What tests are done to monitor tuberculosis?
Cohort analysis is the key management tool used to evaluate the effectiveness of the national TB control programme. It enables the identification of problems, so that the programme managers and staff can institute appropriate action to overcome them …
What is video observed therapy for tuberculosis?
Dec 16, 2009 · Testing to Monitor Tuberculosis Treatment Lab tests are performed during tuberculosis treatment to determine if any TB bacteria are left in your body. Sputum tests, which examine the thick mucous...
What are the treatment options for tuberculosis (TB) disease?
Modalities to monitor the treatment response in tuberculosis Abstract Considering the global epidemic of drug resistance in Mycobacterium tuberculosis, early and accurate diagnosis as well as prompt initiation of antitubercular therapy (ATT) forms the …
How is the response to tuberculosis treatment measured?
Feb 18, 2016 · Direct observation of treatment (directly observed therapy, or DOT) was 1 of the 5 components of the strategy promoted by the World Health Organization (WHO) and public health advocates to address the global TB emergency declared in the early 1990s , (http://www.who.int/tb/dots/whatisdots/en/). Recently, innovative approaches have been …
How is TB monitored?
New pulmonary TB patients with positive sputum smears at the start of treatment. These patients should be monitored by sputum smear microscopy at the end of the fifth and sixth months. If results at the fifth or sixth month are positive, a sputum specimen should be obtained for culture and DST.
What methods of treatment exist for TB How effective are these?
The 4-month rifapentine-moxifloxacin TB treatment regimen is as effective as (noninferior to) the standard daily 6-month regimen in curing drug-susceptible TB disease. Must be administered completely within 70 days from treatment initiation....Rifampin (RIF),Isoniazid (INH),Pyrazinamide (PZA), and.Ethambutol (EMB)Mar 7, 2022
How can clinicians determine whether a patient is responding to TB treatment?
Patient Medical Evaluation Treating TB disease with an LTBI treatment regimen can lead to drug resistance (see the Preventing Drug Resistance section in this Module). To rule out TB disease, clinicians should determine whether the patient has symptoms of TB disease and evaluate the patient with a chest x-ray.
What is the frequencies of follow up services in TB?
During intensive phase: every day during the first weeks if hospitalized and at least every week if treated as outpatient, until the treatment is well tolerated. Once stable, the patient is seen once or twice monthly.
How do you diagnose TB diagnosis?
There are two kinds of tests that are used to detect TB bacteria in the body: the TB skin test (TST) and TB blood tests. A positive TB skin test or TB blood test only tells that a person has been infected with TB bacteria.
What is directly observed therapy for treating tuberculosis?
What is DOT? DOT means that a trained health care worker or other designated individual (excluding a family member) provides the prescribed TB drugs and watches the patient swallow every dose.
Who latent TB Guidelines 2020?
Key RecommendationsThe first of three preferred regimens is once-weekly isoniazid plus rifapentine, for 3 months. ... The second preferred regimen, daily rifampin for 4 months, is also strongly recommended, especially for HIV-negative persons, and has perhaps the lowest toxicity.More items...•Feb 28, 2020
What parameters are used to determine whether treatment should be initiated for LTBI?
Persons with no known risk factors for TB may be considered for treatment of LTBI if they have either a positive IGRA result or if their reaction to the TST is 15 mm or larger. However, targeted TB testing programs should only be conducted among high-risk groups.
What happens if you don't treat tuberculosis?
If tuberculosis treatment isn't successful or isn't followed for the full course, complications may occur. These could include: 1 Permanent damage to the lungs 2 Spread to other organs and organ damage 3 Development of strains of TB bacteria that are resistant to typical drugs 4 Death
What tests are done to check for TB?
Lab tests are performed during tuberculosis treatment to determine if any TB bacteria are left in your body. Sputum tests, which examine the thick mucous that is characteristic of TB, are typically done on people undergoing tuberculosis treatment for active pulmonary (lung) tuberculosis disease.
Is tuberculosis a bacterial infection?
But tuberculosis is no simple bacterial infection, and the many months of tuberculosis treatment require careful monitoring. Your doctor will keep a close eye on your TB once you start receiving treatment to make sure that the tuberculosis treatment is working and that you're no longer able to pass the disease on to anyone else.
Can antibiotics cause TB?
Side effects from the strong antibiotics prescribed to treat TB are also very common and need to be closely monitored, too. "Side effects from the medications vary depending on the drug used, but with most drugs, liver inflammation is the most common side effect," Smulian says.
Monitoring Therapy Adherence of Tuberculosis Patients by using Video-Enabled Electronic Devices
Alistair Story, Richard S. Garfein, Andrew Hayward, Valiantsin Rusovich, Andrei Dadu, Viorel Soltan, Alexandru Oprunenco, Kelly Collins, Rohit Sarin, Subhi Quraishi, Mukta Sharma, Giovanni Battista Migliori, Maithili Varadarajan, and Dennis Falzon
Abstract
A recent innovation to help patients adhere to daily tuberculosis (TB) treatment over many months is video (or virtually) observed therapy (VOT). VOT is becoming increasingly feasible as mobile telephone applications and tablet computers become more widely available.
Acknowledgment
R.S.G. was supported by a National Institutes of Health grant (U01 AI116392) for the writing of this paper; no other dedicated financial support was otherwise provided for the other authors. A.D., D.F., V.R., M.S., and M. V. were all staff members of WHO at the time of writing of this paper.
What is a dot in TB?
DOT is a component of case management that helps ensure patients adhere to therapy. It is the method whereby a trained health-care worker or another trained designated person watches a patient swallow each dose of anti-TB drugs and documents it. DOT is the preferred core management strategy recommended by CDC for treatment of TB disease and, if resources allow, for latent tuberculosis infection (LTBI) treatment. DOT can reduce the development of drug resistance, treatment failure, or relapse after the end of treatment. Good case management, which includes establishing a relationship with the patient and addressing barriers to adherence, facilitates successful DOT.
Can pregnant women take TB medication?
Untreated TB disease represents a greater hazard to a pregnant woman and her fetus than does its treatment. Because of the risk of TB to the fetus, treatment of TB in pregnant women should be initiated whenever the probability of maternal disease is moderate to high. The initial treatment regimen should consist of INH, RIF, and EMB. Although all of these drugs cross the placenta, they do not appear to have teratogenic effects. Streptomycin is the only anti-TB drug documented to have harmful effects on the human fetus (congenital deafness) and should not be used. Although detailed teratogenicity data are not available, PZA can probably be used safely during pregnancy and is recommended by the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD). If PZA is not included in the initial treatment regimen, the minimum duration of therapy is 9 months.
Why is it important for clinicians to evaluate a patient's response to treatment?
It is important for clinicians to evaluate a patient’s response to treatment to determine the ecacy of the treatment and to identify any adverse reactions. Clinicians use three methods to determine whether a patient is responding to treatment:
What are incentives and enablers?
Incentives are small rewards given to patients to encourage them to take their medicines and to keep DOT or clinic appointments. Enablers are things that help the patient receive treatment, such as bus fare to get to the clinic. Incentives and enablers should be chosen according to the patient’s needs, and they are frequently offered along with DOT.
How long does it take to develop a TB control plan?
For each patient with newly diagnosed TB disease, a specific treatment and monitoring plan should be developed in collaboration with the local TB control program within 1 week of the presumptive diagnosis. This plan should include:
Is rifampin a fixed dose?
Although there is no evidence indicating that fixed-dose combination medications are superior to individual drugs, expert opinion suggests that these formulations should be used when DOT is given daily or when DOT is not possible. The use of fixed-dose combination capsules or tablets facilitates DOT administration by minimizing the chance for error through the use of fewer tablets and may reduce the risk of acquired drug resistance since one medication cannot be selectively taken. In the United States, the Food and Drug Administration (FDA) has approved fixed-dose combinations of isoniazid and rifampin (Rifamate®) and of isoniazid, rifampin, and pyrazinamide (Rifater®). Clinicians should become familiar with the management of TB disease using these fixed-dose combination drugs.
What are the drugs that treat TB?
Food and Drug Administration (FDA) for the treatment of TB disease (Table 6.2). In addition, the fluoroquinolones (levofloxacin, moxifloxacin, and gatifloxacin), although not approved by the FDA for TB disease, are commonly used to treat TB disease caused by drug-resistant organisms or for patients who are intolerant of some first-line drugs. Rifabutin, approved for use in preventing Mycobacterium avium complex disease in patients with HIV infection but not approved for TB disease, is useful for treating TB disease in patients concurrently taking drugs that interact with rifampin (e.g., certain antiretroviral drugs). Amikacin and kanamycin, nearly identical aminoglycoside drugs used in treating patients with TB disease caused by drug-resistant organisms, are not approved by the FDA for treatment of TB.
What is a smear microscopy?
•#N#Early and accurate monitoring of TB treatment outcomes is the need of hour.#N#•#N#Smear microscopy is a nonspecific yet universal marker for assessing treatment responses.# N#•#N#An ideal marker should distinguish between viable and non-viable bacilli at the earliest.#N#•#N#Various new and promising phenotypic and genotypic tools are being explored worldwide.#N#•#N#The potential of new and existing tools to act as the best surrogate marker is discussed.
How does sputum smear microscopy help with pulmonary tuberculosis?
Sputum smear microscopy has a fundamental role in monitoring the response to treatment of infectious cases of pulmonary tuberculosis. 12 Diminishing numbers of AFB during the treatment followed by smear-negative status indicates treatment success, while increasing numbers of AFB in the later phase of treatment are an indication of failure. As recommended by WHO and IUATLD, Revised National Tuberculosis Control Program (RNTCP) of India, follows a scheme for monitoring progress during treatment in smear positive patients on three occasions: at the end of intensive phase (2 months for new cases and 3 months for re-treatment cases), two months into continuation phase (at the end of 4 and 5 months for new and re-treatment cases respectively) and at the end of treatment. Smears, those are positive at the end of intensive phase should be retested again at the end of extended intensive phase (3 months in new and 4 months in re-treatment cases).15 In addition to monitoring individual patient's response to treatment, smear examinations showing a conversion rate at 2–3 months is a good operational indicator. It reflects the capacity of the program to maintain patients on treatment, obtain sputum samples, and eliminate sources of infection, and it is an early surrogate of the treatment outcome indicator.12
Is TB a killer disease?
Tuberculosis has been a major killer disease known since antiquity. As an important public health disease, tuberculosis continues to uphold its position worldwide, especially in the developing countries. According to the most recent WHO global tuberculosis report, the TB incidence has fallen by an average of 1.5% per year since 2000 and is now 18% lower than the level of 2000. 1 Despite the global success of tuberculosis control programs in reducing the incidence, year 2014 witnessed estimated 9.6 million new TB cases and 1.5 million TB deaths all over the world. India still remains the top most country among the list of high TB burden countries contributing to 23% of the global total, followed by Indonesia (10%) and China (10%). 1
What is ATT in TB?
Considering the global epidemic of drug resistance in Mycobacterium tuberculosis, early and accurate diagnosis as well as prompt initiation of antitubercular therapy (ATT) forms the mainstay of tuberculosis control programs. Patients on ATT may develop treatment failure due to diverse reasons including emergence of drug resistance in the host during the course of therapy. Monitoring the timely response to treatment in such cases has a significant role in rapid identification of drug resistant strains and institution of change of regimen to further decrease the morbidity and mortality associated with the disease. Furthermore, availability of faster surrogate end points to assess treatment efficacy, disease activity, cure, and relapse is one of the crucial requirements for undertaking innovative clinical trials related to TB. The article presents here the compilation of currently available methods for monitoring the treatment response in pulmonary as well as extrapulmonary TB.
What are colorimetric assays?
Colorimetric assays are based upon use of oxidation–reduction indicator dyes which changes their color in the presence of metabolically active cells of MTB. Number of these dyes; Alamar blue,24 MTT (3- (4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide), 25, 26, 27 XTT (2,3-bis- (2-methoxy-4-nitro-5-sulfophenyl)-2h-tetrazolium-5-carboxanilide), 28 Resazurin 29 and nitrate reductase assay (NRA)30 has been used in past to assess the viability of M. tuberculosis in presence of antitubercular drugs in both direct 31, 32 and indirect, 26, 27, 33 drug sensitivity testing formats. Farnia et al. (2004) 34 evaluated the prospect of using oxidation reduction indicators like Alamar blue and Malachite green for monitoring the treatment of tuberculosis. The sensitivities of 95% and 93% and specificities of 93% and 92% were observed, respectively, for Alamar Blue assay and Malachite Green assay as compared to culture on LJ. The mean time required to get a positive signal by Alamar Blue assay was 9 days, and that of Malachite Green culture medium was 11 days. Another study by Rojas-Ponce et al.35 evaluated a new method using 2,3-diphenyl-5-thienyl- (2)-tetrazoliumchloride (STC) coupled with Nitrate reductase assay (NRA), labeled as STC-NRA method as a potential marker to assess treatment progress. The time to detection (TTD) was 14 days as compared to MGIT which was just 7 days. Further, the TTD was increased with duration of anti-tuberculosis treatment, highlighting the value of this method in monitoring treatment success. A systematic review and metaanalysis of all colorimetric methods concluded that these methods are highly sensitive and specific for the rapid detection of rifampicin and isoniazid resistance in culture isolates with respective 7 and 14 days of average time to have first results.36 They are simple and inexpensive and hence carry great expectations to be a test of choice for evaluation of treatment progress in resource constrained settings.
What is the predominant cell type producing IFN- in response to MTB infection?
37 CD4+T cells are the predominant cell type producing IFN-γ in response to MTB infection.
What are the biomarkers of tuberculosis?
They include biomarkers which can be detected from samples other than sputum like serum, whole blood or even urine. Serum prealbumin (PA) is a kind of plasma protein synthesized by the hepatocytes with a short biological half-life and is considered as a useful indicator in assessing individual's recent nutritional intake and current nutritional state. Luo et al.49 has demonstrated its usefulness as an objective marker for assessment of improvement in nutritional status in tuberculosis patients who were put on treatment, thus, indirectly monitoring treatment response. Acute phase reactant and immune system activation markers like CRP, Beta2 Microglobulin (β 2M) and Neopterin have also been assessed as the fast and effective markers of treatment monitoring at the point-of care setting. CRP showed the most significant decrease by 2 months of treatment (p < 0.0001) whereas levels of β 2 M and Neopterin showed little change by 2 months but a significant decrease by 6 months of treatment ( p = 0.0002 and p < 0.0001 respectively). 50 Amongst the other activation markers, soluble intercellular adhesion molecule (sICAM) 1, soluble urokinase plasminogen activator receptor and procalcitonin have also demonstrated significant decrease in levels following treatment of TB.51
What is a NTIP?
The National Tuberculosis Indicators Project (NTIP) is a secure, web-based monitoring system that uses routinely collected surveillance data on individual tuberculosis (TB) cases to measure the performance of state and local TB control programs, help programs to prioritize improvement efforts and focus on key TB control activities, and track progress toward national program objectives. Data are reported on a yearly basis and with frequent updates. This report summarizes NTIP results from the most recent 5 years for which data are available. Program performance was mixed, with general improvement for indicators related to TB case management (e.g., recommended initial therapy, genotyping data reported, human immunodeficiency virus [HIV] status reported, sputum culture reporting, and culture conversion documentation), but lower performance for indicators related to contact investigations of patients with infectious TB (e.g., contact elicitation, medical evaluation of contacts to infectious TB patients, and treatment initiation rate for persons diagnosed with latent TB infection [LTBI]). All performance indicators remained below the national performance targets for 2015. Starting in 2010, programs receiving CDC cooperative agreement funds for TB prevention and control will be required to use NTIP indicator data to describe their performance and formulate plans for improvement.
How are indicators calculated?
Indicators are calculated using standardized algorithms. The cohort is defined as those cases reported in the year of interest that are eligible to meet the performance objective for the indicator. For each indicator, inclusion and exclusion criteria are defined for the cohort.
