Hematological Changes in Newly Diagnosed Pulmonary Tuberculosis: A Cross-Sectional Study

Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a global health challenge with significant morbidity and mortality rates. This cross-sectional study aimed to compare the nutritional status between pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis (EPTB) patients. A total of 75 newly diagnosed PTB cases and 73 EPTB cases were included. The mean age was 46.92 for PTB patients and 48.75 for EPTB patients, with a notable male predominance in both groups. Lifestyle habits revealed higher rates of alcohol consumption and smoking among PTB patients. Diabetes was a prevalent co-morbidity in both groups, with a higher impact on PTB patients. Tubercular pleural effusion was the most common type of EPTB observed. Clinical examinations showed signs of malnutrition more frequently in PTB patients. Objective measures such as BMI, mid-upper arm circumference (MUAC), hemoglobin, and serum albumin indicated higher rates of malnutrition in PTB patients compared to EPTB patients. Specifically, 75% of PTB patients were malnourished based on BMI, whereas only 35% of EPTB patients fell into this category. Severe anemia and hypoalbuminemia were also more prevalent in PTB patients compared to EPTB patients. These findings underscore the importance of considering nutritional status in the management of TB, with implications for tailored interventions based on disease presentation.    

Shortening tuberculosis (TB) treatment duration is a research priority. We tested the efficacy and safety of 3- and 4-month regimens containing moxifloxacin in a randomised clinical trial in pulmonary TB (PTB) patients in South India. New, sputum-positive, adult, HIV-negative, non-diabetic PTB patients were randomised to 3- or 4-month moxifloxacin regimens [moxifloxacin (M), isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E)] or to a control regimen (2H3 R3 Z3 E3 /4R3 H3 ) [C]. The 4 test regimens were 3R7 H7 Z7 E7 M7 [M3], 2R7 H7 Z7 E7 M7 /2R7 H7 M7 [M4], 2R7 H7 Z7 E7 M7 /2R3 H3 M3 [M4-I] or 2R7 H7 Z7 E7 M7 /2R3 H3 E3 M3 [M4-IE]. Treatment was directly observed. Clinical and bacteriological assessments were done monthly during treatment and for 24months post-treatment. The primary end point was TB recurrence post-treatment. Of 1371 patients, randomised, modified intention-to-treat (ITT) analysis was done in 1329 and per-protocol (PP) analysis in 1223 patients. Regimen M3 was terminated due to high TB recurrence rates. 'Favourable' response at end of treatment was 96-100% in the moxifloxacin regimensand 93% in the control regimen. Among these, the TB recurrence occurred in 4.1% in the M4 regimen and in 4.5% in the control regimen and demonstrated equivalence within a 5% margin (95% CI -3.68, 4.55). Similar findings were observed in modified ITT analysis. The TB recurrence rates in the M4-I and M4-IE regimens did not show equivalence with the control regimen. Sixteen (1.4%) of 1087 patients in the moxifloxacin regimens required treatment modification. The 4-month daily moxifloxacin regimen [M4] was found to be equivalent and as safe as the 6-month thrice-weekly control regimen.

Objectives:This study was planned to define the clinical profile of pulmonary tuberculosis (PTB) patients having renal amyloidosis, to identify the factors responsible for development of amyloidosis, to detect the time period between onset of amyloidosis and PTB, and analyze clinical features of amyloidosis in PTB patients for early diagnosis and timely assessment.Materials and Methods:Patients of PTB having pedal edema, proteinuria, and grossly diseased kidneys on ultrasound abdomen were subjected to renal biopsy and appropriate biochemical investigations. Clinical profile of biopsy proven amyloidosis cases was analyzed.Results:There were 43 patients (32 males, 11 females, age range 20–65 years) having PTB with pedal edema, proteinuria, and renal medical disease on abdominal ultrasound where amyloidosis was confirmed by renal biopsy. The total duration of illness ranged from two months to seven years (mean 2.25 years) and was less than five years in 93% patients. All patients had significant proteinuria. Nephrotic syndrome was seen in 23, hypertension in 19, hypoalbuminemia in 33, hypercholesterolemia in 29, and deranged renal functions in 32 patients. Ninety percent patients had moderate to far advanced pulmonary lesions on chest radiography with smear positivity in 21 patients.Conclusions:Renal amyloidosis is an important complication of PTB and should be suspected clinically in patients presenting with a triad of pedal edema, proteinuria, and medical renal disease on ultrasound. Contrary to general belief, renal amyloidosis may occur in PTB patients having disease for relatively shorter duration, and even if adequately treated.

This study surveys the extent and severity of haematological and biochemical abnormalities which occurred in 265 patients with pulmonary tuberculosis, and records the haematological changes that occur with treatment. Anaemia was present in 60 per cent of patients, more frequently in males than in females. Leucocytosis with neutrophilia occurred in 40 per cent, lymphopenia in 17 per cent and monocytopenia in 50 per cent. Platelet count and erythrocyte sedimentation rate were elevated in 52 and 80 per cent respectively. Bone marrow aspiration and trephine biopsy were of limited diagnostic value. Ferritin and vitamin B12 levels were increased in 94 and 57 per cent of subjects respectively whilst serum and red cell folic acid were within normal limits in 83 per cent. The frequency of the important biochemical changes were hyponatraemia (43 per cent) and hypoalbuminaemia (72 per cent); alkaline phosphatase, aspartic transaminase and lactic dehydrogenase levels were elevated in approximately a third of patients possibly due to unsuspected dissemination. There was a close correlation between the acid-fast bacilli in sputum and abnormal values, particularly those of body weight, haemoglobin, platelet count, white cell count and erythrocyte sedimentation rate. Failure of these indices to return to normal was invariably associated with persistent excretion of acid-fast bacilli. We have shown that haematological and biochemical abnormalities in pulmonary tuberculosis are common and may be valuable aids to diagnosis. Some haematological markers also reflect response to treatment.

BackgroundTuberculosis (TB) remains a major global health problem. The childhood tuberculosis has some unique features different which makes the diagnosis more complicated. Here we described the epidemiologic, clinical and microbiologic features of children with extra pulmonary and pulmonary TB.MethodsThe data of the patients <14 years with active TB were collected and compared in pulmonary (PTB) and extrapulmonary TB (EXPTB) patients.ResultsA total of 128 cases was included. Forty-two cases occurred in children were < 5 years of age; 41 cases between 6–10 years and 45 cases > 10 years. PTB was present in 75,0% of the cases, and EXPTB was present in 25% of cases. There was no significant difference between the EXPTB and PTB by means of distribution of age groups (p=0,201). The rate of patients free of constitutional symptoms were significantly higher in EXPTB compared to PTB(p=0,000). There was no significant difference between EXPTB and PTB by means of sources detection(p=0,069).ConclusionTB is still a major public health problem. EXPTB has an insidious and silent onset without any constitutional symptoms, and both microbiological confirmation and the source by an adult are not frequently found. Moreover, detection of the adult source is mandatory for controlling the TB disease in children

Sir,India has been experiencing the most serious publichealth challenge caused by HIV epidemic since its first detection in 1986 (1). The country has an estimated 4.58 million HIV-infected individuals (2). Prevalence data on HIV infection collected from various parts of the country indicate its spread from urban to rural areas and from high risk to general population (3). Because of continued HIV transmission in the community for the last many years, the country is witnessing several opportunistic infections associated with HIV infection, of which tuberculosis (TB) is the most prominent.Early detection and effective treatment with regular follow-up until complete recovery is the most important strategy to control the spread of tuberculosis in the community. India needs special attention to control TB as the country harbours a large number of TB patients and many of whom are associated with HIV infection. The effects of HIV on TB include: (a) More transmission of TB bacteria in the community, (b) TB progresses faster in HIV-infected people, and (c) TB in HIV-positive people is more likely to be fatal if diagnosed late or left untreated (4).Unfortunately, the HIV status of a sizable number of tuberculosis patients detected by the local physicians remains unknown due to the shortage of HIV testing facilities. The present study, conducted at the National Institute of Cholera and Enteric Diseases (ICMR), Kolkata, India, was aimed at finding a positive predictive factor in tuberculosis patients, particularly in resource-poor settings, so that underlying HIV could be detected to a great extent using minimum diagnostic resources.Data of routine investigations of 34 pulmonary tuberculosis patients associated with HIV infection, diagnosed during July-December 2003, were reviewed. The routine investigations included total count (TC), differential count (DC), haemoglobin (Hb), erythrocyte sedimentation rate (ESR), and mode of diagnosis. The data were compared with data from a similar group of pulmonary tuberculosis patients (n=25), who were detected during the same time but not associated with HIV infection.There was not much difference in basic investigations between these two groups, except in ESR values. Most tuberculosis patients with HIV infection had a much lower ESR value compared to the control group. The mean and median values of ESR, respectively, were 38.5 mm per hour and 30.0 mm per hour among patients with HIV infection (n=34) compared to 102 mm per hour and 108 mm per hour among those without HIV infection (n=25).Table 1 shows the relationship between TB with or without HIV infection and ESR status, and Table 2 shows the age distribution of TB subjects of both the groups. …

Risk factors for false-negative T-SPOT.TB assay results in patients with pulmonary and extra-pulmonary TB

BACKGROUND AND OBJECTIVES:There are few reports of cutaneous tuberculosis with immunosuppressed states such as HIV, use of immunosuppressants or malignancy. Diagnosis is thus difficult and despite scientific advances such as polymerase chain reaction, it is frequently missed. Although rare, given its worldwide prevalence and the rising incidence of HIV, it is important for clinicians to recognize the variants and promptly treat the patient.DESIGN AND SETTING:Retrospective study of all cases of cutaneous tuberculosis diagnosed from October 2007 to November 2009 at an outpatient clinic of a tertiary-care hospital in northern India.METHODS:We collected information on the clinical form of disease, histopathology and HIV concurrence rates and looked for differences in presentation between mmunocompetent and immunocompromised states. We also looked for differences and HIV concurrence between immunocompetent and immunocomprised patients. Diagnosis was based on clinical, histopathological and microbiological tests for tuberculosis and a test for HIV.RESULTS:The overall incidence of cutaneous tuberculosis was 0.7% (131 of 18720 outpatients). HIV concurrence was 9.1% (12 cases) of all cutaneous tuberculosis cases. Most common variants seen were scrofuloderma (36.5%), lupus vulgaris (31%), tuberculosis verruca cutis (12.9%), lichen scrofulosorum (11.4%), papulonecrotic tuberculids (3.8%), erythema nodosum (2.2%) and erythema induratum of Bazin (1.5%).CONCLUSIONS:Cutaneous tuberculosis rates were slightly higher in our study than in other studies from India. HIV co-infection rates were similar to those in other studies. Many atypical morphological forms and presentations were observed in HIV co-infected patients. Due to the varied clinical presentations, physician awareness and a high index of suspicion are necessary to diagnose cutaneous forms of tuberculosis.

Introductiondespite major strides in the prevention, diagnosis and management of tuberculosis, the disease continues to be one of the most pressing global health problems, particularly in developing countries. The purpose of the present study was to describe the epidemiological profile among tuberculosis patients in Laayoune, Morocco.Methodsa retrospective study was conducted among tuberculosis patients (having extrapulmonary tuberculosis and pulmonary tuberculosis), registered in the diagnosis of tuberculosis and respiratory diseases reference center of Laayoune, between January 2017 and May 2018. Demographic characteristics, clinical presentation of TB and apparent risk factors of the disease were obtained from the medical case records of all patients.Resultsduring the study period, a total of 211 patients (125 males and 86 females) with tuberculosis were enrolled. The majority of cases (93.40%) were newly diagnosed and the segment with the pulmonary tuberculosis was 63.50%. The highest disease burden was found in the ≥15 year age group (92.40%; p=0.022). Men were more frequently affected by pulmonary tuberculosis (70.90%), while extrapulmonary tuberculosis was more commonly detected in women (61%) (p<0.0001). The most common sites of extrapulmonary disease were lymphatic (32.47%), pleural (16.88%) and spinal tuberculosis (15.58%). HIV infection and smoking seem to be the most important risk factors that affect host defense against TB infection.Conclusionthe results obtained in tuberculosis patients in Laayoune, Morocco, showed that active tuberculosis was associated with risk factors such as sex, age and smoking.

Objective: It was the aim of this study to evaluate the demographic factors and clinical features of extrapulmonary tuberculosis (EPTB) compared to those of pulmonary tuberculosis (PTB) among adult immunocompetent patients. Subjects and Methods: A total of 427 patients with clinically, radiologically and histopathologically confirmed TB were enrolled in the study, in our clinic at a tertiary care hospital in Turkey, during a 5-year period (2007-2012). Patient data were obtained retrospectively. Among the 427 patients, 55 patients with both PTB and EPTB and who were using steroids or had taken immunosuppressive drugs were excluded from the study. Results: Of the 372 patients, 227 (61%) were males and 168 (45.2%) had EPTB; 204 (54.8%) patients had PTB. The most frequent sites of EPTB were the lymph nodes (n = 45, 12.1%), pleura (n = 40, 10.7%) and brain (n = 7, 1.8%). The most common symptoms were cough (n = 174, 46.7%), night sweats (n = 127, 34.1%) and fever (n = 123, 33%). Compared to EPTB patients, PTB patients were less likely to have received Bacillus Calmette-Guérin vaccination (odds ratio 0.41, 95% confidence interval 0.2-0.63; p < 0.001). Eighty-one (48.2%) of the EPTB and 146 (71.6%) of the PTB patients were males. Pulmonary involvement was more common among men (n = 146, 71.6%) than among women (n = 58, 28.2%; p = 0.000). Conclusion: There was a high incidence of EPTB in our study. Early diagnosis of EPTB is crucial for treatment, and atypical presentations of TB should be kept in mind for immunocompetent patients living in endemic areas. Females especially should be investigated for EPTB.

Extrapulmonary tuberculosis (EPTB) poses a public health challenge, particularly among individuals with human immunodeficiency virus (HIV). However, many EPTB cases arise in those without HIV, leaving the underlying factors unclear. This study aims to characterize patients with pulmonary tuberculosis (PTB) and EPTB, exploring the differences in associated factors for each type in patients with and without HIV. An analytical observational study was conducted on a cohort of tuberculosis (TB) patients diagnosed between 2014 and 2021 in a referral hospital in Bogotá, Colombia. Patients were categorized into PTB or EPTB based on the site of infection. Data on demographic and clinical variables were collected, comparing the two groups. A multivariate logistic regression model was created to identify factors associated with EPTB compared to PTB. The study encompassed 533 patients: 310 with PTB and 223 with EPTB, of which only 65 (14.7%) were HIV positive. PTB patients exhibited higher rates of active smoking, smoking cessation, diabetes mellitus (DM), and other pulmonary diseases. The logistic regression identified HIV infection as the only factor associated with EPTB (OR 2.36 (1.54-3.61), p < 0.001). Conversely, quitting smoking (OR 0.58 (0.35-0.96) p = 0.038), DM (OR 0.41 (0.21-0.82) p = 0.011), chronic obstructive pulmonary disease (COPD) (OR 0.18 (0.08-0.4) p < 0.001), other pulmonary diseases (OR 0.21 (0.61-0.77) p = 0.019), or those using immunosuppressants (OR 0.44 (0.20-0.96) p = 0.04) exhibited a negative association with EPTB compared to PTB. Specific models for pleural and lymph node TB revealed distinct associations, with HIV strongly linked to lymph node TB (OR 3.38, 95% CI 1.57-7.26, p = 0.002). EPTB is primarily associated with HIV infection, while smoking, DM, COPD, other pulmonary diseases, and immunosuppressant use are associated with PTB. Variability in associated factors for specific EPTB forms underlines the need for tailored research into the predisposing factors for EPTB, particularly in HIV-negative patients.

Secondary respiratory infections are frequent and serious complications in patients diagnosed with pulmonary tuberculosis (TB), often complicating clinical management and increasing morbidity and mortality rates. This study assessed the prevalence, demographic profile, and microbiological characteristics of secondary respiratory infections among newly diagnosed microbiologically positive pulmonary TB patients attending a tertiary care hospital. Identifying factors associated with secondary infections could provide insights for improving patient outcomes and guiding targeted interventions. A cross-sectional observational study was conducted at the Respiratory Medicine Outpatient Department of AVBRH JNMC from January 2023 to January 2024. One hundred ten newly diagnosed sputum-positive pulmonary TB patients were enrolled on the basis of the inclusion criteria. Patients with drug-resistant TB, extrapulmonary TB, those unable to expectorate sputum, and those unwilling to provide informed consent were excluded from the study. Demographic details, occupational history, addiction status, differential blood counts, and sputum analysis results (including sputum Gram staining and culture results) were recorded. The prevalence of secondary respiratory infections was determined, and associations with demographic and clinical parameters were statistically analyzed via chi-square tests. Of the 110 patients, 40 (36.4%) were diagnosed with secondary respiratory infections. The study revealed that most patients were male (70, 63.6%), with a significant number belonging to the 41–50-year age group (35, 31.8%). Manual labor was the most common occupation (45, 40.9%), and 50 (45.5%) patients reported a history of tobacco use. Among those with secondary infections, Streptococcus pneumoniae was the predominant pathogen identified in 15 (37.5%) patients, followed by Klebsiella pneumoniae (10, 25.0%) and Staphylococcus aureus (8, 20.0%). A significant association was observed between secondary infection and age group (p=0.033) as well as addiction history (p=0.017). Patients with secondary infections presented increased total leukocyte counts, neutrophil percentages, and erythrocyte sedimentation rates (ESRs) and decreased hemoglobin and lymphocyte percentages, indicating a heightened inflammatory response. This study revealed a considerable prevalence of secondary respiratory infections among newly diagnosed pulmonary TB patients, particularly those with certain demographic and clinical characteristics. Early recognition and management of these infections are crucial for reducing disease burden and improving patient prognosis. Further research is recommended to explore effective prevention and treatment strategies for secondary infections in this vulnerable population.

ObjectiveMonitoring tuberculosis treatment outcomes and understanding the reasons for unsuccessful treatment are important indicators for evaluating the performance of the national tuberculosis control program. The aim of this study was to evaluate the treatment outcomes among pulmonary TB (PTB) patients and identify the predictors of unsuccessful treatment outcome.ResultsTreatment success rate of 67.8% among new and retreatment PTB patients and 69% in new smear positive PTB patients was observed. Close to 21% (20.9%) and 15.7% PTB and new smear positive PTB patients had loss to follow-up during treatment. Overall, older patients (AOR 1.02; 95% CI 1.01–1.0), smokers (AOR 1.65; 95% CI 1.02–2.67) and retreatment cases of TB (AOR 2.34; 95% CI 1.43–3.84) were at greater risk of having unsuccessful treatment outcomes. Moreover, sputum positivity at 2 months (AOR 13.78; 95% CI 5.09–37.26) was a significant predictor of poor treatment outcomes in new smear positive PTB patients. The treatment success rate among PTB patients was lower than the recommended 85% success rate. TB patients at higher risk of unsuccessful treatment outcomes should be provided with enhanced supervision and treatment monitoring to improve the success rate of TB management in Pakistan.

To understand the pathological correlation of the reversed halo sign (RHS) in adult pulmonary tuberculosis (PTB) patients, and to compare the clinical characteristics of PTB patients with RHS with those without RHS. The study included 80 patients consecutively diagnosed with PTB by pathology or smear-positive sputum or bronchoalveolar lavage fluid from 1 January to 31 August 2012. All patients underwent high-resolution computed tomography (HRCT) scan, and were divided into two groups based on HRCT findings: RHS and non-RHS. All patients in the RHS group underwent CT-guided transthoracic lung biopsy to evaluate histopathological abnormalities. Clinical features such as smoking history, TB-related symptoms and comorbidities were compared. The 'ring' in the RHS corresponded to granulomata, with or without acid-fast stain positivity, and with or without caseating necrosis. Compared with the non-RHS group, patients in the RHS group were significantly younger, were less likely to have a smoking history and had fewer TB-related symptoms and comorbidities. Our study shows that younger PTB patients with relatively better baseline status tended to present with RHS on HRCT, have fewer TB-related symptoms and present atypically.

Changes in inflammatory protein and lipid mediator profiles persist after antitubercular treatment of pulmonary and extrapulmonary tuberculosis: A prospective cohort study