[Predictive factors for recurrence of pulmonary tuberculosis in Tunisia: A retrospective study].

Rev Mal Respir. 2012 Mar;29(3):412-8

Authors: Racil H, Ben Amar J, Mami M, Chabbou A

Abstract
INTRODUCTION: Tuberculosis is still endemic in Tunisia. Even though recurrent TB (RT) is rare, there is an increased risk of resistance. The purpose of this study is to investigate predictors of RT.
PATIENTS AND METHODS: This was a case controlled retrospective study, comparing two groups of patients with confirmed pulmonary tuberculosis: a relapse group (GR) of 64 patients with RT and a control group (GT) of 105 patients.
RESULTS: Between September 1995 and December 2007, the incidence of RT was 9.48%. All the patients were male. There was no difference in the average age of the two groups. A smoking history of greater than 20 pack-years was more common in the GR (44.89% versus 21.4%, P=0.055). No difference was found regarding the history and clinical signs except that chest pain and dyspnoea were more frequent in the GR. A low haemoglobin was more common in the GR (11.33±1.57g/dL versus 12.41±1.66g/dL, P=0.008). The tuberculin skin test was negative in 73.7% of GR versus 31.1% of GT (P=0.001). Adverse liver reactions are more frequent in the GR (27.3% versus 8.6%, P<0.05). Discontinuation of TB treatment was more common in the GR (36.7% versus 3.8%, P<0.001). The achievement of sputum negativity was delayed in the GR (46.32±54.01 versus 9.35±11.84 days, P<0.001). Despite this, we have noted no significant difference in drug resistance. In multivariate analysis, hepatic cytolysis and a negative tuberculin skin test were independent predictive factors for RT.
CONCLUSION: All tuberculous patients should have a carefully adapted treatment regimen, particularly the presence of factors predictive for recurrence.

PMID: 22440306 [PubMed - in process]

HIV and tuberculosis: The construction and management of double stigma.

Soc Sci Med. 2012 Mar 7;

Authors: Daftary A

Abstract
Mitigation of the tuberculosis (TB) and HIV syndemic is undermined by critical clinical, operational and social challenges of which the social aspects have been least explored. This paper examines the lived experience of TB disease and HIV from the perspective of affected individuals to analyze how they may think about their dual illness; how they understand their illness with TB in relation to HIV, and vice versa; and how they characterize their (stigmatized) experiences in the context of their perceptions and identities. From February-August 2009, qualitative, semi-structured interviews were conducted with 40 adults with HIV and TB disease at three ambulatory clinics in KwaZulu-Natal, South Africa. Subjective meanings of illness experience were analyzed using modified grounded-theory. Emergent themes on illness perception and disclosure revealed how patients constructed dichotomous identities associated with TB and HIV through social constructs of moral susceptibility and (im)permanence. Each identity was associated with relatively disparate degrees of stigma as a product of labeling, negative stereotyping and discrimination. HIV bore the least desirable identity and invoked the greatest stigma. However, the confluence of the two epidemics rendered TB symbolic and symptomatic of HIV, and enhanced the visibility of AIDS. Dual illness thus introduced a paradox to patients' identity constructions, and produced a unique, overlapping double stigma. This facilitated new forms of stigma against TB, and aggravated existing stigma against HIV. It also conferred visibility to some forms of extra-pulmonary TB. Patients managed their double stigmas through novel forms of information sharing that relied on segregating their dual illness identities. Patients deflected the dominant stigma of HIV through concurrent processes of HIV 'othering' - their symbolic distancing from persons affected by HIV, and 'covering' - their selective disclosure of illness (and identity associated) with TB over that of HIV. Findings call for greater consideration to the complex role of stigma in the delivery of TB/HIV healthcare.

PMID: 22444460 [PubMed - as supplied by publisher]

Host-pathogen interactions in tuberculosis should be studied at the disease site because Mycobacterium tuberculosis is predominately contained in local tissue lesions.

Although M. tuberculosis infection involves different clinical forms of tuberculosis, such as pulmonary tuberculosis, pleural tuberculosis, and lymph node tuberculosis, most studies of human tuberculosis are performed using cells from the peripheral blood, which may not provide a proper reflection of the M. tuberculosis-specific immune responses induced at the local site of infection. A very low proportion of M. tuberculosis-specific effector T cells are found in the blood compared with the infected tissue, and thus there may be considerable differences in the cellular immune response and regulatory mechanisms induced in these diverse compartments. In this review, we discuss differences in the immune response at the local site of infection compared with the peripheral circulation.

The cell types and immune reactions involved in granuloma formation and maintenance as well as the in situ technologies used to assess local tuberculosis pathogenesis are also described.

We need to strengthen and improve the exploratory strategies used to dissect immunopathogenesis in human tuberculosis with the aim to accelerate the implementation of relevant research findings in clinical practice.

Conventional and molecular techniques were applied to detect and characterize drug resistance of mycobacteria in the sputum samples of clinically confirmed tuberculosis. The sensitivity of mycobacteria detection by ZN staining, culture, multiplex-PCR and RFLP were 27.7%, 19.9%, 92.9% and 95.7%, respectively, but all were 100% specific.

The conventional and MAS-PCR methods enabled establishment of the drug resistance in 19.3% and 86.9% cases, respectively. We demonstrated that molecular techniques have potential in accurate diagnosis of tuberculosis.