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Nagashima A, Kobori T, Hattori M, Imura S, Okochi Y. A Case of Miliary Tuberculosis Complicated by Thyroid Involvement: Managing Rifampicin-Induced Thrombocytopenia With Rifabutin. Cureus 2024; 16:e57876. [PMID: 38725736 PMCID: PMC11081410 DOI: 10.7759/cureus.57876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
This case report presents an unusual occurrence of miliary tuberculosis with thyroid tuberculosis in a 75-year-old male patient, who successfully completed the treatment with rifabutin after rifampicin-induced thrombocytopenia. The patient has been suffering from diabetes mellitus and chronic heart failure, and had coronavirus disease of 2019 (COVID-19) just before being diagnosed with miliary tuberculosis. The patient had not been prescribed immunosuppressants and steroids. Chest computed tomography (CT) scans revealed multiple tiny nodules diffusely and equally distributed in bilateral lung fields. Subsequently, polymerase chain reaction (PCR) techniques on the urine samples and culture of sputum demonstrated positivity for Mycobacterium tuberculosis. Thus, we conclusively identified miliary tuberculosis and initiated treatment using anti-tuberculosis drugs. During treatment, the patient developed thyroid tuberculosis, resulting in an enlarged thyroid and hoarseness, but these symptoms improved with continued use of the anti-tuberculosis drugs. Moreover, regarding treatment, the rifabutin dosage was completed after changing drugs due to rifampicin-induced thrombocytopenia. Notably, miliary tuberculosis is rarely complicated by thyroid tuberculosis as a paradoxical reaction, and the substitution of rifabutin for rifampicin-induced thrombocytopenia is not fully studied. We present this case alongside relevant prior data for comprehensive clinical insight.
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Affiliation(s)
- Akimichi Nagashima
- Department of Respiratory Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, JPN
| | - Tomoko Kobori
- Department of Respiratory Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, JPN
| | - Mototaka Hattori
- Department of Respiratory Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, JPN
| | - Shingo Imura
- Department of Respiratory Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, JPN
| | - Yasumi Okochi
- Department of Respiratory Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, JPN
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Torres T, Chiricozzi A, Puig L, Lé AM, Marzano AV, Dapavo P, Dauden E, Carrascosa JM, Lazaridou E, Duarte G, Carvalho AVE, Romiti R, Rompoti N, Teixeira L, Abreu M, Ippoliti E, Maronese CA, Llamas-Velasco M, Vilarrasa E, Del Alcázar E, Daponte AI, Papoutsaki M, Carugno A, Bellinato F, Gisondi P. Treatment of Psoriasis Patients with Latent Tuberculosis Using IL-17 and IL-23 Inhibitors: A Retrospective, Multinational, Multicentre Study. Am J Clin Dermatol 2024; 25:333-342. [PMID: 38265746 PMCID: PMC10867072 DOI: 10.1007/s40257-024-00845-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Tuberculosis has a major global impact. Immunocompetent hosts usually control this disease, resulting in an asymptomatic latent tuberculosis infection (LTBI). Because TNF inhibitors increase the risk of tuberculosis reactivation, current guidelines recommend tuberculosis screening before starting any biologic drug, and chemoprophylaxis if LTBI is diagnosed. Available evidence from clinical trials and real-world studies suggests that IL-17 and IL-23 inhibitors do not increase the risk of tuberculosis reactivation. OBJECTIVE To evaluate psoriasis patients with treated or untreated newly diagnosed LTBI who received IL-17 and IL-23 inhibitors and the tolerability/safety of tuberculosis chemoprophylaxis. METHODS This is a retrospective, observational, multinational study from a series of 14 dermatology centres based in Portugal, Spain, Italy, Greece and Brazil, which included adult patients with moderate-to-severe chronic plaque psoriasis and newly diagnosed LTBI who were treated with IL-23 or IL-17 inhibitors between January 2015 and March 2022. LTBI was diagnosed in the case of tuberculin skin test and/or interferon gamma release assay positivity, according to local guideline, prior to initiating IL-23 or IL-17 inhibitor. Patients with prior diagnosis of LTBI (treated or untreated) or treated active infection were excluded. RESULTS A total of 405 patients were included; complete/incomplete/no chemoprophylaxis was administered in 62.2, 10.1 and 27.7% of patients, respectively. The main reason for not receiving or interrupting chemoprophylaxis was perceived heightened risk of liver toxicity and hepatotoxicity, respectively. The mean duration of biological treatment was 32.87 ± 20.95 months, and only one case of active tuberculosis infection (ATBI) was observed, after 14 months of treatment with ixekizumab. The proportion of ATBI associated with ixekizumab was 1.64% [95% confidence interval (CI): 0-5.43%] and 0% for all other agents and 0.46% (95% CI 0-1.06%) and 0% for IL-17 and IL-23 inhibitors, respectively (not statistically significant). CONCLUSIONS The risk of tuberculosis reactivation in patients with psoriasis and LTBI does not seem to increase with IL-17 or IL-23 inhibitors. IL-17 or IL-23 inhibitors should be preferred over TNF antagonists when concerns regarding tuberculosis reactivation exists. In patients with LTBI considered at high risk for developing complications related to chemoprophylaxis, this preventive strategy may be waived before initiating treatment with IL-17 inhibitors and especially IL-23 inhibitors.
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Affiliation(s)
- Tiago Torres
- Department of Dermatology, CAC ICBAS-CHP - Centro Académico Clínico ICBAS - CHP, Rua D. Manuel II, s/n, 4100, Porto, Portugal.
- UMIB - Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Maria Lé
- Department of Dermatology, CAC ICBAS-CHP - Centro Académico Clínico ICBAS - CHP, Rua D. Manuel II, s/n, 4100, Porto, Portugal
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Paolo Dapavo
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - Esteban Dauden
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Madrid, Spain
| | - Jόse-Manuel Carrascosa
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - Elizabeth Lazaridou
- Second Department of Dermatology-Venereology, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Gleison Duarte
- Instituto Bahiano de Imunoterapias-IBIS, Salvador, Brazil
| | - André V E Carvalho
- Ambulatório de psoríase, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Ricardo Romiti
- Faculty of Medicine, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Natalia Rompoti
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Laetitia Teixeira
- UMIB - Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Miguel Abreu
- UMIB - Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Department of Infectious Diseases, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Elena Ippoliti
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Madrid, Spain
| | - Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elena Del Alcázar
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - Athina-Ioanna Daponte
- Second Department of Dermatology-Venereology, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Marina Papoutsaki
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University Hospital of Verona, Verona, Italy
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Flynn AG, Aiona K, Haas MK, Reves R, Belknap R. Clinical Characteristics of Active Tuberculosis Diagnosed After Starting Treatment for Latent Tuberculosis Infection. Clin Infect Dis 2021; 71:1320-1323. [PMID: 31773132 DOI: 10.1093/cid/ciz1157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/26/2019] [Indexed: 11/14/2022] Open
Abstract
Although rare, subclinical tuberculosis disease can be missed during evaluations for latent tuberculosis infection, and can manifest with symptoms during latent tuberculosis treatment. Among over 8000 patients treated for latent tuberculosis we found no evidence of acquired drug resistance, underscoring the safety of rifampin monotherapy for latent tuberculosis.
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Affiliation(s)
- Andrew G Flynn
- Department of Family Medicine, Duke University Medical Center, Durham, North Carolina, USA.,University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kaylynn Aiona
- Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Michelle K Haas
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Randall Reves
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert Belknap
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Denver Health and Hospital Authority, Denver, Colorado, USA
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Koumpis E, Papathanasiou K, Papakonstantinou I, Tassi I, Serpanou A, Kapsali E, Hatzimichael E. Rifampicin-Induced Thrombocytopenia: A Case Report and Short Review of the Literature. EUROPEAN MEDICAL JOURNAL 2021. [DOI: 10.33590/emj/20-00193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Thrombocytopenia may be associated with a variety of conditions and risks depending on its severity, ranging from mild epistaxis to life-threating bleeding. Many drugs or herbal remedies can cause thrombocytopenia by either inhibiting platelet production and/or enhancing their destruction from the peripheral blood mediated via an immunological mechanism implicating drug-dependent antibodies. The latter entity is called drug-induced immune thrombocytopenia: a life-threatening, under-recognised condition, which is often a diagnostic challenge. Rifampicin is a widely used, well-tolerated, and effective bactericidal drug. Adverse events, except for gastrointestinal effects, headache, skin rash, and pruritus, are uncommon. The authors herein report on a patient with isolated thrombocytopenia with a recent medical history of brucellosis on rifampicin and doxycycline. Thrombocytopenia was proved to be rifampicin-induced. Also presented is a short review of the literature on this rare subject, which should be of great importance to clinicians.
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Affiliation(s)
- Epameinondas Koumpis
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantina Papathanasiou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis Papakonstantinou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Iliana Tassi
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Anastasia Serpanou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Kapsali
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleftheria Hatzimichael
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Ali J. A multidisciplinary approach to the management of nontuberculous mycobacterial lung disease: a clinical perspective. Expert Rev Respir Med 2021; 15:663-673. [PMID: 33593217 DOI: 10.1080/17476348.2021.1887734] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Management of nontuberculous mycobacterial lung disease (NTM-LD) can be encumbered by difficult diagnostic criteria and complex treatment decisions. As prevalence of this debilitating, often refractory, progressive lung disease increases globally, management must evolve beyond antimicrobials to encompass holistic and customized treatments coordinated by practitioners across various specialties. AREAS COVERED This review aims to complement the recently updated NTM-LD treatment guidelines and expand current approaches to diagnosis, treatment, and disease management in a multidisciplinary dimension. The foundation of effective long-term management of NTM-LD is awareness of diagnostic criteria, individual patient risk factors, and the importance of managing underlying pulmonary and nonpulmonary comorbidities. The value of adopting all available pharmacological and nonpharmacological treatment modalities with a patient-centered approach to address the needs of long-term patient care cannot be minimized. EXPERT OPINION This section, while acknowledging the limited advances in understanding of NTM-LD and the availability of newer diagnostic and therapeutic tools over the last decade, underscores the need for a programmatic approach to this chronic, debilitating pulmonary infection. This will not only lead to more comprehensive patient care with better outcomes, but will also inspire and activate robust networks of research and public health initiatives in this field.
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Affiliation(s)
- Juzar Ali
- Section of Pulmonary/Critical Care Medicine & Allergy/Immunology, NTM-Bronchiectasis Program & Registry, University Medical Center, New Orleans, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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6
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Zhou G, Luo Q, Luo S, Teng Z, Ji Z, Yang J, Wang F, Wen S, Ding Z, Li L, Chen T, Abi ME, Jian M, Luo L, Liu A, Bao F. Interferon-γ release assays or tuberculin skin test for detection and management of latent tuberculosis infection: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2020; 20:1457-1469. [PMID: 32673595 DOI: 10.1016/s1473-3099(20)30276-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/20/2020] [Accepted: 03/27/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Use of an interferon-γ (IFN-γ) release assay or tuberculin skin test for detection and management of latent tuberculosis infection is controversial. For both types of test, we assessed their predictive value for the progression of latent infection to active tuberculosis disease, the targeting value of preventive treatment, and the necessity of dual testing. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, and the Cochrane Library, with no start date or language restrictions, on Oct 18, 2019, using the keywords ("latent tuberculosis" OR "latent tuberculosis infection" OR "LTBI") AND ("interferon gamma release assays" OR "Interferon-gamma Release Test" OR "IGRA" OR "QuantiFERON®-TB in tube" OR "QFT" OR "T-SPOT.TB") AND ("tuberculin skin test" OR "tuberculin test" OR "Mantoux test" OR "TST"). We included articles that used a cohort study design; included information that individuals with latent tuberculosis infection detected by IFN-γ release assay, tuberculin skin test, or both, progressed to active tuberculosis; reported information about treatment; and were limited to high-risk populations. We excluded studies that included patients with active or suspected tuberculosis at baseline, evaluated a non-commercial IFN-γ release assay, and had follow-up of less than 1 year. We extracted study details (study design, population investigated, tests used, follow-up period) and the number of individuals observed at baseline, who progressed to active tuberculosis, and who were treated. We then calculated the pooled risk ratio (RR) for disease progression, positive predictive value (PPV), and negative predictive value (NPV) of IFN-γ release assay versus tuberculin skin test. FINDINGS We identified 1823 potentially eligible studies after exclusion of duplicates, of which 256 were eligible for full-text screening. From this screening, 40 studies (50 592 individuals in 41 cohorts) were identified as eligible and included in our meta-analysis. Pooled RR for the rate of disease progression in untreated individuals who were positive by IFN-γ release assay versus those were negative was 9·35 (95% CI 6·48-13·49) compared with 4·24 (3·30-5·46) for tuberculin skin test. Pooled PPV for IFN-γ release assay was 4·5% (95% CI 3·3-5·8) compared with 2·3% (1·5-3·1) for tuberculin skin test. Pooled NPV for IFN-γ release assay was 99·7% (99·5-99·8) compared with 99·3% (99·0-99·5) for tuberculin skin test. Pooled RR for rates of disease progression in individuals positive by IFN-γ release assay who were untreated versus those who were treated was 3·09 (95% CI 2·08-4·60) compared with 1·11 (0·69-1·79) for the same populations who were positive by tuberculin skin test. Pooled proportion of disease progression for individuals who were positive by IFN-γ release assay and tuberculin skin test was 6·1 (95% CI 2·3-11·5). Pooled RR for rates of disease progression in individuals who were positive by IFN-γ release assay and tuberculin skin test who were untreated versus those who were treated was 7·84 (95% CI 4·44-13·83). INTERPRETATION IFN-γ release assays have a better predictive ability than tuberculin skin tests. Individuals who are positive by IFN-γ release assay might benefit from preventive treatment, but those who are positive by tuberculin skin test probably will not. Dual testing might improve detection, but further confirmation is needed. FUNDING National Natural Science Foundation of China and Natural Foundation of Yunnan Province.
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Affiliation(s)
- Guozhong Zhou
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Qingyi Luo
- School of Basic Medical Sciences, Department of Medical Imaging, Affiliated Yanan Hospital, Kunming Medical University, Kunming, Yunnan Province, China
| | - Shiqi Luo
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Zhaowei Teng
- Department of Orthopedic Surgery, The 6th Affiliated Hospital, Kunming Medical University, Kunming, Yunnan Province, China
| | - Zhenhua Ji
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Jiaru Yang
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Feng Wang
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Shiyuan Wen
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Zhe Ding
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Lianbao Li
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Taigui Chen
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Manzama-Esso Abi
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Miaomiao Jian
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Lisha Luo
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Aihua Liu
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, Yunnan Province, China; Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, Yunnan Province, China; The Institute for Tropical Medicine, Kunming Medical University, Kunming, Yunnan Province, China.
| | - Fukai Bao
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China; Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, Yunnan Province, China; The Institute for Tropical Medicine, Kunming Medical University, Kunming, Yunnan Province, China.
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7
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Kim BK, Kim HJ, Kim HJ, Cha JH, Lee JB, Jeon J, Kim CY, Kim Y, Kim JH, Shin C, Lee SH. Experiences of Latent Tuberculosis Infection Treatment for the North Korean Refugees. Tuberc Respir Dis (Seoul) 2019; 82:306-310. [PMID: 31172709 PMCID: PMC6778740 DOI: 10.4046/trd.2019.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/09/2019] [Accepted: 05/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) is increasing in immigrants. We aimed to investigate the current status of latent tuberculosis infection (LTBI) treatment for North Korean Refugees (NKR) compared to South Koreans Contacts (SKC). Methods TB close contacts in a closed facility of SKC and NKR who underwent LTBI screening in a settlement support center for NKR were analyzed retrospectively. Results Among tuberculin skin test (TST) ≥10 mm (n=298) reactors, the males accounted for 72.2% in SKC (n=126) and 19.5% in NKR (n=172) (p<0.01). The mean age was higher in South Korea (42.8±9.9 years vs. 35.4±10.0 years, p<0.01). Additionally, the mean TST size was significantly bigger in NKR (17.39±3.9 mm vs. 16.57±4.2 mm, p=0.03). The LTBI treatments were initiated for all screened NKR, and LTBI completion rate was only 68.0%. However, in NKR, LTBI treatment completion rate was significantly increased by shorter 4R regimen (odds ratio [OR], 9.296; 95% confidence interval [CI], 4.159–20.774; p<0.01) and male (OR, 3.447; 95% CI, 1.191–9.974; p=0.02). Conclusion LTBI treatment compliance must be improved in NKR with a shorter regimen. In addition, a larger study regarding a focus on LTBI with easy access to related data for NKR should be conducted.
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Affiliation(s)
- Beong Ki Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hee Jin Kim
- Korea Institute of Tuberculosis, Cheongju, Korea
| | - Ho Jin Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Hyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jin Beom Lee
- Korea Institute of Tuberculosis, Cheongju, Korea
| | - Jeonghe Jeon
- Settlement Support Center for North Korean Refugees (Hanawon), Hwacheon, Korea
| | - Chi Young Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Young Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Je Hyeong Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Chol Shin
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung Heon Lee
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
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8
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Sandgren A, Vonk Noordegraaf-Schouten M, van Kessel F, Stuurman A, Oordt-Speets A, van der Werf MJ. Initiation and completion rates for latent tuberculosis infection treatment: a systematic review. BMC Infect Dis 2016; 16:204. [PMID: 27184748 PMCID: PMC4869320 DOI: 10.1186/s12879-016-1550-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/07/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Control of latent tuberculosis infection (LTBI) is an important step towards tuberculosis elimination. Preventive treatment will prevent the development of disease in most cases diagnosed with LTBI. However, low initiation and completion rates affect the effectiveness of preventive treatment. The objective was to systematically review data on initiation rates and completion rates for LTBI treatment regimens in the general population and specific populations with LTBI. METHODS A systematic review of the literature (PubMed, Embase) published up to February 2014 was performed. RESULTS Forty-five studies on initiation rates and 83 studies on completion rates of LTBI treatment were found. These studies provided initiation rates (IR) and completion rates (CR) in people with LTBI among the general population (IR 26-99 %, CR 39-96 %), case contacts (IR 40-95 %, CR 48-82 %), healthcare workers (IR 47-98 %, CR 17-79 %), the homeless (IR 34-90 %, CR 23-71 %), people who inject drugs (IR 52-91 %, CR 38-89 %), HIV-infected individuals (IR 67-92 %, CR 55-95 %), inmates (IR 7-90 %, CR 4-100 %), immigrants (IR 23-97 %, CR 7-86 %), and patients with comorbidities (IR 82-93 %, CR 75-92 %). Generally, completion rates were higher for short than for long LTBI treatment regimens. CONCLUSION Initiation and completion rates for LTBI treatment regimens were frequently suboptimal and varied greatly within and across different populations.
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Affiliation(s)
- Andreas Sandgren
- Former Surveillance and Response Section, European Centre for Disease Prevention and Control (ECDC), Stockholm, 171 65, Sweden
| | | | - Femke van Kessel
- Pallas, Health Research and Consultancy B.V., Rotterdam, 3001, The Netherlands
| | - Anke Stuurman
- Pallas, Health Research and Consultancy B.V., Rotterdam, 3001, The Netherlands
| | - Anouk Oordt-Speets
- Pallas, Health Research and Consultancy B.V., Rotterdam, 3001, The Netherlands
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9
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Lee SH. Diagnosis and treatment of latent tuberculosis infection. Tuberc Respir Dis (Seoul) 2015; 78:56-63. [PMID: 25861337 PMCID: PMC4388901 DOI: 10.4046/trd.2015.78.2.56] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 02/12/2015] [Accepted: 03/09/2015] [Indexed: 02/04/2023] Open
Abstract
A small number of viable tuberculosis bacilli can reside in an individual with latent tuberculosis infection (LTBI) without obvious clinical symptoms or abnormal chest radiographs. Diagnosis and treatment for LTBI are important for tuberculosis (TB) control in public and private health, especially in high-risk populations. The updated 2014 Korean guidelines for TB recommend that tuberculin skin tests, interferon-gamma release assays, or a combination of the two can be used for LTBI diagnosis according to age and immune status of the host as well as TB contact history. The regimens for LTBI treatment include isoniazid, rifampicin, or isoniazid/rifampicin. However, results of drug susceptibility test from the index case must be considered in selecting the appropriate drug for recent contacts. Standardized LTBI diagnosis and treatment based on the new 2014 guidelines will contribute to the effective TB control in Korea as well as to the establishment of updated guidelines.
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Affiliation(s)
- Seung Heon Lee
- Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Cruz AT, Ahmed A, Mandalakas AM, Starke JR. Treatment of Latent Tuberculosis Infection in Children. J Pediatric Infect Dis Soc 2013; 2:248-58. [PMID: 26619479 DOI: 10.1093/jpids/pit030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/14/2013] [Indexed: 11/12/2022]
Abstract
Treatment of latent tuberculosis infection (LTBI) is an effective way of preventing future cases of tuberculosis disease. We review pediatric and adult studies of LTBI treatment (isoniazid and rifampin monotherapy, isoniazid plus rifampin, isoniazid plus rifapentine, and rifampin plus pyrazinamide). Based upon this review and our pediatric experience, we can offer recommendations for routine (isoniazid) and alternative courses of therapy.
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Affiliation(s)
- Andrea T Cruz
- The Tuberculosis Initiative of Texas Children's Hospital, and Sections of Infectious Diseases Emergency Medicine
| | - Amina Ahmed
- Division of Infectious Diseases, Department of Pediatrics, Carolinas Medical Center, Charlotte, North Carolina
| | - Anna M Mandalakas
- The Tuberculosis Initiative of Texas Children's Hospital, and Sections of The Tuberculosis Initiative of Texas Children's Hospital, and Sections of
| | - Jeffrey R Starke
- The Tuberculosis Initiative of Texas Children's Hospital, and Sections of Infectious Diseases
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