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Chen Y, Liu J, Zhang Q, Wang Q, Chai L, Chen H, Li D, Qiu Y, Wang Y, Shen N, Wang J, Xie X, Li S, Li M. Epidemiological features and temporal trends of HIV-negative tuberculosis burden from 1990 to 2019: a retrospective analysis based on the Global Burden of Disease Study 2019. BMJ Open 2023; 13:e074134. [PMID: 37770275 PMCID: PMC10546119 DOI: 10.1136/bmjopen-2023-074134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE This study aimed to analyse the burden and temporal trends of tuberculosis (TB) incidence and mortality globally, as well as the association between mortality-to-incidence ratio (MIR) and Socio-Demographic Index (SDI). DESIGN A retrospective analysis of TB data from 1990 to 2019 was conducted using the Global Burden of Disease Study database. RESULTS Between 1990 and 2019, there was a declining trend in the global incidence and mortality of TB. High SDI regions experienced a higher declining rate than in low SDI regions during the same period. Nearly half of the new patients occurred in South Asia. In addition, there is a sex-age imbalance in the overall burden of TB, with young males having higher incidence and mortality than females. In terms of the three subtypes of TB, drug-sensitive (DS)-TB accounted for more than 90% of the incidents and deaths and experienced a decline over the past 30 years. However, drug-resistant TB (multidrug-resistant (MDR)-TB and extensively drug-resistant (XDR)-TB) showed an overall increasing trend in age-standardised incidence rates and age-standardised mortality rates, with an inflection point after the year 2000. At the regional level, South Asia and Eastern Europe remained a high burden of drug-resistant TB incidence and mortality. Interestingly, a negative correlation was found between the MIR and SDI for TB, including DS-TB, MDR-TB and XDR-TB. Notably, central sub-Saharan Africa had the highest MIR, which indicated a higher-than-expected burden given its level of sociodemographic development. CONCLUSION This study provides comprehensive insights into the global burden and temporal trends of TB incidence and mortality, as well as the relationship between MIR and SDI. These findings contribute to our understanding of TB epidemiology and can inform public health strategies for prevention and management.
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Affiliation(s)
- Yuqian Chen
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Jin Liu
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Qianqian Zhang
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Qingting Wang
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Limin Chai
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Huan Chen
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Danyang Li
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Yuanjie Qiu
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Yan Wang
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Nirui Shen
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Jian Wang
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Xinming Xie
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Shaojun Li
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Manxiang Li
- Department of Respiratory and Critical Care Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
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Iribarren SJ, Milligan H, Chirico C, Goodwin K, Schnall R, Telles H, Iannizzotto A, Sanjurjo M, Lutz BR, Pike K, Rubinstein F, Rhodehamel M, Leon D, Keyes J, Demiris G. Patient-centered mobile tuberculosis treatment support tools (TB-TSTs) to improve treatment adherence: A pilot randomized controlled trial exploring feasibility, acceptability and refinement needs. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100291. [PMID: 36061038 PMCID: PMC9426680 DOI: 10.1016/j.lana.2022.100291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Digital adherence technologies hold promise to improve patient-centered tuberculosis (TB) monitoring, yet few studies have incorporated direct adherence monitoring or assessed patients' experiences with these technologies. We explored acceptability, feasibility, and refinement needs of the TB Treatment Support Tools (TB-TSTs) intervention linking a mobile app, a urine drug metabolite test, and interactive communication with a treatment supporter. Methods This pilot study was a parallel-designed single-center randomized controlled trial with exit interviews. Newly diagnosed TB patients were randomized 1:1 using a treatment allocation button in the REDCap software preloaded with a random allocation sequence to usual care or usual care plus the TB-TSTs intervention from a respiratory medicine hospital in the province of Buenos Aires, Argentina and followed for 6-months. Due to the nature of the intervention, blinding to the group allocation could not be achieved for the recruiter or patients. The treatment outcome data extractor was blinded to the group allocation of the participants. Intervention participants used the app to report self-administering medication, potential side effects, submit photos of the urine test, and interact with a treatment supporter. Outcomes were feasibility, acceptability, and treatment outcomes. Findings Forty-two patients were enrolled and evenly assigned to each group. Intervention participants submitted 147·2±58 (mean, SD) medication self-administration and 144·5±55 side effect reports out of 180 and 47.5±38·4 photos of the urine test out of 77. Treatment success for usual care was 81% [17/21] and 95% [20/21] for the TB-TSTs intervention. Thirty-three themes were identified within the main categories of motivation, what worked, issues experienced, and recommendations. Participants (n=12) rated it as 'easy to use' (4.57/5), 'would highly recommend to others' (4·43/5) and reported that access to the treatment support was a critical component. Recommendations included adding an alarm, appointment reminders, and off-line functionality. Interpretation Findings suggest that the TB-TSTs intervention was feasible and acceptable and further refinement and testing is warranted. Funding National Institute of Health K23NR017210.
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Affiliation(s)
- Sarah J Iribarren
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Hannah Milligan
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Cristina Chirico
- Tuberculosis Control Program of the 5 Health Region, Ministry of Health of the Province of Buenos Aires, Hospital Cetrángolo, Buenos Aires, Argentina
| | - Kyle Goodwin
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Rebecca Schnall
- Columbia University School of Nursing, New York City, NY, USA
| | - Hugo Telles
- Tuberculosis Control Program of the 5 Health Region, Ministry of Health of the Province of Buenos Aires, Hospital Cetrángolo, Buenos Aires, Argentina
| | - Alejandra Iannizzotto
- Tuberculosis Control Program of the 5 Health Region, Ministry of Health of the Province of Buenos Aires, Hospital Cetrángolo, Buenos Aires, Argentina
| | - Myrian Sanjurjo
- Hospital del Tórax Dr. Antonio A. Cetrángolo, Provincia de Buenos Aires, Argentina
| | - Barry R Lutz
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Kenneth Pike
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Fernando Rubinstein
- Institute of Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Marcus Rhodehamel
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Daniel Leon
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jesse Keyes
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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Mebratu W, Wedajo S, Mohammed S, Endawkie A, Damtew Y. Prevalence and associated factors of tuberculosis among isoniazid users and non-users of HIV patients in Dessie, Ethiopia. Sci Rep 2022; 12:13500. [PMID: 35931781 PMCID: PMC9356010 DOI: 10.1038/s41598-022-16437-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Tuberculosis (TB) is major public health concern and Isoniazid Preventive Therapy (IPT) helps to prevent TB development among patients living with human immune deficiency virus (PLWHIV). However, the evidence is limited especially in the study area. Therefore, this study aimed to determine the prevalence and factors associated with TB among IPT users and non-IPT users of PLWHIV in Dessie, Ethiopia. A comparative cross-sectional study was employed for1 month in Dessie. A total of 326 respondents were selected using systematic random sampling. Bivariable and multivariable logistic regression analyses were computed to identify factors associated with Tuberculosis. In multivariable analysis, AOR with 95% CI was used to declare statistically significant variables with TB. The prevalence of TB among non-IPT users was 48.5%, (95% CI 40.8-56.2%), and among IPT users was 8%, (95% CI 5-13%). Cotrimoxazole prophylaxis therapy (CPT) (AOR = 5.835, 95% CI 2.565-13.274), IPT (AOR = 10.359, 95% CI 4.054-26.472), ART adherence (AOR = 30.542, 95% CI 12.871-72.475), and believing that IPT use prevents TB (AOR = 0.093, 95% CI 0.018-0.484) were statistically significant factors. The prevalence of TB was higher among non-IPT users than among IPT users. Therefore, efforts should be strengthened to implement widespread use of IPT among adult PLWHIV.
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Affiliation(s)
- Wondwosen Mebratu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Shambel Wedajo
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Semira Mohammed
- Department of General Master of Public Health, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Abel Endawkie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Yeshiwork Damtew
- Department of Masters of Business Administration, College of Business and Economics, Wollo University, Dessie, Ethiopia
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Development and validation of self-management scale for tuberculosis patients. BMC Infect Dis 2022; 22:502. [PMID: 35624424 PMCID: PMC9137130 DOI: 10.1186/s12879-022-07483-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Tuberculosis remains a major threat to global public health. Regarding its control, directly observed therapy is not suitable as a global strategy for all tuberculosis patients. Self-management may be an important patient-centered tuberculosis case management supplement to directly observed therapy. However, there is currently no well-established instrument for measuring the self-management of tuberculosis patients. This study aimed to develop and validate a self-management scale for tuberculosis patients. Methods We developed an initial scale based on the tuberculosis health promotion indicators framework developed by our research group. After item analysis and two rounds of exploratory factor analysis, a final version of the scale was developed. A survey of 462 tuberculosis patients was conducted to develop and validate this scale. Cronbach’s α and intraclass correlation coefficients were used to assess reliability, and Pearson’s correlation coefficients were used to evaluate content validity. Fit indices, convergent validity, and discriminant validity were evaluated using confirmatory factor analysis to determine the construct validity of the scale. Results The scale was composed of 17 items in three dimensions (“adherence to treatment behavior,” “transmission prevention behavior,” and “supportive therapy behavior”). These three dimensions explained 76.60% of the variance. Cronbach’s α of the scale was 0.905, and the intraclass correlation coefficient was 0.897. Additionally, Pearson’s correlation analysis showed that each item was strongly correlated with the dimension to which it belonged (r = 0.849–0.915, p < 0.01). Most fit indices (Comparative Fit Index, Normed Fit Index, Incremental Fit Index, Goodness of fit index) reached the recommended threshold, and the average variance extracted values of the three dimensions were higher than 0.5. The values of the square root of the average variance extracted within each dimension were greater than the correlation between dimensions, and all heterotrait–monotrait values were below 0.85. Conclusions The self-management scale for tuberculosis patient demonstrated good reliability and validity and could be used as an instrument to evaluate the self-management of patients. Additionally, it could be used to develop evidence-based self-management interventions and evaluate those interventions.
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5
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Li W, Tang YF, Yang XF, Huang XY. Misidentification of hepatic tuberculosis as cholangiocarcinoma: A case report. World J Clin Cases 2021; 9:9662-9669. [PMID: 34877304 PMCID: PMC8610856 DOI: 10.12998/wjcc.v9.i31.9662] [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: 05/28/2021] [Revised: 06/28/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic tuberculosis (TB) is uncommon clinically. Because of a lack of specific signs, characteristic symptoms and clinical manifestations and because pathological samples are difficult to obtain, hepatic TB is easily missed or misdiagnosed.
CASE SUMMARY A 62-year-old Chinese man presented with jaundice for 1 wk and no abnormal laboratory tests other than elevated bilirubin, aminotransferases and C-reactive protein. Computed tomography (CT) of the abdomen showed a mass in the left lobe of the liver and hepatic hilum with striped calcified foci. Mild enhancement was visible at the edges, along with extensive intrahepatic biliary ductal dilatation in the right lobe of the liver. In the arterial phase of both CT and magnetic resonance imaging, the main trunk and right branch of the portal artery were partially visualized. Magnetic resonance cholangiopancreatography (MRCP) indicated that the left lobe of the liver and most of the bile ducts in the hilum were not visible. Pathological examination revealed coagulative necrosis, and granulomatous nodules were seen around areas of necrosis; therefore, TB was considered.
CONCLUSION Hepatic tuberculosis is easily misdiagnosed or missed on imaging. Percutaneous puncture biopsy is the most useful tool for definitive diagnosis.
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Affiliation(s)
- Wei Li
- The Affiliated Nanhua Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang 421002, Hunan Province, China
| | - Yan-Fen Tang
- The Affiliated Nanhua Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang 421002, Hunan Province, China
| | - Xue-Feng Yang
- The Affiliated Nanhua Hospital, Department of Gastroenterology, Hengyang Medical School, University of South China, Hengyang 421002, Hunan Province, China
| | - Xiang-Yu Huang
- The Affiliated Nanhua Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang 421002, Hunan Province, China
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Iribarren S, Milligan H, Goodwin K, Aguilar Vidrio OA, Chirico C, Telles H, Morelli D, Lutz B, Sprecher J, Rubinstein F. Mobile Tuberculosis Treatment Support Tools to Increase Treatment Success in Patients with Tuberculosis in Argentina: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e28094. [PMID: 34152281 PMCID: PMC8277351 DOI: 10.2196/28094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is an urgent global health threat and the world's deadliest infectious disease despite being largely curable. A critical challenge is to ensure that patients adhere to the full course of treatment to prevent the continued spread of the disease and development of drug-resistant disease. Mobile health interventions hold promise to provide the required adherence support to improve TB treatment outcomes. OBJECTIVE This study aims to evaluate the effectiveness of the TB treatment support tools (TB-TSTs) intervention on treatment outcomes (success and default) and to assess patient and provider perceptions of the facilitators and barriers to TB-TSTs implementation. METHODS The TB-TSTs study is an open-label, randomized controlled trial with 2 parallel groups in which 400 adult patients newly diagnosed with TB will be randomly assigned to receive usual care or usual care plus TB-TSTs. Participants will be recruited on a rolling basis from 4 clinical sites in Argentina. The intervention consists of a smartphone progressive web app, a treatment supporter (eg, TB nurse, physician, or social worker), and a direct adherence test strip engineered for home use. Intervention group participants will report treatment progress and interact with a treatment supporter using the app and metabolite urine test strip. The primary outcome will be treatment success. Secondary outcomes will include treatment default rates, self-reported adherence, technology use, and usability. We will assess patients' and providers' perceptions of barriers to implementation and synthesize lessons learned. We hypothesize that the TB-TSTs intervention will be more effective because it allows patients and TB supporters to monitor and address issues in real time and provide tailored support. We will share the results with stakeholders and policy makers. RESULTS Enrollment began in November 2020, with a delayed start due to the COVID-19 pandemic, and complete enrollment is expected by approximately July 2022. Data collection and follow-up are expected to be completed 6 months after the last patient is enrolled. Results from the analyses based on the primary end points are expected to be submitted for publication within a year of data collection completion. CONCLUSIONS To our knowledge, this randomized controlled trial will be the first study to evaluate a patient-centered remote treatment support strategy using a mobile tool and a home-based direct drug metabolite test. The results will provide robust scientific evidence on the effectiveness, implementation, and adoption of mobile health tools. The findings have broader implications not only for TB adherence but also more generally for chronic disease management and will improve our understanding of how to support patients facing challenging treatment regimens. TRIAL REGISTRATION ClinicalTrials.gov NCT04221789; https://clinicaltrials.gov/ct2/show/NCT04221789. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/28094.
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Affiliation(s)
- Sarah Iribarren
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Hannah Milligan
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Kyle Goodwin
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | | | - Cristina Chirico
- National Tuberculosis Control Program, Region Five, Buenos Aires Argentina, Buenos Aires, Argentina
| | - Hugo Telles
- National Tuberculosis Control Program, Region Five, Buenos Aires Argentina, Buenos Aires, Argentina
| | - Daniela Morelli
- Institute of Clinical Effectiveness and Healthcare Policy, Buenos Aires, Argentina
| | - Barry Lutz
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Jennifer Sprecher
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Fernando Rubinstein
- Institute of Clinical Effectiveness and Healthcare Policy, Buenos Aires, Argentina
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Wilkinson KA, Schneider-Luftman D, Lai R, Barrington C, Jhilmeet N, Lowe DM, Kelly G, Wilkinson RJ. Antiretroviral Treatment-Induced Decrease in Immune Activation Contributes to Reduced Susceptibility to Tuberculosis in HIV-1/Mtb Co-infected Persons. Front Immunol 2021; 12:645446. [PMID: 33746987 PMCID: PMC7973093 DOI: 10.3389/fimmu.2021.645446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/10/2021] [Indexed: 12/27/2022] Open
Abstract
Antiretroviral treatment (ART) reduces the risk of developing active tuberculosis (TB) in HIV-1 co-infected persons. In order to understand host immune responses during ART in the context of Mycobacterium tuberculosis (Mtb) sensitization, we performed RNAseq analysis of whole blood-derived RNA from individuals with latent TB infection coinfected with HIV-1, during the first 6 months of ART. A significant fall in RNA sequence abundance of the Hallmark IFN-alpha, IFN-gamma, IL-6/JAK/STAT3 signaling, and inflammatory response pathway genes indicated reduced immune activation and inflammation at 6 months of ART compared to day 0. Further exploratory evaluation of 65 soluble analytes in plasma confirmed the significant decrease of inflammatory markers after 6 months of ART. Next, we evaluated 30 soluble analytes in QuantiFERON Gold in-tube (QFT) samples from the Ag stimulated and Nil tubes, during the first 6 months of ART in 30 patients. There was a significant decrease in IL-1alpha and IL-1beta (Ag-Nil) concentrations as well as MCP-1 (Nil), supporting decreased immune activation and inflammation. At the same time, IP-10 (Ag-nil) concentrations significantly increased, together with chemokine receptor-expressing CD4 T cell numbers. Our data indicate that ART-induced decrease in immune activation combined with improved antigen responsiveness may contribute to reduced susceptibility to tuberculosis in HIV-1/Mtb co-infected persons.
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Affiliation(s)
- Katalin A Wilkinson
- Tuberculosis Laboratory, The Francis Crick Institute, London, United Kingdom.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Rachel Lai
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | | | - Nishtha Jhilmeet
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - David M Lowe
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Institute of Immunity and Transplantation, University College London, London, United Kingdom
| | - Gavin Kelly
- Bioinformatics and Biostatistics, The Francis Crick Institute, London, United Kingdom
| | - Robert J Wilkinson
- Tuberculosis Laboratory, The Francis Crick Institute, London, United Kingdom.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Department of Infectious Disease, Imperial College London, London, United Kingdom
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8
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Milligan H, Iribarren SJ, Chirico C, Telles H, Schnall R. Insights from participant engagement with the tuberculosis treatment support tools intervention: Thematic analysis of interactive messages to guide refinement to better meet end user needs. Int J Med Inform 2021; 149:104421. [PMID: 33706032 DOI: 10.1016/j.ijmedinf.2021.104421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tuberculosis (TB) is a largely curable disease, yet it remains one of the top ten causes of death globally. In response to known challenges to completing the long course of TB treatment, our study team developed the TB treatment support tools (TB-TSTs). The mobile application (app) is comprised of the following main components: 1) tracks treatment progress, 2) provides disease tailored information, 3) interactive communication between patients and treatment supporters, and 4) is linked with a direct adherence drug metabolite test. OBJECTIVE The objective of this study was to analyze the interactive communication between the patients and the treatment supporter during the TB-TSTs pilot testing to identify issues and guide intervention refinement. METHODS We used mixed methods to analyze the interactive communication data. The study was conducted at a pulmonary disease specialized hospital in Argentina. Of the 42 study participants enrolled in the pilot study, 21 were randomly assigned to use the TB-TSTs for 6-months during their TB treatment. The treatment supporter was a registered nurse from the regional level of the National TB program. We conducted thematic and content analysis of the messages in their original language, Spanish. We assessed the themes over time and by whom initiated the messages. RESULTS There were 2561 individual messages sent between the participants and treatment supporter. We identified 19 main themes: 7 were participant and 12 were treatment supporter initiated. Participant themes included missed report rationale, arranging in-person meeting, intervention support, TB treatment progress, disease/treatment questions, side effects and additional support. Treatment supporter themes included missed report inquiry, arranging in-person meeting, introduction and instructions, check-in's, positive reinforcement, treatment progress inquiry, test-strip issues, intervention orientation, initial side-effect check in, follow-up on side effects and photo quality issues. Messages and themes decreased over time with most occurring within the first 2 months of treatment. CONCLUSIONS Although there was a decrease in the number of messages and the theme types over the 6-month study participation, treatment adherence support remained needed throughout. Potential solutions are suggested for the main issues and recommendations are being used to guide refinement.
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Affiliation(s)
- Hannah Milligan
- Department of Bio-behavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States.
| | - Sarah J Iribarren
- Department of Bio-behavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States.
| | - Cristina Chirico
- National Tuberculosis Control Program Region Five (Programa Control de la Tuberculosis Región Sanitaria V.), Hospital Zonal Del Torax Dr Antonio Cetrangolo, Buenos Aires, Argentina
| | - Hugo Telles
- National Tuberculosis Control Program Region Five (Programa Control de la Tuberculosis Región Sanitaria V.), Hospital Zonal Del Torax Dr Antonio Cetrangolo, Buenos Aires, Argentina
| | - Rebecca Schnall
- Columbia University School of Nursing, New York, NY, United States
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9
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Yang F, Yang Y, Chen Y, Li G, Zhang G, Chen L, Zhang Z, Mai Q, Zeng G. MiR-21 Is Remotely Governed by the Commensal Bacteria and Impairs Anti-TB Immunity by Down-Regulating IFN-γ. Front Microbiol 2021; 11:512581. [PMID: 33552001 PMCID: PMC7859650 DOI: 10.3389/fmicb.2020.512581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/30/2020] [Indexed: 12/23/2022] Open
Abstract
Tuberculosis (TB), which is a frequent and important infectious disease caused by Mycobacterium tuberculosis, has resulted in an extremely high burden of morbidity and mortality. The importance of intestinal dysbacteriosis in regulating host immunity has been implicated in TB, and accumulating evidence suggests that microRNAs (miRNAs) might act as a key mediator in maintaining intestinal homeostasis through signaling networks. However, the involvement of miRNA in gut microbiota, TB and the host immune system remains unknown. Here we showed that intestinal dysbacteriosis increases the susceptibility to TB and remotely increased the expression of miR-21 in lung. Systemic antagonism of miR-21 enhanced IFN-γ production and further conferred immune protection against TB. Molecular experiments further indicated that miR-21a-3p could specifically target IFN-γ mRNA. These findings revealed regulatory pathways implicating intestinal dysbacteriosis induced-susceptibility to TB: intestinal dysbiosis→lung miRNA→targeting IFN-γ→impaired anti-TB immunity. This study also suggested that deregulated miRNAs by commensal bacteria could become promising targets as TB therapeutics.
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Affiliation(s)
- Fang Yang
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministryof Education, Sun Yat-sen University, Guangzhou, China
| | - Yi Yang
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministryof Education, Sun Yat-sen University, Guangzhou, China
| | - Yiwei Chen
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministryof Education, Sun Yat-sen University, Guangzhou, China
| | - Guobao Li
- Department of Tuberculosis, Shenzhen Third People’s Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Guoliang Zhang
- National Clinical Research Center for Tuberculosis, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People’s Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Lingming Chen
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministryof Education, Sun Yat-sen University, Guangzhou, China
| | - Zhiyi Zhang
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministryof Education, Sun Yat-sen University, Guangzhou, China
| | - Qiongdan Mai
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministryof Education, Sun Yat-sen University, Guangzhou, China
| | - Gucheng Zeng
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministryof Education, Sun Yat-sen University, Guangzhou, China
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Oladimeji O, Adepoju V, Anyiam FE, San JE, Odugbemi BA, Hyera FLM, Sibiya MN, Yaya S, Zoakah AI, Lawson L. Treatment outcomes of drug susceptible Tuberculosis in private health facilities in Lagos, South-West Nigeria. PLoS One 2021; 16:e0244581. [PMID: 33471851 PMCID: PMC7816975 DOI: 10.1371/journal.pone.0244581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022] Open
Abstract
Background The Lagos State Tuberculosis, Buruli Ulcer, and Leprosy Control Program (LSTBLCP) started engaging private hospitals under the Public-Private Mix (PPM) Program in 2008. The study aimed to evaluate the trend and predictors of successful Tuberculosis (TB) treatment outcomes of patients managed across these private health facilities between 2010–2016 in Lagos, Nigeria. Methods Retrospective review of TB treatment register and treatment cards of patients commenced on TB treatment between January 2010 and December 2016 in 36 private health facilities engaged by the LSTBLCP. Between December 2016 and February 2017, data were collected and entered into Microsoft Excel by trained data entry clerks. The analysis was done using SPSS software. Independent predictors of successful treatment outcomes were determined using multivariate analysis at the statistical significance of p<0.05 and 95% confidence interval. Results A total of 1660 records of TB patients were reviewed. 1535 (92.47%) commenced treatment, while 1337 (87.10%) of all records had documented treatment outcomes. Of the 1337 patients with outcomes, 1044 (78.09%) had a successful treatment outcome, and 293 (21.91%) had an unsuccessful outcome. Majority were male, 980 (59.04%), Human Immunodeficiency Virus (HIV) negative status, 1295 (80.24%), diagnosed with smear, 1141 (73.14%), treated in private not-for-profit (PNFP) hospital, 1097 (66.08%), treated for TB between 2014–2016 (18.96%-19.52%). In multivariate analysis, age>20years (aOR = 0.26, p = 0.001), receiving TB treatment in 2013 (aOR = 0.39, p = 0.001), having genexpert for TB diagnosis (aOR = 0.26, p = 0.031) and being HIV positive (aOR = 0.37, p = 0.001) significantly reduced likelihood of successful treatment outcome. The site of TB, being on ART or CPT, were confounding determinants of successful treatment outcomes as they became non-significant at the multivariate analysis level. Conclusion Treatment outcome among Lagos private hospitals was low compared with NTBLCP and World Health Organization (WHO) target. We urge the government and TB stakeholders to strengthen the PPM interventions to improve adherence, particularly among People Living with HIV (PLHIV) and older TB patients. Hence, promotion of early care-seeking, improving diagnostic and case holding efficiencies of health facilities, and TB/HIV collaborative interventions can reduce the risk of an unsuccessful outcome.
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Affiliation(s)
- Olanrewaju Oladimeji
- Department of Public Health, Walter Sisulu University, Eastern Cape, South Africa
- Faculty of Health Sciences, Durban University of Technology, Eastern Cape, South Africa
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
- * E-mail:
| | - Victor Adepoju
- Adolescent Friendly Research Initiative and Care (ADOLFRIC), Ekiti State, Nigeria
| | - Felix Emeka Anyiam
- Center for Health and Development, University of Port Harcourt, Port Harcourt, Nigeria
| | - James Emmanuel San
- Kwazulu-Natal Research and Innovation Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Babatunde A. Odugbemi
- Department of Community Health and Primary Health Care, Lagos State University, College of Medicine, Ikeja, Lagos, Nigeria
| | | | | | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
| | - Ayuba Ibrahim Zoakah
- Department of Community Medicine, Jos University Teaching Hospital, University of Jos, Plateau State, Nigeria
| | - Lovett Lawson
- Zankli Medical Services Ltd, Utako District, Abuja, Nigeria
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11
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Millar JA, Butler JR, Evans S, Mattila JT, Linderman JJ, Flynn JL, Kirschner DE. Spatial Organization and Recruitment of Non-Specific T Cells May Limit T Cell-Macrophage Interactions Within Mycobacterium tuberculosis Granulomas. Front Immunol 2021; 11:613638. [PMID: 33552077 PMCID: PMC7855029 DOI: 10.3389/fimmu.2020.613638] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/01/2020] [Indexed: 12/23/2022] Open
Abstract
Tuberculosis (TB) is a worldwide health problem; successful interventions such as vaccines and treatment require a 2better understanding of the immune response to infection with Mycobacterium tuberculosis (Mtb). In many infectious diseases, pathogen-specific T cells that are recruited to infection sites are highly responsive and clear infection. Yet in the case of infection with Mtb, most individuals are unable to clear infection leading to either an asymptomatically controlled latent infection (the majority) or active disease (roughly 5%-10% of infections). The hallmark of Mtb infection is the recruitment of immune cells to lungs leading to development of multiple lung granulomas. Non-human primate models of TB indicate that on average <10% of T cells within granulomas are Mtb-responsive in terms of cytokine production. The reason for this reduced responsiveness is unknown and it may be at the core of why humans typically are unable to clear Mtb infection. There are a number of hypotheses as to why this reduced responsiveness may occur, including T cell exhaustion, direct downregulation of antigen presentation by Mtb within infected macrophages, the spatial organization of the granuloma itself, and/or recruitment of non-Mtb-specific T cells to lungs. We use a systems biology approach pairing data and modeling to dissect three of these hypotheses. We find that the structural organization of granulomas as well as recruitment of non-specific T cells likely contribute to reduced responsiveness.
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Affiliation(s)
- Jess A Millar
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States.,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - J Russell Butler
- Department of Health and Biomedical Sciences, AdventHealth University, Orlando, FL, United States
| | - Stephanie Evans
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Joshua T Mattila
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer J Linderman
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - JoAnne L Flynn
- Department of Microbiology and Molecular Genetics and the Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, United States
| | - Denise E Kirschner
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
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12
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Freitas M, Magalhães J, Marinho C, Cotter J. Looking beyond appearances: when liver biopsy is the key for hepatic tuberculosis diagnosis. BMJ Case Rep 2020; 13:13/5/e234491. [PMID: 32376662 DOI: 10.1136/bcr-2020-234491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Primary hepatic tuberculosis is a rare clinical entity with non-specific clinical and imaging features that can mimic other liver diseases, representing a diagnostic challenge. We report a case of a 35-year-old man with metabolic syndrome, type 2 diabetes and high alcohol consumption presenting asymptomatic with abnormal liver tests, hepatosplenomegaly and diffuse hepatic steatosis in ultrasound imaging initially suspected to be alcoholic steatohepatitis but later diagnosed as hepatic tuberculosis in the histological specimen. Anti-tuberculosis therapy was started. This clinical case highlights the diagnostic difficulty of hepatic tuberculosis and the importance of not overlooking liver biopsy and to consider it in the differential diagnosis in patients with obvious hepatic injury factors but with atypical clinical presentation.
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Affiliation(s)
- Marta Freitas
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Braga, Portugal .,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Joana Magalhães
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Carla Marinho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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13
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Iribarren SJ, Wallingford J, Schnall R, Demiris G. Converting and expanding mobile support tools for tuberculosis treatment support: Design recommendations from domain and design experts. J Biomed Inform 2020; 112S:100066. [PMID: 34327316 DOI: 10.1016/j.yjbinx.2019.100066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/12/2019] [Accepted: 11/29/2019] [Indexed: 12/23/2022]
Abstract
Background Tuberculosis (TB) remains one of the top ten causes of death globally despite it being largely treatable. Poor adherence to treatment directly contributes to poor outcomes, such as, prolonged infectivity and the development of drug resistance. Mobile phone-based interventions have the potential to improve treatment outcomes. Objective The purpose of this study was to solicit design and domain expert feedback of a previously developed TB support intervention converted to a mobile application. Methods We used prototyping in iterative cycles that included integrating findings from prior formative research with endusers and soliciting feedback from design and content experts. In this project, we used low-fidelity prototype evaluation to inform the design of high-fidelity prototypes for further testing and iterative refinement. Results We received 12 survey results. Overall, the participants agreed that the functions would be easy to learn/use. Recommendations for improvement included: simplify the reporting by offering broad categories; split complex screens to be more intuitive and user friendly; modify feedback graphics to display data more clearly; incorporate instructions for each task/function to guide users and collapse the information once users had viewed it; display navigation icons on each screen and add a main menu button; have medication tracker be homepage and limit redundancies. Several potential functionalities were suggested, such as adding a notes/journal and a social feature. We were able to easily incorporate recommendations and feedback into the high-fidelity prototypes and continue testing and refinement. After we came to a stable prototype through testing, we gave the interactive prototype to our developers to program a base functioning model. Conclusion The proposed design recommendations provide valuable insight to inform initial conversion of an interactive intervention to customize patient support, which include a smartphone app and a direct drug metabolite test reengineered for home use. We argue that iteratively developing low- and high-fidelity prototypes with content and design experts to guide initial programming of a functional beta app paves the way to better explore further refinement needs and recommendations with endusers rather than using hypothetical scenarios.
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Affiliation(s)
- Sarah J Iribarren
- Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195
| | - Jessica Wallingford
- Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195
| | - Rebecca Schnall
- Columbia University, School of Nursing, Columbia University, New York, NY, USA
| | - George Demiris
- University of Pennsylvania, Claire Fagin Hall, Rm 324, 418 Curie Blvd, Philadelphia PA 19104
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14
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Odayar J, Myer L. Transfer of primary care patients receiving chronic care: the next step in the continuum of care. Int Health 2020; 11:432-439. [PMID: 31081907 DOI: 10.1093/inthealth/ihz014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/11/2019] [Indexed: 12/26/2022] Open
Abstract
The burden of chronic conditions is increasing rapidly in low- and middle-income countries. Chronic conditions require long-term and continuous care, including for patients transferring between facilities. Patient transfer is particularly important in the context of health service decentralization, which has led to increasing numbers of primary care facilities at which patients can access care, and high levels of migration, which suggest that patients might require care at multiple facilities. This article provides a critical review of existing evidence regarding transfer of stable patients receiving primary care for chronic conditions. Patient transfer has received limited consideration in people living with HIV, with growing concern that patients who transfer are at risk of poor outcomes; this appears similar for people with TB, although studies are few. There are minimal data on transfer of patients with non-communicable diseases, including diabetes. Patient transfer for chronic conditions has thus received surprisingly little attention from researchers; considering the potential risks, more research is urgently required regarding reasons for and outcomes of transfers, transfer processes and interventions to optimize transfers, for different chronic conditions. Ultimately, it is the responsibility of health systems to facilitate successful transfers, and this issue requires increased attention from researchers and policy-makers.
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Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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15
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Zhang J, Yang Y, Qiao X, Wang L, Bai J, Yangchen T, Chodron P. Factors Influencing Medication Nonadherence to Pulmonary Tuberculosis Treatment in Tibet, China: A Qualitative Study from the Patient Perspective. Patient Prefer Adherence 2020; 14:1149-1158. [PMID: 32764888 PMCID: PMC7360411 DOI: 10.2147/ppa.s252448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Medication nonadherence is one of the most significant obstacles to tuberculosis (TB) control worldwide. Identification of the factors associated with medication nonadherence is important. However, few related studies have been carried out in Tibet. This study aimed to explore factors influencing medication nonadherence to pulmonary TB (PTB) treatment in Tibet, China, from the patient perspective. PATIENTS AND METHODS In this qualitative study, seventeen PTB patients in Tibet were recruited by purposive and maximum variation sampling methods. In-depth semistructured interviews were conducted to collect data on factors influencing medication nonadherence, and Colaizzi's seven-step method was used to analyze the data. RESULTS The medication nonadherence of PTB patients in Tibet was influenced by one or a combination of the following four factors. First, patient-related factors included a lack of knowledge of PTB treatment, poor self-management capability, poor self-regulation capability and misperception of health condition. Second, a medication-related factor was medication side effects. Third, health service-related factors included the poor treatment skills of doctors in primary hospitals and a lack of directly observed treatment (DOT). Last, sociocultural factors included the effect of traditional Tibetan medicine, lack of family member support and discrimination. CONCLUSION Multiple interplaying factors influenced medication nonadherence during PTB treatment in Tibet, and the main influencing factors were a lack of knowledge about PTB treatment, poor self-management capability, and the effect of traditional Tibetan medicine. TB health workers in Tibet should provide permanently viewable PTB treatment knowledge materials to PTB patients when oral health education is conducted, find feasible alternative strategies to DOT and establish links to traditional Tibetan medicine hospitals.
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Affiliation(s)
- Jinjing Zhang
- School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, People’s Republic of China
- Correspondence: Jinjing Zhang School of Medicine, Xizang Minzu University, #6 Wenhui East Road, Xianyang712082, Shaanxi, People’s Republic of ChinaTel +86 186 9100 8710Fax +86 029 3375 5433 Email
| | - Yunyun Yang
- Department of Pulmonary, The Third People’s Hospital of Tibet Autonomous Region, Lhasa, Tibet, People’s Republic of China
| | - Xue Qiao
- School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, People’s Republic of China
| | - Liwen Wang
- School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, People’s Republic of China
| | - Jinyu Bai
- School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, People’s Republic of China
| | - Tsring Yangchen
- School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, People’s Republic of China
| | - Pema Chodron
- School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, People’s Republic of China
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16
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Dong X, Zhang CY, Jin G, Wang Z. Targeting of Nanotherapeutics to Infection Sites for Antimicrobial Therapy. ADVANCED THERAPEUTICS 2019; 2:1900095. [PMID: 33313384 PMCID: PMC7731920 DOI: 10.1002/adtp.201900095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Indexed: 01/07/2023]
Abstract
Bacterial infections cause a wide range of host immune disorders, resulting in local and systemic tissue damage. Antibiotics are pharmacological interventions for treating bacterial infections, but increased antimicrobial resistance and the delayed development of new antibiotics have led to a major global health threat, the so-called "superbugs". Bacterial infections consist of two processes: pathogen invasion and host immune responses. Developing nanotherapeutics to target these two pathways may be effective for eliminating bacteria and restoring host homeostasis, thus possibly finding new treatments for bacterial infections. This review offers new approaches for developing nanotherapeutics based on the pathogenesis of infectious diseases. We have discussed how nanoparticles target infectious microenvironments (IMEs) and how they target phagocytes to deliver antibiotics to eliminate intracellular pathogens. We also review a new concept-host-directed therapy for bacterial infections, such as targeting immune cells for the delivery of anti-inflammatory agents and vaccine developments using bacterial membrane-derived nanovesicles. This review demonstrates the translational potential of nanomedicine for improving infectious disease treatments.
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Affiliation(s)
| | | | | | - Zhenjia Wang
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99210, United States
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17
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Omar A, Elfadl AEA, Ahmed Y, Hosny M. Valuing the use of GeneXpert test as an unconventional approach to diagnose pulmonary tuberculosis. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_88_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Pinto Carneiro S, Moine L, Tessier B, Nicolas V, dos Santos O, Fattal E. Pyrazinoic acid-Poly(malic acid) biodegradable nanoconjugate for efficient intracellular delivery. PRECISION NANOMEDICINE 2019. [DOI: 10.33218/prnano2(3).190523.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tuberculosis is an infectious disease affecting mostly lungs, that is still considered a health global problem as it causes millions of deaths worldwide. Current treatment is effective but associated with severe adverse effects due to the high doses of each anti-tuberculosis drug daily administrated by oral therapy. For the first time, a pyrazinoic acid (PA) biodegradable nanoconjugate was synthesized and developed for pulmonary administration in an attempt to reduce the administered doses by achieving a high drug payload and controlled release at the target site. The conjugate was synthesized by coupling pyrazinoic acid on carboxylic groups of poly(malic acid), which is a biodegradable and biocompatible polymer, and posteriorly self-assembled into nanoconjugates. Characterization confirmed the formation of nanometric, spherical and negatively charged pyrazinoic acid nanoconjugate (NC-PA). NC-PA was stable for 60 days at 4 and 37°C and able to deliver PA in a sustained release manner over time. On macrophages, they exhibited no cell toxicity for a wide range of concentrations (from 1 to 100 µg/mL), demonstrating the safety of NC-PA. In addition, the nanoconjugate was efficiently taken up by RAW 264.7 cells over 6 hours reaching a maximum value after 3 hours of incubation. In conclusion, innovative nanoconjugates are a promising alternative to deliver drugs directly to the lungs and contributing to improving tuberculosis therapy.
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Affiliation(s)
| | | | | | | | - Orlando dos Santos
- Laboratório de Fitotecnologia, Escola de Farmácia, Universidade Federal de Ouro Preto
| | - Elias Fattal
- Institut Galien Paris-Sud, CNRS, Université Paris-Sud
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19
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Ding X, Wang A, Tong W, Xu FJ. Biodegradable Antibacterial Polymeric Nanosystems: A New Hope to Cope with Multidrug-Resistant Bacteria. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2019; 15:e1900999. [PMID: 30957927 DOI: 10.1002/smll.201900999] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/19/2019] [Indexed: 05/14/2023]
Abstract
The human society is faced with daunting threats from bacterial infections. Over decades, a variety of antibacterial polymeric nanosystems have exhibited great promise for the eradication of multidrug-resistant bacteria and persistent biofilms by enhancing bacterial recognition and binding capabilities. In this Review, the "state-of-the-art" biodegradable antibacterial polymeric nanosystems, which could respond to bacteria environments (e.g., acidity or bacterial enzymes) for controlled antibiotic release or multimodal antibacterial treatment, are summarized. The current antibacterial polymeric nanosystems can be categorized into antibiotic-containing and intrinsic antibacterial nanosystems. The antibiotic-containing polymeric nanosystems include antibiotic-encapsulated nanocarriers (e.g., polymeric micelles, vesicles, nanogels) and antibiotic-conjugated polymer nanosystems for the delivery of antibiotic drugs. On the other hand, the intrinsic antibacterial polymer nanosystems containing bactericidal moieties such as quaternary ammonium groups, phosphonium groups, polycations, antimicrobial peptides (AMPs), and their synthetic mimics, are also described. The biodegradability of the nanosystems can be rendered by the incorporation of labile chemical linkages, such as carbonate, ester, amide, and phosphoester bonds. The design and synthesis of the degradable polymeric building blocks and their fabrications into nanosystems are also explicated, together with their plausible action mechanisms and potential biomedical applications. The perspectives of the current research in this field are also described.
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Affiliation(s)
- Xiaokang Ding
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
- Key Lab of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, 100029, China
- Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Anzhi Wang
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
- Key Lab of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, 100029, China
- Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Wei Tong
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
- Key Lab of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, 100029, China
- Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Fu-Jian Xu
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
- Key Lab of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, 100029, China
- Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
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20
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Fang XH, Shen HH, Hu WQ, Xu QQ, Jun L, Zhang ZP, Kan XH, Ma DC, Wu GC. Prevalence of and Factors Influencing Anti-Tuberculosis Treatment Non-Adherence Among Patients with Pulmonary Tuberculosis: A Cross-Sectional Study in Anhui Province, Eastern China. Med Sci Monit 2019; 25:1928-1935. [PMID: 30869079 PMCID: PMC6429981 DOI: 10.12659/msm.913510] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To assess the non-adherence rate among pulmonary tuberculosis (TB) patients in Anhui Province, eastern China and to explore the influential factors, so as to identify targets for intervention. MATERIAL AND METHODS A total of 339 TB patients were recruited from TB dispensaries in 8 counties of Anhui Province, eastern China using a stratified sampling method. All study subjects were surveyed using a structured questionnaire. Differences between groups involving categorical data were analyzed using the chi-square test. RESULTS Overall, of the 339 patients, 33.63% missed medication. Divorced and widowed patients were more likely to miss medication compared with those who were married or unmarried (P<0.01). Regarding the knowledge related to topics such as transmission route, preventive measures, and suspicious symptoms, the awareness rate in the group with good medication compliance was higher than in the group with poor compliance (P<0.05). We found that compliance was not significantly associated with seeking medical treatment in professional institutions, the national free TB treatment policy, or discrimination (P>0.05). The rate of non-compliance under supervision (26.10%) was lower than that without supervision (64.18%) (P<0.001). CONCLUSIONS The anti-TB treatment non-adherence rate in TB patients is relatively high in Anhui Province, eastern China, and is associated with marital status, annual income, TB knowledge, and medical staff visits.
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Affiliation(s)
- Xue-Hui Fang
- Anhui Provincial TB (Tuberculosis) Institute, Hefei, Anhui, China (mainland)
| | - Hui-Hui Shen
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Wan-Qian Hu
- Department of Clinical Medicine, College of Medicine, Yangzhou University, Yangzhou, Jiangsu, China (mainland)
| | - Qi-Qi Xu
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Lei Jun
- Anhui Provincial TB (Tuberculosis) Institute, Hefei, Anhui, China (mainland)
| | - Zhi-Ping Zhang
- Anqing Center for Disease Control and Prevention, Anqing, Anhui, China (mainland)
| | - Xiao-Hong Kan
- Anhui Provincial TB (Tuberculosis) Institute, Hefei, Anhui, China (mainland)
| | - Dong-Chun Ma
- Anhui Provincial TB (Tuberculosis) Institute, Hefei, Anhui, China (mainland)
| | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, Hefei, Anhui, China (mainland)
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21
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Haque MMU, Whadva RK, Luck NH, Mubarak M. Primary hepaticobiliary tuberculosis mimicking gall bladder carcinoma with liver invasion: a case report. Pan Afr Med J 2019; 32:68. [PMID: 31223360 PMCID: PMC6560998 DOI: 10.11604/pamj.2019.32.68.10519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 10/13/2016] [Indexed: 01/10/2023] Open
Abstract
Primary hepatic tuberculosis is a rare presentation and sporadically reported in the literature, mostly from our part of the world. Sometimes the presentation can be atypical and mimics hepatic tumor and poses diagnostic challenge. We, herein, present a case of a 58-year-old man who presented to us with abdominal pain and weight loss. Raised serum alkaline phosphatase (ALP) and imaging raised a suspicion of gall bladder carcinoma with hepatic invasion. Peroperative frozen section revealed hepatic chronic granulomatous inflammation with caseous necrosis consistent with the diagnosis of hepatic tuberculosis. Surgery was postponed and he was put on antituberculous treatment. It is important to consider tuberculosis in the differential diagnosis of the space occupying lesion of liver in a patient with vague symptoms and abnormal findings on imaging.
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Affiliation(s)
- Muhammad Manzoor Ul Haque
- Department of Hepatogastroentrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Rajesh Kumar Whadva
- Department of Hepatogastroentrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Nasir Hassan Luck
- Department of Hepatogastroentrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Muhammed Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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Jhilmeet N, Lowe DM, Riou C, Scriba TJ, Coussens A, Goliath R, Wilkinson RJ, Wilkinson KA. The effect of antiretroviral treatment on selected genes in whole blood from HIV-infected adults sensitised by Mycobacterium tuberculosis. PLoS One 2018; 13:e0209516. [PMID: 30589870 PMCID: PMC6307796 DOI: 10.1371/journal.pone.0209516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/06/2018] [Indexed: 12/23/2022] Open
Abstract
HIV-1 co-infection is a leading cause of susceptibility to tuberculosis (TB), with the risk of TB being increased at all stages of HIV-1 infection. Antiretroviral treatment (ART) is the most effective way to reduce the risk of TB in HIV-1 co-infected people. Studying protective, ART-induced, immune restoration in HIV-1 infected individuals sensitised by Mycobacterium tuberculosis (Mtb) can thus help identify mechanisms of protection against TB. In order to understand ART-mediated prevention of TB in HIV-1 infected adults, we investigated the expression of 30 genes in whole blood from HIV-1 infected patients during the first 6 months of ART-induced immune reconstitution. The 30 selected genes were previously described to be differentially expressed between sorted Mtb specific central and effector memory CD4 T cells. HIV-1 infected persons sensitised by Mtb were recruited in Khayelitsha, South Africa, when initiating ART. RNA was extracted from whole blood at initiation and 1, 3 and 6 months of ART. qRT-PCR was used to determine gene expression and three reference ‘housekeeping’ genes were used to calculate the fold change in the expression of each gene relative to day 0 of ART. Results were assessed longitudinally. We observed a decrease in the expression of a number of genes at 6 months of ART, reflecting a decrease in immune activation. However, following correction for multiple comparisons and increasing CD4 counts, only the decrease in CD27 gene expression remained statistically significant. While not statistically significant, a number of genes also showed increased expression at various timepoints, illustrating the broad regeneration of the T cell pool in HIV-1 infected adults on ART. Our findings generate hypotheses underlying ART- induced protective immune reconstitution and may pave the way for future studies to evaluate ART mediated prevention of TB in HIV-1 infected persons.
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Affiliation(s)
- Nishtha Jhilmeet
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - David M. Lowe
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Riou
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Thomas J. Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Anna Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Robert J. Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- The Francis Crick Institute, London, United Kingdom
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Katalin Andrea Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- The Francis Crick Institute, London, United Kingdom
- * E-mail:
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Módolo DG, Horn CS, Soares JSM, Yunes JA, Lima LM, de Sousa SM, Menossi M. Transgenic Nicotiana tabacum seeds expressing the Mycobacterium tuberculosis Alanine- and Proline-rich antigen. AMB Express 2018; 8:178. [PMID: 30382415 PMCID: PMC6209126 DOI: 10.1186/s13568-018-0708-y] [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: 06/18/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
The glycoprotein APA (Alanine- and Proline-rich Antigen, a 45/47 kDa antigen complex, Rv1860) is considered as a major immunodominant antigen secreted by M. tuberculosis. This antigen has proved to be highly immunogenic in experimental models and humans, presenting a significant potential for further development of a new vaccine for tuberculosis. Glycosylation plays a key role in the immunogenicity of the APA protein. Because plants are known to promote post-translational modification such as glycosylation and to be one of the most economic and safe hosts for recombinant protein expression, we have over expressed the APA protein in transgenic tobacco plants aiming to produce a glycosylated version of the protein. Seeds are known to be a well-suited organ to accumulate recombinant proteins, due to low protease activity and higher protein stability. We used a seed-specific promoter from sorghum, a signal peptide to target the protein to the endoplasmic reticulum and ultimately in the protein storage vacuoles. We show that the recombinant protein accumulated in the seeds had similar isoelectric point and molecular weight compared with the native protein. These findings demonstrate the ability of tobacco plants to produce glycosylated APA protein, opening the way for the development of secure, effective and versatile vaccines or therapeutic proteins against tuberculosis.
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Liver Calcifications and Calcified Liver Masses: Pattern Recognition Approach on CT. AJR Am J Roentgenol 2018; 211:76-86. [DOI: 10.2214/ajr.18.19704] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Affiliation(s)
- Xu Zhu
- Department of Chemistry, Willard Henry Dow Laboratory, University of Michigan, 930 North University Avenue, Ann Arbor, Michigan 48109, United States
| | - Christopher C. McAtee
- Department of Chemistry, Willard Henry Dow Laboratory, University of Michigan, 930 North University Avenue, Ann Arbor, Michigan 48109, United States
| | - Corinna S. Schindler
- Department of Chemistry, Willard Henry Dow Laboratory, University of Michigan, 930 North University Avenue, Ann Arbor, Michigan 48109, United States
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Validation of Cycloserine Efficacy in Treatment of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis in Beijing, China. Antimicrob Agents Chemother 2018; 62:AAC.01824-17. [PMID: 29311073 DOI: 10.1128/aac.01824-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/13/2017] [Indexed: 11/20/2022] Open
Abstract
Cycloserine (Cs) is recommended by the World Health Organization as a second-line drug to treat multidrug-resistant tuberculosis (MDR-TB); however, its efficacy has never been sufficiently evaluated. To gain some insights into the value of cycloserine for MDR-TB treatment, in vitro bacteriostatic effect was determined and patient validations were performed prospectively. The in vitro activity of Cs against 104 wild-type Mycobacterium tuberculosis strains was determined, and serum Cs concentrations were measured for 73 MDR TB patients 2 h after administration. The treatment outcomes for 27 MDR-TB patients who had baseline isolates and were treated with Cs-containing regimens were followed up. The MICs for 90% of the recruited 104 wild-type strains were below 32 μg/ml. Eighteen out of 52 patients had peak serum concentrations (Cmax) below 20 μg/ml at the dosage of 500 mg daily, while 13 out of 21 patients had peak serum concentrations higher than 35 μg/ml at the dosage of 750 mg daily. The percentage of favorable treatment outcomes among patients with a Cmax/MIC ratio of ≥1 was statistically significantly higher than that among the group with a Cmax/MIC ratio of <1 (P = 0.022). The epidemiological cutoff value for Cs susceptibility testing was 32 μg/ml. A high percentage of patients receiving the recommended dosage of 10 mg/kg for Cs administration could not acquire desirable blood concentrations; therefore, adjusting the dosage according to drug concentration monitoring is necessary. The Cmax/MIC ratio might be a good indicator for predicting the treatment outcome for patients with MDR-TB or extensively drug-resistant TB (XDR-TB) who are being administered Cs-containing regimens.
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Gong X, Li Y, Wang J, Wu G, Mohemaiti A, Wushouer Q, Yao L, Lv J, Li R, Li P, Wang B. Treatment adherence among sputum smear-positive pulmonary tuberculosis patients in Xinjiang, China: a prospective study. RSC Adv 2018; 8:8983-8989. [PMID: 35539878 PMCID: PMC9078584 DOI: 10.1039/c7ra11820a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/01/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Despite great effort to control tuberculosis (TB), low treatment adherence threatens the success of drug therapy, increases the risk of TB transmission, and leads to the development of drug resistance. The present study assessed anti-TB treatment adherence in sputum smear-positive TB patients and examined the risk factors for poor patient adherence to identify targets for intervention. Methods: We monitored and followed up TB patients who were diagnosed between July 2014 and June 2015 in Xinjiang, China. A total of 8289 sputum smear-positive TB patients were included in this study. All patients registered their information during the first hospital visit or with the Centers for Disease Control, had regular follow-up visits, and accepted the anti-TB treatment. Insufficient re-examination adherence was defined as undergoing fewer than the recommended three sputum smear examinations during the treatment course. Results: Among 8289 patients, 3827 men (84.4% of male patients) and 3220 women (85.7% of female patients) had good adherence during treatment follow-up. 1242 patients (15.0%) did not complete regular follow-up. 332 (4.0%) patients lost contact. An adjusted logistic regression model showed that ethnicity, household address, treatment classification, patient source, and the actual management were significantly associated with non-adherence. Conclusion: The Xinjiang TB epidemic situation remains grim. Smear-positive patients had a higher proportion of non-adherence, which increased treatment difficulties and the risk of death from TB. Relevant medical departments should strengthen their supervision and interventions during the TB treatment process to improve patient adherence to anti-TB treatment. Background: Despite great effort to control tuberculosis (TB), low treatment adherence threatens the success of drug therapy, increases the risk of TB transmission, and leads to the development of drug resistance.![]()
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Affiliation(s)
- Xinji Gong
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Yuehua Li
- Wuhan City Pulmonary Hospital (Wuhan Tuberculosis Control Institute) Wu Han China
| | - Jing Wang
- Department of Geriatrics, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Gang Wu
- Wuhan City Pulmonary Hospital (Wuhan Tuberculosis Control Institute) Wu Han China
| | - Ayinuer Mohemaiti
- Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention Urumqi China
| | - Qimanguli Wushouer
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Lidan Yao
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Jianghua Lv
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Rongrong Li
- Department of Nutrition, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Pengfei Li
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Buqing Wang
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
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[Treatment outcome, survival and their risk factors among new tuberculosis patients co-infected with HIV during the Ebola outbreak in Conakry]. Rev Epidemiol Sante Publique 2017; 65:419-426. [PMID: 29066256 DOI: 10.1016/j.respe.2017.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 04/16/2017] [Accepted: 05/19/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mortality among TB/HIV co-infected patients remains high in Africa. The study aimed to estimate survival and associated factors in a cohort of TB/HIV co-infected patients who started tuberculosis treatment during the Ebola outbreak in Conakry, Guinea. METHODS A prospective cohort study was conducted from April 2014 to December 2015. TB patients with HIV co-infection were enrolled at the University Hospital of Conakry. Survival and risk factors were analyzed according to Kaplan-Meier's method, log-rank test and Cox's regression. RESULTS Data from 573 patients were analyzed. From these, 86 (15.0%) died before the end of treatment, 52% occurring within eight weeks of treatment onset. Survival at 4, 12 and 24 weeks after the beginning of the TB treatment was 92%, 86% and 83%, respectively. Independent risk factors associated with death were in the cell CD4 <200 cells/mm3 [adjusted hazard ratio (AHR): 2.25; 95% CI (confidence intervals): 1.16-4.37], opportunistic infections other than TB [AHR: 2.89; 95% CI: 1.39-6.02], and comorbidities [AHR: 4.12; 95% CI: 2.10-8.10]. An increase of one unit in hemoglobin [AHR: 0.81; 95% CI: 0.75-0.91] was protective of death. CONCLUSION TB/HIV co-infected patients had a higher fatality rate during treatment of tuberculosis. Prevention of opportunistic infections, anemia and proper management of tuberculosis treatment in early comorbidities may improve survival for TB/HIV co-infected patients in restoring immune function.
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Donnellan S, Stone V, Johnston H, Giardiello M, Owen A, Rannard S, Aljayyoussi G, Swift B, Tran L, Watkins C, Stevenson K. Intracellular delivery of nano-formulated antituberculosis drugs enhances bactericidal activity. ACTA ACUST UNITED AC 2017. [DOI: 10.1002/jin2.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Samantha Donnellan
- Moredun Research Institute; Pentlands Science Park; Bush Loan Penicuik EH26 0PZ UK
- School of Engineering and Physical Sciences, Institute of Biological Chemistry, Biophysics and Bioengineering; Heriot-Watt University; Riccarton Edinburgh EH14 4AS UK
- Research Centre for Drugs and Diagnostics; Liverpool School of Tropical Medicine; Liverpool L3 5QA UK
| | - Vicki Stone
- School of Engineering and Physical Sciences, Institute of Biological Chemistry, Biophysics and Bioengineering; Heriot-Watt University; Riccarton Edinburgh EH14 4AS UK
| | - Helinor Johnston
- School of Engineering and Physical Sciences, Institute of Biological Chemistry, Biophysics and Bioengineering; Heriot-Watt University; Riccarton Edinburgh EH14 4AS UK
| | - Marco Giardiello
- Department of Chemistry; University of Liverpool; Crown Street Liverpool L69 3BX UK
| | - Andrew Owen
- Department of Chemistry; University of Liverpool; Crown Street Liverpool L69 3BX UK
| | - Steve Rannard
- Department of Chemistry; University of Liverpool; Crown Street Liverpool L69 3BX UK
| | - Ghaith Aljayyoussi
- Research Centre for Drugs and Diagnostics; Liverpool School of Tropical Medicine; Liverpool L3 5QA UK
| | - Benjamin Swift
- School of Veterinary Medicine and Science; University of Nottingham; Loughborough LE12 5RD UK
| | - Lang Tran
- Institute of Occupational Medicine; Research Avenue North; Riccarton Edinburgh EH14 4AP UK
| | - Craig Watkins
- Moredun Research Institute; Pentlands Science Park; Bush Loan Penicuik EH26 0PZ UK
| | - Karen Stevenson
- Moredun Research Institute; Pentlands Science Park; Bush Loan Penicuik EH26 0PZ UK
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Wiysonge CS, Ntsekhe M, Thabane L, Volmink J, Majombozi D, Gumedze F, Pandie S, Mayosi BM. Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev 2017; 9:CD000526. [PMID: 28902412 PMCID: PMC5618454 DOI: 10.1002/14651858.cd000526.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tuberculous pericarditis can impair the heart's function and cause death; long term, it can cause the membrane to fibrose and constrict causing heart failure. In addition to antituberculous chemotherapy, treatments include corticosteroids, drainage, and surgery. OBJECTIVES To assess the effects of treatments for tuberculous pericarditis. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register (27 March 2017); the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library (2017, Issue 2); MEDLINE (1966 to 27 March 2017); Embase (1974 to 27 March 2017); and LILACS (1982 to 27 March 2017). In addition we searched the metaRegister of Controlled Trials (mRCT) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal using 'tuberculosis' and 'pericard*' as search terms on 27 March 2017. We searched ClinicalTrials.gov and contacted researchers in the field of tuberculous pericarditis. This is a new version of the original 2002 review. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs. DATA COLLECTION AND ANALYSIS Two review authors independently screened search outputs, evaluated study eligibility, assessed risk of bias, and extracted data; and we resolved any discrepancies by discussion and consensus. One trial assessed the effects of both corticosteroid and Mycobacterium indicus pranii treatment in a two-by-two factorial design; we excluded data from the group that received both interventions. We conducted fixed-effect meta-analysis and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS Seven trials met the inclusion criteria; all were from sub-Saharan Africa and included 1959 participants, with 1051/1959 (54%) HIV-positive. All trials evaluated corticosteroids and one each evaluated colchicine, M. indicus pranii immunotherapy, and open surgical drainage. Four trials (1841 participants) were at low risk of bias, and three trials (118 participants) were at high risk of bias.In people who are not infected with HIV, corticosteroids may reduce deaths from all causes (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.59 to 1.09; 660 participants, 4 trials, low certainty evidence) and the need for repeat pericardiocentesis (RR 0.85, 95% CI 0.70 to 1.04; 492 participants, 2 trials, low certainty evidence). Corticosteroids probably reduce deaths from pericarditis (RR 0.39, 95% CI 0.19 to 0.80; 660 participants, 4 trials, moderate certainty evidence). However, we do not know whether or not corticosteroids have an effect on constriction or cancer among HIV-negative people (very low certainty evidence).In people living with HIV, only 19.9% (203/1959) were on antiretroviral drugs. Corticosteroids may reduce constriction (RR 0.55, 0.26 to 1.16; 575 participants, 3 trials, low certainty evidence). It is uncertain whether corticosteroids have an effect on all-cause death or cancer (very low certainty evidence); and may have little or no effect on repeat pericardiocentesis (RR 1.02, 0.89 to 1.18; 517 participants, 2 trials, low certainty evidence).For colchicine among people living with HIV, we found one small trial (33 participants) which had insufficient data to make any conclusions about any effects on death or constrictive pericarditis.Irrespective of HIV status, due to very low certainty evidence from one trial, it is uncertain whether adding M. indicus pranii immunotherapy to antituberculous drugs has an effect on any outcome.Open surgical drainage for effusion may reduce repeat pericardiocentesis In HIV-negative people (RR 0.23, 95% CI 0.07 to 0.76; 122 participants, 1 trial, low certainty evidence) but may make little or no difference to other outcomes. We did not find an eligible trial that assessed the effects of open surgical drainage in people living with HIV.The review authors found no eligible trials that examined the length of antituberculous treatment needed nor the effects of other adjunctive treatments for tuberculous pericarditis. AUTHORS' CONCLUSIONS For HIV-negative patients, corticosteroids may reduce death. For HIV-positive patients not on antiretroviral drugs, corticosteroids may reduce constriction. For HIV-positive patients with good antiretroviral drug viral suppression, clinicians may consider the results from HIV-negative patients more relevant.Further research may help evaluate percutaneous drainage of the pericardium under local anaesthesia, the timing of pericardiectomy in tuberculous constrictive pericarditis, and new antibiotic regimens.
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Affiliation(s)
- Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Mpiko Ntsekhe
- Groote Schuur HospitalDivision of CardiologyObservatory 7925Cape TownSouth Africa
| | - Lehana Thabane
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics50 Charlton Ave ERoom H325, St. Joseph's HealthcareHamiltonONCanadaL8N 4A6
| | - Jimmy Volmink
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Dumisani Majombozi
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Freedom Gumedze
- University of Cape TownDepartment of Statistical SciencesCape TownSouth Africa
| | - Shaheen Pandie
- University of Cape TownDepartment of MedicineCape TownSouth Africa
| | - Bongani M Mayosi
- University of Cape TownDepartment of MedicineCape TownSouth Africa
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Lefebvre N, Argemi X, Meyer N, Mootien J, Douiri N, Sferrazza-Mandala S, Schramm F, Weingertner N, Christmann D, Hansmann Y, Imperiale A. Clinical usefulness of 18F-FDG PET/CT for initial staging and assessment of treatment efficacy in patients with lymph node tuberculosis. Nucl Med Biol 2017; 50:17-24. [PMID: 28426991 DOI: 10.1016/j.nucmedbio.2017.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/16/2017] [Accepted: 04/05/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Few studies have evaluated the promising role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (PET) and PET/computed tomography FDG PET/CT in evaluating and monitoring treatment response in patients with lymph node tuberculosis (LNTB). The aim of this clinical investigation was to assess the clinical usefulness of FDG PET/CT for initial tuberculosis staging and to determine the prognostic value of the decrease of 18F-FDG uptake during antibiotic treatment in LNTB patients. METHODS We retrospectively reviewed 18 cases of LNTB admitted at a single center from 2004 to 2014. Medical records of patients who underwent two FDG PET/CT (>6 months interval), at initial staging and at the end of therapy were reviewed to determine the impact of FDG PET/CT on initial management of LNTB and response to therapy. Statistical analysis was performed using linear mixed-effects model. RESULTS Thirteen cases of disseminated LNTB and five cases of localized LNTB were included in the study. Initial FDG PET/CT allowed guided biopsy for initial diagnosis in 5 patients and identified unknown extra-LN TB sites in 9 patients. Visual analysis follow-up of FDG PET/CT showed a complete metabolic response in 9/18 patients (all of whom were cured), a partial response in 7/18 (5 of whom were cured) and no response in 2/18 (all of whom were not cured). The semi-quantitative evaluation of 18F-FDG intensity decrease based on the maximum standardized uptake value (SUVmax), compared to targeted estimated decrease allowed to predict correctly a complete response to treatment in 14/18 cases. CONCLUSION FDG PET/CT allows an accurate pre-therapeutic mapping of LNTB and helps for early TB confirmation. The SUVmax follow up is a potential tool for monitoring the treatment response.
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Affiliation(s)
- Nicolas Lefebvre
- Department of Infectious Diseases and Tropical Medicine, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France
| | - Xavier Argemi
- Department of Infectious Diseases and Tropical Medicine, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France.
| | - Nicolas Meyer
- Department of Public Health, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France
| | - Joy Mootien
- Department of Intensive Care Medicine, Munchberg General Hospital, Mulhouse, France
| | - Nawal Douiri
- Department of Infectious Diseases and Tropical Medicine, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France
| | - Stefania Sferrazza-Mandala
- Department of Infectious Diseases and Tropical Medicine, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France
| | - Frédéric Schramm
- Microbiology, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France
| | - Noëlle Weingertner
- Department of Pathology, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France
| | - Daniel Christmann
- Department of Infectious Diseases and Tropical Medicine, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France
| | - Yves Hansmann
- Department of Infectious Diseases and Tropical Medicine, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France
| | - Alessio Imperiale
- Department of Biophysic and Nuclear Medicine, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France
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Woimo TT, Yimer WK, Bati T, Gesesew HA. The prevalence and factors associated for anti-tuberculosis treatment non-adherence among pulmonary tuberculosis patients in public health care facilities in South Ethiopia: a cross-sectional study. BMC Public Health 2017; 17:269. [PMID: 28320351 PMCID: PMC5359861 DOI: 10.1186/s12889-017-4188-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence exists pointing out how non-adherence to treatment remains a major hurdle to efficient tuberculosis control in developing countries. Many tuberculosis (Tb) patients do not complete their six-month course of anti-tuberculosis medications and are not aware of the importance of sputum re-examinations, thereby putting themselves at risk of developing multidrug-resistant and extensively drug-resistant forms of tuberculosis and relapse. However, there is a dearth of publications about non-adherence towards anti-Tb medication in these settings. We assessed the prevalence of and associated factors for anti-Tb treatment non-adherence in public health care facilities of South Ethiopia. METHODS This was a cross-sectional survey using both quantitative and qualitative methods. The quantitative study was conducted among 261 Tb patients from 17 health centers and one general hospital. The qualitative aspect included an in-depth interview of 14 key informants. For quantitative data, the analysis of descriptive statistics, bivariate and multiple logistic regression was carried out, while thematic framework analysis was applied for the qualitative data. RESULTS The prevalence of non-adherence towards anti-Tb treatment was 24.5%. Multiple logistic regression analysis demonstrated that poor knowledge towards tuberculosis and its treatment (AOR = 4.6, 95%CI: 1.4-15.6), cost of medication other than Tb (AOR = 4.7, 95%CI: 1.7-13.4), having of health information at every visit (AOR = 3, 95% CI: 1.1-8.4) and distance of DOTS center from individual home (AOR = 5.7, 95%CI: 1.9-16.8) showed statistically significant association with non-adherence towards anti- tuberculosis treatment. Qualitative study also revealed that distance, lack of awareness about importance of treatment completion and cost of transportation were the major barriers for adherence. CONCLUSIONS A quarter of Tb patients interrupted their treatment due to knowledge, availability and accessibility of DOTS service. We recommend creating awareness about anti-Tb treatment, and decentralization of drug pick-ups to the lowest level of health institutions.
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Affiliation(s)
- Tadele Teshome Woimo
- Department of Infectious diseases, Dawro District Health Office, Dawro, Ethiopia
| | - Wondwossen Kassahun Yimer
- US Department of Human and Health Services, Biostatistics and Bioinformatics Branch (BBB), NICHD, New York, USA
| | - Temesgen Bati
- Department of public health, Wolaita Sodao University, Sodo, Ethiopia
| | - Hailay Abrha Gesesew
- Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia. .,Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia.
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Rocchetti TT, Silbert S, Gostnell A, Kubasek C, Campos Pignatari AC, Widen R. Detection of Mycobacterium chelonae, Mycobacterium abscessus Group, and Mycobacterium fortuitum Complex by a Multiplex Real-Time PCR Directly from Clinical Samples Using the BD MAX System. J Mol Diagn 2017; 19:295-302. [DOI: 10.1016/j.jmoldx.2016.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/03/2016] [Accepted: 10/07/2016] [Indexed: 11/16/2022] Open
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Pintus A, Aragoni MC, Cinellu MA, Maiore L, Isaia F, Lippolis V, Orrù G, Tuveri E, Zucca A, Arca M. [Au(py b-H)(mnt)]: A novel gold(III) 1,2-dithiolene cyclometalated complex with antimicrobial activity (py b-H=C-deprotonated 2-benzylpyridine; mnt=1,2-dicyanoethene-1,2-dithiolate). J Inorg Biochem 2017; 170:188-194. [PMID: 28260677 DOI: 10.1016/j.jinorgbio.2017.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 02/09/2017] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Abstract
The novel heteroleptic cyclometalated complex [AuIII(pyb-H)(mnt)] (1; pyb-H=C-deprotonated 2-benzylpyridine; mnt =1,2-dicyanoethene-1,2-dithiolate) was tested against a panel of ten Gram positive (belonging to the Staphylococcus, Streptococcus spp. and Bacillus clausii), Gram negative (E. coli, K. pneumoniae, P. aeruginosa) bacteria and three yeasts belonging to the Candida spp. Complex 1 showed a remarkable bacteriostatic antimicrobial activity against staphylococci, with Minimum Inhibitory Concentration (MIC) values of 1.56 and 3.13μg/mL for S. haemoliticus and S. aureus, respectively. Spectroscopic and electrochemical measurements, supported by Density Functional Theory (DFT) calculations, were exploited to fully investigate the electronic structure of complex 1 and its relationship with the antimicrobial activity.
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Affiliation(s)
- Anna Pintus
- Dipartimento di Scienze Chimiche e Geologiche, Università degli Studi di Cagliari, S.S. 554 bivio per Sestu, 09042 Monserrato, Cagliari, Italy
| | - M Carla Aragoni
- Dipartimento di Scienze Chimiche e Geologiche, Università degli Studi di Cagliari, S.S. 554 bivio per Sestu, 09042 Monserrato, Cagliari, Italy
| | - Maria A Cinellu
- Dipartimento di Chimica e Farmacia, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Laura Maiore
- Dipartimento di Chimica e Farmacia, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Francesco Isaia
- Dipartimento di Chimica e Farmacia, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Vito Lippolis
- Dipartimento di Scienze Chimiche e Geologiche, Università degli Studi di Cagliari, S.S. 554 bivio per Sestu, 09042 Monserrato, Cagliari, Italy
| | - Germano Orrù
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Cagliari, via Ospedale 40, 09124 Cagliari, Italy
| | - Enrica Tuveri
- Dipartimento di Scienze Chimiche e Geologiche, Università degli Studi di Cagliari, S.S. 554 bivio per Sestu, 09042 Monserrato, Cagliari, Italy; Dipartimento di Scienze Chirurgiche, Università degli Studi di Cagliari, via Ospedale 40, 09124 Cagliari, Italy
| | - Antonio Zucca
- Dipartimento di Chimica e Farmacia, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Massimiliano Arca
- Dipartimento di Scienze Chimiche e Geologiche, Università degli Studi di Cagliari, S.S. 554 bivio per Sestu, 09042 Monserrato, Cagliari, Italy.
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Mycobacterium Tuberculosis in Spinal Tuberculosis. Asian Spine J 2017; 11:138-149. [PMID: 28243382 PMCID: PMC5326722 DOI: 10.4184/asj.2017.11.1.138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/17/2016] [Accepted: 03/10/2016] [Indexed: 01/31/2023] Open
Abstract
Even in an era of remarkable medical advances, there is an issue of why tuberculosis remains in the list of disastrous diseases, afflicting humans and causing suffering. There has not been a plausible answer to this, and it has been suggested that clinicians and medical scientists could presently not win the war against the tubercle bacilli. With regards to this issue, based on the authors' own clinical and research experiences, in this review, the available literature was revisited in order to address the raised questions and to provide recent information on characteristics of tubercle bacilli and possible ways to more effectively treat tuberculosis.
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Chee SP, Khairallah M. Global Variations and Changes in Patterns of Infectious Uveitis. EMERGING INFECTIOUS UVEITIS 2017. [PMCID: PMC7115009 DOI: 10.1007/978-3-319-23416-8_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Before 1940, most uveitis cases were supposed to be due to infectious agents, mainly syphilis or tuberculosis [1]. Progress in the understanding of intraocular inflammation led to the discovery that uveitis can be of infectious and noninfectious origin and that many pathogens can cause infectious uveitis. Theoretically, Koch postulates must be fulfilled, in order to formerly demonstrate that a disease is due to an infectious agent. However, in infectious uveitis, most often, serological evidence, molecular or histological demonstration, and treatment response are usually the only available elements to suggest the infectious origin of the uveitis. Using those evidences, a large number of infectious organisms have been demonstrated to cause infectious uveitis. Some have a global importance around the world, while others have more limited niches. Many of them have been considered as emerging pathogens.
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Affiliation(s)
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, Monastir, Tunisia
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Huai P, Huang X, Cheng J, Zhang C, Wang K, Wang X, Yang L, Deng Z, Ma W. Proportions and Risk Factors of Developing Multidrug Resistance Among Patients with Tuberculosis in China: A Population-Based Case–Control Study. Microb Drug Resist 2016; 22:717-726. [DOI: 10.1089/mdr.2015.0186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pengcheng Huai
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Xinghe Huang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Jun Cheng
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Canyou Zhang
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Kai Wang
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Xinting Wang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Liping Yang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Zhengyi Deng
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
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Seddon JA, Schaaf HS. Drug-resistant tuberculosis and advances in the treatment of childhood tuberculosis. Pneumonia (Nathan) 2016; 8:20. [PMID: 28702299 PMCID: PMC5471710 DOI: 10.1186/s41479-016-0019-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/03/2016] [Indexed: 11/18/2022] Open
Abstract
Over the last 10 years, interest in pediatric tuberculosis (TB) has increased dramatically, together with increased funding and research. We have a better understanding of the burden of childhood TB as well as a better idea of how to diagnose it. Our appreciation of pathophysiology is improved and with it investigators are beginning to consider pediatric TB as a heterogeneous entity, with different types and severity of disease being treated in different ways. There have been advances in how to treat both TB infection and TB disease caused by both drug-susceptible as well as drug-resistant organisms. Two completely novel drugs, bedaquiline and delamanid, have been developed, in addition to the use of older drugs that have been re-purposed. New regimens are being evaluated that have the potential to shorten treatment. Many of these drugs and regimens have first been investigated in adults with children an afterthought, but increasingly children are being considered at the outset and, in some instances studies are only conducted in children where pediatric-specific issues exist.
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Affiliation(s)
- James A Seddon
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK
| | - H Simon Schaaf
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Kapoor AK, Deepani V, Dhall M, Kapoor S. Pattern of socio-economic and health aspects among TB patients and controls. Indian J Tuberc 2016; 63:230-235. [PMID: 27998494 DOI: 10.1016/j.ijtb.2016.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/15/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Socio-economic and health-related factors have a significant impact on tuberculosis (TB) incidence among population residing in resource-scare settings. OBJECTIVE To evaluate the pattern of socio-economic and health-related factors among TB patients and control in Delhi, India. METHODS The present cross-sectional study was performed among 893 TB patients (or cases) and 333 healthy disease-free controls. The data for the present study was obtained from several district TB centres in north, west and south Delhi. The collected data was edited, coded and statistical analysed with the help of SPSS 20.0 version. RESULTS Illiteracy and primary education were significant risk factors being associated with a TB. Rented housing condition had an odds ratio (OR) of 1.4 (95% confidence interval [CI]: 1.09-1.89) compared to owned housing condition. 3-5 individuals per room were 3 times more likely to be associated with a case of TB (95% CI: 2.49-4.41). Migrant individuals were 13 times more likely to be associated with a case of TB (95% CI: 8.77-19.78) in comparison to settled population. Daily consumption of non-vegetarian food also significantly contributed to case of TB with an OR of 3.4 (95% CI: 2.51-4.72). Loss of appetite and family TB served as significant health-related factors associated with TB risk. CONCLUSION Lower educational status, rented household, individuals per room (as a measure of overcrowding) and migratory status served as prominent risk factors for TB disease. Preference and frequency of non-vegetarian food being consumed, night sweating, weight loss, loss of appetite, earlier TB and family TB were principle health-related risk factors associated with TB disease.
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Affiliation(s)
- A K Kapoor
- Professor, Department of Anthropology, University of Delhi, Delhi 110007, India.
| | - Vijit Deepani
- UGC-NET JRF, Department of Anthropology, University of Delhi, Delhi 110007, India
| | - Meenal Dhall
- Assistant Professor, Department of Anthropology, University of Delhi, Delhi 110007, India
| | - Satwanti Kapoor
- Professor, Department of Anthropology, University of Delhi, Delhi 110007, India
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Prosser G, Brandenburg J, Reiling N, Barry CE, Wilkinson RJ, Wilkinson KA. The bacillary and macrophage response to hypoxia in tuberculosis and the consequences for T cell antigen recognition. Microbes Infect 2016; 19:177-192. [PMID: 27780773 PMCID: PMC5335906 DOI: 10.1016/j.micinf.2016.10.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022]
Abstract
Mycobacterium tuberculosis is a facultative anaerobe and its characteristic pathological hallmark, the granuloma, exhibits hypoxia in humans and in most experimental models. Thus the host and bacillary adaptation to hypoxia is of central importance in understanding pathogenesis and thereby to derive new drug treatments and vaccines.
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Affiliation(s)
- Gareth Prosser
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, 20892, United States
| | - Julius Brandenburg
- Microbial Interface Biology, Priority Research Area Infections, Forschungszentrum Borstel, Leibniz Center for Medicine and Biosciences, Parkallee 1-40, D-23845, Borstel, Germany
| | - Norbert Reiling
- Microbial Interface Biology, Priority Research Area Infections, Forschungszentrum Borstel, Leibniz Center for Medicine and Biosciences, Parkallee 1-40, D-23845, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck, Borstel, Germany
| | - Clifton Earl Barry
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, 20892, United States; Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Robert J Wilkinson
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa; The Francis Crick Institute, London, NW1 2AT, United Kingdom; Department of Medicine, Imperial College, London, W2 1PG, United Kingdom.
| | - Katalin A Wilkinson
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa; The Francis Crick Institute, London, NW1 2AT, United Kingdom
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El Azbaoui S, Alaoui Mrani N, Sabri A, Jouhadi Z, Ailal F, Bousfiha AA, Najib J, El Hafidi N, Deswarte C, Schurr E, Bustamante J, Boisson-Dupuis S, Casanova JL, Abel L, El Baghdadi J. Pott's disease in Moroccan children: clinical features and investigation of the interleukin-12/interferon-γ pathway. Int J Tuberc Lung Dis 2016; 19:1455-62. [PMID: 26614186 DOI: 10.5588/ijtld.15.0290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
SETTING Tuberculosis spondylodiscitis (TS), or Pott's disease, an extra-pulmonary form of tuberculosis (TB), is rare and difficult to diagnose in children. Some cases of severe TB in children were recently explained by inborn errors of immunity affecting the interleukin-12/interferon-gamma (IL-12/IFN-γ) axis. OBJECTIVE To analyse clinical data on Moroccan children with TS, and to perform immunological and genetic explorations of the IL-12/IFN-γ axis. DESIGN We studied nine children with TS diagnosed between 2012 and 2014. We investigated the IL-12/IFN-γ circuit by both whole-blood assays and sequencing of the coding regions of 14 core genes of this pathway. RESULTS A diagnosis of TS was based on a combination of clinical, biological, histological and radiological data. QuantiFERON(®)-TB Gold In-Tube results were positive in 75% of patients. Whole-blood assays showed normal IL-12 and IFN-γ production in all but one patient, who displayed impaired decreased response to IL-12. No candidate disease-causing mutations were detected in the exonic regions of the 14 genes. CONCLUSIONS TS diagnosis in children remains challenging, and is based largely on imaging. Further investigations of TS in children are required to determine the role of genetic defects in pathways that may or may not be related to the IL-12/IFN-γ axis.
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Affiliation(s)
- S El Azbaoui
- Genetics Unit, Military Hospital Mohamed V, Hay Riad, Rabat, Morocco; Faculty of Science-Kenitra, Ibn Tofail University, Kenitra, Morocco
| | - N Alaoui Mrani
- Department of Paediatric Surgery, Rabat Children Hospital, Medical and Pharmacy School of Rabat, Mohamed V University, Rabat, Morocco
| | - A Sabri
- Genetics Unit, Military Hospital Mohamed V, Hay Riad, Rabat, Morocco; Faculty of Science-Kenitra, Ibn Tofail University, Kenitra, Morocco
| | - Z Jouhadi
- Department of Paediatric Infectious Diseases, Ibn Rochd Hospital University Centre, King Hassan II University, Casablanca, Morocco
| | - F Ailal
- Department of Paediatric Infectious Diseases, Ibn Rochd Hospital University Centre, King Hassan II University, Casablanca, Morocco
| | - A A Bousfiha
- Department of Paediatric Infectious Diseases, Ibn Rochd Hospital University Centre, King Hassan II University, Casablanca, Morocco
| | - J Najib
- Department of Paediatric Infectious Diseases, Ibn Rochd Hospital University Centre, King Hassan II University, Casablanca, Morocco
| | - N El Hafidi
- Department of Paediatrics, Medical and Pharmacy School of Rabat, Rabat Children Hospital, Rabat, Morocco
| | - C Deswarte
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale Unit 1163, Paris, France
| | - E Schurr
- McGill International TB Centre, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - J Bustamante
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale Unit 1163, Paris, France; Imagine Institute, Paris Descartes University, Paris, France; Centre for the Study of Primary Immunodeficiencies, Assistance Publique-Hôpitaux de Paris, Necker Hospital for Sick Children, Paris, France
| | - S Boisson-Dupuis
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale Unit 1163, Paris, France; Imagine Institute, Paris Descartes University, Paris, France; St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, USA
| | - J-L Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale Unit 1163, Paris, France; Imagine Institute, Paris Descartes University, Paris, France; St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, USA; Howard Hughes Medical Institute, New York, New York, USA; Paediatric Haematology-Immunology Unit, Necker Hospital for Sick Children, Paris, France, France
| | - L Abel
- Department of Paediatrics, Medical and Pharmacy School of Rabat, Rabat Children Hospital, Rabat, Morocco; Imagine Institute, Paris Descartes University, Paris, France; St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, USA
| | - J El Baghdadi
- Genetics Unit, Military Hospital Mohamed V, Hay Riad, Rabat, Morocco
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Agyeman AA, Ofori-Asenso R. Efficacy and safety profile of linezolid in the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob 2016; 15:41. [PMID: 27334498 PMCID: PMC4917997 DOI: 10.1186/s12941-016-0156-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/08/2016] [Indexed: 12/13/2022] Open
Abstract
Background Treatment options for drug-resistant tuberculosis are still limited. Linezolid has been recommended for treatment of patients with multidrug-resistant (MDR) or extensively-drug-resistant (XDR) tuberculosis, although uncertainties remain regarding its safety and tolerability in these circumstances. Objective To systematically evaluate the existing evidence regarding the efficacy and tolerability of linezolid in the treatment of MDR or XDR tuberculosis. Methods We conducted a systematic review and meta-analysis in accordance with the PRISMA guidelines. Searches were conducted in PubMed, Web of Science and EMBASE followed by direct search of abstracts in the International Journal of Tuberculosis and Lung Disease to retrieve primary studies published between January 2000 and January 2016 assessing linezolid efficacy and safety in the treatment of drug-resistant TB. We evaluated the occurrence of outcomes including culture conversion, treatment success and incidence of adverse events such as myelosuppression and neuropathy. Results Twenty-three (23) studies conducted in fourteen (14) countries and involving 507 patients were retrieved. Only 1 randomized controlled trial was identified and none of the identified studies involved participants from Africa. The pooled proportion for treatment success was 77.36 % (95 % CI = 71.38–82.83 %, I2 = 37.6 %) with culture conversion rate determined as 88.45 % (95 % CI = 83.82–92.38 %, I2 = 45.4 %). There was no strong evidence for both culture conversion (p = 0.0948) and treatment success (p = 0.0695) between linezolid daily doses ≤ 600 and > 600 mg. Only myelosuppression showed a strong statistical significance (p < 0.0001) between dose comparisons. The incidence of neuropathy and other adverse events leading to permanent discontinuation of linezolid also showed no significance upon dose comparisons (p = 0.3213, p = 0.9050 respectively). Conclusion Available evidence presents Linezolid as a viable option in the treatment of MDR/XDR TB although patients ought to be monitored closely for the incidence of major adverse events such as myelosuppression and neuropathy. Additionally, highly powered randomized controlled trials including participants from endemic regions are urgently needed to better inform the magnitude and significance of Linezolid treatment effect in MDR and XDR TB patients. Electronic supplementary material The online version of this article (doi:10.1186/s12941-016-0156-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akosua Adom Agyeman
- Research Unit, Health Policy Consult, Weija, P. O. Box WJ 537, Accra, Ghana.
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Lei X, Huang K, Liu Q, Jie YF, Tang SL. Are tuberculosis patients adherent to prescribed treatments in China? Results of a prospective cohort study. Infect Dis Poverty 2016; 5:38. [PMID: 27146470 PMCID: PMC4857377 DOI: 10.1186/s40249-016-0134-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/18/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) patients face numerous difficulties adhering to the long-term, rigorous TB treatment regimen. Findings on TB patients' treatment adherence vary across existing literature and official reports. The present study attempted to determine the actual treatment adherence of new TB patients and to identify factors leading to non-adherence. METHODS A prospective cohort of 481 newly confirmed TB patients from three counties in western China were enrolled during June to December 2012 and was followed until June 2013. Patients who missed at least one dose of drugs or one follow-up re-examination during the treatment course were deemed as non-adherent. Influencing factors were identified using a logistic regression model. RESULTS A total of 173 (36.0 %) patients experienced non-adherence and the loss to follow-up cases reached 136 (28.2 %). Only 13.9 % of patients took drugs under direct observation, and 60.5 % of patients were supervised by phone calls. Factor analyses suggested that patients who were observed by family members (OR:5.54, 95 % CI:2.87-10.69) and paying monthly service expenses above 450 RMB (OR:2.08, 95 % CI:1.35-3.19) were more likely to be non-adherent, while supervision by home visit (OR:0.06, 95 % CI:0.01-0.28) and phone calls (OR:0.27, 95 % CI:0.17-0.44) were protective factors. CONCLUSIONS Despite recent efforts, a large proportion of newly confirmed TB patients could not adhere to standard TB treatment, and patients' lost to follow-up was still a serious problem. Poor treatment supervision and heavy financial burden might be the main causes for non-adherence. More needs to be done to enhance treatment supervision policies and financial supports to both health providers and TB patients.
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Affiliation(s)
- Xun Lei
- China Effective Health Care Network, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Ke Huang
- Public Health Clinical Center of Chengdu, Chengdu, China
| | - Qin Liu
- China Effective Health Care Network, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China.
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Ng BYC, Wee EJH, West NP, Trau M. Naked-Eye Colorimetric and Electrochemical Detection of Mycobacterium tuberculosis—toward Rapid Screening for Active Case Finding. ACS Sens 2015. [DOI: 10.1021/acssensors.5b00171] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin Y. C. Ng
- Centre for Personalized NanoMedicine, Australian
Institute for Bioengineering
and Nanotechnology and ‡School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Eugene J. H. Wee
- Centre for Personalized NanoMedicine, Australian
Institute for Bioengineering
and Nanotechnology and ‡School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Nicholas P. West
- Centre for Personalized NanoMedicine, Australian
Institute for Bioengineering
and Nanotechnology and ‡School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Matt Trau
- Centre for Personalized NanoMedicine, Australian
Institute for Bioengineering
and Nanotechnology and ‡School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland 4072, Australia
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Kakkar C, Polnaya AM, Koteshwara P, Smiti S, Rajagopal KV, Arora A. Hepatic tuberculosis: a multimodality imaging review. Insights Imaging 2015; 6:647-58. [PMID: 26499189 PMCID: PMC4656243 DOI: 10.1007/s13244-015-0440-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES We aim to illustrate the multimodal imaging spectrum of hepatic involvement in tuberculosis (TB). Whilst disseminated tuberculosis on imaging typically manifests as multiple small nodular lesions scattered in the liver parenchyma, isolated hepatic tuberculosis remains a rare and intriguing entity. METHODS Indubitably, imaging is the mainstay for detection of tubercular hepatic lesions which display a broad spectrum of imaging manifestations on different modalities. While sonography and computed tomography (CT) findings have been described in some detail, there is a paucity of literature on magnetic resonance imaging (MRI) features. Due to a significant overlap with other commoner and similar appearing hepatic lesions, hepatic tuberculosis is often either misdiagnosed or labelled as indeterminate lesions. This article is a compendium of cases highlighting the spectrum of imaging patterns that can be encountered in patients with isolated primary hepatic tuberculosis as well as disseminated (secondary) disease. Rare patterns of primary disease such as tubercular cholangitis, hypervascular liver masses, and those with vascular complications are also illustrated and discussed. CONCLUSIONS Imaging plays a valuable role in the detection of tubercular hepatic lesions. Also, imaging can be helpful in their characterisation and for assessing associated complications. TEACHING POINTS • Hepatic TB has myriad imaging manifestations and is often confounded with neoplastic lesions. • Imaging patterns include miliary TB, macronodular TB, serohepatic TB and tubercular cholangitis. • Concurrent splenic, nodal or pulmonary involvements are helpful pointers towards the diagnosis. • Miliary calcifications along the bile ducts are characteristic of tubercular cholangitis. • Histological/microbiological confirmation is often necessary to confirm the diagnosis.
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Affiliation(s)
- Chandan Kakkar
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, India.
| | - Ashwin M Polnaya
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Parel, Mumbai, India.
| | - Prakashini Koteshwara
- Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal, India.
| | - S Smiti
- Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal, India.
| | - K V Rajagopal
- Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal, India.
| | - Ankur Arora
- Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India.
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Boisson-Dupuis S, Bustamante J, El-Baghdadi J, Camcioglu Y, Parvaneh N, El Azbaoui S, Agader A, Hassani A, El Hafidi N, Mrani NA, Jouhadi Z, Ailal F, Najib J, Reisli I, Zamani A, Yosunkaya S, Gulle-Girit S, Yildiran A, Cipe FE, Torun SH, Metin A, Atikan BY, Hatipoglu N, Aydogmus C, Kilic SS, Dogu F, Karaca N, Aksu G, Kutukculer N, Keser-Emiroglu M, Somer A, Tanir G, Aytekin C, Adimi P, Mahdaviani SA, Mamishi S, Bousfiha A, Sanal O, Mansouri D, Casanova JL, Abel L. Inherited and acquired immunodeficiencies underlying tuberculosis in childhood. Immunol Rev 2015; 264:103-20. [PMID: 25703555 DOI: 10.1111/imr.12272] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tuberculosis (TB), caused by Mycobacterium tuberculosis (M.tb) and a few related mycobacteria, is a devastating disease, killing more than a million individuals per year worldwide. However, its pathogenesis remains largely elusive, as only a small proportion of infected individuals develop clinical disease either during primary infection or during reactivation from latency or secondary infection. Subacute, hematogenous, and extrapulmonary disease tends to be more frequent in infants, children, and teenagers than in adults. Life-threatening primary TB of childhood can result from known acquired or inherited immunodeficiencies, although the vast majority of cases remain unexplained. We review here the conditions conferring a predisposition to childhood clinical diseases caused by mycobacteria, including not only M.tb but also weakly virulent mycobacteria, such as BCG vaccines and environmental mycobacteria. Infections with weakly virulent mycobacteria are much rarer than TB, but the inherited and acquired immunodeficiencies underlying these infections are much better known. Their study has also provided genetic and immunological insights into childhood TB, as illustrated by the discovery of single-gene inborn errors of IFN-γ immunity underlying severe cases of TB. Novel findings are expected from ongoing and future human genetic studies of childhood TB in countries that combine a high proportion of consanguineous marriages, a high incidence of TB, and an excellent clinical care, such as Iran, Morocco, and Turkey.
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Affiliation(s)
- Stéphanie Boisson-Dupuis
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA; Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale, INSERM-U1163, Paris, France; Paris Descartes University, Imagine Institute, Paris, France
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Akilimali PZ, Tshilumbu JMK, Mavila AK, Kaba DK. [Therapeutic outcomes of anti-tuberculosis treatment in the context of HIV-tuberculosis co-infection: Cohort of Kabinda Center in Kinshasa, Democratic Republic of Congo]. Rev Epidemiol Sante Publique 2015; 63:387-93. [PMID: 26547669 DOI: 10.1016/j.respe.2015.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 04/22/2015] [Accepted: 09/11/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The study aimed to determine the clinical forms of tuberculosis and therapeutic outcome of anti-tuberculosis treatment in the context of HIV-tuberculosis co-infection. METHODS A retrospective cohort of 120 HIV-positive patients with tuberculosis and 297 HIV-negative patients with tuberculosis attending the Kabinda Center was followed from 2010 to June, 30th 2013. The logistic regression model identified the determinants of a defavorable outcome after initiation of tuberculostatics. RESULTS The proportion of female patients was higher in the co-infected group compared with the non-co-infected group (60.8% versus 42.7%, P<0.001). HIV-seropositive patients had more forms of pulmonary smear-negative (39.2% versus 25.3%, P<0.002) and extra-pulmonary (38% versus 35%, P<0.002) tuberculosis than HIV-negative patients. HIV-positive serology (OR: 3.13, 95%CI: 1.72-5.69) and age of patients more than 41 years (OR: 3.15, 95%CI: 1.36-7.29) were associated with an unfavorable outcome. CONCLUSION This study highlights the usefulness of a systematically determining immunological status in co-infected patients and a timely and systematic ARV treatment, together with early diagnosis of tuberculosis. It also emphasizes the importance of adherence to support measures in order to improve tuberculosis treatment outcomes in co-infected patients.
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Affiliation(s)
- P Z Akilimali
- École de santé publique, université de Kinshasa, PB 11850, Kinshasa, République démocratique du Congo.
| | - J M K Tshilumbu
- École de santé publique, université de Kinshasa, PB 11850, Kinshasa, République démocratique du Congo
| | - A K Mavila
- École de santé publique, université de Kinshasa, PB 11850, Kinshasa, République démocratique du Congo
| | - D K Kaba
- École de santé publique, université de Kinshasa, PB 11850, Kinshasa, République démocratique du Congo
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Zeng J, Song Z, Cai X, Huang S, Wang W, Zhu Y, Huang Y, Kong B, Xiang W, Lin D, Liu G, Zhang J, Chen CY, Shen H, Huang D, Shen L, Yi L, Xu J, Chen ZW. Tuberculous pleurisy drives marked effector responses of γδ, CD4+, and CD8+ T cell subpopulations in humans. J Leukoc Biol 2015; 98:851-7. [PMID: 26156008 PMCID: PMC4600062 DOI: 10.1189/jlb.4a0814-398rr] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 05/27/2015] [Accepted: 06/11/2015] [Indexed: 12/29/2022] Open
Abstract
Although tuberculous pleurisy (TP) presumably involves a hypersensitivity reaction, there is limited evidence indicating overreactive effector responses of γδ T cells and αβ T cells and their interrelation with Foxp3(+) Tregs in pleural and other compartments. We found that TP induced reciprocal representations of Foxp3(+) Tregs and Mtb phosphoantigen-specific Vγ2Vδ2 T cells in different anatomic compartments. Patients with TP exhibited appreciable numbers of "proliferating" Ki-67(+) Vγ2Vδ2 T cells in the airway where Foxp3(+) Tregs were not dominant, whereas striking increases in Foxp3(+) Tregs in the blood and pleural compartments coincided with low frequencies of Vγ2Vδ2 T cells. Interestingly, anti-tuberculosis chemotherapy control of Mtb infection in patients with TP reversed reciprocal representations of Foxp3(+) Tregs and proliferating Vγ2Vδ2 T cells. Surprisingly, despite high-level Foxp3(+) Tregs, TP appeared to drive overreactive responses of IFN-γ-producing Vγ2Vδ2, CD4(+)CD25(+), and CD8(+)CD25(+) T effector subpopulations, whereas IL-22-producing Vγ2Vδ2 T cells increased subtly. Th1 effector responses were sustained despite remarkable declines in Foxp3(+) Tregs at 1 mo after the treatment. Overreactive T effector responses of Mtb-reactive γδ T cells, αβ CD25(+)CD4(+), and CD25(+)CD8(+) T cell subpopulations appear to be immune features for TP. Increased Foxp3(+) Tregs might be responsive to overreactive TP but unable to influence T effector responses despite having an inverse relation with proliferating Vγ2Vδ2 T cells.
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Affiliation(s)
- Jincheng Zeng
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Zeqing Song
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Xiaozhen Cai
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Su Huang
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Wandang Wang
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Yanfen Zhu
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Yinan Huang
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Bin Kong
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Wenyu Xiang
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Dongzi Lin
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Ganbin Liu
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Junai Zhang
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Crystal Y Chen
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Hongbo Shen
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Dan Huang
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Ling Shen
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Lailong Yi
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Junfa Xu
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Zheng W Chen
- *Department of Clinical Immunology, Institute of Laboratory Medicine, and Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan China; Department of Respiration, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China; Department of Respiration, Affiliated Houjie Hospital of Guangdong Medical College, Dongguan, China; Dongguan Hospital for Prophylaxis and Treatment of Chronic Disease, Dongguan, China; Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China; Department of Microbiology and Immunology, Center for Primate Biomedical Research, University of Illinois College of Medicine, Chicago, Illinois, USA
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Ng BY, Wee EJ, West NP, Trau M. Rapid DNA detection of Mycobacterium tuberculosis-towards single cell sensitivity in point-of-care diagnosis. Sci Rep 2015. [PMCID: PMC4602229 DOI: 10.1038/srep15027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Although there have been many recent advances in Tuberculosis (TB) detection technologies, there still remains a major need to develop simpler point-of-care techniques. In an effort towards such a diagnostic test for resource-poor settings, we have designed a bioassay based on detecting amplified DNA via bridging flocculation. The assay is cheap, with a sensitivity approaching a single cell of Mycobacterium tuberculosis and the potential for translation into broader applications.
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50
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Ng BYC, Xiao W, West NP, Wee EJH, Wang Y, Trau M. Rapid, Single-Cell Electrochemical Detection of Mycobacterium tuberculosis Using Colloidal Gold Nanoparticles. Anal Chem 2015; 87:10613-8. [DOI: 10.1021/acs.analchem.5b03121] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin Y. C. Ng
- Centre
for Personalized NanoMedicine, Australian Institute for Bioengineering
and Nanotechnology, The University of Queensland, Brisbane, QLD 4072, Australia
- School
of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Wei Xiao
- Centre
for Personalized NanoMedicine, Australian Institute for Bioengineering
and Nanotechnology, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Nicholas P. West
- School
of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Eugene J. H. Wee
- Centre
for Personalized NanoMedicine, Australian Institute for Bioengineering
and Nanotechnology, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Yuling Wang
- Centre
for Personalized NanoMedicine, Australian Institute for Bioengineering
and Nanotechnology, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Matt Trau
- Centre
for Personalized NanoMedicine, Australian Institute for Bioengineering
and Nanotechnology, The University of Queensland, Brisbane, QLD 4072, Australia
- School
of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia
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