Mathematical Modeling of the Co-Infection Dynamics of HIV and Tuberculosis Incorporating Inconsistency in HIV Treatment

A non-linear HIV-TB co-infection has been formulated and analyzed. The positivity and invariant region has been established. The disease free equilibrium and its stability has been determined. The local stability was determined and found to be stable under given conditions. The basic reproduction number was obtained and according to findings, co-infection diminishes when this number is less than unity, and persists when the number is greater than unity. The global stability of the endemic equilibrium was calculated. The impact of HIV on TB was established as well as the impact of TB on HIV. Numerical solution was also done and the findings indicate that when the rate of HIV treatment increases the latent TB increases while the co-infected population decreases. When the rate of HIV treatment decreases the latent TB population decreases and the co-infected population increases. Encouraging communities to prioritize the consistent treatment of HIV infected individuals must be emphasized in order to reduce the scourge of HIV-TB co-infection.

Dengue and falciparum malaria co-infection in travelers returning from Burkina Faso:Report of two cases in Northeastern Italy

Rationale: Malaria and dengue are the most prevalent vector-borne diseases in tropical countries. Plasmodium parasite and dengue virus(DENV) concurrent infection is possible and often under-recognized in geographical areas where these infections are both endemic.Patients concern and diagnosis: We describe the first two cases of Plasmodium falciparum and DENV-3 co-infection in travelers returning to northeastern Italy from Burkina Faso during 2013-2014.Interventions: Malaria infection in both patients was treated with mefloquine. Due to the persistence of symptoms despite of the antimalaria treatment, dengue was also investigated;the treatment of dengue was symptomatic.Outcomes: The patients were discharged in good general condition.Lessons: The need for surveillance of potential malaria and dengue co-infection in travelers returning to Europe from endemic areas is highlighted, as infection with Plasmodium does not exclude arboviral co-infection.

Prevalence and Clinical Relevance of Schistosoma mansoni Co-Infection with Mycobacterium tuberculosis: A Systematic Literature Review

Tuberculosis disease stands for the second leading cause of death worldwide after COVID-19, most active tuberculosis cases result from the reactivation of latent TB infection through impairment of immune response. Several factors are known to sustain that process.Schistosoma mansoni, a parasite of the helminth genus that possesses switching power from an immune profile type Th1 to Th2 that favors reactivation of latent TB bacteria. The aim of the study was to assess the prevalence of the co-infection between the two endemic infections. Systematic literature was contacted at the University Clinical Research Center at the University of Sciences, Techniques, and Technologies of Bamako in Mali. Original articles were included, and full texts were reviewed to assess the prevalence and better understand the immunological changes that occur during the co-infection. In total, 3530 original articles were retrieved through database search, 53 were included in the qualitative analysis, and data from 10 were included in the meta-analysis. Prevalence of the co-infection ranged from 4% to 34% in the literature. Most of the articles reported that immunity against infection with helminth parasite and more specifically Schistosoma mansoni infection enhances latent TB reactivation through Th1/Th2. In sum, the impact of Schistosoma mansoni co-infection with Mycobacterium tuberculosis is under-investigated. Understanding the role of this endemic tropical parasite as a contributing factor to TB epidemiology and burden could help integrate its elimination as one of the strategies to achieve the END-TB objectives by the year 2035.

Streptococcus pneumoniae and Herpes Simplex Virus-1 Central Nervous System Co-Infection

Co-infections of the central nervous system (CNS) caused by bacterial and viral pathogens are considered to be rare. Herpes simplex virus type-1 (HSV-1) reactivation following Streptococcus pneumoniae infection is well described but most cases are related to oral or cutaneous lesions or in respiratory samples. HSV-1 CNS reactivation after Streptococcus pneumoniae meningitis is a very rare event and may have significant morbidity and mortality. In this case report, we describe a 71-year-old female patient that presented with a history of abdominal pain and confusion/disorientation that had tonic-clonic seizures while in the Emergency Department. The diagnostic work-up confirmed CNS co-infection caused by Streptococcus pneumoniae and HSV-1. Of note, beyond age, the patient had no known risk factors for both entities and recovered fully after antibiotic and antiviral therapy. This case underlines that clinicians must be aware of CNS co-infection despite being a rare diagnosis. This should be suspected particularly in patients who present an unusual clinical course of CNS infection.

Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Context/Objectives: Tuberculosis (TB) and HIV co-infection is a serious health problem in Cameroon. The problems associated with poor adherence to treatment are on the increase worldwide. This problem can be observed in all situations where patients are required to administer their own medication, whatever the type of illness. The general objective of this study was to assess the factors affecting adherence to treatment among HIV-TB co-infected patients in health facilities in the East Region in the COVID context. Method: A retrospective cohort study before and during COVID-19 was conducted in HIV care units in 13 health districts in the East Region of Cameroon. Data were collected using a questionnaire recorded in the Kobo Collect android application, analyzed using SPSS version 25 software and plotted using Excel. Results: The pre-COVID-19 cohort compared to the during-COVID-19 cohort had a 1.90 risk of not adhering to treatment (OR: 1.90, CI {1.90 - 3.37}) and the difference was statistically significant at the 5% level (p-value = 0.029). Frequency of adherence was 65.4% (140/214). Adherence before COVID-19 was 56.9% whereas during COVID-19, it was 74.3%. Conclusion: The implementation of targeted interventions in the COVID-19 context, using evidence-based data and integrating the individual needs of HIV-TB co-infected patients, improved adherence to concurrent anti-tuberculosis treatment and antiretroviral therapy during the COVID-19 Era.

Co-infection of SARS-COV-2 and Influenza A Virus:A Case Series and Fast Review

Coronavirus disease 2019(COVID-19)occurs in the influenza season and has become a global pandemic.The present study aimed to examine severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)co-infection with influenza A virus(IAV)in an attempt to provide clues for the antiviral interventions of co-infected patients.We described two patients who were co-infected with SARS-CoV-2 and IAV treated at Wuhan Union Hospital,China.In addition,we performed a review in PubMed,Web of Science and CNKI(from January 1 up to November 1,2020)with combinations of the following key words:“COVID-19,SARS-COV-2,influenza A and co-infection”.A total of 28 co-infected patients were enrolled in the analysis.Of the 28 patients,the median age was 54.5 years(IQR,34.25–67.5)and 14 cases(50.0%)were classified as severe types.The most common symptoms were fever(85.71%),cough(82.14%)and dyspnea(60.71%).Sixteen patients had lymphocytopenia on admission and 23 patients exhibited abnormal radiological changes.The median time from symptom onset to hospital admission was 4 days(IQR,3–6),and the median time of hospital stay was 14 days(IQR,8.5–16.75).In conclusion,patients with SARSCOV-2 and IAV co-infection were similar to those infected with SARS-COV-2 alone in symptoms and radiological images.SARS-COV-2 co-infection with IAV could lead to more severe clinical condition but did not experience longer hospital stay compared with patients infected with SARSCOV-2 alone.

Co-infection of Epstein-Barr virus and human papillomavirus in human tumorigenesis

Viral infections contribute to approximately 12%of cancers worldwide,with the vast majority occurring in developing countries and areas.Two DNA viruses,Epstein-Barr virus(EBV) and human papillomavirus(HPV),are associated with38%of all virus-associated cancers.The probability of one patient infected with these two distinct types of viruses is increasing.Here,we summarize the co-infection of EBV and HPV in human malignancies and address the possible mechanisms for the co-infection of EBV and HPV during tumorigenesis.

Seroprevalence of HCV and its co-infection with HBV and HIV among liver disease patients of South Tamil Nadu

AIM:To determine the seroprevalence of hepatitis C virus(HCV) and its co-infection with hepatitis B virus(HBV),hepatitis delta agent(HDV) and human immunodeficiency virus(HIV) among liver disease patients of south Tamil Nadu. METHODS:A total of 1012 samples comprising 512 clinically diagnosed cases of liver disease patients and 500 apparently healthy age and sex matched individuals were screened for Hepatitis C virus(anti HCV and HCV RNA) ,Hepatitis B virus(HBsAg),Hepatitis delta agent(anti HDV) and Human immuno virus(antibodies to HIV-1 and HIV-2) using commercially available enzyme linked immunosorbent assay kits.HCV RNA wasdetected by RT-PCR.Liver function tests like ALT,AST,GGT,ALP,bilirubin and albumin were also studied. RESULTS:The seroprevalence of HCV was found to be 5.6%among liver disease patients by ELISA.27/512,49/512 and 12/512 patients were positive for HIV,HBV &HDV respectively.Co-infection of HCV&HBV was found in 8 patients,with 6 for HCV&HIV and 4 for HCV,HBV&HIV co-infections.Sex-wise analysis showed that HIV,HCV&HBV and HCV&HIV co-infection was high among females whereas for HBV it was high in males. The mean ALT and AST in HCV positive cases were 42.1±8.3 and 49±10.1.In people co-infected with HCV&HBV or HCV&HIV or HCV,HBV&HIV the mean ALT of 58.0±03.16,56.78±4.401 and 64.37±4.01 respectively. CONCLUSION:We strongly recommend routine test of the blood for HCV in addition to HBV and HIV.We also recommend individualized counseling to identify those at risk and testing for those who want it.Improved surveillance and periodic epidemiological studies will have to be undertaken to monitor and prevent these blood-borne viruses.

Viral co-infections among children with confirmed measles at hospitals in Hanoi,Vietnam,2014

Objective:To characterize viral co-infections among representative hospitalized measles cases during the 2014 Hanoi outbreak.Methods:Throat swabs were collected from 54 pediatric patients with confirmed measles,and molecular diagnostics performed for 10 additional viral respiratory pathogens(Influenza A/H1N1pdm09;A/H3N2 and influenza B;Parainfluenza 1,2,3;Respiratory Synctial Virus,RSV;human Metapneumovirus,hM PV;Adenovirus and Picornavirus).Results:Twenty-one cases(38.9%) showed evidence of infection with other respiratory viruses:15 samples contained measles plus one additional virus,and 6 samples contained measles plus 2 additional viruses.Adenovirus was detected as a predominant cause of co-infections(13 cases;24.1%),followed by RSV(6 cases;11.1%),A/H1N1pdm09(3 cases;5.6%),PIV3(3 cases;3.7%),Rhinovirus(3 cases;3.7%) and hM PV(1 case;1.96%).Conclusions:Viral co-infections identified from pediatric measles cases may have contributed to increased disease severity and high rate of fatal outcomes.Optimal treatment of measles cases may require control of multiple viral respiratory pathogens.

Rapid Detection Co-infections of Classical Swine Fever Virus and Porcine Reproductive and Respiratory Syndrome Virus by One-step Multiplex RT-PCR

Classical swine fever virus （CSFV） and porcine reproductive and respiratory syndrome virus （PRRSV） have caused immense economic loss in the pig industry and are considered to be the two most important infectious diseases of pigs in the world A multiplex reverse transcription polymerase chain reaction （multiplex RT-PCR） was developed for CSFV and PRRSV co-infections or infections, respectively. A set of two pairs of primer was designed based on the sequence of nonstructural protein NS54B of CSFV and ORF7 gene of PRRSV. The diagnostic accuracy of multiplex RT-PCR assay was evaluated by using 56 field clinical samples by multiplex RT-PCR, single RT-PCR and sequence analysis; and the specificity of multiplex PCR was verified by using constructed plasmids containing the specific viral target fragments of PRRSV and CSFV, respectively. The results indicated that this assay could reliably differentiate PRRSV and CSFV in co-infection samples. The multiplex RT-PCR developed in this study might provide a new avenue to the rapid the detection of CSFV and PRRSV in one reaction.

HIV,HCV,and HBV Co-Infections in a Rural Area of Shanxi Province with a History of Commercial Blood Donation

Background： Unhygienic blood collection in the early 1990s led to blood-borne infections in Central China. This study aimed to estimate human immunodeficiency virus （HIV） co-infection with hepatitis C and B viruses （HCV and HBV） and their risk factors in a rural area of Shanxi Province with a history of commercial blood donation. Methods： A cross-sectional study was conducted in 2004. All adult residents in the target area were invited to participate in the study. Face-to-face interviews were completed and blood specimens were tested for HIV, HCV, and HBV surface antigen （HBsAg）. Results： Prevalence rates of HIV, HCV, and HBsAg were 1.3% （40/3 062）, 12.7% （389/3 062）, and 3.5% （103/2982）, respectively. Of the 40 HIV-positive specimens, 85% were HCV positive and 2.5% were HBsAg positive. The history of commercial blood donation was positively associated with HIV, HCV, and HIV/HCV co-infections, but was negatively associated with HBsAg seropositivity. Migration for employment in the last 5 years was positively related to HIV, HBsAg, and HIV/HCV co-infections. Univariate logistic analysis showed that illegal drug use, number of sex partners, extramarital sex behavior, commercial sex behavior, and condom use rate were not related to anti-HIV, anti-HCV, HBsAg seropositivity or their co-infections. Conclusion： The history of commercial blood donation was the main risk factor for HIV, HCV, and HIV/HCV co-infections in this former commercial blood donation area. HIV and HCV prevention and treatment interventions are important in this area.

Mechanistic insights on immunosenescence and chronic immune activation in HIV-tuberculosis co-infection

Immunosenescence is marked by accelerated degradation of host immune responses leading to the onset of opportunistic infections, where senescent T cells show remarkably higher ontogenic defects as compared to healthy T cells. The mechanistic association between T-cell immunosenescence and human immunodeficiency virus(HIV) disease progression, and functional T-cell responses in HIV-tuberculosis(HIV-TB) co-infection remains to be elaborately discussed. Here, we discussed the association of immunosenescence and chronic immune activation in HIV-TB co-infection and reviewed the role played by mediators of immune deterioration in HIV-TB coinfection necessitating the importance of designing therapeutic strategies against HIV disease progression and pathogenesis.

Progression of Platelet Counts in Treatment Naïve HIV/HCV Co-Infection

Background: Previous research has suggested an association between infection with hepatitis C virus (HCV) or with human immunodeficiency virus (HIV) and low platelet counts. This study estimates platelet count changes over time in HIV/HCV co-infected participants and compares them with the changes in platelet count among HIV mono-infected participants to test if HIV/HCV co-infection is associated with lower platelet counts. Methods: This retrospective cohort study included all HIV treatment naive patients from four sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort with platelet count measurements between 2002 and 2009. We conducted a mixed effects linear regression modeling the mean change in platelet count per year while adjusting for age, sex, race, baseline CD4 cell count, and site. Index date was the first platelet count after 2002, and participants were censored upon initiation of treatment for HIV or HCV. Results: There were 929 HIV/HCV co-infected and 3558 HIV mono-infected participants with a mean follow-up time of 1.2 years. HIV/HCV co-infected participants had on average a slighter lower platelet count at baseline (234,040 vs. 242,780/μL;p-value = 0.004), and a more rapid mean reduction per year (7230 vs. 3580/μL;p-value 0.001) after adjusting for age, sex, baseline CD4 count. Conclusions: In treatment naive participants, HIV/HCV co-infection is associated with a more rapid decline in platelet count compared with HIV mono-infection.

Insights into human immunodeficiency virus-hepatitis B virus co-infection in India

Shared routes of transmission lead to frequent human immunodeficiency virus(HIV)-hepatitis B virus(HBV) coinfection in a host which results in about 10% of HIV positive individuals to have chronic hepatitis B infection worldwide. In post-antiretroviral therapy era, liverdiseases have emerged as the leading cause of morbidity and mortality in HIV-infected individuals and HBV coinfection have become the major health issue among this population particularly from the regions with endemic HBV infection. In setting of HIV-HBV co-infection, HIV significantly impacts the natural history of HBV infection, its disease profile and the treatment outcome in negative manner. Moreover, the epidemiological pattern of HBV infection and the diversity in HBV genome(genotypic and phenotypic) are also varied in HIV co-infected subjects as compared to HBV mono-infected individuals. Several reports on the abovementioned issues are available from developed parts of the world as well as from sub-Saharan African countries. In contrast, most of these research areas remained unexplored in India despite having considerable burden of HIV and HBV infections. This review discusses present knowledge from the studies on HIV-HBV co-infection in India and relevant reports from different parts of the world. Issues needed for the future research relevant to HIV-HBV co-infection in India are also highlighted here, including a call for further investigations on this field of study.

Bacterial co-infection in patients with SARS-CoV-2 in the Kingdom of Bahrain

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic presents a significant challenge to the medical profession,increasing in the presence of microbial coinfection.Bacterial and Fungal co-infections increase the risk of morbidity and mortality in patients with COVID-19.AIM To study the bacterial profile in patients with COVID-19 who needed admission to receive treatment in the main centres concerned with managing COVID-19 disease in the Kingdom of Bahrain.METHODS The study was a retrospective observational analysis of the bacterial profile and the bacterial resistance in patients with confirmed COVID-19 disease who needed admission to receive treatment in the main centres assigned to manage patients with COVID-19 disease in the Kingdom of Bahrain from February to October 2020.We used the electronic patients’records and the microbiology laboratory data to identify patients’demographics,clinical data,microbial profile,hospital or community-acquired,and the outcomes.RESULTS The study included 1380 patients admitted with confirmed COVID-19 disease during the study period.51%were admitted from February to June,and 49%were admitted from July to October 2020,with a recurrence rate was 0.36%.There was a significant increase in bacterial and fungal co-infection in the second period compared to the first period.The most common isolated organisms were the gram-negative bacteria(mainly Klebsiella pneumoniae,Pseudomonas aeruginosa,multi-drug resistant Acinetobacter baumannii,and Escherichia coli),the grampositive bacteria(mainly coagulase negative Staphylococci,Enterococcus faecium,Enterococcus faecalis,Staphylococcus aureus)and fungaemia(Candida galabrata,Candida tropicalis,Candida albicans,Aspergillus fumigatus,Candida parapsilosis,Aspergillus niger).The hospital-acquired infection formed 73.8%,61.6%,100%gram-negative,gram-positive and fungaemia.Most of the hospital-acquired infection occurred in the second period with a higher death rate than communityacquired infections.CONCLUSION Bacterial and fungal co-infections in patients admitted with confirmed COVID-19 disease pose higher morbidity and mortality risks than those without coinfections.We should perform every effort to minimize these risks.

Risk Factors, Clinical Features, Baseline Alanine Aminotransferase and CD4+ Count of Children with HIV Co-Infection with Hepatitis B and C at a Tertiary Hospital in Southwest Nigeria

Background: Human immunodeficiency virus and hepatitis B and C viruses are endemic in sub- Saharan African countries including Nigeria. Researchers have studied the burden of co-infection of HIV with hepatitis B and hepatitis C but the risk factors and clinical presentation have not been much addressed especially in children. Methodology: This was a prospective cross sectional study that determined the prevalence, risk factors, clinical features, baseline CD4+ count, CD4+ percentage, and alanine aminotransferase (ALT) of newly diagnosed, HAART na?ve HIV co-infection among children who were managed at a Tertiary Hospital in Ilorin, Nigeria. Result: Of the 60 HIV- infected children recruited, 11.7% had HIV co-infection with HBV or HCV. Children with co-infec- tions (mean age 8.43 ± 2.37 years) were significantly older than their HIV mono-infected counterparts (mean age 5.25 ± 3.96 years) (p = 0.011). There was no significant difference between HIV monoinfection and HIV co-infection with respect to gender (p = 0.758), ethnicity (p = 0.707), religion of parents (p = 0.436), family type (p = 0.184), social class (p = 0.535), previous transfusion (p = 0.053), scarification (p = 0.612), female genital mutilation (p = 0.778), and sharing of clippers (p = 0.806). The mean BMI, immunological staging (p = 0.535), baseline ALT (p = 0.940), and mean baseline CD4+ count (p = 0.928) were comparable. However, the body mass index of HIV co-infec- ted children decreased with age up till age 10 years. Conclusion: There were no risk factors, nor clinical features predictive of co-infection identified in this study. Co-infection did not negatively impact baseline, CD4+ count and ALT.

Prevalence of Plasmodia and hepatitis B virus co-infection in blood donors at Bishop Murray Medical Centre,Makurdi,Benue State,Nigeria

Objective:To evaluate the prevalence of co-infection of hepatitis B and Plasmodia among potential blood donors in Benue State,and Nigeria at large and offer suggestions and containment methods.Methods:Three hundred and thirty seven(337) potential blood donors,comprising 229(67.95%) Males and 108(32.05%) Females were screened for co-infection with hepatitis B virus(HBV) and Plasmodia between the months of July and December,2009 using standard laboratory methods.Results:An overall co-infection rate of 137(40.67%) was observed among the donors.The month of December showed highest co-infection rates 59(17.51%).Highest rates of infection was observed in males at 129(38.30%) to 8(2.37%) in females.Statistical analysis showed significant difference in infection rates between males and females(P【0.05).The more youthful age groups 18-22,23-27 and 28-32 had higher prevalence of infection at 11.90%,13.05% and 6.53%,respectively.Irrespective of age group,males showed higher rates of infections than females in corresponding age groups.Conclusions:The high rates of co-infection imply that these infections are threats the health of citizens and should be adequately addressed by adoption of strategies to combat and control them.Further,blood should be rigorously screened before transfusion to safeguard the health of recipients.

HIV-tuberculosis co-infection in an Indian scenario:The role of associated evidence of immunosuppression

Objective:To determine the relationship between tuberculosis and the degree of immunosuppression as determined by CD4 count.The impact of immunosuppression on the severity of tuberculosis was also studied.Methods:A retrospective analysis was performed in patients newly diagnosed with HIV infection and antiretroviral therapy(ART)-naive patients with known HIV seropositivity.All patients were diagnosed with active tuberculosis between January 2008 and December 2010,based on review of their medical records.Patients on chemoprophylaxis for opportunistic infection were excluded.Pattern and severity of tuberculosis,associated stigmata of immunosuppression,and CD4 counts were noted.Results:Of 140 patients satisfying the inclusion criteria.52 had mild tuberculosis with no other evidence of immunosuppression,52 had tuberculosis of variable severity with associated evidence of immunosuppression,and 36 had severe tuberculosis with no other evidence of immunosuppression.The CD4 count was highest in the first group[【109.2±99.9) cells/μL]and least in the second group[(58.4±39.8) cells/μL], and the difference was statistically significant(P=0.004).No statistical difference was observed in the CD4 count between those with mild tuberculosis and those with severe tuberculosis. Conclusions:In developing countries with a high prevalence of tuberculosis in the general population,the possibility of incidental tuberculosis in patients with HIV should always be considered.CD4 count does not appear to influence the severity of tuberculosis.The presence of concomitant evidence of immunosuppression in the form of category B and C conditions is indicative of underlying immunosuppression and associated with a significantly lower CD4 count.

Preliminary investigation on the prevalence of malaria and HIV co-infection in Mae Sot District, Tak Province of Thailand

Objective: To preliminarily investigate the prevalence of HIV co-infection in patients with malaria in Mae Sot District, Tak Province of Thailand.Methods: The study was a retrospective study on blood samples collected from a total of 256 patients with malaria(all species and severity) who attended Mae Tao clinic for migrant workers, Tak Province during 2005-2007(148 samples) and 2010-2012(108 samples). Malaria diagnosis was performed based on microscopic examination of patients' blood smears. Chemiluminescent microparticle immunoassay and gel particle passive agglutination were employed for the detection of HIV antigen in patients' plasma. Results: Plasmodium falciparum(P. falciparum) and Plasmodium vivax(P. vivax) are the two predominant malaria species with the ratio of about 1: 1 to 1.5:1. Most of the P. falciparum cases were presented with acute uncomplicated signs and symptoms with highest parasitemia of 1 045 000 asexual parasites/μL bloods. The prevalence of malaria and HIV co-infection during 2005-2007 was 1.35%(2/148 cases, 1 each for P. falciparum and P. vivax co-infection), but was increased to 2.78%(3/108 cases, 2 and 1 for P. falciparum and P. vivax co-infection, respectively) during 2010-2012.Conclusions: The increasing trend of prevalence of malaria and HIV co-infection in Mae Sot, Tak province was of a great concern on either pharmacodynamics or pharmacokinetics aspect. The study in a larger numbers of malaria patients in different endemic areas throughout the country with different time periods is underway.

Tuberculosis/toxoplasmosis co-infection in Egyptian patients:A reciprocal impact

Objective:To assess the concurrent toxoplasmosis infection in Egyptian TB patients and the impact of each infection on the other in terms of increased severity of TB or reactivation of latent Toxoplasma infection.Methods:Three hundred suspected pulmonary TB cases were initially screened for TB using direct Ziehl Neelsen staining and Lowenstein Jensen culture of their sputa.Rifampicin resistance was detected by Xpert MTB/RIF assay.Control group of 30 age and sex-matched healthy individuals negative for TB was included for comparison.All subjects were further assessed for serum levels of anti-Toxoplasma Ig G antibodies and malondialdehyde(MDA).Results:Forty three confirmed TB-infected patients including 10(23.3%)rifampicin-resistant patients were detected.Associated toxoplasmosis was found to be significantly higher among TB patients(OR=2.709;95%CI:1.034-7.099;P<0.05)and among rifampicin sensitive than rifampicin resistant TB patients(OR=0.213;95%CI:0.048-0.951);P<0.05).Serum levels of anti-Toxoplasma IgG antibodies and MDA were significantly higher among TB patients than the control group.Furthermore,serum level of MDA was significantly higher among TB/Toxoplasma co-infected patients as compared to toxoplasmosis free-TB patients.Strong positive correlation was detected between serum levels of anti-Toxoplasma Ig G and MDA in TB patients(r=0.75,P=0.001).Conclusions:Among pulmonary TB Egyptian patients,there is a considerable prevalence of toxoplasmosis.Severity of pulmonary tuberculosis could be increased by Toxoplasma co-infection.