Tuberculosis is one of problems for Azerbaijan Public Health
Tuberculosis (TB) is a major public health threat in Azerbaijan. The recent escalation of the occurrence of the disease has been complicated due to the appearance and development of multi-resistant tuberculosis (MDR TB) or extensively drug-resistant tuberculosis (XDR TB), as well as HIV/TB co-infection, which requires long-term treatment. The ability for the Azerbaijani and worldwide community of TB researchers to understand the nature of the TB disease will be greatly improved by using a common database containing patients’ medical images, treatment information, lab work, and clinical data. This common database can facilitate adherence to the treatment protocol as well as serve as a consistent repository of records of the treatment regime for particular histories of disease.
The goal of the project is to develop the Azerbaijan TB Portal to facilitate research aimed at diagnosis and treatment of drug-resistant tuberculosis. The clinical images of lungs (CT and X-ray) will be used for development of computational methods of TB diagnosis. Clinical data will be collected and stored in Portal’s database for computer-aided analysis of factors contributing to the development of the disease. Connection of Portal’s metadata with the original clinical samples collection (clinical lab samples taken from TB patients) would allow researchers to establish various cohorts for subsequent partial or full-genome sequencing of Azerbaijani TB strains. Analysis of genomes of Azerbaijani TB strains would allow for improved analysis of epidemiological situation in Azerbaijan, and forming informed opinion about required drug regiments and efficiency of diagnosis with common microbiological tools.
To leverage the design and deployment of Azerbaijan TB Portal, we plan on using the common core developed for the Belarus TB Portal. The Azerbaijan TB Portal will store anonymized medical images, lab work, treatment information and clinical data from the Azerbaijani TB patients and use user interface developed for Azerbaijan Portal. The Azerbaijan TB Portal will utilize the software and populate it with the anonymized data from the participating Azerbaijani TB patients including medical images, lab work, treatment information and clinical data. About 100 patient records are anticipated overall, about 10% with sensitive TB, the rest with MDR/XDR TB. Information submitted into the Portal will be appropriately de-identified and authorized for upload by the Azerbaijani researchers ensuring compliance with the appropriate Azerbaijani laws and regulations. Overall, data from about 100 TB patients will be included in the Portal – 10 with sensitive TB and ~90 with MDR/XDR TB.
The National Center for Tuberculosis and Lung Diseases (NCTLD) has unique field of expertise to contribute to the project: the NCTLD research team has extensive experience in bacteriology, genotyping, and DNA sequence analysis of various infectious agents, which will be leveraged for this project.
One of the projects emphases is on the comparative analysis of sputum vs. surgical samples for interesting clinical cases. The purpose of surgery is to remove a large, focal burden of bacilli present in necrotic and non-viable lung tissue. By removing the main focus of infection, it may be possible to prevent further disease spread and allow medical therapy to work better. Two potential mechanisms by which the tuberculous cavity hinders effective medical therapy include reducing drug penetration and providing an environment conducive to drug resistance amplification. While no clinical data exists for second-line drugs, older studies found reduced cavitary penetration of isoniazid and rifampicin. The objective of the project is to create a new open access public health resource for the tuberculsosis (TB) research and education.
Criteria for inclusion clinical cases in the database of the portal:
Patients admitted to the National Center for Tuberculosis and Lung Diseases (NCTLD) with diagnosed or suspected of MDR/XDR-TB.
Anonymized patient case files containing diagnostics, treatment, laboratory and imaging data.