidrug-resistant tuberculosis (MDR-TB). Phenotypic drug susceptibility tests (pDSTs) classify bacteria as resistant if they grow in the presence of a drug, indicating the drug is ineffective. Some pDSTs can determine the minimum inhibitory concentration (MIC) of a drug, while others only test for critical concentration (CC), determining whether a bacteria is susceptible or resistant. pDSTs require a positive culture of Mycobacterium tuberculosis (MTB), which takes 2-3 weeks, and the tests need to be conducte

Patients with Type 2 Diabetes Mellitus (T2DM) and Pulmonary Tuberculosis (PTB) are more likely to experience poor glycemic control, increased frequency of infections, and a higher prevalence of smoking, alcohol consumption, and lack of physical activity. Independent risk factors for concurrent T2DM and PTB include lymphopenia, smoking, a history of TB exposure, and poor glycemic control. Conversely, being overweight or obese is associated with a reduced risk of concurrent PTB in patients with T2DM. Shi H, Yuan Y, Li X, Li YF, Fan L, Yang XM. Analysis of the influencing factors and clinical related characteristics of pulmonary tuberculosis in patients with type 2 diabetes mellitus. World J Diabetes 2024; 15(2): 196-208. === Pan, S.C., Ku, C.C., Kao, D., Ezzati, M., Fang, C.T. and Lin, H.H., 2015. Effect of diabetes on tuberculosis control in 13 countries with high tuberculosis: a modelling study. The lancet Diabetes & endocrinology, 3(5), pp.323-330. Diabetes is recognized as a sign

Iskandar, D., Suwantika, A.A., Pradipta, I.S., Postma, M.J. and van Boven, J.F., 2023. Clinical and economic burden of drug-susceptible tuberculosis in Indonesia: national trends 2017–19.  The Lancet Global Health ,  11 (1), pp.e117-e125. Globally, tuberculosis incidence is decreasing, but it remains high in Indonesia despite improvements in access to health services, funding, surveillance, diagnostics, situation analysis, and policy focus. Indonesia's national tuberculosis information system, Sistem Informasi Tuberkulosis (SITB), captures patient-level data, providing valuable real-world insights that can benefit the country’s evaluation and policymaking process. This real-world data offers detailed trends in actual cases and care, allowing for the assessment of potential efficacy–effectiveness gaps. Between 2017 and 2019, the annual number of notified cases of drug-susceptible tuberculosis in Indonesia gradually increased, and treatment success rates improved. Rapid molecular tes

The adapted tool to measure tuberculosis-related stigma in workplaces in  Indonesia  is valid, internally consistent, reliable, and ready for broader external validation among workers in both formal and informal business sectors in Indonesia. However, the tool may not be generalizable to other areas, including rural regions. Indonesia also has a wide variety of cultures that may affect the interpretation of the questions and findings. Therefore, the items will need to be reviewed and refined before any wider implementation. Questions List: I do not want to eat or drink with coworkers with TB. I feel uncomfortable about being near coworkers with TB. I do not want to talk to coworkers with TB. I try not to touch coworkers with TB. I am worried about being infected by a coworker with TB. I would behave differently towards coworkers with TB. I do not want someone with TB working in my department/division/working room. I think that a coworker with TB should be ashamed. I think that a cowork

The proportion of individuals with dysglycemia (DM or pre-DM) did not significantly differ between those with favorable and unfavorable outcomes. However, dysglycemia was more frequent in TB patients who experienced treatment failure (P = .02) or death (P = .045). Individuals with favorable outcomes had lower HbA1c levels compared to those with treatment modification (P = .016), failure (P = .002), or death (P = .047). Among those with unfavorable outcomes, patients with treatment modification had lower HbA1c levels than those with treatment failure (P < .001) or who died (P = .012). Weight loss was more common in individuals with DM than in those with pre-DM or normoglycemia (P < .001). A higher proportion of TB patients with dysglycemia had a positive smear at baseline compared to those with normoglycemia. DM, but not pre-DM or dysglycemia overall, was independently associated with unfavorable TB treatment outcomes. HbA1c values were also independently linked to unfavorable out

Pando, C., Hazel, A., Tsang, L.Y., Razafindrina, K., Andriamiadanarivo, A., Rabetombosoa, R.M., Ambinintsoa, I., Sadananda, G., Small, P.M., Knoblauch, A.M. and Rakotosamimanana, N., 2023. A social network analysis model approach to understand tuberculosis transmission in remote rural Madagascar.  BMC Public Health ,  23 (1), p.1511. Social network analysis (SNA), informed by ethnographic data on the nature and structure of human interactions, can provide valuable insights and enhance the realism of compartmental models.  Despite 15 years of intervention, the prevalence of latent TB infection only slightly decreased, indicating the persistence of TB reservoirs even after systematic treatment of active cases. The intensity of social contacts may increase TB exposure, and these inter-community differences are often overlooked by conventional transmission models.  (Editor: Yoseph Samodra)

Habib, M.A., Afrin, K., Efa, S.S., Hossain, M.D., Islam, M.R., Rahman, M.M., Islam, N., Afroz, F., Rahim, M.A. and Hossain, M.D., 2024. Effects of diabetes mellitus on retreatment of Tuberculosis: A multi-centered case-control study from Bangladesh.  Journal of Clinical Tuberculosis and Other Mycobacterial Diseases ,  36 , p.100450. Recurrence of active TB after treatment can be due to either a relapse of infection with the same strain or reinfection with a new strain of Mycobacterium tuberculosis . Several factors can influence the likelihood of recurrent TB, including treatment adherence, the severity of the initial episode, the patient’s immune status, and the risk of reinfection. In low-incidence settings, most recurrent TB cases are expected to be due to reactivation. See also: https://lintblab.weebly.com/  Retreatment TB patients are those undergoing treatment again due to relapse, treatment failure, or loss to follow-up. Retreatment patients have lower cure rates compared to new

Patel, D.G., Baral, T., Kurian, S.J., Malakapogu, P., Saravu, K. and Miraj, S.S., 2024. Nutritional status in patients with tuberculosis and diabetes mellitus: A comparative observational study.  Journal of Clinical Tuberculosis and Other Mycobacterial Diseases ,  35 , p.100428. Cardiovascular disease prevalence was highest in the DM group, followed by the TB-DM group. Anaemia was more prevalent in the TB-DM group. Smoking and alcohol use were most common in the TB group, followed by the TB-DM group. See also: TB and kidney function impairment In the TB-DM group, HbA1c levels indicated poor diabetic control (10.47%), higher than in the DM group (8.17%). FBS was also above normal in the TB-DM group, followed by the DM group. Although there were no significant differences in nutritional parameters like albumin, globulin, and total proteins, vitamin B12 levels were highest in the TB-DM group. Notably, 95.83% of patients in the TB-DM group had HbA1c > 6.5, with similarly high FBS and RB

Kaur, R., Egli, T., Paynter, J., Murphy, R., Perumal, L., Lee, A., Harrison, A., Christmas, T., Lewis, C. and Nisbet, M., 2023. Tuberculosis and diabetes: increased hospitalisations and mortality associated with renal impairment. Internal Medicine Journal, 53(9), pp.1588-1594. Geographical Impact : The merging of diabetes and TB epidemics is most notable in South-East Asia, the Western Pacific, and the Middle East, where diabetes is also highly prevalent. While global TB rates are declining, diabetes prevalence is increasing due to obesity and an ageing population. Diabetes and TB Interactions : In TB patients, diabetes increases the risk of mortality, treatment failure, and TB relapse. High glucose conditions reduce phagocyte antigen presentation to T-helper cells, decreasing interferon-γ production, which is necessary for macrophages to kill TB. Active TB induces insulin resistance through the production of ‘stress’ hormones and cytokines (IL-1, TNF-alpha, and IL-6), causing impaired