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Carnero Canales CS, Marquez Cazorla JI, Marquez Cazorla RM, Roque-Borda CA, Polinário G, Figueroa Banda RA, Sábio RM, Chorilli M, Santos HA, Pavan FR. Breaking barriers: The potential of nanosystems in antituberculosis therapy. Bioact Mater 2024; 39:106-134. [PMID: 38783925 PMCID: PMC11112550 DOI: 10.1016/j.bioactmat.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/17/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
Tuberculosis (TB), caused by Mycobacterium tuberculosis, continues to pose a significant threat to global health. The resilience of TB is amplified by a myriad of physical, biological, and biopharmaceutical barriers that challenge conventional therapeutic approaches. This review navigates the intricate landscape of TB treatment, from the stealth of latent infections and the strength of granuloma formations to the daunting specters of drug resistance and altered gene expression. Amidst these challenges, traditional therapies often fail, contending with inconsistent bioavailability, prolonged treatment regimens, and socioeconomic burdens. Nanoscale Drug Delivery Systems (NDDSs) emerge as a promising beacon, ready to overcome these barriers, offering better drug targeting and improved patient adherence. Through a critical approach, we evaluate a spectrum of nanosystems and their efficacy against MTB both in vitro and in vivo. This review advocates for the intensification of research in NDDSs, heralding their potential to reshape the contours of global TB treatment strategies.
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Affiliation(s)
| | | | | | - Cesar Augusto Roque-Borda
- Tuberculosis Research Laboratory, School of Pharmaceutical Science, Sao Paulo State University (UNESP), Araraquara, 14800-903, Brazil
| | - Giulia Polinário
- Tuberculosis Research Laboratory, School of Pharmaceutical Science, Sao Paulo State University (UNESP), Araraquara, 14800-903, Brazil
| | | | - Rafael Miguel Sábio
- School of Pharmaceutical Science, Sao Paulo State University (UNESP), Araraquara, 14800-903, Brazil
- Department of Biomaterials and Biomedical Technology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, 9713 AV, the Netherlands
| | - Marlus Chorilli
- School of Pharmaceutical Science, Sao Paulo State University (UNESP), Araraquara, 14800-903, Brazil
| | - Hélder A. Santos
- Department of Biomaterials and Biomedical Technology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, 9713 AV, the Netherlands
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland
| | - Fernando Rogério Pavan
- Tuberculosis Research Laboratory, School of Pharmaceutical Science, Sao Paulo State University (UNESP), Araraquara, 14800-903, Brazil
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Akalu TY, Clements ACA, Gebreyohannes EA, Gilmour B, Alene KA. Prevalence of tuberculosis infection among contacts of drug-resistant tuberculosis patients: A systematic review and meta-analysis. J Infect 2024:106198. [PMID: 38906264 DOI: 10.1016/j.jinf.2024.106198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Contact investigations with drug-susceptible tuberculosis (DS-TB) patients have demonstrated a high prevalence of tuberculosis infection (TBI). However, the prevalence of TBI among individuals in close contact with drug-resistant tuberculosis (DR-TB) patients is poorly understood. This systematic review and meta-analysis aimed to determine the prevalence of TBI among household and non-household contacts of DR-TB patients. METHOD AND ANALYSIS We searched five databases (Medline, Embase, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) from inception to 2 June 2023. All studies that reported the prevalence of TBI among DR-TB contacts were included in the study. A random-effects meta-analysis was conducted to estimate the pooled prevalence of TBI with a 95% confidence interval (CI). Sub-group analyses were conducted using study characteristics as covariates. RESULTS Thirty studies involving 7,659 study participants from 19 countries were included. The pooled prevalence of TBI among DR-TB contacts was 36.52% (95% CI: 30.27-42.77). The sub-group analysis showed considerable heterogeneity in the estimates, with the highest prevalence reported in Southeast Asia (80.74%; 95% CI: 74.09-87.39), household contacts (38.60%; 95% CI: 30.07-47.14), lower-middle-income countries (LMICs) (54.72; 95% CI: 35.90, 73.55), children (43.27%; 95% CI: 25.50, 61.04), and studies conducted between 2004 and 2012 (45.10; 95% CI: 32.44, 57.76). CONCLUSION The prevalence of TBI among DR-TB contacts was high, with substantial regional variations. Further research is needed to determine the drug susceptibility status of TBI in DR-TB contacts. PROTOCOL REGISTRATION The protocol is registered in PROSPERO (CRD42023390339).
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Affiliation(s)
- Temesgen Yihunie Akalu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Ethiopia; School of Population Health, Faculty of Health Sciences, Curtin University, Australia; Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Australia.
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Australia; Research and Enterprise, Queen's University Belfast, United Kingdom.
| | - Eyob Alemayehu Gebreyohannes
- School of Allied Health, University of Western Australia, Perth, WA, Australia; Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia.
| | - Beth Gilmour
- School of Population Health, Faculty of Health Sciences, Curtin University, Australia; Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Australia.
| | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Australia; Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Australia.
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Yenew B, Kebede A, Alemu A, Diriba G, Mehammed Z, Amare M, Dagne B, Sinshaw W, Tesfaye E, Beyene D, Abegaz WE. Genotypic and phenotypic drug resistance patterns of Mycobacterium tuberculosis isolated from presumptive pulmonary tuberculosis patients in Ethiopia: A multicenter study. PLoS One 2024; 19:e0303460. [PMID: 38753615 PMCID: PMC11098317 DOI: 10.1371/journal.pone.0303460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The emergence of drug-resistant tuberculosis (DR-TB) has been a major obstacle to global tuberculosis control programs, especially in developing countries, including Ethiopia. This study investigated drug resistance patterns and associated mutations of Mycobacterium tuberculosis Complex (MTBC) isolates from the Amhara, Gambella, and Benishangul-Gumuz regions of Ethiopia. METHODS A cross-sectional study was conducted using 128 MTBC isolates obtained from patients with presumptive tuberculosis (TB). Phenotypic (BACTEC MGIT 960) and genotypic (MTBDRplus and MTBDRsl assays) methods were used for drug susceptibility testing. Data were entered into Epi-info and analyzed using SPSS version 25. Frequencies and proportions were determined to describe drug resistance levels and associated mutations. RESULTS Of the 127 isolates recovered, 100 (78.7%) were susceptible to four first-line anti-TB drugs. Any drug resistance, polydrug resistance, and multi-drug resistance (MDR) were detected in 21.3% (27), 15.7% (20), and 15% (19) of the isolates, respectively, by phenotypic and/or genotypic methods. Mono-resistance was observed for Isoniazid (INH) (2, 1.6%) and Streptomycin (STR) (2, 1.6%). There were two genotypically discordant RIF-resistant cases and one INH-resistant case. One case of pre-extensively drug-resistant TB (pre-XDR-TB) and one case of extensively drug-resistant TB (XDR-TB) were identified. The most frequent gene mutations associated with INH and rifampicin (RIF) resistance were observed in the katG MUT1 (S315T1) (20, 76.9%) and rpoB (S531L) (10, 52.6%) genes, respectively. Two MDR-TB isolates were resistant to second-line drugs; one had a mutation in the gyrA MUT1 gene, and the other had missing gyrA WT1, gyrA WT3, and rrs WT1 genes without any mutation. CONCLUSIONS The detection of a significant proportion of DR-TB cases in this study suggests that DR-TB is a major public health problem in Ethiopia. Thus, we recommend the early detection and treatment of DR-TB and universal full first-line drug-susceptibility testing in routine system.
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Affiliation(s)
- Bazezew Yenew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Kebede
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Misikir Amare
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Biniyam Dagne
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Ephrem Tesfaye
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Dereje Beyene
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Woldaregay Erku Abegaz
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Ruixia L, Jiankang L, Hongmei S, Han W, Chang Z. Novel automated AIMLAM for diagnosis of Mycobacterium tuberculosis. Future Microbiol 2024. [PMID: 38592488 DOI: 10.2217/fmb-2024-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Aim: A rapid and precise diagnostic method is crucial for timely intervention and management of tuberculosis. The present study compared the diagnostic accuracy of a novel lipoarabinomannan (LAM) antigen test, AIMLAM, for tuberculosis in urine samples. Methodology: The study subjected 106 TB suspects to smear microscopy, MGIT, GeneXpert and AIMLAM. Results: Among 106, smear microscopy identified 36 as positive (33%) (sensitivity; 70.93%, 95% CI (60.14-80.22%), while MGIT showed 38 positive (36.8%). GeneXpert detected 59 positives (sensitivity; 96.83, 95% CI (89.00-99.61%)). AIMLAM declared 61 as positive (57.5%) (sensitivity; 100.00, 95% CI (94.13-100.00%) and 45 as negative (42.5%). Conclusion: Overall, AIMLAM demonstrated better diagnostic accuracy than GeneXpert Assay, smear microscopy and MGIT liquid culture in urine samples.
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Affiliation(s)
- Liang Ruixia
- Henan Provincial Chest Hospital, Henan Infectious Diseases (TB) Clinical Research Center. No. 1, Weiwu Road, Zhengzhou, Henan Province
| | - Li Jiankang
- Henan Provincial Chest Hospital, Henan Infectious Diseases (TB) Clinical Research Center. No. 1, Weiwu Road, Zhengzhou, Henan Province
| | - Shi Hongmei
- Henan Provincial Chest Hospital, Henan Infectious Diseases (TB) Clinical Research Center. No. 1, Weiwu Road, Zhengzhou, Henan Province
| | - Wu Han
- Henan Provincial Chest Hospital, Henan Infectious Diseases (TB) Clinical Research Center. No. 1, Weiwu Road, Zhengzhou, Henan Province
| | - Zhao Chang
- Henan Provincial Chest Hospital, Henan Infectious Diseases (TB) Clinical Research Center. No. 1, Weiwu Road, Zhengzhou, Henan Province
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Dinh LV, Vo LNQ, Wiemers AMC, Nguyen HB, Vu HQ, Mo HTL, Nguyen LP, Nguyen NTT, Dong TTT, Tran KT, Dang TMH, Nguyen LH, Pham AT, Codlin AJ, Forse RJ. Ensuring Continuity of Tuberculosis Care during Social Distancing through Integrated Active Case Finding at COVID-19 Vaccination Events in Vietnam: A Cohort Study. Trop Med Infect Dis 2024; 9:26. [PMID: 38276637 PMCID: PMC10819868 DOI: 10.3390/tropicalmed9010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
COVID-19 significantly disrupted tuberculosis (TB) services in Vietnam. In response, the National TB Program (NTP) integrated TB screening using mobile chest X-rays into COVID-19 vaccination events. This prospective cohort study evaluated the integrated model's yield, treatment outcomes, and costs. We further fitted regressions to identify risk factors and conduct interrupted time-series analyses in the study area, Vietnam's eight economic regions, and at the national level. At 115 events, we conducted 48,758 X-ray screens and detected 174 individuals with TB. We linked 89.7% to care, while 92.9% successfully completed treatment. The mean costs per person diagnosed with TB was $547. TB risk factors included male sex (aOR = 6.44, p < 0.001), age of 45-59 years (aOR = 1.81, p = 0.006) and ≥60 years (aOR = 1.99, p = 0.002), a history of TB (aOR = 7.96, p < 0.001), prior exposure to TB (aOR = 3.90, p = 0.001), and symptomatic presentation (aOR = 2.75, p < 0.001). There was a significant decline in TB notifications during the Delta wave and significant increases immediately after lockdowns were lifted (IRR(γ1) = 5.00; 95%CI: (2.86, 8.73); p < 0.001) with a continuous upward trend thereafter (IRR(γ2) = 1.39; 95%CI: (1.22, 1.38); p < 0.001). Similar patterns were observed at the national level and in all regions but the northeast region. The NTP's swift actions and policy decisions ensured continuity of care and led to the rapid recovery of TB notifications, which may serve as blueprint for future pandemics.
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Affiliation(s)
- Luong Van Dinh
- National Lung Hospital, Ha Noi 100000, Vietnam; (L.V.D.); (H.B.N.); (H.Q.V.)
| | - Luan Nguyen Quang Vo
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
- Department of Global Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anja Maria Christine Wiemers
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Hoa Binh Nguyen
- National Lung Hospital, Ha Noi 100000, Vietnam; (L.V.D.); (H.B.N.); (H.Q.V.)
| | - Hoa Quynh Vu
- National Lung Hospital, Ha Noi 100000, Vietnam; (L.V.D.); (H.B.N.); (H.Q.V.)
| | - Huong Thi Lan Mo
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Lan Phuong Nguyen
- IRD VN Social Enterprise Company Limited, Ho Chi Minh City 700000, Vietnam;
| | - Nga Thi Thuy Nguyen
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Thuy Thi Thu Dong
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Khoa Tu Tran
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Thi Minh Ha Dang
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700000, Vietnam; (T.M.H.D.); (L.H.N.)
| | - Lan Huu Nguyen
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700000, Vietnam; (T.M.H.D.); (L.H.N.)
| | | | - Andrew James Codlin
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
- Department of Global Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Rachel Jeanette Forse
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
- Department of Global Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
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Li Y, Xu Z, Lv X, Li C, He W, Lv Y, Hou D. Radiomics analysis of lung CT for multidrug resistance prediction in active tuberculosis: a multicentre study. Eur Radiol 2023; 33:6308-6317. [PMID: 37004571 PMCID: PMC10067016 DOI: 10.1007/s00330-023-09589-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES Multidrug-resistant TB (MDR-TB) is a severe burden and public health threat worldwide. This study aimed to develop a radiomics model based on the tree-in-bud (TIB) sign and nodules and validate its predictive performance for MDR-TB. METHODS We retrospectively recruited 454 patients with proven active TB from two hospitals and classified them into three training and testing cohorts: TIB (n = 295, 102), nodules (n = 302, 97), and their combination (n = 261, 81). Radiomics features relating to TIB and nodules were separately extracted. The maximal information coefficient and recursive feature elimination were used to select informative features per the two signs. Two radiomics models were constructed to predict MDR-TB using a random forest classifier. Then, a combined model was built incorporating radiomics features based on these two signs. The capability of the models in the combined training and testing cohorts was validated with ROC curves. RESULTS Sixteen features were extracted from TIB and 15 from nodules. The AUCs of the combined model were slightly higher than those of the TIB model in the combined training cohort (0.911 versus 0.877, p > 0.05) and testing cohort (0.820 versus 0.786, p < 0.05) and similar to the performance of the nodules model in the combined training cohort (0.911 versus 0.933, p > 0.05) and testing cohort (0.820 versus 0.855, p > 0.05). CONCLUSIONS The CT-based radiomics models hold promise for use as a non-invasive tool in the prediction of MDR-TB. CLINICAL RELEVANCE STATEMENT Our study revealed that complementary information regarding MDR-TB can be provided by radiomics based on the TIB sign and nodules. The proposed radiomics models may be new markers to predict MDR in active TB patients. KEY POINTS • This is the first study to build, validate, and apply radiomics based on tree-in-bud sign and nodules for the prediction of MDR-TB. • The radiomics model showed a favorable performance for the identification of MDR-TB. • The combined model holds potential to be used as a diagnostic tool in routine clinical practice.
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Affiliation(s)
- Ye Li
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China
| | - Zexuan Xu
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China
| | - Xinna Lv
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China
| | - Chenghai Li
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China
| | - Wei He
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China
| | - Yan Lv
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China
| | - Dailun Hou
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China.
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Schwan WR. SK-03-92 Drug Kills Intracellular Mycobacterium tuberculosis. Antibiotics (Basel) 2023; 12:1385. [PMID: 37760682 PMCID: PMC10525840 DOI: 10.3390/antibiotics12091385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Tuberculosis affects millions of people worldwide. The emergence of drug-resistant Mycobacterium tuberculosis strains has made treatment more difficult. A drug discovery project initiated to screen natural products identified a lead stilbene compound, and structure function analysis of hundreds of analogs led to the discovery of the SK-03-92 stilbene lead compound with activity against several non-tuberculoid mycobacteria. METHODS For this study, an MIC analysis and intracellular killing assay were performed to test SK-03-92 against M. tuberculosis grown in vitro as well as within murine macrophage cells. RESULTS The MIC analysis showed that SK-03-92 had activity against M. tuberculosis in the range of 0.39 to 6.25 μg/mL, including activity against single-drug-resistant strains. Further, an intracellular kill assay demonstrated that the SK-03-92 lead compound killed M. tuberculosis cells within murine macrophage cells. CONCLUSION Together, the data show the SK-03-92 lead compound can kill M. tuberculosis bacteria within mammalian macrophages.
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Affiliation(s)
- William R Schwan
- Department of Microbiology, University of Wisconsin-La Crosse, 1725 State St., La Crosse, WI 54601, USA
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Ebrahimzadeh A, Pagheh AS, Mousavi T, Fathi M, Moghaddam SGM. Serosal membrane tuberculosis in Iran: A comprehensive review of evidences. J Clin Tuberc Other Mycobact Dis 2023; 31:100354. [PMID: 36874623 PMCID: PMC9982686 DOI: 10.1016/j.jctube.2023.100354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Tuberculosis (TB) is among the most common cause of serositis. There are many uncertainties in diagnostic and therapeutic approach to serous membranes tuberculosis. Our aim in the present review is to discuss the regional facilities for timely diagnosis, rapid decision-making and appropriate treatment regarding to serous membranes tuberculosis; with emphasis on situation in Iran. A comprehensive literature searches about the status of serous membranes tuberculosis in Iran were performed in English databases including Google Scholar, Science Direct, Scopus, Pub Med, and Web of Sciences, Persian SID databases, between 2000 and 2021. The main findings of the present review are as follow: a) pleural tuberculosis is more common than pericardial or peritoneal tuberculosis. b) Clinical manifestations are non-specific and so non-diagnostic. c) Smear and culture, PCR and characteristic granulomatous reaction have been used for definitive TB diagnosis by physicians. d) With Adenosine Deaminase Assays and Interferon-Gamma Release Assays in mononuclear dominant fluid, a possible diagnosis of TB is proposed by experienced physicians in Iran. e) In area of endemic for tuberculosis including Iran, a possible diagnosis of TB is enough to begin empirical treatment. f) In patients with uncomplicated tuberculosis serositis, treatment is similar to pulmonary tuberculosis. First line drugs are prescribed unless evidence of MDR-TB is detected. g) The prevalence of drug resistant tuberculosis (MDR-TB) in Iran is between 1% and 6%, and are treated by empirical standardized treatment. h) It is not known whether adjuvant corticosteroids are effective in preventing long term complication. i) Surgery may be recommended for MDR-TB. Tamponade or constrictive pericarditis and intestinal obstruction. In conclusion, it is recommended to consider serosal tuberculosis in patients who have unknown mononuclear dominant effusion and prolonged constitutional symptoms. Experimental treatment with first line anti-TB drugs can be started based on possible diagnostic findings.
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Affiliation(s)
- Azadeh Ebrahimzadeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Abdol Sattar Pagheh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Tahoora Mousavi
- Molecular and Cell Biology Research Center (MCBRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Fathi
- Parasitology Department of Medical School, Tarbiat Modares University, Tehran, Iran
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Muacevic A, Adler JR. Multidrug-Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB) Among Children: Where We Stand Now. Cureus 2023; 15:e35154. [PMID: 36819973 PMCID: PMC9938784 DOI: 10.7759/cureus.35154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 02/20/2023] Open
Abstract
Drug-resistant tuberculosis (DR-TB) has continued to be a global health cataclysm. It is an arduous condition to tackle but is curable with the proper choice of drug and adherence to the drug therapy. WHO has introduced newer drugs with all-oral shorter regimens, but the COVID-19 pandemic has disrupted the achievements and raised the severity. The COVID-19 controlling mechanism is based on social distancing, using face masks, personal protective equipment, medical glove, head shoe cover, face shield, goggles, hand hygiene, and many more. Around the globe, national and international health authorities impose lockdown and movement control orders to ensure social distancing and prevent transmission of COVID-19 infection. Therefore, WHO proposed a TB control program impaired during a pandemic. Children, the most vulnerable group, suffer more from the drug-resistant form and act as the storehouse of future fatal cases. It has dire effects on physical health and hampers their mental health and academic career. Treatment of drug-resistant cases has more success stories in children than adults, but enrollment for treatment has been persistently low in this age group. Despite that, drug-resistant childhood tuberculosis has been neglected, and proper surveillance has not yet been achieved. Insufficient reporting, lack of appropriate screening tools for children, less accessibility to the treatment facility, inadequate awareness, and reduced funding for TB have worsened the situation. All these have resulted in jeopardizing our dream to terminate this deadly condition. So, it is high time to focus on this issue to achieve our Sustainable Development Goals (SDGs), the goal of ending TB by 2030, as planned by WHO. This review explores childhood TB's current position and areas to improve. This review utilized electronic-based data searched through PubMed, Google Scholar, Google Search Engine, Science Direct, and Embase.
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Akalu GT, Tessema B, Petros B. High proportion of RR-TB and mutations conferring RR outside of the RRDR of the rpoB gene detected in GeneXpert MTB/RIF assay positive pulmonary tuberculosis cases, in Addis Ababa, Ethiopia. PLoS One 2022; 17:e0277145. [PMID: 36584037 PMCID: PMC9803184 DOI: 10.1371/journal.pone.0277145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Globally, TB is the leading cause of infectious disease morbidity and mortality with many diagnostic uncertainties. Access to affordable and rapid diagnostics remained a major challenge for many developing countries which bear the greatest burden of TB delaying the initiation time to treatment. OBJECTIVE This study aimed to assess the GeneXpert MTBRIF assay probe utility for the detection of pulmonary TB and Rifampicin-resistant TB cases in Addis Ababa, Ethiopia. MATERIALS AND METHODS A cross-sectional study was performed from October 2019 to July 2020 in Saint Peter TB Specialized Hospital in Addis Ababa metropolitan area, Ethiopia. This study enrolled 216 clinically suspected new presumptive pulmonary TB cases confirmed by GeneXpert MTB/RIF Assay. Sociodemographic and clinical characteristics were captured using a structured tool. Data were entered in Microsoft Excel 2019, checked for inconsistency, cleaned promptly, and exported to IBM SPSS Statistics for Windows, Version 26.0. Armonk, N.Y: IBM Corp, the USA for analysis. Descriptive analysis and binary and multivariate logistics regression were performed and all statistical significance was determined at a 95% confidence level. RESULTS The majority of the study participants, 55.1% [119/216] were males aged 6-80 years. The prevalence of RR MTB was 11.11% [24/216]. A higher proportion of RR TB was found in female patients [54.2%, 13/24], in patients in the age group of 30-50 years [45.8%, 11/24], in married individuals [62.5%, 15/24], in persons whose residence is urban [79.2%, 19/24], in persons who had a previous history of TB symptoms [100%, 24/24], in persons who had a history of contact with active and LTBI [33.3%, 8/24], and in persons who had a history of HIV and IDUs [41.7%, 10/24]. Occupation (AOR 22.868, 95% CI 1.655-316.022, p = 0.019), history of previous PTB+ (AOR 4.222, 95% CI 1.020-17.47, p = 0.047), and history of HIV and IDUs (AOR 4.733, 95% CI 1.416-15.819, p = 0.012) were independent predictors associated with RR-TB emergence. The commonest mutation 62.5% [15/24] was found in probe E (codons 529-533) region. There was no mutation associated with probe A (codons 507-511), probe B (codons 511-518), and probe C (codons 518-523) regions, as well as no combination of missed probes, was revealed. However, 12.5% [3/24] of RR TB patients were found without unidentified missed probe types detected outside of the RRDR. The delta Ct max was >4.0 and the highest proportion of 35.6% [77/216] RR TB was detected in samples of medium DNA load. CONCLUSION The proportion of RR-TB we observed in this study was high. Similarly, a higher proportion of RR TB was detected outside of the RRDR. Moreover, a significant number of the GeneXpert MTB/RIF Assay probes were identified as unhybridized and this critical observation would mean that most of the probes had no or minimal utility in this geographical region. This calls for further studies to uncover mutation in the rpoB gene conferring RR and reshape TB triage and definite diagnostic algorithm in Ethiopia.
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Affiliation(s)
- Gizachew Taddesse Akalu
- Department of Microbial, Cellular, and Molecular Biology, Faculty of Life Sciences, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology, and Parasitology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- * E-mail:
| | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory Medicine, University of Gondar, Gondar, Ethiopia
| | - Beyene Petros
- Department of Microbial, Cellular, and Molecular Biology, Faculty of Life Sciences, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Synergistic Effect of Q203 Combined with PBTZ169 against Mycobacterium tuberculosis. Antimicrob Agents Chemother 2022; 66:e0044822. [PMID: 36321819 PMCID: PMC9765072 DOI: 10.1128/aac.00448-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Q203 is a first-in-class drug candidate against Mycobacterium tuberculosis. In its recently completed phase 2 clinical trial, Q203 reduced the number of live M. tuberculosis cells in a dose-dependent manner. This orally active small molecule blocks M. tuberculosis growth by inhibiting the cytochrome bc1 complex, which consequently inhibits the synthesis of ATP. Here, we studied the interaction profiles of Q203 with several antituberculosis drugs or drug candidates (specifically, bedaquiline, PBTZ169, PA-824, OPC-67683, SQ109, isoniazid, rifampin, streptomycin, and linezolid) using the checkerboard method, based on resazurin microtiter assays (REMAs). In the assay, none of the interactions between Q203 and the tested drugs were antagonistic, and most of the interactions were additive. However, the interaction between Q203 and PBTZ169 was synergistic, with a fractional inhibitory concentration index of 0.5. Furthermore, Q203 (one-half the MIC50) and PBTZ169 (one-half the MIC50) inhibited more bacterial growth on an agar plate compared to the dimethyl sulfoxide (DMSO) control. This synergistic effect was no longer effective when the Q203-PBTZ169 combination was tested against an M. tuberculosis mutant containing a T313A mutation causing resistance to Q203, suggesting that QcrB inhibition is integral to the Q203-PBTZ169 interaction. Thus, this synergy is not an off-target mechanism. Zebrafish (Danio rerio)-Mycobacterium marinum infection and a curing model further validated the synergistic effect of Q203 and PBTZ169 in vivo. In this study, the synergy between these two new antituberculosis drugs, Q203 and PBTZ169, is an important finding that could lead to the development of a new TB regimen.
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12
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Dartois VA, Rubin EJ. Anti-tuberculosis treatment strategies and drug development: challenges and priorities. Nat Rev Microbiol 2022; 20:685-701. [PMID: 35478222 PMCID: PMC9045034 DOI: 10.1038/s41579-022-00731-y] [Citation(s) in RCA: 116] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 12/12/2022]
Abstract
Despite two decades of intensified research to understand and cure tuberculosis disease, biological uncertainties remain and hamper progress. However, owing to collaborative initiatives including academia, the pharmaceutical industry and non-for-profit organizations, the drug candidate pipeline is promising. This exceptional success comes with the inherent challenge of prioritizing multidrug regimens for clinical trials and revamping trial designs to accelerate regimen development and capitalize on drug discovery breakthroughs. Most wanted are markers of progression from latent infection to active pulmonary disease, markers of drug response and predictors of relapse, in vitro tools to uncover synergies that translate clinically and animal models to reliably assess the treatment shortening potential of new regimens. In this Review, we highlight the benefits and challenges of 'one-size-fits-all' regimens and treatment duration versus individualized therapy based on disease severity and host and pathogen characteristics, considering scientific and operational perspectives.
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Affiliation(s)
- Véronique A Dartois
- Center for Discovery and Innovation, and Hackensack Meridian School of Medicine, Department of Medical Sciences, Hackensack Meridian Health, Nutley, NJ, USA.
| | - Eric J Rubin
- Harvard T.H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, MA, USA
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13
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Development and Optimization of a New UPLC-UV/MS Method through DoE and MLR for Detecting Substandard Drug Products to Treat Tuberculosis. Molecules 2022; 27:molecules27207141. [PMID: 36296733 PMCID: PMC9610718 DOI: 10.3390/molecules27207141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
Drug products used for treating tuberculosis are one of the most widely reported medicines to be classified as falsified or substandard in low- and middle-income countries, representing a major hazard to health. The aim of this study was, firstly, to develop an ultra-performance liquid chromatography (UPLC) method which is able to analyze fixed combination tablets with up to four active pharmaceutical ingredients, including isoniazid, pyrazinamide, rifampicin, and ethambutol. Secondly, we aimed to optimize it through the design of experiments and multi-linear regression based on a central composite design and to validate it according to the guidelines of the International Conference on Harmonization. The application of this tools enabled the identification of the influential factors (flow rate, formic acid, and temperature) and their effects on the studied responses (retention factor and percentage for each drug) as part of the quality by design approach. The method proved to be to be linear in the range from 5.0 to 15 µg/mL for isoniazid, pyrazinamide, and rifampicin, being precise (<1%) and accurate (97−101%). In addition, the method validated for ethambutol proved to be linear from 1.4 to 4.2 µg/mL, as well as precise (0.54%) and accurate (97.3%). The method was stability indicated for all the active pharmaceutical ingredients studied and was able to detect two substandard formulations sampled on the African market.
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14
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Khan MA, Bilal W, Asim H, Rahmat ZS, Essar MY, Ahmad S. MDR-TB in Pakistan: Challenges, efforts, and recommendations. Ann Med Surg (Lond) 2022; 79:104009. [PMID: 35860138 PMCID: PMC9289334 DOI: 10.1016/j.amsu.2022.104009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB), a global health concern is also a leading cause of mortality and morbidity across Pakistan affecting a major proportion of the population. The absence of an integrated system to control the spread of TB has led to a rise in multidrug resistant strains of TB (MDR-Tb) which do not exhibit any sensitivity towards the first line therapy for TB. Such adverse circumstances call for effective planning strategies to mitigate the health hazards of MDR-TB. This article briefly highlights the challenges encountered by the already burdened healthcare system and suggests relatively inexpensive approaches to tackle the ongoing crisis associated with MDR-TB on a national scale.
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Affiliation(s)
| | | | | | | | | | - Shoaib Ahmad
- District Head Quarters Teaching Hospital, Faisalabad, Pakistan
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15
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Chen Y, Liu Q, Takiff HE, Gao Q. Comprehensive genomic analysis of Mycobacterium tuberculosis reveals limited impact of high-fitness genotypes on MDR-TB transmission. J Infect 2022; 85:49-56. [PMID: 35588941 DOI: 10.1016/j.jinf.2022.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/14/2022] [Accepted: 05/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Environmental and host-related factors that contribute to the transmission of multidrug-resistant tuberculosis (MDR-TB) have become an increasing concern, but the impact of bacterial genetic factors associated with bacterial fitness on MDR-TB transmission is poorly understood. Here, we present a global view of the correlation between common fitness-related genotypes and MDR-TB transmission by analyzing a representative number of MDR-TB isolates. METHODS We assembled a global whole genome sequencing (WGS) dataset of MDR-TB strains collected through retrospective cohorts or population-based approaches using public databases and literature curation. WGS-based clusters were defined as groups of strains with genomic difference of ≤ 5 SNPs. RESULTS We curated high-quality WGS data of 4696 MDR-TB isolates from 17 countries with a mean clustering rate of 48% (range 0-100%). Correlational analysis showed that increased risk of MDR-TB strain clustering was not associated with compensatory mutations (OR 1.07, 95% CI 0.72-1.59), low-fitness cost drug-resistant mutations (katG S315T: OR 1.42, 95% CI 0.82-2.47; rpoB S450L: OR 1.26, 95% CI 0.87-1.83) or Lineage 2 (OR 1.50, 95% CI 0.95-2.39). CONCLUSIONS The factors most commonly thought to increase bacterial fitness were not significantly associated with increased MDR-TB transmission, and thus do not appear to be major contributors to the current epidemic of MDR-TB.
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Affiliation(s)
- Yiwang Chen
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China; National Clinical Research Center for Infectious Diseases, Shenzhen, Guangdong, China
| | - Qingyun Liu
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Howard E Takiff
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China; Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela
| | - Qian Gao
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China; National Clinical Research Center for Infectious Diseases, Shenzhen, Guangdong, China.
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16
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The global impact of household contact management for children on multidrug-resistant and rifampicin-resistant tuberculosis cases, deaths, and health-system costs in 2019: a modelling study. THE LANCET GLOBAL HEALTH 2022; 10:e1034-e1044. [PMID: 35597248 PMCID: PMC9197775 DOI: 10.1016/s2214-109x(22)00113-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/21/2022] [Accepted: 03/09/2022] [Indexed: 12/26/2022] Open
Abstract
Background Methods Findings Interpretation Funding
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17
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Ngabonziza JCS, Rigouts L, Torrea G, Decroo T, Kamanzi E, Lempens P, Rucogoza A, Habimana YM, Laenen L, Niyigena BE, Uwizeye C, Ushizimpumu B, Mulders W, Ivan E, Tzfadia O, Muvunyi CM, Migambi P, Andre E, Mazarati JB, Affolabi D, Umubyeyi AN, Nsanzimana S, Portaels F, Gasana M, de Jong BC, Meehan CJ. Multidrug-resistant tuberculosis control in Rwanda overcomes a successful clone that causes most disease over a quarter century. J Clin Tuberc Other Mycobact Dis 2022; 27:100299. [PMID: 35146133 PMCID: PMC8802117 DOI: 10.1016/j.jctube.2022.100299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
SUMMARY BACKGROUND Multidrug-resistant (MDR) tuberculosis (TB) poses an important challenge in TB management and control. Rifampicin resistance (RR) is a solid surrogate marker of MDR-TB. We investigated the RR-TB clustering rates, bacterial population dynamics to infer transmission dynamics, and the impact of changes to patient management on these dynamics over 27 years in Rwanda. METHODS We analysed whole genome sequences of a longitudinal collection of nationwide RR-TB isolates. The collection covered three important periods: before programmatic management of MDR-TB (PMDT; 1991-2005), the early PMDT phase (2006-2013), in which rifampicin drug-susceptibility testing (DST) was offered to retreatment patients only, and the consolidated phase (2014-2018), in which all bacteriologically confirmed TB patients had rifampicin DST done mostly via Xpert MTB/RIF assay. We constructed clusters based on a 5 SNP cut-off and resistance conferring SNPs. We used Bayesian modelling for dating and population size estimations, TransPhylo to estimate the number of secondary cases infected by each patient, and multivariable logistic regression to assess predictors of being infected by the dominant clone. RESULTS Of 308 baseline RR-TB isolates considered for transmission analysis, the clustering analysis grouped 259 (84.1%) isolates into 13 clusters. Within these clusters, a single dominant clone was discovered containing 213 isolates (82.2% of clustered and 69.1% of all RR-TB), which we named the "Rwanda Rifampicin-Resistant clone" (R3clone). R3clone isolates belonged to Ugandan sub-lineage 4.6.1.2 and its rifampicin and isoniazid resistance were conferred by the Ser450Leu mutation in rpoB and Ser315Thr in katG genes, respectively. All R3clone isolates had Pro481Thr, a putative compensatory mutation in the rpoC gene that likely restored its fitness. The R3clone was estimated to first arise in 1987 and its population size increased exponentially through the 1990s', reaching maximum size (∼84%) in early 2000 s', with a declining trend since 2014. Indeed, the highest proportion of R3clone (129/157; 82·2%, 95%CI: 75·3-87·8%) occurred between 2000 and 13, declining to 64·4% (95%CI: 55·1-73·0%) from 2014 onward. We showed that patients with R3clone detected after an unsuccessful category 2 treatment were more likely to generate secondary cases than patients with R3clone detected after an unsuccessful category 1 treatment regimen. CONCLUSIONS RR-TB in Rwanda is largely transmitted. Xpert MTB/RIF assay as first diagnostic test avoids unnecessary rounds of rifampicin-based TB treatment, thus preventing ongoing transmission of the dominant R3clone. As PMDT was intensified and all TB patients accessed rifampicin-resistance testing, the nationwide R3clone burden declined. To our knowledge, our findings provide the first evidence supporting the impact of universal DST on the transmission of RR-TB.
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Affiliation(s)
- Jean Claude S. Ngabonziza
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Clinical Biology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leen Rigouts
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Gabriela Torrea
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Eliane Kamanzi
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | - Pauline Lempens
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Aniceth Rucogoza
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | - Yves M. Habimana
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Lies Laenen
- Clinical Department of Laboratory Medicine and National Reference Center for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
| | - Belamo E. Niyigena
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | - Cécile Uwizeye
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bertin Ushizimpumu
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | - Wim Mulders
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emil Ivan
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | - Oren Tzfadia
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Claude Mambo Muvunyi
- Department of Clinical Biology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Emmanuel Andre
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Clinical Department of Laboratory Medicine and National Reference Center for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, Leuven, Belgium
| | | | | | | | | | - Françoise Portaels
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Michel Gasana
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Bouke C. de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Conor J. Meehan
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- School of Chemistry and Biosciences, University of Bradford, UK
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Kadir R, Luwi NM, Ahmad S, Azlyna AN, Nordin A, Sarmiento M, Acosta A, Azmi M, Uskoković V, Mohamud R. Liposomes as immunological adjuvants and delivery systems in the development of tuberculosis vaccine: A review. ASIAN PAC J TROP MED 2022. [DOI: 10.4103/1995-7645.332806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Verma S, Pathak RK. Discovery and optimization of lead molecules in drug designing. Bioinformatics 2022. [DOI: 10.1016/b978-0-323-89775-4.00004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Chang V, Ling RH, Velen K, Fox GJ. Latent tuberculosis infection among contacts of patients with multidrug-resistant tuberculosis in New South Wales, Australia. ERJ Open Res 2021; 7:00149-2021. [PMID: 34549043 PMCID: PMC8450450 DOI: 10.1183/23120541.00149-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/21/2021] [Indexed: 11/05/2022] Open
Abstract
Background Contacts of an individual with active tuberculosis (TB) disease have a higher risk of developing latent TB infection (LTBI) or active TB disease. Contact tracing is a public health measure that seeks to identify exposed contacts, screen them for co-prevalent TB and consider prophylactic treatment to prevent progression from LTBI to active TB disease. The investigators sought to determine the prevalence of LTBI and active TB disease among contacts of patients with multidrug-resistant (MDR)-TB in New South Wales, Australia. Methodology A retrospective cohort study was performed among the contacts of patients diagnosed with MDR-TB between 2000 and 2016, inclusive, at seven chest clinics. Medical records were used to identify eligible contacts. Outcomes of screening and prophylactic treatment regimens offered to MDR-TB contacts with LTBI were characterised. Collected data included demographic information, screening tests results and initial management. Results In total, 247 contacts of 55 MDR-TB patients were identified. LTBI was identified in 105 contacts (42.5%). Preventive treatment was received by 20 contacts with LTBI (32.3%) in the form of various regimens, ranging from one to three antimicrobials, with various doses and durations. One contact with LTBI who was untreated progressed to active TB disease during the study period, according to clinic notes. Conclusion Contacts of MDR-TB patients have a high prevalence of LTBI. Management of these contacts varies substantially in New South Wales, reflecting a lack of definitive evidence for preventive therapy. Further research is required to determine the optimal management of this population. Given the high likelihood of multidrug resistance in strains responsible for LTBI among MDR-TB contacts, new research is needed to evaluate preventive therapies for this patient populationhttps://bit.ly/2Tf4LLY
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Affiliation(s)
- Vicky Chang
- Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,The Sutherland Hospital, Caringbah, NSW, Australia
| | - Raphael Hongxi Ling
- Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Kavindhran Velen
- Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Greg J Fox
- Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Early detection of MDR Mycobacterium tuberculosis mutations in Pakistan. Sci Rep 2021; 11:16736. [PMID: 34408186 PMCID: PMC8373971 DOI: 10.1038/s41598-021-96116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/15/2021] [Indexed: 11/08/2022] Open
Abstract
The result of improper treatment has led to the rise of Multidrug-resistant (MDR) strains. This concern still exists in Pakistan. In order to save energy, time and resources an early detection of resistant cases is imperative. Thus, a treated group of 100 isolates and a control group of 56 untreated isolates were studied. PCR and gene sequencing showed mutations at codon 531 and 513 in the rpoB gene. 12% of cases showed a double mutation in the rpoB gene. katG gene showed mutations at codon 315 and 299. 28.6% of the control group cases were positive for MDR whereas 100% of the treated group were positive for MDR. This study explores the significantly increasing ratio of MDR-TB among Pakistani population. This study provides prevalent MDR mutations among Pakistanis and suggests developing such molecular assays that are time and cost effective. Importance: Pakistan is a developing country and has fourth highest incidence rate of MDR-TB. The treatment of MDR-TB is the use of second line drugs that has severe side effects as well as it requires long time span. One of the strategies to control the spread of MDR-TB is to decipher the aberrations at molecular level in order to formulate potent drugs that can treat the patients within short span of time. Determining the mutation profile of MDR in Pakistani populations will open new horizons for the improvement of drug treatment regimens to make it more effective or for the development of novel potent drugs and vaccines to better treat the drug-resistant TB. Moreover, this study will be help in disease control program.
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22
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Hajissa K, Marzan M, Idriss MI, Islam MA. Prevalence of Drug-Resistant Tuberculosis in Sudan: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:antibiotics10080932. [PMID: 34438982 PMCID: PMC8388945 DOI: 10.3390/antibiotics10080932] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) is still one of the most critical issues impeding worldwide TB control efforts. The aim of this systematic review and meta-analysis was to give an updated picture of the prevalence of DR-TB in Sudan. A comprehensive systematic search was performed on four electronic databases (PubMed, Scopus, Web of Science and Google Scholar) to identify all published studies reporting prevalence data of DR-TB in Sudan. Sixteen eligible studies published during 2002-2020 were included. Using meta-analysis of proportions, the pooled prevalence of TB cases with resistance to any anti-TB drugs was 47.0% (95% CI: 35.5-58.6%). The overall prevalence of mono, multi, poly and extensive drug resistance were estimated to be 16.2% (95% CI: 9.0-23.4%), 22.8% (95% CI: 16.0-29.7%), 6.8% (95% CI: 0.5-13.0%) and 0.7% (95% CI: 0-2.1%), respectively. Considering any first-line anti-TB drugs, the resistance prevalence was highest for isoniazid (32.3%) and streptomycin (31.7%), followed by rifampicin (29.2%). In contrast, resistance against second-line drugs was reported for only two antibiotics, namely, ofloxacin (2.1%) and kanamycin (0.7%). Of note, the resistance profile of the previously treated patients was found to be remarkably high compared with the newly diagnosed TB patients. The relatively high prevalence estimation of anti-TB drug resistance warrants strengthening TB control and treatment strategies in Sudan.
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Affiliation(s)
- Khalid Hajissa
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Department of Zoology, Faculty of Science and Technology, Omdurman Islamic University, P.O. Box 382, Omdurman 14415, Sudan
| | - Mahfuza Marzan
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh;
| | | | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: or
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Nasir N, Sarfaraz S, Khanum I, Ansari T, Nasim A, Dodani SK, Luxmi S. Tuberculosis in Solid Organ Transplantation: Insights from TB Endemic Areas. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00756-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dos Santos DT, Arroyo LH, Alves YM, Alves LS, Berra TZ, Crispim JDA, Alves JD, Ramos DAC, Alonso JB, de Assis IS, Ramos AV, Dessunti EM, Carvalho Pinto I, Palha PF, Arcêncio RA, Nunes C. Survival time among patients who were diagnosed with tuberculosis, the precocious deaths and associated factors in southern Brazil. Trop Med Health 2021; 49:31. [PMID: 33883022 PMCID: PMC8058757 DOI: 10.1186/s41182-021-00320-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/12/2021] [Indexed: 01/06/2023] Open
Abstract
Background A diagnosis of tuberculosis (TB) does not mean that the disease will be treated successfully, since death may occur even among those who are known to the health services. Here, we aimed to analyze patient survival time from the diagnosis of TB to death, precocious deaths, and associated factors in southern Brazil. Methods We conducted a longitudinal study with patients who were diagnosed with TB and who died due to the disease between 2008 and 2015 in southern Brazil. The starting point for measuring survival time was the patient’s diagnosis date. Techniques for survival analysis were employed, including the Kaplan-Meier test and Cox’s regression. A mixed-effect model was applied for identifying the associated factors to precocious deaths. Hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (95% CI) were estimated. We defined p value <0.05 as statistically significant for all statistics applied. Results One hundred forty-six patients were included in the survival analysis, observing a median survival time of 23.5 days. We observed that alcoholism (HR=1.55, 95% CI=1.04-2.30) and being male (HR=6.49, 95% CI=1.03-2.68) were associated with death. The chance of precocious death within 60 days was 10.48 times greater than the chance of early death within 30 days. Conclusion Most of the deaths occurred within 2 months after the diagnosis, during the intensive phase of the treatment. The use of alcohol and gender were associated with death, revealing inequality between men and women. This study advanced knowledge regarding the vulnerability associated with mortality. These findings must be addressed to fill a gap in the care cascades for active TB and ensure equity in health. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-021-00320-4.
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Affiliation(s)
- Danielle Talita Dos Santos
- Ribeirão Preto College of Nursing (EERP/USP), University of São Paulo, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Luiz Henrique Arroyo
- Ribeirão Preto College of Nursing (EERP/USP), University of São Paulo, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Yan Mathias Alves
- Postgraduate in the Public Health Nursing Program, Ribeirão Preto College of Nursing at University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luana Seles Alves
- Postgraduate in the Public Health Nursing Program, Ribeirão Preto College of Nursing at University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Thais Zamboni Berra
- Postgraduate in the Public Health Nursing Program, Ribeirão Preto College of Nursing at University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Juliane de Almeida Crispim
- Inter-institucional Doctoral Program in Nursing, Ribeirão Preto College of Nursing at University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Josilene Dália Alves
- Nursing Department, Federal University of Mato Grosso, Barra do Garças, Cuiabá, Brazil
| | | | - Jonas Bodini Alonso
- Ribeirão Preto College of Nursing (EERP/USP), University of São Paulo, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | | | - Antônio Vieira Ramos
- Postgraduate in the Public Health Nursing Program, Ribeirão Preto College of Nursing at University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Ione Carvalho Pinto
- Postgraduate in the Public Health Nursing Program, Ribeirão Preto College of Nursing at University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Pedro Fredemir Palha
- Postgraduate in the Public Health Nursing Program, Ribeirão Preto College of Nursing at University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- Ribeirão Preto College of Nursing (EERP/USP), University of São Paulo, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
| | - Carla Nunes
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
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Detection of genomic mutations in katG and rpoB genes among multidrug-resistant Mycobacterium tuberculosis isolates from Tehran, Iran. New Microbes New Infect 2021; 41:100879. [PMID: 34012550 PMCID: PMC8113720 DOI: 10.1016/j.nmni.2021.100879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/29/2021] [Accepted: 04/05/2021] [Indexed: 11/23/2022] Open
Abstract
Multidrug-resistant (MDR) Mycobacterium tuberculosis strains, defined as resistant to at least isoniazid and rifampin, have emerged as a major worldwide health threat. Spontaneous point mutations in various genes of M. tuberculosis cause resistance to isoniazid, with the most frequent gene target being katG; and resistance to rifampin is usually due to mutation in the rpoB gene. The current study was aimed to detect the point mutations in the katG and rpoB regions related to isoniazid and rifampin resistance. A total of 203 respiratory specimens were collected from patients suspected of having tuberculosis respiratory infections referred to hospitals of Tehran, Iran, during 2018-2019. The isolation and identification of M. tuberculosis isolates were performed according to the WHO protocol. Drug susceptibility testing was carried out by proportional method. PCR analysis and sequencing were used to detect mutations in the selected katG and rpoB regions. Forty-four M. tuberculosis strains were isolated, of which 12 (27.3%) and 10 (22.7%) were resistant to isoniazid and rifampin, respectively. Ten isolates were resistant to both isoniazid and rifampin and were considered as MDR isolates. Of the ten MDR isolates, six (60%) carried mutations in both rpoB and katG. The most common mutations among isoniazid- and rifampin-resistant isolates were in codon 315 of the katG gene (70%) and codon 441 of the rpoB gene (50%), respectively. The results of this study indicated that MDR-TB continues to be a serious public health problem in Iran.
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Padmapriyadarsini C, Sachdeva KS, Nair D, Ramachandran R. The paradigm shift in the approach to management of latent tuberculosis infection in high tuberculosis burden countries. Expert Rev Respir Med 2021; 15:899-910. [PMID: 33302729 DOI: 10.1080/17476348.2021.1862652] [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] [Indexed: 10/22/2022]
Abstract
Introduction: Addressing the reservoir of Latent Tuberculosis Infection (LTBI) is critical to TB elimination because if left untreated LTBI can progress to active TB disease. This additional burden can prevent achieving the global targets of TB elimination. Management of LTBI has been a low priority target for National TB Elimination Programs (NTEP) due to various challenges in the field settings.Areas covered: This article reviews the most recent advances in the field of LTBI management including newer diagnostics, treatments, vaccines, programmatic challenges, and gaps and suggests a way forward that can be adopted by NTEPs for LTBI. We searched the electronic databases of PubMed, Scopus, and Web of Science for studies published between 2010 to 2020 using MeSH terms: Latent TB Diagnosis, TB preventive therapy, Vaccines, LTBI, and HIV/ COVID.Expert opinion: NTEPs of developing countries should offer a better, point-of-care diagnostic, and effective treatment for LTBI to reduce the number of new TB cases arising from people infected with M.tb. Awareness about LTBI should be increased among the health system staff and the public. More funding is needed to advance research as well as implement the newer findings in the NTEP to achieve the End TB targets by 2035.
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Affiliation(s)
| | | | - Dina Nair
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
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Redwood L, Mitchell EMH, Nguyen TA, Viney K, Nguyen VN, Fox GJ. Psychometric evaluation of a new drug-resistant tuberculosis stigma scale. J Clin Epidemiol 2021; 133:101-110. [PMID: 33476766 DOI: 10.1016/j.jclinepi.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/22/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Stigma contributes to diagnostic delay, disease concealment, and reduced wellbeing for people with multidrug-resistant tuberculosis (MDR-TB) and their communities. Despite the negative effects of stigma, there are no scales to measure stigma in people with MDR-TB. This study aimed to develop and validate a scale to measure stigma in people affected by MDR-TB in Vietnam. STUDY DESIGN AND SETTING People with rifampicin-resistant (RR)-MDR-TB who had completed at least 3 months of treatment were invited to complete a survey containing 45 draft stigma items. Data analysis included exploratory factor analysis, internal consistency, content, criterion and construct validity, and test-retest reliability. RESULTS A total of 315 people with RR/MDR-TB completed the survey. Exploratory factor analysis revealed a 14 item RR/MDR-TB stigma scale with four subscales, including guilt, social exclusion, physical isolation, and blame. Internal consistency and test-retest reliability were good (Cronbach's Alpha = 0.76, ICC = 0.92). Construct validity was adequate with moderate correlations with related constructs. CONCLUSION Our RR/MDR-TB Scale demonstrated good psychometric properties in Vietnam. This scale will assist in the measurement of stigma in people with RR/MDR-TB. It will also aid in the evaluation of stigma reduction interventions in people with RR/MDR-TB.
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Affiliation(s)
- Lisa Redwood
- The University of Sydney Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, 92-95 Parramatta Road, Camperdown, New South Wales 2050, Australia; The Woolcock Institute of Medical Research, Apartment 203, Building 2G, Van Phuc Diplomatic Compound 298 Kim Ma Street Ba Dinh District, Hanoi, Vietnam.
| | - Ellen M H Mitchell
- Department of Public Health, Institute for Tropical Medicine, Kronenburgstraat 43, 2000 Antwerp, Belgium
| | - Thu Anh Nguyen
- The University of Sydney Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, 92-95 Parramatta Road, Camperdown, New South Wales 2050, Australia; The Woolcock Institute of Medical Research, Apartment 203, Building 2G, Van Phuc Diplomatic Compound 298 Kim Ma Street Ba Dinh District, Hanoi, Vietnam
| | - Kerri Viney
- Research School of Population Health, Australian National University, Building 62 Mills Rd, Acton ACT 2601, Australia; Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm Sweden; School of Public Health, The Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, New South Wales 2050, Australia
| | - Viet Nhung Nguyen
- National Tuberculosis Program, 463 Hoang Hoa Tham, Vinh Phu, Ba Dinh, Hanoi, Vietnam
| | - Greg J Fox
- The University of Sydney Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, 92-95 Parramatta Road, Camperdown, New South Wales 2050, Australia; The Woolcock Institute of Medical Research, Apartment 203, Building 2G, Van Phuc Diplomatic Compound 298 Kim Ma Street Ba Dinh District, Hanoi, Vietnam
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Fu H, Lewnard JA, Frost I, Laxminarayan R, Arinaminpathy N. Modelling the global burden of drug-resistant tuberculosis avertable by a post-exposure vaccine. Nat Commun 2021; 12:424. [PMID: 33462224 PMCID: PMC7814030 DOI: 10.1038/s41467-020-20731-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/16/2020] [Indexed: 11/09/2022] Open
Abstract
There have been notable advances in the development of vaccines against active tuberculosis (TB) disease for adults and adolescents. Using mathematical models, we seek to estimate the potential impact of a post-exposure TB vaccine, having 50% efficacy in reducing active disease, on global rifampicin-resistant (RR-) TB burden. In 30 countries that together accounted for 90% of global RR-TB incidence in 2018, a future TB vaccine could avert 10% (95% credible interval: 9.7-11%) of RR-TB cases and 7.3% (6.6-8.1%) of deaths over 2020-2035, with India, China, Indonesia, Pakistan, and the Russian Federation having the greatest contribution. This impact would increase to 14% (12-16%) and 31% (29-33%) respectively, when combined with improvements in RR-TB diagnosis and treatment relative to a scenario of no vaccine and no such improvements. A future TB vaccine could have important implications for the global control of RR-TB, especially if implemented alongside enhancements in management of drug resistance.
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Affiliation(s)
- Han Fu
- MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, W2 1PG, UK.
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Isabel Frost
- Center for Disease Dynamics, Economics & Policy, New Delhi, India
- Department of Infectious Disease, Imperial College London, London, W2 1NY, UK
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi, India
- Princeton University, Princeton, NJ, 08544, USA
| | - Nimalan Arinaminpathy
- MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, W2 1PG, UK
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Tan C, Kallon II, Colvin CJ, Grant AD. Barriers and facilitators of tuberculosis infection prevention and control in low- and middle-income countries from the perspective of healthcare workers: A systematic review. PLoS One 2020; 15:e0241039. [PMID: 33085717 PMCID: PMC7577501 DOI: 10.1371/journal.pone.0241039] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/07/2020] [Indexed: 12/14/2022] Open
Abstract
Tuberculosis remains a leading cause of death worldwide. Transmission is the dominant mechanism sustaining the multidrug-resistant tuberculosis epidemic. Tuberculosis infection prevention and control (TBIPC) guidelines for healthcare facilities are poorly implemented. This systematic review aimed to explore the barriers and facilitators of implementation of TBIPC guidelines in low- and middle-income countries from the perspective of healthcare workers. Two separate reviewers carried out an electronic database search to select qualitative and quantitative studies exploring healthcare workers attitudes towards TBIPC. Eligible studies underwent thematic synthesis. Derived themes were further organised into a macro-, meso- and micro-level framework, which allows us to analyse barriers at different levels of the healthcare system. We found that most studies focused on assessing implementation within facilities in accordance with the hierarchy of TBIPC measures—administrative, environmental and respiratory protection controls. TBIPC implementation was over-estimated by self-report compared with what researchers observed within facilities, indicating a knowledge-action gap. Macro-level barriers included the lack of coordination of integrated HIV/tuberculosis care, in the context of an expanding antiretroviral therapy programme and hence increasing opportunity for nosocomial acquisition of tuberculosis; a lack of funding; and ineffective occupational health policies, such as poor systems for screening for tuberculosis amongst healthcare workers. Meso-level barriers included little staff training to implement programmes, and managers not understanding policy sufficiently to translate it into an IPC programme. Most studies reported micro-level barriers including the impact of stigma, work culture, lack of perception of risk, poor supply and use of respirators and difficulty sensitising patients to the need for IPC. Existing literature on healthcare workers’ attitudes to TBIPC focusses on collecting data about poor implementation at facility level. In order to bridge the knowledge-action gap, we need to understand how best to implement policy, taking account of the context.
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Affiliation(s)
- Charlene Tan
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Idriss I. Kallon
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J. Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
- Department of Epidemiology, Brown University, Providence, Rhode Island, United States of America
| | - Alison D. Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Africa Health Research Institute, Durban, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Soedarsono S, Mertaniasih NM, Sulistyowati T. FIRST LINE ANTI-TUBERCULOSIS DRUG RESISTANCE PATTERN IN MULTIDRUG-RESISTANT PULMONARY TUBERCULOSIS PATIENTS CORRELATE WITH ACID FAST BACILLI MICROSCOPY GRADING. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2020. [DOI: 10.20473/ijtid.v8i2.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is a global public health crisis. Acid-fast bacilli (AFB) gradation in sputum examination is an important component in Pulmonary Tuberculosis (PTB) diagnosis and treatment outcome monitoring. Previously treated pulmonary TB patients with a higher AFB smear gradation may have higher rates of acquired resistance. Patients with a higher AFB grade indicate a higher bacillary load and had higher rates of acquired resistance. This study aims to evaluate the correlation between AFB gradation and first-line anti-TB drug resistance patterns in MDR pulmonary TB patients. This was a retrospective study conducted from August 2009 to April 2018 in Dr. Soetomo Hospital. Sputum samples were taken from MDR PTB patients. Sputum smear examination was done using Ziehl–Neelsen staining and gradation was measured according to IUATLD criteria. Samples with positive smear were evaluated for resistance patterns based on culture and resistance tests using the MGIT 960 BACTEC System. There were 433 sputum samples with AFB positive collected from MDR PTB patients. Resistance to RHES was found in 22 (14%) AFB +1, 19 (15%) AFB +2, and 29 (20%) AFB +3. Resistance to RHS was found in 22 (14%) AFB +1, 12 (9%) AFB +2, and 13 (9%) AFB +3. Resistance to RHE was found in 39 (25%) AFB +1, 38 (29%) AFB +2, and 35 (24%) AFB +3. Resistance to RH was found in 74 (47%) AFB +1, 61 (47%) AFB +2, and 69 (47%) AFB +3. Statistic analysis by Spearman test showed that there was no significant correlation between AFB gradation and first-line anti-TB drug resistance patterns. Acquired resistance to RHES can also found in lower bacillary load AFB +1.
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Juliasih NN, Soedarsono, Sari RM. Analysis of tuberculosis program management in primary health care. Infect Dis Rep 2020; 12:8728. [PMID: 32874460 PMCID: PMC7447926 DOI: 10.4081/idr.2020.8728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background This study discusses the analysis of Tuberculosis (TB) program management at the Perak Timur Primary Health Care (PHC) and the Sawahan PHC in Surabaya. Early detection and adequate treatment can prevent transmission and improve control programs. Objective This study aims to analyze management of the tuberculosis program at PHCs in Surabaya. Methods The research method used is qualitative research. Data collection was done by interviewing tuberculosis officers about TB program and carrying out observations at the PHCs. Results The study showed that case finding in the Perak Timur PHC and the Sawahan PHC was passive-active. The Perak Timur PHC has facilities for rapid molecular testing, while the Sawahan PHC have to go to a center for Health Laboratory if rapid molecular testing is needed. In terms of treatment, patients at the Perak Timur PHC would come according to an agreement with TB officer, while at the Sawahan PHC, patients have to come every Monday. Officer at the Perak Timur PHC tended to accommodate the needs of TB patients compared to officer at the Sawahan PHC. The level of adherence to taking medication in two PHCs is good but there are a number of patients who have not really understood the frequency of taking medication. Conclusion Generally, both PHCs have good TB program management but the Perak Timur PHC tends to be more flexible towards patients while the Sawahan PHC tends to be stricter towards patients.
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Affiliation(s)
- Ni Njoman Juliasih
- Club Study Tuberculosis, Institute of Tropical Disease, Universitas Airlangga
| | - Soedarsono
- Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Reny Mareta Sari
- Club Study Tuberculosis, Institute of Tropical Disease, Universitas Airlangga
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Leisner JJ. The Diverse Search for Synthetic, Semisynthetic and Natural Product Antibiotics From the 1940s and Up to 1960 Exemplified by a Small Pharmaceutical Player. Front Microbiol 2020; 11:976. [PMID: 32595610 PMCID: PMC7303287 DOI: 10.3389/fmicb.2020.00976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 01/24/2023] Open
Abstract
The 1940s and 1950s witnessed a diverse search for not just natural product antibiotics but also for synthetic and semisynthetic compounds. This review revisits this epoch, using the research by a Danish pharmaceutical company, LEO Pharma, as an example. LEO adopted a strategy searching for synthetic antibiotics toward specific bacterial pathogens, in particular Mycobacterium tuberculosis, leading to the discovery of a new derivative of a known drug. Work on penicillin during and after WWII lead to the development of associated salts/esters and a search for new natural product antibiotics. This led initially to no new, marketable compounds, but concluded with the serendipitous discovery of fusidic acid, an antibiotic used to treat infections by Staphylococcus aureus, in 1960. The discovery process included contemporary approaches such as open innovation; targeting specific pathogens and/or specific organs in the patient; examining the effects of antimicrobial compounds on bacterial virulence as well as on antibiotic-resistant variants, and searching for antibiotic producers among microorganisms not previously well explored. These activities were promoted by the collaboration with a renowned Danish clinical microbiologist, K. A. Jensen, as well as company expertise in fermentation technologies, chemical synthesis and purification of bioactive compounds from organic materials.
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Affiliation(s)
- Jørgen J Leisner
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Jelińska A, Zając M, Dadej A, Tomczak S, Geszke-Moritz M, Muszalska-Kolos I. Tuberculosis - Present Medication and Therapeutic Prospects. Curr Med Chem 2020; 27:630-656. [PMID: 30457045 DOI: 10.2174/0929867325666181120100025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 10/18/2018] [Accepted: 11/08/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tuberculosis (TB) has been present in the history of human civilization since time immemorial and has caused more deaths than any other infectious disease. It is still considered one of the ten most common epidemiologic causes of death in the world. As a transmissible disease, it is initiated by rod-shaped (bacillus) mycobacteria. The management of tuberculosis became possible owing to several discoveries beginning in 1882 with the isolation of the TB bacillus by Robert Koch. The diagnosis of TB was enabled by finding a staining method for TB bacteria identification (1883). It was soon realized that a large-scale policy for the treatment and prevention of tuberculosis was necessary, which resulted in the foundation of International Union against Tuberculosis and Lung Diseases (1902). An antituberculosis vaccine was developed in 1921 and has been in therapeutic use since then. TB treatment regimens have changed over the decades and the latest recommendations are known as Directly Observed Treatment Short-course (DOTS, WHO 1993). METHODS A search of bibliographic databases was performed for peer-reviewed research literature. A focused review question and inclusion criteria were applied. Standard tools were used to assess the quality of retrieved papers. RESULTS A total of 112 papers were included comprising original publications and reviews. The paper overviews anti-TB drugs according to their mechanism of action. The chemical structure, metabolism and unwanted effects of such drugs have been discussed. The most recent treatment regimens and new drugs, including those in clinical trials, are also presented. CONCLUSION Despite a 22% decrease in the tuberculosis fatality rate observed between 2000 and 2015, the disease remains one of the ten prime causes of death worldwide. Increasing bacterial resistance and expensive, prolonged therapies are the main reasons for efforts to find effective drugs or antituberculosis regimens, especially to cure multidrug-resistant tuberculosis.
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Affiliation(s)
- Anna Jelińska
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Poznan University of Medicinal Sciences, Grunwaldzka Str. 6, 60-780, Poznan, Poland
| | - Marianna Zając
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Poznan University of Medicinal Sciences, Grunwaldzka Str. 6, 60-780, Poznan, Poland
| | - Adrianna Dadej
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Poznan University of Medicinal Sciences, Grunwaldzka Str. 6, 60-780, Poznan, Poland
| | - Szymon Tomczak
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Poznan University of Medicinal Sciences, Grunwaldzka Str. 6, 60-780, Poznan, Poland
| | - Małgorzata Geszke-Moritz
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Poznan University of Medicinal Sciences, Grunwaldzka Str. 6, 60-780, Poznan, Poland
| | - Izabela Muszalska-Kolos
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Poznan University of Medicinal Sciences, Grunwaldzka Str. 6, 60-780, Poznan, Poland
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Harries AD, Kumar AM, Satyanarayana S, Thekkur P, Lin Y, Dlodlo RA, Khogali M, Zachariah R. The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground. Trop Med Infect Dis 2020; 5:tropicalmed5020061. [PMID: 32316300 PMCID: PMC7345898 DOI: 10.3390/tropicalmed5020061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
Ending the tuberculosis (TB) epidemic by 2030 requires two key actions: rapid diagnosis and effective treatment of active TB and identification and treatment of latent TB infection to prevent progression to active disease. We introduce this perspective by documenting the growing importance of TB preventive therapy on the international agenda coupled with global data showing poor implementation of preventive activities in programmatic settings. We follow this with two principal objectives. The first is to examine implementation challenges around diagnosis and treatment of active TB. Within this, we include recent evidence about the continued morbidity and heightened mortality that persists after TB treatment is successfully completed, thus elevating the importance of TB preventive therapy. The second objective is to outline how current TB preventive therapy activities have been shaped and are managed and propose how these can be improved through research and innovation. This includes expanding and giving higher priority to certain high-risk groups including those with fibrotic lung lesions on chest X-ray, showcasing the need to develop and deploy new biomarkers to more accurately predict risk of disease and making shorter treatment regimens, especially with rifapentine-isoniazid, more user-friendly and widely available. Ending the TB epidemic requires not only cure of the disease but preventing it before it even begins.
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Affiliation(s)
- Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Correspondence: ; Tel.: +44-(0)-1962-714-297
| | - Ajay M.V. Kumar
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore 575018, India
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Yan Lin
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
- International Union Against Tuberculosis and Lung Disease, No.1 Xindong Road, Beijing 100600, China
| | - Riitta A. Dlodlo
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
| | - Mohammed Khogali
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland; (M.K.); (R.Z.)
| | - Rony Zachariah
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland; (M.K.); (R.Z.)
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Mollel E, Lekule I, Lynen L, Decroo T. Effect of reliance on Xpert MTB/RIF on time to treatment and multidrug-resistant tuberculosis treatment outcomes in Tanzania: a retrospective cohort study. Int Health 2020; 11:520-527. [PMID: 30806660 DOI: 10.1093/inthealth/ihz005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/21/2018] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND During 2009-2013, Xpert MTB/RIF testing was decentralized in Tanzania. Standardized treatment of multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) was centralized at the Kibong'oto Infectious Diseases Hospital. Initially, Xpert MTB/RIF results were confirmed and complemented with phenotypic drug susceptibility testing before MDR-TB treatment was started. Since 2013, the decision to start MDR-TB treatment in patients with RR-TB relied on Xpert MTB/RIF results. METHODS A retrospective cohort study of predictors of unsuccessful treatment outcomes (including death, lost to follow-up and treatment failure) was carried out. RESULTS During the study period, 201 patients started MDR-TB treatment. The number of patients starting MDR-TB treatment increased over time. Out of 201 patients, 48 (23.9%) had an unsuccessful treatment outcome. The median time between sample collection and MDR-TB treatment initiation was reduced from 155 d (IQR 40-228) in the 2009-2012 period to 26 d (IQR 13-64) in 2013. Patients who started MDR-TB treatment in 2013 were more likely (adjusted OR 2.3; 95% CI 1.1-4.7; p=0.02) to have an unsuccessful treatment outcome. CONCLUSIONS Xpert MTB/RIF testing increased enrolment on MDR-TB treatment. Reliance on Xpert MTB/RIF results to start MDR-TB treatment reduced time to treatment. However, treatment outcomes did not improve.
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Affiliation(s)
- Edson Mollel
- Kibong'oto Infectious Diseases Hospital, Ministry of Health, Tanzania
| | - Isack Lekule
- Kibong'oto Infectious Diseases Hospital, Ministry of Health, Tanzania
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Tanzania
| | - Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Tanzania.,Research Foundation Flanders, Brussels, Belgium
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Suryavanshi N, Murrill M, Gupta A, Hughes M, Hesseling A, Kim S, Naini L, Jones L, Smith B, Gupte N, Dawson R, Mave V, Meshram S, Mendoza-Ticona A, Sanchez J, Kumarasamy N, Comins K, Conradie F, Shenje J, Nerette Fontain S, Garcia-Prats A, Asmelash A, Nedsuwan S, Mohapi L, Lalloo U, Cristina Garcia Ferreira A, Okeyo E, Swindells S, Churchyard G, Shah NS. Willingness to Take Multidrug-resistant Tuberculosis (MDR-TB) Preventive Therapy Among Adult and Adolescent Household Contacts of MDR-TB Index Cases: An International Multisite Cross-sectional Study. Clin Infect Dis 2020; 70:436-445. [PMID: 30919881 PMCID: PMC7188234 DOI: 10.1093/cid/ciz254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/26/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Household contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB) are at high risk of infection and subsequent disease. There is limited evidence on the willingness of MDR-TB HHCs to take MDR-TB preventive therapy (MDR TPT) to decrease their risk of TB disease. METHODS In this cross-sectional study of HHCs of MDR-TB and rifampicin-resistant tuberculosis (RR-TB) index cases from 16 clinical research sites in 8 countries, enrollees were interviewed to assess willingness to take a hypothetical, newly developed MDR TPT if offered. To identify factors associated with willingness to take MDR TPT, a marginal logistic model was fitted using generalized estimating equations to account for household-level clustering. RESULTS From 278 MDR-TB/RR-TB index case households, 743 HHCs were enrolled; the median age of HHCs was 33 (interquartile range, 22-49) years, and 62% were women. HHC willingness to take hypothetical MDR TPT was high (79%) and remained high even with the potential for mild side effects (70%). Increased willingness was significantly associated with current employment or schooling (adjusted odds ratio [aOR], 1.83 [95% confidence interval {CI}, 1.07-3.13]), appropriate TB-related knowledge (aOR, 2.22 [95% CI, 1.23-3.99]), confidence in taking MDR TPT (aOR, 7.16 [95% CI, 3.33-15.42]), and being comfortable telling others about taking MDR TPT (aOR, 2.29 [95% CI, 1.29-4.06]). CONCLUSIONS The high percentage of HHCs of MDR-TB/RR-TB index cases willing to take hypothetical MDR TPT provides important evidence for the potential uptake of effective MDR TPT when implemented. Identified HHC-level variables associated with willingness may inform education and counseling efforts to increase HHC confidence in and uptake of MDR TPT.
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Affiliation(s)
- Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
| | | | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael Hughes
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Anneke Hesseling
- Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa
| | - Soyeon Kim
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Linda Naini
- Social and Scientific Systems, Inc, Silver Springs, Maryland
| | - Lynne Jones
- Frontier Science and Technology Research Foundation, Amherst, New York
| | - Betsy Smith
- National Institutes of Health, Bethesda, Maryland
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Rodney Dawson
- University of Cape Town Lung Institute, Mowbray, South Africa
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Sushant Meshram
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
| | | | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, San Miguel Clinical Research Site, Lima, Peru
| | | | - Kyla Comins
- TASK Applied Science Clinical Research Site, Bellville
| | | | - Justin Shenje
- South African Tuberculosis Vaccine Initiative, Cape Town, South Africa
| | - Sandy Nerette Fontain
- GHESKIO Centers–Institute of Infectious Diseases and Reproductive Health, Port-au-Prince, Haiti
| | | | | | - Supalert Nedsuwan
- Program for HIV Prevention and Treatment-Chiangrai Prachanukroh Hospital, Thailand
| | - Lerato Mohapi
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg
| | - Umesh Lalloo
- Durban International Clinical Research Site, South Africa
| | | | | | | | - Gavin Churchyard
- Aurum Institute
- School of Public Health, University of the Witwatersrand, Johannesburg
- Advancing Care and Treatment for TB/HIV, South African Medical Research Council, Parktown, South Africa
| | - N Sarita Shah
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Fox GJ, Nguyen CB, Nguyen TA, Tran PT, Marais BJ, Graham SM, Nguyen BH, Velen K, Dowdy DW, Mason P, Britton WJ, Behr MA, Benedetti A, Menzies D, Nguyen VN, Marks GB. Levofloxacin versus placebo for the treatment of latent tuberculosis among contacts of patients with multidrug-resistant tuberculosis (the VQUIN MDR trial): a protocol for a randomised controlled trial. BMJ Open 2020; 10:e033945. [PMID: 31900274 PMCID: PMC6955503 DOI: 10.1136/bmjopen-2019-033945] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Treatment of latent tuberculosis infection (LTBI) plays a substantial role in the prevention of drug-susceptible tuberculosis (TB). However, clinical trials to evaluate the efficacy of preventive therapy for presumed multidrug-resistant (MDR) LTBI are lacking. This trial aims to evaluate the efficacy of the antibiotic levofloxacin in preventing the development of active TB among latently infected contacts of index patients with MDR-TB. METHODS AND ANALYSIS A double-blind placebo-controlled parallel group randomised controlled trial will be conducted in 10 provinces of Vietnam. Household contacts living with patients with bacteriologically confirmed rifampicin-resistant or MDR-TB will be eligible for recruitment if they have a positive tuberculin skin test or are known to be immunosuppressed, and do not have active TB. Participants will be randomised to receive either levofloxacin or placebo tablets once per day for 6 months. Screening for incident TB will be performed at 6 months intervals. The primary study outcome is the incidence of bacteriologically confirmed TB within 30 months after randomisation. Analysis will be by intention to treat, using Poisson regression. ETHICS Ethical approval from the University of Sydney Human Research Ethics Committee was obtained on 29 April 2015 (2014/929), and from the Vietnam Ministry of Health Institutional Review Board on 30 September 2015 (4040/QD-BYT). DISSEMINATION Findings of the study will be published in peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12616000215426.
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Affiliation(s)
- Greg J Fox
- Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Cam Binh Nguyen
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Thu Anh Nguyen
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Phuong Thuy Tran
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Ben J Marais
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The University of Sydney Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, New South Wales, Australia
| | - Steve M Graham
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Kavi Velen
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - David W Dowdy
- Department of Epidemiology, John Hopkins Bloomberg, Baltimore, Maryland, USA
| | - Paul Mason
- Taronga Institute of Science and Learning, Taronga Conservation Society, Sydney, New South Wales, Australia
| | - Warwick J Britton
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Tuberculosis Research Program, The Centenary Institute of Cancer Medicine and Cell Biology, Sydney, New South Wales, Australia
| | - Marcel A Behr
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, McGill University, Montreal, Quebec, Canada
| | - Andrea Benedetti
- Departments of Medicine and of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Dick Menzies
- McGill International Tuberculosis Centre, McGill University, Montreal, Quebec, Canada
| | | | - Guy B Marks
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Harries AD, Kumar AMV, Satyanarayana S, Takarinda KC, Timire C, Dlodlo RA. Treatment for latent tuberculosis infection in low- and middle-income countries: progress and challenges with implementation and scale-up. Expert Rev Respir Med 2019; 14:195-208. [PMID: 31760848 DOI: 10.1080/17476348.2020.1694907] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Treatment of latent tuberculosis infection (LTBI) is a crucial but neglected component of global tuberculosis control. The 2018 United Nations High-Level Meeting committed world leaders to provide LTBI treatment to at least 30 million people, including 4 million children<5 years, 20 million other household contacts and 6 million HIV-infected people by 2022.Areas covered: This review searched MEDLINE between 1990 and 2019 and discussed: i) high-risk groups to be prioritized for diagnosis and treatment of LTBI; ii) challenges with diagnosing LTBI in programmatic settings; iii) LTBI treatment options including isoniazid monotherapy, shorter regimens (rifampicin-monotherapy, rifampicin-isoniazid and rifapentine-isoniazid) and treatments for contacts of drug-resistant patients; iv) issues with programmatic scale-up of treatment including policy considerations, ruling out active TB, time to start treatment, safety, uninterrupted drug supplies and treatment adherence; and v) recording and reporting.Expert opinion: In 2017, <1.5 million persons were reported to be treated for LTBI. This must rapidly increase to 6 million persons annually. If HIV programs focus on HIV-infected people already accessing or about to start antiretroviral therapy and TB programs focus on household contacts, these targets could be achieved. Isoniazid remains the current treatment of choice although shorter courses of rifapentine-isoniazid are possible alternatives.
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Affiliation(s)
- Anthony D Harries
- The Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ajay M V Kumar
- The Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.,South-East Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India.,Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, India
| | - Srinath Satyanarayana
- The Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.,South-East Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India
| | - Kudakwashe C Takarinda
- The Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.,AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Collins Timire
- The Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.,AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Riitta A Dlodlo
- TB Department, International Union Against Tuberculosis and Lung Disease, Paris, France
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Lange C, Dheda K, Chesov D, Mandalakas AM, Udwadia Z, Horsburgh CR. Management of drug-resistant tuberculosis. Lancet 2019; 394:953-966. [PMID: 31526739 DOI: 10.1016/s0140-6736(19)31882-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/08/2019] [Accepted: 07/18/2019] [Indexed: 12/11/2022]
Abstract
Drug-resistant tuberculosis is a major public health concern in many countries. Over the past decade, the number of patients infected with Mycobacterium tuberculosis resistant to the most effective drugs against tuberculosis (ie, rifampicin and isoniazid), which is called multidrug-resistant tuberculosis, has continued to increase. Globally, 4·6% of patients with tuberculosis have multidrug-resistant tuberculosis, but in some areas, like Kazakhstan, Kyrgyzstan, Moldova, and Ukraine, this proportion exceeds 25%. Treatment for patients with multidrug-resistant tuberculosis is prolonged (ie, 9-24 months) and patients with multidrug-resistant tuberculosis have less favourable outcomes than those treated for drug-susceptible tuberculosis. Individualised multidrug-resistant tuberculosis treatment with novel (eg, bedaquiline) and repurposed (eg, linezolid, clofazimine, or meropenem) drugs and guided by genotypic and phenotypic drug susceptibility testing can improve treatment outcomes. Some clinical trials are evaluating 6-month regimens to simplify management and improve outcomes of patients with multidrug-resistant tuberculosis. Here we review optimal diagnostic and treatment strategies for patients with drug-resistant tuberculosis and their contacts.
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Affiliation(s)
- Christoph Lange
- Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; German Center for Infection Research Clinical Tuberculosis Unit, Borstel, Germany; Department of Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Keertan Dheda
- Department of Medicine, Division of Pulmonology, Centre for Lung Infection and Immunity, Lung Institute, and Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa; South African Medical Research Council, Cape Town, South Africa; Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Dumitru Chesov
- Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; Department of Pneumology and Alergollogy, Nicoale Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Anna Maria Mandalakas
- The Global Tuberculosis Programme, Texas Children's Hospital, and Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Zarir Udwadia
- Hinduja Hospital and Research Center, Veer Savarkar Marg, Mumbai, India
| | - C Robert Horsburgh
- Department of Medicine, School of Medicine, and Department of Epidemiology, Department of Biostatistics, and Department of Global Health, School of Public Health, Boston University, Boston, MA, USA
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40
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The burden of latent multidrug-resistant tuberculosis. THE LANCET. INFECTIOUS DISEASES 2019; 19:802-803. [PMID: 31281060 DOI: 10.1016/s1473-3099(19)30271-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 11/21/2022]
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Affiliation(s)
- Peter J Holmberg
- Division of Pediatric Hospital Medicine, Department of General Pediatric and Adolescent Medicine, and
| | | | - Ritu Banerjee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Activity of a Long-Acting Injectable Bedaquiline Formulation in a Paucibacillary Mouse Model of Latent Tuberculosis Infection. Antimicrob Agents Chemother 2019; 63:AAC.00007-19. [PMID: 30745396 PMCID: PMC6437534 DOI: 10.1128/aac.00007-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 11/20/2022] Open
Abstract
The potent antituberculosis activity and long half-life of bedaquiline make it an attractive candidate for use in long-acting/extended-release formulations for the treatment of latent tuberculosis infection (LTBI). Our objective was to evaluate a long-acting injectable (LAI) bedaquiline formulation in a validated paucibacillary mouse model of LTBI. The potent antituberculosis activity and long half-life of bedaquiline make it an attractive candidate for use in long-acting/extended-release formulations for the treatment of latent tuberculosis infection (LTBI). Our objective was to evaluate a long-acting injectable (LAI) bedaquiline formulation in a validated paucibacillary mouse model of LTBI. Following immunization with Mycobacterium bovis rBCG30, BALB/c mice were challenged by aerosol infection with M. tuberculosis H37Rv. Treatment began 13 weeks after challenge infection with one of the following regimens: an untreated negative-control regimen; positive-control regimens of daily rifampin (10 mg/kg of body weight), once-weekly rifapentine (15 mg/kg) and isoniazid (50 mg/kg), or daily bedaquiline (25 mg/kg); test regimens of one, two, or three monthly doses of LAI bedaquiline at 160 mg/dose (BLAI-160); and test regimens of daily bedaquiline at 2.67 mg/kg (B2.67), 5.33 mg/kg (B5.33), or 8 mg/kg (B8) to deliver the same total amount of bedaquiline as one, two, or three doses of BLAI-160, respectively. All drugs were administered orally, except for BLAI-160 (intramuscular injection). The primary outcome was the decline in M. tuberculosis lung CFU counts during 12 weeks of treatment. The negative- and positive-control regimens performed as expected. One, two, and three doses of BLAI-160 resulted in decreases of 2.9, 3.2, and 3.5 log10 CFU/lung, respectively, by week 12. Daily oral dosing with B2.67, B5.33, and B8 decreased lung CFU counts by 1.6, 2.8, and 4.1 log10, respectively. One dose of BLAI-160 exhibited activity for at least 12 weeks. The sustained activity of BLAI-160 indicates that it shows promise as a short-course LTBI treatment requiring few patient encounters to ensure treatment completion.
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Kulkarni P, Rawtani D, Barot T. Formulation and optimization of long acting dual niosomes using Box-Behnken experimental design method for combinative delivery of Ethionamide and D-cycloserine in Tuberculosis treatment. Colloids Surf A Physicochem Eng Asp 2019. [DOI: 10.1016/j.colsurfa.2019.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Multi and extensively drug-resistant pulmonary tuberculosis: advances in diagnosis and management. Curr Opin Pulm Med 2019; 24:244-252. [PMID: 29470252 DOI: 10.1097/mcp.0000000000000477] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Multidrug-resistant (MDR) tuberculosis (TB) and extensively drug-resistant (XDR)-TB epidemics are key obstacles towards TB control and elimination. RECENT FINDINGS Diagnosis of MDR/XDR-TB is difficult and requires several weeks. New diagnostic tools are being tested and proposed allowing for shorter time to diagnosis and reduced delays in starting an adequate treatment regimen. MDR/XDR-TB treatment strategies are currently on an evolving stage. New shortened treatments based on the recommended 'Bangladesh regimen' or on the newer anti-TB drugs, delamanid and bedaquiline may represent part of the future scenario. In addition, more information on safety and efficacy of delamanid and bedaquiline has been published, allowing to better position these drugs. Recent information on treatment regimens for the paediatric age, with or without delamanid or bedaquiline, has become available. This is of great help in designing safer and more efficacious regimens for the treatment of MDR/XDR-TB in children and adolescents. SUMMARY The accessibility, sustainability and scale-up of new diagnostic technologies are lagging behind and more efforts are needed. In addition, we need high-quality information on safety and efficacy of various combinations of drugs to obtain the best possible regimens to treat the largest possible proportion of patients.
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Vo LNQ, Vu TN, Nguyen HT, Truong TT, Khuu CM, Pham PQ, Nguyen LH, Le GT, Creswell J. Optimizing community screening for tuberculosis: Spatial analysis of localized case finding from door-to-door screening for TB in an urban district of Ho Chi Minh City, Viet Nam. PLoS One 2018; 13:e0209290. [PMID: 30562401 PMCID: PMC6298730 DOI: 10.1371/journal.pone.0209290] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the deadliest infectious disease globally. Current case finding approaches may miss many people with TB or detect them too late. DATA AND METHODS This study was a retrospective, spatial analysis of routine TB surveillance and cadastral data in Go Vap district, Ho Chi Minh City. We geocoded TB notifications from 2011 to 2015 and calculated theoretical yields of simulated door-to-door screening in three concentric catchment areas (50m, 100m, 200m) and three notification window scenarios (one, two and four quarters) for each index case. We calculated average yields, compared them to published reference values and fit a GEE (Generalized Estimating Equation) linear regression model onto the data. RESULTS The sample included 3,046 TB patients. Adjusted theoretical yields in 50m, 100m and 200m catchment areas were 0.32% (95%CI: 0.27,0.37), 0.21% (95%CI: 0.14,0.29) and 0.17% (95%CI: 0.09,0.25), respectively, in the baseline notification window scenario. Theoretical yields in the 50m-catchment area for all notification window scenarios were significantly higher than a reference yield from literature. Yield was positively associated with treatment failure index cases (beta = 0.12, p = 0.001) and short-term inter-province migrants (beta = 0.06, p = 0.022), while greater distance to the DTU (beta = -0.02, p<0.001) was associated with lower yield. CONCLUSIONS This study is an example of inter-departmental collaboration and application of repurposed cadastral data to progress towards the end TB objectives. The results from Go Vap showed that the use of spatial analysis may be able to identify areas where targeted active case finding in Vietnam can help improve TB case detection.
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Affiliation(s)
| | - Thanh Nguyen Vu
- Ho Chi Minh City Public Health Association, Ho Chi Minh City, Viet Nam
| | - Hoa Trung Nguyen
- Go Vap District Preventive Health Center, Ho Chi Minh City, Viet Nam
| | - Tung Thanh Truong
- Ho Chi Minh City Department of Science & Technology, Center for Applied Geographic Information Systems (HCMGIS), Ho Chi Minh City, Viet Nam
| | - Canh Minh Khuu
- Ho Chi Minh City Department of Science & Technology, Center for Applied Geographic Information Systems (HCMGIS), Ho Chi Minh City, Viet Nam
| | - Phuong Quoc Pham
- Ho Chi Minh City Department of Science & Technology, Center for Applied Geographic Information Systems (HCMGIS), Ho Chi Minh City, Viet Nam
| | | | - Giang Truong Le
- Ho Chi Minh City Public Health Association, Ho Chi Minh City, Viet Nam
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Domínguez J, Latorre I, Santin M. Diagnóstico y abordaje terapéutico de la infección tuberculosa latente. Enferm Infecc Microbiol Clin 2018; 36:302-311. [DOI: 10.1016/j.eimc.2017.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 11/14/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
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Domínguez J, Latorre I, Santin M. Diagnosis and therapeutic approach of latent tuberculosis infection. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.eimce.2017.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ng KC, Meehan CJ, Torrea G, Goeminne L, Diels M, Rigouts L, de Jong BC, André E. Potential Application of Digitally Linked Tuberculosis Diagnostics for Real-Time Surveillance of Drug-Resistant Tuberculosis Transmission: Validation and Analysis of Test Results. JMIR Med Inform 2018; 6:e12. [PMID: 29487047 PMCID: PMC5849801 DOI: 10.2196/medinform.9309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the highest-mortality infectious disease in the world and the main cause of death related to antimicrobial resistance, yet its surveillance is still paper-based. Rifampicin-resistant TB (RR-TB) is an urgent public health crisis. The World Health Organization has, since 2010, endorsed a series of rapid diagnostic tests (RDTs) that enable rapid detection of drug-resistant strains and produce large volumes of data. In parallel, most high-burden countries have adopted connectivity solutions that allow linking of diagnostics, real-time capture, and shared repository of these test results. However, these connected diagnostics and readily available test results are not used to their full capacity, as we have yet to capitalize on fully understanding the relationship between test results and specific rpoB mutations to elucidate its potential application to real-time surveillance. OBJECTIVE We aimed to validate and analyze RDT data in detail, and propose the potential use of connected diagnostics and associated test results for real-time evaluation of RR-TB transmission. METHODS We selected 107 RR-TB strains harboring 34 unique rpoB mutations, including 30 within the rifampicin resistance-determining region (RRDR), from the Belgian Coordinated Collections of Microorganisms, Antwerp, Belgium. We subjected these strains to Xpert MTB/RIF, GenoType MTBDRplus v2.0, and Genoscholar NTM + MDRTB II, the results of which were validated against the strains' available rpoB gene sequences. We determined the reproducibility of the results, analyzed and visualized the probe reactions, and proposed these for potential use in evaluating transmission. RESULTS The RDT probe reactions detected most RRDR mutations tested, although we found a few critical discrepancies between observed results and manufacturers' claims. Based on published frequencies of probe reactions and RRDR mutations, we found specific probe reactions with high potential use in transmission studies: Xpert MTB/RIF probes A, Bdelayed, C, and Edelayed; Genotype MTBDRplus v2.0 WT2, WT5, and WT6; and Genoscholar NTM + MDRTB II S1 and S3. Inspection of probe reactions of disputed mutations may potentially resolve discordance between genotypic and phenotypic test results. CONCLUSIONS We propose a novel approach for potential real-time detection of RR-TB transmission through fully using digitally linked TB diagnostics and shared repository of test results. To our knowledge, this is the first pragmatic and scalable work in response to the consensus of world-renowned TB experts in 2016 on the potential of diagnostic connectivity to accelerate efforts to eliminate TB. This is evidenced by the ability of our proposed approach to facilitate comparison of probe reactions between different RDTs used in the same setting. Integrating this proposed approach as a plug-in module to a connectivity platform will increase usefulness of connected TB diagnostics for RR-TB outbreak detection through real-time investigation of suspected RR-TB transmission cases based on epidemiologic linking.
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Affiliation(s)
- Kamela Charmaine Ng
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Conor Joseph Meehan
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gabriela Torrea
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Léonie Goeminne
- Pôle de Microbiologie Médicale, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Maren Diels
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Leen Rigouts
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Bouke Catherine de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emmanuel André
- Pôle de Microbiologie Médicale, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Laboratory of Clinical Bacteriology and Mycology, Katholieke Universiteit Leuven, Leuven, Belgium
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Abstract
The DOTS strategy assisted global tuberculosis (TB) control, but was unable to prevent the emergence and spread of drug-resistant strains. Genomic evidence confirms the transmission of drug-resistant Mycobacterium tuberculosis strains in many different settings, indicative of epidemic spread. These findings emphasise the need for enhanced infection control measures in health care and congregate settings. Young children in TB endemic areas are particularly vulnerable. Although advances in TB drug and vaccine development are urgently needed, improved access to currently available preventive therapy and treatment for drug resistant TB could reduce the disease burden and adverse outcomes experienced by children. We review new insights into the transmission dynamics of drug resistant TB, the estimated disease burden in children and optimal management strategies to consider.
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Affiliation(s)
- Alexander C Outhred
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Philip N Britton
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Ben J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
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