Frontiers in tuberculosis最新文献

Introduction: Comorbid non-communicable diseases (NCDs) like diabetes, cardiovascular diseases (CVD), kidney diseases, and hypertension, could have implications for tuberculosis (TB) treatment management and increase the disease burden amongst active TB patients.

Methods: This cross-sectional study aimed at profiling comorbidities amongst sputum-positive TB patients in the South West and Littoral regions of Cameroon and was relevant for improving disease management and public health interventions. Diabetes was defined by elevated blood glucose, body mass index (underweight: <18.5 kg/m², normal: 18.5-<25.0 kg/m², overweight: 25-<30 kg/m² and obese: ≥30.0 kg/m²) and hypertension by elevated blood pressure levels (i.e., systolic ≥130 mmHg or diastolic ≥80 mmHg). Socio-demographic and clinical data were collected using case report forms. Descriptive analysis was performed, bivariate logistic regression analysis was computed with at least one comorbidity as the dependent variable (global model) and a multivariable logistic regression analysis was done to provide adjusted odds ratios (final model). The covariate with the highest p-value was removed until p < 0.25 cut-off, using R software version 4.3.1. p-value <0.05 at 95% confidence interval was considered statistically significant.

Results: Five hundred and forty-nine sputum-positive microscopically confirmed active TB patients were enrolled into this study. Two-thirds (65.8%) of the total patients were male. Overall, 56 sputum-positive TB patients had at least one non-communicable disease, thus a prevalence of 10.2% (95% CI = 7.9-13.0). The most frequently recorded NCD was diabetes 4.4% (95% CI = 3.1-6.7) followed by kidney disease 2% (95% CI = 1.1-3.6), hypertension 0.9% (95% CI = 0.4-2.2), and CVD 0.91% (95% CI = 0.4-2.2). Three TB patients (0.6%) had all four comorbidities examined. Age group (p < 0.001), and level of education (p = 0.049) were factors significantly associated with having at least one comorbidity.

Discussion: Our findings showed that diabetes was significantly the most prevalent comorbid NCD amongst sputum-positive TB patients (p < 0.001). HIV status, occupation, body mass index (BMI), and alcohol intake were not significantly associated with having at least one comorbidity. Implementing public health intervention programmes such as systematic screening of TB patients for NCDs especially diabetes is highly recommended for better control of these diseases.

Background: Mumbai is one of the most densely populated areas in the world and is a major contributor to the tuberculosis (TB) epidemic in India. A test and treat approach for TB infection (TBI) amongst household contacts (HHC) is part of the national policy for TB preventive treatment (TPT). However, in practice, the use of interferon-gamma release assay (IGRA) tests for infection are limited, and prevalence of TBI in Mumbai is not known.

Methods: We conducted a cross-sectional study among HHCs exposed to persons with microbiologically-confirmed, drug-susceptible pulmonary TB that were notified for antituberculosis treatment in Mumbai, India during September-December, 2021. Community-based field workers made home visits and offered IGRA (QuantiFERON-TB^® Gold In-Tube Plus) tests to HHC aged 5 years and older. After ruling out active TB disease, HHC with IGRA-positive test results were referred for TPT. All HHC were monitored for at least 24 months for progression to active TB disease.

Results: Among 502 HHCs tested, 273 (54%) had IGRA-positive results. A total of 254 (93%) were classified as TBI and were eligible for TPT, of which 215 (85%) initiated TPT, and 194 (90%) completed TPT successfully. There was substantial variation in rates of TBI per household. In 32% of households, all HHC (100%) were IGRA positive and in 64% of households >50% of HHC were infected. In all, 22 HHCs (4%; 22/558) were diagnosed with TB disease; of these, five HHC were diagnosed during follow up, of which three were IGRA positive and had no evidence of disease at initial screening but chose not to initiate TPT.

Conclusion: A test and treat strategy for HHC resulted in the detection of a substantial proportion of TBI and secondary TB cases. Home-based IGRA testing led to high participation rates, clinical evaluations, TPT initiation, and early diagnoses of additional secondary cases. A community-focused, test and treat approach was feasible in this population and could be considered for broader implementation.

Nearly two decades have passed since the first report on autophagy acting as a cell-autonomous defense against Mycobacterium tuberculosis. This helped usher a new area of research within the field of host-pathogen interactions and led to the recognition of autophagy as an immunological mechanism. Interest grew in the fundamental mechanisms of antimicrobial autophagy and in the prophylactic and therapeutic potential for tuberculosis. However, puzzling in vivo data have begun to emerge in murine models of M. tuberculosis infection. The control of infection in mice affirmed the effects of certain autophagy genes, specifically ATG5, but not of other ATGs. Recent studies with a more complete inactivation of ATG genes now show that multiple ATG genes are indeed necessary for protection against M. tuberculosis. These particular ATG genes are involved in the process of membrane atg8ylation. Atg8ylation in mammalian cells is a broad response to membrane stress, damage and remodeling of which canonical autophagy is one of the multiple downstream outputs. The current developments clarify the controversies and open new avenues for both fundamental and translational studies.