Distinguishing tuberculosis from nontuberculous mycobacteria lung disease, Oregon, USA

To determine whether tuberculosis (TB) and nontuberculous mycobacteria (NTM) infection patients could be distinguished from one another with limited information, we compared pulmonary TB and NTM patients during 2005-2006. Our finding that age, birthplace, and presence of chronic obstructive pulmonary disease could differentiate TB and NTM disease could assist tuberculosis control efforts.     

Frequency of Mycobacterium tuberculosis infection among Iranian patients with HIV/AIDS by PPD test

Persons infected with the Human Immunodeficiency Virus (HIV) are particularly susceptible to tuberculosis, either by latent infection reactivation or by a primary infection with rapid progression to active disease. This study was done to determine the frequency of tuberculosis infection among Iranian patients with HIV/AIDS. A total of 262 HIV/AIDS patients attending all three HIV/AIDS health care centers of Tehran, Iran were enrolled in this study. A detailed history and physical examination were obtained from all HIV patients suspected of having pulmonary M. tuberculosis. A positive PPD skin test was used as a diagnostic parameter for probability of TB infection. Out of 262 HIV/AIDS patients, a total of 63 (24%) were shown to have the tuberculosis infection based on a positive PPD skin test. Of the patients with positive PPD skin test, 22 (35%) had pulmonary Tuberculosis, 2 (3.2%) had extrapulmonary tuberculosis, and 39 (53%) had no evidence of M. tuberculosis infection (latent infection). Also 8 (12.7%) had history of long term residence in a foreign country, 32 (50.8%) were exposed to an index case, and 9 (14.3%) had past history of pulmonary tuberculosis, while only 33.3% had clinical manifestations of TB (active disease). There was no resistant case of tuberculosis. Our study showed that near 24% of Iranian patients with HIV/AIDS were infected with M. tuberculosis. This finding denotes the need to improve the diagnostic and preventive measures, and also prompt treatment of this type of infection in the HIV infected individuals.     

Mycobacterial infections in HIV-infected patients in Cali, Colombia]

The prevalence of mycobacterial infections was determined in a sample of 155 individuals infected with human immunodeficiency virus (HIV) who were treated in the Social Security Institute (SSI) of Cali, Colombia. A tuberculin test (2 TU PPD RT23) was used, and the presence of mycobacteria was checked through direct microscopy and culturing blood, urine, feces, and gastric aspirate. When clinically indicated, samples of cerebrospinal fluid, bone marrow, and sputum were also examined and cultivated. The absence of reactivity to tuberculin was significantly more frequent in the patients than in the controls (91.3%, compared to 57.4%; chi 2 = 33, P = 0). The prevalence of tuberculosis was 6.5%, in comparison with 0.04% among a group of HIV-negative ISS members (exact binomial 95% confidence interval: 0.0313% to 0.1154%). Nontuberculous mycobacteria (NTM), present in 43 patients, were significantly more frequent than Mycobacterium tuberculosis (27.7%, versus 6.5%; chi 2 = 24.78, P = 0.000,001), but they caused illness only in some cases. The most common species were those of the M. avium-intracellulare complex. M. avium-intracellulare and M. fortuitum had a total prevalence of 7.1% and were the most-prevalent NTM that caused disease in these patients (4.5%); they were also responsible for three cases of disseminated infection. Clinical disease caused by M. tuberculosis or NTM and complete tuberculin anergy were associated with stage-IV HIV infection and with CD4 lymphocyte counts < or = 400/microL. However, the lack of immunocellular response, shown by limited tuberculin reactivity, was found beginning with the asymptomatic HIV carrier stage. The progressive deterioration of the immune system of HIV-positive patients is the determining factor in the high morbidity and mortality with mycobacteria infections and requires prompt chemoprophylaxis or treatment.     

Tuberculosis and children: the missing diagnosis. A growing problem

About 33% of the world's population (2 billion people) are infected with Mycobacterium tuberculosis. Annually, 3 million people die from tuberculosis (TB) and 8 million acquire TB. Most TB cases are in developing countries. TB can attack the lungs or other organs. Pulmonary TB is most common in adults. Extrapulmonary TB, which is not infectious, is most common in children. Adults are the main source of TB infection in the community. When a TB-infected adult coughs or sneezes, he/she sprays many M bacterium into the air in tiny droplets. TB is curable, yet it is responsible for more deaths in adults than any other infectious disease. About 170,000 children die each year from tuberculous meningitis and disseminated TB disease. The increase in TB in adults will put more children at risk. Children most vulnerable to TB's effects are those younger than 2 and those whose parents suffer or die from TB. Increasing poverty, neglect of TB programs, and the spread of HIV account for the increase in TB cases. TB spreads best in overcrowded, badly ventilated places and among the malnourished. Health systems worldwide have undergone deep cuts and wide-ranging reforms, resulting in reduced access to vital TB services for the poorest members of society. Effective TB control requires properly operating, well-managed health services with adequate diagnostic facilities, trained staff, and available drugs. Limited community education results in people with active TB not seeking treatment and continuing to infect 20-28 others, including children. The HIV epidemic is causing an increase in TB in adults and in young children in some countries. Children infected with both HIV and TB have a poor prognosis. Health workers must be able to identify and treat TB with antibiotics. Proper treatment makes TB patients no longer infectious after 2-3 weeks. The BCG vaccination can protect children against the most severe forms of TB.     

结核病实验室诊断中常见干扰型非结核分枝杆菌的监测分析

目的掌握常见干扰结核病(TB)实验室诊断的非结核分枝杆菌(NTM)菌种组成及生长特性,以提高TB实验室诊断水平。方法采用分子线性探针(LPA)法对139株经实验室初步鉴定为NTM进行快速分型检测,回顾性对照分析其传统细菌学生长特性。结果脓肿、戈登、偶发、胞内、堪萨斯、鸟、瘰疠和外来分枝杆菌分别占41.01%、20.14%、13.67%、12.95%、5.76%、4.32%、1.44%和0.72%。2例NTM与结核分枝杆菌(MTB)混合培养阳性菌分别为戈登与脓肿分枝杆菌。脓肿分枝杆菌为TB复诊样本中常见干扰型NTM。结论综合分析常见干扰TB诊断的NTM的分子分型与细菌学生长特性,可提高TB实验室鉴别诊断准确率。     

TB and AIDS

The Indian National Tuberculosis Survey has indicated that 10 million persons above 5 years of age have pulmonary tuberculosis (TB), of whom 2.5 million are infectious. The annual infection rate amounts to 1.5%. In an average district with a population of 1.5 million, there are about 500 active, infectious TB cases and about 20,000 radiologically active cases. The World Health Organization has declared TB a global health emergency. The pandemic of AIDS had infected 13 million people worldwide by early 1993, and by the year 2000 over 40 million will be infected. In May 1986 only 1 AIDS case was reported, but by May 31, 1994, 728 cases of AIDS and 15,325 cases of HIV infections were reported. At the present rate of infection, there will be 5 million people infected with HIV by 2000 in India. HIV infection is the greatest risk factor for developing TB because of the multiplication of tubercle bacilli in quiescent foci, the progression of dormant infection to disease, and superinfection. The incidence of TB has doubled in the course of 5 years in some countries where HIV is epidemic. 30-70% of TB patients in these countries are estimated to be HIV-positive, imposing significant burden on national health services. On the other hand, efficient health services can still cure TB in HIV-positive patients and forestall the spread of the diseases. One-third of the world's population is infected with TB, and the lives of these people are shortened if they contract HIV. Worse still, for HIV-infected people exposure to TB means death, often within weeks. The only protection against the airborne TB germ is the complete cure of TB patients. At a 1993 conference in London several TB control measures were suggested: national TB control programs offering affordable treatment; faster diagnosis; education and incentives to increase patient compliance; proper drug supplies and quality control; education of influential people; and fight against poverty.     

Health care in-depth. Tuberculosis and HIV

Tuberculosis (TB) probably did not become a problem in sub-Saharan Africa (SSA) until around the 1850s. Poverty, inadequate TB control activities, and the HIV epidemic contribute to SSA having the world's highest TB case notification rate. HIV infection is responsible for a marked increase in TB in 15-45 year olds. In some parts of SSA, up to 70% of TB patients have HIV infection. A healthy immune system controls infection with Mycobacterium tuberculosis and prevents progression to TB but does not rid the body of dormant TB bacilli. HIV infection lowers immunity, therefore increasing susceptibility to TB. 25% of new TB cases each year in SSA are attributable to HIV infection. TB is the leading cause of death in HIV-infected individuals in SSA. The median CD4 count in HIV-infected adult TB patients is 200-250. Many persons in late stage HIV infection with TB are sputum smear negative. HIV-infected persons are more likely to have disseminated and extrapulmonary TB than HIV-negative persons. HIV infection sometimes reduces the skin test response to tuberculin. It is best to avoid anti-TB treatment as a diagnostic test for TB. Clinicians should not treat HIV-infected TB patients with thiacetazone but rather ethambutol. Thiacetazone can induce a severe, and sometimes fatal, skin reaction in HIV-infected persons. Many National TB Programs recommend ethambutol in place of streptomycin due to the problems associated with inadequate sterilization of needles and syringes and the pain associated with streptomycin injections in wasted HIV-infected TB patients. HIV-infected TB patients are more likely to die within 12 months after anti-TB treatment has begun than HIV-negative patients. Active TB may boost HIV replication. The World Health Organization does not yet recommend widespread isoniazid preventive therapy for HIV-positive persons in high TB prevalence countries.     

Control of tuberculosis in relation to the HIV/AIDS epidemic. Work Group at the Secretariat of the National Plan on AIDS

On April 7, 1999, the Monographic Meeting on HIV Infection and Tuberculosis was held at the Secretariat of the National AIDS Plan for the purpose of setting out certain clinical and health care policy recommendations concerning the control of tuberculosis (TB) with regard to the HIV infection epidemic, those in attendance being listed in Appendix 1. This meeting was organized into a number of presentations of papers (Appendix 2) grouped into four subject areas, which were followed by the pertinent debates. These four areas were as follows: 1. Epidemiology of the Dual HIV-TB Infection. 2. Treatments to Combat TB. 3. TB Prevention. 4. Health Care/TB Control Programs. The papers presented regarding a review of current literature focused on the search for scientific evidence with regard to treating and preventing TB among HIV-positive patients. The rest of the papers presented were: 1) regarding epidemiological topics 2) regarding results of different TB control programs and 3) regarding the analysis of the international and national recommendations concerning TB treatments and prevent among HIV-positive patients. Following the meeting, this report has been prepared as a summary thereof and was revised by all those who were in attendance at the meeting, the goal of which is that of setting out some recommendations for health care control and clinical handling of the dual Mycobacterium tuberculosis and HIV infection. This report provides no systematic or sufficiently detailed review of the different topics analyzed, therefore opting with regard to the bibliography to recommend a number of brief articles and reference books as a general source for further consultation. In this report, the term of "dual" TB-HIV infection is used generally and, in others the more specific "dual TB-AIDS disease", depending upon the presence of infection or disease caused by M. Tuberculosis and also AIDS, therefore, in the latter case.     

HIV-associated pulmonary tuberculosis

The problems of diagnosis, treatment and management of tuberculosis associated with HIV infection in Africa are placed in perspective by the former director of the Kenya Medical Research Institute. Tuberculosis (TB) has increased as much as 3-fold in many African countries due to heightened susceptibility of HIV patients. HIV infection may both re-activate latent TB, which virtually all Africans harbor, or increase the likelihood of exogenous infection or re-infection by TB. In most of Africa diagnosis by stained sputum smear is standard: in late AIDS, this method may yield false negatives due to non-pulmonary TB, or pulmonary TB with a negative smear. Chest x-rays are also atypical, since cavitation of the upper zones is not as common, but lobar consolidation and lower zone involvement, and various unusual findings are likely. There is no evidence that mycobacterium avium intracellular has occurred in Africa. Treatment in Africa often centers on long-term thiazina (thiacetazone and isoniazid combined). HIV+ patients are more prone to skin rashes or even lethal epidermal neurolysis as a complication of treatment. Treated patients should be monitored for other symptoms such as diarrhea, recurrent fevers, other chest infections, cerebral space occupying lesions, urinary infections. Many can be treated with broad spectrum antibiotics such as chloramphenicol. Nursing HIV-infected young adults is an expensive and burdensome prospect for overworked and underpaid staff, but curing TB in AIDS patients is possible and worthwhile because of the public health advantages.     

河北省4个县结核病与艾滋病双向筛查结果分析

目的提高结核病与艾滋病双重感染病例的发现率。方法省、市、县三级分别建立结核病和艾滋病防治机构合作机制。对确诊的结核病人进行咨询及HIV抗体检测；对确诊的HIV／AIDS进行结核病筛查。结果2007年1-9月，河北省4个县共确诊结核病人844例，有HIV高危行为人数51例，占7．0％，未检测出HIV抗体阳性病人。397例HIV／AJDS病例中确诊结核病人8例，TB／HIV双重感染率为2．0％。结论应在结核病人和HIV／AIDS中开展结核病与艾滋病双重感染监测，提高TB／HIV双重感染病人发现率，防止传播和蔓延。     

2010-2014年贵州省肺结核报告患者合并HIV感染状况分析

目的 了解贵州省肺结核（tuberculosis,TB）人群中人类免疫缺陷病毒（human immunodeficiency virus,HIV）阳性患者的流行病学特征,确定结核病人感染HIV的高危因素,为制定TB/HIV双重感染防治措施提供科学依据。方法 收集2010-2014年中国疾病预防控制系统结核病专报网中贵州省肺结核患者信息,通过描述性流行病学方法对肺结核病人中HIV感染情况进行分析。结果 肺结核病患者中HIV感染为0.13%,其中,男性感染率为0.16%,女性为0.09%,男性高于女性;高危人群以30～44岁的青壮年为主,感染率为0.29%;侗族感染率为0.42%,高于汉族及其他少数民族;肺结核患者感染HIV的高危职业为驾驶员及海员,家政、家务及待业人员和民工等灵活就业人员。结论 贵州省肺结核人群HIV感染率处于较低水平;青壮年男性、民工等灵活就业人员、少数民族流动人口应作为TB/HIV双重感染防治工作的重点关注对象;尚需进一步加强结核病患者HIV筛查及疫情填报管理工作。     

Tuberculosis and the HIV epidemic: increasing annual risk of tuberculous infection in Kenya, 1986-1996.

OBJECTIVES: The purpose of this study was to assess the impact of the increased incidence of tuberculosis (TB) due to HIV infection on the risk of TB infection in schoolchildren. METHODS: Tuberculin surveys were carried out in randomly selected primary schools in 12 districts in Kenya during 1986 through 1990 and 1994 through 1996. Districts were grouped according to the year in which TB notification rates started to increase. HIV prevalence in TB patients and changes in TB infection prevalence were compared between districts. RESULTS: Tuberculous infection prevalence rates increased strongly in districts where TB notification rates had increased before 1994 (odds ratio = 3.1, 95% confidence interval = 2.3, 4.1) but did not increase in districts where notification rates had increased more recently or not at all. HIV prevalence rates in TB patients were 50% in districts with an early increase in notification rates and 28% in the other study districts. CONCLUSIONS: Countries with an increasing prevalence of HIV infection will need additional resources for TB control, not only for current patients but also for the patients in additional cases arising from the increased risk of TB infection.     

广西652例HIV感染者结核筛查结果分析

[目的]提高TB/HIV双重感染患者发现率,及时治疗,防止传播和蔓延。[方法]对某院2007年1月～2008年7月门诊及住院的652例HIV感染者进行结核病筛查,患者来自广西45个市、县。[结果]652例HIV感染者中筛查出结核病患者186例,结核的发病率为28.52%;CD4+T淋巴细胞计数﹥200/mm3时结核的发病率15.7%,其中肺外结核及肺结核并肺外结核占27.3%;CD4+T淋巴细胞计数0～100/mm3结核的发病率为36.5%,其中肺外结核及肺结核并肺外结核占54.8%;78例有结核诊断直接依据,其中10例大便涂片找到抗酸杆菌。[结论]随着CD4+T淋巴细胞计数的下降结核的发病率显著增加,且尤以肺外结核多见,大便可作为晚期艾滋病患者筛查结核的样本来源之一。     

HIV testing and treatment among tuberculosis patients --- Kenya, 2006-2009

In resource-limited settings, high case-fatality rates are seen among tuberculosis (TB) patients with human immunodeficiency virus (HIV) infection, especially during the early months of TB treatment. HIV prevalence among TB patients has been estimated to be as high as 80%--90% in some areas of sub-Saharan Africa. In 2004, the World Health Organization (WHO) recommended increasing collaboration between HIV and TB programs. Since then, many countries, including Kenya, have worked to increase TB/HIV collaborative activities. In 2005, the Kenya Division of Leprosy, Tuberculosis, and Lung Disease (DLTLD) added questions regarding HIV testing and treatment to the existing TB surveillance system.* This report summarizes HIV data collected from Kenya's extended TB surveillance system during 2006--2009. During this period, HIV testing among TB patients increased from 60% in 2006 to 88% in 2009, and the prevalence of HIV infection among TB patients tested decreased from 52% to 44%. In 2009, 92% of HIV-infected TB patients received cotrimoxazole prophylaxis for the prevention of opportunistic infections. Although these data highlight the increase in HIV services provided to TB patients, only 34% of HIV-infected TB patients started antiretroviral therapy (ART) while being treated for TB. Innovative interventions are needed to increase HIV treatment among TB patients in Kenya, especially considering the 2009 WHO guidelines recommending that all HIV-infected TB patients be started on ART as soon as possible, regardless of CD4 count. Although these guidelines have not yet been implemented in Kenya, officials are working to identify methods of increasing access to ART for TB patients.     

Estimating HIV levels and trends among patients of tuberculosis clinics

Symptomatic tuberculosis (TB) can occur as an opportunistic disease in immunosuppressed persons who are infected with human immunodeficiency virus (HIV) and who have been previously infected with Mycobacterium tuberculosis. Increases in TB cases have occurred in areas which have reported large numbers of cases of the acquired immunodeficiency syndrome (AIDS), and a high proportion of these TB cases have been HIV seropositive. Therefore, increasing numbers of HIV-infected persons may be found in TB clinics and hospitals. HIV serologic surveys in TB clinics and hospitals providing clinical services to TB patients are needed to assess the local prevalence of HIV infection in TB patients and the consequent need for public health intervention to prevent further spread of HIV and TB infection. The Centers for Disease Control (CDC), in collaboration with State and local health departments, has initiated HIV surveillance of patients with confirmed and suspected TB in TB clinics and hospitals in the United States. Blinded (serologic test results not linked to identifiable persons) HIV seroprevalence surveys are conducted in sentinel TB clinics and hospitals that provide TB clinical services each year to obtain estimates of the level of HIV infection in TB patients and to follow trends in infection over time. Nonblinded (voluntary) surveys will also be conducted to evaluate behaviors that have placed TB patients at risk for or protected them against HIV infection. Data from these surveys will be used to target education and prevention and control programs for TB and HIV infection and to monitor changes in behavior in response to such programs.     

Association between Mycobacterium tuberculosis lineage and site of disease in Florida, 2009–2015

BackgroundMycobacterium tuberculosis is characterized into four global lineages with strong geographical restriction. To date one study in the United States has investigated M. tuberculosis lineage association with tuberculosis (TB) disease presentation (extra-pulmonary versus pulmonary). We update this analysis using recent (2009–2015) data from the State of Florida to measure lineage association with pulmonary TB, the infectious form of the disease.MethodsM. tuberculosis lineage was assigned based on the spacer oligonucleotide typing (spoligotyping) patterns. TB disease site was defined as exclusively pulmonary or extra-pulmonary. We used ORs to measure the association between M. tuberculosis lineages and pulmonary compared to extra-pulmonary TB. The final multivariable model was adjusted for patient socio-demographics, HIV and diabetes status.ResultsWe analyzed 3061 cases, 83.4% were infected with a Euro-American lineage, 8.4% Indo-Oceanic and 8.2% East-Asian lineage. The majority of the cases (86.0%) were exclusively pulmonary. Compared to the Indo-Oceanic lineage, infection with a Euro-American (AOR = 1.87, 95% CI: 1.21, 2.91) or an East-Asian (AOR = 2.11, 95% CI: 1.27, 3.50) lineage favored pulmonary disease compared to extra-pulmonary. In a sub-analysis among pulmonary cases, strain lineage was not associated with sputum smear positive status, indicating that the observed association with pulmonary disease is independent of host contagiousness.ConclusionAs an obligate pathogen, M. tuberculosis' fitness is directly correlated to its transmission potential. In this analysis, we show that M. tuberculosis lineage is associated with pulmonary disease presentation. This association may explain the predominance in a region of certain lineages compared to others.     

The rate of TB-HIV co-infection depends on the prevalence of HIV infection in a community

Background  

A complex interaction exists between tuberculosis (TB) and human immunodeficiency virus (HIV) infection at an individual and community level. Limited knowledge about the rate of HIV infection in TB patients and the general population compromises the planning, resource allocation and prevention and control activities. The aim of this study was to determine the rate of HIV infection in TB patients and its correlation with the rate HIV infection in pregnant women attending antenatal care (ANC) in Southern Ethiopia.     

Treatment of tuberculosis: present status and future prospects

Over recent years, tuberculosis (TB) and disease caused by human immunodeficiency virus (HIV) have merged in a synergistic pandemic. The number of new cases of TB is stabilizing and declining, except in countries with a high prevalence of HIV infection. In these countries, where HIV is driving an increase in the TB burden, the capacity of the current tools and strategies to reduce the burden has been exceeded. This paper summarizes the current status of TB management and describes recent thinking and strategy adjustments required for the control of TB in settings of high HIV prevalence. We review the information on anti-TB drugs that is available in the public domain and highlight the need for continued and concerted efforts (including financial, human and infrastructural investments) for the development of new strategies and anti-TB agents.     

湖南省活动性肺结核患者艾滋病病毒感染现况调查

目的了解湖南省活动性肺结核患者中HIV感染现状,分析TB/HIV双重感染的病例,为今后开展TB/HIV双重感染防治工作提供政策建议。方法采用系统抽样的方法,在湖南省随机抽取14个区县作为监测点,对各监测点结防机构于2007年9月1日-12月31日期间新登记的活动性肺结核患者进行免费HIV抗体检测并进行免疫印迹试验(WB)。结果本研究共纳入活动性肺结核患者1947例,其中自愿采血接受HIV抗体检测者1877例,受检率为96.4%。检出TB/HIV双重感染者2例(1.01‰),检出的2例TB/HIV双重感染者均有过HIV高危行为。结论湖南省结核患者中HIV感染率较低,对具有HIV高危行为的人群进行HIV抗体检测有利于发现更多的HIV感染者和病人。     

艾滋病合并非结核分枝杆菌肺病与合并肺结核的临床特征比较

目的 提高对艾滋病合并非结核分枝杆菌(NTM)肺病与艾滋病合并肺结核(TB)临床特征的鉴别诊断水平.方法 收集广州市第八人民医院2009年1月至2015年12月收治的经支气管肺泡灌洗液(BALF)培养阳性确诊的48例艾滋病合并NTM肺病(NTM组)和60例艾滋病合并TB患者(TB组),对相关临床资料进行回顾性比较分析.结果 NTM组与TB组患者均以中青年男性为主,发热、咳嗽、咳痰及消瘦等常见临床表现相似(P均＞0.05),但NTM组午后发热较TB组少(47.9％∶68.3％,x2=4.604,P＜0.05).两组患者主要实验室指标特点相近(P均＞0.05),NTM组的痰抗酸染色、BALF抗酸染色阳性率均低于TB组(6.3％∶20.0％,x2=4.251;12.5％∶43.3％,x2=12.159;P均＜0.05).胸腹部CT影像学结果显示,NTM组上叶侵犯较TB组少(54.2％∶91.7％),出现粟粒影、胸内淋巴结增大、胸腔积液及心包积液的比便低于TB组(14.6％∶31.7％,x2=4.258;66.7％∶86.7％,x2=6.171;25.0％∶43.3％,x2=3.930;6.3％∶21.7％,x2=5.022;P均＜0.05);胸内淋巴结增大部位,NTM组主要位于纵膈(43.8％),TB组主要位于肺门(53.3％).结论 艾滋病合并NTM肺病与TB的临床表现与实验室特点相似,胸部影像学对临床鉴别具有一定意义.