🛡️A recent study conducted at a tertiary military hospital in Manila, Philippines has highlighted significantly higher rates of tuberculosis (TB) and multidrug-resistant TB (MDR-TB) among military personnel compared to civilian patients. The findings reinforce the urgent need for advanced diagnostic tools like Xpert MTB/RIF, especially in high-risk and high-burden populations such as the military.

🔍 Study Overview: Who Was Involved?

Between March 2015 and December 2018, researchers tested 795 individuals presenting with TB symptoms or suspected infection:

• 164 active duty military personnel
• 9 retired military personnel
• 618 civilians
• 4 patients with unidentified status

Sputum samples were assessed using:

• Direct Sputum Smear Microscopy (DSSM) with Ziehl-Neelsen staining
• Xpert MTB/RIF, a molecular assay that simultaneously detects Mycobacterium tuberculosis (MTB) and rifampin resistance

📊 Key Findings

• Overall TB prevalence among all patients: 10% (81/795)
  • Active duty military: 16%
  • Retired military: 44%
  • Civilians: 8%
• Military personnel were 2.5 times more likely to test positive for TB than civilians (p = 0.0003).
• Among MTB-positive cases:
  • Rifampin resistance (a proxy for MDR-TB) was:
    • 15% in active duty military
    • 25% in retired military
    • 18% in civilians

This suggests that military environments may pose increased occupational exposure risks due to factors such as close quarters, deployment stressors, and limited access to healthcare in field settings.

🧪 Diagnostic Accuracy: DSSM vs. Xpert MTB/RIF

While DSSM is widely used in resource-limited settings due to its low cost, the study found it to be less reliable than Xpert MTB/RIF:

• DSSM Sensitivity: 70%
• DSSM Specificity: 96%
• Positive Predictive Value: 74%
• Negative Predictive Value: 95%

Importantly, DSSM’s sensitivity increased with higher bacterial load, but still missed a significant number of cases that were confirmed by Xpert.

“Xpert MTB/RIF should be prioritized as a first-line diagnostic tool to improve case detection and reduce delays in initiating treatment—particularly for identifying rifampin-resistant TB,” the authors recommended.

🧬 Why This Matters

The Philippines is designated by the World Health Organization as a high-burden country for both TB and MDR-TB. This study, one of the first to focus on the military population, highlights a critical need for targeted interventions in armed forces settings, including:

• Routine screening using molecular diagnostics
• Rapid identification of drug resistance
• Tailored public health policies for high-risk groups

Given the occupational risks and mobility of military personnel, prompt diagnosis and treatment not only protect the individual but also help prevent wider community transmission.

✅ Recommendations

• Adopt Xpert MTB/RIF as the standard diagnostic tool for both military and civilian high-risk populations.
• Ensure timely reporting and linkage to care for TB-positive individuals.
• Strengthen preventive health measures within the armed forces.
• Expand TB awareness and surveillance among military medical units.

📖 Reference

Tagayuna MG, et al. (2020). Multidrug Resistant Mycobacterium tuberculosis Among Military and Civilian Personnel Seen at a Tertiary Military Hospital, Manila, Philippines (2015–2018). Military Medicine. https://academic.oup.com/milmed/article-abstract/185/7-8/e1106/5698233