Journal of Tuberculosis Research

Journal Information
ISSN / EISSN: 2329843X / 23298448
Total articles ≅ 226

Latest articles in this journal

Vincent M. Balanag Jr., Vivian S. Lofranco, Mariquita J. Mantala, Mary Rosary T. Santiago, Patrice Jamie E. Cabasis, Arnyl G. Araneta, Anna Marie Celina G. Garfin
Journal of Tuberculosis Research, Volume 10, pp 205-219; https://doi.org/10.4236/jtr.2022.104016

Abstract:
Objectives: Bedaquiline (BDQ) is the first new anti-tuberculosis (TB) drug introduced to the market after 45 years. Recent studies have shown the potential benefits of adding bedaquiline to regimens for drug-resistant TB (DR-TB). In search of more effective regimens for DR-TB, bedaquiline was introduced in the TB program in the Philippines under operational research to assess its effectiveness, safety, and tolerability when given with background regimens among patients with multi-or extensively DR-TB (MDR/XDR-TB). Design: A prospective cohort study of patients with MDR/XDR-TB was given with a bedaquiline-containing regimen from June 2016 to May 2017. Demographic data, presence of comorbidities, and microbiologic profile on entry were recorded. Bedaquiline was administered at the recommended dose of 400 mg once daily for 14 days, then 200 mg three times a week for 22 weeks together with World Health Organization (WHO)-compliant background regimen. The time to culture conversion, interim outcomes at the 6th month of treatment, end-of-treatment outcomes, and post-treatment follow-up outcomes after one year was determined. The frequency and severity of adverse events (SAE) were recorded as part of pharmacovigilance. Results: Seventy-five patients were given with bedaquiline-containing regimen during the study period. Forty-two (56.0%) had second-line injectable resistance, 23 (30.7%) had fluoroquinolone-resistance, 6 (8.0%) had MDR-TB, and 4 (5.3%) had XDR-TB. In the 6th month of post-enrolment, 79% were culture-negative. The treatment success rate was 65.3% (37 were cured and 12 completed treatment), 7 (9.3%) died, 17 (22.7%) lost to follow-up, and 2 (2.7%) were withdrawn from treatment. Adverse events included vomiting (80%), dizziness (69%), nausea (52%), cough (44%), and headache (36%). The post-treatment follow-up of 49 patients in the 12th month showed 92% were culture-negative while 8% of TBC were not done. Conclusion: Bedaquiline-containing regimens for patients with MDR/XDR-TB were highly effective with an acceptable safety profile and favorable treatment outcomes, but the proportion of patients who lost to follow-up remains substantial.
Naira Khachatryan, Hakob Atshemyan, Artak Manukyan, Anush Khachatryan, Karen Poghosyan
Journal of Tuberculosis Research, Volume 10, pp 199-204; https://doi.org/10.4236/jtr.2022.104015

Abstract:
Background: One of the vulnerable components of Tuberculosis Care Programs affected by the Covid-19 pandemic was the detection of tuberculosis (TB). Based on this conviction, a study devoted to the impact of the Covid-19 pandemic on the detection and diagnosis of tuberculosis was conducted in Armenia. Methods: This observational study has a retrospective descriptive research design based on the comparative calculation of the TB incidence rate for the historical pre-pandemic period (01-Mar-2019 to 29-Feb-2020) and during the Covid-19 pandemic period (01-Mar-2020 to 28-Feb-2021). Results: The data evaluation revealed that the number of active TB cases detected during the Covid-19 pandemic was lower by 37.6% compared with the pre-pandemic period (416 vs. 667). The significant reduction of the bacteriologically confirmed cases of pulmonary tuberculosis (28% drop) was most likely related to the decrease in the sputum diagnostic tests, as the number of patients who were tested by sputum microscopy during the pandemic was lower by 43.3% compared with the pre-pandemic period (2329 vs. 4110) and the number of patients tested by sputum GeneXpert test dropped by 23% during the Covid-19 pandemic (2291 vs. 2977). Conclusion: The comparative calculation of TB detection rate changes during the Covid-19 pandemic revealed a significant decrease in TB detection compared with the pre-pandemic period. The probable reasons for this decrease were the restrictions on visits to medical centers, limited access to diagnostic services, and undermined screening and contact tracing activities.
Vindhya Vatsyayan, Theresa Pattery, Khasim Sayyad, Jason Williams, Arnab Pal, Vikas Panibatla, Ashwani Khanna
Journal of Tuberculosis Research, Volume 10, pp 187-198; https://doi.org/10.4236/jtr.2022.104014

Abstract:
Introduction: In India, tuberculosis continues to be a major public health problem and there is a growing concern about drug-resistant tuberculosis as most of the patients are from private sector. The National TB Elimination Programme (NTEP) in collaboration with TB Alert, India (TBAI) and Clinton Health Association of India (CHAI) had implemented a collaborative project to strengthen the network between the private practitioners and public healthcare facilities in New Delhi during 2019 and 2020. Methods: A study was conducted to understand the enablers and challenges encountered by them during the implementation of the project. This is a qualitative exploration of the “healthcare providers” on a project linking DR-TB patients in private sector with government health facilities. The process of data collection involved face-to-face in-depth interviews of healthcare providers, the Doctors mainly from private and public health facilities, the paramedical workers from general health system and paramedical from the project using an interview guide administered through a trained researcher. Results: The study findings revealed that all healthcare providers were completely aware of the DOST project in the health system, the model led to early diagnosis and initiation of quality treatment. There were no major challenges to the implementation of the project. The healthcare providers wish to have this project implemented for a longer duration. Conclusion: The perspectives of healthcare providers towards the “DOST” project were optimistic and call for re-initiating the project in the area.
Maïmouna Fafa Cisse, Emmanuella Mahugnon Tognimassou, Samba Niang, Fatimata Binetou Rassoule Mbaye, Khady Thiam, Yacine Dia Kane, Nafissatou Oumar Toure
Journal of Tuberculosis Research, Volume 10, pp 171-186; https://doi.org/10.4236/jtr.2022.104013

Abstract:
Introduction: Despite current progress, tuberculosis remains a major public health problem, given its still high incidence, prevalence, and mortality, particularly in sub-Saharan African countries, including Senegal. This risk is higher for immunocompromised people. Complications and comorbidities can also affect the course of the disease, affecting the prognosis. It is in this context that this study was undertaken with the objective of determining the risk factors and complications in patients hospitalized for tuberculosis. Materials and Methods: This was a retrospective and descriptive study carried out in 2021, from records of patients hospitalized for tuberculosis from January 1, 2017, to December 31, 2019, at the Pulmonology Department of Fann. Inclusion criteria were all patients on TB treatment after diagnosis of tuberculosis has been confirmed bacteriologically or clinically according to the World Health Organization’s TB case definition. Multidrug-resistant TB was excluded. Results: Out of 4516 hospitalized patients, 20.96% of patients were tuberculosis patients. The sex ratio was 2.18. 4/5 of the patients were between 18 and 39 years old. The main contributing factors of TB found were undernutrition (93.13%), active smoking (36.75%) and diabetes (35.97%). The time between hospitalization and onset of symptoms was greater than 2 months in 60.53% of cases. A complication was noted in 89.10% of patients, particularly bacterial/viral bronchopulmonary co-infection (31.15%). The trend was favorable in 88.49% of cases. It resulted in death in 10.98% of cases. Conclusion: Most integrated-care nutritional support programs focus on HIV. Undernutrition appears to play a much more important role than HIV in the extent of TB in poor countries. It creates a vicious circle with tuberculosis, one of the components of which is immunosuppression and the increased frequency of complications such as bacterial/viral community/nosocomial co-infection, the actual incidence of which is poorly known and deserves special attention given the importance of added morbidity and mortality.
Mahamat Ali Bolti, Rangar Ngakoutou, Abdoulaye Ahmet, Mad-Toingue Joseph, Dluida Dieudonné, Lodoum Mbainadji, Josephine Toralta, Meurde Nemian, Lucien Allawaye, Koboye Bonté Adjougoulta, et al.
Journal of Tuberculosis Research, Volume 10, pp 160-169; https://doi.org/10.4236/jtr.2022.103012

Abstract:
Introduction: Miliary tuberculosis (MT) is a rare form of tuberculosis (TB) and it is a major public health problem in our countries with limited resources. Materials and Methods: It is a retrospective and descriptive study that started from 1st January 2018 to 31 December 2020 at the pneumo-phtisiology service of the CHU-RN of N’Djamena., All records of patients aged at least 15 years treated for miliary tuberculosis confirmed by X-ray chest were included in our study. Results: The prevalence of TD was 1.5% (n = 103) of all TB diagnosed in the service. The sex ratio was 1.34. The average age was 37.7 years with extremes ranging from 19 to 80 years. A low social economic level was found in 75.7%. The principal comorbidity found in this study was HIV with the prevalence of (22.3%). The general signs were dominated by deterioration of general condition (96.1%) and fever (91.3%). The main symptoms were cough (85.4%) and dyspnea (52.4%). The radiology of chest found a homogeneous dissemination and symmetrical in both lung fields in 100% of cases. Our study reported that 14 (13.6%) of death cases were found among patients. Conclusion: TM is a severe form of TB; it affects a young population in our context. Mortality remains high with prevalence of 13.6% of cases. Early management would improve the prognosis.
Lame Sharon Simon, Lesego Gabaitiri, Sikhulile Moyo, Kgalemelo Rodnie Mafa
Journal of Tuberculosis Research, Volume 10, pp 146-159; https://doi.org/10.4236/jtr.2022.103011

Abstract:
The purpose of this study was to identify factors affecting the time to development of tuberculosis in the presence of competing risks. In this case death before developing tuberculosis was deemed a competing risk because it altered the occurrence of the outcome of interest being time to development of tuberculosis from baseline. We used data from a randomized longitudinal clinical trial study called the “Tshepo” study. The “Tshepo” study was a 3-year randomized clinical study following 650 ART-naïve adults (69.4% female) from Botswana who initiated first-line NNRTI-based ART. Participants were assigned in equal proportions (in an open-label, unblinded fashion) to one of 6 initial treatment arms and one of two adherence arms using permuted block randomization. Randomization was stratified by CD4+ cell count (less than 200 cells/mm3, 201 - 350 cells/mm3) and by whether the participants had an adherence assistant. Classical methods such as the Kaplan-Meier method and standard Cox proportional hazards regression were used to analyze survival data ignoring the competing event(s) which may have been inappropriate in the presence of competing risks. The idea was to use competing risk models to investigate how different treatment regimens affect the time to the development of TB and compare the results to those obtained using the classical survival analysis model which does not account for competing risks. Amongst 38 patients who died 15.8% of them developed tuberculosis whilst 84.2% of those who died did not develop the outcome of interest. The hazard ratio of treatment C was 1.069 implying that the risk of developing TB in patients taking treatment C is about 6.9% higher compared to those taking treatment A having adjusted for baseline age, baseline BMI, baseline CD4, Hemoglobin and gender. Similarly, after accounting for competing risks the hazard ratio for treatment C was about 1.89 implying that the risk of developing TB amongst those taking treatment C was about 89% higher as compared to those taking treatment A. From the obtained results it was thus concluded that the standard Cox model of time to event data in the presence of competing risks underestimated the hazard ratios hence when dealing with data with multiple failure events it is important to account for competing events.
Sekossounon Sanni, Haziz Sina, Lamine Baba-Moussa
Journal of Tuberculosis Research, Volume 10, pp 124-145; https://doi.org/10.4236/jtr.2022.103010

Abstract:
Introduction: Polymorphisms are the main genetic factors associated with toxicities of antituberculosis drugs. This literature review summarizes the polymorphisms of the genes that code for the enzymes of the metabolism of antituberculosis drugs and their transmembrane transporters. Some mechanisms of drug-associated toxicities and strategies for their management have also been described in this review. Methods: The bibliographic searches were exclusively carried out in PubMed, over a period of ten years (2010-2020). The search terms were the words “toxicity + antituberculosis drug + one or two word(s) among the following: polymorphism, genetics, mutation, SNP, HLA or haplotype”. Publications in English or French, relating to the various toxicities associated with first-line anti-tuberculosis drugs (Rifampicin, Isoniazid, Ethambutol and Pyrazinamide) administered to patients with pulmonary tuberculosis, extrapulmonary tuberculosis or co-infected with TB/HIV were included in this review. Duplicates, in vitro, in silico or drug-induced toxicity studies other than antituberculosis drugs and genetic mutations of Mycobacteria strains were not included. Results: The studies selected and included were case reports, cohort studies, original research, systematic reviews and meta-analyses on human subjects of different ethnic origins. Hepatotoxicity is the most common toxicity associated with NAT2, CYP2E1, GSTM1 and GSTT1 polymorphisms in patients on antituberculosis drugs. Other forms of toxicity, less frequent, occurring in certain patients under concomitant treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), antiretrovirals (ARVs), antibiotics or antiepileptics have also been identified. Conclusion: The genetic polymorphisms associated with the toxicities of antituberculosis drugs concern both the main enzymes of the metabolic pathways (NAT2, CYP2E1, GST) and the transmembrane transporters (SLCO1B1 and ABCB1). Other genetic polymorphisms (TXNRD1, SOD2, TYMP) have been suspected but their mechanisms are not yet well understood.
Sekossounon Sanni, Ablo Prudence Wachinou, Corinne Simone Colette Merle, Lamine Baba-Moussa, Dissou Affolabi
Journal of Tuberculosis Research, Volume 10, pp 111-123; https://doi.org/10.4236/jtr.2022.103009

Abstract:
SLCO1B1 and NAT2 polymorphisms have been associated with the variability of Rifampicin and Isoniazid pharmacokinetic (PK). The objective of this study was to identify in African patients with tuberculosis (TB) or TB/HIV co-infection, the SLCO1B1 and NAT2 polymorphisms, associated with the variability of Rifampicin and Isoniazid pharmacokinetic. TB or TB/HIV co-infected patients from Benin, Guinea, Senegal, and South Africa were included in this study. The blood samples collected were stored at -80˚C until DNA extractions. The DNA extracts were then frozen at -80˚C after quality control. Double stranded DNA of the samples were quantified using a fluorimetric method to select suitable samples for the preparation of 96-well microplates, containing 100 μl of DNA extract per well at the concentration of 20 ng/μl. Illumina HumanOmniExpress-24 v1.2 microarray genotyping was performed by an external vendor. The genotyping data were analyzed and the polymorphisms with a call rate Hardy-Weinberg Equilibrium (HWE) were excluded. The correlation between significant genetic polymorphisms, the clearance, and the AUC were tested by a multiple linear regression model using the PLINK2 software. Out of 385 samples, five (05) were excluded after quality controls. After the frequency test, 384,586 SNPs failed the Hardy-Weinberg Equilibrium. Finally, 378 samples and 318,751 SNPs were included in the genetic analyses. The SLCO1B1 and NAT2 polymorphisms were associated with the variability of Rifampicin and Isoniazid PK parameters. There are SLCO1B1 and NAT2 polymorphisms carriers among TB and TB/HIV co-infected patients from Sub-Saharan Africa.
Obioma Chijioke-Akaniro, Emperor Ubochioma, Amos Omoniyi, Oluwafunmilayo Omosebi, Olawumi Olarewaju, Mary Etolue, Sunday Asuke, Elias Aniwada, Anyaele Uwaezuoke Ndubuisi, Victor Ombeka, et al.
Journal of Tuberculosis Research, Volume 10, pp 99-110; https://doi.org/10.4236/jtr.2022.103008

Abstract:
Introduction: Finding the missing Tuberculosis (TB) cases remains the single most important priority for TB control in Nigeria. Between 66% - 92% of all cases of respiratory diseases including those with symptoms suggestive of TB are first seen byprivate health providers. Dependable, quality surveillance systems and notification are key roles in health services delivery, particularly as it is related to TB control. However, poor notification has been a challenge. This study was to assess the contribution of the public private mix (PPM) to Nigeria Tuberculosis national case notification. Methods: It was a national cross-sectional study. Data were extracted from the National database and reviewed. Private facilities were engaged in 2017 and assessed over 2018-2020. Interventions included: enrolling private practitioners (Private-For-Profit, Faith Based Organization, Private Medicine Vendors and Community Pharmacists), engaging a private standalone Laboratory for Gene Xpert testing within the network of private facilities, use of Mobile App for easy screening and reporting, instituting a HUB and spoke, and incentives to private providers for participating. Each private provider had a customized approach. Trend analysis was performed using Cochran-Armitage χ2 test for linear trends. Level of significance was at a p value of Results: Total case notification increased from 104,904 cases in 2017 to 138,591 in 2020. There were 2.0% increase in 2018, 13.0% in 2019 and 15.0% in 2020 (p ). PPM contribution to case notification increased from 10,699 cases in 2017 to 12,625 in 2018, then 17,250 in 2019 and 38,865 in 2020. There were 18.0% increase in 2018, 36.6% in 2019 and 125.3% increase in 2020 (p ). Conclusion: Effective engagement of the private sector in TB control efforts in Nigeria using a variety of approaches resulting in improved TB notification is possible. The National TB Programme should engage all private practitioners such that each practitioner will practice at least one TB service model.
Chukwuebuka Emmanuel Nwoke
Journal of Tuberculosis Research, Volume 10, pp 87-98; https://doi.org/10.4236/jtr.2022.103007

Abstract:
The UNHCR 2017 report stated that about 44,400 people are displaced from their homes daily and about 68.5 million people are currently displaced globally. This article aims at critically analyzing the tuberculosis risks among displaced people especially as there is an increase in the number of migrants globally and proliferation of man-made and natural disasters. Research conducted among displaced persons and most of the studies concluded that active surveillance and proper case follow-up are the best ways to ensure adequate tuberculosis case management. In conclusion, the application of diverse methods in tackling tuberculosis risks should be especially through a culturally, acceptable precise and feasible plans without compromising international standards.
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