The altered sputum microbiome profile in patients with moderate and severe COPD exacerbations, compared to the healthy group in the Indian population [version 4; peer review: 2 approved]

Background: Microbial culture-independent sequencing techniques have advanced our understanding of host-microbiome interactions in health and disease. The purpose of this study was to explore the dysbiosis of airway microbiota in patients with moderate or severe chronic obstructive pulmonary disease (COPD) and compare them with healthy controls. Methods: The COPD patients were investigated for disease severity based on airflow limitations and divided into moderate (50%≤FEV12) revealed that marker genera like Streptococcus and Rothia were abundant in moderate COPD. For severe COPD, the genera Pseudomonasand Leptotrichia were most prevalent, whereas Fusobacterium and Prevotella were dominant in the healthy group. Conclusions: Our findings suggest a significant dysbiosis of the respiratory microbiome in COPD patients. The decreased microbial diversity may influence the host immune response and provide microbiological biomarkers for the diagnosis and monitoring of COPD

Same Day Sputum Microscopy for Screening of Pulmonary Tuberculosis: its Accuracy and Usefulness in Comparison with Conventional Method

Sputum microscopy is the primary diagnostic tool for screening pulmonary tuberculosis (PTB) suspects in TB prevalent countries. Our study had evaluated the ‘front loading’ or ‘same day’ sputum microscopy feasibility to screen clinically suspected PTB cases, in comparison to standard method of smear microscopy. In this hospital based cross-sectional study, three sputum specimens i.e., two consecutive spot samples collected in one hour interval on the first day of visit and a single sputum sample was collected on the next day early morning from 312 randomly selected adults suspected for PTB. Sputum samples were cultured on Lowenstein-Jensen (LJ) medium and stained by auramine O method and examined under LED-fluorescence microscopy. Out of 312 presumptive PTB patients, 43 (13.8%) were smear-positive by front loading method and 46 (14.7%) by standard method respectively. Considering LJ media culture as the gold standard test, the sensitivity was 83.7% and 89.8% respectively for front loading and the standard sputum microscopy and specificity was 99.2% by both methods. The statistical difference was insignificant between two methods of sputum microscopy (p-value > 0.05 by McNemar’s test). In health care settings of high burden countries same day sputum microscopy could be an acceptable method to screen the suspects of pulmonary tuberculosis and complete the diagnosis procedure on the first day of visit, which will decrease patients’ drop-out from the diagnostic procedure and initiate treatments as soon as possible

Challenges Perceived by Health Care Providers for Implementation of Contact Screening and Isoniazid Chemoprophylaxis in Karnataka, India

Background: In India, challenges in pediatric TB contact screening and chemoprophylaxis initiation are still underexplored. Elucidating these challenges will help in better implementation of the programme at the grass-roots level thereby helping in early detection of pediatric cases and timely initiation of preventive therapy. This study aimed at exploring the challenges faced by the health care provider in contact screening and chemoprophylaxis initiation implementation of the pediatric household contacts. Methods: A qualitative study was conducted in the districts of Bengaluru and Udupi and in-depth interviews of key participants were adopted to explore the challenges. Qualitative data analysis was done after developing transcripts by generating themes and codes. Results: The key challenges were identified as stigma towards the disease, migrant patients with changing address, difficulty in sample collection, anxiety among parents due to long duration of the prophylactic treatment and adherence to IPT is not well documented, inadequate transportation from rural areas, and the ongoing COVID-19 pandemic. Conclusions: It is important for the National TB programme to address these challenges efficiently and effectively. Innovative solutions, feasible engagements, and massive efforts are to be taken by the programme to improve contact screening and isoniazid chemoprophylaxis implementation