Tuberculosis Research and Treatment The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Nurses’ Roles and Experiences with Enhancing Adherence to Tuberculosis Treatment among Patients in Burundi: A Qualitative Study Tue, 19 Aug 2014 08:47:42 +0000 Background. In TB control, poor treatment adherence is a major cause of relapse and drug resistance. Nurses have a critical role in supporting patients in TB treatment process. Yet, very little research has been done to inform policymakers and practitioners on nurses’ experiences of treatment adherence among patients with TB. Aim. To describe nurses’ experiences of supporting treatment adherence among patients with tuberculosis in Burundi. Method. The study adopted qualitative approach with a descriptive design. A purposive sampling was performed. Eight nurses were selected from two TB treatment centers in Burundi. Content analysis was used to analyze the data. Result. According to the nurses, most patients complete their treatment. Educating patients, providing the medication, observing and following up treatment, and communicating with the patients were the key tasks by nurses to support adherence. Causes for interruption were medication-related difficulties, poverty, and patients’ indiscipline. Treatment adherence could also be affected by patients’ and nurses’ feelings. Providing transportation and meals could enhance treatment compliance. Conclusion. Nurses are critical resources to TB treatment success. In a poverty stricken setting, nurses’ work could be facilitated and adherence further could be enhanced if socioeconomic problems (transportation and nutritional support) were alleviated. Marie Carlsson, Stina Johansson, Remy-Paul Bosela Eale, and Berthollet Bwira Kaboru Copyright © 2014 Marie Carlsson et al. All rights reserved. Pharmacovigilance and Moroccan Tuberculosis Public Program: Current Situation Thu, 12 Jun 2014 00:00:00 +0000 The objective of this work is to demonstrate the interest of integration of pharmacovigilance in Moroccan Tuberculosis Control Program (MTCP). Design and Data Collection. The integration of pharmacovigilance in MTCP was conducted in October 2012 with the Global Fund support. We compared the reports notified before and after this integration (period 1: January 2010–October 2012; period 2: October 2012–December 2013). The detection of signals was based on the Information Component available in VigiMine. We used the SPSS version 10.0 and MedCalc version 7.3 for data analysis. Results. The average number of spontaneous reports increased from 3.6 to 37.4 cases/month (). The average age was years; the sex ratio was 0.8. Hepatic reactions (32.7%) predominated during the first period, while skin reactions (24.1%) were in the second period (), and 40.9% of cases in the first period were serious against 15.8% in second period (). Nine signals were generated (hepatic enzyme increase, cholestasis, jaundice, arthralgia, acne, lower limb edema, pruritus, skin rashes, and vomiting). Conclusion. The integration of pharmacovigilance in Moroccan Tuberculosis Control Program improved the management of ADRs and detected new signals of antituberculosis drugs. Driss Soussi Tanani, Amina Tebaa, Raja Benkirane, Kenza Bennani, Ghali Iraqi, Abdelmajid Soulaymani, and Rachida Soulaymani Bencheikh Copyright © 2014 Driss Soussi Tanani et al. All rights reserved. Prevalence of Extensively Drug Resistant Tuberculosis among Archived Multidrug Resistant Tuberculosis Isolates in Zimbabwe Tue, 20 May 2014 08:26:22 +0000 We conducted a cross-sectional study of second line drug resistance patterns and genetic diversity of MDR-TB isolates archived at the BRTI-TB Laboratory, Harare, between January 2007 and December 2011. DSTs were performed for second line antituberculosis drugs. XDR-TB strains were defined as MDR-TB strains with resistance to either kanamycin and ofloxacin or capreomycin and ofloxacin. Strain types were identified by spoligotyping. No resistance to any second line drugs was shown in 73% of the isolates, with 23% resistant to one or two drugs but not meeting the definition of XDR-TB. A total of 26 shared types were identified, and 18 (69%) matched preexisting shared types in the current published spoligotype databases. Of the 11 out of 18 clustered SITs, 4 predominant (>6 isolates per shared type) were identified. The most and least abundant types were SIT 1468 (LAM 11-ZWE) with 12 (18%) isolates and SIT 53 (T1) with 6 (9%) isolates, respectively. XDR-TB strains are rare in Zimbabwe, but the high proportion of “pre-XDR-TB” strains and treatment failure cases is of concern. The genetic diversity of the MDR-TB strains showed no significant association between SITs and drug resistance. Tichaona Sagonda, Lucy Mupfumi, Rumbidzai Manzou, Beauty Makamure, Mqondisi Tshabalala, Lovemore Gwanzura, Peter Mason, and Reggie Mutetwa Copyright © 2014 Tichaona Sagonda et al. All rights reserved. Gender-Related Barriers and Delays in Accessing Tuberculosis Diagnostic and Treatment Services: A Systematic Review of Qualitative Studies Sun, 11 May 2014 12:17:39 +0000 Background. Tuberculosis (TB) remains a significant global public health problem with known gender-related (male versus female) disparities. We reviewed the qualitative evidence (written/spoken narrative) for gender-related differences limiting TB service access from symptom onset to treatment initiation. Methods. Following a systematic process, we searched 12 electronic databases, included qualitative studies that assessed gender differences in accessing TB diagnostic and treatment services, abstracted data, and assessed study validity. Using a modified “inductive coding” system, we synthesized emergent themes within defined barriers and delays limiting access at the individual and provider/system levels and examined gender-related differences. Results. Among 13,448 studies, 28 studies were included. All were conducted in developing countries and assessed individual-level barriers; 11 (39%) assessed provider/system-level barriers, 18 (64%) surveyed persons with suspected or diagnosed TB, and 7 (25%) exclusively surveyed randomly sampled community members or health care workers. Each barrier affected both genders but had gender-variable nature and impact reflecting sociodemographic themes. Women experienced financial and physical dependence, lower general literacy, and household stigma, whereas men faced work-related financial and physical barriers and community-based stigma. Conclusions. In developing countries, barriers limiting access to TB care have context-specific gender-related differences that can inform integrated interventions to optimize TB services. Lakshmi Krishnan, Tokunbo Akande, Anita V. Shankar, Katherine N. McIntire, Celine R. Gounder, Amita Gupta, and Wei-Teng Yang Copyright © 2014 Lakshmi Krishnan et al. All rights reserved. Prognostic Factors in Tuberculosis Related Mortalities in Hospitalized Patients Wed, 07 May 2014 12:14:29 +0000 Setting. The study was undertaken at the Department of Pulmonology at a public, tertiary care centre in Karachi, Pakistan. Objectives. To evaluate factors concerned with in-hospital deaths in patients admitted with pulmonary tuberculosis (TB). Design. A retrospective case-control audit was performed for 120 patients hospitalised with pulmonary TB. Sixty of those discharged after treatment were compared to sixty who did not survive. Radiological findings, clinical indicators, and laboratory values were compared between the two groups to identify factors related to poor prognosis. Results. Factors concerned with in-hospital mortality listed late presentation of disease (), noncompliance to antituberculosis therapy (), smoking (), longer duration of illness prior to treatment (), and low body weight (). Most deaths occurred during the first week of admission () indicating late referrals as significant. Immunocompromised status and multi-drug resistance were not implicated in higher mortality. Conclusions. Poor prognosis was associated with noncompliance to therapy resulting in longer duration of illness, late patient referrals to care centres, and development of complications. Early diagnosis, timely referrals, and monitored compliance may help reduce mortality. Adherence to a more radically effective treatment regimen is required to eliminate TB early during disease onset. Ghazal Haque, Ashok Kumar, Fatima Saifuddin, Shafaq Ismail, Nadeem Rizvi, Shaista Ghazal, and Sadhna Notani Copyright © 2014 Ghazal Haque et al. All rights reserved. Treatment Outcome of Tuberculosis Patients at Enfraz Health Center, Northwest Ethiopia: A Five-Year Retrospective Study Mon, 05 May 2014 11:34:33 +0000 Objectives. The aim of this study was to assess treatment outcome and associated risk factors among TB patients registered for anti-TB treatment at Enfraz health center, northwest Ethiopia. Methods. A five-year retrospective data (2007–2011) of tuberculosis patients () registered for anti-TB treatment at Enfraz health center, northwest Ethiopia, were reviewed. Tuberculosis outcomes were following the WHO guidelines. Data were entered and analyzed using SPSS version 20. Results. Among 417 study participants, 95 (22.8%), 141 (33.8%), and 181 (43.4%) were smear-positive, smear-negative, and extrapulmonary tuberculosis patients, respectively. Of the 417 study participants, 206 (49.4%) were tested for HIV. The TB-HIV coinfection was 24/206 (11.7%). Seventeen study participants (4.2%) were transferred to other health facilities. Among the 400 study participants, 379 (94.8%) had successful treatment outcome (302 treatment completed and 77 cured). The overall death, default, and failure rates were 3.4%, 0.5%, and 1.2%, respectively. There was no significant association between sex, age, residence, type of TB, HIV status, and successful TB treatment outcome. Conclusion. Treatment outcome of patients who attended their anti-TB treatment at Enfraz health center was successful. Therefore, this treatment success rate should be maintained and strengthened to achieve the millennium development goal. Mengistu Endris, Feleke Moges, Yeshambel Belyhun, Eleni Woldehana, Ahmed Esmael, and Chandrashekhar Unakal Copyright © 2014 Mengistu Endris et al. All rights reserved. Barriers and Delays in Tuberculosis Diagnosis and Treatment Services: Does Gender Matter? Mon, 28 Apr 2014 11:35:03 +0000 Background. Tuberculosis (TB) remains a global public health problem with known gender-related disparities. We reviewed the quantitative evidence for gender-related differences in accessing TB services from symptom onset to treatment initiation. Methods. Following a systematic review process, we: searched 12 electronic databases; included quantitative studies assessing gender differences in accessing TB diagnostic and treatment services; abstracted data; and assessed study validity. We defined barriers and delays at the individual and provider/system levels using a conceptual framework of the TB care continuum and examined gender-related differences. Results. Among 13,448 articles, 137 were included: many assessed individual-level barriers (52%) and delays (42%), 76% surveyed persons presenting for care with diagnosed or suspected TB, 24% surveyed community members, and two-thirds were from African and Asian regions. Many studies reported no gender differences. Among studies reporting disparities, women faced greater barriers (financial: 64% versus 36%; physical: 100% versus 0%; stigma: 85% versus 15%; health literacy: 67% versus 33%; and provider-/system-level: 100% versus 0%) and longer delays (presentation to diagnosis: 45% versus 0%) than men. Conclusions. Many studies found no quantitative gender-related differences in barriers and delays limiting access to TB services. When differences were identified, women experienced greater barriers and longer delays than men. Wei-Teng Yang, Celine R. Gounder, Tokunbo Akande, Jan-Walter De Neve, Katherine N. McIntire, Aditya Chandrasekhar, Alan de Lima Pereira, Naveen Gummadi, Santanu Samanta, and Amita Gupta Copyright © 2014 Wei-Teng Yang et al. All rights reserved. Prevalence and Drug Resistance Patterns of Mycobacterium tuberculosis among New Smear Positive Pulmonary Tuberculosis Patients in Eastern Ethiopia Wed, 16 Apr 2014 09:36:46 +0000 The study aimed at determining the prevalence and drug resistance patterns of Mycobacterium tuberculosis among new smear positive pulmonary tuberculosis patients visiting TB diagnosis and treatment facilities at selected health facilities in eastern Ethiopia. A cross-sectional study was conducted between October 2011 and May 2013. A total of 408 new adult pulmonary TB patients (≥ 18 years) were enrolled in this study. Three consecutive sputum samples (spot, morning, and spot) were collected from each patient and transported to the Armauer Hansen Research Institute TB laboratory located in Addis Ababa for culture on Lowenstein Jensen slant media. DST was performed on 357 (87.5%) of the patient samples for isoniazid (H), rifampicin (R), ethambutol (E), and streptomycin (S) using the standard proportion method. The rate of resistance to any one drug was 23%. Any resistance to H, S, R, and E was 14%, 11.5%, 2.8%, and 0.3%, respectively. The highest proportion of monoresistance was observed against H (9.5%). MDRTB was detected in 1.1% of the patients. Any drug resistance was associated with HIV infection (COR = 3.7, 95% CI 1.905–7.222) (P = 0.000). Although the prevalence of MDRTB is relatively low in the study area, high prevalence of H resistance is a serious concern demanding close monitoring. Expanding diagnostic capacity for mycobacterial culture and DST is a vital step in this regard. Berhanu Seyoum, Meaza Demissie, Alemayehu Worku, Shiferaw Bekele, and Abraham Aseffa Copyright © 2014 Berhanu Seyoum et al. All rights reserved. Seasonality of Tuberculosis in Delhi, India: A Time Series Analysis Sun, 23 Mar 2014 12:39:28 +0000 Background. It is highly cost effective to detect a seasonal trend in tuberculosis in order to optimize disease control and intervention. Although seasonal variation of tuberculosis has been reported from different parts of the world, no definite and consistent pattern has been observed. Therefore, the study was designed to find the seasonal variation of tuberculosis in Delhi, India. Methods. Retrospective record based study was undertaken in a Directly Observed Treatment Short course (DOTS) centre located in the south district of Delhi. Six-year data from January 2007 to December 2012 was analyzed. Expert modeler of SPSS ver. 21 software was used to fit the best suitable model for the time series data. Results. Autocorrelation function (ACF) and partial autocorrelation function (PACF) at lag 12 show significant peak suggesting seasonal component of the TB series. Seasonal adjusted factor (SAF) showed peak seasonal variation from March to May. Univariate model by expert modeler in the SPSS showed that Winter’s multiplicative model could best predict the time series data with 69.8% variability. The forecast shows declining trend with seasonality. Conclusion. A seasonal pattern and declining trend with variable amplitudes of fluctuation were observed in the incidence of tuberculosis. Varun Kumar, Abhay Singh, Mrinmoy Adhikary, Shailaja Daral, Anita Khokhar, and Saudan Singh Copyright © 2014 Varun Kumar et al. All rights reserved. Acceptance of Provider Initiated HIV Testing and Counseling among Tuberculosis Patients in East Wollega Administrative Zone, Oromia Regional State, Western Ethiopia Thu, 20 Mar 2014 11:44:36 +0000 Human immunodeficiency virus (HIV) is a powerful risk factor for the development of tuberculosis. This study assessed the acceptance and associated factors that can affect provider initiated HIV testing and counseling (PITC) among tuberculosis patients at the East Wollega administrative zone, Oromia regional state, western Ethiopia, from January to August, 2010. A single population proportion formula is used to calculate the total sample size of 406 and the cluster sampling technique was used to select 13 health centers that provide PITC services. The sample size was proportionally allocated to each health center. The study participants were selected using a simple random sampling technique using the lottery method. Structured questionnaire was used for collection of sociodemographic data. From the total of study subjects, 399 (98.2%) TB patients were initiated for HIV test and 369 (92.5%) patients accepted the initiation. Of those, 353 (95.5%) patients had taken HIV test and received their results. According to the reviewed documents, the prevalence of HIV among tuberculosis (TB) patients in the study area was 137 (33.7%). The logistic regression result showed the PITC was significantly associated with their knowledge about HIV (AOR = 3.22, 95% CI: 1.3–7.97), self-perceived risk (AOR = 2.93, 95% CI: 1.12–7.66), educational status (AOR = 3.51, 95% CI: 1.13–10.91), and knowledge on transmission of HIV/AIDS (AOR = 7.56, 95% CI: 1.14–40.35) which were significantly associated with the acceptance of PITC among TB patients. Therefore, this study’s results showed, the prevalence of HIV among TB patient was high; to enhance the acceptance of PITC among TB patients, health extension workers must provide health education during home-to-home visiting. TB treatment supervisors also provide counseling intensively for all forms of TB patients during their first clinical encounter. Wakjira Kebede, Fikru Keno, Temesgen Ewunetu, and Gutu Mamo Copyright © 2014 Wakjira Kebede et al. All rights reserved. Tuberculin Skin Tests versus Interferon-Gamma Release Assays in Tuberculosis Screening among Immigrant Visa Applicants Thu, 06 Mar 2014 15:58:33 +0000 Objective. Use of tuberculin skin tests (TSTs) and interferon gamma release assays (IGRAs) as part of tuberculosis (TB) screening among immigrants from high TB-burden countries has not been fully evaluated. Methods. Prevalence of Mycobacterium tuberculosis infection (MTBI) based on TST, or the QuantiFERON-TB Gold test (QFT-G), was determined among immigrant applicants in Vietnam bound for the United States (US); factors associated with test results and discordance were assessed; predictive values of TST and QFT-G for identifying chest radiographs (CXRs) consistent with TB were calculated. Results. Of 1,246 immigrant visa applicants studied, 57.9% were TST positive, 28.3% were QFT-G positive, and test agreement was 59.4%. Increasing age was associated with positive TST results, positive QFT-G results, TST-positive but QFT-G-negative discordance, and abnormal CXRs consistent with TB. Positive predictive values of TST and QFT-G for an abnormal CXR were 25.9% and 25.6%, respectively. Conclusion. The estimated prevalence of MTBI among US-bound visa applicants in Vietnam based on TST was twice that based on QFT-G, and 14 times higher than a TST-based estimate of MTBI prevalence reported for the general US population in 2000. QFT-G was not better than TST at predicting abnormal CXRs consistent with TB. Stella O. Chuke, Nguyen Thi Ngoc Yen, Kayla F. Laserson, Nguyen Huu Phuoc, Nguyen An Trinh, Duong Thi Cam Nhung, Vo Thi Chi Mai, An Dang Qui, Hoang Hoa Hai, Le Thien Huong Loan, Warren G. Jones, William C. Whitworth, J. Jina Shah, John A. Painter, Gerald H. Mazurek, and Susan A. Maloney Copyright © 2014 Stella O. Chuke et al. All rights reserved. Performance of Tuberculin Skin Test Measured against Interferon Gamma Release Assay as Reference Standard in Children Mon, 10 Feb 2014 08:23:42 +0000 Objectives. International guidelines differ in the threshold of tuberculin skin test (TST) induration regarded as indicating Mycobacterium (M.) tuberculosis infection. Interferon gamma release assay (IGRA) results were used as reference to assess performance of TST induration thresholds for detection of M. tuberculosis infection in children. Design. Systematic review which included studies containing data on TST, IGRA, and Bacillus Calmette-Guérin (BCG) status in children. Data bases searched were PubMed, EMBASE, and the Cochrane library. Specificities and sensitivities were calculated for TST thresholds 5, 10, and 15 mm and correlated with age and geographical latitude. Results. Eleven studies with 2796 children were included. For BCG immunised children diameters of 5, 10, and 15 mm had median sensitivities of 87, 70, and 75% and specificities of 67, 93, and 90%, respectively. In non-BCG immunised children median sensitivities were 94, 95, and 83% and specificities 91, 95, and 97%. At the 10 mm threshold age correlated negatively with sensitivity of TST (, ) and latitude correlated positively (, ). Conclusions. For the 10 mm threshold the sensitivity of the TST is lower in BCG immunised children. Younger age and higher geographical latitude were associated with higher sensitivity of the TST. Michael Eisenhut and Katy Fidler Copyright © 2014 Michael Eisenhut and Katy Fidler. All rights reserved. Quality of Tuberculosis Care in Private Health Facilities of Addis Ababa, Ethiopia Wed, 29 Jan 2014 00:00:00 +0000 Ensuring provision of good quality tuberculosis (TB) care, especially in private for profit health facilities, is an important component of TB control strategy to reduce poor medical practice which results in multidrug resistant TB (MDR-TB). The aim of this study was to investigate quality of TB care in private health facilities of Addis Ababa. A facility based cross-sectional study was conducted based on Donabedian’s structure-process-outcome model of health care quality. Quality of care was determined by adherence to National TB Program guidelines, treatment success rate, and client satisfaction. Exit interview was conducted on 292 patients on the intensive phase of treatment and 384 patient records were reviewed in eight private health facilities. Initial diagnostic AFB test was done for 95.4% of pulmonary TB patients. Most important components of TB care recommended by national guidelines were delivered for a significant proportion of patients. Majority (75%) of the clients were found to be satisfied with each component of TB care. The treatment success rate was 90.9%. The quality of TB care was fairly good. However, only 77.7% of the patients were counseled for HIV testing. Strengthening HIV counseling and testing, tackling shortage of streptomycin and laboratory reagent at private TB clinic is crucial. Gezahegn Gebrekidan, Gezahegn Tesfaye, Mitiku Teshome Hambisa, and Negussie Deyessa Copyright © 2014 Gezahegn Gebrekidan et al. All rights reserved. Application of Cox Proportional Hazards Model in Case of Tuberculosis Patients in Selected Addis Ababa Health Centres, Ethiopia Sun, 12 Jan 2014 16:54:09 +0000 Introduction. Tuberculosis (TB) is a chronic infectious disease and mainly caused by mycobacterium tuberculosis (MTB). It has been one of the major causes of mortality in Ethiopia. The objective of the study was to identify factors that affect the survival of the patients with tuberculosis who started treatment for tuberculosis. Methods. This was a retrospective study in six randomly selected health centres in Addis Ababa, Ethiopia. The data were obtained from medical records of TB patients registered from September 2012 to August 2013 and treated under directly observed treatment surgery (DOTS) strategy. Kaplan Meier plots, logrank tests, and Wilcoxon tests were used to assess the survival pattern. Cox proportional hazards model for multivariable analysis was discussed. Results. Out of the total 826 registered TB patients, 105 (12.71%) died during the study period and 712 (87.29%) were censored. Based on Kaplan Meier survival curves, logrank test, and Wilcoxon test, it was found that the patients had statistically significant differences in survival experience with respect to age, body weight at initiation of treatment, TB patient category, and HIV status. Multivariable Cox hazards regression analysis revealed that the covariates age, TB patient category, HIV, and age by HIV interaction were significant risk factors associated with death status in TB patients. Conclusion. Deaths of individuals with diseases especially HIV coinfected and nonnew TB cases were high. Therefore, this needs to strengthen the follow-up of patients with TB treatment from the day of anti-TB treatment initiation to completion days. Kabtamu Tolosie and M. K. Sharma Copyright © 2014 Kabtamu Tolosie and M. K. Sharma. All rights reserved. Histopathological Findings in Immunohistological Staining of the Granulomatous Tissue Reaction Associated with Tuberculosis Sun, 05 Jan 2014 10:24:34 +0000 Purpose. The histological diagnosis of Mycobacterium tuberculosis (MTB) remains a diagnostic challenge despite different methods. Immunohistochemistry (IHC) not only could confirm granulomatous tissue involvement but also can demonstrate MTB antigen immunolocalization. This study tries to clarify the details of immunohistochemical staining for MTB with pAbBCG. Materials/Methods. Twenty-three confirmed TB granulomatous tissue samples were studied by Ziehl-Neelsen and immunohistochemistry (IHC) staining with pAbBCG. Samples were selected from the archive of the Department of Pathology, National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran. Results. IHC staining was positive in all samples, whereas Ziehl-Neelsen was positive in 9 cases out of 23 (39.1%). Tissue types used were pleural tissue, lymph nodes, and lung tissue. IHC showed positive coarse granular cytoplasmic and round, fragmented bacillary staining. In this study, epithelioid cells clearly showed more positive staining at the periphery of the granuloma rather than the center of granuloma. There is also positive staining in endothelial cells, fibroblasts, plasma cells, lymphocytes, and macrophages outside the granuloma. Conclusion. Considering the criteria of positive immunohistochemical staining of TB granulomatous reactions, this stain not only highlights the presence of mycobacterial antigens for tissue diagnosis, but also could morphologically localize its distribution in different cells. Shirin Karimi, Masoud Shamaei, Mihan Pourabdollah, Makan Sadr, Mehrdad Karbasi, Arda Kiani, and Moslem Bahadori Copyright © 2014 Shirin Karimi et al. All rights reserved. Nontuberculous Mycobacteria in Guadeloupe, Martinique, and French Guiana from 1994 to 2012 Wed, 18 Dec 2013 10:44:02 +0000 Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms able to cause severe opportunistic human infections. Their distribution patterns are subject to geographical variations. This study describes their isolation frequencies from clinical specimen in the three French overseas departments of the Americas, namely, Guadeloupe, Martinique, and French Guiana during 1994–2012. A total of 651 strains from as many patients (one isolate per species per patient) were analysed regarding regional isolation patterns and potential pattern changes over time. The Mycobacterium avium complex was the most common group of NTM in Guadeloupe and French Guiana. In Martinique it was the second most common after the rapidly growing mycobacteria. M. fortuitum was the most commonly isolated species in all three departments. Some species (M. kansasii, M. xenopi, and M. terrae complex) displayed a clear regional preference. Furthermore a change in isolation frequency was observed for M. intracellulare (increase) and M. kansasii (decrease) in Guadeloupe. In conclusion, marked regional differences in isolation frequencies of NTM species were observed in the study area. Results are discussed in context of variables such as study populations, risk factors, methodology employed, isolation from pulmonary versus sterile isolation sites (blood, urine, and CSF), and in vitro drug-susceptibility patterns. Elisabeth Streit, Julie Millet, and Nalin Rastogi Copyright © 2013 Elisabeth Streit et al. All rights reserved. TextTB: A Mixed Method Pilot Study Evaluating Acceptance, Feasibility, and Exploring Initial Efficacy of a Text Messaging Intervention to Support TB Treatment Adherence Thu, 12 Dec 2013 08:26:06 +0000 Objective. To assess a text messaging intervention to promote tuberculosis (TB) treatment adherence. Methods. A mixed-methods pilot study was conducted within a public pulmonary-specialized hospital in Argentina. Patients newly diagnosed with TB who were 18 or older, and had mobile phone access were recruited and randomized to usual care plus either medication calendar () or text messaging intervention () for the first two months of treatment. Primary outcomes were feasibility and acceptability; secondary outcomes explored initial efficacy. Results. Feasibility was evidenced by high access to mobile phones, familiarity with texting, most phones limited to basic features, a low rate of participant refusal, and many describing suboptimal TB understanding. Acceptability was evidenced by participants indicating feeling cared for, supported, responsible for their treatment, and many self-reporting adherence without a reminder. Participants in the texting group self-reported adherence on average 77% of the days whereas only 53% in calendar group returned diaries. Exploring initial efficacy, microscopy testing was low and treatment outcomes were similar in both groups. Conclusion. The texting intervention was well accepted and feasible with greater reporting of adherence using text messaging than the diary. Further evaluation of the texting intervention is warranted. Sarah Iribarren, Susan Beck, Patricia F. Pearce, Cristina Chirico, Mirta Etchevarria, Daniel Cardinale, and Fernando Rubinstein Copyright © 2013 Sarah Iribarren et al. All rights reserved. Perspectives of Stakeholders on the Sustainability of Tuberculosis Control Programme in Ghana Thu, 28 Nov 2013 16:52:32 +0000 Objectives. To solicit the views of some key stakeholders involved in TB control in Ghana on the sustainability of the current programme and corresponding interventions and to further discuss these views in the context of improving and/or ensuring the sustainability of existing interventions and structures. Methods. The study employed an interpretivist (qualitative) approach in order to obtain the “lived” experiences of personnel who are involved in TB control, either directly or indirectly. Purposive sampling was applied to select 19 respondents who provided data for the study through in-depth interviews (IDIs). The IDI data was analysed inductively in a progressive manner. Thus, respective codes were allowed to emerge from the data as opposed to deductive coding where themes are precoded. Results. The findings reveal two main strands of views about the sustainability of the current TB control programmes: optimism and pessimism. The optimists revealed that the integration of TB into the generalised health system, integration of TB and HIV control services, the use of internally generated funds of health facilities, and a general improvement in socioeconomic conditions of the general population could provide positive pathways to sustainability. The pessimists on the other hand noted that the existing programme was not likely to be sustainable so long as much of the operational funds were derived from external sources. Largely, the views of the pessimists were influenced by their past experiences in TB control. Conclusions. This paper has shown both opportunities and threats to sustainability of TB control in Ghana. The opportunities and threats could be managed positively depending on how policy actors respond to the issues raised. Joshua Amo-Adjei Copyright © 2013 Joshua Amo-Adjei. All rights reserved. Pastoralist Community’s Perception of Tuberculosis: A Quantitative Study from Shinille Area of Ethiopia Wed, 27 Nov 2013 10:31:38 +0000 Background. In Ethiopia the prevalence of all forms of TB is estimated at 261/100 000 population, leading to an annual mortality rate of 64/100 000 population. The incidence rate of smear-positive TB is 108/100 000 population. Objectives. To assess knowledge, attitudes, and practices regarding TB among pastoralists in Shinille district, Somali region, Ethiopia. Method. A community-based cross-sectional study was conducted among 821 pastoralists aged >18 years and above from February to May, 2011 using self-structured questionnaire. Results. Most (92.8%) of the study participants heard about TB, but only 10.1% knew about its causative agent. Weight loss as main symptom, transmittance through respiratory air droplets, and sputum examination for diagnosis were the answers of 34.3%, 29.9%, and 37.9% of pastoralists, respectively. The majority (98.3%) of respondents reported that TB could be cured, of which 93.3% believed with modern drugs. About 41.3% of participants mentioned covering the nose and mouth during sneezing and coughing as a preventive measure. The multivariate logistic regression analysis indicated that household income >300 Ethiopian Birr and Somali ethnicity were associated with high TB knowledge. Regarding health seeking behaviour practice only 48.0% of the respondents preferred to visit government hospital and discuss their problems with doctors/health care providers. Conclusion. This study observed familiarity with gaps and low overall knowledge on TB and revealed negative attitudes like discrimination intentions in the studied pastoral community. Samuel Melaku, Hardeep Rai Sharma, and Getahun Asres Alemie Copyright © 2013 Samuel Melaku et al. All rights reserved. Early Therapeutic Drug Monitoring for Isoniazid and Rifampin among Diabetics with Newly Diagnosed Tuberculosis in Virginia, USA Sun, 17 Nov 2013 09:45:26 +0000 Slow responders to tuberculosis (TB) treatment in Virginia have prolonged treatment duration and consume more programmatic resources. Diabetes is an independent risk factor for slow response and low serum anti-TB drug concentrations. Thus, a statewide initiative of early therapeutic drug monitoring (TDM) for isoniazid and rifampin at 2 weeks after TB treatment was piloted for all diabetics with newly diagnosed TB. During the period of early TDM, 12/01/2011–12/31/2012, 21 diabetics had concentrations performed and 16 (76%) had a value below the expected range for isoniazid, rifampin, or both. Fifteen had follow-up concentrations after dose adjustment and 12 (80%) increased to within the expected range (including all for rifampin). Of 16 diabetic patients with pulmonary TB that had early TDM, 14 (88%) converted their sputum culture to negative in <2 months. Early TDM for diabetics was operationally feasible, may speed response to TB therapy, and can be considered for TB programs with high diabetes prevalence. Scott K. Heysell, Jane L. Moore, Debbie Staley, Denise Dodge, and Eric R. Houpt Copyright © 2013 Scott K. Heysell et al. All rights reserved. Drug Resistance Pattern of MTB Isolates from PTB Patients Thu, 24 Oct 2013 17:06:02 +0000 Background. TB is a global pandemic disease. All TB control programs were not successful due to the emergence of multidrug resistance in M. tuberculosis strains. Objective of the present study was to detect the rate of MDR-MTB in this part of India. Methods. One hundred and thirty clinical MTB strains isolated from patients on treatment and confirmed as MTB by MPT64 antigen detection were tested for drug susceptibility against Streptomycin, INH, Rifampicin, and Ethambutol by MBBact automated system. Result. Thirty-two were MDRs (25.61%). 31.2%, 28%, 17.6%, and 21.6% were resistant to INH, RIF, Ethambutol, and Streptomycin, respectively. Resistance to either INH or Rifampicin was 20.8% and 13.88%, respectively. Combined INH and Rifampicin resistance was seen in 18.05% isolates. Conclusion. Drug resistance rate is high in patients treated previously and who have been irregular on treatment. Rajani Ranganath, Vijay G. S. Kumar, Ravi Ranganath, Gangadhar Goud, and Veerabhadra Javali Copyright © 2013 Rajani Ranganath et al. All rights reserved. Initial Antituberculous Regimen with Better Drug Penetration into Cerebrospinal Fluid Reduces Mortality in HIV Infected Patients with Tuberculous Meningitis: Data from an HIV Observational Cohort Study Mon, 12 Aug 2013 11:39:11 +0000 Tuberculous meningitis (TM) is the deadliest form of tuberculosis. Nearly two-thirds of HIV infected patients with TM die, and most deaths occur within one month. Current treatment of TM involves the use of drugs with poor penetration into the cerebro-spinal fluid (CSF). In this study, we present the mortality before and after implementing a new antituberculous regimen (ATR) with a higher drug penetration in CSF than the standard ATR during the initial treatment of TM in an HIV cohort study. The new ATR included levofloxacin, ethionamide, pyrazinamide, and a double dose of rifampicin and isoniazid and was given for a median of 7 days (interquartile range 6–9). The new ATR was associated with an absolute 21.5% (95% confidence interval (CI), 7.3–35.7) reduction in mortality at 12 months. In multivariable analysis, independent factors associated with mortality were the use of the standard ATR versus the new ATR (hazard ratio 2.05; 95% CI, 1.2–3.5), not being on antiretroviral therapy, low CD4 lymphocyte counts, and low serum albumin levels. Our findings suggest that an intensified initial ATR, which likely results in higher concentrations of active drugs in CSF, has a beneficial effect on the survival of HIV-related TM. Gerardo Alvarez-Uria, Manoranjan Midde, Raghavakalyan Pakam, and Praveen Kumar Naik Copyright © 2013 Gerardo Alvarez-Uria et al. All rights reserved. Mycobacterial Etiology of Pulmonary Tuberculosis and Association with HIV Infection and Multidrug Resistance in Northern Nigeria Tue, 16 Jul 2013 12:44:04 +0000 Objective. Data on pulmonary tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB) complex in Nigeria are limited. We investigated species of MTB complex in TB cases from northern Nigeria. Methods. New TB suspects were enrolled, screened for HIV and their sputum samples were cultured after routine microscopy. Genotypes MTBC and MTBDRplus were used to characterize the MTB complex species and their resistance to isoniazid and rifampicin. Results. Of the 1,603 patients enrolled, 375 (23%) had MTB complex infection: 354 (94.4%) had Mycobacterium tuberculosis; 20 (5.3%) had Mycobacterium africanum; and one had Mycobacterium bovis (0.3%). Cases were more likely to be male (AOR = 1.87, 95% CI : 1.42–2.46; ), young (AOR = 2.03, 95% CI : 1.56–2.65; ) and have HIV (AOR = 1.43, 95% CI : 1.06–1.92; ). In 23 patients (6.1%), the mycobacterium was resistant to at least one drug, and these cases were more likely to have HIV and prior TB treatment (AOR = 3.62, 95% CI : 1.51–8.84; ; AOR : 4.43; 95% CI : 1.71–11.45 resp.), compared to cases without any resistance. Conclusion. Mycobacterium tuberculosis remained the predominant specie in TB in this setting followed by Mycobacterium africanum while Mycobacterium bovis was rare. The association of TB drug resistance with HIV has implications for TB treatment. Gambo Aliyu, Samer S. El-Kamary, Alash'le Abimiku, Nicholas Ezati, Iwakun Mosunmola, Laura Hungerford, Clayton Brown, Kathleen J. Tracy, Joshua Obasanya, and William Blattner Copyright © 2013 Gambo Aliyu et al. All rights reserved. Immunisation with BCG in the Maringue District, Sofala Province, Mozambique Tue, 30 Apr 2013 10:43:41 +0000 Objectives. We evaluated immunisation with Bacille Calmette-Guérin (BCG) among newborns in 2011 in the Maringue District, Sofala Province, Mozambique, which includes seven health units. The study was motivated by the fact that in official reports, immunisation coverage was unreliable (more than 100%). Methods. The office of maternal-child health of the central Maringué-Sede health unit provided the number of live newborns in 2011 at the maternal clinics of the seven health units and an estimate of the number of home deliveries. From vaccination registers, we abstracted records of BCG vaccinations administered in the period 01/01/2011–30/06/2012 to children born in 2011. Results. The number of live newborns was 3,353. Overall, the number of BCG vaccinations administered was 2,893, with a coverage of 86.3%. Conclusion. In this study, we could only calculate an approximate coverage estimate, because of unavailability of adequate individual information. Recording practices should be changed in order to allow use of individual information and linkage across different information sources and thus a more precise vaccination coverage assessment. Dario Consonni, Marina Margarida Montenegro Agorostos Karagianis, and Giuseppe Bufardeci Copyright © 2013 Dario Consonni et al. All rights reserved. Psychiatric Morbidity and Other Factors Affecting Treatment Adherence in Pulmonary Tuberculosis Patients Mon, 15 Apr 2013 13:47:13 +0000 As the overall prevalence of TB remains high among certain population groups, there is growing awareness of psychiatric comorbidity, especially depression and its role in the outcome of the disease. The paper attempts a holistic approach to the effects of psychiatric comorbidity to the natural history of tuberculosis. In order to investigate factors associated with medication nonadherence among patients suffering from tuberculosis, with emphasis on psychopathology as a major barrier to treatment adherence, we performed a systematic review of the literature on epidemiological data and past medical reviews from an historical perspective, followed by theoretical considerations upon the relationship between psychiatric disorders and tuberculosis. Studies reporting high prevalence rates of psychiatric comorbidity, especially depression, as well as specific psychological reactions and disease perceptions and reviews indicating psychiatric complications as adverse effects of anti-TB medication were included. In sum, data concerning factors affecting medication nonadherence among TB patients suggested that better management of comorbid conditions, especially depression, could improve the adherence rates, serving as a framework for the effective control of tuberculosis, but further studies are necessary to identify the optimal way to address such issues among these patients. Argiro Pachi, Dionisios Bratis, Georgios Moussas, and Athanasios Tselebis Copyright © 2013 Argiro Pachi et al. All rights reserved. Evaluation of MGIT 960 System for the Second-Line Drugs Susceptibility Testing of Mycobacterium tuberculosis Thu, 28 Mar 2013 15:24:20 +0000 Many laboratories validate DST of the second-line drugs by BACTEC MGIT 960 system. The objective of this study is to evaluate the critical concentration and perform DST for the 2nd line drugs. We evaluated 193 clinical strains of M. tuberculosis isolated from patients in South Korea. Testing the critical concentration of six second-line drugs was performed by MGIT 960 and compared with L-J proportion method. The critical concentration was determined to establish the most one that gave the difference between drug resistance and susceptibility in MGIT960 system. Good agreement of the following concentrations was found: Concordance was 95% for 0.5 μg/mL of moxifloxacin; 93.6%, 1.0 μg/mL of levofloxacin; 97.5%, 2.5 μg/mL of kanamycin; 90.6%, 2.5 μg/mL of capreomycin; 86.2%, 5.0 μg/mL of ethionamide; and 90.8%, 2.0 μg/mL of -aminosalicylic acid. The critical concentrations of the four drugs, moxifloxacin, levofloxacin, kanamycin, and capreomycin, were concordant and reliable for testing 2nd line drug resistance. Further study of ethionamide and ρ-aminosalicylic acid is required. Hyejin Kim, Minji Seo, Young Kil Park, Jae-Il Yoo, Yeong Seon Lee, Gyung Tae Chung, and Sungweon Ryoo Copyright © 2013 Hyejin Kim et al. All rights reserved. Cytokine Polymorphisms, Their Influence and Levels in Brazilian Patients with Pulmonary Tuberculosis during Antituberculosis Treatment Sun, 24 Mar 2013 18:08:53 +0000 Cytokines play an essential role during active tuberculosis disease and cytokine genes have been described in association with altered cytokine levels. Therefore, the aim of this study was to verify if IFNG, IL12B, TNF, IL17A, IL10, and TGFB1 gene polymorphisms influence the immune response of Brazilian patients with pulmonary tuberculosis (PTB) at different time points of antituberculosis treatment (T1, T2, and T3). Our results showed the following associations: IFNG +874 T allele and IFNG +2109 A allele with higher IFN-γ levels; IL12B +1188 C allele with higher IL-12 levels; TNF −308 A allele with higher TNF-α plasma levels in controls and mRNA levels in PTB patients at T1; IL17A A allele at rs7747909 with higher IL-17 levels; IL10 −819 T allele with higher IL-10 levels; and TGFB1 +29 CC genotype higher TGF-β plasma levels in PTB patients at T2. The present study suggests that IFNG +874T/A, IFNG +2109A/G, IL12B +1188A/C, IL10 −819C/T, and TGFB1 +21C/T are associated with differential cytokine levels in pulmonary tuberculosis patients and may play a role in the initiation and maintenance of acquired cellular immunity to tuberculosis and in the outcome of the active disease while on antituberculosis treatment. Eliana Peresi, Larissa Ragozo Cardoso Oliveira, Weber Laurentino da Silva, Érika Alessandra Pellison Nunes da Costa, João Pessoa Araujo Jr., Jairo Aparecido Ayres, Maria Rita Parise Fortes, Edward A. Graviss, Ana Carla Pereira, and Sueli Aparecida Calvi Copyright © 2013 Eliana Peresi et al. All rights reserved. Design of Thymidine Analogues Targeting Thymidilate Kinase of Mycobacterium tuberculosis Sun, 24 Mar 2013 13:18:42 +0000 We design here new nanomolar antituberculotics, inhibitors of Mycobacterium tuberculosis thymidine monophosphate kinase (TMPKmt), by means of structure-based molecular design. 3D models of TMPKmt-inhibitor complexes have been prepared from the crystal structure of TMPKmt cocrystallized with the natural substrate deoxythymidine monophosphate (dTMP) (1GSI) for a training set of 15 thymidine analogues (TMDs) with known activity to prepare a QSAR model of interaction establishing a correlation between the free energy of complexation and the biological activity. Subsequent validation of the predictability of the model has been performed with a 3D QSAR pharmacophore generation. The structural information derived from the model served to design new subnanomolar thymidine analogues. From molecular modeling investigations, the agreement between free energy of complexation () and values explains 94% of the TMPKmt inhibition () by variation of the computed and 92% for the pharmacophore (PH4) model (). The analysis of contributions from active site residues suggested substitution at the 5-position of pyrimidine ring and various groups at the 5′-position of the ribose. The best inhibitor reached a predicted of 0.155 nM. The computational approach through the combined use of molecular modeling and PH4 pharmacophore is helpful in targeted drug design, providing valuable information for the synthesis and prediction of activity of novel antituberculotic agents. Luc Calvin Owono Owono, Melalie Keita, Eugene Megnassan, Vladimir Frecer, and Stanislav Miertus Copyright © 2013 Luc Calvin Owono Owono et al. All rights reserved. Active Case Finding of Pulmonary Tuberculosis through Screening of Respiratory Symptomatics Using Sputum Microscopy: Is It Time to Change the Paradigm? Thu, 28 Feb 2013 09:50:22 +0000 Background. One of the main strategies for the early detection of pulmonary tuberculosis (PTB) is through the screening of individuals with symptoms compatible with PTB. Although this is programmatic strategy for active case finding, its yield is not well known. Objective. To determine the yield of pulmonary tuberculosis active case finding through the screening of respiratory symptomatic (RS) patients at a general hospital. Methods. RS patients were defined as subjects complaining of cough and/or sputum for a period of 2 or more weeks. Outpatients and their companions were approached while they waited in the outpatient care areas of the hospital to detect RS. Two samples from different days or 2 samples taken 2 hours apart on the same day were collected. Results. 122 RS patients were identified. Fifty-seven patients (46.7%) had at least one sputum sample analyzed. Three patients presented a positive smear and 2 were culture positive; neither had upper airway symptoms. None of the patients with productive cough and upper airway symptoms had a positive smear (). Only 19 (33.3%) returned to the laboratory to retrieve their results. Conclusion. Current strategy to screen RS patients based only on clinical data has a low compliance. Specific strategies to increase compliance (removal of barriers, incentives, etc.) should be implemented. Eva Carolina del Portillo-Mustieles and Rafael Laniado-Laborín Copyright © 2013 Eva Carolina del Portillo-Mustieles and Rafael Laniado-Laborín. All rights reserved. The Effect of Low CD4+ Lymphocyte Count on the Radiographic Patterns of HIV Patients with Pulmonary Tuberculosis among Nigerians Wed, 30 Jan 2013 11:31:07 +0000 Objective. To assess the radiographic features in patients with Human Immunodeficiency Virus (HIV) complicated by pulmonary tuberculosis (PTB), and the association with CD4 lymphocyte count and sputum smear. Method. A prospective study was carried out on 89 HIV positive patients with PTB. The demographics, smoking history, sputum smear result, chest radiographic findings and CD4 lymphocyte count were documented. Results. Out of the 89 patients recruited in the study, 41 were males and 48 were females. Eighteen (18) patients had typical radiographic features, 60 patients had atypical radiographic features while only 11 of them had normal radiographic films. Sixty eight (68) patients had CD4 count <200 cells/mm3, 19 patients had CD4 count between 200–499 cells/mm3, while only 2 patients had CD4 count from 500 cells/mm3 upwards. The association between low CD4 count and radiographic finding was statistically significant, ( value ). Sixty (60) patients had negative sputum smear for Acid and Alcohol Fast Bacilli (AAFB), while the remaining 29 patients had positive smear. The association between low CD4 count and negative smear was statistically significant ( value ). Conclusion. The radiographic pattern and the result of the sputum smear for AAFB has a significant relationship and association with the immune status of patients with Human Immunodeficiency Virus (HIV) complicated by pulmonary tuberculosis. Christopher Affusim, Vivien Abah, Emeka B. Kesieme, Kester Anyanwu, Taofik A. T. Salami, and Reuben Eifediyi Copyright © 2013 Christopher Affusim et al. All rights reserved.