TUBERCULOSIS: Alternative Methods for Diagnosing TB

7/13 BIRMINGHAM, Ala. (Ivanhoe Newswire) –



(AP Photo)

Two new methods to diagnosing tuberculosis, an endemic infectious disease, can be used in poor countries.
One study suggests that less sputum tests collected the same day of consultation are needed and the other suggests that a faster laboratory test can be used while maintaining the same level of accuracy for diagnosis. Both studies show that alternative, less labor-intensive tests that are more convenient for patients could be effectively used in poorer countries.
The researchers enrolled 6627 patients in Ethiopia, Nepal, Nigeria and Yemen who had had a cough for more than two weeks (a characteristic symptom of tuberculosis).
In the main trial the centers participating in the study were randomly assigned each week for a year to use different methods of sputum collection. The results suggest that a sputum collection scheme in which two samples are collected one hour apart followed by a morning specimen could identify as many smear-positive patients as the standard "spot-morning-spot" scheme in which patients provide an on-the-spot specimen during their initial consultation, a specimen collected at home the next morning, and another on-the-spot specimen when they bring their morning specimen to the clinic. The study also confirmed that examination of the first two specimens alone identifies most smear-positive patients, independently of which scheme is used.
"The identification of the majority of smear-positive patients may require no more than one patient visit, and the scheme presented here has the potential to improve the diagnosis of pulmonary tuberculosis in Low and Middle-Income Countries. A single-visit diagnosis would represent a substantial opportunity to improve the delivery of TB services, particularly to the poor," the authors were quoted as saying.
In the second study, which is a sub-study of the main trial, the researchers examined nearly 2,400 patients to show that a faster laboratory test, a variant form of smear microscopy—light emitting-diode fluorescence microscopy (LED-FM)— could identify more people with tuberculosis than the standard smear microscopy test (in which technicians use a stain called Ziehl Neelsen from a patient's sputum). However LED-FM might also lead to more people without tuberculosis being needlessly treated, as this test picks up more false positives, that is, people who don't have TB but who are incorrectly classified as test-positive for the disease.
"This study has shown that LED-FM can play a key role in reaching the [World Health Organization] targets for TB detection, reducing laboratory workloads, and ensuring poor patients' access to TB diagnosis and prompt treatment," the authors said.

SOURCE: PLoS, published online July 12, 2011
http://www.cbs42.com/content/health/story/Alternative-Methods-for-Diagnosing-TB/_HsVL1rQjEGr8Fuk289xrg.cspx

Tuberculosis: Nepal

BUDDHA BASNYAT, MD : Kathmandu, Nepal:

Tuberculosis has been around for centuries. In Nepal before there was effective cure for TB with antimicrobial drugs, Ranas built sanatoriums with many pine trees in places like Tokha, north of Kathmandu above Budanilkantha. In these sanatoriums, patients, mostly Ranas would go to recuperate from the illness; but of course without proper drugs, the ambience of the place including the pine trees did little to cure the disease. Because of tremendous overcrowding and exclusively joint family arrangements in Nepal especially during the last century, TB spread like wildfire when someone in the household was affected by it. Because there was hardly any awareness of the disease, no one at that time stopped to consider the transmission of the disease via cough droplets. So no one did anything to stop the spread of the illness. But although TB without proper medicines was more deadly then, it has unfortunately continued to cause huge problems even to this day.
According to the World Health Organization ( WHO) there will be ten million new cases of tuberculosisthis year in the developing world. But the good news is that effective therapy will prevent the deaths of many of these patients. However, by the time the sick patients are diagnosed and treated, they will have infected many others in their community. Indeed, this failure of interruption continues to keep the global epidemic alive and well. So prompt diagnosis is very important in the treatment of tuberculosis to help fight the spread of the disease.
Unfortunately the techniques of diagnosis of TB are antiquated. The most widely used method to test the sputum( “khakar” in Nepali) for the tuberculosis bug is called the ZiehlNeelsen stain which is 125 years old. If this disease was still a major affliction in the Western world, to be sure there would have been new major breakthroughs in the diagnostic techniques, but basically tuberculosis is a poor man’s disease.
So it was welcome news when a few days ago the WHO endorsed the GeneXpertdevice, a rapid test for TB as “a major milestone for global tuberculosis diagnosis”.
Unlike the ZehilNeilsen technique, the GeneXpert does not need anyone to be an expert in making the sputum slide and look for the bug under the microscope. Amazingly this new molecular approach is more straightforward. After the patient spits into a cup, the sample is placed in a “espresso” machine which examines the sample’s DNA to see if it contains the genetic signature of tuberculosis. A simple, reliable “yes” or “no “ answer is available in two hours. Importantly in this time frame, the GeneXpert can determine if the bacteria is resistant to rifampicin, the most effective of the four drug cocktail prescribed for tuberculosis. This knowledge allows the doctor to know from the start if they are dealing with resistant bacteria and thus tailor therapy accordingly.
However the initial cost of about $ 30,000 for the machine and at least $ 20 for the tests are daunting rates for the developing world. Unskilled workers can carry this test out with minimal training, but electricity is required. From hospitals in Bihar to the well appointed Hinduja Hospital in Mumbai,great satisfaction has been expressed about the usefulness and accuracy of the device. But the cost continues to be an important issue, regardless of the scientific enormity of the breakthrough.
http://mediaforfreedom.com/readarticle.php?AID=17394

TUBERCULOSIS: INDIA: treatment outcomes are better among women in Nepal

Bobby Ramakant – Citizen News Service • on March 12, 2011

Tuberculosis (TB) treatment outcomes are better among women as compared to those in men, said Dr KS Sachdeva, Chief Medical Officer (CMO), Revised National TB Control Programme (RNTCP) of the Government of India. According to the RNTCP data, among new sputum positive cases of TB registered in 2009, TB treatment success rates were higher in women (89 per cent) than those in men (87 per cent) and less women dropped out of TB treatment than men (4 per cent drop out or default rate for women, and 6 per cent default rate in men). He was speaking at a focussed meeting on TB and women organized in New Delhi by Global Health Advocates (GHA) on 8th March 2011.
Although TB treatment outcomes are better in women, there are reported delays in getting women diagnosed and put on standard treatment. In a study in Nepal, women had a longer total delay before diagnosis of TB than men, said Dr KS Sachdeva.
Results from a study in Nepal comparing active and passive case finding methods showed higher detection of female TB cases by active case detection method in comparison to passive case detection method (46 per cent in women and 28 per cent in men who had TB). These facts pave the way to the assumption that female TB cases are under detected & under reported, said Dr Sachdeva.
TB is the third leading cause of death globally among women aged 15-44. In the year 2008, globally 3.6 million women got TB and 700,000 of them died due to TB. In some settings, women who become ill with TB may be stigmatized, discriminated against or ostracized by their families and communities.
In most countries men carry more of the TB burden, however more women are detected with TB in some settings such as Afghanistan, and parts of Pakistan and these conditions merit further investigation. Many community-based studies conducted by TB Research Centre (TRC), Chennai, have indicated that men are more infected with TB in India, said Dr KS Sachdeva, CMO at RNTCP in India. It is not clear to what extent these differences result from biological factors, socio-cultural contexts, and from under-recognition of TB among women due to poor access to care, said Dr Sachdeva.
According to the WHO Global TB Report 2010, men are twice as likely to get TB, said Dr KS Sachdeva as 35% of incident TB cases globally were reported in women. Dr Sachdeva said that data doesn’t support the assumption of poor health seeking behaviour or under utilization of health services among females.
Most of the RNTCP strategies are gender neutral, said Dr Sachdeva. However there are dedicated efforts being made to reach out to women and men with TB who are currently not accessing available services. Involvement of female healthcare providers and ASHA workers in RNTCP, sputum transportation schemes, choice of DOTS providers, stigma reduction through mass media, community awareness, interpersonal communication with family members, among other strategies, linking poor and vulnerable populations with social welfare schemes are some of the measures currently undertaken by RNTCP to reach out to those women and men who are currently not accessing available TB care services, said Dr KS Sachdeva.
There are dedicated social assessment studies currently ongoing to identify TB risk factors of women and other marginalised populations, said Dr Sachdeva.
TB-HIV collaborative activities are also being implemented in India although they are gender neutral yet will benefit women living with HIV too, said Dr Sachdeva.
One of the most significant achievements of RNTCP is to bring down the mortality rate from 1000 every day to 750. Saving 250 lives daily from TB is a remarkable programme achievement, said Dr Sachdeva.
A hospital based multi-centric study conducted by TRC Chennai indicated that detection of smear-positive TB per 100,000 new adult out-patients was nearly three times higher among males than females (765 in males, 253 in females). At all study sites, women were more likely than men to utilize health services with higher female: male ratio among outpatients; but the prevalence of cough and smear positive TB was more among males, said Dr KS Sachdeva.
To reach out to the unreached people with TB, it appears new active TB case detection programmes need to become more gender sensitive (and not gender neutral) so that women who need TB services and are currently being not covered by the TB programme, get their long overdue right to health. This will also have pronounced favourable public health outcomes.
http://elitestv.com/pub/2011/03/tuberculosis-treatment-outcomes-are-better-among-women