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Giubelan LI, Neacșu AI, Rotaru-Zavaleanu AD, Osiac E. Antimicrobial Resistance in Sepsis Cases Due to Escherichia coli and Klebsiella pneumoniae: Pre-Pandemic Insights from a Single Center in Southwestern Romania. Healthcare (Basel) 2024; 12:1713. [PMID: 39273737 PMCID: PMC11395092 DOI: 10.3390/healthcare12171713] [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: 07/11/2024] [Revised: 08/26/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
Sepsis is an uncontrolled reaction of the body to an infection, and if not effectively treated, it can progress to septic shock, multiple organ failure, and ultimately, death. OBJECTIVE To determine the resistance profile of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) strains isolated in sepsis cases diagnosed at the Infectious Diseases Clinic in Craiova, Romania. METHODS The bacteria responsible for sepsis cases were identified using the Vitek 2 Systems version 06.01, which was then employed to assess their antimicrobial susceptibility (Global CLSI and Phenotypic 2017). RESULTS We have identified 989 patients diagnosed with bacterial sepsis. Among these, 953 cases were caused by Gram-negative rods, with 415 attributed to E. coli and 278 to K. pneumoniae. High levels of resistance to ampicillin were recorded for E. coli strains isolated in sepsis cases (64.6%); adding sulbactam lowers the level of resistance to 41.8%. Resistance to 3rd generation cephalosporins varied between 7.47 and 14.6% and another 3.41 to 11.1% are dose-dependent susceptibility strains. Resistance to carbapenems (i.e., ertapenem, meropenem) is low-2.18-2.42%. More than 95% of the tested K. pneumoniae strains were resistant to ampicillin and adding sulbactam as a β-lactamase inhibitor only halves that level. Resistance to 3rd generation cephalosporins varied between 20.7% and 22.5%; resistance levels for K. pneumoniae were notably higher than those for E. coli. Over 95% of K. pneumoniae strains showed resistance to ampicillin, and resistance to 3rd generation cephalosporins varied between 20.7% and 22.5%. Additionally, K. pneumoniae exhibited higher resistance to carbapenems (13.7-19.5%) compared to E. coli (2.18-2.42%). CONCLUSIONS Antimicrobial resistance levels are generally lower than continental and national data, except for ampicillin and carbapenems (meropenem and ertapenem). K. pneumoniae strains are significantly more resistant than E. coli strains.
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Affiliation(s)
- Lucian-Ion Giubelan
- Department of Infectious Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Infectious Diseases and Pulmonology 'Victor Babes' Hospital, 200515 Craiova, Romania
| | - Alexandru Ionuț Neacșu
- Department of Infectious Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Alexandra Daniela Rotaru-Zavaleanu
- Experimental Research Center for Normal and Pathological Aging, Department of Functional Sciences, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Eugen Osiac
- Experimental Research Center for Normal and Pathological Aging, Department of Functional Sciences, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Biophysics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Yi L, Yan J, Wei P, Long S, Wang X, Gu M, Yang B, Chen Y, Ma S, Wang C, Zheng M, Sun Q, Shi Y, Wang G. The levels of soluble CD137 are increased in tuberculosis patients and associated with disease severity and prognosis. Eur J Immunol 2024; 54:e2350796. [PMID: 38922884 DOI: 10.1002/eji.202350796] [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: 09/29/2023] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 06/28/2024]
Abstract
Tuberculosis (TB) was the leading cause of death from a single infectious agent before the coronavirus pandemic. Therefore, it is important to search for severity biomarkers and devise appropriate therapies. A total of 139 pulmonary TB (PTB) patients and 80 healthy controls (HCs) were recruited for plasma soluble CD137 (sCD137) detection through ELISA. Moreover, pleural effusion sCD137 levels were measured in 85 TB patients and 36 untreated lung cancer patients. The plasma cytokine levels in 64 patients with PTB and blood immune cell subpopulations in 68 patients with PTB were analysed via flow cytometry. Blood sCD137 levels were higher in PTB patients (p = 0.012) and correlated with disease severity (p = 0.0056). The level of sCD137 in tuberculous pleurisy effusion (TPE) was markedly higher than that in malignant pleurisy effusion (p = 0.018). Several blood cytokines, such as IL-6 (p = 0.0147), IL-8 (p = 0.0477), IP-10 (p ≤ 0.0001) and MCP-1 (p = 0.0057), and some laboratory indices were significantly elevated in severe PTB (SE) patients, but the percentages of total lymphocytes (p = 0.002) and cytotoxic T cells (p = 0.036) were significantly lower in SE patients than in non-SE patients. In addition, the sCD137 level was negatively correlated with the percentage of total lymphocytes (p = 0.0008) and cytotoxic T cells (p = 0.0021), and PTB patients with higher plasma sCD137 levels had significantly shorter survival times (p = 0.0041). An increase in sCD137 is a potential biomarker for severe TB and indicates a poor prognosis.
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Affiliation(s)
- Ling Yi
- Department of Central Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Jun Yan
- Department of Clinical Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Panjian Wei
- Department of Central Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Sibo Long
- Department of Clinical Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Xiaojue Wang
- Department of Central Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Meng Gu
- Department of Central Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Bin Yang
- Department of Clinical Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yan Chen
- Department of Clinical Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Shang Ma
- Department of Clinical Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Chaohong Wang
- Department of Clinical Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Maike Zheng
- Department of Clinical Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Qing Sun
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Yiheng Shi
- Department of Clinical Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Guirong Wang
- Department of Clinical Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
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Chacko B, Chaudhry D, Peter JV, Khilnani GC, Saxena P, Sehgal IS, Ahuja K, Rodrigues C, Modi M, Jaiswal A, Jasiel GJ, Sahasrabudhe S, Bose P, Ahuja A, Suprapaneni V, Prajapat B, Manesh A, Chawla R, Guleria R. ISCCM Position Statement on the Approach to and Management of Critically Ill Patients with Tuberculosis. Indian J Crit Care Med 2024; 28:S67-S91. [PMID: 39234233 PMCID: PMC11369919 DOI: 10.5005/jp-journals-10071-24783] [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: 07/02/2024] [Accepted: 07/24/2024] [Indexed: 09/06/2024] Open
Abstract
Tuberculosis (TB) is an important cause of morbidity and mortality globally. About 3-4% of hospitalized TB patients require admission to the intensive care unit (ICU); the mortality in these patients is around 50-60%. There is limited literature on the evaluation and management of patients with TB who required ICU admission. The Indian Society of Critical Care Medicine (ISCCM) constituted a working group to develop a position paper that provides recommendations on the various aspects of TB in the ICU setting based on available evidence. Seven domains were identified including the categorization of TB in the critically ill, diagnostic workup, drug therapy, TB in the immunocompromised host, organ support, infection control, and post-TB sequelae. Forty-one questions pertaining to these domains were identified and evidence-based position statements were generated, where available, keeping in focus the critical care aspects. Where evidence was not available, the recommendations were based on consensus. This position paper guides the approach to and management of critically ill patients with TB. How to cite this article Chacko B, Chaudhry D, Peter JV, Khilnani G, Saxena P, Sehgal IS, et al. isccm Position Statement on the Approach to and Management of Critically Ill Patients with Tuberculosis. Indian J Crit Care Med 2024;28(S2):S67-S91.
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Affiliation(s)
- Binila Chacko
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Pt BDS Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - John V Peter
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Prashant Saxena
- Department of Pulmonary, Critical Care and Sleep Medicine, Fortis Hospital, Vasant Kung, New Delhi, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Kunal Ahuja
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Camilla Rodrigues
- Department of Lab Medicine, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Manish Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Anand Jaiswal
- Deparment of Respiratory Diseases, Medanta Medicity, Gurugram, Haryana, India
| | - G Joel Jasiel
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shrikant Sahasrabudhe
- Department of Critical Care Medicine and Pulmonology, KIMS Manavata Hospital, Nashik, Maharashtra, India
| | - Prithviraj Bose
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aman Ahuja
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India
| | - Vineela Suprapaneni
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India
| | - Brijesh Prajapat
- Department of Pulmonary and Critical Care Medicine, Yashoda Group of Hospitals, Ghaziabad, Uttar Pradesh, India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajesh Chawla
- Department of Respiratory Medicine, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Randeep Guleria
- Institute of Internal Medicine and Respiratory and Sleep Medicine, Medanta Medical School, Gurugram, Haryana, India
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Lu C, Xu Y, Li X, Wang M, Xie B, Huang Y, Li Y, Fan J. Nutritional status affects immune function and exacerbates the severity of pulmonary tuberculosis. Front Immunol 2024; 15:1407813. [PMID: 39086487 PMCID: PMC11288837 DOI: 10.3389/fimmu.2024.1407813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
Aim To comprehensively evaluate the association and impact of nutritional status and immune function on the severity of pulmonary tuberculosis (PTB). Methods This descriptive cross-sectional study involved 952 participants who were diagnosed with active PTB. Severe PTB involves three or more lung field infections based on chest radiography. Nutritional status was evaluated using various indicators, including body mass index (BMI), the nutritional risk screening score (NRS-2002), total protein (TP), prealbumin (PA), transferrin (TRF), and serum albumin (ALB) levels and the prognostic nutritional index (PNI). Immune dysfunction was defined as a CD4+ count <500 cells/µl or a CD4+/CD8+ ratio <1. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were also calculated. Multivariate logistic and generalized linear regression were used to assess the associations between nutritional status, immune function, the severity of PTB, and the number of infected lung fields, adjusting for age, sex, and diabetes. Mediation analysis was conducted to evaluate the extent to which immune function mediated the impact of nutritional status on the severity of PTB. Sensitivity analysis was performed to enhance the robustness of the results. Results Compared to those in the general PTB group, patients in the severe PTB group tended to be older men with diabetes. Higher nutritional risk, higher proportion of immune dysfunction and lower lymphocyte counts were observed in the severe group. BMI and the PNI were found to be protective factors, while PLR was identified as a risk factor for disease severity. Immune dysfunction and the PLR are mediators of the relationship between nutritional status and PTB severity. When BMI, the PNI, and the PLR were combined with traditional clinical indicators, these parameters showed promising diagnostic value, and the AUC reached 0.701 (95% CI: 0.668-0.734). Conclusion The findings suggest that nutritional status is significantly associated with the severity of PTB, and immune function mediates the effects of nutritional status on the severity of PTB. Maintaining adequate BMI, PNI levels, and immune function or reducing PLR levels helps reduce the risk of severe PTB.
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Affiliation(s)
- Chunli Lu
- Department of Clinical Nutrition, Guangzhou Chest Hospital, Guangzhou, China
| | - Yunyi Xu
- Department of Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou, China
| | - Xueya Li
- Department of Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou, China
| | - Min Wang
- Department of Tuberculosis, Guangzhou Chest Hospital, Guangzhou, China
| | - Bei Xie
- Department of Institute of Tuberculosis, Guangzhou Chest Hospital, Guangzhou, China
| | - Yaling Huang
- Department of Clinical Nutrition, Guangzhou Chest Hospital, Guangzhou, China
| | - Yan Li
- Department of Tuberculosis, Guangzhou Chest Hospital, Guangzhou, China
| | - Jiahua Fan
- State Key Laboratory of Respiratory Disease, Department of Clinical Nutrition, Guangzhou Chest Hospital, Institute of Tuberculosis, Guangzhou Medical University, Guangzhou, China
- Guangzhou Key Laboratory of Tuberculosis Research, Department of Clinical Nutrition, Guangzhou Chest Hospital, Institute of Tuberculosis, Guangzhou Medical University, Guangzhou, China
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Cui K, Mao Y, Feng S, Luo H, Yang J, Bai L. Development and Validation of a Risk Mortality Prediction Model for Patients with Pulmonary Tuberculosis Complicated by Severe Community-Acquired Pneumonia in the Intensive Care Unit. Infect Drug Resist 2024; 17:3113-3124. [PMID: 39050825 PMCID: PMC11268563 DOI: 10.2147/idr.s459290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose The mortality rate from pulmonary tuberculosis (PTB) complicated by severe community-acquired pneumonia (SCAP) in the intensive care unit (ICU) remains high. We aimed to develop a rapid and simple model for the early assessment and stratification of prognosis in these patients. Patients and Methods All adult patients with PTB complicated by SCAP admitted to the ICU of a tertiary hospital in Chengdu, Sichuan, China between 2019 and 2021 (development cohort) and 2022 (validation cohort) were retrospectively included. Data on demographics, comorbidities, laboratory values, and interventions were collected. The outcome was the 28-day mortality. Stepwise backward multivariate Cox analysis was used to develop a mortality risk prediction score model. Receiver operating characteristic (ROC) and calibration curves were used to evaluate the model's predictive efficiency. Decision curve analysis (DCA) was used to validate the model's clinical value and impact on decision making. Results Overall, 357 and 168 patients were included in the development and validation cohorts, respectively. The Pulmonary Tuberculosis Severity Index (PTSI) score included long-term use of glucocorticoid, body mass index (BMI) <18.5 kg/m2, diabetes, blood urea nitrogen (BUN) ≥7.14 mmol/L, PO2/FiO2 <150 mmHg, and vasopressor use. The area under the ROC curve (AUC) values were 0.817 (95% CI: 0.772-0.863) and 0.814 for the development and validation cohorts, respectively. The PTSI score had a higher AUC than the APACHE II, SOFA, and CURB-65 score. The calibration curves indicated good calibration in both cohorts. The DCA of the PTSI score indicated the high clinical application of the model compared with the APACHE II and SOFA scores. Conclusion This prognostic tool was designed to rapidly evaluate the 28-day mortality risk in individuals with PTB complicated by SCAP. It can stratify this patient group into relevant risk categories, guide targeted interventions, and enhance clinical decision making, thereby optimizing patient care and improving outcomes.
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Affiliation(s)
- Kunping Cui
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Yi Mao
- Intensive Care Unit, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, 610000, People’s Republic of China
| | - Shuang Feng
- Ultrasonic Medicine, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, 610000, People’s Republic of China
| | - Haixia Luo
- Intensive Care Unit, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, 610000, People’s Republic of China
| | - Jiao Yang
- Intensive Care Unit, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, 610000, People’s Republic of China
| | - Lang Bai
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
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Tan DTM, See KC. Diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients: A mini review for clinicians. World J Crit Care Med 2024; 13:91435. [PMID: 38855275 PMCID: PMC11155508 DOI: 10.5492/wjccm.v13.i2.91435] [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: 12/30/2023] [Revised: 02/04/2024] [Accepted: 03/25/2024] [Indexed: 06/03/2024] Open
Abstract
Among critically ill patients, severe pulmonary and extrapulmonary tuberculosis has high morbidity and mortality. Yet, it is a diagnostic challenge given its nonspecific clinical symptoms and signs in early stages of the disease. In addition, management of severe pulmonary and extrapulmonary tuberculosis is complicated given the high risk of drug-drug interactions, drug-disease interactions, and adverse drug reactions. To help clinicians acquire an up-to-date approach to severe tuberculosis, this paper will provide a narrative review of contemporary diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients.
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Affiliation(s)
- Dominic Ti Ming Tan
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Kay Choong See
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
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Mishra S, Gala J, Chacko J. Factors Affecting Mortality in Critically Ill Patients With Tuberculosis: A Systematic Review and Meta-Analysis. Crit Care Med 2024; 52:e304-e313. [PMID: 38345418 DOI: 10.1097/ccm.0000000000006226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
OBJECTIVES Critically ill patients with tuberculosis carry high mortality. Identification of factors associated with mortality in critically ill tuberculosis patients may enable focused treatment. DATA SOURCES An extensive literature search of PubMed (MEDLINE), Embase, the Cochrane Library, and Google Scholar was performed using Medical Subject Headings terms "tuberculosis," "critical care," "critical care outcome," and "ICU." We aimed to identify factors affecting mortality in critically ill tuberculosis patients. STUDY SELECTION All the studies comparing factors affecting mortality between survivors and nonsurvivors in critically ill tuberculosis patients were included. The database search yielded a total of 3017 records, of which 17 studies were included in the meta-analysis. DATA EXTRACTION Data were collected including the name of the author, year and country of publication, duration of the study, number of patients studied, type of tuberculosis, patient demography, smoking history, laboratory parameters, comorbidities, the requirement for mechanical ventilation, duration of ventilation, ICU and hospital length of stay (LOS), type of lung involvement, complications, and outcomes. DATA SYNTHESIS The major factors that contributed to mortality in critically ill tuberculosis patients were age, platelet count, albumin, C-reactive protein (CRP), the requirement and duration of invasive mechanical ventilation, Pa o2 /F io2 ratio, presence of acute respiratory distress syndrome, shock, hospital-acquired infections, renal replacement therapy, and ICU and hospital LOS. CONCLUSIONS Patient age, platelet count, albumin and CRP levels, the requirement and duration of invasive mechanical ventilation, Pa o2 /F io2 ratio, hospital-acquired infections, renal replacement therapy, and ICU LOS were variables associated with mortality.
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Affiliation(s)
- Shivangi Mishra
- Department of Critical Care Medicine, Manipal Hospital Whitefield, Bengaluru, Karnataka, India
| | - Jinay Gala
- Department of Critical Care Medicine, Mazumdar Shaw Medical Center, Bengaluru, India
| | - Jose Chacko
- Department of Critical Care Medicine, Mazumdar Shaw Medical Center, Bengaluru, India
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Chethkwo F, Tanih NF, Nsagha DS. Analysis of the Outcomes of Tuberculosis Treatment and Factors Associated with Successful Treatment at the Bamenda Regional Hospital: A 10-year Retrospective Study. Int J Mycobacteriol 2024; 13:65-72. [PMID: 38771282 DOI: 10.4103/ijmy.ijmy_219_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/12/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a global public health issue, impacting millions of people worldwide. This study determined the outcomes of TB treatment managed within a 10 year period at the Bamenda Regional Hospital in Cameroon. METHODS A retrospective study was carried out among 2428 patients diagnosed and treated for active TB infection from 2013 to 2022, at the Bamenda Regional Hospital. Data collection was done from March to April 2023 using a data extraction form. Bivariate and multivariate logistic regression models were used to identify factors associated with successful TB treatment outcomes. Data was analyzed using SPSS software version 26. RESULTS Of the 2428 patients with TB, 1380 (56.8%) were cured, 739 (30.4%) completed treatment, treatment failures were recorded in 10 (0.4%) patients, and 200 (8.2%) died during or after receiving treatment. Treatment default was the outcome in 99 (4.1%). Successful treatment outcomes were reported in 2119 (87.3%). Patients within age groups 41-50 (P = 0.010), 51-60 (P = 0.041), and >60 years (P = 0.006), male (P = 0.004), and human immunodeficiency virus-positive patients (P < 0.001) had decreased odds of successful treatment outcomes. CONCLUSION The outcomes of treatment within a 10 year period showed that the treatment success was 2.7% below the World Health Organizations target. Prioritizing vulnerable patient groups in TB management and implementing public health interventions such as financial assistance and nutritional support will go a long way in improving treatment outcomes.
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Affiliation(s)
- Fabrice Chethkwo
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Nicoline F Tanih
- Department of Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Dickson S Nsagha
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Haile H, Tema L, Anjulo A, Temesgen Z, Jerene D. Pulmonary tuberculosis complicated by pneumothorax, and acute respiratory distress syndrome (ARDS) in the settings of advanced HIV disease: A case report. J Clin Tuberc Other Mycobact Dis 2023; 33:100396. [PMID: 37736243 PMCID: PMC10509693 DOI: 10.1016/j.jctube.2023.100396] [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] [Indexed: 09/23/2023] Open
Abstract
Introduction A large proportion of the global burden of HIV-associated TB occurs in sub-Saharan Africa; including 74% of new cases of TB and 79% of deaths occurs in this area. Spontaneous pneumothorax occurs more frequently in patients with AIDS than the general population with the estimated incidence to be about 2-5% of overall total cases. Tuberculosis ARDS and septic shock are rare but carries extremely poor prognosis. Case summary A 27 year old male with advanced HIV disease with very low CD4 count presented to Wolaita Sodo University comprehensive specialized hospital, Ethiopia on July 6, 2023. The patient diagnosed with spontaneous pneumothorax secondary to drug susceptible tuberculosis after positive urine LF-LAM and sputum gene expert. He was intubated after emergency tube thoracostomy, and subsequently treated with anti-TB, corticosteroid, broad-spectrum IV antibiotics and high dose cotrimoxazole. The patient developed ARDS due to possible tuberculosis related septic shock and died of multi-organ failure. Discussion Spontaneous pneumothorax in the setting of HIV raises concern for PCP, though in this case it could be secondary to TB. Tuberculosis related ARDS and septic shock are rare complication but carries poor prognosis especially in setting of AHD. We had limited experience and difficulties in the management of patient with persistent pneumothorax with the concomitant ARDS requiring lung protective management, and this part remain the future area of scientific research. Conclusion In patients with advanced HIV disease, who present with signs of respiratory failure, the likelihood of spontaneous pneumothorax, TB-ARDS and septic shock should be anticipated in the differential diagnosis and optimal management plan should be designed.
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Affiliation(s)
- Haba Haile
- Wolaita Sodo University College of Health Science and Medicine. P.O.BOX 138, Wolaita, Ethiopia
| | - Lijalem Tema
- Wolaita Sodo University College of Health Science and Medicine. P.O.BOX 138, Wolaita, Ethiopia
| | - Assegid Anjulo
- Wolaita Sodo University College of Health Science and Medicine. P.O.BOX 138, Wolaita, Ethiopia
| | | | - Degu Jerene
- KNCV Tuberculosis Foundation, 's-Gravenhage, Netherlands
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Shang X, Zhang H, Chen S, Wang C, Lin M, Yu R. Diagnosis and ECMO Treatment of a Critically Ill Patient With Disseminated Mycobacterium tuberculosis: A Case Report. Front Public Health 2022; 10:938913. [PMID: 35910925 PMCID: PMC9330379 DOI: 10.3389/fpubh.2022.938913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMycobacterium tuberculosis infection remains a public health concern worldwide. The diagnosis and treatment of disseminated M. tuberculosis is very difficult, so we shared our experiences and lessons learned in this case report.Case PresentationA 36-year-old female with a history of epilepsy presented to our hospital with fever, upper abdominal pain, muscle soreness in limbs for 7 days, and shortness of breath for 4 days. On admission, she presented with acute respiratory distress syndrome (ARDS) and liver dysfunction. Due to the critical nature of her clinical presentation, the patient was admitted directly to the Intensive Care Unit (ICU), received mechanical ventilation in prone position and VV-ECMO treatment. Her condition improved gradually, and the ECMO was removed after 7 days and she was weaned off the ventilator after 8 days. However, her fever recurred and she underwent PET-CT examination, liver contrast ultrasound, acid-fast staining and second-generation sequencing of cerebrospinal fluid, which confirmed M. tuberculosis infection.ConclusionThis case report briefly described the treatment and diagnosis of a critically ill patient with intra and extra-pulmonary tuberculosis infection. Timely and appropriate treatment is crucial to save lives, but the timing of ECMO treatment needs to be carefully considered for patients with ARDS caused by tuberculosis.
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Affiliation(s)
- Xiuling Shang
- The Third Department of Critical Care Medicine, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Hongxuan Zhang
- The Third Department of Critical Care Medicine, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasound, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Chen Wang
- Department of Pathology, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Meifu Lin
- Department of Radiology, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Rongguo Yu
- The Third Department of Critical Care Medicine, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Rongguo Yu ;
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Akkerman OW, Duarte R, Tiberi S, Schaaf HS, Lange C, Alffenaar JWC, Denholm J, Carvalho ACC, Bolhuis MS, Borisov S, Bruchfeld J, Cabibbe AM, Caminero JA, Carvalho I, Chakaya J, Centis R, Dalcomo MP, D Ambrosio L, Dedicoat M, Dheda K, Dooley KE, Furin J, García-García JM, van Hest NAH, de Jong BC, Kurhasani X, Märtson AG, Mpagama S, Torrico MM, Nunes E, Ong CWM, Palmero DJ, Ruslami R, Saktiawati AMI, Semuto C, Silva DR, Singla R, Solovic I, Srivastava S, de Steenwinkel JEM, Story A, Sturkenboom MGG, Tadolini M, Udwadia ZF, Verhage AR, Zellweger JP, Migliori GB. Clinical standards for drug-susceptible pulmonary TB. Int J Tuberc Lung Dis 2022; 26:592-604. [PMID: 35768923 PMCID: PMC9272737 DOI: 10.5588/ijtld.22.0228] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice´ for diagnosis, treatment and management of drug-susceptible pulmonary TB (PTB).METHODS: A panel of 54 global experts in the field of TB care, public health, microbiology, and pharmacology were identified; 46 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all 46 participants.RESULTS: Seven clinical standards were defined: Standard 1, all patients (adult or child) who have symptoms and signs compatible with PTB should undergo investigations to reach a diagnosis; Standard 2, adequate bacteriological tests should be conducted to exclude drug-resistant TB; Standard 3, an appropriate regimen recommended by WHO and national guidelines for the treatment of PTB should be identified; Standard 4, health education and counselling should be provided for each patient starting treatment; Standard 5, treatment monitoring should be conducted to assess adherence, follow patient progress, identify and manage adverse events, and detect development of resistance; Standard 6, a recommended series of patient examinations should be performed at the end of treatment; Standard 7, necessary public health actions should be conducted for each patient. We also identified priorities for future research into PTB.CONCLUSION: These consensus-based clinical standards will help to improve patient care by guiding clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment for PTB.
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Affiliation(s)
- O W Akkerman
- TB Center Beatrixoord, University Medical Center Groningen, University of Groningen, Haren, the Netherlands, Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R Duarte
- Centro Hospitalar de Vila Nova de Gaia/Espinho; Instituto de Ciencias Biomédicas de Abel Saalazar, Universidade do Porto, Instituto de Saúde Publica da Universidade do Porto, Unidade de Investigação Clínica, ARS Norte, Porto, Portugal
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Borstel, Germany, Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany, The Global Tuberculosis Program, Texas Children´s Hospital, Immigrant and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - J W C Alffenaar
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, NSW, Australia, School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Sydney, NSW, Australia, Westmead Hospital, Sydney, NSW, Australia
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Department of Infectious diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - A C C Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - M S Bolhuis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, Moscow, Russia
| | - J Bruchfeld
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden, Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden
| | - A M Cabibbe
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - J A Caminero
- Department of Pneumology, University General Hospital of Gran Canaria "Dr Negrin", Las Palmas, Spain, ALOSA (Active Learning over Sanitary Aspects) TB Academy, Spain
| | - I Carvalho
- Pediatric Department, Vila Nova de Gaia Outpatient Tuberculosis Centre, Vila Nova de Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - J Chakaya
- Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences. Liverpool School of Tropical Medicine, Liverpool, UK
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - M P Dalcomo
- Reference Center Helio Fraga, FIOCRUZ, Brazil
| | - L D Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - M Dedicoat
- Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - K Dheda
- Centre for Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa, South African Medical Research Council Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - K E Dooley
- Center for Tuberculosis Research, Johns Hopkins, Baltimore, MD
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - N A H van Hest
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Municipal Public Health Service Groningen, Groningen, The Netherlands
| | - B C de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - X Kurhasani
- UBT-Higher Education Institution Prishtina, Kosovo
| | - A G Märtson
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - S Mpagama
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzani, Kibong´oto Infectious Diseases Hospital, Sanya Juu, Siha, Kilimanjaro, United Republic of Tanzania
| | - M Munoz Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, México City, Mexico
| | - E Nunes
- Department of Pulmonology of Central Hospital of Maputo, Maputo, Mozambique, Faculty of Medicine of Eduardo Mondlane University, Maputo, Mozambique
| | - C W M Ong
- Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore, Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - D J Palmero
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - R Ruslami
- Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, Research Center for Care and Control of Infectious Disease (RC3iD), Universitas Padjadjaran, Bandung, Indonesia
| | - A M I Saktiawati
- Department of Internal Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - C Semuto
- Research, Innovation and Data Science Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - D R Silva
- Instituto Vaccarezza, Hospital Muñiz, Buenos Aires, Argentina
| | - R Singla
- National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | - I Solovic
- National Institute of Tuberculosis, Lung Diseases and Thoracic Surgery, Faculty of Health, Catholic University, Ružomberok, Vyšné Hágy, Slovakia
| | - S Srivastava
- Department of Pulmonary Immunology, University of Texas Health Science Centre at Tyler, Tyler, TX, USA
| | - J E M de Steenwinkel
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - A Story
- Institute of Epidemiology and Healthcare, University College London, London, UK, Find and Treat, University College Hospitals NHS Foundation Trust, London, UK
| | - M G G Sturkenboom
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M Tadolini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Z F Udwadia
- P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - A R Verhage
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J P Zellweger
- TB Competence Center, Swiss Lung Association, Berne, Switzerland
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
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12
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Almatroudi A. Non-Coding RNAs in Tuberculosis Epidemiology: Platforms and Approaches for Investigating the Genome's Dark Matter. Int J Mol Sci 2022; 23:4430. [PMID: 35457250 PMCID: PMC9024992 DOI: 10.3390/ijms23084430] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/05/2022] [Accepted: 04/14/2022] [Indexed: 02/07/2023] Open
Abstract
A growing amount of information about the different types, functions, and roles played by non-coding RNAs (ncRNAs) is becoming available, as more and more research is done. ncRNAs have been identified as potential therapeutic targets in the treatment of tuberculosis (TB), because they may be essential regulators of the gene network. ncRNA profiling and sequencing has recently revealed significant dysregulation in tuberculosis, primarily due to aberrant processes of ncRNA synthesis, including amplification, deletion, improper epigenetic regulation, or abnormal transcription. Despite the fact that ncRNAs may have a role in TB characteristics, the detailed mechanisms behind these occurrences are still unknown. The dark matter of the genome can only be explored through the development of cutting-edge bioinformatics and molecular technologies. In this review, ncRNAs' synthesis and functions are discussed in detail, with an emphasis on the potential role of ncRNAs in tuberculosis. We also focus on current platforms, experimental strategies, and computational analyses to explore ncRNAs in TB. Finally, a viewpoint is presented on the key challenges and novel techniques for the future and for a wide-ranging therapeutic application of ncRNAs.
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Affiliation(s)
- Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia
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13
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Migliori GB, Tiberi S, Duarte R. Investigating the response to COVID-19 and understanding severe TB cases: the 2022 Pulmonology TB series. Pulmonology 2022; 28:155-157. [PMID: 35241410 PMCID: PMC8824165 DOI: 10.1016/j.pulmoe.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/25/2022] Open
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