Table of Contents
Overview
Definition and Causes
Tuberculosis (TB) is a contagious and infectious disease primarily caused by the bacterium Mycobacterium tuberculosis (MT). This disease has posed a significant challenge throughout human history due to its severe social implications and the chronic nature of the infection, which often persists throughout an individual's life.[3.1] The origins of TB can be traced back over 40,000 years, with evidence suggesting that Mycobacterium prototuberculosis, the presumed ancestor of the Mycobacterium tuberculosis complex, first emerged in the Fertile Crescent and subsequently evolved along human migration routes.[6.1] Genetic studies indicate that strains of M. tuberculosis have coexisted with humans for approximately 9,000 years, revealing a long-standing relationship between the bacterium and its human hosts.[2.1] The disease is characterized by the formation of tubercles in various parts of the body, which are indicative of the infection.[3.1] The term "tuberculosis" itself is derived from "tubercle," reflecting the nature of the lesions associated with the disease.[6.1] In addition to its historical significance, TB remains a public health concern today, as it spreads from person to person through the inhalation of respiratory droplets containing the bacteria.[48.1] This transmission mechanism distinguishes TB from infections caused by nontuberculous mycobacteria, which are typically acquired from environmental sources and do not cause tuberculosis.[47.1] Thus, understanding the definition and causes of tuberculosis is crucial for addressing its impact on global health.Transmission and Risk Factors
Tuberculosis (TB) transmission is significantly influenced by various socioeconomic factors, which play a crucial role in the dynamics of the disease. High-risk socioeconomic activities, such as mining, have been associated with increased transmission of communicable illnesses, including TB and HIV/AIDS. Population migration further exacerbates this issue by facilitating the spread of TB and disrupting treatment continuity.[21.1] Research indicates that social risk factors and comorbidities, including gender, education, employment status, and body mass index (BMI), are correlated with TB prognosis and management, highlighting the socioeconomic impact on treatment outcomes.[22.1] In regions like Karamoja in North-Eastern Uganda, where the treatment success rate for TB is notably low at 48%, addressing these social determinants is essential for improving TB control efforts.[23.1] The progression from TB exposure to active disease and eventual cure is influenced by multiple risk factors. While well-known factors such as HIV infection and immunosuppressive drug use are critical, emerging socioeconomic and behavioral aspects also significantly increase susceptibility to TB infection.[24.1] Poor living and working conditions, which are prevalent in many communities, contribute to a higher risk of TB transmission and impair the host's defenses against the disease. Additional factors such as malnutrition, smoking, diabetes, alcohol abuse, and indoor air pollution further complicate TB management.[25.1] The World Health Organization (WHO) has recognized the importance of addressing social and economic determinants in TB control strategies. In 2009, a commitment was made to "move beyond the TB box," reflecting a shift towards a more holistic approach that considers these determinants.[26.1] Furthermore, the increase in tobacco consumption is a factor that must be integrated into TB control programs, emphasizing the need for a multidisciplinary approach to effectively combat the disease.[27.1] Mathematical models have been employed to understand the dynamics of TB transmission, linking social, economic, and biological determinants to the disease. These models serve as valuable tools for comparing control scenarios, especially when interventional studies are not feasible.[28.1] In 2023, TB remains a leading cause of death from infectious diseases, with 10.8 million people falling ill and 1.25 million deaths attributed to the disease. The global burden of TB is disproportionately high in low- and middle-income countries, particularly in sub-Saharan Africa and Southeast Asia, where socioeconomic factors significantly influence transmission dynamics.[42.1] The commitments made at the UN High-Level Meeting on the Fight Against Tuberculosis in 2023 reflect a renewed focus on addressing these inequities and improving public health strategies to combat TB.[41.1]History
Ancient Origins
Tuberculosis (TB) has been a significant presence in human history, with evidence of its existence in ancient civilizations. The disease, caused by Mycobacterium tuberculosis, primarily targets the lungs but can affect other organs as well. Historically referred to as consumption, TB has posed challenges not only due to its health implications but also because of its profound social impact.[52.1] The 19th century marked a turning point in the understanding of TB. René Laennec, a key figure in this era, made notable contributions to the study of the disease, known as phthisiology. Despite his advancements, Laennec tragically died from TB at 45, having contracted it during his research. He is renowned for inventing the stethoscope, which he used to link pulmonary lesions found in autopsies with symptoms in living patients.[51.1] Further progress was made in 1865 when Jean-Antoine Villemin demonstrated the transmissibility of Mycobacterium tuberculosis, highlighting its infectious nature.[53.1] A landmark discovery occurred on March 24, 1882, when Robert Koch identified the tubercle bacillus as the disease's causative agent, significantly advancing the understanding of TB's pathogenesis.[53.1] While effective medical treatments for TB were not developed until the mid-20th century, the establishment of sanatoria in the late 19th and early 20th centuries provided a means for managing TB patients. This development underscored the growing awareness of the disease's public health impact.[53.1]Evolution of Treatment
The evolution of tuberculosis (TB) treatment has been marked by significant advancements over the past few decades, driven by a combination of scientific research and public health initiatives. Robert Koch's discovery of Mycobacterium tuberculosis laid the groundwork for understanding the disease and its treatment, which has since evolved to include new therapeutic approaches and improved patient outcomes.[58.1] In recent years, the introduction of shorter treatment regimens has transformed TB management. New World Health Organization (WHO) guidelines now recommend a 6-month treatment regimen for individuals with multidrug-resistant TB (MDR/RR-TB), utilizing a combination of drugs such as bedaquiline, pretomanid, linezolid, and moxifloxacin, collectively referred to as BPaLM.[76.1] This regimen is particularly significant as it addresses the challenges posed by drug resistance, which has historically complicated TB treatment. Moreover, advancements in therapy have included the development of new anti-mycobacterial agents specifically designed for treating drug-resistant forms of TB, such as bedaquiline and delamanid.[75.1] These innovations have contributed to improved treatment outcomes, particularly for patients with drug-resistant TB, as highlighted by the 2019 Lancet Commission on Tuberculosis, which emphasized the importance of smart investments in TB control.[77.1] The integration of adherence interventions has also played a crucial role in enhancing treatment success rates. Strategies such as patient education, counseling, and the use of digital health technologies have been shown to improve adherence to treatment protocols, thereby positively impacting patient outcomes.[78.1] These multifaceted approaches underscore the importance of not only medical advancements but also the need for comprehensive support systems in TB management. Despite these advancements, the historical context of TB treatment reveals that external factors, such as armed conflicts and pandemics, have significantly influenced TB morbidity and mortality rates. For instance, TB mortality peaked during the influenza pandemics of 1889 and 1918, illustrating how major historical events can exacerbate the spread of the disease.[74.1] Additionally, armed conflicts have been shown to increase TB infection rates due to conditions that facilitate transmission, highlighting the ongoing challenges in controlling TB in conflict settings.[72.1]In this section:
Symptoms And Diagnosis
Active Tuberculosis Symptoms
Active tuberculosis (TB) presents with a variety of symptoms that can vary depending on the affected area of the body. Common symptoms include a persistent cough, chest pain, and coughing up blood or sputum, which are particularly indicative of pulmonary TB, the most prevalent form of the disease.[113.1] In addition to respiratory symptoms, general signs of active TB may include feelings of sickness or weakness, weight loss, fever, and night sweats.[127.1] The symptoms of active TB can develop gradually over weeks to months, although in certain populations, such as young children or immunocompromised individuals, symptoms may present more acutely.[127.1] The typical triad of fever, night sweats, and weight loss is observed in approximately 75%, 45%, and 55% of patients, respectively, with a persistent non-remitting cough being the most frequently reported symptom, noted in about 95% of cases.[127.1] In children, symptoms of active TB can manifest differently compared to adults. Common symptoms in younger children include fever, weight loss, poor growth, cough, swollen glands, and chills.[128.1] Adolescents may experience a cough that lasts longer than usual, alongside other systemic symptoms.[128.1] It is crucial for individuals exhibiting these symptoms to seek medical evaluation promptly, as untreated active TB can lead to severe lung damage or respiratory failure.[111.1] Early diagnosis and treatment are essential for effective management of the disease and to prevent its spread.[112.1]Diagnostic Methods
Diagnosis of tuberculosis (TB) involves a combination of clinical evaluations and laboratory tests to confirm the presence of Mycobacterium tuberculosis. A comprehensive medical evaluation typically includes a detailed medical history, physical examination, chest X-ray, and microbiological testing.[95.1] Chest X-rays are a crucial diagnostic tool, as they can reveal abnormalities indicative of TB, such as upper lobe consolidation and cavitation in adults, while lymphadenopathy without lung nodules is a common finding in children.[102.1] The posterior-anterior view is the most common chest X-ray view used, which allows doctors to identify TB effectively.[98.1] However, it is important to note that TB can mimic other conditions on X-rays, which can reduce specificity and necessitate additional laboratory tests for confirmation of active TB.[101.1] Direct sputum smear microscopy remains the most widely used method for diagnosing pulmonary TB, despite its limitations, as it is only positive in about half of active TB cases.[109.1] This method is inexpensive and rapid, making it accessible in many primary health-care settings.[107.1] In addition to smear microscopy, other diagnostic tools include TB skin tests and blood tests, which help identify individuals who may require further evaluation.[102.1] Recent advancements in imaging technology, such as computer-aided detection (CAD) systems utilizing artificial intelligence (AI), have shown promise in enhancing the accuracy and efficiency of TB diagnosis. These systems analyze chest X-rays for abnormalities suggestive of pulmonary TB, potentially improving case detection and reducing physician workloads.[122.1]In this section:
Types Of Tuberculosis
Pulmonary Tuberculosis
Pulmonary tuberculosis (PTB) is the most prevalent form of tuberculosis, primarily affecting the lungs. It is characterized by the presence of Mycobacterium tuberculosis bacteria in the pulmonary parenchyma, leading to various respiratory symptoms. The diagnosis of PTB is critical, as it is often the most discussed type of tuberculosis, yet it is essential to recognize that approximately one in five cases of tuberculosis presents as extrapulmonary tuberculosis (EPTB), which poses distinct diagnostic and management challenges.[140.1] The symptoms of PTB typically include a persistent cough, chest pain, and hemoptysis, alongside systemic signs such as fever, night sweats, and weight loss. In contrast, EPTB can manifest in various organs, including the gastrointestinal tract, skeletal system, and liver, making its diagnosis more complex.[142.1] The diagnostic approaches for PTB often involve chest radiography and sputum tests, while EPTB may require more specialized imaging and biopsies depending on the affected organ.[141.1] In immunocompetent individuals, lung involvement in active TB cases is estimated to be between 79% and 87%, while this rate remains similar in immunocompromised hosts, such as those with HIV, where lung involvement is reported at 70% to 92%.[165.1] The progression from latent tuberculosis infection to active disease is particularly concerning in immunocompromised individuals, who are at a higher risk of developing active TB due to their weakened immune systems.[164.1] Therefore, early diagnosis and treatment of latent tuberculosis infection are crucial to prevent progression to active disease, especially in vulnerable populations.[163.1]Extrapulmonary Tuberculosis
Extrapulmonary tuberculosis (EPTB) shares similar symptoms with pulmonary tuberculosis (PTB), as both conditions stem from the same disease process. The primary distinction lies in the location of the infection; while PTB affects the lungs, EPTB occurs in other parts of the body. Consequently, the treatment protocols for PTB are applicable to EPTB, as the underlying disease is identical regardless of the affected site.[134.1]Recent Advancements
New Treatment Options
Recent advancements in tuberculosis (TB) treatment have significantly improved outcomes for both drug-susceptible and drug-resistant cases. Clinical trials have confirmed the safety and efficacy of shorter treatment regimens, which are now part of the new World Health Organization (WHO) guidelines. Notably, a 6-month regimen for multidrug-resistant (MDR) and rifampicin-resistant TB (RR-TB), known as BPaLM, includes bedaquiline, pretomanid, linezolid, and moxifloxacin. This regimen is particularly promising for enhancing treatment outcomes, though caution is advised for patients with low CD4 counts, such as those with HIV, due to potential adverse effects.[178.1] Research has also focused on host-directed therapies and novel drug combinations to improve treatment effectiveness for drug-sensitive TB and evaluate standard regimens for MDR-TB.[181.1] Individualized treatment regimens are being developed to prevent drug resistance and ensure patient-centered access to new treatment options.[183.1] Furthermore, recent studies have shown that shorter regimens can match the efficacy and safety of longer ones. A phase 3 trial demonstrated that a 9-11 month regimen for rifampin-resistant TB was as effective as a traditional 20-month course.[191.1] Systematic reviews support these findings, indicating that shorter regimens result in higher treatment success rates compared to longer ones.[192.1]Challenges in Treatment
The integration of recent advancements in tuberculosis (TB) treatment into existing healthcare systems faces several significant challenges. A primary obstacle is non-adherence to treatment, which jeopardizes individual health and contributes to the emergence of drug-resistant TB strains, complicating control efforts.[203.1] To address this, patient-centered interventions, such as education, counseling, and digital health technologies, have been identified as effective strategies to improve adherence.[205.1] The introduction of shorter treatment regimens for multidrug-resistant TB (MDR/RR-TB), guided by new WHO recommendations, aims to enhance treatment efficacy. Regimens like BPaLM and BPaL require careful patient assessment, especially for those with compromised immune systems, such as individuals living with HIV.[201.1] The complexity of these regimens necessitates precise diagnostic and treatment planning tailored to each patient's clinical presentation, which can be challenging in resource-limited settings.[201.1] Additionally, global health threats, including the COVID-19 pandemic and geopolitical conflicts like the war in Ukraine, have strained healthcare services and TB control programs. These disruptions hinder progress towards the targets set by the End TB Strategy, as TB remains a significant burden, being the 13th leading cause of death worldwide.[202.1] Furthermore, integrating new TB diagnostics, such as Interferon-Gamma Release Assays (IGRA), into healthcare systems is crucial for improving early detection and treatment, particularly among high-risk groups. However, systemic challenges often impede the implementation of these advancements, affecting patient access and outcomes.[200.1]In this section:
Global Burden
Statistics and Trends
In 2023, tuberculosis (TB) emerged as the leading infectious disease killer, with approximately 7.5 million reported cases, surpassing COVID-19.[259.1] This marked an increase from 6.5 million cases in 2022, continuing a concerning upward trend since 2020.[257.1] The World Health Organization (WHO) Global Tuberculosis Report 2023 noted an estimated TB incidence rate of 133 new cases per 100,000 population in 2022, indicating a return to pre-pandemic levels.[260.1] The incidence of drug-resistant tuberculosis (DR-TB) also rose, with 450,000 cases of rifampicin-resistant TB reported in 2021, a 3% increase from the previous year.[223.1] Despite this, only 40% of individuals with drug-resistant TB received treatment in 2023, highlighting significant healthcare access gaps.[224.1] Multidrug-resistant TB (MDR-TB) remains a critical public health issue, especially in Eastern Europe and Central Asia, where over half of previously treated patients showed resistance.[223.1] Risk factors such as dietary habits, high body-mass index, and substance use, particularly tobacco and alcohol, significantly contribute to the age-standardized Disability-Adjusted Life Years (DALY) associated with TB.[222.1] Additionally, regions with lower Social Development Index (SDI) values experience higher TB incidence and mortality rates, underscoring the need for targeted interventions.[222.1]Socioeconomic Factors
Tuberculosis (TB) is significantly influenced by socioeconomic factors, particularly in developed countries where it has historically been linked to poverty and low socioeconomic status (SES). Over the past 25 years, the demographic of TB cases in the United States has shifted from predominantly native-born individuals to foreign-born persons, who represented over 60% of newly diagnosed cases in 2010.[226.1] This shift underscores the critical role that socioeconomic deprivation plays in TB transmission and treatment adherence, as individuals from lower SES backgrounds often face barriers that hinder their access to healthcare services.[227.1] Access to health services is a crucial determinant of treatment success for TB patients. Vulnerable populations frequently encounter difficulties in accessing necessary healthcare, which can lead to poor treatment outcomes.[229.1] The promotion of equity in disease prevention and control is essential, as poverty remains a significant barrier to healthcare access. Efforts to improve health outcomes must focus on socially excluded groups to reduce inequities and achieve health-related goals.[230.1] Interventions aimed at controlling TB must consider both proximate risk factors and upstream determinants, integrating biomedical and structural approaches. Effective TB control strategies should leverage knowledge from various disciplines, including molecular biology and social determinants, to enhance treatment accessibility and support for high-risk populations.[228.1] Such interdisciplinary approaches are vital for addressing the complex interplay between socioeconomic status and healthcare access, ultimately improving TB outcomes.Prevention And Control
Public Health Strategies
Public health strategies for the prevention and control of tuberculosis (TB) are multifaceted and aim to minimize the transmission of Mycobacterium tuberculosis within populations. These strategies encompass a combination of administrative, environmental, and respiratory protection measures, forming a three-level hierarchy of controls that has proven effective in reducing TB incidence.[265.1] A critical component of TB prevention is the implementation of TB preventive treatment (TPT), particularly for high-risk groups such as individuals living with HIV and household contacts of active TB cases. The World Health Organization (WHO) advocates for TPT as a primary intervention to halt the progression from latent TB infection to active disease.[266.1] Additionally, applying epidemiology-based prevention principles, such as utilizing setting-related TB infection-control data and promoting proper cough etiquette through signage, further enhances TB control efforts.[267.1] Community-level interventions play a vital role in TB prevention. Effective strategies include health education programs that raise awareness about TB symptoms and transmission, as well as organizing regular screening and treatment camps in high-risk areas to facilitate early identification and treatment of TB cases.[271.1] Community-based interventions, particularly those involving community health workers (CHWs), have demonstrated improved access to care and enhanced treatment adherence, thereby contributing to better health outcomes.[272.1] Evaluating the effectiveness of public health interventions is essential for informing policies aimed at controlling TB. A systematic review of existing literature has shown that successful strategies can significantly reduce TB transmission in high-risk populations, highlighting the importance of evidence-based decision-making in public health.[270.1] Despite the availability of effective strategies, challenges remain, particularly in ensuring treatment adherence among patients. Factors influencing adherence include structural issues such as poverty and gender discrimination, as well as health service and personal factors.[274.1] Understanding these barriers is crucial for healthcare providers to support patients in overcoming obstacles to treatment compliance.[276.1]In this section:
References
[2] Tuberculosis - History, Causes, Treatment | Britannica — Tuberculosis - History, Causes, Treatment: Evidence that M. tuberculosis and humans have long coexisted comes primarily from studies of bone samples collected from a Neolithic human settlement in the eastern Mediterranean. Genetic evidence gathered from these studies indicates that roughly 9,000 years ago there existed a strain of M. tuberculosis similar to strains present in the 21st century.
[3] The history of tuberculosis: from the first historical records to the ... — Tuberculosis (TB) is a contagious, infectious disease, due to Mycobacterium tuberculosis (MT) that has always been a permanent challenge over the course of human history, because of its severe social implications. Tuberculosis (TB) is a contagious, infectious disease, due to Mycobacterium tuberculosis (MT), which usually lasts throughout the life course and determines the formation of tubercles in different parts of the body . As described in Villemin's work Cause et nature de la tuberculose: son inoculation de l'homme au lapin, the inoculated animal remained alive and no disease signs were discovered, but at autopsy, three months later, extensive TB was evident .
[6] The evolution of a neglected disease: tuberculosis discoveries in the ... — Tuberculosis (TB) and humans have coexisted for more than 40,000 years, since Mycobacterium prototuberculosis, supposed ancestor of the Mycobacterium tuberculosis complex (MTBC), reached the Fertile Crescent. Then, evolving and differentiating into various lineages, it followed the main human migration routes to the present day [] ().The word "tuberculosis" derives from "tubercle", the
[21] Qualitative assessment of the impact of socioeconomic and cultural ... — Socioeconomic activities such as mining are reported high risk for communicable illness including TB and HIV/AIDS. 19 Population migration has been shown to facilitate transmission of TB as well as causing treatment disruptions. 23 24 We set out to investigate these factors and the ways they impede uptake of health technologies in order to
[22] Role of socio-economic factors in tuberculosis prevalence - ResearchGate — Social risk factors and comorbidities show associations with gender and education; employment and BMI are correlated, highlighting the socioeconomic impact in TB prognosis and management. 29, 30
[23] Impact of socio-economic factors on Tuberculosis treatment ... - PubMed — Background: Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja.
[24] Tuberculosis, social determinants and co-morbidities (including HIV ... — The risk of exposure, progression to active tuberculosis (TB) and then to cure is a process affected by several risk factors. Along with well known risk factors such as human immunodeficiency virus (HIV), use of immunosuppressive drugs and being of young age, emerging risk factors such socio-economic and behavioral aspects play a significant role in increasing the susceptibility to infection
[25] Drivers of tuberculosis epidemics: The role of risk factors and social ... — Risk factors that seem to be of importance at the population level include poor living and working conditions associated with high risk of TB transmission, and factors that impair the host's defence against TB infection and disease, such as HIV infection, malnutrition, smoking, diabetes, alcohol abuse, and indoor air pollution.
[26] The Social Determinants of Tuberculosis: From Evidence to Action — In December 2009, at the International Union Against Tuberculosis (TB) and Lung Disease's World Conference in Cancun, Mexico, Mario Raviglione, director of the World Health Organization (WHO) Stop TB Department, made a clear commitment to "moving beyond the TB box." 1 His remarks echoed an emerging shift within the TB sector toward recognizing the importance of social and economic
[27] Factors that influence current tuberculosis epidemiology — The impact of the increase in tobacco consumption will have to be followed-up. Moreover, this factor will have to be considered in TB control programs. Only with a multidisciplinary approach where measures that observe coadjutant factors it will be able to impact on disease that kills every year close to 2 million people . Drug resistance and TB
[28] Modeling social, environmental and biological determinants of tuberculosis — Here, we summarize evidence linking social, economic and biologic determinants to tuberculosis (TB) and … Mathematical models have facilitated our understanding of infectious diseases dynamics and proved useful tools to compare control scenarios when interventional studies are not feasible or ethical.
[41] Addressing the growing TB disease burden in England — In 2023, commitments made at the UN High-Level Meeting on the Fight Against Tuberculosis offered a renewed sense of hope and purpose after the COVID-19 pandemic.1 Nevertheless, tuberculosis disease remains the leading cause of death from a single infection, causing 1·3 million deaths per year in 2023.2 The global burden of tuberculosis disease remains grossly inequitable, with 80% of those
[42] Epidemiological Trends and Forecasting of Tuberculosis burden in the ... — Tuberculosis (TB) remains a leading cause of death from infectious diseases, surpassed only by COVID-19 and HIV/AIDS .In 2020, around 10 million people contracted TB, with 1.5 million deaths, including 214,000 among those with HIV-associated TB .The global burden is highest in low- and middle-income countries, particularly sub-Saharan Africa and Southeast Asia .
[47] What is the Difference Between Mycobacterium Tuberculosis and ... — The main difference between mycobacterium tuberculosis and nontuberculous mycobacteria is that M. tuberculosis is a pathogenic bacterium that causes tuberculosis, whereas nontuberculous mycobacteria are environmental mycobacteria that do not cause tuberculosis or leprosy.. M. tuberculosis and nontuberculous mycobacteria are two types of mycobacteria that belong to the phylum Actinomycetota.
[48] Distinguishing Tuberculosis from Nontuberculous Mycobacteria Lung ... — Patients seeking treatment who have respiratory specimens positive for acid-fast bacilli present a public health dilemma. Although Mycobacterium tuberculosis and nontuberculous mycobacteria (NTM) cause chronic lung infections, only tuberculosis (TB) spreads from person to person by inhalation of organisms expectorated into the air. NTM infections are acquired directly from the environment
[51] History of tuberculosis - Wikipedia — One of the most important physicians dedicated to the study of phthisiology was René Laennec, who died from the disease at the age of 45, after contracting tuberculosis while studying contagious patients and infected bodies. Laennec invented the stethoscope which he used to corroborate his auscultatory findings and prove the correspondence between the pulmonary lesions found on the lungs of autopsied tuberculosis patients and the respiratory symptoms seen in living patients. On 24 March 1882, Robert Koch revealed the disease was caused by an infectious agent. In 1895, Wilhelm Röntgen discovered the X-ray, which allowed physicians to diagnose and track the progression of the disease, and although an effective medical treatment would not come for another fifty years, the incidence and mortality of tuberculosis began to decline.
[52] The history of tuberculosis: from the first historical records to the ... — Tuberculosis (TB) is a contagious, infectious disease, due to Mycobacterium tuberculosis (MT) that has always been a permanent challenge over the course of human history, because of its severe social implications. Tuberculosis (TB) is a contagious, infectious disease, due to Mycobacterium tuberculosis (MT), which usually lasts throughout the life course and determines the formation of tubercles in different parts of the body . As described in Villemin's work Cause et nature de la tuberculose: son inoculation de l'homme au lapin, the inoculated animal remained alive and no disease signs were discovered, but at autopsy, three months later, extensive TB was evident .
[53] The history of tuberculosis - ScienceDirect — The history of tuberculosis - ScienceDirect Search ScienceDirect The history of tuberculosis Understanding of the pathogenesis of tuberculosis began with the work of Théophile Laennec at the beginning of the 19th century and was further advanced by the demonstration of the transmissibility of Mycobacterium tuberculosis infection by Jean-Antoine Villemin in 1865 and the identification of the tubercle bacillus as the etiologic agent by Robert Koch in 1882. In the late 19th and early 20th centuries sanatoria developed for the treatment of patients with tuberculosis. Previous article in issue Next article in issue Tuberculosis Mycobacterium tuberculosis History of tuberculosis Recommended articles Copyright © 2006 Published by Elsevier Ltd. Recommended articles No articles found. For all open access content, the relevant licensing terms apply.
[58] [Historical development of tuberculosis since Robert Koch's discovery ... — Robert Koch's single-handed discovery of M. tuberculosis, one of the most gigantic scientific accomplishments of all times, provided the necessary foundation for subsequent investigative breakthroughs that have made it possible for experts to begin to contemplate the ultimate eradication of TB: the dreaded pestilence that for centuries was the greatest cause of death in the world.
[72] Impacts of armed conflicts on tuberculosis burden and treatment ... — The impact of armed conflicts on tuberculosis notification is complex and is influenced by multiple factors. The findings of this review underscore the importance of concerted efforts to control tuberculosis in conflict settings using available resources.
[74] Influenza Pandemics and Tuberculosis Mortality in 1889 and 1918 ... — Tuberculosis (TB) mortality declined in the northern hemisphere over the last 200 years, but peaked during the Russian (1889) and the Spanish (1918) influenza pandemics. We studied the impact of these two pandemics on TB mortality. We retrieved
[75] Evolution of Tuberculosis Treatments: Hope Is on the Horizon — These include advances in therapy, such as shorter courses for treatment of tuberculosis infection (as brief as 3 months, even in younger children), new anti-mycobacterial agents for use in treating drug resistant tuberculosis (including the drugs bedaquiline, delamanid, and pretomanid), and new information on diagnostic testing, such as
[76] Recent advancements in tuberculosis (TB) treatment regimens — New WHO guidelines now include these shorter regimens based on recent trial data and recommended the new 6-month treatment regimen for individuals with MDR/RR-TB, this includes bedaquiline (B), pretomanid (Pa), linezolid (L), and moxifloxacin (M), collectively referred to as BPaLM [Table 1] and for those with pre-XDR-TB, the regimen can be used without moxifloxacin (BPaL). Special caution is advised for patients with low CD4 counts (<100 cells/mm3), (e.g., Person with HIV infection) as compromised immune function may impact tolerance and increase the risk of adverse effects of BPaLM/BPaL regimen, necessitating careful assessment and potentially additional monitoring or treatment adjustments. Additionally, while effective for most forms of TB, the BPaLM/BPaL regimen is not recommended for severe cases such as extrapulmonary TB involving the central nervous system, osteoarticular TB, or disseminated (miliary) TB, highlighting the importance of precise diagnostic and treatment planning tailored to the specific clinical presentation of each TB case. These considerations collectively guide healthcare providers in optimizing treatment outcomes while navigating the complexities and limitations associated with the BPaLM/BPaL regimen in managing challenging forms of tuberculosis.
[77] Scientific advances and the end of tuberculosis: a report from the — The 2019 Lancet Commission on Tuberculosis laid out an optimistic vision for how to build a tuberculosis-free world through smart investments based on sound science and shared responsibility.1 Since then, several major strides have been made towards ending tuberculosis, including substantive improvements in treatment outcomes for people with drug-resistant disease.2,3 Although COVID-19 has
[78] Adherence interventions and outcomes of tuberculosis treatment: A ... — TB treatment outcomes are improved with the use of adherence interventions, such as patient education and counseling, incentives and enablers, psychological interventions, reminders and tracers, and digital health technologies. Trained healthcare providers as well as community delivery provides pati …
[95] Diagnosing Tuberculosis | Tuberculosis (TB) | CDC - Centers for Disease ... — How diagnosis works. Anyone with symptoms of TB disease or a positive TB blood test or TB skin test result should be evaluated by a health care provider for TB disease. Medical evaluation for TB disease. A health care provider may diagnose you with inactive TB or active TB disease based on your: Medical history. Physical examination
[98] Tuberculosis X-ray Findings and What They Mean - Healthline — The most common chest X-ray view is the posterior-anterior view, which shows your chest from the front and back. This is usually enough for a doctor to identify TB on an X-ray.
[101] Imaging findings in TB - The Radiology Assistant — Unfortunately on a chest X-ray TB can look like many other conditions, which reduces the specificity and additional lab-tests are often necessary to confirm the diagnosis of active TB. In this article we will focus on chest X-ray abnormalities that may indicate active TB disease. In adults with a competent immune system, TB more often presents with upper lobe consolidation and cavitation (figure left lung). Lymphadenopathy without a lung nodule is a common finding in children and has a high specificity for TB. Lymphadenopathy without a lung nodule is a common finding in children and has a high specificity for TB. Apical fibrotic lesions or scars, also known as old healed tuberculosis, are a common finding on chest X-rays in areas with endemic TB.
[102] Tuberculosis X-ray Findings and What They Mean - Healthline — Doctors often use chest X-rays to help diagnose active tuberculosis (TB). Read on to learn more about how and why doctors use chest X-rays to help diagnose TB. Using a few different tests together, such as a skin test, blood test, and chest X-ray, can help a doctor detect a TB infection. If you have TB symptoms or a positive skin or blood test indicating a TB infection, you’ll get a chest X-ray that can help a doctor find areas in your lungs where TB bacteria are growing. Doctors can use X-ray findings along with the results of a skin or blood test to check for a TB infection.
[107] Diagnosis of Pulmonary Tuberculosis: Recent Advances and Diagnostic ... — Prompt diagnosis of active pulmonary TB is a priority for TB control, ... Direct sputum smear microscopy is the most widely used method for diagnosing pulmonary TB and is available in most primary health-care laboratories at the health-center level3,12. Smear microscopy may, however, be costly and inconvenient for patients, who must make
[109] Diagnosis - Tuberculosis in Adults and Children - NCBI Bookshelf — Diagnosis for the majority of patients worldwide suspected of TB is still made by sputum smear microscopy for acid-fast bacilli. The test, which was developed 100 years ago by Franz Ziehl and Frederick Neelsen, is inexpensive, simple, rapid and specific but is only positive in around half of patients with active TB.
[111] Tuberculosis and Nontuberculous Mycobacterial Disease — The symptoms of active TB or NTM may progress slowly and resemble those of other lung conditions or medical conditions. It is important that you contact your physician for a diagnosis early, as leaving the condition untreated may cause severe damage to the lungs or respiratory failure. Symptoms include: A persistent cough; Coughing blood or sputum
[112] PDF — The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB disease of the lungs also include coughing, chest pain, and coughing up blood. Symptoms of TB disease in other parts of the body depend on the area affected.
[113] Signs and Symptoms of Tuberculosis | Tuberculosis (TB) | CDC — Signs and Symptoms of Tuberculosis | Tuberculosis (TB) | CDC Tuberculosis (TB) TB Prevention in Healthcare Settings | Information for Tuberculosis Programs View All Tuberculosis (TB) About Signs and Symptoms Causes and Spread Vaccine Testing for Tuberculosis Exposure Risk Factors Prevention View All Symptoms of active tuberculosis (TB) disease depend on where the TB germs are growing in the body. Common symptoms of active TB disease include cough, pain in the chest, and coughing up blood or sputum (phlegm). Symptoms of active TB disease depend on where in the body the TB germs are growing. Active TB disease in the lungs may cause symptoms such as: Other symptoms of active TB disease are: Do you have symptoms of active TB disease? Tuberculosis (TB)
[122] Enhanced tuberculosis detection using Vision Transformers and ... — The new use of Vision Transformers, special to the demanding task of medical imaging and TB detection as such, is a radical break from the traditional image processing methodologies through leveraging the ability of the model to handle sequential data at high efficiency.
[127] Clinical Manifestations - Tuberculosis in Adults and Children - NCBI ... — TB symptoms are usually gradual in onset and duration varying from weeks to months, although more acute onset can occur in young children or immunocompromised individuals. The typical triad of fever, nightsweats and weightloss are present in roughly 75, 45 and 55 % of patients respectively, while a persistent non-remitting cough is the most
[128] Tuberculosis (TB) in Children - Stanford Medicine Children's Health — What are the symptoms of TB in a child? Symptoms can occur a bit differently in each child, and they depend on the child's age. The most common symptoms of active TB in younger children include: Fever. Weight loss. Poor growth. Cough. Swollen glands. Chills . The most common symptoms of active TB in adolescents include: Cough that lasts longer
[134] Tuberculosis classification - Wikipedia — Tuberculosis classification system. The current clinical classification system for tuberculosis (TB) is based on the pathogenesis of the disease. ... Classification System for TB Class Type Description 0: No TB exposure Not infected: No history of exposure Negative reaction to tuberculin skin test 1:
[140] Diagnosis of extra pulmonary tuberculosis: An update on novel ... — Novel approaches Molecular diagnosis ABSTRACT Tuberculosis (TB) remains a major global public health problem worldwide. Though Pulmonary TB (PTB) is mostly discussed, one in five cases of TB present are extrapulmonary TB (EPTB) that manifests conspicuous diagnostic and management challenges with respect to the site of infection. The diagnosis
[141] Point of care diagnostics for tuberculosis | Pulmonology — Xpert has shown high sensitivity and specificity to diagnose pulmonary tuberculosis and extrapulmonary tuberculosis . 19-21 Introduced in 2011, Xpert is WHO-approved as a frontline test for pulmonary, extrapulmonary, and paediatric TB, 6 undergone widespread global scale-up (∼25 million cartridges and 25,000 modules procured by end of 2016
[142] What pulmonologists need to know about extrapulmonary tuberculosis — Extrapulmonary tuberculosis (EPT) can affect any organ and can be potentially life threatening or disabling. Looking for concomitant pulmonary tuberculosis is essential to facilitate a diagnosis and because of its implications for isolation of the patient, protective measures and contact tracing.
[163] Tuberculosis in immunosuppressed patients - PubMed — Tuberculosis (TB) is one of the most significant infections in immunosuppressed patients due to its high frequency and high morbidity and mortality. TB is the leading cause of death among HIV-infected patients. The diagnosis and early treatment of latent tuberculosis infection is vital to preventing it progression to disease.
[164] Tuberculosis Overview - StatPearls - NCBI Bookshelf — Approximately 5% of people infected with TB develop active disease within the first 2 years after infection; an additional 5% develop the infection later. The risk factors associated with the development of active TB are immunocompromised state, tobacco use, and excessive alcohol use. The immunocompromised state may be due to the following:
[165] Clinical manifestations and immune response to tuberculosis — Pulmonary tuberculosis. The lungs are the most commonly affected organ in an immunocompetent host during TB infection. Lung involvement in subjects having active TB has been estimated at 79-87%, whilst the estimate of lung involvement is similar in immunocompromised hosts, like those having HIV-HIV infection (70-92% lung involvement rate).
[178] Recent advancements in tuberculosis (TB) treatment regimens — New WHO guidelines now include these shorter regimens based on recent trial data and recommended the new 6-month treatment regimen for individuals with MDR/RR-TB, this includes bedaquiline (B), pretomanid (Pa), linezolid (L), and moxifloxacin (M), collectively referred to as BPaLM [Table 1] and for those with pre-XDR-TB, the regimen can be used without moxifloxacin (BPaL). Special caution is advised for patients with low CD4 counts (<100 cells/mm3), (e.g., Person with HIV infection) as compromised immune function may impact tolerance and increase the risk of adverse effects of BPaLM/BPaL regimen, necessitating careful assessment and potentially additional monitoring or treatment adjustments. Additionally, while effective for most forms of TB, the BPaLM/BPaL regimen is not recommended for severe cases such as extrapulmonary TB involving the central nervous system, osteoarticular TB, or disseminated (miliary) TB, highlighting the importance of precise diagnostic and treatment planning tailored to the specific clinical presentation of each TB case. These considerations collectively guide healthcare providers in optimizing treatment outcomes while navigating the complexities and limitations associated with the BPaLM/BPaL regimen in managing challenging forms of tuberculosis.
[181] New developments in tuberculosis diagnosis and treatment — The aim of this article is to: review current practice in the diagnosis and treatment of TB; outline new diagnostic techniques under development; discuss new drug therapies and treatment regimens under review; and review the evidence for vaccination. In addition to shorter regimens, with new or re-purposed drugs, there is research into methods of modifying the host immune response to improve treatment outcomes and prevent permanent morbidity from TB disease. For contacts of MDR-TB cases, the current recommendation is for 6–12 months treatment with a FLQ with or without a second drug. Two-month regimens using novel combinations to augment treatment effectiveness for drug-sensitive tuberculosis (TRUNCATE-TB). The evaluation of a standard treatment regimen of anti-tuberculosis drugs for patients with MDR-TB (STREAM).
[183] Recent advances in the treatment of tuberculosis - ScienceDirect — Future research should be directed to individualize regimens and protect these recent breakthroughs by preventing and identifying the selection of drug resistance and providing widespread, affordable, patient-centred access to new treatment options for all people affected by TB. In 2018, WHO recommended a regimen consisting of 6 months of rifampicin, ethambutol, pyrazinamide, and levofloxacin to treat isoniazid-resistant TB, following an individual patient data meta-analysis containing 3923 patients with isoniazid-resistant, rifampicin-susceptible TB, which indicated that the addition of a fluoroquinolone, compared with 6 months of standard treatment with or without isoniazid, increased the likelihood of treatment success (adjusted OR: 2.8 [95% CI: 1.1–7.3]) . To describe demographics, clinical features, and treatment outcomes of patients with highly drug-resistant tuberculosis (TB) in Ukraine, and to evaluate risk factors for an unsuccessful outcome.
[191] Systematic review of efficacy and safety of shorter regimens for drug ... — As an alternative approach, the use of a short-term regimen (STR) may be viable. 6 A phase 3 trial conducted in 2019 showed that a shorter regimen of 9-11 months for rifampin-resistant tuberculosis (RR-TB) had comparable efficacy and safety, as a longer treatment course of 20 months. 7 A 9-month all-oral regimen was suggested for patients
[192] A Comprehensive Review on Long vs. Short Regimens in Multidrug ... — The comparative effectiveness of short regimens versus long regimens in the treatment of MDR-TB has been a focal point of research. A systematic review and meta-analysis revealed that the shorter regimen exhibited higher treatment success rates compared to longer regimens (pooled proportions 80.0% versus 75.3%), primarily attributed to reduced
[200] Challenges and Future Perspectives in Tuberculosis Research — For instance, the integration of new TB diagnostics, such as Interferon-Gamma Release Assays (IGRA), into healthcare systems is a step in the right direction. These advancements can improve early detection and treatment, particularly among high-risk groups.
[201] Recent advancements in tuberculosis (TB) treatment regimens — New WHO guidelines now include these shorter regimens based on recent trial data and recommended the new 6-month treatment regimen for individuals with MDR/RR-TB, this includes bedaquiline (B), pretomanid (Pa), linezolid (L), and moxifloxacin (M), collectively referred to as BPaLM [Table 1] and for those with pre-XDR-TB, the regimen can be used without moxifloxacin (BPaL). Special caution is advised for patients with low CD4 counts (<100 cells/mm3), (e.g., Person with HIV infection) as compromised immune function may impact tolerance and increase the risk of adverse effects of BPaLM/BPaL regimen, necessitating careful assessment and potentially additional monitoring or treatment adjustments. Additionally, while effective for most forms of TB, the BPaLM/BPaL regimen is not recommended for severe cases such as extrapulmonary TB involving the central nervous system, osteoarticular TB, or disseminated (miliary) TB, highlighting the importance of precise diagnostic and treatment planning tailored to the specific clinical presentation of each TB case. These considerations collectively guide healthcare providers in optimizing treatment outcomes while navigating the complexities and limitations associated with the BPaLM/BPaL regimen in managing challenging forms of tuberculosis.
[202] Tuberculosis: current challenges and beyond - PMC — While the majority of targets of the End TB Strategy remain off track, and we have not yet overcome the disruptions caused by the COVID-19 pandemic, recent conflicts such as the ongoing war in Ukraine are threatening the decrease of the burden of TB even further. Tuberculosis (TB) represents a major global health threat that, despite being preventable and treatable, is the 13th leading cause of death worldwide and the second leading infectious killer after coronavirus disease 2019 (COVID-19) . In the past decades, the TB burden has been slowly decreasing; however, with the emergence of COVID-19 and the current political conflicts, including the war in Ukraine, proper functioning of healthcare services and TB control programmes are threatened, and the milestones set by the international health community to end TB remain unreached.
[203] PDF — Non-adherence to treatment not only jeopardizes the health of the individual but also fuels the emergence of drug-resistant TB strains, making the disease even more challenging to control. To combat this issue, patient-centered interventions have emerged as effective strategies to improve TB treatment adherence.
[205] Patient-centred care, social support and adherence to treatment — A patient-centred approach to programmatic management of drug-resistant TB may increase the chances of successful treatment outcomes, and improve wellbeing and financial risk protection by improving adherence to treatment, benefiting patients and society as a whole (3, 4).
[222] Global, regional, and national burden of tuberculosis and attributable ... — Global, regional, and national burden of tuberculosis and attributable risk factors for 204 countries and territories, 1990–2021: a systematic analysis for the Global Burden of Diseases 2021 study | BMC Public Health | Full Text Analyzing risk factors from the Global Burden of Disease study, it was determined that globally, dietary risks, high body-mass index, high fasting plasma glucose, low physical activity, tobacco, and alcohol use were the main contributors to TB age-standardized Disability-Adjusted Life Years, with tobacco and alcohol use having the most significant impact. Our analysis sends evidence to a result of significant negative correlations between Social Development Index (SDI) values and tuberculosis burden, including incidence, mortality, and age-standardized Disability-Adjusted Life Years (DALY) rates.
[223] WHO's Global Tuberculosis Report 2022 - The Lancet Microbe — The burden of drug-resistant tuberculosis also increased by 3% between 2020 and 2021, with 450 000 incident cases of rifampicin-resitant tuberculosis reported in 2021. Russia and other countries in eastern Europe and central Asia reported the highest proportions (>50%) of MDR or rifampicin-resistant tuberculosis among previously treated
[224] Tuberculosis - World Health Organization (WHO) — Only about 2 in 5 people with drug resistant TB accessed treatment in 2023. Some people with TB disease do not have any symptoms. TB preventive treatment (or TPT) prevents infection from becoming disease. Treatment is recommended for both TB infection and disease. Globally in 2023, 5646 people with MDR/RR-TB were reported to have been started treatment on the BPaLM/BPaL regimen, up from 1744 in 2022. WHO recommends a 12-component approach of collaborative TB-HIV activities, including actions for prevention and treatment of infection and disease, to reduce deaths. monitoring and reporting on the status of the TB epidemic and progress in financing and implementation of the response at global, regional and country levels.
[226] A national study of socioeconomic status and tuberculosis rates by ... — Background Tuberculosis (TB) in developed countries has historically been associated with poverty and low socioeconomic status (SES). In the past quarter century, TB in the United States has changed from primarily a disease of native-born to primarily a disease of foreign-born persons, who accounted for more than 60% of newly-diagnosed TB cases in 2010. The purpose of this study was to assess
[227] Enriching tuberculosis research by measuring poverty better: a ... — The relationship between poverty and tuberculosis (TB) is well-documented, as socio-economic deprivation constitutes a risk factor that drives TB transmission and progression while hindering treatment adherence. Despite the importance of controlling for socio-economic status (SES) in TB research, no …
[228] The Social Determinants of Tuberculosis: From Evidence to Action — These interventions are generally delivered by what the CSDH refers to as “the systems put in place to deal with illness,”3 and include the use of diagnostic technologies to identify cases and medicines to treat patients and prevent infection among their close contacts.12 Existing TB control efforts also seek to increase the accessibility of health systems to the communities they serve through treatment support, along with active case-finding and outreach services for high-risk populations. The question is not what level should be targeted in public health interventions: proximate risk factors or upstream determinants, individuals or societies, biomedical or structural factors, or pills or poverty reduction strategies.43 Rather, the opportunity for the TB community is to best use knowledge about TB, from molecular biology to social determinants, to develop effective control approaches based on strong interdisciplinary approaches that capitalize on rather than disperse the medical, microbiological, and social notions we have of the disease.
[229] PDF — Background: Tuberculosis affects vulnerable populations and has become a challenge for the health system. There are difficulties accessing services which create serious consequences for treatment success. Aim: To establish the relationship between the determinants of access to health services and treatment adherence in patients with tuberculosis.
[230] Equity of and access to services for prevention of tuberculosis and ... — The promotion of equity and access for all in disease prevention and control activities is based on the recognition of poverty as a major determinant of ill-health and a barrier to health care. There is a need to accelerate health progress in poor and socially excluded groups in order to reach the health-related MDGs and to reduce inequities in access to health care. This chapter highlights the population groups that are often not reached by routine TB control measures and outlines the practical approaches required to address their needs. This section addresses the integration of pro-poor measures in NTPs and outlines the practical issues involved and options for action to improve access and minimize the financial burden for patients. Determine which barriers prevent access of vulnerable groups to TB services
[257] National Data | Reported Tuberculosis in the United States, 2023 | CDC — The number of reported tuberculosis (TB) disease cases and incidence rate increased in 2023 for the third year since 2020, surpassing pre-COVID-19 pandemic levels.
[259] Tuberculosis resurges as top infectious disease killer — This represents a notable increase from 7.5 million reported in 2022, placing TB again as the leading infectious disease killer in 2023, surpassing COVID-19. WHO's Global Tuberculosis Report 2024 highlights mixed progress in the global fight against TB, with persistent challenges such as significant underfunding.
[260] PDF — Global tuberculosis report 2023 ... in 2023 or 2024. The global gap between the estimated number of people ... from around 4 million in both 2020 and 2021 and back to the pre-pandemic level of 2019. Globally, the estimated TB incidence rate (new cases per 100 000 population per year) was 133 (95% UI: 124-143) in 2022. The net reduction from
[265] PDF — prevention and control measures TB prevention and control consists of a combination of measures designed to minimize the risk of M. tuberculosis transmission within populations. A three-level hierarchy of controls comprising administrative controls, environmental controls and respiratory protection has been shown to
[266] 3. Tuberculosis prevention and screening - World Health Organization (WHO) — Preventing tuberculosis (TB) infection and stopping progression from infection to disease are critical for reducing TB incidence to the levels envisaged by the End TB Strategy (1, 2).The main health care intervention to stop progression from infection to disease is TB preventive treatment (TPT), which the World Health Organization (WHO) recommends for people living with HIV, household contacts
[267] Tuberculosis Infection Control | TB Prevention in Health Care Settings ... — Applying epidemiology-based prevention principles, including the use of setting-related TB infection-control data; Using posters and signs to remind patients and staff of proper cough etiquette and respiratory hygiene (covering mouth when coughing) or offering surgical or procedure masks to patients); and
[270] PDF — Evaluating the effectiveness of public health interventions in reducing the spread of tuberculosis (TB) in high-risk populations is crucial to inform policies and strategies aimed at controlling and eliminating the disease. By evaluating the effectiveness of public health interventions in reducing TB transmission in high-risk populations, policymakers and healthcare professionals can identify successful strategies and make evidence-based decisions to further control and eliminate the disease. METHODOLOGY : To evaluate the effectiveness of public health interventions in reducing the spread of TB in high-risk populations, a comprehensive review of existing literature was conducted. Search terms included "tuberculosis," "public health interventions," "high-risk populations," "effectiveness," and "evaluation." Relevant studies that provided data on intervention outcomes, including reductions in TB incidence, improvements in treatment adherence, and overall impact on population health, were included in the analysis .
[271] Effective Strategies for Tuberculosis Prevention - Medicover Hospitals — Community-Level Interventions. Community-level interventions play a critical role in TB prevention. Effective strategies include: Health Education Programs: Implementing health education programs to raise awareness about TB symptoms, transmission, and prevention. Screening and Treatment Camps: Organizing regular screening and treatment camps in high-risk areas to identify and treat TB cases early.
[272] Community based interventions for the prevention and control of ... — We systematically evaluated the effectiveness of community based interventions (CBI) for the prevention and treatment of TB and a total of 41 studies were identified for inclusion. Qualitative synthesis suggests that community based TB treatment delivery through community health workers (CHW) not only improved access and service utilization but also contributed to capacity building and improving the routine TB recording and reporting systems. CBI: Community based interventions; CHW: Community health workers; CI: Confidence interval; DOTS: Direct observed therapy; HIV: Human immunodeficiency virus; MDR-TB: Multi drug resistant tuberculosis; NGO: Non-governmental organization; PMTCT: Prevention of mother-to-child transmission; RCT: Randomized controlled trial; RR: Relative risk; SMD: Standard mean difference; TB: Tuberculosis; WHO: World Health organization.
[274] Patient Adherence to Tuberculosis Treatment: A Systematic Review of ... — The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence. We searched 19 electronic databases (1966–February 2005) for qualitative studies on patients', caregivers', or health care providers' perceptions of adherence to preventive or curative TB treatment with the free text terms “Tuberculosis AND (adherence OR compliance OR concordance)”. Our interpretation of the themes across all studies produced a line-of-argument synthesis describing how four major factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors; and personal factors. We included studies that examined adherence or nonadherence to preventive or curative TB treatments and described the perspectives of patients, care givers, or health care providers.
[276] Facilitators and barriers for tuberculosis preventive treatment among ... — Background Various factors influence tuberculosis preventive treatment (TPT) decisions thus it is important to understand the health beliefs and concerns of patients before starting TPT to ensure treatment compliance. This study aims to explore facilitators and barriers for TPT among patients diagnosed with Latent Tuberculosis infection (LTBI) attending six primary healthcare clinics in