Validation of a questionnaire to screen chronic obstructive respiratory diseases
Tran HT, Nguyen CT, Nguyen HT, Godin I and Michel O
BACKGROUNDSpirometry is the gold standard for diagnosing chronic obstructive respiratory diseases (CORD), but it is not widely available in primary healthcare in Vietnam. We aimed to validate a simple CORD Screening Questionnaire (CORD-SQ) for the Vietnamese population to screen subjects requiring spirometry.METHODSIn a cross-sectional study, 589 volunteers seen in a primary healthcare unit were submitted to the CORD-SQ. This questionnaire included four items (cumulative smoking, history of tuberculosis, current breathlessness and wheezing or whistling) with a total score ranging from 0 to 6. The cut-off point of the CORD-SQ was previously determined as a predictor of CORD, which was last defined by spirometry (forced expiratory volume in 1 second/forced vital capacity < lower limit of normal) measured in each subject.RESULTSThe prevalence of CORD was 10% among the 517 subjects with non-asthmatic history. With a cut-off point of 2 for the CORD-SQ, the sensitivity and specificity were 69% and 91%, respectively, with a 46% positive predictive value and 94% negative predictive value. The area under the receiver operating characteristic curve of the CORD-SQ to discriminate the CORD was 0.83 (95% CI 0.75-0.90).CONCLUSIONIn the non-asthmatic Vietnamese primary health care population, the simple CORD-SQ efficiently identifies the people at risk of CORD, requiring spirometry..
Adaptation and validation of perceived HIV and TB stigma scales among persons with TB
Ponticiello MN, Nanziri LM, Hennein R, Ochom E, Gupta AJ, Turimumahoro P, White MA, Armstrong-Hough M, Katamba A and Davis JL
BACKGROUNDStigma is a barrier to care for people affected by TB and HIV in Uganda, where these conditions remain endemic. While scales have been adapted and validated to measure stigma among TB-affected households in Uganda, there is a need for scales that measure the experiences of persons with TB (PWTB).METHODSWe adapted the Van Rie 12-item individual perspectives TB scale and 10-item individual perspectives HIV scale for use in Uganda through cross-cultural discussions with a multidisciplinary research team and four cognitive interviews with community health workers and PWTB. We then conducted a cross-sectional study administering each scale to 125 PWTB. We performed exploratory factor analysis, evaluated internal validity, and assessed convergent validity with perceived social support.RESULTSExploratory factor analysis yielded a one-factor solution for both scales, with marginal model fit (standardised root mean square residual = 0.09 for TB, = 0.07 for HIV). There was evidence of convergent validity through a positive correlation of the TB ( = 0.22, = 0.01) and HIV stigma ( = 0.22, = 0.01) scales with perceived social support. Both scales had good internal validity (Cronbach's α = 0.86 for TB, = 0.87 for HIV).CONCLUSIONAdapted scales to measure perceived HIV and TB stigma among PWTB in Uganda demonstrated promising psychometric properties by removing one and two items, respectively..
Urine metabolite-determined isoniazid adherence under programmatic conditions in people living with HIV
Nabity SA, Moffitt AD, Mponda K, Melgar M, Zimba SB, Surie D, Marshall RE, Nyirenda R, Girma B, Mekonnen TF, Maida A, Auld AF, Gunde LJ, Muula AS, Gutreuter S and Oeltmann JE
BACKGROUNDChemotherapy to prevent TB is a core component of care for persons living with HIV (PLHIV). There are few reports describing adherence to TB prevention under programmatic conditions in high TB burden settings.METHODSWe measured adherence to daily isoniazid (INH) preventive treatment (IPT) using a commercially available colourimetric assay to detect urine INH metabolites among PLHIV who self-reported INH ingestion within the preceding 24 h. Enrollee characteristics associated with non-adherence despite self-reported INH ingestion were identified in multivariate log-binomial regression. Interoperator reliability for the detection of INH metabolites was calculated among three independent operators.RESULTSSelf-reported INH ingestion and metabolite data were known for 300 PLHIV. INH metabolite was detected in 112 (68.7%) of 163 PLHIV who self-reported INH ingestion in the preceding 24 h. The prevalence of alcohol consumption was significantly higher among INH-non-adherent PLHIV compared with INH-adherent PLHIV (adjusted prevalence ratio 2.43, 95% CI 1.16-5.12). Two-way interoperator reliability ranged from κ 0.86 to κ 0.94.CONCLUSIONSCompared with self-reported 24-h INH ingestion in a high TB-HIV-incidence programmatic setting, biometric adherence to IPT was suboptimal in this sample of PLHIV. Alcohol consumption was the only potentially modifiable risk factor significantly associated with INH non-adherence. Colourimetric interpretation reliability across three operators was moderate/strong..
Supplementary inspired oxygen fraction is a simple clinical tool that predicts clinical deterioration
Crooks CJ, West J, Morling JR, Simmonds M, Juurlink I, Briggs S, Hammond-Pears S, Shaw D, Card TR and Fogarty AW
Clinical and imaging characteristics associated with hospitalisation for post-TB lung disease
Li X, Shi Z, Huang T, Zhou Y, Zou L, Tang S and Wu G
Contribution of post-infectious bronchiolitis obliterans to non-cystic fibrosis bronchiectasis in children
Gie A, Le Roux C, van der Zalm MM, Jacobs C, Parker N, Eber E and Goussard P
BACKGROUNDPost-infectious bronchiolitis obliterans (PIBO) is a complication of severe childhood respiratory infection resulting in small airway injury, bronchiectasis, and prolonged respiratory consequences. Risk factors for PIBO and PIBO-associated bronchiectasis are unclear.METHODSThis retrospective study identified all children with PIBO at a South African tertiary hospital between 1 January 2016 and 31 December 2022. The clinical characteristics, chest CT findings, and details of prior hospitalisation for respiratory infection were collected, and the characteristics of those with and without bronchiectasis were compared.RESULTSA total of 59 children were included (median age at primary lung insult: 10 months, IQR 6-17; median age at PIBO diagnosis: 16 months, IQR 11-28). Twenty-three had comorbidities, most frequently premature birth (30.5%) and HIV infection (6.8%). The most common pathogen was adenovirus ( = 41; 69.5%). At initial lung insult, 19 (32.2%) required mechanical ventilation. Mosaic attenuation on the chest CT was present in all. Thirty-three (55.9%) had bronchiectasis. The clinical characteristics, ventilation, causative pathogen, and comorbidity were similar in those with and without bronchiectasis.CONCLUSIONBronchiectasis occurs frequently in paediatric PIBO and is present within months of initial respiratory insult with no identified risk factors. Premature birth is common and may contribute to PIBO development..
Glutathione and -acetylcysteine in TB management
Nasiri MJ, Khoshdel N and Venketaraman V
BACKGROUNDTB remains a major global health challenge. Glutathione (GSH) and -acetylcysteine (NAC) have been proposed as adjunctive therapies with potential clinical and immunomodulatory benefits. This systematic review aims to evaluate the efficacy, safety, and immunomodulatory effects of GSH and NAC as adjunctive therapies in TB management.METHODSPubMed/MEDLINE, Embase, and Cochrane CENTRAL were searched until October 15, 2024. We included studies assessing the efficacy of GSH and NAC in TB management, focusing on clinical outcomes such as lung function recovery, sputum conversion, hepatoprotection, and immune response modulation. The quality of the studies was assessed using the Cochrane Risk of Bias tool.RESULTSEight controlled trials were included. GSH and NAC significantly improved lung function accelerated sputum conversion, and provided hepatoprotective effects. GSH, particularly in its liposomal form, enhanced immune responses by modulating cytokine levels and reducing oxidative stress. Most adverse effects reported were mild and manageable, indicating a favourable safety profile for both agents.CONCLUSIONSGSH and NAC show promise as adjunctive therapies in TB management, demonstrating improvements in lung function, sputum conversion, and hepatoprotection while also enhancing immune responses..
Stagnation in the decline of TB in Japan: introduction of the pre-entry TB screening programme
Ukai T, Lee S, Thu KS, Sugiura K and Ohkado A
Geographic information systems analysis to focus TB screening among people born in endemic countries
Zavala S, Kiritsy MC, Cox GM, Ahmed A, Stout JE and Turner NA
BACKGROUNDGeographic information systems may help focus TB screening and treatment efforts to populations in greatest need, such as people born in endemic countries (PBEC).DESIGN/METHODSNorth Carolina USA census and TB surveillance data were used to examine the relationship between the population proportion of PBEC and incident TB cases in the subsequent 5-year period by census tract. Census tract population:incident TB ratios for thresholds of PBEC were used to measure screening efficiency.RESULTSOf 3,290 PBEC TB cases, 2,764 (84%) had a mappable address. The proportion of census tract PBEC during 2006-2010 was strongly associated with incident TB in that tract in 2011-2015 ( < 0.001). Thresholds of 6%, 12%, and 19% PBEC in a tract during 2006-2010 as cutoffs for screening would have detected 75%, 50%, and 25% of incident TB cases in 2011-2015 with respective population:incident TB ratios of 11,840, 6,864, and 5,524 population/case. The same thresholds using 2011-2015 census data would have detected 75%, 50%, and 25% of incident TB cases during 2016-2018 with population:incident TB ratios of 17,804, 10,807, and 7,031 population/case.CONCLUSIONCensus tract demographics are a simple and powerful tool to focus targeted testing and treatment of latent TB in areas likely to have incident TB disease..
Drug susceptibility testing for TB using the Xpert MTB/XDR assay on stool specimens
Khumalo W, Maphalala N, Mulengwa D, Ziyane M, Sibandze DB, Niemann S, Dreyer V, Seeger A, Madison M, Ness T, Jele T, Garcia-Basteiro AL, Maphalala G, DiNardo AR, Mandalakas AM and Kay A
Effect of community awareness, screening, diagnosis, and treatment campaigns on TB care in Uganda
Mulebeke R, Chemutai C, Mubangizi I, Balina M, Obwalatum JE, Senyimba C and Izudi J
SETTINGEight districts in central Uganda with 105 health facilities.OBJECTIVETo evaluate the effectiveness of the community awareness, screening, testing, diagnosis, and treatment (CAST-TB) campaigns on the number of people screened for, presumed to have, and diagnosed with TB disease.DESIGNWe designed a quasi-experimental study and utilised Bayesian Structural Time-Series analysis for counterfactual predictions over 24 months (12 months before vs 12 months during intervention). The intervention was the CAST-TB campaigns. The outcomes included the number of people screened for, presumed to have, and diagnosed with TB disease.RESULTSThe intervention led to a 36% (95% credible interval [CrI] 8.4-65, = 0.005) increase in the number of people screened for TB disease (1,194,257 observed vs 875,211 predicted), a 29% (95% CrI 5.3-52, = 0.01) increase in the number of people presumed to have TB disease (25,784 observed vs 19,997 predicted), and a 49% (95% CrI 25-75) increase in the number of people diagnosed with TB disease (2,566 observed vs 1,719 counterfactual).CONCLUSIONCAST-TB campaigns improved the number of people screened for, presumed to have, and diagnosed with TB disease in central Uganda, supporting scale-up efforts nationally and across sub-Saharan Africa where such indicators are suboptimal..
Population pharmacokinetics and dose evaluation for second-line TB drugs in patients with diabetes
Cao J, Shao G, Zhong H, Davies Forsman L, Wang S, Dong S, Li X, Ning Z, Cao H and Hu Y
BACKGROUNDTo evaluate currently recommended dosage using the population pharmacokinetics (PK) of bedaquiline (BDQ), clofazimine, cycloserine, linezolid (LZD) and moxifloxacin (MFX) in patients with multidrug-resistant TB (MDR-TB) and type II diabetes mellitus (DM).METHODSA prospective multi-centre PK study was conducted in China between 2016 and 2019. Population PK models were developed using nonlinear mixed-effect analyses based on the blood samples collected by rich sampling. The probability of target attainment (PTA) analysis was estimated using the Monte Carlo simulation.RESULTSA total of 1,450 plasma samples were collected from 58 participants with DM. Simulations showed that the WHO-recommended regimens of LZD (600 mg daily) and MFX (400 mg daily) achieved > 90% PTA for isolates with MICs below 0.50 and 0.25 mg/L, respectively. The currently recommended BDQ regimen (400 mg daily for 2 weeks, followed by 200 mg thrice weekly) might fail to achieve >90% PTA at an MIC of 0.06 mg/L or higher.CONCLUSIONThe population PK models for the five second-line drugs were established in Chinese patients with MDR-TB and DM. The model-based dosage evaluation showed that dosing adjustments may be necessary for isolates with borderline resistance levels..
Reply to Authors: addressing concerns to ensure effective TB preventive therapy
Borse R, Randive B, Mattoo S, Malik P, Solanki H, Gupta A, Chaisson RE, Mave V and Suryavanshi N
Mobility patterns, activity locations, and TB in Nairobi, Kenya
Tram KH, Ong'ang'o J, Kiplimo R, Hawn TR, Nduba V, Horne DJ and Ross JM
BACKGROUNDAnnually, over 3 million people develop TB but are not diagnosed and treated. We aimed to characterize the mobility patterns and activity locations of people with TB in an urban, high-burden setting to inform future active case-finding (ACF) efforts.METHODSWe conducted a population-based TB prevalence survey in Nairobi, Kenya, in 2022. Participants aged ≥15 years with TB symptoms or a suggestive chest X-ray submitted sputum for Xpert Ultra and culture. We collected data on individual activity locations and mobility and evaluated their association with the risk of pulmonary TB.RESULTSThe prevalence survey enrolled 6,369 participants across nine clusters. There were significant differences in mobility patterns and activity locations between sexes and age groups. Mobility factors were not significantly associated with TB. In the adjusted analysis, age group 45-54 (OR 2.45), male sex (OR 2.95), and use of a social activity location (OR 1.96) were significantly associated with a higher risk of TB.CONCLUSIONSWe did not find a significant association between mobility patterns and TB, but there was a positive association between reported 'social' activity locations and TB. Identification of 'social' activity locations, particularly bars, provides important insight into possible venues for spatially-targeted ACF activities..
TB as a risk factor for severe COVID-19 mortality
Borges IC, Lino FM, Luna-Muschi A, Litvoc MN, Lopes MIBF, Higashino HR, da Costa ÁF, Pereira RHM, Nakaya HI, de Araújo JDA, Orlandi GM, Rújula MJP, Carvalhanas TRMP, Nielsen L, Minto CM, Sabino EC, Costa SF and Ranzani O
Expanding TB infection screening and treatment to eliminate TB
Riccardi N, Matucci T and Sotgiu G
Successful rechallenge of rifabutin in rifampicin-induced thrombocytopenia during TB treatment
Nelson RR, Louw VJ, Curtis B and Peter J
Asthma and allergies in schoolchildren: data from the European SINPHONIE study
Sarno G, Maio S, Stanisci I, Angino A, Tagliaferro S, Silvi P, Baldacci S, Sestini P, Pandics T, Hadjipanayis A, Csobod E, Annesi-Maesano I, Täubel M, Gabriel M, Oliveira Fernandez E, Rudnai P and Viegi G
BACKGROUNDAsthma and allergies are the most frequent chronic diseases among children. We have assessed the prevalence of asthma and allergies in European schoolchildren who participated in the SINPHONIE (Schools Indoor Pollution and Health-Observatory Network in Europe) project, accounting for geographical differences.METHODSWe analysed questionnaires from parents and guardians of 4,899 schoolchildren aged 6-14 from 54 cities in 23 European countries in 2011-2012. Logistic regression models were used to estimate adjusted prevalence rates of symptoms/diseases and associations among symptoms/diseases and geographical clusters (Northern Europe [NE] as reference).RESULTSHigher odd ratios (ORs) were found for eczema in Western Europe (WE) (OR 1.4) and Central-Eastern Europe (CEE) (OR 1.4); and dry cough at night in WE (OR 1.6), CEE (OR 1.7) and Southern Europe (SE) (OR 2.6). Lower ORs were observed for eczema in SE (OR 0.8), allergic rhinitis in WE (OR 0.6), cat/dog hypersensitivity/allergy in WE (OR 0.4), CEE (OR 0.6) and SE (OR 0.5); pollen hypersensitivity/allergy in WE (OR 0.6); asthma in CEE (OR 0.7); any drug for asthma in WE (OR 0.6), CEE (OR 0.7) and SE (OR 0.7); wheezing/whistling in WE (OR 0.6); cough on most days in WE (OR 0.5) and SE (OR 0.6); phlegm on most days in WE (OR 0.5); sneezing/runny/blocked nose in WE (OR 0.8).CONCLUSIONSThe frequency of asthma/allergies in European children varies widely geographically. This variability should be considered for preventive purposes..
Cross-sectional versus longitudinal estimates of annual risk of TB infection
Jolliffe DA, Middelkoop K, Ganmaa D, Dowdy DW and Martineau AR
Epidemiology, detection, diagnosis and treatment of TB in children in Kazakhstan
Prikhodchenko O, Arbuzova Y, Serikbayeva K, Zhakhina G, Rakisheva A, Mussabekova G, Akhmedullin R, Tursynbayeva A, Gaipov A, Adenov M and Ismailov S
BACKGROUNDTB remains a significant global health challenge, particularly for children, who are often more susceptible to severe disease and complications.METHODSThis study provides a comprehensive analysis of TB epidemiology and treatment outcomes in people under 18 years of age in Kazakhstan between 2018 and 2023, utilising a nationwide database that covers the entire country, with a focus on drug-susceptible (DS-TB) and drug-resistant TB (DR-TB) cases.RESULTSDuring the study period, 3,317 pediatric TB cases were registered, with 76% being DS-TB and a significant proportion being girls and adolescents over 15 years of age. Our findings show a declining trend in TB notification and prevalence from 2018 to 2020, followed by a plateau in subsequent years. According to the data, young children under 5 years of age had the lowest TB caseload. Logistic regression analysis revealed that adolescents of 15-17 years of age had higher odds of unsuccessful treatment, while DR-TB patients had better outcomes than DS-TB patients.CONCLUSIONThe study highlights the need for targeted interventions, improved diagnostic capabilities, and continuous public health efforts to address the burden of TB in children, especially in high-risk regions..
Use of different genotyping methods to estimate TB transmission in the United States, 2020-2021
Schildknecht KR, Cowen LS, Posey JE, Talarico S, Haddad MB, Wortham JM and Kammerer JS
