Multinational Database Aids Sharing of Information about TB

By Mike Bassett

A multinational approach to collect and consolidate data — including radiological data — related to various forms of drug-resistant tuberculosis (TB), has the potential to help improve TB diagnostics, drugs and treatment outcomes, new research shows.

Gabrielian

The TB Portals program — described during a Wednesday poster discussion by Andrei E. Gabrielian, PhD, lead, TB Portals Program, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases/National Institutes of Health — is an example of one of those approaches.

With participation from the U.S., China, South Africa, Georgia, Romania, Belarus, Moldova and Azerbaijan, the objective of the program is to collect and consolidate radiologic, genomic, clinical and socioeconomic information related to various forms of drug-resistant TB cases as a resource for both researchers and physicians.

"Many countries in Eastern Europe, as well as China, India and Bangladesh have witnessed a growing threat from drug-resistant tuberculosis, but the sharing of information is lacking," Dr. Gabrielian said. "In many tuberculosis hospitals in small cities, the documentation is still either on paper, or Excel spreadsheets, so there are no centralized databases, no concept of cloud data that could be used by researchers in other countries."

Researchers sought to create a patient-centric database that would allow doctors to connect the dots about each patient and establish recommendations and best practices.

"If we know everything about the patient, and we know that this x-ray corresponds to this strain of tuberculosis, and it corresponds to a particular history of the disease, we can then try to find correlations — and hopefully find causation — that are otherwise impossible to tie together," Dr. Gabrielian said.

The database currently contains 1,299 patient cases and is open for public use. In addition to a query capability that allows users to search for and view specific tuberculosis cases, the TB DEPOT tool allows advanced search functions, visualization, and comparative statistical analysis of associated data.

Of the cases in the database, 675 patient cases include CT data. Dr. Gabrielian explained that with this data a researcher could, for example, create cohorts composed either of patients who have large lung cavities (greater than 25 mm) or those with small cavities (less than 10 mm) — under the hypothesis that large cavities can harbor drug resistant TB.

"We can compare these two cohorts and see how they differ in drugs that have been administered, the outcome of the treatment and whether we can see any trends regarding different kinds of drug-resistant tuberculosis," he said, pointing out that depending on the number and size of cavities, TB bacteria can actually hide and make the disease more difficult to treat, even though the sputum of patients will not have detectable amounts of microbacterium TB.

"So we need to make sure — especially in cases of drug-resistant tuberculosis — that it doesn't go undetected," he said. "And that is the motivation behind this kind of analysis. It contrasts the cohorts with different types of cavities and looks at various parameters that might distinguish between them."

Dr. Gabrielian said that one of his goals in presenting at RSNA was to try to expand his program's support base of radiologists, since, while his team has been able to collect a number of x-ray and CT images, not all of them have been annotated.

"So we would like to be able to use radiologists from our member countries to annotate them," he said. "To look at the images and tell whether there are cavities or anything else that might be instrumental in dissecting tuberculosis."

For more information about the TB Portals program, go to https://tbportals.niaid.nih.gov