International Journal of Tuberculosis and Lung Disease最新文献

Existing TB diagnostic tests rely on sputum samples, which can be difficult to collect from all patients. This study examines plasma Mycobacterium tuberculosis cell-free DNA (Mtb cfDNA) based quantitative PCR (qPCR) assay for the diagnosis of pulmonary TB (PTB).The qPCR assay targeted insertion sequence (IS6110), cyp141, and devR genes on plasma samples from 106 PTB patients and 60 controls. Sensitivity was calculated using the Xpert^® MTB/RIF test, culture, and clinical diagnosis for the PTB group, while specificity was determined based on results from controls.Among PTB cases, 92 (86.8%) were bacteriologically confirmed, with the remaining 14 (13.2%) diagnosed clinically. The sensitivity of the plasma Mtb cfDNA assay, considering all three genes, was 71.7% (95% CI 62.6-71.7) for all PTB cases, with higher sensitivity in bacteriologically confirmed cases (78.3%) than in clinically diagnosed cases (28.6%). The combined specificity was 91.7%. The combination of IS6110 and cyp141 targeted qPCR demonstrated a sensitivity of 70.8%, and IS6110 and devR showed a sensitivity of 69.8%. However, devR and cyp141 resulted in a lower sensitivity of 63.2%. IS6110 and cyp141 had sensitivities of respectively 59.4% and 60.4%, while devR had 53.8%.Targeting multiple genes for plasma Mtb cfDNA-based TB diagnosis improves sensitivity and could be an important addition to current sputum-based diagnostic approaches..

Population-based surveys are crucial for understanding smoking and TB epidemiology.A sub-national cross-sectional survey was conducted among individuals aged ≥15 years in 180 clusters in Southern India.Among 130,914 participants included for analysis, 117,091 were non-smokers, 5,410 were past smokers, and 8,413 were current smokers. Sixty-two (0.7%) participants in the current smoking group, 31 (0.6%) participants in the past smoking group, and 151 (0.1%) participants in the non-smoking group were diagnosed with microbiologically confirmed pulmonary TB (MCPTB). The crude prevalence ratio (cPR) of MCPTB in the smoking population was 4.33 (95% CI 3.30-5.68, P < 0.01). The adjusted PR (aPR) of MCPTB among the smoking population for the 31-45-years age group was 4.38 (95% CI 0.96-20.04); among those aged 46-60 years, this was 9.69 (95% CI 2.29-40.91); and among those aged >60 years, it was 11.59 (95% CI 2.74-49.05). The aPR among those with a body mass index of <16.50 kg/m², was 13.18 (95% CI 5.46-31.86). The aPR among those with alcohol use was 2.43 (95% CI 1.10-5.35), and 3.19 (95% CI 1.79-5.69) among those with a history of TB.The prevalence of MCPTB in smokers is significantly higher than in non-smokers. Increasing age, undernutrition, alcohol use, and history of PTB were strongly associated with PTB among smoking participants..

Although physical activity is an important outcome in patients with chronic respiratory disease, it has not been characterised in those with non-tuberculous mycobacterial pulmonary disease (NTM-PD). This study aimed to evaluate physical activity and its associated factors in patients with NTM-PD.This prospective observational study measured daily step counts using an accelerometer to assess physical activity (steps per day). We investigated serum C-reactive protein (CRP), incremental shuttle walk test distance (ISWD), Leicester Cough Questionnaire (LCQ), modified Medical Research Council (mMRC) dyspnoea scale, and chronic cough and sputum symptoms (CCS). Patients were divided into two groups based on the presence or absence of CCS, and their physical activity were compared. The association between physical activity and these variables was examined using multivariate analysis.We included 131 patients, with a median daily step count of 3,960. Patients with CCS had significantly lower daily step counts than those without CCS (3,426 vs 4,567). Daily step count significantly correlated with age, mMRC dyspnoea grade, CRP level, ISWD, and LCQ. Multiple regression analysis showed that the daily step count was significantly associated with ISWD and CCS.These results suggest that CCS should be considered when assessing physical activity in patients with NTM-PD..

To assess the predictive value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and systemic immune inflammation index in severe post-operative pulmonary infection in haemorrhagic stroke patients based on sex.This retrospective study included 193 male and 129 female patients with haemorrhagic stroke and post-operative pulmonary infection. Univariate and multivariate logistic regression models were used to determine the association between inflammatory markers from peripheral blood counts and severe pulmonary infection in these patients.The proportions of severe pulmonary infections in male and female patients were respectively 35.8% and 24.8%, with a significant difference. Among female haemorrhagic stroke patients, the results of the multivariate logistic regression model showed that the NLR on the third post-operative day (≥9.17) was associated with severe pulmonary infection. Among male haemorrhagic stroke patients, the results of the multivariate logistic regression model showed that NLR on the first post-operative day (≥13.28) and NLR on the third post-operative day (≥8.85) were associated with severe pulmonary infection.The predictive values of NLR for post-operative severe pulmonary infection varied among haemorrhagic stroke patients of different sexes. However, a higher NLR on the third post-operative day was associated with severe pulmonary infection in both male and female patients with haemorrhagic stroke..

Sputum culture is the gold standard for diagnosing TB disease and confirming treatment outcomes. However, the turnaround time is 6-8 weeks, which leads to delays in decision-making regarding the care of TB patients.To evaluate isoniazid hair drug levels as a predictor of sputum culture conversion at 8 weeks of TB treatment.We enrolled 56 TB patients and started them on treatment. We collected sputum and hair samples at baseline and Weeks 4, 8, and 26. Sputum culture was done on solid and liquid media. The hair drug levels assay was done using liquid chromatography-tandem mass spectrometry.We excluded 22 participants (8 with contaminated cultures, 10 were unable to produce sputum, and 4 missed the Week 8 visit). Of the remaining 28, about 24 (86%) were TB sputum culture-negative with a median hair drug level of 0.0514 ng/ml (IQR 0.1165-0.0314), and 4 (14.1%) were TB culture-positive, with a median hair drug level of 0.0192 (IQR 0.0267-0.0132).A median isoniazid hair level of ≥0.05 ng/ml may be predictive of sputum culture conversion by the end of the intensive phase of TB treatment..

This study aimed to investigate the overall prognostic performance of the DECAF (dyspnoea, eosinopenia, consolidation, acidaemia, atrial fibrillation) score for in-hospital death in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) through a retrospective cohort study and an updated meta-analysis.Sensitivity, specificity, and predictive performance of DECAF were analysed, using receiver operating characteristic (ROC) curves and area under the curve (AUC) as criteria for accuracy. A literature search was performed in databases. The summary ROC (SROC) curve was used to assess the overall performance of the DECAF score.Twenty-three non-survivors and 292 survivors of AECOPD were included. At a cut-off value of 1.5, DECAF scores showed good sensitivity (78.3%), low specificity (55.1%), and AUC (0.719, 95% CI 0.614-0.824). Additionally, 22 studies (including our study) with 824 non-survivors and 8,957 survivors were included in this meta-analysis. The summary estimates were listed as follows: sensitivity 0.77 (95% CI 0.69-0.83); specificity 0.76 (95% CI 0.67-0.85); positive likelihood ratio 3.2 (95% CI 2.4-4.3); negative likelihood ratio 0.31 (95% CI 0.23-0.40); and diagnostic odds ratio 10.00 (95% CI 7-16). The AUC was 0.83 (95% CI 0.79-0.86).The DECAF score is a simple tool to predict mortality in hospitalised patients with AECOPD, and the results of this study should be further validated..