The aim of the study was to evaluate visual parameters for early detection of ethambutol toxicity to prevent irreversible optic nerve damage.
Method
This cohort study included 50 newly diagnosed cases of pulmonary tuberculosis, i.e. 100 eyes, in people aged 18–72 years, who received ethambutol as part of the antitubercular therapy. Before starting antitubercular treatment, at each monthly visit, ophthalmic examination was done that included best corrected visual acuity, optic disc evaluation, colour vision, contrast sensitivity, pupil cycle time and automated perimetry for a period of six months. Ethambutol was discontinued in patients who showed signs of visual impairment. These patients were observed for another three months for reversibility of toxicity.
Results
Visual functions were normal in all patients at baseline. Out of 50 patients, 47 didn't show any signs of deterioration in visual functions even after six months of oral administration of ethambutol. However, 3 out of 50 patients, i.e. 6 eyes (6 %), showed signs of toxicity after 4–5 months – LogMAR visual acuity deteriorated from 0.00 to 1.08 (±0.40); mean contrast sensitivity deteriorated from 1.725 (±0.075) to 1.12 (±0.18); mean deviation in visual fields got impaired from −1.37 (±0.15) to −10.93 (±2.66); and colour vision got severely affected. All the affected patients were aged above 65.
Conclusion
In the present study, six percent of 50 patients showed ethambutol toxic optic neuropathy. It was concluded that patients should be comprehensively evaluated for visual parameters before starting the ethambutol treatment. They should be closely monitored by an ophthalmologist for visual functions every month to detect ethambutol toxicity at the early reversible stage to prevent irreversible damage to the optic nerve. Patients should be asked to report immediately if they detect any blurring of vision or colour vision abnormality.
{"title":"Prospective evaluation of ethambutol toxic optic neuropathy in patients of pulmonary tuberculosis","authors":"Neharika Sharma , Abha Gahlot , Jawahar Lal Goyal , Devendra Kumar singh , Divya Singh , Arushi Gupta , Pulkit Gandhi","doi":"10.1016/j.ijtb.2023.11.001","DOIUrl":"10.1016/j.ijtb.2023.11.001","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of the study was to evaluate visual parameters for early detection of ethambutol<span> toxicity to prevent irreversible optic nerve damage.</span></div></div><div><h3>Method</h3><div><span>This cohort study included 50 newly diagnosed cases of pulmonary tuberculosis, i.e. 100 eyes, in people aged 18–72 years, who received ethambutol as part of the antitubercular therapy. Before starting antitubercular treatment, at each monthly visit, </span>ophthalmic<span> examination was done that included best corrected visual acuity, optic disc evaluation, colour vision, contrast sensitivity, pupil cycle time and automated perimetry for a period of six months. Ethambutol was discontinued in patients who showed signs of visual impairment. These patients were observed for another three months for reversibility of toxicity.</span></div></div><div><h3>Results</h3><div>Visual functions were normal in all patients at baseline. Out of 50 patients, 47 didn't show any signs of deterioration in visual functions even after six months of oral administration of ethambutol. However, 3 out of 50 patients, i.e. 6 eyes (6 %), showed signs of toxicity after 4–5 months – LogMAR visual acuity deteriorated from 0.00 to 1.08 (±0.40); mean contrast sensitivity deteriorated from 1.725 (±0.075) to 1.12 (±0.18); mean deviation in visual fields got impaired from −1.37 (±0.15) to −10.93 (±2.66); and colour vision got severely affected. All the affected patients were aged above 65.</div></div><div><h3>Conclusion</h3><div>In the present study, six percent of 50 patients showed ethambutol toxic optic neuropathy. It was concluded that patients should be comprehensively evaluated for visual parameters before starting the ethambutol treatment. They should be closely monitored by an ophthalmologist for visual functions every month to detect ethambutol toxicity at the early reversible stage to prevent irreversible damage to the optic nerve. Patients should be asked to report immediately if they detect any blurring of vision or colour vision abnormality.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 1","pages":"Pages 69-73"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139295896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.ijtb.2024.09.002
Shilpa Madhava Kunjathur , Ronald Jaswanth Kumar Katta , Sharath Burguina Nagaraja , Sangeetha M D , Sreenath Menon P K , Anil Singarajapure
Context
Tuberculosis (TB) remains a major health challenge in India, with the country bearing the highest global burden. Co-existing with this epidemic is the surge in diabetes mellitus (DM) cases, earning India the title of "Diabetes Capital."
Aim
This study investigates the association between TB and DM, focusing on the feasibility and outcomes of screening TB patients for diabetes. It also explores the challenges and opportunities for integrated care of TB-DM comorbidities.
Settings
and Design: This cross-sectional study was conducted in 32 tuberculosis units in the BBMP district of Bengaluru, Karnataka, India.
Materials and methods
Data were collected from TB laboratory registers and through interviews with National Tuberculosis Elimination Program (NTEP) healthcare providers. The study assessed the implementation of diabetes screening, challenges in the process, and suggestions for improvement.
Results
As part of the Quantitative data, of the 17,052 presumptive TB cases examined, 41% were aware of their diabetes status. Diabetics constituted 14.61% of the presumptive cases. Of the diagnosed TB patients, 25.2% were found to be positive for DM as well. Qualitatively, healthcare providers highlighted operational challenges, mainly concerning the timing of blood sugar testing and the need for referral to higher-level facilities. They also emphasized the importance of generating awareness among communities and training healthcare workers for on-the-spot diabetes screening.
Conclusion
The findings highlight the urgent need for improved screening of TB patients for diabetes, timely initiation of anti-diabetic treatment, and comprehensive healthcare services under one roof. Advocacy, communication, and social mobilization strategies should be intensified to create awareness of TB-DM comorbidities in the general population.
{"title":"“Diabetes among tuberculosis patients in Bengaluru is alarming: Time to tackle it efficiently!”","authors":"Shilpa Madhava Kunjathur , Ronald Jaswanth Kumar Katta , Sharath Burguina Nagaraja , Sangeetha M D , Sreenath Menon P K , Anil Singarajapure","doi":"10.1016/j.ijtb.2024.09.002","DOIUrl":"10.1016/j.ijtb.2024.09.002","url":null,"abstract":"<div><h3>Context</h3><div>Tuberculosis (TB) remains a major health challenge in India, with the country bearing the highest global burden. Co-existing with this epidemic is the surge in diabetes mellitus (DM) cases, earning India the title of \"Diabetes Capital.\"</div></div><div><h3>Aim</h3><div>This study investigates the association between TB and DM, focusing on the feasibility and outcomes of screening TB patients for diabetes. It also explores the challenges and opportunities for integrated care of TB-DM comorbidities.</div></div><div><h3>Settings</h3><div>and Design: This cross-sectional study was conducted in 32 tuberculosis units in the BBMP district of Bengaluru, Karnataka, India.</div></div><div><h3>Materials and methods</h3><div>Data were collected from TB laboratory registers and through interviews with National Tuberculosis Elimination Program (NTEP) healthcare providers. The study assessed the implementation of diabetes screening, challenges in the process, and suggestions for improvement.</div></div><div><h3>Results</h3><div>As part of the Quantitative data, of the 17,052 presumptive TB cases examined, 41% were aware of their diabetes status. Diabetics constituted 14.61% of the presumptive cases. Of the diagnosed TB patients, 25.2% were found to be positive for DM as well. Qualitatively, healthcare providers highlighted operational challenges, mainly concerning the timing of blood sugar testing and the need for referral to higher-level facilities. They also emphasized the importance of generating awareness among communities and training healthcare workers for on-the-spot diabetes screening.</div></div><div><h3>Conclusion</h3><div>The findings highlight the urgent need for improved screening of TB patients for diabetes, timely initiation of anti-diabetic treatment, and comprehensive healthcare services under one roof. Advocacy, communication, and social mobilization strategies should be intensified to create awareness of TB-DM comorbidities in the general population.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 ","pages":"Pages S60-S63"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The recent gain in the fight against Tuberculosis is potentially being threatened by the delays in the diagnosis and treatment of infected patients. These patients continue to make contacts with other people in the community and spread the disease without knowing. Thus, there is a need to identify the factors associated with these delays and the possibility of mitigating them.
Methods
This was a cross-sectional study conducted in Ibadan, Nigeria. Three primary health care centres with high burden of tuberculosis were selected for this study. Patients with newly diagnosed tuberculosis was recruited, delays for presentation at the health centres were evaluated and associated factors were determined using their clinical records and a standard questionnaire.
Results
A total of 135 patients met the criteria for this study, and 68 (50.4%) of them were males. Two levels of delays were identified: delay between symptoms onset and presentation in health centres and delays between diagnosis and treatment commencement. Factors associated with these delays were: socio-economic status (p = 0.006), type of area of residence (p = 0.015), current smoking status (p = 0.016) and seeking treatment elsewhere before the current ailment (p = 0.037).
Conclusions
This study showed that socio-economic factors, area of residence, cigarette smoking and previous presentation at other health facilities were factors associated with delays at DOTS centres.
{"title":"Factors associated with delay of patients with cough to tuberculosis treatment centres in selected DOTS in South-West Nigeria","authors":"Olatunde Olayanju , Idemudia Otaigbe , Kolawole Sodeinde , Olumide Abiodun , Akindele Adebiyi","doi":"10.1016/j.ijtb.2023.08.009","DOIUrl":"10.1016/j.ijtb.2023.08.009","url":null,"abstract":"<div><h3>Background</h3><div>The recent gain in the fight against Tuberculosis is potentially being threatened by the delays in the diagnosis and treatment of infected patients. These patients continue to make contacts with other people in the community and spread the disease without knowing. Thus, there is a need to identify the factors associated with these delays and the possibility of mitigating them.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study conducted in Ibadan, Nigeria. Three primary health care centres with high burden of tuberculosis were selected for this study. Patients with newly diagnosed tuberculosis was recruited, delays for presentation at the health centres were evaluated and associated factors were determined using their clinical records and a standard questionnaire.</div></div><div><h3>Results</h3><div>A total of 135 patients met the criteria for this study, and 68 (50.4%) of them were males. Two levels of delays were identified: delay between symptoms onset and presentation in health centres and delays between diagnosis and treatment commencement. Factors associated with these delays were: socio-economic status (p = 0.006), type of area of residence (p = 0.015), current smoking status (p = 0.016) and seeking treatment elsewhere before the current ailment (p = 0.037).</div></div><div><h3>Conclusions</h3><div>This study showed that socio-economic factors, area of residence, cigarette smoking and previous presentation at other health facilities were factors associated with delays at DOTS centres.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 1","pages":"Pages 25-31"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47302495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Post-pulmonary Tuberculosis (PTB) sequelae are chest alterations caused by pulmonary tuberculosis problems, even after treatment and infection elimination. These alterations can cause pulmonary dysfunction, ranging from mild irregularities to acute dyspnea, increasing the risk of respiratory-related deaths. Current research aims to investigate the type, severity, clinical management, and impact on quality of life in affected individuals.
Materials and methods
A prospective observational study with 66 patients was carried out in a South Indian tertiary care facility. We gathered sociodemographic and clinical data from the patients. Imaging investigations (chest X-ray, CT scans) and pulmonary function test reports (Spirometry) were used to assess the post-pulmonary TB sequelae. The patient's quality of life was evaluated using the WHOQoL-BREF questionnaire.
Results
Out of 66 patients, 66.7% were men, and the average age was 57.2 years. According to radiological analysis, most patients had airway difficulties (38%), followed by parenchymal problems (36.3%). Obstruction was the most typical abnormality identified (81.9%). Bronchodilators, LABA + ICS, SABA, leukotriene antagonists, antibiotics, and other fixed medications treat post-PTB sequelae. Substantial impairment was observed in quality of life.
Conclusion
Patients who have had pulmonary TB are prone to post-TB respiratory symptoms and sequelae. The quality of life noticeably declined. This study's findings underscore the importance of robust, evidence-based guidelines and practical implementation techniques for managing post-pulmonary TB.
{"title":"Impact of post-pulmonary tuberculosis sequelae and its management in a tertiary care facility in South India","authors":"Swathy Govindaswamy , Venugopal Jaganathan , Abdul kadhar Sathick Batcha , Mowfiya Nazeer , Simran Ravichandran , Swetha Balasubramaniyam","doi":"10.1016/j.ijtb.2024.10.008","DOIUrl":"10.1016/j.ijtb.2024.10.008","url":null,"abstract":"<div><h3>Background</h3><div>Post-pulmonary Tuberculosis (PTB) sequelae are chest alterations caused by pulmonary tuberculosis problems, even after treatment and infection elimination. These alterations can cause pulmonary dysfunction, ranging from mild irregularities to acute dyspnea, increasing the risk of respiratory-related deaths. Current research aims to investigate the type, severity, clinical management, and impact on quality of life in affected individuals.</div></div><div><h3>Materials and methods</h3><div>A prospective observational study with 66 patients was carried out in a South Indian tertiary care facility. We gathered sociodemographic and clinical data from the patients. Imaging investigations (chest X-ray, CT scans) and pulmonary function test reports (Spirometry) were used to assess the post-pulmonary TB sequelae. The patient's quality of life was evaluated using the WHOQoL-BREF questionnaire.</div></div><div><h3>Results</h3><div>Out of 66 patients, 66.7% were men, and the average age was 57.2 years. According to radiological analysis, most patients had airway difficulties (38%), followed by parenchymal problems (36.3%). Obstruction was the most typical abnormality identified (81.9%). Bronchodilators, LABA + ICS, SABA, leukotriene antagonists, antibiotics, and other fixed medications treat post-PTB sequelae. Substantial impairment was observed in quality of life.</div></div><div><h3>Conclusion</h3><div>Patients who have had pulmonary TB are prone to post-TB respiratory symptoms and sequelae. The quality of life noticeably declined. This study's findings underscore the importance of robust, evidence-based guidelines and practical implementation techniques for managing post-pulmonary TB.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 ","pages":"Pages S75-S79"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.ijtb.2024.08.015
Ibrahim Khalil
Tuberculosis is a pressing global health concern that affects not only the respiratory system but also various extrapulmonary sites. In addition to pulmonary symptoms, tuberculosis can also manifest outside the lungs. The ocular involvement of tuberculosis, often presenting as primary tuberculous chorioretinitis (PTCR), poses a significant diagnostic challenge for healthcare professionals. This review article sheds light on the intricate nature of diagnosing tuberculous infectious diseases in Bangladesh, highlighting the specific challenges faced in this setting. Despite commendable progress in tuberculosis control in Bangladesh, the advanced diagnosis of tuberculosis, particularly when it involves the eyes, presents formidable obstacles. This is especially true in cases of primary tuberculous chorioretinitis, which can pose a grave threat to vision and lead to life-threatening conditions, particularly in resource-poor settings. The article underscores the necessity for innovative and improvised diagnostic approaches to address the unique nature of these cases. Furthermore, the article delves into the implications of Mycobacterium tuberculosis infection in the eye, emphasizing its potential to cause severe blindness. To mitigate bias and enhance patient outcomes, the healthcare community must focus on raising public awareness, improving diagnostic techniques, and ensuring adherence to regulatory standards. This multifaceted approach is essential to effectively combat the challenges posed by tuberculosis, particularly in cases involving ocular manifestations.
{"title":"Challenges in diagnosing primary tubercular chorioretinitis and ocular tuberculosis in resource-limited settings of Bangladesh","authors":"Ibrahim Khalil","doi":"10.1016/j.ijtb.2024.08.015","DOIUrl":"10.1016/j.ijtb.2024.08.015","url":null,"abstract":"<div><div>Tuberculosis is a pressing global health concern that affects not only the respiratory system but also various extrapulmonary sites. In addition to pulmonary symptoms, tuberculosis can also manifest outside the lungs. The ocular involvement of tuberculosis, often presenting as primary tuberculous chorioretinitis (PTCR), poses a significant diagnostic challenge for healthcare professionals. This review article sheds light on the intricate nature of diagnosing tuberculous infectious diseases in Bangladesh, highlighting the specific challenges faced in this setting. Despite commendable progress in tuberculosis control in Bangladesh, the advanced diagnosis of tuberculosis, particularly when it involves the eyes, presents formidable obstacles. This is especially true in cases of primary tuberculous chorioretinitis, which can pose a grave threat to vision and lead to life-threatening conditions, particularly in resource-poor settings. The article underscores the necessity for innovative and improvised diagnostic approaches to address the unique nature of these cases. Furthermore, the article delves into the implications of Mycobacterium tuberculosis infection in the eye, emphasizing its potential to cause severe blindness. To mitigate bias and enhance patient outcomes, the healthcare community must focus on raising public awareness, improving diagnostic techniques, and ensuring adherence to regulatory standards. This multifaceted approach is essential to effectively combat the challenges posed by tuberculosis, particularly in cases involving ocular manifestations.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 ","pages":"Pages S80-S84"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As the global health care commits to the ambitious goal of TB elimination, System for TB Elimination in Private Sector (STEPS) was introduced to provide appropriate standards of TB care to all patients. This study aims to assess the outcome of TB patients treated under STEPS programme in a Private hospital and find any significant factors in determining favourable and unfavourable outcomes.
Setting
Private Quaternary care hospital in South India.
Design
Retrospective study which included 163 patients diagnosed with Pulmonary and Extra-Pulmonary Tuberculosis from January 2020 to June 2022. Details like clinical profile, type and site of tuberculosis, modification of ATT regimen, adverse effects and outcomes were recorded.
Results
The study population included 62.6% males. 45.3% had Type-2 Diabetes mellitus. More than half of the cases were Extra-Pulmonary TB (52.2%) and 54.6% had microbiological confirmation. The Cure Rate in Pulmonary and Extra-Pulmonary TB cases were 76.7% and 79.2% respectively. 29 patients expired during TB treatment out of which 41.3% had renal failure. Advanced age and chronic kidney disease as a co-morbidity were significant in causing unfavourable outcomes.
Conclusion
Proper implementation of STEPS can help in 100% TB notification and effective care of TB patients.
{"title":"Outcome of patients with tuberculosis managed under NTEP through STEPS in a private hospital in India","authors":"Jaisy Thomas, Merin Yohannan, Rajkrishnan Soman Pillai","doi":"10.1016/j.ijtb.2024.03.012","DOIUrl":"10.1016/j.ijtb.2024.03.012","url":null,"abstract":"<div><h3>Objective</h3><div><span>As the global health care commits to the ambitious goal of TB elimination, System for TB Elimination in Private Sector (STEPS) was introduced to provide appropriate standards of </span>TB care to all patients. This study aims to assess the outcome of TB patients treated under STEPS programme in a Private hospital and find any significant factors in determining favourable and unfavourable outcomes.</div></div><div><h3>Setting</h3><div>Private Quaternary care hospital in South India.</div></div><div><h3>Design</h3><div>Retrospective study which included 163 patients diagnosed with Pulmonary and Extra-Pulmonary Tuberculosis from January 2020 to June 2022. Details like clinical profile, type and site of tuberculosis, modification of ATT regimen, adverse effects and outcomes were recorded.</div></div><div><h3>Results</h3><div>The study population included 62.6% males. 45.3% had Type-2 Diabetes mellitus. More than half of the cases were Extra-Pulmonary TB (52.2%) and 54.6% had microbiological confirmation. The Cure Rate in Pulmonary and Extra-Pulmonary TB cases were 76.7% and 79.2% respectively. 29 patients expired during TB treatment out of which 41.3% had renal failure. Advanced age and chronic kidney disease as a co-morbidity were significant in causing unfavourable outcomes.</div></div><div><h3>Conclusion</h3><div>Proper implementation of STEPS can help in 100% TB notification and effective care of TB patients.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 ","pages":"Pages S18-S22"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.ijtb.2024.08.019
Shini Preetha Nirmalson , Vijayakarthikeyan M , Thenmozhi M.D
Background
Tuberculosis mostly affects adults in their most productive years. However, all age groups are at risk. One of the high risk groups for tuberculosis is the elderly population due to factors like physiological ageing related changes, presence of comorbidities and immunodeficiency.
Objective
1. To estimate the prevalence of pulmonary tuberculosis among the elderly population residing in selected old age homes.2. To assess the epidemiological profile of pulmonary tuberculosis among the elderly population residing in selected old age homes.
Methodology
An analytical cross sectional study was carried out among elderly inmates (N – 300) of selected 10 old age homes in Salem district of Tamilnadu. A pre tested semi-structured questionnaire was used as a study tool for data collection. Investigations like CBNAAT and X ray were carried out on individuals with presumptive symptoms.
Results
Among 300 participants, about 50.7% were between 61 and 70 Years and 60.7% were females. Nearly 4.3% were current smokers, 28.7% were hypertensive and 20.6% were diabetic About 15.6% had cough, 11.2% had fever and 4.8% had hemoptysis Prevalence of tuberculosis was 2.6% (260 per 10,000 popultion) in this study. Tuberculosis was reported more in Females, those with presumptive symptoms, underweight individuals, those living in dormitory and those with comorbidity.
Conclusion
The results indicate that the key population should be concentrated for routine screening for tuberculosis. Pro-active interventions to seek and diagnose TB disease among older adults are more effective than traditional passive case-finding as we march towards elimination of tuberculosis in India.
{"title":"Prevalence and epidemiological profile of pulmonary tuberculosis among elderly population residing in old age homes in Salem district, Tamilnadu","authors":"Shini Preetha Nirmalson , Vijayakarthikeyan M , Thenmozhi M.D","doi":"10.1016/j.ijtb.2024.08.019","DOIUrl":"10.1016/j.ijtb.2024.08.019","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis mostly affects adults in their most productive years. However, all age groups are at risk. One of the high risk groups for tuberculosis is the elderly population due to factors like physiological ageing related changes, presence of comorbidities and immunodeficiency.</div></div><div><h3>Objective</h3><div>1. To estimate the prevalence of pulmonary tuberculosis among the elderly population residing in selected old age homes.2. To assess the epidemiological profile of pulmonary tuberculosis among the elderly population residing in selected old age homes.</div></div><div><h3>Methodology</h3><div>An analytical cross sectional study was carried out among elderly inmates (N – 300) of selected 10 old age homes in Salem district of Tamilnadu. A pre tested semi-structured questionnaire was used as a study tool for data collection. Investigations like CBNAAT and X ray were carried out on individuals with presumptive symptoms.</div></div><div><h3>Results</h3><div>Among 300 participants, about 50.7% were between 61 and 70 Years and 60.7% were females. Nearly 4.3% were current smokers, 28.7% were hypertensive and 20.6% were diabetic About 15.6% had cough, 11.2% had fever and 4.8% had hemoptysis Prevalence of tuberculosis was 2.6% (260 per 10,000 popultion) in this study. Tuberculosis was reported more in Females, those with presumptive symptoms, underweight individuals, those living in dormitory and those with comorbidity.</div></div><div><h3>Conclusion</h3><div>The results indicate that the key population should be concentrated for routine screening for tuberculosis. Pro-active interventions to seek and diagnose TB disease among older adults are more effective than traditional passive case-finding as we march towards elimination of tuberculosis in India.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 ","pages":"Pages S55-S59"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The burden of tuberculous meningitis varies substantially by location, and is influenced by the overall burden of tuberculosis in that geographical area, and the age structure of the population. Conventional methods for diagnosis of tuberculous meningitis include acid fast bacilli (AFB) smear and culture. AFB smear has low sensitivity and culture techniques are time consuming. During the last few years, rapid and sensitive molecular methods such as cartridge based nucleic acid amplification technique (CBNAAT) is being used for the diagnosis of tuberculous meningitis. In this study, we evaluated the burden of tuberculosis and rifampicin resistance in suspected cases of tuberculous meningitis in Bhubaneswar, Odisha, during February 2016 to December 2022 using CBNAAT.
Methods
Under the National Strategic Plan 2012–2017, CBNAAT machines were rolled out in 2016, of which 1 was installed in the National Reference Laboratory (NRL) for Tuberculosis in Bhubaneswar. For this study, retrospective data on CBNAAT testing of cerebrospinal fluid (CSF) samples at the NRL was collected and analyzed from February 2016 to December 2022. All the demographic and laboratory data were entered in Excel 2010 (Microsoft office, USA) for data analysis. The age and sex distribution of the presumptive TB patients, proportion of samples referred from public and private health care facilities, proportion of M. tuberculosis positive CSF samples along with sensitivity to rifampicin was evaluated. The study was approved by the Institutional Human Ethics Committee.
Results
During February 2016 to December 2022, a total of 1627 CSF samples from presumptive TB meningitis patients were received in the NRL for CBNAAT testing. 60.7% (988/1627) of the presumptive TB patients were males. Of the 1627 patients, 3.1% (50/1627) were positive for M. Tuberculosis by CBNAAT. 56% (28/50) of the patients positive for tuberculous meningitis were males. The positivity for M. tuberculosis varied from 2.1% in 2017 to 5.1% in 2021. The CSF positivity for M. tuberculosis ranged from 0.7% in patients aged >60 years to 6.1% in 15–30 years age group. Of the 50 M. tuberculosis positive samples, 6% (3/50) were resistant for rifampicin.
Conclusion
Our study which included more than 1600 samples over a period of approximately 7 years found a 3.1% positivity for M. tuberculosis in CSF samples using CBNAAT. 6% of the M. tuberculosis positive samples were resistant to rifampicin. Future studies involving data from other districts of Odisha will help provide a more accurate information on the prevalence of tuberculous meningitis in Odisha state.
{"title":"Tuberculous meningitis in Bhubaneswar, Odisha, during 2016 to 2022","authors":"Chinmayee Mohanty , Triyambakesh Mohanty , Sarita Kar , Sujeet Kumar , Sunil Swick Rout , Himadri Bhusan Bal , Subrat Kumar Barik , Jyotirmayee Turuk , Dasarathi Das , Sooman Sundaray , Prasanta Kumar Hota , Sanghamitra Pati , Sidhartha Giri","doi":"10.1016/j.ijtb.2023.09.007","DOIUrl":"10.1016/j.ijtb.2023.09.007","url":null,"abstract":"<div><h3>Background</h3><div><span><span>The burden of tuberculous meningitis<span><span> varies substantially by location, and is influenced by the overall burden of tuberculosis in that geographical area, and the age structure<span> of the population. Conventional methods for diagnosis of tuberculous meningitis include </span></span>acid fast bacilli (AFB) smear and culture. AFB smear has low sensitivity and culture techniques are time consuming. During the last few years, rapid and sensitive molecular methods such as cartridge based </span></span>nucleic acid amplification technique (CBNAAT) is being used for the diagnosis of tuberculous meningitis. In this study, we evaluated the burden of tuberculosis and </span>rifampicin resistance in suspected cases of tuberculous meningitis in Bhubaneswar, Odisha, during February 2016 to December 2022 using CBNAAT.</div></div><div><h3>Methods</h3><div><span>Under the National Strategic Plan 2012–2017, CBNAAT machines were rolled out in 2016, of which 1 was installed in the National Reference Laboratory (NRL) for Tuberculosis in Bhubaneswar. For this study, retrospective data on CBNAAT testing of cerebrospinal fluid<span> (CSF) samples at the NRL was collected and analyzed from February 2016 to December 2022. All the demographic and laboratory data were entered in Excel 2010 (Microsoft office, USA) for data analysis. The age and sex distribution of the presumptive TB patients, proportion of samples referred from public and private health care facilities, proportion of </span></span><em>M. tuberculosis</em><span> positive CSF samples along with sensitivity to rifampicin was evaluated. The study was approved by the Institutional Human Ethics Committee.</span></div></div><div><h3>Results</h3><div>During February 2016 to December 2022, a total of 1627 CSF samples from presumptive TB meningitis patients were received in the NRL for CBNAAT testing. 60.7% (988/1627) of the presumptive TB patients were males. Of the 1627 patients, 3.1% (50/1627) were positive for <em>M. Tuberculosis</em> by CBNAAT. 56% (28/50) of the patients positive for tuberculous meningitis were males. The positivity for <em>M. tuberculosis</em> varied from 2.1% in 2017 to 5.1% in 2021. The CSF positivity for <em>M. tuberculosis</em> ranged from 0.7% in patients aged >60 years to 6.1% in 15–30 years age group. Of the 50 <em>M. tuberculosis</em> positive samples, 6% (3/50) were resistant for rifampicin.</div></div><div><h3>Conclusion</h3><div>Our study which included more than 1600 samples over a period of approximately 7 years found a 3.1% positivity for <em>M. tuberculosis</em> in CSF samples using CBNAAT. 6% of the <em>M. tuberculosis</em> positive samples were resistant to rifampicin. Future studies involving data from other districts of Odisha will help provide a more accurate information on the prevalence of tuberculous meningitis in Odisha state.</div></div>","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 1","pages":"Pages 46-50"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135347715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>Deaths among tuberculosis patients due to varied causes are frequently reported. Usually, the death rate is high during the first six to eight months, i.e., the intensive phase of treatment. The healthcare personnel working under National Tuberculosis Elimination Program are reluctant to ascribe death to tuberculosis and may prefer to attribute the death to other causes. On the other hand, in hospitals, most death are attributed to tuberculosis without careful death audits and reasonable investigations. Comorbidities like diabetes, HIV, drug resistance, and drug-induced toxicity consequent to administering secondary lines of drugs need due consideration while ascertaining the cause of death. The study aimed to measure mortality within one year and a maximum of two years after registration. We also determined the cause of death by conducting a verbal autopsy by medico-social workers using the WHO modified autopsy tool. Two pairs of physicians ascertained cause of death by reviewing the collected information. We obtained the consensus opinion of a pair of physicians. In case of disputed opinion, opinion of senior physician from the other group was considered final.</div></div><div><h3>Material and methods</h3><div>We obtained the list of registered tuberculosis patients in 2019–2020 in Pune Municipal Corporation. The authors conducted the study in 2021–22. The authors prepared a verbal autopsy tool based on the WHO tool. We trained the experienced medical social workers. They called registered phone numbers to know the patient's present status. The social workers paid home visits and confirmed the present status if the phone was not connected even after repeated calls. They collected all the required details, reviewed information and decided the cause of death. The collected detailed information was shared with pairs of senior physicians who ascertained the cause of death. We calculated standardized mortality ratio and Kaplan-Meier survival analysis.</div></div><div><h3>Results</h3><div>The eligible patients were 7461, and there were 506 deaths. The death rate among males was higher (8.29%) compared to females (5.02%) [χ2 (with Yates correction) = 30.73; <em>p</em> < 0.00001]. The mean age of deceased and living patients was 42.77 (S.D. = 18.07) and 38.46 (S.D. = 17.54) years, respectively (t = 5.33; <em>p</em><span><span> < 0.0001). The death rate was 3.88 per 1000 person-months. More than 60% of patients died within six months of initiation of treatment. The overall standardized mortality ratio was 9.61; it decreased as the age advanced. Kaplan-Meier survival analysis showed that the </span>overall survival<span><span> for two years was 92.7%. The common causes were pneumonia, pulmonary tuberculosis, </span>acute coronary syndrome, and some liver injury/disease.</span></span></div></div><div><h3>Conclusions</h3><div>The standardized mortality ratio due to tuberculosis is high. The common causes of death are pneu
{"title":"Mortality among registered tuberculosis patients in Pune Municipal Corporation area, India","authors":"Jayashree Gothankar , Aarati Pokale , Purwa Doke , Shilpa Sule , Swati Chouhan , Prajakta Patil , Prashant Bothe , Prakash Doke","doi":"10.1016/j.ijtb.2023.09.010","DOIUrl":"10.1016/j.ijtb.2023.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Deaths among tuberculosis patients due to varied causes are frequently reported. Usually, the death rate is high during the first six to eight months, i.e., the intensive phase of treatment. The healthcare personnel working under National Tuberculosis Elimination Program are reluctant to ascribe death to tuberculosis and may prefer to attribute the death to other causes. On the other hand, in hospitals, most death are attributed to tuberculosis without careful death audits and reasonable investigations. Comorbidities like diabetes, HIV, drug resistance, and drug-induced toxicity consequent to administering secondary lines of drugs need due consideration while ascertaining the cause of death. The study aimed to measure mortality within one year and a maximum of two years after registration. We also determined the cause of death by conducting a verbal autopsy by medico-social workers using the WHO modified autopsy tool. Two pairs of physicians ascertained cause of death by reviewing the collected information. We obtained the consensus opinion of a pair of physicians. In case of disputed opinion, opinion of senior physician from the other group was considered final.</div></div><div><h3>Material and methods</h3><div>We obtained the list of registered tuberculosis patients in 2019–2020 in Pune Municipal Corporation. The authors conducted the study in 2021–22. The authors prepared a verbal autopsy tool based on the WHO tool. We trained the experienced medical social workers. They called registered phone numbers to know the patient's present status. The social workers paid home visits and confirmed the present status if the phone was not connected even after repeated calls. They collected all the required details, reviewed information and decided the cause of death. The collected detailed information was shared with pairs of senior physicians who ascertained the cause of death. We calculated standardized mortality ratio and Kaplan-Meier survival analysis.</div></div><div><h3>Results</h3><div>The eligible patients were 7461, and there were 506 deaths. The death rate among males was higher (8.29%) compared to females (5.02%) [χ2 (with Yates correction) = 30.73; <em>p</em> < 0.00001]. The mean age of deceased and living patients was 42.77 (S.D. = 18.07) and 38.46 (S.D. = 17.54) years, respectively (t = 5.33; <em>p</em><span><span> < 0.0001). The death rate was 3.88 per 1000 person-months. More than 60% of patients died within six months of initiation of treatment. The overall standardized mortality ratio was 9.61; it decreased as the age advanced. Kaplan-Meier survival analysis showed that the </span>overall survival<span><span> for two years was 92.7%. The common causes were pneumonia, pulmonary tuberculosis, </span>acute coronary syndrome, and some liver injury/disease.</span></span></div></div><div><h3>Conclusions</h3><div>The standardized mortality ratio due to tuberculosis is high. The common causes of death are pneu","PeriodicalId":39346,"journal":{"name":"Indian Journal of Tuberculosis","volume":"72 1","pages":"Pages 51-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135429288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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