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PubMed1994

Seroepidemiological associations between tuberculosis, malaria, hepatitis B, and AIDS in West Africa.

Serum samples from 51 patients with malaria, 35 patients with hepatitis B virus infection, 111 patients with tuberculosis, and 166 healthy controls were studied to determine any associations between tuberculosis, malaria, hepatitis B, and AIDS in Nigeria, West Africa. All serum samples were examined for the presence of HIV-1/HIV-2, hepatitis B virus surface antigen (HBsAg), and malaria antibodies. Only one patient was HIV-1 antibody-positive and none HIV-2 antibody-positive. Statistical associations were found between the presence of malaria antibody titres on the one hand and a diagnosis of hepatitis B virus infection (P < 0.05) or tuberculosis (P < 0.05). A stronger association (P < 0.001) was found between the presence of HBsAg and tuberculosis suggesting that HBsAg carriers are at higher risk of contracting tuberculosis.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Relationship between whole-blood interferon-gamma production and extent of radiographic disease in patients with pulmonary tuberculosis.

The aim of this study was to determine whether whole-blood interferon-gamma (IFN-gamma) production correlates with the radiographic extent of pulmonary tuberculosis before treatment. The subjects were 40 human immunodeficiency virus-negative patients with pulmonary tuberculosis and 36 healthy volunteers. The concentrations of IFN-gamma in whole blood stimulated with Mycobactrium tuberculosis purified protein derivatives (tuberculous PPD) and phytohemagglutinin (PHA) were evaluated. PHA-stimulated IFN-gamma (PHA-IFN-gamma) was lower in the patients than in healthy volunteers (p < 0.05), and inversely correlated with the disease extent (p < 0.01). Tuberculous PPD-stimulated IFN-gamma as a percentage of PHA response (tuberculous PPD-IFN-gamma/PHA-IFN-gamma) was higher in the patients than in healthy volunteers (p < 0.05). However, tuberculous PPD-IFN-gamma/PHA-IFN-gamma did not correlate with the disease extent. Our results indicate that the tuberculous PPD-IFN-gamma/PHA-IFN-gamma may be useful for the diagnosis of tuberculosis but not for evaluating the disease severity, and suggest that PHA-IFN-gamma could be considered as a marker of disease severity.

Adult↗

PubMed2000

HLA-DR antigens in patients with pulmonary tuberculosis in northern Poland. Preliminary report.

The aim of the present study was the analysis of the association between particular class II HLA antigens and the incidence of tuberculosis in northern Poland. HLA-DR antigens in a group of 26 patients with pulmonary tuberculosis (PTB) and 58 healthy volunteers were determined. Histocompatibility typing was performed by the PCR-SSP method using primers from the Dynal company. For statistical analysis, the chi2 test was used with Yates' correction. The probability values were weighted for the number of antigens tested (pc). The relative risk (RR) was calculated by Woolf's method. We found that HLA-DR16(2) antigen expression was significantly higher in patients with tuberculosis than in the tested group of healthy controls (p < 0.001, pc < < 0.01); the highest relative risk (RR = 12.4) of tuberculosis incidence was connected with DR16(2) antigen, the prevalence of HLA-DR13(6) antigen was significantly lower in pulmonary tuberculosis (with RR = 0.09) than the control (p < 0.001, pc < 0.01). The results obtained suggest that the presence of HLA-DR16(2) antigen can extend the risk of developing tuberculosis whereas HLA-DR13(6) antigen occurrence was significantly more rare in pulmonary tuberculosis than in healthy individuals and that the relative risk (RR = 0.09) can be connected to their relation with the genes of insusceptibility to tuberculosis.

Adult↗

PubMedDate not supplied

[Tuberculin survey and its meaning for a correct prevention in a high risk population. Epidemiological data relative to students of the faculty of medicine and soldiers residing in Ferrara (author's transl)].

The Authors list the results obtained from a tuberculin survey carried out on students of the Faculty of Medicine of the University of Ferrara (school year 1977/1978) and on enlisting soldiers. A different skin positivity is here confirmed: a higher percentage in males (27.41%) than in females (17.91%). A higher frequency of positive responses is noted in students originating from the centre-south of Italy. Such tendency is principally due to the greater differences in skin positivity found in females. Students over 26 years of age show a skin positivity of more than 40%, whilst for 17 to 20 years old skin positivity ranges between 22% to 25%. The frequency of skin positivity in soldiers confirms the data found in male students of the same age group. Post vaccine control, although limited to a smaller group of students, shows a definite turn towards positivity with an average figure in both sexes of 63%. The Authors, although admit having carried out their survey on a small population, believe to have contributed with useful information on the epidemiological situation of tuberculosis in age groups with scarce statistical data.

Adolescent↗

PubMed1993

[Surveillance of tuberculosis in the Czech Republic in 1991].

They authors present an interim report on the epidemiological situation of tuberculosis and the effectiveness of control measures as regards tuberculosis in the Czech Republic in 1991. The data are compared with previous years. The incidence of tuberculosis of all forms was 19.9/100,000 population, TB of the respiratory organs 16.2/100,000 and the incidence of bacteriologically confirmed respiratory TB 11.5/100,000 population. As compared with previous years, no statistically significant differences were found. Extrapulmonary TB accounted for less than 10% of the incidence, the position was similar also as regards mycobacterioses other than TB. The incidence of TB in children was 1.3/100,000 children under 15 years, after a transient increase in 1990 (microepidemic in gypsy children), a marked decline was recorded. The TB mortality rate was low (1.1/100,000 population), the prevalence to the date of Dec. 31 1991 was 21.7/100,000 population. On account of complaints 76% new cases were detected, the majority within 1 month, antituberculous treatment was effective, the mean period of treatment was reduced to less than 8 months. However, long in-patient treatment persists usually at the beginning of antituberculous treatment (3 months).

Adolescent↗

PubMed2001

[Association of HLA-DRB1 genes with pulmonary tuberculosis].

OBJECTIVE: To assess the association of HLA-DRB1 genes with pulmonary tuberculosis (PTB) and the correlation between HLA-DRB1 alleles and clinical manifestations of patients with PTB. METHOD: Alleles at the HLA-DRB1 typing were analyzed by polymerase chain reaction with sequence-specific primers (PCR-SSP) in 74 patients and 90 healthy controls. RESULTS: Compared with controls, a significant increased frequency of DRB1 * 15 was found (34.3% vs 17.0%, Pc < 0.05, RR = 2.91). The frequency of DRB1 * 12 was also increased, but the difference was not statistically significant(15.4% vs 7.5%, Pc > 0.05). The frequency of DRB1 * 11 was significantly decreased (1.4% vs 9.9%, Pc < 0.05, RR = 0.12). More retreated and drug-resistant cases were found in DRB1 * 15 positive patients than in DRB1 * 15 negative patients. CONCLUSIONS: These results show that HLA-DRB1 * 15 allele is susceptible gene in PTB, DRB1 * 11 may be a protective allele, HLA-DRB1 * 15 allele may be related to patients with refractory PTB.

Adolescent↗

PubMedDate not supplied

Autopsy as clinical quality control: a study of 15,143 autopsy cases.

The results of autopsy records at the Institute of Pathology of Münster University documented between 1961-70, 1978-87 and 1988-92 were compared with the documented clinical diagnoses of these cases. In the decade 1961-70, 23% of clinical diagnoses were found incorrect (with therapeutic relevance). In the decade 1978-87, the error rate was 18% and in 1988-92, 12%. The difference between the three groups was statistically significant (p < 0.01). Specific data were assembled for the main malignant tumor types. With respect to infectious diseases, the agreement between clinical and autopsy diagnosis is even poorer. Lues (syphilis) is now rarely recognized in clinical diagnosis, even if it is fatal. Merely 50% of all patients with active tuberculosis as primary disease and cause of death, had been diagnosed clinically. Endocarditis in all its forms was underdiagnosed clinically in 75% of the cases. In view of the widely ranging discussion about the value of autopsy today, and in view of the fact that in epidemiological studies the correctness of in vivo diagnosis is tacitly presumed, it has to be stated that autopsy is the best quality control for progress in clinical medicine.

Adolescent↗

PubMed2002

Testing of susceptibility of Mycobacterium tuberculosis to pyrazinamide with the nonradiometric BACTEC MGIT 960 system.

The reliability of the novel BACTEC MGIT 960 pyrazinamide (PZA) kit (Becton Dickinson Microbiology Systems, Sparks, Md.) was assessed for testing of susceptibility of Mycobacterium tuberculosis to PZA. Results generated by the BACTEC MGIT 960 system (Becton Dickinson) were compared with those obtained with the BACTEC 460TB system. Extensive proficiency testing (phase I) and reproducibility testing (phase II) as well as susceptibility testing of blinded strains of M. tuberculosis from the Centers for Disease Control and Prevention (phase III) were performed prior to testing 58 strains isolated from clinical specimens (phase IV). After resolution of discrepant results obtained by the two BACTEC methods by two other laboratories which acted as independent arbiters (phase V), overall agreement of the BACTEC MGIT 960 system with the BACTEC 460TB system for PZA testing of phase IV strains was 96.6%. Between the two systems there was no statistically significant difference in time until results were obtained, i.e., 6.8 days (BACTEC MGIT 960) versus 5.4 days (BACTEC 460TB), the latter not counting the time required for a subculture with a growth index of 200, however. The new BACTEC MGIT PZA susceptibility testing procedure works equally well for inocula prepared from liquid (MGIT) and solid (Löwenstein-Jensen) cultures. PZA MGIT medium in plastic tubes yielded results equivalent to medium dispensed in glass tubes.

Antitubercular Agents↗

PubMed1981

[Angiotensin-converting enzyme in sarcoidosis: diagnostic and prognostic value (author's transl)].

Between April 1976 and February 1980, serum levels of angiotensin-converting enzyme were determined in 61 cases of sarcoidosis at different stages of evolution. Cases were divided in three groups on the basis of social determinations done every 3-6 months. In the group with 46 active cases the increase in mean value of the enzyme is statistically significant compared to the control group; 30 of these (65.2%) had values higher than + 2DS. In the second group with 24 cases of non-progressive or inactive sarcoidosis the mean value was slightly higher than the normal mean value, without being statistically significant; 21 patients (87.5%) showed normal values: in the third group with 19 patients who had been treated with corticosteroids, mean value was equal to normal values; after 12 months treatment values were normal in 17 cases (89.5%). In the control group of 80 patients with a variety of pulmonary diseases other than sarcoidosis (pulmonary tuberculosis, pneumonia, pulmonary thromboembolism and primary lung cancer) only 9 cases presented values higher than the normal + 2SD (11.2% false positive). Serial determination of angiotensin-converting enzyme is a useful diagnostic parameter in sarcoidosis; especially in evaluating progression of the disease as well as the efficacy of corticosteroid treatment.

Adolescent↗

PubMedDate not supplied

Risk factors for tuberculosis among human immunodeficiency virus-infected persons. A case-control study in Belo Horizonte, Minas Gerais, Brazil (1985-1996).

The objective of this study was to identify tuberculosis risk factors and possible surrogate markers among human immunodeficiency virus (HIV)-infected persons. A retrospective case-control study was carried out at the HIV outpatient clinic of the Universidade Federal de Minas Gerais in Belo Horizonte. We reviewed the demographic, social-economical and medical data of 477 HIV-infected individuals evaluated from 1985 to 1996. The variables were submitted to an univariate and stratified analysis. Aids related complex (ARC), past history of pneumonia, past history of hospitalization, CD4 count and no antiretroviral use were identified as possible effect modifiers and confounding variables, and were submitted to logistic regression analysis by the stepwise method. ARC had an odds ratio (OR) of 3.5 (CI 95% - 1.2-10.8) for tuberculosis development. Past history of pneumonia (OR 1.7 - CI 95% 0.6-5.2) and the CD4 count (OR 0.4 - CI 0. 2-1.2) had no statistical significance. These results show that ARC is an important clinical surrogate for tuberculosis in HIV-infected patients. Despite the need of confirmation in future studies, these results suggest that the ideal moment for tuberculosis chemoprophylaxis could be previous to the introduction of antiretroviral treatment or even just after the diagnosis of HIV infection.

AIDS-Related Complex↗

PubMedDate not supplied

BCG vaccination to prevent tuberculosis in health care workers: a decision analysis.

OBJECTIVE: To perform a decision analysis to determine the optimal strategy to prevent tuberculosis (TB) in health care workers with negative tuberculin skin tests. METHODS: We used a Markov model to study the occurrence of events each year and compared BCG vaccination to annual tuberculin testing plus isoniazid (INH) preventive therapy for those who become skin test positive. The outcome measures studied were the number of cases and deaths from TB and BCG and/or INH adverse reactions over 10 years. RESULTS: Annual tuberculin testing decreases the number of TB cases by 9% and BCG vaccination decreases the number by 49%, relative to no prevention intervention. BCG vaccination results in fewer deaths than annual tuberculin testing if the workplace incidence of Mycobacterium tuberculosis infection is greater than 0.06%, BCG vaccination effectiveness exceeds 3%, or the rate of fatal BCG adverse reactions is less than 15 times the rate reported in the literature. CONCLUSIONS: BCG vaccination results in less morbidity and mortality than annual tuberculin skin testing for health care workers in workplaces with documented TB transmission despite comprehensive infection control policies and procedures. Current policy on the prevention of TB among health care workers should be reconsidered.

Antitubercular Agents↗

PubMed2000

Tuberculosis control and molecular epidemiology in a South African gold-mining community.

BACKGROUND: Gold miners have very high rates of tuberculosis. The contribution of infections imported into mining communities versus transmission within them is not known and has implications for control strategies. METHODS: We did a prospective, population-based molecular and conventional epidemiological study of pulmonary tuberculosis in a group of goldminers. Clusters were defined as groups of patients with Mycobacterium tuberculosis isolates with identical IS6110 DNA fingerprints. We compared the frequency of possible risk factors in the clustered and non-clustered patients whose isolates had fingerprints with more than four bands, and re-interviewed members of 45 clusters. FINDINGS: Of 448 patients, ten were excluded because they had false-positive cultures. Fingerprints were made in 419 of 438, of which 371 had more than four bands. 248 of 371 were categorised into 62 clusters. At least 50% of tuberculosis cases were due to transmission within the community. Patients who had failed treatment at entry to the study were more likely to be in clusters (adjusted odds ratio 3.41 [95% CI 1.25-9.27]). Patients with multidrug-resistant isolates were more likely to have failed treatment but were less likely to be clustered than those with a sensitive strain (0.27 [0.09-0.83]). HIV infection was common (177 of 370 tested) but not associated with clustering. INTERPRETATION: Despite a control programme that cures 86% of new cases, most tuberculosis in this mining community is due to ongoing transmission. Persistently infectious individuals who have previously failed treatment may be responsible for one third of tuberculosis cases. WHO targets for cure rates are not sufficient to interrupt transmission of tuberculosis in this setting. Indicators that are more closely linked to the rate of ongoing transmission are needed.

Adult↗

PubMed2004

Protective effect of BCG among children vaccinated under universal immunization programme.

A case-control study was conducted to estimate the protective effect of BCG vaccination against tuberculosis among children. The children with suspicion of tuberculosis (TB) attending two hospitals in Bangalore city were registered into the study and subjected to detailed clinical examination and investigations. The presence of BCG scar was taken as evidence of vaccination. Modified Stegen-Jones scoring method was adopted for diagnosing TB. The hospital children with score of 7 were considered as TB cases. Children residing in the neighbourhood of cases were similarly investigated and those scoring 4 were labeled as controls. A total of 118 age-sex matched case-control pairs were identified and final analysis was confined to 113 cases and 109 controls after excluding children with doubtful BCG scar. A low protective effect of BCG vaccination at 31% (not significant, statistically) was observed against TB - all forms combined, among children vaccinated as under Universal Immunization Programme. Though the protective efficacy against extra-pulmonary TB was observed to be higher than for pulmonary TB, it was also not significant, statistically. It will be appropriate to conduct further studies on protection rendered by BCG vaccination against tuberculous meningitis and other severe forms of TB. Besides, the quality of vaccination programme including cold chain maintenance also needs to be evaluated.

Adolescent↗

PubMed2004

Should the 'bleach microscopy method' be recommended for improved case detection of tuberculosis? Literature review and key person analysis.

SETTING: It has been proposed that the sensitivity of direct sputum smear microscopy can be improved if sputum is liquefied with sodium hypochlorite (NaOCl or household bleach), and concentrated by centrifugation before acid-fast staining. OBJECTIVE: To summarise the results of the studies of the bleach method for improved sensitivity of sputum microscopy and to describe the opinions and knowledge of key persons in National Tuberculosis Control Programmes (NTPs) about this method. DESIGN: We searched Medline, EMBASE and Web of Science for studies comparing the bleach method to direct sputum smear microscopy in low- or middle-income countries. Each study was assessed regarding methodology and field applicability. We also sent out questionnaires concerning the bleach method to key persons in NTPs in 85 countries. RESULTS: In 15 of the 19 studies identified there was a statistically significant improvement in the proportion of positive tests or sensitivity ranging from 7-253%. The majority (73%) of the key persons had heard of the bleach method. Forty-four per cent thought it could improve case detection in their countries, while 49% did not know; 93% of them would promote the bleach method; the most common reasons for doing so would be recommendations from the WHO or the IUATLD, or favourable studies performed in their own country. The bleach method was used routinely in only three countries. CONCLUSION: There is enough evidence to recommend the evaluation and introduction of the bleach method in most settings where mycobacterial culture is not performed routinely.

Centrifugation↗

PubMed1994

Randomized controlled trial of dexamethasone in tuberculous meningitis.

SETTING: The patients admitted to the Neurology ward of the All India Institute of Medical Sciences Hospital. OBJECTIVE: To assess the role of dexamethasone as an adjunct to antimicrobial therapy in the treatment of tuberculous meningitis. DESIGN: A randomised controlled trial of 47 patients was conducted over a 13-month period. 41 patients completed the trial. Patients were stratified into mild, moderate and severe groups and randomly allocated to steroid and non-steroid groups. All patients received a standardized antituberculosis drug regime. The end point was 3 months, or death if earlier. The evaluation at the end point included survival, resolution of symptoms, sequelae and activities of daily living. Results were analysed using the Wilcoxon rank sum test. RESULTS: The patients in the dexamethasone group fared better. 75% of this group had mild sequelae as opposed to 62% of the control group. Amongst the survivors, those who received dexamethasone sensorium improved earlier, and there was greater improvement in mental function and daily activities. The difference, however, did not reach statistical significance. CONCLUSIONS: Dexamethasone appears useful as an adjunct in the treatment of tuberculous meningitis especially in patients who have severe disease. The results need confirmation by a larger trial.

Adolescent↗

PubMed1996

Passive smoking and risk of pulmonary tuberculosis in children immediately following infection. A case-control study.

SETTING: Passive smoking-related respiratory disorders in children. OBJECTIVES: To assess the effect of passive smoking on the development of active pulmonary tuberculosis (PTB) in children immediately following infection by Mycobacterium tuberculosis within the family. DESIGN: An unmatched case-control study in which 93 contacts who became cases (active PTB diagnosed) and 95 contacts who did not became cases (tuberculin-positive children without evidence of active disease) were included. All were household contacts of a new case of pulmonary bacillary tuberculosis. Smoking habits were investigated by a questionnaire. Urinary cotinine was analysed. Odds Ratio (OR) was adjusted for age and socio-economic status using multiple logistic regression analysis. RESULTS: Passive smoking was a risk factor for PTB (OR: 5.29; 95% confidence interval (CI): 2.33-12.82; P < 0.00005). The adjusted OR was 5.39 (95% CI: 2.44-11.91; P < 0.00001). The risk increased when contacts were passive smokers both at home and outside the home within the family (OR: 6.35; 95% CI: 3.20, 12.72; P < 0.00001). Contacts 0-4 and 5-9 years old showed a significantly higher risk than those aged > or = 10. There was a dose-response relationship between the risk of developing active PTB immediately following infection and the number of cigarettes smoked daily by the household adults (P < 0.001). Mean (SD) urinary continine detectable concentrations (ng/ml) were different between disease contacts (119.46 [68.61]) and non diseased contacts (91.87 [73.10]). The difference was statistically significant (P < 0.001). CONCLUSIONS: Passive exposure to tobacco smoke in children was associated with an increased risk of developing pulmonary tuberculosis immediately following infection. This is an association of great concern requiring health education programmes and antitobacco medical advice.

Adolescent↗

PubMed1999

Tuberculosis preventive therapy for HIV-infected people in sub-Saharan Africa is cost-effective.

OBJECTIVE: Since antiretroviral therapy is largely unavailable to HIV-infected patients in developing countries and recent clinical trials have shown that tuberculosis (TB) preventive therapy can reduce TB and HIV-associated morbidity and mortality, we studied the effectiveness and cost-effectiveness of TB preventive therapy for HIV-infected persons in sub-Saharan Africa. METHODS: A Markov model that used results of clinical trials of TB preventive therapy in sub-Saharan Africa and literature-derived medical care costs was used to evaluate three preventive therapy regimens in HIV-infected, tuberculin-positive patients in Uganda: (1) daily isoniazid (INH) for 6 months, (2) daily INH and rifampin (RIF) for 3 months, and (3) twice-weekly RIF and pyrazinamide (PZA) for 2 months. RESULTS: All three regimens extend life expectancy and reduce the number of TB cases. When only medical care costs are considered, all three preventive therapy regimens cost more than not providing preventive therapy to extend life and prevent active tuberculosis. When medical care and social costs are considered together, 6-months of daily INH treatment will save money relative to no preventive therapy and when the costs associated with treating secondary infections are included, all three preventive therapy regimens are less expensive than no preventive therapy. With the inclusion of secondary infection costs, 6 months of daily INH results in savings of $24.16 per person. CONCLUSIONS: TB preventive therapy taken by HIV-infected tuberculin reactors in sub-Saharan Africa results in extended life-expectancy, reduction of the incidence of TB and monetary savings in medical care and social costs. TB control policy in sub-Saharan Africa should include preventive therapy.

AIDS-Related Opportunistic Infections↗

PubMed1995

[The prevalence of tuberculous infection in the 6- to 7-year-old schoolchild population in Albacete].

To analyze the prevalence of tuberculosis infection, tuberculin tests were given to 3,292 elementary school children in the first and second grades in the environs of Albacete (Spain) in 1992. There were 1,532 children aged 6 (122 vaccinated with BCG) and 1,760 children aged 7 (162 vaccinated); 51 children tested positive (20 who had been vaccinated and 31 who had not been). The prevalence of infection was 0.78% at 6 years of age and 1.25 at 7 years of age in non vaccinated children, a rate similar to that found by earlier national surveys. One case of active pulmonary tuberculosis was identified. Inclusion of the 8.6% who had been vaccinated caused significant distortion of the initial prevalences. The annual rate of infection, estimated based on an annual decline of 4%, was 0.143 %. Differences in tuberculosis infection by family socioeconomic level, as indicted by level of parental studies or place of residence, were not statistically significant, although we did observe a slightly greater rate among children living in poorer areas and with parents with only elementary school education. Our results confirm a downward trend in the prevalence of tuberculosis infection in the population studied, as well as the importance of carrying out this type of survey to provide a reference for active control and for taking an active stand.

Chi-Square Distribution↗