Tuberculosis 101

In 2020, an estimated 370,000 new cases of tuberculosis (TB) were attributable to diabetes mellitus (DM). Globally, over 15% of people with TB have DM, compared to 9.3% of the general population. The number of global DM cases is expected to increase by 50% from 2019 to 2045. In the Republic of Korea, the prevalence of DM was 16.7% among adults in 2020, but only 65.8% of adults with DM were aware of their disease and treated with antidiabetic medications. Furthermore, only 24.5% of these individuals achieved optimal glycemic control. The incidence of TB in Korea was 44.6 per 100,000 people in 2021. In Korea, a public-private mix TB control project was expanded nationwide in 2011. All patients are monitored and followed up until treatment completion. Patients with pulmonary TB and DM were older, predominantly male, had a higher body mass index (BMI), and a higher malignancy rate. The proportion of unfavorable outcomes was significantly higher in patients with DM than in those without DM....

Diabetes mellitus (DM) poses a significant health risk, leading to complications in multiple organs, including the lungs. Lung function is notably reduced in DM patients, with pulmonary complications commonly observed. The comorbidity of pulmonary tuberculosis (PTB) and DM is high, with a global prevalence of about 13.73%. PTB also raises the risk of developing DM, with higher DM prevalence in PTB patients compared to those without PTB. DM increases susceptibility to PTB by disrupting innate and adaptive immune responses, while PTB impairs islet cell function through islet amyloidosis. Anti-tuberculosis drugs further affect glucose homeostasis by disrupting liver and kidney functions. Hyperglycemia in DM affects macrophage phagocytosis by altering recognition receptor expression, impairing immunity against PTB. Specifically, hyperglycemia reduces the phagocytic function of alveolar macrophages. Infection with Mycobacterium tuberculosis triggers dendritic cell maturation and migration,...

The world is undergoing an epidemiological transition in disease burden, with a gradual decline in deaths from communicable diseases (CDs) and a steady rise in non-communicable diseases (NCDs). This shift has intensified competition for policy attention and resources between advocates for CDs, such as tuberculosis (TB), and those focused on NCDs, like cardiovascular diseases and diabetes mellitus (DM). The global increase in type 2 DM has emerged as a substantial challenge for TB control, as today more TB patients are living with diabetes than with concomitant human immunodeficiency virus (HIV) infection. Thus, the association between DM and TB may become the next significant challenge for global TB control. The bidirectional relationship between TB and DM is well-documented. Diabetes is an independent risk factor for TB development, while TB can also lead to impaired glucose tolerance (IGT) and new-onset diabetes. Additionally, diabetes may alter TB symptoms, radiological findings, ...

The notification rate for all tuberculosis cases in Central Java Province in 2022 was 179 per 100,000 population, an increase from 110 per 100,000 population in 2021. Semarang City continues to rank as the highest regency/city, with a Case Notification Rate (CNR) for all TB cases at 348 per 100,000 population. Kedungmundu District has the highest number of pulmonary TB cases, with a total of 186 cases, followed by Bangetayu District with 158 pulmonary TB cases. TB treatment begins with an intensive phase lasting for the first two months, potentially followed by an advanced phase. Long-term TB treatment often leads to issues with patient compliance. Noncompliance in tuberculosis treatment can have a negative impact on clinical outcomes and public health. Hematological abnormalities are common in TB patients, including leukocytosis, monocytosis, lymphocytosis, thrombocytosis, lymphopenia, and anemia. Anti-TB drugs such as isoniazid and rifampicin can cause hemolytic anemia or metabolic d...

Immunopathy associated with diabetes or pre-diabetes is characterized, in part, by chronic inflammation driven by persistent hyperglycemia, resulting in several complications. Generally, data from clinical tuberculosis (TB) studies indicate that patients with diabetes demonstrate a robust TB antigen-specific immune response. However, diabetes is paradoxically associated with worse TB clinical outcomes, including delayed culture conversion, increased risk of mortality, and higher rates of TB relapse. Although diabetes is an established risk factor for TB disease, additional information to identify individuals with diabetes and latent TB infection (LTBI) at greatest risk of progression to TB disease is urgently needed. Previous studies among children, adolescents, and adults who converted from a negative to a positive LTBI test reported that increased quantitative QuantiFERON-TB Gold (QFT) interferon-gamma (IFN-γ) values were predictive of progression to TB disease. Participants who self...

·   High TB Incidence in the Philippines : The Philippines has one of the highest TB incidences globally (539/100,000). ·   Diabetes Prevalence : In 2020, 6.5% of Filipino adults were estimated to have diabetes mellitus (DM), as reported by the International Diabetes Federation. ·   Impact of Poor Glycemic Control : Poor long-term glycemic control, measured by HbA1c, is associated with an increased risk of TB, severe clinical presentations, and poor TB treatment outcomes. ·   Factors Affecting Glycemic Control : Individual health status, disease management practices, and the health system all influence glycemic control in DM patients. ·   Central Obesity as a Diabetes Risk Factor : Central obesity, common in Asian populations, predicts diabetes and is associated with hyperglycemia and poor glycemic control at TB treatment onset, which can negatively impact TB outcomes. ·   TB and Transient Hyperglycemia : TB-related inflammation and insulin resistance may c...

Treatment of Drug-Susceptible TB (DS-TB) For the past 50 years, DS-TB has been treated with the 'short-course chemotherapy' regimen, which includes an ‘intensive’ phase of 2 months of rifampicin, isoniazid, and pyrazinamide, followed by a ‘continuation’ phase of 4 months with rifampicin and isoniazid. This approach has been effective in curing most patients. Rifapentine, a rifamycin with a longer half-life, combined with isoniazid, pyrazinamide, and moxifloxacin, has been shown to reduce therapy duration to 4 months. In May 2022, the WHO conditionally recommended this 4-month regimen for eligible individuals aged 12 and older with pulmonary DS-TB. Treatment of Isoniazid-Resistant, Rifampicin-Susceptible TB Isoniazid resistance without concurrent rifampicin resistance is the most common form of Mycobacterium tuberculosis resistance globally, affecting an estimated 10.6% of all TB cases in 2019. In 2018, WHO recommended a regimen of 6 months of rifampicin, ethambutol, pyrazinamid...

The technology to control TB has long existed, but it remains underutilized. Initially, the term "DOTS" (Directly Observed Treatment, Short-course) referred specifically to directly observed treatment combined with short-course chemotherapy. However, DOTS has evolved into a broader public health strategy with five principal elements: Political commitment. Case detection by sputum smear microscopy, primarily among symptomatic, self-referring patients. Standard short-course chemotherapy with supportive patient management, including DOT. A reliable system for regular drug supply. A standard recording and reporting system, including the evaluation of treatment outcomes. The MDG framework for TB control includes two measures aimed at DOTS implementation (case detection and treatment success) and three impact measures (incidence, prevalence, and deaths) relevant to all TB control methods. This second set of measures not only promotes epidemiological evaluation beyond implementation...

A TB outbreak is a situation where there is a sudden increase in tuberculosis (TB) cases within a specific geographic area or among a particular population over a set time period (commonly within 2 years). It indicates that TB is spreading more rapidly than anticipated in that area, which raises public health concerns. For an event to be considered a TB outbreak, there are typically two main components: More TB Cases Than Expected : An outbreak is identified when the number of TB cases exceeds the expected baseline within a certain population or area over a specific timeframe. This timeframe is usually around 2 years, as it helps differentiate between isolated cases and those indicating a significant increase in transmission. Evidence of Recent Transmission : In a TB outbreak, there must also be evidence suggesting that the cases are linked by recent transmission, meaning that people are infecting each other directly within a short period. This distinguishes an outbreak from situation...

In tuberculosis (TB) contact investigation or tracing, the terms "case," "index case," and "source case" are used to identify individuals involved in the chain of transmission. Here’s what each term means: Case : A case refers to any individual who has been diagnosed with TB, particularly active TB disease. In the context of contact tracing, this term typically denotes someone with pulmonary TB, as this form is more likely to be infectious. Index Case : The index case is the first diagnosed person within a specific setting (such as a household, workplace, or social environment) that triggers the contact investigation. In other words, the index case is the first TB case that healthcare providers identify and investigate. Importantly, the index case is not always the person who initially introduced TB into the group or setting; they are simply the first person identified. Source Case : The source case is the individual responsible for transmitting TB to othe...

The fall in tuberculosis incidence under DOTS is greater in younger populations than in older ones. Non-curative treatment can prevent death without eliminating infectiousness. In countries where tuberculosis incidence is stable and HIV-1 is absent: A control program reaching WHO targets (70% case detection, 85% cure) would reduce the incidence rate by 11% per year (range 8–12%). It would reduce the death rate by 12% per year (range 9–13%). If tuberculosis has been in decline for several years, the same case detection and cure rates would have a smaller effect on incidence. DOTS saves a greater proportion of deaths than cases, with a larger difference in the presence of HIV-1. HIV-1 epidemics increase tuberculosis incidence but do not significantly reduce the preventable proportion of cases and deaths. Source :  Dye, C., Garnett, G.P., Sleeman, K. and Williams, B.G., 1998. Prospects for worldwide tuberculosis control under the WHO DOTS strategy. The Lancet, 352(9144), pp.1886-1891....

Tuberculosis (TB) remains the leading cause of death from an infectious disease among adults worldwide, with over 10 million people becoming newly infected each year. Despite the challenges, advances in diagnosis and treatment hold promise for changing the trajectory of TB control, although the disease remains a serious global public health threat. Advances in Diagnosis Rapid molecular testing and whole-genome sequencing have become crucial tools in diagnosing TB, detecting drug resistance, and improving our understanding of transmission. Molecular tests such as the Xpert MTB/RIF assay have revolutionized TB diagnostics by enabling quick detection of Mycobacterium tuberculosis (M. tuberculosis) and rifampicin resistance. The Xpert MTB/RIF Ultra, a more sensitive version, offers results comparable to traditional culture methods but in a fraction of the time. Another significant development is the urinary lipoarabinomannan (LAM) test, which has shown clear mortality benefits, especially...

·   Background : WHO has endorsed several promising new diagnostic methods and algorithms for tuberculosis. National tuberculosis programs must decide which methods to implement and where to place them in the diagnostic process. ·   Methods : An integrated model was used to assess the effects of different diagnostic algorithms involving Xpert MTB/RIF and LED fluorescence microscopy in Tanzania. The model incorporated both operational and transmission components, representing the epidemiological context of Tanzania. The analysis compared the effects and cost-effectiveness of various diagnostic options. ·   Findings : Three strategies were identified as cost-effective in Tanzania. Full scale-up of Xpert would have the greatest population-level impact, averting 346,000 DALYs at an additional cost of $36.9 million over 10 years. The incremental cost-effectiveness ratio (ICER) of Xpert scale-up is $169 per DALY averted (95% CrI 104–265), be...