Sunday, August 10, 2025

Diagnostic Advancements and Clinical Prognostic Indicators

1. Clinical Prognostic Indicators & Treatment Monitoring

  • BMI recovery during M/XDR-TB treatment was a strong predictor of survival; nearly 70% of patients gained weight, and lack of weight gain (especially among underweight and normal BMI patients) was linked to a fivefold increase in mortality.
  • Early weight change during treatment (3–6 months) emerged as a potential independent prognostic factor for survival.
  • Highlights the importance of integrating BMI monitoring and nutritional interventions into TB programs.

See also: Hsien-Ho Lin TB Lab


2. Diagnostic Advancements and Test Performance

  • GeneXpert enabled rapid, accurate TB and rifampicin resistance detection within two hours, supporting early treatment.
  • Second-generation IGRAs showed superior sensitivity (~90%) and fewer indeterminate results compared to traditional IGRAs, especially in smear-negative and extrapulmonary TB cases.
  • Lower false negatives and improved performance across HIV and diabetes patients make these new IGRAs promising for routine use.

See also: Jago Beasiswa


3. TB and Comorbidity Management (Diabetes Focus)

  • Historical and current data affirm that diabetes significantly increases TB risk, especially with poor glycemic control.
  • Dual burden (TB-DM) remains prevalent in high-incidence regions, necessitating integrated care approaches.
  • Evidence also suggests bidirectional interaction, with TB potentially worsening glucose tolerance.


4. Early Detection Strategies & Screening Value

  • Two-way TB screening among DM patients using symptom checklists and imaging uncovered TB cases that might be missed in routine care.
  • Even with a low confirmation rate, the study demonstrated operational feasibility and value of systematic screening in high-risk populations.
  • Reinforces the need to combine symptoms, imaging, and sputum tests for robust case identification.


5. Biomarker and Immunologic Insights

  • A 16-gene transcriptomic signature (COR) was successfully validated for predicting TB progression in two African cohorts.
  • The COR signature, regulated by type I and II interferons, suggests interferon activity as a preclinical marker for TB.
  • Transition from RNA-seq to PCR-based platforms makes gene expression tools more accessible for broader screening and risk stratification.

References:

  1. Chakhaia, T., Blumberg, H.M., Kempker, R.R., Luo, R., Dzidzikashvili, N., Chincharauli, M., Tukvadze, N., Avaliani, Z., Stauber, C. and Magee, M.J., 2025. Lack of weight gain and increased mortality during and after treatment among adults with drug-resistant tuberculosis: a retrospective cohort study in Georgia, 2009–2020. ERJ Open Research.
  2. Hariyanto, S.W., Avidati, H., Ulfah, U., Nurlaily, A.N. and Tejaningrum, K.D., Tuberculosis Screening in Patients with Diabetes Mellitus at the Internal Medicine Clinic of UGM Academic Hospital: Descriptive Study. Academic Hospital Journal, 7(1), p.8.
  3. Petruccioli, E., Scriba, T.J., Petrone, L., Hatherill, M., Cirillo, D.M., Joosten, S.A., Ottenhoff, T.H., Denkinger, C.M. and Goletti, D., 2016. Correlates of tuberculosis risk: predictive biomarkers for progression to active tuberculosis. European Respiratory Journal, 48(6), pp.1751-1763.
  4. Wati, N., Mu’awanah, I.A.U. and Amalia, A.A., 2024. Pulmonary Tuberculosis Incidence Rate with Genexpert Examination Method at Mlati II Public Health Center, Sleman In 2020-2023. International Journal of Health, Economics, and Social Sciences, 6(4), pp.1124-1129.
  5. Cadena, J., Rathinavelu, S., Lopez-Alvarenga, J.C. and Restrepo, B.I., 2019. The re-emerging association between tuberculosis and diabetes: lessons from past centuries. Tuberculosis, 116, pp.S89-S97.
  6. Whitworth, H.S., Badhan, A., Boakye, A.A., Takwoingi, Y., Rees-Roberts, M., Partlett, C., Lambie, H., Innes, J., Cooke, G., Lipman, M. and Conlon, C., 2019. Clinical utility of existing and second-generation interferon-γ release assays for diagnostic evaluation of tuberculosis: an observational cohort study. The Lancet Infectious Diseases, 19(2), pp.193-202.

Yoseph Leonardo Samodra

TBC 069

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