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Gwela A, Mupere E, Berkley JA, Lancioni C. Undernutrition, Host Immunity and Vulnerability to Infection Among Young Children. Pediatr Infect Dis J 2019; 38:e175-e177. [PMID: 31306401 PMCID: PMC7613497 DOI: 10.1097/inf.0000000000002363] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Agnes Gwela
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi,KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ezekiel Mupere
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi,Department of Pediatrics, Makerere University, Kampala, Uganda
| | - James A Berkley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi,KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
| | - Christina Lancioni
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi,Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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Lee N, White LV, Marin FP, Saludar NR, Solante MB, Tactacan-Abrenica RJC, Calapis RW, Suzuki M, Saito N, Ariyoshi K, Parry CM, Edwards T, Cox SE. Mid-upper arm circumference predicts death in adult patients admitted to a TB ward in the Philippines: A prospective cohort study. PLoS One 2019; 14:e0218193. [PMID: 31246958 PMCID: PMC6597043 DOI: 10.1371/journal.pone.0218193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/28/2019] [Indexed: 11/18/2022] Open
Abstract
Background The Philippines is ranked 3rd globally for tuberculosis incidence (554/100,000 population). The tuberculosis ward at San Lazaro Hospital, Manila receives 1,800–2,000 admissions of acutely unwell patients per year with high mortality. Objectives of this prospective cohort study were to quantify the association of under-nutrition (primary) and diabetes (secondary) with inpatient mortality occurring between 3–28 days of hospital admission in patients with suspected or previously diagnosed TB. Methods and results We enrolled 360 adults (≥18 years); 348 were eligible for the primary analysis (alive on day 3). Clinical, laboratory, anthropometric and enhanced tuberculosis diagnostic data were collected at admission with telephone tracing for mortality up to 6 months post-discharge. In the primary analysis population (mean age 45 years, SD = 15.0 years, 70% male), 58 (16.7%) deaths occurred between day 3–28 of admission; 70 (20.1%) between day 3 and discharge and documented total post-day 3 mortality including follow-up was 96 (27.6%). In those in whom it could be assessed, body mass index (BMI) ranged from 11.2–30.6 kg/m2 and 141/303 (46.5%) had moderate/severe undernutrition (BMI<17 kg/m2). A sex-specific cut-off for mid-upper arm circumference predictive of BMI<17 kg/m2 was associated with inpatient Day 3–28 mortality in males (AOR = 5.04, 95% CI: 1.50–16.86; p = 0.009; p = 0.032 for interaction by sex). The inability to stand for weight/height for BMI assessment was also associated with mortality (AOR = 5.59; 95% CI 2.25–13.89; p<0.001) as was severe compared to normal/mild anaemia (AOR = 9.67; 95% CI 2.48–37.76; p<0.001). No TB specific variables were associated with Day 3–28 mortality, nor was diabetes (HbA1c ≥6.5% or diabetes treatment). Similar effects were observed when the same multivariable model was applied to confirmed TB patients only and to the outcome of all post-day 3 in-patient mortality. Conclusion This research supports the use of mid-upper arm circumference for triaging acutely unwell patients and the design and testing of nutrition-based interventions to improve patient outcomes.
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Affiliation(s)
- Nathaniel Lee
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Royal Free Hospital, London, United Kingdom
| | - Laura V. White
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | - Marietta B. Solante
- San Lazaro Hospital, Manila, the Philippines
- The Lung Center, Manila, the Philippines
| | | | | | - Motoi Suzuki
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Nobuo Saito
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Koya Ariyoshi
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Christopher M. Parry
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Tansy Edwards
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sharon E. Cox
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Non-antibiotic adjunctive therapy: A promising approach to fight tuberculosis. Pharmacol Res 2019; 146:104289. [PMID: 31152788 DOI: 10.1016/j.phrs.2019.104289] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 12/15/2022]
Abstract
Tuberculosis (TB) is currently a clinical and public health problem. There is a concern about the emergence and development of multidrug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) species. Additionally, the lack of effective vaccines is another limitation to control the related infections. To overcome these problems various approaches have been pursued such as finding novel drug candidates with a new mechanism of action or repurposing conventional antibiotics. However, these strategies are still far from clinical application. Hence, the use of adjunctive therapy has been suggested for TB. In this paper, we review non-antibiotic adjunctive treatment options for TB. Natural products, vitamins, micronutrients, and trace elementals, as well as non-antibiotic drugs, are examples of agents which have been used as adjunctive therapies. The use of these adjunctive therapies has been shown to improve disease outcomes and reduce the adverse effects of antibiotic drugs. Employing these agents, either alone or in combination with antibiotics, might be considered as a promising approach to control TB infections and achieve better clinical outcomes. However, supportive evidence from randomized controlled trials is still scant and merits further investigations.
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Iron Supplementation Therapy, A Friend and Foe of Mycobacterial Infections? Pharmaceuticals (Basel) 2019; 12:ph12020075. [PMID: 31108902 PMCID: PMC6630247 DOI: 10.3390/ph12020075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/21/2022] Open
Abstract
Iron is an essential element that is required for oxygen transfer, redox, and metabolic activities in mammals and bacteria. Mycobacteria, some of the most prevalent infectious agents in the world, require iron as growth factor. Mycobacterial-infected hosts set up a series of defense mechanisms, including systemic iron restriction and cellular iron distribution, whereas mycobacteria have developed sophisticated strategies to acquire iron from their hosts and to protect themselves from iron’s harmful effects. Therefore, it is assumed that host iron and iron-binding proteins, and natural or synthetic chelators would be keys targets to inhibit mycobacterial proliferation and may have a therapeutic potential. Beyond this hypothesis, recent evidence indicates a host protective effect of iron against mycobacterial infections likely through promoting remodeled immune response. In this review, we discuss experimental procedures and clinical observations that highlight the role of the immune response against mycobacteria under various iron availability conditions. In addition, we discuss the clinical relevance of our knowledge regarding host susceptibility to mycobacteria in the context of iron availability and suggest future directions for research on the relationship between host iron and the immune response and the use of iron as a therapeutic agent.
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Tan W, Soodeen-Lalloo AK, Chu Y, Xu W, Chen F, Zhang J, Sha W, Huang J, Yang G, Qin L, Wang J, Huang X, Shi J, Feng Y. Sex influences the association between haemostasis and the extent of lung lesions in tuberculosis. Biol Sex Differ 2018; 9:44. [PMID: 30305157 PMCID: PMC6180492 DOI: 10.1186/s13293-018-0203-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background Worldwide tuberculosis (TB) reports show a male bias in morbidity; however, the differences in pathogenesis between men and women with TB, as well as the mechanisms associated with such differences, are poorly investigated. We hypothesized that comparison of the degree of lung injury and clinical indices of well-matched men and women with newly diagnosed TB, and statistical analysis of the correlation between these indices and the extent of lung lesions, can provide insights into the mechanism of gender bias in TB. Methods We evaluated the acid-fast bacilli grading of sputum samples and compiled computed tomography (CT) data of the age-matched, newly diagnosed male and female TB patients without history of smoking or comorbidities. Inflammatory biomarker levels and routine haematological and coagulation-associated parameters were compared. Binary logistic regression analysis was used to define the association between the indices and lung lesions, and the influence of sex adjustment. Results Women with TB have a longer delay in seeking healthcare than men after onset of the TB-associated symptoms. Men with TB have significantly more severe lung lesions (cavities and healing-associated features) and higher bacterial counts compared to women with TB. Scoring of the CT images before and after anti-TB treatment showed a faster response to therapy in women than in men. Coagulation- and platelet-associated indices were in models from multivariate regression analysis with groups of males or females with TB or in combination. In univariate regression analysis, lower lymphocyte counts were associated with both cavity and more bacterial counts, independent of sex, age and BMI. The association of international normalized ratios (INR), prothrombin times (PTs), mean platelet volumes (MPVs) and fibrinogen (FIB) level with lung lesions was mostly influenced by sex adjustment. Conclusions Sex influences the association between haemostasis and extent of TB lung lesions, which may be one mechanism involved in sex bias in TB pathogenesis. Electronic supplementary material The online version of this article (10.1186/s13293-018-0203-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wenling Tan
- Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Adiilah K Soodeen-Lalloo
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Yue Chu
- Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Weijie Xu
- Department of Clinical Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Fengfang Chen
- Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China.,Key Laboratory of Environment Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, 550025, Guizhou, China
| | - Jie Zhang
- Department of Epidemiology and Biostatistics, Tongji University School of Medicine, Shanghai, 200433, China
| | - Wei Sha
- Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China.,Clinic and Research Centre of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Jin Huang
- Key Laboratory of Environment Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, 550025, Guizhou, China
| | - Guanghong Yang
- Key Laboratory of Environment Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, 550025, Guizhou, China
| | - Lianhua Qin
- Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Jie Wang
- Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Xiaochen Huang
- Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
| | - Yonghong Feng
- Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China. .,Clinic and Research Centre of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
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Filate M, Mehari Z, Alemu YM. Longitudinal body weight and sputum conversion in patients with tuberculosis, Southwest Ethiopia: a retrospective follow-up study. BMJ Open 2018; 8:e019076. [PMID: 30185566 PMCID: PMC6129038 DOI: 10.1136/bmjopen-2017-019076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To describe the association between change in body weight and sputum smear conversion and to identify factors linked with body weight and sputum smear conversion in Jimma University Specialized Hospital, Southwest Ethiopia. DESIGN A retrospective follow-up study. SETTING Teaching hospital in Southwest Ethiopia. PARTICIPANTS A total of 450 patients with tuberculosis (TB) were included in the follow-up between 2011 and 2013. MAIN OUTCOME MEASURES The association between body weight and sputum conversion was measured using joint modelling. RESULTS The association between change in body weight and change in sputum conversion was -0.698 (p<0.001). A strong inverse association between change in body weight and change in sputum conversion was observed. The study variables sex, age, type of TB, HIV status, dose of anti-TB drug and length of enrolment to TB treatment were significantly associated with change in body weight of patients with TB. The study variables age, type of TB, dose of anti-TB drug and length of enrolment were significantly associated with change in sputum status of patients with TB. CONCLUSIONS Among patients with TB who were on anti-TB treatment, increase in body weight and positive sputum status were inversely related over time. TB prevention and control strategies should give emphasis on factors such as female sex, older age, non-pulmonary positive type of TB, HIV-positive, lower dose of anti-TB drug and length of enrolment to TB treatment during monitoring of trends in body weight and sputum status.
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Affiliation(s)
- Mersha Filate
- Department of Statistics, Jimma University, Jimma, Ethiopia
| | - Zelalem Mehari
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yihun Mulugeta Alemu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Beyanga M, Kidenya BR, Gerwing-Adima L, Ochodo E, Mshana SE, Kasang C. Investigation of household contacts of pulmonary tuberculosis patients increases case detection in Mwanza City, Tanzania. BMC Infect Dis 2018; 18:110. [PMID: 29510670 PMCID: PMC5840829 DOI: 10.1186/s12879-018-3036-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 03/01/2018] [Indexed: 11/29/2022] Open
Abstract
Background Tuberculosis (TB) contact tracing is a key strategy for containing TB and provides addition to the passive case finding approach. However, this practice has not been implemented in Tanzania, where there is unacceptably high treatment gap of 62.1% between cases estimated and cases detected. Therefore calls for more aggressive case finding for TB to close this gap. We aimed to determine the magnitude and predictors of bacteriologically-confirmed pulmonary TB among household contacts of bacteriologically-confirmed pulmonary TB index cases in the city of Mwanza, Tanzania. Methods This study was carried out from August to December 2016 in Mwanza city at the TB outpatient clinics of Tertiary Hospital of the Bugando Medical Centre, Sekou-Toure Regional Hospital, and Nyamagana District Hospital. Bacteriologically-confirmed TB index cases diagnosed between May and July 2016 were identified from the laboratory registers book. Contacts were traced by home visits by study TB nurses, and data were collected using a standardized TB screening questionnaire. To detect the bacterioriologically-confirmed pulmonary TB, two sputum samples per household contact were collected under supervision for all household contacts following standard operating procedures. Samples were transported to the Bugando Medical Centre TB laboratory for investigation for TB using fluorescent smear microscopy, GeneXpert MTB/RIF and Löwenstein–Jensen (LJ) culture. Logistic regression was used to determine predictors of bacteriologically-confirmed pulmonary TB among household contacts. Results During the study period, 456 household contacts from 93 TB index cases were identified. Among these 456 household contacts, 13 (2.9%) were GeneXpert MTB/RIF positive, 18 (3.9%) were MTB-culture positive and four (0.9%) were AFB-smear positive. Overall, 29 (6.4%) of contacts had bacteriologically-confirmed pulmonary TB. Predictors of bacteriologically-confirmed pulmonary TB among household contacts were7being married (Odds ratio [OR], 3.3; 95% confidence interval [CI], 1.4–8.0; p = 0.012) and consuming less than three meals a day (OR, 3.7; 95% CI, 1.6–8.7; p = 0.009). Conclusions Our data suggest that in Mwanza, Tanzania, seven in 100 contacts living in the same house with a TB patient develop bacteriologically-confirmed pulmonary TB. These results therefore underscore the need to implement routine TB contact tracing to control tuberculosis in high TB burden countries such as Tanzania.
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Affiliation(s)
- Medard Beyanga
- Bugando Medical Centre, Department of Clinical Laboratory Services, Mwanza, Tanzania
| | - Benson R Kidenya
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Mwanza, Tanzania.
| | - Lisa Gerwing-Adima
- Bugando Medical Centre, Department of Clinical Laboratory Services, Mwanza, Tanzania
| | - Eleanor Ochodo
- Centre for Evidence-based Health Care, Stellenbosch University Cape Town, Cape Town, South Africa
| | - Stephen E Mshana
- Department of Microbiology, Weill Bugando School of Medicine, Mwanza, Tanzania
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