Factors associated with sputum culture conversion in patients with pulmonary tuberculosis

Musteikienė, Greta; Miliauskas, Skaidrius; Zaveckienė, Jurgita; Žemaitis, Marius; Vitkauskienė, Astra

doi:10.1016/j.medici.2018.01.005

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…Furthermore, while most patients are cured and remain free of TB upon the completion of a 6-month treatment regimen, some patients relapse even if they were fully adherent to treatment (7). To date, this interpatient variability in treatment responses has primarily been attributed to differences in host factors such as baseline mycobacterial loads, the presence of cavitary lesions, HIV infection, and smoking (8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of Drug-Induced Tolerance in Mycobacterium tuberculosis

2020

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SUMMARY Successful treatment of tuberculosis (TB) can be hampered by Mycobacterium tuberculosis populations that are temporarily able to survive antibiotic pressure in the absence of drug resistance-conferring mutations, a phenomenon termed drug tolerance. We summarize findings on M. tuberculosis tolerance published in the past 20 years. Key M. tuberculosis responses to drug pressure are reduced growth rates, metabolic shifting, and the promotion of efflux pump activity. Metabolic shifts upon drug pressure mainly occur in M. tuberculosis’s lipid metabolism and redox homeostasis, with reduced tricarboxylic acid cycle activity in favor of lipid anabolism. Increased lipid anabolism plays a role in cell wall thickening, which reduces sensitivity to most TB drugs. In addition to these general mechanisms, drug-specific mechanisms have been described. Upon isoniazid exposure, M. tuberculosis reprograms several pathways associated with mycolic acid biosynthesis. Upon rifampicin exposure, M. tuberculosis upregulates the expression of its drug target rpoB. Upon bedaquiline exposure, ATP synthesis is stimulated, and the transcription factors Rv0324 and Rv0880 are activated. A better understanding of M. tuberculosis’s responses to drug pressure will be important for the development of novel agents that prevent the development of drug tolerance following treatment initiation. Such agents could then contribute to novel TB treatment-shortening strategies.

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Section: Introductionmentioning

confidence: 99%

Mechanisms of Drug-Induced Tolerance in Mycobacterium tuberculosis

2020

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“…Because of the poor scientific evidence, clinical guidelines cannot provide a clear recommendation about the isolation period, although some authors recognize a typical conversion period between 30 and 60 days [16] , [17] . Other guidelines suggest that respiratory isolation could be discontinued 2 to 3 weeks after the initiation of treatment if there is clinical improvement, low risk of resistance, and evidence of good therapeutic compliance [18] , [19] , [20] , although these recommendations differ in several publications that have determined that approximately 40–60% of patients could be contagious after one month of initiating treatment [5] , [21] , [22] . These studies included patients with various nationalities (European, African, Asiatic, and Latin American) and comorbidities (HIV, DM, chronic bronchopathy, tobacco, and alcohol consumption), and in line with this data, in our investigation, 41% of patients remained culture positive at 4 weeks, a fact that supports the generalization of the score in subjects with different characteristics.…”

Section: Discussionmentioning

confidence: 99%

Time to sputum conversion in patients with pulmonary tuberculosis: A score to estimate the infectious period

Ramírez-Hidalgo

Trujillano

Espluges-Vidal³

et al. 2023

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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“…In a clinical trial conducted in Ethiopia, daily supplementation with vitamin D could ameliorate TB symptoms but it played no role in sputum smear conversion [22]. A recent study in Lithuania also concluded that the sputum culture conversion rate in TB patients was not associated with serum vitamin D levels at baseline [23].…”

Section: Discussionmentioning

confidence: 99%

Unfavourable treatment outcomes in tuberculosis patients with different vitamin D status and blood glucose levels in a programme setting in China

Lin

Bai

Zhang

et al. 2020

Tropical Med Int Health

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Objective Tuberculosis (TB) treatment success rates are high in China, but there are still a considerable number of cases who have unfavourable treatment outcomes (UTO). We aimed to determine the proportion of TB patients with UTO and to assess whether baseline characteristics that included glycaemic status [normal fasting blood glucose (FBG), transient hyperglycaemia and diabetes mellitus (DM)] and vitamin D status were associated with UTO. Method Prospective cohort study conducted between November 2015 and July 2016 at six clinics within routine TB services in Jilin province, where persons with TB were consecutively recruited. Data analysis was performed using the chi‐squared test and multivariate logistic regression. Results Of the 306 recruited TB patients, 96 (31.4%) had smear‐positive pulmonary TB, 187 (61.1%) had smear‐negative pulmonary TB and 23 (7.5%) had extrapulmonary TB (EPTB). Of these, 95 (31.1%) had normal blood glucose, 83 (27.1%) had transient hyperglycaemia and 128 (41.8%) had DM. 227 (74.2%) patients had vitamin D deficiency/severe deficiency. There were 125 (40.8%) patients with UTO of whom the majority were lost to follow‐up (57.6%) or not evaluated (28.8%). UTO was significantly associated with smear‐negative pulmonary TB (P = 0.009), EPTB (P < 0.001) and DM (P = 0.007). Conclusion The proportion of TB patients with UTO increased with smear‐negative pulmonary TB, EPTB and DM. TB programmes need to pay more attention to these issues and ensure intensive patient support to those at risk and early detection of DM.

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Factors associated with sputum culture conversion in patients with pulmonary tuberculosis

Abstract: The most important factors in predicting sputum culture conversion after 1 month of treatment were grades of acid-fast bacilli in sputum smears at time of diagnosis and scores of SGRQ.

Cited by 12 publications

References 21 publications

Mechanisms of Drug-Induced Tolerance in Mycobacterium tuberculosis

Mechanisms of Drug-Induced Tolerance in Mycobacterium tuberculosis

Time to sputum conversion in patients with pulmonary tuberculosis: A score to estimate the infectious period

Unfavourable treatment outcomes in tuberculosis patients with different vitamin D status and blood glucose levels in a programme setting in China

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