International Journal of Mycobacteriology最新文献

Bedaquiline (BDQ) has been shown to improve the cure rate and accelerate the time to culture conversion in patients with drug-resistant tuberculosis (DR-TB). However, pulmonary lesion improvement based on chest imaging after BDQ treatment has not been evaluated. We aimed to evaluate pulmonary lesion improvement in patients with DR-TB following treatment with BDQ-containing regimens. Five electronic databases (CENTRAL, Clinicaltrials.gov., PubMed, ScienceDirect, and SinoMed) were searched for this meta-analysis of randomized controlled trials (RCTs; PROSPERO: CRD42024571134). RCTs with a BDQ-receiving intervention arm and a BDQ-free control arm that reported radiological outcomes were included. Outcomes of this study were lesion absorption and cavitary closure on imaging. Subgroup analysis was conducted according to study quality (i.e., Jadad scale). Of the 476 retrieved records, eleven RCTs were eligible (pooled participants: 973, 50.2% received BDQ). Lesion improvement (risk ratio [RR] [95% confidence interval (CI)] = 1.51 [1.28-1.78], P = 0.001, I2= 0%) and cavitary closure (RR [95% CI] = 1.40 [1.26-1.55], P = 0.001, I2= 27%) were higher in the BDQ arms compared to controls. Patient improvements were more evident among high-quality RCTs compared to low-quality RCTs. Overall, BDQ-containing regimens improve pulmonary lesions and cavitations among patients with DR-TB.

Background: Tuberculosis (TB) remains a significant public health problem in India, with both pulmonary and extra-pulmonary forms contributing substantially to disease burden. Smear microscopy, though inexpensive and rapid, has limited sensitivity, particularly in paucibacillary cases. TrueNat Mycobacterium tuberculosis (MTB)/rifampicin (RIF), a chip-based real-time Polymerase Chain Reaction endorsed by the World Health Organization, provides rapid molecular detection and RIF resistance profiling. Here, we aimed to evaluate the diagnostic performance and agreement between Ziehl-Neelsen (ZN) smear microscopy and TrueNat MTB/RIF for Pulmonary TB and at a tertiary care hospital in Eastern Uttar Pradesh.

Methods: A retrospective study was conducted on 4249 clinical specimens (65.0% pulmonary, 35.0% extra-pulmonary). All samples were tested by both ZN microscopy and TrueNat MTB/RIF. Diagnostic positivity rates, RIF resistance, and agreement across sample categories and patient subgroups (HIV, diabetes) were analyzed using P values.

Results: The majority of patients were aged 18-40 years (37.6%) and were males (55.4%). Cough (71.5%) and fever (40.8%) were the most frequent symptoms. Smear microscopy detected acid-fast bacilli in 4.3% (185/4249) of samples, whereas TrueNat MTB/RIF identified MTB in 13.7% (583/4249). RIF resistance was observed in 5.6% of TrueNat-positive cases, with 26.4% indeterminate results. The overall agreement between microscopy and TrueNat was 0.42. Agreement was higher in pulmonary (0.57) than extrapulmonary samples (0.06), with the highest concordance in sputum (0.60). Agreement was also higher among HIV-positive (0.78) and diabetic patients (0.58) compared to their counterparts.

Conclusion: TrueNat MTB/RIF demonstrated superior sensitivity over smear microscopy, particularly in extrapulmonary and paucibacillary cases, while simultaneously detecting RIF resistance. Despite moderate agreement, the findings highlight the complementary role of molecular diagnostics alongside microscopy to improve TB case detection in high-burden, resource-limited settings.

Background: Extrapulmonary tuberculosis (EPTB) accounts for 15%-20% of all tuberculosis (TB). The diagnosis of EPTB is challenging and the emergence of drug-resistant EPTB further threatens the progress toward end TB strategy. Early detection of EPTB is crucial for initiation of appropriate treatment. This study aimed to detect rifampicin resistance (RR) in Mycobacterium tuberculosis Complex (MTBC) from EPTB samples using Xpert Mycobacterium tuberculosis (MTB)/Rif, Mycobacterium Growth Indicator Tube 960 (MGIT960), and Lowenstein Jensen (LJ) medium and compare RR detected by Xpert MTB/Rif and MGIT960 against LJ proportion method.

Methods: Laboratory-based cross-sectional study was conducted at a tertiary care hospital, New Delhi, from October 2019 to September 2021. A total of 822 EPTB samples were subjected to MGIT960 culture and Xpert MTB/Rif simultaneously. First 30 samples that were MGIT960 flagged and confirmed as MTBC using MPT-64 detection kit were included for rifampicin susceptibility testing by MGIT960 system and LJ proportion method. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each method were calculated with LJ proportion as the gold standard.

Results: With 30 samples analyzed for RR detection, the overall sensitivity, specificity, PPV, NPV, and accuracy of Xpert MTB/Rif were 50%, 100%, 100%, 96.5%, and 96.6%, respectively, and of MGIT were 100%, 100%, 100%, 100%, and 100%, respectively, with gold standard.

Conclusion: While Xpert MTB/Rif provides rapid results and serves as useful initial diagnostic tool, it should be integrated with phenotypic methods such as MGIT960, especially in Xpert MTB/Rif negative cases to confirm clinically suspected EPTB.

Novel anti-tuberculosis (TB) drugs have been shown to effectively treat drug-resistant TB (DR-TB). However, there is a risk of hepatotoxicity. We aimed to evaluate the incidence of hepatotoxicity in TB patients receiving bedaquiline (BDQ), delamanid (DLM), and/or pretomanid (Pa). This meta-analysis (PROSPERO: CRD42024564922) systematically explored electronic databases (i.e., Clinicaltrials.gov, Cochrane CENTRAL, Embase, PROQUEST, PubMed, ScienceDirect, and SinoMed) for clinical trials reporting the incidence of hepatotoxicity upon administering BDQ, DLM, and/or Pa. Primary endpoints were the overall incidence of elevated liver enzymes, particularly alanine transferase (ALT), aspartate transferase (AST), and gamma-glutamyl transferase (GGT). Proportion meta-analysis was performed for each outcome of interest. Sixteen trials with pooled 4086 participants. The combination of BDQ + Pa was associated with increased ALT (10.6%) and AST (10.4%). Among the individual drugs, Pa-containing regimens had the highest incidence of elevated liver enzymes (ALT [18.9%], AST [20.3%], and GGT [12.8%]). DLM-containing regimens had the lowest incidence (ALT [0.2%], AST [0.7%], and GGT [1%]). For BDQ-containing regimens, the incidence of elevated liver enzymes was similar to the standard of care (SOC): ALT (5.5%) vs. (6.9%) and AST (7.5%) vs. (10.8%), respectively. GGT elevation was more common among the groups receiving BDQ compared to SOC (10% vs. 3.1%). Overall, all the included trials were of high or fair quality. Among all the studied drugs, DLM alone demonstrated the highest hepatic safety, while regimens containing BDQ, Pa, or their combination showed higher hepatotoxic risks compared to SOC. We recommend regular liver function monitoring for DR-TB patients receiving these novel anti-TB drugs.

Tuberculosis (TB) and leprosy are major mycobacterial infections in Indonesia, but coinfection is rare. We describe a 57-year-old male with pulmonary TB and borderline lepromatous leprosy complicated by reversal reaction. He also had type 2 diabetes mellitus and oral candidiasis. TB was confirmed by GeneXpert MTB/RIF, rifampicin-sensitive sputum culture, and chest radiography, showing right suprahilar infiltrates. Leprosy was diagnosed by slit skin smear positive for Mycobacterium leprae. During the 6th month of multidrug therapy (MDT), he developed reversal reaction with fever, painful erythematous plaques, and sensory loss. Management included systemic corticosteroids, continuation of MDT without rifampicin, anti-TB drugs, and supportive care. Clinical improvement was observed after treatment modification. This case highlights the complex immunological interplay between M. leprae and Mycobacterium tuberculosis, therapeutic challenges of drug interactions, and the importance of multidisciplinary management.

Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, one of which involves miR-146a-5p as a specific microRNA molecule that is expressed exclusively on immune cells to modulate innate immunity. This study aims to examine and compare the expression of miR-146a-5p in active and latent TB patients. This study utilized a descriptive-analytic and cross-sectional design.

Methods: We used real-time quantitative polymerase chain reaction method to examine the strength of miR-146a-5p expression. Statistical analysis involved employing descriptive statistics to summarize the sample characteristics. One-way analysis of variance was utilized to conduct inferential analysis, evaluating the differences in miR-146a-5p expression across various groups. The odds ratio calculation was employed to assess the strength of association, whereas the receiver-operating characteristic curve analysis was performed to examine the diagnostic potential.

Results: The results showed that men dominated the incidence of active TB compared to women with a prevalence of 83% and 17%, respectively. While in latent TB, women dominated compared to men (78% and 22%). The results of the examination of miR-146a-5pexpression in active TB samples were up regulation with a value of 24,86535, whereas in latent TB samples were down regulation with a value of 0,22727. Active TB and latent TB samples showed a significant comparison in terms of miR-146a-5p expression.

Conclusions: Based on the research we have done, miR-146a-5p can be used as a biomarker in TB infection.

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. This study aimed to compare serum interleukin-17 (IL-17) and tumor necrosis factor-alpha (TNF-α) levels among Sudanese patients with and without leprosy to assess their impact on disease immunopathogenesis.

Methods: A case-control cross-sectional study was conducted at Abu Rouf Leprosy Clinic and Khartoum Dermatology Teaching Hospital between August 2018 and October 2020. IL-17 and TNF-α levels were quantified using Sandwich enzyme-linked immunosorbent assay kits (Sunlong Biotech, China). Statistical analyses were performed in SPSS v21.

Results: Leprosy patients had significantly lower mean IL-17 levels (1.6 ± 1.2 pg/ml) than healthy controls (5.5 ± 2.6 pg/ml, P < 0.001), whereas TNF-α was higher in patients (103.1 ± 25.5 ng/L) than controls (30.8 ± 15.1 ng/L, P < 0.001). IL-17 correlated negatively with disease duration, while TNF-α showed a positive correlation (r = 0.201, P = 0.037).

Conclusion: Cytokine dysregulation, particularly reduced IL-17 and elevated TNF-α, reflects distinct immune pathways in leprosy pathogenesis. These biomarkers may aid in assessing disease activity and treatment response.

Interferon-γ serves as the pivotal cytokine for macrophage activation. Anti-interferon-γ autoantibody (AIGA)-mediated adult-onset immunodeficiency (AOID) represents a phenocopy of primary immunodeficiency, characterized by recurrent disseminated infections predominantly caused by Mycobacterium abscessus complex (MABC) and other nontuberculous mycobacteria. Disseminated MABC (dMABC) in AOID poses significant therapeutic challenges, requiring long-term multidrug antimicrobial therapy combined with AIGA-targeted immunotherapy. This report details three cases of AOID with dMABC. All patients exhibited recurrent fevers, widespread cutaneous erythema, nodules, pustules, and painful multifocal lymphadenopathy over several months to 2 years. Serum AIGA testing was positive in all cases. MABC was isolated from skin and lymph node specimens through culture or next-generation sequencing. Radiologic studies confirmed systemic involvement, including pulmonary, lymphatic, and osteoarticular sites. A therapeutic regimen of combined antibiotics and low-to-medium-dose oral glucocorticoids (prednisone 20-30 mg/day initiated, tapered to 5 mg/day maintenance) was instituted, leading to clinical resolution in all patients. All were discharged successfully and remained disease-free on long-term follow-up.

Background: Pneumocystis jirovecii pneumonia (PJP) is still a common opportunistic infection among patients with human immunodeficiency virus (HIV) infection, which has significant mortality if not diagnosed and treated in time.

Methods: This study identified and compared demographic, clinical, and radiological characteristics between individuals with solitary PJP and those with concurrent pulmonary infections with other agents.

Results: The medical records of 1040 HIV-positive patients with pulmonary diseases were analyzed, and 140 cases of PJP pneumonia were selected. The average age was 37.2 ± 9.2 years, 72% were male, and 52% were intravenous drug users. Most patients had low CD4+ cell counts (median: 25 cells/mm3), were new cases (65%), and antiretroviral drug-naïve (82%). Among confirmed PJP cases, 25.9% had concurrent infections, mainly tuberculosis (TB; 8 cases) and cytomegalovirus pneumonia (8 cases). The comparison showed that there were no significant differences between the two groups in terms of age, gender, history of antiretroviral treatment, history of PJP, history of TB, erythrocyte sedimentation rate, CD4 count, HIV viral load, and the pattern of lung involvement in computed tomography scan imaging. The mortality rates were 17.2% for patients solely infected with PJP and 44.7% for those with coinfections (P < 0.001).

Conclusions: These results suggest that diagnosing coinfection of PJP and other pulmonary infections is essential, given the higher mortality.

Background: Tuberculosis (TB) remains a major global health challenge. In addition to Mycobacterium tuberculosis (MTB), nontuberculous mycobacteria (NTM) are increasingly recognized as causative agents of mycobacterial infections. However, the limited access to rapid diagnostics often delays appropriate treatment. Accurate and timely differentiation is critical for selecting effective antibiotic regimens. In Indonesia, there is a lack of population-based data comparing MTB and NTM in TB-suspected cases. This study aimed to detect and differentiate MTB and NTM in clinical samples from suspected TB patients in North Sumatra and to assess their drug resistance profiles using a molecular diagnostic approach.

Methods: We conducted a prospective cohort study using 56 clinical samples (45 smear-positive sputum and 11 fine-needle aspiration biopsies) from suspected TB patients in North Sumatra. DNA was extracted and analyzed using the Genoscholar™ NTM + multidrug-resistant TB (MDR-TB) II line probe assay (LPA) to detect MTB, NTM, and anti-TB drug resistance.

Results: Of the 56 samples, 40 (71.4%) were positive for MTB, 2 (3.6%) for Mycobacterium avium, and 5 (8.9%) for other NTM species, while 9 (16.1%) were negative. MDR MTB was detected in 9 (28%) sputum samples and 1 (12.5%) biopsy sample. Both M. avium isolates were susceptible to rifampicin and isoniazid, while resistance profiles for the other NTM species could not be determined.

Conclusion: LPA effectively differentiated MTB from NTM and identified drug resistance patterns in clinical samples. Implementation of this rapid diagnostic tool may strengthen TB management in high-burden areas such as North Sumatra, enabling earlier and more targeted treatment.