126
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Nookeu P, Angkasekwinai N, Foongladda S, Phoompoung P. Clinical Characteristics and Treatment Outcomes for Patients Infected with Mycobacterium haemophilum. Emerg Infect Dis 2020; 25:1648-1652. [PMID: 31441427 PMCID: PMC6711220 DOI: 10.3201/eid2509.190430] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Mycobacterium haemophilum is a nontuberculous mycobacterium that can infect immunocompromised patients. Because of special conditions required for its culture, this bacterium is rarely reported and there are scarce data for long-term outcomes. We conducted a retrospective study at Siriraj Hospital, Bangkok, Thailand, during January 2012–September 2017. We studied 21 patients for which HIV infection was the most common concurrent condition. The most common organ involvement was skin and soft tissue (60%). Combination therapy with macrolides and fluoroquinolones resulted in a 60% cure rate for cutaneous infection; adding rifampin as a third drug for more severe cases resulted in modest (66%) cure rate. Efficacy of medical therapy in cutaneous, musculoskeletal, and ocular diseases was 80%, 50%, and 50%, respectively. All patients with central nervous system involvement showed treatment failures. Infections with M. haemophilum in HIV-infected patients were more likely to have central nervous system involvement and tended to have disseminated infections and less favorable outcomes.
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127
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Campbell JR, Johnston JC, Cook VJ, Sadatsafavi M, Elwood RK, Marra F. Cost-effectiveness of Latent Tuberculosis Infection Screening before Immigration to Low-Incidence Countries. Emerg Infect Dis 2019; 25:661-671. [PMID: 30882302 PMCID: PMC6433018 DOI: 10.3201/eid2504.171630] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Prospective migrants to countries where the incidence of tuberculosis (TB) is low (low-incidence countries) receive TB screening; however, screening for latent TB infection (LTBI) before immigration is rare. We evaluated the cost-effectiveness of mandated and sponsored preimmigration LTBI screening for migrants to low-incidence countries. We used discrete event simulation to model preimmigration LTBI screening coupled with postarrival follow-up and treatment for those who test positive. Preimmigration interferon-gamma release assay screening and postarrival rifampin treatment was preferred in deterministic analysis. We calculated cost per quality-adjusted life-year gained for migrants from countries with different TB incidences. Our analysis provides evidence of the cost-effectiveness of preimmigration LTBI screening for migrants to low-incidence countries. Coupled with research on sustainability, acceptability, and program implementation, these results can inform policy decisions.
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128
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Paudel S, Nakajima C, Mikota SK, Gairhe KP, Maharjan B, Subedi S, Poudel A, Sashika M, Shimozuru M, Suzuki Y, Tsubota T. Mixed Mycobacterium tuberculosis Lineage Infection in 2 Elephants, Nepal. Emerg Infect Dis 2019; 25:1031-1032. [PMID: 31002055 PMCID: PMC6478232 DOI: 10.3201/eid2505.181898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Tuberculosis in elephants is primarily caused by Mycobacterium tuberculosis. We identified mixed M. tuberculosis lineage infection in 2 captive elephants in Nepal by using spoligotyping and large sequence polymorphism. One elephant was infected with Indo-Oceanic and East African-Indian (CAS-Delhi) lineages; the other was infected with Indo-Oceanic and East Asian (Beijing) lineages.
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129
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Buser GL, Laidler MR, Cassidy PM, Moulton-Meissner H, Beldavs ZG, Cieslak PR. Outbreak of Nontuberculous Mycobacteria Joint Prosthesis Infections, Oregon, USA, 2010-2016. Emerg Infect Dis 2019; 25:849-855. [PMID: 31002056 PMCID: PMC6478192 DOI: 10.3201/eid2505.181687] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We investigated a cluster of Mycobacterium fortuitum and M. goodii prosthetic joint surgical site infections occurring during 2010–2014. Cases were defined as culture-positive nontuberculous mycobacteria surgical site infections that had occurred within 1 year of joint replacement surgery performed on or after October 1, 2010. We identified 9 cases by case finding, chart review, interviews, surgical observations, matched case–control study, pulsed-field gel electrophoresis of isolates, and environmental investigation; 6 cases were diagnosed >90 days after surgery. Cases were associated with a surgical instrument vendor representative being in the operating room during surgery; other potential sources were ruled out. A tenth case occurred during 2016. This cluster of infections associated with a vendor reinforces that all personnel entering the operating suite should follow infection control guidelines; samples for mycobacterial culture should be collected early; and postoperative surveillance for <90 days can miss surgical site infections caused by slow-growing organisms requiring specialized cultures, like mycobacteria.
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130
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Goldstein N, St Clair JB, Kasperbauer SH, Daley CL, Lindeque B. Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA. Emerg Infect Dis 2019. [PMID: 31107224 PMCID: PMC6537735 DOI: 10.3201/eid2506.181041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Early identification and aggressive treatment are crucial for patients with these
infections. Nontuberculous mycobacteria represent an uncommon but important cause of
infection of the musculoskeletal system. Such infections require aggressive
medical and surgical treatment, and cases are often complicated by delayed
diagnosis. We retrospectively reviewed all 14 nonspinal cases of nontuberculous
mycobacterial musculoskeletal infections treated over 6 years by orthopedic
surgeons at a university-affiliated tertiary referral center. All patients
required multiple antimicrobial agents along with aggressive surgical treatment;
13 of 14 patients ultimately achieved cure. Four patients required amputation to
control the infection. Half these patients were immunosuppressed by medications
or other medical illness when they sought care at the referral center. Six cases
involved joint prostheses; all ultimately required hardware removal and
placement of an antimicrobial spacer for eradication of infection. Our findings
highlight the importance of vigilance for nontuberculous mycobacterial
musculoskeletal infection, particularly in patients who are immunosuppressed or
have a history of musculoskeletal surgery.
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131
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Chen Z, Kuang Y, Jiang H, Zhang W, Shi Y, Chokkakula S, Chen H, Li J, Wang H. Intact Mycobacterium leprae Isolated from Placenta of a Pregnant Woman, China. Emerg Infect Dis 2019; 25:1604-1607. [PMID: 31310204 PMCID: PMC6649342 DOI: 10.3201/eid2508.190114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Whether Mycobacterium leprae transmits from placenta to fetus remains unknown. We describe the case of a pregnant woman with untreated histoid leproma. Although her newborn was healthy, laboratory examination revealed intact M. leprae present in the placenta, suggesting that the placental barrier might prevent vertical dissemination of M. leprae.
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132
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Mbuagbaw L, Guglielmetti L, Hewison C, Bakare N, Bastard M, Caumes E, Fréchet-Jachym M, Robert J, Veziris N, Khachatryan N, Kotrikadze T, Hayrapetyan A, Avaliani Z, Schünemann HJ, Lienhardt C. Outcomes of Bedaquiline Treatment in Patients with Multidrug-Resistant Tuberculosis. Emerg Infect Dis 2019; 25:936-943. [PMID: 31002070 PMCID: PMC6478224 DOI: 10.3201/eid2505.181823] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Bedaquiline is recommended by the World Health Organization for the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB). We pooled data from 5 cohorts of patients treated with bedaquiline in France, Georgia, Armenia, and South Africa and in a multicountry study. The rate of culture conversion to negative at 6 months (by the end of 6 months of treatment) was 78% (95% CI 73.5%-81.9%), and the treatment success rate was 65.8% (95% CI 59.9%-71.3%). Death rate was 11.7% (95% CI 7.0%-19.1%). Up to 91.1% (95% CI 82.2%-95.8%) of the patients experienced >1 adverse event, and 11.2% (95% CI 5.0%-23.2%) experienced a serious adverse event. Lung cavitations were consistently associated with unfavorable outcomes. The use of bedaquiline in MDR and XDR TB treatment regimens appears to be effective and safe across different settings, although the certainty of evidence was assessed as very low.
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133
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Brode SK, Chung H, Campitelli MA, Kwong JC, Marchand-Austin A, Winthrop KL, Jamieson FB, Marras TK. Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease in Ontario, Canada, 2001-2013. Emerg Infect Dis 2019; 25. [PMID: 31215507 PMCID: PMC6590764 DOI: 10.3201/eid2507.181817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Surveys suggest that clinicians diverge from guidelines when treating Mycobacterium avium complex (MAC) pulmonary disease (PD). To determine prescribing patterns, we conducted a cohort study of adults >66 years of age in Ontario, Canada, with MAC or Mycobacterium xenopi PD during 2001-2013. Using linked laboratory and health administrative databases, we studied the first treatment episode (>60 continuous days of >1 of a macrolide, ethambutol, rifamycin, fluoroquinolone, linezolid, inhaled amikacin, or, for M. xenopi, isoniazid). Treatment was prescribed for 24% MAC and 15% of M. xenopi PD patients. Most commonly prescribed was the recommended combination of macrolide, ethambutol, and rifamycin, for 47% of MAC and 36% of M. xenopi PD patients. Among MAC PD patients, 20% received macrolide monotherapy and 33% received regimens associated with emergent macrolide resistance. Although the most commonly prescribed regimen was guidelines-recommended, many regimens prescribed for MAC PD were associated with emergent macrolide resistance.
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134
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Huang F, van den Hof S, Qu Y, Li Y, Zhang H, Wang L, Sun M, Lu W, Hou S, Zhang T, Huan S, Chin DP, Cobelens F. Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear-Negative Drug-Resistant Tuberculosis, China. Emerg Infect Dis 2019; 25:1289-1296. [PMID: 31211666 PMCID: PMC6590765 DOI: 10.3201/eid2507.181417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The increase in drug-resistant tuberculosis in China calls for scaling up rapid diagnosis. We evaluated introduction of rapid resistance testing by line-probe assay for all patients with a diagnosis of pulmonary tuberculosis in 2 prefectures in middle and eastern China. We analyzed sputum samples for smear-positive patients and cultures for smear-negative patients. We used a before–after comparison of baseline and intervention periods (12 months each) and analyzed data for 5,222 baseline period patients and 4,364 intervention period patients. The number of patients with rifampin resistance increased from 30 in the baseline period to 97 in the intervention period for smear-positive patients and from 0 to 13 for smear-negative patients, reflecting a low proportion of positive cultures (410/2,844, 14.4%). Expanding rapid testing for drug resistance for smear-positive patients resulted in a 3-fold increase in patients with diagnoses of rifampin-resistant tuberculosis. However, testing smear-negative patients had limited added value because of a low culture-positive rate.
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135
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Goldstein N, St Clair JB, Kasperbauer SH, Daley CL, Lindeque B. Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA. Emerg Infect Dis 2019; 25:1075-1083. [PMID: 31107224 DOI: 10.3201/eid2406.181041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Nontuberculous mycobacteria represent an uncommon but important cause of infection of the musculoskeletal system. Such infections require aggressive medical and surgical treatment, and cases are often complicated by delayed diagnosis. We retrospectively reviewed all 14 nonspinal cases of nontuberculous mycobacterial musculoskeletal infections treated over 6 years by orthopedic surgeons at a university-affiliated tertiary referral center. All patients required multiple antimicrobial agents along with aggressive surgical treatment; 13 of 14 patients ultimately achieved cure. Four patients required amputation to control the infection. Half these patients were immunosuppressed by medications or other medical illness when they sought care at the referral center. Six cases involved joint prostheses; all ultimately required hardware removal and placement of an antimicrobial spacer for eradication of infection. Our findings highlight the importance of vigilance for nontuberculous mycobacterial musculoskeletal infection, particularly in patients who are immunosuppressed or have a history of musculoskeletal surgery.
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136
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Higgitt RL, Louis van Schalkwyk O, de Klerk-Lorist LM, Buss PE, Caldwell P, Rossouw L, Manamela T, Hausler GA, Hewlett J, Mitchell EP, van Helden PD, Parsons SD, Miller MA. Mycobacterium bovis Infection in African Wild Dogs, Kruger National Park, South Africa. Emerg Infect Dis 2019; 25:1425-1427. [PMID: 31211936 PMCID: PMC6590757 DOI: 10.3201/eid2507.181653] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We screened African wild dogs (Lycaon pictus) in Kruger National Park, South Africa, for Mycobacterium bovis infection using an interferon-gamma release assay. We detected M. bovis sensitization in 20 of 21 packs; overall apparent infection prevalence was 83%. These animals experience high infection pressure, which may affect long-term survival and conservation strategies.
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137
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Sakhaee F, Vaziri F, Bahramali G, Taremian K, Siadat SD, Fateh A. Pulmonary Infection Associated with Mycobacterium canariasense in Suspected Tuberculosis Patient, Iran. Emerg Infect Dis 2019; 25:1984-1986. [PMID: 31538933 PMCID: PMC6759235 DOI: 10.3201/eid2510.190156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mycobacterium canariasense had only been isolated in humans from blood and contaminated catheters. We report a case of pulmonary disease associated with M. canariasense infection that was identified by multilocus sequence analysis; the illness was initially ascribed to M. tuberculosis. M. canariasense should be considered a cause of respiratory infection.
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138
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Singh PK, Jain A. Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone. Emerg Infect Dis 2019; 25:1760-1762. [PMID: 31441763 PMCID: PMC6711219 DOI: 10.3201/eid2509.190105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Resistance to second-line tuberculosis drugs for patients with multidrug-resistant tuberculosis has emerged globally and is a potential risk factor for unfavorable outcomes of shorter duration drug regimens. We assessed the proportion of patients eligible for a shorter drug regimen in Uttar Pradesh, India, which had the highest rate of multidrug-resistant tuberculosis in India.
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139
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Baffoe-Bonnie A, Houpt ER, Turner L, Dodge D, Heysell SK. Drug-Susceptible and Multidrug-Resistant Mycobacterium tuberculosis in a Single Patient. Emerg Infect Dis 2019; 25:2120-2121. [PMID: 31454310 PMCID: PMC6810186 DOI: 10.3201/eid2511.180638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A patient who had initial infection with mixed strains of drug-susceptible and multidrug-resistant tuberculosis was presumed to have acquired drug resistance before confirmation that sequential strains were genotypically distinct. Transmitted infection with mixed strains is likely underappreciated; identifying these infections requires spoligotyping and whole-genome sequencing.
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140
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El Achkar S, Demanche C, Osman M, Rafei R, Ismail MB, Yaacoub H, Pinçon C, Duthoy S, De Matos F, Gaudin C, Trovato A, Cirillo DM, Hamze M, Supply P. Drug-Resistant Tuberculosis, Lebanon, 2016 - 2017. Emerg Infect Dis 2019; 25:564-568. [PMID: 30789124 PMCID: PMC6390733 DOI: 10.3201/eid2503.181375] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In a 12-month nationwide study on the prevalence of drug-resistant tuberculosis (TB) in Lebanon, we identified 3 multidrug-resistant cases and 3 extensively drug-resistant TB cases in refugees, migrants, and 1 Lebanon resident. Enhanced diagnostics, particularly in major destinations for refugees, asylum seekers, and migrant workers, can inform treatment decisions and may help prevent the spread of drug-resistant TB.
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141
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Loveday M, Hlangu S, Furin J. Healthcare Provider Discrimination toward Pregnant Women with Rifampin-Resistant Tuberculosis. Emerg Infect Dis 2019; 25:609-610. [PMID: 30789334 PMCID: PMC6390748 DOI: 10.3201/eid2503.181571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Little is known about the treatment experiences of pregnant women with rifampin-resistant tuberculosis. We conducted qualitative interviews with 10 women who had this condition; 9 reported facing discrimination from healthcare providers. Our findings underscore an urgent need to ensure a human-rights–based, patient-centered approach for women with rifampin-resistant tuberculosis who are pregnant.
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142
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Osman M, Harausz EP, Garcia-Prats AJ, Schaaf HS, Moore BK, Hicks RM, Achar J, Amanullah F, Barry P, Becerra M, Chiotan DI, Drobac PC, Flood J, Furin J, Gegia M, Isaakidis P, Mariandyshev A, Ozere I, Shah NS, Skrahina A, Yablokova E, Seddon JA, Hesseling AC. Treatment Outcomes in Global Systematic Review and Patient Meta-Analysis of Children with Extensively Drug-Resistant Tuberculosis. Emerg Infect Dis 2019; 25:441-450. [PMID: 30789141 PMCID: PMC6390755 DOI: 10.3201/eid2503.180852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Extensively drug-resistant tuberculosis (XDR TB) has extremely poor treatment outcomes in adults. Limited data are available for children. We report on clinical manifestations, treatment, and outcomes for 37 children (<15 years of age) with bacteriologically confirmed XDR TB in 11 countries. These patients were managed during 1999-2013. For the 37 children, median age was 11 years, 32 (87%) had pulmonary TB, and 29 had a recorded HIV status; 7 (24%) were infected with HIV. Median treatment duration was 7.0 months for the intensive phase and 12.2 months for the continuation phase. Thirty (81%) children had favorable treatment outcomes. Four (11%) died, 1 (3%) failed treatment, and 2 (5%) did not complete treatment. We found a high proportion of favorable treatment outcomes among children, with mortality rates markedly lower than for adults. Regimens and duration of treatment varied considerably. Evaluation of new regimens in children is required.
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143
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Holland DP, Alexander S, Onwubiko U, Goswami ND, Yamin A, Mohamed O, Sales RM, Grant G, Talboy P, Ray S, Toomey KE. Response to Isoniazid-Resistant Tuberculosis in Homeless Shelters, Georgia, USA, 2015-2017. Emerg Infect Dis 2019; 25:593-595. [PMID: 30789335 PMCID: PMC6390744 DOI: 10.3201/eid2503.181678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2008, an outbreak of isoniazid-resistant tuberculosis was identified among residents of homeless shelters in Atlanta, Georgia, USA. When initial control efforts involving standard targeted testing failed, a comprehensive approach that involved all providers of services for the homeless successfully interrupted the outbreak.
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144
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Hasan NA, Epperson LE, Lawsin A, Rodger RR, Perkins KM, Halpin AL, Perry KA, Moulton-Meissner H, Diekema DJ, Crist MB, Perz JF, Salfinger M, Daley CL, Strong M. Genomic Analysis of Cardiac Surgery-Associated Mycobacterium chimaera Infections, United States. Emerg Infect Dis 2019; 25:559-563. [PMID: 30789131 PMCID: PMC6390774 DOI: 10.3201/eid2503.181282] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A surgical heater–cooler unit has been implicated as the source for Mycobacterium chimaera infections among cardiac surgery patients in several countries. We isolated M. chimaera from heater–cooler units and patient infections in the United States. Whole-genome sequencing corroborated a risk for these units acting as a reservoir for this pathogen.
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145
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Cruz AT, Starke JR. Window Period Prophylaxis for Children Exposed to Tuberculosis, Houston, Texas, USA, 2007-2017. Emerg Infect Dis 2019; 25:523-528. [PMID: 30789136 PMCID: PMC6390765 DOI: 10.3201/eid2503.181596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In this retrospective study, we assessed the safety of window period prophylaxis and proportion of tuberculin skin test (TST) conversions in children <5 years of age who were exposed to an adult with tuberculosis disease during 2007-2017. Children included in this study had unremarkable examination and chest radiograph findings and negative test results for TB infection. In total, 752 children (41% cohabitating with the index patient) received prophylaxis during the window period, usually directly observed therapy with isoniazid. Hepatotoxicity and tuberculosis disease did not develop in any child. TST conversion occurred in 37 (4.9%) children and was associated with the index patient being the child's parent (odds ratio 3.2, 95% CI 1.2-8.2). TST conversion was not associated with sputum smear results, culture positivity, or cohabitation. Thresholds for initiation of window prophylaxis in exposed young children should be low given the safety of medication and difficulties with risk stratification.
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146
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Wansaula Z, Wortham JM, Mindra G, Haddad MB, Salinas JL, Ashkin D, Morris SB, Grant GB, Ghosh S, Langer AJ. Bacillus Calmette-Guérin Cases Reported to the National Tuberculosis Surveillance System, United States, 2004-2015. Emerg Infect Dis 2019; 25:451-456. [PMID: 30789145 PMCID: PMC6390767 DOI: 10.3201/eid2503.180686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mycobacterium bovis bacillus Calmette-Guérin (BCG) is used as a vaccine to protect against disseminated tuberculosis (TB) and as a treatment for bladder cancer. We describe characteristics of US TB patients reported to the National Tuberculosis Surveillance System (NTSS) whose disease was attributed to BCG. We identified 118 BCG cases and 91,065 TB cases reported to NTSS during 2004-2015. Most patients with BCG were US-born (86%), older (median age 75 years), and non-Hispanic white (81%). Only 17% of BCG cases had pulmonary involvement, in contrast with 84% of TB cases. Epidemiologic features of BCG cases differed from TB cases. Clinicians can use clinical history to discern probable BCG cases from TB cases, enabling optimal clinical management. Public health agencies can use this information to quickly identify probable BCG cases to avoid inappropriately reporting BCG cases to NTSS or expending resources on unnecessary public health interventions.
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147
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Arandjelović I, Merker M, Richter E, Kohl TA, Savić B, Soldatović I, Wirth T, Vuković D, Niemann S. Longitudinal Outbreak of Multidrug-Resistant Tuberculosis in a Hospital Setting, Serbia. Emerg Infect Dis 2019; 25:555-558. [PMID: 30789133 PMCID: PMC6390760 DOI: 10.3201/eid2503.181220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A retrospective population-based molecular epidemiologic study of multidrug-resistant Mycobacterium tuberculosis complex strains in Serbia (2008–2014) revealed an outbreak of TUR genotype strains in a psychiatric hospital starting around 1990. Drug unavailability, poor infection control, and schizophrenia likely fueled acquisition of additional resistance and bacterial fitness–related mutations over 2 decades.
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148
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Genestet C, Tatai C, Berland JL, Claude JB, Westeel E, Hodille E, Fredenucci I, Rasigade JP, Ponsoda M, Jacomo V, Vachée A, Gaudart A, Gaillard JL, Roux AL, Ader F, Tararbit K, Terpant G, Bryant JE, Lina G, Dumitrescu O. Prospective Whole-Genome Sequencing in Tuberculosis Outbreak Investigation, France, 2017-2018. Emerg Infect Dis 2019; 25:589-592. [PMID: 30789329 PMCID: PMC6390740 DOI: 10.3201/eid2503.181124] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
During June 2017–April 2018, active tuberculosis with Beijing SIT1 isolates was diagnosed in 14 persons living in 4 distant cities in France. Whole-genome sequencing indicated that these patients belonged to a single transmission chain. Whole-genome sequencing–based laboratory investigations enabled prompt tracing of linked cases to improve tuberculosis control.
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149
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Skiba Y, Mokrousov I, Nabirova D, Vyazovaya A, Maltseva E, Malakhova N, Ismagulova G, Pole I, Ranka R, Sapiyeva Z, Ismailov S, Moffett D. Mycobacterium tuberculosis RD-Rio Strain in Kazakhstan. Emerg Infect Dis 2019; 25:604-606. [PMID: 30789328 PMCID: PMC6390763 DOI: 10.3201/eid2503.181179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mycobacterium tuberculosis RD-Rio strains are still rare in the former Soviet Union countries and Asia. We describe a strain in Kazakhstan that belongs to the RD-Rio secondary branch, which is endemic to northwest Russia and eastern Europe. Although RD-Rio strains are frequently multidrug resistant, this heterogeneous branch included only drug-susceptible isolates.
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Acosta F, Agapito J, Cabibbe AM, Cáceres T, Sola C, Pérez-Lago L, Abascal E, Herranz M, Meza E, Klotoe B, Muñoz P, Rossolini GM, Bartoloni A, Tortoli E, Cirillo DM, Gotuzzo E, García de Viedma D. Exportation of MDR TB to Europe from Setting with Actively Transmitted Persistent Strains in Peru. Emerg Infect Dis 2019; 25:596-598. [PMID: 30789333 PMCID: PMC6390752 DOI: 10.3201/eid2503.180574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We performed a cross-border molecular epidemiology analysis of multidrug-resistant tuberculosis in Peru, Spain, and Italy. This analysis revealed frequent transmission in Peru and exportation of a strain that recreated similar levels of transmission in Europe during 2007–2017. Transnational efforts are needed to control transmission of multidrug-resistant tuberculosis globally.
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