Introducción: La tuberculosis sigue siendo un problema de salud pública en el mundo, la TBC causa más de 1,4 millones de muertes al año y es la segunda causa principal de muerte debido a una enfermedad infecciosa. El envejecimiento poblacional es una realidad. La inmunidad en la vejez va disminuyendo, y conociendo las altas tasas de infección de M. tuberculosis a temprana edad, los adultos mayores tendrían un alto riesgo de desarrollar la enfermedad debido principalmente a la reactivación, es así que la tuberculosis en ancianos cuenta con una serie de características diferenciales que hacen necesario su estudio como entidad aparte. Objetivo: Determinar las características clínico-epidemiológicas de pacientes mayores de 60 años con tuberculosis en el hospital nacional Dos de Mayo durante el periodo 2008 a 2014. Metodología: Estudio observacional, descriptivo, retrospectivo. Resultados: Entre enero del 2008 y diciembre del 2014 se registraron 4397 pacientes diagnosticados de tuberculosis, 436 tenían 60 años o más representando el 10,1%. La forma pulmonar tuvo una frecuencia de 47,7% (n=208) y la extrapulmonar de 52,3% (n=228); dentro de la forma extrapulmonar, la afección pleural fue la más frecuente con 9,4% (n=41). El método más usado para inicio de tratamiento fue el BK positivo con 55,7% (n=243). La patología más prevalente encontrada fue la diabetes mellitus en un 10,3% (n=45). Conclusiones: La tuberculosis en el anciano demuestra gran diferencia que la observada en jóvenes, en donde la forma pulmonar no es necesariamente la más predominante. La frecuencia de la tuberculosis en el anciano es similar al de otros estudios pero dentro de las formas extrapulmonares hay grandes diferencias con respecto a otros estudios.

South Africa has a heavy burden of tuberculosis (TB) which is exacerbated by the concurrent epidemic of HIV. Molecular techniques have been used in most developed countries to investigate the dynamics of the TB epidemic, but despite the high prevalence of TB in sub-Saharan Africa, little data on strain types are available outside of the Western Cape. This study aims to provide information on the genotypic characteristics of multidrug-resistant (MDR) Mycobacterium tuberculosis strains in Johannesburg. Patient data obtained from the National Health Laboratory Service (NHLS) referral TB diagnostic laboratory and from Sizwe hospital, a MDR-TB referral hospital, were used to determine the risk factors for treatment outcomes in patients with MDR tuberculosis. Multidrug-resistant M. tuberculosis isolates from over 100 clinics and hospitals in Johannesburg were stored for the study. Spoligotyping and MIRU-VNTR were used to genotype the strains. Drug susceptibility profiles showed that 238 (55%) of the 434 M. tuberculosis isolates tested were resistant to streptomycin and ethambutol, in addition to being resistant to rifampicin and isoniazid. A comparison of spoligotyping results with the international spoligotyping database (SITVIT2) showed a total of 50 shared international types (SITs). Forty-five shared types, containing 417 isolates (96%) matched a pre-existing shared type whereas 5 shared types (containing 11 isolates) were newly created. Diverse strain types were noted, with Beijing, LAM, EAI, T, S, H and X families being dominant. Spoligotype defined families were split into sub-clusters by MIRU typing, resulting in 76 MIRU international types (MITs), containing 389 isolates and 45 orphan isolates. Spoligotyping showed lower discrimination (Hunter-Gaston discriminative index (HGDI) of 0.917) compared with MIRU typing (HGDI = 0.957) but there was no remarkable difference in the discriminatory power of combined spoligotyping and MIRU (HGDI = 0.962) compared with MIRU typing used alone. Twenty-four loci MIRU-VNTR typing was performed on strains from Beijing and CAS, EAI and H families to identify loci with high discriminatory power in our region. The proposed 15 MIRU-VNTR locus combination, together with MIRU 39, was found to be sufficient as a secondary typing method for the routine epidemiological investigation of the Beijing family isolates. Non-Beijing families could be sufficiently differentiated by the 15 MIRU locus combination. This study also describes the treatment outcomes of 351 MDR-TB patients at Sizwe hospital, who started treatment between 2004 and 2007, and investigates possible risk factors associated with poor outcomes. Final treatment outcome was available for 324 (92%) of the patients. Treatment success (completion and cure) was recorded in 158 (48.8%) of patients, while 73 (22.5%) had poor outcomes and 93 (28.7%) defaulted. Eleven (3.1%) patients were transferred out to another health facility and 16 (4.6%) had no recorded final outcome. The proportion of successful treatment increased significantly over time. Univariable and multivariable analysis (P = 0.05) identified the year of MDR-TB diagnosis and spoligotype-defined families as factors associated with treatment outcome. No associations were found between treatment outcome and HIV status, previous TB and additional MDR resistance to either streptomycin or ethambutol. The patient isolates were also characterised molecularly, complementing the study of isolates from Johannesburg alone, and providing information for the Gauteng Province. A sub-study illustrating genotypic diversity of the families constituting extensively drug-resistant TB (XDR-TB) strains in South Africa was conducted subsequent to the nosocomial outbreak in KwaZulu Natal (KZN). The results show that multiple, parallel development of resistance, rather than transmission alone, also plays an important role in the incidence of this extended form of resistance.

A research report submitted in partial fulfillment of the requirements for the degree of Master of Science in Epidemiology and Biostatistics University of the Witwatersrand, Faculty of Health Sciences, School of Public Health May, 2014 / Introduction HIV-associated TB is curable with standard TB therapy and yet it is the leading cause of illness and death in patients infected with HIV. Coinfection with HIV poses considerable challenges to early diagnosis of TB in HIV-infected people and diagnostic delay and the rapidly progressive TB associated with HIV results in rapid clinical deterioration and increased mortality. There is an urgent need for research to identify risk factors for TB in HIV-infected people in order to refine diagnostic algorithms for the early and accurate diagnosis of tuberculosis in HIV-positive patients. The aim of this study was to determine the prevalence of TB, and identify factors associated with prevalent TB in HIV-infected adults paying a subsidized, all-inclusive monthly fee for HIV care in a private setting in downtown Johannesburg – a unique sub-population. Material and Methods This study was a retrospective, cross-sectional, secondary analysis of data extracted from the routine electronic medical records of HIV-infected adults who attended ZuziMpilo from August 2009 to December 2011. The outcome of interest was prevalent TB at the time of enrollment into care and exposures included age, sex, ethnicity, CD4 count, WHO Clinical Stage, BMI, alcohol and tobacco use history, level of education, employment status, monthly income, monthly cell phone expenditure, medical insurance status, source of funding for HIV care and source of knowledge about ZuziMpilo Medical Centre. Multivariable logistic regression modeling was used to determine risk factors for prevalent TB at the time of enrollment. Results Approximately 8 out of every 100 HIV-infected adults enrolling at ZuziMpilo from August 2009 to December 2011 had prevalent TB disease (8.24%). Significant predictors for prevalent TB included BMI categorised as non-obese, CD4 count <350 cells/mm3 and duration on HAART of less than six months. With respect to BMI, individuals who were not obese had greater risk of prevalent TB, the risk increasing in a dose response fashion as the BMI decreased. Compared to obese patients, overweight patients were 2.8 times as likely (aOR = 2.83, CI 1.06 – 7.52, p = 0.037), normal weight patients were more than 3.7 times more likely (aOR = 3.72, CI 1.44 – 9.60, p = 0.007) and underweight patients were more than 6.4 times more likely to have prevalent TB (aOR = 6.42, CI 2.33 – 17.70, p = 0.000). A CD4 count of < 200 cells/mm3 predicted an 11.3 times increased risk of prevalent TB relative to CD4 count greater than 350 cells/mm3 (aOR = 11.27, CI 4.84 – 26.28, p = 0.000). Patients treated with HAART for longer than 6 months were significantly less likely to have prevalent TB than HAART-naïve patients (aOR = 0.47, CI 0.23 – 0.98, p = 0.043). Conclusion and Recommendations This study corroborates the growing body of evidence that underpins several key recommendations that have the potential to reduce mortality from TB in those people infected with HIV; vigilant and regular routine TB screening in HIV-infected patients at all CD4 counts and especially in those with profound immunosuppression and in the first three to four months following HAART initiation, the urgent development and distribution of more sensitive and point of care diagnostic tests for TB in HIV-infected patients at all levels of health care (most especially primary health care facilities) and the importance of initiation of HAART before CD4 counts drop below 350 cells/mm3. This study highlights that BMI is a useful proxy marker of TB risk among HIV-positive individuals. Height and weight are easily assessed anthropomorphic measures and should be conducted routinely in all patients at regular intervals. This study has described a unique population with the capacity to pay a subsidised monthly fee for their HIV care and thus the results may not be generalisable to the large population of HIV-infected adults in South Africa, who receive free-of-charge health care in public sector facilities. However, they may certainly be generalisable to other clinics that provide services for a fee and this information may be especially important if this model is replicated and scaled up in private and semi-private facilities around the country.

The introduction of the Directly Observed Treatment Short course (DOTS) recommended by the World Health Organization (WHO) in 1991 was developed as the ideal public health measure for the treatment and management of tuberculoisis (TB) (Naidoo, Dick & Cooper 2008:1). However, despite attempts to cure and control tuberculosis, two million new cases are reported in the sub-Saharan region of Africa. The problem of TB in South Africa is made worse by the high incidence and prevalence of HIV/AIDS. There are many contributing factors that may play a part in South Africa’s low cure rate such as unequal national drug distribution, lack of healthcare personnel, patient superstitions and myths concerning tuberculosis. I have touched upon some of these issues. But in this research report I have mainly concentrated on the South African DOTS programme and some of the ethical issues involved in the problem of patient adherence as it concerns the fair societal distribution of burdens and benefits. I have used the ethical framework for public health ethics for my analysis as proposed by Nancy Kass, and also placed a special focus on adherence problems as they concern vulnerable populations. Quality of the DOTS programme in South Africa such as staff attitudes towards TB patients and poor communication skills, nursing care, broken equipment, dirty facilities, absenteeism may contribute towards non-adherence. Moreover, poor quality healthcare services may encourage TB patients to seek alternative treatment other than hospital care thereby increasing their vulnerability to infection and disease progression. Cultural differences in health care and practices may be a barrier to the effective distribution of quality healthcare.

A research report submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Masters in Science in Epidemiology and Biostatistics June 2017 / Introduction Delays in diagnosing and treating tuberculosis increase the risk of transmission, morbidity and mortality especially in low socio-economic settings with high HIV and TB rates. The aim of this study was to determine factors associated with the delay in the diagnosis and treatment of suspected TB by HIV status in hospitalised patients in South Africa. Methods This study was a secondary analysis of data from a three centre prospective cohort of inpatients recruited between 2006 and 2009 that were clinically diagnosed with active TB on admission. Results Data from 1018 patients (67% female) of a median age of 36 years (IQR: 30-44) with known HIV status were analysed: 875 (86%) positive and 143 (14%) negative. HIV positive patients had significantly longer median total delays relative to the negative (39 days, IQR: 28-74 vs. 32 days, IQR: 21-56; p<0.02). Unemployment, seeking prior treatment and use of cotrimoxazole predicted total delay in the HIV positive patients. Conclusion Patient delay is high in HIV positive patients compared to the HIV negative. Public health interventions targeting earlier diagnosis of TB disease in HIV positive patients should be enhanced. / MT2017

"The purpose of this study is to provide information in the area of tuberculosis admission practices and policies which may assist in the control of tuberculosis in the State of Florida"--Introduction. / Typescript. / "May 12, 1953." / "Submitted to the Graduate Council of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: Joseph Golden, Professor Directing Study. / Includes bibliographical references.

No description available.

Thesis (M Med(Family Medicine)) -- University of Limpopo, 2010. / BACKGROUND AND OBJECTIVE Tuberculosis remains an important curable disease particularly in the developing world. One third of the world's population is infected with T8 and new infections are occurring at a rate of about one per second(Tuberculosis Wikipedia Encyclopedia 2009).The distribution globally is not uniform with eighty percent of cases in Africa and Asia(Tuberculosis Wikipedia Encyclopedia 2009). Treatment is challenging because it requires compliance to long courses of multiple antibiotics. WHO highlights the global failure of health service providers to deal with the burden of tuberculosis (Fourie et aI1999). The researcher observed that socio-economic factors, political and intrapersonal aspects associated with T8 infection might as well be important to the treatment outcome. It was therefore important to explore factors that could be associated with treatment outcomes in the prison environment where the full impact of these factors could be found. This study was conducted at Potchefstroom prison in North Westprovince of South Africa. METHODS A quantitative cross-sectional study was done. A record review of all T8 patients in Potchefstroom prison who initiated their treatment in 2007 and ending their treatment up to 2010 was conducted. Data was recorded on data collection sheet and results were then analyzed. Descriptive analysis was done to provide frequencies, mean and standard deviation. Measures of association between characteristics and treatment outcome using odds ratio was done. RESULTS 202 T8 patients in this prison had T8 during the period covered by the study. The age group distribution of the patients shows that majority, 142(70.3%) belong to the age group 21- 37 years while those aged 38 - 53 years was 48(23.8%) and their mean age was 33.7yrs. There were 197(97.5%) male and 4(2.0%) female and 1 (0.5%) no records. Of these, therewere 92(45.5%) patients cured 4 (2%) death, 1 (0.5%) treatment failure and 102 recorded as other outcomes belonging to the transferred and treatment interruption cluster. Factors compared with these outcomes were, age, gender, initial body weight, level of education, treatment initiation time, regimen type, social support, co morbidities, smoking, application of DOT ant the type of T8. Factors that were significantly associated with favorable outcomes were occasional visits providing some social support (39.4%, OR 3.78, 95% CI1.25-11.54), DOT application (37.4%, OR 3.99, 95% CI 2.35-11.23), young age (32.6% OR 3.14, 95% CI 2.1-5.3) and Regimen 1 (34.0%, OR 1.5, 95% CI0.11-12.61) Social habits like smoking were significantly higher in patients with other treatment outcome(OR=1.56, 95% CI=1.92 to 2.05), other factors found to be aligned to negative outcomes but lacking statistical significance were extra-pulmonary tuberculosis, non application of DOT, regimens other than regimen 1, and lack of social visits. Factors like co-morbidity and gender were found not to be significantly associated with any treatment outcome because there was no point of difference in the association of different grouping in these categories with particular outcome. CONCLUSION Many factors could be associated with treatment outcomes to some varying degree, but only significant factors explored in this study were considered important. Factors that were ultimately identified as important in determining treatment outcome were age, smoking status, social support, DOT and regimen type. These were factors that were found to be contributory to the pathology of TB in many other studies and which are amenable to interventions that would improve the outcomes.

Mycobacterium tuberculosis exploits various molecules on host cells to gain entry and establish a niche for survival and replication. We characterized the role of the glycoprotein CD43 in the pathogenesis of M. tuberculosis. Using gene-deleted mice (CD43-/-), we assessed association of the bacterium with macrophages and found that CD43 was required for optimal binding of M. tuberculosis strain Erdman by splenic, peritoneal, alveolar, and bone marrow-derived macrophages. Macrophages from heterozygote (CD43+/-) mice, which express 50% less CD43 than wild type (CD43+/+) mice, bound more bacteria than CD43-/- but less than CD43+/+ indicating that the surface expression of CD43 correlates with binding of M. tuberculosis. The role of CD43 in binding bacteria may be restricted to mycobacterial species as CD43-/- macrophages also bound less Mycobacterium avium and Mycobacterium tuberculosis H37Rv, but there was no observed role in the binding of Salmonella typhimurium or Listeria monocytogenes. Although absence of CD43 resulted in decreased binding of M. tuberculosis, the subsequent growth of the bacterium within CD43-/- macrophages was enhanced as illustrated by increased bacterial numbers and decreased doubling times, indicating that that the mechanism of entry may influence subsequent. To elucidate mechanisms by which CD43 controls of growth of M. tuberculosis, we examined the induction of antimycobacterial activities. In response to M. tuberculosis, CD43-/- macrophages were deficient in the production of nitric oxide, TNF-⍺, and IL-12. Furthermore, M. tuberculosis induced less apoptosis, but more necrosis, in CD43-/- macrophages compared to CD43+/+. The enhanced growth of M. tuberculosis was abrogated by IFN-Ɣ-stimulation with whereas addition of TNF-⍺ restored both the intracellular growth rates and amounts of apoptosis to wild type levels. To investigate the role of CD43 in vivo, we infected CD43-/- and CD43+/+ mice with M. tuberculosis and assessed bacterial loads and organ pathology. Absence of CD43 resulted in increased bacterial loads in lungs and spleens during both acute and chronic stages of infection, and formation of granulomas occurred more quickly in CD43-/- mice. These data point to a dual role for CD43 in the uptake and subsequent growth of M. tuberculosis in macrophages and mice.

El presente estudio titulado: “actitudes del paciente con Tuberculosis hacia su condición de Multidrogoresistente en el C.S. Fortaleza. Lima Perú. 2008”, los objetivos fueron determinar las actitudes de los pacientes con tuberculosis hacia su condición de multidrogorresistente e Identificar las características de cada uno de los componentes. El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La población estuvo conformada por todos los pacientes de la Estrategia Sanitaria de Prevención y Control de la Tuberculosis (ESN-PCT) del C.S. Fortaleza. Los resultados fueron que de 100% (20), 70% (14) presentan una actitud de indiferencia hacia su condición de MDR. En el componente Cognitivo un 45% (9) presentan un conocimiento medianamente favorable acerca de la enfermedad. En cuanto al componente Afectivo un 50% (10) presentan sentimientos medianamente favorable acerca de la Tuberculosis MDR. En el Componente Conductual un 45% (9) presentan conductas medianamente favorables. Por lo que se concluye que la actitud de los pacientes con Tuberculosis hacia su condición de multidrogoresitencia es de indiferencia ya que en todos los componentes presentan actitudes medianamente favorables hacia su enfermedad. Palabras Claves: Paciente con Tuberculosis Multidrogoresistente, Actitud hacia su Condición Multidrogoresistente, Componentes de las Actitudes. / The present titled study: "attitudes of the patient with Tuberculosis toward their condition of Multidrogoresistente in the C.S. Strength. Lima Peru. 2008", the objectives were to determine the attitudes of the patients with tuberculosis toward their multidrogorresistente condition and to identify the characteristics of each one of the components. The study is of level applicative, quantitative type, descriptive method of cross section. The population was conformed by all the patients of the Sanitary Strategy of Prevention and Control of the Tuberculosis (ESN-PCT) of the C.S. Strength. The results were that of 100% (20), 70% (14) they present an attitude of indifference toward their condition of MDR. In the Cognitive component 45% (9) they present a fairly favorable knowledge about the illness. As for the Affective component 50% (10) they present fairly favorable feelings about the Tuberculosis MDR. In the Behavioral Component 45% (9) they present fairly favorable behaviors. For what you concludes that the attitude of the patients with Tuberculosis toward its multidrogoresitencia condition is since of indifference in all the components they present fairly favorable attitudes toward its illness. Passwords: Patient with Tuberculosis Multidrogoresistente, Attitude toward their Condition Multidrogoresistente, Components of the Attitudes.