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Laycock KM, Enane LA, Steenhoff AP. Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People. Trop Med Infect Dis 2021; 6:148. [PMID: 34449722 PMCID: PMC8396328 DOI: 10.3390/tropicalmed6030148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 02/01/2023] Open
Abstract
Adolescents and young adults (AYA, ages 10-24 years) comprise a uniquely important but understudied population in global efforts to end tuberculosis (TB), the leading infectious cause of death by a single agent worldwide prior to the COVID-19 pandemic. While TB prevention and care strategies often overlook AYA by grouping them with either children or adults, AYA have particular physiologic, developmental, and social characteristics that require dedicated approaches. This review describes current evidence on the prevention and control of TB among AYA, including approaches to TB screening, dynamics of TB transmission among AYA, and management challenges within the context of unique developmental needs. Challenges are considered for vulnerable groups of AYA such as migrants and refugees; AYA experiencing homelessness, incarceration, or substance use; and AYA living with HIV. We outline areas for needed research and implementation strategies to address TB among AYA globally.
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Affiliation(s)
- Katherine M. Laycock
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Andrew P. Steenhoff
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
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Mowry JB, Shepherd G, Hoffman RS, Lavergne V, Gosselin S, Nolin TD, Vijayan A, Kielstein JT, Roberts DM, Ghannoum M. Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup. Pharmacotherapy 2021; 41:463-478. [PMID: 33660266 DOI: 10.1002/phar.2519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/11/2022]
Abstract
Isoniazid toxicity from self-poisoning or dosing errors remains common in regions of the world where tuberculosis is prevalent. Although the treatment of isoniazid poisoning is centered on supportive care and pyridoxine administration, extracorporeal treatments (ECTRs), such as hemodialysis, have been advocated to enhance elimination of isoniazid. No systematic reviews or evidence-based recommendations currently exist on the benefit of ECTRs for isoniazid poisoning. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup systematically collected and rated the available evidence on the effect of and indications for ECTRs in cases of isoniazid poisoning. We conducted a systematic review of the literature, screened studies, extracted data on study characteristics, outcomes, and measurement characteristics, summarized findings, and formulated recommendations following published EXTRIP methods. Forty-three studies (two animal studies, 34 patient reports or patient series, and seven pharmacokinetic studies) met inclusion criteria. Toxicokinetic or pharmacokinetic analysis was available for 60 patients, most treated with hemodialysis (n = 38). The workgroup assessed isoniazid as "Moderately Dialyzable" by hemodialysis for patients with normal kidney function (quality of evidence = C) and "Dialyzable" by hemodialysis for patients with impaired kidney function (quality of evidence = A). Clinical data for ECTR in isoniazid poisoning were available for 40 patients. Mortality of the cohort was 12.5%. Historical controls who received modern standard care including appropriately dosed pyridoxine generally had excellent outcomes. No benefit could be extrapolated from ECTR, although there was evidence of added costs and harms related to the double lumen catheter insertion, the extracorporeal procedure itself, and the extracorporeal removal of pyridoxine. The EXTRIP workgroup suggests against performing ECTR in addition to standard care (weak recommendation, very low quality of evidence) in patients with isoniazid poisoning. If standard dose pyridoxine cannot be administered, we suggest performing ECTR only in patients with seizures refractory to GABAA receptor agonists (weak recommendation, very low quality of evidence).
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Affiliation(s)
- James B Mowry
- Division of Medical Toxicology, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Greene Shepherd
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Valery Lavergne
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Sophie Gosselin
- Centre Intégré de Santé et de Services Sociaux (CISSS) Montérégie-Centre Emergency Department, Hôpital Charles-Lemoyne, Greenfield Park, Quebec, Canada.,Department of Emergency Medicine, McGill University, Montreal, Quebec, Canada.,Centre Antipoison du Québec, Montréal, Quebec, Canada
| | - Thomas D Nolin
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA.,Department of Medicine Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anitha Vijayan
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jan T Kielstein
- Medical Clinic V Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Darren M Roberts
- Departments of Renal Medicine and Transplantation and Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Drug Health Clinical Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Marc Ghannoum
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, University of Montreal, Montreal, Quebec, Canada
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Navalkele B, Bueno Rios MX, Wofford JD, Kumar V, Webb RM. Seizures in an Immunocompetent Adult From Treatment of Latent Tuberculosis Infection: Is Isoniazid to Blame? Open Forum Infect Dis 2020; 7:ofaa144. [PMID: 32462048 PMCID: PMC7237819 DOI: 10.1093/ofid/ofaa144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/21/2020] [Indexed: 12/03/2022] Open
Abstract
Isoniazid-induced seizures are a rare adverse reaction especially in immunocompetent adults. We report a case of a healthy man with seizures shortly after ingestion of his first therapeutic dose of isoniazid with rifapentine therapy for treatment of latent tuberculosis infection. Only 6 other similar cases are reported in the literature.
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Affiliation(s)
| | | | - John D Wofford
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Vijay Kumar
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Risa M Webb
- University of Mississippi Medical Center, Jackson, Mississippi, USA
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Kanegi R, Yasugi M, Nabetani T, Tanaka T, Wada Y, Hirai K, Sugiura K, Hatoya S. Clinical findings and treatment of disseminated 'Mycobacterium avium subspecies hominissuis' infection in a domestic cat. J Vet Med Sci 2019; 81:1842-1849. [PMID: 31666444 PMCID: PMC6943314 DOI: 10.1292/jvms.19-0492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A cat was referred because of diffuse parenchymal lung disease. Close examinations
revealed a swollen abdominal lymph node and multiple nodules of the liver.
Mycobacterium avium subspecies hominissuis infection
was confirmed by culture and single nucleotide polymorphism analysis of samples recovered
from the liver and bronchoalveolar lavage. After administration of combination antibiotics
for 6 months, culture results were negative. Though atonic seizures were observed during
the treatment, it disappeared after isoniazid discontinuation and pyridoxal phosphate
administration. On day 771 of illness, no clinical signs, lung diseases, or obvious
swelling of lymph nodes was observed. This is the first report to confirm
Mycobacterium avium subspecies hominissuis infection
in cats through gene analysis and to completely cure it with combination antibiotics.
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Affiliation(s)
- Ryoji Kanegi
- Veterinary Medical Center, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-oraikita, Izumisano, Osaka 598-8531, Japan
| | - Mayo Yasugi
- Department of Bioenvironmental Sciences, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-oraikita, Izumisano, Osaka 598-8531, Japan
| | - Tomoyo Nabetani
- Veterinary Medical Center, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-oraikita, Izumisano, Osaka 598-8531, Japan
| | - Toshiyuki Tanaka
- Veterinary Medical Center, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-oraikita, Izumisano, Osaka 598-8531, Japan
| | - Yusuke Wada
- Veterinary Medical Center, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-oraikita, Izumisano, Osaka 598-8531, Japan
| | - Kotaro Hirai
- Higashi Kishiwada Animal Hospital, 2-30-15 Habucho, Kishiwada, Osaka 596-0825, Japan
| | - Kikuya Sugiura
- Department of Advanced Pathobiology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-oraikita, Izumisano, Osaka 598-8531, Japan
| | - Shingo Hatoya
- Department of Advanced Pathobiology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-oraikita, Izumisano, Osaka 598-8531, Japan
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