Tuberculosis (TB): Practice Essentials, Background, Pathophysiology
WHO Applauds ICMR-funded Study On Nutrition's Critical Role In Combating TB
By Shalini BhardwajNew Delhi: A study funded by the Indian Council of Medical Research (ICMR) has demonstrated the powerful impact of nutritional supplementation on tuberculosis (TB) patients and their families.
The World Health Organisation (WHO) has lauded the findings and incorporated them into its updated global guidance on TB control, marking a major milestone in India's contribution to global health policy.
"A landmark study by the Indian Council of Medical Research (ICMR), conducted in Jharkhand, has demonstrated the powerful impact of improved nutrition in reducing tuberculosis (TB) cases and fatalities.
World Health Organisation (WHO) has recognised this research, incorporating its findings into updated global guidance on TB control, marking a significant milestone in India's contributions to global health policy," the ICMR said in a statement."In India, tuberculosis and undernutrition are syndemics with a high burden of tuberculosis coexisting with a high burden of undernutrition in patients and in the population.
The aim of this study was to determine the effect of nutritional supplementation on tuberculosis incidence in household contacts of adults with microbiologically confirmed pulmonary tuberculosis," said the ICMR study published by The Lancet.
"To our knowledge, this is the first randomised trial looking at the effect of nutritional support on tuberculosis incidence in household contacts, whereby the nutritional intervention was associated with a substantial (39-48%) reduction in tuberculosis incidence in the household during 2 years of follow-up.This biosocial intervention can accelerate reduction in tuberculosis incidence in countries or communities with a tuberculosis and undernutrition syndemic," the study said.
The study was conducted on 2800 patients with TB across 28 tuberculosis units of the National Tuberculosis Elimination Programme in four districts of Jharkhand.
"In this field-based, open-label, cluster-randomised controlled trial, we enrolled household contacts of 2800 patients with microbiologically confirmed pulmonary tuberculosis across 28 tuberculosis units of the National Tuberculosis Elimination Programme in four districts of Jharkhand, India," the study mentioned."The tuberculosis units were randomly allocated 1:1 by block randomisation to the control group or the intervention group, by a statistician using computer-generated random numbers.
Although microbiologically confirmed pulmonary tuberculosis patients in both groups received food rations (1200 kcal, 52 grams of protein per day with micronutrients) for 6 months, only household contacts in the intervention group received monthly food rations and micronutrients (750 kcal, 23 grams of protein per day with micronutrients)," it said.
"After screening all household contacts for co-prevalent tuberculosis at baseline, all participants were followed up actively until July 31, 2022, for the primary outcome of incident tuberculosis (all forms). The ascertainment of the outcome was by independent medical staff in health services," the study added.
"We used the Cox proportional hazards model and Poisson regression via the generalised estimating equation approach to estimate unadjusted hazard ratios, adjusted hazard ratios (aHRs), and incidence rate ratios (IRRs)," it added.
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ICMR Study Shows Improved Nutrition's Impact In Curbing TB WHO Recognises It
New Delhi, Aug 19 (PTI) A study funded by the Indian Council of Medical Research (ICMR) has demonstrated the impact of improved nutrition in reducing tuberculosis cases and fatalities, with the WHO incorporating the findings into updated global guidance on controlling the disease. The aim of the study was to determine the effect of nutritional supplementation on tuberculosis incidence in household contacts of adults with microbiologically confirmed pulmonary tuberculosis. Household contacts of 2,800 patients with microbiologically confirmed pulmonary tuberculosis across 28 units of the National Tuberculosis Elimination Programme in four districts of Jharkhand were enrolled for this field-based, open-label, cluster-randomised controlled trial. The study, published by The Lancet, said that in India, tuberculosis and undernutrition are syndemic, with a high burden of TB coexisting with a high burden of undernutrition in patients and in the population. In a post on X on August 7, ICMR said the WHO has recognised this research and incorporated its findings into updated global guidance on TB control. During the study, although microbiologically confirmed pulmonary tuberculosis patients in both groups received food rations for six months, only household contacts in the intervention group received monthly food rations and micronutrients. After screening all household contacts for co-prevalent tuberculosis at baseline, all participants were followed up actively until July 31, 2022, for the primary outcome of incident tuberculosis, the study said. Between August 16, 2019, and January 31, 2021, there were 10,345 household contacts, of whom 5,328 (94.8 per cent) of 5,621 household contacts in the intervention group and 4,283 (90.7 per cent) of 4,724 household contacts in the control group completed the primary outcome assessment. Almost two-thirds of the population belonged to indigenous communities such as Santhals, Ho, Munda, Oraon, and Bhumij) and 34 per cent suffered from undernutrition. "To our knowledge, this is the first randomised trial looking at the effect of nutritional support on tuberculosis incidence in household contacts, whereby the nutritional intervention was associated with a substantial reduction in tuberculosis incidence in the household during 2 years of follow-up. "This biosocial intervention can accelerate reduction in tuberculosis incidence in countries or communities with a tuberculosis and undernutrition syndemic," the study said.
Progression From Infection To Pulmonary Tuberculosis Follows Distinct ...
Researchers have uncovered a sequence of biological processes that occur in humans infected with the bacterium Mycobacterium tuberculosis as the infection progresses to pulmonary tuberculosis, according to new research published in PLOS Pathogens.
M. Tuberculosis infects about a quarter of all people worldwide. Some infected people remain healthy, but five to 15 percent eventually develop active tuberculosis disease, which can be deadly. The most common form of the disease occurs in the lungs and is known as pulmonary tuberculosis. Pulmonary tuberculosis can be cured, but little is known about how it develops from the initial infection.
To better understand the mechanisms that underlie development of tuberculosis, Thomas Scriba of the University of Cape Town, South Africa, and colleagues followed 150 adolescents infected with M. Tuberculosis for several years. 106 of the study participants remained healthy, but 44 went on to develop pulmonary tuberculosis within a few years of initial infection.
During the study period, the researchers took regular measurements to monitor and compare immune system activity between individuals who remained healthy and those who eventually fell ill. They found that some differences were detectable as early as one to two years before diagnosis, while some were only detectable just before active disease began.
Eighteen months before diagnosis, the researchers found, individuals had elevated activity of immune system signaling molecules known as interferons, which aid in fighting infection. They also had elevated activity of the complement system, another immune system component. In the days just before diagnosis, additional immune changes occurred, including increased activity of white blood cells.
The scientists also analyzed which genes were expressed in T cells (a type of white blood cell) purified from study participants' blood. They found that certain genes associated with T cells' response to infection were suppressed in those who later developed pulmonary tuberculosis.
Overall, these findings lay out a clearer timeline of biological events that occur along the path from infection to disease. With further research, this knowledge could aid development of new strategies for diagnosis, vaccination, and treatment.
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