Amitesh Gupta

Chronic obstructive pulmonary disease (COPD) is a prevalent and debilitating condition, increasingly recognized for its complex interaction with psychiatric disorders such as anxiety and depression. This study assesses and compares the prevalence of anxiety and depression among COPD patients, including those with a history of pulmonary tuberculosis (TB), and examines their associations with COPD severity. This descriptive, cross-sectional study included 100 patients diagnosed with COPD, aged 40 to 80 years. Patients underwent comprehensive clinical evaluation, including spirometry and COPD assessment tests, and were assessed for anxiety and depression using the Hospital Anxiety and Depression Scale. Participants were classified based on their COPD status and history of TB. Data on sociodemographic and clinical characteristics were collected, and associations between psychiatric illnesses and COPD status were analyzed. The study population was predominantly male (73%), with a mean age of 56.33 years. The COPD assessment score was medium in 65% of participants, with 30% of patients exhibiting high levels. Anxiety was present in 21% of the cohort, while 30% had depression. Analysis revealed a significant association between high COPD scores and increased prevalence of both anxiety and depression (p<0.05). Additionally, patients with a history of pulmonary TB showed higher rates of psychiatric comorbidities. Specifically, anxiety was more prevalent among patients with severe COPD and a history of TB. These findings highlight a substantial burden of anxiety and depression among COPD patients, particularly those with severe disease and a history of TB. These results align with the existing literature, suggesting a strong link between COPD severity, psychiatric comorbidities, and the impact of historical TB on mental health. These insights underscore the need for integrated management strategies addressing both respiratory and psychiatric aspects of COPD care.

COVID-19 affected millions of people worldwide, and tuberculosis (TB) continues to affect millions of people each year. The combined pandemic of COVID-19 and TB had a catastrophic effect on healthcare policies and healthcare setups around the globe. The clinical profile and factors affecting the outcome of COVID-19 disease in TB patients on treatment in field conditions have not been studied in detail. The present study attempted to study the occurrence of COVID-19 among patients on TB treatment in terms of the severity of COVID-19 disease and outcome of both COVID-19 and TB in patients at National Tuberculosis Elimination Program treatment centers over a period of one year during peak COVID-19 times. Out of 1400 TB patients enrolled, 65 (5%) suffered from COVID-19 disease. Of the 65 TB patients with COVID-19 disease, 37 (57%) were male and under 45 years old, 33 (51%) had a TB diagnosis after first receiving a COVID-19 diagnosis, 29 (45%) had a TB diagnosis first and received anti-TB treatment before receiving a COVID-19 diagnosis, and only 3 patients (5%) had a COVID-19 and TB diagnosis concurrently. The majority of 59 (91%) patients had mild COVID-19 disease. The outcome of TB treatment was available in 25 patients out of these 65 COVID-19-positive patients, with 21 (84%) patients having a favorable outcome. Out of the 65 COVID-19-positive patients, 4/25 (16%) had unfavorable outcomes, with one patient (4%) failing TB treatment and two patients (8%) dying. This is the first study from India that studied the occurrence and course of COVID-19 among a large number of TB patients taking anti-TB treatment under programmatic conditions. Due to the similarity in symptoms of TB and certain viral respiratory illnesses, a protocol should be established for healthcare workers to check patients for both illnesses.

This study was carried out to assess the role of therapeutic drug monitoring of crucial first-line anti-tubercular drugs [rifampicin (R) and isoniazid (H)] among 75 non-responding proven drug-sensitive tuberculosis (TB) patients on treatment followed by intervention in field conditions. The intervention was done in the form of either an increase in the dosage of R and H in patients with minimally low drug levels or a modification of the regimen in a certain group of patients with significantly low drug levels by augmenting it with three or four second-line drugs in addition to standard first-line drugs. This study also aimed to determine the relationship between the measured plasma concentration of anti-tubercular drugs and various demographic, microbiological, radiological, and malabsorption factors, and the presence of comorbidities affecting them. The study also focused on the clinical impact of the intervention for low plasma levels of anti-tubercular drugs on TB treatment outcomes. In our study, overall, 85.5% of patients had low levels of any drug. In 85.3% of patients, R levels were low, and in 39.1%, H levels were low. On univariate analysis, low body mass index (BMI), hypoalbuminemia, bilateral disease on chest X-rays, and the presence of cavities were found to be significantly associated with low drug levels, while none of the factors were independently significantly associated. Low BMI, pulmonary TB, and disseminated TB, far-advanced disease, and bilateral disease on chest X-ray, presence of cavities, and only low R levels were associated with unfavorable outcomes, with none of the factors found to be significant on multivariate analysis. In our study, it was seen that the treatment outcome was favorable in 59.6% of patients in whom this intervention was done by augmenting the treatment regimen with three/four second-line drugs along with increasing the dose of R and H. To conclude, various factors may be associated with low plasma levels of anti-tubercular drugs. If such patients show clinical non-response after ≥6 months of treatment and have significantly low drug levels, with an absence of drug resistance, their treatment regimen may need augmentation with three/four second-line drugs along with an increase in the dose of R and H, which may lead to a favorable outcome.

This review presents a comprehensive examination of the contemporary landscape pertaining to latent tuberculosis infection (LTBI) diagnostics, with a particular emphasis on the global ramifications and the intricacies surrounding LTBI diagnosis and treatment. It accentuates the imperative of bolstering diagnostic, preventive, and treatment modalities for tuberculosis (TB) to fulfill the ambitious targets set forth by the World Health Organization aimed at reducing TB-related mortalities and the incidence of new TB cases. The document underscores the significance of addressing LTBI as a means of averting the progression to active TB, particularly in regions burdened with high TB prevalence, such as India. An in-depth analysis of the spectrum delineating latent and active TB disease is provided, elucidating the risk factors predisposing individuals with LTBI to progress towards active TB, including compromised immune functionality, concurrent HIV infection, and other immunosuppressive states. Furthermore, the challenges associated with LTBI diagnosis are elucidated, encompassing the absence of a definitive diagnostic assay, and the merits and demerits of tuberculin skin testing (TST) and interferon-γ release assays (IGRAs) are expounded upon. The document underscores the necessity of confronting these challenges and furnishes a meticulous examination of the advantages and limitations of TST and IGRAs, along with the intricacies involved in interpreting their outcomes across diverse demographics and settings. Additionally, attention is drawn towards the heritability of the interferon-γ response to mycobacterial antigens and the potential utility of antibodies in LTBI diagnosis.

Both tuberculosis and COVID-19 being communicable and prevalent diseases in India, the co-existence can lead to worse outcomes, as seen in our study where there was high mortality among active as well as treated TB patients with COVID-19 co-infection.