Tuberculosis Diagnosis And Treatment Pdf
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- Pulmonary Tuberculosis
- Diagnosis and treatment of tuberculosis: latest developments and future priorities
- All you need to know about tuberculosis (TB)
- Pulmonary Tuberculosis
Despite recent advances in diagnostics and treatment options, tuberculosis TB remains a substantial global health challenge. Worldwide, in , there were
Mayara A. Cardoso, Pedro Emmanuel A. Tuberculosis treatment has undergone recent changes in Brazil. To assess whether favorable outcomes on tuberculosis therapy improved in recent years. HIV infection without antiretroviral therapy [OR 0. Predictors of default, that is, use of noninjecting drugs [OR 3.
Tuberculosis diagnosis based on sputum smear [OR 7. Mortality and default were low considering the prevalence of HIV infection; however cure was not significantly increased. Tuberculosis TB is still a challenge in developing countries. Brazil is one of the 22 countries with the highest number of TB cases and the 16th in the world in absolute number of cases [ 1 ]. In , 67, new cases were diagnosed and 4, subjects died of TB in Brazil.
Between and , the Brazilian Ministry of Health recommended a standard first-line TB treatment with rifampicin, isoniazid, and pyrazinamide in the intensive phase [ 3 ]. The first change was the inclusion of the 4th drug ethambutol in the intensive phase of therapy.
This change was justified by an increase in rifampicin and isoniazid primary resistance detected during the preliminary analysis of the 2nd Brazilian resistance survey. TB treatment with FDC pills was already recommended by World Health Organization WHO at that time, since there were evidences of a similar efficacy, sputum conversion, cure, and relapse rates, with operational and logistic advantages. Brazilian updates were implemented recently and studies regarding the impact of such strategies in therapeutic outcomes are scarce, do not address all the outcomes, were done with few HIV-TB patients, or were conducted with secondary data [ 6 ].
The aim of this study was to estimate TB treatment outcomes cure, treatment default, treatment failure, and death and to identify factors associated with each of them in a cohort of TB patients followed between and The exclusion criteria included the following: a death within the first 15 days of treatment, b treatment default during the first 30 days after treatment initiation, c change of TB diagnosis during treatment, d transfer to other health unit, or e unknown treatment outcome.
This is a retrospective observational study, based on secondary data of a prospective ongoing cohort study conducted at the same site.
Positive culture for M. A negative sputum culture or two negative sputum smears after 5 months of treatment indicated that TB was cured. In the absence of expectoration, cure was defined as clinical and radiological improvement when the patient finished therapy.
In cases of extrapulmonary or pleuropulmonary TB with initially negative smears, cure was defined as treatment completion with clinical, radiological, and other laboratory tests improvement. Relapse or recurrence of disease means patients who were considered cured or had completed treatment but returned to the health service with a positive sputum smear. Effective treatment is the regimen used for the longest period during TB treatment, with or without rifampicin.
Only patients who had to suspend TB therapy because of adverse reactions grade 3 or 4 were considered in the analysis.
The Clinical Research Laboratory on Mycobacteria maintains an open cohort of patients for TB diagnosis and treatment since There is a well-defined health care protocol including structured interviews and systematic collection of demographic, socioeconomic, clinical, and laboratory data as well as therapeutic outcomes of all patients during the visits, which are recorded in a data capture software.
Visits take place at 0, 15, 30, 60, 90, , , and days after the initiation of TB treatment. Patients who needed a longer treatment had visits after days scheduled monthly up to one year. The same schedule was done for patients using rifamycins or not. Analysis was done with R-project software.
Data were described as fractions, medians, and interquartile range if not Gaussian or means and standard deviation if Gaussian. Logistic regression was fit for each one of the outcomes of interest cure, treatment default, and treatment failure. Variables selection was performed by backward removal from the full model, with the Akaike Information Criterion AIC less than 0.
Performance measures such as Brier score, area under the Receiver Operating Characteristic Curve ROC , and 2 were estimated to allow goodness of fit interpretations. Three hundred and five subjects were screened, but 26 were excluded, staying patients in the study Figure 1. The mean age standard deviation was The predominant clinical form of TB was pulmonary and most of the participants attended secondary school Table 1.
Most of TB cases were confirmed by culture Table 2. Table 4 shows that a a low education level, b use of noninjecting drugs, and c treatment interrupted by adverse reactions increased the chance of treatment default and that d older age and e female sex reduced this chance.
Patients with a TB confirmed only by smear or b systemic hypertension had an increased chance of treatment failure Table 5. Three patients died and all of them were HIV positive. It was not possible to explore potential death predictors due to the very low number of deaths. A higher number of patients treated with HAART and TB regimens including rifamycins could explain this favorable outcome in the study period.
BFP has two main objectives: transferring incomes to poor families and improving access to education and health care. This programme was associated with a reduction in TB incidence rate [ 10 ] and improved TB cure rate in Brazil [ 11 ]. Therefore, this cash transfer programme could have contributed to a mortality decrease observed in the present study.
We found a higher chance of treatment failure when TB diagnosis was based only on the smear results. This exam does not allow mycobacteria identification and drug sensitivity test performance which could result in misdiagnosis and makes treatment adequacy for microbiological resistance impossible. This will probably increase the number of accurate TB diagnoses , which could decrease mortality associated with the disease.
TB diagnosis only by a positive smear was associated with another unfavorable outcome, a decreased chance of cure. These patients could have a disease caused by other non-TB mycobacteria or resistant MTB, thus leading to an inadequate treatment. Noninjectable drug users and patients with adverse reactions also had a lower chance of TB cure, probably because of a high default rate. Lifestyle is a very important issue in the modern world and drug use is a choice made by some patients.
Recently, illicit crack cigarettes commercialization started in Brazilian states. As it is not very expensive and a highly addictive drug, it became widespread throughout the biggest cities. In our study, noninjectable drug users were associated with therapy default. However, it was classified as a group, without the information of what type of drug was used. In a previous period, when crack was less available in Brazil, noninjectable drug users were not associated with treatment default.
Male gender and younger age were also predictors of low adherence. This was also found in a study of factors influencing TB treatment default conducted in Africa [ 13 ].
Therefore, efforts should be concentrated in men and young patients to achieve a better treatment adherence since default is the worst problem when the aim is to achieve TB cure.
Evidence regarding the impact of FDC on treatment failure is scarce. However, a meta-analysis pointed out that FDC is not superior compared to individualized TB drugs administration to prevent treatment failure or disease relapse [ 14 ]. Another study published after this meta-analysis also suggested that FDC regimen may have performed slightly less well than separated drugs [ 15 ].
Additionally, FDC adopts lower dosages of drugs when compared to individualized formulations recommended by previous Brazilian guidelines [ 4 ]. It is possible that FDC and failure are not directly related, since the motivation for FDC adoption in Brazil was the inclusion of a 4th drug ethambutol to optimize TB treatment because MTB rifampicin primary resistance had raised.
Another explanation already pointed out that the meta-analysis could be a reduced bioavailability of FDC pills when compared to individualized TB drugs. In our study, a few patients failed TB treatment and most of them had TB diagnosis based only on smear results no culture available.
These could represent cases of non-TB mycobacteria diseases or MTB resistant to one or more drugs used. Those cases could have been diagnosed by rapid tests which are able to identify MTB and to give rifampicin resistance result allowing a more effective TB therapy.
Systemic hypertension was another factor associated with treatment failure and it is not explained by the condition itself. Nevertheless, this is the first study to our knowledge that reports systemic hypertension as a risk factor for failure.
Further studies have to be done to better understand this result. Mortality was too low to explore potential predictors of death; however, death decrease is an important information to be considered along with recent studies performed in Rio de Janeiro that also reported lower TB mortality.
Another important point that should be considered is that INI is a peculiar health care unit, with several particular characteristics which are not representative of the whole Brazilian Health System in terms of HIV prevalence, diagnostic resources, standard protocols, and data collection.
Mortality and treatment default improved in recent years but this was not associated with an increased cure rate. Failure is still significant and associated with no MTB identification and systemic hypertension, which should be confirmed in further studies. Females, older subjects, and nondrug users are expected to have better outcomes, as patients with TB are diagnosed by culture and without hypertension.
Actions directed to improve treatment default have to be addressed including programs to noninjectable drug young men users. Hypertension programs could investigate possible drug interactions in patients treating for both diseases to find possible causes of TB treatment failure in hypertensive patients.
Main Contributions of the Study. Higher failure risk was observed in patients who had systemic hypertension and those with TB diagnosis based only on acid fast smear without culture results , which could represent Mycobacterium tuberculosis misdiagnosis or a microbiological resistance not detected. This result shows how it is important to have a TB diagnosis confirmation with sensitivity test done. Crack recently entered in Brazil and became a new challenge. New approaches and innovative actions are being done; however, drug addiction is difficult to treat, is predisposed to TB treatment default, and allows Mycobacterium tuberculosis propagation.
Cardoso et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Journal overview. Special Issues. Cardoso, 1 Pedro Emmanuel A. Academic Editor: Isabel Portugal. Received 11 Aug Revised 25 Nov Accepted 07 Dec Published 28 Dec Abstract Tuberculosis treatment has undergone recent changes in Brazil.
Introduction Tuberculosis TB is still a challenge in developing countries.
Diagnosis and treatment of tuberculosis: latest developments and future priorities
Tuberculosis TB is an infectious disease that usually affects the lungs, though it can affect any organ in the body. It can develop when bacteria spread through droplets in the air. TB can be fatal, but in many cases, it is preventable and treatable. Following improvements in living conditions and the development of antibiotics , the prevalence of TB fell dramatically in industrialized countries. However, in the s , numbers started to rise again.
All you need to know about tuberculosis (TB)
Explore the latest in tuberculosis, including recent advances in screening, prevention, diagnosis, treatment, and global control. A woman in her 50s presented with an edematous, massively enlarged right auricle; histopathologic evaluation revealed noncaseating granulomatous dermatitis. What is your diagnosis?
Tuberculosis TB is an infectious disease that usually affects the lungs, though it can affect any organ in the body. It can develop when bacteria spread through droplets in the air. TB can be fatal, but in many cases, it is preventable and treatable.
Mayara A. Cardoso, Pedro Emmanuel A. Tuberculosis treatment has undergone recent changes in Brazil.
BioMed Research International
Tuberculosis is spread from one person to the next through the air when people who have active TB in their lungs cough, spit, speak, or sneeze. As of one quarter of the world's population is thought to have latent infection with TB. Tuberculosis may infect any part of the body, but most commonly occurs in the lungs known as pulmonary tuberculosis. General signs and symptoms include fever, chills , night sweats, loss of appetite , weight loss, and fatigue. The upper lung lobes are more frequently affected by tuberculosis than the lower ones. A potentially more serious, widespread form of TB is called "disseminated tuberculosis", it is also known as miliary tuberculosis.
The bacterium Mycobacterium tuberculosis causes tuberculosis TB , a contagious, airborne infection that destroys body tissue. Pulmonary TB occurs when M. However, it can spread from there to other organs. Pulmonary TB is curable with an early diagnosis and antibiotic treatment. Pulmonary TB, also known as consumption, spread widely as an epidemic during the 18th and 19th centuries in North America and Europe. After the discovery of antibiotics like streptomycin and especially isoniazid, along with improved living standards, doctors were better able to treat and control the spread of TB.
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