TB TW ID etc.

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  

Observational studies on diabetes and PTB (pulmonary tuberculosis) are impacted by reverse causality, confounding factors, and lack of specification regarding diabetes phenotypes, particularly between T1DM and T2DM. T1DM is associated with metabolic disorders, such as disturbed glucose and lipid metabolism, obesity, and a higher susceptibility to PTB infections. An estimated 7.5% of TB cases are linked to poor glycemic control. PTB patients often exhibit lower HDL-C, LDL-C, and total cholesterol levels. There is a log-linear relationship between BMI and TB incidence, with TB incidence decreasing by about 14% per unit increase in BMI. Mendelian Randomization (MR) uses genetic variants as instrumental variables to clarify causal relationships, reducing biases from confounders and reverse causality. MR analysis revealed: A positive genetic association between T1DM and PTB. HDL-C genetic predisposition correlates with increased PTB risk. No causal links between PTB and other T1DM-related t

·   Technology for TB Control : While the technology to control TB exists, it is generally underused. ·   DOTS (Directly Observed Treatment, Short-course) : Originally referred to directly observed treatment with short-course chemotherapy. Now a broader public health strategy with five key elements: Political commitment . Case detection through sputum smear microscopy, mostly among self-referring, symptomatic patients. Standard short-course chemotherapy with supportive patient management, including DOT. Reliable drug supply system . Standardized recording and reporting system , including treatment outcome evaluations. ·   MDG Framework for TB Control : Comprises two DOTS-focused measures: Case detection . Treatment success . Includes three impact measures applicable to TB control in general: Incidence . Prevalence . Deaths . Promotes epidemiologica

There is a significant association between diabetes mellitus (DM) and multidrug-resistant tuberculosis (MDR-TB). TB patients without DM have a lower risk of developing MDR-TB compared to those with DM. Factors contributing to MDR-TB emergence in TB patients with DM include: Impaired immune function Altered microbial genomics Uncontrolled glucose levels, increasing susceptibility to MDR-TB Compromised phagocytic activity and reduced chemotactic response Increased oxidative species and microbe proliferation Altered drug disposition Higher likelihood of non-adherence to treatment TB patients with DM also experience higher treatment failure rates compared to those without DM. Most information on these associations is based on self-reported data or patient health records, which may introduce assessment errors Rehman Au, Khattak M, Mushtaq U, Latif M, Ahmad I, Rasool MF, Shakeel S, Hayat K, Hussain R, Alhazmi GA, Alshomrani AO, Alalawi MI, Alghamdi S, Imam MT, Almarzoky Abuhussain SS, Khayya

·   Increased Health Risks for Tuberculosis Survivors : Higher likelihood of recurrent tuberculosis and increased all-cause mortality, regardless of treatment adequacy. Increased risk of chronic respiratory diseases, with many survivors experiencing abnormal spirometry, chronic symptoms, and impaired lung function (such as low forced vital capacity and reduced forced expiratory volume). Elevated risk of mortality, cardiovascular disease, and hospitalizations due to respiratory issues. Reduction in health-related quality of life, exercise tolerance, and increased social stigma and economic challenges post-treatment. See also: Lin TB Lab ·   Social and Economic Impacts : Social stigma may persist, leading to isolation, diminished marriage prospects, and possible divorce. Financial strain from medical costs and income loss during treatment can deepen poverty, potentially affecting family members, particula

Alvarado-Valdivia, N.T., Flores, J.A., Inolopú, J.L. and Rosales-Rimache, J.A., 2024. Type 2 diabetes mellitus and recurrent Tuberculosis: A retrospective cohort in Peruvian military workers.  Journal of Clinical Tuberculosis and Other Mycobacterial Diseases ,  35 , p.100432. ·   The study of Type 2 Diabetes Mellitus (DM2) as a risk factor for Tuberculosis (TB) is complex due to: Population heterogeneity worldwide, including differences in age, access to medical care, level of glucose control, types and number of complications, and available medications. See also:  https://tbreadingnotes.blogspot.com/2024/07/cost-effectiveness-and-resource.html ·   Findings from the study indicate: A higher prevalence of recurrent TB in military personnel with DM2 compared to those without DM2. A more rapid increase in cumulative risk for recurrent TB among patients with DM2. This suggests that military personnel diagnosed with DM2 may be more predisposed to

Dye, C., Garnett, G.P., Sleeman, K. and Williams, B.G., 1998. Prospects for worldwide tuberculosis control under the WHO DOTS strategy.  The Lancet ,  352 (9144), pp.1886-1891. The fall in tuberculosis incidence under DOTS is greater in younger populations than in older ones. Non-curative treatment can prevent death without eliminating infectiousness. In countries where tuberculosis incidence is stable and HIV-1 is absent: A control program reaching WHO targets (70% case detection, 85% cure) would reduce the incidence rate by 11% per year (range 8–12%). It would reduce the death rate by 12% per year (range 9–13%). If tuberculosis has been in decline for several years, the same case detection and cure rates would have a smaller effect on incidence. DOTS saves a greater proportion of deaths than cases, with a larger difference in the presence of HIV-1. HIV-1 epidemics increase tuberculosis incidence but do not significantly reduce the preventable proportion of cases and deaths. == == ==

Charles, F., Lin, Y.D., Greig, J., Gurra, S., Morikawa, R., Graham, S.M. and Maha, A., 2024. Loss to follow-up among adults with drug-resistant TB in Papua New Guinea. Public Health Action, 14(3), pp.85-90. Papua New Guinea (PNG) is listed by WHO as one of 30 high-burden countries for TB and MDR/RR-TB. TB incidence in PNG (2022) is 432 per 100,000 population, while MDR/RR-TB incidence is 22 per 100,000. PNG is a middle-income country with 22 provinces, approximately 12 million people, and 80% of the population living in rural, often remote areas. Around 75% of PNG’s population is under 35 years old, making younger people particularly vulnerable to TB. The treatment success rate for TB is approximately 50%, well below the national target of 90%. Loss to follow-up (LTFU) is high at 22%, especially among people aged 15-34 years, and is linked to socioeconomic and geographic barriers, particularly in rural areas. Young untreated patients are at risk of complications and contribute to the t

Khanna, A., Saha, R. and Ahmad, N., 2023. National TB elimination programme-what has changed.  Indian Journal of Medical Microbiology ,  42 , pp.103-107. Tuberculosis (TB) is the leading cause of death among adults from an infectious agent worldwide. TB has been a global public health emergency for 25 years. See also:  https://tbreadingnotes.blogspot.com/2024/07/tuberculosis-and-diabetes-in-low-and.html TB incidence and death rates can be reduced through addressing poverty, malnutrition, HIV, and smoking. In India, hundreds of millions have latent TB, with a significant portion at risk of reactivation due to malnutrition and risk factors like diabetes, air pollution, and smoking. See also:  https://tbreadingnotes.blogspot.com/2024/07/diabetes-mellitus-and-latent.html Inadequately treated TB can recur, particularly among patients seeking care from private providers, leading to poor outcomes. Public sector TB care has better outcomes, but 1/3 of patients are lost to follow-up before succ

Reid, M., Agbassi, Y.J.P., Arinaminpathy, N., Bercasio, A., Bhargava, A., Bhargava, M., Bloom, A., Cattamanchi, A., Chaisson, R., Chin, D. and Churchyard, G., 2023. Scientific advances and the end of tuberculosis: a report from the Lancet Commission on Tuberculosis.  The Lancet ,  402 (10411), pp.1473-1498. Progress toward ending tuberculosis varies greatly across countries, with some achieving substantial improvements and others making minimal progress. Key challenges include frail health systems, underinvestment, and reliance on one-size-fits-all approaches. Insufficient case finding and diagnosis remain the most significant issues in high-burden countries, where only 38% of all tuberculosis cases were tested with WHO-recommended rapid molecular diagnostics in 2021. Two-thirds of tuberculosis deaths occurred in just eight countries, with over half of these in India, Indonesia, and Nigeria. Despite these challenges, some sub-Saharan African countries have seen improvements in tubercul

Langley, I., Lin, H.H., Egwaga, S., Doulla, B., Ku, C.C., Murray, M., Cohen, T. and Squire, S.B., 2014. Assessment of the patient, health system, and population effects of Xpert MTB/RIF and alternative diagnostics for tuberculosis in Tanzania: an integrated modelling approach.  The Lancet Global Health ,  2 (10), pp.e581-e591. New diagnostic methods and algorithms could address weaknesses in current diagnostic processes but may increase resource and funding demands. Full rollout of Xpert (B1) offers the greatest patient-level benefits among diagnostic options. Xpert reduces the mean number of patient visits for diagnosis by 1.2 (95% CrI 1.1–1.3). Time to start treatment decreases by 6.6 days (95% CrI 5.9–7.3) with Xpert. Diagnostic loss to follow-up reduces by 7% (95% CrI 6–9), increasing successful diagnosis and treatment completion by 18%. At the health-system level, full Xpert scale-up reduces required sputum samples by 34% (441,000 vs. 730,000 annually). Xpert requires only 45% of

Williams, V., Onwuchekwa, C., Vos, A.G., Grobbee, D.E., Otwombe, K. and Klipstein-Grobusch, K., 2022. Tuberculosis treatment and resulting abnormal blood glucose: a scoping review of studies from 1981-2021. Global Health Action, 15(1), p.2114146. Diabetes as a Risk Factor for Tuberculosis (TB): Numerous studies suggest that diabetes (DM) is a risk factor for TB. It remains unclear whether TB or its treatment increases the risk of developing diabetes. Impaired glucose tolerance (IGT) may occur during treatment with anti-TB drugs and might resolve after treatment. This IGT could result from: Undiagnosed diabetes. A stress response to infection, which increases levels of stress hormones (interleukin-1, interleukin-6, TNF-alpha). Abnormal pancreatic function or TB-induced pancreatitis affecting endocrine function. Blood Glucose Testing During TB Treatment: The Fasting Blood Glucose (FBG) test was the most common method for estimating blood sugar, followed by the Oral Glucose Tolerance Test