title: Hookworm infection among patients with pulmonary tuberculosis: Impact of co-infection on the therapeutic failure of pulmonary tuberculosis.
abstract: OBJECTIVE
  The aim of this study is to determine the rate of hookworm infection among patients with pulmonary tuberculosis (TB) and to find out if there is a relation between hookworm infection and the therapeutic failure of pulmonary TB.
  
  
  METHODS
  We carried out a prospective, hospital-based study. The study included 231 naïve patients with pulmonary TB, consecutively. Patients were evaluated at the 4th month of therapy for persistence of Mycobacterium tuberculosis infection. All patients had clinical evaluation, laboratory investigations (including sputum culture and stool microscopic examination), and imaging studies (abdominal ultrasonography and chest radiography).
  
  
  RESULTS
  The study population mean age was 42.7±13.9 years old with 26.8% of them 40 years old or more. Out of 231 patients, 133 (57.6%) were men. Therapeutic failure rate of pulmonary TB was 29.4%. Hookworm infection was diagnosed among 16.5% of patients and 27.7% had diabetes mellitus (DM). Using multivariate analysis, it was found that age of 40 years or more (odds ratio [OR] 8.4; 95% confidence interval [CI] 1.7-41.3; p=.009), hookworm infection (OR 7.6; 95% CI 1.2-49.9; p=.034), and DM (OR 5.9; 1.2-28; p=.027) were independently associated with therapeutic failure of pulmonary TB among the study population with pulmonary TB.
  
  
  CONCLUSIONS
  In conclusion, the rate of therapeutic failure of pulmonary TB is high. Besides older age and DM, hookworm infection can reduce the therapeutic response of pulmonary TB. Screening for and control of DM and hookworm infection among patients with pulmonary TB may improve their therapeutic response.
authors.affiliation: Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Ahmad Farooq Alsayed
authors.initials: AF
authors.lastname: Hasanain
authors.affiliation: Department of Chest Diseases, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Ali Abdel-Azeem Hasan
authors.initials: AA
authors.lastname: Zayed
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Reem Ezzat
authors.initials: RE
authors.lastname: Mahdy
authors.affiliation: Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Amany Mohamed Adawi
authors.initials: AM
authors.lastname: Nafee
authors.affiliation: Department of Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Rasha Abdel-Monem Hassan
authors.initials: RA
authors.lastname: Attia
authors.affiliation: Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: a.fh@outlook.com.
authors.forename: Asmaa Omar
authors.initials: AO
authors.lastname: Mohamed
mesh_terms: D000328:Adult; D000368:Aged; D000723:Ancylostomatoidea / Q000502:physiology; D000818:Animals; D000995:Antitubercular Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy* / Q000382:microbiology / Q000469:parasitology; D005260:Female; D006725:Hookworm Infections / Q000150:complications* / Q000469:parasitology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000502:physiology; D011446:Prospective Studies; D017211:Treatment Failure; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Coinfection; Hookworm; Therapeutic failure; Tuberculosis