Asymptomatic Tuberculosis (TB) represents up to 60

Tuberculosis (TB) diagnosis and management in special populations remain challenging. Data about TB and transgender individuals is scarce, and strategies aimed at reducing the TB burden in this at-risk group are needed. We conducted an observational monocentric study from a national reference center for TB, including transgender individuals with active TB in a low-TB burden country (Italy), over 34 years (1990-2023). Sixty-six transgender males and two transgender females (median age 30 years, interquartile range 26-38 years, 65 migrants) were included. Most patients (38/66, 57.6%) lived in poor social conditions. 65.2% (43/66) of patients were people living with HIV. Multidrug- and rifampicin-resistant tuberculosis and isoniazid-resistant TB were diagnosed in five (7.6%) and three (4.5%) patients, respectively. The overall treatment success rate was 72.7% (48/66 patients), with differences observed according to social conditions. Our study highlights the need for a tailored approach to increase treatment success in this at-risk population.

A 24-year-old Ukrainian man with post-natal developmental disability was treated for presumptive facial cutaneous TB in 2018 in his home country. After moving to Italy, his nostril lesion recurred in 2021, expanding to the upper lip, but he was lost to follow-up before a diagnosis was made. In 2023, when symptoms worsened, a biopsy was performed showing chronic inflammation and negative microbiological molecular tests and culture. By 2024, the lesion spread to the eyelids with worsening ulcerations. After surgical resection, histology revealed a vegetative, haemorrhagic mucosa with necrotic granulomatous inflammation and rifampin-susceptible Mycobacterium tuberculosis (Mtb) was detected at molecular testing. Diagnosis of recurrent primary cutaneous TB without pulmonary involvement was made and treatment for drug susceptible TB was initiated, leading to complete remission of the facial lesions. Primary cutaneous TB without pulmonary involvement is rare, presenting as nodules, plaques, papules, or ulcers. Diagnosis requires systemic evaluation, imaging, infection screening and expert consultation. Cutaneous TB (CTB) is uncommon in Ukraine and accounts for less than 2% of extrapulmonary TB cases with frequent association with immunosuppression and delayed presentation. Although infrequent, CTB mirrors the wider TB scenario, that is also characterized by MDR-TB in 27% of new and 45% of retreatment cases, and XDR-TB in 13% of MDR-TB cases. In individuals coming from TB endemic areas with strong clinical suspicion, empirical TB diagnosis should always be considered despite negative microbiology to enable timely treatment and prevent progression. A multidisciplinary approach is essential for accurate diagnosis and optimal management.

Even if in the past years new effective, safe, and orally administrable drugs are available to create shorter regimens, drug-resistant (DR) tuberculosis (TB) treatment remains a critical issue and a major challenge faced by clinicians worldwide. We present the first case of transborder pulmonary pre-extensively drug-resistant (pre-XDR)-TB treated in Italy with the bedaquiline-pretomanid-linezolid regimen. Diagnosis and treatment were started in Ukraine, and, after a month of treatment, due to the Russo-Ukrainian war, the patient moved to Italy, where the diagnosis was confirmed both by genotypic and phenotypic drug susceptibility tests, and treatment continued. In this short report, we highlight challenges and future opportunities to improve the clinical management of patient with DR-TB.

Background: An increasing number of patients require immunosuppressive treatment. Therefore, screening for latent tuberculosis infection (LTBI) is important to detect and potentially treat those patients who are at risk to develop active tuberculosis. Aims: The aim of our study is to highlight the features of the patients requiring LTBI screening and the treatment regimens. Methods: This retrospective, observational, cohort study enrolled patients referring to Villa Marelli outpatient clinic during the last 15 years. LTBI status, underlying medical conditions leading to screening, treatment regimens, duration and side effects data were collected during follow-up visits. Results: Overall, 840 patients were screened. Mean age was 51.4 years, 58.3% were males, 84.2% Italians, 4.9% Asians, 4.3% Africans, 4.0 % South Americans and 2.6% Europeans other than Italians. Reasons for screening were dermatological autoimmune diseases 66.2%, rheumatoid arthritis 12.4%, transplant 6.3%, inflammatory bowel disorders 6.2%, hidradenitis 4.9% and 4.0% others. A total of 363 patients underwent preventive treatment: 42.2% with isoniazid, 37.7% with isoniazid plus rifampicin, 7.4% with rifampicin and 12.7% with alternative treatment combinations. 19.6% of patients treated with isoniazid reported adverse events, followed by 19% with isoniazid plus rifampicin and 14.8% with rifampicin alone. Conclusions: Dermatological autoimmune diseases were the most common conditions requiring LTBI screening, followed by rheumatoid arthritis. Isoniazid was the prevalent treatment but was the regimen associated with the highest incidence of adverse events.

Background: Latent tuberculosis infection (LTBI) is a common finding requiring preventive treatment in certain conditions. Treatment can, however, be responsible for adverse events (AEs). Aims: Evaluate the prevalence and kinds of AEs in patients undergoing the three most commonly used treatment regimens. Methods: This single centre, retrospective, observational, cohort study enrolled patients affected by LTBI referring to Villa Marelli outpatient clinic from 1992 to 2022. Treatment regimen, reported AEs and blood tests results were collected before treatment and during follow-up visits. Results: A total of 23602 patients were treated for LTBI, of which 3413 (14.5 %) developed a relevant AE (see Table1.) Table 1. Conclusions: Gastrointestinal AEs were the most commonly reported in all of the three treatment regimens, followed by central nervous system AEs for isoniazid. Rifampicin alone was the most frequently linked to allergic reactions. All other reported AEs were less common.

SETTING: Screening for latent tuberculous infection (LTBI) of groups at high risk of active tuberculosis (TB) is a key component of the End TB Strategy. OBJECTIVE: To conduct a retrospective descriptive analysis of LTBI rates among foreign-born individuals applying to shelters in the metropolitan area of Milan, Italy. DESIGN: All foreign-born individuals registering for accommodation centres in the city of Milan from November 2009 to April 2017 were screened for active TB and LTBI. Individuals aged <36 years with a tuberculin skin test (TST) induration of >10 mm were offered confirmatory testing with QuantiFERON (R)-TB Gold In-Tube (QFT-GIT). RESULTS: Of the 2666 TST-positive migrants aged <36 years who underwent LTBI confirmation testing, 1322 (49.6%) tested negative, 1339 (50.2%) were positive and five (0.2%) had indeterminate results. In the multivariate analysis, TB incidence in the country of origin and age were significantly associated with QFT-GIT positivity. Although estimated TB incidence in Eritrea, Morocco and Romania was <= 100/100 000 person-years (py), the probability of being QFT-GIT-positive in individuals from these countries were not statistically significantly different from individuals from countries with TB incidence > 250/100 000 person-years. CONCLUSION: Our data showed a high proportion of LTBI among individuals coming from intermediate TB burden countries.

Tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide. Early diagnosis and treatment are key to prevent Mycobacterium tuberculosis transmission. Bronchoscopy can play a primary role in pulmonary TB diagnosis, particularly for suspected patients with scarce sputum or sputum smear negativity, and with endobronchial disease. Bronchoscopic needle aspiration techniques are accurate and safe means adopted to investigate hilar and mediastinal lymph nodes in cases of suspected TB lymphadenopathy. Tracheobronchial stenosis represents the worst complication of endobronchial tuberculosis. Bronchoscopic procedures are less invasive therapeutic strategies than conventional surgery to be adopted in the management of TB-related stenosis. We conducted a non-systematic review aimed at describing the scientific literature on the role of bronchoscopic techniques in the diagnosis and therapy of patients with TB. We focused on three main areas of interventions: bronchoscopic diagnosis of smear negative/sputum scarce TB patients, endobronchial TB diagnosis and treatment and needle aspiration techniques for intrathoracic TB lymphadenopathy. We described experiences on bronchoalveolar lavage, bronchial washing, and biopsy techniques for the diagnosis of patients with tracheobronchial and pulmonary TB; furthermore, we described the role played by conventional and ultrasound-guided transbronchial needle aspiration in the diagnosis of suspected hilar and mediastinal TB adenopathy. Finally, we assessed the role of the bronchoscopic therapy in the treatment of endobronchial TB and its complications, focusing on dilation techniques (such as balloon dilation and airway stenting) and ablative procedures (both heat and cold therapies).

From 2000 to 2015, the slow TB decrease in Milan area was partially covered at our outpatient Centre by a sharp increase in NTM cases, especially for adult pulmonary forms (PNTM). In total, 5996 patients with mycobacterial disease (MD) have been diagnosed or referred to the CRR-TB, declining from around 400/year to <350/year. TB and HIV/TB decreased due to various factors, including improvement in regional control measures for risk groups like contacts, immigrants (IMM) etc., while MDR-TB cases remained stable. Meanwhile, patients with NTM disease have more than doubled, mostly because of an increase of PNTM Despite negative forecast, due to the longer and more complicated treatment regimens of NTM compared with “normal” TB, especially after adoption of new international protocols, the yearly visit workload in our Center has not decreased in the considered period.

Tuberculosis (TB) affects women, especially in the child-bearing years.TB is associated with a poorer outcome of pregnancy, although this may be due to the general risk factors for TB, namely poverty, malnutrition and overcrowding.New studies have shown that symptom screening has a low sensitivity and specificity, but is improved by the addition of a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) or, in high incidence areas, DNA amplification tests (e.g.Xpert MTB/RIF).TB-HIV co-infection is a common cause of mortality and morbidity in pregnancy.The diagnostic process remains the same in pregnancy, but non-specific symptoms and extra pulmonary disease demand a higher level of suspicion of TB.Standard first-line treatment is safe in pregnancy.Data on second-line drugs in pregnancy is still limited, but injectable drugs may affect the hearing and balance of the fetus.The IGRA responses appear to change during pregnancy, with more positive responses after delivery.The increasing incidence of drug-resistant TB, especially in Eastern Europe and Central Asia, requires an evaluation of the safety of second-line drugs in pregnancy.

Introduction Patterns of cough in tuberculosis influence transmission of disease yet have been little studied. We report the prevalence, duration, severity and frequency of coughing in tuberculosis. Method The first part was a retrospective review of the medical records of all individuals diagnosed with pulmonary tuberculosis (PTB) at our hospital during 2012–3. The reported presence and duration of coughing was noted. In the second part of the study, successive patients with an ultimate diagnosis of PTB wore the Leicester Cough Monitor for 24 h prior to commencing treatment. Controls had latent TB infection (LTBI). Participants rated their cough severity from 0–100 with a visual analogue scale (VAS). Cough characteristics were compared with other clinical variables. Results 108 cases of PTB from 2012–3 were included. 82 reported cough of median (IQR) duration 4 (1–8) weeks. There was a significant association of the presence of cough with TB sputum culture positivity (odds ratio, 11.0; 95% confidence interval, 2.5–50.0) but not gender, smoking, smear positivity, cavitary disease or extent of radiographic change. No clear predictor of the duration of cough was identified and there were too few patients to estimate the effect of TB strain. Cough frequency was measured in subjects with sputum smear positive PTB (S+; n = 20), smear negative PTB (S-; n = 10) and LTBI (n = 11). Variability was high: median (IQR) cough rates were 238 (121–701), 126 (15–395) and 11 (7–56) coughs/24 h, respectively, and not significantly different for S+ vs. S- (figure). For active TB, cough rates were reduced overnight (2.8 [0.2–12.4] vs. 12.7 [3.3–23.4] coughs/h for night vs. day, respectively; p = 0.01). No effect of smoking was detected, nor was there a correlation between cough frequency and radiographic extent of disease, cavities or time to sputum culture positivity. Cough severity was higher for S+ than S- but also variable and the difference not statistically significant (VAS: 60 [13–94] vs. 22 [1.5–70] respectively; p = 0.41). Severity correlated with cough frequency in active tuberculosis (Spearman’s r = 0.60, p = 0.001). Conclusion Cough in TB reduces overnight and is related to culture positivity. Bacterial burden and extent of disease may not be important. Other determinants of cough await characterisation.

Background Interferon-gamma release assays (IGRAs) are being used to confirm significant exposure to tuberculosis (TB) after a positive tuberculin skin test (TST). We explored the variability of a positive test in a large UK TB clinic amongst contacts of active disease. Methods The records of all individuals notified with active TB and of their screened contacts from 2012–3 were reviewed retrospectively. Uni- and multivariate analysis identified variables associated with active TB and/or QuantiFERON® test positivity in contacts. Results Of 203 notified tuberculosis index cases, 470 contacts were screened. 116 had immunological evidence of TB exposure including 11 with active disease. The estimated background rate of positive TB immune response was 18% and was the same in contacts of index cases who were later denotified (7/39) as in contacts of extrapulmonary disease (24/132). On univariate analysis, index case variables associated with a positive TST and IGRA were a pulmonary vs. extrapulmonary site of disease (OR 2.1; 95% confidence interval 1.3–3.5) and, for contacts of pulmonary TB (PTB), presence of cough (2.5; 1.1–4.0), duration of cough (p = 0.04),sputum smear positivity (1.7; 1.0–2.8), sputum smear grade (p = 0.02), radiographic extent of disease (p = 0.008), and perhaps pulmonary cavities (1.6; 1.0–2.6). No effect was detected of gender, smoking status, or TB strain of the index case (Beijing or Cameroon vs. other lineage), or nature of contact (household vs. other), even when considering only child contacts. Contact variables associated with positive tests were birth in a high TB prevalence country (2.3; 1.4–3.6), age ≥12 years (2.0; 1.2–3.3), smoking (2.2; 1.0–5.1) and perhaps alcohol excess (3.2; 0.9–10.7), but not diabetes or BCG vaccination. There were insufficient data to investigate an effect of HIV and homelessness. Contact country of birth (1.9; 1.1–3.1) and index site of disease (2.0; 1.2–3.4), sputum smear positivity (2.6; 1.3–5.6) and radiographic extent of disease (p = 0.008) remained significant on multi-variate analysis. Conclusion The likelihood of significant TB exposure is a consequence of bacillary load, radiographic extent of disease and coughing behaviour.

BACKGROUND:Limited exercise tolerance is a cardinal clinical feature in COPD. Depression and COPD share some clinical features, such as reduced physical activity and impaired nutritional status. The aim of the present study was to evaluate maximum and daily physical activities and the nutritional status of COPD patients affected or not by depression.METHODS:In 70 COPD out-patients, daily and maximum physical activities were assessed by multisensor accelerometer armband, 6-min walk test, and cardiopulmonary exercise test. Mental status, metabolic/muscular status, and systemic inflammation were evaluated using the Hospital Anxiety and Depression Scale, by bioelectrical impedance analysis, and with regard to fibrinogen/C-reactive protein, respectively.RESULTS:Depressed subjects (27% of the sample) showed a similar level of respiratory functional impairment but a higher level of shortness of breath and a worse quality of life compared to non-depressed subjects (P < .05). Specifically, they displayed a physical activity impairment consisting of a reduced number of steps per day, a lower peak of oxygen consumption, an early anaerobic threshold, and a reduced distance in the 6-min walk test (P < .05) but the same nutritional status compared to non-depressed subjects. In the multivariate analysis, a reduced breathing reserve, obesity, and a higher level of shortness of breath, but not depression, were found to be independent factors associated with a reduced daily number of steps.CONCLUSIONS:Our study found that depressed COPD patients have a reduced daily and maximum exercise capacity compared to non-depressed patients. This further suggests the potential utility of screening for depression in COPD.