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Background: Tuberculosis (TB) poses a significant public health challenge, particularly because it can exist in an asymptomatic latent phase. Latent TB infection indicates the presence of Mycobacterium tuberculosis without clinical symptoms. Effectively distinguishing between active and latent TB is essential, especially in regions with high TB prevalence, as it may help reduce transmission rates. This study aims to evaluate C1q as a potential biomarker for differentiating active TB from latent forms. Methods: This prospective cross-sectional study was conducted from January 2017 to February 2018, involving HIV-negative adults aged 18 and older attending TB clinics. Participants were categorized based on clinical symptoms, imaging results, and laboratory tests into active or latent TB. Blood samples were collected to assess serum C1q levels, which were then compared between the two groups. Results: Out of 81 patients referred for TB evaluation, 38 were diagnosed with active TB. The overall median C1q level was 6.46 μg/ml (interquartile range 4.66–10). The active TB group exhibited significantly elevated C1q levels (10.21 μg/ml) compared to the latent TB group (6.03 μg/ml, P < 0.001). The area under the receiver operating characteristic curve for C1q in distinguishing active from latent TB was 0.74 (95% confidence interval, 0.63–0.85), with sensitivity varying between 61% and 82% at different threshold values. Conclusions: C1q shows potential as a reliable and easily obtainable biomarker for differentiating active TB from latent infection, demonstrating high sensitivity. These results underscore the need for further research to explore the clinical application of C1q in TB diagnostics.

Background: This study performed at the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran, aimed to evaluate the effect of concomitant pulmonary hypertension on the outcome of pulmonary tuberculosis. Methods: New cases of pulmonary tuberculosis were recruited for the study. Pulmonary hypertension was defined as systolic pulmonary arterial pressure ≥35 mm Hg estimated by transthoracic Doppler echocardiography. We assessed the relationship between pulmonary hypertension and mortality during the six-month treatment of tuberculosis. Results: Of 777 new cases of pulmonary tuberculosis, 74 (9.5%) had systolic pulmonary arterial pressure ≥35 mm Hg. Ten of them (13.5%) died during treatment compared to 5% of cases with pulmonary arterial pressure less than 35 mm Hg (p = 0.007). Logistic regression analysis showed that pulmonary hypertension and drug abuse remained independently associated with mortality (OR = 3.1; 95% CI: 1.44–6.75 and OR = 4.4; 95% CI: 2.35–8.17, respectively). Conclusion: A significant association was found between mortality and presence of pulmonary hypertension and drug abuse among new cases of pulmonary tuberculosis. Keywords: Tuberculosis, Pulmonary hypertension, Echocardiography, Survival

Background: The risk of death is significantly higher in TB/HIV-infected patients than in those patients with just one disease or the other. This study aims to evaluate the impact of demographic, clinical and laboratory characteristics on the treatment outcome and mortality of TB/HIV co-infected patients in a TB tertiary center in Iran. Materials and methods: The study was conducted at Iran's National Referral Center for Tuberculosis. In total, 111 patients were recruited between 2004 and 2007. Mycobacteriology studies were performed for all patients. Demographic, clinical, and lab data of all patients were analyzed, and predictors of unsuccessful outcomes, as well as mortality, were determined. Results: The mean age for all 111 TB/HIV patients was 38±9 years (range 22–70) and 107 patients (96.3%) were male; 104 patients (93.7%) had a history of drug abuse, and 96 patients (86.4%) had a history of imprisonment. The route of transmission of HIV was intravenous drug use in 88 of the patients (79.3%); 23 patients (20.7%) had a history of Category 1 (CAT-1) (5.4%) and CAT-2 treatment. Highly Active Antiretroviral Therapy (HAART) was given to 48 patients (43.2%). There was no significant association found between treatment outcome or mortality with sex, smoking, drug and alcohol abuse, imprisonment, route of transmission, history of CAT-1 and CAT-2, cluster of differentiation 4 (CD4), and adverse effects (p > 0.05). Administration of HAART led to a significantly higher rate of good outcome (p < 0.001). Lower Albumin levels and body weight were significantly associated with mortality. Conclusion: Albumin levels and weight can be predictors of mortality and an unsuccessful outcome. Administration of HAART led to a better outcome.

Acute tubercular appendicitis has remained a rare disease despite frequent cases of tuberculosis. The following study reports a patient with multidrug-resistant (MDR) pulmonary tuberculosis that developed acute appendicitis. Histopathology of the appendix was compatible with tuberculosis. The patient had a good outcome after surgery and medical therapy.

Objective/background: The risk of mortality and morbidity among tuberculosis (TB) and human immunodeficiency virus (HIV) coinfected patients is significantly higher than that of patients infected with TB alone. The aim of this study was to evaluate the survival of TB-HIV patients in a TB-referral center during a 10-year follow-up. Methods: All TB-HIV patients in our referral center were enrolled in the study from 2003 to 2014, and patients were divided into two groups: HIV-TB patients without a history of TB treatment (new cases of TB) and HIV-TB patients with a history of TB treatment. Both groups were treated based on World Health Organization TB-treatment guidelines, and multivariate analysis was performed to evaluate risk factors of all-cause mortality. Results: During the study, 22 HIV-TB patients with a history of TB treatment and 263 HIV-TB patients with newly diagnosed TB were included. Baseline demographic and clinical characteristics were similar, except that miliary TB (98% vs. 2%) and mortality (97% vs. 3%; p = 0.06) were more likely in HIV patients with newly diagnosed TB. During TB treatment and subsequent follow-up, two patients did not respond to treatment and 92 (32.3%) patients died, whereas the cure rate was 60%. Pneumothorax [hazard ratio (HR): 3.17], coinfection (herpes zoster, toxoplasmosis, cytomegalovirus infection, Pneumocystis jiroveci, candidiasis, and other opportunistic infection; HR: 1.75), CD4

Disseminated Mycobacterium kansasii infection is a rare infection in non-HIV patients. This research has uncovered a very rare manifestation of disseminated M. kansasii infection in a non-HIV patient with lung and pericardial involvement.

Objectives: Pulmonary hypertension is a serious disorder with catastrophic outcomes. This study aimed to evaluate the effect of pulmonary arterial hypertension on the outcome among new cases of pulmonary tuberculosis. Novel modalities are available as therapeutic options, so early diagnosis of pulmonary arterial hypertension may be important. Methods: In a cross-sectional study, 777 new cases of pulmonary tuberculosis were recruited in the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran. Pulmonary arterial pressure was measured by resting transthoracic echocardiography on the beginning of tuberculosis treatment. Echocardiography was performed by a cardiologist expert in the field. Patients with systolic pulmonary arterial pressure more than 35 mmHg were defined as pulmonary hypertensive. The relationship between pulmonary arterial hypertension and mortality was assessed during six months of tuberculosis treatment. Results: Seventy-four (9.5%) of 777 new cases of pulmonary tuberculosis had pulmonary arterial hypertension. Among them, 10 (13.5%) died during the treatment period. In comparison with 5% mortality among cases without pulmonary arterial hypertension, death was significantly associated with pulmonary hypertension (p = 0.007). Logistic regression analysis showed that pulmonary arterial pressure more than 35 mmHg is an independent predictor of death among tuberculosis patients. Conclusion: Among new cases of pulmonary tuberculosis, a significant association between mortality and pulmonary arterial pressure >35 mmHg was found. Therapeutic intervention may change the outcome of these patients.

Introduction: Nontuberculous mycobacterium (NTM) has clinical and radiological manifestations that are indistinguishable from Mycobacterium tuberculosis (MTB). In an endemic area for tuberculosis (TB), limited data about prevalence and outcome of treatment of these patients is available. In this study the prevalence of different types of mycobacterium and response to treatment in a tertiary referral center in Iran will be evaluated. Materials and method: All NTM cases from 2004 to 2013 at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) in Iran were extracted from the database. All NTM patients who were treated for NTM diseases entered this study, and the outcome of treatment was evaluated. Results: A total of 104 cases were detected. The mean age was 56.34±15.77 years. Half of the patients were male. Most of the patients had a history of prior TB treatment. The most common types of NTM were Mycobacterium simiae (44 [42.3%]), Mycobacterium kansasii (18 [17.3%]), Mycobacterium abcessus (15 [14.4%]), and Mycobacterium chelonea (14 [13.5%]), respectively. The outcome of treatment was as follows: cure 61 (58.7%), failure 17 (16.3%), relapse 3 (2.9%), default 13 (12.5%) and death in 10 (9.6%) patients. Conclusion: Treatment of NTM had a low cure rate despite low mortality.

Background and objective: Diabetes mellitus (DM) has an effect on many aspects of tuberculosis (TB). The aim of this study is to determine the impact of DM on anti-tuberculosis drug resistance in new cases of TB patients. Materials and Methods: A case-control study was conducted on all newly diagnosed pulmonary TB adult patients with DM as cases and without DM as controls who were hospitalized and treated at the National Research Institute of Tuberculosis and Lung Disease (NRITLD) from May 2013 to October 2013. A molecular resistance test for rapid detection of resistance to isoniazid and rifampin was done for all smear-positive TB patients. A multivariate analysis was performed to determine the impact of DM on any anti-TB drug resistance. Results: 45TB cases with DM and 45TB cases without DM were included. TB cases with DM were more likely to be older (61 vs. 47 years, p = 0.001). Two TB–DM patients had multidrug-resistant TB (MDR-TB) (4.4%) compared with zero cases of MDR-TB in the control group, and TB–DM cases were resistant to at least one drug (11.1% vs. 4.4%, p = 0.43). DM remained significantly associated with any drug resistance (OR: 6.32, 95% CI: 1–40.72) in multivariate analysis. Conclusion: New TB patients with DM are at increased risk of anti-TB drug resistance. More studies are needed to confirm these results.

Objectives: HIV patients are prone to tuberculosis (TB) disease, and screening these patients for TB is important. The aim of this study is to analyze the prevalence of active and latent TB and the sensitivity, specificity, negative (NPV) and positive predictive value (PPV) of clinical signs and symptoms for the diagnosis of active TB in HIV-infected subjects. Method: From April 2008 to March 2011, 154 consecutive HIV-infected patients attending the HIV clinic at Masih Daneshvari Hospital were enrolled in the study. For the diagnosis of active TB, two sputum samples (one on presentation and another early morning) were collected from each subject and examined by Ziehl–Neelsen (ZN) microscopy for identification of acid-fast bacilli (AFB). Mycobacterial culture sputum specimens were inoculated on Lowenstein–Jensen (LJ) slants for 4–8 weeks to detect colonies. In those patients with a negative sputum sample for AFB, a polymerase chain reaction (PCR) was performed. Active TB was defined as positive sputum smear or culture for mycobacterium TB or positive polymerase chain reaction (PCR). Also, patients with signs and symptoms compatible with TB who responded to anti-tuberculous medications were classified as having active TB. Results: The mean of age was 36±8 (ranged, 22–62) and 127 (82%) were male. The antiretroviral therapy (ART) had been started in 40 (26%) patients, with 15 (10%) receiving trimethoprim/sulfamethoxazole as a prophylaxis; 119 (77%) were intravenous drug users. Among these patients, 58 (38%) individuals were diagnosed with active TB, of which 48 (83%) had smear-positive pulmonary TB. The mean of the baseline CD4 cell count in HIV patients with and without active TB was 67cells/ μl and 180cells/ μl, respectively (P-value=0.018). The multivariable regression analyses found that CD4

Objectives: Drug-resistant tuberculosis (TB) is a major challenge in controlling TB. HIV-positive patients are vulnerable to TB 100 times more than the general population. Drug-resistant TB leads to high morbidity and mortality in this population. In this study, the outcome of treatment of drug-resistant TB among HIV positive patients from 2003 to 2013 in a tertiary center in Iran will be reviewed. Materials and Methods: All HIV-positive patients with any drug-resistant TB from 2003 to 2013 were selected. The outcome of treatment was extracted from patients’ charts. Results: Out of 269 TB-HIV patients, 34 patients were recruited. All patients were male and the mean age was 37.38±7.03. Isoniazid (INH) resistant, rifampin (RIF) resistant and multi-drug resistant (MDR) was diagnosed in 11 (32.4%), 7 (20.6%) and 16 (47.1%), respectively. Mean CD4 count was 91.61±23.55. Outcome of treatment in the INH-resistant cases was cured in 5 (45.5%), failure in 2 (18.2%) and death in 4 (36.4%). In the RIF-resistant group, outcome was as follows: cured 5 (71.4%) and failure in 2 (28.6%). In the MDR-TB patients’ group, cured, failure and death were 12 (75%), 2 (12.5%) and 2 (12.5%), respectively. Conclusion: Treatment of drug-resistant TB can be achieved despite considerable mortality.