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The Predicted Potential Impact of COVID-19 Pandemic on Tuberculosis Epidemic in Tamil Nadu, South India
Objective: To estimate the prevalence and incidence of TB before and during the COVID-19
pandemic in Tamil Nadu, south India. Methods: In the present study, the effect of COVID-19 epidemiology
on the TB epidemic was assessed by the SEIR (Susceptible-Exposed-Infected-Recovered),
a compartmental epidemiological model. The model input parameters on compartments of TB and
incidence of COVID-19 were collected from the published literature. Based on the data collected,
point prevalence and incidence of TB per 100,000 population is calculated with and without COVID-
19. A prediction was conducted up to 2025, trend analysis was performed, and a trend chi-square
test and chi-square test of independence were used to test the difference between the prevalence
with and without COVID-19. R software 2000 (R 4.0.0) was used for analysis. Results: The TB
prevalence without and with COVID-19 decreases from 289 in 2020 to 271 in 2025 and from 289 in
2020 to 269 in 2025, respectively. Similarly, the incidence of TB was decreasing from 144 in 2020 to
135 in 2025 without COVID-19 and 143 in 2020 to 134 in 2025 with COVID-19. Though the TB burden
is decreasing over the years, the trend was not statistically significant (p > 0.05). With respect to
the district level, the prevalence and incidence of TB with and without COVID-19 is also found to be decreasing over the years. It was also found that the difference in the prevalence and incidence of TB with and without COVID-19 was not statically significant. Conclusion: The results of our
study shows that there was an annual decline of around 2% from 2020 to 2025 in the trend of the prevalence and incidence of TB with and without COVID-19. Overall, there is a reduction, but it was not significant, and there is no significant effect of COVID-19 on TB in Tamil Nadu
Operational Challenges in Conducting a Subnational TB Prevalence Survey in India: Lessons Learned for Resource-Limited, High-Burden Settings
Estimating the burden of TB at the subnational level is critical to planning and prioritizing resources for TB control activities according to the local epidemiological situation. We report the experiences and operational challenges of implementing a TB prevalence survey at the subnational level in India. Information was collected from research reports that gathered data from periodic meetings, informal discussions with study teams, letters of
communication, and various site visit reports. During the implementation of the survey, several challenges were encountered, including frequent turnover in human resources, lack of survey participation and community engagement, breakdown of X-ray machines, laboratory issues that delayed sputum sample testing, delays in X-ray reading, and network and Internet connectivity issues that impeded data management. To help ensure the survey was implemented in a timely manner, we developed several solutions, including planning ahead to anticipate challenges, ensuring timely communication, having a high commitment from all stakeholders, having strong team motivation, providing repetitive hands-on training, and involving local leaders to increase community engagement. This experience may help future states and countries that plan to conduct TB prevalence surveys to address these anticipated challenges and develop alternative strategies well in advance
Ethambutol-induced optic neuropathy: should we mandate ophthalmic examination in TB treatment?
India’s National Tuberculosis Elimination Programme
(NTEP)1 and the WHO have recommended ethambutol (EMB) for use in the continuation phase of TB treatment due to the higher prevalence of isoniazid resistance in the patient community. This leaves only a single drug in the continuation phase that might adversely affect treatment
outcomes.2 While reporting adverse drug reactions
(ADRs), we found that EMB often induced optic neuropathy during anti-TB therapy (ATT) for drugsusceptible
TB (DS-TB). In the study presented here, we define these ADRs and recommend adopting safety precautions when treating DS-TB patients
Role for Linezolid in drug sensitive tuberculosis
Tuberculosis (TB) continues to be a global challenge. Reducing the duration of TB treatment for drugsensitive
TB (DSTB) has direct and distinct advantages. We ventured into the aspect of utilizing linezolid as a
pivotal drug in shortening therapy in DSTB. Linezolid has gained prominence as it is faring well in resistant
TB management. Only a few studies use the strategy of Linezolid in DS-TB but it seems a lucrative approach,
the bactericidal effects have been reported favourably in the studies. There have been concerns about the
potential adverse drug effects of Linezolid reported but clinical trials have demonstrated safety and tolerability
when administered for shorter periods. If the safety and efficacy of giving Linezolid for a shorter period along with standard drugs for DSTB is established it could lead to newer avenues using Linezolid for shortening the duration of treatment for DSTB as an alternative to treat DSTB
A Dose-Finding Study to Guide Use of Verapamil as an Adjunctive Therapy in Tuberculosis
Induction of mycobacterial efflux pumps is a cause of Mycobacterium tuberculosis (Mtb) drug tolerance, a barrier
to shortening antitubercular treatment. Verapamil inhibits Mtb efflux pumps that mediate tolerance to rifampin, a
cornerstone of tuberculosis (TB) treatment. Verapamil’s mycobacterial efflux pump inhibition also limits Mtb growth
in macrophages in the absence of antibiotic treatment. These findings suggest that verapamil could be used as an
adjunctive therapy for TB treatment shortening. However, verapamil is rapidly and substantially metabolized when
co-administered with rifampin. We determined in a dose-escalation clinical trial of persons with pulmonary TB that
rifampin-induced clearance of verapamil can be countered without toxicity by the administration of larger than usual
doses of verapamil. An oral dosage of 360 mg sustained-release (SR) verapamil given every 12 hours concomitantly
with rifampin achieved median verapamil exposures of 903.1 ng.h/mL (area under the curve (AUC)0-12 h) in the 18 participants receiving this highest studied verapamil dose; these AUC findings are similar to those in persons receiving daily doses of 240 mg verapamil SR but not rifampin. Moreover, norverapamil:verapamil, R:S verapamil,
and R:S norverapamil AUC ratios were all significantly greater than those of historical controls receiving SR verapamil in the absence of rifampin. Thus, rifampin administration favors the less-cardioactive verapamil metabolites and enantiomers that retain similar Mtb efflux inhibitory activity to verapamil, increasing overall benefit. Finally, rifampin exposures were 50% greater after verapamil administration, which may also be advantageous. Our findings suggest that a higher dosage of verapamil can be safely used as adjunctive treatment in rifampin-containing treatment regimens
Prevalence and factors associated with tuberculosis infection in India
Background: The risk of tuberculosis (TB) disease is higher in individuals with TB infection. In a TB endemic country like India, it is essential to understand the current burden of TB infection at the population level. The objective of the present analysis is to estimate the prevalence of TB infection in India and to explore the factors associated with TB infection. Methods: Individuals aged > 15 years in the recently completed National TB prevalence survey in India who were tested for TB infection by QuantiFERON-TB Gold Plus (QFT-Plus) assay were considered for this sub- analysis. TB infection was defined as positive by QFT-Plus (value > 0.35 IU/ml). The estimates for prevalence, prevalence ratio (PR) and adjusted risk ratio (aRR) estimates with 95% confidence intervals (CIs) were calculated. Results: Of the 16864 individuals analysed, the prevalence of TB infection was 22.6% (95% CI:19.4 −25.8). Factors more likely to be associated with TB infection include age > 30 years (aRR:1.49;95% CI:1.29–1.73), being male (aRR:1.26; 95%CI: 1.18–1.34), residing in urban location (aRR:1.58; 95%CI: 1.03–2.43) and past history of TB (aRR:1.49; 95%CI: 1.26–1.76). Conclusion: About one fourth (22.6%) of the individuals were infected with TB in India. Individuals aged > 30 years, males, residing in urban location, and those with past history of TB were more likely to have TB infection. Targeted interventions for prevention of TB and close monitoring are essential to reduce the burden of TB in India
Time Elapsed from Onset of Symptoms to Antituberculosis Treatment in Children with Central Nervous System Tuberculosis in a Tertiary Hospital in South India: A Mixed‑Methods Pilot Study
A pilot study with a mixed‑methods design was conducted to estimate the time for tuberculosis (TB) treatment initiation and associated
factors among children with central nervous system‑TB (CNS‑TB). A total of 38 children were enrolled for the quantitative component, and
20 in‑depth interviews were conducted. The median duration (interquartile range) from onset of symptoms to treatment initiation was 23 (11,
55) days. About 44% and 31% of the children presented with Stage II and Stage III of CNS‑TB, respectively. The major reasons for delay
were symptoms not taken seriously (50%) and too many referrals (21%). About 89% of the families went into catastrophic health expenditure
due to the disease. The treatment delay may be due to both patient delay and health system delay. Tailoring approaches to target the pediatric
population could further improve early detection and treatment initiation of CNS‑TB
Next‑Gen Dual Transcriptomics for Adult Extrapulmonary Tuberculosis Biomarkers and Host–Pathogen Interplay in Human Cells: A Strategic Review
Tuberculosis (TB) is a major public health concern that results in significant morbidity and mortality,
particularly in middle- to low-income countries. Extrapulmonary tuberculosis (EPTB) in adults is a form of TB
that affects organs other than the lungs and is challenging
to diagnose and treat due to a lack of accurate early diagnostic markers and inadequate knowledge of host immunity. Next-generation sequencing-based approaches have shown potential for identifying diagnostic biomarkers and host immune responses related to EPTB. This strategic review
discusses on the significance using primary human cells
and cell lines for in vitro transcriptomic studies on common
forms of EPTB, such as lymph node TB, brain TB, bone
TB, and endometrial TB to derive potential insights. While
organoids have shown promise as a model system, primary
cell lines still remain a valuable tool for studying host–pathogen interplay due to their conserved immune system, noniPSC origin, and lack of heterogeneity in cell population. This review outlines a basic workflow for researchers interested in performing transcriptomics studies in EPTB, and also discusses the potential of cell-line based dual RNA-Seq technology for deciphering comprehensive transcriptomic signatures, host–pathogen interplay, and biomarkers from the host and Mycobacterium tuberculosis. Thus, emphasizing the implementation of this technique which can significantly contribute to the global anti-TB effort and advance our understanding of EPTB
The Cost-Effectiveness of the BEAT-TB Regimen for Pre-Extensively Drug-Resistant TB
Objective: To measure the economic impacts of the longer pre-XDR-TB treatment regimen and the shorter BEAT-TB India regimen. Methods: In the current study, the economic impacts of the current 18-month pre-XDR-TB treatment regimen and the 6–9 month BEAT-TB regimen were evaluated using an economic model via a decision tree analysis from a societal perspective. The incremental costs and quality-adjusted life years (QALYs) gained from the introduction of the BEAT-
TB regimen for pre-XDR-TB patients were estimated. Results: For a cohort of 1000 pre-XDR-TB patients, we found that the BEAT-TB India regimen yielded higher undiscounted life years (40,548 vs.21,009) and more QALYs gained (27,633 vs. 15,812) than the 18-month regimen. The BEAT-TB India regimen was found to be cost-saving, with an incremental cost of USD −128,651 when compared to the 18-month regimen. The current analysis did not consider the possibility of reduced TB recurrence after use of the BEAT-TB regimen, so it might have under-estimated the benefits. Conclusion: As a
lower-cost intervention with improved health outcomes, the BEAT-TB India regimen is dominant when compared to the 18-month regimen
Dodecanoic acid & palmitic acid disarms rifampicin resistance by putatively targeting mycobacterial efflux pump Rv1218c
Background & objectives: Drug-resistant tuberculosis (TB) jeopardizes the treatment process with poor outcomes. Efflux pumps (EPs) belonging to the ABC transporter family in Mycobacterium tuberculosis confer resistance to rifampicin (RMP) besides genetic mutations thus serving as a target for a potential adjunct therapeutic inhibitory molecule. Rv1218c is one such pump that was previously reported to be active in multidrug-resistant TB clinical isolates