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  1. Fulltext Diagnostic delay among pulmonary tuberculosis patients in Sarawak, Malaysia: a cross-sectional study
    Chang CT, Esterman A
    Rural Remote Health, 2007 Apr-Jun;7(2):667.
    PMID: 17511524
    Delayed diagnosis of tuberculosis (TB) can lead to an increased period of infectivity in the community, a delay in treatment and a severe form of the disease. The objective of this study was to determine the length of delay, and factors linking the delay from the onset of symptoms of pulmonary tuberculosis (PTB) until the commencement of treatment in Sarawak, Malaysia.
    Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*; Tuberculosis, Pulmonary/epidemiology*; Tuberculosis, Pulmonary/therapy
  2. Fulltext "Discovery to treatment" window in patients with smear-positive pulmonary tuberculosis
    Loh LC, Codati A, Jamil M, Noor ZM, Vijayasingham P
    Med J Malaysia, 2005 Aug;60(3):314-9.
    PMID: 16379186
    Delay in commencing treatment in patients diagnosed with smear-positive pulmonary tuberculosis (PTB) may promote the spread of PTB in the community. Socio-demographic and clinical data from 169 patients (119 retrospectively and 50 prospectively collected) treated for smear-positive PTB in our hospital Chest Clinic from June 2002 to February 2003 were analysed. One hundred and fifty eight (93.5%) patients were started on treatment in less than 7 days from the time when the report first became available while 11 (6.5%) patients had their treatment started > or = 7 days. The median 'discovery to treatment' window was 1 day (range, 0 to 24 days). Of the factors studied, longevity of symptoms, absence of fever or night sweats and having sought traditional medicine were associated with delay in treatment commencement. The urgency and importance of anti-TB treatment should be emphasized especially to patients who are inclined towards treatment with traditional medicine.
    Keywords: Smear positive, pulmonary tuberculosis, treatment delay, traditional medicine, Malaysia, Seremban, Negeri Sembilan
    Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*; Tuberculosis, Pulmonary/drug therapy*; Tuberculosis, Pulmonary/microbiology
  3. Fulltext Diabetes mellitus and its influence on sputum smear positivity at the 2nd month of treatment among pulmonary tuberculosis patients in Kuala Lumpur, Malaysia: A case control study
    Shariff NM, Safian N
    Int J Mycobacteriol, 2015 Dec;4(4):323-9.
    PMID: 26964816 DOI: 10.1016/j.ijmyco.2015.09.003
    OBJECTIVE/BACKGROUND: Many studies have suggested that sputum smear conversion after 2 months of antituberculosis treatment is an important determinant of treatment success and can be a predictor for relapse. The objective of this study is to determine the factors that influence sputum smear conversion after 2 months of treatment among pulmonary tuberculosis patients receiving treatment in the Institute of Respiratory Medicine in Kuala Lumpur, Malaysia.
    METHODS: A total of 75 cases and 75 controls were interviewed, and their medical records were retrieved in order to extract the information needed. All analyses were conducted using SPSS version 17, and binary logistic regression analysis was used to determine the predictors of sputum smear nonconversion.
    RESULTS: Results showed that the following factors were associated with sputum smear positivity after 2 months of intensive treatment: diabetes mellitus (p=.013, odds ratio [OR]=2.59, 95% confidence interval [CI] 1.27-5.33), underweight body mass index (p=.025, OR=1.67, 95% CI 0.80-3.49), nonadherent to tuberculosis treatment (p=.024, OR=2.85, 95% CI 1.21-6.74), and previous history of tuberculosis (p=.043, OR=2.53, 95% CI 1.09-5.83). Multivariable analysis identified diabetes mellitus (p=.003, OR=4.01, 95% CI 1.61-9.96) as being independently associated with the risk of persistent sputum smear positivity after 2 months of intensive treatment.
    CONCLUSION: Based on the findings, identification of these factors is valuable in strengthening the management and treatment of tuberculosis in Malaysia in the future. This study emphasizes the importance of diabetes screening and integration of diabetic controls among tuberculosis patients in achieving better treatment outcome.
    KEYWORDS: Risk factors; Sputum smear nonconversion; Tuberculosis
    Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*; Tuberculosis, Pulmonary/microbiology; Tuberculosis, Pulmonary/epidemiology
  4. Delay in the diagnosis and treatment of pulmonary tuberculosis in patients attending a university teaching hospital
    Liam CK, Tang BG
    Int J Tuberc Lung Dis, 1997 Aug;1(4):326-32.
    PMID: 9432388
    University Hospital, Kuala Lumpur, Malaysia.
    Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*; Tuberculosis, Pulmonary/drug therapy; Tuberculosis, Pulmonary/epidemiology
  5. Fulltext Sociodemographic factors associated with quality of life (QoL) among pulmonary tuberculosis patients in a Specialist Respiratory Hospital in Kuala Lumpur
    Nurul Asyiqin Aziz, Anisah Baharom
    Malaysian Journal of Medicine and Health Sciences, 2019;15(104):88-88.
    MyJurnal
    Introduction: Tuberculosis negatively impacts the patients’ quality of life (QoL). Information on QoL among tuber-culosis patients may highlight gaps in the current management of the disease by identifying target groups with lower QoL. This study aimed to identify the sociodemographic factors associated with QoL among patients followed up in an urban tertiary hospital. Methods: A cross sectional study was conducted among adults with drug-sensitive pulmonary tuberculosis, selected using simple random sampling method, in the Institute of Respiratory Medicine, Kuala Lumpur. The WHOQOL BREF was utilised to evaluate the physical, psychological, social relationships and environment domains of QoL. Descriptive analysis and univariate analyses to test association between independent sociodemographic factors and QoL domain mean scores were done. Results: A total of 237 patients participated with a response rate of 96.34%. The factor associated with the physical domain was sex (t = 2.06, p = 0.04), whilst age (F = 3.77, p = 0.02), sex (t = 4.04, p < 0.001), marital status (F = 3.09, p = 0.04) and education level (F = 4.92, p = 0.008) were associated with the social relationships domain. Age (F = 3.55, p = 0.03), sex (t = 2.12, p = 0.03), edu-cation level (F = 7.97, p < 0.001) and monthly household income (F = 3.57, p = 0.03) were factors associated with the environment domain. No sociodemographic factors were associated with the psychological domain in this study. Conclusion: Patients who were younger, female, married, had tertiary education or monthly household income of more than RM6000 were associated with higher QoL. Targeted interventions among the sociodemographic groups with lower QoL could complement current clinical management to improve tuberculosis patients’ QoL.
    Matched MeSH terms: Tuberculosis, Pulmonary
  6. Fulltext A training module to empower marginalised Northern Borneo islanders for tuberculosis control
    Jeffree MS, Ahmedy F, Ibrahim MY, Awang Lukman K, Ahmed K, Giloi N, et al.
    J Public Health Res, 2020 Jul 28;9(3):1757.
    PMID: 33117755 DOI: 10.4081/jphr.2020.1757
    Empowering marginalised urban islanders with limited health accessibility through knowledge transfer program for controlling pulmonary tuberculosis (PTB) requires a specific training module. The study was aimed to develop this training module by adapting and modifying the IMCI (Integrated Management of Childhood Illness) framework. Structuring the content for the knowledge and skills for PTB control in the module was based on the National Strategic Plan for Tuberculosis Control 2016-2020. A total of five knowledge and skills were structured: i) PTB disease and diagnosis, ii) PTB treatment, iii) preventive PTB measures, iv) prevention of malnutrition, and v) psychosocial discrimination. The IMCI framework was modified through 3 ways: i) identifying signs and symptoms of PTB, ii) emphasising the IMCI's 5 steps of integrated management: assess, diagnose, treat, counsel and detect, and iii) counseling on BCG immunisation, malnutrition, environmental modifications and stigma on PTB.
    Matched MeSH terms: Tuberculosis, Pulmonary
  7. Fulltext Systematic Screening of Tuberculosis Using Mobile Digital Chest Radiography in Sabah
    Goroh, Michelle, Avoi, Richard, Deena Baharuddin
    Borneo Journal of Medical Sciences, 2018;12(101):49-0.
    MyJurnal
    Chest radiography, or chest X-ray (CXR), is not only an important tool for triaging and screening for pulmonary tuberculosis (TB) but is also useful in aiding diagnosis when pulmonary TB cannot be confirmed bacteriologically. Sabah is a state with high TB burden with the incidence rate of 124/100,000 population in 2015. Access to chest radiography is limited in many settings in Sabah. In 2016, the TB and Leprosy Control Unit of Sabah State Health Department started systematic screening for TB with the help of a mobile digital X-ray unit. 
    Matched MeSH terms: Tuberculosis, Pulmonary
  8. Paradoxical worsening of chest radiographs secondary to immune reconstitution syndrome (IRIS) in a patient with advanced HIV infection and Rhodococcus pneumonia
    Koh KC, Ibrahim NM, Ong SCL
    Med J Malaysia, 2020 03;75(2):164-166.
    PMID: 32281599
    We present a rare case of post-antiretroviral therapy (ART) paradoxically worsening of radiological findings in a patient with advanced HIV-infection on treatment for Rhodococcus pneumonia who was misdiagnosed with pulmonary tuberculosis. Despite clinical improvement, serial chest radiographs showed deteriorations a month after starting ART. This was attributed to Immune Reconstitution Inflammatory Syndrome (IRIS) which spontaneously resolved without any treatment.
    Matched MeSH terms: Tuberculosis, Pulmonary
  9. Fulltext Pulmonary tuberculosis in outpatients in Sabah, Malaysia: advanced disease but low incidence of HIV co-infection
    William T, Parameswaran U, Lee WK, Yeo TW, Anstey NM, Ralph AP
    BMC Infect Dis, 2015;15:32.
    PMID: 25636334 DOI: 10.1186/s12879-015-0758-6
    BACKGROUND: Tuberculosis (TB) is generally well controlled in Malaysia, but remains an important problem in the nation's eastern states. In order to better understand factors contributing to high TB rates in the eastern state of Sabah, our aims were to describe characteristics of patients with TB at a large outpatient clinic, and determine the prevalence of HIV co-infection. Additionally, we sought to test sensitivity and specificity of the locally-available point-of-care HIV test kits.
    METHODS: We enrolled consenting adults with smear-positive pulmonary TB for a 2-year period at Luyang Clinic, Kota Kinabalu, Malaysia. Participants were questioned about ethnicity, smoking, prior TB, disease duration, symptoms and comorbidities. Chest radiographs were scored using a previously devised tool. HIV was tested after counselling using 2 point-of-care tests for each patient: the test routinely in use at the TB clinic (either Advanced Quality™ Rapid Anti-HIV 1&2, FACTS anti-HIV 1/2 RAPID or HIV (1 + 2) Antibody Colloidal Gold), and a comparator test (Abbott Determine™ HIV-1/2, Inverness Medical). Positive tests were confirmed by enzyme immunoassay (EIA), particle agglutination and line immunoassay.
    RESULTS: 176 participants were enrolled; 59 (33.5%) were non-Malaysians and 104 (59.1%) were male. Smoking rates were high (81/104 males, 77.9%), most had cavitary disease (51/145, 64.8%), and 81/176 (46.0%) had haemoptysis. The median period of symptoms prior to treatment onset was 8 weeks. Diabetes was present in 12. People with diabetes or other comorbidities had less severe TB, suggesting different healthcare seeking behaviours in this group. All participants consented to HIV testing: three (1.7%) were positive according to Determine™ and EIA, but one of these tested negative on the point-of-care test available at the clinic (Advanced Quality™ Rapid Anti-HIV 1&2). The low number of positive tests and changes in locally-available test type meant that accurate estimates of sensitivity and specificity were not possible.
    CONCLUSION: Patients had advanced disease at diagnosis, long diagnostic delays, low HIV co-infection rates, high smoking rates among males, and migrants may be over-represented. These findings provide important insights to guide local TB control efforts. Caution is required in using some point-of-care HIV tests, and ongoing quality control measures are of major importance.
    Study site: Klinik Kesihatan Luyang (Tuberculosis Clinic), Kota Kinabalu, Sabah, Malaysia,
    Matched MeSH terms: Tuberculosis, Pulmonary/complications; Tuberculosis, Pulmonary/diagnosis; Tuberculosis, Pulmonary/epidemiology*
  10. The reliability of a rapid molecular detection method in determining the prevalence of rifampicin-resistant Mycobacterium tuberculosis in an urban district health facility in Malaysia
    Ding CH, Ismail Z, Sulong A, Wahab AA, Gan B, Mustakim S, et al.
    Malays J Pathol, 2020 Dec;42(3):401-407.
    PMID: 33361721
    INTRODUCTION: Rifampicin is a key first-line antimycobacterial agent employed for the treatment of pulmonary tuberculosis (PTB). This study sought to obtain prevalence data on rifampicin-resistant Mycobacterium tuberculosis among smear-positive PTB patients in the Klang District of Malaysia.

    MATERIALS AND METHODS: A total of 103 patients from the Chest Clinic of Hospital Tengku Ampuan Rahimah with sputum smears positive for acid-fast bacilli were included in this cross-sectional study. All sputa were tested using Xpert MTB/RIF to confirm the presence of M. tuberculosis complex and detect rifampicin resistance. Sputa were also sent to a respiratory medicine institute for mycobacterial culture. Positive cultures were then submitted to a reference laboratory, where isolates identified as M. tuberculosis complex underwent drug susceptibility testing (DST).

    RESULTS: A total of 58 (56.3%) patients were newly diagnosed and 45 (43.7%) patients were previously treated. Xpert MTB/RIF was able to detect rifampicin resistance with a sensitivity and specificity of 87.5% and 98.9%, respectively. Assuming that a single resistant result from Xpert MTB/RIF or any DST method was sufficient to denote resistance, a total of 8/103 patients had rifampicinresistant M. tuberculosis. All eight patients were previously treated for PTB (p<0.05). The overall prevalence of rifampicin resistance among smear-positive PTB patients was 7.8%, although it was 17.8% among the previously treated ones.

    CONCLUSION: The local prevalence of rifampicin-resistant M. tuberculosis was particularly high among previously treated patients. Xpert MTB/RIF can be employed in urban district health facilities not only to diagnose PTB in smear-positive patients, but also to detect rifampicin resistance with good sensitivity and specificity.

    Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy; Tuberculosis, Pulmonary/microbiology*; Tuberculosis, Pulmonary/epidemiology
  11. Fulltext Pneumoperitoneum or Chilaiditi's sign
    Teoh SW, Mimi O, Poonggothai SP, Liew SM, Kumar G
    Malays Fam Physician, 2016;11(1):22-24.
    PMID: 28461845
    Chilaiditi's sign describes the incidental radiographic finding of the bowel positioned between the right diaphragm and the liver. This is often misdiagnosed as pneumoperitoneum or free air under the diaphragm, which may lead to unnecessary investigations or surgical procedures. Here, we report two incidental chest radiograph findings of air under the diaphragm in patients who were being screened for pulmonary tuberculosis. This case series highlights the importance of awareness of the diagnosis of Chilaiditi's sign to avoid unnecessary hospital referrals.
    Matched MeSH terms: Tuberculosis, Pulmonary
  12. Fulltext A Rare Case of Ileocecal Tuberculosis with Pulmonary Embolism and Deep Vein Thrombosis
    Huei TJ, Henry TCL, Ho CA, Mohamad Y
    J Clin Diagn Res, 2017 Jul;11(7):PD03-PD04.
    PMID: 28892968 DOI: 10.7860/JCDR/2017/27923.10192
    Venous thromboembolism in tuberculosis is not a well recognised entity. It is a less frequently reported complication of severe pulmonary tuberculosis. It is exceedingly rare when it complicates extrapulmonary tuberculosis. Here, we present a case of 22-year-old young female with abdominal tuberculosis complicated with reverse ileocecal intussusception, deep vein thrombosis and pulmonary embolism. An emergency vena cava filter was inserted prior to a limited right hemicolectomy. In this article, we discuss the rare association of venous thromboembolism with ileocecal tuberculosis.
    Matched MeSH terms: Tuberculosis, Pulmonary
  13. Tuberculosis: clinical manifestations and outcomes
    Nissapatorn V, Kuppusamy I, Anuar AK, Quek KF, Latt HM
    Southeast Asian J Trop Med Public Health, 2003;34 Suppl 2:147-52.
    PMID: 19238668
    A total of 290 HIV/AIDS patients were recruited into this retrospective study, which was carried out at the National Tuberculosis Center (NTBC), Kuala Lumpur. The age range was 18 to 75 years with a mean age of 36.10 (SD +/- 7.44) years. Males outnumbered females by a ratio of 31:1. In this study, the majority of patients were male (96.9%), Malay (47.2%), single (66.9%), unemployed (81%), and smoked (61.4%). The main risk marker identified was injecting drug use (74.5%). The most common clinical manifestations were cough, fever, sputum, lymphadenopathy, and chest infiltrations. More than half of the patients (85.9%) were diagnosed with localized tuberculosis (pulmonary) and the others (14.1%) had extra-pulmonary or disseminated tuberculosis. At the time of this study, the majority of the patients (16.9%) had CD4 cell counts of less than 200 cell/mm3, with a median of 221 cell/mm3. Clinical outcomes demonstrated that among those who survived, 11.0% and 20.7% of the patients had completed treatment either > or = 6 or > or = 9 months, respectively, whereas 54.8% of patients were lost to follow-up, including 0.7% for MDR-TB. Diagnostic criteria for tuberculosis in this study were mainly clinical symptoms/signs and chest x-ray findings (31.0%).
    Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy; Tuberculosis, Pulmonary/epidemiology; Tuberculosis, Pulmonary/physiopathology
  14. Fulltext Clinical analysis of foreign-born patients with tuberculosis found in Malaysia
    Nissapatorn V, Kuppusamy I, Wan-Yusoff WS, Anuar AK
    Southeast Asian J Trop Med Public Health, 2005 May;36(3):713-21.
    PMID: 16124444
    In this retrospective study, we investigated 263 foreign patients who were diagnosed as having tuberculosis at the National Tuberculosis Center (NTBC) from January 2001 to December 2002. The age range was 14-72 years, with a mean of 33.3 +/- 9.95 years. The study subjects were predominantly males (60%) and females comprised 40%, where the greater impact of tuberculosis was observed in the young and active ones (up to 34 years of age), than middle-age (up to 54). A significantly higher percentage of these patients were from the Southeast Asian countries (87%) and particularly occurred in single male (47.5%) and married female (71.4%) patients (p<0.05). We also found that tuberculosis was significantly higher in female (50.5%) and male (64%) with smoking laborers (p<0.05). Fever (70%), cough (90.5%) and BCG vaccination status showed a significantly higher percentage in male patients (p<0.05), whereas lymphadenopathy (22%) was found in a significantly higher percentage in females (p<0.05). Overall, pulmonary disease (94.3%) occurred more commonly in males and the pleura (3.2%) was the most common site of disseminated tuberculosis. By contrast, the lymph node (11.4%) and miliary (4.8%) forms were the more common extrapulmonary tuberculosis in females. More males had higher percentage of treatment completed at > or = 6 (38%) and > or = 9 (13.3%) months in pulmonary tuberculosis, whilst, more females showed higher percentage of treatment completed (8.7%) in extrapulmonary tuberculosis. Surprisingly, more women showed non-compliance to the anti-tubercular therapy than their counterpart in this study.
    Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis; Tuberculosis, Pulmonary/drug therapy; Tuberculosis, Pulmonary/ethnology*
  15. Fulltext Tuberculosis in diabetic patients: a clinical perspective
    Nissapatorn V, Kuppusamy I, Jamaiah I, Fong MY, Rohela M, Anuar AK
    Southeast Asian J Trop Med Public Health, 2005;36 Suppl 4:213-20.
    PMID: 16438212
    This retrospective and descriptive study was a report on the clinical situation of tuberculosis in diabetic patients, with 1,651 patients recruited. The mean age of TBDM patients was significantly higher than that of non-diabetic patients (p<0.05). Moreover, TBDM patients had a higher ratio of male to female than the other group. The significant proportion of TB appeared to increase steadily with age in diabetic patients compared to non-diabetic ones (p<0.05). However, they showed similarities in terms of sex, race, marital status, present address, and occupation. A higher percentage of pulmonary tuberculosis (91.4%) was shown in the TBDM group. We found that both groups had no differences in the radiological findings, with opacity or cavity of the upper lobe involvement being 89% and 91% in TBDM and non-diabetic groups, respectively. TBDM patients were shown to have more treatment success (33.3%), particularly the pulmonary type of tuberculosis in the longer duration ( 9 months). Further findings demonstrated that a lower proportion of the TBDM group defaulted in their treatment (19.8%) and experienced resistance to anti-tubercular therapy (1.4%) compared to non-diabetics.
    Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy; Tuberculosis, Pulmonary/epidemiology; Tuberculosis, Pulmonary/physiopathology*
  16. Fulltext Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis: an interview study of physicians in India, Pakistan and Bangladesh
    Sreeramareddy CT, Rahman M, Harsha Kumar HN, Shah M, Hossain AM, Sayem MA, et al.
    BMC Med Inform Decis Mak, 2014;14:67.
    PMID: 25104297 DOI: 10.1186/1472-6947-14-67
    BACKGROUND: To estimate the amount of regret and weights of harm by omission and commission during therapeutic decisions for smear-negative pulmonary Tuberculosis.
    METHODS: An interviewer-administered survey was done among young physicians in India, Pakistan and Bangladesh with a previously used questionnaire. The physicians were asked to estimate probabilities of morbidity and mortality related with disease and treatment and intuitive weights of omission and commission for treatment of suspected pulmonary Tuberculosis. A comparison with weights based on literature data was made.
    RESULTS: A total of 242 physicians completed the interview. Their mean age was 28 years, 158 (65.3%) were males. Median probability (%) of mortality and morbidity of disease was estimated at 65% (inter quartile range [IQR] 50-75) and 20% (IQR 8-30) respectively. Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively. Probability of absolute treatment mortality was 0.7% which was nearly eight times higher than 0.09% reported in the literature data. The omission vs. commission harm ratios based on intuitive weights, weights calculated with literature data, weights calculated with intuitive estimates of determinants adjusted without and with regret were 3.0 (1.4-5.0), 16 (11-26), 33 (11-98) and 48 (11-132) respectively. Thresholds based on pure regret and hybrid model (clinicians' intuitive estimates and regret) were 25 (16.7-41.7), and 2(0.75-7.5) respectively but utility-based thresholds for clinicians' estimates and literature data were 2.9 (1-8.3) and 5.9 (3.7-7.7) respectively.
    CONCLUSION: Intuitive weight of harm related to false-negatives was estimated higher than that to false-positives. The mortality related to treatment was eightfold overestimated. Adjusting expected utility thresholds for subjective regret had little effect.
    Matched MeSH terms: Tuberculosis, Pulmonary/therapy*
  17. Fulltext Recurrent haemoptysis
    Khajotia R, Somaweera N
    Aust Fam Physician, 2011 Mar;40(3):128-9.
    PMID: 21597515
    A man, 56 years of age, presents to his general practitioner after coughing up half a cupful of fresh, bright red blood every day for 1 week. He has no other medical complaints. He reports previous pulmonary tuberculosis 12 years ago treated with 6 months of standard therapy. Routine follow up was discontinued after 5 years after no evidence of reactivation. He is a nonsmoker, does office clerical duties and is not known to have diabetes or hypertension.
    Matched MeSH terms: Tuberculosis, Pulmonary/complications
  18. Fluoroquinolones for treating tuberculosis
    Ziganshina LE, Vizel AA, Squire SB
    Cochrane Database Syst Rev, 2005.
    PMID: 16034951
    Fluoroquinolones are sometimes used to treat multiple-drug-resistant and drug-sensitive tuberculosis. The effects of fluoroquinolones in tuberculosis regimens need to be assessed.
    Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*
  19. Fulltext Pulmonary disease empirically treated as tuberculosis-a retrospective study of 107 cases
    Loh LC, Abdul Samah SZ, Zainudin A, Wong GLS, Gan WH, Yusuf WS, et al.
    Med J Malaysia, 2005 Mar;60(1):62-70.
    PMID: 16250282
    Pulmonary disease is sometimes treated empirically as tuberculosis (TB) in the absence of microbial confirmation if the clinical suspicion of active TB is high. In a country of relatively high TB and low HIV burden, we retrospectively studied 107 patients (69.2% male; mean age (SD): 45 (17) years) who received empirical anti-TB treatment for intrapulmonary opacities or pleural effusions suspected of active TB in our hospitals between 1998 and 2002. The diagnosis of definite or probable 'smear-negative' pulmonary TB was made based on treatment outcome at two months with rifampicin, isoniazid, pyrazinamide and ethambutol (or streptomycin). At this end-point, 81 patients (84.4%) had both clinical and radiological improvement (definite cases), 12 (12.5%) had clinical improvement alone and 3 (3.1%) had radiological improvement alone (probable cases). Confirmation of acid-fast bacilli was subsequently obtained in 12 patients (all definite cases) from culture of initial pulmonary specimens. Eleven patients (10.5%) were diagnosed as 'non-TB' based on absence of both clinical and radiological improvement or discovery of another cause for the pulmonary condition at or before this two-month study end-point. In the 'non-TB' group, 2 had carcinoma, 2 had HIV-related pulmonary diseases, 1 had bronchiectasis, while in 6 causes were indeterminate. Six (6.3%) and 3 (27.3%) patients reported adverse effects from anti-TB drugs from the 'TB' and 'non-TB' groups respectively. Our findings suggest that empirical anti-TB treatment is an acceptable practice if clinical suspicion is high in patients coming in our region.
    Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
  20. Duration of treatment in pulmonary tuberculosis: are international guidelines on the management of tuberculosis missing something?
    Atif M, Sulaiman SA, Shafie AA, Babar ZU
    Public Health, 2015 Jun;129(6):777-82.
    PMID: 25999175 DOI: 10.1016/j.puhe.2015.04.010
    BACKGROUND: Despite evidence of an association between tuberculosis (TB) treatment outcomes and the performance of national tuberculosis programmes (NTP), no study to date has rigorously documented the duration of treatment among TB patients. As such, this study was conducted to report the durations of the intensive and continuation phases of TB treatment and their predictors among new smear-positive pulmonary tuberculosis (PTB) patients in Malaysia.
    STUDY DESIGN: Descriptive, non-experimental, follow-up cohort study.
    METHODS: This study was conducted at the Chest Clinic of Penang General Hospital between March 2010 and February 2011. The medical records and TB notification forms of all new smear-positive PTB patients, diagnosed during the study period, were reviewed to obtain sociodemographic and clinical data. Based on standard guidelines, the normal benchmarks for the durations of the intensive and continuation phases of PTB treatment were taken as two and four months, respectively. A patient in whom the clinicians decided to extend the intensive phase of treatment by ≥2 weeks was categorized as a case with a prolonged intensive phase. The same criterion applied for the continuation phase. Multiple logistic regression analysis was performed to find independent factors associated with the duration of TB treatment. Data were analyzed using Predictive Analysis Software Version 19.0.
    RESULTS: Of the 336 patients included in this study, 261 completed the intensive phase of treatment, and 226 completed the continuation phase of treatment. The mean duration of TB treatment (n = 226) was 8.19 (standard deviation 1.65) months. Half (49.4%, 129/261) of the patients completed the intensive phase of treatment in two months, whereas only 37.6% (85/226) of the patients completed the continuation phase of treatment in four months. On multiple logistic regression analysis, being a smoker, being underweight and having a history of cough for ≥4 weeks at TB diagnosis were found to be predictive of a prolonged intensive phase of treatment. Diabetes mellitus and the presence of lung cavities at the start of treatment were the only predictors found for a prolonged continuation phase of treatment.
    CONCLUSIONS: The average durations of the intensive and continuation phases of treatment among PTB patients were longer than the targets recommended by the World Health Organization. As there are no internationally agreed criteria, it was not possible to judge how well the Malaysian NTP performed in terms of managing treatment duration among PTB patients.
    KEYWORDS: Duration of continuation phase; Duration of intensive phase; Duration of tuberculosis treatment; Malaysia; Penang; Smear-positive pulmonary tuberculosis
    Matched MeSH terms: Tuberculosis, Pulmonary/therapy*
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