An assessment survey of anti-tuberculosis drug management in Cambodia.

SETTING: One hundred and seven public health facilities with tuberculosis (TB) service and 66 private pharmacies in 14 provinces. OBJECTIVES: To assess the knowledge, attitudes and practices (KAP) of TB service providers, new smear-positive pulmonary TB out-patients and drug storekeepers, to document practices in the public sector TB drug procurement system, to measure TB drug availability in private pharmacies and to compare public and private sector TB drug prices with international prices. DESIGN: Documents and treatment record reviews, inventory checks and structured interviews. RESULTS: The prescribing practices of the TB service providers were acceptable. The level of new smear-positive TB out-patients' knowledge of TB treatment was high. The storekeepers' inventory practices for TB drugs indicated a need for improvement. Various TB drugs were available in the private pharmacies. TB drug prices in the public sector were similar to international reference prices, although they were higher than the Global TB Drug Facility prices. CONCLUSIONS: An indicator-based anti-tuberculosis drug management assessment survey can measure the current situation and quality of DOTS, identify any weaknesses or changes in practice from the norm, and simultaneously serve as a basis for training of TB service providers and storekeepers.     

HIV-TB co-infection in children: associated factors and access to HIV services in Lagos,Nigeria

Background: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The World Health Organization estimates that the prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the access to HIV services of HIV-TB co-infected children.Methods: A retrospective review of data of children diagnosed with TB in Lagos State, Nigeria from 1 January 2012 to 31 December 2013.Results: A total of 1199 children aged between 0 and 14 years were diagnosed with TB. Of 1095 (91.3%) who underwent testing for HIV, 320 (29.2%) were HIV seropositive. The male-to-female ratio of HIV-TB positive outcomes was 1:0.9. Of the 320 HIV-TB co-infected children, 57 (17.8%) were aged <1 year, 86 (26.9%) 1–4 years and 186 (58.1%) 5–14 years; 186/320 (58.1%) began cotrimoxazole preventive therapy (CPT), and 151 (47.2%) were put on antiretroviral treatment (ART). ART uptake was not significantly higher in facilities where HIV-TB services were co-located (P > 0.05).Conclusion: The uptake of CPT and ART was low. There is a need to intensify efforts to improve access to HIV services in Lagos State, Nigeria.     

Screening patients with tuberculosis for diabetes mellitus in Ampara,Sri Lanka

Given the well-known linkage between diabetes mellitus (DM) and tuberculosis (TB), the World Health Organization recommends bidirectional screening. Here we report the first screening effort of its kind from a chest clinic in the Ampara district of Sri Lanka. Of 112 TB patients registered between January 2013 and October 2014, eight had pre-existing DM. Of those remaining, 83 (80%) underwent fasting plasma glucose testing, of whom two (2%) and 17 (20%) were found to have diabetes and impaired fasting glucose, respectively. All of these were enrolled in care. Screening TB patients for DM was found to be feasible at the district level. Further studies at the provincial/country level are required before making any decision to scale up bidirectional screening.     

Screening difficult-to-reach populations for tuberculosis using a mobile medical unit,Punjab India

Background: In India, the National Health Mission has provided one mobile medical unit (MMU) per district in the state of Punjab to provide primary health care services for difficult-to-reach populations.Objectives: To determine the number of patients with presumptive tuberculosis (TB) and the number of TB cases detected and treated among patients who used the MMU services from May to December 2012 in Mohali district, Punjab, India.Methods: A cross-sectional study was conducted and registers of the out-patient, laboratory, radiology, and TB departments of the MMU were reviewed to determine the number of persons presumed to have TB and the number of persons diagnosed with TB.Results: Of 8346 patients who attended the MMUs, 663 (8%) had symptoms suggestive of TB. Among those with TB symptoms, 540 (81%) were evaluated for pulmonary TB using sputum examination or chest X-ray. In total, 58 (11%) patients had clinical or laboratory evidence of pulmonary TB, of whom 21 (36%) started anti-tuberculosis treatment.Conclusion: As MMUs are an integral part of the general public health system, these units have the potential to detect TB cases among difficult-to-reach populations. Additional research is required to optimise the diagnosis of TB at MMUs and to increase rates of TB treatment initiation.     

Penitentiary population of Mycobacterium tuberculosis in Kyrgyzstan: Exceptionally high prevalence of the Beijing genotype and its Russia-specific subtype

Here, we present results of the first study of the Mycobacterium tuberculosis genotypes circulating in Kyrgyzstan. We focused on the incarcerated population known to be at high-risk for tuberculosis (TB) and with a significant impact on TB incidence in the general population. Beijing genotype was detected in 42 of 56 M. tuberculosis sputum-extracted DNA samples from newly-diagnosed adult pulmonary TB patients. RIF and INH resistance was genotypically detected in 28% and 55% samples; 13 of 15 MDR strains belonged to Beijing genotype. 12-locus MIRU-VNTR typing showed 8 of 56 samples to be mixed cases; 7 of them contained a Beijing strain. MIRU analysis demonstrated a high homogeneity of the studied collection (HGI = 0.66) while 28 of 56 strains had a profile 223325153533 corresponding to Beijing/M2 subtype highly prevalent in different Russian settings. Three hypervariable loci, QUB-3232, VNTR-3820 and VNTR-4120, permitted to further subdivide 28 Beijing/M2 strains into 11 subtypes shared by 1 to 9 strains. To conclude, all markers taken together, the penitentiary population of M. tuberculosis in Kyrgyzstan exhibited a strong genetic affinity to Russia and a weak relatedness to East Asia.     

Clinical Significance of Mycobacterium asiaticum Isolates in Queensland,Australia

Mycobacterium asiaticum was first reported as a cause of human disease in 1982, with only a few cases in the literature to date. This study aims to review the clinical significance of M. asiaticum isolates in Queensland, Australia. A retrospective review (1989 to 2008) of patients with M. asiaticum isolates was conducted. Data were collected through the Queensland TB Control Centre database. Disease was defined in accordance with the American Thoracic Society criteria. Twenty-four patients (13 female) had a positive culture of M. asiaticum, many residing around the Tropic of Capricorn. M. asiaticum was responsible for pulmonary disease (n = 2), childhood lymphadenitis (n = 1), olecranon bursitis (n = 1), 6 cases of possible pulmonary disease, and 2 possible wound infections. Chronic lung disease was a risk factor for pulmonary infection, and wounds/lacerations were a risk factor for extrapulmonary disease. Extrapulmonary disease responded to local measures. Pulmonary disease responded to ethambutol-isoniazid-rifampin plus pyrazinamide for the first 2 months in one patient, and amikacin-azithromycin-minocycline in another patient. While M. asiaticum is rare in Queensland, there appears to be an environmental niche. Although often a colonizer, it can be a cause of pulmonary and extrapulmonary disease. Treatment of pulmonary disease remains challenging. Extrapulmonary disease does not mandate specific nontuberculous mycobacterium (NTM) treatment.Nontuberculous mycobacteria (NTM) have been recognized as human pathogens since the 1950s (17, 30). Over recent decades the taxonomy has continued to evolve, and new species are being recognized. This is attributable to improved methods of identification, including chemotaxonomic and molecular methods (11).Mycobacterium asiaticum was first named by Weiszfeiler et al., who recognized it as a new slow-growing mycobacterium species with characteristics separate from those of Mycobacterium simiae and the other slow growers, Mycobacterium kansasii and Mycobacterium marinum (31). It was first reported in humans in Queensland (QLD), Australia, by Blacklock et al. in 1982, where M. asiaticum was thought to be responsible for pulmonary disease in 2 of 5 human cases (5). The first case report of pulmonary disease secondary to M. asiaticum in the United States was in 1990 (27). These reported patients with progressive pulmonary disease secondary to M. asiaticum mostly had an underlying chronic respiratory problem such as chronic obstructive pulmonary disease (COPD). M. asiaticum has also been reported to be responsible for extrapulmonary disease in humans, namely, flexor tenosynovitis (8), olecranon bursitis (6), and keratitis (7).Previous studies, with their limitations, have suggested climate as a factor responsible for the distribution of M. asiaticum, with an association noted between prevalence of M. asiaticum and subtropical climates, such as Queensland''s, particularly an area of northern Queensland near the Tropic of Capricorn (5). This association was noted in both animal and human studies (31).There are limited data about the antimicrobial susceptibilities of M. asiaticum and response to treatment. Weiszfeiler et al. reported that M. asiaticum in monkeys is resistant to streptomycin, isoniazid, p-aminosalicylate, and rifampin but susceptible to cycloserine (32). However the use of antituberculosis therapy, including agents such as isoniazid, rifampin, ethambutol, pyrazinamide, streptomycin, and capreomycin, yielded more-encouraging results in humans (5, 27), with clinical response not correlating with in vitro susceptibilities. Older fluoroquinolones, such as ofloxacin, have also been used, although M. asiaticum has higher mean inhibitory concentrations than other slow-growing mycobacteria (15).The aim of this study was to evaluate isolates of M. asiaticum in Queensland and describe the incidence and epidemiology of disease, risk factors, clinical and radiological spectrum, treatments, and outcome.