Emerging evidence indicates that the causative agent of tuberculosis is more genetically and functionally diverse than appreciated previously. The impact of this variation on the clinical manifestation of the disease remains largely unknown. In addition, there exists significant variability in the immune status of the host governing susceptibility to tuberculosis. The effect of these variations on the host pathogen interaction was investigated by taking varying pathogen phenotypes (virulent H37Rv, a-virulent H37Ra and a multidrug resistant strain #591) and varying host (18 MDR-TB and 16 fresh TB patients and 10 healthy, BCG-vaccinated individuals). The key question was whether the intracellular survival of Mycobacterium tuberculosis (MTB) in human monocyte-derived macrophages (MDM), an attribute of pathogenic potential, can be modulated by the immune status of the hosts or phenotype of MTB. The findings of this study indicate that induction of TNF-α may not be a global indicator of virulence of a strain. TNF-α release may be differentially regulated in response to the same strain depending upon the immune status of the host. Moreover, the phenotype of the infecting MTB and the host's immune status played a comparable role in the intracellular survival of MTB. This picture supports the hypothesis that in addition to the phenotype variation of the mycobacteria, the immune status of an individual will greatly influence the outcome of the host–pathogen interaction. These results may have a bearing on the future endeavors in vaccine development and TB control strategy.

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In 1993, the World Health Organization (WHO) declared tuberculosis (TB) a global emergency, and subsequently introduced the directly observed therapy short course (DOTS) strategy, a technical and management package, based on the earlier work of the International Union Against Tuberculosis and Lung Disease (IUATLD) and international experience with DOTS, which strategy beyond a doubt has played a great role in the initial success of this program, especially in hospitalized patients under the initial intensive phase of 4-drug, anti-TB treatment with Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. This results in rapid clinical well-being and early sputum conversion. This is indeed epidemiologically very important to break the chain of infection. Despite successful implementation of most of the elements of this strategy in several African countries and settings, TB case rates continue to escalate where the prevalence of HIV infection is high. There are also various other reasons which render the patients defaulter. Non-compliance is not only detrimental to the defaulters themselves as seen in this case study, but overall exposes the community to increased risk. Development of acquired resistance is more common in these patients, which makes their management very difficult. Therefore, it is important to anticipate those at risk of being defaulters and make them adhere to anti-TB treatment. It is very rare to trace and know what happened to a defaulter after he or she has dropped out, especially after migrating from one place to another, in the absence of any documentation. The following study is based on the story of a recurrent defaulter, a 64-year-old Saudi male who was admitted on 27 July 2011 to SBAH-City Rehabilitation Hospital & Medical Centre, Riyadh, Saudi Arabia.

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Mycobacterial diseases are a group of illnesses that cause a considerable number of deaths throughout the world, regardless of years of public health control efforts. Personalized medicine is a new but rapidly advancing field of healthcare. Personalized medicine in the field of mycobacteriology may be applied in the different levels of management such as prevention, diagnosis, treatment and prognosis. A genetic predisposition and a protein dysfunction study are recommended to tailor an individual approach in mycobacterial diseases.

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Objective: To study prevalence of diabetes type-2 and pulmonary tuberculosis among Filipino patients and treatment out comes. Tuberculosis centre of Dammam medical complex (MOH) is a referral centre for the Eastern Saudi Arabia where patients from all government and private hospitals having open pulmonary tuberculosis are admitted for isolation till they are rendered noninfectious. All patients are treated for 6 months under DOTS strategy with 4 drugs (2HRZE) for 2 months as initial intensive phase and 2 drugs (HR) for 4 months as continuation phase. Methods and materials: We retrospectively reviewed clinical records of 1388 patients admitted with open pulmonary tuberculosis between Jan- 2003 and June-2010. Results: Among 1388 patients, 39% (n = 542) were Saudis and 61% (n = 846) were non-Saudis. Among these 12.39% (n = 172) were Filipinos,153 males and 19 females respectively. Out of 1388 patients, 114 (7.17%) were found to have diabetes type-2. Among these diabetics, majority n = 91 (79.82%) were Filipinos. Sputum conversion was late in diabetic patients resulting in relatively longer hospital stay compared to fellow patients having only tuberculosis. Conclusion: Our study has shown that one possible risk factor for tuberculosis is diabetes. Majority of TB patients having diabetes type-2, n = 91 (79.82%) were Filipinos. Their sputum conversion was relatively late and their hospital stay was longer than their fellow patients having only tuberculosis. Our findings are in agreement with the current literature on the correlation of diabetes and tuberculosis.

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Objective: A descriptive study of drug-resistance patterns by age group and among culture-positive pulmonary tuberculosis (TB) patients referred to the Research Institute for Pulmonology and Phthisiology of Belarus between January 2007 and January 2008. Methods: Drug susceptibility tests were performed for first- and second-line anti-tuberculosis drugs. Patients were clustered into five resistance categories: mono-resistant (Mono); multi-drug resistant (MDR); all first-line drug resistance (MDR+ES); and extensively drug resistant (XDR). The patients were divided into primary and secondary and into six groups based on age in years (<15, 15–24, 25–44, 45–54, 55–65, and >65). Results: An analysis was undertaken of information gathered from 934TB patients, of whom 660 were men (70.67±1.5%) and 274 were women (29.33±1.5%) (p < 0.001). In the age group 25–65 years, men outnumbered women between 2.7 and 9.0 times higher. Cases of secondary TB totaled 414 (52.02±1.77%), and primary cases totaled 382 (47.98±1.77%) (p > 0.05); 756 of the patients were of working age, and 170 were of non-working age, of whom 570 men of working age (18–60 years) and 188 women of working age (18–55 years) participated. Males were significantly more likely to have MDR-TB than females. All cases with XDR-TB were older than 14 years old. Conclusion: As Belarus is a high-burden MDR-TB country and treatment of drug-resistant TB is long and complicated, the findings of this study provided useful information to deliver effective community-based disease control measures and a proposed plane for the effective management of drug-resistant TB at the national level.

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Background: The risk of death is significantly higher in TB/HIV-infected patients than in those patients with just one disease or the other. This study aims to evaluate the impact of demographic, clinical and laboratory characteristics on the treatment outcome and mortality of TB/HIV co-infected patients in a TB tertiary center in Iran. Materials and methods: The study was conducted at Iran's National Referral Center for Tuberculosis. In total, 111 patients were recruited between 2004 and 2007. Mycobacteriology studies were performed for all patients. Demographic, clinical, and lab data of all patients were analyzed, and predictors of unsuccessful outcomes, as well as mortality, were determined. Results: The mean age for all 111 TB/HIV patients was 38±9 years (range 22–70) and 107 patients (96.3%) were male; 104 patients (93.7%) had a history of drug abuse, and 96 patients (86.4%) had a history of imprisonment. The route of transmission of HIV was intravenous drug use in 88 of the patients (79.3%); 23 patients (20.7%) had a history of Category 1 (CAT-1) (5.4%) and CAT-2 treatment. Highly Active Antiretroviral Therapy (HAART) was given to 48 patients (43.2%). There was no significant association found between treatment outcome or mortality with sex, smoking, drug and alcohol abuse, imprisonment, route of transmission, history of CAT-1 and CAT-2, cluster of differentiation 4 (CD4), and adverse effects (p > 0.05). Administration of HAART led to a significantly higher rate of good outcome (p < 0.001). Lower Albumin levels and body weight were significantly associated with mortality. Conclusion: Albumin levels and weight can be predictors of mortality and an unsuccessful outcome. Administration of HAART led to a better outcome.

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The Beijing family of Mycobacterium tuberculosis (MTB) has been reported to have an exceptional capacity to spread tuberculosis (TB) and induce multi-drug resistance. A method has been developed to distinguish this family from the rest of the MTB families through real-time DNA amplification and subsequent analysis of the melting point of an amplicon. Two pools of multi-drug resistant (MDR) MTB samples collected at two different time periods from various regions in Syria have been selected. This preliminary screening indicated a complete absence of the Beijing family in all samples. This research presents an effective differentiation of bacterial Beijing strains, with minimal effort and cost through analysis of differential amplicon melting points.

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A 22-year-old Iraqi male presented with a case of intestinal obstruction secondary to primary ileocecal tuberculosis (TB). The presumptive diagnosis of either Crohn's disease or neoplasm was expected. A right hemicolectomy was performed. Histopathology revealed an inflammatory mass of TB origin; a polymerase chain reaction (PCR) confirmed the diagnosis. The patient was treated with standard anti-TB drugs for 6 months. Following the treatment, the systemic symptoms disappeared and the laboratory investigations returned to normal. Follow-up period showed no recurrence of the disease.

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