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PubMed1960

The distribution of tuberculous infection among households in African communities.

Is tuberculosis in under-developed areas to some extent a household infection, as several authorities claim it to be in Europe and in temperate climates in general? The following analysis, based on data collected in a number of territories in Africa south of the Sahara, shows that, although a statistically significant accumulation of infection does occur in certain households, its extent is so moderate that it would be unjustifiable to confine control work to any limited category of households, whatever the criterion for their selection.The main conclusion, therefore, is that the entire community must be covered in anti-tuberculosis schemes designed to reduce the tuberculosis problem in the population at large in such countries as those surveyed here.

Africa, Northern↗
PubMed1990

A patient education program to improve adherence rates with antituberculosis drug regimens.

The design, logic, and results of a two-year health education study directed at improving rates of patient adherence to antituberculosis medical regimens are presented. An incentive scheme to reward positive health behaviors plus targeted educational counseling sessions was implemented in a randomized clinical controlled trial. The 205 subjects who participated in the study are categorized according to patients with active tuberculosis (n = 88) or preventive patients with no evidence of active disease (n = 117). Patients in each of these groups were randomly assigned to a special intervention (SI) group or a usual care (UC) control group and were followed monthly throughout their treatment program. While SI patients with active tuberculosis demonstrated higher levels of appointment-keeping behavior and mean percent of medication taken compared to UC patients, no statistically significant differences between the two groups were found. Preventive therapy patients assigned to the SI group, however, were significantly more likely than UC patients to remain in care during their 12-month regimen (64% vs 47%; p = .003). Furthermore, SI patients had significantly higher levels of adherence to their medical regimen compared to UC patients (68% vs 38%; p less than .001). These results demonstrate the positive effects of a structured health education program on the improvement of continuity of care and adherence behavior among patients with tuberculosis.

Adolescent↗
PubMed2001

p53 expression in cultured blood human monocytes infected with mycobacterial strains.

BACKGROUND: An upregulation of the cell-cycle associated proteins p53 and p21/Waf1/Cip1 induced by mycobacteria was previously reported. We aimed to evaluate the expression of such proteins in peripheral blood human monocyte cultures infected with strains of different mycobacterial pathogens. METHODS: The study relied on the immunocytochemical determination of p53, p21/Waf1/Cipl, bcl-2 and on the Tunel detection of apoptosis in monocytes populations cultured on four-welled chamber slides (10(6) cells/well) infected with Mycobacterium tuberculosis, M. bovis and M. avium for four consecutive days (mycobacterium/monocyte ratio 10:1). The results were expressed as mean values and SD of the percentages of stainings recorded in five fields per slide. RESULTS: The statistical analysis with Fischer test demostrated that at most sampling times the p53 and p21/Waf1/Cip1 expression and the apoptosis index were significantly higher in M. tuberculosis infected cultures than in controls (p<0.05). The M. bovis related picture diverged from the previous one for a lower p53 expression (p<0.05) at all sampling times. The M. avium infected culture values did not diverge significantly from the controls. CONCLUSIONS: The p53 and p21/Wafl/Cipl upregulation is compatible with both host defense strategies and pathogen strategies (safeguard of intracellular sanctuaries). The discrepancies among different cultures suggest a direct relationship between p53 activation and mycobacterial ability to enter host cells.

Apoptosis↗
PubMed1992

Diagnosis of mycobacterial infection in acquired immunodeficiency syndrome (AIDS) patients and HIV carriers.

Differences in tuberculosis diagnosis between infected and non-infected HIV patients were described. In Barcelona, tuberculosis is present in 41.6% of 851 patients in whom AIDS was detected between 1981 and the first quarter of 1990. We reviewed the results of the methods used for tuberculosis diagnosis in 270 AIDS patients controlled in our hospital, in whom tuberculosis was detected (33.3%), and we compared these data with the results obtained in HIV carriers with tuberculosis and with tuberculous patients without HIV infection. Statistically significant differences were found between the three groups with respect to sex, age, results of Ziehl-Neelsen stain in pulmonary specimens and skin test reaction; between AIDS patients and the non-HIV infected population differences were observed in tuberculosis site. Positive skin test reaction diminished from tuberculous individuals non-HIV infected (95%), to HIV carriers with tuberculosis (71.8%) and AIDS patients with tuberculosis (21.8%). Acid-fast smears from pulmonary specimens were positive in 35.7%, 23.5% and 43.7% respectively. Statistically significant differences were found in tuberculosis localization between tuberculous patients non-HIV infected and tuberculous patients with AIDS, in the last group tuberculosis lymphadenitis was the most frequent localization (33.3%) of extrapulmonary tuberculosis, followed by abdominal tuberculosis (15.5%). The incidence of HIV infection among tuberculous patients was 4.6 in our study, but could be higher if patients between 19 and 30 years old were always checked for anti-HIV antibodies.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Effect of inflammatory diseases of the pulmonary parenchyma on ventilatory function in school children and adolescents].

The group of 35 children and adolescents aged from 7 18 years with previous inflammatory diseases of lung parenchyma, pneumonias and tuberculosis, in clinically nonactive phase was compared with the control group of 35 healthy children and adolescents. The results of the ventilation tests in the two groups were analyzed by t-test. Results showed statistically significantly lower values of one-second forced expiratory volume, Tiffeneau index, peak-expiratory flow, forced expiratory flow between 25 and 75% of vital capacity, and flow rates at 50 and 25% of the vital capacity in the affected group. The children with previous inflammatory diseases of lung parenchyma showed the initial obstructive ventilatory disorders of large and small airways. This partly disagrees with generalized including of these diseases in the causes of restrictive ventilatory disorders. The obtained results point to the need for examining ventilatory lung function in children and young people, in asymptomatic phase, in order to reveal latent obstructions and prevent possible disorders in adults.

Adolescent↗
PubMed1986

Diagnosis of tuberculosis by detection of mycobacterial antigen in pleural effusions and ascites.

We describe a method for the diagnosis of pleural and peritoneal tuberculosis by the detection of tuberculous antigens using an enzyme-linked immunosorbent assay. Eleven tuberculous pleural fluid and 10 tuberculous ascitic fluid samples were studied by this technique, using 10 non-tuberculous pleural fluid and 14 non-tuberculous ascitic fluid samples as controls. An absorbance value of 0.3 was found to separate the tuberculous groups from their controls to a statistically significant extent (ascitic fluid P less than 0.05; pleural fluid P less than 0.01).

Antigens, Bacterial↗
PubMed1990

[Determination of lymphocyte subsets in pulmonary tuberculosis by Mc-Ab- rosette reagent method].

The lymphocyte subsets in peripheral blood were determined in 73 cases of active pulmonary tuberculosis and 40 healthy subjects using rosette reagent of monoclonal antibody (McAb) to anti-T lymphocyte. The results showed that the percentages of T3, T4, T8, and T4/T8 ratio were 54.3 +/- 6.7%, 34.3 +/- 7.9%, 35.5 +/- 10.0%, 1.0 +/- 0.4 of patients group 66.3 +/- 7.9%, 45.3 +/- 6.3%, 29.9 +/- 5.8% and 1.6 +/- 0.3 of healthy control group respectively. There was statistically significant difference between these two groups (P less than 0.01).

Adult↗
PubMed2001

Screening for pulmonary tuberculosis among immigrants: estimated effect on severity of disease and duration of infectiousness.

OBJECTIVE: To estimate the effect of tuberculosis screening among recent immigrants on the severity of disease at diagnosis and on the duration of the infectious period. DESIGN: Comparison of pulmonary tuberculosis cases among immigrants detected through screening with those detected passively, using information from the Netherlands Tuberculosis Register. PARTICIPANTS: Immigrants from highly endemic countries diagnosed with culture-positive pulmonary tuberculosis within 30 months after arrival in The Netherlands, 1993 through 1998. OUTCOME MEASURES: Severity of disease (smear-positive disease, hospitalisation, case fatality) and duration of symptomatic period. RESULTS: A total of 882 bacteriologically confirmed tuberculosis patients from highly endemic countries had been in The Netherlands less than 30 months, and were detected through screening (454), or passively (368). Compared with patients detected passively, patients found through screening were less often sputum smear-positive (OR 0.5, 95%CI 0.3-0.8) and less often hospitalised (OR 0.2, 95%CI 0.1-0.2). Those detected through screening had a shorter symptomatic period. Screening is estimated to have reduced the infectious period by approximately 33%. CONCLUSION: The screening programme detected cases earlier, resulting in fewer hospital admissions, shorter duration of symptoms and therefore probably reduced tuberculosis transmission.

Adolescent↗
PubMed1995

Cytogenetic study of tuberculosis patients before and after tuberculostatic drug treatment.

Cytogenetic analyses were carried out in lymphocytes of 15 untreated tuberculosis (tb) patients and 15 other tb patients who had received combined tuberculostatic chemotherapy HRZ (isoniazid+rifampicin+pyrazinamide) for 2 months. The frequency of chromosomal aberrations and sister-chromatid exchanges (SCEs) did not show any statistically significant differences in the patients before treatment and after exposure to combined HRZ therapy as compared to controls (p > 0.05). However, we observed that the mitotic index was significantly decreased in both groups (p < 0.05). Based on the results of the present study, we believe there is no indication for a chromosome damaging effect of HRZ and their metabolites in human lymphocytes in vivo after treatment of tuberculosis patients with optimum doses.

Adult↗
PubMed1993

The impact of HIV on infectiousness of pulmonary tuberculosis: a community study in Zambia.

OBJECTIVE: To examine the impact of HIV on infectiousness of pulmonary tuberculosis (TB). DESIGN: A cross-sectional tuberculin survey carried out among household contacts of HIV-1-positive and negative patients with bacteriologically confirmed pulmonary TB. Contacts were also examined for active TB. SETTING: Index cases were recruited from patients attending the University Teaching Hospital in Lusaka, Zambia and household contacts were examined during visits to their homes within Lusaka. PATIENTS, PARTICIPANTS: A total of 207 contacts of 43 HIV-positive patients, and 141 contacts of 28 HIV-negative patients with pulmonary TB were examined. MAIN OUTCOME MEASURES: Proportion of contacts of HIV-positive and negative index cases with a positive tuberculin response (diameter of induration > or = 5 mm to a dose of 2 tuberculin units). RESULTS: Fifty-two per cent of contacts of HIV-positive pulmonary TB patients had a positive tuberculin response compared with 71% of contacts of HIV-negative patients (odds ratio, 0.43; 95% CI, 0.26-0.72; P < 0.001). This difference persisted after allowing for between-household variations in the tuberculin response. Tuberculin response in the contact was related to age of contact, intimacy with the index case and crowding in the household. However, the effect of HIV status of the index case was not confounded by these variables. Tuberculin response in the contact was also related to the number of bacilli seen in the sputum smear of the index case which partially explained the effect of HIV status of the index case. Active TB was diagnosed in 4% of contacts of HIV-positive and 3% of contacts of HIV-negative cases, respectively (P = 0.8). CONCLUSIONS: HIV-positive patients with pulmonary TB may be less infectious than their HIV-negative counterparts and this may partly be explained by lower bacillary load in the sputum.

Adolescent↗
PubMed2000

Impact of pulmonary tuberculosis on survival of HIV-infected adults: a prospective epidemiologic study in Uganda.

BACKGROUND: Retrospective cohort studies of tuberculosis suggest that active tuberculosis accelerates the progression of HIV infection. The validity of these findings has been questioned because of their retrospective design, diverse study populations, variable compliance with anti-tuberculous therapy and use of anti-retroviral medication. To assess the impact of tuberculosis on survival in HIV infection we performed a prospective study among HIV-infected Ugandan adults with and without tuberculosis. METHODS: In a prospective cohort study, 230 patients with HIV-associated tuberculosis and 442 HIV-infected subjects without tuberculosis were followed for a mean duration of 19 months for survival. To assess changes in viral load over 1 year, 20 pairs of tuberculosis cases and controls were selected and matched according to baseline CD4 lymphocyte count, age, sex and tuberculin skin test status. RESULTS: During the follow-up period, 63 out of of 230 tuberculosis cases (28%) died compared with 85 out of 442 controls (19%), with a crude risk ratio of 1.4 [95% confidence interval (CI), 1.07-1.87]. Most deaths occurred in patients with CD4 lymphocyte counts < 200 x 10(6) cells/l at baseline (n = 99) and occurred with similar frequency in the tuberculosis cases (46%) and the controls (44%). When the CD4 lymphocyte count was > 200 x 10(6)/l, however, the relative risk of death in HIV-associated tuberculosis was 2.1 (95% CI, 1.27-3.62) compared with subjects without tuberculosis. For subjects with a CD4 lymphocyte count > 200 x 10(6)/l, the 1-year survival proportion was slightly lower in the cases than in the controls (0.91 versus 0.96), but by 2 years the survival proportion was significantly lower in the cases than in the controls (0.84 versus 0.91; P < 0.02; log-rank test). For subjects with a CD4 lymphocyte count of 200 x 10(6) cells/l or fewer, the survival proportion at 1 year for the controls was lower than cases (0.59 versus 0.64), but this difference was not statistically significant (P = 0.53; logrank test). After adjusting for age, sex, tuberculin skin test status, CD4 lymphocyte count, and history of HIV-related infections, the overall relative hazard for death associated with tuberculosis was 1.81 (95% CI, 1.24-2.65). In a nested Cox regression model, the relative hazard for death was 3.0 (95% CI, 1.62-5.63) for subjects with CD4 lymphocyte counts > 200 x 10(6)/l and 1.5 (95% CI, 0.99-2.40) for subjects with a CD4 lymphocyte count of 200 x 10(6)/l or fewer. CONCLUSION: The findings from this prospective study indicate that active tuberculosis exerts its greatest effect on survival in the early stages of HIV infection, when there is a reserve capacity of the host immune response. These observations provide a theoretical basis for the treatment of latent tuberculous infection in HIV-infected persons.

AIDS-Related Opportunistic Infections↗
PubMed2000

Co-morbidity in Gaucher's disease results of a nationwide enquiry in Spain.

SHORT INTRODUCTION: Gaucher's disease (GD) is an autosomal recessive disease produced by mutations of the Glucocerebrosidase gene. Carriers are considered to be healthy subjects because there is no manifestation of the disease, but they show signs of macrophage disfunction. The aim of the study was to determine if GD patients and non affected carriers risk suffering other diseases when compared to healthy non-carrier relatives. MATERIAL AND METHODS DESIGN: Epidemiologic study of historic cohorts. The fact that they have one or two mutated alleles has been considered to be the risk factor leading to other conditions (Dementia, Parkinson disease, Ischemic stroke, Ischemic heart disease, Non rheumatic valvular disease, Cancer hematological and non-hematological, Pulmonary fibrosis, Tuberculosis, Gallstones and Schizophrenia). All people, patients, carriers and healthy controls shared the same genetical background and environmental influence. - Patients and relatives enrolled on the Spanish Gaucher Disease Registry were evaluated. STATISTICS: For the Relative-Risk calculation the Mantel-Haenszel test was applied. Yates' correction was used when size sample was too small. A value of p <0.05 was accepted for statistical significance. RESULTS: 370 people, from 79 different families, were surveyed. We received evaluable information from 45 families (56%), totalling 258 people (69%): 59 healthy subjects (Mean age 32. 20, RANGE: 10-85; M 57.63%/F 42.37%), 132 carriers (Mean age 35.91, RANGE: 1-79; M 56.82%/F 43.18%) and 67 patients (Mean age 32.16, Range: 1-76; M 44.78%/F 55.22%. - Relative Risk of suffering any disease with regard to Gaucher's status: Patient vs Healthy 9.69 (95% Confidence interval [CI] 2.00-63.99; p 0.0006). Patient vs Carrier 3.74 (CI 1.53-9.27; p 0.001); Carrier vs Healthy 2.59 (CI 0. 52-12.50; p 0.21). Relative Risk of suffering any disease with regard to sex was 3.96 for female patients (CI 1.01-16.75; p 0.02) and 1.34 for female carriers (CI 0.27-6.75; p = 0.68). CONCLUSION: As a group, Gaucher's patients seem to have a greater risk of suffering other common unrelated diseases than carriers or healthy relatives. This excess of risk is particularly higher among female patients and can not be explained in terms of differences in age. Carrier status doesn't seem to highten the risk of suffering other diseases.

Adolescent↗
PubMedDate not supplied

Tuberculosis incidence and the seroprevalence of HIV infection in the United States.

Unlike other available studies, this article not only recognizes a human immunodeficiency virus-tuberculosis (HIV-TB) correlation but also shows its strength, statistical significance, and the method of calculation. These results increase comparability of the data on the HIV-TB relationship and allow more accurate analysis for developing better control of the two diseases. This population-based study compares data by states on HIV seroprevalence among 1,799,771 military recruits and the incidence of TB in the general population of the United States in 1987. The corresponding correlation coefficient was 0.8 (P less than .001). Although military recruits do not constitute a random sampling of the population at risk for TB, the high correlation suggests that HIV infection contributes substantially to population-based rates of TB.

Female↗
PubMed1999

[Evaluation of preventive studies of Chinese Journal of Tuberculosis and Respiratory Diseases 1978-1997].

OBJECTIVE: To investigate the current situation of clinical trial about preventive research paper on respiratory diseases in China. To stress the design of the research, and to improve the quality of the studies. METHODS: All the preventive and treatment studies of Chinese Journal of Tuberculosis and Respiratory Diseases (1978-1997) were assessed according to evidence based medicine (EBM) standard. RESULTS: In the past 20 years, 394 preventive study papers were published, 41 were random control trial (RCT), 50 were clinical control trial (CCT), the total percentage of RCT and CCT was 23.1%, and quality problem also existed. CONCLUSIONS: The design of the study in the respiratory diseases is not rigorous, thus the accuracy of the result is greatly affected. Improving the design of the research and the statistics method is very important to improve the quality of the research.

China↗
PubMed2000

[Effectiveness of smears and cultures in gastric aspirate samples in the diagnosis of tuberculosis].

AIM: To evaluate the effectiveness of smears and cultures in gastric juice samples in the diagnosis of childhood pulmonary tuberculosis and to assess the relationship between clinical, radiological and epidemiological parameters in children with tuberculosis. MATERIALS AND METHODS: Blind, prospective, controlled study of 421 gastric aspirate samples from 139 children referred because of suspected tuberculosis. Children were classified according to clinicoradiological factors, irrespective of microbiological results. To verify the clinical diagnosis an extended followup was carried out. RESULTS: Smears were positive in 6 of the 46 children with active tuberculosis (sensitivity: 13%) and in 3 of the 93 children in the control groups (specificity: 96.8%). Cultures were positive in 15 children with active disease (sensitivity: 32.6%) and effectiveness was greater when the chest radiograph showed parenchymal involvement. Mycobacterium tuberculosis was also isolated in two children with tuberculous infection who showed no apparent signs of the disease and in one of these children, CT scan revealed mediastinal adenopathies which were not evident on the chest radiograph. Mean growth time for positive cultures was 42 days. CONCLUSIONS: The sensitivity of smears and cultures in gastric aspirate samples of children with pulmonary tuberculosis is low. Results of culture take several weeks and smears can give false positive results. Some children with tuberculous infection without apparent signs of the disease show microbiological activity that can be caused by mediastinal adenopathies that are not evident on chest radiographs.

Adolescent↗
PubMed2000

False-positive results for Mycobacterium celatum with the AccuProbe Mycobacterium tuberculosis complex assay.

Mycobacterium celatum type 1 was found to cross-react in the AccuProbe Mycobacterium tuberculosis complex assay. Subsequently, we found a statistically significant increase in the relative light units with lower temperatures, suggesting that it is necessary to perform this AccuProbe assay at between 60 and 61 degrees C. We also recommend the inclusion of M. celatum type 1 as a negative control.

DNA Probes↗
PubMed2002

The epidemiology of tuberculosis among foreign-born persons in Alberta, Canada, 1989-1998: identification of high risk groups.

BACKGROUND: To date, there have been no comprehensive epidemiological studies in Canada of the incidence rates of tuberculosis among foreign-born persons. Accurate rate estimates are needed to develop cost-effective strategies for the prevention, control, and ultimate elimination of tuberculosis. METHODS: Most new immigrants to Canada settle in one of four provinces: Ontario, British Columbia, Quebec and Alberta. Data from the provincial reporting system for tuberculosis, from Statistics Canada censuses and population estimates of Treaty Status Indians provided by the Department of Indian and Northern Affairs Canada, were used to estimate the rate of tuberculosis in Alberta's Canadian-born and foreign-born population between 1989 and 1998. RESULTS: Age-adjusted tuberculosis case rates per 100,000 person-years were 19.4 and 61.9 in the foreign-born and Canadian-born Treaty Indians-approximately 10 times and 30 times, respectively, higher than the rate in the remainder of the Canadian-born population (2.1/100,000 person-years). Age-specific rates in male and female foreign-born persons were highest at ages 15-34 and > or = 65 years, whereas rates in Canadian-born non-Treaty and Treaty males and females increased incrementally, with a single peak at > or = 65 years. Tuberculosis case rates in the foreign-born varied significantly according to World Bank region and country of birth. By far the highest rates were seen in immigrants to Canada from Asia, in particular Vietnam, the Philippines, China, Hong Kong and India. Most (90%) tuberculosis patients from these countries had not been identified as requiring medical surveillance in Canada after arrival. CONCLUSION: Immigrants to Alberta from Asia and Treaty Status Indians are at high risk for tuberculosis. Physicians in Alberta who care for foreign-born persons should be aware that their patients are at increased risk for tuberculosis, even if they have been medically cleared during the legal immigration process.

Adolescent↗