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Fulltext Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis

Nathavitharana RR, Bond P, Dramowski A, Kotze K, Lederer P, Oxley I, et al.

Presse Med, 2017 Mar;46(2 Pt 2):e53-e62.
PMID: 28256382 DOI: 10.1016/j.lpm.2017.01.014

Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired well-being in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection (LTBI) can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.

Matched MeSH terms: Latent Tuberculosis/epidemiology
Evidence and potential risk factors of tuberculosis among captive Asian elephants and wildlife staff in Peninsular Malaysia

Yakubu Y, Ong BL, Zakaria Z, Hassan L, Mutalib AR, Ngeow YF, et al.

Prev Vet Med, 2016 Mar 1;125:147-53.
PMID: 26775804 DOI: 10.1016/j.prevetmed.2016.01.008

Elephant tuberculosis (TB) caused by Mycobacterium tuberculosis is an important re-emerging zoonosis with considerable conservation and public health risk. We conducted prospective cohort and cross-sectional studies in elephants and wildlife staff respectively in order to identify potential risk factors associated with TB in captive Asian elephants and their handlers in Peninsular Malaysia. Sixty elephants in six different facilities were screened for TB longitudinally using the ElephantTB STAT-PAK and DPP VetTB assays from February 2012 to May 2014, and 149 wildlife staff were examined for tuberculosis infection using the QuantiFERON-TB Gold In-tube (QFT) assay from January to April, 2012. Information on potential risk factors associated with infection in both elephants and staff were collected using questionnaires and facility records. The overall seroprevalence of TB amongst the elephants was 23.3% (95% CI: 13.8-36.3) and the risk of seroconversion was significantly higher among elephants with assigned mahouts [p=0.022, OR=4.9 (95% CI: 1.3-18.2)]. The percentage of QFT responders among wildlife staff was 24.8% (95% CI: 18.3-32.7) and the risk of infection was observed to be significantly associated with being a zoo employee [p=0.018, OR=2.7 (95% CI: 1.2-6.3)] or elephant handler [p=0.035, OR=4.1 (95% CI: 1.1-15.5)]. These findings revealed a potential risk of TB infection in captive elephants and handlers in Malaysia, and emphasize the need for TB screening of newly acquired elephants, isolating sero-positive elephants and performing further diagnostic tests to determine their infection status, and screening elephant handlers for TB, pre- and post-employment.

Matched MeSH terms: Latent Tuberculosis
Fulltext Tuberculosis and biologics - a glimpse of Sabah rheumatology patients

Le Low, Darman Shah N. S., Mohd Noh M., Y. Y. Chong

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):66-66.
MyJurnal

Introduction: Biologic patients are at increased risk of tuberculosis (TB) infection, especially in TB prevalent areas like Sabah. We present three cases of rheumatology patients who developed tuberculosis infection while on bi-ologics. Case description: Case1: 47 year old lady with active rheumatoid arthritis despite being on four disease modifying antirheumatic drugs (DMARDS) was given subcutaneous Etanercept after prescreening with mantoux test and interferon gamma release assay (IGRA). Due to poor response, she was switched to Tofacitinib with a repeat pre-screening done except IGRA. Three months after biologics, she developed pulmonary tuberculosis and Tofacitinib was stopped. Case2: 50 year old male with seropositive rheumatoid arthritis and seroconverted hepatitis B. He was worked up for biologic treatment after failing multiple DMARDS; mantoux was 10mm, IGRA not done. He was start-ed on subcutaneous Etanercept for disabling arthritis while being treated for latent TB but developed TB Lymphadeni-tis on his third month of biologic therapy which was withheld thereafter. Case3:48 year old teacher with seropositive rheumatoid arthritis and old pulmonary TB, had intolerance to methotrexate, was initiated on three DMARDS but symptoms remained uncontrolled. Prescreening with IGRA was negative and Adalimumab commenced. Following two years of biologic, she developed reactivation of TB. Rituximab was commenced a year after for persistent active arthritis but withheld due to dermatitis. Conclusion: All patients had mantoux test done routinely but not IGRA due to its cost and limited availability. A follow up study to analyze the effectiveness of IGRA versus Mantoux in detecting latent TB in such patients would be beneficial.

Matched MeSH terms: Latent Tuberculosis
Fulltext Chromosomal rearrangements and protein globularity changes in Mycobacterium tuberculosis isolates from cerebrospinal fluid

Saw SH, Tan JL, Chan XY, Chan KG, Ngeow YF

PeerJ, 2016;4:e2484.
PMID: 27688977 DOI: 10.7717/peerj.2484

BACKGROUND: Meningitis is a major cause of mortality in tuberculosis (TB). It is not clear what factors promote central nervous system invasion and pathology but it has been reported that certain strains of Mycobacterium tuberculosis (Mtb) might have genetic traits associated with neurotropism.
METHODS: In this study, we generated whole genome sequences of eight clinical strains of Mtb that were isolated from the cerebrospinal fluid (CSF) of patients presenting with tuberculous meningitis (TBM) in Malaysia, and compared them to the genomes of H37Rv and other respiratory Mtb genomes either downloaded from public databases or extracted from local sputum isolates. We aimed to find genomic features that might be distinctly different between CSF-derived and respiratory Mtb.
RESULTS: Genome-wide comparisons revealed rearrangements (translocations, inversions, insertions and deletions) and non-synonymous SNPs in our CSF-derived strains that were not observed in the respiratory Mtb genomes used for comparison. These rearranged segments were rich in genes for PE (proline-glutamate)/PPE (proline-proline-glutamate), transcriptional and membrane proteins. Similarly, most of the ns SNPs common in CSF strains were noted in genes encoding PE/PPE proteins. Protein globularity differences were observed among mycobacteria from CSF and respiratory sources and in proteins previously reported to be associated with TB meningitis. Transcription factors and other transcription regulators featured prominently in these proteins. Homologs of proteins associated with Streptococcus pneumoniae meningitis and Neisseria meningitidis virulence were identified in neuropathogenic as well as respiratory mycobacterial spp. examined in this study.
DISCUSSION: The occurrence of in silico genetic differences in CSF-derived but not respiratory Mtb suggests their possible involvement in the pathogenesis of TBM. However, overall findings in this comparative analysis support the postulation that TB meningeal infection is more likely to be related to the expression of multiple virulence factors on interaction with host defences than to CNS tropism associated with specific genetic traits.

Matched MeSH terms: Latent Tuberculosis
Fulltext Prevalence and Factors Associated with Tuberculosis Treatment Success among TB/HIV Co-Infection in North-East Malaysia

Jalal TMT, Abdullah S, Wahab FA, Dir S, Naing NN

Malays J Med Sci, 2017 Dec;24(6):75-82.
PMID: 29379389 DOI: 10.21315/mjms2017.24.6.9

Background: One of the six strategies developed by WHO, in order to stop Tuberculosis (TB) is addressing TB/HIV high-risk groups. This study aimed to determine the prevalence of successful TB treatment and factors associated with TB treatment success among TB/HIV co-infection patients in North-East Malaysia.
Methods: A cross-sectional study was carried out in the a-year period from 2003 to 2012 by reviewing TB/HIV records in all hospitals and health clinics. The outcome of interest was treatment success as defined by Ministry of Health (MOH) when the patients was cured or completed TB treatment.
Results: Out of 1510 total TB/HIV co-infection cases, 27.9% (95% CI: 25.2, 30.6) of the patients were having treatment success. A majority of TB/HIV co-infection cases were male (91.1%). Fifty-eight percent the patients were drug addicts and 6% were having positive tuberculin tests. The multiple logistic regression revealed that male (OR: 0.39, 95% CI: 0.22, 0.71) and positive tuberculin test result (OR: 2.61, 95% CI: 1.63, 4.19) were significantly associated with the treatment success of TB/HIV co-infection patients. Other factors such as age, comorbid, sputum smear and x-ray findings were not significantly factors in this study.
Conclusion: Female patients and those with negative tuberculin test should be emphasised for successful tuberculosis treatment.

Matched MeSH terms: Latent Tuberculosis
Fulltext A review of tuberculosis research in Malaysia

Swarna Nantha Y

Med J Malaysia, 2014 Aug;69 Suppl A:88-102.
PMID: 25417956 MyJurnal

One hundred seventy four articles related to tuberculosis were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred fifty three articles were selected and reviewed on the basis of clinical relevance and future research implications. Topics related to epidemiology, clinical presentation, detection methods and treatment were well researched. However, limited information was available on screening and behavioural interventions. The younger population were more vulnerable to tuberculosis infection and had higher prevalence of risk factors that reactivate tuberculosis infection. Screening of tuberculosis was conducted primarily on healthcare workers, tuberculosis contacts, prisoners and foreign workers. Data on the clinical presentation of pulmonary and extrapulmonary tuberculosis was comprehensive. There was a general focus on related risk factors such as HIV and diabetes mellitus. A great degree of information was available on the treatment and various detection methods to identify tuberculosis. The efficacy and the practicality of investigative methods was analysed in this review. In conclusion, the direction of research should be aimed at novel preventive and control measures of tuberculosis. There should be emphasis on the screening of high risk groups (other than HIV) within the population namely diabetic patients, smokers and immunosuppressed individuals. The design of health policies should be guided by information gathered from research evaluation of communitybased behavioural interventions.

Matched MeSH terms: Latent Tuberculosis
Fulltext Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn's disease in Asia

Ooi CJ, Hilmi I, Banerjee R, Chuah SW, Ng SC, Wei SC, et al.

Intest Res, 2019 Jul;17(3):285-310.
PMID: 31146509 DOI: 10.5217/ir.2019.00026

The Asia-Pacific Working Group on inflammatory bowel disease (IBD) was established in Cebu, Philippines, under the auspices of the Asian Pacific Association of Gastroenterology with the goal of improving IBD care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in the conjunction with conventional treatments for ulcerative colitis (UC) and Crohn's disease (CD) in Asia. These statements also address how pharmacogenetics influence the treatments of UC and CD and provide guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of IBD workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing and future revisions are likely as new data continue to emerge.

Matched MeSH terms: Latent Tuberculosis
Fulltext Knowledge and practice among nurses on management of tuberculosis in a teaching hospital

Hng, S.H., Siti Nabihah, S., Siti Nabilah, S.

Medicine & Health, 2018;13(1):153-164.
MyJurnal

Tuberculosis (TB) has become a worldwide public concern with 10.4 million new cases reported in 2015 and 1.4 million deaths. More importantly, an increase in trend in TB incidence among healthcare workers has become a major concern. Therefore, the present study was conducted to explore the knowledge and practice towards TB and the factors associated with it among nurses in a teaching hospital. The present study used cross-sectional design and stratified sampling method. A total of 275 nurses in a teaching hospital participated in this study. The knowledge and practice on management of TB was measured using a structured questionnaire. Majority of the respondents had good knowledge and practice on management of TB represented by 70.2% and 63.3%, respectively. However, knowledge gap (1.8%) and practice gap (0.4%) were identified in method of sputum collection. Work place setting was the only demographic factor found significantly associated with level of knowledge and practice (p=0.028). Level of knowledge and practice on management of TB identified among nurses was not associated with many socio-demographic factors. Nurses as frontline healthcare workers are at high risk of being exposed due to frequent contact with various patients especially those who are undiagnosed and TB suspect patients. Hence, implementation of TB Infection Control (TBIC) measures is important to minimize the risk of infection and cross-infection within hospital.

Matched MeSH terms: Latent Tuberculosis
Fulltext Factors associated with tuberculosis among children and adolescents in kelantan: a cross-sectional study

Hafizuddin Awang

Malaysian Journal of Paediatrics and Child Health, 2018;24(1):1-14.
MyJurnal

Objectives: This study aimed to estimate the proportion of tuberculosis patients among children and adolescents, to describe the socio-demography and clinical factors for tuberculosis infection among children and adolescents in Kelantan from 2012 until 2015. Methods: This study was a retrospective cross-sectional study between tuberculosis and non-tuberculosis cases among children and adolescents using Tuberculosis Information System as a source population. All notified cases that fulfilled the inclusion and exclusion criteria were included in the study. Descriptive statistics, simple and multiple logistic regressions were used for data analysis. Results: Out of 5412 tuberculosis cases, 8.4% were children and adolescents group with mean age of 15. Among 322 children and adolescents with tuberculosis, majority of them were Malay (91.2%), 7.5% illiterate and 79.6% resided in non-urban area. By clinical factors, 2.8% were Human Immunodeficiency Virus (HIV) positive and 14.6% were cigarettes smokers. Older age, cigarettes smoking, female gender, Malay ethnicity, good education level and non-urban residence were the significant associated factors for tuberculosis infection among children and adolescents with AOR 1.41 (95%CI: 1.29,1.54; p

Matched MeSH terms: Latent Tuberculosis
Fulltext An evaluation of treatment outcome in tuberculosis directly observed treatment short course facilities in Jigawa State, Nigeria (2010–2014)

Faisal, M., Moniruddin, C., Alauddin, A.B.M.C.

JUMMEC, 2017;20(2):1-7.
MyJurnal

Tuberculosis (TB) is a major public health problem worldwide. It is estimated that 2 billion people, a third of
the world population, have TB infection, but are not down with the disease. Globally, incident cases of TB
showed a rising trend, with a 6.6 million reported in 1990, 8.3 million in 2000, 9.24 million in 2004, and an
estimated 9.27 million incident cases in 2007. The aim of this study was to evaluate the treatment outcome of
TB patients in Nigeria in the state of Jigawa. A cross sectional retrospective study was conducted to evaluate the
treatment outcome in directly observed treatment with a short course for tuberculosis (TB DOTS) in facilities
in the state between the years 2010 to 2014. The study population were all the patients with TB, who had
access to DOTS therapy. Data were collected from the various local governmental areas for tuberculosis control
(LGA TB) register. The LGA TB control registers contained basic information of the patients, and a statistical
software SPSS-V22.0 was used to analyse the data. A total of 963 TB patients were studied. More than half
(57.4%) of the patients were male, and nearly three- fourths (71.2%) of the patients accessed care from urban
local government areas in the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis
(PTB). Among the patients, more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them
were HIV positive. This study revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria
was higher than the overall TSR of Nigeria, and the defaulter rate in this state was lower than the Nigerian
average. The aim of this study was to evaluate the treatment outcome of TB patients in Nigeria in the state
of Jigawa. A cross sectional retrospective study was conducted to evaluate the treatment outcome in directly
observed treatment with a short course for tuberculosis (TB DOTS) in facilities in the state between the years
2010 to 2014. The study population were all the patients with TB, who had access to DOTS therapy. Data were
collected from the various local governmental areas for tuberculosis control (LGA TB) register. The LGA TB
control registers contained basic information of the patients, and a statistical software SPSS-V22.0 was used
to analyse the data. A total of 963 TB patients were studied. More than half (57.4%) of the patients were
male, and nearly three- fourths (71.2%) of the patients accessed care from urban local government areas in
the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis (PTB). Among the patients,
more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them were HIV positive. This study
revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria was higher than the overall TSR
of Nigeria, and the defaulter rate in this state was lower than the Nigerian average.

Matched MeSH terms: Latent Tuberculosis
Fulltext Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 2: management

Park DI, Hisamatsu T, Chen M, Ng SC, Ooi CJ, Wei SC, et al.

Intest Res, 2018 Jan;16(1):17-25.
PMID: 29422794 DOI: 10.5217/ir.2018.16.1.17

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised 3 parts: management of latent TB in preparation for anti-TNF therapy, monitoring during anti-TNF therapy, and management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Matched MeSH terms: Latent Tuberculosis
Fulltext Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 1: risk assessment

Park DI, Hisamatsu T, Chen M, Ng SC, Ooi CJ, Wei SC, et al.

Intest Res, 2018 Jan;16(1):4-16.
PMID: 29422793 DOI: 10.5217/ir.2018.16.1.4

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised 2 parts: risk of TB infection Recommendaduring anti-TNF therapy, and screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Matched MeSH terms: Latent Tuberculosis
Tuberculosis screening in a novel substance abuse treatment center in Malaysia: implications for a comprehensive approach for integrated care

Al-Darraji HA, Wong KC, Yeow DG, Fu JJ, Loeliger K, Paiji C, et al.

J Subst Abuse Treat, 2014 Feb;46(2):144-9.
PMID: 24074846 DOI: 10.1016/j.jsat.2013.08.023

People who use drugs (PWUD) represent a key high risk group for tuberculosis (TB). The prevalence of both latent TB infection (LTBI) and active disease in drug treatment centers in Malaysia is unknown. A cross-sectional convenience survey was conducted to assess the prevalence and correlates of LTBI among attendees at a recently created voluntary drug treatment center using a standardized questionnaire and tuberculin skin testing (TST). Participants (N=196) were mostly men (95%), under 40 (median age=36 years) and reported heroin use immediately before treatment entry (75%). Positive TST prevalence was 86.7%. Nine (4.6%) participants were HIV-infected. Previous arrest/incarcerations (AOR=1.1 for every entry, p<0.05) and not being HIV-infected (AOR=6.04, p=0.03) were significantly associated with TST positivity. There is an urgent need to establish TB screening and treatment programs in substance abuse treatment centers and to tailor service delivery to the complex treatment needs of patients with multiple medical and psychiatric co-morbidities.

Matched MeSH terms: Latent Tuberculosis/diagnosis*; Latent Tuberculosis/epidemiology
Genomic plasticity between human and mycobacterial DNA: A review

Danjuma L, Ling MP, Hamat RA, Higuchi A, Alarfaj AA, Marlina, et al.

Tuberculosis (Edinb), 2017 12;107:38-47.
PMID: 29050770 DOI: 10.1016/j.tube.2017.03.006

Mycobacterium tuberculosis has a remarkable ability of long-term persistence despite vigorous host immunity and prolonged therapy. The bacteria persist in secure niches such as the mesenchymal stem cells in the bone marrow and reactivate the disease, leading to therapeutic failure. Many bacterial cells can remain latent within a diseased tissue so that their genetic material can be incorporated into the genetic material of the host tissue. This incorporated genetic material reproduces in a manner similar to that of cellular DNA. After the cell division, the incorporated gene is reproduced normally and distributed proportionately between the two progeny. This inherent adoption of long-term persistence and incorporating the bacterial genetic material into that of the host tissue remains and is considered imperative for microbial advancement and chemotherapeutic resistance; moreover, new evidence indicates that the bacteria might pass on genetic material to the host DNA sequence. Several studies focused on the survival mechanism of M. tuberculosis in the host immune system with the aim of helping the efforts to discover new drugs and vaccines against tuberculosis. This review explored the mechanisms through which this bacterium affects the expression of human genes. The first part of the review summarizes the current knowledge about the interactions between microbes and host microenvironment, with special reference to the M. tuberculosis neglected persistence in immune cells and stem cells. Then, we focused on how bacteria can affect human genes and their expression. Furthermore, we analyzed the literature base on the process of cell death during tuberculosis infection, giving particular emphasis to gene methylation as an inherited process in the neutralization of possibly injurious gene components in the genome. The final section discusses recent advances related to the M. tuberculosis interaction with host epigenetic circuitry.

Matched MeSH terms: Latent Tuberculosis/drug therapy; Latent Tuberculosis/genetics*; Latent Tuberculosis/immunology; Latent Tuberculosis/microbiology*
Fulltext Epidemiology of latent tuberculosis infection among patients with and without diabetes mellitus

Swarna Nantha Y, Puri A, Mohamad Ali SZ, Suppiah P, Che Ali SA, Ramasamy B, et al.

Fam Pract, 2017 09 01;34(5):532-538.
PMID: 28369346 DOI: 10.1093/fampra/cmx017

Background: Individuals with type 2 diabetes mellitus (DM) are at a greater risk of tuberculosis (TB) reactivation. There is a paucity of information about the risk factors associated with latent tuberculosis infection (LTBI) in patients with diabetes.

Objective: We conducted an observational study to compare the prevalence and risk factors associated with LTBI factors in Malaysian adults with and without DM.

Methods: Four hundred and four patients with DM and 359 patients with non-DM at a regional primary care clinic were recruited as participants in this case-control study. The tuberculin sensitivity test (TST) was performed. The presence of LTBI was defined by a TST value of 10 mm in DM patients and 10 mm in the non-DM group. A logistic regression model was used to identify variables associated with LTBI.

Results: There was no statistical significant difference in the prevalence rates seen between the DM and non-DM group of the study. LTBI prevalence among patients with DM was 28.5%. The proportion of patients in the non-DM group with LTBI was 29.2%. When a critical cut-off of 8 mm was used, the adjusted odds ratio of LTBI in DM patients was 1.88 (95% confidence interval: 1.22-2.82). Smoking was an independent risk factor for LTBI regardless of DM status. HbA1c levels or anthropometric measurements were not associated with LTBI in diabetic patients.

Conclusions: There is no significant risk of contracting LTBI in DM patients using the standard 10-mm TST cut-off. Nonetheless, using lower cut-offs in a DM population appear valid. Smoking is an important predictor of LTBI.

Matched MeSH terms: Latent Tuberculosis/epidemiology*
Fulltext Prevalence and risk factors of latent tuberculosis infection among health care workers in Malaysia

Rafiza S, Rampal KG, Tahir A

BMC Infect Dis, 2011;11:19.
PMID: 21244645 DOI: 10.1186/1471-2334-11-19

BACKGROUND: Health care workers are exposed to patients with tuberculosis and are at risk of nosocomial infection. The aim of this study was to determine the prevalence and factors associated with latent tuberculosis infection among health care workers in Malaysia and also to evaluate the agreement between Quantiferon TB Gold in tube test with Tuberculin Skin Test.
METHODS: A cross sectional study was conducted at four randomly selected hospitals in the Klang Valley from December 2008 to May 2009. Self administered questionnaire was used to obtain information on health care workers and possible risk factors. The response rate for this study was 90.8% with 954 respondents completed the questionnaire and were tested with Quantiferon TB Gold in tube for latent tuberculosis infection. Agreement between Quantiferon TB Gold in tube and Tuberculin Skin Test was assessed among 95 health care workers who consented to undergo both tests.
RESULTS: The overall prevalence of latent tuberculosis infection among health care workers was 10.6% (CI: 8.6%; 12.6%). Factors significantly associated with latent tuberculosis infection were aged 35 years and older [9.49 (CI: 2.22; 40.50)], history of living in the same house with close family members or friends who had active tuberculosis [8.69 (CI: 3.00; 25.18)], worked as a nurse [4.65 (CI: 1.10; 19.65)] and being male [3.70 (CI: 1.36; 10.02)]. Agreement between Quantiferon TB Gold in tube test and tuberculin skin test at cut-off points of 10 mm and 15 mm was 50.5% and 82.1% respectively. However, Kappa-agreement was poor for both cut-off points.
CONCLUSION: The prevalence of latent tuberculosis infection in Malaysia was relatively low for an intermediate TB burden country. We could not comment on the occupational risk of latent tuberculosis infection among health care worker compared to the general population as there were no prevalence data available for latent tuberculosis infection in the general population. Kappa agreement between Quantiferon TB gold in-tube and tuberculin skin test was poor.

Matched MeSH terms: Latent Tuberculosis/diagnosis; Latent Tuberculosis/epidemiology*; Latent Tuberculosis/transmission*
Fulltext Preventing tuberculosis in healthcare workers of the radiology department: a Malaysian perspective

Tan L, Kamarulzaman A

Biomed Imaging Interv J, 2006 Jan;2(1):e3.
PMID: 21614220 MyJurnal DOI: 10.2349/biij.2.1.e3

Tuberculosis (TB) is a well recognised occupational hazard for healthcare workers (HCWs). Concerns on the safety of healthcare settings in Malaysia was raised following a report of 25 HCWs working in 11 general hospitals in Malaysia who were infected with TB in 2004 being publicised in the media recently. As the disease burden in general is high in Malaysia, due attention should be given to this disease in our healthcare facilities including the radiology department, an often neglected area in TB infection control programmes. This article focuses on the key control measures that can be implemented in radiology departments in a developing country with limited resources.

Matched MeSH terms: Latent Tuberculosis
Fulltext Understanding the tuberculosis disease progression and future directions of research in tuberculosis: a mini review

Siti, H.N., Syarifah-Noratiqah, S.B., Zulfarina, M.S., Isa, N.M., Kamisah, Y.

Medicine & Health, 2018;13(1):20-28.
MyJurnal

Eradication of tuberculosis seems to be a long way off especially with the growing of drug resistance tuberculosis and HIV co-infection tuberculosis. The gaps in our knowledge and the limited sensitive and specific biomarkers especially for latent tuberculosis infection make it defensive. The fate of tuberculosis treatment ranged from cured to failure and there are many risk factors involved apart from the immune state and age. Therefore, this review focuses on the understanding of tuberculosis disease progression and the associated risk factors of the events in the disease progression. This article also highlights the diagnostic and predictive marker that may predict the disease progression. In addition, this review highlights the potential use of rifabutin in tuberculosis treatment regimen. It is hoped that this review could give an overview on future directions of research in tuberculosis.

Matched MeSH terms: Latent Tuberculosis
Fulltext Close contact investigation of TB in high-burden, low- and middle-income countries

Pang YK

Malays Fam Physician, 2014;9(2):11-17.
PMID: 25893066 MyJurnal

Tuberculosis (TB) remains a very common disease in most of the low- and middle-income countries. As a result of high disease burden, TB control measures in these countries are usually concentrated on intensifying active disease case-finding and early treatment of infectious TB. On the contrary, in countries with low disease burden, the focus is on contact investigation to identify latently infected individuals and prophylactically treating them to prevent disease reactivation and transmission. These two strategies are deemed important for the effective TB control. Nonetheless, WHO cautions that targeted contact investigation and latent TB infection (LTBI) treatment should only be undertaken by countries that have the operational capacity/ resources and have achieved ≥ 85% treatment success rate of active TB. The screening of LTBI is further challenged by the lack of a “gold standard” test to identify and validate individuals with this condition. Tuberculin skin test (TST) is still the preferred investigation as it is cheap, widely available and validated in many trials. The sensitivity and specificity of the newer test—interferon gamma release assay (IGRA) for LTBI screening has been encouraging in low prevalence countries. However, the evidence supporting such usage remains uncertain in high burden settings. Diagnosis of LTBI should adhere to the strict criteria outlined in the guidelines to avoid misdiagnosing active TB as LTBI. The treatment of the latter involved only one or two anti-TB drugs. It has been demonstrated that in the properly conducted contact screening and LTBI treatment, chances of the emergence of multi-drug-resistant TB is very low.

Matched MeSH terms: Latent Tuberculosis
Fulltext Latent tuberculosis infection in a Malaysian prison: implications for a comprehensive integrated control program in prisons

Al-Darraji HA, Kamarulzaman A, Altice FL

BMC Public Health, 2014 Jan 10;14:22.
PMID: 24405607 DOI: 10.1186/1471-2458-14-22

Prisons continue to fuel tuberculosis (TB) epidemics particularly in settings where access to TB screening and prevention services is limited. Malaysia is a middle-income country with a relatively high incarceration rate of 138 per 100,000 population. Despite national TB incidence rate remaining unchanged over the past ten years, data about TB in prisons and its contribution to the overall national rates does not exist. This survey was conducted to address the prevalence of latent TB infection (LTBI) in Malaysia's largest prison.

Matched MeSH terms: Latent Tuberculosis/epidemiology*; Latent Tuberculosis/prevention & control

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