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Zhang R, Wu M, Xu Y, Zhang J. Tuberculosis in Adolescents, Particularly in Those Older Than 15 Years, May Present Characteristics Similar to Those of Adults. Pediatr Infect Dis J 2024; 43:e331. [PMID: 38709987 DOI: 10.1097/inf.0000000000004378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Ruoyu Zhang
- Department of Tuberculosis, The Fifth People's Hospital of Suzhou, (The Affiliated Infectious Disease Hospital of Soochow University), Suzhou, China
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John S, Ghosh D, Michael V, Kruger D, Jain R, Dhir K, Mohan S, Bhangu A. Patterns and Outcomes in Pediatric Abdominal Tuberculosis: A Single Centre Cohort Study. J Pediatr Surg 2024; 59:1886-1891. [PMID: 38769032 DOI: 10.1016/j.jpedsurg.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/15/2024] [Accepted: 04/14/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Abdominal tuberculosis presents in a variety of ways. Different testing modalities must be applied in addition to having a high clinical suspicion to diagnose and initiate therapy. Medications have a good response; however, morbidity has been seen following surgical management of complicated presentations like intestinal obstruction and perforation. There is a paucity of studies in the pediatric age group which evaluate response to the different treatment regimen and identify factors associated with poorer outcomes in children with abdominal tuberculosis. METHODS Patient records of 75 children with abdominal tuberculosis at a single center were evaluated using a questionnaire, covering a 14-year period from 2007 to 2021. Demographic features, presenting signs and symptoms, investigations and treatment details were studied. In- person or telephonic follow-up was conducted to identify treatment outcomes. RESULTS Incidence of abdominal TB was 7%, of all TB children with a mean age of 10.1 years. Mesenteric lymph nodes were involved in 67% and small intestine in 33% cases. Surgery was required in 22 children. 85% children completed treatment. Small intestine involvement had higher probability of undergoing surgery. Of the 70 children with complete follow up, 64 were well and 6 children succumbed to the disease. Older age, small intestine involvement and surgery were independently associated with higher mortality. CONCLUSION Intestinal involvement is associated with greater need for surgical intervention and greater mortality. Adolescents have poorer outcomes. Further studies are required focusing on these individual subgroups to understand the patterns of presentation, causes for mortality and prevention. LEVEL OF EVIDENCE Level 5.
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Affiliation(s)
- Susan John
- NIHR Health Research Unit on Global Surgery, India Hub, Christian Medical College, Ludhiana, Punjab, India
| | - Dhruva Ghosh
- NIHR Health Research Unit on Global Surgery, India Hub, Christian Medical College, Ludhiana, Punjab, India; Department of Paediatric Surgery, Christian Medical College, Ludhiana, Punjab, India.
| | - Vishal Michael
- Department of Paediatric Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Deirdre Kruger
- NIHR Health Research Unit on Global Surgery Statistics Hub, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ritu Jain
- NIHR Health Research Unit on Global Surgery, India Hub, Christian Medical College, Ludhiana, Punjab, India
| | - Karan Dhir
- NIHR Health Research Unit on Global Surgery, India Hub, Christian Medical College, Ludhiana, Punjab, India
| | - Sangeetha Mohan
- Department of Microbiology, Christian Medical College, Ludhiana, Punjab, India
| | - Aneel Bhangu
- NIHR Health Research Unit on Global Surgery, University of Birmingham, United Kingdom
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Krishnan N, Priestman M, Uhía I, Charitakis N, Glegola-Madejska IT, Baer TM, Tranberg A, Faraj A, Simonsson USH, Robertson BD. A noninvasive BCG skin challenge model for assessing tuberculosis vaccine efficacy. PLoS Biol 2024; 22:e3002766. [PMID: 39159267 PMCID: PMC11361749 DOI: 10.1371/journal.pbio.3002766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 08/29/2024] [Accepted: 07/25/2024] [Indexed: 08/21/2024] Open
Abstract
We report here on the characterisation in mice of a noninvasive bacille Calmette-Guérin (BCG) skin challenge model for assessing tuberculosis (TB) vaccine efficacy. Controlled human infection models (CHIMs) are valuable tools for assessing the relevant biological activity of vaccine candidates, with the potential to accelerate TB vaccine development into the clinic. TB infection poses significant constraints on the design of a CHIM using the causative agent Mycobacterium tuberculosis (Mtb). A safer alternative is a challenge model using the attenuated vaccine agent Mycobacterium bovis BCG as a surrogate for Mtb, and intradermal (skin) challenge as an alternative to pulmonary infection. We have developed a unique noninvasive imaging system based on fluorescent reporters (FluorBCG) to quantitatively measure bacterial load over time, thereby determining a relevant biological vaccine effect. We assessed the utility of this model to measure the effectiveness of 2 TB vaccines: the currently licenced BCG and a novel subunit vaccine candidate. To assess the efficacy of the skin challenge model, a nonlinear mixed-effects models was built describing the decline of fluorescence over time. The model-based analysis identified that BCG vaccination reduced the fluorescence readout of both fluorophores compared to unvaccinated mice (p < 0.001). However, vaccination with the novel subunit candidate did not alter the fluorescence decline compared to unvaccinated mice (p > 0.05). BCG-vaccinated mice that showed the reduced fluorescent readout also had a reduced bacterial burden in the lungs when challenged with Mtb. This supports the fluorescence activity in the skin as a reflection of vaccine induced functional pulmonary immune responses. This novel noninvasive approach allows for repeated measurements from the challenge site, providing a dynamic readout of vaccine induced responses over time. This BCG skin challenge model represents an important contribution to the ongoing development of controlled challenge models for TB.
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Affiliation(s)
- Nitya Krishnan
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Miles Priestman
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Iria Uhía
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Natalie Charitakis
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Izabella T. Glegola-Madejska
- Department of Life Sciences, Centre for Bacterial Resistance Biology, Imperial College London, London, United Kingdom
| | - Thomas M. Baer
- Stanford Photonics Research Center, Stanford University, Stanford, California, United States of America
| | - Albin Tranberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Alan Faraj
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Ulrika SH Simonsson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Brian D. Robertson
- Department of Infectious Disease, Imperial College London, London, United Kingdom
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Walsh KF, Lee MH, Chaguza C, Pamphile W, Royal G, Escuyer V, Pape JW, Fitzgerald D, Cohen T, Ocheretina O. Molecular Epidemiology of Isoniazid-resistant M tuberculosis in Port-au-Prince, Haiti. Open Forum Infect Dis 2024; 11:ofae421. [PMID: 39119477 PMCID: PMC11306977 DOI: 10.1093/ofid/ofae421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
Background Isoniazid-resistant, rifampin-susceptible tuberculosis (Hr-TB) is associated with poor treatment outcomes and higher rates of acquisition of further drug resistance during treatment. Due to a lack of widespread diagnostics, Hr-TB is frequently undetected and its epidemiology is incompletely understood. Methods We studied the molecular epidemiology of Hr-TB among all patients diagnosed with culture-positive pulmonary tuberculosis between January 1 and June 30, 2017, at an urban referral tuberculosis clinic in Port-au-Prince, Haiti. Demographic and clinical data were extracted from the electronic medical record. Archived diagnostic Mycobacterium tuberculosis isolates were tested for genotypic and phenotypic isoniazid resistance using the Genotype MTBDRplus assay (Hain, Nehren, Germany) and culture-based testing, respectively. All isoniazid-resistant isolates and a randomly selected subset of isoniazid-susceptible isolates underwent whole-genome sequencing to confirm the presence of mutations associated with isoniazid resistance, to validate use of Genotype MTBDRplus in this population, and to identify potential transmission links between isoniazid-resistant isolates. Results and Conclusions Among 845 patients with culture-positive pulmonary tuberculosis in Haiti, 65 (7.7%) had Hr-TB based on the Genotype MTBDRplus molecular assay. Age < 20 years was significantly associated with Hr-TB (odds ratio, 2.39; 95% confidence interval, 1.14, 4.70; P = .015). Thirteen (20%) isoniazid-resistant isolates were found in 5 putative transmission clusters based on a single nucleotide polymorphism distance of ≤ 5. No patients in these transmission clusters were members of the same household. Adolescents are at higher risk for Hr-TB. Strains of isoniazid-resistant M tuberculosis are actively circulating in Haiti and transmission is likely occurring in community settings.
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Affiliation(s)
- Kathleen F Walsh
- General Internal Medicine, Weill Cornell Medicine, New York, New York, USA
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Myung Hee Lee
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Chrispin Chaguza
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Widman Pamphile
- Groupe Haitian d'Etude du Sarcoma da Kaposi at des Infections Opportunistas (GHESKIO), Port-au-Prince, Haiti
| | - Gertrude Royal
- Groupe Haitian d'Etude du Sarcoma da Kaposi at des Infections Opportunistas (GHESKIO), Port-au-Prince, Haiti
| | - Vincent Escuyer
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Jean W Pape
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Groupe Haitian d'Etude du Sarcoma da Kaposi at des Infections Opportunistas (GHESKIO), Port-au-Prince, Haiti
| | - Daniel Fitzgerald
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Oksana Ocheretina
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
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Ledesma JR, Ma J, Zhang M, Basting AVL, Chu HT, Vongpradith A, Novotney A, LeGrand KE, Xu YY, Dai X, Nicholson SI, Stafford LK, Carter A, Ross JM, Abbastabar H, Abdoun M, Abdulah DM, Aboagye RG, Abolhassani H, Abrha WA, Abubaker Ali H, Abu-Gharbieh E, Aburuz S, Addo IY, Adepoju AV, Adhikari K, Adnani QES, Adra S, Afework A, Aghamiri S, Agyemang-Duah W, Ahinkorah BO, Ahmad D, Ahmad S, Ahmadzade AM, Ahmed H, Ahmed M, Ahmed A, Akinosoglou K, AL-Ahdal TMA, Alam N, Albashtawy M, AlBataineh MT, Al-Gheethi AAS, Ali A, Ali EA, Ali L, Ali Z, Ali SSS, Allel K, Altaf A, Al-Tawfiq JA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amani R, Amusa GA, Amzat J, Andrews JR, Anil A, Anwer R, Aravkin AY, Areda D, Artamonov AA, Aruleba RT, Asemahagn MA, Atre SR, Aujayeb A, Azadi D, Azadnajafabad S, Azzam AY, Badar M, Badiye AD, Bagherieh S, Bahadorikhalili S, Baig AA, Banach M, Banik B, Bardhan M, Barqawi HJ, Basharat Z, Baskaran P, Basu S, Beiranvand M, Belete MA, Belew MA, Belgaumi UI, Beloukas A, Bettencourt PJG, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhargava A, Bhat V, Bhatti JS, Bhatti GK, Bikbov B, Bitra VR, Bjegovic-Mikanovic V, Buonsenso D, Burkart K, Bustanji Y, Butt ZA, Camargos P, Cao Y, Carr S, Carvalho F, Cegolon L, Cenderadewi M, Cevik M, Chahine Y, Chattu VK, Ching PR, Chopra H, Chung E, Claassens MM, Coberly K, Cruz-Martins N, Dabo B, Dadana S, Dadras O, Darban I, Darega Gela J, Darwesh AM, Dashti M, Demessa BH, Demisse B, Demissie S, Derese AMA, Deribe K, Desai HD, Devanbu VGC, Dhali A, Dhama K, Dhingra S, Do THP, Dongarwar D, Dsouza HL, Dube J, Dziedzic AM, Ed-Dra A, Efendi F, Effendi DE, Eftekharimehrabad A, Ekadinata N, Ekundayo TC, Elhadi M, Elilo LT, Emeto TI, Engelbert Bain L, Fagbamigbe AF, Fahim A, Feizkhah A, Fetensa G, Fischer F, Gaipov A, Gandhi AP, Gautam RK, Gebregergis MW, Gebrehiwot M, Gebrekidan KG, Ghaffari K, Ghassemi F, Ghazy RM, Goodridge A, Goyal A, Guan SY, Gudeta MD, Guled RA, Gultom NB, Gupta VB, Gupta VK, Gupta S, Hagins H, Hailu SG, Hailu WB, Hamidi S, Hanif A, Harapan H, Hasan RS, Hassan S, Haubold J, Hezam K, Hong SH, Horita N, Hossain MB, Hosseinzadeh M, Hostiuc M, Hostiuc S, Huynh HH, Ibitoye SE, Ikuta KS, Ilic IM, Ilic MD, Islam MR, Ismail NE, Ismail F, Jafarzadeh A, Jakovljevic M, Jalili M, Janodia MD, Jomehzadeh N, Jonas JB, Joseph N, Joshua CE, Kabir Z, Kamble BD, Kanchan T, Kandel H, Kanmodi KK, Kantar RS, Karaye IM, Karimi Behnagh A, Kassa GG, Kaur RJ, Kaur N, Khajuria H, Khamesipour F, Khan YH, Khan MN, Khan Suheb MZ, Khatab K, Khatami F, Kim MS, Kosen S, Koul PA, Koulmane Laxminarayana SL, Krishan K, Kucuk Bicer B, Kuddus MA, Kulimbet M, Kumar N, Lal DK, Landires I, Latief K, Le TDT, Le TTT, Ledda C, Lee M, Lee SW, Lerango TL, Lim SS, Liu C, Liu X, Lopukhov PD, Luo H, Lv H, Mahajan PB, Mahboobipour AA, Majeed A, Malakan Rad E, Malhotra K, Malik MSA, Malinga LA, Mallhi TH, Manilal A, Martinez-Guerra BA, Martins-Melo FR, Marzo RR, Masoumi-Asl H, Mathur V, Maude RJ, Mehrotra R, Memish ZA, Mendoza W, Menezes RG, Merza MA, Mestrovic T, Mhlanga L, Misra S, Misra AK, Mithra P, Moazen B, Mohammed H, Mokdad AH, Monasta L, Moore CE, Mousavi P, Mulita F, Musaigwa F, Muthusamy R, Nagarajan AJ, Naghavi P, Naik GR, Naik G, Nair S, Nair TS, Natto ZS, Nayak BP, Negash H, Nguyen DH, Nguyen VT, Niazi RK, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Oancea B, Obamiro KO, Odetokun IA, Odo DBO, Odukoya OO, Oh IH, Okereke CO, Okonji OC, Oren E, Ortiz-Brizuela E, Osuagwu UL, Ouyahia A, P A MP, Parija PP, Parikh RR, Park S, Parthasarathi A, Patil S, Pawar S, Peng M, Pepito VCF, Peprah P, Perdigão J, Perico N, Pham HT, Postma MJ, Prabhu ARA, Prasad M, Prashant A, Prates EJS, Rahim F, Rahman M, Rahman MA, Rahmati M, Rajaa S, Ramasamy SK, Rao IR, Rao SJ, Rapaka D, Rashid AM, Ratan ZA, Ravikumar N, Rawaf S, Reddy MMRK, Redwan EMM, Remuzzi G, Reyes LF, Rezaei N, Rezaeian M, Rezahosseini O, Rodrigues M, Roy P, Ruela GDA, Sabour S, Saddik B, Saeed U, Safi SZ, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Sahebkar A, Sahiledengle B, Sahoo SS, Salam N, Salami AA, Saleem S, Saleh MA, Samadi Kafil H, Samadzadeh S, Samodra YL, Sanjeev RK, Saravanan A, Sawyer SM, Selvaraj S, Senapati S, Senthilkumaran S, Shah PA, Shahid S, Shaikh MA, Sham S, Shamshirgaran MA, Shanawaz M, Sharath M, Sherchan SP, Shetty RS, Shirzad-Aski H, Shittu A, Siddig EE, Silva JP, Singh S, Singh P, Singh H, Singh JA, Siraj MS, Siswanto S, Solanki R, Solomon Y, Soriano JB, Sreeramareddy CT, Srivastava VK, Steiropoulos P, Swain CK, Tabuchi T, Tampa M, Tamuzi JJLL, Tat NY, Tavakoli Oliaee R, Teklay G, Tesfaye EG, Tessema B, Thangaraju P, Thapar R, Thum CCC, Ticoalu JHV, Tleyjeh IM, Tobe-Gai R, Toma TM, Tram KH, Udoakang AJ, Umar TP, Umeokonkwo CD, Vahabi SM, Vaithinathan AG, van Boven JFM, Varthya SB, Wang Z, Warsame MSA, Westerman R, Wonde TE, Yaghoubi S, Yi S, Yiğit V, Yon DK, Yonemoto N, Yu C, Zakham F, Zangiabadian M, Zeukeng F, Zhang H, Zhao Y, Zheng P, Zielińska M, Salomon JA, Reiner Jr RC, Naghavi M, Vos T, Hay SI, Murray CJL, Kyu HH. Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. THE LANCET. INFECTIOUS DISEASES 2024; 24:698-725. [PMID: 38518787 PMCID: PMC11187709 DOI: 10.1016/s1473-3099(24)00007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/09/2023] [Accepted: 01/08/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020. METHODS We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990-2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data. FINDINGS We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5-14 years, 6·29% (5·05 to 7·70) in those aged 15-49 years, 5·72% (4·02 to 7·39) in those aged 50-69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5-14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15-49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50-69 years, and a 3·29% (-5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (-713 to 2180) fewer deaths. INTERPRETATION Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups. FUNDING Bill & Melinda Gates Foundation.
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Shang W, Cao G, Jing W, Liu J, Liang W, Liu M. Global Burden of Tuberculosis in Adolescents and Young Adults: 1990-2019. Pediatrics 2024; 153:e2023063910. [PMID: 38482587 DOI: 10.1542/peds.2023-063910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE Tuberculosis (TB) is a major health threat in adolescents and young adults. However, its burden in this population remains unclear. This study aimed to assess TB burden and changing trends in individuals aged 10 to 24 years from 1990 to 2019. METHODS All data were obtained from the Global Burden of Disease Study 2019. We calculated the percentage of relative changes in incident cases, deaths, and disability-adjusted life years (DALYs). The temporal trends of the incidence, mortality, and DALYs were assessed using estimated annual percentage changes (EAPCs). RESULTS At global level, TB incidence (per 100 000 population) decreased from 144.12 in 1990 to 97.56 in 2019, with average 1.28% (95% confidence interval [CI]: 1.36%-1.19%) of decline per year. Similar decreasing trends occurred across sex, age, sociodemographic index regions, and in most Global Burden of Disease study regions and countries. TB incidence in female adolescents decreased faster than that in male. However, there was an increasing trend in the incidence of extensively drug-resistant TB (EAPC = 11.23, 95% CI: 8.22-14.33) and multidrug-resistant TB without extensive drug resistance (EAPC = 3.28, 95% CI: 1.73-4.86). South Africa had the highest increase in TB incidence (EAPC = 3.51, 95% CI: 3.11-3.92). CONCLUSIONS Global TB incidence, mortality, and DALYs in adolescents and young adults decreased from 1990 to 2019. However, the incidence of drug-resistant TB increased. TB remains a threat in adolescents and young adults worldwide, especially in low- and middle-income countries.
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Affiliation(s)
- Weijing Shang
- School of Public Health, Peking University, Beijing, China
| | - Guiying Cao
- School of Public Health, Peking University, Beijing, China
| | - Wenzhan Jing
- Vanke School of Public Health
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Jue Liu
- School of Public Health, Peking University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Min Liu
- School of Public Health, Peking University, Beijing, China
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Yerezhepov D, Gabdulkayum A, Akhmetova A, Kozhamkulov UA, Rakhimova SE, Kairov UY, Zhunussova G, Kalendar RN, Akilzhanova A. Vitamin D Status, VDR, and TLR Polymorphisms and Pulmonary Tuberculosis Epidemiology in Kazakhstan. Nutrients 2024; 16:558. [PMID: 38398882 PMCID: PMC10892443 DOI: 10.3390/nu16040558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) and vitamin D deficiency remain major public health problems in Kazakhstan. Due to the high incidence of pulmonary tuberculosis in the country and based on the importance of vitamin D in the modulation of the immune response and the association of its deficiency with many health conditions, the aim of our research was to study the vitamin D status, VDR and TLR gene polymorphisms, and pulmonary tuberculosis epidemiology in Kazakhstan. METHODS A case-control study included 411 individuals diagnosed with pulmonary TB and 686 controls with no family history of pulmonary tuberculosis. Concentrations of serum vitamin D (25-(OH)D) levels were measured by electrochemiluminescence immunoassay. The gene polymorphisms were determined by real-time polymerase chain reaction (PCR) allelic discrimination assay using TaqMan probes. The association between the risk of pulmonary TB and polymorphisms was evaluated using multimodal logistic regression and assessed with the ORs, corresponding to 95% Cis, and the significance level was determined as p < 0.05. RESULTS 1097 individuals were recruited from 3 different regions of Kazakhstan. Biochemical data showed vitamin D deficiency (25-(OH)D < 20 ng/mL) was present in both groups, with the case group accounting for almost 95% and 43.7% in controls. Epidemiological data revealed that socioeconomic factors such as BMI < 25 kg/m2 (p < 0.001), employment (p < 0.001), diabetes (p < 0.001), and vitamin D deficiency (p < 0.001) were statistically different between case and control groups. Logistic regression analysis, adjusted by sex, age, BMI, residence, employment, smoking, alcohol consumption, and diabetes, showed that T/T polymorphism of the VDR gene (rs1544410, OR = 1.97, 95% CI: 1.04-3.72, p = 0.03) and A/A polymorphism of the TLR8 gene (rs3764880, OR = 2.44, 95% CI: 1.20-4.98, p = 0.01) were associated with a high risk of developing pulmonary tuberculosis. CONCLUSIONS Vitamin D deficiency remains prevalent in our study cohort and is associated with TB progression. Socioeconomic determinants such as unemployment, BMI under 25 kg/m2, and diabetes are the main risk factors for the development of pulmonary TB in our study. A/A polymorphism of TLR8 (rs3764880) and T/T polymorphism (BsmI, rs1544410) of VDR genes may act as biomarkers for pulmonary tuberculosis in the Kazakh population.
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Affiliation(s)
- Dauren Yerezhepov
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan
| | - Aidana Gabdulkayum
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan
| | - Ainur Akhmetova
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan
| | - Ulan A. Kozhamkulov
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan
| | - Saule E. Rakhimova
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan
| | - Ulykbek Y. Kairov
- Laboratory of Bioinformatics and Systems Biology, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan
| | | | - Ruslan N. Kalendar
- Institute of Biotechnology HiLIFE, University of Helsinki, P.O. Box 65, 00014 Helsinki, Finland
| | - Ainur Akilzhanova
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan
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8
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Bradford SD, Ryan KJ, Divens AM, Povroznik JM, Bonigala S, Robinson CM. IL-27 alters inflammatory cytokine expression and limits protective immunity against Mycobacterium tuberculosis in a neonatal BCG vaccination model. Front Immunol 2024; 15:1217098. [PMID: 38390338 PMCID: PMC10881868 DOI: 10.3389/fimmu.2024.1217098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Background Efforts to control tuberculosis (TB), caused by the pathogen Mycobacterium tuberculosis (Mtb), have been hampered by the immense variability in protection from BCG vaccination. While BCG protects young children from some forms of TB disease, long-term protection against pulmonary disease is more limited, suggesting a poor memory response. New vaccines or vaccination strategies are required to have a realistic chance of eliminating TB disease. In TB endemic areas, routine immunization occurs during the neonatal period and as such, we hypothesized that inadequate protective immunity elicited by BCG vaccination could be the result of the unique early-life immune landscape. Interleukin (IL)-27 is a heterodimeric cytokine with immune suppressive activity that is elevated in the neonatal period. Objective We investigated the impact of IL-27 on regulation of immune responses during neonatal BCG vaccination and protection against Mtb. Methods Here, we used a novel model of neonatal vaccination and adult aerosol challenge that models the human timeline of vaccine delivery and disease transmission. Results Overall, we observed improved control of Mtb in mice unresponsive to IL-27 (IL-27Rα-/-) that was consistent with altered expression patterns of IFN-γ and IL-17 in the lungs. The balance of these cytokines with TNF-α expression may be key to effective bacterial clearance. Conclusions Our findings suggest the importance of evaluating new vaccines and approaches to combat TB in the neonatal population most likely to receive them as part of global vaccination campaigns. They further indicate that temporal strategies to antagonize IL-27 during early life vaccination may improve protection.
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Affiliation(s)
- Shelby D. Bradford
- Department of Microbiology, Immunology, & Cell Biology, West Virginia University School of Medicine, Morgantown, WV, United States
- Vaccine Development Center, West Virginia University Health Sciences Center, Morgantown, WV, United States
| | - Kenneth J. Ryan
- Department of Statistics, West Virginia University, Morgantown, WV, United States
| | - Ashley M. Divens
- Department of Microbiology, Immunology, & Cell Biology, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Jessica M. Povroznik
- Department of Microbiology, Immunology, & Cell Biology, West Virginia University School of Medicine, Morgantown, WV, United States
- Vaccine Development Center, West Virginia University Health Sciences Center, Morgantown, WV, United States
| | - Sunilkanth Bonigala
- Department of Microbiology, Immunology, & Cell Biology, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Cory M. Robinson
- Department of Microbiology, Immunology, & Cell Biology, West Virginia University School of Medicine, Morgantown, WV, United States
- Vaccine Development Center, West Virginia University Health Sciences Center, Morgantown, WV, United States
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9
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Enane LA, Duda SN, Chanyachukul T, Bolton-Moore C, Navuluri N, Messou E, Mbonze N, McDade LR, Figueiredo MC, Ross J, Evans D, Diero L, Akpata R, Zotova N, Freeman A, Pierre MF, Rupasinghe D, Ballif M, Byakwaga H, de Castro N, Tabala M, Sterling TR, Sohn AH, Fenner L, Wools-Kaloustian K, Poda A, Yotebieng M, Huebner R, Marcy O. The Tuberculosis Sentinel Research Network (TB-SRN) of the International epidemiology Databases to Evaluate AIDS (IeDEA): protocol for a prospective cohort study in Africa, Southeast Asia and Latin America. BMJ Open 2024; 14:e079138. [PMID: 38195167 PMCID: PMC10806577 DOI: 10.1136/bmjopen-2023-079138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/23/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Tuberculosis (TB) is a leading infectious cause of death globally. It is the most common opportunistic infection in people living with HIV, and the most common cause of their morbidity and mortality. Following TB treatment, surviving individuals may be at risk for post-TB lung disease. The TB Sentinel Research Network (TB-SRN) provides a platform for coordinated observational TB research within the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS AND ANALYSIS This prospective, observational cohort study will assess treatment and post-treatment outcomes of pulmonary TB (microbiologically confirmed or clinically diagnosed) among 2600 people aged ≥15 years, with and without HIV coinfection, consecutively enrolled at 16 sites in 11 countries, across 6 of IeDEA's global regions. Data regarding clinical and sociodemographic factors, mental health, health-related quality of life, pulmonary function, and laboratory and radiographic findings will be collected using standardised questionnaires and data collection tools, beginning from the initiation of TB treatment and through 12 months after the end of treatment. Data will be aggregated for proposed analyses. ETHICS AND DISSEMINATION Ethics approval was obtained at all implementing study sites, including the Vanderbilt University Medical Center Human Research Protections Programme. Participants will provide informed consent; for minors, this includes both adolescent assent and the consent of their parent or primary caregiver. Protections for vulnerable groups are included, in alignment with local standards and considerations at sites. Procedures for requesting use and analysis of TB-SRN data are publicly available. Findings from TB-SRN analyses will be shared with national TB programmes to inform TB programming and policy, and disseminated at regional and global conferences and other venues.
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Affiliation(s)
- Leslie A Enane
- The Ryan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Center for Global Health Equity, Indianapolis, Indiana, USA
| | - Stephany N Duda
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | | | - Neelima Navuluri
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Eugène Messou
- Centre de Prise en Charge de Recherche et de Formation (Aconda-CePReF), Abidjan, Côte d'Ivoire
| | - Nana Mbonze
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - LaQuita R McDade
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marina Cruvinel Figueiredo
- Vanderbilt Tuberculosis Center, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jeremy Ross
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lameck Diero
- Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | | | - Natalia Zotova
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Aimee Freeman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marie Flore Pierre
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Helen Byakwaga
- Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda
| | | | - Martine Tabala
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Timothy R Sterling
- Vanderbilt Tuberculosis Center, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Annette H Sohn
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Kara Wools-Kaloustian
- Indiana University Center for Global Health Equity, Indianapolis, Indiana, USA
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Armel Poda
- Centre Hospitalier Universitaire Sourô Sanou, Bobo Dioulasso, Burkina Faso
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robin Huebner
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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10
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Esguerra-Paculan MJA, Soldera J. Hepatobiliary tuberculosis in the developing world. World J Gastrointest Surg 2023; 15:2305-2319. [PMID: 37969705 PMCID: PMC10642457 DOI: 10.4240/wjgs.v15.i10.2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Hepatobiliary tuberculosis is a challenging disease that poses diagnostic difficulties due to its resemblance to other etiologies. Delayed diagnosis may lead to inadequate treatment, thus necessitating an urgent need for accurate diagnosis and appropriate management. AIM To systematically review case reports on hepatobiliary tuberculosis, focusing on symptomatology, diagnostic procedures, management, and outcomes to provide patient safety and ensure an uneventful recovery. METHODS A systematic search was conducted on PubMed from 1992 to 2022, using keywords such as hepatobiliary, liver, tuberculosis cholangitis, cholangiopathy, and mycobacterium. Only case reports or case series in English were included in the study, and research papers published as abstracts were excluded. The search yielded a total of 132 cases, which were further narrowed down to 17 case studies, consisting of 24 cases of hepatobiliary tuberculosis. RESULTS The 10 most common symptoms observed in these cases were fever, abdominal pain, weight loss, jaundice, anorexia, generalized weakness, pruritus, chills, fatigue, and chest pains. Objective findings in these cases included hepatomegaly, hepatic nodules, elevated liver enzymes, and elevated bilirubin. Computed tomography scan and ultrasound of the abdomen were the most useful diagnostic tools reported. Histologic demonstration of Mycobacterium tuberculosis confirmed the cases of hepatobiliary tuberculosis. Treatment regimens commonly used included Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol. Out of the 24 cases, 18 presented improvements while 4 had completely recovered. CONCLUSION Hepatobiliary tuberculosis is a disease that requires accurate diagnosis and appropriate management to avoid complications.
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Affiliation(s)
| | - Jonathan Soldera
- Acute Medicine, University of South Wales, Cardiff CF37 1DL, United Kingdom
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Nkereuwem E, Agbla S, Jatta ML, Masterton U, Owolabi O, Edem VF, Kampmann B, Togun T. Childhood TB sequel: evaluating respiratory function after treatment for pulmonary tuberculosis in a prospective cohort of Gambian children - a study protocol. BMC Pulm Med 2023; 23:387. [PMID: 37828470 PMCID: PMC10571308 DOI: 10.1186/s12890-023-02659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND 1.2 million children under 15 years are estimated to have developed tuberculosis (TB) in 2021. 85% of paediatric patients achieve successful treatment outcomes if treated for the first episode of TB. However, despite so-called successful treatment, TB leaves many survivors with permanently destroyed or damaged lungs. Data from prospective paediatric cohorts to establish the burden and evolution of post-TB lung disease (PTLD) are still absent. The Childhood TB Sequel study aims to describe respiratory consequences associated with pulmonary TB in Gambian children, describe the evolution of these sequelae, and determine associated epidemiological risk factors. METHODS We aim to recruit up to 80 subjects aged 19 years and below who have recently completed treatment for pulmonary TB. Recruitment started in April 2022 and is expected to continue until June 2024. Clinical assessment, chest X-ray, and comprehensive lung function assessment are carried out at treatment completion and again six and 12 months later. DISCUSSION The Childhood TB Sequel study will address existing research gaps to enhance our knowledge and understanding of the burden of PTLD in Gambian children. The study will also contribute to formulating a plan for post-TB evaluation and long-term follow-up strategies. TRIAL REGISTRATION ClinicalTrials.gov: NCT05325125, April 13, 2022.
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Affiliation(s)
- Esin Nkereuwem
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia.
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Schadrac Agbla
- Department of Health Data Science, University of Liverpool, Liverpool, UK
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Muhammed Lamin Jatta
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Uma Masterton
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Olumuyiwa Owolabi
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Victory Fabian Edem
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Charité Centre for Global Health, Institute of International Health, Charité Unversitatsmedizin, Berlin, Germany
| | - Toyin Togun
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- TB Centre, London School of Hygiene and Tropical Medicine, London, UK
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12
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Amofa-Sekyi M, Schaap A, Mureithi L, Kosloff B, Cheeba M, Kangololo B, Vermaak R, Paulsen R, Ruperez M, Floyd S, de Haas P, Fidler S, Hayes R, Ayles H, Shanaube K. Prevalence and risk factors of M tuberculosis infection in young people across 14 communities in Zambia and South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002077. [PMID: 37773934 PMCID: PMC10540968 DOI: 10.1371/journal.pgph.0002077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/31/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND From 2018-2021 the TB Reduction through Expanded Antiretroviral Treatment and TB Screening (TREATS) project took place in 21 Zambian and South African communities. The TREATS Incidence of TB Infection Cohort Study was conducted in adolescents and young people (AYP), aged 15-24 years in 14 communities. We describe the baseline prevalence and risk factors of Mycobacterium tuberculosis (M. tuberculosis) infection among this cohort and explore the quantitative QFT-Plus interferon gamma (IFN-γ) responses. METHODS AND FINDINGS A random sample of approximately 300 AYP per community were recruited and information on TB/HIV risk factors, TB symptoms and social mixing patterns collected. QuantiFERON TB Gold Plus assay (QFT-Plus) was used to detect M. tuberculosis infection, following manufacturer's instructions. Logistic regression was used to determine factors associated with infection. 5577 eligible AYP were invited to participate across both countries, with 4648 enrolled. QFT-Plus results were available for 4529: 2552(Zambia) and 1977(South Africa). Overall, 47.6% (2156/4529) AYP had positive QFT-Plus results, the prevalence of infection in South Africa being twice that in Zambia (64.7% (1280/1977) vs 34.3% (867/2552) p<0.001). Infection was associated with age, household contact with TB and alcohol in Zambia but showed no associations in South Africa. The antigen tube differential (TB2-TB1>0.6 IU/ml) of the assay at baseline showed no evidence of association with recent TB exposure. CONCLUSION The high prevalence of infection in AYP warrants urgent action to address TB control, especially in South Africa. Further research is required to delineate antigen tube responses of the QFT-Plus assay more precisely to fully realise the benefit of the additional TB2 tube in high TB/HIV burden settings.
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Affiliation(s)
| | - Ab Schaap
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Infectious and Tropical Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Linda Mureithi
- Health Systems Research Unit, Health Systems Trust, Cape Town, South Africa
| | - Barry Kosloff
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maina Cheeba
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia
| | - Bxyn Kangololo
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia
| | - Redwaan Vermaak
- Health Systems Research Unit, Health Systems Trust, Cape Town, South Africa
| | - Robynn Paulsen
- Health Systems Research Unit, Health Systems Trust, Cape Town, South Africa
| | - Maria Ruperez
- Department of Infectious and Tropical Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sian Floyd
- Department of Infectious and Tropical Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Petra de Haas
- KNCV Tuberculosis Foundation, The Hague, Netherlands
| | - Sarah Fidler
- HIV Trials Unit, Imperial College London, London, United Kingdom
| | - Richard Hayes
- Department of Infectious and Tropical Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Ayles
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kwame Shanaube
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia
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13
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Novina N, Ritonga MA, Yusuf AS. Gonadotropin Levels and Underlying Diseases in Adolescent With Secondary Amenorrhea. Int J Womens Health 2023; 15:1397-1404. [PMID: 37701180 PMCID: PMC10493105 DOI: 10.2147/ijwh.s412482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose To provide characteristics and hormonal profiles of secondary amenorrhea cases in adolescent patients treated at Hasan Sadikin General Hospital in Bandung. Patients and Methods The study was retrospective in nature and involved the analysis of medical records from 2017 to 2022 for 44 adolescent patients aged 10-18 who had secondary amenorrhea. Results There were 44 adolescents included in this study after excluded 69 adults from 113 secondary amenorrhea cases. The majority of patients were 14-17 years old (38.63%), in senior high school (45.45%), had started menarche at 11 years old (45.45%), had normal nutritional status (65.91%), and had normal stature (65.91%). The underlying diseases found in most patients were systemic lupus erythematosus (SLE) and tuberculosis. Among the patients, 29 had FSH, LH, and estradiol levels measured. The results of hormonal assays showed a wide range of abnormal serum levels, with normal to low concentrations of FSH and low levels of LH and estradiol. The median (interquartile range) results for FSH, LH, and estradiol were 4.57 (0.64, 90.65), 1.635 (0.06, 55.76), and 24.3 (0.2, 154.71), respectively. Positive significant correlation between FSH and LH (p < 0.01) was found in children with secondary amenorrhea. Conclusion Hormonal assay for FSH, LH, and Estradiol showed a wide range of abnormal serum level. Normal to low concentration levels of FSH and low LH and estradiol. The majority of secondary amenorrhea patients are associated with autoimmune disease and infection.
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Affiliation(s)
- Novina Novina
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran / Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Mulyanusa Amarullah Ritonga
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran / Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Scholtz D, Jooste T, Möller M, van Coller A, Kinnear C, Glanzmann B. Challenges of Diagnosing Mendelian Susceptibility to Mycobacterial Diseases in South Africa. Int J Mol Sci 2023; 24:12119. [PMID: 37569495 PMCID: PMC10418440 DOI: 10.3390/ijms241512119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Inborn errors of immunity (IEI) are genetic disorders with extensive clinical presentations. They can range from increased susceptibility to infections to significant immune dysregulation that results in immune impairment. While IEI cases are individually rare, they collectively represent a significant burden of disease, especially in developing countries such as South Africa, where infectious diseases like tuberculosis (TB) are endemic. This is particularly alarming considering that certain high penetrance mutations that cause IEI, such as Mendelian Susceptibility to Mycobacterial Disease (MSMD), put individuals at higher risk for developing TB and other mycobacterial diseases. MSMD patients in South Africa often present with different clinical phenotypes than those from the developed world, therefore complicating the identification of disease-associated variants in this setting with a high burden of infectious diseases. The lack of available data, limited resources, as well as variability in clinical phenotype are the reasons many MSMD cases remain undetected or misdiagnosed. This article highlights the challenges in diagnosing MSMD in South Africa and proposes the use of transcriptomic analysis as a means of potentially identifying dysregulated pathways in affected African populations.
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Affiliation(s)
- Denise Scholtz
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; (D.S.); (T.J.); (M.M.); (C.K.)
| | - Tracey Jooste
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; (D.S.); (T.J.); (M.M.); (C.K.)
| | - Marlo Möller
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; (D.S.); (T.J.); (M.M.); (C.K.)
- Centre for Bioinformatics and Computational Biology, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Ansia van Coller
- South African Medical Research Council (SAMRC) Genomics Platform, Cape Town 7505, South Africa;
| | - Craig Kinnear
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; (D.S.); (T.J.); (M.M.); (C.K.)
- South African Medical Research Council (SAMRC) Genomics Platform, Cape Town 7505, South Africa;
| | - Brigitte Glanzmann
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; (D.S.); (T.J.); (M.M.); (C.K.)
- South African Medical Research Council (SAMRC) Genomics Platform, Cape Town 7505, South Africa;
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15
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Swanepoel J, van der Zalm MM, Preiser W, van Zyl G, Whittaker E, Hesseling AC, Moore DAJ, Seddon JA. SARS-CoV-2 infection and pulmonary tuberculosis in children and adolescents: a case-control study. BMC Infect Dis 2023; 23:442. [PMID: 37386354 DOI: 10.1186/s12879-023-08412-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND The Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic has had an impact on the global tuberculosis (TB) epidemic but evidence on the possible interaction between SARS-CoV-2 and TB, especially in children and adolescents, remains limited. We aimed to evaluate the relationship between previous infection with SARS-CoV-2 and the risk of TB in children and adolescents. METHODS An unmatched case-control study was conducted using SARS-CoV-2 unvaccinated children and adolescents recruited into two observational TB studies (Teen TB and Umoya), between November 2020 and November 2021, in Cape Town, South Africa. Sixty-four individuals with pulmonary TB (aged < 20 years) and 99 individuals without pulmonary TB (aged < 20 years) were included. Demographics and clinical data were obtained. Serum samples collected at enrolment underwent quantitative SARS-CoV-2 anti-spike immunoglobulin G (IgG) testing using the Abbott SARS-CoV-2 IgG II Quant assay. Odds ratios (ORs) for TB were estimated using unconditional logistic regression. RESULTS There was no statistically significant difference in the odds of having pulmonary TB between those who were SARS-CoV-2 IgG seropositive and those who were seronegative (adjusted OR 0.51; 95% CI: 0.23-1.11; n = 163; p = 0.09). Of those with positive SARS-CoV-2 serology indicating prior infection, baseline IgG titres were higher in individuals with TB compared to those without TB (p = 0.04) and individuals with IgG titres in the highest tertile were more likely to have pulmonary TB compared to those with IgG levels in the lowest tertile (OR: 4.00; 95%CI: 1.13- 14.21; p = 0.03). CONCLUSIONS Our study did not find convincing evidence that SARS-CoV-2 seropositivity was associated with subsequent pulmonary TB disease; however, the association between magnitude of SARS-CoV-2 IgG response and pulmonary TB warrants further investigation. Future prospective studies, evaluating the effects of sex, age and puberty on host immune responses to M. tuberculosis and SARS-CoV-2, will also provide more clarity on the interplay between these two infections.
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Affiliation(s)
- Jeremi Swanepoel
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
- TB Centre, London School of Hygiene and Tropical Medicine, London, UK.
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Wolfgang Preiser
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Gert van Zyl
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Academic Hospital, Cape Town, South Africa
| | | | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - David A J Moore
- TB Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Infectious Disease, Imperial College London, London, UK
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16
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Murthy PR, A K AK, N N, K V VG. Adolescent tuberculosis in the ICU. Indian J Tuberc 2023; 70 Suppl 1:S24-S28. [PMID: 38110256 DOI: 10.1016/j.ijtb.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 12/20/2023]
Abstract
TB is a major concern in the paediatric age group, especially in India. More than 3.33 lakh children between 0 and 14 years of age are affected by TB. Adolescent tuberculosis has been a neglected area and this age group accounts for about 800,000 cases of tuberculosis (TB) cases every year. Information regarding adolescent tuberculosis patient requiring ICU admission/care is very scanty (unlike adult tuberculosis), and the authors believe that the mode of ICU presentation and challenges in adolescents would almost be the same as in adults, although the outcome is generally expected to be better in the adolescent population in view of lesser comorbidities when compared to adults. ARDS, multiorgan dysfunction and meningitis are the most common reasons for admission to ICU. Critically ill patients with TB carry a high mortality and the increased mortality is likely due to multiorgan dysfunction, nosocomial infections and sepsis. Advanced disease with chronic undernourishment influences not just morbidity but mortality as well. Further, the heavy financial burden incurred for ICU care in TB patients with poor expected outcome is a major concern since TB occurs predominantly in low socio-economic populations.
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Affiliation(s)
- Pooja R Murthy
- Department of Critical Care Medicine, Aster Whitefield Hospital, Bengaluru, (560 066), Karnataka, India
| | - Ajith Kumar A K
- Department of Critical Care Medicine, Aster Whitefield Hospital, Bengaluru, (560 066), Karnataka, India.
| | - Nikhil N
- Department of Critical Care Medicine, Aster Whitefield Hospital, Bengaluru, (560 066), Karnataka, India
| | - Venkatesha Gupta K V
- Department of Critical Care Medicine, Aster Whitefield Hospital, Bengaluru, (560 066), Karnataka, India
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17
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Tang S, Li X, Wang M, Sha L. Nutrition literacy mediates the relationship between self-efficacy and eating behavior in young tuberculosis patients: A cross-sectional study. Prev Med Rep 2023; 33:102187. [PMID: 37223557 PMCID: PMC10201870 DOI: 10.1016/j.pmedr.2023.102187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 05/25/2023] Open
Abstract
Objective To assess the associations between self-efficacy, nutrition literacy and eating behavior, and to examine if nutrition literacy mediates the relationship between self-efficacy and eating behavior in young tuberculosis patients. Methods This cross-sectional study used a convenience sampling strategy to select 230 young tuberculosis patients at the Second Hospital of Nanjing (Public Health Medical Center of Nanjing), China, from June 2022 to August 2022. The data were collected using a demographic data form, the Eating Behavior Scale, the Food and Nutrition Literacy Questionnaire and the Tuberculosis Self-Efficacy Scale. Descriptive statistics, Pearson bivariate correlation analysis, Pearson partial correlation analysis, hierarchical multiple regression, and mediation analysis were conducted in the study. Results The mean self-efficacy score for young tuberculosis patients was 92.56 (SD = 9.89, range = 21 ∼ 105). The average nutrition literacy score for young tuberculosis patients was 68.24(SD = 6.75, range = 0 ∼ 100). The bivariate correlation analysis and partial correlation analysis found that self-efficacy was positively correlated with nutrition literacy (P < 0.01). The regression analysis showed that self-efficacy (F = 5.186, β = 0.233, P < 0.001)and nutrition literacy (F = 7.749, β = 0.545, P < 0.001) significantly predicted eating behavior. The three dimensions of nutrition literacy including nutritional knowledge (mediation effect ratio = 13.1%, 95% CI = - 0.089; -0.005), preparing food (mediation effect ratio = 17.4%, 95 %CI = 0.011; 0.077) and eating (mediation effect ratio = 54.7%, 95 %CI = 0.070; 0.192) mediated the relationship between self-efficacy and eating behavior in young tuberculosis patients. Conclusion Nutrition literacy mediated the relationship between self-efficacy and eating behavior. To promote healthy eating behavior among young tuberculosis patients, interventions aimed at improving self-efficacy and nutrition literacy should be conducted.
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Affiliation(s)
- Suyao Tang
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing 210023, China
| | - Xinyue Li
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing 210023, China
| | - Mengmeng Wang
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing 210023, China
| | - Li Sha
- Medical Examination Centre, Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine (The Second Hospital of Nanjing), 1-1 Zhongfu Road, Nanjing 210023, China
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18
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Peres TG, Castro YM, Corrêa ML, Emmendorfer LR, Zhang L. Trends in tuberculosis mortality among children and adolescents in Brazil, 1996-2020: a joinpoint analysis. J Bras Pneumol 2023; 49:e20230019. [PMID: 37255164 PMCID: PMC10578908 DOI: 10.36416/1806-3756/e20230019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Tyele Goulart Peres
- . Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande (RS) Brasil
| | - Yasmin Marques Castro
- . Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande (RS) Brasil
| | - Mariana Lima Corrêa
- . Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas (RS) Brasil
| | - Leonardo Ramos Emmendorfer
- . Programa de Pós-Graduação em Ciências da Computação, Universidade Federal de Santa Maria, Santa Maria (RS) Brasil
| | - Linjie Zhang
- . Unidade de Pneumologia Pediátrica, Programas de Pós-Graduação em Saúde Pública e em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande (RS) Brasil
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19
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Zhou J, Ma X, Lu TJ, Zhuang Y, Li JL, Chen H. Epidemiological characteristics of pulmonary tuberculosis among students in Guizhou, China: a retrospective study from 2010 to 2020. BMJ Open 2023; 13:e072010. [PMID: 37197814 PMCID: PMC10193094 DOI: 10.1136/bmjopen-2023-072010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE We described epidemiological characteristics of pulmonary tuberculosis (PTB) among students and evaluated susceptible populations and areas in Guizhou province and also to provide scientific suggestions for prevention and control. SETTING Guizhou, China. DESIGN This is a retrospective epidemiological study on PTB in students. METHODS Data are from the China Information System for Disease Control and Prevention. We collected all PTB cases among the student population from 2010 to 2020 in Guizhou. Incidence, composition ratio and hotspot analysis were used to describe epidemiological and some clinical characteristics. RESULTS A total of 37 147 new student PTB cases were registered among the population aged 5-30 years during 2010-2020. The proportions of men and women were 53.71% and 46.29%, respectively. Cases aged 15-19 years dominated (63.91%), and the proportion of ethnic groups was increasing during the period. Generally, the raw annual incidence of PTB among the population was increasing from 32.585 per 100 000 persons in 2010 to 48.872 per 100 000 persons in 2020 (c 2 trend=1283.230, p<0.001). March and April were the peak months of a year, and cases were clearly grouped in Bijie city. New cases were mainly identified via physical examination, and cases from active screening were still low (0.76%). Additionally, secondary PTB accounted for 93.68%, positive rate of pathogen was only 23.06%, and the recovery rate was 94.60%. CONCLUSIONS The population aged 15-19 years is the vulnerable population, and Bijie city is the susceptible area. BCG vaccination and promotion for active screening should be the priority of futural PTB prevention and control. Tuberculosis laboratory capacity should be improved.
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Affiliation(s)
- Jian Zhou
- Institute for Tuberculosis Prevention and Control, Guizhou Center for Disease Control and Prevention, Guiyang, China
| | - Xiaoxue Ma
- Institute for Health Promotion,Publicity and Education, Guizhou Center for Disease Control and Prevention, Guiyang, China
| | - Ting-Jia Lu
- Haixiao Street Community Health Service Center, Guizhou, Zunyi, Guizhou, China
| | - Yan Zhuang
- Institute for Health Promotion,Publicity and Education, Guizhou Center for Disease Control and Prevention, Guiyang, China
| | - Jin-Lan Li
- Institute for Health Promotion,Publicity and Education, Guizhou Center for Disease Control and Prevention, Guiyang, China
| | - Huijuan Chen
- Institute for Health Promotion,Publicity and Education, Guizhou Center for Disease Control and Prevention, Guiyang, China
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20
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Upadhyay A, Pal D, Kumar A. Combinatorial enzyme therapy: A promising neoteric approach for bacterial biofilm disruption. Process Biochem 2023. [DOI: 10.1016/j.procbio.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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21
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Denholm JT. Children and TB pharmacokinetics: no longer in infancy? Eur Respir J 2023; 61:61/3/2202003. [PMID: 36894189 DOI: 10.1183/13993003.02003-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/07/2022] [Indexed: 03/11/2023]
Affiliation(s)
- Justin T Denholm
- Victorian Tuberculosis Program, Melbourne, Australia
- Department of Infectious Diseases, University of Melbourne, Parkville, Australia
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22
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Gafar F, Wasmann RE, McIlleron HM, Aarnoutse RE, Schaaf HS, Marais BJ, Agarwal D, Antwi S, Bang ND, Bekker A, Bell DJ, Chabala C, Choo L, Davies GR, Day JN, Dayal R, Denti P, Donald PR, Engidawork E, Garcia-Prats AJ, Gibb D, Graham SM, Hesseling AC, Heysell SK, Idris MI, Kabra SK, Kinikar A, Kumar AKH, Kwara A, Lodha R, Magis-Escurra C, Martinez N, Mathew BS, Mave V, Mduma E, Mlotha-Mitole R, Mpagama SG, Mukherjee A, Nataprawira HM, Peloquin CA, Pouplin T, Ramachandran G, Ranjalkar J, Roy V, Ruslami R, Shah I, Singh Y, Sturkenboom MGG, Svensson EM, Swaminathan S, Thatte U, Thee S, Thomas TA, Tikiso T, Touw DJ, Turkova A, Velpandian T, Verhagen LM, Winckler JL, Yang H, Yunivita V, Taxis K, Stevens J, Alffenaar JWC. Global estimates and determinants of antituberculosis drug pharmacokinetics in children and adolescents: a systematic review and individual patient data meta-analysis. Eur Respir J 2023; 61:2201596. [PMID: 36328357 PMCID: PMC9996834 DOI: 10.1183/13993003.01596-2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Suboptimal exposure to antituberculosis (anti-TB) drugs has been associated with unfavourable treatment outcomes. We aimed to investigate estimates and determinants of first-line anti-TB drug pharmacokinetics in children and adolescents at a global level. METHODS We systematically searched MEDLINE, Embase and Web of Science (1990-2021) for pharmacokinetic studies of first-line anti-TB drugs in children and adolescents. Individual patient data were obtained from authors of eligible studies. Summary estimates of total/extrapolated area under the plasma concentration-time curve from 0 to 24 h post-dose (AUC0-24) and peak plasma concentration (C max) were assessed with random-effects models, normalised with current World Health Organization-recommended paediatric doses. Determinants of AUC0-24 and C max were assessed with linear mixed-effects models. RESULTS Of 55 eligible studies, individual patient data were available for 39 (71%), including 1628 participants from 12 countries. Geometric means of steady-state AUC0-24 were summarised for isoniazid (18.7 (95% CI 15.5-22.6) h·mg·L-1), rifampicin (34.4 (95% CI 29.4-40.3) h·mg·L-1), pyrazinamide (375.0 (95% CI 339.9-413.7) h·mg·L-1) and ethambutol (8.0 (95% CI 6.4-10.0) h·mg·L-1). Our multivariate models indicated that younger age (especially <2 years) and HIV-positive status were associated with lower AUC0-24 for all first-line anti-TB drugs, while severe malnutrition was associated with lower AUC0-24 for isoniazid and pyrazinamide. N-acetyltransferase 2 rapid acetylators had lower isoniazid AUC0-24 and slow acetylators had higher isoniazid AUC0-24 than intermediate acetylators. Determinants of C max were generally similar to those for AUC0-24. CONCLUSIONS This study provides the most comprehensive estimates of plasma exposures to first-line anti-TB drugs in children and adolescents. Key determinants of drug exposures were identified. These may be relevant for population-specific dose adjustment or individualised therapeutic drug monitoring.
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Affiliation(s)
- Fajri Gafar
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen, The Netherlands
| | - Roeland E Wasmann
- University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa
| | - Helen M McIlleron
- University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa
- University of Cape Town, Institute of Infectious Disease and Molecular Medicine, Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Cape Town, South Africa
| | - Rob E Aarnoutse
- Radboud University Medical Center, Radboud Institute of Health Sciences, Department of Pharmacy, Nijmegen, The Netherlands
| | - H Simon Schaaf
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
| | - Ben J Marais
- The Children's Hospital at Westmead, Sydney, Australia
- The University of Sydney, Sydney Institute for Infectious Diseases, Sydney, Australia
| | - Dipti Agarwal
- Ram Manohar Lohia Institute of Medical Sciences, Department of Paediatrics, Lucknow, India
| | - Sampson Antwi
- Komfo Anokye Teaching Hospital, Department of Child Health, Kumasi, Ghana
- Kwame Nkrumah University of Science and Technology, School of Medical Sciences, Department of Child Health, Kumasi, Ghana
| | | | - Adrie Bekker
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
| | - David J Bell
- NHS Greater Glasgow and Clyde, Infectious Diseases Unit, Glasgow, UK
| | - Chishala Chabala
- University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa
- University of Zambia, School of Medicine, Department of Paediatrics, Lusaka, Zambia
- University Teaching Hospitals - Children's Hospital, Lusaka, Zambia
| | - Louise Choo
- University College London, Medical Research Council Clinical Trials Unit, London, UK
| | - Geraint R Davies
- Malawi Liverpool Wellcome Clinical Research Programme, Clinical Department, Blantyre, Malawi
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
| | - Jeremy N Day
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- University of Oxford, Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford, UK
| | - Rajeshwar Dayal
- Sarojini Naidu Medical College, Department of Pediatrics, Agra, India
| | - Paolo Denti
- University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa
| | - Peter R Donald
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
| | - Ephrem Engidawork
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Addis Ababa, Ethiopia
| | - Anthony J Garcia-Prats
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, USA
| | - Diana Gibb
- University College London, Medical Research Council Clinical Trials Unit, London, UK
| | - Stephen M Graham
- University of Melbourne, Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Anneke C Hesseling
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
| | - Scott K Heysell
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, VA, USA
| | - Misgana I Idris
- University of Alabama at Birmingham, Department of Biology, Birmingham, AL, USA
| | - Sushil K Kabra
- All India Institute of Medical Sciences, Departments of Pediatrics, New Delhi, India
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Agibothu K Hemanth Kumar
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Awewura Kwara
- University of Florida, Emerging Pathogens Institute, College of Medicine, Gainesville, FL, USA
| | - Rakesh Lodha
- All India Institute of Medical Sciences, Departments of Pediatrics, New Delhi, India
| | | | - Nilza Martinez
- Instituto Nacional de Enfermedades Respiratorias y Del Ambiente, Asunción, Paraguay
| | - Binu S Mathew
- Christian Medical College and Hospital, Department of Pharmacology and Clinical Pharmacology, Vellore, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University, Department of Medicine and Infectious Diseases, Baltimore, MD, USA
| | - Estomih Mduma
- Haydom Lutheran Hospital, Center for Global Health Research, Haydom, Tanzania
| | | | | | - Aparna Mukherjee
- All India Institute of Medical Sciences, Departments of Pediatrics, New Delhi, India
| | - Heda M Nataprawira
- Universitas Padjadjaran, Hasan Sadikin Hospital, Faculty of Medicine, Department of Child Health, Division of Paediatric Respirology, Bandung, Indonesia
| | | | - Thomas Pouplin
- Mahidol University, Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Geetha Ramachandran
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Jaya Ranjalkar
- Christian Medical College and Hospital, Department of Pharmacology and Clinical Pharmacology, Vellore, India
| | - Vandana Roy
- Maulana Azad Medical College, Department of Pharmacology, New Delhi, India
| | - Rovina Ruslami
- Universitas Padjadjaran, Faculty of Medicine, Department of Biomedical Sciences, Division of Pharmacology and Therapy, Bandung, Indonesia
| | - Ira Shah
- Bai Jerbai Wadia Hospital for Children, Department of Pediatric Infectious Diseases, Pediatric TB Clinic, Mumbai, India
| | - Yatish Singh
- Sarojini Naidu Medical College, Department of Pediatrics, Agra, India
| | - Marieke G G Sturkenboom
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Elin M Svensson
- Radboud University Medical Center, Radboud Institute of Health Sciences, Department of Pharmacy, Nijmegen, The Netherlands
- Uppsala University, Department of Pharmacy, Uppsala, Sweden
| | - Soumya Swaminathan
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
- World Health Organization, Public Health Division, Geneva, Switzerland
| | - Urmila Thatte
- Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Department of Clinical Pharmacology, Mumbai, India
| | - Stephanie Thee
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, Germany
| | - Tania A Thomas
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, VA, USA
| | - Tjokosela Tikiso
- University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa
| | - Daan J Touw
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Anna Turkova
- University College London, Medical Research Council Clinical Trials Unit, London, UK
| | - Thirumurthy Velpandian
- All India Institute of Medical Sciences, Ocular Pharmacology and Pharmacy Division, Dr R.P. Centre, New Delhi, India
| | - Lilly M Verhagen
- Radboud University Medical Center, Radboud Center for Infectious Diseases, Laboratory of Medical Immunology, Section of Pediatric Infectious Diseases, Nijmegen, The Netherlands
- Radboud University Medical Center, Amalia Children's Hospital, Department of Paediatric Infectious Diseases and Immunology, Nijmegen, The Netherlands
- Stellenbosch University, Family Centre for Research with UBUNTU, Department of Paediatrics and Child Health, Cape Town, South Africa
| | - Jana L Winckler
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Tygerberg, South Africa
| | - Hongmei Yang
- University of Rochester, School of Medicine and Dentistry, Department of Biostatistics and Computational Biology, Rochester, NY, USA
| | - Vycke Yunivita
- Universitas Padjadjaran, Faculty of Medicine, Department of Biomedical Sciences, Division of Pharmacology and Therapy, Bandung, Indonesia
| | - Katja Taxis
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen, The Netherlands
| | - Jasper Stevens
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
- Both authors contributed equally and shared senior authorship
| | - Jan-Willem C Alffenaar
- The University of Sydney, Sydney Institute for Infectious Diseases, Sydney, Australia
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia
- Westmead Hospital, Sydney, Australia
- Both authors contributed equally and shared senior authorship
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23
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Chiang SS, Waterous PM, Atieno VF, Bernays S, Bondarenko Y, Cruz AT, de Oliveira MCB, Del Castillo Barrientos H, Enimil A, Ferlazzo G, Ferrand RA, Furin J, Hoddinott G, Isaakidis P, Kranzer K, Maleche-Obimbo E, Mansoor H, Marais BJ, Mohr-Holland E, Morales M, Nguyen AP, Oliyo JO, Sant'Anna CC, Sawyer SM, Schaaf HS, Seddon JA, Sharma S, Skrahina A, Starke JR, Triasih R, Tsogt B, Welch H, Enane LA. Caring for Adolescents and Young Adults With Tuberculosis or at Risk of Tuberculosis: Consensus Statement From an International Expert Panel. J Adolesc Health 2023; 72:323-331. [PMID: 36803849 PMCID: PMC10265598 DOI: 10.1016/j.jadohealth.2022.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 02/19/2023]
Abstract
Background: Despite being a preventable and treatable disease, tuberculosis (TB) is a leading cause of death among young people globally. Each year, an estimated 1.8 million adolescents and young adults (AYAs; 10–24 years old) develop TB. In 2019, an estimated 161,000 AYAs died of the disease. AYAs have unique developmental, psychosocial, and healthcare needs, but these needs have been neglected in both TB care and research agendas. In order to improve outcomes in this age group, the specific needs of AYAs must be considered and addressed. Methods: Through a consensus process, an international panel of 34 clinicians, researchers, TB survivors, and advocates with expertise in child/adolescent TB and/or adolescent health proposed interventions for optimizing AYA engagement in TB care. The process consisted of reviewing the literature on TB in AYAs; identifying and discussing priority areas; and drafting and revising proposed interventions until consensus, defined a priori , was reached. Results: The panel acknowledged the dearth of evidence on best practices for identifying and managing AYAs with TB. The final consensus statement, based on expert opinion, proposes nine interventions to reform current practices that may harm AYA health and well-being, and nine interventions to establish high-quality AYA-centered TB services. Conclusion: AYA-specific interventions for TB care and research are critical for improving outcomes in this age group. In the absence of evidence on best practices, this consensus statement from an international group of experts can help address the needs of AYA with TB or at risk for TB.
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Affiliation(s)
- Silvia S Chiang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island.
| | - Patricia M Waterous
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sarah Bernays
- School of Public Health, University of Sydney, Sydney, Australia; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Yaroslava Bondarenko
- Department of Phthisiology and Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Márcia C B de Oliveira
- Department of Pediatrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Pediatrics, Souza Marques School of Medicine, Rio de Janeiro, Brazil
| | | | - Anthony Enimil
- Child Health Department, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Child Health Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Gabriella Ferlazzo
- Médecins Sans Frontières, Cape Town, South Africa; Médecins Sans Frontières, Mumbai, India
| | - Rashida Abbas Ferrand
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Sentinel Project on Pediatric Drug-Resistant Tuberculosis, Boston, Massachusetts
| | - Graeme Hoddinott
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Petros Isaakidis
- Médecins Sans Frontières, Cape Town, South Africa; Médecins Sans Frontières, Mumbai, India
| | - Katharina Kranzer
- School of Public Health, University of Sydney, Sydney, Australia; Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | | | - Ben J Marais
- Sydney Infectious Diseases Institute (Sydney ID), University of Sydney, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia
| | | | | | | | | | - Clemax Couto Sant'Anna
- Department of Pediatrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Australia; Department of Peadiatrics, The University of Melbourne, Melbourne, Australia
| | - H Simon Schaaf
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - James A Seddon
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa; Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Alena Skrahina
- Clinical Department, The Republican Research and Practica Centre for Pulmonology and TB, Minsk, Belarus
| | - Jeffrey R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Rina Triasih
- Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | - Henry Welch
- Department of Pediatrics, Souza Marques School of Medicine, Rio de Janeiro, Brazil; Department of Pediatrics, School of Medicine and Health Sciences, The University of Papua New Guinea, Port Moresby, Papua New Guinea; Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Leslie A Enane
- Department of Pediatrics, The Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Center for Global Health, Indianapolis, Indiana.
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Swanepoel J, Zimri K, van der Zalm MM, Hoddinott G, Palmer M, Doruyter A, De Beer G, Kleynhans L, Johnson SM, Jongen V, Wademan D, Mcimeli K, Jacobs S, Swanepoel R, Van Zyl G, Allwood BW, Malherbe S, Heuvelings C, Griffith-Richards S, Whittaker E, Moore DAJ, Schaaf HS, Hesseling AC, Seddon JA. Understanding the biology, morbidity and social contexts of adolescent tuberculosis: a prospective observational cohort study protocol (Teen TB). BMJ Open 2022; 12:e062979. [PMID: 36600434 PMCID: PMC9772637 DOI: 10.1136/bmjopen-2022-062979] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION A considerable burden of the tuberculosis (TB) epidemic is found in adolescents. The reasons for increased susceptibility to TB infection and higher incidence of TB disease in adolescence, compared with the 5-10 years old age group, are incompletely understood. Despite the pressing clinical and public health need to better understand and address adolescent TB, research in this field remains limited. METHODS AND ANALYSIS Teen TB is an ongoing prospective observational cohort study that aims to better understand the biology, morbidity and social context of adolescent TB. The study plans to recruit 50 adolescents (10-19 years old) with newly diagnosed microbiologically confirmed pulmonary TB disease and 50 TB-exposed controls without evidence of TB disease in Cape Town, South Africa, which is highly endemic for TB. At baseline, cases and controls will undergo a detailed clinical evaluation, chest imaging, respiratory function assessments and blood collection for viral coinfections, inflammatory cytokines and pubertal hormone testing. At 2 weeks, 2 months and 12 months, TB disease cases will undergo further chest imaging and additional lung function testing to explore the patterns of respiratory abnormalities. At week 2, cases will complete a multicomponent quantitative questionnaire about psychological and social impacts on their experiences and longitudinal, in-depth qualitative data will be collected from a nested subsample of 20 cases and their families. ETHICS AND DISSEMINATION The study protocol has received ethical approval from the Stellenbosch University Health Research Ethics Committee (N19/10/148). The study findings will be disseminated through peer-reviewed publications, academic conferences and formal presentations to health professionals. Results will also be made available to participants and caregivers.
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Affiliation(s)
- Jeremi Swanepoel
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Klassina Zimri
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alex Doruyter
- NuMeRI Node for Infection Imaging, Central Analytical Facilities, Stellenbosch University, Cape Town, South Africa
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa
| | - Gezila De Beer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leanie Kleynhans
- South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, DSI-NRF Centre of Excellence, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Sarah M Johnson
- Department of Infectious Disease, Imperial College London, London, UK
| | - Vita Jongen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Dillon Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Khanyisa Mcimeli
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephanie Jacobs
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ruan Swanepoel
- Division of Pulmonology, Department of Internal Medicine, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Gert Van Zyl
- Division of Medical Virology, Department of Pathology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Stephanus Malherbe
- South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, DSI-NRF Centre of Excellence, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Charlotte Heuvelings
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephanie Griffith-Richards
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | | | - David A J Moore
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Disease, Imperial College London, London, UK
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Seid G, Alemu A, Dagne B, Sinshaw W, Gumi B. Tuberculosis in Household Contacts of Tuberculosis Patients in sub-Saharan African countries: A Systematic Review and Meta-analysis. J Clin Tuberc Other Mycobact Dis 2022; 29:100337. [DOI: 10.1016/j.jctube.2022.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wang Z, Guo T, Jiang T, Zhao Z, Zu X, li L, Zhang Q, Hou Y, Song K, Xue Y. Regional distribution of Mycobacterium tuberculosis infection and resistance to rifampicin and isoniazid as determined by high-resolution melt analysis. BMC Infect Dis 2022; 22:812. [PMCID: PMC9620668 DOI: 10.1186/s12879-022-07792-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/29/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Identifying the transmission mode and resistance mechanism of Mycobacterium tuberculosis (MTB) is key to prevent disease transmission. However, there is a lack of regional data. Therefore, the aim of this study was to identify risk factors associated with the transmission of MTB and regional patterns of resistance to isoniazid (INH) and rifampicin (RFP), as well as the prevalence of multidrug-resistant tuberculosis (MDR-TB). Methods High-resolution melt (HRM) analysis was conducted using sputum, alveolar lavage fluid, and pleural fluid samples collected from 17,515 patients with suspected or confirmed MTB infection in the downtown area and nine counties of Luoyang City from 2019 to 2021. Results Of the 17,515 patients, 82.6% resided in rural areas, and 96.0% appeared for an initial screening. The HRM positivity rate was 16.8%, with a higher rate in males than females (18.0% vs. 14.1%, p < 0.001). As expected, a positive sputum smear was correlated with a positive result for HRM analysis. By age, the highest rates of MTB infection occurred in males (22.9%) aged 26–30 years and females (28.1%) aged 21–25. The rates of resistance to RFP and INH and the incidence of MDR were higher in males than females (20.5% vs. 16.1%, p < 0.001, 15.9% vs. 12.0%, p < 0.001 and 12.9% vs. 10.2%, p < 0.001, respectively). The HRM positivity rate was much higher in previously treated patients than those newly diagnosed for MTB infection. Notably, males at the initial screening had significantly higher rates of HRM positive, INH resistance, RFP resistance, and MDR-TB than females (all, p < 0.05), but not those previously treated for MTB infection. The HRM positivity and drug resistance rates were much higher in the urban vs. rural population. By multivariate analyses, previous treatment, age < 51 years, residing in an urban area, and male sex were significantly and positively associated with drug resistance after adjusting for smear results and year of testing. Conclusion Males were at higher risks for MTB infection and drug resistance, while a younger age was associated with MTB infection, resistance to INH and RFP, and MDR-TB. Further comprehensive monitoring of resistance patterns is needed to control the spread of MTB infection and manage drug resistance locally.
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Affiliation(s)
- Zhenzhen Wang
- grid.453074.10000 0000 9797 0900The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, 471000 Luo Yang, China ,grid.453074.10000 0000 9797 0900School of Medical Technology and Engineering, Henan University of Science and Technology, Luo Yang, 471000 China
| | - Tengfei Guo
- grid.453074.10000 0000 9797 0900The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, 471000 Luo Yang, China
| | - Tao Jiang
- grid.453074.10000 0000 9797 0900The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, 471000 Luo Yang, China
| | - Zhanqin Zhao
- grid.453074.10000 0000 9797 0900Animal Science and Technology, Henan University of Science and Technology, Luo Yang, 471000 China
| | - Xiangyang Zu
- grid.453074.10000 0000 9797 0900School of Medical Technology and Engineering, Henan University of Science and Technology, Luo Yang, 471000 China
| | - Long li
- grid.453074.10000 0000 9797 0900The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, 471000 Luo Yang, China
| | - Qing Zhang
- grid.453074.10000 0000 9797 0900The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, 471000 Luo Yang, China
| | - Yi Hou
- Luoyang City CDC, Luo Yang, 471000 China
| | - Kena Song
- grid.453074.10000 0000 9797 0900School of Medical Technology and Engineering, Henan University of Science and Technology, Luo Yang, 471000 China
| | - Yun Xue
- grid.453074.10000 0000 9797 0900School of Medical Technology and Engineering, Henan University of Science and Technology, Luo Yang, 471000 China
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Resistance patterns among drug-resistant tuberculosis patients and trends-over-time analysis of national surveillance data in Gabon, Central Africa. Infection 2022; 51:697-704. [DOI: 10.1007/s15010-022-01941-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
Abstract
Objective
Routinely generated surveillance data are important for monitoring the effectiveness of MDR-TB control strategies. Incidence of rifampicin-resistant tuberculosis (RR-TB) is a key indicator for monitoring MDR-TB.
Methods
In a longitudinal nationwide retrospective study, 8 years (2014–2021) of sputum samples from presumptively drug-resistant tuberculosis patients from all regions of Gabon were referred to the national tuberculosis reference laboratory. Samples were analysed using GeneXpert MTB/RIF and Genotype MTBDRsl version 2/Line Probe Assay.
Results
Of 3057 sputum samples from presumptive tuberculosis patients, both from local hospital and from referral patients, 334 were RR-TB. The median patient age was 33 years (interquartile range 26–43); one third was newly diagnosed drug-resistant tuberculosis patients; one-third was HIV-positive. The proportion of men with RR-TB was significantly higher than that of women (55% vs 45%; p < 0.0001). Patients aged 25–35 years were most affected (32%; 108/334). The cumulative incidence of RR-TB was 17 (95% CI 15–19)/100,000 population over 8 years. The highest incidences were observed in 2020 and 2021. A total of 281 samples were analysed for second-line drug resistance. The proportions of study participants with MDR-TB, pre-XDR-TB and XDR-TB were 90.7% (255/281), 9% (25/281) and 0.3% (1/281), respectively. The most-common mutations in fluoroquinolones resistance isolates was gyrA double mutation gyrA MUT3B and MUT3C (23%; 4/17). Most (64%; 6/8) second-line injectable drugs resistance isolates were characterised by missing both rrs WT2 and MUT2 banding.
Conclusion
The increasing incidence of MDR-TB infection in Gabon is alarming. It is highest in the 25–35 years age category. The incidence of MDR-TB infection in treatment-naïve patients calls for case finding and contact tracing strategy improvement.
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Smith N, Quan D, Nagalingam G, Triccas JA, Rendina LM, Rutledge PJ. Carborane clusters increase the potency of bis-substituted cyclam derivatives against Mycobacterium tuberculosis. RSC Med Chem 2022; 13:1234-1238. [PMID: 36325397 PMCID: PMC9579921 DOI: 10.1039/d2md00150k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/28/2022] [Indexed: 08/04/2023] Open
Abstract
Bis-substituted cyclam derivatives have recently emerged as a promising new class of antibacterial agents, displaying excellent activity against drug-resistant Mycobacterium tuberculosis (Mtb) and in vivo efficacy in a zebrafish assay. Herein we report the synthesis and biological activity of new carborane derivatives within this class of antitubercular compounds. The resulting carborane-cyclam conjugates incorporating either hydrophobic closo-1,2-carborane or anionic, hydrophilic nido-7,8-carborane clusters display promising activity in an antibacterial assay employing the virulent Mtb strain H37Rv. The most active of these carborane derivatives exhibit MIC50 values of <1 μM, making them the most active compounds in this unique class of antibacterial cyclams reported to date.
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Affiliation(s)
- Nicholas Smith
- School of Chemistry, The University of Sydney Sydney NSW 2006 Australia +61 2 9351 5020 +61 2 9351 4781
| | - Diana Quan
- Sydney Institute of Infectious Diseases and Charles Perkins Centre, The University of Sydney Sydney NSW 2006 Australia
- School of Medical Sciences, The University of Sydney Sydney NSW 2006 Australia
| | - Gayathri Nagalingam
- Sydney Institute of Infectious Diseases and Charles Perkins Centre, The University of Sydney Sydney NSW 2006 Australia
- School of Medical Sciences, The University of Sydney Sydney NSW 2006 Australia
| | - James A Triccas
- Sydney Institute of Infectious Diseases and Charles Perkins Centre, The University of Sydney Sydney NSW 2006 Australia
- School of Medical Sciences, The University of Sydney Sydney NSW 2006 Australia
| | - Louis M Rendina
- School of Chemistry, The University of Sydney Sydney NSW 2006 Australia +61 2 9351 5020 +61 2 9351 4781
- The University of Sydney Nano Institute (Sydney Nano), The University of Sydney Sydney NSW 2006 Australia
| | - Peter J Rutledge
- School of Chemistry, The University of Sydney Sydney NSW 2006 Australia +61 2 9351 5020 +61 2 9351 4781
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Kamble BD, Malhotra S. Profile and treatment outcomes among young patients with tuberculosis aged 15-24 years in Faridabad district of Haryana, India. BMJ Open 2022; 12:e060363. [PMID: 36171030 PMCID: PMC9528668 DOI: 10.1136/bmjopen-2021-060363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study examined profile and treatment outcomes of young patients with tuberculosis (TB) registered at a district TB centre under the National TB Elimination Programme in Faridabad district of Haryana state in India. METHODS In this secondary data analysis, we studied the records of young TB patients aged 15-24 years registered under a TB programme during October 2013-December 2017 in Faridabad district of Haryana state. RESULTS We analysed records of 5257 young patients with TB. Majority (58.7%) were patients with pulmonary TB and most of them (83.6%) were registered as new patients. Majority of the young patients with TB (93.2%) had a successful treatment outcome, and patients having sputum result 2+ or less and patients who did not have a previous history of TB were found to be significantly associated with a successful treatment outcome on multivariable analysis. CONCLUSION There was a high treatment success rate noted in young patients with TB. More focus is needed to patients having a history of TB and sputum result >2+. Targeted interventions can be designed for these groups in future programmatic strategies to reduce disease burden in this section of young population.
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Affiliation(s)
- Bhushan Dattatray Kamble
- Community and Family Medicine, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Xu Z, Liu H, Liu Y, Tang Y, Tan Y, Hu P, Zhang C, Yang C, Wan K, Wang Q. Whole-Genome Sequencing and Epidemiological Investigation of Tuberculosis Outbreaks in High Schools in Hunan, China. Infect Drug Resist 2022; 15:5149-5160. [PMID: 36082241 PMCID: PMC9448353 DOI: 10.2147/idr.s371772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Tuberculosis (TB) seriously threatens individual and public health. Recently, TB outbreaks in schools have been reported more frequently in China and have attracted widespread attention. We reported three TB outbreaks in high schools in Hunan Province, China. Methods When a tuberculosis patient was reported in a school, we carried out field epidemiological investigations, including tuberculin skin testing (TST), chest X-ray (CXR) and laboratory test for all close contacts, and whole-genome sequencing (WGS) analyses to understand the transmission patterns, the causes and the risk factors for the outbreaks, thereby providing a foundation for the control of TB epidemics in schools. Results A total of 49 students with TB patients were identified in the three schools where TB outbreaks occurred, including nine patients in School A, 14 patients in School B, and 26 patients in School C. In Schools A, B and C, the putative attack rates in the classes of the index case were 13.8% (8/58), 7.6% (5/66), and 40.4% (21/52), while the putative attack rates of expanding screening in the school were 0.3% (1/361), 0.2% (9/3955), and 0.2% (5/2080), respectively. Thirteen patients had patient delay, with a median delay interval of 69 days (IQR 30.5–113 days). Twelve patients had a healthcare diagnostic delay with a median delay interval of 32 days (IQR 24–82 days). Phylogenetic analysis of culture-positive patients revealed that most of them shared a small genetic distance (≤12 SNPs), with three separate genetic clusters (including one MDR-TB genomic cluster), indicating the recent transmission of Mycobacterium tuberculosis strains. Conclusion This combination of field investigation and WGS analysis revealed the transmission of three TB outbreaks in schools. Reinforced implementation is needed to improve timely case finding and reduce diagnosis delay in routine TB control in the school population.
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Affiliation(s)
- Zuhui Xu
- Xiangya School of Public Health, Central South University, Changsha, 410078, People’s Republic of China
- Tuberculosis Control Institute of Hunan Province, Changsha, 410013, People’s Republic of China
| | - Haican Liu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Yanping Liu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518000, People’s Republic of China
| | - Yi Tang
- Tuberculosis Control Institute of Hunan Province, Changsha, 410013, People’s Republic of China
| | - Yunhong Tan
- Tuberculosis Control Institute of Hunan Province, Changsha, 410013, People’s Republic of China
| | - Peilei Hu
- Tuberculosis Control Institute of Hunan Province, Changsha, 410013, People’s Republic of China
| | - Chuanfang Zhang
- Tuberculosis Control Institute of Hunan Province, Changsha, 410013, People’s Republic of China
| | - Chongguang Yang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518000, People’s Republic of China
| | - Kanglin Wan
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
- Kanglin Wan, State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155 of Changbai Road, Changping District, Beijing, 102206, People’s Republic of China, Tel +86 13910065264, Email
| | - Qiaozhi Wang
- Tuberculosis Control Institute of Hunan Province, Changsha, 410013, People’s Republic of China
- Correspondence: Qiaozhi Wang, Department of Institute office, Tuberculosis Control Institute of Hunan Province, No. 519 of Xianjiahu Road, Changsha, 410013, People’s Republic of China, Tel/fax +86073188809748, Email
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Kim B, Kang YA, Lee J. Heterogeneous impact of Covid-19 response on tuberculosis burden by age group. Sci Rep 2022; 12:13773. [PMID: 35962020 PMCID: PMC9374296 DOI: 10.1038/s41598-022-18135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/05/2022] [Indexed: 11/09/2022] Open
Abstract
Apart from the incidence and mortality caused by it, Coronavirus disease (COVID-19) has had a significant impact on other diseases. This study aimed to estimate the influences of COVID-19 pandemic on the incidence of tuberculosis (TB) and the number of TB-associated deaths in Republic of Korea. A dynamic compartment model incorporating age-structure was developed for studying TB transmission and progression using the Korean population data. After calibration with notification of incidence data from South Korea, the TB burden over 6 years (2020-2025) was predicted under the nine different scenarios. Under the scenario of strong social distancing and low-level health service disruption, new TB cases were reduced by 761 after 1 year in comparison to the baseline. However, in the elderly population, social distancing had little impact on TB incidence. On the other hand, the number of TB-related deaths mainly depends on the level of health service disruption for TB care. It was predicted that with a high degree of health service disruption, the number of TB-related deaths would increase up to 155 in 1 year and 80 percent of the TB-related deaths would be in the elderly population. The decrease of tuberculosis incidence is significantly affected by social distancing, which is owing to reduction of contacts. The impact of health service disruption is dominant on TB-related deaths, which occurs mainly in the elderly. It suggests that it is important to monitor TB-related deaths by COVID-19 because the TB burden of the elderly is high in the Republic of Korea.
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Affiliation(s)
- Boyeon Kim
- School of Mathematics and Computing (Mathematics), Yonsei University, Seoul, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. .,Institute of Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jeehyun Lee
- School of Mathematics and Computing (Mathematics), Yonsei University, Seoul, Republic of Korea.
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Al Mahrouqi S, Gadalla A, Al Azri S, Al-Hamidhi S, Al-Jardani A, Balkhair A, Al-fahdi A, Al Balushi L, Al Zadjali S, Al Marhoubi AMN, Babiker HA. Drug resistant Mycobacterium tuberculosis in Oman: resistance-conferring mutations and lineage diversity. PeerJ 2022; 10:e13645. [PMID: 35919400 PMCID: PMC9339217 DOI: 10.7717/peerj.13645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/07/2022] [Indexed: 01/17/2023] Open
Abstract
Background The Sultanate of Oman is country a low TB-incidence, with less than seven cases per 105 population detected in 2020. Recent years have witnessed a persistence in TB cases, with sustained incidence rate among expatriates and limited reduction among Omanis. This pattern suggests transmission from the migrant population. The present study examined the genetic profile and drug resistance-conferring mutations in Mycobacterium tuberculosis collected from Omanis and expatriates to recognise possible causes of disease transmission. Methods We examined M. tuberculosis cultured positive samples, collected from Omanis (n = 1,344) and expatriates (n = 1,203) between 2009 and 2018. These isolates had a known in vitro susceptibility profile to first line anti-TB, Streptomycin (SM), Isoniazid (INH), Rifampicin (RIF), Ethambutol (EMB) and Pyrazinamide (PZA). The diversity of the isolates was assessed by spacer oligo-typing (spoligotyping). Drug resistance-conferring mutations resulted from full-length sequence of nine genes (katG, inhA, ahpc, rpoB, rpsL, rrs, embB, embC, pncA) and their phenotypic relationship were analysed. Results In total, 341/2192 (13.4%), M. tuberculosis strains showed resistance to any drug, comprising mono-resistance (MR) (242, 71%), poly-resistance (PR) (40, 11.7%) and multi-drug resistance (MDR) (59, 17.3%). The overall rate of resistance among Omanis and expatriates was similar; however, MDR and PZAR were significantly higher among Omanis, while INHR was greater among expatriates. Mutations rpsL K43R and rpoB S450L were linked to Streptomycin (SMR) and Rifampicin resistance (RIFR) respectively. Whereas, katG S315T and inhA -C15T/G-17T were associated with Isoniazid resistance (INHR). The resistance patterns (mono-resistant, poly-resistant and MDR) and drug resistance-conferring mutations were found in different spoligo-lineages. rpsL K43R, katG S315T and rpoB S450L mutations were significantly higher in Beijing strains. Conclusions Diverse drug resistant M. tuberculosis strains exist in Oman, with drug resistance-conferring mutations widespread in multiple spoligo-lineages, indicative of a large resistance reservoir. Beijing's M. tuberculosis lineage was associated with MDR, and multiple drug resistance-conferring mutations, favouring the hypothesis of migration as a possible source of resistant lineages in Oman.
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Affiliation(s)
- Sara Al Mahrouqi
- Biochemistry Department, College of Medicine and Health Sciences, Sultan Qaboos University, Oman, Muscat, Oman
| | - Amal Gadalla
- Division of Population Medicine, School of Medicine, College of Biomedical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Saleh Al Azri
- Central Public Health Laboratories, MOH, Muscat, Oman
| | - Salama Al-Hamidhi
- Biochemistry Department, College of Medicine and Health Sciences, Sultan Qaboos University, Oman, Muscat, Oman
| | | | - Abdullah Balkhair
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Oman, Muscat, Oman
| | - Amira Al-fahdi
- Biochemistry Department, College of Medicine and Health Sciences, Sultan Qaboos University, Oman, Muscat, Oman
| | | | | | | | - Hamza A. Babiker
- Biochemistry Department, College of Medicine and Health Sciences, Sultan Qaboos University, Oman, Muscat, Oman,Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Gabrovska N, Spasova A, Galacheva A, Kostadinov D, Yanev N, Milanov V, Gabrovski K, Velizarova S. Tuberculosis in Adolescents in Bulgaria for a Three-Year Period: 2018-2020. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060785. [PMID: 35740721 PMCID: PMC9221996 DOI: 10.3390/children9060785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
Background: Each year, approximately two million adolescents and young adults in the world become infected with tuberculosis (TB). The problem is that the classification of the disease includes children in the age group 0−14 years and young adults aged 15 and over. The present study aims to analyze and compare the epidemiology and clinical presentation of TB in Bulgaria in the different age subgroups of childhood. Methods: A retrospective study was undertaken of the newly diagnosed children (n = 80) with TB treated onsite from January 2018 to December 2020 at the Multiprofile Hospital for Active Treatment of Pulmonary Diseases (“St. Sofia”). They were distributed into three age groups: aged 8−11 (prepuberty), aged 12−14 (younger adolescents), and aged above 15 (older adolescents). Results: A clear finding of the research indicated that adolescent children develop TB both as primary and secondary infections. In a large number of cases with the children under our care, we found enlarged intrathoracic lymph nodes as well as infiltrative changes in the lungs, i.e., we observed transitional forms. There were statistically significant differences between the age group >15 years old and each of the other two younger groups for diagnosis, the severity of intoxication, and BK spreading status. Conclusion: The course of tuberculosis in adolescence has its own specifics and differences between the three age groups in the current study.
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Affiliation(s)
- Natalia Gabrovska
- Department of Pediatrics, Specialized Hospital for Active Treatment of Children’s Diseases “Prof. Ivan Mitev”, Medical University–Sofia, 1606 Sofia, Bulgaria; (A.S.); (A.G.); (S.V.)
- Correspondence: ; Tel.: +359-887-931-009
| | - Albena Spasova
- Department of Pediatrics, Specialized Hospital for Active Treatment of Children’s Diseases “Prof. Ivan Mitev”, Medical University–Sofia, 1606 Sofia, Bulgaria; (A.S.); (A.G.); (S.V.)
| | - Anabela Galacheva
- Department of Pediatrics, Specialized Hospital for Active Treatment of Children’s Diseases “Prof. Ivan Mitev”, Medical University–Sofia, 1606 Sofia, Bulgaria; (A.S.); (A.G.); (S.V.)
| | - Dimitar Kostadinov
- Department of Pulmonary Diseases, Multiprofile Hospital for Active Treatment of Pulmonary Diseases “St. Sofia”, Medical University–Sofia, 1431 Sofia, Bulgaria; (D.K.); (N.Y.); (V.M.)
| | - Nikolay Yanev
- Department of Pulmonary Diseases, Multiprofile Hospital for Active Treatment of Pulmonary Diseases “St. Sofia”, Medical University–Sofia, 1431 Sofia, Bulgaria; (D.K.); (N.Y.); (V.M.)
| | - Vladimir Milanov
- Department of Pulmonary Diseases, Multiprofile Hospital for Active Treatment of Pulmonary Diseases “St. Sofia”, Medical University–Sofia, 1431 Sofia, Bulgaria; (D.K.); (N.Y.); (V.M.)
| | - Kaloyan Gabrovski
- Department of Neurosurgery, University Hospital “St. Ivan Rilski”, Medical University–Sofia, 1431 Sofia, Bulgaria;
| | - Svetlana Velizarova
- Department of Pediatrics, Specialized Hospital for Active Treatment of Children’s Diseases “Prof. Ivan Mitev”, Medical University–Sofia, 1606 Sofia, Bulgaria; (A.S.); (A.G.); (S.V.)
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Graham SM, Marais BJ, Amanullah F. Tuberculosis in Children and Adolescents: Progress and Perseverance. Pathogens 2022; 11:pathogens11040392. [PMID: 35456067 PMCID: PMC9029126 DOI: 10.3390/pathogens11040392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Stephen M. Graham
- Department of Paediatrics and Murdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- The Burnet Institute, Melbourne, VIC 3004, Australia
- Correspondence: ; Tel.: +61-405782505
| | - Ben J. Marais
- Department of Paediatrics and Child Health, The Children’s Hospital at Westmead, The University of Sydney, Westmead, NSW 2145, Australia;
| | - Farhana Amanullah
- Department of Paediatrics, The Indus Hospital and Health Network, The Aga Khan University Hospital, Karachi 75500, Pakistan;
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Addressing the Data Gaps on Child and Adolescent Tuberculosis. Pathogens 2022; 11:pathogens11030352. [PMID: 35335677 PMCID: PMC8955570 DOI: 10.3390/pathogens11030352] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 01/17/2023] Open
Abstract
The burden of tuberculosis (TB) among children and young adolescents (<15 years old) is estimated at 1.1 million; however, only 400,000 are treated for TB, indicating a large gap between the number who are cared for and the number estimated to have TB. Accurate data on the burden of pediatric TB is essential to guide action. Despite several improvements in estimating the burden of pediatric TB in the last decade, as well as enhanced data collection efforts, several data gaps remain, both at the global level, but also at the national level where surveillance systems and collaborative research are critical. In this article, we describe recent advances in data collection and burden estimates for TB among children and adolescents, and the remaining gaps. While data collection continues to improve, burden estimates must evolve in parallel, both in terms of their frequency and the methods used. Currently, at the global level, there is a focus on age-disaggregation of TB notifications, the collection of data on TB-HIV, multi-drug resistant (MDR)-TB and treatment outcomes, as well as estimates of the disease burden. Additional data from national surveillance systems or research projects on TB meningitis, as well as other forms of extra-pulmonary TB, would be useful. We must capitalize on the current momentum in child and adolescent TB to close the remaining data gaps for these age groups to better understand the epidemic and further reduce morbidity and mortality due to TB.
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Djannah F, Massi MN, Hatta M, Bukhari A, Hasanah I. Profile and histopathology features of top three cases of Extra Pulmonary Tuberculosis (EPTB) in West Nusa Tenggara: A retrospective cross-sectional study. Ann Med Surg (Lond) 2022; 75:103318. [PMID: 35242312 PMCID: PMC8857446 DOI: 10.1016/j.amsu.2022.103318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 10/28/2022] Open
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du Preez K, Gabardo BMA, Kabra SK, Triasih R, Lestari T, Kal M, Tsogt B, Dorj G, Purev E, Nguyen TA, Naidoo L, Mvusi L, Schaaf HS, Hesseling AC, de Oliveira Rossoni AM, Carvalho ACC, Cardoso CAA, Sant’Anna CC, Orti DGD, Costa FD, Vega LR, Sant’Anna MDFP, Hoa NB, Phuc PH, Fiogbe AA, Affolabi D, Badoum G, Ouédraogo AR, Saouadogo T, Combary A, Kuate Kuate A, Prudence BNA, Magassouba AS, Bangoura AM, Soumana A, Hermana G, Gando H, Fall N, Gning B, Dogo MF, Mbitikon O, Deffense M, Zimba K, Chabala C, Sekadde MP, Luzze H, Turyahabwe S, Dongo JP, Lopes C, dos Santos M, Francis JR, Arango-Loboguerrero M, Perez-Velez CM, Koura KG, Graham SM. Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries. Pathogens 2022; 11:196. [PMID: 35215139 PMCID: PMC8878304 DOI: 10.3390/pathogens11020196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 01/25/2023] Open
Abstract
Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality-over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy-practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors.
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Affiliation(s)
- Karen du Preez
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Betina Mendez Alcântara Gabardo
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Sushil K. Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Rina Triasih
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (R.T.); (T.L.)
| | - Trisasi Lestari
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (R.T.); (T.L.)
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia;
| | - Margaret Kal
- National Department of Health, Port Moresby 131, Papua New Guinea;
| | | | - Gantsetseg Dorj
- Tuberculosis Surveillance and Research Department, National Center for Communicable Diseases, Ulaanbaatar 210648, Mongolia;
| | - Enkhtsetseg Purev
- Tuberculosis Clinic, National Center for Communicable Diseases, Ulaanbaatar 210648, Mongolia;
| | - Thu Anh Nguyen
- Woolcock Institute of Medical Research, Ha Noi 100000, Vietnam;
| | - Lenny Naidoo
- Health Department, Cape Town 8000, South Africa;
| | - Lindiwe Mvusi
- National TB Control & Management Cluster, National Department of Health, Pretoria 0187, South Africa;
| | - Hendrik Simon Schaaf
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Anneke C. Hesseling
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Andrea Maciel de Oliveira Rossoni
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Anna Cristina Calçada Carvalho
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21045-900, Brazil
| | - Claudete Aparecida Araújo Cardoso
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Clemax Couto Sant’Anna
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Danielle Gomes Dell’ Orti
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Fernanda Dockhorn Costa
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Liliana Romero Vega
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Maria de Fátima Pombo Sant’Anna
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | | | - Phan Huu Phuc
- National Pediatric Hospital, Ha Noi 100000, Vietnam;
| | - Attannon Arnauld Fiogbe
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Cotonou 03 BP 2819, Benin;
| | - Dissou Affolabi
- National Tuberculosis Program, Cotonou 03 BP 2819, Benin;
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou 03 BP 2819, Benin
| | - Gisèle Badoum
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Health Sciences Unit, University Joseph Ki-Zerbo, Ouagadougou 03 BP 7047, Burkina Faso
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Abdoul Risgou Ouédraogo
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Health Sciences Unit, University Joseph Ki-Zerbo, Ouagadougou 03 BP 7047, Burkina Faso
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Tandaogo Saouadogo
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Adjima Combary
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Yaoundé BP 6000, Cameroon;
| | - Albert Kuate Kuate
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Yaoundé BP 6000, Cameroon;
| | | | - Aboubakar Sidiki Magassouba
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Conakry 63570, Guinea;
| | | | - Alphazazi Soumana
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Niamey 22 646, Niger
| | - Georges Hermana
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Hervé Gando
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Nafissatou Fall
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Dakar 12000, Senegal;
| | - Barnabé Gning
- National Tuberculosis Program, Dakar 12000, Senegal;
| | - Mohammed Fall Dogo
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Lomé BP 526, Togo
| | - Olivia Mbitikon
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Manon Deffense
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
| | - Kevin Zimba
- Lusaka Provincial Health Office, Ministry of Health, Lusaka 10101, Zambia;
| | - Chishala Chabala
- Department of Pediatrics and Child Health, School of Medicine, University of Zambia, Lusaka 10101, Zambia;
- Children’s Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
| | | | - Henry Luzze
- National Tuberculosis and Leprosy Program, Kampala 7025, Uganda; (M.P.S.); (H.L.); (S.T.)
| | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Program, Kampala 7025, Uganda; (M.P.S.); (H.L.); (S.T.)
| | | | - Constantino Lopes
- National Tuberculosis Program, Ministerio da Saude, Dili NM 87109, Timor-Leste;
| | - Milena dos Santos
- Hospital Nacional Guido Valadares, Ministerio da Saude, Dili NM 87109, Timor-Leste;
| | | | | | - Carlos M. Perez-Velez
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ 85721, USA;
| | - Kobto Ghislain Koura
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- COMUE Sorbonne Paris Cité, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, 75006 Paris, France
- École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Epidémiologique, Université de Parakou, Parakou 03 BP 351, Benin
| | - Stephen M. Graham
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Department of Pediatrics, Murdoch Childrens Research Institute, University of Melbourne Royal Children’s Hospital, Melbourne, VIC 3052, Australia
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Drug resistance characteristics of Mycobacterium tuberculosis isolates obtained between 2018 and 2020 in Sichuan, China. Epidemiol Infect 2022; 150:e27. [PMID: 35086596 PMCID: PMC8888273 DOI: 10.1017/s0950268822000127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We investigated the drug resistance of Mycobacterium tuberculosis isolates from patients with tuberculosis (TB) and HIV, and those diagnosed with only TB in Sichuan, China. TB isolates were obtained from January 2018 to December 2020 and subjected to drug susceptibility testing (DST) to 11 anti-TB drugs and to GeneXpert MTB/RIF testing. The overall proportion of drug-resistant TB (DR-TB) isolates was 32.1% (n = 10 946). HIV testing was not universally available for outpatient TB cases, only 29.5% (3227/10 946) cases had HIV testing results. The observed proportion of multidrug-resistant TB (MDR-TB) isolates was almost double than that of the national level, with approximately 1.5% and 0.1% of the isolates being extensively drug resistant and universally drug resistant, respectively. The proportions of resistant isolates were generally higher in 2018 and 2019 than in 2020. Furthermore, the sensitivities of GeneXpert during 2018–2020 demonstrated a downward trend (80.9, 95% confidence intervals (CI) 76.8–85.0; 80.2, 95% CI 76.4–84.1 and 75.4, 95% CI 70.7–80.2, respectively). Approximately 69.0% (7557/10 946) of the TB cases with DST results were subjected to GeneXpert detection. Overall, the DR-TB status and the use of GeneXpert in Sichuan have improved, but DR-TB challenges remain. HIV testing for all TB cases is recommended.
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Zürcher K, Riou J, Morrow C, Ballif M, Koch A, Bertschinger S, Warner DF, Middelkoop K, Wood R, Egger M, Fenner L. Estimating Tuberculosis Transmission Risks in a Primary Care Clinic in South Africa: Modeling of Environmental and Clinical Data. J Infect Dis 2022; 225:1642-1652. [PMID: 35039860 PMCID: PMC9071349 DOI: 10.1093/infdis/jiab534] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/09/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Congregate settings, such as healthcare clinics, may play an essential role in Mycobacterium tuberculosis (Mtb) transmission. Using patient and environmental data, we studied transmission at a primary care clinic in South Africa. METHODS We collected patient movements, cough frequency, and clinical data, and measured indoor carbon dioxide (CO2) levels, relative humidity, and Mtb genomes in the air. We used negative binomial regression model to investigate associations. RESULTS We analyzed 978 unique patients who contributed 14 795 data points. The median patient age was 33 (interquartile range [IQR], 26-41) years, and 757 (77.4%) were female. Overall, median CO2 levels were 564 (IQR 495-646) parts per million and were highest in the morning. Median number of coughs per day was 466 (IQR, 368-503), and overall median Mtb DNA copies/μL/day was 4.2 (IQR, 1.2-9.5). We found an increased presence of Mtb DNA in the air of 32% (95% credible interval, 7%-63%) per 100 additional young adults (aged 15-29 years) and 1% (0-2%) more Mtb DNA per 10% increase of relative humidity. Estimated cumulative transmission risks for patients attending the clinic monthly for at least 1 hour range between 9% and 29%. CONCLUSIONS We identified young adults and relative humidity as potentially important factors for transmission risks in healthcare clinics. Our approach should be used to detect transmission and evaluate infection control interventions.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Julien Riou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Carl Morrow
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa,Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, University of Cape Town, Cape Town, South Africa
| | - Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anastasia Koch
- South African Medical Research Council/National Health Laboratory Service/University of Cape Town Molecular Mycobacteriology Research Unit and Department of Science and Innovation/National Research Foundation Centre of Excellence for Biomedical TB Research, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Simon Bertschinger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,Institute for Medical Informatics, Bern University of Applied Sciences, Bern, Switzerland
| | - Digby F Warner
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa,South African Medical Research Council/National Health Laboratory Service/University of Cape Town Molecular Mycobacteriology Research Unit and Department of Science and Innovation/National Research Foundation Centre of Excellence for Biomedical TB Research, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Keren Middelkoop
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa,Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, University of Cape Town, Cape Town, South Africa
| | - Robin Wood
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa,Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,Correspondence: Lukas Fenner, MD, MSc, Institute of Social and Preventive Medicine, University of Bern (ISPM), Mittelstrasse 43, 3012 Bern, Switzerland ()
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Ali ZA, Al-Obaidi MJ, Sameer FO, Mankhi AA, Misha'al KI, Jassim IA, Taqi EA, Ad'hiah AH. Epidemiological profile of tuberculosis in Iraq during 2011-2018. Indian J Tuberc 2022; 69:27-34. [PMID: 35074147 DOI: 10.1016/j.ijtb.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/10/2020] [Accepted: 01/14/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Tuberculosis (TB) is one of the most progressive infectious diseases caused by Mycobacterium tuberculosis. The pathogen is the first cause of mortality linked to a single pathogen worldwide, especially in poor and developing countries. METHODS A cross-sectional descriptive study was conducted to estimate incidence rate (IR) of TB in Iraq during a period of eight years (2011-2018). TB data were extracted from the computer system of the National Specialized Center for Chest and Respiratory Diseases in Baghdad. RESULTS During 2011-2018, 65,102 confirmed TB cases were reported in Iraq; 39,640 pulmonary TB (PTB) and 25,462 extra-pulmonary TB (EPTB). The average IR (case/100,000 inhabitants) of TB was 23.4 (14.2 for PTB and 9.1 for EPTB). Annual rate of TB cases showed a gradual decline over years (from 29.2 in 2011 to 18.6 in 2018). The decline in IR was more pronounced in PTB than EPTB. However PTB/EPTB ratio showed a gradual decreasing over years (from 2.04 in 2011 to 1.56 in 2018). GIS-mapping revealed that PTB and EPTB IRs show variations between the 18 governorates of Iraq. Most of the recorded PTB cases were new (average: 90.5%), followed by relapse cases (average: 7.9%). Among the reported PTB cases, percentage of males was greater than females (average: 52.1 vs. 47.9%), whereas an opposite trend was observed in EPTB (42.9 vs. 57.1%). The frequency distribution of PTB and EPTB varied between age groups, and lowest average frequency was recorded in age groups 1-4 and 5-14 year. CONCLUSIONS TB is still a public health threat, and although a declining trend in incidence was depicted over the years 2011-2018, the disease is still out of control in Iraq, and more investments of resource are necessitated to eliminate the disease. In this context, EPTB and PTB relapse need a recognized attention.
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Affiliation(s)
- Zainab A Ali
- Biotechnology Department, College of Science, University of Baghdad, Baghdad, Iraq
| | - Mohammed J Al-Obaidi
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq
| | - Fadhaa O Sameer
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq
| | - Ahmed A Mankhi
- National Specialized Center for Chest and Respiratory Diseases, Ministry of Health and Environment, Baghdad, Iraq
| | - Khawla I Misha'al
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq
| | - Iftikhar A Jassim
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq
| | - Estabraq A Taqi
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq
| | - Ali H Ad'hiah
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Baghdad, Iraq.
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Ojuawo OB, Desalu OO, Aladesanmi AO, Opeyemi CM, Azeez AT, Fawibe AE, Salami AK. Outpatient burden of adult respiratory diseases in University of Ilorin Teaching Hospital, Nigeria. Niger J Clin Pract 2022; 25:1233-1238. [DOI: 10.4103/njcp.njcp_1864_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maina T, Willetts A, Ngari M, Osman A. Tuberculosis infection among youths in overcrowded university hostels in Kenya: a cross-sectional study. Trop Med Health 2021; 49:100. [PMID: 34961552 PMCID: PMC8714442 DOI: 10.1186/s41182-021-00391-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) remains a top global health problem and its transmission rate among contacts is higher when they are cohabiting with a person who is sputum smear-positive. Our study aimed to describe the prevalence of TB among student contacts in the university and determine factors associated with TB transmission. Methods We performed a cross-sectional study with an active contact case finding approach among students receiving treatment at Kilifi County Hospital from January 2016 to December 2017. The study was conducted in a public university in Kilifi County, a rural area within the resource-limited context of Kenya. The study population included students attending the university and identified as sharing accommodation or off-campus hostels, or a close social contact to an index case. The index case was defined as a fellow university student diagnosed with TB at the Kilifi County Hospital during the study period. Contacts were traced and tested for TB using GeneXpert. Results Among the 57 eligible index students identified, 51 (89%) agreed to participate. A total of 156 student contacts were recruited, screened and provided a sputum sample. The prevalence of TB (GeneXpert test positive/clinical diagnosis) among all contacts was 8.3% (95% CI 4.5–14%). Among the 8.3% testing positive 3.2% (95% CI 1.0–7.3%) were positive for GeneXpert only. Sharing a bed with an index case was the only factor significantly associated with TB infection. No other demographic or clinical factor was associated with TB infection. Conclusion Our study identified a high level of TB transmission among university students who had contact with the index cases. The study justifies further research to explore the genetic sequence and magnitude of TB transmission among students in overcrowded university in resource limited contexts.
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Affiliation(s)
- Teresia Maina
- Department of Public Health, School of Health and Human Sciences, Pwani University, P.O Box 196-80108, Kilifi, Kenya
| | - Annie Willetts
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Moses Ngari
- Department of Public Health, School of Health and Human Sciences, Pwani University, P.O Box 196-80108, Kilifi, Kenya.,Clinical Research Department, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Abdullahi Osman
- Department of Public Health, School of Health and Human Sciences, Pwani University, P.O Box 196-80108, Kilifi, Kenya.
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Fack C, Wood R, Hatherill M, Cobelens F, Hermans S. The impact of a change in infant BCG vaccination policy on adolescent TB incidence rates: A South African population-level cohort study. Vaccine 2021; 40:364-369. [PMID: 34872798 DOI: 10.1016/j.vaccine.2021.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE South Africa's infant Bacille Calmette Guerin (BCG) vaccine policy changed from percutaneous (PC) BCG Japan to intradermal (ID) BCG Denmark in 2000. This study investigated whether this change in infant BCG vaccination had any durable impact on TB incidence rates (IR) into adolescence. METHODS The Cape Town electronic TB register provided data (from 2008 to 2018) on HIV-negative TB patients born in 1991-1999 (BCG Japan cohort) and 2001-2008 (BCG Denmark cohort). Statistics South Africa provided population estimates. Annual TB IR per 100,000 population were calculated stratified by age, gender and birth year. Interrupted time series analysis with a segmented Poisson regression and birth cohort analyses were used to compare incidence between the BCG cohorts and trends over time. FINDINGS TB IR increased throughout adolescence, with 17-year-olds having 7.34 [95% confidence interval (CI), 6.48-8.32] times higher TB IR than 10-year-olds. Females had 1.22 [95% CI 1.17-1.27] higher IR than males. Overall, adolescents who received ID BCG Denmark had a lower TB IR compared to PC BCG Japan (rate ratio 0.86, [95% CI 0.80-0.94]). No interaction between BCG and age, nor BCG and gender were identified. Birth cohort analyses showed the increase in TB IR started around one year earlier in females than in males. CONCLUSION The change in infant BCG policy was associated with a modest decrease in TB incidence in 10- to 17-year-old HIV-negative adolescents. However, TB incidence rapidly increased with age in both adolescent cohorts and remained high despite BCG vaccination at birth.
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Affiliation(s)
- Carlotta Fack
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands.
| | - Robin Wood
- Desmond Tutu HIV Centre, P.O. Box 13801, Mowbray, 7705 Cape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Anzio Rd, Observatory, Cape Town 7925, South Africa
| | - Mark Hatherill
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Anzio Rd, Observatory, Cape Town 7925, South Africa; South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Anzio Rd, Observatory, Cape Town 7925, South Africa
| | - Frank Cobelens
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands; Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Sabine Hermans
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands; Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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Zawedde-Muyanja S, Reuter A, Tovar MA, Hussain H, Loando Mboyo A, Detjen AK, Yuen CM. Provision of Decentralized TB Care Services: A Detect-Treat-Prevent Strategy for Children and Adolescents Affected by TB. Pathogens 2021; 10:1568. [PMID: 34959523 PMCID: PMC8705395 DOI: 10.3390/pathogens10121568] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
In this review, we discuss considerations and successful models for providing decentralized diagnosis, treatment, and prevention services for children and adolescents. Key approaches to building decentralized capacity for childhood TB diagnosis in primary care facilities include provider training and increased access to child-focused diagnostic tools and techniques. Treatment of TB disease should be managed close to where patients live; pediatric formulations of both first- and second-line drugs should be widely available; and any hospitalization should be for as brief a period as medically indicated. TB preventive treatment for child and adolescent contacts must be greatly expanded, which will require home visits to identify contacts, building capacity to rule out TB, and adoption of shorter preventive regimens. Decentralization of TB services should involve the private sector, with collaborations outside the TB program in order to reach children and adolescents where they first enter the health care system. The impact of decentralization will be maximized if programs are family-centered and designed around responding to the needs of children and adolescents affected by TB, as well as their families.
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Affiliation(s)
- Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Anja Reuter
- Médecins Sans Frontières, Cape Town 7784, South Africa;
| | - Marco A. Tovar
- Socios En Salud Sucursal Perú, Lima 15001, Peru;
- Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru
| | - Hamidah Hussain
- Interactive Research and Development Global, Singapore 238884, Singapore;
| | - Aime Loando Mboyo
- Elizabeth Glaser Pediatric AIDS Foundation, Kinshasa B.P. 1002030, Democratic Republic of the Congo;
| | - Anne K. Detjen
- United Nations Children’s Fund, New York, NY 10017, USA;
| | - Courtney M. Yuen
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA;
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Babafemi EO, Cherian BP, Ouma B, Mogoko GM. Paediatric tuberculosis diagnosis using Mycobacterium tuberculosis real-time polymerase chain reaction assay: a systematic review and meta-analysis. Syst Rev 2021; 10:278. [PMID: 34706779 PMCID: PMC8554997 DOI: 10.1186/s13643-021-01836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Rapid and accurate diagnosis of paediatric tuberculosis (TB) is key to manage the disease and to control and prevent its transmission. Collection of quality sputum samples without invasion methods from paediatrics (age < 16 years) with presumptive pulmonary tuberculosis (PTB) remains a challenge. Thus, the aim of this meta-analysis was to assess the overall accuracy of a real-time polymerase chain reaction (RT-PCR)-based assay, for routine diagnosis of MTB in different samples from paediatrics with active pulmonary and extra-pulmonary tuberculosis using mycobacterial culture as the gold standard in clinical microbiology laboratories. METHODS We conducted a systematic review and meta-analysis to examine the diagnostic test accuracy of RT-PCR based assay for the detection of MTB in paediatric clinical samples. A systematic literature search was performed for publications in any language. MEDLINE via PubMed, EMBASE, and Web of Science were among 9 bibliographic databases searched from August 2019 until November 2020. Bivariate random-effects model of meta-analysis were performed to generate pooled summary estimates (95% CIs) for overall accuracy of RT-PCR based assay compared to mycobacterial culture as the reference standard. RESULTS Of the 1592 candidate studies, twenty-one eligible studies met our inclusion criteria. In total, the review and meta-analysis included 5536 (3209 PTB and 2327 EPTB). Summary estimates for pulmonary TB (11 studies) were as follows: sensitivity 56 (95% CI 51-62), specificity 97 (95% CI 96-98) and summary estimates for extra-pulmonary TB (10 studies) were as follows: sensitivity 87 (95% CI 82-91)) specificity 100 (95% CI 99-100). There was significant heterogeneity in sensitivity and specificity among the enrolled studies (p < 0.001). CONCLUSIONS Our results suggested that the RT-PCR based assay could be a useful test for the diagnosis of paediatrics TB with high sensitivity and specificity in low-income/high-burden and upper medium income/low-burden settings. From the study, RT-PCR assay demonstrated a high degree of sensitivity for extra-pulmonary TB and good sensitivity for pulmonary TB which is an important factor in achieving effective global control and for patient management in terms of initiating early and appropriate anti-tubercular therapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018104052.
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Affiliation(s)
| | - Benny P Cherian
- Liverpool John Moores University-City Campus, Liverpool, Merseyside, UK
| | - Beatrice Ouma
- Liverpool John Moores University-City Campus, Liverpool, Merseyside, UK
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Zvonareva O, Witte S, Kabanets N, Filinyuk O. Adolescents in a tuberculosis hospital: Qualitative study of how relationships with doctors, caregivers, and peers mediate their mental wellbeing. PLoS One 2021; 16:e0257379. [PMID: 34597311 PMCID: PMC8486124 DOI: 10.1371/journal.pone.0257379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/31/2021] [Indexed: 11/19/2022] Open
Abstract
Lengthy hospitalization can impact adolescents’ mental wellbeing in a number of negative ways. Scholarship has indicated that a young patient’s relationships play an important role in reducing the amount of stress felt and in improving emotional state. In this article we turn to the experiences of adolescents with tuberculosis [TB] in Russia to explore how exactly hospitalization together with the TB diagnosis itself impact their mental wellbeing and how relationships with others mediate these impacts. We conducted a qualitative, interview-based study in Tomsk pediatric TB clinic. Interviews were conducted with three groups relevant for reaching the aim of this research: adolescent patients, their adult caregivers, and their treating physicians [17 informants in total]. Interview data were complemented with prolonged observations in the same clinic. The results of our study highlight that threats to mental wellbeing of adolescents with TB are multiple. Adolescents who are about to enter the in-patient treatment feel apprehensive and anxious about their future. They tend to have a hard time accepting their diagnosis, which they often feel is something shameful, and, consequently, may develop a negative attitude towards themselves. Most importantly, many undergo painful loss of personal relationships and expect or actually experience rejection by peers because of having tuberculosis. However, relationships with physicians, caregivers, and other patients in the clinic mediate negative impacts of TB diagnosis and hospitalization on adolescents’ mental wellbeing and can open ways for providing support. Supportive practices include physicians leaving it up to adolescents to decide what they want to discuss and when, caregivers remaining available for contact and keeping regular communication, and other adolescents with TB proactively seeking contact with the newcomers and behaving in a non-judgmental way. These results can inform design of adolescent-friendly TB services.
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Affiliation(s)
- Olga Zvonareva
- Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands
- StrAU Integrative Approaches to Public Health and Health Care, Siberian State Medical University, Tomsk, The Russian Federation
- Policy Analysis and Studies of Technologies Center, National Research Tomsk State University, Tomsk, The Russian Federation
- * E-mail:
| | - Saskia Witte
- Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands
| | - Nadezhda Kabanets
- Department of Tuberculosis and Pulmonology, Siberian State Medical University, Tomsk, The Russian Federation
| | - Olga Filinyuk
- Department of Tuberculosis and Pulmonology, Siberian State Medical University, Tomsk, The Russian Federation
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Maharjan B, Gopali RS, Zhang Y. A scoping review on climate change and tuberculosis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1579-1595. [PMID: 33728507 DOI: 10.1007/s00484-021-02117-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
Climate change is a global public health challenge. The changes in climatic factors affect the pattern and burden of tuberculosis, which is a worldwide public health problem affecting low and middle-income countries. However, the evidence related to the impact of climate change on tuberculosis is few and far between. This study is a scoping review following a five-stage version of Arksey and O'Malley's method. We searched the literature using the keywords and their combination in Google scholar, and PubMed. Climate change affects tuberculosis through diverse pathways: changes in climatic factors like temperature, humidity, and precipitation influence host response through alterations in vitamin D distribution, ultraviolet radiation, malnutrition, and other risk factors. The rise in extreme climatic events induces population displacement resulting in a greater number of vulnerable and risk populations of tuberculosis. It creates a conducive environment of tuberculosis transmission and development of active tuberculosis and disrupts tuberculosis diagnosis and treatment services. Therefore, it stands to reasons that climate change affects tuberculosis, particularly in highly vulnerable countries and areas. However, further studies and novel methodologies are required to address such a complex relationship and better understand the occurrence of tuberculosis attributable to climate change.
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Affiliation(s)
- Bijay Maharjan
- Japan-Nepal Health and Tuberculosis Research Association, Kathmandu, Nepal.
| | - Ram Sharan Gopali
- Japan-Nepal Health and Tuberculosis Research Association, Kathmandu, Nepal
| | - Ying Zhang
- School of Public Health, University of Sydney, Sydney, Australia
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Chenciner L, Annerstedt KS, Pescarini JM, Wingfield T. Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study. Lancet Glob Health 2021; 9:e1380-e1390. [PMID: 34534486 DOI: 10.1016/s2214-109x(21)00300-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Tuberculosis elimination strategies in Brazil might neglect adolescents and young adults aged 10-24 years, hampering tuberculosis control. However, little is known about factors associated with tuberculosis treatment outcomes in this underserved group. In this study, we aimed to investigate social and health factors associated with unfavourable treatment outcomes in young people with tuberculosis in Brazil. METHODS A national retrospective cohort study was done using data from Sistema de Informação de Agravos de Notificação (SINAN), the national tuberculosis registry in Brazil. People aged 10-24 years (young people) with tuberculosis registered in SINAN between Jan 1, 2015, and Dec 31, 2018, were included. Unfavourable outcomes were defined as loss to follow-up, treatment failure, and death. Favourable outcome was defined as treatment success. Multiple logistic regression models estimated the association between social and health factors and tuberculosis treatment outcomes. FINDINGS 67 360 young people with tuberculosis were notified to SINAN, and we included 41 870 young people in our study. 7024 (17%) of the 41 870 included individuals had unfavourable treatment outcomes. Young people who received government cash transfers were less likely to have an unfavourable outcome (adjusted odds ratio 0·83, 95% CI 0·70-0·99). Homelessness (3·03, 2·07-4·42), HIV (2·89, 2·45-3·40), and illicit drug use (2·22, 1·93-2·55) were the main factors associated with unfavourable treatment outcome. INTERPRETATION In this national cohort of young people with tuberculosis in Brazil, tuberculosis treatment success rates were lower than WHO End TB Strategy targets, with almost a fifth of participants experiencing unfavourable treatment outcomes. Homelessness, HIV, and illicit drug use were the main factors associated with unfavourable outcome. In Brazil, strategies are required to support this underserved group to ensure favourable tuberculosis treatment outcomes. FUNDING Wellcome Trust, UK Medical Research Council, and UK Foreign Commonwealth and Development Office.
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Affiliation(s)
- Louisa Chenciner
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Solna, Sweden.
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Solna, Sweden
| | - Julia M Pescarini
- Centre for Data and Knowledge Integration for Health, Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tom Wingfield
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Solna, Sweden; Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK; Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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du Preez K, Osman M, Seddon JA, Naidoo P, Schaaf HS, Munch Z, Dunbar R, Mvusi L, Dlamini SS, Hesseling AC. The Impact of the Evolving Human Immunodeficiency Virus Response on the Epidemiology of Tuberculosis in South African Children and Adolescents. Clin Infect Dis 2021; 73:e967-e975. [PMID: 33532853 PMCID: PMC8366817 DOI: 10.1093/cid/ciab095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Few studies have evaluated tuberculosis control in children and adolescents. We used routine tuberculosis surveillance data to quantify age- and human immunodeficiency virus (HIV)-stratified trends over time and investigate the relationship between tuberculosis, HIV, age, and sex. METHODS All children and adolescents (0-19 years) routinely treated for drug-susceptible tuberculosis in South Africa and recorded in a de-duplicated national electronic tuberculosis treatment register (2004-2016) were included. Age- and HIV-stratified tuberculosis case notification rates (CNRs) were calculated in four age bands: 0-4, 5-9, 10-14, and 15-19 years. The association between HIV infection, age, and sex in children and adolescents with tuberculosis was evaluated using multivariable logistic regression. RESULTS Of 719 400 children and adolescents included, 339 112 (47%) were 0-4 year olds. The overall tuberculosis CNR for 0-19 year olds declined by 54% between 2009 and 2016 (incidence rate ratio [IRR] = 0.46; 95% confidence interval [CI], .45-.47). Trends varied by age and HIV, with the smallest reductions (2013-2016) in HIV-positive 0-4 year olds (IRR = 0.90; 95% CI, .85-.95) and both HIV-positive (IRR = .84; 95% CI, .80-.88) and HIV-negative (IRR = 0.89; 95% CI, .86-.92) 15-19 year olds. Compared with 0- to 4-year-old males, odds of HIV coinfection among 15-19 year olds were nearly twice as high in females (adjusted odds ratio [aOR] = 2.49; 95% CI, 2.38-2.60) than in males (aOR = 1.35; 95% CI, 1.29-1.42). CONCLUSIONS South Africa's national response to the HIV epidemic has made a substantial contribution to the observed declining trends in tuberculosis CNRs in children and adolescents. The slow decline of tuberculosis CNRs in adolescents and young HIV-positive children is concerning. Understanding how tuberculosis affects children and adolescents beyond conventional age bands and by sex can inform targeted tuberculosis control strategies.
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Affiliation(s)
- Karen du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Diseases, Imperial College London, United Kingdom
| | - Pren Naidoo
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Zahn Munch
- Department of Geography and Environmental Studies, Stellenbosch University, Stellenbosch, South Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lindiwe Mvusi
- National TB Control & Management Cluster, National Department of Health, South Africa
| | - Sicelo S Dlamini
- Research Information Monitoring, Evaluation & Surveillance (RIMES), National TB Control & Management Cluster, National Department of Health, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Seifert M, Aung HT, Besler N, Harris V, Mar TT, Colman RE, Rodwell TC, Aung ST. Age and sex distribution of Mycobacterium tuberculosis infection and rifampicin resistance in Myanmar as detected by Xpert MTB/RIF. BMC Infect Dis 2021; 21:781. [PMID: 34372793 PMCID: PMC8351356 DOI: 10.1186/s12879-021-06296-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022] Open
Abstract
Background Detection of tuberculosis disease (TB) and timely identification of Mycobacterium tuberculosis (Mtb) strains that are resistant to treatment are key to halting tuberculosis transmission, improving treatment outcomes, and reducing mortality. Methods We used 332,657 Xpert MTB/RIF assay results, captured as part of the Myanmar Data Utilization Project, to characterize Mtb test positivity and rifampicin resistance by both age and sex, and to evaluate risk factors associated with rifampicin resistance. Results Overall, 70% of individuals diagnosed with TB were males. Test positivity was higher among males (47%) compared to females (39%). The highest positivity by age occurred among individuals aged 16–20, with test positivity for females (65%) higher than for males (57%). Although a greater absolute number of males were rifampicin resistant, a greater proportion of females (11.4%) were rifampicin resistant as compared to males (9.3%). In the multivariate model, history of previous treatment, age less than 30, testing in the Yangon region, and female sex were significantly positively associated with rifampicin resistance after adjusting for HIV status and year test was performed. Conclusions Our results indicate that young adults were more likely to test positive for TB and be identified as rifampicin resistant compared to older adults.
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Affiliation(s)
- Marva Seifert
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | | | - Nicole Besler
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Victoria Harris
- FIND, the global alliance for diagnostics, Campus Biotech, 9 Chemin des Mines -, 1202, Geneva, Switzerland
| | - Tin Tin Mar
- Ministry of Health and Sports, Office No. 4, Naypyitaw, Myanmar
| | - Rebecca E Colman
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Timothy C Rodwell
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Si Thu Aung
- Ministry of Health and Sports, Office No. 4, Naypyitaw, Myanmar
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