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Khattak M, Rehman AU, Muqaddas T, Hussain R, Rasool MF, Saleem Z, Almalki MS, Alturkistani SA, Firash SZ, Alzahrani OM, Bahauddin AA, Abuhussain SA, Najjar MF, Elsabaa HMA, Haseeb A. Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis. Ann Med 2024; 56:2313683. [PMID: 38346381 PMCID: PMC10863515 DOI: 10.1080/07853890.2024.2313683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2 DM on treatment outcomes of TB patients treated under the DOTS Programme. METHODS This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results. RESULTS In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56-0.83, p < .01 and HR 0.93, 95% CI 0.70-1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60-0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I2 = 55.79%). CONCLUSIONS A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB.
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Affiliation(s)
- Mahnoor Khattak
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anees ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Tuba Muqaddas
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Rabia Hussain
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | | | | | - Shuruq Zuhair Firash
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | | | - Muath Fahmi Najjar
- Department of Clinical Pharmacy, Al Rayan Private College of Health Sciences and Nursing, Madinah, Saudi Arabia
| | | | - Abdul Haseeb
- Department of Clinical Pharmacy, Al Rayan Private College of Health Sciences and Nursing, Madinah, Saudi Arabia
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Wagnew F, Alene KA, Kelly M, Gray D. Undernutrition increases the risk of unsuccessful treatment outcomes of patients with tuberculosis in Ethiopia: A multicenter retrospective cohort study. J Infect 2024; 89:106175. [PMID: 38729526 DOI: 10.1016/j.jinf.2024.106175] [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: 12/06/2023] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND While undernutrition has been identified as a common risk factor for tuberculosis (TB), its impact on treatment outcomes has yet to be investigated in high TB burden and low-income countries such as Ethiopia. Therefore, this study aimed to investigate the effect of undernutrition on treatment outcomes among patients with TB in northwest Ethiopia. METHODS A retrospective cohort study was conducted using data from different hospitals in northwest Ethiopia, for the period from July 2017 to August 2023. A Cox proportional hazard model was performed to determine the effect of undernutrition on TB treatment outcomes, which were defined as a composite of death, treatment failure, or loss to follow-up. RESULTS A total of 602 patients with TB were included in the analysis. Of these, 367 (60.9%) were male, and 344 (57.1%) were undernourished. Upon completion of the follow-up period, 65 (10.8%) adults with TB had unsuccessful treatment outcomes. After adjusting for potential confounders, patients with undernutrition had a two times higher risk of experiencing unsuccessful treatment outcomes compared to well-nourished patients (AHR: 2.0, 95% CI: 1.2, 3.6). In addition, patients residing in rural areas (AHR: 3.1, 95% CI: 1.7, 5.4), having a history of prior TB treatment (AHR: 2.2, 95%CI: 1.1, 4.1), and the presence of diabetes comorbidity (AHR: 2.4, 95% CI: 1.1, 5.2) were at higher risk of unsuccessful treatment outcomes. CONCLUSIONS Undernutrition increases the risk of unsuccessful treatment outcomes in Ethiopia. This finding suggests that nutritional support during TB treatment can improve successful treatment outcomes in high TB burden and low-income countries such as Ethiopia.
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Affiliation(s)
- Fasil Wagnew
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia; College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia; Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.
| | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Darren Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Oliveira Hashiguchi L, Ferrer JP, Suzuki S, Faguer BN, Solon JA, Castro MC, Ariyoshi K, Cox SE, Edwards T. Glycemic control during TB treatment among Filipinos: The Starting Anti-Tuberculosis Treatment Cohort Study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003156. [PMID: 38696522 PMCID: PMC11065219 DOI: 10.1371/journal.pgph.0003156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/03/2024] [Indexed: 05/04/2024]
Abstract
Poor TB treatment outcomes are observed in patients with type 2 diabetes mellitus (DM) comorbidity and glycemic control throughout treatment may play a role. The objective of this study was to investigate glycemic control longitudinally among Filipino adults undergoing TB treatment using mixed-effects linear and logistic regression. Analyses were conducted in 188 DM-TB patients out of 901 enrolled in the Starting Anti-TB Treatment (St-ATT) cohort, with a median baseline glycosylated hemoglobin (HbA1c) of 8.2% (range 4.5-13.3%). Previous versus new DM diagnosis was associated with higher mean HbA1c (worse glycemic control) during treatment, with a smaller effect amongst those with central obesity (coefficient 0.80, 95% confidence interval [CI] 0.26, 1.57, P = 0.043) than amongst those without central obesity (coefficient 3.48, 95% CI 2.16, 4.80, P<0.001). In those with a new DM diagnosis, central obesity was associated with higher blood glucose (coefficient 1.62, 95% CI 0.72, 2.53, P = 0.009). Of 177 participants with ≥2 HbA1c results, 40% had uncontrolled glycemia (≥2 HbA1c results ≥8%). Of 165 participants with ≥3 HbA1c results, 29.9% had consistently-controlled glycemia, 15.3% had initially-uncontrolled glycemia, and 18.6% had consistently-uncontrolled glycemia. Previous versus new DM diagnosis and glucose-lowering medication use versus no use were associated with having uncontrolled versus controlled glycemia (adjusted odds ratio [aOR] 2.50 95%CI 1.61, 6.05, P = 0.042; aOR 4.78 95% CI 1.61,14.23, P<0.001) and more likely to have consistently-uncontrolled versus consistently-controlled glycemia (adjusted relative risk ratio [aRRR] 5.14 95% CI 1.37, 19.20, P = 0.015; aRRR 10.24 95% CI 0.07, 0.95, P = 0.003). Relapse cases of TB were less likely than new cases to have uncontrolled (aOR 0.20 95%CI 0.06, 0.63, P = 0.031) or consistently-uncontrolled (aRRR 0.25 95%CI 0.07, 0.95, P = 0.042) versus controlled glycemia. Those with long-term DM, suggested by previous diagnosis, glucose-lowering medication use and possibly central obesity, may require additional support to manage blood glucose during TB treatment.
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Affiliation(s)
- Lauren Oliveira Hashiguchi
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Shuichi Suzuki
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Benjamin N. Faguer
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Juan Antonio Solon
- Nutrition Center of the Philippines, Muntinlupa City, Manila, Philippines
| | | | - Koya Ariyoshi
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Sharon E. Cox
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Tuberculosis Unit, United Kingdom Health Security Agency, London, United Kingdom
| | - Tansy Edwards
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
- Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
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López-González JA, Martínez-Soto JM, Avila-Cervantes C, Mata-Pineda AL, Álvarez-Hernández G, Álvarez-Meza JB, Bolado-Martínez E, Candia-Plata MDC. Evaluation of Systemic Inflammation Before and After Standard Anti-tuberculosis Treatment in Patients With Active Pulmonary Tuberculosis and Diabetes Mellitus. Cureus 2024; 16:e55391. [PMID: 38562330 PMCID: PMC10984244 DOI: 10.7759/cureus.55391] [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: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Diabetes mellitus (DM) is a common comorbidity of active pulmonary tuberculosis (APTB) that increases the risk of treatment failure during anti-tuberculosis chemotherapy. Evaluating systemic inflammatory response could help determine differences in response to treatment between APTB patients and those with APTB and DM. Methodology To explore changes in systemic inflammation, measured by a set of inflammatory mediators in subjects with APTB and TBDM before and after six months of anti-tuberculosis chemotherapy, 30 APTB and nine TBDM subjects underwent cytokine testing, including interleukin (IL)-6, IL-8, IL-10, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and transforming growth factor-beta 1 (TGF-β1) by enzyme-linked immunosorbent assay, C-reactive protein by nephelometry, and sialic acid by colorimetric assay at baseline and following six months of standard anti-tuberculosis treatment. Sputum smear microscopy or molecular biology (Xpert MTB/RIF) was used for diagnosis, and sputum smear microscopy was performed monthly during the treatment of the patient with pulmonary tuberculosis to evaluate his evolution. Principal component analysis examined changes in the inflammatory status. Results Both groups showed negative sputum smear microscopy in the sixth month after starting anti-tuberculosis chemotherapy. TGF-β1 was found to be significantly higher in subjects with TBDM before treatment compared to APTB patients (p<0.001), and systemic inflammation continued only in TBDM subjects after treatment (accumulation and persistence of inflammatory mediators like IL-6, IL-8, IL-10, IFN-γ, TNF-α, TGF-β1, C-reactive protein, and sialic acid in blood). On the other hand, the mediators IFN-γ, C-reactive protein, and total sialic acid were found to be most influential in distinguishing pre- and post-treatment inflammatory response in subjects with APTB without DM. Conclusions Inflammatory mediators analyzed in combination, including IFN-γ, CRP, and total sialic acid, may be useful in evaluating the systemic inflammatory response in subjects with APTB and TBDM before and after anti-tuberculosis treatment. Determining these mediators revealed persistent systemic inflammation in TBDM subjects after six months of standard tuberculosis treatment, despite negative sputum smear microscopy results and good glycemic control. This suggests a need for inflammation-modulating therapies during tuberculosis control. Finally, monitoring sputum smear microscopy results alongside the determination of proposed inflammatory mediators (IFN-γ, CRP, and total sialic acid) are effective in evaluating the response to anti-tuberculosis treatment in APTB subjects without DM, warranting further investigation.
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Panda S, Arora A, Luthra K, Mohan A, Vikram NK, Kumar Gupta N, Singh A. Hyperglycemia modulates M1/M2 macrophage polarization in chronic diabetic patients with pulmonary tuberculosis infection. Immunobiology 2024; 229:152787. [PMID: 38271857 DOI: 10.1016/j.imbio.2024.152787] [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: 08/31/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024]
Abstract
Increased susceptibility to bacterial infections like tuberculosis (TB) is one of the complications of type 2 diabetes, however the underlying mechanisms remains poorly characterized. To explore how chronic hyperglycemia in diabetes affects progression of active TB, we examined mRNA expression of M1 (proinflammatory) and M2 (anti-inflammatory) cytokines/markers, in monocyte-derived macrophages obtained from patients with PTB + DM (pulmonary TB + diabetes mellitus type 2), patients with DM alone, patients with PTB alone, and healthy individuals (controls). Our findings indicate a dysregulated cytokine response in patients with both PTB and DM, characterized by decreased expression levels of interferon-gamma (IFN-γ) and inducible nitric oxide synthase (iNOS), along with increased expression levels of interleukin-1 beta (IL-1β) and CD206. Furthermore, we observed a positive correlation of IL-1β and CD206 expression with levels of glycosylated hemoglobin (HbA1c) in both PTB + DM and DM groups, while IFN-γ showed a positive correlation with HbA1c levels, specifically in the PTB + DM group. Additionally, M1 cytokines/markers, IL-1β and iNOS were found to be significantly associated with the extent of sputum positivity in both PTB and PTB + DM groups, suggesting it to be a function of increased bacterial load and hence severity of infection. Our data demonstrates that tuberculosis in individuals with PTB + DM is characterized by altered M1/M2 cytokine responses, indicating that chronic inflammation associated with type 2 diabetes may contribute to increased immune pathology and inadequate control of tuberculosis infection.
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Affiliation(s)
- Sudhasini Panda
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi -110029, India
| | - Alisha Arora
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi -110029, India
| | - Kalpana Luthra
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi -110029, India
| | - Anant Mohan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi -110029, India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi -110029, India
| | - Neeraj Kumar Gupta
- Department of Pulmonary Medicine, VMMC and Safdarjung Hospital, New Delhi -110029, India
| | - Archana Singh
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi -110029, India.
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Kwak SH, Jeong D, Mok J, Jeon D, Kang HY, Kim HJ, Kim HS, Choi H, Kang YA. Association between diabetes mellitus and cause of death in patients with tuberculosis: A Korean nationwide cohort study. PLoS One 2023; 18:e0295556. [PMID: 38096233 PMCID: PMC10721100 DOI: 10.1371/journal.pone.0295556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/24/2023] [Indexed: 12/17/2023] Open
Abstract
Despite its significant impact on mortality, tuberculosis (TB)-diabetes mellitus (DM) co-prevalence has not been well-elucidated for the cause of death. We investigated the impact of DM on TB-related and non-TB-related deaths in patients with TB. This retrospective nationwide cohort study included patients diagnosed with TB between 2011 and 2017 in South Korea. We performed Fine and Gray regression model analyses to assess the mortality risk of DM classified by cause of death. Of 239,848 patients, 62,435 (26.0%) had DM, and 20,203 died during anti-TB treatment. Of all deaths, 47.9% (9,668) were caused by TB, and the remaining 52.1% (10,535) was attributed to various non-TB-related causes. The mortality rate was higher in the DM than in the non-DM groups in both men and women. DM was associated with a higher risk of TB-related (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [CI] 1.01-1.13) and non-TB-related (aHR 1.21, 95% CI 1.15-1.27) deaths in men; however, only a higher risk of non-TB-related deaths (aHR 1.29, 95% CI 1.20-1.38) in women. Our findings indicate that DM is independently associated with a greater risk of death during anti-TB treatment among patients with TB for both TB-related and non-TB-related deaths.
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Affiliation(s)
- Se Hyun Kwak
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Dawoon Jeong
- Department of Preventive Medicine, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Jeongha Mok
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Doosoo Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Hee-Yeon Kang
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Hee Jin Kim
- Jeju double cross clinic, Korean National Tuberculosis Association, Jeju, Republic of Korea
| | - Hee-Sun Kim
- Department of Health Policy Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Hongjo Choi
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
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Rojas-Espinosa O, Arce-Mendoza AY, Islas-Trujillo S, Muñiz-Buenrostro A, Arce-Paredes P, Popoca-Galván O, Moreno-Altamirano B, Rivero Silva M. Necrosis, netosis, and apoptosis in pulmonary tuberculosis and type-2 diabetes mellitus. Clues from the patient's serum. Tuberculosis (Edinb) 2023; 143:102426. [PMID: 38180029 DOI: 10.1016/j.tube.2023.102426] [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: 07/07/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 01/06/2024]
Abstract
Pulmonary tuberculosis (PTB) and type 2 diabetes mellitus (T2DM) are two inflammatory diseases whose pathology involves neutrophils (NEU) as key participants. Countless inflammatory elements produced at the lesion sites leak into the blood and are distributed systemically. The study aimed to investigate the effect of the serum of patients with PTB, T2DM, and PTB + T2DM on the cellular and nuclear morphology of healthy NEU. Monolayers of NEU were prepared and incubated with sera from PTB (n꓿ 10), T2DM (n꓿10), PTB + T2DM (n꓿ 10) patients, or sera from healthy people (n = 10). Monolayers were stained for histones, elastase, and myeloperoxidase for NETosis, annexin V for apoptosis, and Iris fuchsia for necrosis. Hoechst stain (DNA) was used to identify the nuclear alterations. Necrosis was the predominant alteration. Sera from PTB + T2DM were the most potent change inducers. Normal sera did not induce cell alterations. The blood of TBP and T2DM patients carries a myriad of abnormal elements that induce necrosis of NEU in normal people, thus reflecting what might occur in the neutrophils of the patients themselves. These findings reinforce the participation of NEU in the pathology of these diseases. Necrosis is expected to be the most frequent neutrophil-induced alteration in tuberculosis and diabetes mellitus.
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Affiliation(s)
- Oscar Rojas-Espinosa
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, 11340, Ciudad de México, Mexico.
| | - Alma Yolanda Arce-Mendoza
- Departamento de Inmunología, Facultad de Medicina, Universidad Autónoma de Nuevo León, 64460, Monterrey, Mexico.
| | - Sergio Islas-Trujillo
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, 11340, Ciudad de México, Mexico.
| | - Antonio Muñiz-Buenrostro
- Departamento de Inmunología, Facultad de Medicina, Universidad Autónoma de Nuevo León, 64460, Monterrey, Mexico.
| | - Patricia Arce-Paredes
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, 11340, Ciudad de México, Mexico.
| | - Omar Popoca-Galván
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, 11340, Ciudad de México, Mexico.
| | - Bertha Moreno-Altamirano
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, 11340, Ciudad de México, Mexico.
| | - Miguel Rivero Silva
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, 11340, Ciudad de México, Mexico.
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Herai Y, Yahaba M, Taniguchi T, Murata S, Chiba H, Igari H. Factors Influencing the Indeterminate Results in a T-SPOT.TB test: A Matched Case-control Study. Intern Med 2023; 62:3321-3326. [PMID: 37005270 DOI: 10.2169/internalmedicine.1006-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Objective A T-SPOT.TB can yield indeterminate results under two test observation conditions: a high response to the nil in negative control wells (high nil-control) or a low response to the mitogen in positive control wells (low mitogen-control). The most strongly influential factors for these indeterminate results, however, have yet to be identified. Methods From June 1, 2015, to June 30, 2021, we conducted a 1:1 matched case-control, retrospective study. Patients Patients who underwent a T-SPOT.TB test at Chiba University Hospital. Results The study included 5,956 participants. Indeterminate results were found in 63 participants (1.1%), including high nil-control in 37 and low mitogen-control in 26. Human T-cell leukemia virus type 1 (HTLV-1) positivity was the only influencing factor associated with high nil-control (adjusted odds ratio=98.5, 95% confidence interval: 6.59-1,480). Conclusion Regarding the indeterminate results, all HTLV-1 positive participants had a high nil response and no low mitogen response. It was suspected that abnormally produced interferon γ caused a nonspecific reaction to the negative control well, resulting in a high nil response. Low mitogen-control, conversely, did not appear to have any statistically significant influential factors.
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Affiliation(s)
- Yoriko Herai
- Division of Infection Control, Chiba University, Japan
| | - Misuzu Yahaba
- Division of Infection Control, Chiba University, Japan
| | | | - Shota Murata
- Division of Laboratory Medicine, Chiba University Hospital, Japan
| | - Hitoshi Chiba
- Division of Infection Control, Chiba University, Japan
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Meng F, Lan L, Wu G, Ren X, Yuan X, Yang M, Chen Q, Peng X, Liu D. Impact of diabetes itself and glycemic control status on tuberculosis. Front Endocrinol (Lausanne) 2023; 14:1250001. [PMID: 38027218 PMCID: PMC10663330 DOI: 10.3389/fendo.2023.1250001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives To explore the impact of diabetes itself and glycemic control status on tuberculosis (TB). Methods A total of 3393 patients with TB and diabetes mellitus (DM) who were hospitalized in the Public Health Clinical Center of Chengdu from January 1, 2019, to December 31, 2021, were retrospectively included and divided into three groups according to baseline glycemic control status: two groups according to glycemic status at discharge, two groups according to cavity occurrence, three groups according to sputum results, and three groups according to lesion location. The influencing factors and the differences in cavity occurrence, sputum positivity and lesion location among different glycemic control groups or between different glycemic status groups were analyzed. Results In this TB with DM cohort, most of the subjects were male, with a male to female ratio of 4.54:1, most of them were 45-59 years old, with an average age of 57.44 ± 13.22 years old. Among them, 16.8% (569/3393) had cavities, 52.2% (1770/3393) were sputum positive, 30.4% (1030/3393) had simple intrapulmonary lesions, 68.1% (2311/3393) had both intra and extrapulmonary lesions, only 15.8% (537/3393) had good glycemic control,16.0% (542/3393) and 68.2% (2314/3393) had fair and poor glycemic control, respectively. Compared with the non-cavity group, the sputum-negative group and the extrapulmonary lesion group, the cavity group, sputum-positive group, intrapulmonary lesion group and the intra and extrapulmonary lesion group all had higher fasting plasma glucose (FPG) and glycosylated hemoglobin A 1c (HbA1c) and lower good glycemic control rates at admission (all P<0.001). Another aspect, compared with the good glycemic control group, the poor glycemic control group had a higher cavity occurrence rate, sputum positive rate, and greater proportion of intrapulmonary lesions. Moreover, FPG and HbA1c levels and poor glycemic control were significantly positively correlated with cavity occurrence, sputum positivity, and intrapulmonary lesions and were the main risk factors for TB disease progression. On the other hand, cavity occurrence, sputum positivity, and intrapulmonary lesions were also main risk factors for hyperglycemia and poor glycemic control. Conclusion Diabetes itself and glycemic control status could impact TB disease. Good glycemic control throughout the whole process is necessary for patients with TB and DM to reduce cavity occurrence and promote sputum negative conversion and lesion absorption.
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Affiliation(s)
- Fanqi Meng
- The First Ward of Internal Medicine, Public Health Clinic Centre of Chengdu, Chengdu, China
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Lijuan Lan
- The First Ward of Internal Medicine, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Guihui Wu
- Tuberculosis (TB) Department, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Xiaoxia Ren
- The First Ward of Internal Medicine, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Xiaoyan Yuan
- The First Ward of Internal Medicine, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Ming Yang
- Tuberculosis (TB) Department, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Qing Chen
- Tuberculosis (TB) Department, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Xiaoli Peng
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Dafeng Liu
- The First Ward of Internal Medicine, Public Health Clinic Centre of Chengdu, Chengdu, China
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10
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Tamez-Torres KM, Mongua-Rodríguez N, Ferreyra-Reyes L, Torres-Gonzalez P, Delgado-Sánchez G, Martínez-Hernández M, Bobadilla-del-Valle M, Jasso-Sosa VY, López-Castillo PDS, Ferreira-Guerrero E, Cruz-Hervert LP, Sifuentes-Osornio J, Aguilar-Salinas CA, García-García L, Ponce-de-Leon A. Safety and Tolerability of Six Months of Isoniazid Plus Pyridoxine or Three Months of Rifampicin for Tuberculosis among Subjects with Diabetes Mellitus: A Randomized Trial. Microorganisms 2023; 11:1917. [PMID: 37630477 PMCID: PMC10459081 DOI: 10.3390/microorganisms11081917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Tuberculosis (TB) associated with diabetes mellitus (DM) is a growing problem, particularly in low- and medium-resource countries. We conducted an open-label, parallel-group, randomized, and controlled trial in a tertiary care center in Mexico City to assess TB preventive treatment (TPT) with isoniazid (INH) or rifampicin (RIF) in people with type 2 DM. Participants were assigned six months of INH 300 mg/day plus pyridoxine 75 mg or three months of RIF 600 mg/day. The primary outcomes were adverse events resulting in permanent treatment cessation and considered possibly or probably related to study drugs. We included 130 subjects, 68 randomized to INH and 62 to RIF. We prematurely halted the study based on recommendations of the Adverse Event Safety Panel. There was no difference between arms in the overall frequency of adverse events. However, the INH group had significantly more permanent treatment interruptions due to grade 2 recurrent or grade 3 or 4 hepatoxicity. In comparison, the RIF arm had more treatment interruptions due to grade 3 or 4 gastrointestinal intolerance. TPT using INH or RIF is not safe enough to be considered a universal indication to patients with type 2 DM and TB infection. These results underline the need to search for alternative TB preventions with better safety profiles for type 2 DM patients.
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Affiliation(s)
- Karla M. Tamez-Torres
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Norma Mongua-Rodríguez
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Leticia Ferreyra-Reyes
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Pedro Torres-Gonzalez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Guadalupe Delgado-Sánchez
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Maribel Martínez-Hernández
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
| | - Velma Y. Jasso-Sosa
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Priscila del S. López-Castillo
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Elizabeth Ferreira-Guerrero
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Luis Pablo Cruz-Hervert
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
- División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Jose Sifuentes-Osornio
- Dirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
| | - Carlos A. Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Lourdes García-García
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Alfredo Ponce-de-Leon
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
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11
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Alhamar G, Briganti S, Maggi D, Viola V, Faraj M, Zannella C, Galdiero M, Franci G, Fusco C, Isgrò C, Leanza G, Malandrucco I, Spinelli A, Tramontana F, Iaria D, Tortoriello R, Pieralice S, Rosati M, Matarese G, Pozzilli P, Galgani M, Strollo R. Prevaccination Glucose Time in Range Correlates With Antibody Response to SARS-CoV-2 Vaccine in Type 1 Diabetes. J Clin Endocrinol Metab 2023; 108:e474-e479. [PMID: 36611249 PMCID: PMC10807908 DOI: 10.1210/clinem/dgad001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
CONTEXT Poor glucose control has been associated with increased mortality in COVID-19 patients with type 1 diabetes (T1D). OBJECTIVE This work aimed to assess the effect of prevaccination glucose control on antibody response to the SARS-CoV-2 vaccine BNT162b2 in T1D. METHODS We studied 26 patients with T1D scheduled to receive 2 doses, 21 days apart, of BNT162b2, followed prospectively for 6 months with regular evaluation of SARS-CoV-2 antibodies and glucose control. Immunoglobulin G (IgG) to spike glycoprotein were assessed by enzyme-linked immunosorbent assay, and serum neutralization by a live SARS-CoV-2 assay (Vero E6 cells system). Glycated hemoglobin A1c (HbA1c) and continuous glucose monitoring (CGM), including time in range (TIR) and above range (TAR), were collected. The primary exposure and outcome measures were prevaccination glucose control, and antibody response after vaccination, respectively. RESULTS Prevaccination HbA1c was unrelated to postvaccine spike IgG (r = -0.33; P = .14). Of note, the CGM profile collected during the 2 weeks preceding BNT162b2 administration correlated with postvaccine IgG response (TIR: r = 0.75; P = .02; TAR: r = -0.81; P = .008). Patients meeting the recommended prevaccination glucose targets of TIR (≥ 70%) and TAR (≤ 25%) developed stronger neutralizing antibody titers (P < .0001 and P = .008, respectively), regardless of HbA1c. Glucose control along the study time frame was also associated with IgG response during follow-up (TIR: r = 0.93; P < .0001; TAR: r = -0.84; P < .0001). CONCLUSION In T1D, glucose profile during the 2 weeks preceding vaccination is associated with stronger spike antibody binding and neutralization, highlighting a role for well-controlled blood glucose in vaccination efficacy.
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Affiliation(s)
- Ghadeer Alhamar
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Dasman Diabetes Institute, 15462 Kuwait City, Kuwait
| | - Silvia Briganti
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Daria Maggi
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Viola Viola
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Malak Faraj
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Carla Zannella
- Dipartimento di Medicina Sperimentale, Università degli Studi della Campania “Luigi Vanvitelli,”80138 Naples, Italy
| | - Massimiliano Galdiero
- Dipartimento di Medicina Sperimentale, Università degli Studi della Campania “Luigi Vanvitelli,”80138 Naples, Italy
| | - Gianluigi Franci
- Dipartimento di Medicina Chirurgia ed Odontoiatria “Scuola Medica Salernitana,” Università degli Studi di Salerno, 84081 Baronissi, Italy
| | - Clorinda Fusco
- Istituto per l’Endocrinologia e l’Oncologia Sperimentale “G. Salvatore,” Consiglio Nazionale delle Ricerche, 80131 Naples, Italy
- Unità di Neuroimmunologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Santa Lucia, 00179 Rome, Italy
| | - Camilla Isgrò
- Department of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro,”70121 Bari, Italy
| | - Giulia Leanza
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Ilaria Malandrucco
- Unità Operativa Semplice Dipartimentale Endocrinologia e Malattie Metaboliche, Azienda Sanitaria Locale (ASL) Frosinone, 03100 Frosinone, Italy
| | - Andrea Spinelli
- Department of Science and Technology for Humans and the Environment, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Flavia Tramontana
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Domenico Iaria
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Rachele Tortoriello
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Silvia Pieralice
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Milena Rosati
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Giuseppe Matarese
- Istituto per l’Endocrinologia e l’Oncologia Sperimentale “G. Salvatore,” Consiglio Nazionale delle Ricerche, 80131 Naples, Italy
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli “Federico II,”80131 Naples, Italy
| | - Paolo Pozzilli
- Department of Medicine, Endocrinology & Diabetes Unit, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Mario Galgani
- Istituto per l’Endocrinologia e l’Oncologia Sperimentale “G. Salvatore,” Consiglio Nazionale delle Ricerche, 80131 Naples, Italy
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli “Federico II,”80131 Naples, Italy
| | - Rocky Strollo
- Department of Science and Technology for Humans and the Environment, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
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12
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Al-Neyadi M, Alghfeli S, Dukandar M. Hydropneumothorax With Bronchopleural Fistula Following the Activation of Mycobacterium tuberculosis: A Case Report. Cureus 2023; 15:e40844. [PMID: 37492837 PMCID: PMC10364847 DOI: 10.7759/cureus.40844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Tuberculosis is not a disease of the current era; failure to eradicate it continues to cause unusual complications, which results in detrimental sequelae to the patients. It usually presents with respiratory symptoms such as shortness of breath, cough, and fever, in addition to extrapulmonary symptoms. While there have been a few published case reports on patients presenting with hydropneumothorax due to tuberculosis, its occurrence is relatively rare. Furthermore, to the best of our knowledge, this is the first published case of hydropneumothorax due to tuberculosis within the United Arab Emirates, as confirmed by a search on PubMed. Here, we present a case of a young farmer from Bangladesh who presented with shortness of breath and fever and was found to have decreased air entry along with hyperresonance sounds on examination. Fortunately, the patient was in a stable state, required minimum oxygen therapy, and was not escalated for further noninvasive or invasive mechanical ventilation. The patient was admitted to a tertiary hospital to receive initial medical therapy interim to transfer the patient to a facility where thoracic surgeons are found.
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13
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Abbas U, Masood KI, Khan A, Irfan M, Saifullah N, Jamil B, Hasan Z. Tuberculosis and diabetes mellitus: Relating immune impact of co-morbidity with challenges in disease management in high burden countries. J Clin Tuberc Other Mycobact Dis 2022; 29:100343. [DOI: 10.1016/j.jctube.2022.100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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14
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Kathamuthu GR, Kumar NP, Moideen K, Menon PA, Babu S. Decreased Frequencies of Gamma/Delta T Cells Expressing Th1/Th17 Cytokine, Cytotoxic, and Immune Markers in Latent Tuberculosis-Diabetes/Pre-Diabetes Comorbidity. Front Cell Infect Microbiol 2021; 11:756854. [PMID: 34765568 PMCID: PMC8577793 DOI: 10.3389/fcimb.2021.756854] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
Antigen-specific gamma-delta (γδ) T cells are important in exhibiting anti-mycobacterial immunity, but their role in latent tuberculosis (LTB) with diabetes mellitus (DM) or pre-DM (PDM) and non-DM comorbidities have not been studied. Thus, we have studied the baseline, mycobacterial (PPD, WCL), and positive control antigen-stimulated γδ T cells expressing Th1 (IFNγ, TNFα, IL-2) and Th17 (IL-17A, IL-17F, IL-22) cytokine as well as cytotoxic (perforin [PFN], granzyme [GZE B], granulysin [GNLSN]) and immune (GMCSF, PD-1, CD69) markers in LTB (DM, PDM, NDM) comorbidities by flow cytometry. In the unstimulated (UNS) condition, we did not observe any significant difference in the frequencies of γδ T cells expressing Th1 and Th17 cytokine, cytotoxic, and immune markers. In contrast, upon PPD antigen stimulation, the frequencies of γδ T cells expressing Th1 (IFNγ, TNFα) and Th17 (IL-17F, IL-22) cytokine, cytotoxic (PFN, GZE B, GNLSN), and immune (CD69) markers were significantly diminished in LTB DM and/or PDM individuals compared to LTB NDM individuals. Similarly, upon WCL antigen stimulation, the frequencies of γδ T cells expressing Th1 (TNFα) and Th17 (IL-17A, IL-22) cytokine, cytotoxic (PFN), and immune (PD-1, CD69) markers were significantly diminished in LTB DM and/or PDM individuals compared to LTB NDM individuals. Finally, upon P/I stimulation we did not observe any significant difference in the γδ T cell frequencies expressing cytokine, cytotoxic, and immune markers between the study populations. The culture supernatant levels of IFNγ, TNFα, and IL-17A cytokines were significantly increased in LTB DM and PDM after stimulation with Mtb antigens compared to LTB NDM individuals. Therefore, diminished γδ T cells expressing cytokine, cytotoxic, and other immune markers and elevated levels of cytokines in the supernatants is a characteristic feature of LTB PDM/DM co-morbidities.
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Affiliation(s)
- Gokul Raj Kathamuthu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India.,Indian Council of Medical Research-National Institute for Research in Tuberculosis (ICMR-NIRT), Chennai, India
| | - Nathella Pavan Kumar
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India.,Indian Council of Medical Research-National Institute for Research in Tuberculosis (ICMR-NIRT), Chennai, India
| | - Kadar Moideen
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | - Pradeep A Menon
- Indian Council of Medical Research-National Institute for Research in Tuberculosis (ICMR-NIRT), Chennai, India
| | - Subash Babu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India.,Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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15
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Gupte AN, Kumar P, Araújo-Pereira M, Kulkarni V, Paradkar M, Pradhan N, Menon P, Chandrasekaran PD, Hanna LE, Yogendra Shivakumar SVB, Rockwood N, Du Bruyn E, Karyakarte R, Gaikwad S, Bollinger R, Golub J, Gupte N, Viswanathan V, Wilkinson RJ, Mave V, Babu S, Kornfeld H, Andrade BB, Gupta A. Baseline IL-6 is a biomarker for unfavorable tuberculosis treatment outcomes: a multi-site discovery and validation study. Eur Respir J 2021; 59:13993003.00905-2021. [PMID: 34711538 PMCID: PMC7612881 DOI: 10.1183/13993003.00905-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
Abstract
Background Biomarkers of unfavorable tuberculosis treatment outcomes are needed to accelerate new drug and regimen development. Whether plasma cytokine levels can predict unfavorable tuberculosis treatment outcomes is unclear. Methods We identified and internally validated the association between 20 a-priori selected plasma inflammatory markers and unfavorable treatment outcomes of failure, recurrence and all-cause mortality among adults with drug-sensitive pulmonary tuberculosis in India. We externally validated these findings in two independent cohorts of predominantly diabetic and HIV coinfected tuberculosis patients in India and South Africa, respectively. Results Pre-treatment IFN-γ, IL-13 and IL-6 were associated with treatment failure in the discovery analysis. Internal validation confirmed higher pre-treatment IL-6 concentrations among failure cases compared to controls. External validation among predominantly diabetic tuberculosis patients found an association between pre-treatment IL-6 concentrations and subsequent recurrence and death. Similarly, external validation among predominantly HIV coinfected tuberculosis patients found an association between pre-treatment IL-6 concentrations and subsequent treatment failure and death. In a pooled analysis of 363 tuberculosis cases from the Indian and South African validation cohorts, high pre-treatment IL-6 concentrations were associated with higher risk of failure (adjusted odds ratio [aOR]=2.16, 95%CI 1.08-4.33, p=0.02), recurrence (aOR=5.36, 95%CI 2.48-11.57, p<0.001) and death (aOR=4.62, 95%CI 1.95-10.95, p<0.001). Adding baseline IL-6 to a risk-prediction model comprising of low BMI, high smear grade and cavitation improved model performance by 15 percent (C-statistic of 0.66 versus 0.76, p=0.02). Conclusion Pre-treatment IL-6 is a biomarker for unfavorable tuberculosis treatment outcomes. Future studies should identify optimal IL-6 concentrations for point-of-care risk prediction.
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Affiliation(s)
- Akshay N Gupte
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA .,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Pavan Kumar
- National Institute for Research in Tuberculosis, Chennai, India
| | - Mariana Araújo-Pereira
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Vandana Kulkarni
- Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA.,Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins India Private Limited, Pune, India
| | - Mandar Paradkar
- Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA.,Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins India Private Limited, Pune, India
| | - Neeta Pradhan
- Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA.,Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins India Private Limited, Pune, India
| | - Pradeep Menon
- National Institute for Research in Tuberculosis, Chennai, India
| | | | | | | | - Neesha Rockwood
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Microbiology, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka.,Department of Infectious Diseases, Imperial College London, United Kingdom
| | - Elsa Du Bruyn
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Infectious Diseases, University of Cape Town, Observatory, South Africa
| | - Rajesh Karyakarte
- Department of Microbiology, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Sanjay Gaikwad
- Department of Pulmonary Medicine, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Robert Bollinger
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jonathan Golub
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Tuberculosis Research, Johns Hopkins University, Baltimore, USA
| | - Nikhil Gupte
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Robert J Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Infectious Diseases, Imperial College London, United Kingdom.,Department of Infectious Diseases, University of Cape Town, Observatory, South Africa.,The Francis Crick Institute, London, UK
| | - Vidya Mave
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Subash Babu
- National Institutes of Health - National Institute for Research in Tuberculosis - International Center for Excellence in Research, Chennai, India
| | - Hardy Kornfeld
- Division of Pulmonary Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Bruno B Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, USA
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16
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Ssekamatte P, Nakibuule M, Nabatanzi R, Egesa M, Musubika C, Bbuye M, Hepworth MR, Doherty DG, Cose S, Biraro IA. Type 2 Diabetes Mellitus and Latent Tuberculosis Infection Moderately Influence Innate Lymphoid Cell Immune Responses in Uganda. Front Immunol 2021; 12:716819. [PMID: 34512639 PMCID: PMC8432960 DOI: 10.3389/fimmu.2021.716819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/16/2021] [Indexed: 12/19/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a major risk factor for the acquisition of latent tuberculosis (TB) infection (LTBI) and development of active tuberculosis (ATB), although the immunological basis for this susceptibility remains poorly characterised. Innate lymphoid cells (ILCs) immune responses to TB infection in T2DM comorbidity is anticipated to be reduced. We compared ILC responses (frequency and cytokine production) among adult patients with LTBI and T2DM to patients (13) with LTBI only (14), T2DM only (10) and healthy controls (11). Methods Using flow cytometry, ILC phenotypes were categorised based on (Lin−CD127+CD161+) markers into three types: ILC1 (Lin−CD127+CD161+CRTH2-CD117−); ILC2 (Lin−CD127+CD161+CRTH2+) and ILC3 (Lin−CD127+CD161+CRTH2−NKp44+/−CD117+). ILC responses were determined using cytokine production by measuring percentage expression of interferon-gamma (IFN-γ) for ILC1, interleukin (IL)-13 for ILC2, and IL-22 for ILC3. Glycaemic control among T2DM patients was measured using glycated haemoglobin (HbA1c) levels. Data were analysed using FlowJo version 10.7.1, and GraphPad Prism version 8.3. Results Compared to healthy controls, patients with LTBI and T2DM had reduced frequencies of ILC2 and ILC3 respectively (median (IQR): 0.01 (0.005-0.04) and 0.002 (IQR; 0.002-0.007) and not ILC1 (0.04 (0.02-0.09) as expected. They also had increased production of IFN-γ [median (IQR): 17.1 (5.6-24.9)], but decreased production of IL-13 [19.6 (12.3-35.1)]. We however found that patients with T2DM had lower ILC cytokine responses in general but more marked for IL-22 production (median (IQR): IFN-γ 9.3 (4.8-22.6); IL-13 22.2 (14.7-39.7); IL-22 0.7 (IQR; 0.1-2.1) p-value 0.02), which highlights the immune suppression status of T2DM. We also found that poor glycaemic control altered ILC immune responses. Conclusion This study demonstrates that LTBI and T2DM, and T2DM were associated with slight alterations of ILC immune responses. Poor T2DM control also slightly altered these ILC immune responses. Further studies are required to assess if these responses recover after treatment of either TB or T2DM.
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Affiliation(s)
- Phillip Ssekamatte
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marjorie Nakibuule
- Immunomodulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Rose Nabatanzi
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Egesa
- Immunomodulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda.,Department of Infection Biology, Faculty of Infectious and Tropical Diseases, LSHTM, London, United Kingdom
| | - Carol Musubika
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mudarshiru Bbuye
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Matthew R Hepworth
- Division of Infection, Immunity & Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Lydia Becker Institute of Immunology and Inflammation and Manchester Collaborative Centre for Inflammation Research (MCCIR), Manchester, United Kingdom
| | | | - Stephen Cose
- Immunomodulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Irene Andia Biraro
- Immunomodulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda.,Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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17
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Lesnic E, Malic A, Tafuni O. The impact of diabetes mellitus on the anti-tuberculosis treatment outcome: a series of cases from the Republic of Moldova. Med Pharm Rep 2021; 94:325-332. [PMID: 34430854 DOI: 10.15386/mpr-1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/17/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background and aims The Republic of Moldova ranks among the European Region countries with the highest global incidence of tuberculosis. Almost 5% of the cases with pulmonary TB had been diagnosed with DM in 2017. The aim of this study was to assess the impact of diabetes mellitus on the anti-tuberculosis treatment effectiveness for the improvement of the disease outcome. Methods A retrospective, longitudinal and case-control study, which included a total number of 252 patients diagnosed with pulmonary tuberculosis and distributed into a study group of 93 patients diagnosed with diabetes mellitus and a control group of 159 patients without glycemic disorders was performed. The statistical analysis was performed using EpiInfo software. The statistical analysis of the differences between normally distributed continuous variables was tested with the Student T-test. Results Based on the collected data we established that the majority of the patients with glycemic disorders were diagnosed with the type 2 diabetes, associated with hyperglycemia and in half of them complications of diabetes were revealed. The age older 55 years and the low economical state were common characteristics of the diabetic patients. Tuberculosis was detected in every second diabetic patient through the radiological screening compared with the passive detection of most of the non-diabetic patients. The anti-tuberculosis treatment outcome was endangered by a higher rate of the adverse drug events in patients with diabetes, which contributed to death in 15%, lost to follow-up 7%, and therapeutic failure in 6%. Conclusions The anti-tuberculous treatment outcome in patients diagnosed with tuberculosis and diabetes mellitus was significantly diminished by glycemic disorders, history of the previous anti-tuberculous treatment and adverse drug reactions. Individualized therapeutic approach to tuberculosis could improve the treatment effectiveness.
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Affiliation(s)
- Evelina Lesnic
- Department of Pneumophthisiology, Nicolae Testemiţanu State Medicine and Pharmacy University, Republic of Moldova
| | - Alina Malic
- Department of Pneumophthisiology, Nicolae Testemiţanu State Medicine and Pharmacy University, Republic of Moldova
| | - Ovidiu Tafuni
- Department of Pneumophthisiology, Nicolae Testemiţanu State Medicine and Pharmacy University, Republic of Moldova
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18
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Chen Z, Liu Q, Song R, Zhang W, Wang T, Lian Z, Sun X, Liu Y. The association of glycemic level and prevalence of tuberculosis: a meta-analysis. BMC Endocr Disord 2021; 21:123. [PMID: 34134685 PMCID: PMC8207612 DOI: 10.1186/s12902-021-00779-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 06/01/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Diabetes is a well-known risk factor for tuberculosis and poorly glycemic control may increase the risk of tuberculosis. We performed a meta-analysis to explore the association of glycemic control in diabetic patients and their tuberculosis prevalence. METHODS We included observational studies that investigated the prevalence of tuberculosis associated with glycemic control. The markers of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose were used to evaluate the exposure of interest in the study. We searched related articles in PubMed, EMBASE and Web of Science through 14 December 2019. The Newcastle-Ottawa scale was used to assess the risk of bias of included studies. RESULTS Seventeen studies (four cohort studies, five case-control studies and eight cross-sectional studies) were included, involving 1,027,074 participants. The meta-analysis found the pooled odds ratio of prevalent tuberculosis increased a 2.05-fold (95%CI: 1.65, 2.55) for the patients with HbA1c ≥7.0% compared to those with HbA1c concentration < 7.0%. Furthermore, we found the mean of HbA1c was higher in the diabetes mellitus with tuberculosis group than the diabetes-only group (P = 0.002). In the sensitivity analysis, the finding remains consistent. CONCLUSION Our study provides the evidence that poorly controlled diabetes in diabetics may be associated with increased prevalence of tuberculosis. More efforts should focus on screening tuberculosis in uncontrolled diabetes.
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Affiliation(s)
- Zhifei Chen
- Wuhan Pulmonary Hospital, Wuhan, Hubei, China.
| | - Qi Liu
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ranran Song
- Department of Maternal and Child Health and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Wuhan, Hubei, China
| | - Wenxin Zhang
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Zhan Lian
- Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Xuezhi Sun
- Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Yanli Liu
- Wuhan Pulmonary Hospital, Wuhan, Hubei, China
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19
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Karamat A, Ambreen A, Ishtiaq A, Tahseen S, Rahman MA, Mustafa T. Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan. BMC Infect Dis 2021; 21:381. [PMID: 33894767 PMCID: PMC8070300 DOI: 10.1186/s12879-021-06086-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/14/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is scarce knowledge on the prevalence of diseases caused by non-tuberculous mycobacteria (NTM) in Pakistan. In the absence of culture and identification, acid-fast bacilli (AFB) causing NTM disease are liable to be misinterpreted as tuberculosis (TB). Introduction of nucleic acid amplification testing for Mycobacterium tuberculosis complex (MTBC) offers improved diagnostic accuracy, compared with smear microscopy, and also assists in differentiating MTBC from other mycobacteria. This study aimed to investigate the prevalence of NTM among patients investigated for TB and describe NTM disease and treatment outcomes at a tertiary care hospital in Pakistan. METHODS This is a retrospective study, data on NTM isolates among culture-positive clinical samples over 4 years (2016-19) was retrieved from laboratory records. Information on clinical specimens processed, AFB smear results, and for the AFB positive isolates, results of species identification for MTBC, and for NTM isolates, results of species characterization and drug susceptibility testing was collected. Additional clinical data including patient characteristics, treatment regimens, and outcomes were collected for patients with NTM disease treated at Gulab Devi Hospital, Lahore. RESULTS During the study period, 12,561 clinical specimens were processed for mycobacterial culture and 3673 (29%) were reported positive for AFB. Among these 3482 (95%) were identified as MTBC and 191 (5%) as NTM. Among NTM, 169 (88%) were isolated from pulmonary and 22 (12%) from extrapulmonary specimens. Results of NTM speciation were available for 60 isolates and included 55% (n = 33) M. avium complex and 25% (n = 15) M. abscesses. Among these patients, complete clinical records were retrieved for 12 patients with pulmonary disease including nine infected with M. avium complex and three with M. abscessus. All 12 patients had a history of poor response to standard first-line anti-TB treatment. Ten patients were cured after 18 months of treatment, whereas, one with M. abscessus infection died and another was lost to follow up. CONCLUSION In TB endemic areas, NTM can be misdiagnosed as pulmonary TB leading to repeated failed anti-TB treatment and increased morbidity, emphasizing the need for improved diagnosis.
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Affiliation(s)
- Asifa Karamat
- Department of Tuberculosis and Chest Medicine, Gulab Devi Hospital, Lahore, Pakistan
| | - Atiqa Ambreen
- Department of Microbiology, Gulab Devi Hospital, Lahore, Pakistan
| | - Aamira Ishtiaq
- Department of Tuberculosis and Chest Medicine, Gulab Devi Hospital, Lahore, Pakistan
| | - Sabira Tahseen
- National Tuberculosis Control Programme and National Tuberculosis Reference Laboratory, Islamabad, Pakistan
| | | | - Tehmina Mustafa
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. box 7804, N-5020, Bergen, Norway. .,Department of Thoracic medicine, Haukeland University Hospital, Bergen, Norway.
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20
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Yu KK, Fischinger S, Smith MT, Atyeo C, Cizmeci D, Wolf CR, Layton ED, Logue JK, Aguilar MS, Shuey K, Loos C, Yu J, Franko N, Choi RY, Wald A, Barouch DH, Koelle DM, Lauffenburger D, Chu HY, Alter G, Seshadri C. Comorbid illnesses are associated with altered adaptive immune responses to SARS-CoV-2. JCI Insight 2021; 6:146242. [PMID: 33621211 PMCID: PMC8026190 DOI: 10.1172/jci.insight.146242] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/17/2021] [Indexed: 12/16/2022] Open
Abstract
Comorbid medical illnesses, such as obesity and diabetes, are associated with more severe COVID-19, hospitalization, and death. However, the role of the immune system in mediating these clinical outcomes has not been determined. We used multiparameter flow cytometry and systems serology to comprehensively profile the functions of T cells and antibodies targeting spike, nucleocapsid, and envelope proteins in a convalescent cohort of COVID-19 subjects who were either hospitalized (n = 20) or not hospitalized (n = 40). To avoid confounding, subjects were matched by age, sex, ethnicity, and date of symptom onset. Surprisingly, we found that the magnitude and functional breadth of virus-specific CD4+ T cell and antibody responses were consistently higher among hospitalized subjects, particularly those with medical comorbidities. However, an integrated analysis identified more coordination between polyfunctional CD4+ T cells and antibodies targeting the S1 domain of spike among subjects who were not hospitalized. These data reveal a functionally diverse and coordinated response between T cells and antibodies targeting SARS-CoV-2, which is reduced in the presence of comorbid illnesses that are known risk factors for severe COVID-19.
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Affiliation(s)
- Krystle Kq Yu
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Stephanie Fischinger
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA.,PhD program in Immunology and Virology, University of Duisburg-Essen, Essen, Germany
| | - Malisa T Smith
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Caroline Atyeo
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA.,PhD program in Virology, Division of Medical Sciences, Harvard University, Boston, Massachusetts, USA
| | - Deniz Cizmeci
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Caitlin R Wolf
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erik D Layton
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jennifer K Logue
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Melissa S Aguilar
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kiel Shuey
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Carolin Loos
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Jingyou Yu
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas Franko
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Anna Wald
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Epidemiology and.,Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Dan H Barouch
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA.,Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David M Koelle
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA.,Benaroya Research Institute, Seattle, Washington, USA
| | - Douglas Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Helen Y Chu
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | - Chetan Seshadri
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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21
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DiNardo AR, Nishiguchi T, Grimm SL, Schlesinger LS, Graviss EA, Cirillo JD, Coarfa C, Mandalakas AM, Heyckendorf J, Kaufmann SHE, Lange C, Netea MG, Van Crevel R. Tuberculosis endotypes to guide stratified host-directed therapy. MED 2021; 2:217-232. [PMID: 34693385 DOI: 10.1016/j.medj.2020.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is hope that host-directed therapy (HDT) for Tuberculosis (TB) can either shorten treatment duration, help cure drug resistant disease or limit the immunopathology. Many candidate HDT drugs have been proposed, however solid evidence only exists for a few select patient groups. The clinical presentation of TB is variable, with differences in severity, tissue pathology, and bacillary burden. TB clinical phenotypes likely determine the potential benefit of HDT. Underlying TB clinical phenotypes, there are TB "endotypes," defined as distinct molecular profiles, with specific metabolic, epigenetic, transcriptional, and immune phenotypes. TB endotypes can be characterized by either immunodeficiency or pathologic excessive inflammation. Additional factors, like comorbidities (HIV, diabetes, helminth infection), structural lung disease or Mycobacterial virulence also drive TB endotypes. Precise disease phenotyping, combined with in-depth immunologic and molecular profiling and multimodal omics integration, can identify TB endotypes, guide endotype-specific HDT, and improve TB outcomes, similar to advances in cancer medicine.
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Affiliation(s)
- Andrew R DiNardo
- The Global Tuberculosis Program, Texas Children's Hospital, Immigrant and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Tomoki Nishiguchi
- The Global Tuberculosis Program, Texas Children's Hospital, Immigrant and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sandra L Grimm
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.,Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | | | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Jeffrey D Cirillo
- Department of Microbial and Molecular Pathogenesis, Texas A&M College of Medicine, Bryan, TX, USA
| | - Cristian Coarfa
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.,Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | - Anna M Mandalakas
- The Global Tuberculosis Program, Texas Children's Hospital, Immigrant and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jan Heyckendorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Borstel, Germany.,Respiratory Medicine & International Health, University of Lübeck, Lü beck, Germany
| | - Stefan H E Kaufmann
- Max Planck Institute for Infection Biology, Berlin, Germany.,Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA.,Max Planck Institute for Biophysical Chemistry, Am Faßberg 11, 37077 Gö ttingen, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Borstel, Germany.,Respiratory Medicine & International Health, University of Lübeck, Lü beck, Germany
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
| | - Reinout Van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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22
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Wachinou AP, Ade S, Ndour Mbaye M, Bah B, Baldé N, Gninkoun J, Bekou W, Sarr M, Bah Sow O, Affolabi D, Merle C. Tuberculosis prevalence and associated factors among persons with diabetes mellitus after intensified case finding in three West African countries. Multidiscip Respir Med 2021; 16:783. [PMID: 34557300 PMCID: PMC8404526 DOI: 10.4081/mrm.2021.783] [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: 05/13/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022] Open
Abstract
Background To determine the prevalence of tuberculosis (TB) and associated factors in persons with diabetes mellitus (DM) in Benin, Guinea and Senegal. Patients and Method A cross-sectional study was conducted in the largest DM center in each country. Participants systematically underwent clinical screening and chest radiography. Participants who were symptomatic or with abnormal radiography underwent bacteriological investigations (sputum smear, Xpert MTB/RIF and culture) on sputum. Participants with no TB at enrolment were re-examined for TB six months later. Logistic regression was performed to identify factors associated with TB. Results There were 5,870 DM patients: 1,881 (32.0%) in Benin, 1,912 (32.6%) in Guinea and 2,077 (35.4%) in Senegal. Out of these, 114 had bacteriologically-confirmed TB, giving a pooled prevalence of 1.9% (95%CI=1.6-2.3). TB prevalence was 0.5% (95%CI=0.3-1.0), 2.4% (95%CI=1.8-3.2) and 2.8% (95%CI=2.2-3.6), respectively, in Benin, Guinea and Senegal. Factors associated with an increased odds of TB diagnosis were a usual residence in Guinea (aOR=2.62;95%CI=1.19-5.77; p=0.016) or in Senegal (aOR=3.73;95%CI=1.85-7.51; p<0.001), the age group of 35-49 years (aOR=2.30;95%CI=1.11-4.79; p=0.025), underweight (aOR=7.34;95%CI=4.65-11.57; p<0.001) and close contact with a TB case (aOR=2.27;95%CI=1.37-3.76; p=0.002). Obesity was associated with lower odds of TB (aOR=0.20; 95%CI=0.06-0.65; p=0.008). Conclusion TB is prevalent among DM patients in Benin, Guinea and Senegal and higher than among the general population. The findings support the need for intensified case finding in DM patients in order to ensure systematic early detection of TB during the routine consultation process.
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Affiliation(s)
- Ablo Prudence Wachinou
- Faculty of School of Medicine, University of Abomey-Calavi, Cotonou, Benin.,National Tuberculosis Programme of Benin, Cotonou, Benin
| | - Serge Ade
- National Tuberculosis Programme of Benin, Cotonou, Benin.,Faculty of Medicine, University of Parakou, Parakou, Benin
| | | | - Boubacar Bah
- Service de Pneumophtisiologie, Centre National Hospitalier Ignace Deen, Conakry, Guinea
| | - Naby Baldé
- Service d'endocrinologie, Centre Hospitalier Universitaire Donka, Conakry, Guinea
| | - Jules Gninkoun
- Faculty of School of Medicine, University of Abomey-Calavi, Cotonou, Benin
| | - Wilfried Bekou
- National Tuberculosis Programme of Benin, Cotonou, Benin
| | - Marie Sarr
- National Tuberculosis Programme of Senegal, Dakar, Senegal
| | - Oumou Bah Sow
- Service de Pneumophtisiologie, Centre National Hospitalier Ignace Deen, Conakry, Guinea
| | - Dissou Affolabi
- Faculty of School of Medicine, University of Abomey-Calavi, Cotonou, Benin.,National Tuberculosis Programme of Benin, Cotonou, Benin
| | - Corinne Merle
- Tropical Disease Research Special Programme, World Health Organization, Geneva, Switzerland.,London School of Hygiene and Tropical Medicine, LSHTM, London, UK
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23
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Mily A, Sarker P, Taznin I, Hossain D, Haq MA, Kamal SMM, Agerberth B, Brighenti S, Raqib R. Slow radiological improvement and persistent low-grade inflammation after chemotherapy in tuberculosis patients with type 2 diabetes. BMC Infect Dis 2020; 20:933. [PMID: 33287713 PMCID: PMC7722325 DOI: 10.1186/s12879-020-05473-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Diabetes mellitus type 2 (DM) may impede immune responses in tuberculosis (TB) and thus contribute to enhanced disease severity. In this study, we aimed to evaluate DM-mediated alterations in clinical, radiological and immunological outcomes in TB disease. Methods Newly diagnosed pulmonary TB patients with or without DM (TB n = 40; TB-DM n = 40) were recruited in Dhaka, Bangladesh. Clinical symptoms, sputum smear and culture conversion as well as chest radiography were assessed. Peripheral blood and sputum samples were collected at the time of diagnosis (baseline) and after 1, 2 and 6 months of standard anti-TB treatment. Blood samples were also obtained from healthy controls (n = 20). mRNA expression of inflammatory markers in blood and sputum samples were quantified using real-time PCR. Results The majority of TB-DM patients had poor glycemic control (HbA1c > 8%) and displayed elevated pulmonary pathology (P = 0.039) particularly in the middle (P < 0.004) and lower lung zones (P < 0.02) throughout the treatment period. However, reduction of clinical symptoms and time to sputum smear and culture conversion did not differ between the groups. Transcripts levels of the pro-inflammatory cytokines IL-1β (P = 0.003 at month-1 and P = 0.045 at month-2) and TNF-α (P = 0.005 at month-1) and the anti-inflammatory cytokine IL-10 (P = 0.005 at month-2) were higher in peripheral blood after anti-TB treatment in TB-DM compared to TB patients. Conversely in sputum, TB-DM patients had reduced CD4 (P < 0.009 at month-1) and IL-10 (P = 0.005 at month-1 and P = 0.006 at month-2) transcripts, whereas CD8 was elevated (P = 0.016 at month-2). At 1- and 2-month post-treatment, sputum IL-10 transcripts were inversely correlated with fasting blood glucose and HbA1c levels in all patients. Conclusion Insufficient up-regulation of IL-10 in the lung may fuel persistent local inflammation thereby promoting lung pathology in TB-DM patients with poorly controlled DM.
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Affiliation(s)
- Akhirunnesa Mily
- Center for Infectious Medicine (CIM), Department of Medicine Huddinge, ANA Futura, Karolinska Institutet, Stockholm, Sweden.,Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Protim Sarker
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Inin Taznin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Delwar Hossain
- Respiratory Medicine, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Md Ahsanul Haq
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - S M Mostofa Kamal
- National Institute of the Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - Birgitta Agerberth
- Clinical Microbiology, Department of Laboratory Medicine (Labmed), ANA Futura, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Brighenti
- Center for Infectious Medicine (CIM), Department of Medicine Huddinge, ANA Futura, Karolinska Institutet, Stockholm, Sweden
| | - Rubhana Raqib
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
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24
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Yu KK, Fischinger S, Smith MT, Atyeo C, Cizmeci D, Wolf CR, Layton ED, Logue JK, Aguilar MS, Shuey K, Loos C, Yu J, Franko N, Choi RY, Wald A, Barouch DH, Koelle DM, Lauffenburger D, Chu HY, Alter G, Seshadri C. T cell and antibody functional correlates of severe COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.25.20235150. [PMID: 33269369 PMCID: PMC7709190 DOI: 10.1101/2020.11.25.20235150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Comorbid medical illnesses, such as obesity and diabetes, are associated with more severe COVID-19, hospitalization, and death. However, the role of the immune system in mediating these clinical outcomes has not been determined. We used multi-parameter flow cytometry and systems serology to comprehensively profile the functions of T cells and antibodies targeting spike, nucleocapsid, and envelope proteins in a convalescent cohort of COVID-19 subjects who were either hospitalized (n=20) or not hospitalized (n=40). To avoid confounding, subjects were matched by age, sex, ethnicity, and date of symptom onset. Surprisingly, we found that the magnitude and functional breadth of virus-specific CD4 T cell and antibody responses were consistently higher among hospitalized subjects, particularly those with medical comorbidities. However, an integrated analysis identified more coordination between polyfunctional CD4 T-cells and antibodies targeting the S1 domain of spike among subjects that were not hospitalized. These data reveal a functionally diverse and coordinated response between T cells and antibodies targeting SARS-CoV-2 which is reduced in the presence of comorbid illnesses that are known risk factors for severe COVID-19. Our data suggest that isolated measurements of the magnitudes of spike-specific immune responses are likely insufficient to anticipate vaccine efficacy in high-risk populations.
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Affiliation(s)
- Krystle K.Q. Yu
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Stephanie Fischinger
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA
- PhD program in Immunology and Virology, University of Duisburg-Essen, Essen, Germany
| | - Malisa T. Smith
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Caroline Atyeo
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA
- PhD program in Virology, Division of Medical Sciences, Harvard University, Boston, MA, USA
| | - Deniz Cizmeci
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Caitlin R. Wolf
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Erik D. Layton
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jennifer K. Logue
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Melissa S. Aguilar
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Kiel Shuey
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Carolin Loos
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jingyou Yu
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Nicholas Franko
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Anna Wald
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Dan H. Barouch
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - David M. Koelle
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Benaroya Research Institute, Seattle, WA, USA
| | - Douglas Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Helen Y. Chu
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA
| | - Chetan Seshadri
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Koo HK, Min J, Kim HW, Lee J, Kim JS, Park JS, Lee SS. Prediction of treatment failure and compliance in patients with tuberculosis. BMC Infect Dis 2020; 20:622. [PMID: 32831044 PMCID: PMC7446045 DOI: 10.1186/s12879-020-05350-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background To improve treatment outcomes for tuberculosis (TB), efforts to reduce treatment failure are necessary. The aim of our study was to describe the characteristics of subjects who had failed treatment of tuberculosis and identify the risk factors for treatment failure and poor compliance using national data. Methods A multicenter cross-sectional study was performed on tuberculosis subjects whose final outcome was reported as treatment failure during 2015–2017. The same number of subjects with treatment success during the same study period were randomly selected for comparison. Demographics, microbiological, radiographic, and clinical data were collected based on in-depth interviews by TB nurse specialists at all Public Private Mix (PPM) participating hospitals in South Korea. Results A total of 52 tuberculosis patients with treatment failure were enrolled. In a multivariable analysis, the presence of diabetes, previous history of tuberculosis, and cavity were identified as risk factors for treatment failure; and Medicaid support was a favorable factor for treatment success (area under the curve [AUC]: 0.79). Age, low body mass index (BMI), presence of diabetes, preexisting lung disease, positive sputum acid-fast bacilli (AFB) smear result, and the presence of multidrug-resistant tuberculosis (MDR-TB) were significantly associated with presence of cavities. Younger age, lower BMI and previous history of TB were associated with poor compliance during treatment (AUC: 0.76). Conclusion To reduce treatment failure, careful evaluation of the presence of diabetes, previous TB history, underlying lung disease, cavity, results of sputum AFB smears, and socioeconomic status are needed. To enhance treatment compliance, more attention should be paid to younger patients with lower BMIs during follow-up.
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Affiliation(s)
- Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Juhwa-ro 170, Ilsanseo-gu, Goyang, 10380, Republic of Korea
| | - Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - 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, Republic of Korea
| | - Joosun Lee
- Division of TB Epidemic Investigation, Korea Centers for Disease Control and Prevention, Osong, Republic of 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, Republic of Korea
| | - Jae Seuk Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Juhwa-ro 170, Ilsanseo-gu, Goyang, 10380, Republic of Korea.
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26
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Kim OH, Kwon BS, Han M, Koh Y, Kim WS, Song JW, Oh YM, Lee SD, Lee SW, Lee JS, Lim CM, Choi CM, Huh JW, Hong SB, Shim TS, Jo KW. Association Between Duration of Aminoglycoside Treatment and Outcome of Cavitary Mycobacterium avium Complex Lung Disease. Clin Infect Dis 2020; 68:1870-1876. [PMID: 30239615 DOI: 10.1093/cid/ciy804] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/13/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although aminoglycosides are recommended for cavitary Mycobacterium avium complex lung disease (MAC-LD), the optimal duration of treatment is unclear. We investigated the association between duration of aminoglycoside treatment and outcomes in cavitary MAC-LD. METHODS Among patients diagnosed with macrolide-susceptible cavitary MAC-LD between 2000 and 2013, 101 who received treatment up to August 2017 with a regimen containing aminoglycosides were enrolled at a tertiary referral center in South Korea. Their medical records were retrospectively reviewed. The duration of aminoglycoside treatment was at the discretion of the attending physician. RESULTS A total of 75 patients (74.3%) were administered aminoglycosides for ≥3 months (median 164 days), whereas the remaining 26 patients (25.7%) received treatment for <3 months (median 59 days). The overall treatment success rate was 63.4% (64/101). Patients treated with aminoglycosides for ≥3 months had a significantly higher success rate than those treated for <3 months (69.3% vs 46.2%; P = .035). Multivariate analysis revealed that aminoglycoside treatment for ≥3 months was a significant factor for treatment success (adjusted odds ratio, 3.602; 95% confidence interval, 1.249-10.390; P = .018). Recurrence occurred in 8 (22.9%) of 35 patients who were followed up for at least 3 years after the end of treatment; all 8 patients received aminoglycosides for ≥3 months. CONCLUSIONS Patients with cavitary MAC-LD treated with aminoglycosides for ≥3 months showed higher treatment success rate than those treated for <3 months. However, treatment for ≥3 months was not associated with the development of recurrence.
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Affiliation(s)
- Ock-Hwa Kim
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Byoung Soo Kwon
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Younsuck Koh
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Woo-Sung Kim
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jin-Woo Song
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yeon-Mok Oh
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang-Do Lee
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sei Won Lee
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jae-Seung Lee
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Chae-Man Lim
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Chang-Min Choi
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jin-Won Huh
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang-Bum Hong
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Tae Sun Shim
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kyung-Wook Jo
- Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Charles-Messance H, Sheedy FJ. Train to Lose: Innate Immune Memory in Metaflammation. Mol Nutr Food Res 2020; 65:e1900480. [PMID: 32529783 DOI: 10.1002/mnfr.201900480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 06/02/2020] [Indexed: 01/21/2023]
Abstract
Westernized diets and lifestyle are linked to the development of metabolic syndrome, characterized by obesity, type 2 diabetes, and increased cardiovascular disease risk. Systemic low-grade inflammation is a common feature of chronic metabolic disorders and is believed to promote disease progression. Therefore, modulating inflammation is a commonly explored strategy to prevent obesity-associated co-morbidities. In this review, how current knowledge on the recently described concept of innate immune memory could underline metaflammation in the context of metabolic syndrome is explored. It is hoped that these insights provide a new perspective to address the question of innate immune activation during disease progression.
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Affiliation(s)
- Hugo Charles-Messance
- Macrophage Homeostasis Research Group, School of Biochemistry and Immunology, Trinity College, Dublin, D02 R590, Ireland.,Trinity Biomedical Sciences Institute, Trinity College, Dublin, D02 R590, Ireland
| | - Frederick J Sheedy
- Macrophage Homeostasis Research Group, School of Biochemistry and Immunology, Trinity College, Dublin, D02 R590, Ireland.,Trinity Biomedical Sciences Institute, Trinity College, Dublin, D02 R590, Ireland
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Dabhi PA, Thangakunam B, Gupta R, James P, Thomas N, Naik D, Christopher DJ. Screening for prevalence of current TB disease and latent TB infection in type 2 diabetes mellitus patients attending a diabetic clinic in an Indian tertiary care hospital. PLoS One 2020; 15:e0233385. [PMID: 32502176 PMCID: PMC7274437 DOI: 10.1371/journal.pone.0233385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/03/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Diabetes triples the risk of developing tuberculosis (TB). This study was designed to determine the prevalence of past and current TB disease and Latent TB infection (LTBI) in type 2 Diabetes Mellitus (NIDDM) patients. DESIGN This was a prospective descriptive study on all NIDDM patients attending a Diabetic clinic. Detailed history, included details of previous history of TB (Past TB)and symptoms of active TB and a thorough physical exam was also done. When clinical suspicion of TB was present, appropriate investigations were carried out to diagnose 'Current TB'. Subsequently, 200 consecutive patients who were negative for Past and Current TB were screened for Latent TB infection (LTBI) by tuberculin skin test. RESULTS Of 1000 NIDDM patients enrolled, 43(4.3%) had Past TB. Of remaining 957 patients, 50 were evaluated for New TB on the basis of suggestive symptoms and 10(1%) patients were confirmed to have Current TB. Risk factors for Past or Current TB 'DM-TB' in comparison with 'DM Only' group were; male sex (72% VS 57%; P = 0.033), manual laborer (28% VS 15%; P = 0.012), smoking (26% VS 14%; P = 0.015), alcohol consumption (23% VS 9%; P<0.001)& being on treatment with Insulin (40% VS 20%; P<0.001). There was a protective effect with being a home maker (17% VS 37%; P = 0.034&overweightstatus (53% VS 71%; P = 0.004). Of the 200 patient without Past or Current TB, who were screened for LTBI, 96(48%) patients were found to have LTBI. Male sex was the only significant risk factor for LTBI (72% VS 59%; P = 0.05). CONCLUSION Past and Current TB was substantial in patients attending a Diabetic Clinic. Active symptom screening for TB in these clinics could lead to increase in case detection and earlier diagnosis.
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Affiliation(s)
| | | | - Richa Gupta
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prince James
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Dukhabandhu Naik
- Department of Endocrinology, Jawaharlal Institute of postgraduate medical education and Research (JIPMER), Pondicherry, India
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Adults with Mycobacterium tuberculosis infection and pre-diabetes have increased levels of QuantiFERON interferon-gamma responses. Tuberculosis (Edinb) 2020; 122:101935. [PMID: 32501260 DOI: 10.1016/j.tube.2020.101935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/31/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes is associated with increased prevalence of TB infection in the US. We assessed associations between diabetes and interferon-gamma (IFN-γ) TB antigen response among adults with TB infection using US representative data. METHODS National Health and Nutrition Examination (NHANES) participants >19 years from 2011 to 2012 with positive QuantiFERON®-TB Gold-In-Tube (QFT) results were eligible. Diabetes was defined by combination of self-report and glycated hemoglobin (HbA1c). Quantitative IFN-γ TB antigen was classified as high (≥10 IU/mL), intermediate (1.01-9.99 IU/mL), or low (0.35-1.00 IU/mL). Analyses accounted for NHANES weighted design. RESULTS Among NHANES participants >19 years, n = 513 had positive QFT (5.9%). Among those with positive QFT, diabetes prevalence was 22.2% and pre-diabetes was 25.9%. Overall, 16.7% of positive QFT participants had high IFN-γ TB antigen levels including 21.7% among those with diabetes, 20.8% among those with pre-diabetes, and 12.6% among euglycemic participants. In adjusted analyses, high IFN-γ TB antigen response was more common among those with pre-diabetes (aOR 1.9, 95%CI 1.0, 3.6) compared to euglycemic participants. CONCLUSION Higher antigen responses may reflect immunopathy consistent with an exaggerated inflammatory but ineffectual response to TB or a reflection of more Mtb replication in participants with pre-diabetes or diabetes.
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Fernández RDV, Díaz A, Bongiovanni B, Gallucci G, Bértola D, Gardeñez W, Lioi S, Bertolin Y, Galliano R, Bay ML, Bottasso O, D'Attilio L. Evidence for a More Disrupted Immune-Endocrine Relation and Cortisol Immunologic Influences in the Context of Tuberculosis and Type 2 Diabetes Comorbidity. Front Endocrinol (Lausanne) 2020; 11:126. [PMID: 32265833 PMCID: PMC7099637 DOI: 10.3389/fendo.2020.00126] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/25/2020] [Indexed: 12/18/2022] Open
Abstract
Pulmonary tuberculosis (PTB), caused by Mycobacterium tuberculosis (Mtb), is a major health problem worldwide, further aggravated by the convergence of type 2 diabetes mellitus (DM) which constitutes an important risk factor for TB development. The worse scenario of patients with PTB and DM may be partly related to a more unbalanced defensive response. As such, newly diagnosed PTB patients with DM (TB+DM, n = 11) or not (TB, n = 21), as well as DM (n = 18) patients and pair matched controls (Co, n = 22), were investigated for the circulating immuno-endocrine-metabolic profile (ELISA), along with studies in peripheral blood mononuclear cells (PBMC) analyzing transcript expression (RT-qPCR) of mediators involved in glucocorticoid functionality. Given the hyperglycemic/hypercortisolemic scenario of TB+DM patients, PBMC were also exposed to stress-related cortisol concentrations (0.1 and 1 μM) and supraphysiologic glucose doses (10, 20, and 40 mM) and assessed for the specific response against Mtb stimulation (lymphoproliferation, -thymidine incorporation-, and cytokine production -bead-cytometry). All TB patients displayed increased plasma amounts of cortisol, growth hormone -hGH-, and proinflammatory mediators. In turn, TB+DM showed even higher levels of interferon gamma -IFN-γ- and hGH (vs. TB), or IL-6, C reactive protein, cortisol and hGH (vs. DM). Both DM groups had equally augmented values of IL-10. All TB patients showed decreased dehydroepiandrosterone- sulfate concentrations, even more in TB+DM cases. Leptin was also decreased in both TB cases, particularly in the TB group, revealing a lower body mass index, as well. Unlike PBMC from TB cases showing a decreased relationship between the glucocorticoids receptor (GR) isoforms (GRα/GRβ; functional isoform/negative isoform), cells from TB+DM patients had no changes in this regard, along with an increased expression of 11-beta hydroxysteroid dehydrogenase type-1, the enzyme facilitating intracellular cortisone to cortisol conversion. TB+DM patients also showed an increased Mtb antigen-driven lymphoproliferation. Compared to TB, DM and HCo counterparts, PBMC from TB+DM patients had a biased Th1 response to Mtb stimulation (increased IL-2 and IFN-γ production), even when exposed to inhibitory cortisol doses. TB+DM patients show a more unbalanced immuno-endocrine relationship, respect the non-diabetic counterparts, with a relative deficiency of cortisol immunomodulatory influences, despite their more favorable microenvironment for cortisol-mediated immune effects.
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Affiliation(s)
- Rocío D. V. Fernández
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
| | - Ariana Díaz
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
| | - Bettina Bongiovanni
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
| | - Georgina Gallucci
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
| | - Diego Bértola
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
- Hospital Provincial del Centenario, Rosario, Argentina
| | - Walter Gardeñez
- Servicio de Neumonología, Hospital Provincial del Centenario, Rosario, Argentina
| | - Susana Lioi
- Laboratorio Central, Hospital Provincial del Centenario, Rosario, Argentina
| | - Yésica Bertolin
- Servicio de Medicina Transfusional, Hospital Provincial del Centenario, Rosario, Argentina
| | - Romina Galliano
- Servicio de Medicina Transfusional, Hospital Provincial del Centenario, Rosario, Argentina
| | - María L. Bay
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
| | - Oscar Bottasso
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
| | - Luciano D'Attilio
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
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Song C, Xie W, Gong L, Ren M, Pan P, Luo B. The relationship between HbA1c control levels and antituberculosis treatment effects: a meta-analysis. J Chin Med Assoc 2019; 82:915-921. [PMID: 31800532 DOI: 10.1097/jcma.0000000000000205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Multiple studies of tuberculosis (TB) treatment have indicated that patients with diabetes mellitus (DM) may experience poor outcomes. We performed a meta-analysis to summarize evidence for the relationship between HbA1c control levels and anti-TB treatment effects in patients afflicted with both TB and DM. METHODS Both English and Chinese databases were searched. Chinese databases included CNKI, WanFang, SinoMed, and VIP. PubMed, Ovid MEDLINE, Embase, Cochrane Library, and Web of Science were searched for English articles. We included studies that were restricted to the relationship between HbA1c levels and anti-TB treatment effects (sputum conversion rate [SCR] and TB focus absorption) in diabetic patients receiving treatment for TB. We used RevMan 5.3 software to analyze the data. RESULTS We included 12 studies, of which five reported SCR at 2 months, seven reported the conversion at 3 months, and seven reported TB focus absorption. According to the five studies which reported 2 months-SCR, patients with diabetes and TB had an odds ratio (OR) of 2.14 (95% CI: 0.84-5.43) for the 2 months-SCR between controlled (HbA1c <7.0) and uncontrolled diabetes (HbA1c ≥7.0). However, additional seven studies reporting 3 months-SCR showed that controlled diabetics had higher SCR than uncontrolled (OR 3.39, 95% CI: 2.12-5.43). Moreover, seven of the 12 studies demonstrated that there were differences in TB focus absorption between controlled and uncontrolled diabetes (OR 2.69, 95% CI: 1.91-3.79). CONCLUSION HbA1c control levels influence the SCR at 3 months and the TB focus absorption at the end of the anti-TB intensive treatment phase. This study highlights a need for increased attention to HbA1c or glucose control in patients afflicted with both TB and DM.
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Affiliation(s)
- Chao Song
- Respiratory Department, Xiangya Hospital, Central South University, Changsha, China
| | - Wang Xie
- Tongji University, Shanghai, China
| | - Li Gong
- Respiratory Department, Xiangya Hospital, Central South University, Changsha, China
| | - Min Ren
- Respiratory Department, Xiangya Hospital, Central South University, Changsha, China
| | - Pinhua Pan
- Respiratory Department, Xiangya Hospital, Central South University, Changsha, China
| | - Bailing Luo
- Respiratory Department, Xiangya Hospital, Central South University, Changsha, China
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Zhang M, He JQ. Impacts of metformin on tuberculosis incidence and clinical outcomes in patients with diabetes: a systematic review and meta-analysis. Eur J Clin Pharmacol 2019; 76:149-159. [PMID: 31786617 DOI: 10.1007/s00228-019-02786-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/23/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Accumulating evidence suggested that the use of metformin had more benefits for both prevention and treatment of tuberculosis (TB) than non-metformin use in patients with diabetes mellitus (DM); however, it remains to be fully elucidated on this topic. Thus, we conducted a systematic review and meta-analysis of published studies to determine the association between metformin use and TB in patients with diabetes. METHODS The MEDLINE, EMBASE, Information Sciences Institute (ISI) Web of Science, and Cochrane CENTRAL databases were searched from their inception to 15 April 2019. Studies that evaluated the use of metformin and TB disease were included. The quality of each study was evaluated through the Newcastle-Ottawa Scale (NOS). For pooled data, the relative risk (RR) and 95% confidence intervals (CIs) were calculated; otherwise, a systematic review. RESULTS Seventeen observational studies were included, all of which indicated a low risk of bias according to the NOS. The pooled analysis showed that metformin use was associated with a significantly lower active TB incidence and mortality among individuals with DM (RR = 0.51; 95% CI, 0.38-0.69, P ⩽ 0.001) and with TB-DM (RR = 0.34; 95% CI, 0.20-0.57, P ⩽ 0.001), respectively. CONCLUSIONS This meta-analysis indicated metformin use is related to benefits in both prevention and treatment outcomes of tuberculosis among patients with diabetes. Prospective clinical trials are needed to confirm these associations.
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Affiliation(s)
- Meng Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37,Guo Xue Alley, Chengdu, 610041, China
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37,Guo Xue Alley, Chengdu, 610041, China.
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The Intracellular Growth of M. tuberculosis Is More Associated with High Glucose Levels Than with Impaired Responses of Monocytes from T2D Patients. J Immunol Res 2019; 2019:1462098. [PMID: 31815150 PMCID: PMC6877949 DOI: 10.1155/2019/1462098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 07/18/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022] Open
Abstract
Diabetes mellitus, a metabolic disease characterized by hyperglycemia and poor glucose control, is a risk factor for Mycobacterium tuberculosis (M. tuberculosis) infection and the development of active tuberculosis. To evaluate whether M. tuberculosis infection susceptibility is associated with an intrinsic factor in monocytes from type 2 diabetes (T2D) patients or it is associated with hyperglycemia per se, we analyzed TLR-2 and TLR-4 expression by flow cytometry and the cytokines IL-1β, IL-6, IL-8, IL-10, and TNF-α by cytometric bead array assays, either stimulated with TLR-2 and TLR-4 ligands or infected with M. tuberculosis in the whole blood from T2D patients (n = 43) and healthy subjects (n = 26) or in CD14+ monocytes from healthy subjects cultured in high glucose (HG) (30 mM). The intracellular growth of M. tuberculosis was evaluated by CFU counts at 0, 1, and 3 days in both monocytes from T2D patients and monocytes from healthy subjects cultured in HG. We did not find significant differences in TLR expression, cytokine production, or growth of M. tuberculosis in monocytes from T2D patients compared with those in monocytes from healthy subjects. Despite these results, in vitro assays of monocytes cultured with 30 mM glucose led to significantly increased TLR-2 and TLR-4 basal expression compared to those of monocytes cultured with 11 mM glucose (P < 0.05). Conversely, the production of IL-6 by TLR-2 ligand stimulation, of IL-1β, IL-6, and IL-8 by TLR-4 ligand stimulation, and of IL-8 by M. tuberculosis infection significantly decreased in monocytes cultured in HG (P < 0.05). Additionally, the intracellular survival of M. tuberculosis increased in monocytes in HG after day 3 of culture (P < 0.05). In conclusion, HG decreased IL-8 production and the intracellular growth control of M. tuberculosis by monocytes, supporting the hypothesis that hyperglycemia plays an important role in the impaired immune responses to M. tuberculosis in patients with T2D.
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Shivakoti R, Dalli J, Kadam D, Gaikwad S, Barthwal M, Colas RA, Mazzacuva F, Lokhande R, Dharmshale S, Bharadwaj R, Kagal A, Pradhan N, Deshmukh S, Atre S, Sahasrabudhe T, Kakrani A, Kulkarni V, Raskar S, Suryavanshi N, Chon S, Gupte A, Gupta A, Gupte N, Arriaga MB, Fukutani KF, Andrade BB, Golub JE, Mave V. Lipid mediators of inflammation and Resolution in individuals with tuberculosis and tuberculosis-Diabetes. Prostaglandins Other Lipid Mediat 2019; 147:106398. [PMID: 31726221 DOI: 10.1016/j.prostaglandins.2019.106398] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/31/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
Individuals with concurrent tuberculosis (TB) and Type 2 diabetes (DM) have a higher risk of adverse outcomes. To better understand potential immunological differences, we utilized a comprehensive panel to characterize pro-inflammatory and pro-resolving (i.e., mediators involved in the resolution of inflammation) lipid mediators in individuals with TB and TB-DM. A nested cross-sectional study of 40 individuals (20 newly diagnosed DM and 20 without DM) was conducted within a cohort of individuals with active drug-susceptible treatment-naïve pulmonary TB. Lipid mediators were quantified in serum samples through lipid mediator profiling. We conducted correlation-based analysis of these mediators. Overall, the arachidonic acid-derived leukotriene and prostaglandin families were the most abundant pro-inflammatory lipid mediators, while lipoxins and maresins families were the most abundant pro-resolving lipid mediators in individuals with TB and TB-DM. Individuals with TB-DM had increased correlations and connectivity with both pro-inflammatory and pro-resolving lipid mediators compared to those with TB alone. We identified the most abundant lipid mediator metabolomes in circulation among individuals with TB and TB-DM; in addition, our data shows a substantial number of significant correlations between both pro-inflammatory and pro-resolving lipid mediators in individuals with TB-DM, delineating a molecular balance that potentially defines this comorbidity.
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Affiliation(s)
- Rupak Shivakoti
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Jesmond Dalli
- William Harvey Research Institute, Queens Mary University of London, London, UK
| | - Dileep Kadam
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Sanjay Gaikwad
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Madhusudan Barthwal
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Romain A Colas
- William Harvey Research Institute, Queens Mary University of London, London, UK
| | - Francesca Mazzacuva
- William Harvey Research Institute, Queens Mary University of London, London, UK
| | - Rahul Lokhande
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Sujata Dharmshale
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Renu Bharadwaj
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Anju Kagal
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Neeta Pradhan
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Sona Deshmukh
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Sachin Atre
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Tushar Sahasrabudhe
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Arjun Kakrani
- Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Vandana Kulkarni
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Swapnil Raskar
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Nishi Suryavanshi
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Sandy Chon
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Akshay Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Nikhil Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - María B Arriaga
- Instituto Goncalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research, Fundação José Silveira, Salvador, Brazil
| | - Kiyoshi F Fukutani
- Instituto Goncalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research, Fundação José Silveira, Salvador, Brazil; Curso de Medicina, Faculdade de Tecnologia e Ciências, Salvador, Brazil
| | - Bruno B Andrade
- Instituto Goncalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research, Fundação José Silveira, Salvador, Brazil; Curso de Medicina, Faculdade de Tecnologia e Ciências, Salvador, Brazil; Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil; Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Jonathan E Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vidya Mave
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
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35
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Abstract
Diabetes mellitus is a chronic, progressive, incompletely understood metabolic disorder whose prevalence has been increasing steadily worldwide. Even though little attention has been paid to lung disorders in the context of diabetes, its prevalence has recently been challenged by newer studies of disease development. In this review, we summarize and discuss the role of diabetes mellitus involved in the progression of pulmonary diseases, with the main focus on pulmonary fibrosis, which represents a chronic and progressive disease with high mortality and limited therapeutic options.
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Affiliation(s)
- Saeed Kolahian
- Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, and Interfaculty Center of Pharmacogenomics and Drug Research (ICePhA), Eberhard Karls University Hospitals and Clinics, Tübingen, Germany.
- Department of Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Eberhard Karls University Hospitals and Clinics, Tübingen, Germany.
- Department of Pharmacogenomics, University of Tübingen, Wilhelmstrasse. 56, D-72074, Tübingen, Germany.
| | - Veronika Leiss
- Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, and Interfaculty Center of Pharmacogenomics and Drug Research (ICePhA), Eberhard Karls University Hospitals and Clinics, Tübingen, Germany
| | - Bernd Nürnberg
- Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, and Interfaculty Center of Pharmacogenomics and Drug Research (ICePhA), Eberhard Karls University Hospitals and Clinics, Tübingen, Germany
- Department of Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Eberhard Karls University Hospitals and Clinics, Tübingen, Germany
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36
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Kumar NP, Moideen K, Nancy A, Viswanathan V, Shruthi BS, Sivakumar S, Natarajan M, Kornfeld H, Babu S. Heterogeneity in the cytokine profile of tuberculosis - diabetes co-morbidity. Cytokine 2019; 125:154824. [PMID: 31472402 DOI: 10.1016/j.cyto.2019.154824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 01/08/2023]
Abstract
Tuberculosis - diabetes (TB-DM) co-morbidity is characterized by heterogeneity in clinical and biochemical parameters between newly diagnosed diabetic individuals with TB (TB-NDM) and known diabetic individuals at incident TB (TB-KDM). However, the immunological profile underlying this heterogeneity is not explored. To identify the cytokine profiles in TB-NDM and TB-KDM individuals, we examined the plasma cytokine levels as well as TB-antigen stimulated levels of pro-inflammatory cytokines. TB-KDM individuals exhibit significantly higher levels of IFNγ, IL-2, TNFα, IL-17A, IL-1α, IL-1β and IL-6 in comparison to TB-NDM, TB alone and DM alone individuals. TB-NDM individuals are characterized by significantly lower levels of blood glucose and glycated hemoglobin in comparison to TB-KDM with both groups exhibiting a significant lowering of glycated hemoglobin levels at 6 months of anti-tuberculosis therapy (ATT). TB-NDM individuals are characterized by significantly diminished - unstimulated levels of IFNγ, IL-2, TNFα, IL-17A, IL-1α, IL-1β and IL-12 at pre-treatment, of IFNγ, IL-2 and IL-1α at 2 months of ATT and IL-2 at post-treatment in comparison to TB-KDM. TB-NDM individuals are also characterized by significantly diminished TB-antigen stimulated levels of IFNγ, IL-2, TNFα, IL-17A, IL-17F, IL-1α, IL-1β and/or IL-6 at pre-treatment and at 2 months of ATT and IFNγ, IL-2, IL-1α and IL-1β at post-treatment. In addition, TB-NDM individuals are characterized by significantly diminished mitogen - stimulated levels of IL-17F and IL-6 at pre-treatment and IL-6 alone at 6 months of ATT. Therefore, our data reveal considerable heterogeneity in the immunological underpinnings of TB-DM co-morbidity. Our data also suggest that TB-NDM exhibits a characteristic profile, which is both biochemically and immunologically distinct from TB-KDM.
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Affiliation(s)
- Nathella P Kumar
- National Institutes of Health-NIRT- International Center for Excellence in Research, Chennai, India
| | - Kadar Moideen
- National Institutes of Health-NIRT- International Center for Excellence in Research, Chennai, India
| | - Arul Nancy
- National Institutes of Health-NIRT- International Center for Excellence in Research, Chennai, India; Prof. M. Viswanathan Diabetes Research Center, Chennai, India
| | | | | | | | - Mohan Natarajan
- National Institute for Research in Tuberculosis, Chennai, India
| | - Hardy Kornfeld
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Subash Babu
- National Institutes of Health-NIRT- International Center for Excellence in Research, Chennai, India; University of Massachusetts Medical School, Worcester, MA, USA; LPD, NIAID, NIH, MD, USA.
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37
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Kumar NP, Fukutani KF, Shruthi BS, Alves T, Silveira-Mattos PS, Rocha MS, West K, Natarajan M, Viswanathan V, Babu S, Andrade BB, Kornfeld H. Persistent inflammation during anti-tuberculosis treatment with diabetes comorbidity. eLife 2019; 8:46477. [PMID: 31271354 PMCID: PMC6660216 DOI: 10.7554/elife.46477] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/20/2019] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus (DM) increases risk for pulmonary tuberculosis (TB) and adverse treatment outcomes. Systemic hyper-inflammation is characteristic in people with TB and concurrent DM (TBDM) at baseline, but the impact of TB treatment on this pattern has not been determined. We measured 17 plasma cytokines and growth factors in longitudinal cohorts of Indian and Brazilian pulmonary TB patients with or without DM. Principal component analysis revealed virtually complete separation of TBDM from TB individuals in both cohorts at baseline, with hyper-inflammation in TBDM that continued through treatment completion at six months. By one year after treatment completion, there was substantial convergence of mediator levels between groups within the India cohort. Non-resolving systemic inflammation in TBDM comorbidity could reflect delayed lesion sterilization or non-resolving sterile inflammation. Either mechanism portends unfavorable long-term outcomes including risk for recurrent TB and for damaging immune pathology.
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Affiliation(s)
- Nathella Pavan Kumar
- National Institutes of Health, National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India
| | - Kiyoshi F Fukutani
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Fundação José Silveira, Salvador, Brazil.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Faculdade de Tecnologia e Ciências, Salvador, Brazil
| | | | - Thabata Alves
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Fundação José Silveira, Salvador, Brazil.,Universidade Salvador, Laureate Universities, Salvador, Brazil
| | - Paulo S Silveira-Mattos
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Fundação José Silveira, Salvador, Brazil.,Faculdade de Tecnologia e Ciências, Salvador, Brazil
| | - Michael S Rocha
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Fundação José Silveira, Salvador, Brazil
| | - Kim West
- University of Massachusetts Medical School, Worcester, United States
| | - Mohan Natarajan
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Subash Babu
- National Institutes of Health, National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India
| | - Bruno B Andrade
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Fundação José Silveira, Salvador, Brazil.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Faculdade de Tecnologia e Ciências, Salvador, Brazil.,Universidade Salvador, Laureate Universities, Salvador, Brazil
| | - Hardy Kornfeld
- University of Massachusetts Medical School, Worcester, United States
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Cadena J, Rathinavelu S, Lopez-Alvarenga JC, Restrepo BI. The re-emerging association between tuberculosis and diabetes: Lessons from past centuries. Tuberculosis (Edinb) 2019; 116S:S89-S97. [PMID: 31085129 DOI: 10.1016/j.tube.2019.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 12/11/2022]
Abstract
The association between tuberculosis (TB) and diabetes mellitus (DM) had a common place in the literature up to the first half of the 20th century, but virtually disappeared with the discovery of insulin to treat DM and antibiotics to cure TB. In the late 1990s the literature began to re-emerge with the worldwide increase in type 2 DM, particularly in TB-endemic countries. Today, type 2 DM is the most prevalent comorbidity among TB patients and the World Health Organization considers it a threat to TB control. We summarize the literature on TB and DM up to the 1960s. Then we evaluate unique aspects of this comorbidity in older times, such as the frequent diabetic comas that suggest challenges for proper DM management as insulin was being implemented, or the absence of antibiotics to cure TB. Despite the unique aspects of each study period, the literature across times is consistent in key aspects of the association. Namely, a higher TB prevalence among DM (versus non-DM patients), the importance of glucose control and chronic DM on TB susceptibility and the higher risk of death among patients with the co-morbidity. From the older literature, we can infer the likely contribution of type 1 DM to TB (in addition to type 2), regardless of their differing autoimmune or metabolic pathophysiology, respectively. Furthermore, in the older literature there was a notable reporting of DM development among TB patients, even though DM usually preceded TB. This observation deserves further epidemiological and basic studies to elucidate this intriguing aspect of the relationship between TB and DM.
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Affiliation(s)
- Jose Cadena
- University of Texas Health, San Antonio, TX 78229, USA; South Texas Veterans Health Care System, San Antonio TX 78229, USA.
| | - Selvalakshmi Rathinavelu
- University of Texas Health Houston, School of Public Health, Brownsville Campus, Brownsville, TX 78520, USA.
| | - Juan C Lopez-Alvarenga
- University of Texas Rio Grande Valley, South Texas Diabetes and Obesity Institute, School of Medicine, Edinburg, TX 78541, USA
| | - Blanca I Restrepo
- University of Texas Health Houston, School of Public Health, Brownsville Campus, Brownsville, TX 78520, USA; University of Texas Rio Grande Valley, South Texas Diabetes and Obesity Institute, School of Medicine, Edinburg, TX 78541, USA.
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39
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Lee YJ, Han SK, Park JH, Lee JK, Kim DK, Chung HS, Heo EY. The effect of metformin on culture conversion in tuberculosis patients with diabetes mellitus. Korean J Intern Med 2018; 33. [PMID: 29540054 PMCID: PMC6129638 DOI: 10.3904/kjim.2017.249] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS Patients with diabetes mellitus (DM) and tuberculosis (TB) have increased morbidity and a high risk of treatment failure or recurrence. It is important to manage both diseases simultaneously. Among anti-diabetic drugs, metformin inhibits intracellular growth of mycobacteria. Therefore, we examined the effects of metformin on TB treatment, especially in patients with DM. METHODS This retrospective cohort study included patients with culture-positive pulmonary TB diagnosed between 2011 and 2012. The primary study outcome was sputum culture conversion after 2 months of treatment. RESULTS Of 499 patients diagnosed with culture-positive pulmonary TB, 105 (21%) had DM at diagnosis. Among them, 62 (59.5%) were treated with metformin. Baseline characteristics, except for the presence of chronic renal disease, were not significantly different between the metformin and non-metformin groups. Metformin treatment had no significant effect on sputum culture conversion (p = 0.60) and recurrence within 1 year after TB treatment completion (p = 0.39). However, metformin improved the sputum culture conversion rate in patients with cavitary pulmonary TB, who have higher bacterial loads (odds ratio, 10.8; 95% confidence interval, 1.22 to 95.63). CONCLUSION Among cavitary pulmonary TB patients with DM, metformin can be an effective adjunctive anti-TB agent to improve sputum culture conversion after 2 months of treatment.
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Affiliation(s)
- Ye-Jin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Hee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Deog Keom Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hee Soon Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Correspondence to Eun Young Heo, M.D. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea Tel: +82-2-870-3207 Fax: +82-2-831-0714 E-mail:
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40
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Salgado-Bustamante M, Rocha-Viggiano AK, Rivas-Santiago C, Magaña-Aquino M, López JA, López-Hernández Y. Metabolomics applied to the discovery of tuberculosis and diabetes mellitus biomarkers. Biomark Med 2018; 12:1001-1013. [PMID: 30043640 DOI: 10.2217/bmm-2018-0050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Tuberculosis (TB) and diabetes mellitus Type 2 (DM2) are two diseases as ancient as they are harmful to human health. The outcome for both diseases in part depends on immune and metabolic individual responses. DM2 is increasing yearly, mainly due to environmental, genetic and lifestyle habits. There are multiple evidence that DM2 is one of the most important risk factor of becoming infected with TB or reactivating latent TB. Mass spectrometry-based metabolomics is an important tool for elucidating the metabolites and metabolic pathways that influence the immune responses to M. tuberculosis infection during diabetes. We provide an up-to-date review highlighting the importance and benefit of metabolomics for identifying biomarkers as candidate molecules for diagnosis, disease activity or prognosis.
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Affiliation(s)
- Mariana Salgado-Bustamante
- Biochemistry Department, Medicine Faculty, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Ana K Rocha-Viggiano
- Biochemistry Department, Medicine Faculty, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - César Rivas-Santiago
- CONACyT, Unidad Academica de Ciencias Biologicas, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
| | - Martín Magaña-Aquino
- Infectology Department, Hospital Central Ignacio Morones Prieto, San Luis Potosi, Mexico
| | - Jesús A López
- MicroRNAs Laboratory, Unidad Academica de Ciencias Biologicas, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
| | - Yamilé López-Hernández
- CONACyT, Unidad Academica de Ciencias Biologicas, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
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Sánchez-Jiménez R, Cerón E, Bernal-Alcántara D, Castillejos-López M, Gonzalez-Trujano E, Negrete-García MC, Alvarado-Vásquez N. Association between IL-15 and insulin plasmatic concentrations in patients with pulmonary tuberculosis and type 2 diabetes. Tuberculosis (Edinb) 2018; 111:114-120. [PMID: 30029895 DOI: 10.1016/j.tube.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/31/2018] [Accepted: 06/07/2018] [Indexed: 11/30/2022]
Abstract
IL-15 is part of the immune response in pulmonary tuberculosis (PTB) but amazingly, it may also induce physiological effects similar to those of insulin. We evaluated the IL-15 and insulin plasmatic levels in adults with PTB and with or without type 2 diabetes mellitus (DM2), who received previous antituberculosis therapy for at least 2 months. We analyzed the concentrations of glucose, glycated hemoglobin, insulin, as well as levels of IL-15, IL-2, IFN-γ, and TNF-α in patients with PTB, patients with PTB-DM2, household contacts with DM2 (C-DM2), and healthy household contacts (H-C). Our results showed unexpected high levels of glucose, insulin, and IL-15 in the PTB and C-DM2 groups. In comparison, low levels of these same indicators were observed in the PTB-DM2 and H-C groups. Interestingly, our analysis showed a positive correlation of IL-15 with insulin in the PTB group (r = 0.73) and in the C-DM2 group (r = 0.66). In comparison, a weak correlation between IL-15 and insulin was observed in the PTB-DM group (r = 0.10) and in the H-C group (ρ = 0.26). Our results suggest an association between IL-15 and insulin levels in the patient with PTB. Intriguingly, this association was weaker in the patient with PTB-DM2.
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Affiliation(s)
- Roberto Sánchez-Jiménez
- Graduate and Research Section, Higher School of Medicine of the National Polytechnic Institute, Mexico City, 11340, Mexico
| | - Eduarda Cerón
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Demetrio Bernal-Alcántara
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Manuel Castillejos-López
- Epidemiological Surveillance Unit, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Eva Gonzalez-Trujano
- National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, 14370, Mexico
| | - Maria Cristina Negrete-García
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Noé Alvarado-Vásquez
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico.
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42
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Zhao Y, Yang X, Zhang X, Yu Q, Zhao P, Wang J, Duan C, Li J, Johnson H, Feng X, Zhang H. IP-10 and RANTES as biomarkers for pulmonary tuberculosis diagnosis and monitoring. Tuberculosis (Edinb) 2018; 111:45-53. [PMID: 30029914 DOI: 10.1016/j.tube.2018.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/20/2018] [Accepted: 05/12/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to determine whether IP-10 and RANTES plasma levels can be used in diagnosis and monitoring of pulmonary tuberculosis (PTB). METHODS Plasma levels of cytokines/chemokines were measured using a Bio-Plex® multiplex cytokine assay system in a cohort containing 457 clinically suspected PTB patients including a training set (n = 41)and two independent test sets A (n = 242) and B (n = 174). RESULTS Plasma levels of IP-10 and RANTES were significantly higher in PTB patients than healthy controls' in both training and independent test sets (P < 0.05). Compared with other combinations, the combination of IP-10 and RANTES had the best performance with an AUC of 1.0 in training set. The performance characteristic of this model was successfully validated in independent test set A although this combination only resulted in a slightly improvement of AUC value in independent test set B. Plasma IP-10 and RANTES levels were weakly and positively correlated with blood glucose concentrations. Moreover, IP-10 levels were positively correlated with CRP and ESR in PTB patients. Furthermore, in response to therapy, both IP-10 and RANTES levels significantly decreased over the period of 6 months (P < 0.001). CONCLUSIONS Taken together, combination of IP-10 and RANTES could be potentially used as diagnostic and monitoring biomarker in PTB management.
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Affiliation(s)
- Yanfeng Zhao
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China; Beijing Research Institute for Tuberculosis Control, No 5, Dongguang Hutong, Xinjiekou, Beijing, 100035, China
| | - Xiqin Yang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China
| | - Xuhui Zhang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China
| | - Qin Yu
- Chaoyang District Center for Disease Control and Prevention, 25 Panjiayuan, Huaweili, Beijing, 100029, China
| | - Ping Zhao
- Chaoyang District Center for Disease Control and Prevention, 25 Panjiayuan, Huaweili, Beijing, 100029, China
| | - Jianxia Wang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China
| | - Cuimi Duan
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China
| | - Jiangxue Li
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China
| | | | - Xiaoyan Feng
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China.
| | - Heqiu Zhang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China.
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Parsa A, Mirzaie M, Ebrahimzadeh MH, Birjandinejad A, Malek A, Mousavian A. Hip Surgery in Quiescent or Active Tubercular Hip Arthritis; Is Reactivation Risk Really a Matter. THE ARCHIVES OF BONE AND JOINT SURGERY 2018; 6:169-175. [PMID: 29911133 PMCID: PMC5990708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/19/2018] [Indexed: 06/08/2023]
Abstract
About 15 % of all musculoskeletal tuberculosis (TB) have hip involvement. Early anti-tubercular drug therapy and other conservative treatment including short-term traction and mobilization programs could prevent hip joint destruction. Reactivation of TB accounts for a significant of active TB incidence, especially in the developed countries with a low TB prevalence. The risk of TB activation for population with the latent form of disease is about 5-10%. According to the existing literature surgery in tubercular hip arthritis would be safe once sufficient debridement and precise anti tubercular chemotherapy has been done.
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Affiliation(s)
- Ali Parsa
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Community and Preventive Medicine Specialist, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Mirzaie
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Community and Preventive Medicine Specialist, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad H Ebrahimzadeh
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Community and Preventive Medicine Specialist, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Birjandinejad
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Community and Preventive Medicine Specialist, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolreza Malek
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Community and Preventive Medicine Specialist, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Mousavian
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Community and Preventive Medicine Specialist, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
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Boillat-Blanco N, Tumbo AMN, Perreau M, Amelio P, Ramaiya KL, Mganga M, Schindler C, Gagneux S, Reither K, Probst-Hensch N, Pantaleo G, Daubenberger C, Portevin D. Hyperglycaemia is inversely correlated with live M. bovis BCG-specific CD4 + T cell responses in Tanzanian adults with latent or active tuberculosis. IMMUNITY INFLAMMATION AND DISEASE 2018; 6:345-353. [PMID: 29642283 PMCID: PMC5946156 DOI: 10.1002/iid3.222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/30/2018] [Accepted: 02/26/2018] [Indexed: 01/09/2023]
Abstract
Introduction The rising prevalence of Diabetes mellitus (DM) in high TB‐endemic countries may adversely affect sustainability of TB control since DM constitutes a risk factor for development of active tuberculosis (TB). The impact of DM on TB specific adaptive immune responses remains poorly addressed, particularly in people living in Sub‐Saharan countries. We performed a functional characterization of TB specific cellular immune response in Tanzanian subjects with active or latent Mycobacterium tuberculosis (Mtb) infection stratified by their diabetic status. Methods HIV negative active TB patients (≥18 years) with Xpert MTB/RIF positive pulmonary TB were included before starting TB treatment in Dar es Salaam, Tanzania between April and December 2013. HIV negative healthy controls latently infected with TB but without past TB history were also included. Active and latent TB patients were stratified in two groups according to their diabetic status. Peripheral Blood Mononuclear cells were stimulated with either live M. bovis BCG or Mtb‐specific peptide pools and analyzed by intracellular cytokine staining and polychromatic flow cytometry. Results Our results show a lower frequency of IFN‐γ CD4+ T cells in patients with active TB and DM compared to patients with active TB only after live M. bovis BCG (p = 0.04) but not after Mtb peptide pools re‐stimulation. Irrespective of TB status, level of glycaemia is selectively inversely correlated with IFN‐γ and TNF‐α CD4+ T cell production (p = 0.02 and p = 0.03) after live M. bovis BCG stimulation. Conclusions These results support the hypothesis that hyperglycaemia negatively impacts antigen processing and/or presentation of whole mycobacteria delaying secretion of key cytokines involved in TB immunity.
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Affiliation(s)
- Noémie Boillat-Blanco
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland.,Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Matthieu Perreau
- Division of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrizia Amelio
- Division of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
| | - Kaushik L Ramaiya
- Shree Hindu Mandal Hospital and Muhimbili University of Health Sciences, Dar es Salaam, United Republic of Tanzania
| | - Maliwaza Mganga
- Kinondoni Municipal Council, National Tuberculosis Program, Dar es Salaam, United Republic of Tanzania
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Klaus Reither
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Giuseppe Pantaleo
- Division of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
| | - Claudia Daubenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Damien Portevin
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
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45
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Mendoza-Almanza G, Rivas-Santiago CE, Salgado Bustamante M, López-Hernández Y. Diabetes and tuberculosis in Mexico: results from epidemiological studies. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-017-0599-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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46
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Kumar NP, Banurekha VV, Nair D, Dolla C, Kumaran P, Babu S. Modulation of iron status biomarkers in tuberculosis-diabetes co-morbidity. Tuberculosis (Edinb) 2018. [PMID: 29523313 DOI: 10.1016/j.tube.2017.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Tuberculosis (TB) and diabetes mellitus (DM) remain vital disease burdens in developing countries and the dual burden of DM and TB clearly signifies a growing global public health concern. While modulation of iron status biomarkers in TB is well described, very little is known about the association of these markers with TB-DM. To examine the association of circulating iron status biomarkers in TB disease, we examined the systemic levels of ferritin, hepcidin, soluble transferrin receptor (sTfR), transferrin, apotransferrin and hemopexin in pulmonary TB (PTB) individuals with DM (PTB-DM), without DM (PTB) and those with diabetes only (DM). Circulating levels of ferritin and hepcidin were significantly enhanced in PTB-DM and PTB compared to the DM group. On the other hand, the circulating levels of transferrin and apotransferrin were significantly diminished in PTB-DM and PTB compared to the DM group. The levels of ferritin and hepcidin exhibited a significant positive relationship with HbA1c, whereas apotransferrin exhibited negative relationship with HbA1c in PTB-DM and PTB. ROC analysis revealed that ferritin, hepcidin and transferrin are markers that can distinguish PTB-DM from DM individuals. Our results suggest that some of these circulating iron status markers could prove useful as biomarkers to monitor disease severity.
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Affiliation(s)
- Nathella Pavan Kumar
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India.
| | | | - Dina Nair
- National Institutes for Research in Tuberculosis, Chennai, India
| | | | - Paul Kumaran
- National Institutes for Research in Tuberculosis, Chennai, India
| | - Subash Babu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India; Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, USA
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47
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Pan SW, Yen YF, Kou YR, Chuang PH, Su VYF, Feng JY, Chan YJ, Su WJ. The Risk of TB in Patients With Type 2 Diabetes Initiating Metformin vs Sulfonylurea Treatment. Chest 2017; 153:1347-1357. [PMID: 29253553 DOI: 10.1016/j.chest.2017.11.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/28/2017] [Accepted: 11/15/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Metformin and the sulfonylureas are common initial antidiabetic agents; the former has demonstrated anti-TB action in in vitro and animal studies. The comparative effect of metformin vs the sulfonylureas on TB risk in patients with type 2 diabetes mellitus (T2DM) remains unclear. METHODS In this retrospective cohort study, patients without chronic kidney disease who received a T2DM diagnosis during 2003 to 2013 were identified from the Taiwan National Health Insurance Research Database. Participants with ≥ 2 years of follow-up were reviewed and observed for TB until December 2013. Patients receiving metformin ≥ 60 cumulative defined daily dose (cDDD) and sulfonylureas < 15 cDDD in the initial 2 years were defined as metformin majors; it was the inverse for sulfonylurea majors. The two groups were matched 1:1 by propensity score and compared for TB risk by multivariate Cox regression analysis. RESULTS Among 40,179 patients with T2DM, 263 acquired TB (0.65%) over a mean follow-up of 6.1 years. In multivariate analysis, the initial 2-year dosage of metformin, but not that of the sulfonylureas, was an independent predictor of TB (60-cDDD increase (adjusted hazard ratio [HR], 0.931; 95% CI, 0.877-0.990) after adjustment by cofactors, including adapted diabetes complication severity index. Metformin majors had a significantly lower TB risk than that of sulfonylurea majors before and after matching (HR, 0.477; 95% CI, 0.268-0.850 and HR, 0.337; 95% CI, 0.169-0.673; matched pairs, n = 3,161). Compared with the reference group (initial 2-year metformin < 60 cDDD), metformin treatment showed a dose-dependent association with TB risk (60-219 cDDD; HR, 0.860; 95% CI, 0.637-1.161; 220-479 cDDD, HR, 0.706; 95% CI, 0.485-1.028; ≥ 480 cDDD, HR, 0.319; 95% CI, 0.118-0.863). CONCLUSIONS Metformin use in the initial 2 years was associated with a decreased risk of TB, and metformin users had a reduced risk compared with their sulfonylurea comparators.
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Affiliation(s)
- Sheng-Wei Pan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Feng Yen
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan
| | - Yu Ru Kou
- Institute of Physiology, National Yang-Ming University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taipei, Taiwan
| | - Vincent Yi-Fong Su
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Jia-Yih Feng
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Jiun Chan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Juin Su
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Blanco-Guillot F, Delgado-Sánchez G, Mongua-Rodríguez N, Cruz-Hervert P, Ferreyra-Reyes L, Ferreira-Guerrero E, Yanes-Lane M, Montero-Campos R, Bobadilla-del-Valle M, Torres-González P, Ponce-de-León A, Sifuentes-Osornio J, Garcia-Garcia L. Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis. PLoS One 2017; 12:e0184675. [PMID: 28902922 PMCID: PMC5597214 DOI: 10.1371/journal.pone.0184675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/24/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Many studies have explored the relationship between diabetes mellitus (DM) and tuberculosis (TB) demonstrating increased risk of TB among patients with DM and poor prognosis of patients suffering from the association of DM/TB. Owing to a paucity of studies addressing this question, it remains unclear whether patients with DM and TB are more likely than TB patients without DM to be grouped into molecular clusters defined according to the genotype of the infecting Mycobacterium tuberculosis bacillus. That is, whether there is convincing molecular epidemiological evidence for TB transmission among DM patients. Objective: We performed a systematic review and meta-analysis to quantitatively evaluate the propensity for patients with DM and pulmonary TB (PTB) to cluster according to the genotype of the infecting M. tuberculosis bacillus. Materials and methods We conducted a systematic search in MEDLINE and LILACS from 1990 to June, 2016 with the following combinations of key words “tuberculosis AND transmission” OR “tuberculosis diabetes mellitus” OR “Mycobacterium tuberculosis molecular epidemiology” OR “RFLP-IS6110” OR “Spoligotyping” OR “MIRU-VNTR”. Studies were included if they met the following criteria: (i) studies based on populations from defined geographical areas; (ii) use of genotyping by IS6110- restriction fragment length polymorphism (RFLP) analysis and spoligotyping or mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) or other amplification methods to identify molecular clustering; (iii) genotyping and analysis of 50 or more cases of PTB; (iv) study duration of 11 months or more; (v) identification of quantitative risk factors for molecular clustering including DM; (vi) > 60% coverage of the study population; and (vii) patients with PTB confirmed bacteriologically. The exclusion criteria were: (i) Extrapulmonary TB; (ii) TB caused by nontuberculous mycobacteria; (iii) patients with PTB and HIV; (iv) pediatric PTB patients; (v) TB in closed environments (e.g. prisons, elderly homes, etc.); (vi) diabetes insipidus and (vii) outbreak reports. Hartung-Knapp-Sidik-Jonkman method was used to estimate the odds ratio (OR) of the association between DM with molecular clustering of cases with TB. In order to evaluate the degree of heterogeneity a statistical Q test was done. The publication bias was examined with Begg and Egger tests. Review Manager 5.3.5 CMA v.3 and Biostat and Software package R were used. Results Selection criteria were met by six articles which included 4076 patients with PTB of which 13% had DM. Twenty seven percent of the cases were clustered. The majority of cases (48%) were reported in a study in China with 31% clustering. The highest incidence of TB occurred in two studies from China. The global OR for molecular clustering was 0.84 (IC 95% 0.40–1.72). The heterogeneity between studies was moderate (I2 = 55%, p = 0.05), although there was no publication bias (Beggs test p = 0.353 and Eggers p = 0.429). Conclusion There were very few studies meeting our selection criteria. The wide confidence interval indicates that there is not enough evidence to draw conclusions about the association. Clustering of patients with DM in TB transmission chains should be investigated in areas where both diseases are prevalent and focus on specific contexts.
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Affiliation(s)
- Francles Blanco-Guillot
- Doctorado en Ciencias en Enfermedades Infecciosas, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Norma Mongua-Rodríguez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Maestría en Ciencias Médicas con énfasis en Epidemiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Distrito Federal, México
| | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Mercedes Yanes-Lane
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Pedro Torres-González
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Lourdes Garcia-Garcia
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
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Banurekha V, Bhatnagar T, Savithri S, Kumar ND, Kangusamy B, Mehendale S. Sputum Conversion and Treatment Success among Tuberculosis Patients with Diabetes Treated under the Tuberculosis Control Programme in an Urban Setting in South India. Indian J Community Med 2017; 42:180-182. [PMID: 28852286 PMCID: PMC5561700 DOI: 10.4103/ijcm.ijcm_179_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Studies from India on sputum conversion and tuberculosis (TB) treatment outcomes among TB patients with diabetes are limited. Objective: The objective of this study is to estimate the proportion of sputum smear conversion and successful treatment outcomes among diabetic–TB patients treated under Revised National TB Control Programme (RNTCP). Methodology: Information on TB disease, diabetes, sputum conversion, and treatment outcomes were collected from treatment cards of adult TB patients (age >18 years) treated in the District TB Centre TB Unit, Tiruchirapalli, Tamil Nadu from July 1, 2014, to October 31, 2015. Results: Diabetes was documented in 163 (14%) of 1131 TB patients. Sputum conversion was in 107 (94%) of 114 smear positive-TB patients. Successful TB treatment outcome was in 116 (85%) of 136 patients and 107 (86%) of 124 new TB patients. Conclusion: Sputum conversion was as per RNTCP target while treatment success rate among the new TB patients with diabetes was suboptimal.
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Affiliation(s)
- Velayutham Banurekha
- Department of Clinical Research, National Institute for Research in TB, Chennai, Tamil Nadu, India
| | - Tarun Bhatnagar
- ICMR School of Public Health, National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | | | - Boopathi Kangusamy
- Department of Biostatistics, National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India
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Shin HJ, Kim TO, Oh HJ, Park HY, Chang JS, Ahn S, Kim YI, Lim SC, Kwon YS. Impact of diabetes mellitus on indeterminate results of the QuantiFERON TB Gold In-Tube test: A propensity score matching analysis. PLoS One 2017; 12:e0181887. [PMID: 28732078 PMCID: PMC5521843 DOI: 10.1371/journal.pone.0181887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/07/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The sensitivity of interferon-gamma release assays (IGRAs) in the detection of Mycobacterium tuberculosis infection could be affected by conditions of immune dysregulation. For this reason, diabetes mellitus (DM) may increase the frequency of indeterminate results of IGRAs. However, there have been inconsistent reports of role of DM on indeterminate IGRA results. METHODS We retrospectively reviewed all patients who underwent QuantiFERON-TB Gold In-Tube testing (QFT-GIT) at Chonnam National University Hospital. We collected the clinical and laboratory data of these patients. RESULTS Of all 3,391 subjects, 1,265 (37.3%) had a positive QFT-GIT result, 266 (7.8%) had an indeterminate result, and 1,860 (54.9%) had a negative result. The mean age was 54.8 ± 18.1 years and 55.0% of the patients were male. There were 512 (15.1%) patients with DM. Multivariable analysis revealed that systemic corticosteroid use, tuberculosis, lymphocytopenia, low serum albumin, and high serum C-reactive protein (CRP) levels were significantly associated with indeterminate QFT-GIT results. However, DM was not associated with indeterminate QFT-GIT results (adjusted odds ratio, 0.98; 95% confidence interval, 0.69-1.41; P = 0.939). After propensity score matching, DM was not associated with indeterminate results of QFT-GIT. CONCLUSION In this large cohort study, DM does not affect the incidence of indeterminate results of QFT-GIT.
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Affiliation(s)
- Hong-Joon Shin
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Tae-Ok Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyung-Joo Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ha-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sun Chang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seong Ahn
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
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