Korea National Tuberculosis Association

The evaluation of health-related quality of life (HRQOL) is gaining importance among patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). We assessed whether the BACES score reflects HRQOL and associated factors in these patients. Data were collected from the nationwide NTM-KOREA prospective cohort of patients with NTM-PD who started antibiotic treatment and included symptoms, Quality of Life-Bronchiectasis (QOL-B) questionnaire, nutritional status using the Mini Nutritional Assessment-Short Form (MNA-SF) and Prognostic Nutritional Index (PNI), physical activity, body composition, spirometry, handgrip strength, and 6-min walking distance. Multivariate linear and logistic regressions were used for analysis. As the BACES score increased, so did the odds (adjusted odds ratio [95% confidence interval]) of cough (1.24 [1.04-1.48]), dyspnea (1.69 [1.28-2.27]), weight loss (1.78 [1.36-2.36]), and malnutrition, defined as MNA-SF score ≤ 7 (1.71 [1.21-2.45]), and PNI < 45 (2.14 [1.66-2.81]). The QOL-B respiratory symptom score (estimate: -2.259, P = 0.002) and 6-min walking distance (estimate: -18.015, P < 0.001) were negatively associated with the BACES score. Moreover, the odds of adipopenia (1.08 [1.03-1.13]), possible sarcopenia (1.80 [1.35-2.45]), and sarcopenia (2.09 [1.48-3.03]) increased in women. The BACES score can estimate HRQOL and associated conditions at antimicrobial treatment initiation in patients with NTM-PD.

Abstract Rationale: Health-related quality of life (HRQOL) is gaining importance among patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). We investigated whether the BACES score reflects HRQOL and associated factors in patients with NTM-PD. Methods: We used data from the nationwide NTM-KOREA prospective cohort of patients with NTM-PD who started antibiotic treatment. HRQOL and associated factors were measured, including symptoms, Quality of Life-Bronchiectasis (QOL-B) questionnaire, nutritional status using the Mini Nutritional Assessment-Short Form (MNA-SF) and prognostic nutritional index (PNI), physical activity, body composition, spirometry, handgrip strength, and 6-min walking distance. Associations between the BACES score and HRQOL and associated factors at enrollment were investigated in multivariate linear and logistic regression analyses. Results: We included 409 patients (median, 64 years; men, 27.6%). As the BACES score increased, the odds (adjusted odds ratio [95% confidence interval]) of cough (1.24 [1.04-1.48]), dyspnea (1.69 [1.28-2.27]), weight loss (1.78 [1.36-2.36]), malnutrition defined as MNA-SF score ≤ 7 (1.71 [1.21-2.45]), and PNI &amp;lt; 45 (2.14 [1.66-2.81]) also increased. The QOL-B respiratory symptom score (estimate −2.259, P=0.002) and 6-min walking distance (estimate −18.015, P&amp;lt;0.001) were negatively associated with the BACES score. Moreover, the odds of adipopenia (1.08 [1.03-1.13]), possible sarcopenia (2.15 [1.35-3.59]), and sarcopenia (2.37 [1.33-4.55]) increased in women, while adipopenia (1.15, [1.05-1.26] was associated with the BACES score in men. Conclusions: The BACES score can serve as a proxy for HRQOL and associated conditions at antimicrobial treatment initiation in patients with NTM-PD.

PurposeThe strategy of latent tuberculosis infection (LTBI) treatment in household tuberculosis (TB) contacts has been expanding in South Korea. However, there is little evidence of the cost-effectiveness of LTBI treatment in patients over 35 years of age. This study aimed to evaluate the cost-effectiveness of LTBI treatment among household TB contacts in different age groups in South Korea.Materials and MethodsAn age-structured model of TB was developed based on the reports from the Korea Disease Control and Prevention Agency and the National Health Insurance Service. Quality-adjusted life-years (QALY) and the averted number of TB-related deaths were estimated along with discounted costs for a measure of incremental cost-effectiveness ratios.ResultsThe number of cumulative active TB cases would decrease by 1564 and 7450 under the scenario of LTBI treatment for those aged <35 years and <70 years, respectively, relative to the no-treatment scenario. The treatment strategies for patients aged 0 to <35 years, <55 years, <65 years, and <70 years would add 397, 1482, 3782, and 8491 QALYs at a cost of $660, $5930, $4560, and $2530, respectively, per QALY. For the averted TB-related deaths, LTBI treatment targeting those aged 0 to <35 years, <55 years, <65 years, and <70 years would avert 7, 89, 155, and 186 deaths at a cost of $35900, $99200, $111100, and $115700 per deaths, respectively, in 20 years.ConclusionThe age-specific expansion policy of LTBI treatment not only for those under 35 years of age but also for those under 65 years of age among household contacts was cost-effective in terms of QALYs and averted TB deaths.

ObjectivesThis study aimed to identify the prevalence of diabetes mellitus (DM) among patients with tuberculosis (TB) using a nationwide cohort in South Korea.DesignA retrospective cohort study.SettingThis study used the Korean Tuberculosis and Post-Tuberculosis cohort, which was constructed by linking the Korean National Tuberculosis Surveillance, National Health Information Database (NHID) and Statistics Korea data for the causes of death.ParticipantsDuring the study period, all notified patients with TB with at least one claim in the NHID were included. Exclusion criteria were age less than 20 years, drug resistance, initiation of TB treatment before the study period and missing values in covariates.Outcome measuresDM was defined as having at least two claims of the International Classification of Diseases (ICD) code for DM or at least one claim of the ICD code for DM and prescription of any antidiabetic drugs. Newly diagnosed DM (nDM) and previously diagnosed DM (pDM) were defined as DM diagnosed after and before TB diagnosis, respectively.ResultsA total of 26.8% (70 119) of patients were diagnosed with DM. The age-standardised prevalence increased as age increased or income decreased. Patients with DM were more likely to be men, older, had the lowest income group, had more acid-fast bacilli smear and culture positivity, had a higher Charlson Comorbidity Index score and had more comorbidities compared with patients without DM. Approximately 12.5% (8823) patients had nDM and 87.4% (61 296) had pDM among those with TB-DM.ConclusionsThe prevalence of DM among patients with TB was considerably high in Korea. To achieve the goal of TB control and improve the health outcomes of both TB and DM, integrated screening of TB and DM and care delivery in clinical practice are necessary.

Four months of rifampin treatment for latent tuberculosis infection is safer, has superior treatment completion rates, and is as effective as 9 months of isoniazid. However, daily medication costs are higher for a 4-month rifampin regimen than a 9-month isoniazid regimen. To compare health care use and associated costs of 4 months of rifampin and 9 months of isoniazid. Health system cost comparison using all health care activities recorded during 2 randomized clinical trials. (ClinicalTrials.gov: NCT00931736 and NCT00170209). High-income countries (Australia, Canada, Saudi Arabia, and South Korea), middle-income countries (Brazil and Indonesia), and African countries (Benin, Ghana, and Guinea). Adults and children with clinical or epidemiologic factors associated with increased risk for developing tuberculosis that warranted treatment for latent tuberculosis infection. Health system costs per participant. A total of 6012 adults and 829 children were included. In both adults and children, greater health system use and higher costs were observed with 9 months of isoniazid than with 4 months of rifampin. In adults, the ratios of costs of 4 months of rifampin versus 9 months of isoniazid were 0.76 (95% CI, 0.70 to 0.82) in high-income countries, 0.90 (CI, 0.85 to 0.96) in middle-income countries, and 0.80 (CI, 0.78 to 0.81) in African countries. Similar findings were observed in the pediatric population. Costs may have been overestimated because the trial protocol required a minimum number of follow-up visits, although fewer than recommended by many authoritative guidelines. A 4-month rifampin regimen was safer and less expensive than 9 months of isoniazid in all settings. This regimen could be adopted by tuberculosis programs in many countries as first-line therapy for latent tuberculosis infection. Canadian Institutes of Health Research.

To present results of the first national anti-tuberculosis (TB) drug resistance survey conducted in Lao PDR between May 2016 and August 2017 to determine the prevalence of resistance to first-line anti-TB drugs among new and previously treated pulmonary TB cases in the country. Patients with sputum smear-positive pulmonary TB were enrolled from 42 TB laboratories distributed in 40 clusters throughout the country. Survey sites were selected using probability-proportional-to-size sampling among all diagnostic centres in the country. In addition to smear microscopy, all patients underwent Xpert MTB/RIF testing and those found positive to Mycobacterium tuberculosis underwent sputum culture and drug susceptibility testing using the proportion method on solid Löwenstein-Jensen medium. Among 1006 eligible patients, 946 sputum smear-positive and Xpert MTB/RIF positive (Mycobacterium tuberculosis detected) patients were included in the survey, comprising 897 new and 49 previously treated TB cases. The prevalence of rifampicin-resistant TB was 1.2% (95% CI: 0.5-2.0%, n=11/897) among new cases and 4.1% (95% CI: 0-9.6%, n=2/49) among previously treated cases. Among the 946 TB cases confirmed by Xpert MTB/RIF, phenotypic drug sensitivity testing was available for 820 (776 new and 44 previously treated). The prevalence of multidrug-resistant TB (MDR-TB) was 0.5% (95% CI: 0-1.0%, n=4/776) among new cases and 2.3% (95% CI: 0-6.7%, n=1/44) among previously treated cases. No resistance to second-line injectable agents nor to fluoroquinolones was detected among MDR-TB patients. The first national anti-TB drug resistance survey in Lao PDR demonstrated an encouragingly low prevalence of MDR-TB. The results appear lower than previous WHO estimates, and in line with the routine surveillance based on Xpert MTB/RIF testing (conducted among 50% of presumptive TB patients in 2017). The country should continue to expand its Xpert MTB/RIF network and strive to achieve universal drug susceptibility testing.

BackgroundGlobally, case detection of tuberculosis (TB) has stabilized in recent years. Active case finding (ACF) has regained an increased attention as a complementary strategy to fill the case detection gap. In the Philippines, the DetecTB project implemented an innovative ACF strategy that offered a one-stop diagnostic service with a mobile unit equipped with enhanced diagnostic tools including chest X-ray (CXR) and Xpert®MTB/RIF (Xpert). The project targeted the rural poor, the urban poor, prison inmates, indigenous population and high school students.MethodsThis is a retrospective review of TB screening data from 25,103 individuals. A descriptive analysis was carried out to compare screening and treatment outcomes across target populations. Univariate and multivariate analyses were performed to identify predictors of TB for each population. The composition of bacteriologically-confirmed cases by smear and symptom status was further investigated.ResultsThe highest yield with lowest number needed to screen (NNS) was found in prison (6.2%, NNS: 16), followed by indigenous population (2.9%, NNS: 34), the rural poor (2.2%, NNS: 45), the urban poor (2.1%, NNS: 48), and high school (0.2%, NNS: 495). The treatment success rate for all populations was high with 89.5% in rifampicin-susceptible patients and 83.3% in rifampicin-resistant patients. A relatively higher loss to follow-up rate was observed in indigenous population (7.5%) and the rural poor (6.4%). Only cough more than two weeks showed a significant association with TB diagnosis in all target populations (Adjusted Odds Ratio ranging from 1.71 to 6.73) while other symptoms and demographic factors varied in their strength of association. The urban poor had the highest proportion of smear-positive patients with cough more than two weeks (72.0%). The proportion of smear-negative (Xpert-positive) patients without cough more than two weeks was the highest in indigenous population (39.3%), followed by prison inmates (27.7%), and the rural poor (22.8%).ConclusionsThe innovative ACF strategy using mobile unit yielded a substantial number of TB patients and achieved successful treatment outcomes. TB screening in prison, indigenous population, and urban and rural poor communities was found to be effective. The combined use of CXR and Xpert largely contributed to increased case detection.

The incidence of drug-resistant tuberculosis (DR-TB) in pediatric populations is a critical indicator of national TB management and treatment strategies. Limited data exist regarding the rate of pediatric DR-TB. In this study, we aimed to analyze the status of DR-TB in Korean children from 2007 to 2013. We analyzed specimens submitted to the Korean Institute of Tuberculosis using Mycobacterium tuberculosis culture and drug susceptibility tests (DSTs) from January 2007 through December 2013. Specimens from patients ≤ 19 years of age were included. Among the 2,690 cases, 297 cases were excluded because of insufficient data, leaving 2,393 cases for the final analysis. In total, resistance to one or more TB drugs was 13.5%. The resistance rates of each of the drugs were as follows: isoniazid (INH) 10.2%, rifampin (RFP) 5.1%, ethambutol (EMB) 3.7%, and pyrazinamide (PZA) 3.1%. The resistance rate of multidrug-resistant TB (MDR-TB) was 4.2%, and that of extensively drug-resistant TB (XDR-TB) was 0.8%. The overall drug resistance rate demonstrated significant increase throughout the study period (P < 0.001) but showed no significant difference compared to previous study from 1999 to 2007. The drug resistance rate of PZA in ≤ 15 years of age group was significantly greater than that of > 15 years (P < 0.001). The drug resistance rate has increased throughout the study period.

Tuberculosis (TB) is one of the major global health threats especially in developing countries. Although newly diagnosed TB patients can be recovered with high cure rate, many curable TB patients in the developing countries are obliged to die because of delayed diagnosis, partly by the lack of radiography and radiologists. Therefore, developing a computer-aided diagnosis (CAD) system for TB screening can contribute to early diagnosis of TB, which results in prevention of deaths from TB. Currently, most CAD algorithms adopt carefully designed morphological features distinguishing different lesion types to improve screening performances. However, such engineered features cannot be guaranteed to be the best descriptors for TB screening. Deep learning has become a majority in machine learning society. Especially in computer vision fields, it has been verified that deep convolutional neural networks (CNN) is a very promising algorithm for various visual tasks. Since deep CNN enables end-to-end training from feature extraction to classification, it does not require objective-specific manual feature engineering. In this work, we designed CAD system based on deep CNN for automatic TB screening. Based on large-scale chest X-rays (CXRs), we achieved viable TB screening performance of 0.96, 0.93 and 0.88 in terms of AUC for three real field datasets, respectively, by exploiting the effect of transfer learning.