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PubMed2001

Evidence for action? Patterns of clinical and public health research on tuberculosis in South Africa, 1994-1998.

OBJECTIVES: To describe patterns of clinical and public health research into tuberculosis in South Africa from 1994-1998, and to assess the quality of studies of diagnostic accuracy and treatment. DESIGN: MEDLINE and the African Health Anthology were searched for journal articles published from 1994-1998 reporting clinical and public health research into tuberculosis in South Africa. Information extracted from the reports included research setting, study design, aspects of the quality of study design and reporting, and evidence of attention to statistical power. RESULTS: One hundred and thirty-five eligible studies were identified; 39 (28.9%) of the studies were case reports or case series. Important methodological flaws were identified in studies of diagnosis and treatment that compromised the validity of the study results. Of the 28 studies assessing interventions, 10 (35.7%) were randomised controlled trials with only one reporting adequate allocation. Of the 34 studies assessing diagnosis, 16 (47.0%) were cross-sectional assessments of diagnostic accuracy, and none reported that comparison of the reference standard was independent or blind. Fifty-four (79.4%) of the analytical studies with statistically non-significant results showed no evidence of consideration of sample size. CONCLUSION: The usefulness of tuberculosis research in South Africa is compromised by the questionable validity of many studies and a lack of attention to sample size.

Case-Control Studies↗
PubMed1983

Hyperuricaemia induced by ethambutol.

Seventy patients with pulmonary tuberculosis and 12 healthy controls were included in a study to observe the effect of ethambutol on serum uric acid level. In ethambutol-treated cases a statistically significant increase in mean serum uric acid levels was observed in the second, third and fourth week of treatment. This increase was independent of dosage of ethambutol. However, 22 of the 52 (42%) ethambutol-treated cases showed no increase. Streptomycin was found not to potentiate the hyperuricaemic action of ethambutol. Hyperuricaemia due to ethambutol was reversed with probenicid but not by salicylates. No patient developed acute gouty arthritis although two developed arthralgia.

Adolescent↗
PubMed2005

Case-control study of medical history and idiopathic pulmonary fibrosis in Japan.

OBJECTIVES: A few epidemiological studies have indicated that a patient's past medical history may contribute to the risk of developing idiopathic pulmonary fibrosis (IPF). A relationship between a history of selected disorders and the risk of IPF was assessed in a multicentre hospital-based case-control study in Japan. METHODOLOGY: Included in the study were 104 patients of IPF, aged 40 years or over, who had been diagnosed within the previous 2 years, in accordance with the most recent criteria. Control subjects, aged 40 years or over, consisted of 56 hospitalized patients diagnosed as having acute bacterial pneumonia and four outpatients with the common cold. Adjustment was made for age, gender, region, pack-years of smoking, employment status, occupational exposure and BMI. RESULTS: Medical histories of hypertension, hyperlipidaemia, coronary heart disease, diabetes mellitus, hepatitis C virus infection, tuberculosis, asthma, atopic dermatitis and allergic rhinitis were not statistically significantly associated with the risk of IPF, although cases were more likely to have suffered from allergic rhinitis and less likely to have been asthmatics than control subjects. Having a child with a history of allergic rhinitis, but not of asthma or atopic dermatitis, was significantly related to an increased risk of IPF. CONCLUSIONS: These findings suggest that a genetic predisposition to allergic rhinitis may be associated with an increased risk of IPF.

Aged↗
PubMed1989

[Short term treatment of infantile pulmonary tuberculosis].

Due to the scarcity of published articles on short-course chemotherapeutic regimens for pediatric pulmonary tuberculosis, the following study has been carried out: Twenty-five children diagnosed of pulmonary tuberculosis were administered a short course therapeutic regimen consisting of three tuberculostatics for the first two month (isoniazid, rifampicin and pyrazinamide) and only two (isoniazid and rifampicin) for the following four months. The results were compared with those obtained from a control group of twenty-five children receiving the "classical" therapy: two drugs (isoniazid and rifampicin) for a nine month period. The statistical analysis did not demonstrate any significant difference related to evolution, duration and complications of the disease, between both groups. Therefore, this short course therapeutic regimen could be accepted for pediatric pulmonary tuberculosis.

Antitubercular Agents↗
PubMed1986

Enzyme immunoassay using BCG in serodiagnosis of pulmonary tuberculosis.

Amounts of Mycobacterium tuberculosis antibodies were determined in sera from patients with either active or inactive tuberculosis and in healthy subjects by an immunoenzymatic assay in which whole BCG cells attached covalently to polystyrene disks were used as antigen. Statistically significant differences (P less than 0.005) were found both between the active and inactive tuberculosis groups and between the active group and healthy controls. No significant differences were found between the inactive group and controls. Since this procedure is efficient (91%) and can be used in areas which lack laboratory equipment, it appears promising for individual serodiagnosis and for epidemiological surveys.

Antibodies, Bacterial↗
PubMed1999

[Tuberculosis in Russia].

An unfavorable epidemiological trend in tuberculosis morbidity and mortality has been registered in the last decade. The number of newly detected cases and mortality in 1997 vs 1991 rose more than 2-fold reaching 73.9 and 16.7 per 100,000, respectively. The effectiveness of tuberculosis treatment is worsening: bacterial discharge stopped in 72.6%, destruction cavities in the lungs closed in 62.6%, clinical recovery was obtained in 17.2% of patients (relevant statistics for 1986 were 89.9, 81.6 and 21.9%, respectively). To correct the situation, government of the Russian Federation has adopted the program of tuberculosis control for 1998-2004. The Health Administration of the Ivanovo and Tomsk Regions has successfully introduced the DOTS program. Now, this positive experience is applied in other regions and institutions.

Communicable Disease Control↗
PubMed2001

Atypical radiological images of pulmonary tuberculosis in 192 diabetic patients: a comparative study.

SETTING: Comparative studies of pulmonary tuberculosis images in diabetics have yielded conflicting results. OBJECTIVE: To assess radiological images of pulmonary tuberculosis in a large population of diabetic patients. DESIGN: Radiographs from in-patients admitted with pulmonary tuberculosis and diabetes (TBDM group, n = 192) were reviewed and compared with a control group of patients with pulmonary tuberculosis alone (TB group, n = 130). RESULTS: Both groups had a similar evolution time of tuberculosis (approximately 2 years). Statistical differences were observed as follows: TBDM patients were older (51.3+/-0.9 vs. TB group 44.9+/-1.8 years, mean +/- SEM), and had a decreased frequency of upper (17% vs. 56%), and an increased frequency of lower (19% vs. 7%) and upper + lower (64% vs. 36%) lung field lesions. More TBDM patients developed cavitations (82% vs. 59%) more often in the lower lung fields (29% vs. 3%). More multiple cavities were seen in TBDM patients (25% vs. 2%). TBDM group had a lower total leukocyte count (8836.7+/-219.5 vs. 10013.1+/-345.2 cells/mm3), mainly due to a lower number of non-lymphocyte cells (6815.8+/-221.8 vs. 8095.7+/-321.9 cells/mm3). Multiple logistic regression showed that being a diabetic patient was the most important factor determining lower lung field lesions and cavities. CONCLUSIONS: This study in a large number of diabetics with pulmonary tuberculosis confirmed that their chest X-ray images significantly depart from the typical presentation. Clinicians must keep this in mind to avoid misdiagnosis.

Adult↗
PubMed1990

USPHS Tuberculosis Short-Course Chemotherapy Trial 21: effectiveness, toxicity, and acceptability. The report of final results.

STUDY OBJECTIVE: To determine the effectiveness, toxicity, and acceptability of a 6-month antituberculous regimen compared with a 9-month regimen. DESIGN: A nonblinded, unbalanced, randomized, multicenter clinical trial. SETTING: Twenty-two tuberculosis clinics in public health departments and hospitals in the United States. PATIENTS: Patients were eligible if Mycobacterium tuberculosis, isolated from sputum cultures, was susceptible to study drugs. Of 1451 patients enrolled, 75% (617 of 823) assigned to the 6-month regimen and 71% (445 of 628) assigned to the 9-month regimen were eligible. INTERVENTIONS: Patients took self-administered isoniazid and rifampin daily for 24 weeks (6-month regimen) or 36 weeks (9-month regimen). In addition, patients assigned to the 6-month regimen took self-administered pyrazinamide daily during the first 8 weeks. RESULTS: Patients on the 6-month regimen converted more rapidly than patients on the 9-month regimen (94.6% compared with 89.9% after 16 weeks of therapy, with a difference of 4.7% [95% CI, 0.7% to 8.7%]); had similar rates of adverse drug reactions (7.7% compared with 6.4%, with a difference of 1.3% [95% CI, 0.0% to 4.6%]); had lower noncompliance rates (16.8% compared with 29.2%, with a difference of 12.4% [95% CI, 6.8% to 18.0%]); and had similar relapse rates 96 weeks after completing therapy (3.5% compared with 2.8%, with a difference of 0.7% [95% CI, 0.0% to 3.9%]). A significantly greater proportion of patients assigned to the 6-month regimen successfully completed therapy (61.4% compared with 50.6%; chi 2 = 11.976). CONCLUSIONS: Our results suggest that this 6-month regimen is similar in effectiveness, toxicity, and acceptability to the 9-month regimen for treating pulmonary tuberculosis.

Adult↗
PubMed1996

Effectiveness of bacillus Calmette Guerin (BCG) vaccination against extra-pulmonary tuberculosis: a case-control study.

A hospital-based pair-matched case-control study was carried out at Govt. Medical College Hospital, Nagpur, to estimate the effectiveness of BCG vaccination against extra-pulmonary tuberculosis. The study included 125 cases of extra-pulmonary tuberculosis in the age group of 0-30 years and 375 tuberculosis free control. Each case was pair matched against three separate controls for age, sex and socioeconomic status. The protective effectiveness and prevented fraction were higher for the subjects in the age group of 0-10 years, males and subjects from middle and upper strata of socio-economic class but it was statistically nonsignificant. The overall vaccine effectiveness and prevented fraction was estimated to be 80.86 (72.68-86.60) and 53.20 (41.97-63.73) per cent respectively. Results of this study thus indicated that BCG vaccination was highly effective against extra-pulmonary tuberculosis and played a significant role in its prevention in this population.

Adolescent↗
PubMed1984

Possible role of mycobacteria in inflammatory bowel disease. II. Mycobacterial antibodies in Crohn's disease.

An unclassified Mycobacterium species has been isolated from two patients with Crohn's disease (CD). Antibodies to the unclassified mycobacteria cross-reacted with Mycobacterium paratuberculosis. Because of this cross-reactivity, an enzyme-linked immunosorbent assay (ELISA) was used to examine the sera of inflammatory bowel disease (IBD) patients, both CD (N = 56), and ulcerative colitis (UC) (N = 34), for antibodies to M. paratuberculosis, Mycobacterium kansasii, and Mycobacterium tuberculosis. Controls consisted of healthy, PPD-negative individuals (N = 67), and from PPD-positive patients (N = 41). Eighteen resected CD patients were also examined. CD patients had a statistically significant increase in antibody titer (P = 0.0003) to M. paratuberculosis compared to healthy controls. Although patients with positive PPD had elevated titers to this organism, the positive response of CD patients was not related to PPD responsiveness, area of involvement in the gut, nor to activity of the disease process.

Adolescent↗
PubMed1981

Risk factors in multiple sclerosis: tuberculin reactivity, age at measles infection, tonsillectomy and appendectomy.

The purpose of the present study was to investigate whether risk of multiple sclerosis (MS) is associated with the occurrence of viral or bacterial diseases, with vaccinations, or with operative events during childhood. Our reference population was 198,000 persons recorded in the register of school health records from the Copenhagen council. We compared 92 MS patients contained in the register with matched controls from the register, three for each patients. Risk of MS was inversely associated with a positive tuberculin skin test at age 7 years, i.e. with exposure to tuberculosis before the age of 7, possibly also with the occurrence of measles infection before age 7 (not statistically significant). Disease risk was not significantly related to other viral or bacterial infections of childhood, nor to routine vaccinations, tonsillectomy, adenoidectomy or appendectomy. Our findings suggest a difference between MS patients and controls with respect to environment before school age, the former being less exposed to air-borne infections.

Adenoidectomy↗
PubMed1986

Statistical quality control methods in standardization of BCG vaccines.

The quality control of the BCG vaccine lacks the requirements of exact statistical methods, although the principles of bioassay have been required in the control of other biological products for a long time. For a remedy and to eliminate controversies in the interpretation of the laboratory results of BCG products valid statistical control is needed. In the four major laboratory test systems generally used to control: the viability of the BCG products, the residual virulence of the BCG strains, the allergenic potency and 4) the immunogenic potency of the BCG vaccines the following statistical methods should be required: estimations of the unbiased point and 95% confidence interval of the viable units 10(6)/ml, the mean residual virulence, the mean allergizing and protective capacity in appropriate models, the expressions of the relative potency of the in vitro viability and the in vivo test systems to a Reference Preparation, hypothesis tests using the unbiased estimates for the comparison of the estimated parameters of the controlled vaccines (Anova) and testing the stability of the viability (Regranal), multiple comparison with the ranked estimates to diminish Type I error in rejected null hypotheses, test of concordance between the sets of ranked parameters of the different test systems. Valid models will promote the standardization of the BCG vaccine, will ensure the objective statistical inference of the control results, the interpretation of the immunogenicity and reactogenicity of the BCG vaccines and the understanding of the epidemiological processes in tuberculosis.

Animals↗
PubMed1998

Demographic/socioeconomic factors in mental disorders associated with tuberculosis in southwest Nigeria.

In spite of the high prevalence of tuberculosis worldwide, there are few studies on its psychiatric complications. The mental state of 53 patients with pulmonary tuberculosis seen in a Nigerian chest clinic was examined using the 30-item General Health Questionnaire (GHQ-30), the Present State Examination (PSE), and a clinical evaluation based on the International Classification of Disease, tenth edition (ICD-10). Results were compared with two comparison groups: (1) a group of 20 long-stay orthopedic patients with lower limb fractures; and (2) a group of 20 apparently healthy controls. The sociodemographic characteristics of the groups were also compared. A significantly higher prevalence of psychiatric disorders was found in the tuberculosis group (30.2%) than in the orthopedic group (15%) and the apparently healthy controls (5%). The types of psychiatric disorders encountered included mild depressive episode, generalized anxiety disorder, and adjustment disorder (ICD-10). Psychiatric morbidity was higher in tuberculosis patients with low educational attainment, and did not show a statistically significant relationship with other sociodemographic parameters. Ways of improving the mental health of tuberculosis patients are discussed.

Adolescent↗
PubMed1979

[The control of animal diseases in france during the last fifteen years, as it appears throught the eradication of bovine tuberculosis. proposals for the future (author's transl)].

In the general outline of the success, on a national scale, of the eradication of bovine tuberculosis in France up to 1974, we have tried to find out the factors which could explain the differences, sometimes important, between French departments in the efficiency of this eradication. We have selected twenty seven parameters distinctive of each of the 74 departments having more than 50 000 bovine under the control of State Veterinary service. These parameters describe 1) tuberculosis infection rates of animals and herds, at three periods; 2) some structural characteristics of bovine production; 3) sanitary environment (veterinary practicioners, State Veterinary service, breeders association for sanitary protection). Statistical analysis by principal components show that department infection rate decreases as the first three factors evidenced by this analysis vary positively; they are: 1) "Sanitary Consciousness", which is defined both by the important of bovine production and by precociousness in developing prophylactic measures, these two factors being independent. 2) Specialization in bovine production, characterized by the percentage of young animals reared in the herd and by the proportion of grass produced by ley. 3) Intensity of sanitary environment. These three factors, which are interlinked to various degrees, control respectively 25%, 13% and 13% of the total variance. A complementary analysis of the data suggest that the efficiency of eradication could be improved by a better knowledge of the movement of breeding animals between the departments, and by a more careful recording, in some instances, of infected animals in slaughter hourses. When the importance of a herd increase sanitation of tuberculosis in infected herds is less readily achieved and brucellosis abortion rate increases. At the departement level, efficiency of eradication is not correlated to the expenses of prophylaxy. For the development of an integrated sanitary policy, taking into account such non specific factors as those exemplified in the study could help to a better control of animal diseases, in parallel to the desirable improvement of the specific means of combatting each disease.

Animal Husbandry↗
PubMed1998

[Time trend in incidence and mortality of tuberculosis and characteristics of notified tuberculosis patients in urban area of Mongolia].

Recent Mongolian political, social and economic changes have had a great impact on its health care system and tuberculosis control program. The objective of this study is to assess time trend in incidence and mortality of tuberculosis and characteristics of notified tuberculosis cases in Mongolia. 1) Data on statistics of tuberculosis are obtained from reports of the National Tuberculosis Center in Mongolia. The mortality of tuberculosis in Mongolia shows a downward trend during 1985-1995. The number of notified tuberculosis cases had gradually decreased during 1985-1989. It suddenly dropped in 1990 and was the lowest in 1993. After that, about two fold increase in the notified cases was observed in recent three years from 1993 to 1995. Such a large fluctuation in the number of notified cases after 1990 is unlikely to be associated with the epidemiologic situation of tuberculosis, but rather due to a reporting bias. The shortage of drugs and economic hardship prevented patients from consulting medical facilities. The shortage of drugs also prevented doctors from notifying patients to the tuberculosis registry, because the notification did not lead to treating the disease. The improvement of health care system and the supply of essential drugs since 1994 seems to contribute to the increase in the number of notified cases. 2) The study subjects include 618 patients who were diagnosed as active tuberculosis at ten tuberculosis specialized facilities in Ulaanbaatar, Mongolia from May 1995 to March 1996. Patients were interviewed about their demographic factors and their medical records were reviewed. Fifty one percent of the cases were female. The mean age was 26.9 years old. Ninety percent of the cases underwent chest X-ray examination, while 72% of the cases underwent bacteriological examination and only 21% were confirmed bacteriologically. It is necessary to improve the quality control of sputum smear examination and the validity of diagnosis of tuberculosis in Mongolia. As for treatment regimens, only 29% of the cases were being treated with at least four drugs (isoniazid, rifampicin, pyrazinamide, ethambutol and/or streptomycin). It is needed to provide directly observed treatment using the WHO recommended standard regimen to at least smear positive tuberculosis cases.

Adolescent↗
PubMed2003

Haematological profile of patients with pulmonary tuberculosis in Ibadan, Nigeria.

The haematological indices of sixty two pre-treatment, sputum-smear-AFB positive pulmonary tuberculosis patients were examined. Haematocrit, white cell count and differentials and erythrocyte sedimentation rates (ESR) were estimated by manual methods. The heamatological parameters were compared with age and sex matched control subjects. Statistically significant heamatologic abnormalities found include high erythrocyte sedimentation rate (ESR), anaemia occurred in 93.6%, leucocytosis in 22.3%, neutrophilia in 45.2% and lymphopaenia in 4.8% of the patients. Thrombocytosis occurred in 12.9%,while 8% had thrombocytopaenia. None of the patients had leucopaenia and only 8.4% had lymphocytosis.

Adolescent↗
PubMed2026

Evaluation of the SLC11A1 non-synonymous variant rs17235409 and tuberculosis susceptibility in a multi-ethnic population from southwestern China.

Tuberculosis (TB) remains a major infectious disease burden, and inter-individual heterogeneity in progression from exposure to active disease suggests contributions from host genetic factors. SLC11A1 (formerly NRAMP1) encodes a phagosomal divalent cation transporter implicated in macrophage-mediated antimicrobial defense; the non-synonymous rs17235409 polymorphism (D543N) has been evaluated in multiple populations with inconsistent results. We conducted a retrospective matched case-control study in Qiandongnan, Guizhou Province, China, including 50 patients diagnosed with TB (2022-2023) and 50 healthy controls frequency-matched by ethnicity and selected demographics. Participants were drawn from Miao, Dong, and other minority groups. Among TB cases, the frequencies of the GG, GA, and AA genotypes were 80.0%, 20.0%, and 0%, respectively, compared with 74.0%, 18.0%, and 8.0% among controls. The overall genotype distribution did not differ significantly between the 2 groups (P = .124). Under the dominant model, no significant association was observed between rs17235409 and TB susceptibility (OR = 0.71, 95% CI: 0.28-1.82; P = .635). Allelic analysis showed that the frequency of the A allele was lower in cases than in controls (10.0% vs 17.0%), but this difference was not statistically significant (OR = 0.54, 95% CI: 0.24-1.25; P = .214). Ethnicity-stratified analyses similarly showed no statistically detectable associations in Miao, Dong, or other groups. The minor allele frequency was 0.095, lower than the Han Chinese reference from 1000 Genomes. In this pilot study of multi-ethnic populations from southwestern China, no statistically significant association was identified between the SLC11A1 rs17235409 polymorphism and tuberculosis susceptibility. Although the A allele appeared less frequent among cases, the limited sample size and statistical power preclude definitive conclusions regarding modest or ethnic-specific effects. These findings provide preliminary genetic data from underrepresented ethnic minority populations and warrant validation in larger multicenter studies.

Adult↗