TBC 036: Diagnostic Technologies etc.

·  TB Diagnostic Technologies and Hospital Impact

• Medical Center A in Taipei transitioned to auramine-rhodamine staining from Ziehl-Neelsen staining by 2014, aiming to improve TB detection and patient isolation.

• Enhanced diagnostic sensitivity resulted in doubling the positive sputum smear rate from 22.8% to 48.1%, especially for non-cavitary lung lesions.

• The median duration of non-isolated infectiousness reduced significantly from 12.5 days to 3 days, and the total number of non-isolated infectious patient-days decreased by 69% from 2001 to 2014.

• Suggestion: Implement continuous training for healthcare staff on the latest TB diagnostic technologies to maintain high detection rates and reduce the time to isolation.

·  Risk Factors and Control Measures in Healthcare Settings

• Inadequate ventilation and insufficient environmental cleaning in healthcare settings heighten TB transmission risks.

• Frequent healthcare visits are closely linked to increased TB incidence, necessitating robust infection control measures in high-traffic areas like internal medicine and family medicine.

• Suggestion: Prioritize the installation of germicidal ultraviolet systems and upgraded ventilation in outpatient areas to minimize airborne transmission.

·  Epidemiological Insights and Trends

• TB incidence and related mortality have declined in younger populations (<20 and 20–50 years) in mainland China, reflecting effective control measures.

• However, SS- TB cases and mortality in the >50 age group remained high, indicating ongoing vulnerabilities.

• Suggestion: Develop targeted health campaigns and screening programs focused on the elderly to address the persistently high TB rates in this demographic.

·  Regional and Systemic Challenges in Taiwan

• Increased Health System Delay (HSD) in diagnosing TB was noted between 2003 and 2008, influenced by factors such as patient’s age, gender, and the type of health facility visited.

• Eastern Taiwan showed shorter HSDs due to a higher concentration of TB-specialized providers, while medical centers experienced longer delays.

• Suggestion: Enhance the distribution and accessibility of specialized TB healthcare services across different regions to ensure timely diagnosis and treatment.

·  Link Between TB and Chronic Conditions

• Tuberculosis is a significant risk factor for developing chronic obstructive pulmonary disease (COPD), with risks increasing due to delays in TB treatment initiation.

• Early diagnosis and timely treatment of TB are crucial to mitigate COPD risk.

• Suggestion: Strengthen the integration of TB and COPD management protocols to improve patient outcomes and reduce the incidence of COPD among former TB patients.

See also: https://lintblab.weebly.com

References:

1. Sun H-Y, Wang J-Y, Chen Y-C, Hsueh PR, Chen Y-H, Chuang Y-C, et al. (2020) Impact of introducing fluorescent microscopy on hospital tuberculosis control: A before-after study at a high caseload medical center in Taiwan. PLoS ONE 15(4): e0230067.

2. Pan, S.C., Chen, C.C., Chiang, Y.T., Chang, H.Y., Fang, C.T. and Lin, H.H., 2016. Health care visits as a risk factor for tuberculosis in Taiwan: a population-based case–control study. American journal of public health, 106(7), pp.1323-1328.

3. Liu, K.H., Xiao, Y.X. and Jou, R., 2024. Multidrug-resistant tuberculosis clusters and transmission in Taiwan: a population-based cohort study. Frontiers in Microbiology, 15, p.1439532.

4. Huang, F. and Bello, S.T., 2024. Spatiotemporal analysis of regional and age differences in tuberculosis prevalence in mainland China. Tropical Medicine & International Health, 29(9), pp.833-841.

5. Fu, H., Lin, HH., Hallett, T.B. et al. Explaining age disparities in tuberculosis burden in Taiwan: a modelling study. BMC Infect Dis 20, 191 (2020). 

6. Chen, C.C., Chiang, C.Y., Pan, S.C., Wang, J.Y. and Lin, H.H., 2015. Health system delay among patients with tuberculosis in Taiwan: 2003–2010. BMC infectious diseases, 15, pp.1-9.

7. Lee C-H, Lee M-C, Lin H-H, Shu C-C, Wang J-Y, et al. (2012) Pulmonary Tuberculosis and Delay in Anti-Tuberculous Treatment Are Important Risk Factors for Chronic Obstructive Pulmonary Disease. PLoS ONE 7(5): e37978.