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Ko PY, Lin SD, Tu ST, Hsieh MC, Su SL, Hsu SR, Chen YC. High diabetes mellitus prevalence with increasing trend among newly-diagnosed tuberculosis patients in an Asian population: A nationwide population-based study. Prim Care Diabetes 2016; 10:148-155. [PMID: 26494183 DOI: 10.1016/j.pcd.2015.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 11/24/2022]
Abstract
AIMS Our aims were to investigate the prevalence of diabetes mellitus (DM) among patients with newly-diagnosed tuberculosis (TB) and to determine its associated factors in an Asian population. METHODS The data were obtained from the National Health Insurance Research Database and included 9831 newly-diagnosed TB individuals in the period of 2000-2010. The data were divided into a DM group and a non-DM group. We measured the prevalence and the associated comorbidities of DM. RESULTS During 2000-2010, the prevalence of DM progressively increased, with an average prevalence rate of 27.9%. The patients with ages of 55-64 years had the highest association of DM (OR=3.53) compared with those under 45 years. TB patients with heart failure, ischemic heart disease, cerebral vascular disease, hypertension, dyslipidemia, chronic kidney disease, and liver disease were more likely to associate with DM (ORs=1.27, 1.23, 1.30, 2.32, 3.26, 1.6, and 1.68, respectively) compared to those without the variables. CONCLUSIONS The prevalence of DM among TB patients in Taiwan was high and tended to increase in the past decade. Clinically, inquiring about DM history and screening routinely for those without DM history among TB patients should be carried out in Taiwan.
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Affiliation(s)
- Po-Yen Ko
- Division of Cardiology, Department of Medicine, China Medical University Hospital, 2 Yuh-Der Road, 40447 Taichung, Taiwan; China Medical University, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Shi-Dou Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Shih-Te Tu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital Lukang Branch, Lukang, Taiwan
| | - Ming-Chia Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital Yuanlin Branch, Yuanlin, Taiwan
| | - Shih-Li Su
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Shang-Ren Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Cheng Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital Yunlin Branch, Yunlin, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital Yuanlin Branch, Yuanlin, Taiwan.
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152
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Limonia acidissima L. leaf mediated synthesis of zinc oxide nanoparticles: A potent tool against Mycobacterium tuberculosis. Int J Mycobacteriol 2016; 5:197-204. [PMID: 27242232 DOI: 10.1016/j.ijmyco.2016.03.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 03/05/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE/BACKGROUND The present investigation was undertaken to synthesize zinc oxide nanoparticles using Limonia acidissima L. and to test their efficacy against the growth of Mycobacterium tuberculosis. METHODS The formation of zinc oxide nanoparticles was confirmed with UV-visible spectrophotometry. Fourier transform infrared spectroscopy shows the presence of bio-molecules involved in the stabilization of zinc oxide nanoparticles. The shape and size was confirmed with atomic force microscope, X-ray diffraction, and high resolution transmission electron microscope. These nanoparticles were tested for their effect on the growth of M. tuberculosis through the microplate alamar blue assay technique. RESULTS The UV-visible data reveal that an absorbance peak at 374nm confirms formation of zinc oxide nanoparticles and they are spherical in shape with sizes between 12nm and 53nm. These nanoparticles control the growth of M. tuberculosis at 12.5μg/mL. CONCLUSION Phytosynthesis of zinc oxide nanoparticles is a green, eco-friendly technology because it is inexpensive and pollution free. In the present investigation, based on our results we conclude that the aqueous extract of leaves of L. acidissima can be used for the synthesis of zinc oxide nanoparticles. These nanoparticles control the growth of M. tuberculosis and this was confirmed with the microplate alamar blue method. The potential of biogenic zinc oxide nanoparticles may be harnessed as a novel medicine ingredient to combat tuberculosis disease.
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153
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Liao TL, Lin CH, Shen GH, Chang CL, Lin CF, Chen DY. Risk for Mycobacterial Disease among Patients with Rheumatoid Arthritis, Taiwan, 2001-2011. Emerg Infect Dis 2016. [PMID: 26196158 PMCID: PMC4517709 DOI: 10.3201/eid2108.141846] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Increasing evidence indicates that the risk of acquiring tuberculosis (TB) and nontuberculous mycobacterial disease is elevated among patients with rheumatoid arthritis (RA). To determine the epidemiology of mycobacterial diseases among RA patients in Asia, we conducted a retrospective cohort study. We used a nationwide database to investigate the association of RA with mycobacterial diseases. The risk for development of TB or nontuberculous mycobacterial disease was 2.28-fold and 6.24-fold higher among RA patients than among the general population, respectively. Among RA patients, risk for development of mycobacterial disease was higher among those who were older, male, or both. Furthermore, among RA patients with mycobacterial infections, the risk for death was increased. Therefore, RA patients, especially those with other risk factors, should be closely monitored for development of mycobacterial disease.
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154
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Trinh QM, Nguyen HL, Nguyen VN, Nguyen TVA, Sintchenko V, Marais BJ. Tuberculosis and HIV co-infection-focus on the Asia-Pacific region. Int J Infect Dis 2016; 32:170-8. [PMID: 25809776 DOI: 10.1016/j.ijid.2014.11.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 12/23/2022] Open
Abstract
Tuberculosis (TB) is the leading opportunistic disease and cause of death in patients with HIV infection. In 2013 there were 1.1 million new TB/HIV co-infected cases globally, accounting for 12% of incident TB cases and 360,000 deaths. The Asia-Pacific region, which contributes more than a half of all TB cases worldwide, traditionally reports low TB/HIV co-infection rates. However, routine testing of TB patients for HIV infection is not universally implemented and the estimated prevalence of HIV in new TB cases increased to 6.3% in 2013. Although HIV infection rates have not seen the rapid rise observed in Sub-Saharan Africa, indications are that rates are increasing among specific high-risk groups. This paper reviews the risks of TB exposure and progression to disease, including the risk of TB recurrence, in this vulnerable population. There is urgency to scale up interventions such as intensified TB case-finding, isoniazid preventive therapy, and TB infection control, as well as HIV testing and improved access to antiretroviral treatment. Increased awareness and concerted action is required to reduce TB/HIV co-infection rates in the Asia-Pacific region and to improve the outcomes of people living with HIV.
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Affiliation(s)
- Q M Trinh
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, Australia; Centre for Infectious Disease and Microbiology - Public Health, ICPMR, Westmead Hospital, Sydney, Australia; Tuberculosis Laboratory, Vietnam National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
| | - H L Nguyen
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - V N Nguyen
- Vietnam National Lung Hospital, Hanoi, Vietnam
| | - T V A Nguyen
- Tuberculosis Laboratory, Vietnam National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - V Sintchenko
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, Australia; Centre for Infectious Disease and Microbiology - Public Health, ICPMR, Westmead Hospital, Sydney, Australia
| | - B J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, Australia
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155
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Workneh MH, Bjune GA, Yimer SA. Prevalence and Associated Factors of Diabetes Mellitus among Tuberculosis Patients in South-Eastern Amhara Region, Ethiopia: A Cross Sectional Study. PLoS One 2016; 11:e0147621. [PMID: 26808967 PMCID: PMC4726615 DOI: 10.1371/journal.pone.0147621] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022] Open
Abstract
Background The association between diabetes mellitus (DM) and tuberculosis (TB) is re-emerging worldwide. Recently, the prevalence of DM is increasing in resource poor countries where TB is of high burden. The objective of the current study was to determine the prevalence and analyze associated factors of TB and DM comorbidity in South-Eastern Amhara Region, Ethiopia. Methods This was a facility based cross-sectional study. All newly diagnosed TB patients attending selected health facilities in the study area were consecutively screened for DM. DM was diagnosed based on the World Health Organization diagnostic criteria. A pre-tested semi-structured questionnaire was used to collect socio-demographic, lifestyles and clinical data. Logistic regression analysis was performed to identify factors associated with TB and DM comorbidity. Result Among a total of 1314 patients who participated in the study, the prevalence of DM was estimated at 109 (8.3%). Being female [odds ratio (OR) 1.70; 95% confidence interval (CI) (1.10–2.62)], patients age [41–64 years (OR 3.35; 95% CI (2.01–5.57), 65–89 years (OR 3.18; 95% CI (1.52–6.64)], being a pulmonary TB case [(OR 1.69; 95% CI 1.09–2.63)] and having a family history of DM [(OR 4.54; 95% CI (2.36–8.73)] were associated factors identified with TB and DM comorbidity. Conclusion The prevalence of DM among TB patients in South-Eastern Amahra Region is high. Routine screening of TB patients for DM is recommended in the study area.
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Affiliation(s)
- Mahteme Haile Workneh
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- * E-mail:
| | - Gunnar Aksel Bjune
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
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156
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Lee SW, Wu LSH, Huang GM, Huang KY, Lee TY, Weng JTY. Gene expression profiling identifies candidate biomarkers for active and latent tuberculosis. BMC Bioinformatics 2016; 17 Suppl 1:3. [PMID: 26818387 PMCID: PMC4895247 DOI: 10.1186/s12859-015-0848-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a serious infectious disease in that 90% of those latently infected with Mycobacterium tuberculosis present no symptoms, but possess a 10% lifetime chance of developing active TB. To prevent the spread of the disease, early diagnosis is crucial. However, current methods of detection require improvement in sensitivity, efficiency or specificity. In the present study, we conducted a microarray experiment, comparing the gene expression profiles in the peripheral blood mononuclear cells among individuals with active TB, latent infection, and healthy conditions in a Taiwanese population. RESULTS Bioinformatics analysis revealed that most of the differentially expressed genes belonged to immune responses, inflammation pathways, and cell cycle control. Subsequent RT-PCR validation identified four differentially expressed genes, NEMF, ASUN, DHX29, and PTPRC, as potential biomarkers for the detection of active and latent TB infections. Receiver operating characteristic analysis showed that the expression level of PTPRC may discriminate active TB patients from healthy individuals, while ASUN could differentiate between the latent state of TB infection and healthy condidtion. In contrast, DHX29 may be used to identify latently infected individuals among active TB patients or healthy individuals. To test the concept of using these biomarkers as diagnostic support, we constructed classification models using these candidate biomarkers and found the Naïve Bayes-based model built with ASUN, DHX29, and PTPRC to yield the best performance. CONCLUSIONS Our study demonstrated that gene expression profiles in the blood can be used to identify not only active TB patients, but also to differentiate latently infected patients from their healthy counterparts. Validation of the constructed computational model in a larger sample size would confirm the reliability of the biomarkers and facilitate the development of a cost-effective and sensitive molecular diagnostic platform for TB.
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Affiliation(s)
- Shih-Wei Lee
- Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan. .,Department of Life Sciences, National Central University, Taoyuan, Taiwan.
| | | | - Guan-Mau Huang
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, Taiwan.
| | - Kai-Yao Huang
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, Taiwan.
| | - Tzong-Yi Lee
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, Taiwan. .,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, Taiwan.
| | - Julia Tzu-Ya Weng
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, Taiwan. .,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, Taiwan.
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157
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Asiimwe SB, Amir A, Vittinghoff E, Muzoora CK. Causal impact of malnutrition on mortality among adults hospitalized for medical illness in sub-Saharan Africa: what is the role of severe sepsis? BMC Nutr 2015. [DOI: 10.1186/s40795-015-0023-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
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158
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Huaman MA, Henson D, Ticona E, Sterling TR, Garvy BA. Tuberculosis and Cardiovascular Disease: Linking the Epidemics. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2015; 1. [PMID: 26835156 PMCID: PMC4729377 DOI: 10.1186/s40794-015-0014-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The burden of tuberculosis and cardiovascular disease (CVD) is enormous worldwide. CVD rates are rapidly increasing in low- and middle-income countries. Public health programs have been challenged with the overlapping tuberculosis and CVD epidemics. Monocyte/macrophages, lymphocytes and cytokines involved in cellular mediated immune responses against Mycobacterium tuberculosis are also main drivers of atherogenesis, suggesting a potential pathogenic role of tuberculosis in CVD via mechanisms that have been described for other pathogens that establish chronic infection and latency. Studies have shown a pro-atherogenic effect of antibody-mediated responses against mycobacterial heat shock protein-65 through cross reaction with self-antigens in human vessels. Furthermore, subsets of mycobacteria actively replicate during latent tuberculosis infection (LTBI), and recent studies suggest that LTBI is associated with persistent chronic inflammation that may lead to CVD. Recent epidemiologic work has shown that the risk of CVD in persons who develop tuberculosis is higher than in persons without a history of tuberculosis, even several years after recovery from tuberculosis. Together, these data suggest that tuberculosis may play a role in the pathogenesis of CVD. Further research to investigate a potential link between tuberculosis and CVD is warranted.
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Affiliation(s)
- Moises A Huaman
- Division of Infectious Diseases, Department of Medicine, University of Kentucky, Lexington, KY, USA
| | - David Henson
- Division of Infectious Diseases, Department of Medicine, University of Kentucky, Lexington, KY, USA
| | - Eduardo Ticona
- Infectious Diseases & Tropical Medicine Research Unit, Hospital Nacional Dos de Mayo, Lima, Peru
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Beth A Garvy
- Division of Infectious Diseases, Department of Medicine, University of Kentucky, Lexington, KY, USA; Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, KY, USA
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159
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Matoto V, Viney K, Roseveare C, Colaguiri R, Marais BJ. Burden and spectrum of disease in people with diabetes in Tonga. Public Health Action 2015; 4:S44-9. [PMID: 26477287 DOI: 10.5588/pha.13.0080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 11/10/2013] [Indexed: 01/08/2023] Open
Abstract
SETTING National Diabetes Centre, Tonga. OBJECTIVE To describe the diabetes patient profile and disease spectrum, assess the impact of diabetic care and evaluate diabetes-attributable adverse outcomes. DESIGN Retrospective descriptive study of patients registered in the National Diabetes Registry from its inception in May 2004 to 2012, and review of the National Deaths Registry (2011-2012). RESULTS Of 4653 patients with diabetes mellitus (DM) identified, 95.8% had type 2 DM, 0.2% type 1, 1.2% gestational DM and 2.9% pre-DM. Of the 4409 patients with type 2 DM, 64.7% were female, 82.7% were aged ⩾40 years, 25.3% had hypertension and 53.3% were obese. Among those in care for >2 years, no positive impact on body mass index or glycosylated haemoglobin could be demonstrated, but there was significant improvement in hypertension control. Morbidity included lower limb amputations in 272 (6.1%) patients. DM was listed as a contributory cause of death due to sepsis (15/30, 50.0%), kidney failure (16/28, 57.1%), stroke (7/16, 43.8%) and ischaemic heart disease (20/59, 33.9%). CONCLUSION DM was associated with high levels of morbidity and mortality. DM care improved hypertension control, but had little impact on other comorbid conditions. Enhanced monitoring and greater patient involvement should improve care; creative strategies are required to prevent and reduce obesity.
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Affiliation(s)
- V Matoto
- National Diabetes Centre, Nuku'alofa, Tonga
| | - K Viney
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - C Roseveare
- Regional Public Health, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - R Colaguiri
- The Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
| | - B J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
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160
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Colagiuri R, Boylan S, Morrice E. Research Priorities for NCD Prevention and Climate Change: An International Delphi Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12941-57. [PMID: 26501301 PMCID: PMC4627009 DOI: 10.3390/ijerph121012941] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/01/2015] [Accepted: 10/13/2015] [Indexed: 11/23/2022]
Abstract
Climate change and non-communicable diseases (NCDs) are arguably the greatest global challenges of the 21st Century. However, the confluence between them remains under-examined and there is little evidence of a comprehensive, systematic approach to identifying research priorities to mitigate their joint impact. Consequently, we: (i) convened a workshop of academics (n = 25) from the Worldwide Universities Network to identify priority areas at the interface between NCDs and climate change; (ii) conducted a Delphi survey of international opinion leaders in public health and relevant other disciplines; and (iii) convened an expert panel to review and advise on final priorities. Three research areas (water security; transport; conceptualising NCD harms to support policy formation) were listed among the top 10 priorities by >90% of Delphi respondents, and ranked among the top 12 priorities by >60% of respondents who ranked the order of priority. A fourth area (reducing the carbon footprint of cities) was ranked highest by the same >60% of respondents. Our results are consistent with existing frameworks on health and climate change, and extends them by focusing specifically on NCDs. Researching these priorities could progress understanding of climate change and NCDs, and inform global and national policy decisions for mitigating associated harms.
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Affiliation(s)
- Ruth Colagiuri
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Sinead Boylan
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Emily Morrice
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia.
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161
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Alkabab YM, Al-Abdely HM, Heysell SK. Diabetes-related tuberculosis in the Middle East: an urgent need for regional research. Int J Infect Dis 2015; 40:64-70. [PMID: 26409203 PMCID: PMC4863943 DOI: 10.1016/j.ijid.2015.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/21/2015] [Accepted: 09/16/2015] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Diabetes mellitus (DM) triples the risk of tuberculosis (TB) disease, complicates TB treatment, and increases the risk of a poor TB outcome. As DM prevalence is increasing across the Middle East, this review was performed to identify regional gaps in knowledge and research priorities for DM/TB. METHODS Online databases were searched for studies published from Middle East countries on DM and TB and the studies summarized based on topic and major findings. Studies included had a principle hypothesis related to both diseases, or described TB patients with individual data on DM. RESULTS Fifty-nine studies from 10 countries met search criteria. No published studies were found from Lebanon, Bahrain, Syria, Jordan, Cyprus, or the United Arab Emirates. DM prevalence among TB patients was high, but varied considerably across studies. The vast majority of studies were not specifically designed to compare DM/TB and non-DM/TB patients, but many suggested worse treatment outcomes for DM/TB, in accordance with reports from other regions. CONCLUSIONS Opportunity exists for the regional study of bidirectional screening, management strategies for both DM and TB diseases, and whether such efforts could take place through the integration of services.
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Affiliation(s)
- Yosra M Alkabab
- Division of Infectious Diseases, King Khalid University Hospital, Riyadh, Saudi Arabia.
| | - Hail M Al-Abdely
- Division of Infectious Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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162
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Marais BJ. Strategies to improve tuberculosis case finding in children. Public Health Action 2015; 5:90-1. [PMID: 26393106 DOI: 10.5588/pha.15.0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI) and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia
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163
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Peer N. The converging burdens of infectious and non-communicable diseases in rural-to-urban migrant Sub-Saharan African populations: a focus on HIV/AIDS, tuberculosis and cardio-metabolic diseases. Trop Dis Travel Med Vaccines 2015; 1:6. [PMID: 28883938 PMCID: PMC5526364 DOI: 10.1186/s40794-015-0007-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/10/2015] [Indexed: 12/22/2022] Open
Abstract
Africa has the unenviable challenge of dealing with a double burden of disease: infectious diseases (IDs) such as HIV/AIDS and tuberculosis are high while non-communicable diseases (NCDs) are rapidly rising in the region. Populations with increased susceptibility to both include migrants. This review highlights the susceptibility of rural-to-urban migrants in Sub-Saharan Africa to the IDs of HIV/AIDS and tuberculosis, and to NCDs, particularly cardiovascular diseases. The disruption that occurs with migration is often accompanied by unhealthy exposures and environments. These include partaking in risky sexual practices and a subsequent greater risk for HIV infection in migrants than the general populations which contributes to the spread of the disease. Migrants frequently work and live in conditions that are poorly ventilated and overcrowded with suboptimal sanitation which increases their risk for tuberculosis. Considering that migrants have an increased risk of acquiring both HIV/AIDS and tuberculosis, and in view of the interaction between these diseases, they are likely to be at high risk for co-infection. They are also likely to facilitate the geographical spread of these infections and serve as conduits of disease dissemination to rural areas. Changes in lifestyle behaviours that accompany migration and urbanisation are exemplified primarily by shifts in physical activity and dietary patterns which promote the development of obesity, diabetes, hypertension and cardiovascular diseases. Urban living and employment is generally less physically exerting than rural routines; when migrants relocate from their rural residence they adapt to their new environment by significantly reducing their physical activity levels. Also, nutritional patterns among migrants in urban centres change rapidly with a shift to diets higher in fat, sugar and salt. Consequently, increases in weight, blood pressure and glucose levels have been reported within a year of migration. Interactions between IDs and NCDs are common; considering that migrants have an increased susceptibility to IDs and demonstrate a rapid rise in their risk for NCDs, the concurrent prevalence of both is likely in this population. There is a need for a combined strategy to combat IDs and NCDs with screening and treatment programmes geared towards this high risk group.
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Affiliation(s)
- Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, 491 Ridge Road, Overport, Durban, 4001 South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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164
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Genotype heterogeneity of Mycobacterium tuberculosis within geospatial hotspots suggests foci of imported infection in Sydney, Australia. INFECTION GENETICS AND EVOLUTION 2015; 40:346-351. [PMID: 26187743 DOI: 10.1016/j.meegid.2015.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 07/06/2015] [Accepted: 07/13/2015] [Indexed: 01/11/2023]
Abstract
In recent years the State of New South Wales (NSW), Australia, has maintained a low tuberculosis incidence rate with little evidence of local transmission. Nearly 90% of notified tuberculosis cases occurred in people born in tuberculosis-endemic countries. We analyzed geographic, epidemiological and genotypic data of all culture-confirmed tuberculosis cases to identify the bacterial and demographic determinants of tuberculosis hotspot areas in NSW. Standard 24-loci mycobacterium interspersed repetitive unit-variable number tandem repeat (MIRU-24) typing was performed on all isolates recovered between 2009 and 2013. In total 1692/1841 (91.9%) cases with confirmed Mycobacterium tuberculosis infection had complete MIRU-24 and demographic data and were included in the study. Despite some year-to-year variability, spatio-temporal analysis identified four tuberculosis hotspots. The incidence rate and the relative risk of tuberculosis in these hotspots were 2- to 10-fold and 4- to 8-fold higher than the state average, respectively. MIRU-24 profiles of M. tuberculosis isolates associated with these hotspots revealed high levels of heterogeneity. This suggests that these spatio-temporal hotspots, within this low incidence setting, can represent areas of predominantly imported infection rather than clusters of cases due to local transmission. These findings provide important epidemiological insight and demonstrate the value of combining tuberculosis genotyping and spatiotemporal data to guide better-targeted public health interventions.
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165
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Ke CC, Lin CS, Yeh CC, Chung CL, Hung CJ, Liao CC, Chen TL. Adverse Outcomes after Non-Chest Surgeries in Patients with Pulmonary Tuberculosis: A Nationwide Study. PLoS One 2015; 10:e0133064. [PMID: 26172153 PMCID: PMC4501732 DOI: 10.1371/journal.pone.0133064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/23/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The association between pulmonary tuberculosis (TB) and postoperative outcomes remains unknown. This study investigated outcomes following non-chest surgeries in patients with previous pulmonary TB. METHODS Using Taiwan's National Health Insurance Research Database, we analyzed 6911 patients (aged ≥ 20 years) with preoperative diagnosis of pulmonary TB and 6911 propensity score-matched controls receiving non-chest surgeries in 2008-2010. Postoperative outcomes were compared between patients with or without pulmonary TB by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in the multivariate logistic regressions. RESULTS Surgical patients with pulmonary TB had a significantly higher postoperative complication rates than controls, including septicemia, pneumonia, acute renal failure, deep wound infection, overall complications, and 30-day postoperative mortality (OR 1.41; 95% CI 1.07-1.86). The ORs of patients with low-income status were as high as 2.27 (95% CI 1.03-5.03). Preoperative use of TB drugs and TB-related medical expenditure also associated with higher postoperative mortality among surgical patients with pulmonary TB. CONCLUSIONS Surgical patients with pulmonary TB have significantly increased risks of postoperative complications and mortality after non-chest surgeries. This study suggests the need to improve postoperative care for surgical patients with pulmonary TB.
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Affiliation(s)
- Chi-Chen Ke
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chao-Shun Lin
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, United States of America
| | - Chi-Li Chung
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chih-Jen Hung
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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166
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Dirlikov E, Raviglione M, Scano F. Global Tuberculosis Control: Toward the 2015 Targets and Beyond. Ann Intern Med 2015; 163:52-8. [PMID: 25915859 DOI: 10.7326/m14-2210] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Since 1990, progress has been made toward global tuberculosis (TB) control, as measured by targets set for 2015. However, TB remains a major threat to health around the world. In 2013, there were an estimated 11 million prevalent cases, and an estimated 9.0 million incident cases occurred globally. Approximately 1.5 million deaths were caused by TB, including 360,000 among people living with HIV. Substantial challenges threaten future control efforts. These include multidrug-resistant forms and co-infection with HIV, as well as other factors, such as the increased prominence of noncommunicable diseases and adverse socioeconomic conditions. Beyond 2015, TB control must be seen as both a public health imperative unto itself and a vital component of economic development plans. To that end, control strategies should exploit technical and operational innovations to improve TB control and care and should promote universal health coverage and social protection mechanisms to expand access to essential prevention, diagnostics, and treatment services while avoiding catastrophic costs incurred by patients.
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Affiliation(s)
- Emilio Dirlikov
- From McGill University, Montreal, Quebec, Canada; University of Turin, Turin, Italy; and University of Padua, Padua, Italy
| | - Mario Raviglione
- From McGill University, Montreal, Quebec, Canada; University of Turin, Turin, Italy; and University of Padua, Padua, Italy
| | - Fabio Scano
- From McGill University, Montreal, Quebec, Canada; University of Turin, Turin, Italy; and University of Padua, Padua, Italy
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167
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Johnson TJ, Youngquist JS, Garman AN, Hohmann S, Cieslak PR. Factors influencing medical travel into the United States. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2015. [DOI: 10.1108/ijphm-02-2013-0004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– This paper aims to evaluate the potential of 24 country-level measures for predicting the number of outbound international medical travelers into the USA, including health and healthcare system, economic, social and diplomatic and travel pattern factors. Medical travel is recognized as a growing global market and is an important subject of inquiry for US academic medical centers, hospitals and policy makers. Few data-driven studies exist to shed light on efficient and effective strategies for attracting international medical travelers.
Design/methodology/approach
– This was a retrospective, cross-sectional study of the 194 member and/or observer countries of the United Nations. Data for medical traveler volume into the USA between 2008 and 2010 were obtained from the USA Department of Commerce, Office of Travel and Tourism Industries, Survey of International Air Travelers. Data on country-level factors were collected from publicly available databases, including the United Nations, World Bank and World Health Organization. Linear regression models with a negative binomial distribution and log link function were fit to test the association between each independent variable and the number of inbound medical travelers to the USA.
Findings
– Seven of the 24 country-level factors were significantly associated with the number of outbound medical travelers to the USA These factors included imports as a per cent of gross domestic product, trade in services as a per cent of gross domestic product, per cent of population living in urban areas, life expectancy, childhood mortality, incidence of tuberculosis and prevalence of human immunodeficiency virus.
Practical implications
– Results of this model provide evidence for a data-driven approach to strategic outreach and business development for hospitals and policy makers for attracting international patients to the USA for medical care.
Originality/value
– The model developed in this paper can assist US hospitals in promoting their services to international patients as well as national efforts in identifying “high potential” medical travel markets. Other countries could also adapt this methodology for targeting the international patient market.
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168
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He G, Li Y, Zhao F, Wang L, Cheng S, Guo H, Klena JD, Fan H, Gao F, Gao F, Han G, Ren L, Song Y, Xiong Y, Geng M, Hou Y, He G, Li J, Guo S, Yang J, Yan D, Wang Y, Gao H, An J, Duan X, Wu C, Duan F, Hu D, Lu K, Zhao Y, Rao CY, Wang Y. The Prevalence and Incidence of Latent Tuberculosis Infection and Its Associated Factors among Village Doctors in China. PLoS One 2015; 10:e0124097. [PMID: 25996960 PMCID: PMC4440671 DOI: 10.1371/journal.pone.0124097] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background China is a high tuberculosis (TB) burden country. More than half of acute TB cases first seek medical care in village doctors’ clinics or community health centers. Despite being responsible for patient referral and management, village doctors are not systematically evaluated for TB infection or disease. We assessed prevalence and incidence of latent TB infection (LTBI) among village doctors in China. Methods and Findings A longitudinal study was conducted in Inner Mongolia Autonomous Region. We administered a questionnaire on demographics and risk factors for TB exposure and disease; Tuberculin skin testing (TST) and QuantiFERON-TB Gold in-tube assay (QFT-GIT) was conducted at baseline and repeated 12 months later. We used a logistic regression model to calculate adjusted odds ratios (ORs) for risk factors for TST and QFT-GIT prevalence and incidence. At the time of follow up, 19.5% of the 880 participating village doctors had a positive TST and 46.0% had a positive QFT-GIT result. Factors associated with TST prevalence included having a BCG scar (OR = 1.45, 95%CI 1.03–2.04) and smoking (OR = 1.69, 95%CI 1.17–2.44). Risk factors associated with QFT-GIT prevalence included being male (OR = 2.17, 95%CI 1.63–2.89), below college education (OR=1.42, 95%CI 1.01–1.97), and working for ≥25 years as a village doctor (OR = 1.64, 95%CI 1.12–2.39). The annual incidence of LTBI was 11.4% by TST and 19.1% by QFT-GIT. QFT-GIT conversion was associated with spending 15 minutes or more per patient on average (OR = 2.62, 95%CI 1.39–4.97) and having BCG scar (OR = 0.53, 95%CI 0.28–1.00). Conclusions Prevalence and incidence of LTBI among Chinese village doctors is high. TB infection control measures should be strengthened among village doctors and at village healthcare settings.
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Affiliation(s)
- Guangxue He
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Li
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America
| | - Fei Zhao
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lixia Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiming Cheng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Guo
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - John D. Klena
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America
| | - Haiying Fan
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fangfang Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Fei Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Guoxin Han
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Liping Ren
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Yudan Song
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yongchao Xiong
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mengjie Geng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yueyun Hou
- The Tongzhou Maternal & Child Health Hospital, Beijing, China
| | - Guoming He
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Jianbo Li
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Shufang Guo
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Jun Yang
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Daiqin Yan
- the Bayannur for Tuberculosis Control and Prevention, Bayannur, China
| | - Yali Wang
- the Bayannur for Tuberculosis Control and Prevention, Bayannur, China
| | - Haiyan Gao
- the Bayannur for Tuberculosis Control and Prevention, Bayannur, China
| | - Jing An
- Linhe District Center for Disease Control and Prevention, Bayannur, China
| | - Xiaoyan Duan
- Linhe District Center for Disease Control and Prevention, Bayannur, China
| | - Chunru Wu
- Hanggin Rear Banner Center for Disease Control and Prevention, Bayannur, China
| | - Fengming Duan
- Hanggin Rear Banner Center for Disease Control and Prevention, Bayannur, China
| | - Dongmei Hu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kai Lu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanlin Zhao
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Carol Y. Rao
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America
- * E-mail: (YW); (CYR)
| | - Yu Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (YW); (CYR)
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169
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Pan SC, Ku CC, Kao D, Ezzati M, Fang CT, Lin HH. Effect of diabetes on tuberculosis control in 13 countries with high tuberculosis: a modelling study. Lancet Diabetes Endocrinol 2015; 3:323-30. [PMID: 25754415 DOI: 10.1016/s2213-8587(15)00042-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diabetes increases the risk of tuberculosis incidence and the risk of adverse treatment outcomes in patients with tuberculosis. Because prevalence of diabetes is increasing in low-income and middle-income countries where the burden of tuberculosis is high, prevention of diabetes carries the potential to improve tuberculosis control worldwide. METHODS We used dynamic tuberculosis transmission models to analyse the potential effect of diabetes on tuberculosis epidemiology in 13 countries with high tuberculosis burden. We used data for previous diabetes prevalence in each country and constructed scenarios to represent the potential ranges of future diabetes prevalence. The country-specific model was calibrated to the estimated trend of tuberculosis incidence. We estimated the tuberculosis burden that can be reduced by alternative scenarios of diabetes prevention. FINDINGS If the prevalence of diabetes continues to rise as it has been in the past decade in the 13 countries (base case scenario), by 2035, the cumulative reduction in tuberculosis incidence would be 8·8% (95% credible interval [CrI] 4·0-15·8) and mortality would be 34·0% (30·3-39·6). Lowering the prevalence of diabetes by an absolute level of 6·6-13·8% could accelerate the decline of tuberculosis incidence by an absolute level of 11·5-25·2% and tuberculosis mortality by 8·7-19·4%. Compared with the base case scenario, stopping the rise of diabetes would avoid 6·0 million (95% CrI 5·1-6·9) incident cases and 1·1 million (1·0-1·3) tuberculosis deaths in 13 countries during 20 years. If interventions reduce diabetes incidence by 35% by 2025, 7·8 million (6·7-9·0) tuberculosis cases and 1·5 million (1·3-1·7) tuberculosis deaths could be averted by 2035. INTERPRETATION The diabetes epidemic could substantially affect tuberculosis epidemiology in high burden countries. The communicable disease and non-communicable disease sectors need to move beyond conventional boundaries and link with each other to form a joint response to diabetes and tuberculosis. FUNDING Taiwan National Science Council.
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Affiliation(s)
- Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chu-Chang Ku
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Diana Kao
- Department of Epidemiology and Biostatistics, University of British Columbia, Vancouver, Canada
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - Chi-Tai Fang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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170
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Hodgson K, Morris J, Bridson T, Govan B, Rush C, Ketheesan N. Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology 2015; 144:171-85. [PMID: 25262977 DOI: 10.1111/imm.12394] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/12/2014] [Accepted: 08/19/2014] [Indexed: 12/11/2022] Open
Abstract
Diabetes has been recognized as an important risk factor for a variety of intracellular bacterial infections, but research into the dysregulated immune mechanisms contributing to the impaired host-pathogen interactions is in its infancy. Diabetes is characterized by a chronic state of low-grade inflammation due to activation of pro-inflammatory mediators and increased formation of advanced glycation end products. Increased oxidative stress also exacerbates the chronic inflammatory processes observed in diabetes. The reduced phagocytic and antibacterial activity of neutrophils and macrophages provides an intracellular niche for the pathogen to replicate. Phagocytic and antibacterial dysfunction may be mediated directly through altered glucose metabolism and oxidative stress. Furthermore, impaired activation of natural killer cells contributes to decreased levels of interferon-γ, required for promoting macrophage antibacterial mechanisms. Together with impaired dendritic cell function, this impedes timely activation of adaptive immune responses. Increased intracellular oxidation of antigen-presenting cells in individuals with diabetes alters the cytokine profile generated and the subsequent balance of T-cell immunity. The establishment of acute intracellular bacterial infections in the diabetic host is associated with impaired T-cell-mediated immune responses. Concomitant to the greater intracellular bacterial burden and potential cumulative effect of chronic inflammatory processes, late hyper-inflammatory cytokine responses are often observed in individuals with diabetes, contributing to systemic pathology. The convergence of intracellular bacterial infections and diabetes poses new challenges for immunologists, providing the impetus for multidisciplinary research.
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Affiliation(s)
- Kelly Hodgson
- Infectious Diseases and Immunopathogenesis Research Group, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Qld, Australia
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171
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Zumla A, Rao M, Parida SK, Keshavjee S, Cassell G, Wallis R, Axelsson-Robertsson R, Doherty M, Andersson J, Maeurer M. Inflammation and tuberculosis: host-directed therapies. J Intern Med 2015; 277:373-87. [PMID: 24717092 DOI: 10.1111/joim.12256] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tuberculosis (TB) is an airborne infectious disease that kills almost two million individuals every year. Multidrug-resistant (MDR) TB is caused by strains of Mycobacterium tuberculosis (M. tb) resistant to isoniazid and rifampin, the backbone of first-line antitubercular treatment. MDR TB affects an estimated 500,000 new patients annually. Genetic analysis of drug-resistant MDR-TB showed that airborne transmission of undetected and untreated strains played a major role in disease outbreaks. The need for new TB vaccines and faster diagnostics, as well as the development of new drugs, has recently been highlighted. The major problem in terms of current TB research and clinical demands is the increasing number of cases of extensively drug-resistant and 'treatment-refractory' TB. An emerging scenario of adjunct host-directed therapies is intended to target pulmonary TB where inflammatory processes can be deleterious and lead to immune exhaustion. 'Target-organ-saving' strategies may be warranted to prevent damage to infected tissues and achieve focused, clinically relevant and long-lasting anti-M. tb cellular immune responses. Candidates for such interventions may be biological agents or already approved drugs that can be 're-purposed' to interfere with biologically relevant cellular checkpoints. Here, we review current concepts of inflammation in TB disease and discuss candidate pathways for host-directed therapies to achieve better clinical outcomes.
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Affiliation(s)
- A Zumla
- University College London, University College London Hospitals NHS Foundation Trust, London, UK
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172
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Okumura K, Kato M, Kirikae T, Kayano M, Miyoshi-Akiyama T. Construction of a virtual Mycobacterium tuberculosis consensus genome and its application to data from a next generation sequencer. BMC Genomics 2015; 16:218. [PMID: 25879806 PMCID: PMC4425900 DOI: 10.1186/s12864-015-1368-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although Mycobacterium tuberculosis isolates are consisted of several different lineages and the epidemiology analyses are usually assessed relative to a particular reference genome, M. tuberculosis H37Rv, which might introduce some biased results. Those analyses are essentially based genome sequence information of M. tuberculosis and could be performed in sillico in theory, with whole genome sequence (WGS) data available in the databases and obtained by next generation sequencers (NGSs). As an approach to establish higher resolution methods for such analyses, whole genome sequences of the M. tuberculosis complexes (MTBCs) strains available on databases were aligned to construct virtual reference genome sequences called the consensus sequence (CS), and evaluated its feasibility in in sillico epidemiological analyses. RESULTS The consensus sequence (CS) was successfully constructed and utilized to perform phylogenetic analysis, evaluation of read mapping efficacy, which is crucial for detecting single nucleotide polymorphisms (SNPs), and various MTBC typing methods virtually including spoligotyping, VNTR, Long sequence polymorphism and Beijing typing. SNPs detected based on CS, in comparison with H37Rv, were utilized in concatemer-based phylogenetic analysis to determine their reliability relative to a phylogenetic tree based on whole genome alignment as the gold standard. Statistical comparison of phylogenic trees based on CS with that of H37Rv indicated the former showed always better results that that of later. SNP detection and concatenation with CS was advantageous because the frequency of crucial SNPs distinguishing among strain lineages was higher than those of H37Rv. The number of SNPs detected was lower with the consensus than with the H37Rv sequence, resulting in a significant reduction in computational time. Performance of each virtual typing was satisfactory and accorded with those published when those are available. CONCLUSIONS These results indicated that virtual CS constructed from genome sequence data is an ideal approach as a reference for MTBC studies.
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Affiliation(s)
- Kayo Okumura
- Department of Animal and Food Hygiene, Obihiro University of Agriculture and Veterinary Medicine, Inada-cho, Obihiro, Hokkaido, 080-8555, Japan.
| | - Masako Kato
- Department of Infectious Diseases, National Center for Global Health and Medicine, 1-21-1, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Teruo Kirikae
- Department of Infectious Diseases, National Center for Global Health and Medicine, 1-21-1, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Mitsunori Kayano
- Department of Animal and Food Hygiene, Obihiro University of Agriculture and Veterinary Medicine, Inada-cho, Obihiro, Hokkaido, 080-8555, Japan.
| | - Tohru Miyoshi-Akiyama
- Department of Infectious Diseases, National Center for Global Health and Medicine, 1-21-1, Shinjuku-ku, Tokyo, 162-8655, Japan.
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173
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Zumla A, Chakaya J, Centis R, D'Ambrosio L, Mwaba P, Bates M, Kapata N, Nyirenda T, Chanda D, Mfinanga S, Hoelscher M, Maeurer M, Migliori GB. Tuberculosis treatment and management—an update on treatment regimens, trials, new drugs, and adjunct therapies. THE LANCET RESPIRATORY MEDICINE 2015; 3:220-34. [DOI: 10.1016/s2213-2600(15)00063-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 01/08/2023]
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174
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Byrne AL, Marais BJ, Mitnick CD, Lecca L, Marks GB. Tuberculosis and chronic respiratory disease: a systematic review. Int J Infect Dis 2015; 32:138-46. [DOI: 10.1016/j.ijid.2014.12.016] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/05/2014] [Indexed: 11/24/2022] Open
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175
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Viney K, Cavanaugh J, Kienene T, Harley D, Kelly PM, Sleigh A, O'Connor J, Mase S. Tuberculosis and diabetes mellitus in the Republic of Kiribati: a case-control study. Trop Med Int Health 2015; 20:650-657. [PMID: 25598275 DOI: 10.1111/tmi.12462] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To better inform local management of TB-diabetes collaborative activities, we aimed to determine the prevalence of diabetes among persons with and without TB and to determine the association between TB and diabetes in Kiribati, a Pacific Island nation. METHODS We compared consecutively enrolled TB cases to a group of randomly selected community controls without evidence of TB. Diabetes was diagnosed by HbA1c, and clinical and demographic data were collected. A tuberculin skin test was administered to controls. The chi-square test was used to assess significance in differences between cases and controls. We also calculated an odds ratio, with 95% confidence intervals, for the odds of diabetes among cases relative to controls. Unweighted multivariate logistic regression was performed to adjust for the effects of age and sex. RESULTS A total of 275 TB cases and 499 controls were enrolled. The diabetes prevalence in cases (101, 37%) was significantly greater than in controls (94, 19%) (adjusted odds ratio: 2.8; 95% CI 2.0-4.1). Fifty-five percent (108) of all diabetic diagnoses were new; this proportion was higher among controls (64.8%) than cases (46.5%). Five patients with TB were screened to detect one patient with diabetes. CONCLUSIONS There is a strong association between TB and diabetes in Kiribati and bidirectional screening should be conducted in this setting.
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Affiliation(s)
- K Viney
- Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - J Cavanaugh
- Division of TB Elimination, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - T Kienene
- National TB Programme, Ministry of Health and Medical Services, Tarawa, Kiribati
| | - D Harley
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - P M Kelly
- Population Health Division, ACT Health Directorate, Canberra, ACT, Australia.,Australian National University Medical School, Canberra, ACT, Australia
| | - A Sleigh
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - J O'Connor
- Public Health Consultant, Auckland, New Zealand
| | - S Mase
- Division of TB Elimination, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
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176
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Fluegge KR. Using Spatial Disease Patterns and Patient-Level Characteristics to Describe Prevalence Elastic Behavior in Treatment for Latent Tuberculosis Infection (LTBI). Public Health Nurs 2015; 32:517-31. [PMID: 25655175 DOI: 10.1111/phn.12170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individual adherence to a 9-month regimen of isoniazid (9INH) for treatment of latent tuberculosis infection (LTBI) was hypothesized to reflect a prevalent elastic health behavior pattern, or prevention behavior correlated with relevant disease burden. METHOD Log-rank tests were used to compare survival functions among raw prevalence tertiles for diseases including TB, diabetes, and obesity. Own and cross-prevalence elasticities were calculated and spatially characterized behavioral response to diseases that may impact TB re-infection and/or re-activation. Discrete choice models were used to assess the significance of the spatial elasticities among an ethnically diverse clinic population of 552 patients in an urban American county in 2010. RESULTS Log-rank results revealed a statistical association between dropout and chronic disease prevalence (p < .01), but not TB prevalence (p = .13). Discrete choice models incorporating spatial elasticities and controlling for patient- and treatment-level characteristics demonstrated significant associations with adherence (p < .01), an effect robust to various alternative treatment definitions. CONCLUSION Individual LTBI adherence tracks a prevalence elastic pattern that may represent a potential risk for re-infection and re-activation.
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Affiliation(s)
- Kyle R Fluegge
- Agricultural, Environmental, and Development Economics, College of Food, Agriculture and Environmental Sciences and Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio.,Institute of Health and Environmental Research (IHER), Cleveland, Ohio.,Department of Epidemiology and Biostatistics, Case Western Reserve University, 2103 Cornell Road, Cleveland, OH, 44106
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177
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Bates M, Marais BJ, Zumla A. Tuberculosis Comorbidity with Communicable and Noncommunicable Diseases. Cold Spring Harb Perspect Med 2015; 5:cshperspect.a017889. [PMID: 25659380 DOI: 10.1101/cshperspect.a017889] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The 18th WHO Global Tuberculosis Annual Report indicates that there were an estimated 8.6 million incident cases of tuberculosis (TB) in 2012, which included 2.9 million women and 530,000 children. TB caused 1.3 million deaths including 320,000 human immunodeficiency virus (HIV)-infected people; three-quarters of deaths occurred in Africa and Southeast Asia. With one-third of the world's population latently infected with Mycobacterium tuberculosis (Mtb), active TB disease is primarily associated with a break down in immune surveillance. This explains the strong link between active TB disease and other communicable diseases (CDs) or noncommunicable diseases (NCDs) that exert a toll on the immune system. Comorbid NCD risk factors include diabetes, smoking, malnutrition, and chronic lung disease, all of which have increased relentlessly over the past decade in developing countries. The huge overlap between killer infections such as TB, HIV, malaria, and severe viral infections with NCDs, results in a "double burden of disease" in developing countries. The current focus on vertical disease programs fails to recognize comorbidities or to encourage joint management approaches. This review highlights major disease overlaps and discusses the rationale for better integration of tuberculosis care with services for NCDs and other infectious diseases to enhance the overall efficiency of the public health responses.
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Affiliation(s)
- Matthew Bates
- University of Zambia-University College London Medical School (UNZA-UCLMS) Research and Training Project, University Teaching Hospital, Lusaka RW1X, Zambia Center for Clinical Microbiology, Department of Infection, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI) and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Alimuddin Zumla
- National Institute of Health Research, Biomedical Research Centre, Royal Free Campus Rowland Hill St, University College London Hospitals, London NW3 2PF, United Kingdom
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178
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Kumar NP, Banurekha VV, Nair D, Sridhar R, Kornfeld H, Nutman TB, Babu S. Coincident pre-diabetes is associated with dysregulated cytokine responses in pulmonary tuberculosis. PLoS One 2014; 9:e112108. [PMID: 25393696 PMCID: PMC4230980 DOI: 10.1371/journal.pone.0112108] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/13/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cytokines play an important role in the pathogenesis of pulmonary tuberculosis (PTB)--Type 2 diabetes mellitus co-morbidity. However, the cytokine interactions that characterize PTB coincident with pre-diabetes (PDM) are not known. METHODS To identify the influence of coincident PDM on cytokine levels in PTB, we examined circulating levels of a panel of cytokines in the plasma of individuals with TB-PDM and compared them with those without PDM (TB-NDM). RESULTS TB-PDM is characterized by elevated circulating levels of Type 1 (IFNγ, TNFα and IL-2), Type 17 (IL-17A and IL-17F) and other pro-inflammatory (IL-1β, IFNβ and GM-CSF) cytokines. TB-PDM is also characterized by increased systemic levels of Type 2 (IL-5) and regulatory (IL-10 and TGFβ) cytokines. Moreover, TB antigen stimulated whole blood also showed increased levels of pro-inflammatory (IFNγ, TNFα and IL-1β) cytokines as well. However, the cytokines did not exhibit any significant correlation with HbA1C levels or with bacterial burdens. CONCLUSION Our data reveal that pre-diabetes in PTB individuals is characterized by heightened cytokine responsiveness, indicating that a balanced pro and anti - inflammatory cytokine milieu is a feature of pre-diabetes--TB co-morbidity.
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Affiliation(s)
- Nathella Pavan Kumar
- National Institutes of Health—International Center for Excellence in Research, Chennai, India
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Dina Nair
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Subash Babu
- National Institutes of Health—International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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179
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Characteristics and TB treatment outcomes in TB patients with viral hepatitis, New York City, 2000-2010. Epidemiol Infect 2014; 143:1972-81. [PMID: 25387450 DOI: 10.1017/s0950268814002970] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Literature surrounding the burden of and factors associated with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in persons with tuberculosis (TB) disease remains limited and focused on populations outside the USA. Cross-matched New York City (NYC) TB and viral hepatitis surveillance data were used to estimate the proportion of NYC adults diagnosed with TB from 2000 to 2010 with a report of viral hepatitis infection and to describe the impact of viral hepatitis infection on TB treatment completion and death. For 9512 TB patients, HCV infection was reported in 4.2% and HBV infection in 3.7%; <1% of TB patients had both HCV and HBV infection. The proportion of TB patients with HCV infection to die before TB treatment completion was larger than in TB patients without a viral hepatitis report (21% vs. 9%); this association remained when stratified by HIV status. There was no significant difference in death before treatment completion for TB patients with HBV infection compared to TB patients without a viral hepatitis report when stratified by HIV status. These findings reinforce the importance of hepatitis testing and providing additional support to TB patients with viral hepatitis infection.
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180
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Abstract
World War 1 was a key transition point towards scientific medicine. Medical officers incorporated Louis Pasteur's discoveries into their understanding of microorganisms as the cause of infectious diseases, which were therefore susceptible to rational control and treatment measures even in the pre-antibiotic era. Typhoid vaccination led to the successful evasion of the disastrous epidemics of previous wars. The incidence of tetanus was probably decreased by giving millions of doses of horse antitoxin to wounded soldiers. Quinine treated but could not control malaria; its use required mass compulsion. Tuberculosis was not a great military problem during World War 1, although mortality in civilian populations increased substantially. Treatment of sexually transmitted infections remained a matter of aversive conditioning, with invasive antiseptics used in the absence of antibiotics. Pandemic influenza in 1918-19 killed more people than died during the entire war, showing how much remained beyond the capability of the scientists and doctors who fought infectious diseases during World War 1.
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Affiliation(s)
- G Dennis Shanks
- Australian Army Malaria Institute, Enoggera, QLD, Australia; Centre for Australian Military and Veterans' Health, School of Population Health, University of Queensland, Brisbane, QLD, Australia; Department of Zoology, Oxford University, Oxford, UK.
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181
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Moni MA, Liò P. Network-based analysis of comorbidities risk during an infection: SARS and HIV case studies. BMC Bioinformatics 2014; 15:333. [PMID: 25344230 PMCID: PMC4363349 DOI: 10.1186/1471-2105-15-333] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 09/19/2014] [Indexed: 01/02/2023] Open
Abstract
Background Infections are often associated to comorbidity that increases the risk of medical conditions which can lead to further morbidity and mortality. SARS is a threat which is similar to MERS virus, but the comorbidity is the key aspect to underline their different impacts. One UK doctor says "I’d rather have HIV than diabetes" as life expectancy among diabetes patients is lower than that of HIV. However, HIV has a comorbidity impact on the diabetes. Results We present a quantitative framework to compare and explore comorbidity between diseases. By using neighbourhood based benchmark and topological methods, we have built comorbidity relationships network based on the OMIM and our identified significant genes. Then based on the gene expression, PPI and signalling pathways data, we investigate the comorbidity association of these 2 infective pathologies with other 7 diseases (heart failure, kidney disorder, breast cancer, neurodegenerative disorders, bone diseases, Type 1 and Type 2 diabetes). Phenotypic association is measured by calculating both the Relative Risk as the quantified measures of comorbidity tendency of two disease pairs and the ϕ-correlation to measure the robustness of the comorbidity associations. The differential gene expression profiling strongly suggests that the response of SARS affected patients seems to be mainly an innate inflammatory response and statistically dysregulates a large number of genes, pathways and PPIs subnetworks in different pathologies such as chronic heart failure (21 genes), breast cancer (16 genes) and bone diseases (11 genes). HIV-1 induces comorbidities relationship with many other diseases, particularly strong correlation with the neurological, cancer, metabolic and immunological diseases. Similar comorbidities risk is observed from the clinical information. Moreover, SARS and HIV infections dysregulate 4 genes (ANXA3, GNS, HIST1H1C, RASA3) and 3 genes (HBA1, TFRC, GHITM) respectively that affect the ageing process. It is notable that HIV and SARS similarly dysregulated 11 genes and 3 pathways. Only 4 significantly dysregulated genes are common between SARS-CoV and MERS-CoV, including NFKBIA that is a key regulator of immune responsiveness implicated in susceptibility to infectious and inflammatory diseases. Conclusions Our method presents a ripe opportunity to use data-driven approaches for advancing our current knowledge on disease mechanism and predicting disease comorbidities in a quantitative way. Electronic supplementary material The online version of this article (doi:10.1186/1471-2105-15-333) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammad Ali Moni
- Computer Laboratory, University of Cambridge, William Gates Building, 15 JJ Thomson Avenue, Cambridge CB3 0FD, UK.
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182
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Odone A, Houben RMGJ, White RG, Lönnroth K. The effect of diabetes and undernutrition trends on reaching 2035 global tuberculosis targets. Lancet Diabetes Endocrinol 2014; 2:754-64. [PMID: 25194888 DOI: 10.1016/s2213-8587(14)70164-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To achieve the post-2015 global tuberculosis target of 90% reduction in tuberculosis incidence by 2035, the present rate of decline must accelerate. Among factors that hinder tuberculosis control, malnutrition and diabetes are key challenges. We review available data to describe the complex relationship between tuberculosis, diabetes, and nutritional status. Additionally, we review past trends, present burden, and available future global projections for diabetes, overweight and obesity, as well as undernutrition and food insecurity. Using a mathematical model, we estimate the potential effect of these factors on tuberculosis burden up to 2035. Great potential exists for reduction of worldwide tuberculosis burden by combination of improved prevention and care of diabetes with reduction of undernutrition. To achieve this combination will require joint efforts and strong cross-programme links, enabling synergistic effects of public health policies that promote good nutrition and optimum clinical care for tuberculosis and diabetes.
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Affiliation(s)
- Anna Odone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Rein M G J Houben
- Tuberculosis Modelling Group, Tuberculosis Centre and Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard G White
- Tuberculosis Modelling Group, Tuberculosis Centre and Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Knut Lönnroth
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
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183
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Lönnroth K, Roglic G, Harries AD. Improving tuberculosis prevention and care through addressing the global diabetes epidemic: from evidence to policy and practice. Lancet Diabetes Endocrinol 2014; 2:730-9. [PMID: 25194886 DOI: 10.1016/s2213-8587(14)70109-3] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diabetes triples the risk of tuberculosis and is also a risk factor for adverse tuberculosis treatment outcomes, including death. Prevalence of diabetes is increasing globally, but most rapidly in low-income and middle-income countries where tuberculosis is a grave public health problem. Growth in this double disease burden creates additional obstacles for tuberculosis care and prevention. We review how the evolution of evidence on the link between tuberculosis and diabetes has informed global policy on collaborative activities, and how practice is starting to change as a consequence. We conclude that coordinated planning and service delivery across communicable and non-communicable disease programmes is necessary, feasible, and creates synergies that will help to reduce the burden of both tuberculosis and diabetes.
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Affiliation(s)
- Knut Lönnroth
- Departments of Global TB Programme, World Health Organization, Geneva, Switzerland.
| | - Gojka Roglic
- Management of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
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184
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Riza AL, Pearson F, Ugarte-Gil C, Alisjahbana B, van de Vijver S, Panduru NM, Hill PC, Ruslami R, Moore D, Aarnoutse R, Critchley JA, van Crevel R. Clinical management of concurrent diabetes and tuberculosis and the implications for patient services. Lancet Diabetes Endocrinol 2014; 2:740-53. [PMID: 25194887 PMCID: PMC4852378 DOI: 10.1016/s2213-8587(14)70110-x] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in patients with tuberculosis, and screening and preventive therapy for latent tuberculosis infections in individuals with diabetes. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher risk of drug toxicity than tuberculosis patients without diabetes. Good glycaemic control, which reduces long-term diabetes complications and could also improve tuberculosis treatment outcomes, is hampered by chronic inflammation, drug-drug interactions, suboptimum adherence to drug treatments, and other factors. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. From a health systems point of view, delivery of optimum care and integration of services for tuberculosis and diabetes is a huge challenge in many countries. Experience from the combined tuberculosis and HIV/AIDS epidemic could serve as an example, but more studies are needed that include economic assessments of recommended screening and systems to manage concurrent tuberculosis and diabetes.
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Affiliation(s)
- Anca Lelia Riza
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands; Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Fiona Pearson
- Population Health Research Institute, St Georges University, London, UK
| | - Cesar Ugarte-Gil
- Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bachti Alisjahbana
- Center for TB-HIV research, Medical Faculty, Padjadjaran University, Hasan Sadikin Hosptial, Bandung, Indonesia
| | - Steven van de Vijver
- African Population and Health Research Center, Nairobi, Kenya; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Nicolae M Panduru
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania; 2nd Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Philip C Hill
- Centre for International Health, Faculty of Medicine, Otago University, Dunedin, New Zealand
| | - Rovina Ruslami
- Department of Pharmacology and Therapy, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - David Moore
- London School of Hygiene and Tropical Medicine, London, UK
| | - Rob Aarnoutse
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Julia A Critchley
- Population Health Research Institute, St Georges University, London, UK
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
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185
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Lyons MA. Computational pharmacology of rifampin in mice: an application to dose optimization with conflicting objectives in tuberculosis treatment. J Pharmacokinet Pharmacodyn 2014; 41:613-23. [PMID: 25173151 DOI: 10.1007/s10928-014-9380-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
Dose selection for rifampin in the treatment of active pulmonary tuberculosis (TB) illustrates some of the challenges for dose optimization within multidrug therapies. Rifampin-based anti-TB regimens are often combined with antiretroviral therapies to treat human immunodeficiency virus (HIV) coinfection. The potent cytochrome P450 (CYP) enzyme inducing properties of rifampin give rise to significant drug-drug interactions, the minimization of which by limiting the dose, conflicts with the maximization of bacterial killing by increasing the dose. Such multiple and conflicting objectives lead to a set of trade-off optimal solutions for dose optimization rather than a single best solution. Here, we combine pharmacokinetic/pharmacodynamic (PK/PD) modeling with multiobjective optimization to quantitatively explore trade-offs between therapeutic and adverse effects of optimal dosing for the example of rifampin in TB-infected mice. The PK/PD model describes rifampin concentrations in plasma and liver following oral administration together with hepatic CYP enzyme induction and bacterial killing kinetics. We include optimization objectives descriptive of antimicrobial efficacy, CYP-mediated drug-drug interactions, and drug exposure-dependent toxicity. Results show non-conventional dosing scenarios that allow for increased efficacy relative to uniform dosing without increasing drug-drug interactions. Additionally, we find currently employed dosages for rifampin to be nearly optimal with respect to trade-offs between efficacy and toxicity. While limited by the accuracy and applicability of the PK/PD model, these results provide an avenue for experimental investigation of complex dose optimization problems. This method can be extended to include additional drugs and optimization objectives, and may provide a useful tool for individualized medicine.
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Affiliation(s)
- Michael A Lyons
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA,
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186
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Temporal dynamics of Mycobacterium tuberculosis genotypes in New South Wales, Australia. BMC Infect Dis 2014; 14:455. [PMID: 25149181 PMCID: PMC4262242 DOI: 10.1186/1471-2334-14-455] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 08/12/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Molecular epidemiology of Mycobacterium tuberculosis, its transmission dynamics and population structure have become important determinants of targeted tuberculosis control programs. Here we describe recent changes in the distribution of M. tuberculosis genotypes in New South Wales (NSW), Australia and compared strain types with drug resistance, site of disease and demographic data. METHODS We evaluated all culture-confirmed newly identified tuberculosis cases in NSW, Australia, from 2010-2012. M. tuberculosis population structure and clustering rates were assessed using 24-loci Mycobacterial interspersed repetitive unit (MIRU) analysis and compared to MIRU data from 2006-2008. RESULTS Of 1177 tuberculosis cases, 1128 (95.8%) were successfully typed. Beijing and East African Indian (EAI) lineage strains were most common (27.6% and 28.5%, respectively) with EAI strains increasing in relative abundance from 11.8% in 2006-2008 to 28.5% in 2010-2012. Few cases of multi-drug resistant tuberculosis were identified (18; 1.7%). Compared to 12-loci, 24-loci MIRU provided improved cluster resolution with 695 (61.6%) and 227 (20.1%) clustered cases identified, respectively. Detailed analysis of the largest cluster identified (an 11 member Beijing cluster) revealed wide geographic diversity in the absence of documented social contact. CONCLUSIONS EAI strains of M. tuberculosis recently overtook Beijing family as a prevalent cause of tuberculosis in NSW, Australia. This lineage appeared to be less commonly related to multi-drug resistant tuberculosis as compared to Beijing strain lineage. The resolution provided by 24-loci MIRU typing was insufficient for reliable assessment of transmissions, especially of Beijing family strains.
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187
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Bruixola G, Díaz-Beveridge R, Jiménez E, Caballero J, Salavert M, Escoin C, Aparicio J. Pleuropulmonary angiosarcoma involving the liver, the jejunum and the spine, developed from chronic tuberculosis pyothorax: Multidisciplinary approach and review of literature. Lung Cancer 2014; 86:105-11. [PMID: 25097031 DOI: 10.1016/j.lungcan.2014.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/04/2014] [Accepted: 07/15/2014] [Indexed: 02/07/2023]
Abstract
Pleuropulmonary angiosarcomas are very rare, with less than fifty cases reported in the literature. In most cases, the etiology is unknown but the presence of a chronic tuberculous pyothorax has been reported in several Asian case reports as a possible risk factor. We report the case of a Caucasian 68-year old man who presented with a pleuropulmonary angiosarcoma that arose from a chronic tuberculous pyothorax and which involved the ribs and the vertebrae, the psoas muscle, and the jejunum. The patient received adapted anti-tuberculosis treatment, embolization of the mass in the small bowel, palliative external beam radiotherapy on the spine and systemic chemotherapy with liposomal non-pegylated doxorubicin and ifosfamide. With this multidisciplinary approach the patient's symptoms were well controlled and he achieved a complete metabolic response after six cycles of chemotherapy. Unfortunately, the patient died after eight months from the beginning of chemotherapy due to an acute lung injury secondary to extensive bilateral interstitial infiltrates. Opportunistic pathogens or drug-induced lung toxicity were the most probable causes. Treatment with liposomal non-pegylated doxorubicin and ifosfamide could be a reasonable option in pleuropulmonary angiosarcoma but it should be validated in clinical trials. Chronic pyothorax seems to be a predisposing factor for the development of pleural angiosarcoma but further investigations are required to assess a causal association.
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Affiliation(s)
- Gema Bruixola
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
| | | | - Enrique Jiménez
- Pathology Department, University Hospital La Fe, Valencia, Spain
| | - Javier Caballero
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Miguel Salavert
- Infectious Diseases Unit, Internal Medicine Department, University Hospital La Fe, Valencia, Spain
| | - Corina Escoin
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Jorge Aparicio
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
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188
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Jørgensen ME, Faurholt-Jepsen D. Is there an effect of glucose lowering treatment on incidence and prognosis of tuberculosis? A systematic review. Curr Diab Rep 2014; 14:505. [PMID: 24806518 DOI: 10.1007/s11892-014-0505-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The association between diabetes and incidence of tuberculosis is well established, and observational studies have shown poor treatment outcome in tuberculosis related to hyperglycemia. The WHO recommends screening for diabetes among all patients with tuberculosis and optimized glycemic control aiming at improving tuberculosis outcome. However, no intervention studies support this notion. Patients with tuberculosis are often vulnerable with high degree of comorbidity, and, therefore, at high risk of adverse effects of intensive glucose control. Controlled intervention studies of the effect of glucose lowering treatment on tuberculosis outcomes are clearly warranted to justify screening for- and tight control of diabetes.
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189
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Chronic diseases and multi-morbidity--a conceptual modification to the WHO ICCC model for countries in health transition. BMC Public Health 2014; 14:575. [PMID: 24912531 PMCID: PMC4071801 DOI: 10.1186/1471-2458-14-575] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 06/04/2014] [Indexed: 11/25/2022] Open
Abstract
Background The burden of non-communicable diseases is rising, particularly in low and middle-income countries undergoing rapid epidemiological transition. In sub-Saharan Africa, this is occurring against a background of infectious chronic disease epidemics, particularly HIV and tuberculosis. Consequently, multi-morbidity, the co-existence of more than one chronic condition in one person, is increasing; in particular multimorbidity due to comorbid non-communicable and infectious chronic diseases (CNCICD). Such complex multimorbidity is a major challenge to existing models of healthcare delivery and there is a need to ensure integrated care across disease pathways and across primary and secondary care. Discussion The Innovative Care for Chronic Conditions (ICCC) Framework developed by the World Health Organization provides a health systems roadmap to meet the increasing needs of chronic disease care. This framework incorporates community, patient, healthcare and policy environment perspectives, and forms the cornerstone of South Africa’s primary health care re-engineering and strategic plan for chronic disease management integration. However, it does not significantly incorporate complexity associated with multimorbidity and CNCICD. Using South Africa as a case study for a country in transition, we identify gaps in the ICCC framework at the micro-, meso-, and macro-levels. We apply the lens of CNCICD and propose modification of the ICCC and the South African Integrated Chronic Disease Management plan. Our framework incorporates the increased complexity of treating CNCICD patients, and highlights the importance of biomedicine (biological interaction). We highlight the patient perspective using a patient experience model that proposes that treatment adherence, healthcare utilization, and health outcomes are influenced by the relationship between the workload that is delegated to patients by healthcare providers, and patients’ capacity to meet the demands of this workload. We link these issues to provider perspectives that interact with healthcare delivery and utilization. Summary Our proposed modification to the ICCC Framework makes clear that healthcare systems must work to make sense of the complex collision between biological phenomena, clinical interpretation, beliefs and behaviours that follow from these. We emphasize the integration of these issues with the socio-economic environment to address issues of complexity, access and equity in the integrated management of chronic diseases previously considered in isolation.
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190
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Abstract
Running over timescales that span decades or centuries, the epidemiological transition provides the central narrative of global health. In this transition, a reduction in mortality is followed by a reduction in fertility, creating larger, older populations in which the main causes of illness and death are no longer acute infections of children but chronic diseases of adults. Since the year 2000, the Millennium Development Goals (MDGs) have provided a framework for accelerating the decline of infectious diseases, backed by a massive injection of foreign investment to low-income countries. Despite the successes of the MDGs era, the inhabitants of low-income countries still suffer an enormous burden of disease owing to diarrhoea, pneumonia, HIV/AIDS, tuberculosis, malaria and other pathogens. Adding to the predictable burden of endemic disease, the threat of pandemics is ever-present and global. With a view to the future, this review spotlights five aspects of the fight against infection beyond 2015, when the MDGs will be replaced by a new set of goals for poverty reduction and sustainable development. These aspects are: exploiting the biological links between infectious and non-infectious diseases; controlling infections among the new urban majority; enhancing the response to international health threats; expanding childhood immunization programmes to prevent acute and chronic diseases in adults; and working towards universal health coverage. By scanning the wider horizon now, infectious disease specialists have the chance to shape the post-2015 era of health and development.
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Affiliation(s)
- Christopher Dye
- Office of the Director General, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland
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191
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Marais BJ, Schaaf HS, Graham SM. Child health and tuberculosis. THE LANCET RESPIRATORY MEDICINE 2014; 2:254-6. [DOI: 10.1016/s2213-2600(14)70009-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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192
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Vasan A, Ellner A, Lawn SD, Gove S, Anatole M, Gupta N, Drobac P, Nicholson T, Seung K, Mabey DC, Farmer PE. Integrated care as a means to improve primary care delivery for adults and adolescents in the developing world: a critical analysis of Integrated Management of Adolescent and Adult Illness (IMAI). BMC Med 2014; 12:6. [PMID: 24423387 PMCID: PMC3895758 DOI: 10.1186/1741-7015-12-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/17/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND More than three decades after the 1978 Declaration of Alma-Ata enshrined the goal of 'health for all', high-quality primary care services remain undelivered to the great majority of the world's poor. This failure to effectively reach the most vulnerable populations has been, in part, a failure to develop and implement appropriate and effective primary care delivery models. This paper examines a root cause of these failures, namely that the inability to achieve clear and practical consensus around the scope and aims of primary care may be contributing to ongoing operational inertia. The present work also examines integrated models of care as a strategy to move beyond conceptual dissonance in primary care and toward implementation. Finally, this paper examines the strengths and weaknesses of a particular model, the World Health Organization's Integrated Management of Adolescent and Adult Illness (IMAI), and its potential as a guidepost toward improving the quality of primary care delivery in poor settings. DISCUSSION Integration and integrated care may be an important approach in establishing a new paradigm of primary care delivery, though overall, current evidence is mixed. However, a number of successful specific examples illustrate the potential for clinical and service integration to positively impact patient care in primary care settings. One example deserving of further examination is the IMAI, developed by the World Health Organization as an operational model that integrates discrete vertical interventions into a comprehensive delivery system encompassing triage and screening, basic acute and chronic disease care, basic prevention and treatment services, and follow-up and referral guidelines. IMAI is an integrated model delivered at a single point-of-care using a standard approach to each patient based on the universal patient history and physical examination. The evidence base on IMAI is currently weak, but whether or not IMAI itself ultimately proves useful in advancing primary care delivery, it is these principles that should serve as the basis for developing a standard of integrated primary care delivery for adults and adolescents that can serve as the foundation for ongoing quality improvement. SUMMARY As integrated primary care is the standard of care in the developed world, so too must we move toward implementing integrated models of primary care delivery in poorer settings. Models such as IMAI are an important first step in this evolution. A robust and sustained commitment to innovation, research and quality improvement will be required if integrated primary care delivery is to become a reality in developing world.
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Affiliation(s)
- Ashwin Vasan
- Program in Global Primary Care and Social Change, Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health, Boston, MA, USA
- Partners In Health, Kigali, Rwanda
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Medicine, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA
| | - Andrew Ellner
- Program in Global Primary Care and Social Change, Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA, USA
| | - Stephen D Lawn
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandy Gove
- IMAI-IMCI Alliance, San Francisco, CA, USA
| | - Manzi Anatole
- Partners In Health, Boston, MA, USA
- Partners In Health, Kigali, Rwanda
| | - Neil Gupta
- Partners In Health, Boston, MA, USA
- Partners In Health, Kigali, Rwanda
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA, USA
| | - Peter Drobac
- Partners In Health, Boston, MA, USA
- Partners In Health, Kigali, Rwanda
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA, USA
| | - Tom Nicholson
- Partners In Health, Boston, MA, USA
- Partners In Health, Kigali, Rwanda
| | - Kwonjune Seung
- Partners In Health, Boston, MA, USA
- Partners In Health, Kigali, Rwanda
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA, USA
| | - David C Mabey
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul E Farmer
- Program in Global Primary Care and Social Change, Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health, Boston, MA, USA
- Partners In Health, Kigali, Rwanda
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA, USA
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193
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Weigl BH, Neogi T, McGuire H. Point-of-Care Diagnostics in Low-Resource Settings and Their Impact on Care in the Age of the Noncommunicable and Chronic Disease Epidemic. ACTA ACUST UNITED AC 2013; 19:248-57. [PMID: 24366968 DOI: 10.1177/2211068213515246] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Indexed: 11/16/2022]
Abstract
The emergence of point-of-care (POC) diagnostics specifically designed for low-resource settings coupled with the rapid increase in need for routine care of patients with chronic diseases should prompt reconsideration of how health care can be delivered most beneficially and cost-effectively in developing countries. Bolstering support for primary care to provide rapid and appropriate integrated acute and chronic care treatment may be a possible solution. POC diagnostics can empower local and primary care providers and enable them to make better clinical decisions. This article explores the opportunity for POC diagnostics to strengthen primary care and chronic disease diagnosis and management in a low-resource setting (LRS) to deliver appropriate, consistent, and integrated care. We analyze the requirements of resource-appropriate chronic disease care, the characteristics of POC diagnostics in LRS versus the developed world, the many roles of diagnostics in the care continuum in LRS, and the process and economics of developing LRS-compatible POC diagnostics.
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Affiliation(s)
- Bernhard H Weigl
- Program for Appropriate Technology in Health (PATH), Seattle, WA, USA
| | - Tina Neogi
- Program for Appropriate Technology in Health (PATH), Seattle, WA, USA University of Washington, Seattle, WA, USA
| | - Helen McGuire
- Program for Appropriate Technology in Health (PATH), Seattle, WA, USA
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194
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Point-of-care system for detection of Mycobacterium tuberculosis and rifampin resistance in sputum samples. J Clin Microbiol 2013; 52:502-7. [PMID: 24478480 DOI: 10.1128/jcm.02209-13] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Early detection of Mycobacterium tuberculosis complex (MTBC) and markers conveying drug resistance can have a beneficial impact on preventive public health actions. We describe here a new molecular point-of-care (POC) system, the Genedrive, which is based on simple sample preparation combined with PCR to detect MTBC and simultaneously detect mutation markers in the rpoB gene directly from raw sputum sample. Hybridization probes were used to detect the presence of the key mutations in codons 516, 526, and 531 of the rpoB gene. The sensitivities for MTBC and rpoB detection from sputum samples were assessed using model samples spiked with known numbers of bacteria prepared from liquid cultures of M. tuberculosis. The overall sensitivities were 90.8% (95% confidence interval [CI], 81, 96.5) for MTBC detection and 72.3% (95% CI, 59.8, 82.7) for rpoB detection. For samples containing ≥1,000 CFU/ml, the sensitivities were 100% for MTBC and 85.7% for rpoB detection, while for samples containing ≤100 CFU/ml, the sensitivities were 86.4% and 65.9% for MTBC and rpoB detection, respectively. The specificity was shown to be 100% (95% CI, 83.2, 100) for MTBC and rpoB. The clinical sputum samples were processed using the same protocol and showed good concordance with the data generated from the model. Tuberculosis-infected subjects with smear samples assessed as scanty or negative were detectable by the Genedrive system. In these paucibacillary patients, the performance of the Genedrive system was comparable to that of the GeneXpert assay. The characteristics of the Genedrive platform make it particularly useful for detecting MTBC and rifampin resistance in low-resource settings and for reducing the burden of tuberculosis disease.
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195
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Zumla A, George A, Sharma V, Herbert N. WHO's 2013 global report on tuberculosis: successes, threats, and opportunities. Lancet 2013; 382:1765-7. [PMID: 24269294 DOI: 10.1016/s0140-6736(13)62078-4] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alimuddin Zumla
- Division of Infection and Immunity, University College London, UCL Royal Free Campus and University College London Hospitals NHS Foundation Trust, London NW3 2PF, UK.
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Vasan A, Ellner A, Lawn SD, Gupta N, Anatole M, Drobac P, Nicholson T, Gove S, Seung K, Mabey D, Farmer P. Strengthening of primary-care delivery in the developing world: IMAI and the need for integrated models of care. LANCET GLOBAL HEALTH 2013; 1:e321-3. [PMID: 25104589 DOI: 10.1016/s2214-109x(13)70102-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ashwin Vasan
- Department of Medicine, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA; Partners In Health, Boston, MA, USA, and Rwanda; Program in Global Primary Care and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Andrew Ellner
- Program in Global Primary Care and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Stephen D Lawn
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Gupta
- Partners In Health, Boston, MA, USA, and Rwanda; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Peter Drobac
- Partners In Health, Boston, MA, USA, and Rwanda; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Sandy Gove
- IMAI-IMCI Alliance, former WHO IMAI Team Leader, WHO, Geneva, Switzerland
| | - Kwonjune Seung
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - David Mabey
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Farmer
- Partners In Health, Boston, MA, USA, and Rwanda; Program in Global Primary Care and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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197
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Whole-cell screening-based identification of inhibitors against the intraphagosomal survival of Mycobacterium tuberculosis. Antimicrob Agents Chemother 2013; 57:6372-7. [PMID: 24060878 DOI: 10.1128/aac.01444-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe here an efficient strategy that employs whole-cell-based screening and further short listing of the compounds by cytotoxicity- and fluorescence-based intracellular assays, resulting in potential bactericidal hits against the growth of Mycobacterium tuberculosis in broth culture as well as in phagosomes. These compounds also inhibited multidrug-resistant strains of M. tuberculosis but showed no or poor inhibition of nonpathogenic mycobacteria or other bacterial species such as Escherichia coli.
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198
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Bates M, Ahmed Y, Chilukutu L, Tembo J, Cheelo B, Sinyangwe S, Kapata N, Maeurer M, O'Grady J, Mwaba P, Zumla A. Use of the Xpert(®) MTB/RIF assay for diagnosing pulmonary tuberculosis comorbidity and multidrug-resistant TB in obstetrics and gynaecology inpatient wards at the University Teaching Hospital, Lusaka, Zambia. Trop Med Int Health 2013; 18:1134-1140. [PMID: 23834035 PMCID: PMC4016757 DOI: 10.1111/tmi.12145] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In high-tuberculosis (TB)-endemic countries, comorbidity of pulmonary TB in hospitalised patients with non-communicable diseases is well documented. In this study, we evaluated the use of the Xpert® MTB/RIF assay for the detection of concomitant pulmonary TB in patients admitted to the University Teaching Hospital, Lusaka, Zambia, with a primary obstetric or gynaecological condition. METHODS The Study population were inpatients admitted with a primary obstetric or gynaecological problem who had a concomitant cough and were able to expectorate a sputum sample. Sputum samples from 94 patients were analysed for the presence of Mycobacterium tuberculosis (M.tb) by standard smear microscopy, MGIT culture, MGIT drug-susceptibility testing (DST) and the Xpert® MTB/RIF assay. The sensitivity and specificity of the Xpert® MTB/RIF assay were evaluated against the culture gold standard. RESULTS Twenty-six of 94 (27.7%) patients had culture-confirmed pulmonary TB. The Xpert® MTB/RIF assay had a sensitivity of 80.8% [95% CI: 60.0–92.7%]) compared against MGIT culture. The Xpert® MTB/RIF assay was more sensitive than sputum smear microscopy (21/26 (80.8%) vs. 13/26 (50.0%), P = 0.02) and detected an additional eight culture-confirmed cases. Culture DST analysis identified two monoresistant M.tb strains: one resistant to rifampicin (rifampicin sensitive by the Xpert® MTB/RIF assay) and one to ethambutol. HIV infection was linked with a 3-fold increase in risk of TB, accounting for 87.5% (21/24) of TB cases. 50% of cases presented as comorbidities with other communicable diseases (CDs) and non-communicable diseases (NCDs). CONCLUSIONS As an alternative to sputum microscopy, the Xpert® MTB/RIF assay provides a sensitive, specific and rapid method for the diagnosis of pulmonary TB in obstetric or gynaecological inpatients. Pulmonary TB is an important cause of concomitant comorbidity to the obstetric or gynaecological condition necessitating admission. TB and HIV comorbidities with other communicable and non-communicable diseases were also common. More proactive screening for TB comorbidity is required in obstetric and gynaecological wards.
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Affiliation(s)
- Matthew Bates
- Center for Clinical Microbiology, University College, London, UK.,University of Zambia and University College London Medical School Research and Training Programme, Lusaka, Zambia
| | - Yusuf Ahmed
- Department of Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia
| | - Lophina Chilukutu
- University of Zambia and University College London Medical School Research and Training Programme, Lusaka, Zambia
| | - John Tembo
- University of Zambia and University College London Medical School Research and Training Programme, Lusaka, Zambia
| | - Busiku Cheelo
- University of Zambia and University College London Medical School Research and Training Programme, Lusaka, Zambia
| | - Sylvester Sinyangwe
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Nathan Kapata
- University of Zambia and University College London Medical School Research and Training Programme, Lusaka, Zambia.,National Tuberculosis Control Programme, Ministry of Health, Lusaka, Zambia
| | - Markus Maeurer
- Department of Tumour Immunology and Microbiology, Karolinska Institute, Stockholm, Sweden
| | - Justin O'Grady
- Center for Clinical Microbiology, University College, London, UK.,University of Zambia and University College London Medical School Research and Training Programme, Lusaka, Zambia
| | - Peter Mwaba
- University of Zambia and University College London Medical School Research and Training Programme, Lusaka, Zambia.,Ministry of Health, Lusaka, Zambia
| | - Alimuddin Zumla
- Center for Clinical Microbiology, University College, London, UK.,University of Zambia and University College London Medical School Research and Training Programme, Lusaka, Zambia
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Marais BJ, Graham SM, Maeurer M, Zumla A. Progress and challenges in childhood tuberculosis. THE LANCET. INFECTIOUS DISEASES 2013; 13:287-9. [DOI: 10.1016/s1473-3099(13)70031-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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