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Medrano BA, Lee M, Gemeinhardt G, Yamba L, Restrepo BI. High all-cause mortality and increasing proportion of older adults with tuberculosis in Texas, 2008-2020. Epidemiol Infect 2024; 152:e82. [PMID: 38736419 PMCID: PMC11131009 DOI: 10.1017/s0950268824000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/22/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024] Open
Abstract
Pulmonary tuberculosis (PTB) elimination efforts must consider the global growth of the ageing population. Here we used TB surveillance data from Texas, United States (2008-2020; total n = 10656) to identify unique characteristics and outcomes in older adults (OA, ≥65 years) with PTB, compared to young adults (YA, 18-39 years) or middle-aged adults (40-64 years). We found that the proportion of OA with PTB increased from 15% in 2008 to 24% in 2020 (trend p < 0.05). Diabetes was highly prevalent in OA (32%) but not associated with adverse outcomes. Death was 13-fold higher in OA compared to YA and was 7% at the time of diagnosis which suggests diagnostic delays. However, once TB was suspected, we found no differences in culture, smear, or nucleic acid detection of mycobacteria (although less lung cavitations) in OA. During treatment, OA had less drug-resistant TB, few adverse reactions and adhered with TB treatment. We recommend training healthcare workers to 'think TB' in OA, for prompt treatment initiation to diminish deaths. Furthermore, OA should be added as a priority group to the latent TB treatment guidelines by the World Health Organization, to prevent TB disease in this highly vulnerable group.
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Affiliation(s)
- Belinda A. Medrano
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Miryoung Lee
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Gretchen Gemeinhardt
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lana Yamba
- Tuberculosis Elimination Division, Texas Department of Health and Human Services, Austin, TX, USA
| | - Blanca I. Restrepo
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Brownsville, TX, USA
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
- School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, USA
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2
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Raghu S. Challenges in treating tuberculosis in the elderly population in tertiary institute. Indian J Tuberc 2022; 69 Suppl 2:S225-S231. [PMID: 36400514 DOI: 10.1016/j.ijtb.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Tuberculosis (TB) epidemic is most prevalent in the India with increase in mortality and morbidity. Ongoing elderly population as a result of increase in health care facilities are at high risk of TB. Elderly people are four-fold more prone to TB. Most cases of TB in the elderly result from reactivation of latent TB due to immunosenescence. Major challenge in dealing with therapeutic aspects of elderly patients is recognising frailty to prevent loss of independence. Challenges facing with elderly TB are difficult to reach out to hospital because of poor health seeking behaviour especially elderly female either due to ignorance or neglected by the family members, atypical presentation mimicking other disorders leading to diagnostic delay, if at all diagnosed impoverished tolerance and adherence to treatment due to various factors like associated comorbidities leading to pill load, impaired renal and hepatic functions with aging and stigma. Emerging resistance with usage of non-standard treatment regimens lead to unpropitious outcomes and increases mortality. The mortality rate is six times higher in elderly compared to younger individuals. Hence elderly people need tertiary level health care facilities for enhancing the diagnosis and appropriate management of tuberculosis and its complications. New set of guidelines to be made for elderly to increase adherence and tolerance thereby decreasing drug interactions and adverse drug reactions. With the increased prevalence of TB in the elderly, it is the need of the hour for India, to focus on this vulnerable population as they are a potential source of infection in the community. Awareness to be created among the elderly community regarding this deadly disease and its outcomes to increase their health consciousness and medical attention. Priming the special focus on females coterie as they are the most neglected population in our society.
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Affiliation(s)
- Srikanti Raghu
- Department of Pulmonary Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India; Superintendent of Government Hospital for Chest and Communicable Diseases, Guntur, Andhra Pradesh, India.
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3
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Lafuse WP, Wu Q, Kumar N, Saljoughian N, Sunkum S, Ahumada OS, Turner J, Rajaram MVS. Psychological stress creates an immune suppressive environment in the lung that increases susceptibility of aged mice to Mycobacterium tuberculosis infection. Front Cell Infect Microbiol 2022; 12:990402. [PMID: 36189368 PMCID: PMC9523253 DOI: 10.3389/fcimb.2022.990402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/26/2022] [Indexed: 01/18/2023] Open
Abstract
Age is a major risk factor for chronic infections, including tuberculosis (TB). Elderly TB patients also suffer from elevated levels of psychological stress. It is not clear how psychological stress impacts immune response to Mycobacterium tuberculosis (M.tb). In this study, we used social disruption stress (SDR) to investigate effects of psychological stress in young and old mice. Unexpectedly, we found that SDR suppresses lung inflammation in old mice as evidenced by lower pro-inflammatory cytokine levels in bronchial lavage fluid and decreased cytokine mRNA expression by alveolar macrophages. To investigate effects of stress on M.tb infection, mice were subjected to SDR and then infected with M.tb. As previously reported, old mice were better at controlling infection at 30 days than young mice. This control was transient as CFUs at 60 days were higher in old control mice compared to young mice. Consistently, SDR significantly increased M.tb growth at 60 days in old mice compared to young mice. In addition, SDR in old mice resulted in accumulation of IL-10 mRNA and decreased IFN-γ mRNA at 60 days. Also, confocal microscopy of lung sections from old SDR mice showed increased number of CD4 T cells which express LAG3 and CD49b, markers of IL-10 secreting regulatory T cells. Further, we also demonstrated that CD4 T cells from old SDR mice express IL-10. Thus, we conclude that psychological stress in old mice prior to infection, increases differentiation of IL-10 secreting T cells, which over time results in loss of control of the infection.
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Affiliation(s)
- William P. Lafuse
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States,*Correspondence: William P. Lafuse, ; Murugesan V. S. Rajaram,
| | - Qian Wu
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States
| | - Naresh Kumar
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States
| | - Noushin Saljoughian
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States
| | - Shrayes Sunkum
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States
| | | | - Joanne Turner
- Host Pathogen Interactions Program, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Murugesan V. S. Rajaram
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States,*Correspondence: William P. Lafuse, ; Murugesan V. S. Rajaram,
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4
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Kim HW, Myong JP, Kim JS. Estimating the burden of nosocomial exposure to tuberculosis in South Korea, a nationwide population based cross-sectional study. Korean J Intern Med 2021; 36:1134-1145. [PMID: 33327686 PMCID: PMC8435488 DOI: 10.3904/kjim.2020.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/01/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND/AIMS The aim of the study was to investigate the current nationwide burden of nosocomial exposure to tuberculosis (TB) using national health insurance claims data. METHODS All patients who had claims for drug susceptibility testing for TB from 2012 to 2016, which indicated culture-proven TB, were included. The first day of the infectious period was defined as 3 months before a doctor's suspicion of TB in patients with respiratory symptoms and 1 month before in patients without symptoms. The last day of the infectious period was defined as one day before the prescription of anti-TB medications. Patients hospitalized during infectious periods were investigated and their hospitalization days were calculated. Records of medical procedures which increased the risk of nosocomial transmission by generating aerosols were also investigated. RESULTS A total of 7,186 cases with 94,636 person-days of hospitalization with unrecognized active TB were found. Patients above 60 years of age accounted for 63.99% of the total number and 69.70% of the total duration of hospitalization. TB patients in the older age group showed a trend toward higher risks for hospitalization with unrecognized active TB. Patients in their 80s showed the highest risk (12.65%). Bronchoscopy (28.86%), nebulizer therapy (28.48%), and endotracheal intubation (13.02%) were common procedures performed in these patients during hospitalization. CONCLUSION The burden of nosocomial exposure to TB in South Korea is still substantial. Hospitalization with unrecognized active TB, especially among the elderly TB patients could be a serious public health issue in South Korea.
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Affiliation(s)
- Hyung Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jun-Pyo Myong
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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5
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Scordo JM, Aguillón-Durán GP, Ayala D, Quirino-Cerrillo AP, Rodríguez-Reyna E, Joya-Ayala M, Mora-Guzmán F, Ledezma-Campos E, Villafañez A, Schlesinger LS, Torrelles JB, Turner J, Restrepo BI. Interferon Gamma Release Assays for Detection of Latent Mycobacterium tuberculosis in Elderly Hispanics. Int J Infect Dis 2021; 111:85-91. [PMID: 34389503 PMCID: PMC8540394 DOI: 10.1016/j.ijid.2021.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Interferon gamma release assays (IGRAs) are used to detect latent Mycobacterium tuberculosis (M.tb) infection (LTBI) in adults, but their performance in older people is not well-established. We evaluated IGRAs for LTBI detection in older Hispanic recent TB contacts (ReC) or community controls (CoC). Methods: Cross-sectional assessment of LTBI with T-SPOT.TB and/or QuantiFERON-Gold in-tube or –Plus assay in older (≥60 years) and adult (18–50 years) Hispanic people. Results: We enrolled 193 CoC (119 adults, 74 older persons) and 459 ReC (361 adults, 98 older persons). LTBI positivity increased with age in CoC (19%–59%, P<0.001), but was similar in ReC (59%–69%, P=0.329). Older people had lower concordance between IGRAs (kappa 0.465 vs 0.688 in adults) and more inconclusive results (indeterminate/borderline 11.6% vs 5.8% in adults, P=0.012). With simultaneous IGRAs, inconclusive results were resolved as positive or negative with the other IGRA. The magnitude of response to M.tb peptides in IGRAs was similar among age groups, but responsiveness to mitogens was lower in older people. Conclusions: IGRAs are suitable for LTBI detection in older people. Discordant and inconclusive findings are more prevalent in older people, but results are resolved when IGRA is repeated with a different IGRA test.
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Affiliation(s)
- Julia M Scordo
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA; The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Génesis P Aguillón-Durán
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Doris Ayala
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA
| | - Ana Paulina Quirino-Cerrillo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA
| | - Eminé Rodríguez-Reyna
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Mateo Joya-Ayala
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA
| | - Francisco Mora-Guzmán
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Eder Ledezma-Campos
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Alejandro Villafañez
- Casa Club del Adulto Mayor, Sistema para el Desarrollo Integral de la Familia, Matamoros, Tamaulipas, Mexico
| | - Larry S Schlesinger
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Jordi B Torrelles
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Joanne Turner
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Blanca I Restrepo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA; School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX 78541, USA.
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6
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Undernutrition and Mortality among Adult Tuberculosis Patients in Addis Ababa, Ethiopia. Adv Prev Med 2020; 2020:5238010. [PMID: 32802521 PMCID: PMC7403904 DOI: 10.1155/2020/5238010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/20/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background In developing countries, there are several adult tuberculosis (TB) patients suffering from profound undernutrition. Undernutrition is a significant risk factor for developing tuberculosis. In the world, TB is one of the top ten and leading causes of death. To appropriately intervene death of adult TB patients, it is crucial to understand the magnitude of undernutrition and its associated factors among them. The study assessed undernutrition and mortality among adult tuberculosis patients in Addis Ababa, Ethiopia. Methods Institutional-based retrospective study was conducted in Addis Ababa, Ethiopia, from January 2019 to August 2019. The total sample size of the study was 284. The source populations were TB patients who have followed up for TB treatment at public health facilities of Addis Ababa. The sample size was allocated to the selected health facilities proportional to their size, and study subjects were enrolled to the study during the study period. Data were collected by a structured data sheet from the selected health center registration book. Data were entered into Epi Data software and analyzed by using SPSS version 20. Descriptive statistical methods were used to summarize the sociodemographic characteristics of the study participants. Survival curves were generated using the Kaplan-Meier method for all TB patients. Result A total of 284 study participants were included in the study. It was found that 46.8% of the study population have undernutrition (BMI <18.5 kg/m2) at the time of registration for treatment. Out of undernourished patients, 54 (19.0%) had severe malnutrition and 78 (27.5%) had moderate undernutrition. At the end of the two-month intensive treatment period, the under nutrition prevalence declined to 38.7%. Of the 284 patients, 17 (6.0%) died before completing anti-TB treatment. Three quarters of all forms of TB deaths occurred within 57 days after the start of anti-TB treatment. The proportion of deaths by nutritional status at treatment initiation among normal, moderate acute malnutrition, and severe acute malnutrition TB patients was 3.1%, 8.9%, and 16.3%, respectively. Conclusion Almost half of the TB patients were undernourished at the start of anti-TB treatment based on BMI. From the malnourished, less than 20% of the participants gained weight and moved to normal weight at the end of the two-month intensive treatment period. The high death rate was reported among severely malnourished tuberculosis patients, but it needs a larger study to further understand predictors. To enhance the increment of nutritional status during treatment, the government should give attention to support nutritional supplements for TB patients.
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7
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Cui Y, Shen H, Wang F, Wen H, Zeng Z, Wang Y, Yu C. A Long-Term Trend Study of Tuberculosis Incidence in China, India and United States 1992-2017: A Joinpoint and Age-Period-Cohort Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3334. [PMID: 32403353 PMCID: PMC7246898 DOI: 10.3390/ijerph17093334] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/03/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) is one of the major infectious diseases with the largest number of morbidity and mortality. Based on the comparison of high and low burden countries of tuberculosis in China, India and the United States, the influence of age-period-cohort on the incidence of tuberculosis in three countries from 1992 to 2017 was studied based on the Global burden of Disease Study 2017. We studied the trends using Joinpoint regression in the age-standardized incidence rate (ASIR). The regression model showed a significant decreasing behavior in China, India and the United States between 1992 and 2017. Here, we analyzed the tuberculosis incidence trends in China, India, as well as the United States and distinguished age, period and cohort effects by using age-period-cohort (APC) model. We found that the relative risks (RRs) of tuberculosis in China and India have similar trends, but the United States was found different. The period effect showed that the incidence of the three countries as a whole declines with time. The incidence of tuberculosis had increased in most age group. The older the age, the higher the risk of TB incidence. The net age effect in China and India showed a negative trend, while the cohort effect decreased from the earlier birth cohort to the recent birth cohort. Aging may lead to a continuous increase in the incidence of tuberculosis. It is related to the aging of the population and the relative decline of the immune function in the elderly. This should be timely population intervention or vaccine measures, especially for the elderly. The net cohort effect in the United States showed an unfavorable trend, mainly due to rising smoking rates and the emergence of an economic crisis. Reducing tobacco consumption can effectively reduce the incidence.
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Affiliation(s)
- Yiran Cui
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China; (Y.C.); (H.S.); (F.W.); (H.W.); (Z.Z.); (Y.W.)
| | - Hui Shen
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China; (Y.C.); (H.S.); (F.W.); (H.W.); (Z.Z.); (Y.W.)
| | - Fang Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China; (Y.C.); (H.S.); (F.W.); (H.W.); (Z.Z.); (Y.W.)
| | - Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China; (Y.C.); (H.S.); (F.W.); (H.W.); (Z.Z.); (Y.W.)
| | - Zixin Zeng
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China; (Y.C.); (H.S.); (F.W.); (H.W.); (Z.Z.); (Y.W.)
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China; (Y.C.); (H.S.); (F.W.); (H.W.); (Z.Z.); (Y.W.)
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China; (Y.C.); (H.S.); (F.W.); (H.W.); (Z.Z.); (Y.W.)
- Global Health Institute, Wuhan University, Wuhan 430071, China
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8
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Cheng KC, Liao KF, Lin CL, Lai SW. Case-Control Study Investigating the Association Between Use of Selective Serotonin Reuptake Inhibitors and Pulmonary Tuberculosis in Taiwan. Dose Response 2019; 17:1559325819897165. [PMID: 31903071 PMCID: PMC6928540 DOI: 10.1177/1559325819897165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/03/2019] [Accepted: 11/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background and Objective: The aim of the study was to investigate whether use of selective serotonin reuptake inhibitors (SSRIs) was associated with pulmonary tuberculosis. Methods: The case–control study was conducted to analyze the database between 2000 and 2013. Patients aged 20 to 84 years with newly diagnosed pulmonary tuberculosis were selected as the cases (n = 8593). Participants without pulmonary tuberculosis were selected as the controls (n = 43 472). Patients who never had a prescription for SSRIs were defined as never use. Those who ever had a prescription for SSRIs were defined as ever use. Results: The adjusted odds ratio (OR) of pulmonary tuberculosis was 1.03 for patients with ever use of SSRIs (95% confidence interval [CI]: 0.93-1.14), compared to never use. The adjusted OR of pulmonary tuberculosis was 1.00 for patients with increasing cumulative duration of SSRI use for every 1 month (95% CI: 0.99-1.00), compared to never use. The adjusted OR of pulmonary tuberculosis was 0.99 for patients with increasing cumulative dosage of SSRI use for every 1 mg (95% CI: 0.99-1.00), compared to never use. Conclusion: No significant association can be detected between SSRI use and pulmonary tuberculosis in Taiwan. No duration-dependent effect or dose-dependent effect of SSRIs use can be detected on the risk of pulmonary tuberculosis.
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Affiliation(s)
- Kao-Chi Cheng
- College of Medicine, China Medical University, Taichung.,Department of Family Medicine, China Medical University Hospital, Taichung.,Department of Food and Nutrition, Providence University, Taichung
| | - Kuan-Fu Liao
- Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung.,College of Medicine, Tzu Chi University, Hualien
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung.,Management Office for Health Data, China Medical University Hospital, Taichung
| | - Shih-Wei Lai
- College of Medicine, China Medical University, Taichung.,Department of Family Medicine, China Medical University Hospital, Taichung
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Lafuse WP, Rajaram MVS, Wu Q, Moliva JI, Torrelles JB, Turner J, Schlesinger LS. Identification of an Increased Alveolar Macrophage Subpopulation in Old Mice That Displays Unique Inflammatory Characteristics and Is Permissive to Mycobacterium tuberculosis Infection. THE JOURNAL OF IMMUNOLOGY 2019; 203:2252-2264. [PMID: 31511357 DOI: 10.4049/jimmunol.1900495] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022]
Abstract
The elderly population is more susceptible to pulmonary infections, including tuberculosis. In this article, we characterize the impact of aging on the phenotype of mouse alveolar macrophages (AMs) and their response to Mycobacterium tuberculosis. Uninfected AMs were isolated from bronchoalveolar lavage of young (3 mo) and old (18 mo) C57BL/6 mice. AMs from old mice expressed higher mRNA levels of CCL2, IFN-β, IL-10, IL-12p40, TNF-α, and MIF than young mice, and old mice contained higher levels of CCL2, IL-1β, IFN-β, and MIF in their alveolar lining fluid. We identified two distinct AM subpopulations, a major CD11c+ CD11b- population and a minor CD11c+ CD11b+ population; the latter was significantly increased in old mice (4-fold). Expression of CD206, TLR2, CD16/CD32, MHC class II, and CD86 was higher in CD11c+ CD11b+ AMs, and these cells expressed monocytic markers Ly6C, CX3CR1, and CD115, suggesting monocytic origin. Sorted CD11c+ CD11b+ AMs from old mice expressed higher mRNA levels of CCL2, IL-1β, and IL-6, whereas CD11c+ CD11b- AMs expressed higher mRNA levels of immune-regulatory cytokines IFN-β and IL-10. CD11c+ CD11b+ AMs phagocytosed significantly more M. tuberculosis, which expressed higher RNA levels of genes required for M. tuberculosis survival. Our studies identify two distinct AM populations in old mice: a resident population and an increased CD11c+ CD11b+ AM subpopulation expressing monocytic markers, a unique inflammatory signature, and enhanced M. tuberculosis phagocytosis and survival when compared with resident CD11c+ CD11b- AMs, which are more immune regulatory in nature.
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Affiliation(s)
- William P Lafuse
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210; and
| | - Murugesan V S Rajaram
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210; and
| | - Qian Wu
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210; and
| | - Juan I Moliva
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210; and.,Texas Biomedical Research Institute, San Antonio, TX 78227
| | - Jordi B Torrelles
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210; and.,Texas Biomedical Research Institute, San Antonio, TX 78227
| | - Joanne Turner
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210; and.,Texas Biomedical Research Institute, San Antonio, TX 78227
| | - Larry S Schlesinger
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210; and.,Texas Biomedical Research Institute, San Antonio, TX 78227
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10
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Minimum 5-Year Follow-Up Outcomes for Comparison Between Titanium Mesh Cage and Allogeneic Bone Graft to Reconstruct Anterior Column Through Posterior Approach for the Surgical treatment of Thoracolumbar Spinal Tuberculosis with Kyphosis. World Neurosurg 2019; 127:e407-e415. [DOI: 10.1016/j.wneu.2019.03.139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/17/2022]
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11
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Kirirabwa NS, Kimuli D, DeJene S, Nanziri C, Birabwa E, Okello DA, Suarez PG, Kasozi S, Byaruhanga R, Lukoye D. Response to anti-tuberculosis treatment by people over age 60 in Kampala, Uganda. PLoS One 2018; 13:e0208390. [PMID: 30566486 PMCID: PMC6300205 DOI: 10.1371/journal.pone.0208390] [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: 11/24/2017] [Accepted: 11/18/2018] [Indexed: 12/13/2022] Open
Abstract
While old age is a known risk factor for developing active tuberculosis (TB), studies on TB in the population aged 60 years and older (considered elderly in this study) are few, especially in the developing world. Results of the TB prevalence survey in Uganda found high TB prevalence (570/100,000) in people over 65. We focused on treatment outcomes in the elderly to understand this epidemic better. We conducted a retrospective analysis of data from TB facility registers in Kampala City for the period 2014-2015. We analyzed the 2014-15 cohort with respect to age, sex, disease class, patients' human immunodeficiency virus (HIV) and directly observed therapy (DOT) status, type of facility, and treatment outcomes and compared findings in the elderly (≥60) and younger (<60) age groups. Of 15,429 records, 3.3% (514/15,429) were for elderly patients. The treatment success rate (TSR) among elderly TB patients (68.3%) was lower than that of the non-elderly (80.9%) and the overall TSR 80.5%, (12,417/15,429) in Kampala. Although the elderly were less likely to test positive for HIV than the young (AOR 0.39; 95% CI 0.33-0.48, p<0.001), they had a two-fold higher risk of unfavorable treatment outcomes (AOR 2.14; CI 1.84-2.72, p<0.001) and were more likely to die while on treatment (AOR 1.86; CI 1.27-2.73; p = 0.001). However, there was no statistically significantly difference between treatment outcomes among HIV-positive and HIV-negative elderly TB patients. Compared to the younger TB patients, elderly TB patients have markedly poorer treatment outcomes, although TB/HIV co-infection rates in this age group are lower.
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Affiliation(s)
| | - Derrick Kimuli
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Seyoum DeJene
- United States Agency for International Development, Kampala, Uganda
| | - Carol Nanziri
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Estella Birabwa
- United States Agency for International Development, Kampala, Uganda
| | - Daniel Ayen Okello
- Kampala Capital City Authority, Directorate of Public Health and Environment, Kampala, Uganda
| | | | - Samuel Kasozi
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Raymond Byaruhanga
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Deus Lukoye
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
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12
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Mok J, An D, Kim S, Lee M, Kim C, Son H. Treatment outcomes and factors affecting treatment outcomes of new patients with tuberculosis in Busan, South Korea: a retrospective study of a citywide registry, 2014-2015. BMC Infect Dis 2018; 18:655. [PMID: 30545315 PMCID: PMC6293515 DOI: 10.1186/s12879-018-3574-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/30/2018] [Indexed: 01/30/2023] Open
Abstract
Background This study investigated the treatment outcomes, and factors affecting the outcomes, of new tuberculosis (TB) patients in Busan, South Korea. Methods We retrospectively analysed the citywide TB registry data (collected for the Korean National TB Surveillance System) of new TB patients registered in Busan from January 2014 to December 2015. Results A total of 4732 patients were included in this study (mean age, 52.5 ± 19.9 years; 58.4% male). The overall treatment success rate was 83.9% (cured, 20.2%; completed, 63.7%); 8.0% of patients died, and 3.6% were lost to follow-up. In multivariate analyses, a higher rate of loss to follow-up was associated with foreign nationality, registered as TB-positive at least twice, and being in Q4 (fourth quintile) or Q5 (fifth quintile) of the regional deprivation index. Conversely, a lower rate of loss to follow-up was associated with female gender, smear-positive for pulmonary TB (PTB), and the treatment outcome being reported by a public health centre. Higher mortality was associated with old age (≥ 75 years), smear-positive PTB, treatment outcome being reported by the hospital, and being registered as TB-positive twice. Lower mortality was associated with female gender, treatment outcome being reported by a public health centre or clinic, and Q5 of the regional deprivation index. Conclusions Treatment outcomes of new TB patients were sub-optimal in Busan. TB control programs should maintain close monitoring and provide greater socioeconomic support to patients at high risk of poor treatment outcomes.
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Affiliation(s)
- Jeongha Mok
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, South Korea.,Medical Research Institute, Pusan National University Hospital, Busan, South Korea.,Busan Center for Infectious Disease Control and Prevention, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea
| | - Daeseong An
- Department of Statistics, Pukyong National University, Busan, South Korea
| | - Seoungjin Kim
- Busan Center for Infectious Disease Control and Prevention, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea
| | - Miyoung Lee
- Busan Center for Infectious Disease Control and Prevention, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea
| | - Changhoon Kim
- Medical Research Institute, Pusan National University Hospital, Busan, South Korea.,Busan Center for Infectious Disease Control and Prevention, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea.,Department of Preventive Medicine, College of Medicine, Pusan National University, Busan, South Korea
| | - Hyunjin Son
- Busan Center for Infectious Disease Control and Prevention, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea.
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13
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Barreira-Silva P, Torrado E, Nebenzahl-Guimaraes H, Kallenius G, Correia-Neves M. Aetiopathogenesis, immunology and microbiology of tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10020917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Huang TY, Hung CH, Hsu WH, Peng KT, Hung MS, Lai LJ, Chuang HJ, Tai WL, Ku YP, Wu TS. Genitourinary tuberculosis in Taiwan: A 15-year experience at a teaching hospital. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:312-319. [PMID: 30472096 DOI: 10.1016/j.jmii.2018.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 10/08/2018] [Accepted: 10/29/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Genitourinary tuberculosis (GUTB) is rare but fatal if not diagnosed early. The purpose of this study was to investigate the outcomes of GUTB in Taiwan. METHODS We retrospectively reviewed medical records of 57 patients who were diagnosed as GUTB from January 2002 to December 2016, over a 15-year period. Demographic data and clinical manifestations were recorded for analysis. RESULTS There were 37 males and 20 females with a median age of 71 years. Kidney (24.6%) was the most involved organ. Fever (56.1%) was the major presentation. Sixteen (28.1%) patients presented unfavorable outcome. Compared with the favorable outcome group, the unfavorable outcome group had more malignancy (p = 0.013), fever (p = 0.020), anemia (p = 0007), thrombocytopenia (p = 0.003), and hypoalbuminemia (p = 0.015). In a multivariate analysis, fever (odds ratio: 42.716, 95% confidence interval: 1.032-1767.569; p = 0.048) was identified as prognostic factors for unfavorable outcome. CONCLUSION GUTB is often in advanced stages with a high mortality in Taiwan. Establishing a diagnosis is difficult and requires thorough investigation. Fever is associated with unfavorable outcome.
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Affiliation(s)
- Tsung-Yu Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan; Infection Control Team, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chien-Hui Hung
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Hsiu Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Chinese Medicine, School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Kuo-Ti Peng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Chinese Medicine, School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ming-Szu Hung
- Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Li-Ju Lai
- Department of Chinese Medicine, School of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hui-Ju Chuang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wan-Ling Tai
- Infection Control Team, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Pei Ku
- Infection Control Team, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ting-Shu Wu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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15
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Time to death and risk factors among tuberculosis patients in Northern Ethiopia. BMC Res Notes 2018; 11:696. [PMID: 30286801 PMCID: PMC6172746 DOI: 10.1186/s13104-018-3806-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/27/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The main objective of this study was to assess time to death and associated risk factors among tuberculosis (TB) patients. RESULTS A total of 769 TB patients were studied and of those, 87 (11.3%) patients died. All of the deaths occurred within 7 months of anti-tuberculosis therapy. Extra-pulmonary TB (AHR = 17.376, 95% CI; 3.88-77.86, p < 0.001) as compared to pulmonary TB and cotrimoxazole prophylaxis therapy (CPT) (AHR = 0.15, 95% CI; 0.03-0.74, p = 0.02) were found to be the predictors of mortality. We noticed higher rates of mortality. Extra-pulmonary TB patients have high risk and TB-HIV co-infected patients who received CPT have low risk of death. Improving early diagnosis of extra-pulmonary TB and early CPT initiation of TB-HIV co-infected patients could minimize patient's mortality.
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16
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Uddin S, Khan FU, Ahmad T, Rehman MMU, Arif M. Two Years of Retrospective Study on the Incidence of Tuberculosis in Dir Lower Valley, Khyber Pakhtunkhwa, Pakistan. Hosp Pharm 2018; 53:344-349. [PMID: 30210154 PMCID: PMC6130118 DOI: 10.1177/0018578718758603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Pakistan has high tuberculosis (TB) burden with alarming mortality and morbidity, and its rate increases day by day, especially in remote areas where access of quality health is not available. Objective: The objective of the study was to determine the incidence rate of pulmonary TB in the Dir valley among the suspected patients according to age-, gender-, and location-wise prevalence of the disease. Methods: A retrospective descriptive study was designed from January 2015 to December 2016. All the 556 people registered are suspected patients of pulmonary tuberculosis sputum smear (PTB-SS) positive, whereas the remaining cases were diagnosed with extra-pulmonary TB and hence excluded from the study. Results: The ratio of PTB-SS-positive cases was higher in females (50.5%, n = 281) compared with males (49.5%, n = 275). Furthermore, in the age group 1 to 20 years, the percentage of PTB-SS-positive cases was 28.1% (n = 156), in 21 to 40 years 40.3% (n = 224), in 41 to 60 years 18.7% (n = 104), in 61 to 80 years 11.2% (n = 62), and at age group >81 years, it was 1.8% (n = 10). No difference was found in the years 2015 and 2016 regarding PTB-SS-positive cases registration. Age and health care facilities (P < .000) and treatment outcome (P < .000) have a strong relationship. No significant relation was found with other demographics variables (P > 0.05). Conclusion: It was concluded from our finding that TB was considerably increased in the general population of District Dir (Lower), and proper supervision, diagnosis, treatment, and awareness of rapid prophylactic measures are needed to eradicate the issue.
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Affiliation(s)
| | | | - Tariq Ahmad
- Quaid-i-Azam University, Islamabad, Pakistan
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17
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Cheng KC, Liao KF, Lin CL, Lai SW. Gastrectomy correlates with increased risk of pulmonary tuberculosis: A population-based cohort study in Taiwan. Medicine (Baltimore) 2018; 97:e11388. [PMID: 29979430 PMCID: PMC6076070 DOI: 10.1097/md.0000000000011388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/12/2018] [Indexed: 11/26/2022] Open
Abstract
The objective to assess the association between gastrectomy and the risk of pulmonary tuberculosis among patients without gastric cancer in Taiwan.There were 762 subjects with newly performing gastrectomy as the gastrectomy group since 2000 to 2012, and 2963 randomly selected subjects without gastrectomy as the non-gastrectomy group. Subjects with history of pulmonary tuberculosis or gastric cancer before the index date were excluded. Both gastrectomy and non-gastrectomy groups were matched with sex, age, and comorbidities. The incidence of pulmonary tuberculosis was assessed in both groups. The multivariable Cox proportional hazards regression model was used to assess the hazard ratio and 95% confidence interval for risk of pulmonary tuberculosis associated with gastrectomy.The overall incidence of pulmonary tuberculosis was 1.97-fold greater in the gastrectomy group than that in the non-gastrectomy group. The multivariable Cox proportional hazards regression analysis demonstrated that the adjusted HR of pulmonary tuberculosis was 1.97 for the gastrectomy group, compared with the non-gastrectomy group. Male sex, age (increase per 1 year), chronic obstructive pulmonary disease, and splenectomy were other factors that could be related to pulmonary tuberculosis.Gastrectomy is associated with 1.97-fold increased risk of pulmonary tuberculosis among patients without gastric cancer.
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Affiliation(s)
- Kao-Chi Cheng
- College of Medicine, China Medical University
- Department of Family Medicine
- Department of Food and Nutrition, Providence University
| | - Kuan-Fu Liao
- Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi General Hospital
- College of Medicine, Tzu Chi University, Hualien
| | - Cheng-Li Lin
- College of Medicine, China Medical University
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- College of Medicine, China Medical University
- Department of Family Medicine
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18
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Piergallini TJ, Turner J. Tuberculosis in the elderly: Why inflammation matters. Exp Gerontol 2018; 105:32-39. [PMID: 29287772 PMCID: PMC5967410 DOI: 10.1016/j.exger.2017.12.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 12/20/2022]
Abstract
Growing old is associated with an increase in the basal inflammatory state of an individual and susceptibility to many diseases, including infectious diseases. Evidence is growing to support the concept that inflammation and disease susceptibility in the elderly is linked. Our studies focus on the infectious disease tuberculosis (TB), which is caused by Mycobacterium tuberculosis (M.tb), a pathogen that infects approximately one fourth of the world's population. Aging is a major risk factor for developing TB, and inflammation has been strongly implicated. In this review we will discuss the relationship between inflammation in the lung and susceptibility to develop and succumb to TB in old age. Further understanding of the relationship between inflammation, age, and M.tb will lead to informed decisions about TB prevention and treatment strategies that are uniquely designed for the elderly.
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Affiliation(s)
- Tucker J Piergallini
- Texas Biomedical Research Institute, San Antonio, TX 78227, United States; College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Joanne Turner
- Texas Biomedical Research Institute, San Antonio, TX 78227, United States.
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19
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Li J, Chung PH, Leung CLK, Nishikiori N, Chan EYY, Yeoh EK. The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets. Infect Dis Poverty 2017; 6:70. [PMID: 28569191 PMCID: PMC5452345 DOI: 10.1186/s40249-017-0284-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/13/2017] [Indexed: 11/10/2022] Open
Abstract
With the rapid pace of population ageing, tuberculosis (TB) in the elderly increasingly becomes a public health challenge. Despite the increasing burden and high risks for TB in the elderly, targeted strategy has not been well understood and evaluated. We undertook a scoping review to identify current TB strategies, research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets. Databases of Embase, MEDLINE, Global health and EBM reviews were searched for original studies, review articles, and policy papers published in English between January 1990 and December 2015. Articles examining TB strategy, program, guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria. Most of them were qualitative studies, issued in high- and middle-income countries and after 2000. To break the chain of TB transmission and reactivation in the elderly, infection control, interventions of avoiding delay in diagnosis and containment are essential for preventing transmission, especially in elderly institutions and aged immigrants; screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people; optimizing early case-finding with a high index of suspicion, systematic screening for prioritized high-risk groups, initial empirical and adequate follow-up treatment with close monitoring and evaluation, as well as enhanced programmatic management are fundamental pillars for active TB elimination. Evaluation of TB epidemiology, risk factors, impacts and cost-effectiveness of interventions, adopting accurate and rapid diagnostic tools, shorter and less toxic preventive therapy, are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway. The framework and principals identified in this study will help to evaluate and improve current program, develop targeted strategy, as well as raise more discussions on the research priority settings and policy transitions. Given the scarceness of policy and evaluated interventions, as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries, the increasing need of a ready TB program for the elderly warrants further research.
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Affiliation(s)
- Jun Li
- JC School of Public Health and Primary Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Pui-Hong Chung
- JC School of Public Health and Primary Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
| | - Cyrus L K Leung
- JC School of Public Health and Primary Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Nobuyuki Nishikiori
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Emily Y Y Chan
- JC School of Public Health and Primary Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
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20
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Debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of multilevel noncontiguous spinal tuberculosis in elderly patients via a posterior-only. Injury 2017; 48:378-383. [PMID: 28063678 DOI: 10.1016/j.injury.2016.12.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 09/22/2016] [Accepted: 12/26/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyse the efficacy and feasibility of surgical management for elderly patients with multilevel non-contiguous spinal tuberculosis(MNSTB)by using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion. METHODS From September 2009 to October 2013, 15 elderly patients with MNSTB were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion. There were 10 males and 5 females with a mean age of 63.2 years (range: 60-68 years) at the time of surgery. The mean follow-up time was 40 months(range 26-68 months). Patients were evaluated before and after surgery in terms of erythrocyte sedimentation rate(ESR), neurological status, pain and kyphotic angle. RESULTS The spinal tuberculosis was completely cured, and the grafted bones were fused in all 15 patients. There were no recurrent tuberculous infections. The ESR reached a normal level within 3 months in all patients. The ASIA neurological classification improved in all cases, and pain relief was reported by all patients. The average preoperative kyphosis was 20.1° (range 8-38°) and decreased to 7.6° (range 1-18°) postoperatively. There was no significant loss of the correction at the latest follow-up. CONCLUSIONS Our results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion was an effective treatment for elderly patients with MNSTB. It is characterized by minimum surgical trauma, good neurological recovery, and good correction of kyphosis.
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21
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Cheng KC, Liao KF, Lin CL, Lai SW. Increased Risk of Pulmonary Tuberculosis in Patients with Depression: A Cohort Study in Taiwan. Front Psychiatry 2017; 8:235. [PMID: 29180971 PMCID: PMC5694036 DOI: 10.3389/fpsyt.2017.00235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/31/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/OBJECTIVE Tuberculosis (TB) and depression were major public health issues worldwide and the mutual causative relationships between them were not exhaustive. This study was performed to explore the association between depression, comorbidities, and the risk of pulmonary TB in Taiwan. METHODS The cohort study used the database of the Taiwan National Health Insurance Program. The depression group included 34,765 subjects aged 20-84 years with newly diagnosed depression from 2000 to 2012, and the non-depression group included 138,187 randomly selected subjects without depression. Both depression and non-depression groups were matched with respect to sex, age, and comorbidities. We explored the incidence of pulmonary TB at the end of 2013 in both the groups and used multivariable Cox proportional hazards regression model to explore the hazard ratio (HR) and 95% confidence interval (CI) for the risk of pulmonary TB associated with depression. RESULTS The overall incidence of pulmonary TB was 1.16-fold greater in the depression group than that in the non-depression group (1.52 vs. 1.31 per 1,000 person-years, 95% CI 1.12, 1.21). The multivariable Cox proportional hazards regression analysis revealed that the adjusted HR of pulmonary TB was 1.15 for the depression group (95% CI 1.03, 1.28), compared with the non-depression group. CONCLUSION Depression is associated with 1.15-fold increased hazard of pulmonary TB in Taiwan.
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Affiliation(s)
- Kao-Chi Cheng
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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Helbig S, Rekhtman S, Dostie K, Casler A, Schneider T, Hochberg NS, Ganley-Leal L. B cell responses in older adults with latent tuberculosis: Considerations for vaccine development. ACTA ACUST UNITED AC 2016; 1:44-52. [PMID: 30271881 PMCID: PMC6159916 DOI: 10.15761/gvi.1000112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Reactivation of latent tuberculosis (LTBI) is more common among the aging population and may contribute to increased transmission in long-term health care facilities. Difficulties in detecting LTBI due to potential blunting of the tuberculin skin test (TST), and the lowered ability of the elderly to tolerate the course of antibiotics, underscore the need for an effective vaccine. Immuno-senescence reduces the capacity of vaccines to induce sufficient levels of protective immunity against many pathogens, further increasing the susceptibility of the elderly to infectious diseases. We sought to evaluate the response of B cells to Mycobacterium tuberculosis (Mtb) in residents of long-term care facilities to determine the feasibility of using a vaccine to control infection and transmission from reactivated LTBI. Our results demonstrate that although B cell responses were higher in subjects with LTBI, Mtb antigens could stimulate B cell activation and differentiation in vitro in TST negative subjects. B cells from elderly subjects expressed high basal levels of Toll-like receptor (TLR)2 and TLR4 and responded strongly to Mtb ligands with some activation pathways dependent on TLR2. B cells derived from blood, tonsil and spleen from younger subjects responded similarly and to the same magnitude. These results suggest that B cell responses are robust in the elderly and modifications to a TB vaccine, such as TLR2 ligand-based adjuvants, may help increase immune responses to a protective level.
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Affiliation(s)
- Sina Helbig
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - Sergey Rekhtman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Kristen Dostie
- Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | | | | | - Natasha S Hochberg
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lisa Ganley-Leal
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA.,Center for International Health Research, Rhode Island Hospital, Providence, RI, USA.,STC Biologics, Inc. Cambridge, MA, USA
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Karo B, Hauer B, Hollo V, van der Werf MJ, Fiebig L, Haas W. Tuberculosis treatment outcome in the European Union and European Economic Area: an analysis of surveillance data from 2002-2011. ACTA ACUST UNITED AC 2016; 20:30087. [PMID: 26676247 DOI: 10.2807/1560-7917.es.2015.20.49.30087] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022]
Abstract
Monitoring the treatment outcome (TO) of tuberculosis (TB) is essential to evaluate the effectiveness of the intervention and to identify potential barriers for TB control. The global target is to reach a treatment success rate (TSR) of at least 85%. We aimed to assess the TB TO in the European Union and European Economic Area (EU/EEA) between 2002 and 2011, and to identify factors associated with unsuccessful treatment. Only 18 countries reported information on TO for the whole observation period accounting for 250,854 new culture-confirmed pulmonary TB cases. The 85% target of TSR was not reached in any year between 2002 and 2011 and was on average 78%. The TSR for multidrug-resistant (MDR)-TB cases at 24-month follow-up was 49%. In the multivariable regression model, unsuccessful treatment was significantly associated with increasing age (odds ratio (OR) = 1.02 per a one-year increase, 95% confidence interval (CI): 1.02-1.02), MDR-TB (OR = 8.7, 95% CI: 5.09-14.97), male sex (OR = 1.40, 95% CI: 1.28-1.52), and foreign origin (OR = 1.32, 95% CI: 1.03-1.70). The data highlight that special efforts are required for patients with MDR-TB and the elderly aged ≥65 years, who have particularly low TSR. To allow for valid monitoring at EU level all countries should aim to report TO for all TB cases.
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Affiliation(s)
- Basel Karo
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
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Karo B, Krause G, Hollo V, van der Werf MJ, Castell S, Hamouda O, Haas W. Impact of HIV infection on treatment outcome of tuberculosis in Europe. AIDS 2016; 30:1089-98. [PMID: 26752278 DOI: 10.1097/qad.0000000000001016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The effect of HIV on tuberculosis (TB) treatment outcomes has not been well established. We aimed to assess the impact of HIV infection on TB treatment outcomes by using data from notifiable disease surveillance in Europe. METHODS We analyzed the treatment outcomes of TB cases reported from nine European countries during 2010-2012. We investigate the effect of HIV on TB treatment outcomes using a multilevel and a multinomial logistic model, and considering the interaction between HIV and multidrug-resistant (MDR) TB. RESULTS A total of 61,138 TB cases including 5.5% HIV-positive were eligible for our analysis. In the multilevel model adjusted for age and an interaction with MDR TB, HIV was significantly associated with lower treatment success in all MDR strata [non-MDR TB: odds ratio (OR) 0.24 CI (confidence interval) 0.20-0.29; unknown MDR TB status: OR 0.26 CI 0.23-0.30; MDR TB: OR 0.57 CI 0.35-0.91]. In the multinomial regression model, HIV-positive cases had significantly higher relative risk ratio (RRR) for death (non-MDR TB: RRR 4.30 CI 2.31-7.99; unknown MDR TB status: 5.55 CI 3.10-9.92; MDR TB: 3.59 CI 1.56-8.28) and being 'still on treatment' (non-MDR TB: RRR 7.27 CI 3.00-17.6; unknown MDR TB status: 5.36 CI 2.44-11.8; MDR TB: 3.76 CI 2.48-5.71). We did not find any significant association between HIV and TB treatment failure (non-MDR TB: RRR 0.50 CI 0.15-1.67; unknown MDR TB status: 1.51 CI 0.86-2.64; MDR TB: 0.51 CI 0.13-1.87). CONCLUSION This large study confirms that HIV is a strong risk factor for an adverse TB treatment outcome, which is mainly manifested by an increased risk of death and still being on TB treatment.
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One-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of lumbo-sacral spinal tuberculosis in the aged. INTERNATIONAL ORTHOPAEDICS 2016; 40:1117-24. [DOI: 10.1007/s00264-016-3161-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/06/2016] [Indexed: 12/19/2022]
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Lin HS, Cheng CW, Lin MS, Chou YL, Chang PJ, Lin JC, Ye JJ. The clinical outcomes of oldest old patients with tuberculosis treated by regimens containing rifampicin, isoniazid, and pyrazinamide. Clin Interv Aging 2016; 11:299-306. [PMID: 27042029 PMCID: PMC4795580 DOI: 10.2147/cia.s95411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives To investigate the clinical characteristics, adverse drug reactions, and outcomes of the oldest old patients (aged ≥80 years) with tuberculosis (TB) treated with rifampicin, isoniazid, and pyrazinamide (RIP)-containing regimens. Design A retrospective chart review study. Setting A 1,200-bed tertiary teaching hospital in southwest Taiwan. Participants We conducted a retrospective observational study between January 1, 2005 and December 31, 2011. Seven hundred adult patients (aged ≥18 years) with TB treated with RIP-containing anti-TB regimens were reviewed, including 161 oldest old patients. Outcome measures Clinical outcomes included clinical responsiveness and microbiological eradication. Adverse outcomes included drug-induced hepatitis, and other symptoms included gastrointestinal upset (eg, abdominal pain, vomiting, diarrhea, or dyspepsia), skin rash, joint pain, and hyperuricemia. Results Compared with the non-oldest old adult patients, the oldest old patients more frequently had hepatitis (P=0.014), gastrointestinal upset (P=0.029), and unfavorable outcomes (P<0.001). In a multivariate analysis, hepatitis during treatment (adjusted odds ratio: 3.482, 95% confidence interval: 1.537–7.885; P<0.003) and oldest old age (adjusted odds ratio: 5.161, 95% confidence interval: 2.294–11.613; P<0.010) were independent risk factors for unfavorable outcomes. In the oldest old patients with hepatitis, rifampicin use was more common in the favorable outcome group than in the unfavorable outcome group (100% vs 37.5%; P=0.001). Conclusion The oldest old age and hepatitis during RIP treatment were associated with unfavorable outcomes. For the oldest old patients with TB having hepatitis during treatment, rifampicin rechallenge and use might benefit the treatment outcome.
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Affiliation(s)
- Huang-Shen Lin
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Wen Cheng
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Shyan Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Yen-Li Chou
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Pey-Jium Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jing-Chi Lin
- Division of Allergy and Immunology and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Jung-Jr Ye
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Jackson DA, Mailer K, Porter KA, Niemeier RT, Fearey DA, Pope L, Lambert LA, Mitruka K, de Perio MA. Challenges in assessing transmission of Mycobacterium tuberculosis in long-term-care facilities. Am J Infect Control 2015; 43:992-6. [PMID: 25952618 PMCID: PMC4635053 DOI: 10.1016/j.ajic.2015.03.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/26/2015] [Accepted: 03/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- David A Jackson
- University of Cincinnati Medical Center and Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Kimberly A Porter
- Epidemic Intelligence Service, Alaska State Health Department, Centers for Disease Control and Prevention, Atlanta, GA
| | - R Todd Niemeier
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
| | - Donna A Fearey
- Alaska Department of Health and Social Services, Anchorage, AK
| | - Linda Pope
- Providence Health & Services, Anchorage, AK
| | - Lauren A Lambert
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kiren Mitruka
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - Marie A de Perio
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH.
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Chaparro JMO, Reyes-Ortiz CA, Soto R, Reynolds JW. Abdominal tuberculosis presenting as ascites in an older indigenous woman: a case report. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- José Mauricio Ocampo Chaparro
- Jefe del Servicio de Hospitalización Geriátrica programa ‘Siéntete como en Casa’ Corporación Comfenalco-Universidad Libre; Profesor Asociado, Departamento de Medicina Familiar, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Carlos A Reyes-Ortiz
- Division of Geriatric and Palliative Medicine, University of Texas Medical School at Houston, Houston, TX, USA
- Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | - Ramiro Soto
- Especialista Medicina Familiar, Universidad del Cauca, Popayán, Colombia
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Xu Z, Wang X, Shen X, Luo C, Zeng H, Zhang P, Peng W. Posterior only versus combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged. Spinal Cord 2015; 53:482-7. [DOI: 10.1038/sc.2014.252] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 12/18/2014] [Accepted: 12/29/2014] [Indexed: 11/09/2022]
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Tsou PH, Huang WC, Huang CC, Lin CF, Wu KM, Hsu JY, Shen GH. Quantiferon TB-Gold conversion can predict active tuberculosis development in elderly nursing home residents. Geriatr Gerontol Int 2014; 15:1179-84. [PMID: 25495670 DOI: 10.1111/ggi.12416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2014] [Indexed: 11/30/2022]
Abstract
AIM The study was carried out on elderly nursing home residents in Taiwan. We assessed whether the serial QuantiFERON-TB Gold (QFT-G) assay and serial tuberculin skin test (TST) were reliable tools to predict or exclude the development of active tuberculosis (TB). METHODS This prospective observational cohort study involved non-bacillus Calmette-Guérin-vaccinated 259 elderly nursing home residents free of active TB at baseline. Of these, 147 were eligible for follow up. Participants underwent serial QFT-G and TST at baseline and 2-year follow up, and were monitored for active TB over 5 years. Agreement between QFT-G and TST, incidence rate ratio, positive predictive value, and negative predictive value for progression to active TB were measured. RESULTS During 5-year follow up, three participants developed active TB. The agreement between these two tests was 54.13% (ĸ = 0.167, P = 0.001). The incidence rate ratio was 15.8 (P = 0.016) for the QFT-G-conversion group compared with the TST-positive group at baseline. Positive predictive value for QFT-G conversion groups was 25%. Negative predictive value was 100% for the TST-negative group at baseline. CONCLUSION In the elderly nursing home residents, QFT-G conversion is a more reliable tool to predict the development of active TB. Meanwhile, TST is a valuable tool for predicting the chance of not developing active TB.
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Affiliation(s)
- Ping-Hsien Tsou
- Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsin-Chu, Taiwan
| | - Wei-Chang Huang
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Medical Technology, Jen-The Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Chen-Cheng Huang
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chen-Fu Lin
- Department of Microbiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Ming Wu
- Reference Medical Laboratory, Taichung, Taiwan
| | - Jeng-Yuan Hsu
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Gwan-Han Shen
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Molecular Biology, National Chung Hsing University, Taichung, Taiwan.,Institute of Respiratory Therapy, China Medical University, Taichung, Taiwan
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Reilley B, Bloss E, Byrd KK, Iralu J, Neel L, Cheek J. Death rates from human immunodeficiency virus and tuberculosis among American Indians/Alaska Natives in the United States, 1990-2009. Am J Public Health 2014; 104 Suppl 3:S453-9. [PMID: 24754664 PMCID: PMC4035874 DOI: 10.2105/ajph.2013.301746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We used race-corrected data and comprehensive diagnostic codes to better compare HIV and tuberculosis (TB) mortality from 1999 to 2009 between American Indian/Alaska Natives (AI/ANs) and Whites. METHODS National Vital Statistics Surveillance System mortality data were adjusted for AI/AN racial misclassification through linkage with Indian Health Service registration records. We compared average annual 1990 to 2009 HIV and TB death rates (per 100,000 people) for AI/AN persons with those for Whites; Hispanics were excluded. RESULTS Although death rates from HIV in AI/AN persons were significantly lower than those in Whites from 1990 to 1998 (4.2 vs 7.0), they were significantly higher than those in Whites from 1999 to 2009 (3.6 vs 2.0). Death rates from TB in AI/AN persons were significantly higher than those in Whites, with a significant disparity during both 1990 to 1998 (3.3 vs 0.3) and 1999 to 2009 (1.5 vs 0.1). CONCLUSIONS The decrease in death rates from HIV and TB was greater among Whites, and death rates remained significantly higher among AI/AN individuals. Public health interventions need to be prioritized to reduce the TB and HIV burden and mortality in AI/AN populations.
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Affiliation(s)
- Brigg Reilley
- Brigg Reilley, Jonathan Iralu, and Lisa Neel are with the Indian Health Service, Albuquerque, NM. Emily Bloss and Kathy K. Byrd are with the Centers for Disease Control and Prevention, Atlanta, GA. James Cheek is with Department of Family and Community Medicine, University of New Mexico, Albuquerque
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Guerra-Laso JM, González-García S, González-Cortés C, Diez-Tascón C, López-Medrano R, Rivero-Lezcano OM. Macrophages from elders are more permissive to intracellular multiplication of Mycobacterium tuberculosis. AGE (DORDRECHT, NETHERLANDS) 2013; 35:1235-50. [PMID: 22791369 PMCID: PMC3705107 DOI: 10.1007/s11357-012-9451-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 06/24/2012] [Indexed: 05/15/2023]
Abstract
The elderly account for a disproportionate share of all tuberculosis cases, and the population ageing may not fully explain this phenomenon. We have performed in vitro infection experiments to investigate whether there is an immunological basis for the apparent susceptibility of elders to tuberculosis. In our infection model, Mycobacterium tuberculosis induces a higher production of interleukin (IL)-6 and reactive oxygen species in macrophages from elders than from younger adults. This response did not prevent, however, an increased multiplication of M. tuberculosis in macrophages from elders as compared with the growth observed within cells from adults. By performing a factorial experiment, we have found that IFN-γ, but not IL-1β, IL-6 or TNF-α, stimulate the macrophages to restrict the multiplication of the bacterium in macrophages from elders. Although monocytes from elders seem to be in a higher level of activation, we present evidences that protein tyrosine phosphorylation response induced by M. tuberculosis is stronger in monocytes from adults than from elders. Using a protein array that detects 71 tyrosine phosphorylated kinases, we identified Pyk2 as the only kinase that displayed a difference of intensity larger than 50 % in adults than in elders. Furthermore, monocytes from elders that were incubated in the presence of tyrosine kinase inhibitors (genistein and PP2) allowed a higher level of bacterial multiplication. These observations may help to explain the susceptibility of elders to tuberculosis. An unexpected result was that both genistein and its negative control, daidzein, abundant soy isoflavones, promoted intracellular mycobacterial growth.
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Affiliation(s)
- José M. Guerra-Laso
- />Servicio de Medicina Interna, Hospital de León, Altos de Nava s/n, 24008 León, Spain
| | - Sandra González-García
- />Unidad de Investigación, Hospital de León, Edif. S. Antonio Abad, Altos de Nava s/n, 24008 León, Spain
| | - Carolina González-Cortés
- />Unidad de Investigación, Hospital de León, Edif. S. Antonio Abad, Altos de Nava s/n, 24008 León, Spain
| | - Cristina Diez-Tascón
- />Servicio de Anatomía Patológica, Hospital de León, Altos de Nava s/n, 24008 León, Spain
| | - Ramiro López-Medrano
- />Servicio de Microbiología, Hospital Comarcal del Bierzo, Médicos sin Fronteras, 7, 24411 Fuentesnuevas, Spain
| | - Octavio M. Rivero-Lezcano
- />Unidad de Investigación, Hospital de León, Edif. S. Antonio Abad, Altos de Nava s/n, 24008 León, Spain
- />Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León, Parque de Santa Clara s/n, 42002 Soria, Spain
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Kwon YS, Chi SY, Oh IJ, Kim KS, Kim YI, Lim SC, Kim YC. Clinical characteristics and treatment outcomes of tuberculosis in the elderly: a case control study. BMC Infect Dis 2013; 13:121. [PMID: 23510403 PMCID: PMC3599150 DOI: 10.1186/1471-2334-13-121] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 03/01/2013] [Indexed: 01/15/2023] Open
Abstract
Background The purpose of this study was to evaluate the differences in clinical characteristics and treatment outcomes between older and younger tuberculosis (TB) patients in Korea. Methods We retrospectively analyzed the medical records of 271 younger (20–64 years old at diagnosis) and 199 older (≥65 years) TB patients who had been newly diagnosed and treated at Chonnam National University Hospital from May 2008 to August 2010. Results Dyspnea and comorbid medical conditions were more frequent and positive TB culture rates were higher in older TB patients. In chest computed tomography (CT) scans of pulmonary TB patients, older patients were less likely to have micronodules (<7 mm in diameter), nodules (<30 mm in diameter), masses (>30 mm in diameter), and cavities compared with younger patients, but were more likely to have consolidations. Incidence of adverse drug reactions did not differ between the two groups, except for severe gastrointestinal disorders. There were no significant differences in favorable treatment outcomes between younger and older TB patients (97% vs. 94%, respectively; p = 0.251). Conclusions Older TB patients had more frequent dyspnea and less frequent active TB findings on chest CT. Treatment success and adverse drug reaction rates were similar in older and younger TB patients.
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Affiliation(s)
- Yong Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea.
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Zhang HQ, Li JS, Zhao SS, Shao YX, Liu SH, Gao Q, Lin MZ, Liu JY, Wu JH, Chen J. Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches. Arch Orthop Trauma Surg 2012; 132:1717-23. [PMID: 23053192 DOI: 10.1007/s00402-012-1618-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the clinical outcomes of surgical management by posterior only and combined posterior and anterior approaches for thoracic spinal tuberculosis in the elderly. MATERIALS AND METHODS This was a retrospective cohort study. Thirty-six cases of thoracic spinal tuberculosis treated by two different surgical procedures in our center from January 2004 to June 2009 were studied. All the cases were divided into two groups: 20 cases in Group A underwent single-stage posterior debridement, transforaminal fusion and instrumentation, and 16 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single- or two-stage procedure. The operation time, blood loss, correction rate, recovery of neurological function, fusion time and complications were, respectively, compared between Group A and Group B. RESULTS All patients were followed up for an average of 35.1 ± 5.8 months (range 26-45 months). It was obviously that the average operative duration, blood loss, hospitalization and complication rate of Group A was less than those of Group B. Spinal tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. However, loss of correction also occurred in both groups. CONCLUSION Our study showed that the posterior approach only procedure obtained better clinical outcomes than combined posterior and anterior surgeries. It might be a better surgical treatment for thoracic spinal tuberculosis in aged patients with poor health status, especially for cases in early phase of bone destruction and/or mild and moderate kyphosis.
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Affiliation(s)
- Hong Qi Zhang
- Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Changsha 410008, People's Republic of China.
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Asymptomatic giant tuberculoma in an elderly patient. A case report. Eur Geriatr Med 2011. [DOI: 10.1016/j.eurger.2011.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Huang SF, Li CP, Feng JY, Chao Y, Su WJ. Increased risk of tuberculosis after gastrectomy and chemotherapy in gastric cancer: a 7-year cohort study. Gastric Cancer 2011; 14:257-65. [PMID: 21503597 DOI: 10.1007/s10120-011-0037-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 02/18/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrectomy for peptic ulcers and chemotherapy for malignancy are known risk factors for tuberculosis (TB). However, this relationship has rarely been investigated in patients with gastric cancer. METHODS In a retrospective cohort study from 2000 to 2006, data for 2215 patients diagnosed with gastric cancer at our hospital were compared with data from the Centers for Disease Control (CDC), Taiwan, to identify confirmed cases of TB. RESULTS In patients with gastric cancer without a history of gastrectomy and without previous anti-TB treatment, the overall crude incidence of new-onset TB was 788 per 100,000 person-years. Compared with the general population, the overall age-sex standardized incidence (SI) in gastric cancer patients was 134.3 (SI ratio [SIR]: 2.11, p < 0.05), and the recurrence rate among patients with previous anti-TB treatment was 18% (4/22) after gastric cancer diagnosis. Gastrectomy was a significant risk factor for active TB incidence [SI 159 (95% confidence interval [CI], 80-237, SIR: 2.5, p < 0.05), and chemotherapy alone seemed to be a risk factor, but was without statistical significance (SIR: 12.5, p > 0.05). Multivariate analysis showed old age, male gender, previous anti-TB treatment, and gastrectomy as significant risk factors for TB. In stratified analysis, an interaction between old TB patterns on chest films and chemotherapy was observed. CONCLUSIONS Old age, male gender, previous anti-TB treatment, and gastrectomy were significant risk factors for TB. An increased risk of TB incidence after chemotherapy was observed in patients with old TB pattern chest films initially, suggesting an interaction between chest film patterns and chemotherapy.
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Affiliation(s)
- Shiang-Fen Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, Taiwan, ROC
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Mortality and associated risk factors in a cohort of tuberculosis patients treated under DOTS programme in Addis Ababa, Ethiopia. BMC Infect Dis 2011; 11:127. [PMID: 21575187 PMCID: PMC3118140 DOI: 10.1186/1471-2334-11-127] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 05/16/2011] [Indexed: 11/05/2022] Open
Abstract
Background Tuberculosis (TB) is the leading cause of mortality among infectious diseases worldwide. Ninty five percent of TB cases and 98% of deaths due to TB occur in developing countries. Globally, the mortality rate has declined with the introduction of effective anti TB chemotherapy. Nevertheless, some patients with active TB still die while on treatment for their disease. In Ethiopia, little is known on survival and risk factors for mortality among a cohort of TB patients. The objective of the study is to determine the magnitude and identify risk factors associated with time to death among TB patients treated under DOTS programme in Addis Ababa, Ethiopia. Methods This is a retrospective cohort study. Data was obtained by assessing medical records of TB patients registered from June 2004 to July 2009 G.C and treated under the DOTS strategy in three randomly selected health centers. A step-wise multivariable Cox's regression model and Kaplan- Meier curves were used to model the outcome of interest. Mortality was used as an outcome measure. Person-years of observation (PYO) were calculated from the date of starting anti-TB treatment to date of outcome and was calculated as the number of deaths/100 PYO. Statistical analysis SPSS version 16 was used for data analysis and results were reported significant whenever P-value was less than 5%. Results From a total of 6,450 registered TB patients 236(3.7%) were died. More than 75% death occurred within eight month of treatment initiation. The mean and median times of survival starting from the date of treatment initiation were 7.2 and 7.9 months, respectively. Comparison of survival curves using Kaplan Meier curves method with log-rank test showed that the survival status was significantly different between patient categories as well as across treatment centers (P < 0.05). The death rate of pulmonary positive, pulmonary negative and extra pulmonary TB patients were 2.7%, 3.6%, and 4.3%, respectively. Body weight at initiation of anti-TB treatment (<35 kg), patient category, year of enrollment and treatment center were independent predictors for time to death. Conclusions Most of the patients were died at the end of treatment period. This underlines the need for devising a mechanism of standardizing the existing DOTS programme and nutritional support for underweight patients for better clinical and treatment outcome.
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Pratt RH, Winston CA, Kammerer JS, Armstrong LR. Tuberculosis in older adults in the United States, 1993-2008. J Am Geriatr Soc 2011; 59:851-7. [PMID: 21517786 DOI: 10.1111/j.1532-5415.2011.03369.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe older adults with tuberculosis (TB) and compare demographic, diagnostic, and disease characteristics and treatment outcomes between older and younger adults with TB. DESIGN Descriptive analysis of all confirmed people with TB aged 21 and older. SETTING The National Tuberculosis Surveillance System (NTSS) for the 50 United States and the District of Columbia from 1993 to 2008. PARTICIPANTS A total of 250,784 adult TB cases were reported, including 61,119 people with TB aged 65 and older. MEASUREMENTS TB case count and rates and proportion of TB cases in older adults. RESULTS Older adults had consistently higher incidence rates of TB than younger adults. In 2008, the rate of TB in older adults was 6.4 per 100,000, compared with 5.0 per 100,000 for younger adults. A lower percentage of older adults had TB diagnostic test results (tuberculin skin test, sputum smear, sputum culture) or human immunodeficiency virus (HIV) infection status reported. TB risk factors (substance use, homelessness, HIV infection) and multidrug-resistant TB were less prevalent in older than younger adults. Seven percent of older adults were dead at diagnosis, and 21% died during therapy, compared with 2% and 7%, respectively, of younger adults. Sputum culture conversion percentages were similar for people who did not die. Older adults also completed therapy in a timely manner, similar to younger adults. CONCLUSION Although older adults had higher rates of TB and mortality, for older adults who survived therapy, successful treatment outcomes were similar to those of younger adults.
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Affiliation(s)
- Robert H Pratt
- Northrop Grumman Information Systems, Atlanta, Georgia, USA.
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Bartu V, Kopecka E, Havelkova M. Factors associated with multidrug-resistant tuberculosis: comparison of patients born inside and outside of the Czech Republic. J Int Med Res 2010; 38:1156-63. [PMID: 20819455 DOI: 10.1177/147323001003800345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is defined as resistance of Mycobacterium tuberculosis complex (MTB) to at least isoniazid and rifampicin. The aim of this study was to evaluate and compare a cohort of 50 patients with MDR-TB according to birthplace, resistance type, clinical outcome, length of bacteriological positivity of sputum and length of hospitalization. Thirty-three of the patients were born in the Czech Republic (group A) and 17 were immigrants to the Czech Republic (group B). Patients in group B were significantly younger (mean [range] age 33 [19 - 56] years) than those in group A (mean [range] age 48 [33 - 80] years). Primary resistance was present in 16 (48%) cases in group A and in 13 (76%) cases in group B. There were 36 (72%) cured patients, five (10%) remained on treatment and nine (18%) died; no patients failed or transferred out of the study. The mean length of bacteriological positivity of sputum samples was 5.9 months and the mean length of hospitalization was 8.2 months. Resistance to capreomycin was an important predictor of poor outcome.
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Affiliation(s)
- V Bartu
- Department of Respiratory Diseases, Medicon, Prague, Czech Republic.
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Winston CA, Navin TR. Birth cohort effect on latent tuberculosis infection prevalence, United States. BMC Infect Dis 2010; 10:206. [PMID: 20626871 PMCID: PMC2915994 DOI: 10.1186/1471-2334-10-206] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 07/13/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Latent tuberculosis infection (LTBI) prevalence in the United States decreased approximately 60% in the three decades between the 1971-1972 and 1999-2000 National Health and Nutrition Examination Survey (NHANES) surveys. We examined the effects of birth cohort on LTBI prevalence over time. METHODS Using weighted data analysis software to account for NHANES survey design, we calculated the difference in LTBI prevalence between 1971-1972 and 1999-2000 for birth cohorts corresponding to 5-year intervals (1912-1916, 1917-1921,1922-1926, 1927-1931, 1932-1936, 1937-1941, 1942-1946). RESULTS LTBI prevalence was significantly lower in 1999-2000 compared to 1971-1972 for cohorts born in 1926 or earlier (19% versus 5%), but not for cohorts born 1927-1946 (9% versus 7%). Adjustment for cohort restriction and foreign-birth did not qualitatively change the results. CONCLUSIONS Although older age groups have higher rates of TB infection than younger groups, nationally representative U.S. survey data suggest that observed LTBI prevalence in older people represents an underestimate of infection, because of the birth cohort effect and waning immunologic reactivity.
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Affiliation(s)
- Carla A Winston
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-10, Atlanta, Georgia, 30333, USA
| | - Thomas R Navin
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-10, Atlanta, Georgia, 30333, USA
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Salvadó M, Garcia-Vidal C, Vázquez P, Riera M, Rodríguez-Carballeira M, Martínez-Lacasa J, Cuchi E, Garau J. Mortality of tuberculosis in very old people. J Am Geriatr Soc 2010; 58:18-22. [PMID: 20122037 DOI: 10.1111/j.1532-5415.2009.02619.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the clinical characteristics and outcomes of tuberculosis (TB) in elderly people. DESIGN Observational analysis of a prospective cohort of adults with TB (1995-2004). A case-control study to determine attributable mortality to TB in very old people was done. RESULTS Of 319 patients with TB, 109 (34.2%) were aged 65 and older. The older group was more likely to have comorbidities (1.4% vs 0.4%; P<.001), extrapulmonary and disseminated TB (50.4% vs 26.1%; P<.001), toxicity (22% vs 9.8%; P=.006), and 30-day mortality (18.3% vs 1.6%; P<.001). When patients aged 65 to 79 were compared with those aged 80 and older, only differences in TB-related mortality were detected (9.8% vs 44.4%; P=.01). In the attributable mortality analysis, 30-day and 6-month mortality were higher in very old patients with TB than in controls without TB (41.7% vs 11.1%, P=.005; 45.8% and 19.4%, P=.01, respectively). No differences in mortality were shown when excluding patients with postmortem TB diagnosis or those who died within the first 72 hours of diagnosis. CONCLUSION Older people with TB had a higher frequency of atypical features, more adverse drug reactions, and greater TB-related mortality than younger people. Data suggest that very old patients with TB have higher mortality, but if diagnosed early and adequately treated, very old patients with TB do not have greater mortality than those without.
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Affiliation(s)
- Meritxell Salvadó
- Department of Internal Medicine, Hospital Universitari Mútua de Terrassa and Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
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Mugusi FM, Mehta S, Villamor E, Urassa W, Saathoff E, Bosch RJ, Fawzi WW. Factors associated with mortality in HIV-infected and uninfected patients with pulmonary tuberculosis. BMC Public Health 2009; 9:409. [PMID: 19909501 PMCID: PMC2779816 DOI: 10.1186/1471-2458-9-409] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 11/12/2009] [Indexed: 11/29/2022] Open
Abstract
Background HIV has fuelled the TB epidemic in sub-Saharan Africa. Mortality in patients co-infected with TB and HIV is high. Managing factors influencing mortality in TB patients might help reducing it. This study investigates factors associated with mortality including patients' HIV sero-status, CD4 cell count, laboratory, nutritional and demographic characteristics in AFB smear positive pulmonary TB patients. Methods We studied 887 sputum smear positive PTB patients, between 18 and 65 years of age receiving standard 8 months anti-TB treatment. Demographic, anthropometric and laboratory data including HIV, CD4 and other tests were collected at baseline and at regular intervals. Patients were followed for a median period of 2.5 years. Results Of the 887 participants, 155 (17.5%) died, of whom 90.3% (140/155) were HIV-infected, a fatality of 29.7% (140/471) compared to 3.6% (15/416) among HIV-uninfected. HIV infection, age, low Karnofsky score, CD4 cell counts and hemoglobin, high viral load, and oral thrush were significantly associated with high mortality in all patients. Conclusion Mortality among HIV-infected TB patients is high despite the use of effective anti-TB therapy. Most deaths occur after successful completion of therapy, an indication that patients die from causes other than TB. HIV infection is the strongest independent predictor of mortality in this cohort.
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Affiliation(s)
- Ferdinand M Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Abstract
Many functional, demographic, and immunologic changes associated with aging are responsible for increasing the incidence and severity of infectious diseases in the elderly. Management is complicated by age-related organ system changes. Because many of the elderly are on multiple medications for underlying illnesses, antimicrobial therapy needs to be chosen keeping drug interactions and adverse events in mind. Common infections seen in the elderly are infections of skin and soft tissue, urinary tract, respiratory tract, and gastrointestinal tract. Organized and well-funded programs to address infectious disease issues in the elderly are the only way to improve care.
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Affiliation(s)
- Tin Han Htwe
- Division of Infectious Diseases, Southern Illinois University School of Medicine, Post Box 19636, Springfield, IL 62794-9636, USA
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Abstract
Evaluation of elderly patients who have fever of unknown origin (FUO) requires a different perspective from that needed for young patients. Differential diagnosis often varies with age, and presentation of the disease frequently is nonspecific and symptoms difficult to interpret. Noninfectious diseases are the most frequent cause of FUO in the elderly and temporal arteritis the most frequent specific cause. Tuberculosis is the most common infectious disease associated with FUO in elderly patients. FUO often is associated with treatable conditions in the elderly. Therefore, intensive, accelerated evaluation is necessary, as the lack of physiologic reserve makes this population vulnerable to irreversible changes and functional deterioration.
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Affiliation(s)
- Sari Tal
- Subacute Department, Harzfeld Geriatric Hospital, Kaplan Medical Center, Gedera, Israel.
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Falzon D, Aït-Belghiti F. What Is Tuberculosis Surveillance in the European Union Telling Us? Clin Infect Dis 2007; 44:1261-7. [PMID: 17443460 DOI: 10.1086/514343] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Accepted: 12/05/2006] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Today's European Union (EU) encompasses countries with diverse patterns of tuberculosis epidemiology. METHODS We explored national tuberculosis data for 1999-2003 reported to the EuroTB surveillance network. We analyzed only complete, representative data for drug resistance (from 15 countries) and treatment outcomes (from 19 countries). RESULTS Between 1999 and 2003, overall tuberculosis notification rates in the 25 EU countries decreased by 4% each year, down to 14 cases per 100,000 population in 2003, but Italy and the United Kingdom registered increases because of tuberculosis in immigrants. In 2003, EU countries reported 62,743 tuberculosis cases; of these, 76% were in persons who were previously untreated, 22% were in persons >64 years old, and 30% were in foreigners (the percentage in individual countries ranged from 2% to 75%). In Estonia, Latvia, and Lithuania, resistance to isoniazid and rifampicin occurred in 15%-23% of cases in which resistance testing was performed, but it was uncommon elsewhere (median resistance, 1%). Among previously untreated culture-positive patients with pulmonary tuberculosis, 76% had successful outcome (the percentage in individual countries ranged from 54% to 100%); among these patients, the probability of successful outcome diminished with advancing age. Of 9414 patients with AIDS reported in the EU, 2207 (23%) had tuberculosis as the initial defining illness, representing 3% of all tuberculosis cases notified that year (the percentage in individual countries ranged from 0% to 10%). The prevalence of HIV infection among patients with tuberculosis was highest in Portugal (16.1%) and Spain (9.6%), but it increased in Estonia (from 0.1% to 2.9%) and in Latvia (from 0.5% to 2.3%) between 1999 and 2003. CONCLUSIONS Surveillance data would be more comparable if more countries reported exhaustive and representative data. Drug resistance is low in most EU countries other than former Soviet states. HIV infection and tuberculosis comorbidity is important in certain countries. Prevention and control of tuberculosis in the EU should target groups at higher risk of infection or death, including foreigners and the elderly population.
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Affiliation(s)
- Dennis Falzon
- EuroTB, Department of Infectious Diseases, Institut de Veille Sanitaire, Saint-Maurice, France.
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Sex- and age-dependent association of SLC11A1 polymorphisms with tuberculosis in Chinese: a case control study. BMC Infect Dis 2007; 7:19. [PMID: 17371589 PMCID: PMC1847518 DOI: 10.1186/1471-2334-7-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Accepted: 03/19/2007] [Indexed: 12/27/2022] Open
Abstract
Background Host genetic factors are important determinants in tuberculosis (TB). The SLC11A1 (or NRAMP1) gene has been studied extensively for genetic association with TB, but with inconsistent findings. In addition, no study has yet looked into the effect of sex and age on the relationship between SLC11A1 polymorphisms and TB. Methods A case-control study was conducted. In total, 278 pulmonary TB patients and 282 sex- and age-matched controls without TB were recruited. All subjects were ethnic Chinese. On the basis of linkage disequilibrium pattern, three genetic markers from SLC11A1 and one from the nearby IL8RB locus were selected and examined for association with TB susceptibility. These markers were genotyped using single strand conformation polymorphism analysis or fragment analysis of amplified products. Results Statistically significant differences in allele (P = 0.0165, OR = 1.51) and genotype (P = 0.0163, OR = 1.59) frequencies of the linked markers SLC6a/b (classically called D543N and 3'UTR) of the SLC11A1 locus were found between patients and controls. With stratification by sex, positive associations were identified in the female group for both allele (P = 0.0049, OR = 2.54) and genotype (P = 0.0075, OR = 2.74) frequencies. With stratification by age, positive associations were demonstrated in the young age group (age ≤65 years) for both allele (P = 0.0047, OR = 2.52) and genotype (P = 0.0031, OR = 2.92) frequencies. All positive findings remained significant even after correction for multiple comparisons. No significant differences were noted in either the male group or the older age group. No significant differences were found for the other markers (one SLC11A1 marker and one IL8RB marker) either. Conclusion This study confirmed the association between SLC11A1 and TB susceptibility and demonstrated for the first time that the association was restricted to females and the young age group.
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Abstract
OBJECTIVE The aim of the present study was to ascertain the degree of occurrence of tuberculous infection in patients presenting with low back pain (LBP). METHODS Forty consecutive patients seeking primary medical attention for the main symptom of LBP and presenting to the Rheumatology Outpatient Clinic of our institution from January 2004 to June 2005, were recruited in this cohort study. All patients were thoroughly interrogated (occupational, trauma, infection, diabetes mellitus and medication history), subjected to a rigorous clinical examination and a battery of investigations RESULTS Twelve of the 40 patients (33%) proved to have spinal TB as the cause of backache. Eight of these patients were above the age of 65. Five of the 12 patients with spinal TB also had concomitant osteoarthritic changes of the spine and two patients had concomitant disc prolapse. Eleven of the 12 patients with spinal TB had a completely normal chest X-ray and in 10 of these patients the plain X-ray of the lumbosacral region failed to show any significant lesion. In all 12 patients, sputum analysis failed to reveal acid-fast bacilli. CONCLUSIONS The findings of this study indicate that TB is a common cause of LBP that is liable to be overlooked in the differential diagnosis of LBP. Furthermore, evidence of concurrent active intrathoracic TB may be lacking and consequently a high level of suspicion is required. The need for prompt diagnosis and treatment of skeletal TB is of utmost importance to prevent serious bone and joint destruction and severe neurological sequelae. A reliable imaging modality for diagnosing spinal TB seems to be magnetic resonance imaging.
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Affiliation(s)
- S Abou-Raya
- Geriatric Unit, Internal Medicine Department, University of Alexandria, Alexandria, Egypt.
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Abstract
The aging process results in changes in pulmonary physiology that make the elderly population more susceptible to pulmonary disease. These physiologic changes also alter the clinical presentation of such diseases, making the diagnosis and treatment of pulmonary disorders particularly challenging for the clinician. It is important for the clinician to have a high index of suspicion for pulmonary disorders to make the proper diagnosis. It is essential to keep in mind the subtle differences between pulmonary diseases in the elderly compared with younger patients.
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Affiliation(s)
- Jason Imperato
- Department of Emergency Medicine, Mount Auburn Hospital, 330 Mount Auburn Street, Cambridge, MA 02138, USA.
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