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Noppert GA, Hegde ST, Kubale JT. Exposure, Susceptibility, and Recovery: A Framework for Examining the Intersection of the Social and Physical Environments and Infectious Disease Risk. Am J Epidemiol 2023; 192:475-482. [PMID: 36255177 PMCID: PMC10372867 DOI: 10.1093/aje/kwac186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/30/2022] [Accepted: 10/13/2022] [Indexed: 01/13/2023] Open
Abstract
Despite well-documented evidence that structurally disadvantaged populations are disproportionately affected by infectious diseases, our understanding of the pathways that connect structural disadvantage to the burden of infectious diseases is limited. We propose a conceptual framework to facilitate more rigorous examination and testing of hypothesized mechanisms through which social and environmental factors shape the burden of infectious diseases and lead to persistent inequities. Drawing upon the principles laid out by Link and Phelan in their landmark paper on social conditions (J Health Soc Behav. 1995;(spec no.):80-94), we offer an explication of potential pathways through which structural disadvantage (e.g., racism, sexism, and economic deprivation) operates to produce infectious disease inequities. Specifically, we describe how the social environment affects an individual's risk of infectious disease by 1) increasing exposure to infectious pathogens and 2) increasing susceptibility to infection. This framework will facilitate both the systematic examination of the ways in which structural disadvantage shapes the burden of infectious disease and the design of interventions that can disrupt these pathways.
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Affiliation(s)
- Grace A Noppert
- Survey Research Center, Institute for Social Research, University of Michigan
| | - Sonia T Hegde
- Department of Epidemiology, Johns Hopkins University
| | - John T Kubale
- ICPSR, Institute for Social Research, University of Michigan
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2
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Diel R, Nienhaus A. Pathways of TB Transmission in Children-A Systematic Review of Molecular Epidemiological Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1737. [PMID: 36767111 PMCID: PMC9914148 DOI: 10.3390/ijerph20031737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
The widespread paradigm that younger children usually do not transmit M. tuberculosis complex (Mtbc) to their contacts has not yet been proven by genotypically confirmed transmissions. Therefore, we undertook a systematic review of molecular-epidemiological studies to investigate documented source and secondary TB (tuberculosis) cases among children. We searched the literature published before August 2022 using PubMed, Cochrane, and Google Scholar databases. PRISMA statement was used for systematic review. Of 312 records retrieved, 39 studies including children aged below 15 years offered epidemiological links between cluster members. In the 39 studies from 16 countries, 225 children were reported as cluster members of whom the overwhelming majority were infected by adults. Only 3 children-of those were 2 children aged below 10-were reported to be the definite source cases of 11 other children and 1 adult with genotypically matched Mtbc isolates. To date, molecular-epidemiological studies involving children with verified transmission links are scarce. As far as the heterogeneity of the studies we identified allows, we could conclude that the results confirm the paradigm that children aged below 10 hardly ever transmit Mtbc to others. The true extent of TB transmission through children may, however, be underestimated by those selected studies.
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Affiliation(s)
- Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, 24105 Kiel, Germany
- LungClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Albert Nienhaus
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Department for Occupational Medicine, Hazardous Substances and Health Sciences (AGG), Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
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Zdziarski P, Paściak M, Chudzik A, Kozińska M, Augustynowicz-Kopeć E, Gamian A. Cutaneous tuberculosis-ambiguous transmission, bacterial diversity with biofilm formation in humoral abnormality: case report illustration. Front Public Health 2023; 11:1091373. [PMID: 37213612 PMCID: PMC10194659 DOI: 10.3389/fpubh.2023.1091373] [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: 11/15/2022] [Accepted: 03/27/2023] [Indexed: 05/23/2023] Open
Abstract
Background Cutaneous tuberculosis (CTB) and its paucibacillary forms are rare and difficult to diagnose, especially in immunocompromised patients with significant comorbidity. The aim of the study was to introduce the modern concept of the microbiome and diagnostic chain into clinical practice (patient-centered care) with the presentation of an atypical form of cutaneous tuberculosis with necrotizing non-healing ulcers leading to polymicrobial infection. Methods The study material included samples from sputum, broncho-alveolar lavage and skin ulcer, taken from a patient developing cutaneous tuberculosis. The microbiological investigation was performed, and identification of the isolates was carried out using genotyping and the matrix-assisted laser desorption ionization-time of flight mass spectrometry. Results The immunocompromised patient with humoral abnormality (plasma cell dyscrasia) and severe paraproteinemia developed multiorgan tuberculosis. Although cutaneous manifestation preceded systemic and pulmonary symptoms (approximately half a year), the mycobacterial genotyping confirmed the same MTB strain existence in skin ulcers and the respiratory system. Therefore, the infectious chain: transmission, the portal of entry, and bacterial spreading in vivo, were unclear. Microbial diversity found in wound microbiota (among others Gordonia bronchialis, Corynebacterium tuberculostearicum, Staphylococcus haemolyticus, and Pseudomonas oryzihabitans) was associated with the spread of a skin lesion. The in vitro biofilm-forming capacity of strains isolated from the wound may represent the potential virulence of these strains. Thus, the role of polymicrobial biofilm may be crucial in ulcer formation and CTB manifestation. Conclusions Severe wound healing as a unique biofilm-forming niche should be tested for Mycobacterium (on species and strain levels) and coexisting microorganisms using a wide range of microbiological techniques. In immunodeficient patients with non-typical CTB presentation, the chain of transmission and MTB spread is still an open issue for further research.
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Affiliation(s)
- Przemysław Zdziarski
- Department of Clinical Immunology, Tuberculosis and Pulmonary Disease, Lower Silesian Oncology Center, Wroclaw, Poland
- *Correspondence: Przemysław Zdziarski
| | - Mariola Paściak
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Anna Chudzik
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Monika Kozińska
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Ewa Augustynowicz-Kopeć
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Andrzej Gamian
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
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Chen Q, Yu S, Rui J, Guo Y, Yang S, Abudurusuli G, Yang Z, Liu C, Luo L, Wang M, Lei Z, Zhao Q, Gavotte L, Niu Y, Frutos R, Chen T. Transmissibility of tuberculosis among students and non-students: an occupational-specific mathematical modelling. Infect Dis Poverty 2022; 11:117. [PMID: 36461098 PMCID: PMC9716537 DOI: 10.1186/s40249-022-01046-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Recently, despite the steady decline in the tuberculosis (TB) epidemic globally, school TB outbreaks have been frequently reported in China. This study aimed to quantify the transmissibility of Mycobacterium tuberculosis (MTB) among students and non-students using a mathematical model to determine characteristics of TB transmission. METHODS We constructed a dataset of reported TB cases from four regions (Jilin Province, Xiamen City, Chuxiong Prefecture, and Wuhan City) in China from 2005 to 2019. We classified the population and the reported cases under student and non-student groups, and developed two mathematical models [nonseasonal model (Model A) and seasonal model (Model B)] based on the natural history and transmission features of TB. The effective reproduction number (Reff) of TB between groups were calculated using the collected data. RESULTS During the study period, data on 456,423 TB cases were collected from four regions: students accounted for 6.1% of cases. The goodness-of-fit analysis showed that Model A had a better fitting effect (P < 0.001). The average Reff of TB estimated from Model A was 1.68 [interquartile range (IQR): 1.20-1.96] in Chuxiong Prefecture, 1.67 (IQR: 1.40-1.93) in Xiamen City, 1.75 (IQR: 1.37-2.02) in Jilin Province, and 1.79 (IQR: 1.56-2.02) in Wuhan City. The average Reff of TB in the non-student population was 23.30 times (1.65/0.07) higher than that in the student population. CONCLUSIONS The transmissibility of MTB remains high in the non-student population of the areas studied, which is still dominant in the spread of TB. TB transmissibility from the non-student-to-student-population had a strong influence on students. Specific interventions, such as TB screening, should be applied rigorously to control and to prevent TB transmission among students.
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Affiliation(s)
- Qiuping Chen
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China ,grid.8183.20000 0001 2153 9871CIRAD, URM 17, Intertryp, Montpellier, France ,grid.121334.60000 0001 2097 0141Université de Montpellier, Montpellier, France
| | - Shanshan Yu
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Jia Rui
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China ,grid.8183.20000 0001 2153 9871CIRAD, URM 17, Intertryp, Montpellier, France ,grid.121334.60000 0001 2097 0141Université de Montpellier, Montpellier, France
| | - Yichao Guo
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Shiting Yang
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Guzainuer Abudurusuli
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Zimei Yang
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Chan Liu
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Li Luo
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Mingzhai Wang
- Xiamen Center for Disease Control and Prevention, Xiamen, Fujian People’s Republic of China
| | - Zhao Lei
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
| | - Qinglong Zhao
- Jilin Provincial Center for Disease Control and Prevention, Changchun, Jilin People’s Republic of China
| | - Laurent Gavotte
- grid.121334.60000 0001 2097 0141Espace-Dev, Université de Montpellier, Montpellier, France
| | - Yan Niu
- grid.198530.60000 0000 8803 2373Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, China
| | - Roger Frutos
- grid.8183.20000 0001 2153 9871CIRAD, URM 17, Intertryp, Montpellier, France
| | - Tianmu Chen
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian People’s Republic of China
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Nuraini N, Fauzi IS, Lestari BW, Rizqina S. The Impact of COVID-19 Quarantine on Tuberculosis and Diabetes Mellitus Cases: A Modelling Study. Trop Med Infect Dis 2022; 7:tropicalmed7120407. [PMID: 36548662 PMCID: PMC9782997 DOI: 10.3390/tropicalmed7120407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022] Open
Abstract
COVID-19 has currently become a global pandemic and caused a high number of infected people and deaths. To restrain the coronavirus spread, many countries have implemented restrictions on people’s movement and outdoor activities. The enforcement of health emergencies such as quarantine has a positive impact on reducing the COVID-19 infection risk, but it also has unwanted influences on health, social, and economic sectors. Here, we developed a compartmental mathematical model for COVID-19 transmission dynamic accommodating quarantine process and including tuberculosis and diabetic people compartments. We highlighted the potential negative impact induced by quarantine implementation on the increasing number of people with tuberculosis and diabetes. The actual COVID-19 data recorded in Indonesia during the Delta and Omicron variant attacks were well-approximated by the model’s output. A positive relationship was indicated by a high value of Pearson correlation coefficient, r=0.9344 for Delta and r=0.8961 for Omicron with a significance level of p<0.05. By varying the value of the quarantine parameter, this study obtained that quarantine effectively reduces the number of COVID-19 but induces an increasing number of tuberculosis and diabetic people. In order to minimize these negative impacts, increasing public awareness about the dangers of TB transmission and implementing a healthy lifestyle were considered the most effective strategies based on the simulation. The insights and results presented in this study are potentially useful for relevant authorities to increase public awareness of the potential risk of TB transmission and to promote a healthy lifestyle during the implementation of quarantine.
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Affiliation(s)
- Nuning Nuraini
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Bandung 40132, Indonesia
- Center for Mathematical Modeling and Simulation, Institut Teknologi Bandung, Bandung 40132, Indonesia
| | - Ilham Saiful Fauzi
- Department of Accounting, Politeknik Negeri Malang, Malang 65141, Indonesia
- Correspondence:
| | - Bony Wiem Lestari
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Sila Rizqina
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Bandung 40132, Indonesia
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Multidrug-Resistant Tuberculosis—Diagnostic Procedures and Treatment of Two Beijing-like TB Cases. Diagnostics (Basel) 2022; 12:diagnostics12071699. [PMID: 35885603 PMCID: PMC9318939 DOI: 10.3390/diagnostics12071699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
The Beijing/W genotype is one of the major molecular families of Mycobacterium tuberculosis complex (MTBC), responsible for approximately 50% of tuberculosis (TB) cases in Far East Asia and at least 25% of TB cases globally. Studies have revealed that the Beijing genotype family is associated with a more severe clinical course of TB, increased ability to spread compared to other genotypes, and an unpredictable response to treatment. Based on the profile of spacers 35–43 in the Direct Repeat (DR) locus of the MTBC genome determined by spoligotyping, classical (typical) and modern (Beijing-like) clones can be identified within the Beijing family. While the modern and ancient Beijing strains appear to be closely related at the genetic level, there are marked differences in their drug resistance, as well as their ability to spread and cause disease. This paper presents two cases of drug-resistant tuberculosis caused by rare mycobacteria from the Beijing family: the Beijing 265 and Beijing 541 subtypes. The genotypes of isolated strains were linked with the clinical course of TB, and an attempt was made to initially assess whether the Beijing subtype can determine treatment outcomes in patients.
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7
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Chen J, Chen L, Zhou M, Wu G, Yi F, Jiang C, Duan Q, Zhou M. Transmission of multidrug-resistant tuberculosis within family households by DTM-PCR and MIRU-VNTR genotyping. BMC Infect Dis 2022; 22:192. [PMID: 35219320 PMCID: PMC8881899 DOI: 10.1186/s12879-022-07188-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Drug-resistant tuberculosis (TB) continues to be a public health threat. There are few studies on transmission and genotyping of MDR-TB family households in China. This study aimed to investigate transmission of multidrug-resistant tuberculosis (MDR-TB) within family households by deletion-targeted multiplex polymerase chain reaction (DTM-PCR), mycobacterial interspersed repetitive unit variable number tandem repeats (MIRU-VNTR) genotyping.
Methods Among 993 MDR-TB patients registered from Wuhan Institute for Tuberculosis Control, drug resistance and the time interval between the index patients and secondary patients were analyzed in 49 MDR-TB patients from 23 families, in which 22 MDR-TB strains from 11 families who had matched strains were genotyped by DTM-PCR and standard 24-loci MIRU-VNTR genotyping method. Results The time interval between the index patients and the secondary patients ranged from half a month to 110 months. Thirteen secondary patients developed active MDR-TB within two years and accounted for 50% (13/26) of all secondary patients. Among eleven pairs of MDR-TB families, six pairs had identical genotypes, the cluster rate was 54.5% (12/22); three pairs had a single MIRU-VNTR locus variation. If a single MIRU-VNTR locus variation was tolerated in the cluster definition, the cluster rate raised to 81.8% (18/22). Conclusions The family households of MDR-TB patients are at risk for infection of MDR-TB. To reduce transmission, MDR-TB patients should be diagnosed earlier and promptly treated in an effective manner, meanwhile, the close family contacts should be screened for TB infection.
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Kozińska M, Bogucka K, Kędziora K, Szpak-Szpakowska J, Pędzierska-Olizarowicz W, Pustkowski A, Augustynowicz-Kopeć E. XDR-TB Transmitted from Mother to 10-Month-Old Infant: Diagnostic and Therapeutic Problems. Diagnostics (Basel) 2022; 12:diagnostics12020438. [PMID: 35204528 PMCID: PMC8871013 DOI: 10.3390/diagnostics12020438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 02/06/2023] Open
Abstract
Drug-resistant TB (DR-TB) in children is a special epidemiological, clinical, and diagnostic problem, and its global incidence remains unknown. DR-TB in children is usually of a primary nature and is most often transmitted to the child from a household contact, so these cases reflect the prevalence of DR-TB in the population of adult patients. The risk of infection with Mycobacterium tuberculosis complex (MTBC) in children depends on age, duration of exposure, proximity of contact with the infected person, and the level of source virulence. Most cases of TB in children, especially in infants, are caused by household contacts, where the main sources of infection are parents, grandparents or older siblings. However, there are many documented cases of TB transmission outside the family. The most common source of infection is an adult who is profusely positive for mycobacteria, diagnosed too late, and inadequately treated. It has been estimated that a sputum-positive patient might infect 30–50% of their household members. For this reason, active epidemiological investigation and contact tracing in the environment of sputum-positive patients are the most appropriate methods of identifying infected family members. This paper presents a case report concerning the transmission of extensively drug-resistant TB, Beijing 265 genotype, from a mother to her 10-month-old daughter. It is the first case diagnosed in Poland, and one of very few described in the literature where treatment was effective in the mother and the infant recovered spontaneously.
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Affiliation(s)
- Monika Kozińska
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, 01-138 Warsaw, Poland;
- Correspondence:
| | - Krystyna Bogucka
- Medical Laboratory BRUSS, ALAB Group, Department of Mycobacterium Tuberculosis Diagnostics, Powstania Styczniowego 9B, 81-519 Gdynia, Poland;
| | - Krzysztof Kędziora
- Department of Tuberculosis and Lung Diseases, Specialist Hospital in Prabuty, Kuracyjna 30, 82-550 Prabuty, Poland; (K.K.); (J.S.-S.)
| | - Jolanta Szpak-Szpakowska
- Department of Tuberculosis and Lung Diseases, Specialist Hospital in Prabuty, Kuracyjna 30, 82-550 Prabuty, Poland; (K.K.); (J.S.-S.)
| | - Wiesława Pędzierska-Olizarowicz
- Department of Allergology, Immunology and Lung Diseases, The Maciej Płażyński Polanki Children’s Hospital, Polanki 119, 80-308 Gdansk, Poland;
| | - Andrzej Pustkowski
- Department of Tuberculosis and Lung Diseases, Hospital Specialist Clinic Polanki, Polanki 119, 80-308 Gdansk, Poland;
| | - Ewa Augustynowicz-Kopeć
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, 01-138 Warsaw, Poland;
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Chiang SS, Brooks MB, Jenkins HE, Rubenstein D, Seddon JA, van de Water BJ, Lindeborg MM, Becerra MC, Yuen CM. Concordance of Drug-resistance Profiles Between Persons With Drug-resistant Tuberculosis and Their Household Contacts: A Systematic Review and Meta-analysis. Clin Infect Dis 2021; 73:250-263. [PMID: 32448887 DOI: 10.1093/cid/ciaa613] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/18/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Household contacts of patients with drug-resistant tuberculosis (TB) are at high risk for being infected with Mycobacterium tuberculosis and for developing TB disease. To guide regimen composition for the empirical treatment of TB infection and disease in these household contacts, we estimated drug-resistance profile concordance between index patients with drug-resistant TB and their household contacts. METHODS We performed a systematic review and meta-analysis of studies published through 24 July 2018 that reported resistance profiles of drug-resistant TB index cases and secondary cases within their households. Using a random-effects meta-analysis, we estimated resistance profile concordance, defined as the percentage of secondary cases whose M. tuberculosis strains were resistant to the same drugs as strains from their index cases. We also estimated isoniazid/rifampin concordance, defined as whether index and secondary cases had identical susceptibilities for isoniazid and rifampin only. RESULTS We identified 33 eligible studies that evaluated resistance profile concordance between 484 secondary cases and their household index cases. Pooled resistance profile concordance was 54.3% (95% confidence interval [CI], 40.7-67.6%; I2 = 85%). Pooled isoniazid/rifampin concordance was 82.6% (95% CI, 72.3-90.9%; I2 = 73%). Concordance estimates were similar in a subanalysis of 16 studies from high-TB-burden countries. There were insufficient data to perform a subanalysis among pediatric secondary cases. CONCLUSIONS Household contacts of patients with drug-resistant TB should receive treatment for TB infection and disease that assumes that they, too, are infected with a drug-resistant M. tuberculosis strain. Whenever possible, drug susceptibility testing should be performed for secondary cases to optimize regimen composition.
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Affiliation(s)
- Silvia S Chiang
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Meredith B Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Helen E Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Dana Rubenstein
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James A Seddon
- Department of Infectious Diseases, Imperial College London, London, United Kingdom.,Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Brittney J van de Water
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael M Lindeborg
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Courtney M Yuen
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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10
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Shao M, Wu F, Zhang J, Dong J, Zhang H, Liu X, Liang S, Wu J, Zhang L, Zhang C, Zhang W. Screening of potential biomarkers for distinguishing between latent and active tuberculosis in children using bioinformatics analysis. Medicine (Baltimore) 2021; 100:e23207. [PMID: 33592820 PMCID: PMC7870233 DOI: 10.1097/md.0000000000023207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/19/2020] [Indexed: 01/05/2023] Open
Abstract
Tuberculosis (TB) is one of the leading causes of childhood morbidity and death globally. Lack of rapid, effective non-sputum diagnosis and prediction methods for TB in children are some of the challenges currently faced. In recent years, blood transcriptional profiling has provided a fresh perspective on the diagnosis and predicting the progression of tuberculosis. Meanwhile, combined with bioinformatics analysis can help to identify the differentially expressed genes (DEGs) and functional pathways involved in the different clinical stages of TB. Therefore, this study investigated potential diagnostic markers for use in distinguishing between latent tuberculosis infection (LTBI) and active TB using children's blood transcriptome data.From the Gene Expression Omnibus database, we downloaded two gene expression profile datasets (GSE39939 and GSE39940) of whole blood-derived RNA sequencing samples, reflecting transcriptional signatures between latent and active tuberculosis in children. GEO2R tool was used to screen for DEGs in LTBI and active TB in children. Database for Annotation, Visualization and Integrated Discovery tools were used to perform Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway analysis. STRING and Cytoscape analyzed the protein-protein interaction network and the top 15 hub genes respectively. Receiver operating characteristics curve was used to estimate the diagnostic value of the hub genes.A total of 265 DEGs were identified, including 79 upregulated and 186 downregulated DEGs. Further, 15 core genes were picked and enrichment analysis revealed that they were highly correlated with neutrophil activation and degranulation, neutrophil-mediated immunity and in defense response. Among them TLR2, FPR2, MMP9, MPO, CEACAM8, ELANE, FCGR1A, SELP, ARG1, GNG10, HP, LCN2, LTF, ADCY3 had significant discriminatory power between LTBI and active TB, with area under the curves of 0.84, 0.84, 0.84, 0.80, 0.87, 0.78, 0.88, 0.84, 0.86, 0.82, 0.85, 0.85, 0.79, and 0.88 respectively.Our research provided several genes with high potential to be candidate gene markers for developing non-sputum diagnostic tools for childhood Tuberculosis.
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Affiliation(s)
- Meng Shao
- Department of Pathophysiology, Shihezi University School of Medicine/The Key Laboratory of Xinjiang Endemic and Ethnic Diseases
| | - Fang Wu
- Department of Pathophysiology, Shihezi University School of Medicine/The Key Laboratory of Xinjiang Endemic and Ethnic Diseases
| | - Jie Zhang
- The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, XinJiang, PR China
| | - Jiangtao Dong
- The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, XinJiang, PR China
| | - Hui Zhang
- Department of Pathophysiology, Shihezi University School of Medicine/The Key Laboratory of Xinjiang Endemic and Ethnic Diseases
| | - Xiaoling Liu
- Department of Pathophysiology, Shihezi University School of Medicine/The Key Laboratory of Xinjiang Endemic and Ethnic Diseases
| | - Su Liang
- The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, XinJiang, PR China
| | - Jiangdong Wu
- Department of Pathophysiology, Shihezi University School of Medicine/The Key Laboratory of Xinjiang Endemic and Ethnic Diseases
| | - Le Zhang
- Department of Pathophysiology, Shihezi University School of Medicine/The Key Laboratory of Xinjiang Endemic and Ethnic Diseases
| | - Chunjun Zhang
- Department of Pathophysiology, Shihezi University School of Medicine/The Key Laboratory of Xinjiang Endemic and Ethnic Diseases
| | - Wanjiang Zhang
- Department of Pathophysiology, Shihezi University School of Medicine/The Key Laboratory of Xinjiang Endemic and Ethnic Diseases
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11
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Comella-Del-Barrio P, Abellana R, Villar-Hernández R, Jean Coute MD, Sallés Mingels B, Canales Aliaga L, Narcisse M, Gautier J, Ascaso C, Latorre I, Dominguez J, Perez-Porcuna TM. A Model Based on the Combination of IFN-γ, IP-10, Ferritin and 25-Hydroxyvitamin D for Discriminating Latent From Active Tuberculosis in Children. Front Microbiol 2019; 10:1855. [PMID: 31474956 PMCID: PMC6702835 DOI: 10.3389/fmicb.2019.01855] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/29/2019] [Indexed: 01/31/2023] Open
Abstract
In recent years, pediatric research on tuberculosis (TB) has focused on addressing new biomarkers with the potential to be used as immunological non-sputum-based methods for the diagnosis of TB in children. The aim of this study was to characterize a set of cytokines and a series of individual factors (ferritin, 25-hydroxyvitamin D [25(OH)D], parasite infections, and nutritional status) to assess different patterns for discriminating between active TB and latent TB infection (LTBI) in children. The levels of 13 cytokines in QuantiFERON-TB Gold In-Tube (QFT-GIT) supernatants were analyzed in 166 children: 74 with active TB, 37 with LTBI, and 55 uninfected controls. All cytokines were quantified using Luminex or ELISA. Ferritin and 25(OH)D were also evaluated using CLIA, and Toxocara canis Ig-G antibodies were detected with a commercial ELISA kit. The combination of IP-10, IFN-γ, ferritin, and 25(OH)D achieved the best diagnostic performance to discriminate between active TB and LTBI cases in children in relation to the area under receiver operating characteristic (ROC) curve 0.955 (confidence interval 95%: 0.91–1.00), achieving optimal sensitivity and specificity for the development of a new test (93.2 and 90.0%, respectively). Children with TB showed higher ferritin levels and an inverse correlation between 25(OH)D and IFN-γ levels. The model proposed includes a combination of biomarkers for discriminating between active TB and LTBI in children to improve the accuracy of TB diagnosis in children. This combination of biomarkers might have potential for identifying the onset of primary TB in children.
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Affiliation(s)
- Patricia Comella-Del-Barrio
- Research Institute Germans Trias i Pujol, CIBER Respiratory Diseases, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Rosa Abellana
- Department of Basic Clinical Practice, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Raquel Villar-Hernández
- Research Institute Germans Trias i Pujol, CIBER Respiratory Diseases, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | | | - Lydia Canales Aliaga
- Radiology Service, Research Unit of the Mútua Terrassa Foundation, University Hospital Mútua Terrassa, Terrassa, Spain
| | | | | | - Carlos Ascaso
- Department of Basic Clinical Practice, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Irene Latorre
- Research Institute Germans Trias i Pujol, CIBER Respiratory Diseases, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jose Dominguez
- Research Institute Germans Trias i Pujol, CIBER Respiratory Diseases, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Tomas M Perez-Porcuna
- Department of Pediatrics, Tuberculosis and International Health Care Unit, Primary Care and Mútua Terrassa University Hospital, University of Barcelona, Terrassa, Spain
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12
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Pan D, Lin M, Lan R, Graviss EA, Lin D, Liang D, Long X, Qin H, Huang L, Huang M, Chongsuvivatwong V. Tuberculosis Transmission in Households and Classrooms of Adolescent Cases Compared to the Community in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2803. [PMID: 30544676 PMCID: PMC6313540 DOI: 10.3390/ijerph15122803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 11/17/2022]
Abstract
The aim of this paper is to evaluate the link between the history of exposure to tuberculosis (TB) in the household and diagnosed TB cases at school, and to compare the detection rate of active TB among household contacts and classroom contacts of adolescent TB cases with the rates among contacts of healthy controls. From November 2016 to December 2017, a prospective matched case-control study was conducted using passively identified index adolescent student cases from the TB surveillance system and healthy controls (matched by county, school type, sex, age and ethnicity). Contacts in households and classrooms of index cases and of controls were investigated. Matched tabulation of 117 case-control pairs revealed exposure to TB in the household as a strong risk factor (odds ratio (OR) = 21.0, 95% confidence interval (CI): 3.4, 868.6). Forty-five (case detection rate 0.69%) and two (case detection rate 0.03%) new active TB cases were detected among 6512 and 6480 classroom contacts of the index cases and controls, respectively. Having an index case in the classroom significantly increased the risk of classmates contracting active TB (OR = 22.5, 95% CI: 5.9, 191.4). Our findings suggested that previous exposure to TB in the household could lead a child to catch TB at school, then spread TB to classmates.
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Affiliation(s)
- Dongxiang Pan
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai 90110, Songkhla, Thailand.
| | - Mei Lin
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Rushu Lan
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, The Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX 77030, USA.
| | - Dingwen Lin
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Dabin Liang
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Xi Long
- School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China.
| | - Huifang Qin
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Liwen Huang
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Minying Huang
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
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13
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Conceição EC, Guimarães AEDS, Lopes ML, Furlaneto IP, Rodrigues YC, da Conceição ML, Barros WA, Cardoso NC, Sharma A, Lima LNGC, Gomes HM, Duarte RS, Frota C, Rutaihwa LK, Gagneux S, Suffys PN, Lima KVB. Analysis of potential household transmission events of tuberculosis in the city of Belem, Brazil. Tuberculosis (Edinb) 2018; 113:125-129. [DOI: 10.1016/j.tube.2018.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/16/2018] [Accepted: 09/29/2018] [Indexed: 12/17/2022]
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14
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Baliashvili D, Kempker RR, Blumberg HM, Kuchukhidze G, Merabishvili T, Aslanikashvili A, Magee MJ. A population-based tuberculosis contact investigation in the country of Georgia. Public Health Action 2018; 8:110-117. [PMID: 30271726 DOI: 10.5588/pha.18.0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/04/2018] [Indexed: 12/28/2022] Open
Abstract
Setting: Identification and screening of contacts of patients with active tuberculosis (TB) is infrequent in low- and middle-income countries. Objective: To estimate the incidence, prevalence and risk factors of latent tuberculous infection (LTBI) and active TB among contacts of newly reported smear-positive TB patients. Design: A population-based contact investigation of sputum smear-positive pulmonary TB (PTB) cases diagnosed between April and December 2012 in Georgia was conducted. LTBI was assessed using the tuberculin skin test (TST). Contacts with active TB were identified from the National TB Program surveillance database. Results: Among 896 index patients with active TB, 3133 contacts were identified and 1157 (37%) underwent a TST, 34% of whom were positive. Most contacts were household contacts (86%) and female (58%). Among contacts, the 1-year period prevalence of active TB was 3.3% (95%CI 2.70-3.98); the incidence rate was 1101 per 100 000 person-years (95%CI 822-1443). In multivariable analysis, household contacts were more likely to have LTBI (adjusted OR [aOR] 2.28, 95%CI 1.49-3.49) than close contacts. Conclusions: A high prevalence of both LTBI and active TB was identified among contacts of PTB cases. Efforts aimed at active case finding among TB contacts should improve early case detection and enhance TB control efforts.
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Affiliation(s)
- D Baliashvili
- National Center for Disease Control and Public Health, Tbilisi, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - R R Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine Atlanta, Georgia, USA
| | - H M Blumberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine Atlanta, Georgia, USA.,Departments of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - G Kuchukhidze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - T Merabishvili
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - A Aslanikashvili
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - M J Magee
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA
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15
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Zaniani FR, Moghim S, Esfahani BN. Genetic Diversity of Drug-resistant Mycobacterium tuberculosis Isolates in Isfahan Province of Iran. Adv Biomed Res 2018. [PMID: 29531921 PMCID: PMC5840967 DOI: 10.4103/2277-9175.225594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Increasing drug resistance is an important factor in the complexity of tuberculosis (TB) control. The identification of disease transmission type, recurrence of a previous infection, or new transmission of the disease is the key factor in the control of TB. In this study, we aimed to identify the genetic diversity of drug-resistant Mycobacterium tuberculosis isolates in Isfahan province of Iran through the mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing method based on 24 loci. Materials and Methods: Of 300 isolates obtained from a variety of clinical specimens, 18 drug-resistance M. tuberculosis clinical isolates (resistant to a single drug to more than one drug) were collected between 2013 and 2015 from regional TB reference laboratory in Isfahan. All drug-resistance M. tuberculosis isolates were typed by 24-locus MIRU-VNTR typing. Results: The highest percentage of isolates, 38.8%, belonged to the East-Asian lineage (lineage 2), while the lineages Indo-Oceanic (lineage 1), East-African–Indian (lineage 3), and Euro-American (lineage 4) represented 5.5%, 22.2%, and 33.3%, respectively. Among the 33.3% (6/18) Euro-American strains, the Latin American– Mediterranean and Ural sub-lineage were 22.2% (4/18) and 11.1% (2/18), respectively. Conclusion: The results of this study show that the lineages of drug-resistant M. tuberculosis isolates in Isfahan province of Iran are similar to those reported in the Eastern Mediterranean region (indicative of the epidemiological relationship between the countries in the region). Continued molecular monitoring is important as it has been proposed that the genetics and evolutionary backgrounds of drug-resistant M. tuberculosis strains may have an impact on the transmissibility profile.
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Affiliation(s)
- Fatemeh Riyahi Zaniani
- Department of Microbiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sharareh Moghim
- Department of Microbiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahram Nasr Esfahani
- Department of Microbiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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Lalor MK, Anderson LF, Hamblion EL, Burkitt A, Davidson JA, Maguire H, Abubakar I, Thomas HL. Recent household transmission of tuberculosis in England, 2010-2012: retrospective national cohort study combining epidemiological and molecular strain typing data. BMC Med 2017; 15:105. [PMID: 28606177 PMCID: PMC5469076 DOI: 10.1186/s12916-017-0864-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/27/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We estimate the proportion of tuberculosis (TB) in England due to recent household transmission, identify factors associated with being a household transmitter, and investigate the impact that identification of a case has on time to treatment of subsequent cases. METHODS TB cases notified between 2010 and 2012 in England in the same household as another case were identified; 24 locus MIRU-VNTR strain typing (ST) was used to identify household cases with likely recent transmission. Treatment delay in index and subsequent cases was compared. Risk factors for being a household transmitter were identified in univariable and multivariable analyses. RESULTS Overall, 7.7% (1849/24,060) of TB cases lived in a household with another case. We estimate that 3.9% were due to recent household transmission. ST data was unavailable for 67% (1242) of household pairs. For those with ST data, 64% (386) had confirmed, 11% probable (66) and 25% (155) refuted household transmission. The median treatment delay was 65 days for index cases and 37 days for subsequent asymptomatic cases. Risk factors for being a household transmitter included being under 25 years old, UK-born with Black African, Indian or Pakistani ethnicity, or born in Somalia or Romania. CONCLUSIONS This study has a number of implications for household TB contact tracing in low incidence countries, including the potential to reduce the diagnostic delay for subsequent household cases and the benefit of using ST to identify when to conduct source contact tracing outside the household. As 25% of TB cases in households had discordant strains, households with multiple TB cases do not necessarily represent household transmission. The additional fact that 25% of index cases within households only had extra-pulmonary TB demonstrates that, if household contact tracing is limited to pulmonary TB cases (as recently recommended in UK guidelines), additional cases of active TB in households will be missed. Our finding that no lineage of TB was associated with recent household transmission and with no increased transmissibility in the Beijing lineage compared to others, suggests that the lineage need not impact contact tracing efforts. Improvements in contact tracing have the potential to reduce transmission of TB in low incidence countries.
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Affiliation(s)
- Maeve K Lalor
- TB Section, Centre for Infectious Disease Surveillance, National Infection Service, Public Health England, London, UK. .,Institute for Global Health, University College London, London, UK.
| | - Laura F Anderson
- TB Section, Centre for Infectious Disease Surveillance, National Infection Service, Public Health England, London, UK
| | - Esther L Hamblion
- Field Epidemiology Services, National Infection Service, Public Health England, London, UK
| | - Andy Burkitt
- Field Epidemiology Services, National Infection Service, Public Health England, London, UK.,Field Epidemiology Services, National Infection Service, Public Health England, Newcastle upon Tyne, UK
| | - Jennifer A Davidson
- TB Section, Centre for Infectious Disease Surveillance, National Infection Service, Public Health England, London, UK
| | - Helen Maguire
- Institute for Global Health, University College London, London, UK.,Field Epidemiology Services, National Infection Service, Public Health England, London, UK
| | - Ibrahim Abubakar
- TB Section, Centre for Infectious Disease Surveillance, National Infection Service, Public Health England, London, UK.,Institute for Global Health, University College London, London, UK
| | - H Lucy Thomas
- TB Section, Centre for Infectious Disease Surveillance, National Infection Service, Public Health England, London, UK
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17
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Tuite AR, Gallant V, Randell E, Bourgeois AC, Greer AL. Stochastic agent-based modeling of tuberculosis in Canadian Indigenous communities. BMC Public Health 2017; 17:73. [PMID: 28086846 PMCID: PMC5237134 DOI: 10.1186/s12889-016-3996-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/23/2016] [Indexed: 01/15/2023] Open
Abstract
Background In Canada, active tuberculosis (TB) disease rates remain disproportionately higher among the Indigenous population, especially among the Inuit in the north. We used mathematical modeling to evaluate how interventions might enhance existing TB control efforts in a region of Nunavut. Methods We developed a stochastic, agent-based model of TB transmission that captured the unique household and community structure. Evaluated interventions included: (i) rapid treatment of active cases; (ii) rapid contact tracing; (iii) expanded screening programs for latent TB infection (LTBI); and (iv) reduced household density. The outcomes of interest were incident TB infections and total diagnosed active TB disease over a 10- year time period. Results Model-projected incidence in the absence of additional interventions was highly variable (range: 33–369 cases) over 10 years. Compared to the ‘no additional intervention’ scenario, reducing the time between onset of active TB disease and initiation of treatment reduced both the number of new TB infections (47% reduction, relative risk of TB = 0.53) and diagnoses of active TB disease (19% reduction, relative risk of TB = 0.81). Expanding general population screening was also projected to reduce the burden of TB, although these findings were sensitive to assumptions around the relative amount of transmission occurring outside of households. Other potential interventions examined in the model (school-based screening, rapid contact tracing, and reduced household density) were found to have limited effectiveness. Conclusions In a region of northern Canada experiencing a significant TB burden, more rapid treatment initiation in active TB cases was the most impactful intervention evaluated. Mathematical modeling can provide guidance for allocation of limited resources in a way that minimizes disease transmission and protects population health. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3996-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ashleigh R Tuite
- Dalla Lana School of Public Health, University of Toronto, University of Toronto, Toronto, ON, Canada. .,Harvard T.H. Chan School of Public Health, 1633 Tremont Street, Boston, MA, 02120, United States.
| | - Victor Gallant
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON, Canada
| | | | - Annie-Claude Bourgeois
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Amy L Greer
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
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18
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Koné Z, Coulibaly G, Daix ATJ, Bakayoko AS, Samaké K, Kouassi DP, Domoua KMS. [Current situation of primary prophylaxis with isoniazid (INH) in children who are contacts of patients with bacillary pulmonary tuberculosis in Abidjan (Cote d'Ivoire)]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:340-345. [PMID: 27776945 DOI: 10.1016/j.pneumo.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 08/20/2016] [Accepted: 08/27/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The National tuberculosis program (NTP) in Ivory Coast recommends that children under 5 years living in a family environment with contagious tuberculosis patients, should receive Prophylactic treatment with INH (PTI), whatever the result of the tuberculin skin test (positive or negative) and their BCG status (vaccinated or not), at a dose of 5mg/kg/day for 6 months. We conducted this study to check the implementation of this recommendation in three support services of tuberculosis in Abidjan, the economic capital. MATERIAL AND METHOD We conducted a multicenter, cross-sectional and descriptive study over 3 years (2011-2013), on consented patients, adolescents and adults aged at least 15 years, with a first episode of infectious pulmonary tuberculosis, in order to look for information on the INH prophylaxis in children under 5 years living under the same roof. We made patients interviews during their visit for bacteriological sputum controls at the second month of TB treatment. RESULTS Of a total of 412 patients (53% males and 47% females) with a mean age of 34.5 years and with a low level of instruction (66.5%), we noticed 639 children under 5 years living under the same roof with them. Information on the screening of contact children was given to 71% of interviewed patients (291/412). Of the 339 children examined among 639 contacts, 234 (69%) had received only an intradermoreaction (IDR) and PTI was finally administered to 64% of them (217/339). CONCLUSION High proportion of contact children under 5 not examined is a major concern for the NTP and a missed opportunity to prevent additional cases of tuberculosis among children.
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Affiliation(s)
- Z Koné
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire.
| | - G Coulibaly
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire
| | - A T J Daix
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire
| | - A S Bakayoko
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire
| | - K Samaké
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire
| | - D P Kouassi
- Service de surveillance épidémiologique, Institut national d'hygiène publique, Antenne régional de Bouaké, Bouaké, Cote d'Ivoire
| | - K M S Domoua
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire
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Lancella L, Lo Vecchio A, Chiappini E, Tadolini M, Cirillo D, Tortoli E, de Martino M, Guarino A, Principi N, Villani A, Esposito S, Galli L. How to manage children who have come into contact with patients affected by tuberculosis. J Clin Tuberc Other Mycobact Dis 2015; 1:1-12. [PMID: 31723675 PMCID: PMC6850253 DOI: 10.1016/j.jctube.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/14/2015] [Accepted: 07/05/2015] [Indexed: 11/21/2022] Open
Abstract
Childhood tuberculosis (TB) indicates a recent infection, particularly in children aged < 5 years, and therefore is considered a sentinel event insofar as it highlights the presence of an undiagnosed or untreated source case. The risk of acquiring TB is directly proportional to the number of bacilli to which a subject is exposed and the environment in which the contact occurred. This document contains the recommendations of a group of Italian scientific societies for managing a child exposed to a case of TB based on an analysis of the risk factors for acquiring latent tuberculous infection (LTBI) and developing the disease, and the particular aspects TB transmission during the first years of life. The guidance includes a detailed description of the methods used to identify the index case, the tests that the exposed child should receive and the possibilities of preventive chemoprophylaxis depending on the patient's age and immune status, the chemotherapy and monitoring methods indicated in the case of LTBI, the management of a child who has come into contact with a case of multidrug-resistant or extensively drug-resistant TB, and the use of molecular typing in the analysis of epidemics. The group of experts identified risk factors for tuberculous infection and disease in pediatric age as well as gave recommendation on management of contacts of cases of TB according to their age, risk factors and exposure to multidrug-resistant or extensively drug-resistant TB.
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Affiliation(s)
- Laura Lancella
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Andrea Lo Vecchio
- Section of Pediatrics, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Elena Chiappini
- Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy
| | - Marina Tadolini
- Section of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniela Cirillo
- Microbiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Enrico Tortoli
- Microbiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Villani
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy
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20
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Wampande EM, Mupere E, Jaganath D, Nsereko M, Mayanja HK, Eisenach K, Boom WH, Gagneux S, Joloba ML. Distribution and transmission of Mycobacterium tuberculosis complex lineages among children in peri-urban Kampala, Uganda. BMC Pediatr 2015; 15:140. [PMID: 26424324 PMCID: PMC4588907 DOI: 10.1186/s12887-015-0455-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 09/14/2015] [Indexed: 11/15/2022] Open
Abstract
Background To gain insight into the transmission of tuberculosis (TB) in peri-urban Kampala-Uganda, we performed a household contact study using children as a surrogate for recent transmission of Mycobacterium tuberculosis (MTB). Using this approach, we sought to understand M. tuberculosis complex (MTBC) lineage diversity, distribution and how these relate to TB transmission to exposed children. Method MTBC isolates from children aged ≤ 15 years, collected from 2002 to 2010 in a household-contact study, were analyzed using a LightCycler RT-PCR SNP genotyping assay (LRPS). The resultant genotypic data was used to determine associations between MTBC lineage and the children’s clinical and epidemiological characteristics. Results and discussion Of the 761 children surveyed, 9 % (69/761) had culture-positive TB an estimate in the range of global childhood TB; of these 71 % (49/69) were infected with an MTBC strain of the “Uganda family”, 17 % (12/69) infected with MTBC lineage 4 strains other than MTBC Uganda family and 12 % (8/69) infected with MTBC lineage 3, thereby disproportionately causing TB in the study area. Overall the data showed no correlation between the MTBC lineages studied and transmission (OR = 0.304; P-value = 0.251; CI: 95 %; 0.039-2.326) using children a proxy for TB transmission. Conclusions Our findings indicate that MTBC Uganda family strains are the main cause of TB in children in peri-urban Kampala. Furthermore, MTBC lineages did not differ in their transmissibility to children.
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Affiliation(s)
- Eddie M Wampande
- Department of Medical Microbiology, College of Health Sciences, Makerere University, P.O box 7072, Kampala, Uganda. .,Department of Bio-molecular Resources and Biolab Sciences, College of Veterinary Medicine, Animal Resources and Bio Security, Makerere University, Kampala, Uganda.
| | - Ezekiel Mupere
- Department of Pediatrics and Child Health College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Devan Jaganath
- The Johns Hopkins School of medicine, Department of Pediatricss, Baltimore, USA.
| | - Mary Nsereko
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda.
| | - Harriet K Mayanja
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda. .,Department of Medicine College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Kathleen Eisenach
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - W Henry Boom
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda. .,Tuberculosis Research Unit, School of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio, USA.
| | - Sebastien Gagneux
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Moses L Joloba
- Department of Medical Microbiology, College of Health Sciences, Makerere University, P.O box 7072, Kampala, Uganda. .,Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda.
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21
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Gebrezgabiher G, Romha G, Ameni G. Spoligotyping of Mycobacterium tuberculosis isolates from tuberculosis diagnosed patients at Dilla University Referral Hospital and other private clinics, Southern Ethiopia. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(14)60792-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Birch E, Andersson M, Koch A, Stenz F, Søborg B. Ten years of tuberculosis intervention in Greenland - has it prevented cases of childhood tuberculosis? Int J Circumpolar Health 2014; 73:24843. [PMID: 25045654 PMCID: PMC4095760 DOI: 10.3402/ijch.v73.24843] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/15/2014] [Accepted: 06/15/2014] [Indexed: 11/29/2022] Open
Abstract
Background The incidence of tuberculosis (TB) disease in Greenland doubled in the 1990s. To combat the increase, national TB interventions were initiated in 2000 and strengthened in 2007. Objective To determine whether the effect of interventions could be detected, we estimated the TB disease risk among children≤15 years before and after interventions were implemented. Design For a study cohort, we recruited all children ≤15 years of age included in the Greenlandic Civil Registration System (CRS) from 1990 to 2010. The CRS identifier was used to link cohort participants with TB cases identified based on the Greenlandic National TB registry. Bacille Calmette Guerin (BCG) vaccination status was identified through year of birth, as BCG was offered to newborns born either before 1991 or after 1996. Years with interventions were defined as 2000–2006 (primary interventions) and 2007–2010 (intensified interventions). Risk of TB was estimated using Poisson regression. Results The study included 35,858 children, of whom 209 had TB disease. The TB disease incidence decreased after interventions were implemented (2007–2010: IRR [incidence rate ratios] 0.62, 95% CI: 0.39–0.95, p=0.03, compared with the 1995–1999 period). The TB disease risk was inversely associated with BCG vaccination (IRR: 0.54, 95% CI: 0.41–0.72, p<0.001). Conclusions Years with national TB interventions in Greenland, including neonate BCG vaccination, are associated with a lower TB disease incidence among children ≤15 years of age.
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Affiliation(s)
- Emilie Birch
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark ; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Mikael Andersson
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Koch
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Bolette Søborg
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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23
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Mycobacterium tuberculosis Latin American-Mediterranean family and its sublineages in the light of robust evolutionary markers. J Bacteriol 2014; 196:1833-41. [PMID: 24584500 DOI: 10.1128/jb.01485-13] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium tuberculosis has a clonal population structure, and the Latin American-Mediterranean (LAM) family is one of the largest and most widespread within this species, showing evidence for remarkable pathobiology and a confusing phylogeny. Here, we applied robust phylogenetic markers to study the evolution of the LAM family and its major sublineages circulating in Russia and neighboring countries. A total of 250 M. tuberculosis isolates were confirmed to belong to the LAM family based on the analysis of the LAM-specific single-nucleotide polymorphisms (SNPs) in the Rv3062 and Rv0129c genes. At this stage, the family status was rectified for 121 isolates misleadingly assigned by CRISPR spoligotyping to non-LAM families (T1- or T5-RUS1). Consequently, the reestimated LAM prevalence rate increased 2-fold in Russia and Kazakhstan and 4-fold in Belarus. The majority (91.8 to 98.7%) of the LAM isolates from all three countries belonged to the LAM-RUS sublineage. In contrast, the Ibero-American LAM RD-Rio sublineage was identified in only 7 Russian isolates. Taken together, our findings and further analyses suggest a monophyletic origin of LAM-RUS: at a historically distant time, in Russia, in a small founding bacterial/human population. Its dissemination pattern and high prevalence rate in Northern Eurasia may indicate a long-term coexistence of the LAM-RUS sublineage and local human populations hypothetically leading to coadaptation and reduced pathogenicity of the relatively more ancient clones, such as spoligotype international type 254 (SIT254), compared to the more recent SIT252 and SIT266 clones. In contrast, rare LAM RD-Rio isolates were likely brought to Russia through occasional human contact. The spread of RD-Rio strains is not as global as commonly claimed and is determined largely by human migration flows (rather than by pathobiological properties of these strains). Consequently, a host population factor appears to play a major role in shaping the in situ dissemination pattern of the imported strains in an autochthonous population.
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Current methods in the molecular typing of Mycobacterium tuberculosis and other mycobacteria. BIOMED RESEARCH INTERNATIONAL 2014; 2014:645802. [PMID: 24527454 PMCID: PMC3914561 DOI: 10.1155/2014/645802] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/18/2013] [Indexed: 11/18/2022]
Abstract
In the epidemiology of tuberculosis (TB) and nontuberculous mycobacterial (NTM) diseases, as in all infectious diseases, the key issue is to define the source of infection and to disclose its routes of transmission and dissemination in the environment. For this to be accomplished, the ability of discerning and tracking individual Mycobacterium strains is of critical importance. Molecular typing methods have greatly improved our understanding of the biology of mycobacteria and provide powerful tools to combat the diseases caused by these pathogens. The utility of various typing methods depends on the Mycobacterium species under investigation as well as on the research question. For tuberculosis, different methods have different roles in phylogenetic analyses and person-to-person transmission studies. In NTM diseases, most investigations involve the search for environmental sources or phylogenetic relationships. Here, too, the type of setting determines which methodology is most suitable. Within this review, we summarize currently available molecular methods for strain typing of M. tuberculosis and some NTM species, most commonly associated with human disease. For the various methods, technical practicalities as well as discriminatory power and accomplishments are reviewed.
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du Plessis N, Walzl G. Helminth-M. tb co-infection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 828:49-74. [PMID: 25253027 DOI: 10.1007/978-1-4939-1489-0_3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nelita du Plessis
- Biomedical Sciences, Division Molecular Biology and Human Genetics, DST/NRF, Centre of Excellence in Biomedical TB Research, Stellenbosch University, Cape Town, Western Cape, South Africa,
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Kumar K, Shorten RJ, Capocci S, Solamalai A, Goodburn A, Cropley I, McHugh TD, Lipman M. The value of “inform and advise” guidance in a case of extensive tuberculosis transmission. J Infect 2013; 67:158-60. [DOI: 10.1016/j.jinf.2013.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 10/27/2022]
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