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Panin F, Orlandini E, Galli L, De Martino M, Chiappini E. Tuberculosis burden in immigrants and natives, adults and children, in Tuscany between 2000-2018. Travel Med Infect Dis 2021; 44:102185. [PMID: 34715364 DOI: 10.1016/j.tmaid.2021.102185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Updated data on epidemiology of tuberculosis are needed in Italy. The aim of this study is to evaluate trends in incidence and associated lethality of tuberculosis in immigrants compared with Italians. METHODS All tuberculosis cases diagnosed from 2000 to 2018 in 31 Tuscan hospitals were retrospectively identified. RESULTS In 10,827 tuberculosis cases 6715 were males (62%), 4312 (60%) were Italian-born. Hospitalization rate was 15.37/100,000 population/year. The most common comorbidity were liver disease (832/10,827; 7.7%), COPD (675/10,827; 6.2%), cancer (614/10,827; 5.7%). HIV was more frequent in the immigrants (p < 0.001). Extra-pulmonary tuberculosis cases (EPTB) were mainly localized in pleura (740/3,894, 19%) and lymph nodes (449/3,894, 11,5%). HIV was associated with an increased risk of EPTB (OR 3.51 95% CI 2.92-4.23, p < 0.0001). EPTB risk was increased in South Asian-born patients (OR 1.77, 95% CI 1.46-2.15, p < 0.0001) as well in African-born patients (OR 1.13, 95% CI 1.03-1.24, p = 0.0091), who were at risk for gastroenteric tuberculosis (OR 3.74, 95% CI 2.69-5.22, p < 0.0001). Overall mortality rate was 0.006 per 1000. Most of death cases (89%) were Italians (p < 0.02) and mainly affected by pulmonary tuberculosis (PTB). CONCLUSIONS In Tuscany, tuberculosis is still a health concern in terms of both morbidity and mortality.
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Affiliation(s)
- Fiorenza Panin
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Elisa Orlandini
- Tuscany Regional Government Department of Right to Health and Solidarity Policies, Information Technology Section, Via T. Alderotti 26/n, 50123, Florence, Italy
| | - Luisa Galli
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Maurizio De Martino
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Elena Chiappini
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy.
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2
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Räisänen PE, Haanperä M, Soini H, Ruutu P, Nuorti JP, Lyytikäinen O. Transmission of tuberculosis between foreign-born and Finnish-born populations in Finland, 2014-2017. PLoS One 2021; 16:e0250674. [PMID: 33891668 PMCID: PMC8064540 DOI: 10.1371/journal.pone.0250674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/08/2021] [Indexed: 11/19/2022] Open
Abstract
We describe the epidemiology of tuberculosis (TB) and characterized Mycobacterium tuberculosis (M. tuberculosis) isolates to evaluate transmission between foreign-born and Finnish-born populations. Data on TB cases were obtained from the National Infectious Disease Register and denominator data on legal residents and their country of birth from the Population Information System. M. tuberculosis isolates were genotyped by spoligotyping and Mycobacterial Interspersed Repetitive Unit Variable Number Tandem Repeat (MIRU-VNTR). We characterized clusters by age, sex, origin and region of living which included both foreign-born cases and those born in Finland. During 2014-2017, 1015 TB cases were notified; 814 were confirmed by culture. The proportion of foreign-born cases increased from 33.3% to 39.0%. Foreign-born TB cases were younger (median age, 28 vs. 75 years), and had extrapulmonary TB or multidrug-TB more often than Finnish-born cases (P<0.01 for all comparisons). Foreign-born cases were born in 60 different countries; most commonly in Somalia (25.5%). Altogether 795 isolates were genotyped; 31.2% belonged to 80 different clusters (range, 2-13 cases/cluster). Fourteen (17.5%) clusters included isolates from both Finnish-born and foreign-born cases. An epidemiological link between cases was identified by (epidemiological) background information in two clusters. Although the proportion of foreign-born TB cases was considerable, our data suggests that transmission of TB between foreign and Finnish born population is uncommon.
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Affiliation(s)
- Pirre Emilia Räisänen
- Health Sciences unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marjo Haanperä
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Soini
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Petri Ruutu
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - J Pekka Nuorti
- Health Sciences unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Outi Lyytikäinen
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
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3
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Ocular tuberculosis epidemiology, clinic features and diagnosis: A brief review. Tuberculosis (Edinb) 2020; 124:101963. [PMID: 32745954 DOI: 10.1016/j.tube.2020.101963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 11/21/2022]
Abstract
The spread of tuberculosis is directly related to the processes of globalization and migration. Tuberculosis has also been the main cause of fatality associated with antimicrobial resistance and also the main cause of death in people who have HIV infection. Additionally, tuberculosis smites the lungs in 80% of patients, and in the remaining 20% of patients the tuberculosis may smites other organs, such as the vision/eye. Ocular tuberculosis is a specific infectious disease of bacterial etiology with a chronic and persistent course, the prognosis of which is extremely doubtful. Even effective chemotherapy can be accompanied by a decrease in visual acuity, and clinical recovery is not always persistent. Ocular tuberculosis often leads to permanent disability and, as a result, the quality of life of patients decreases. A statistical reporting of this disease does not always reflect the true picture, since ocular tuberculosis sometimes develops against the background of an existing specific lesion in the lung tissue. Currently, ocular tuberculosis remains substantially a conjectural clinical diagnosis. This review paper presents an analytical review of the literature on the epidemiology, clinical features, and diagnosis methods of ocular tuberculosis. The results of recent studies that focused on the modern clinical manifestations of this pathology, its diagnosis, and complex therapy are systematized. The development of new rational regimens and pathogenetic treatment methods are also highlighted in this review.
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4
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Tewes S, Hensen B, Jablonka A, Gawe D, Kastikainen M, Happle C, Carlens J, Berthold LD, Wacker F. Tuberculosis screening during the 2015 European refugee crisis. BMC Public Health 2020; 20:200. [PMID: 32033555 PMCID: PMC7006076 DOI: 10.1186/s12889-020-8303-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/30/2020] [Indexed: 01/08/2023] Open
Abstract
Background The purpose of our study was to describe and evaluate management, performance and results of Tuberculosis (TB)-screening among refugees and asylum seekers in a rural area in Germany in 2015. Methods Refugees or asylum seekers, staying in shared-accommodation are obligated to participate on screening chest X-ray (CXR) in order to screen for signs of potentially infectious pulmonary TB (German Protection against Infection Act and German Asylum Procedure Act). n = 705 individuals underwent screening chest X-ray (CXR) to detect pulmonary TB in September and October 2015 on site. One experienced radiologist interpreted and reported each CXR within 24 h after the enrollment in the screening program and results were sent to the local Public Health Department for potential further medical care. Image abnormalities suggestive for TB were defined according to established radiographic criteria such as pleural effusion, cavitation, consolidation, fibrous scarring or calcification. Only in case of TB-suggestive findings on CXR, further diagnostics were arranged (pulmonological examination, follow-up CXR, sputum culture, interferon-gamma release assay, bronchoscopy). Follow-up data was collected in collaboration with the local Public Health Department. Descriptive statistics were calculated using GraphPad Prism software. Results n = 637 CXR examinations (90%) did not show abnormal findings, n = 54 CXR (8%) showed incidental findings, and n = 14 CXR (2%) were suspicious for acute TB. Of these, n = 14 individuals, eight underwent further TB diagnostics. Active TB was confirmed in one individual (0.001% of the screening cohort). Conclusions Our cohort reflects current immigrations statistics in Europe and illustrates an overall low TB prevalence amongst individuals entering Germany in 2015. However, our findings support the improvement of diagnostic algorithms.
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Affiliation(s)
- Susanne Tewes
- Hannover Medical School, Institute for Diagnostic and Interventional Radiology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bennet Hensen
- Hannover Medical School, Institute for Diagnostic and Interventional Radiology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Alexandra Jablonka
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.,Hannover Medical School, German Center for Infection Research, Hannover-Brunswick, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Dana Gawe
- Local Public Health Department, Osterholz, Heimstr. 1-3, 27711, Osterholz-Scharmbeck, Germany
| | - Maija Kastikainen
- Local Public Health Department, Osterholz, Heimstr. 1-3, 27711, Osterholz-Scharmbeck, Germany
| | - Christine Happle
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Julia Carlens
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Lars-Daniel Berthold
- Hannover Medical School, Institute for Diagnostic and Interventional Radiology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank Wacker
- Hannover Medical School, Institute for Diagnostic and Interventional Radiology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
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Abstract
RATIONALE Membranous nephropathy (MN), a chronic kidney disease (CKD), due to hypoproteinemia, malnutrition, anemia, long-term intake of immunosuppressive agents, changes in cellular immune state, and decrease in antimicrobial peptides, is a high risk for Mycobacterium tuberculosis (MTB) infection, which can cause tuberculosis (TB). TB manifests by various clinical symptoms. Ocular symptoms is a rare presentation of TB. Here, we describe a case of ocular tuberculosis in a patient with MN. PATIENT CONCERNS A 63-year-old man with membranous nephropathy (MN) history presented with ocular symptoms. DIAGNOSES According to the pathological manifestations of ocular tissue biopsy and a positive polymerase chain reaction (PCR) on samples from sputum and bronchoalveolar lavage fluid (BALF), we elicited a diagnosis of disseminated tuberculosis. INTERVENTION The patient received antituberculous therapy and immunosuppressive therapy. OUTCOMES The clinical manifestations significantly improved. LESSONS Clinicians should be aware of the possibility of TB in cases of immunocompromised patients and perform an appropriate diagnostic work-up for TB.
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Affiliation(s)
| | - Haibo Ge
- Nanjing Hospital of Chinese Medicine
| | - Ruifen Miao
- Department of Chronic Communicable Disease, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
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6
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Song JH, Koreishi AF, Goldstein DA. Tuberculous Uveitis Presenting with a Bullous Exudative Retinal Detachment: A Case Report and Systematic Literature Review. Ocul Immunol Inflamm 2018; 27:998-1009. [PMID: 29969330 DOI: 10.1080/09273948.2018.1485958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To describe tuberculous uveitis (TU) presenting as a bullous retinal detachment (RD) and to perform a comprehensive literature review on TU with similar features. Methods: Observational case report and systematic literature review. Results: An 84-year-old woman presented with bilateral granulomatous uveitis and bullous RD in the left eye. The interferon gamma release assay was strongly positive, but all other tests were unremarkable. The patient was diagnosed with TU and started on anti-tubercular therapy (ATT) and systemic steroids with excellent treatment response. Twenty-six articles (32 cases) reported TU with exudative RD. Choroidal tuberculoma was the most common clinical manifestation, followed by optic disc edema and retinal exudate. Systemic steroids with ATT improved vision in more patients (78.6%) than ATT alone (50.0%) or oral steroids followed by ATT (50.0%). Conclusion: Atypical presentations of TU make diagnosis and treatment difficult. A high level of suspicion for TU is needed to minimize ocular morbidity.
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Affiliation(s)
- Ji Hun Song
- Department of Ophthalmology, Ajou University School of Medicine , Suwon , South Korea.,Department of Ophthalmology, Northwestern University, Feinberg School of Medicine , Chicago , Illinois , USA
| | - Anjum F Koreishi
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine , Chicago , Illinois , USA
| | - Debra A Goldstein
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine , Chicago , Illinois , USA
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7
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Räisänen PE, Soini H, Turtiainen P, Vasankari T, Ruutu P, Nuorti JP, Lyytikäinen O. Enhanced surveillance for tuberculosis among foreign-born persons, Finland, 2014-2016. BMC Public Health 2018; 18:610. [PMID: 29743059 PMCID: PMC5943992 DOI: 10.1186/s12889-018-5501-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) in foreign-born residents is increasing in many European countries including Finland. We conducted enhanced TB surveillance to collect supplementary information on TB cases among recent immigrants and their children to provide data for revising TB control policies in Finland to take into account the decrease in native cases and increase in foreign-born cases. METHODS TB cases were identified from the National Infectious Diseases Register. Data on foreign-born (if not available, most recent nationality other than Finnish) TB cases notified during 2014-2016 (country of birth, date of arrival to Finland, participation in TB screening, date of first symptoms, and details of possible contact tracing) were requested from physicians responsible for regional communicable disease control through a web-based questionnaire. RESULTS Questionnaires were returned for 203 (65%) of 314 foreign-born TB cases; 36 (18%) were paediatric cases TB was detected in arrival screening in 42 (21%) and during contact tracing of another TB case in 18 (9%); 143 (70%) cases sought care for symptoms or were identified by chance (e.g. chest x-ray because of an accident). Of cases with data available, 48 (24%) cases were diagnosed within 3 months of arrival to Finland, 55 (27%) cases between 3 months and 2 years from arrival, and 84 (42%) cases after 2 years from arrival. Of all the foreign-born cases, 17% had been in a reception centre in Finland and 15% had been in a refugee camp abroad. CONCLUSIONS In addition to asylum seekers and refugees, TB screening should be considered for immigrants arriving from high TB incidence countries, since the majority of TB cases were detected among persons who immigrated to Finland due to other reasons, presumably work or study. Further evaluation of the target group and timing of TB screening is warranted to update national screening guidance.
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Affiliation(s)
- Pirre E Räisänen
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland. .,Department of Epidemiology, Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland.
| | - Hanna Soini
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland
| | - Pirjo Turtiainen
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland
| | - Tuula Vasankari
- Finnish Lung Health Association (Filha), Helsinki, Finland.,Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Petri Ruutu
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland
| | - J Pekka Nuorti
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland.,Department of Epidemiology, Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Outi Lyytikäinen
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland
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8
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Kalogeropoulos D, Kitsos G, Konstantinidis A, Gartzonika C, Svarna E, Malamos K, Katsanevakis E, Kalogeropoulos C. Tuberculous Posterior Sclero-Uveitis with Features of Vogt-Koyanagi-Harada Uveitis: An Unusual Case. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:367-374. [PMID: 28389634 PMCID: PMC5391803 DOI: 10.12659/ajcr.903304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient: Male, 32 Final Diagnosis: Ocular tuberculosis (tuberculous posterior sclero-uveitis with features of Vogt-Koyanagi-Harada uveitis) Symptoms: Pain and progressive visual impairment of his left eye Medication: Systemic anti-tuberculosis treatment (6-month course) Clinical Procedure: Thorough ophthalmological and systemic exploration Specialty: Ophthalmology
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - George Kitsos
- Department of Ophthalmology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Athanasios Konstantinidis
- Department of Pulmonology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Ioannina, Greece
| | - Constantina Gartzonika
- Laboratory of Microbiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Evgenia Svarna
- Department of Radiology, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Malamos
- Department of Ophthalmology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Emmanouil Katsanevakis
- School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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9
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Weinrich JM, Diel R, Sauer M, Henes FO, Meywald-Walter K, Adam G, Schön G, Bannas P. Yield of chest X-ray tuberculosis screening of immigrants during the European refugee crisis of 2015: a single-centre experience. Eur Radiol 2017; 27:3244-3248. [DOI: 10.1007/s00330-016-4684-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/28/2016] [Accepted: 11/29/2016] [Indexed: 01/15/2023]
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10
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Ang M, Chee SP. Controversies in ocular tuberculosis. Br J Ophthalmol 2016; 101:6-9. [DOI: 10.1136/bjophthalmol-2016-309531] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 11/04/2022]
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11
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Ang M, Vasconcelos-Santos DV, Sharma K, Accorinti M, Sharma A, Gupta A, Rao NA, Chee SP. Diagnosis of Ocular Tuberculosis. Ocul Immunol Inflamm 2016; 26:208-216. [PMID: 27379384 DOI: 10.1080/09273948.2016.1178304] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ocular tuberculosis remains a presumptive clinical diagnosis, as the gold standard tests for diagnosing ocular tuberculosis are often not useful: Mycobacterium tuberculosis cultures require weeks to process on Lowenstein-Jenson media and have low yield from ocular samples; while acid-fast bacilli smears or polymerase chain reaction detection of M. tuberculosis DNA have low sensitivities. Thus, diagnosis is often based on suggestive clinical signs, which are supported by positive investigations: tuberculin skin test or interferon-gamma release assays; chest X-ray findings suggestive of pulmonary tuberculosis, and/or evidence of associated systemic tuberculosis infections in the absence of other underlying disease. The aim of this review is to provide an update on the methods of diagnosing ocular tuberculosis, and discuss the challenges of its diagnosis. We also suggest a step-ladder approach to a more accurate diagnosis of ocular tuberculosis by combining the available diagnostic tests.
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Affiliation(s)
- Marcus Ang
- a Singapore National Eye Centre , Singapore.,b Singapore Eye Research Institute , Singapore.,c Yong Loo Lin School of Medicine, National University of Singapore , Singapore.,d Department of Ophthalmology and Visual Sciences , Duke-National University of Singapore, Graduate Medical School , Singapore
| | - Daniel V Vasconcelos-Santos
- e Department of Ophthalmology , Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,f Hospital São Geraldo/HC - Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Kusum Sharma
- g Department of Medical Microbiology, Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Massimo Accorinti
- h Department of Ophthalmology , Sapienza University of Rome , Rome , Italy
| | - Aman Sharma
- g Department of Medical Microbiology, Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Amod Gupta
- g Department of Medical Microbiology, Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India.,i Department of Ophthalmology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Narsing A Rao
- j USC Eye Institute , Los Angeles , USA.,k Keck School of Medicine, University of Southern California , Los Angeles , USA
| | - Soon-Phaik Chee
- a Singapore National Eye Centre , Singapore.,b Singapore Eye Research Institute , Singapore.,c Yong Loo Lin School of Medicine, National University of Singapore , Singapore.,d Department of Ophthalmology and Visual Sciences , Duke-National University of Singapore, Graduate Medical School , Singapore
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12
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Abstract
The World Health Organization currently estimates that nearly two billion people, or one-third of the world’s population, are infected by tuberculosis, and that roughly 10% of the infected people are symptomatic. Tuberculosis affects the lungs in 80% of patients, while in the remaining 20% the disease may affect other organs, including the eye. Uveitis can be seen concurrently with tuberculosis, but a direct association is difficult to prove. Ocular tuberculosis is usually not associated with clinical evidence of pulmonary tuberculosis, as up to 60% of extrapulmonary tuberculosis patients may not have pulmonary disease. The diagnosis of tuberculous uveitis is often problematic and in nearly all reported cases, the diagnosis was only presumptive. Tuberculous uveitis is a great mimicker of various uveitis entities and it can be considered in the differential diagnosis of any type of intraocular inflammation. It is still unknown if ocular manifestations result from a direct mycobacterium infection or hypersensitivity reaction and this is reflected on the management of tuberculous uveitis. Prevalence of tuberculosis as an etiology of uveitis may reach up to 10% in endemic areas. Tuberculous uveitis is a vision-threatening disease that inevitably leads to blindness if not properly diagnosed and treated. The aim of this review is to illustrate the various clinical features and management of presumed tuberculous uveitis. The current review focuses on the diagnostic criteria, significance of tuberculin skin test, and use of systemic corticosteroids in the management of tuberculous uveitis as recommended in recent publications.
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Affiliation(s)
- Faiz I Shakarchi
- Ibn Al-Haetham Teaching Eye Hospital, Al-Mustansiriya University, Baghdad, Iraq ; Department of Opthalmology, Medical College, Al-Mustansiriya University, Baghdad, Iraq
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13
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Marx FM, Fiebig L, Hauer B, Brodhun B, Glaser-Paschke G, Magdorf K, Haas W. Higher Rate of Tuberculosis in Second Generation Migrants Compared to Native Residents in a Metropolitan Setting in Western Europe. PLoS One 2015; 10:e0119693. [PMID: 26061733 PMCID: PMC4465484 DOI: 10.1371/journal.pone.0119693] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 05/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Western Europe, migrants constitute an important risk group for tuberculosis, but little is known about successive generations of migrants. We aimed to characterize migration among tuberculosis cases in Berlin and to estimate annual rates of tuberculosis in two subsequent migrant generations. We hypothesized that second generation migrants born in Germany are at higher risk of tuberculosis compared to native (non-migrant) residents. METHODS A prospective cross-sectional study was conducted. All tuberculosis cases reported to health authorities in Berlin between 11/2010 and 10/2011 were eligible. Interviews were conducted using a structured questionnaire including demographic data, migration history of patients and their parents, and language use. Tuberculosis rates were estimated using 2011 census data. RESULTS Of 314 tuberculosis cases reported, 154 (49.0%) participated. Of these, 81 (52.6%) were first-, 14 (9.1%) were second generation migrants, and 59 (38.3%) were native residents. The tuberculosis rate per 100,000 individuals was 28.3 (95CI: 24.0-32.6) in first-, 10.2 (95%CI: 6.1-16.6) in second generation migrants, and 4.6 (95%CI: 3.7-5.6) in native residents. When combining information from the standard notification variables country of birth and citizenship, the sensitivity to detect second generation migration was 28.6%. CONCLUSIONS There is a higher rate of tuberculosis among second generation migrants compared to native residents in Berlin. This may be explained by presumably frequent contact and transmission within migrant populations. Second generation migration is insufficiently captured by the surveillance variables country of birth and citizenship. Surveillance systems in Western Europe should allow for quantifying the tuberculosis burden in this important risk group.
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Affiliation(s)
- Florian M. Marx
- Department of Pediatric Pneumology and Immunology, Charité –Universitätsmedizin, Berlin, Germany
- Division of Global Health Equity, Brigham and Women’s Hospital and Harvard Medical School, Boston, United States of America
- * E-mail:
| | - Lena Fiebig
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Bonita Brodhun
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Klaus Magdorf
- Department of Pediatric Pneumology and Immunology, Charité –Universitätsmedizin, Berlin, Germany
| | - Walter Haas
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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14
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Hou W, Wen J, Li J, Ji Z. Usefulness of interferon-gamma release assay in diagnosis of renal tuberculosis. Infect Dis (Lond) 2014; 47:62-4. [PMID: 25342574 DOI: 10.3109/00365548.2014.959045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Weibin Hou
- From the Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , P. R. China
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Garyfalia V, Irini G, Vasilios S, Konstantinos G. Annual risk of tuberculosis infection in hellenic air force recruits. Open Respir Med J 2013; 7:77-82. [PMID: 24459536 PMCID: PMC3899589 DOI: 10.2174/1874306401307010077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/05/2013] [Accepted: 11/15/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The annual risk of Tuberculosis infection (ARTI) is a key indicator in epidemiology, of the extent of transmission in a community. There have been several suggested methods in order to evaluate the prevalence of Tuberculosis infection using tuberculin skin data. This survey estimates the ARTI in young Hellenic air force recruits. The effect of BCG vaccination has also been investigated. MATERIALS AND METHODS During the period November 2006-November 2007 tuberculin skin tests were conducted to estimate the prevalence of mycobacterium tuberculosis infection and also to determine the ARTI. Tuberculin PPD-RT 23, dose 2 IU was used in 7.492 Greek air force military recruits with a mean age of 23.57 years. All recruits were examined for previous bacill Calmette-Guérin vaccination through BCG scar. A vast number of personal, epidemiological significance, data of the participants was collected. RESULTS The ARTI was 0.2%, in those who were not previously BCG vaccinated; this was derived from a tuberculin skin test cut-off point of 10 mm. There were not any statistically significant differences, neither between urban and rural population concerning the positivity of the tuberculin skin test, nor among the population in recent contact with immigrants from high-incidence countries. CONCLUSION The estimated ARTI among non BCG vaccinated young Greek men is 0.2%.
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Affiliation(s)
- Vlachou Garyfalia
- Department of Respiratory Medicine, General Panarkadian Hospital, Tripolis, Greece
| | - Gerogianni Irini
- Department of Respiratory Medicine, University of Thessaly School of Medicine, Larissa, Greece
| | - Skoufaras Vasilios
- Department of Respiratory Medicine, 251 Air Force General Hospital, Athens, Greece
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Abstract
Syphilis, cholera and TB have re-emerged and now affect the health of countless humans globally. In this article, we review current information concerning the biology and epidemiology of these bacterial diseases with the goal of developing a better understanding of factors that have led to their resurgence and that threaten to compromise their control. The impact of microbial and environmental change notwithstanding, the main factors common to the re-emergence of syphilis, cholera and TB are human demographics and behavior. This information is critical to developing targeted strategies aimed at preventing and controlling these potentially deadly infectious diseases.
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Affiliation(s)
- Lola V Stamm
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Abubakar I, Zignol M, Falzon D, Raviglione M, Ditiu L, Masham S, Adetifa I, Ford N, Cox H, Lawn SD, Marais BJ, McHugh TD, Mwaba P, Bates M, Lipman M, Zijenah L, Logan S, McNerney R, Zumla A, Sarda K, Nahid P, Hoelscher M, Pletschette M, Memish ZA, Kim P, Hafner R, Cole S, Migliori GB, Maeurer M, Schito M, Zumla A. Drug-resistant tuberculosis: time for visionary political leadership. THE LANCET. INFECTIOUS DISEASES 2013; 13:529-39. [DOI: 10.1016/s1473-3099(13)70030-6] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marais BJ, Lönnroth K, Lawn SD, Migliori GB, Mwaba P, Glaziou P, Bates M, Colagiuri R, Zijenah L, Swaminathan S, Memish ZA, Pletschette M, Hoelscher M, Abubakar I, Hasan R, Zafar A, Pantaleo G, Craig G, Kim P, Maeurer M, Schito M, Zumla A. Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts. THE LANCET. INFECTIOUS DISEASES 2013; 13:436-48. [PMID: 23531392 DOI: 10.1016/s1473-3099(13)70015-x] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recent data for the global burden of disease reflect major demographic and lifestyle changes, leading to a rise in non-communicable diseases. Most countries with high levels of tuberculosis face a large comorbidity burden from both non-communicable and communicable diseases. Traditional disease-specific approaches typically fail to recognise common features and potential synergies in integration of care, management, and control of non-communicable and communicable diseases. In resource-limited countries, the need to tackle a broader range of overlapping comorbid diseases is growing. Tuberculosis and HIV/AIDS persist as global emergencies. The lethal interaction between tuberculosis and HIV coinfection in adults, children, and pregnant women in sub-Saharan Africa exemplifies the need for well integrated approaches to disease management and control. Furthermore, links between diabetes mellitus, smoking, alcoholism, chronic lung diseases, cancer, immunosuppressive treatment, malnutrition, and tuberculosis are well recognised. Here, we focus on interactions, synergies, and challenges of integration of tuberculosis care with management strategies for non-communicable and communicable diseases without eroding the functionality of existing national programmes for tuberculosis. The need for sustained and increased funding for these initiatives is greater than ever and requires increased political and funder commitment.
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Affiliation(s)
- Ben J Marais
- Sydney Emerging Infections and Biosecurity Institute, and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Ang M, Wong W, Ngan CCL, Chee SP. Interferon-gamma release assay as a diagnostic test for tuberculosis-associated uveitis. Eye (Lond) 2012; 26:658-65. [PMID: 22302066 PMCID: PMC3351054 DOI: 10.1038/eye.2012.1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To study the use of interferon-gamma release assay (IFN-γ) (IGRAs) as a diagnostic test for tuberculosis (TB)-associated uveitis (TAU). DESIGN Prospective cohort study. PARTICIPANTS Consecutive new patients (n=162) with clinical ocular signs suggestive of TAU, seen >1 year period at a single tertiary center. METHODS All subjects underwent investigations to rule out underlying disease, including T-SPOT.TB and tuberculin skin test (TST). Twenty-one subjects with underlying disease and three with interdeterminate T-SPOT.TB results were excluded. Those with T-SPOT.TB- or TST-positive results were referred to infectious diseases physician for evaluation. Anti-TB therapy (ATT) was prescribed if required. Patients' treatment response and recurrence were monitored for six months after completion of ATT, if given; or 1 year if no ATT was given. MAIN OUTCOME MEASURE Diagnosis of TAU. RESULTS Mean age of study cohort (n=138) was 46.8 ± 15.3 years. Majority were Chinese (n=80, 58.0%) and female (n=75, 54.3%). TST was more sensitive than T-SPOT.TB (72.0% vs 36.0%); but T-SPOT.TB was more specific (75.0% vs 51.1%) for diagnosing TAU. Patients with either a T-SPOT.TB (1.44; 95% confidence intervals (CI), 0.86-2.42) or TST (1.47; 95% CI, 1.12-1.94)-positive result are more likely to have TAU. The accuracy of diagnosing TAU increases when both tests are used in combination (area under the receiver operator curve=0.665; 95% CI, 0.533-0.795). Patients with both tests positive are 2.16 (95% CI, 1.23-3.80) times more likely to have TAU. Negative T-SPOT.TB or TST results do not exclude TAU (negative likelihood ratios <1.0). CONCLUSIONS We recommend using a combination of clinical signs, IGRA, and TST to diagnose TAU.
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Affiliation(s)
- M Ang
- Singapore National Eye Centre, National University of Singapore, Singapore, Singapore
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Norredam M, Olsbjerg M, Petersen JH, Bygbjerg I, Krasnik A. Mortality from infectious diseases among refugees and immigrants compared to native Danes: a historical prospective cohort study. Trop Med Int Health 2011; 17:223-30. [DOI: 10.1111/j.1365-3156.2011.02901.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Greenwood MJ, Warriner WR. Immigrants and the Spread of Tuberculosis in the United States: A Hidden Cost of Immigration. POPULATION RESEARCH AND POLICY REVIEW 2011. [DOI: 10.1007/s11113-011-9213-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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