Journal of Clinical & Biomedical Research

Introduction

Tuberculosis is an infectious necrotizing granulomatous multisystem disease caused by mycobacterium bacilli, mainly mycobacterium tuberculosis. Although it is multisystem disease it mainly affects the lung causing pulmonary tuberculosis which is the most common tuberculosis presentation worldwide, but in Red sea state eastern Sudan prevalence of extrapulmonary tuberculosis is more than pulmonary tuberculosis and represent more than 53% of all tuberculosis cases in this area [1,2]. In Sudan as other developing countries tuberculosis still represent major public health problem with an estimation of 29000 cases in 2019 [3].

In those individual who exposed to mycobacterium tuberculosis just 10% develop TB disease while the immune system beside other factors as load of organism and size of droplet prevent the remainder 90% from developing TB disease [4].

Developing TB disease rather than Tb infection and presenting of TB as latent or active TB depend on many risk factors that divided into environmental factors, such ventilation, host factors such as immunosuppression as in diabetes, HIV and corticosteroid and other immunosuppressive drugs, those with occupational diseases as silicosis and pneumoconiosis are at increased risk to develop tuberculosis, and there are factors that related to organism as amount of organisms and size of droplets [5-7].

Symptomatically patient with pulmonary tuberculosis presented with chronic productive cough, nocturnal fever, shortness of breath, haemoptysis and weight loss while those with extrapulmonary tuberculosis presented with different manifestations that related to affected organ [8].

Diagnosis of tuberculosis confirmed by detecting the mycobacterium either with Ziehl neelsen stain, Gene X pert, culture or PCR, in addition to CXR in correlation to clinical presentation while mantoux test and IGRA (Interferon Gama Release Assay are used for survey in addition to diagnosis [9-11].

Treatment of tuberculosis follow DOTS (Direct Observed Therapy Strategy), which contain several elements that include both treatment and contact tracing in addition to its other components, DOTS treat tuberculosis with four drugs in intensive phase of two months, those are Rifampicin, Isoniazid, wPyrazinamide and Ethambutol and two drugs continuation phase of four months which are Rifampicin and isoniazid in FDC (Fixed Dose Concentration). With exception of tuberculous meningitis and Potts disease [12].

Contact tracing has major concern in DOTS because early detection and early standard management decrease both prevalence and complication of tuberculosis and improve outcome, there for this study concern on the prevalence and risk factors of tuberculosis among smear positive contact individuals.

Objectives
General Objective

This research aims to study the prevalence and risk factors of tuberculosis among TB smear positive contact whose registered in Port Sudan chest hospital TBMU center during third and fourth quarters; June to December 2023.

Specific Objectives

1. Determine the associated risk factors among contact persons:
2. Assess the effectiveness of tuberculosis control program in contact tracing.
3. Diagnose contact with latent or active tuberculosis.

Material and Method Study Design

This is a descriptive cross-sectional community base study.

Study Area

The study conducted in Port Sudan, Red Sea state, eastern Sudan.

Study Duration

This study done within the period from June 2023 to December 2023, the period which cover the third and fourth quarter according to tuberculosis control program policy.

Study Population

All household contact to TB smear positive who registered in Port Sudan chest hospital TBMU are included in this study.

Exclusion Criteria

Casual contact excluded because of difficulty in tracing reaching them, and those with history of previous tuberculosis also excluded.

Data Collection Method and Technique

Data collected through direct interview with participants using structured questionnaire that covering demographical, symptoms and risk factors of tuberculosis. IGRA done for all contact and those with positive IGRA considered as the prevalence and their data analyzed to reach the study objectives.

Data Analysis

Data analyzed using SPSS version 28.0.

Result

Close contact during study period were 522. From those 24 persons have Positive IGRA giving rate of 4.6% as prevalence of tuberculosis among smear positive contact individuals.

15 of those are females (62.5%) while males are 9 (37.5%). Their age between 5 years to 60 years, those below 10 years are 9 (37.5%), 11 to 20 years 2 participants (4.2%), those in age group between 21 to 30 years are 3 (12.5%) no one between 31 to 40 year 2 participants (4.2%) in age group 41 to 50 years while 8 (33.3%) are over 50 years old.8 of participants (33.3%) are living in poor ventilated houses. 12 of them (50%) live in crowded house with more than 10 households.

18 (75%) of participants are diabetics, 7 (29.2%) malnourished and 3 (12.5%) with chronic kidney disease. 11 (45.8%) of participants are smoker and 3 (12.5%) alcoholism.

Most of participants are a symptomatic while 8 (33.3%) have cough and fever also appear in 8 (33.3%) while shortness of breath in 4 (16.7%) of participants and weight loss in 3 of them (12.5%).

Discussion

Tuberculosis represent a serious and common health problem in Port Sudan, eastern Sudan with high social stigma this area; the thing that affect cases detection and diagnosis may be reached after complications as pulmonary fibrosis, traction bronchiectasis and even pulmonary hypertension, therefore contact tracing should be active to facilitate early detection and early management of cases which are decrease the incidence and improve the outcome.

In this study we exclude casual contact because of difficulties in reaching them and include the close contact therefore the prevalence of tuberculosis appears low than literature 4.6% and 10% respectively (4), the other reasons in this study we use IGRA as single diagnostic tool.

Tuberculosis spread among female more than male 1.5: 1 while in many other study like Alfaham et al, study that studied the prevalence of pulmonary tuberculosis and risk factors in patient at Wad Madani tuberculosis center the prevalence among male is more than female and in literature, this because in this area most of female not employee and they look after patients in home in a situation of poor ventilation and crowd houses as shown in results [7,13]. The study shows increase risk of tuberculosis in child and elder as are at risk for both endogenous reactivation and exogenous infection due to low immunity [12].

Immunosuppression represent a major risk factor as 75% of positive IGRA are diabetics, 29.2% malnourished and 12.5% have CKD, the latter is approximately equal to that in previous study done in Port Sudan to studied the frequency and presentation of tuberculosis among patient with ESRD [14]. Smoking appears in in more than 45% of participants and more than 10% are alcoholism and both smoking and alcohol affect the phagocytosis and increase the risk of tuberculosis [7].

Most of participant are a symptomatic either this is latent TB as IGRA didn’t differentiate between active and latent tuberculosis or they may deny symptoms because of social stigma the thing that delay the diagnosis and worsen the outcome.

Conclusion

The prevalence of tuberculosis among smear positive contact individuals in Port Sudan is low comparing to literature and other studies due to strong tuberculosis program and stigma which lead to some social isolation of patient also play a role in this reduction. Tuberculosis spread more among female and both child and elder contact as they spend more time in the home. And immunosuppression, poor ventilation and crowded household play an essential role in developing tuberculosis.

Contact tracing as a part of DOTS should be activated to enable early detection of TB cases and early intervention that prevent irreversible complication such as pulmonary fibrosis, traction bronchiectasis and even pulmonary hypertension.

References

1. Kumar P, Clark M (2002) Textbook of clinical medicine. 9^th edition 893.
2. Bashir Abdrhman Bashir, Yousif Mohammed Saeed (2017) Red Sea state, TB control program, Statistic department. American Journal of Internal Medicine 5: 79.
3. World Health Organization, Global Tuberculosis report (2021) https://www.who.int/publications/i/item/9789240037021.
4. Alfred P, Fishman, Jack A, Elias (2002) Fishman manual of pulmonary disease and disorders, third edition 868.
5. Alzayer Z, AL Nasser (2022) Y-Primary lung tuberculosis. Htt://www. nchi: nLm-nih.gov/book/ NBK567737.
6. Senkoro M, Kumar AMV, Chinnakali P, Mfinanga SG, Egwaga S, et al. (2016) Population impact factors associated with pulmonary tuberculosis in Tanzania. Int J Tubere Lung Dis 20: 1326-1333.
7. Anthony Seaton, A Gordon Leitich (2002) Crofton and Douglas Respiratory diseases. Fifth edition 330.
8. John F Murray (2016) Murray Nadels Textbook of Respiratory medicine. et al ,6th edition 889.
9. Loddenk emper R, Lipman M, Zumla A (2019) Clinical aspects of adult tuberculosis. Gold sprin Harb perspect Med 6: a017848.
10. Heemskerk D, Caws M, Marias B, Farraret J (2015) Tuberculosis in Adult and Children. London: Spriger; 2017 Chaspter 4, Diagnosis. https://www. ncbi. NLm. Nih. Gov/ book/ NBK 344401.
11. Stephen C (2014) Oxford handbook of respiratory medicine. 8th edition 490.
12. Ismail A Elsoni (2000) Manual of the national tuberculosis control in Sudan. 2nd edition 9.
13. Alfaham ZH, Ahmed EA, Ibrahim EM, Mohamed MS, Mohamed MM, et al. (2022) Pulmonary Tuberculosis and Risk Factors in New and Treated Presumptive Patients at Wad Madani Tuberculosis Center, Sudan (2018 - 2019): A Cross -Sectional Study. Journal of Tuberculosis Research 10: 18-27.
14. Murwan Mohamed Saeed Elnour, Yasir Mohammed Mahmmoud, Shimoos Obied Margani (2019) Prevalence and Presentation of Tuberculosis in Esrd in Port Sudan. International Journal of Current Advanced Research 8: 17430-17433.