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Showing 21 results for Tuberculosis
Bone and joint tuberculosis, Review of the patients treated in the Shafa Yahiaian Hospital, 1350-74
M Jabalameli , E Ameri ,
Volume 56, Issue 4 (7-1998)
Abstract
This paper represents a retrospective study of 142 patients with skeletal tuberculosis during the years 1350 to 1357 at Shafa Yahiaian Hospital. Confirmation of diagnosis is made by positive culture or pathology. The mean age of the patients was 27.5 years (range from 1.5 to 72 years). Most of the patients were in the second, first and third decade respectively. 45.3% of the patients were female. The spine was the most common site and was affected in 40.88% of the patients. The next sites were knee, hip and elbow, in order of frequency. The commonest site in spine was thoracic. The mean of sedimentation rate in the first visit was 48. Tuberculin skin test was negative in 23% of the patients. Evidence of pulmonary tuberculosis in chest radiography was present in 48.61% of the patients. Five patients had tuberculosis osteomylitis without involvement of the joint.
Sputum Conversion Among Patients With Smear Positive Pulmonary Tuberculosis
Soudbakhsh A R, Ahmadinejad Z, Sistanizadeh M,
Volume 61, Issue 1 (4-2003)
Abstract
Introduction: In the patients with smear-positive pulmonary tuberculosis (TB) bacteriologic assessment of sputum for detection of acid bacilli (AFB) Has essential role. This evaluation is accomplished by direct sputum smear & sputum culture. These examinations must be done in regular and preferably monthly after beginning of treatment. These tests have two important aims, including, determining of treatment efficacy & duration of isolation.
Methods and Materials: Most of the studies have that classic six month regimen led to sputum smear conversion & negative sputum culture in 85% of patient. This treatment regimen has two phases, including, attack phase and maintenance phase. In the attack phase we use four drugs, including, Isoniazid (INH), Rifampin (RMP), Pyrazinamide (PZA) and Ethambutol (EMB) for the first 2 months and if necessary until the end of third month. In the maintenance phase we use INH and Rif for the remaining of treatment course. The main objectives of this study were to determine the time needed for smear conversion and assessment of probable factors which may influence the smear conversion until 4 months after beginning of therapy. The factors that were assessed, were, Age, nationality, sex, clinical symptoms, underlying diseases, chest radiography (number of cavities), smoking, drug abuse and concentration of AF13 in the sputum Generally, we did this cross sectional study on the patient's records, who had been observed in Imam Khomeni Hospital, west health service center and masih daneshvary hospital between.
Results: This study showed that from totally 218 patients, 138(74.6%) patients had sputum conversion at the first 2 months of treatment and until the end of 3rd & 4th month this rate reached to 83.3% respectively. So in the end of fourth month only 32(14.7%) patients did not show sputum smear conversion. On the other hand this study showed that two factors including presence of cavities in chest radiography & concentration of AFB in the sputum are influencing this rate strongly.
Conclusion: Role of other factors such as age, nationality , Smoking, diabetes mellitus and weigh loss are controversial and another studies are necessary for confirming their roles. Other factors including sex, clinical symptoms has not been show to be important. Some factors such as drug abuse and immunosuppresive therapy has not been assessed in this study, because number of cases were not enough for statistical analysis.
Peripheral Blood Mononuclear Cell Mycobacterium tuberculosis PCR sensitivity in diagnosis of Tuberculosis
Hajiabdolbaghi M, Allishah H.a, Rasoolinejad M, Bahador A, Izadi M, Mobaien A.r,
Volume 65, Issue 11 (2-2008)
Abstract

Background: Tuberculosis is still one of the most important causes of mortality and morbidity in many countries and is the second only to human immunodeficiency virus as a cause of death worldwide resulting from a single infectious agent. In 1993, the World Health Organization declared tuberculosis a global public health emergency. Conven-tional methods for the diagnosis of Mycobacterium tuberculosis (MTB) infections are time consuming, as MTB culture requires 3-8 weeks for growth. To determine the sensitivity of polymerase chain reaction (PCR) in peripheral blood mononuclear cells (PBMC), we have evaluated Mycobacterium tuberculosis DNA in peripheral blood samples with PCR technique in adults with new cases of pulmonary and extra-pulmonary tuberculosis. Setting: Department of Infectious disease of Imam Khomeini Hospital, 2004- 2005, Tehran, Iran.

Methods: In this cross-sectional study, we evaluated MTB DNA extracted from 3ml citrated peripheral blood samples from 95 adults with new cases of pulmonary and extra-pulmonary tuberculosis. DNA extraction was performed using a commercial PCR kit with IS1081 primers. For prevention of cross contamination and reduction of false positives, all steps were performed under laminar hood.

Results: The 95 patients, 59 of whom were male, had a mean age 44.44 years (SD±20.26) 69 cases had pulmonary and 26 had extra-pulmonary tuberculosis. PCR was positive in 32 (33.7%) patients and negative in 63 (66.3%) cases. The overall sensitivity and accuracy of the PCR assay was 44.1% for pulmonary, 19.2% for extra-pulmonary and 10% for disseminated tuberculosis, respectively.

Conclusion: The low sensitivity of the IS1081 primer MTB-PCR assay on PBMC may pose problems for the rapid diagnosis of tuberculosis. However, further studies are needed to confirm this technique as an alternative test for the diagnosis of tuberculosis.


Visceral leishmaniasis and peritoneal tuberculosis: a case report
Zamani A, Atarod L, Zamani F,
Volume 66, Issue 12 (3-2009)
Abstract

Background: Leishman Denovani is an obligatory intracellular parasite that is seen such as Leishmanbody or Amustigote in intra reticolo-endothelial system. Leishmanenios is seen as sporadic-endemic or epidemic in many places in the world. In Iran in Fars state and west Azarbayjan is endemic and in other places are in sporadic form and is found in rural areas.

Case report: A four year-old girl was admitted with visceral Leishmaniasis and Subsequently developed peritoneal tuberculosis. The patient who lived in Dashte- Moghan, complained of abdominal pain and distention and weight loss from 1.5 years ago. The titre of IFA test for leishmansis was 1/1280. Leishman body was seen in bone marrow aspiration specimen. Bone marrow culture for leishmania was negative. The specimen of acsities fluid revealed sero- fibrino- purulent exudate with lymphocyic dominancy (over 90%). No response to classic lishmanisis treatment had been started unless the patient treated with anti tuberculoid regimen. 

Conclusion: The function of the T-helper (Tht) lymphocytes will decrease in Kala-azar disease. This is why there is no skin reaction to Manteaux (PPD) diagnostic test the patient. The patient have been suffering from long-term malnutrition with its consequent immune defect. There was no evidences of cure in our patient during classic Kala-azar therapy. After she received anti tuberculosis therapy she revealed clinical improvement with Glucantim regimen as well.


Rapid detection of Mycobacterium tuberculosis complex: PCR method using insertion sequence 6110
Rohani M, Khorshidi A, Moniri R, Torfeh M, Abddoshah F, Saffari M, Shajari Gh R, Moosavi Gh A,
Volume 67, Issue 3 (6-2009)
Abstract

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Tuberculosis is an important cause of death in some countries. The world health organization estimates that if stronger measures are not taken up to control the prevalence of this disease, from 2000 to 2020 a billion people will be infected by the bacterium. According to time consuming of common detection methods of Mycobact-erium tuberculosis such as culture, it is necessary to evaluate a rapid detection tests such as PCR. Rapid diagnosis of tuberculosis may have profound effects in patients' care According to importance of rapid detection and treatment of tuberculosis and for determine of sensitivity, specificity, positive predictive value and negative predictive value of PCR by using IS6110 this study was done in Kashan university of medical science.
Methods: A total of 248 sputum samples from patients suspected of mycobacterial diseases were studied. DNA was extracted by boiling method. IS6110 PCR method by a specific pair of primers designed to amplify 123bp and 245bp sequences of the insertion sequence, 6110, in the M. tuberculosis genome was used to analyze sputum samples.
Results: 32 out of 248 (12.9%) of samples had positive culture. PCR yielded a sensitivity of 93.8% and specificity of 99.1% for the diagnosis of TB patients with TB confirmed by culture. There were two out of 32 (6.3%) PCR-positive cases among the patients with non-TB disease.
Conclusion: The findings of the present study indicate that Multiplex PCR may provide a faster method of detecting tuberculosis, thus enhancing diagnostic procedures and we conclude that the performance of an IS6110 PCR assay is valuable in the rapid diagnosis of tuberculosis.


Drug-induced complications of anti-tuberculosis drugs in HIV patients
Rasoulinejad M, Bouyer M, Emadi Kouchak H, Hasibi M, Mollazadeh N, Moradmand Badie B,
Volume 68, Issue 10 (1-2011)
Abstract
Background: Tuberculosis with high prevalence in HIV/AIDS patients is the main reason for morbidity and mortality in these patients. About one-third of patients with HIV infection have concomitant tuberculosis. Lack of appropriate infection control on many social and economic communities will impose. Comprehensive study on the effects of anti-tuberculosis drugs in patients with HIV infecting less done, also due to the importance of reducing morbidity and mortality, reduce the cost of disease, identifying drug pharmacokinetics, the importance of completing treatment tuberculosis, this study was performed to evaluate the effects of anti- tuberculosis drugs on HIV infection and to identify the drug pharmacokinetics and so more complete tuberculosis treatment.
Methods: A historical cohort study was performed on patients referring to the research center for HIV/AIDS, consultation center, department of infection diseases of Imam Khomeini Hospital in Tehran, Iran. A total number of 75 cases with HIV negative versus HIV positive patients with pulmonary tuberculosis and positive sputum smear in accordance with inclusion and exclusion criteria were selected.
Results: In this study, the frequency of peripheral neuropathy 27(73%), arthralgia 31(83.8%), vomiting 18(48.6%), headache 26(70.3%), dizziness 20(54.1%), renal toxicity 4(10.8%) and of skin rash 10(27%) in patients with HIV virus infection were significantly more than HIV- negative patients. Hepatotoxicity, fever and anemia were not significantly more common in patients who infected with HIV virus.
Conclusion: The HIV patients, who have not received antiretroviral drugs during tuberculosis treatment, may show higher incidence of anti-tuberculosis drugs complications.


Sputum induction in the diagnosis of pulmonary tuberculosis in patients without sputum
Safavi E, Rahimi B, Jafari S, Seifirad S, Derakhshandeilami Gh, Zahedpouranaraki M, Abtahi H,
Volume 69, Issue 1 (4-2011)
Abstract

Background: Sputum induction has been recently introduced as an effective and inexpensive method for obtaining high quality sputum samples in patients without spontaneous sputum. As all Iranian physicians might not be familiar with this method yet, the results of this study could be of help in this regard.

Methods: During June 2010 to January 2011, all pulmonary tuberculosis (PTB) suspected patients, with clinical and/or radiological evidence in favor of PTB who had been referred to the Pulmonary Diseases department of Imam Khomeini Medical Center were enrolled in the study, if they were without spontaneous sputum. Sputum induction was performed using ultrasound nebulized hypertonic 3% sterile saline for 20 minutes. The laboratory was requested to report if the samples were of the intended quality (Polymorphonuclear Cells/Squamus Epithelial Cells≥2). The patients' demographic data, HIV serology and chest radiological findings in favor of PTB were recorded and analyzed.

Results: In 50 patients with suspected PTB [23 men (mean age (±SD), 51.21±20.24) and 27 women (mean age (±SD) 55.40±18.00)], cough was the most common complaint. The most prevalent radiological findings were infiltration and consolidation. PPD was positive in 21 (42%) patients. Sputum induction led to obtaining proper sputum samples in 90% of the patients. Positive sputum smear and culture were seen in 13 (26%) cases.

Conclusion: Sputum induction is a cost-effective and minimally invasive method which is associated with satisfactory results for obtaining high quality sputum samples in patients without spontaneous sputum.


Risk factors for tuberculosis infection: a brief report
Biranvand E, Abediankenari S, Khalilian A, Biranvand B,
Volume 70, Issue 5 (8-2012)
Abstract

Background: Tuberculosis is one of the most important diseases with annually 8 million new cases worldwide. The purpose of this study was to investigate the risk factors for tuberculosis (TB) infection.

Methods: In this descriptive study performed in Health center of Maznadaran province during 2010-2011, 183 patients with pulmonary and extrapulmonary TB infection were recruited. After measuring fasting blood sugar, and human immunodeficiency virus (HIV) antibodies, history of smoking was taken by using a questionnaire.

Results: The mean age of the participants was 46.8±19.8 years. The most common risk factor was diabetes and the lowest was HIV infection. Moreover, the prevalence of diabetes in women compared with that of men (OR=0.19, 95% CI=0.07±0.46) and smoking in men compared with women (OR=12.4, 95% CI=2.8±54.4, P<0.05) had statistically significant differences (P<0.05).

Conclusion: The results of this research show that diabetes and smoking could be risk factors for tuberculosis infection. It is concluded that, in case of respiratory symptoms in patients with diabetes and smoking, tuberculosis can be considered as an important differential diagnosis.


Prevalence of latent tuberculosis infection in low-risk children using tuberculin skin test: a study in Shiraz
Masoumi Asl H, Alborzi A, Pourabbas B,
Volume 70, Issue 7 (10-2012)
Abstract

Background: Tuberculin skin test (TST) is a readily available test for the diagnosis of latent tuberculosis infection (LTBI). This study was designed to evaluate LTBI in low-risk children aged 1-15 years.
Methods: This cross-sectional study was performed in Shiraz, Iran, over six months during 2009. Totally, 1289 boys and girls were selected by stratified multistage random sampling from four municipality areas before allocating them to 15 groups. Inclusion criteria included age 1-15 years, documented history of BCG vaccination at birth, Iranian nationality and a healthy state of being. Children with acute febrile diseases, immunosuppression, on medication and immigrants were excluded. We considered a TST ≥ 10 mm of induration as positive.
Results: The prevalence of LTBI in 1-15 years old children was 4.5%. The percentage was 3.5% in 1-5 year old, 4.1% in 6-10 year old and 5.7% in 11-15 year old children. The highest rate of infection was 9.8% in 15 year olds and the lowest was 2.2% in 3-year old children. Gender had no effect on LTBI rate. There is no significant difference of LTBI prevalence between four municipality areas.
Conclusion: The prevalence of LTBI in this study was lower in comparison with other studies performed in Iran. Positive predictive value of TST decreases in low endemic areas for tuberculosis, especially in low-risk groups therefore, most positive results are false-positive created by nonspecific reactions and infection with environmental mycobacteria. Hence, there is a need for new diagnostic tools that are easy and cost-effective.


Tuberculosis of spine as the first clinical presentation of Multiple Myeloma: a case report
Zahra Ahmadinejad , Seddighe Mansouri ,
Volume 71, Issue 4 (7-2013)
Abstract
Background: Patients with hematologic malignancies are at risk of advanced tuberculosis. The prevalence of tuberculosis between these patients is 2.1- 2.6 percent. The cellular immune deficiency caused by hematologic malignancies and or its treatment increases the risk of tuberculosis in these patients. Multiple Myeloma is malignant proliferations of plasma cells that involves different classes of immune system. Cellular and humeral immune deficiency due to the Multiple Myeloma and drugs for its treatment results in susceptibility to unusual infections. Infections are of the important factors of morbidity and mortality in patients suffering from multiple myeloma ,but coincidence of Multiple Myeloma and tuberculosis  is rare and very little has been reported
Case presentation: In this paper a 60-year-old woman from Kermanshah, Iran who is suffering from back pain, weight loss, weakness and sweating will be introduced. Spondylitis was seen in her lumbar imaging. Her husband suffered from pulmonary tuberculosis. In diagnostic studies tuberculose spondylitis and multiple myeloma were diagnosed simultaneously.
Conclusion: Although the accompanying of Multiple Myeloma and tuberculosis is not common, but immunodeficiency caused by a hematologic malignancy as well as a history of close contact with a patient with tuberculosis resulted in tuberculosis of spine in this patient. Clinical features of abovementioned diseases are very similar. But in endemic area for tuberculosis, this disease should be considered because delay in diagnosis leads to increment in mortality and morbidities. Diagnosis of tuberculos spondylitis is based on radiologic and histologic features of the disease and on the response to treatment because the sensitivity of definitive diagnostic tests such as culture and PCR is low in extra pulmonary tuberculosis. 

Outcome of TB in HIV patients treated with standard regimen
Mehrnaz Rasoolinejad , Azar Hadadi , Mojtaba Hedayat Yaghoobi , Banafshe Moradmand Badie , Neda Alijani ,
Volume 71, Issue 7 (10-2013)
Abstract

Background: HIV infection reduces the immune system and is the most significant factor in the spread of TB in recent years and one of the causes of death in HIV -seropositive patients. TB is the most commonly diagnosed opportunistic infection and the most frequent direct cause of death among HIV infected patients. The HIV infection can accelerate progression of TB infection to active TB disease. Among patients with active TB, those with HIV co-infection have the greatest risk for relapse. Regardless of increasing rate of TB and HIV in Iran, we decided to s urvey outcome of TB in HIV positive patients who treated with standard regimens in the years 2003-2012.

Methods: This retrospective cohort study was conducted on HIV-positive patients with TB referred to Behavioral Diseases Consultation Center and Infectious Diseases Ward of Imam Khomeini Hospital from 2003 to 2012. Outcome was defined as failure, relapse and mortality. Moreover, the relationship between outcomes and number of CD4, co-trimoxazole and antiretroviral intake, type of TB and AIDS defining illness was studied.

Results: This study had 135 patients, 8 (5.9%) were females and 127 (94.1%) were males. The mean age of the patients was 40.14+10.02 and the most way to catch HIV in this study was intravenous drug user. There were 3 (2.22%) cases of failure, 15 ( 11.1%) relapse , and 21 ( 15.8%) deaths. Antiretroviral therapy, AIDS defining illness, type of TB and co-trimoxazole intake did not soley affect relapse. CD4 level was the most effective variables in relapse [ Hazard ratio: 0.392 (0.11-1.4) Relative Risk: 0.809 (0.593-1.103) (P=0.068) ]. However, regard to CI95%, the impact of CD4 on relapse is not significant and antiretroviral intake was the most important and effective variable in increasing their survival. Hazard ratio: 0.137 (0.141-0.45) Relative Risk: 0.686 (0.513-0.918) (P=0.001)

Conclusion: Overall, receiving antiretroviral was the most important factor influencing the outcome of patients.


Epidemiology of Tuberculosis in south-west of Iran: a brief report
Reza Beiranvand , Shahnaz Ghalavandi , Ali Delpisheh , Kourosh Sayemiri , Shokrollah Salmanzadeh ,
Volume 72, Issue 4 (7-2014)
Abstract
Background: Tuberculosis is still one of the main causes of mortality and disability in developing countries. Despite of socio-economic development of communities and controlling majority of communicable diseases, With respect to importance and high incidence of Tuberculosis in marginal provinces, the present study was aimed to assess the epidemiology of Tuberculosis. Methods: In this Descriptive-Analytical Retrospective Study, documents of 6363 patients diagnosed with TB in the beginning of March 2005 to the end of the September 2012 in Khuzestan province, Iran, by used census sampling size, were used. Demographic variables and other necessity data were recorded by TB-Register software and then these data were analyzed by SPSS 16.0 software and Chi-square and independent t-tests with a significance level of less than 5%. For comparison Tuberculosis incidence in consecutive years used by Poisson tests (with a significance level of less than 5%). Results: mean age of patients and median age of patients were 39.3±18 and 35±6.5 years, for women mean age was older 2.1 years than men and there was significant relationship to age (P=0.0001). Of all patients 75.7% were pulmonary tuberculosis, 2.7% were infected with HIV and 91.2% were new cases. Cumulative incidence in province was 148.84/100,000. Most prevalent in Non-pulmonary TB was Lymphatic glands. Poisson test showed that changing trends of TB incidence in study years was statistically significant (P<0.05). Conclusion: Increasing concurrent of HIV infection and TB and decreasing patients mean age (39.3±18) and median (35±6.5) in southwest of Iran has high prevalence. Screening, training and preventive activities for controlling of disease is highly recommended for the whole country and in margin provinces in particular.
Assessment of Tuberculosis distribution by geographical information system in Khuzestan province: a brief report
Reza Beiranvand, Ali Delpisheh , Samira Solymani , Kourosh Sayehmiri , Keywan Weysi , Shahnaz Ghalavandi ,
Volume 72, Issue 6 (9-2014)
Abstract
Background: Distribution of Tuberculosis (TB) has a special template affected by geographic and social factors. Nowadays Geographical Information System (GIS) software is one of the most important and useful epidemiologic devise for identifying geographic areas and high risk population for infection by TB. Aim of this study was assessment of Tuberculosis distribution by GIS in Khuzestan province, Iran. Methods: In this retrospective cohort study, documents of 6363 TB patients identified in Khuzestan province at the beginning of 2005 until the end of the September of 2012 were assessed and sampling method was census. The data was gathered by TB-Register Center. TB incidence was evaluated by GIS maps according to climatic and vegetation with 1:25,000 scale. The data was analyzed in SPSS software and means plot and Independent’s t-test, ANOVA with a significance level of less than 5% and Eta Correlation. Results: Spread of Tuberculosis in climatic and vegetation were plotted in GIS maps, cumulative incidence rate was calculated separately for each area. There was a statistical significant relationship between cumulative incidence rate of disease and climatic (P=0.017) and the Eta correlation coefficient was 0.379 (P=0.011). There was a statistical significant relationship between cumulative incidence rate of TB and vegetation (P=0.004) and the Eta correlation coefficient was 0.388 (P=0.188). Mean age and median age of patients were 39.3±18 and 35±6.5 years respectively. For women, mean age was 2.1 years older than men and this difference was statistically significant. (P=0.0001). Conclusion: The risk of TB infection is closely associated with the climatic and vegetation. So the risk of TB in extra-dry climate and vegetation of highland meadows is more than other areas. Special care and services to high-risk areas is recommended.
A patient with isolated pancreatic tuberculosis: case report
Ramin Ebrahimian , Davod Tasa ,
Volume 73, Issue 6 (9-2015)
Abstract
Background: Although Tuberculosis (TB) is prevalent in developing countries, visceral TB is rare. Most cases of pancreatic tuberculosis are seen in association with disseminated TB (miliary) but isolated pancreatic infection is very rare. Especially when present in immunocompetent hosts. In clinical and radiological evaluation, pancreatic TB may present as a pancreatic abscess, acute or chronic pancreatitis, and cystic or solid pancreatic masses, so can confused with neoplasm in most cases. Case presentation: In winter of 2013, a 52-year-old woman was admitted to this hospital with epigastric pain. She also mentioned a history of weight loss during previous three months. Liver transaminases and total bilirubin were within normal range. Chest X-ray performed was negative for any cardiopulmonary process, and lung fields were noted to be clear. A purified protein derivative (PPD) skin test for tuberculosis yielded an induration of less than 1 centimeter. An abdominal CT- scan with IV and oral contrast was done. A 2×2 cm mass was seen in the pancreatic head. A diagnostic laparotomy was done. Conclusion: During surgery, a completely necrotic mass was in the pancreatic head. samples were sent for frozen section. The tuberculosis granuloma was diagnosed. Four drug anti-tuberculosis medication was started and continued for six months. Repeat imaging of the abdomen performed 6-months after the initiation of anti-TB therapy revealed complete resolution of the pancreatic mass, and antitubercular therapy was discontinued after a 6-month duration. Pancreatic tuberculosis can present with a variable spectrum of imaging findings. Furthermore, TB should be considered as a cause of any suspicious pancreatic lesion, especially in patients from areas where the infection is endemic.
HLA-DRB1, DQB1 allele frequencies in Iranian patients (sistani ethnic) with tuberculosis and healthy control
Sadegh Baniaghil, Gholamreza Nikbakht Borujeni , Hassan Tajbakhsh, Atefeh Esmailnejad, Ali Akbar Amirzargar ,
Volume 75, Issue 3 (6-2017)
Abstract

Background: HLA disease association was investigated in several autoimmune, cancer and infectious diseases. The outcome of tuberculosis (TB) infection may be influenced by host genetic factors like MMP-1, MCP-1, IL-10, IL-12, TNF-α, IFN-γ and human leukocyte antigen (HLA). Given the paucity of information with regard to the association between the human leukocyte antigens (HLA) and TB infection among Iranians, we aimed to identify HLA polymorphisms that might confer susceptibility or protect against TB.

Methods: In this case-control study, to investigate the association between the HLA-DRB1 and DQB1 alleles and TB, 50 patients with tuberculosis were selected from Sistani population in Golstan University of Medical Sciences, Golestan Province, North East of Iran, from September 2015 to February 2016. Allele frequencies in patients were compared with a 100 aged and sex match control group from healthy blood donor of that ethnic population. HLA-DRB1 and -DQB1 alleles were determined using polymerase chain reaction based on sequence specific primer (PCR-SSP) method by low to intermediate resolution kits supplied by CTS (Collaborative Transplant Study, Heidelber University, Germany). Using EPI-info statistical software Chi-square test and fisher exact test, 95% confidence interval and odd ratio were calculated and allele frequencies in patients and control subjects were compared. P-value less than 0.05 were considering statistically significant.

Results: The results of this study showed a significant increase and positive association  with -DRB1*04:03 (OR=3.13, CI 95% (2.47-3.96), -DRB1*14:04 (OR=3.13, CI 95% (2.47-3.96), -DQB1*0201 (OR=2.67, CI 95% (1.18-6.04), -DQB1*0601 (OR=3.16, CI 95% (1.36-7.73) ,while the frequency of -DRB1*07 (OR=0.16, CI 95% (0.05-0.52) were lower in patients than control group and shows negative association.

Conclusion: The results of this study confirmed some of the previous positive and/or negative association, however it is suggested that HLA-DRB1*04:03, -DRB1*14:04, -DQB1*0201, -DQB1*0601- have an important role in susceptibility to tuberculosis infection and -DRB1*07 was associated with protection in Iranian Sistani population. Larger case-control sample size studies may be helpful to confirm our investigation. In addition population-specific studies is needed for evaluation of the role of HLA polymorphisms in tuberculosis in different ethnic groups.

Tuberculin skin test: review article
Hadi Peeridogaheh , Roghayeh Teimourpour , Mohsen Arzanlou , Sina Rostami , Elham Raeisi ,
Volume 75, Issue 8 (11-2017)
Abstract
Historically, tuberculosis has been the leading cause of death throughout human history. Tuberculosis infection (TB) causes by Mycobacterium tuberculosis that is very dangerous and can affect any parts of the body, especially lungs. Tuberculosis infection still remains a serious threat to human public health due to its contagious nature, capability to stay latent form in host for indefinite time and then appear as active disease. It is estimated that one third of world’s population, nearly 2 billion persons are infected with Mycobacterium tuberculosis. Transmission occurs among people through inhalation of infected droplets. Lungs and especially alveolar macrophage are primary sites of infection. Mycobacterium tuberculosis bacilli by preventing fusion of phagosome with lysosome can remain alive inside the macrophages. Such situation defined as latent infection. In fact, persons with latent tuberculosis infection (LTBI) are only infected with M. tuberculosis without any sign of infectious. Latent infection in compared with active infection is not contagious, but in about 10-5 percent of people will develop active tuberculosis especially in elderly and people who use immunosuppressive drugs. Pulmonary TB is an active form of tuberculosis infection in which bacteria can spread among people by infected droplets. So identifying and treating people with latent TB infection can significantly reduce the progression of latent form to active infection. The tuberculin skin test (TST) is the most widely used test in worldwide that is applied to determine a person who is infected with M. tuberculosis. TST provide valubale information for diagnosis LTBI however its specificity can be reduced by bacillus Calmette-Guérin (BCG) vaccination and infected with non-tuberculous mycobacteria (NTM). In TST test host hypersensitivity responses to Purified protein derivative (PPD) from mycobacterium are evaluated. TST positive reaction indicates the presence of high risk for acquiring TB infection or progression of latent tuberculosis to active form. Previous studies indicated that there is correlation between TST response and subsequent risk of active TB. Experimental evidence has shown that treatment of latent infection in the basis of positive TST reduces the risk of active TB. Although TST is far from gold standard but it's low cost and simplicity make it a suitable laboratory test especially in developing country.
 

Latent tuberculosis infection in health care workers: review article
Davood Mansury , Mahdis Ghavidel , Kiarash Ghazvini ,
Volume 75, Issue 10 (1-2018)
Abstract
The members of Mycobacterium tuberculosis complex (MTBC) known as causative agents of human tuberculosis. Tuberculosis infection is one of the most important occupational risks for healthcare workers (HCWs) in most countries, such as Iran. In general, there are two types of tuberculosis, they include: latent infection and active TB. Latent tuberculosis infection (LTBI) means: a patient is infected with Mycobacterium tuberculosis but, the patient does not have active tuberculosis, clinical symptoms and radiological findings. According to studies, TB infection from patients to health care workers, depending on geographic region and economic situation is two to five times more than general population. The lowest incidence and the highest rates of LTBI prevalence among HCWs were 7% in Mashhad and 82.8% in Zahedan respectively. The risk factor acquisition of TB infection was a significant relationship with certain hospital wards (lung disease unit, laboratory, etc.), Increasing age and duration of employment. And results of this study show that TB is a significant problem among HCWs in Iran. Infection control and personal protective measures with training programs to patients and HCW is required to reduce the occupational risk of TB. Early detection of Mycobacterium tuberculosis and prevention treatment in people with latent TB are key elements in control of tuberculosis. Until now, different methods for detection of latent tuberculosis infection has been introduced that are not gold standard none of them. However, the most important methods, tuberculin skin test and the tests that based on measuring the production of interferon gamma are recommended, but each one of them has advantages and disadvantages. However, in all the articles of the tuberculin skin test is used for screening and early diagnosis of latent tuberculosis infection. So, the aim of this study was to Incidence and prevalence of latent tuberculosis infection in health care workers and risk factors, advantages and disadvantages of each method for diagnosis of latent tuberculosis infection and evaluate different strategies for reducing the incidence of latent tuberculosis infection in health care workers.

Role of metalloproteinase matrix in development of cavity and diagnosis of pulmonary tuberculosis
Abbasali Niyazi , Shima Javanbakht , Nezar Ali Muolaie , Mohamad Kazem Momeni , Mosayeb Shahriyar , Mehdi Nourallahzadeh,
Volume 77, Issue 1 (4-2019)
Abstract
Background: Matrix metalloproteases (MMPs) are multi-chain proteins that regulated by tissue inhibitor of metalloproteinases (TIMP) and several other mechanisms. This Includes transcription regulation and protein form secretion. The roles of MMPs in wound healing and tissue repair. In tuberculosis (TB), the activity of MMPs is increased and TIMP inhibitors decrease activity. Therefore, in tuberculosis, MMPs cause excessive damage to the lung tissue and cavity formation.
Methods: In a case-control study, plasma samples of healthy controls, symptomatic respiratory tract controls and tuberculosis patients were evaluated by available sampling in Ali Ibn Abitaleb and Bouali Hospitals, Zahedan, Iran, from Apri1 2015 to April 2018. Patients were divided into two groups: tuberculosis and control group and the level of MMPs were measured by the enzyme-linked immunosorbent assay (ELISA) method in plasma samples of the two groups. For MMP-8, which was important in the diagnosis of tuberculosis, a cutoff point was obtained.
Results: 384 people including 123 healthy controls. 107 non-tuberculosis, and 154 tuberculosis patients were examined; 230 patients in the control group and 154 patients in the tuberculosis group. Levels of MMPs in tuberculosis and symptomatic respiratory group were higher than healthy group. The mean of MMP-8 was significantly different between two groups (P<0.001). In this study, sensitivity, specificity, positive and negative predictive value of plasma MMP-8 in detection of TB in non-TB patients in MMP-8 cutoff point=6650 pg/ml were 65.4%, 78.2%, 50%, and 93% respectively outcome. Significantly, the rate of pulmonary cavity was significantly higher in the TB group; Higher cavity, higher concentration of plasma MMPs.
Conclusion: In this study, first comprehensive analysis of MMPs was performed. Two collagenases, MMP-1 and MMP-8, were active in tuberculosis, but MMP-8 was specifically higher in tuberculosis than in both symptomatic and healthy controls. Level of MMP-1, 3, 8, 9 was higher in men than in women. The analysis of genders separately showed MMP-8 was increased in tuberculosis group in comparison with control group and MMP-1 group in both TB and symptomatic respiratory tract increased.

Tuberculosis incidence predicting system using time series neural network in Iran
Atefeh Sedighnia , Sharareh Rostam Niakan Kalhori, Mahshid Nasehi , Ahmad Ali Hanafi-Bojd ,
Volume 77, Issue 4 (7-2019)
Abstract
Background: Tuberculosis (TB) is an important infectious disease with high mortality in the world. None of the countries stay safe from TB. Nowadays, different factors such as Co-morbidities, increase TB incidence. World Health Organization (WHO) last report about Iran's TB status shows rising trend of multidrug-resistant tuberculosis (MDR-TB) and HIV/TB. More than 95% illness and death of TB cases are in developing countries. The most infections are in South East Asia and West Pacific that 56% of them are new cases in the world. The incidence is actually new cases of each year. Incidence prediction is affecting TB prevention, management and control. The purpose of this study is designing and creating a system to predict TB incidence by time series artificial neural networks (ANN) in Iran.
Methods: This study is a retrospective analytic. 10651 TB cases that registered on Iran’s Stop TB System from March 2014 to March 2016, Were analyzed. Most of reliable data used directly, some of them merged together and create new indicators and two columns used to compute a new indicator. At first, effective variables were evaluating with correlation coefficient tests then extracting by linear regression on SPSS statistical software, version 20 (IBM, Armonk, NY, USA). We used different algorithms and number of neurons in hidden layer and delay in time series neural network. R, MSE (mean squared error) and regression graph were used for compare and select the best network. Incidence prediction neural network were designed on MATLAB® software, version R2014a (Mathworks Inc., Natick, MA, USA).
Results: At first, 23 independent variables entered to study. After correlation coefficient and regression, 12 variables with P≤0.01 in Spearman and P≤0.05 in Pearson were selected. We had the best value of R, MSE (mean squared error) and also regression graph in train, validation and tested by Bayesian regularization algorithm with 10 neuron in hidden layer and two delay.
Conclusion: This study showed that artificial neural network had acceptable function to extract knowledge from TB raw data; ANN is beneficial to TB incidence prediction.

Comparison of sensitivity and specificity of PCR and sputum smear compared to culture in diagnosis of tuberculosis
Marzieh Kazerani , Nahid Jalalian Elahi , Najmeh Mohajeri , Kiarash Ghazvini , Sara Taghdisi , Mohmadreza Ghafghazi , Mahdieh Motaghi , Mahdieh Motaghi ,
Volume 77, Issue 7 (10-2019)
Abstract
Background: Molecular detection has recently been proposed by nucleic acid amplification, known as polymerase chain reaction (PCR). The aim of this study was to compare the diagnostic method of smear and polymerase chain reaction with culture in terms of sensitivity, specificity, positive and negative predictive value in the diagnosis of pulmonary tuberculosis.
Methods: In this cross-sectional study, sputum samples were collected from 58 patients with suspected pulmonary tuberculosis referred to Ghaem Hospital in Mashhad from the beginning of April 2017 to the end of March 2018. The samples were delivered to the laboratory in less than 72 hours. Patients were sampled for three times. Bronchoscopy and Broncho alveolar lavage were performed in patients who were unable to produce sputum. The smear test was reported by Ghaem’s Laboratory after 24 hours. In our study, the culture method was considered as the gold standard and the sensitivity and specificity of the PCR methods and smear were compared with it.
Results: Patients ranged in age from 18 to 89 years. Among 58 suspected pulmonary tuberculosis, the method of cultivation confirmed the presence of the disease in 25 cases (43.1%). However, with smear, the presence of the disease has been proved in 27 patients (46.6%) and with the method of PCR in 24 patients was (41.4%). Sensitivity of smear in the diagnosis of pulmonary tuberculosis was (100%), and its specificity was 93.9%, the positive predictive value of this test was (92.6%) and the negative predictive value was (100.0%). The sensitivity of the PCR method in diagnosis of pulmonary tuberculosis was 88.0% and its specificity was 93.9%. The positive predictive value of this was (91.7%) and the negative predictive value was (91.2%).
Conclusion: In this study, between the two methods of smear and polymerase chain reaction, the acid fast smear method was more sensitive to the diagnosis of pulmonary tuberculosis than the polymerase chain reaction and the specificity of both methods were the same.

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