<i>Aim</i>: To survey practices in the diagnosis and management of latent tuberculosis infection (LTBI) in Australia and New Zealand. <i>Methods</i>: Infectious diseases and respiratory physicians and trainees were invited to complete an online questionnaire concerning various aspects of LTBI management.  <i>Results</i>: The questionnaire was completed by 126 clinicians self-reporting regular management of LTBI. Respondents were experienced physicians, with 95/126 (75.4%) having managed LTBI for more than 5 years. Forty-seven (37.3%) reported seeing more than 5 patients per month for assessment of LTBI. Substantial variation among clinicians was reported in relation to a number of common clinical scenarios. For instance, while 52/126 (43.7%) informed patients that the incidence of severe hepatotoxicity related to isoniazid monotherapy was 0.1–0.5%, 21/126 (15.7%) thought it was <i>&gt;</i>5%. 36/126 (28.6%) clinicians would proceed with TNF-<i><i>a</i></i>therapy following an indeterminate screening: interferon-<i><i>?</i></i>assay, while 78/126 (61.9%) would perform further investigations and 12/126 (9.5%) would initiate isoniazid therapy. Follow-up intervals during therapy varied from 1–3 monthly, with liver function testing performed routinely by 89/126 (70.6%). <i>Conclusion</i>: This study demonstrated a large degree of variation in clinical practice of LTBI management in Australia and New Zealand. Strategies for increasing uniformity of practice are required, including improved guidelines and physician education.

Justin T. Denholm

Emma S. McBryde

Management of Latent Tuberculosis Infections in Australia and New Zealand: A Review of Current Practice

<i  >Purpose</i>. The aim of this work was to develop specific radiopharmaceutical and to evaluate its efficacy in human to detect and locate the tubercular lesion. <i  >Materials and Methods</i>. <svg style="vertical-align:-0.12538pt;width:36.049999px;" id="M2" height="13.925" version="1.1" viewBox="0 0 36.049999 13.925" width="36.049999"  xmlns="http://www.w3.org/2000/svg">
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</svg>-Ethambutol (EMB) was produced by direct labeling method. <i  >In vitro and in vivo</i> biological studies and animal experiments were done. Phase I Clinical trial was performed. As per plan, 2 normal human subjects for biodistribution studies and fourteen patients (8 males and 6 females; age range of 25&#x2013;50, with one patient aged 12 years as an exception) were chosen for clinical trial. Whole body scan and spots were acquired at 1 hour and 4 hour. Angiography, blood pool, and 24-hours spot images of the infected areas were also acquired. <i  >Result</i>. Radiolabeling yielded <svg style="vertical-align:-0.30096pt;width:42.474998px;" id="M3" height="11.5375" version="1.1" viewBox="0 0 42.474998 11.5375" width="42.474998"  xmlns="http://www.w3.org/2000/svg">
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</svg> of labeled complex. <i  >In vitro and in vivo</i> biological studies and animal experiments indicated <svg style="vertical-align:-0.12538pt;width:36.049999px;" id="M4" height="13.925" version="1.1" viewBox="0 0 36.049999 13.925" width="36.049999"  xmlns="http://www.w3.org/2000/svg">
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</svg>-EMB as a specific tuberculosis imaging agent. The biodistribution study in normal human subjects suggested stability of <svg style="vertical-align:-0.12538pt;width:36.049999px;" id="M5" height="13.925" version="1.1" viewBox="0 0 36.049999 13.925" width="36.049999"  xmlns="http://www.w3.org/2000/svg">
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</svg>-EMB, with main excretory pathways being renal and hepatobiliary, which appeared to be similar to the known behavior of unlabeled EMB. No adverse reactions were observed. <svg style="vertical-align:-0.12538pt;width:36.049999px;" id="M6" height="13.925" version="1.1" viewBox="0 0 36.049999 13.925" width="36.049999"  xmlns="http://www.w3.org/2000/svg">
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</svg>-EMB got localized in pulmonary and bone tubercular lesions. Scintigrams of <svg style="vertical-align:-0.12538pt;width:36.049999px;" id="M7" height="13.925" version="1.1" viewBox="0 0 36.049999 13.925" width="36.049999"  xmlns="http://www.w3.org/2000/svg">
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		</g>
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</svg>-EMB and <svg style="vertical-align:-0.12538pt;width:36.049999px;" id="M8" height="13.925" version="1.1" viewBox="0 0 36.049999 13.925" width="36.049999"  xmlns="http://www.w3.org/2000/svg">
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</svg>-Ciprofloxacin were compared at different time intervals. <i  >Conclusion</i>. The present study states that developed <svg style="vertical-align:-0.12538pt;width:36.049999px;" id="M9" height="13.925" version="1.1" viewBox="0 0 36.049999 13.925" width="36.049999"  xmlns="http://www.w3.org/2000/svg">
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			</text>

		</g>
	</g>
</svg>-EMB  has high potential to qualify as a specific tuberculosis imaging radiopharmaceutical and is safe for human use.

Namrata Singh

A. Bhatnagar

Clinical Evaluation of Efficacy of <sup>99m</sup>TC -Ethambutol in Tubercular Lesion Imaging

The role of soluble <i  >soluble urokinase</i>-type <i  >plasminogen activator receptor</i> (suPAR) as a biological marker for TB  treatment efficacy on active pulmonary TB-AFB(+) patients was investigated.  Twenty pulmonary TB-AFB(+) patients participated in a cohort study for six months. The plasma suPAR level was measured using ELISA method before treatment, two months, four months and six months after treatment.  At the same time clinical parameters were also measured. Results indicated that all patients (<svg style="vertical-align:-0.17555pt;width:42.912498px;" id="M1" height="10.9125" version="1.1" viewBox="0 0 42.912498 10.9125" width="42.912498"  xmlns="http://www.w3.org/2000/svg">
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</svg>) showed highest plasma suPAR levels before treatment (median 12.775&#x2009;ng/mL) and significantly decreased (
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</svg>&#x3c;.05, <svg style="vertical-align:-0.27588pt;width:64.525002px;" id="M3" height="14.1125" version="1.1" viewBox="0 0 64.525002 14.1125" width="64.525002"  xmlns="http://www.w3.org/2000/svg">
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</svg>) after 2 months (median 8.019&#x2009;ng/mL) and 4 months (median 5.771&#x2009;ng/mL) of treatment, respectively. However, only slightly declined after 6 months therapy (median 5.009&#x2009;ng/mL), near control group level (median 4.772&#x2009;ng/mL). Interestingly, the significant reduced of suPAR level was parallel to treatment efficacy and correlated with other clinical and laboratory parameters, that is,  decreasing of patients' complaints, increasing of BMI (<svg style="vertical-align:-0.17554pt;width:71.762497px;" id="M4" height="10.9125" version="1.1" viewBox="0 0 71.762497 10.9125" width="71.762497"  xmlns="http://www.w3.org/2000/svg">
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</svg>), thoracic imaging improvement, sputum conversion, decreasing of ESR (<svg style="vertical-align:-0.17555pt;width:61.049999px;" id="M5" height="11.1" version="1.1" viewBox="0 0 61.049999 11.1" width="61.049999"  xmlns="http://www.w3.org/2000/svg">
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			</text>

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</svg>) and monocytes count (<svg style="vertical-align:-0.17555pt;width:61.049999px;" id="M6" height="11.1" version="1.1" viewBox="0 0 61.049999 11.1" width="61.049999"  xmlns="http://www.w3.org/2000/svg">
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			</text>

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</svg>) with exception the width of lesion in thoracic imaging. 
In conclusion, the suPAR level in could reflect the progress of TB therapy.

Tri Yudani Mardining Raras

Iin Noor Chozin

The Soluble Plasminogen <i>Activator Receptor</i> as a Biomarker on Monitoring the Therapy Progress of  Pulmonary TB-AFB(+) Patients

Patients with tuberculosis frequently develop anergy, a state of T-cell hyporesponsiveness in which defective T-cell costimulation could be a factor. To know if the expression of T-cell costimulatory molecules was altered in tuberculosis, we analyzed the peripheral blood T-cell phenotype of 23 Mexican patients with pulmonary tuberculosis. There was severe CD4 (<svg style="vertical-align:-0.30096pt;width:56.150002px;" id="M1" height="11.0625" version="1.1" viewBox="0 0 56.150002 11.0625" width="56.150002"  xmlns="http://www.w3.org/2000/svg">
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				<tspan style="font-size: 12.50px; " x="38.559254" y="0">1</tspan>
			</text>

		</g>
	</g>
</svg>) and CD8 (<svg style="vertical-align:-0.30096pt;width:48.337502px;" id="M2" height="11.0625" version="1.1" viewBox="0 0 48.337502 11.0625" width="48.337502"  xmlns="http://www.w3.org/2000/svg">
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		<g transform="translate(72,-63.15)">
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				<tspan style="font-size: 12.50px; " x="32.307751" y="0">1</tspan>
			</text>

		</g>
	</g>
</svg>) lymphopenia and upregulation of costimulatory molecule CD30 on CD4 and CD8 T cells (<svg style="vertical-align:-0.30096pt;width:48.337502px;" id="M3" height="11.25" version="1.1" viewBox="0 0 48.337502 11.25" width="48.337502"  xmlns="http://www.w3.org/2000/svg">
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		<g transform="translate(72,-63)">
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				<tspan style="font-size: 12.50px; " x="32.307751" y="0">5</tspan>
			</text>

		</g>
	</g>
</svg>); this increase was higher in relapsing tuberculosis. The main finding was severe downregulation of the major costimulatory molecule CD28 on both CD8 and CD4 T cells (<svg style="vertical-align:-0.30096pt;width:56.150002px;" id="M4" height="11.0625" version="1.1" viewBox="0 0 56.150002 11.0625" width="56.150002"  xmlns="http://www.w3.org/2000/svg">
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		<g transform="translate(72,-63.15)">
			<text transform="matrix(1,0,0,-1,-71.95,63.5)">
				<tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
				<tspan style="font-size: 12.50px; " x="10.890113" y="0">&lt;</tspan>
				<tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="32.307751" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="38.559254" y="0">1</tspan>
			</text>

		</g>
	</g>
</svg>). Depletion of the CD4/CD28 subset, a hitherto undescribed finding, is relevant because CD4 T cells constitute the main arm of the cell-mediated antimycobacterial immune response.

German Bernal-Fernandez

Patricia Espinosa-Cueto

Rosario Leyva-Meza

Nathalie Mancilla

Raul Mancilla

Decreased Expression of T-Cell Costimulatory Molecule CD28 on CD4 and CD8 T Cells of Mexican Patients with Pulmonary Tuberculosis

<i  >Objective</i>. To describe the yield of smear-microscopy and radiological findings by male and female patients with symptoms of tuberculosis in Abuja, Nigeria. <i  >Methods</i>. Patients &#x2265;15 years old with cough for &#x3e;3 weeks submitted 3 sputum samples for smear microscopy. One specimen was cultured using MGIT-960. All patients had lung X-rays and screened for HIV. <i  >Results</i>. were more likely to be smear-positive than females (262/774 [34&#x25;] and 137/547 [25&#x25;], <svg style="vertical-align:-0.30096pt;width:48.337502px;" id="M1" height="11.0625" version="1.1" viewBox="0 0 48.337502 11.0625" width="48.337502"  xmlns="http://www.w3.org/2000/svg">
    <g transform="matrix(1.25,0,0,-1.25,0,11.0625)">
        <g transform="translate(72,-63.15)">
            <text transform="matrix(1,0,0,-1,-71.95,63.5)">
                <tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
                <tspan style="font-size: 12.50px; " x="10.890113" y="0">&lt;</tspan>
                <tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
                <tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
                <tspan style="font-size: 12.50px; " x="32.307751" y="0">1</tspan>
            </text>

        </g>
    </g>
</svg>), but similar proportions of males and females were culture-positive (437/691 [63&#x25;] and 294/495 [59&#x25;], <svg style="vertical-align:-0.27588pt;width:48.337502px;" id="M2" height="11.0375" version="1.1" viewBox="0 0 48.337502 11.0375" width="48.337502"  xmlns="http://www.w3.org/2000/svg">
    <g transform="matrix(1.25,0,0,-1.25,0,11.0375)">
        <g transform="translate(72,-63.17)">
            <text transform="matrix(1,0,0,-1,-71.95,63.5)">
                <tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
                <tspan style="font-size: 12.50px; " x="10.890113" y="0">=</tspan>
                <tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
                <tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
                <tspan style="font-size: 12.50px; " x="32.307751" y="0">9</tspan>
            </text>

        </g>
    </g>
</svg>).  317/626 (50.6&#x25;) males and 249/419 (59.4&#x25;) females were HIV-positive (<svg style="vertical-align:-0.30096pt;width:56.150002px;" id="M3" height="11.25" version="1.1" viewBox="0 0 56.150002 11.25" width="56.150002"  xmlns="http://www.w3.org/2000/svg">
    <g transform="matrix(1.25,0,0,-1.25,0,11.25)">
        <g transform="translate(72,-63)">
            <text transform="matrix(1,0,0,-1,-71.95,63.35)">
                <tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
                <tspan style="font-size: 12.50px; " x="10.890113" y="0">&lt;</tspan>
                <tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
                <tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
                <tspan style="font-size: 12.50px; " x="32.307751" y="0">0</tspan>
                <tspan style="font-size: 12.50px; " x="38.559254" y="0">5</tspan>
            </text>

        </g>
    </g>
</svg>). Among culture-positives patients, HIV-infected males were less likely to have positive smears than HIV-negative males (49.2&#x25; versus 66&#x25;, <svg style="vertical-align:-0.17555pt;width:56.150002px;" id="M4" height="10.9125" version="1.1" viewBox="0 0 56.150002 10.9125" width="56.150002"  xmlns="http://www.w3.org/2000/svg">
    <g transform="matrix(1.25,0,0,-1.25,0,10.9125)">
        <g transform="translate(72,-63.27)">
            <text transform="matrix(1,0,0,-1,-71.95,63.5)">
                <tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
                <tspan style="font-size: 12.50px; " x="10.890113" y="0">=</tspan>
                <tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
                <tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
                <tspan style="font-size: 12.50px; " x="32.307751" y="0">0</tspan>
                <tspan style="font-size: 12.50px; " x="38.559254" y="0">1</tspan>
            </text>

        </g>
    </g>
</svg>). Among females, smear positivity did not vary with HIV (46.4&#x25; for HIV-positive and 52.9&#x25; for HIV-negative, <svg style="vertical-align:-0.17555pt;width:48.337502px;" id="M5" height="10.9125" version="1.1" viewBox="0 0 48.337502 10.9125" width="48.337502"  xmlns="http://www.w3.org/2000/svg">
    <g transform="matrix(1.25,0,0,-1.25,0,10.9125)">
        <g transform="translate(72,-63.27)">
            <text transform="matrix(1,0,0,-1,-71.95,63.5)">
                <tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
                <tspan style="font-size: 12.50px; " x="10.890113" y="0">=</tspan>
                <tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
                <tspan style="font-size: 12.50px; " x="26.056252" y="0">3</tspan>
                <tspan style="font-size: 12.50px; " x="32.307751" y="0">8</tspan>
            </text>

        </g>
    </g>
</svg>).  Of 274 culture-confirmed TB cases, 226 (82.5&#x25;) had cavities, and 271 (99&#x25;) had &#x2265;1 lung areas affected. HIV-positive males were more likely to have lung cavities than HIV-positive females (85&#x25; versus 69&#x25;, <svg style="vertical-align:-0.30096pt;width:48.337502px;" id="M6" height="11.0625" version="1.1" viewBox="0 0 48.337502 11.0625" width="48.337502"  xmlns="http://www.w3.org/2000/svg">
    <g transform="matrix(1.25,0,0,-1.25,0,11.0625)">
        <g transform="translate(72,-63.15)">
            <text transform="matrix(1,0,0,-1,-71.95,63.5)">
                <tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
                <tspan style="font-size: 12.50px; " x="10.890113" y="0">&lt;</tspan>
                <tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
                <tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
                <tspan style="font-size: 12.50px; " x="32.307751" y="0">4</tspan>
            </text>

        </g>
    </g>
</svg>) and to have &#x2265;3 lung areas affected (<svg style="vertical-align:-0.17555pt;width:48.337502px;" id="M7" height="10.9125" version="1.1" viewBox="0 0 48.337502 10.9125" width="48.337502"  xmlns="http://www.w3.org/2000/svg">
    <g transform="matrix(1.25,0,0,-1.25,0,10.9125)">
        <g transform="translate(72,-63.27)">
            <text transform="matrix(1,0,0,-1,-71.95,63.5)">
                <tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
                <tspan style="font-size: 12.50px; " x="10.890113" y="0">=</tspan>
                <tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
                <tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
                <tspan style="font-size: 12.50px; " x="32.307751" y="0">3</tspan>
            </text>

        </g>
    </g>
</svg>). 
<i  >Conclusion</i>. Differences in the yield of smear-microscopy, culture and X-rays on presentation are due to several factors including HIV coinfection and gender.

Lovett Lawson

Mohammed A. Yassin

Alex N. Onuoha

Andrew Ramsay

Rachel R. M. Anderson de Cuevas

Sally Theobald

Peter D. O. Davies

Luis E. Cuevas

Yield of Smear Microscopy and Radiological Findings of Male and Female Patients with Tuberculosis in Abuja, Nigeria

We set out to determine the levels of <i>Mycobacterium tuberculosis</i> resistance to first- and second-line TB drugs in an urban population in Zambia. Sputum samples were collected consecutively from all smear-positive, new and previously treated patients, from four diagnostic centres in Ndola between January and July 2006. Drug susceptibility testing was performed using the proportion method against four first- and two second-line TB drugs. 
<i>Results</i>. Among 156 new cases, any resistance was  observed to be 7.7%, monoresistance to isoniazid and rifampicin was 4.5% and 1.3%, respectively. Of 31 retreatment cases, any resistance was observed to be 16.1%, monoresistance to isoniazid and rifampicin was 3.3% for each drug, and one case of resistance to both isoniazid and rifampicin (multidrug resistance) was detected. No resistance to kanamycin or ofloxacin was detected. <i>Conclusion</i>. Although not representative of the country, these results show low levels of drug resistance in a community with a long-standing DOTS experience. Resource constrained countries may reduce TB drug resistance by implementing community-based strategies that enhance treatment completion.

Chanda Mulenga

Allan Chonde

Innocent C. Bwalya

Nathan Kapata

Mathilda Kakungu-Simpungwe

Sven Docx

Krista Fissette

Isdore Chola Shamputa

Françoise Portaels

Leen Rigouts

Low Occurrence of Tuberculosis Drug Resistance among Pulmonary Tuberculosis Patients from an Urban Setting, with a Long-Running DOTS Program in Zambia

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<p><em>Tuberculosis Research and Treatment</em> publishes original research articles and&nbsp;review articles related to all aspects of tuberculosis, from the immunological basis of disease to translational and clinical research.</p>


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Tuberculosis Research and Treatment publishes original research articles and review articles related to all aspects of tuberculosis, from the immunological basis of disease to translational and clinical research.

Tuberculosis Research and Treatment