• Haiti
• food security
• low- and middle-income countries
• tuberculosis
• undernutrition

• Humans
• Haiti/epidemiology
• Female
• Male
• Prospective Studies
• Adult
• Rural Population/statistics & numerical data
• Food Insecurity
• Middle Aged
• Tuberculosis/drug therapy
• Tuberculosis/epidemiology
• Antitubercular Agents/therapeutic use
• Treatment Outcome
• Nutritional Status
• Treatment Failure

• TB immunotherapy
• TB latency
• TB vaccination
• lung inflammation
• mycobacteria and host gene expression
• tuberculosis

• Adult psychiatry
• PUBLIC HEALTH
• Substance misuse
• Tuberculosis

• Male
• Female
• Humans
• Mental Health
• Cross-Sectional Studies
• South Africa/epidemiology
• Comorbidity
• Substance-Related Disorders/epidemiology
• Tuberculosis/complications
• Tuberculosis/drug therapy
• Tuberculosis/epidemiology

• U01 AI115940 NIAID NIH HHS
• Wellcome Trust
• Medical Research Council
• NIH
• Francis Crick Institute
• Cancer Research UK

• American Indian or Alaska Native (AIAN) persons
• Health disparities
• Native Hawaiian or other Pacific Islander (NHPI) persons
• Tuberculosis

• Alaska Natives
• Humans
• Incidence
• Indigenous Peoples
• Native Hawaiian or Pacific Islander
• Tuberculosis/epidemiology
• United States/epidemiology

• CC999999 Intramural CDC HHS

• Adolescent
• Adult
• Contact Tracing
• Cross-Sectional Studies
• DNA, Bacterial/chemistry
• DNA, Bacterial/metabolism
• Diphenhydramine/administration & dosage
• Diphenhydramine/urine
• Drug Combinations
• Drug Users/statistics & numerical data
• Female
• Humans
• Male
• Methamphetamine/administration & dosage
• Methamphetamine/urine
• Methaqualone/administration & dosage
• Methaqualone/urine
• Mycobacterium tuberculosis/genetics
• Mycobacterium tuberculosis/isolation & purification
• Reagent Kits, Diagnostic
• Registries
• South Africa
• Sputum/microbiology
• Surveys and Questionnaires
• Tuberculosis/diagnosis
• Tuberculosis/transmission
• Young Adult

• R01 AI147316 NIAID NIH HHS
• National Institute of Allergy and Infectious Diseases

• clinical pharmacology
• infectious diseases
• substance misuse
• tuberculosis

• Antitubercular Agents/therapeutic use
• Catha
• Cross-Sectional Studies
• Ethiopia/epidemiology
• Humans
• Medication Adherence
• Prospective Studies
• Substance-Related Disorders/epidemiology

• individual (Dr. Michael Odenwald)
• Institute of Psychiatric Phenomics and Genomics (IPPG)
• Jimma University Institute of Health

After traumatic brain injury (TBI), an inflammatory response in the brain might affect the immune system. The risk of pulmonary infection reportedly increases in patients with TBI. We aimed to evaluate the risk of tuberculosis (TB) in patients with TBI in Taiwan. All participants were selected from the intensive care unit (ICU). Patients with TBI were defined as patients in ICU with intracranial injury, and comparison cohort were patients in ICU without TBI diagnosis. There was a significant difference in TB risk between the patients with TBI and the comparison cohort according to age and the Charlson’s comorbidity index (CCI) score. Thus, we divided patients based on CCI into three groups for further analysis: mild (CCI = 0), moderate (CCI = 1/2), severe (CCI > 2). Mild-CCI group had a lower TB incidence rate (0.74%) and longer time to TB development (median: 2.43) than the other two groups. Moderate-CCI group had 1.52-fold increased risk of TB infection (p < 0.0001) compared with mild-CCI group. In the severe-CCI group, patients aged ≥ 80 years had 1.91-fold risk of TB compared with mild-CCI group (p = 0.0481). Severe-CCI group had significantly higher mortality than the mild-CCI group (p = 0.0366). Patients with TBI and more comorbidities had higher risk of TB infection with higher mortality rate.

• HIV
• Mortality
• Transmission
• Tuberculosis

• Adolescent
• Adult
• Aged
• Female
• HIV Infections/epidemiology
• Humans
• Male
• Middle Aged
• Risk Factors
• Tuberculosis/mortality
• Tuberculosis/transmission
• United States/epidemiology
• Young Adult

• CC999999 Intramural CDC HHS
• n/a CDC HHS

Despite considerable efforts to control tuberculosis (TB) among Ethiopian immigrants in Israel, an outbreak of TB among second-generation Ethiopian immigrants that involved native Israelis occurred between January 2011 and December 2019. The aim of this article is to report on this outbreak and discuss the patient and health system barriers that led to its propagation. Overall, 13 culture-positive TB patients were diagnosed in this outbreak. An additional 36 cases with identical mycobacterium tuberculosis genotypes were identified through cross-checking with the National TB Laboratory Registry. Among the 32 close contacts of the index case, 18 (56.3%) reported for screening and treatment of latent TB infection (LTBI) was recommended for 11 (61.1%) of them. However, none completed treatment and eight eventually developed TB. Of the 385 close contacts identified in this outbreak, 286 (74.3%) underwent contact investigation, 154 (53.8%) were recommended LTBI treatment, but only 26 (16.9%) completed the treatment. Routine contact investigation and treatment practice measures failed to contain the cascade of infection and disease, leading to the spread of the infecting strain of TB. This report highlights the challenges to identify the high-risk group and address barriers to care among such a vulnerable population.

• Epidemiology
• Tuberculosis (TB)
• infectious disease
• public health

Addressing social determinants of tuberculosis (TB) is essential to achieve elimination, including in low-incidence settings. We measured the association between socio-economic status and intermediate social determinants of health (SDHs, including drug misuse, tobacco smoking and alcohol), and TB, taking into account their clustering in individuals. We conducted a case-control study in 23–38 years old UK-born White adults with first tuberculosis episode, and randomly selected age and sex frequency-matched community controls. Data was collected on education, household overcrowding, tobacco smoking, alcohol and drugs use, and history of homelessness and prison. Analyses were done using logistic regression models, informed by a formal theoretical causal framework (Directed Acyclic Graph). 681 TB cases and 1183 controls were recruited. Tuberculosis odds were four times higher in subjects with education below GCSE O-levels, compared to higher education (OR = 3.94; 95%CI: 2.74, 5.67), after adjusting for other TB risk factors (age, sex, BCG-vaccination and stays ≥3 months in Africa/Asia). When simultaneously accounting for respective SDHs, higher tuberculosis risk was independently associated with tobacco smoking, drugs use (especially injectable drugs OR = 5.67; 95%CI: 2.68, 11.98), homelessness and area-level deprivation. Population Attributable Fraction estimates suggested that tobacco and class-A drug use were, respectively, responsible for 18% and 15% of TB cases in this group. Our findings suggest that socio-economic deprivation remains a driver of tuberculosis in England, including through drugs misuse, tobacco smoking, and homelessness. These findings further support the integration of health and social services in high-risk young adults to improve TB control efforts.

• Drug use
• HIV
• Infections
• Infectious diseases
• Injecting drug use

• Disease control
• Epidemiology
• Tuberculosis
• United States

• Humans
• Incidence
• Tuberculosis/epidemiology
• United States

• CC999999 Intramural CDC HHS

• Alcohol
• Epidemiology
• Health care disparities
• Health care utilization
• Tuberculosis

• food insecurity
• high-risk behavior
• malnutrition
• mental health
• tuberculosis

In this chapter, we will explore a case involving an outbreak of tuberculosis that occurred among men living in a homeless shelter. The case delves into both the public health challenges involved in investigating a disease outbreak in a vulnerable population and the delicate balance of protecting individuals’ autonomy and confidentiality while protecting the public’s health. By the conclusion of the case, learners will be able to apply the socioecological model to tuberculosis, analyze an outbreak of disease using epidemiologic tools, and identify conflicts in balancing autonomy and justice while managing potential public health threats.

• Acute respiratory distress syndrome
• Endocarditis
• Interstitial
• Lung cancer
• Mimic
• Pneumonia
• Tuberculosis
• Vasculitis

• Diagnosis, Differential
• Endocarditis/diagnosis
• Endocarditis/physiopathology
• Humans
• Lung Diseases, Interstitial/diagnosis
• Lung Diseases, Interstitial/physiopathology
• Lung Neoplasms/diagnosis
• Lung Neoplasms/physiopathology
• Pneumonia/diagnosis
• Pneumonia/physiopathology
• Pulmonary Alveoli/blood supply
• Pulmonary Alveoli/physiopathology
• Radiography/methods
• Respiratory Distress Syndrome/diagnosis
• Respiratory Distress Syndrome/physiopathology
• Tomography, X-Ray Computed/methods
• Tuberculosis/diagnosis
• Tuberculosis/physiopathology
• Vasculitis/diagnosis
• Vasculitis/physiopathology

Prospective universal genotyping of tuberculosis (TB) isolates is used by many laboratories to detect clusters of cases and inform contact investigations. Prior to universal genotyping, most TB prevention programs genotyped isolates on request only, relying on requests from public health professionals whose knowledge of a patient's clinical, demographic, and epidemiological characteristics suggested potential transmission. To justify the switch from on-request to universal genotyping—particularly in the public health domain, with its limited resources and competing priorities—it is important to demonstrate the additional benefit provided by a universal genotyping program. We compared the clustering patterns revealed by retrospective 24-locus mycobacterial interspersed repetitive unit–variable-number tandem repeat genotyping of all culture-positive isolates over a 5-year period to the patterns previously established by our genotyping-on-request program in the low-incidence setting of British Columbia, Canada. We found that 23.8% of isolates were requested during the study period, and while requested isolates had increased odds of belonging to a genotype cluster (adjusted odds ratio, 2.3; 95% confidence interval, 1.5 to 3.3), only 54.6% clustered with the requested comparator strain. Universal genotyping revealed 94 clusters ranging in size from 2 to 53 isolates (mean = 5) and involving 432 individuals. On-request genotyping missed 54 (57.4%) of these clusters and 130 (30.1%) clustered individuals. Our results underscore that TB patient networks are complex, with unrecognized linkages between patients, and a prospective province-wide universal genotyping program provides an informative, bias-free tool to explore transmission to a degree not possible with on-request genotyping.

• MIRU-VNTR genotyping
• program assessment
• tuberculosis

• Alcohol Drinking/prevention & control
• Diabetes Mellitus/prevention & control
• Global Burden of Disease/statistics & numerical data
• Global Burden of Disease/trends
• Global Health/statistics & numerical data
• Global Health/trends
• HIV Infections/prevention & control
• Humans
• Incidence
• Prevalence
• Risk Factors
• Smoking
• Smoking Prevention
• Tuberculosis/epidemiology
• Tuberculosis/mortality

• Wellcome Trust
• 201900 Wellcome Trust
• 201900/Z/16/Z Wellcome Trust

• disease outbreaks
• drug resistance
• homeless people
• infection control
• tuberculosis

• Adolescent
• Adult
• Disease Outbreaks
• Drug Resistance, Bacterial
• Female
• Georgia/epidemiology
• Ill-Housed Persons
• Humans
• Male
• Middle Aged
• Mycobacterium tuberculosis/drug effects
• Mycobacterium tuberculosis/isolation & purification
• Tuberculosis/drug therapy
• Tuberculosis/epidemiology
• Young Adult

• disease outbreaks
• infection control
• tuberculosis

Although the prevalence of tuberculosis has decreased significantly over the past decades, the certain populations with mental illness are at increased risk for tuberculosis infection and transmission. However, no studies have examined the performance of different laboratory examination methods among people with severe mental illness in China.

In this study, we firstly performed a retrospective study to evaluate the feasibility of three routine laboratory methods, including sputum microscopy, solid culture and GeneXpert, to diagnose tuberculosis patients with mental illness.

During August 2010 and March 2013, a total of 251 TB patients based on clinical and radiographic criteria with severe mental illness were enrolled in this study. The majority of patients was homeless (97/251, 38.6%), and the other 62 (24.7%) and 92 (36.7%) were from urban and rural region, respectively. The most frequently diagnosed mental illness was schizophrenia, accounting for 84.1% (211/251) of patients available for analysis. In addition, the laboratory received 753 sputum samples collected from these 251 TB patients, of which 76.0% (572/753) of samples were classified as salivary sputum, which were unqualified for microscopy and culture. When the test results were analyzed by patients, the positive numbers of TB patients detected by sputum microscopy, solid culture and GeneXpert were 3 (1.2%), 5 (2.0%) and 5 (2.0%), respectively.

In conclusion, our findings reveal that the current laboratory examinations based on sputum samples seem not to be suitable for the diagnosis of active TB in the persons with severe mental illness. The products using a non-invasive specimen such as urine deserve further evaluation, which may generate benefit for the early diagnosis of TB in this special population.

• Barriers
• HIV
• Health outcomes
• Homeless
• Infectious disease
• Inmates
• Minorities
• Underserved populations

• Chronic medical condition
• Criminal justice
• Drug abuse
• Drug court
• Health care
• Substance use disorder

Lack of trust in government-supported services after the death of a health care worker with symptoms of Ebola resulted in ongoing Ebola transmission in 2 Liberia counties. Ebola transmission was facilitated by attempts to avoid cremation of the deceased patient and delays in identifying and monitoring contacts.

• Ebola
• Ebola virus disease
• Liberia
• cluster investigation
• contact tracing
• trust
• viruses

• Adolescent
• Adult
• Aged
• Cluster Analysis
• Contact Tracing
• Fatal Outcome
• Female
• Hemorrhagic Fever, Ebola/diagnosis
• Hemorrhagic Fever, Ebola/transmission
• Humans
• Liberia
• Male

• genotype
• transmission
• tuberculosis

• Singapore
• TB
• characteristics
• ethnic group
• operational research

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Odds Ratio
• Postoperative Complications/etiology
• Taiwan
• Tuberculosis, Pulmonary/complications
• Young Adult

• substance use
• mycobacterium tuberculosis
• directly observed therapy
• sputum culture
• culture conversion

• Adolescent
• Adult
• Aged
• Alcohol Drinking/epidemiology
• Antitubercular Agents/therapeutic use
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Prevalence
• Risk Factors
• Sputum/microbiology
• Treatment Outcome
• Tuberculosis/drug therapy
• Tuberculosis/epidemiology
• United States/epidemiology
• Young Adult

• CC999999 Intramural CDC HHS

• grounded theory
• health system delay
• patient delay
• tuberculosis

• Taiwan National Health Insurance Research Database
• liver cirrhosis
• risk factor
• tuberculosis

• Adolescent
• Adult
• Age Factors
• Alcoholism/complications
• Case-Control Studies
• Female
• Hepatitis C/complications
• Humans
• Kaplan-Meier Estimate
• Liver Cirrhosis/complications
• Liver Cirrhosis/epidemiology
• Longitudinal Studies
• Male
• Middle Aged
• Proportional Hazards Models
• Risk Factors
• Sex Factors
• Taiwan/epidemiology
• Tuberculosis, Pulmonary/epidemiology
• Tuberculosis, Pulmonary/etiology
• Young Adult

Selection of the appropriate donor is essential to a successful allograft recipient outcome for solid organ transplantation. Multiple infectious diseases have been transmitted from the donor to the recipient via transplantation. Donor-transmitted infections cause increased morbidity and mortality to the recipient. In recent years, a series of high-profile transmissions of infections have occurred in organ recipients prompting increased attention on the process of improving the selection of an appropriate donor that balances the shortage of needed allografts with an approach that mitigates the risk of donor-transmitted infection to the recipient. Important advances focused on improving donor screening diagnostics, using previously excluded high-risk donors, and individualizing the selection of allografts to recipients based on their prior infection history are serving to increase the donor pool and improve outcomes after transplant. This article serves to review the relevant literature surrounding this topic and to provide a suggested approach to the selection of an appropriate solid organ transplant donor.

• Donor selection
• Infection
• Transplantation
• Mass screening
• Treatment outcome

• India
• alcohol
• multidrug-resistant tuberculosis
• multidrug-resistant tuberculosis treatment outcome
• tuberculosis

• Adult
• Alcohol Drinking/adverse effects
• Alcohol Drinking/epidemiology
• Antitubercular Agents/therapeutic use
• Female
• Follow-Up Studies
• Humans
• Incidence
• India/epidemiology
• Male
• Middle Aged
• Mycobacterium tuberculosis/isolation & purification
• Population Surveillance
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Sputum/microbiology
• Survival Rate/trends
• Treatment Outcome
• Tuberculosis, Multidrug-Resistant/drug therapy
• Tuberculosis, Multidrug-Resistant/epidemiology
• Tuberculosis, Multidrug-Resistant/microbiology

• 001 World Health Organization
• CC999999 Intramural CDC HHS

In Russia, active case finding (ACF) for certain population groups has been practiced uninterruptedly for many decades, but no studies comparing ACF and passive case finding (PCF) approaches in Russia have been published.

The aim of this study was to describe the main differences in symptoms and diagnostic delay between patients who come to TB services through PCF and ACF strategies.

A cross-sectional study was conducted among 453 new pulmonary tuberculosis (PTB) patients, who met criteria of TB diagnostic delay in Arkhangelsk.

ACF patients used self-treatment more often than PCF patients (90.1% vs. 24.6%) and 36.3% of them were alcohol abusers (as opposed to only 26.2% of PCF patients). The median patient delay (PD) in PCF was 4 weeks, IQR (1–8 weeks), and less than 1 week in ACF. Twenty-three per cent of the PCF patients were seen by a medical provider within the first week of their illness onset.

Patients diagnosed through ACF tended to under-report their TB symptoms and showed low attention to their own health. However, ACF allowed for discovering TB patients earlier than PCF, and this was also the case for alcohol abusing patients. PCF systems should be supplemented with ACF strategies.

• active and passive case finding
• diagnostic delay
• tuberculosis

Control of tuberculosis (TB) depends on early diagnosis and treatment at the primary health care level. However, many patients are still diagnosed late with TB at hospitals. The present study aimed to investigate the delay in diagnosis of TB patients at the emergency department.

This was a prospective study in a general, tertiary care, university-affiliated hospital of a city with a high prevalence of TB in Brazil. New TB patients ≥ 14 years diagnosed with pulmonary TB at the emergency department of Hospital de Clínicas de Porto Alegre were prospectively recruited between February 2010 and January 2012. The consenting patients meeting our inclusion criteria were interviewed using a pre-tested questionnaire. We evaluated the delay in time until diagnosis and identified factors associated with delayed diagnosis (patient and health care system delays).

We included 153 patients. The median total time of delay, patient delay, and health care system delay were 60 (interquartile range [IQR]: 30–90.5 days), 30 (lQR: 7–60 days), and 18 (IQR: 9–39.5 days) days, respectively. The factors that were independently associated with patient delay (time ≥ 30 days) were crack (odds ratio [OR] = 4.88, p = 0.043) and cocaine (OR = 6.68, p = 0.011) use. The factors that were independently associated with health care system delay (time ≥ 18 days) were weight loss (OR = 2.76, p = 0.025), miliary pattern (OR = 5.33, p = 0.032), and fibrotic changes (OR = 0.12, p = 0.013) on chest X-ray.

Patient delay appears to be the main problem in this city with a high prevalence of TB in Brazil. The main factor associated with patient delay is drug abuse (crack and cocaine). Our study shows substance abuse programs need to be aware of control of TB, with health interventions focusing on TB education programs.