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Mithunage CT, Denning DW. Timing of recurrence after treatment of pulmonary TB. IJTLD OPEN 2024; 1:456-465. [PMID: 39398436 PMCID: PMC11467853 DOI: 10.5588/ijtldopen.24.0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/17/2024] [Indexed: 10/15/2024]
Abstract
Pulmonary TB (PTB) may recur due to reinfection or relapse after initial successful treatment. Based on microbiologically documented cases, we searched Embase, PubMed, Web of Science, and Medline for PTB recurrence. The timeframe of overall recurrences, relapse, reinfection, and risk factors were assessed. We compared the time to recurrence, relapse, and reinfection from treatment completion and plotted this using Kaplan-Meier curves. This systematic review included 23 articles describing 2,153 PTB recurrences in 75,224 treated people across all continents. Genotyping data to distinguish relapse from reinfection was available for 402 recurrences. The cumulative recurrence percentage was 2.9% over 5 years, and the median time for recurrence was 18 months (95% CI 16.99-19.0). Most recurrences (93%) were in HIV-negative people. Relapse occurred earlier than reinfection at 12 months (95% CI 10.86-13.14) vs 24 months (95% CI 21.61-26.39) (P < 0.001, χ2 59.89). In low TB burden settings, recurrences were mainly caused by relapse (85%), whereas in high-burden settings, relapses comprised 56% of recurrences. Recurrences occurred slightly earlier in HIV-positive patients (P = 0.038, χ2 4.30). The emergence of resistance to one or more first-line anti-TB agents was documented in 40 of 421 cases (9.5%). Early recurrences are mainly relapses, while late recurrences are mainly reinfections.
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Affiliation(s)
- C T Mithunage
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - D W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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2
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Nosik M, Ryzhov K, Kudryavtseva AV, Kuimova U, Kravtchenko A, Sobkin A, Zverev V, Svitich O. Decreased IL-1 β Secretion as a Potential Predictor of Tuberculosis Recurrence in Individuals Diagnosed with HIV. Biomedicines 2024; 12:954. [PMID: 38790916 PMCID: PMC11117744 DOI: 10.3390/biomedicines12050954] [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: 03/10/2024] [Revised: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The mechanisms of the formation of immunological competence against tuberculosis (TB), and especially those associated with HIV co-infection, remain poorly understood. However, there is an urgent need for risk recurrence predictive biomarkers, as well as for predictors of successful treatment outcomes. The goal of the study was to identify possible immunological markers of TB recurrence in individuals with HIV/TB co-infection. Methods: The plasma levels of IFN-γ, TNF-α, IL-10, and IL-1β (cytokines which play important roles in the immune activation and protection against Mycobacterium tuberculosis) were measured using ELISA EIA-BEST kits. The cytokine concentrations were determined using a standard curve obtained with the standards provided by the manufacturer of each kit. Results: A total of 211 individuals were enrolled in the study as follows: 62 patients with HIV/TB co-infection, 52 with HIV monoinfection, 52 with TB monoinfection, and 45 healthy donors. Out of the 62 patients with HIV/TB, 75.8% (47) of patients were newly diagnosed with HIV and TB, and 24.2% (15) displayed recurrent TB and were newly diagnosed with HIV. Decreased levels of IFN-γ, TNF-α, and IL-10 were observed in patients with HIV/TB when compared with HIV and TB patients. However, there was no difference in IFN-γ, TNF-α, or IL-10 secretion between both HIV/TB groups. At the same time, an almost 4-fold decrease in Il-1β levels was detected in the HIV/TB group with TB recurrence when compared with the HIV/TB group (p = 0.0001); a 2.8-fold decrease when compared with HIV patients (p = 0.001); and a 2.2-fold decrease with newly diagnosed TB patients (p = 0.001). Conclusions: Significantly decreased Il-1β levels in HIV/TB patients' cohort with secondary TB indicate that this cytokine can be a potential biomarker of TB recurrence.
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Affiliation(s)
- Marina Nosik
- I.I. Mechnikov Institute of Vaccines and Sera, 105064 Moscow, Russia; (K.R.); (V.Z.); (O.S.)
| | - Konstantin Ryzhov
- I.I. Mechnikov Institute of Vaccines and Sera, 105064 Moscow, Russia; (K.R.); (V.Z.); (O.S.)
| | - Asya V. Kudryavtseva
- La Facultad de Ciencias Médicas, Universidad Bernardo O’Higgings-Escuela de Medicina, Santiago 8370993, Chile;
| | - Ulyana Kuimova
- Central Research Institute of Epidemiology, Rospotrebnadzor, 111123 Moscow, Russia; (U.K.); (A.K.)
| | - Alexey Kravtchenko
- Central Research Institute of Epidemiology, Rospotrebnadzor, 111123 Moscow, Russia; (U.K.); (A.K.)
| | - Alexandr Sobkin
- G.A. Zaharyan Moscow Tuberculosis Clinic, Department for Treatment of TB Patients with HIV, 125466 Moscow, Russia;
| | - Vitaly Zverev
- I.I. Mechnikov Institute of Vaccines and Sera, 105064 Moscow, Russia; (K.R.); (V.Z.); (O.S.)
| | - Oxana Svitich
- I.I. Mechnikov Institute of Vaccines and Sera, 105064 Moscow, Russia; (K.R.); (V.Z.); (O.S.)
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3
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Martinez-Martinez YB, Huante MB, Chauhan S, Naqvi KF, Bharaj P, Endsley JJ. Helper T cell bias following tuberculosis chemotherapy identifies opportunities for therapeutic vaccination to prevent relapse. NPJ Vaccines 2023; 8:165. [PMID: 37898618 PMCID: PMC10613213 DOI: 10.1038/s41541-023-00761-4] [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: 01/29/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023] Open
Abstract
Therapeutic vaccines have promise as adjunctive treatment for tuberculosis (TB) or as preventives against TB relapse. An important development challenge is the limited understanding of T helper (Th) cell roles during these stages of disease. A murine model of TB relapse was used to identify changes in Th populations and cytokine microenvironment. Active TB promoted expansion of Th1, Th2, Th17, and Th22 cells and cytokines in the lung. Following drug therapy, pulmonary Th17 and Th22 cells contracted, Th1 cells remained elevated, while Th cells producing IL-4 or IL-10 expanded. At relapse, Th22 cells failed to re-expand in the lung despite a moderate re-expansion of Th1 and Th17 cells and an increase in Th cytokine polyfunctionality. The dynamics of Th populations further differed by tissue compartment and disease presentation. These outcomes identify immune bias by Th subpopulations during TB relapse as candidate mechanisms for pathogenesis and targets for therapeutic vaccination.
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Affiliation(s)
- Yazmin B Martinez-Martinez
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Matthew B Huante
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Sadhana Chauhan
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Kubra F Naqvi
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Preeti Bharaj
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555, USA
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, 07103, USA
| | - Janice J Endsley
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555, USA.
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Pourali F, Khademloo M, Abedi S, Roozbeh F, Barzegari S, Moosazadeh M. Relationship between smoking and tuberculosis recurrence: A systematic review and meta-analysis. Indian J Tuberc 2023; 70:475-482. [PMID: 37968054 DOI: 10.1016/j.ijtb.2023.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Of the problems in tuberculosis (TB) control program is the recurrence of this disease. In some studies, smoking has been reported as the most important risk factor. Therefore, the present study aimed at examining the association between smoking and tuberculosis recurrence using meta-analysis. METHODS To report the findings of this meta-analysis, we used PRISMA. The protocol of this study has been recorded in PROSPERO. The research question has been formulated based on PICO, and the search was performed using both MeSH and non-MeSH keywords. After screening and selecting the articles and evaluating their quality using the NOS checklist, the overall estimate of the odds ratio of tuberculosis recurrence in smokers was assessed with a 95% confidence interval. RESULTS Fourteen studies met the inclusion criteria. The total number of samples in the group of patients with tuberculosis recurrence was 1988 with 855 (43%) smokers, and in the group of patients affected by tuberculosis without recurrence, it was 27,226 with 7503 (27.56%) smokers. In 13 studies, the odds ratio of tuberculosis recurrence was higher in smokers; this difference was statistically significant in 12 of them. Combining the results of these 14 studies, the odds ratio of tuberculosis recurrence in smokers was 2.10 times higher, using the random effects model (95% CI:1.69, 2.61). CONCLUSION Based on the results of study present, smoking increases the risk of tuberculosis recurrence. Therefore, to eradicate tuberculosis by 2030, more serious interventions should be taken to quit smoking, which in turn reduces the incidence of tuberculosis.
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Affiliation(s)
- Fatemeh Pourali
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Khademloo
- Department of Community Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavosh Abedi
- Department of Internal Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Roozbeh
- Health Deputy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeed Barzegari
- Department of Paramedicine, Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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Amorim G, Jaworski J, Cordeiro-Santos M, Kritski AL, Figueiredo MC, Turner M, Andrade BB, Velez Edwards DR, Santos AR, Rolla VC, Sterling TR, Haas DW. Pharmacogenetics of tuberculosis treatment toxicity and effectiveness in a large Brazilian cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.30.23294860. [PMID: 37693472 PMCID: PMC10491388 DOI: 10.1101/2023.08.30.23294860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Genetic polymorphisms have been associated with risk of anti-tuberculosis treatment toxicity. We characterized associations with adverse events and treatment failure/recurrence among adults treated for tuberculosis in Brazil. Methods Participants were followed in Regional Prospective Observational Research in Tuberculosis (RePORT)-Brazil. We included persons with culture-confirmed drug-susceptible pulmonary tuberculosis who started treatment between 2015-2019, and who were evaluable for pharmacogenetics. Treatment included 2 months of isoniazid, rifampin or rifabutin, pyrazinamide, and ethambutol, then 4 months of isoniazid and rifampin or rifabutin, with 24 month follow-up. Analyses included 43 polymorphisms in 20 genes related to anti-tuberculosis drug hepatotoxicity or pharmacokinetics. Whole exome sequencing was done in a case-control toxicity subset. Results Among 903 participants in multivariable genetic association analyses, NAT2 slow acetylator status was associated with increased risk of treatment-related grade 2 or greater adverse events, including hepatotoxicity. Treatment failure/recurrence was more likely among NAT2 rapid acetylators, but not statistically significant at the 5% level. A GSTM1 polymorphism (rs412543) was associated with increased risk of treatment-related adverse events, including hepatotoxicity. SLCO1B1 polymorphisms were associated with increased risk of treatment- related hepatoxicity and treatment failure/recurrence. Polymorphisms in NR1/2 were associated with decreased risk of adverse events and increased risk of failure/recurrence. In whole exome sequencing, hepatotoxicity was associated with a polymorphism in VTI1A , and the genes METTL17 and PRSS57 , but none achieved genome-wide significance. Conclusions In a clinical cohort representing three regions of Brazil, NAT2 acetylator status was associated with risk for treatment-related adverse events. Additional significant polymorphisms merit investigation in larger study populations.
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6
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Torres M, Tubay J, de losReyes A. Quantitative Assessment of a Dual Epidemic Caused by Tuberculosis and HIV in the Philippines. Bull Math Biol 2023; 85:56. [PMID: 37211585 DOI: 10.1007/s11538-023-01156-1] [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: 07/19/2022] [Accepted: 04/05/2023] [Indexed: 05/23/2023]
Abstract
Tuberculosis (TB) and human immunodeficiency virus (HIV) are the two major public health emergencies in the Philippines. The country is ranked fourth worldwide in TB incidence cases despite national efforts and initiatives to mitigate the disease. Concurrently, the Philippines has the fastest-growing HIV epidemic in Asia and the Pacific region. The TB-HIV dual epidemic forms a lethal combination enhancing each other's progress, driving the deterioration of immune responses. In order to understand and describe the transmission dynamics and epidemiological patterns of the co-infection, a compartmental model for TB-HIV is developed. A class of people living with HIV (PLHIV) who did not know their HIV status is incorporated into the model. These unaware PLHIV who do not seek medical treatment are potential sources of new HIV infections that could significantly influence the disease transmission dynamics. Sensitivity analysis using the partial rank correlation coefficient is performed to assess model parameters that are influential to the output of interests. The model is calibrated using available Philippine data on TB, HIV, and TB-HIV. Parameters that are identified include TB and HIV transmission rates, progression rates from exposed to active TB, and from TB-latent with HIV to active infectious TB with HIV in the AIDS stage. Uncertainty analysis is performed to identify the degree of accuracy of the estimates. Simulations predict an alarming increase of 180% and 194% in new HIV and TB-HIV infections in 2025, respectively, relative to 2019 data. These projections underscore an ongoing health crisis in the Philippines that calls for a combined and collective effort by the government and the public to take action against the lethal combination of TB and HIV.
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Affiliation(s)
- Monica Torres
- Institute of Mathematical Sciences and Physics, University of the Philippines Los Baños, Los Baños, 4031, Laguna, Philippines
| | - Jerrold Tubay
- Institute of Mathematical Sciences and Physics, University of the Philippines Los Baños, Los Baños, 4031, Laguna, Philippines.
| | - Aurelio de losReyes
- Institute of Mathematics, University of the Philippines Diliman, Quezon City, 1101, Philippines
- Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea
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7
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Sang Y, Zhang L, Song B, Zhang Y. Global Stability for an Endogenous-Reactivated Tuberculosis Model with Beddington-DeAngelis Incidence, Distributed Delay and Relapse. QUALITATIVE THEORY OF DYNAMICAL SYSTEMS 2023; 22:89. [PMID: 37124842 PMCID: PMC10123595 DOI: 10.1007/s12346-023-00788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
A tuberculosis (TB) epidemic model with Beddington-DeAngelis incidence and distributed delay is proposed to characterize the interaction between latent period, endogenous reactivation, treatment of latent TB infection, as well as relapse. The basic reproduction number R 0 is defined, and the globally asymptotic stability of disease-free equilibrium is shown when R 0 < 1 , while if R 0 > 1 the globally asymptotic stability of endemic equilibrium is also acquired. Theoretical results are validated through performing numerical simulations, wherein we detect that TB dynamic behavior between models with discrete and distributed delays could be same and opposite, and TB is more persistent in the model with distributed delay. Besides, increasing the protection level of susceptible and infectious individuals is crucial for the control of TB.
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Affiliation(s)
- Yuan Sang
- College of Mathematics and Systems Science, Xinjiang University, Ürümqi, 830017 People’s Republic of China
- The Key Laboratory of Applied Mathematics of Xinjiang Uygur Autonomous Region, Ürümqi, People’s Republic of China
| | - Long Zhang
- College of Mathematics and Systems Science, Xinjiang University, Ürümqi, 830017 People’s Republic of China
- The Key Laboratory of Applied Mathematics of Xinjiang Uygur Autonomous Region, Ürümqi, People’s Republic of China
| | - Bing Song
- College of Mathematics and Systems Science, Xinjiang University, Ürümqi, 830017 People’s Republic of China
- The Key Laboratory of Applied Mathematics of Xinjiang Uygur Autonomous Region, Ürümqi, People’s Republic of China
| | - Yuru Zhang
- College of Mathematics and Systems Science, Xinjiang University, Ürümqi, 830017 People’s Republic of China
- The Key Laboratory of Applied Mathematics of Xinjiang Uygur Autonomous Region, Ürümqi, People’s Republic of China
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8
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Mujtaba MA, Richardson M, Shahzad H, Javed MI, Raja GK, Shaiq PA, Haldar P, Saeed S. Demographic and Clinical Determinants of Tuberculosis and TB Recurrence: A Double-Edged Retrospective Study from Pakistan. J Trop Med 2022; 2022:4408306. [PMID: 36478977 PMCID: PMC9722313 DOI: 10.1155/2022/4408306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 09/10/2024] Open
Abstract
Objective TB recurrence is the second episode of TB after initial treatment bringing about an additional 7% load in TB burden intensified by 17.7% of multidrug-resistant recurrent cases. It is necessary to curb recurrence so that attempts to deal with active disease can be made more effective. This study aimed to characterize sociodemographic and clinical factors associated with recurrent TB in a high-burden setting. Methodology. A retrospective case-control study was carried out at two hospitals in Rawalpindi, Pakistan. TB patients and controls were included in the study. Sociodemographic and clinical data were collected by questionnaire from all subjects. Multivariate regression analysis was performed to determine factors associated with TB and TB recurrence respectively. Results In our study cohort, factors significantly associated with TB were low BMI (OR: 0.961 (CI 0.954-0.968), p < 0.001), female gender (OR: 2.065 (CI 1.922-2.219), p < 0.001), being single/unmarried (OR: 1.214 (CI 1.109-1.328), p=0.003), middle-income status (OR: 1.935 (CI 1.616-2.323), p < 0.001), smoking (OR: 1.567 (CI 1.435-1.710), p < 0.001), and diabetes mellitus (OR: 1.142 (CI 1.017-1.278), p=0.023). TB recurrence constituted 11.2% of patients presenting to the hospital. Compared with the first episode of TB, cases with recurrence were more likely to be older (OR: 1.011 (CI 1.004-1.017), p < 0.001), have disease awareness (OR: 1.906 (CI 1.486-2.437), p < 0.001), smear positive (OR: 2.384 (CI 1.650-3.536), p < 0.001), and be drug-resistant (OR: 5.615 (CI 4.265-7.386), p < 0.001). Conclusion In the present study cohort, low BMI, female gender, being single, middle-income status, being unemployed, smoking, and being diabetic came out to be the sociodemographic and clinical risk factors for TB. Further exploring the TB cases increasing age, drug resistance and smear positivity stood out to be the major sociodemographic and clinical factors of TB recurrence despite high disease awareness.
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Affiliation(s)
- Mariam Ahmed Mujtaba
- University Institute of Biochemistry and Biotechnology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi 46000, Pakistan
- NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Matthew Richardson
- NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Hira Shahzad
- University Institute of Biochemistry and Biotechnology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi 46000, Pakistan
| | - Muhammad Ishaq Javed
- University Institute of Biochemistry and Biotechnology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi 46000, Pakistan
| | - Ghazala Kaukab Raja
- University Institute of Biochemistry and Biotechnology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi 46000, Pakistan
| | - Pakeeza Arzoo Shaiq
- University Institute of Biochemistry and Biotechnology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi 46000, Pakistan
| | - Pranabashis Haldar
- NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sadia Saeed
- University Institute of Biochemistry and Biotechnology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi 46000, Pakistan
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Investigation on the cause of recurrent tuberculosis in a rural area in China using whole-genome sequencing: A retrospective cohort study. Tuberculosis (Edinb) 2022; 133:102174. [DOI: 10.1016/j.tube.2022.102174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/17/2022]
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10
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Fischinger S, Cizmeci D, Shin S, Davies L, Grace PS, Sivro A, Yende-Zuma N, Streeck H, Fortune SM, Lauffenburger DA, Naidoo K, Alter G. A Mycobacterium tuberculosis Specific IgG3 Signature of Recurrent Tuberculosis. Front Immunol 2021; 12:729186. [PMID: 34630406 PMCID: PMC8493041 DOI: 10.3389/fimmu.2021.729186] [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: 06/22/2021] [Accepted: 09/03/2021] [Indexed: 01/23/2023] Open
Abstract
South Africa has the highest prevalence of HIV and tuberculosis (TB) co-infection globally. Recurrent TB, caused by relapse or reinfection, makes up the majority of TB cases in South Africa, and HIV infected individuals have a greater likelihood of developing recurrent TB. Given that TB remains a leading cause of death for HIV infected individuals, and correlates of TB recurrence protection/risk have yet to be defined, here we sought to understand the antibody associated mechanisms of recurrent TB by investigating the humoral response in a longitudinal cohort of HIV co-infected individuals previously treated for TB with and without recurrent disease during follow-up, in order to identify antibody correlates of protection between individuals who do not have recurrent TB and individuals who do. We used a high-throughput, “systems serology” approach to profile biophysical and functional characteristics of antibodies targeting antigens from Mycobacterium tuberculosis (Mtb). Differences in antibody profiles were noted between individuals with and without recurrent TB, albeit these differences were largely observed close to the time of re-diagnosis. Individuals with recurrent TB had decreased Mtb-antigen specific IgG3 titers, but not other IgG subclasses or IgA, compared to control individuals. These data point to a potential role for Mtb-specific IgG3 responses as biomarkers or direct mediators of protective immunity against Mtb recurrence.
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Affiliation(s)
- Stephanie Fischinger
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, United States.,University of Duisburg-Essen, Essen, Germany
| | - Deniz Cizmeci
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, United States.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Sally Shin
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, United States
| | - Leela Davies
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, United States
| | - Patricia S Grace
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, United States
| | - Aida Sivro
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Medical Research Council - Centre for the AIDS Programme of Research in South Africa (MRC-CAPRISA) HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | | | - Sarah M Fortune
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, United States.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Douglas A Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Medical Research Council - Centre for the AIDS Programme of Research in South Africa (MRC-CAPRISA) HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, United States
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11
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Su H, Lin K, Tiwari D, Healy C, Trujillo C, Liu Y, Ioerger TR, Schnappinger D, Ehrt S. Genetic models of latent tuberculosis in mice reveal differential influence of adaptive immunity. J Exp Med 2021; 218:e20210332. [PMID: 34269789 PMCID: PMC8289691 DOI: 10.1084/jem.20210332] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/27/2021] [Accepted: 06/29/2021] [Indexed: 01/29/2023] Open
Abstract
Studying latent Mycobacterium tuberculosis (Mtb) infection has been limited by the lack of a suitable mouse model. We discovered that transient depletion of biotin protein ligase (BPL) and thioredoxin reductase (TrxB2) results in latent infections during which Mtb cannot be detected but that relapse in a subset of mice. The immune requirements for Mtb control during latency, and the frequency of relapse, were strikingly different depending on how latency was established. TrxB2 depletion resulted in a latent infection that required adaptive immunity for control and reactivated with high frequency, whereas latent infection after BPL depletion was independent of adaptive immunity and rarely reactivated. We identified immune signatures of T cells indicative of relapse and demonstrated that BCG vaccination failed to protect mice from TB relapse. These reproducible genetic latency models allow investigation of the host immunological determinants that control the latent state and offer opportunities to evaluate therapeutic strategies in settings that mimic aspects of latency and TB relapse in humans.
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Affiliation(s)
- Hongwei Su
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY
| | - Kan Lin
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY
| | - Divya Tiwari
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY
| | - Claire Healy
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY
| | - Carolina Trujillo
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY
| | - Yao Liu
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY
| | - Thomas R. Ioerger
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX
| | - Dirk Schnappinger
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY
| | - Sabine Ehrt
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY
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12
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White AD, Sibley L, Gullick J, Sarfas C, Clark S, Fagrouch Z, Verschoor E, Salguero FJ, Dennis M, Sharpe S. TB and SIV Coinfection; a Model for Evaluating Vaccine Strategies against TB Reactivation in Asian Origin Cynomolgus Macaques: A Pilot Study Using BCG Vaccination. Vaccines (Basel) 2021; 9:945. [PMID: 34579182 PMCID: PMC8473354 DOI: 10.3390/vaccines9090945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
This pilot study aimed to determine the utility of a cynomolgus macaque model of coinfection with simian immunodeficiency virus (SIV) for the assessment of vaccines designed to prevent reactivation of TB. Following infection caused by aerosol exposure to an ultralow dose of Mycobacterium tuberculosis (M. tb), data trends indicated that subsequent coinfection with SIVmac32H perturbed control of M. tb infection as evidenced by the increased occurrence of progressive disease in this group, higher levels of pathology and increased frequency of progressive tuberculous granulomas in the lung. BCG vaccination led to improved control of TB-induced disease and lower viral load in comparison to unvaccinated coinfected animals. The M. tb-specific IFNγ response after exposure to M. tb, previously shown to be associated with bacterial burden, was lower in the BCG-vaccinated group than in the unvaccinated groups. Levels of CD4+ and CD8+ T cells decreased in coinfected animals, with counts recovering more quickly in the BCG-vaccinated group. This pilot study provides proof of concept to support the use of the model for evaluation of interventions against reactivated/exacerbated TB caused by human immunodeficiency virus (HIV) infection.
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Affiliation(s)
- Andrew D. White
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Laura Sibley
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Jennie Gullick
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Charlotte Sarfas
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Simon Clark
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Zahra Fagrouch
- Department of Virology, Biomedical Primate Research Centre, Lange Kleiweg 161, 2288 GJ Rijswijk, The Netherlands; (Z.F.); (E.V.)
| | - Ernst Verschoor
- Department of Virology, Biomedical Primate Research Centre, Lange Kleiweg 161, 2288 GJ Rijswijk, The Netherlands; (Z.F.); (E.V.)
| | - Francisco J. Salguero
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Mike Dennis
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Sally Sharpe
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
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A T, Aggarwal R, Raj YA. A fractional order HIV-TB co-infection model in the presence of exogenous reinfection and recurrent TB. NONLINEAR DYNAMICS 2021; 104:4701-4725. [PMID: 34075277 PMCID: PMC8159726 DOI: 10.1007/s11071-021-06518-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/04/2021] [Indexed: 05/13/2023]
Abstract
In this article, a novel fractional order model has been introduced in Caputo sense for HIV-TB co-infection in the presence of exogenous reinfection and recurrent TB along with the treatment for both HIV and TB. The main aim of considering the fractional order model is to incorporate the memory effect of both diseases. We have analyzed both sub-models separately with fractional order. The basic reproduction number, which measures the contagiousness of the disease, is determined. The HIV sub-model is shown to have a locally asymptotically stable disease-free equilibrium point when the corresponding reproduction number, R H , is less than unity, whereas, for R H > 1 , the endemic equilibrium point comes into existence. For the TB sub-model, the disease-free equilibrium point has been proved to be locally asymptotically stable for R T < 1 . The existence of TB endemic equilibrium points in the presence of reinfection and recurrent TB for R T < 1 justifies the existence of backward bifurcation under certain restrictions on the parameters. Further, we numerically simulate the fractional order model to verify the analytical results and highlight the role of fractional order in co-infection modeling. The fractional order derivative is shown to have a crucial role in determining the transmission dynamics of HIV-TB co-infection. It is concluded that the memory effect plays a significant role in reducing the infection prevalence of HIV-TB co-infection. An increment in the number of recovered individuals can also be observed when the memory effect is taken into consideration by introducing fractional order model.
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Affiliation(s)
- Tanvi A
- Department of Mathematics, Deshbandhu College, University of Delhi, New Delhi, 110019 India
| | - Rajiv Aggarwal
- Department of Mathematics, Deshbandhu College, University of Delhi, New Delhi, 110019 India
| | - Yashi A. Raj
- Department of Mathematics, Shaheed Rajguru College of Applied Sciences for Women, University of Delhi, New Delhi, 110096 India
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TB47 and clofazimine form a highly synergistic sterilizing block in a second-line regimen for tuberculosis in mice. Biomed Pharmacother 2020; 131:110782. [PMID: 33152940 DOI: 10.1016/j.biopha.2020.110782] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/23/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) remains a serious public health threat worldwide. To date, the anti-TB activity of TB47 (T), an imidazopyridine amide class of antibiotics targeting QcrB in the electron transport chain, has not been systematically evaluated, especially in a new regimen against MDR-TB. This study employed both macrophage infection and a mouse model to test the activity of T alone or in combination with other antimicrobial agents. Different regimens containing amikacin (A), levofloxacin (L), ethambutol (E), and pyrazinamide (Z) + clofazimine (C)/T were evaluated in the mouse model. The bacterial burdens of mice from different groups were monitored at different time points while relapse was assessed 6 months after treatment cessation. Colonies obtained at relapse underwent drug susceptibility testing. We found that T exhibited highly synergistic bactericidal activity with C in all models. Adding T to ALEZC might shorten the MDR-TB treatment duration from ≥ 9 months to ≤ 5months, as five months of treatment with ALEZCT achieved zero relapse rates in 2 animal experiments. These findings indicate that T exhibits a highly synergistic sterilizing activity when combined with C. All isolates from relapsing mice remained sensitive to each drug, suggesting that the relapse was not due to drug resistance but rather associated with the type of regimen.
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15
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Xie Z, Wang T, Chen H, Wang D, Gao X, Hui Y. Factors associated with diagnostic delay in recurrent TB. BMC Public Health 2020; 20:1207. [PMID: 32770986 PMCID: PMC7414540 DOI: 10.1186/s12889-020-09005-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background Recurrent tuberculosis (TB) contributes to the burden of TB. The study was designed to explore the time of diagnostic delay and risk of delay in patients with recurrent TB in China. Methods A total of 13,334 patients with new and recurrent TB registered in Yulin a city in China were included. The Kaplan-Meier survival curve was employed to estimate the median delay time. The mixed-effects survival model was used to identify the correlates associated with diagnostic delay. The outcome of interest in the model was"being diagnosed". Results We found that 6.5% of cases with TB were attributed to recurrence. The median delay time of recurrent TB cases (73 days) was more than twice as long as that of new TB (35 days). Individuals with recurrent TB had a higher risk of diagnostic delay than new TB (HR, 0.5, 95%CI, 0.5–0.6). Factors associated with diagnostic delay differed between new TB and recurrent TB cases. Immigrants (HR, 0.5, 95%CI, 0.3–0.9), cases notified by way of recommendation (HR, 0.6, 95%CI, 0.4–0.9) and diagnosed at TB dispensary (HR, 0.4, 95%CI, 0.3–0.6) were associated with a higher risk of a longer delay for recurrent TB cases. Conclusions The proportion of TB cases attributed to recurrence was high. Patients with recurrent TB had a longer delay time and a higher risk of diagnostic delay. Further interventions to improve diagnostic delay should focus on screening for TB in immigrants, improving public health services at the lowest healthcare level and update of TB diagnosis and management model.
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Affiliation(s)
- Zhongyao Xie
- Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China
| | - Tingwei Wang
- Yulin Center for Disease Control and Prevention, Yulin, 719000, Shaanxi, China
| | - Hongguang Chen
- Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Key Laboratory of Mental Health, Ministry of Health (Peking University), No. 51 Hua Yuan Bei Road, Beijing, 100191, China.
| | - Donglin Wang
- Yulin Center for Disease Control and Prevention, Yulin, 719000, Shaanxi, China
| | - Xiangqi Gao
- Yulin Center for Disease Control and Prevention, Yulin, 719000, Shaanxi, China
| | - Yi Hui
- Yulin Center for Disease Control and Prevention, Yulin, 719000, Shaanxi, China
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16
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Campbell JR, Winters N, Menzies D. Absolute risk of tuberculosis among untreated populations with a positive tuberculin skin test or interferon-gamma release assay result: systematic review and meta-analysis. BMJ 2020; 368:m549. [PMID: 32156698 PMCID: PMC7190060 DOI: 10.1136/bmj.m549] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the annual rate of tuberculosis development after a positive tuberculin skin test (TST) or interferon-gamma release assay result (IGRA), or both, among untreated populations with characteristics believed to increase the risk of tuberculosis (at risk populations). DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Medline, and Cochrane Controlled Register of Trials from 1 January 1990 to 17 May 2019, for studies in humans published in English or French. Reference lists were reviewed. ELIGIBILITY CRITERIA AND DATA ANALYSIS Retrospective or prospective cohorts and randomised trials that included at least 10 untreated participants who tested positive to tuberculosis antigens (contained in TST or IGRA, or both) followed for at least 12 months. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and meta-analyses of observational studies in epidemiology (MOOSE) guidelines, two reviewers independently extracted study data and assessed quality using a modified quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Data were pooled using random effects generalised linear mixed models. MAIN OUTCOME MEASURES The primary outcome was tuberculosis incidence per 1000 person years among untreated participants who tested positive (TST or IGRA, or both) in different at risk subgroups. Secondary outcomes were the cumulative incidence of tuberculosis and incidence rate ratios among participants with a positive test result for latent tuberculosis infection compared with those with a negative test result in at risk subgroups. RESULTS 122 of 5166 identified studies were included. In three general population studies, the incidence of tuberculosis among 33 811 participants with a TST induration of ≥10 mm was 0.3 (95% confidence interval 0.1 to 1.1) per 1000 person years. Among 116 197 positive test results for latent tuberculosis infection in 19 different at risk populations, incidence rates were consistently higher than those in the general population. Among all types of tuberculosis contacts, the incidence of tuberculosis was 17.0 (95% confidence interval 12.9 to 22.4) per 1000 person years for participants with a positive IGRA result and 8.4 (5.6 to 12.6) per 1000 person years for participants with a positive TST result of ≥5 mm. Among people living with HIV, the incidence of tuberculosis was 16.9 (10.5 to 27.3) for participants with a positive IGRA result and 27.1 (15.0 to 49.0) for participants with a positive TST result of ≥5 mm. Rates were also high for immigrants, people with silicosis or requiring dialysis, transplant recipients, and prisoners. Incidence rate ratios among test positive versus test negative participants were significantly greater than 1.0 in almost all risk groups, for all tests. CONCLUSIONS The incidence of tuberculosis is substantial in numerous at risk populations after a positive TST or IGRA result. The information from this review should help inform clinical decisions to test and treat for latent tuberculosis infection. STUDY REGISTRATION PROSPERO CRD42019136608.
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Affiliation(s)
- Jonathon R Campbell
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- McGill International TB Centre, Montreal, QC, Canada
| | - Nicholas Winters
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- McGill International TB Centre, Montreal, QC, Canada
| | - Dick Menzies
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- McGill International TB Centre, Montreal, QC, Canada
- Montreal Chest Institute, Montreal, QC, Canada
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17
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Chin AT, Rylance J, Makumbirofa S, Meffert S, Vu T, Clayton J, Mason P, Woodruff P, Metcalfe J. Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study. Int J Tuberc Lung Dis 2020; 23:203-211. [PMID: 30808453 DOI: 10.5588/ijtld.18.0313] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To examine the prevalence and magnitude of chronic lung disease (CLD) and its association with empiric anti-tuberculosis treatment (due to lack of bacteriologic confirmation) among recurrent tuberculosis (TB) survivors in a human immunodeficiency virus (HIV) prevalent setting. METHODS Prospective cohort study of retreatment TB survivors in Harare, Zimbabwe. At median follow-up of 2 years post-treatment initiation, we characterized mortality, respiratory impairment, and mental health. RESULTS Among 175 retreatment TB survivors, 65% of whom were HIV-positive and 21% had been empirically treated, multiparameter CLD was noted at follow-up among 14% of patients (95%CI 9.0-19.7), with a six-fold increase in age-adjusted death in the first year following treatment completion. Empirically treated TB (relative risk [RR] 3.4, 95%CI 1.4-8.3) was associated with CLD, as was the number of previous anti-tuberculosis treatment courses in dose-dependent fashion (three vs. one, RR 6.2, 95%CI 1.7-22.1). Among retreatment TB survivors, 33% (95%CI 26.0-40.1) had persistent respiratory symptoms (Chronic Obstructive Pulmonary Disease Assessment Test score 10); 26% (95%CI 19.8-33.0) significant deficits in exercise capacity (median incremental shuttle walk test distance, 550 m; Q1-Q₃ 440-730 m); 83% (95%CI 75.7-89.7) residual radiographic abnormalities on chest X-ray; 12% (95%CI 6.6-16.1%) moderate-to-severe obstruction on spirometry; and 13% (95%CI 7.6-17.5%) major depression. CONCLUSIONS Despite successful treatment, retreatment TB survivors retain a substantial risk of morbidity and mortality.
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Affiliation(s)
- A T Chin
- School of Medicine, University of California, San Francisco, California, USA
| | - J Rylance
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - S Makumbirofa
- Biomedical Research & Training Institute, Harare, Zimbabwe
| | | | | | - J Clayton
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, USA
| | - P Mason
- Biomedical Research & Training Institute, Harare, Zimbabwe
| | - P Woodruff
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, USA
| | - J Metcalfe
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, USA
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18
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van der Heijden YF, Karim F, Chinappa T, Mufamadi G, Zako L, Shepherd BE, Maruri F, Moosa MYS, Sterling TR, Pym AS. Older age at first tuberculosis diagnosis is associated with tuberculosis recurrence in HIV-negative persons. Int J Tuberc Lung Dis 2019; 22:871-877. [PMID: 29991395 DOI: 10.5588/ijtld.17.0766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
SETTING Tuberculosis (TB) clinic in Durban, South Africa. OBJECTIVE To assess the factors associated with TB recurrence among human immunodeficiency virus (HIV) negative adults and children. DESIGN We conducted a retrospective longitudinal study from January 2000 to December 2012. We defined recurrence as a TB episode occurring within the study period after treatment completion or cure of a previous episode. We used a multivariable Poisson regression model to assess the factors associated with the number of recurrences among HIV-negative patients. RESULTS Among 17 941 patients with known HIV status, 3653 (20%) were HIV-negative; of these, 235 (6%) had one recurrence, 21 (1%) had two recurrences and 4 (0.1%) had three recurrences. The median follow-up time from the end of treatment for the first episode was 3.0 years (interquartile range 1.9-4.2). Age at the first TB episode was significantly associated with the number of TB recurrences: younger patients had the lowest rate of recurrence, with a steady increase in rates until age 40 years, after which rates stabilized. CONCLUSIONS TB recurrence rates among HIV-negative patients were higher at increased age at the first TB episode. Further translational studies are needed to clarify the factors that drive multiple TB recurrences in older age, including impaired immunity, the results of which have implications for TB vaccine development.
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Affiliation(s)
- Y F van der Heijden
- Vanderbilt Tuberculosis Center, Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - F Karim
- Vanderbilt Tuberculosis Center, Africa Health Research Institute, Durban
| | - T Chinappa
- Vanderbilt Tuberculosis Center, eThekwini Municipality, Durban, South Africa
| | - G Mufamadi
- Vanderbilt Tuberculosis Center, eThekwini Municipality, Durban, South Africa
| | - L Zako
- Vanderbilt Tuberculosis Center, eThekwini Municipality, Durban, South Africa
| | - B E Shepherd
- Vanderbilt Tuberculosis Center, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - F Maruri
- Vanderbilt Tuberculosis Center, Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - M-Y S Moosa
- Vanderbilt Tuberculosis Center, Department of Infectious Diseases, Division of Internal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - T R Sterling
- Vanderbilt Tuberculosis Center, Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - A S Pym
- Vanderbilt Tuberculosis Center, Africa Health Research Institute, Durban
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Wangari IM, Trauer J, Stone L. Modelling heterogeneity in host susceptibility to tuberculosis and its effect on public health interventions. PLoS One 2018; 13:e0206603. [PMID: 30427891 PMCID: PMC6235601 DOI: 10.1371/journal.pone.0206603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 10/16/2018] [Indexed: 11/25/2022] Open
Abstract
A tuberculosis (TB) model that accounts for heterogeneity in host susceptibility to tuberculosis is proposed, with the aim of investigating the implications this may have for the effectiveness of public health interventions. The model examines the possibility that recovered individuals treated from active TB and individuals treated with preventive therapy acquire different levels of immunity. This contrasts with recent studies that assume the two cohorts acquire the same level of immunity, and therefore both groups are reinfected at the same rate. The analysis presented here examines the impact of this assumption when designing intervention strategies. Comparison of reinfection rates between cohorts treated with preventive therapy and recovered individuals who were previously treated for active TB provides important epidemiological insights. It is found that the reinfection rate of the cohort treated with preventive therapy is the one that plays the key role in qualitative changes in TB dynamics. By contrast, the reinfection rate of recovered individuals (previously treated from active TB) plays a minor role. Moreover, the study shows that preventive treatment of individuals during early latency is always beneficial regardless of the level of susceptibility to reinfection. Further, if patients have greater immunity following treatment for late latent infection, then treatment is again beneficial. However, if susceptibility increases following treatment for late latent infection, the effect of treatment depends on the epidemiological setting. That is: (i) in (very) low burden settings, the effect on reactivation predominates and the burden declines with treatment; (ii) in moderate to high burden settings the effect of reinfection predominates and burden increases with treatment. The effect is most dominant between the two reinfection thresholds, RT2 and RT1, respectively associated with individuals being treated with preventive therapy and individuals with untreated late latent TB infection.
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Affiliation(s)
- Isaac Mwangi Wangari
- Mathematical Sciences, School of Science, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
- * E-mail:
| | - James Trauer
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Lewi Stone
- Mathematical Sciences, School of Science, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
- Biomathematics Unit, Department of Zoology, Faculty of Life Sciences, Tel Aviv University, Israel
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20
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Naidoo K, Dookie N. Insights into Recurrent Tuberculosis: Relapse Versus Reinfection and Related Risk Factors. Tuberculosis (Edinb) 2018. [DOI: 10.5772/intechopen.73601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Naidoo K, Dookie N, Naidoo K, Yende-Zuma N, Chimukangara B, Bhushan A, Govender D, Gengiah S, Padayatchi N. Recurrent tuberculosis among HIV-coinfected patients: a case series from KwaZulu-Natal. Infect Drug Resist 2018; 11:1413-1421. [PMID: 30233220 PMCID: PMC6130302 DOI: 10.2147/idr.s150644] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Recurrent tuberculosis (TB) following TB treatment completion in HIV-infected individuals remains a major public health burden. We assessed the role of various risk factors in mediating the development of recurrent TB and subsequent resistance to antiretroviral therapy and anti-TB drugs. Patients and methods We analyzed secondary demographic, clinical, and laboratory data from medical records of five HIV-infected TB patients enrolled between 2009 and 2014 in a prospective observational study investigating TB recurrence. Paired clinical isolates of Myco-bacterium tuberculosis were typed by IS6110 restriction fragment length polymorphism analysis to determine the mechanism of TB recurrence. Plasma samples were genotyped to determine acquisition of HIV drug resistance mutations on antiretroviral treatment (ART). Results All five patients were HIV-coinfected, with a previous history of TB infection and prior exposure to anti-TB treatment, and residual lung damage, and demonstrated poor treatment adherence – significant risk factors linked to the development of recurrent TB disease. Furthermore, three of the five patients had multiple episodes of drug-susceptible TB infection with subsequent drug-resistant TB infection. Genotyping of the initial and recurrent M. tuberculosis isolates demonstrated three cases of recurrent TB because of relapse and two because of reinfection. All five patients had no mutations at ART initiation; however, by the end of the study follow-up, all patients developed dual class resistance. Conclusion This series demonstrates the complexity of recurrent TB in HIV coinfection. We highlight the challenges of managing coinfected patients and the increased propensity for the development of drug resistance. We report on the role of various risk factors mediating the development of resistance and subsequent clinical impact. This report underscores the need for structural clinical and adherence interventions for the management of complex treatment and dosing.
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Affiliation(s)
- Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,South African Medical Research Council (SAMRC) - CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa,
| | - Navisha Dookie
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,KwaZulu Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa
| | - Kasavan Naidoo
- South African Medical Research Council (SAMRC) - CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa,
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Benjamin Chimukangara
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,KwaZulu Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa.,Department of Virology, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
| | - Ambika Bhushan
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Dhineshree Govender
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Santhanalakshmi Gengiah
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,South African Medical Research Council (SAMRC) - CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa,
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22
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Khan PY, Crampin AC, Mzembe T, Koole O, Fielding KL, Kranzer K, Glynn JR. Does antiretroviral treatment increase the infectiousness of smear-positive pulmonary tuberculosis? Int J Tuberc Lung Dis 2018; 21:1147-1154. [PMID: 29037295 PMCID: PMC5644739 DOI: 10.5588/ijtld.17.0162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Understanding of the effects of human immunodeficiency virus (HIV) infection and antiretroviral treatment (ART) on Mycobacterium tuberculosis transmission dynamics remains limited. We undertook a cross-sectional study among household contacts of smear-positive pulmonary tuberculosis (TB) cases to assess the effect of established ART on the infectiousness of TB. METHOD Prevalence of tuberculin skin test (TST) positivity was compared between contacts of index cases aged 2-10 years who were HIV-negative, HIV-positive but not on ART, on ART for <1 year and on ART for 1 year. Random-effects logistic regression was used to take into account clustering within households. RESULTS Prevalence of M. tuberculosis infection in contacts of HIV-negative patients, HIV-positive patients on ART 1 year and HIV-positive patients not on ART/on ART <1 year index cases was respectively 44%, 21% and 22%. Compared to contacts of HIV-positive index cases not on ART or recently started on ART, the odds of TST positivity was similar in contacts of HIV-positive index cases on ART 1 year (adjusted OR [aOR] 1.0, 95%CI 0.3-3.7). The odds were 2.9 times higher in child contacts of HIV-negative index cases (aOR 2.9, 95%CI 1.0-8.2). CONCLUSIONS We found no evidence that established ART increased the infectiousness of smear-positive, HIV-positive index cases.
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Affiliation(s)
- P Y Khan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, Karonga Prevention Study, Chilumba, Malawi
| | - A C Crampin
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, Karonga Prevention Study, Chilumba, Malawi
| | - T Mzembe
- Karonga Prevention Study, Chilumba, Malawi
| | - O Koole
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - K L Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - K Kranzer
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, National and Supranational Mycobacterium Reference Laboratory, Forschungszentrum Borstel, Germany
| | - J R Glynn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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23
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Wangari IM, Stone L. Backward bifurcation and hysteresis in models of recurrent tuberculosis. PLoS One 2018; 13:e0194256. [PMID: 29566101 PMCID: PMC5863985 DOI: 10.1371/journal.pone.0194256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 02/27/2018] [Indexed: 11/18/2022] Open
Abstract
An epidemiological model is presented that provides a comprehensive description of the transmission pathways involved for recurrent tuberculosis (TB), whereby cured individuals can become reinfected. Our main goal is to determine conditions that lead to the appearance of a backward bifurcation. This occurs when an asymptotically stable infection free equilibrium concurrently exists with a stable non-trivial equilibria even though the basic reproduction number R0 is less than unity. Although, some 10-30% cases of TB are recurrent, the role of recurrent TB as far as the formation of backward bifurcation is concerned, is rarely if ever studied. The model used here incorporates progressive primary infection, exogenous reinfection, endogenous reactivation and recurrent TB as transmission mechanisms that contribute to TB progression. Unlike other studies of TB dynamics that make use of frequency dependent transmission rates, our analysis provides exact backward bifurcation threshold conditions without resorting to commonly applied approximations and simplifying assumptions. Exploration of the model through analytical and numerical analysis reveal that recurrent TB is sometimes capable of triggering hysteresis effects which allow TB to persist when R0 < 1 even though there is no backward bifurcation. Furthermore, recurrent TB can independently induce backward bifurcation phenomena if it exceeds a certain threshold.
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Affiliation(s)
- Isaac Mwangi Wangari
- School of Science, Department of Mathematics and Geospatial Sciences, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
- * E-mail:
| | - Lewi Stone
- School of Science, Department of Mathematics and Geospatial Sciences, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
- Biomathematics Unit, Department of Zoology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
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24
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Rosser A, Richardson M, Wiselka MJ, Free RC, Woltmann G, Mukamolova GV, Pareek M. A nested case-control study of predictors for tuberculosis recurrence in a large UK Centre. BMC Infect Dis 2018; 18:94. [PMID: 29486715 PMCID: PMC5830048 DOI: 10.1186/s12879-017-2933-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023] Open
Abstract
Background Tuberculosis (TB) recurrence represents a challenge to control programs. In low incidence countries, the prevailing risk factors leading to recurrence are poorly characterised. Methods We conducted a nested case–control study using the Leicester TB service TBIT database. Cases were identified from database notifications between 1994 and 2014. Controls had one episode and were matched to cases on a ratio of two to one by the date of notification. Multiple imputation was used to account for missing data. Multivariate conditional logistic regression analysis was employed to identify clinical, sociodemographic and TB specific risk factors for recurrence. Results From a cohort of 4628 patients, 82 TB recurrences occurred (1.8%). Nineteen of 82 patients had paired isolates with MIRU-VNTR strain type profiles available, of which 84% were relapses and 16% reinfections. On multivariate analysis, smoking (OR 3.8; p = 0.04), grade 3/4 adverse drug reactions (OR 5.6; p = 0.02), ethnicity ‘Indian subcontinent’ (OR 8.5; p = <0.01), ethnicity ‘other’ (OR 31.2; p = 0.01) and receipt of immunosuppressants (OR 6.8; p = <0.01) were independent predictors of TB recurrence. Conclusions Within this UK setting, the rate of TB recurrence was low, predominantly due to relapse. The identification of an elevated recurrence risk amongst the ethnic group contributing most cases to the national TB burden presents an opportunity to improve individual and population health. Electronic supplementary material The online version of this article (10.1186/s12879-017-2933-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrew Rosser
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 7RH, UK.,Department of Infection and Tropical Medicine, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Matthew Richardson
- Department of Infection, Respiratory Biomedical Research Centre, Institute for Lung Health, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Martin J Wiselka
- Department of Infection and Tropical Medicine, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Robert C Free
- Department of Infection, Respiratory Biomedical Research Centre, Institute for Lung Health, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Gerrit Woltmann
- Department of Infection, Respiratory Biomedical Research Centre, Institute for Lung Health, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Galina V Mukamolova
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 7RH, UK
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 7RH, UK. .,Department of Infection and Tropical Medicine, University Hospitals Leicester NHS Trust, Leicester, UK.
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25
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Silva TC, Matsuoka PDFS, Aquino DMCD, Caldas ADJM. Factors associated with tuberculosis retreatment in priority districts of Maranhão, Brazil. CIENCIA & SAUDE COLETIVA 2017; 22:4095-4104. [PMID: 29267726 DOI: 10.1590/1413-812320172212.20612015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/28/2016] [Indexed: 11/22/2022] Open
Abstract
This study investigated factors associated with cases of tuberculosis retreatment due to relapse and readmission after treatment abandonment. This is an analytical cross-sectional study type of cases reported in the Information System for Notifiable Diseases in priority municipalities in the State of Maranhão, from January 2005 to December 2010. A logistic regression model was used to identify the association. Patients aged between 40 and 59 years (OR = 1.49, p = 0.029) with a pulmonary clinical form (OR = 2.79, p = 0.016) were more likely to incur relapse. Readmissions after abandonment were more likely in males (OR = 1.53, p = 0.046), aged between 20 and 39 years (OR = 1.65, p = 0.007), with less than eight years of schooling (OR = 2.01, p = 0.037) and with alcohol dependence (OR=1.66, p = 0.037), which showed a higher probability of another abandonment (OR = 5.96, p < 0.001). These data reinforce the need for strategies aimed at this group, such as increased supervised treatment, intensified active search, post-discharge follow-up and health education action.
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Affiliation(s)
- Tereza Cristina Silva
- Departamento Acadêmico de Biologia, Instituto Federal de Educação Ciência e Tecnologia do Maranhão. Av. Getúlio Vargas 4, Monte Castelo. 65030-005 São Luís MA Brasil.
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26
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Vieira AA, Leite DT, Adreoni S. Tuberculosis recurrence in a priority city in the state of São Paulo, Brazil. J Bras Pneumol 2017; 43:106-112. [PMID: 28538777 PMCID: PMC5474373 DOI: 10.1590/s1806-37562016000000002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 09/01/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: To describe cases of tuberculosis recurrence (TBR), stratified by temporal classification (early or late TBR), and to identify possible predictors of such recurrence. Methods: This was an analytical retrospective observational epidemiological study involving a cohort of 963 new cases of pulmonary tuberculosis, reported and treated via the Tuberculosis Control Program in the city of Carapicuíba, Brazil. The study period was from 2000 to 2010. All of the pulmonary tuberculosis patients who successfully completed the treatment (with or without confirmation of cure) were selected and followed until December 31, 2012. Results: Of the 963 cases, TBR occurred in 47 (4.88%). The mean time between the first and second tuberculosis episodes was 36.12 months. Of the 47 TBR cases, 16 (34.04%) occurred within the first 18 months after the completion of the initial treatment (early TBR) and 31 (65.96%) occurred thereafter (late TBR). There were statistically significant differences between the early and late TBR groups only regarding level of education (≤ 3 vs. > 3 years of schooling; p < 0.004) and weight gain at completion of the initial treatment (1.78 kg vs. 5.31 kg; p < 0.045)-not regarding any of the other variables studied. Conclusions: A low level of education might translate to poor treatment adherence, which impedes the killing of bacilli and facilitates their survival in a latent state, making it appear as if the treatment was effective. Minimal or no weight gain at completion of the initial treatment might be a reliable biomarker to be used by health care facilities that provide tuberculosis treatment.
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Affiliation(s)
- Amadeu Antonio Vieira
- . Programa de Controle da Tuberculose do Município de Carapicuíba, Carapicuíba (SP) Brasil.,. Universidade Federal de São Paulo, São Paulo (SP) Brasil
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27
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Shen X, Yang C, Wu J, Lin S, Gao X, Wu Z, Tian J, Gan M, Luo T, Wang L, Yu C, Mei J, Pan Q, DeRiemer K, Yuan Z, Gao Q. Recurrent tuberculosis in an urban area in China: Relapse or exogenous reinfection? Tuberculosis (Edinb) 2017; 103:97-104. [PMID: 28237039 PMCID: PMC5638046 DOI: 10.1016/j.tube.2017.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 12/12/2022]
Abstract
Recurrent tuberculosis is an important indicator of the effectiveness of tuberculosis control and can occur by relapse or exogenous reinfection. We conducted a retrospective cohort study on all bacteriologically confirmed tuberculosis cases that were successfully treated between 2000 and 2012 in Shanghai, an urban area with a high number but a low prevalence rate of tuberculosis cases and a low prevalence of HIV infection. Genotyping the Mycobacterium tuberculosis from clinical isolates was used to distinguish between relapse and reinfection. In total, 5.3% (710/13,417) of successfully treated cases had a recurrence, a rate of 7.55 (95% CI 7.01-8.13) episodes per 1000 person-years, more than 18 times the rate of tuberculosis in the general population. Patients who were male, age 30-59, retreatment cases, had cavitation, diabetes, drug-resistant or multidrug-resistant tuberculosis in their initial episode of tuberculosis, were at high risk for a recurrence. Among 141 recurrent cases that had paired isolates, 59 (41.8%) had different genotypes, indicating reinfection with a different strain. Patients who completed treatment were still at high risk of another episode of tuberculosis and exogenous reinfection contributed a significant proportion of the recurrent tuberculosis cases. Targeted control strategies are needed to prevent new tuberculosis infections in this setting.
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Affiliation(s)
- Xin Shen
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China; The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China
| | - Chongguang Yang
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China; Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06510, USA
| | - Jie Wu
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Senlin Lin
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Xu Gao
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China
| | - Zheyuan Wu
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Jiyun Tian
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China
| | - Mingyu Gan
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China
| | - Tao Luo
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China
| | - Lili Wang
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Chenlei Yu
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Jian Mei
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Qichao Pan
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Kathryn DeRiemer
- School of Medicine, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA.
| | - ZhengAn Yuan
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China.
| | - Qian Gao
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China.
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Tiberi S, Carvalho ACC, Sulis G, Vaghela D, Rendon A, Mello FCDQ, Rahman A, Matin N, Zumla A, Pontali E. The cursed duet today: Tuberculosis and HIV-coinfection. Presse Med 2017; 46:e23-e39. [PMID: 28256380 DOI: 10.1016/j.lpm.2017.01.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/23/2016] [Accepted: 01/17/2017] [Indexed: 01/22/2023] Open
Abstract
The tuberculosis (TB) and HIV syndemic continues to rage and are a major public health concern worldwide. This deadly association raises complexity and represent a significant barrier towards TB elimination. TB continues to be the leading cause of death amongst HIV-infected people. This paper reports the challenges that lay ahead and outlines some of the current and future strategies that may be able to address this co-epidemic efficiently. Improved diagnostics, cheaper and more effective drugs, shorter treatment regimens for both drug-sensitive and drug-resistant TB are discussed. Also, special topics on drug interactions, TB-IRIS and TB relapse are also described. Notwithstanding the defeats and meagre investments, diagnosis and management of the two diseases have seen significant and unexpected improvements of late. On the HIV side, expansion of ART coverage, development of new updated guidelines aimed at the universal treatment of those infected, and the increasing availability of newer, more efficacious and less toxic drugs are an essential element to controlling the two epidemics. On the TB side, diagnosis of MDR-TB is becoming easier and faster thanks to the new PCR-based technologies, new anti-TB drugs active against both sensitive and resistant strains (i.e. bedaquiline and delamanid) have been developed and a few more are in the pipeline, new regimens (cheaper, shorter and/or more effective) have been introduced (such as the "Bangladesh regimen") or are being tested for MDR-TB and drug-sensitive-TB. However, still more resources will be required to implement an integrated approach, install new diagnostic tests, and develop simpler and shorter treatment regimens.
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Affiliation(s)
- Simon Tiberi
- Barts health NHS trust, Royal London hospital, division of infection, 80, Newark street, E1 2ES London, United Kingdom.
| | - Anna Cristina C Carvalho
- Oswaldo Cruz institute (IOC), laboratory of innovations in therapies, education and bioproducts, (LITEB), Fiocruz, Rio de Janeiro, Brazil.
| | - Giorgia Sulis
- University of Brescia, university department of infectious and tropical diseases, World health organization collaborating centre for TB/HIV co-infection and TB elimination, Brescia, Italy.
| | - Devan Vaghela
- Barts Health NHS Trust, Royal London hospital, department of respiratory medicine, 80, Newark street, E1 2ES London, United Kingdom.
| | - Adrian Rendon
- Hospital universitario de Monterrey, centro de investigación, prevención y tratamiento de infecciones respiratorias, Monterrey, Nuevo León UANL, Mexico.
| | - Fernanda C de Q Mello
- Federal university of Rio de Janeiro, instituto de Doenças do Tórax (IDT)/Clementino Fraga Filho hospital (CFFH), rua Professor Rodolpho Paulo Rocco, n° 255 - 1° Andar - Cidade Universitária - Ilha do Fundão, 21941-913, Rio De Janeiro, Brazil.
| | - Ananna Rahman
- Papworth hospital NHS foundation trust, department of respiratory medicine, Papworth Everard, Cambridge, United Kingdom.
| | - Nashaba Matin
- Barts Health NHS Trust, Royal London hospital, HIV medicine, infection and immunity, London, United Kingdom.
| | - Ali Zumla
- UCL hospitals NHS Foundation Trust, university college London, NIHR biomedical research centre, division of infection and immunity, London, United Kingdom.
| | - Emanuele Pontali
- Galliera hospital, department of infectious diseases, Genoa, Italy.
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29
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Kalema N, Lindan C, Glidden D, Yoo SD, Katamba A, Alfred A, Katagira W, Byanyima P, Musisi E, Kaswabuli S, Ingvar S, Zawedde J, Yoon C, Ayakaka I, Davis JL, Huang L, Worodria W, Cattamanchi A. Predictors and short-term outcomes of recurrent pulmonary tuberculosis, Uganda: a cohort study. SOUTH AFRICAN RESPIRATORY JOURNAL 2017; 23:106-112. [PMID: 29368752 PMCID: PMC5777612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Recurrent tuberculosis (TB) occurring >2 years after completing treatment for a prior TB episode is most often due to reinfection with a new strain of M. tuberculosis. OBJECTIVES We determined the prevalence and outcome of late recurrent TB among hospitalized patients in Kampala, Uganda. METHODS We conducted a retrospective analysis of patients admitted to Mulago Hospital who had cough of >2 weeks' duration and completed TB treatment >2 years prior to admission. All patients had mycobacterial culture performed on two sputum specimens and vital status ascertained 2-months post-enrollment. We performed modeling to identify predictors of recurrent TB and of survival. RESULTS Among 234 patients, 84 (36%) had recurrent TB. Independent predictors included younger age (aOR=0.64, 95% CI=0.42-0.97, p=0.04), chest pain >2 weeks (aOR=3.32, 95% CI=1.38-8.02, p=0.007), severe weight loss ≥5 kilograms (aOR=4.88, 95% CI=1.66-14.29, p=0.004) and presence of ≥1 WHO danger sign of severe illness (aOR=3.55, 95% CI=1.36-9.29, p=0.01). Two-month mortality was 17.8% (95% CI=10.5-29.2%), and was higher among patients not initiated on TB treatment (aHR=16.67, 95% CI=1.18-200, p=0.04), not on ART if HIV-positive (aHR=16.99, 95% CI=1.17-246.47, p=0.04) and with a history of smoking (aHR=1.20, 95% CI=1.03-1.40, p=0.02). CONCLUSION The high prevalence of late recurrent TB likely reflects high levels of TB transmission in Kampala. Increased use of empiric TB treatment and early ART treatment initiation if HIV-positive should be considered in patients with a prior history of TB, particularly if young, with weight loss ≥5kgs, chest pain >2 weeks or ≥1 WHO danger sign of severe illness.
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Affiliation(s)
- Nelson Kalema
- Infectious Disease Research Collaboration, Kampala, Uganda
- Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda
| | - Christina Lindan
- Department of Epidemiology and Biostatistics and Global Health Sciences, University of California San Francisco, San Francisco, CA
| | - Dave Glidden
- Department of Epidemiology and Biostatistics and Global Health Sciences, University of California San Francisco, San Francisco, CA
| | - Samuel D. Yoo
- Infectious Disease Research Collaboration, Kampala, Uganda
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Achilles Katamba
- Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda
| | - Andama Alfred
- Infectious Disease Research Collaboration, Kampala, Uganda
| | | | | | | | | | - Sanyu Ingvar
- Infectious Disease Research Collaboration, Kampala, Uganda
| | | | - Christina Yoon
- Infectious Disease Research Collaboration, Kampala, Uganda
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - Irene Ayakaka
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - J. Lucian Davis
- Yale School of Public Health, New Haven, CT
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, CT
| | - Laurence Huang
- Infectious Disease Research Collaboration, Kampala, Uganda
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
- HIV, Infectious Diseases, and Global Medicine Division, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - William Worodria
- Infectious Disease Research Collaboration, Kampala, Uganda
- Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda
| | - Adithya Cattamanchi
- Infectious Disease Research Collaboration, Kampala, Uganda
- Department of Epidemiology and Biostatistics and Global Health Sciences, University of California San Francisco, San Francisco, CA
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
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30
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Trinh QM, Nguyen HL, Nguyen VN, Nguyen TVA, Sintchenko V, Marais BJ. Tuberculosis and HIV co-infection-focus on the Asia-Pacific region. Int J Infect Dis 2016; 32:170-8. [PMID: 25809776 DOI: 10.1016/j.ijid.2014.11.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 12/23/2022] Open
Abstract
Tuberculosis (TB) is the leading opportunistic disease and cause of death in patients with HIV infection. In 2013 there were 1.1 million new TB/HIV co-infected cases globally, accounting for 12% of incident TB cases and 360,000 deaths. The Asia-Pacific region, which contributes more than a half of all TB cases worldwide, traditionally reports low TB/HIV co-infection rates. However, routine testing of TB patients for HIV infection is not universally implemented and the estimated prevalence of HIV in new TB cases increased to 6.3% in 2013. Although HIV infection rates have not seen the rapid rise observed in Sub-Saharan Africa, indications are that rates are increasing among specific high-risk groups. This paper reviews the risks of TB exposure and progression to disease, including the risk of TB recurrence, in this vulnerable population. There is urgency to scale up interventions such as intensified TB case-finding, isoniazid preventive therapy, and TB infection control, as well as HIV testing and improved access to antiretroviral treatment. Increased awareness and concerted action is required to reduce TB/HIV co-infection rates in the Asia-Pacific region and to improve the outcomes of people living with HIV.
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Affiliation(s)
- Q M Trinh
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, Australia; Centre for Infectious Disease and Microbiology - Public Health, ICPMR, Westmead Hospital, Sydney, Australia; Tuberculosis Laboratory, Vietnam National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
| | - H L Nguyen
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - V N Nguyen
- Vietnam National Lung Hospital, Hanoi, Vietnam
| | - T V A Nguyen
- Tuberculosis Laboratory, Vietnam National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - V Sintchenko
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, Australia; Centre for Infectious Disease and Microbiology - Public Health, ICPMR, Westmead Hospital, Sydney, Australia
| | - B J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, Australia
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Niu NK, Yin JJ, Yang YX, Wang ZL, Zhou ZW, He ZX, Chen XW, Zhang X, Duan W, Yang T, Zhou SF. Novel targeting of PEGylated liposomes for codelivery of TGF-β1 siRNA and four antitubercular drugs to human macrophages for the treatment of mycobacterial infection: a quantitative proteomic study. Drug Des Devel Ther 2015; 9:4441-70. [PMID: 26300629 PMCID: PMC4535548 DOI: 10.2147/dddt.s79369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Tuberculosis (TB) is still a major public health issue in developing countries, and its chemotherapy is compromised by poor drug compliance and severe side effects. This study aimed to synthesize and characterize new multimodal PEGylated liposomes encapsulated with clinically commonly used anti-TB drugs with linkage to small interfering RNA (siRNA) against transforming growth factor-β1 (TGF-β1). The novel NP-siRNA liposomes could target THP-1-derived human macrophages that were the host cells of mycobacterium infection. The biological effects of the NP-siRNA liposomes were evaluated on cell cycle distribution, apoptosis, autophagy, and the gene silencing efficiency of TGF-β1 siRNA in human macrophages. We also explored the proteomic responses to the newly synthesized NP-siRNA liposomes using the stable isotope labeling with amino acids in cell culture approach. The results showed that the multifunctional PEGylated liposomes were successfully synthesized and chemically characterized with a mean size of 265.1 nm. The novel NP-siRNA liposomes functionalized with the anti-TB drugs and TGF-β1 siRNA were endocytosed efficiently by human macrophages as visualized by transmission electron microscopy and scanning electron microscopy. Furthermore, the liposomes showed a low cytotoxicity toward human macrophages. There was no significant effect on cell cycle distribution and apoptosis in THP-1-derived macrophages after drug exposure at concentrations ranging from 2.5 to 62.5 μg/mL. Notably, there was a 6.4-fold increase in the autophagy of human macrophages when treated with the NP-siRNA liposomes at 62.5 μg/mL. In addition, the TGF-β1 and nuclear factor-κB expression levels were downregulated by the NP-siRNA liposomes in THP-1-derived macrophages. The Ingenuity Pathway Analysis data showed that there were over 40 signaling pathways involved in the proteomic responses to NP-siRNA liposome exposure in human macrophages, with 160 proteins mapped. The top five canonical signaling pathways were eukaryotic initiation factor 2 signaling, actin cytoskeleton signaling, remodeling of epithelial adherens junctions, epithelial adherens junction signaling, and Rho GDP-dissociation inhibitor signaling pathways. Collectively, the novel synthetic targeting liposomes represent a promising delivery system for anti-TB drugs to human macrophages with good selectivity and minimal cytotoxicity.
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Affiliation(s)
- Ning-Kui Niu
- Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Juan-Juan Yin
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Yin-Xue Yang
- Department of Colorectal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
| | - Zi-Li Wang
- Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Zhi-Wei Zhou
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Zhi-Xu He
- Guizhou Provincial Key Laboratory for Regenerative Medicine, Stem Cell and Tissue Engineering Research Center and Sino-US Joint Laboratory for Medical Sciences, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Xiao-Wu Chen
- Department of General Surgery, The First People’s Hospital of Shunde Affiliated to Southern Medical University, Shunde, Foshan, Guangdong, People’s Republic of China
| | - Xueji Zhang
- Research Center for Bioengineering and Sensing Technology, University of Science and Technology Beijing, Beijing, People’s Republic of China
| | - Wei Duan
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Tianxin Yang
- Department of Internal Medicine, University of Utah and Salt Lake Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Shu-Feng Zhou
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA
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Guerra-Assunção JA, Houben RMGJ, Crampin AC, Mzembe T, Mallard K, Coll F, Khan P, Banda L, Chiwaya A, Pereira RPA, McNerney R, Harris D, Parkhill J, Clark TG, Glynn JR. Recurrence due to relapse or reinfection with Mycobacterium tuberculosis: a whole-genome sequencing approach in a large, population-based cohort with a high HIV infection prevalence and active follow-up. J Infect Dis 2015; 211:1154-63. [PMID: 25336729 PMCID: PMC4354982 DOI: 10.1093/infdis/jiu574] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/04/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recurrent tuberculosis is a major health burden and may be due to relapse with the original strain or reinfection with a new strain. METHODS In a population-based study in northern Malawi, patients with tuberculosis diagnosed from 1996 to 2010 were actively followed after the end of treatment. Whole-genome sequencing with approximately 100-fold coverage was performed on all available cultures. Results of IS6110 restriction fragment-length polymorphism analyses were available for cultures performed up to 2008. RESULTS Based on our data, a difference of ≤10 single-nucleotide polymorphisms (SNPs) was used to define relapse, and a difference of >100 SNPs was used to define reinfection. There was no evidence of mixed infections among those classified as reinfections. Of 1471 patients, 139 had laboratory-confirmed recurrences: 55 had relapse, and 20 had reinfection; for 64 type of recurrence was unclassified. Almost all relapses occurred in the first 2 years. Human immunodeficiency virus infection was associated with reinfection but not relapse. Relapses were associated with isoniazid resistance, treatment before 2007, and lineage-3 strains. We identified several gene variants associated with relapse. Lineage-2 (Beijing) was overrepresented and lineage-1 underrepresented among the reinfecting strains (P = .004). CONCLUSIONS While some of the factors determining recurrence depend on the patient and their treatment, differences in the Mycobacterium tuberculosis genome appear to have a role in both relapse and reinfection.
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Affiliation(s)
| | - Rein M. G. J. Houben
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
| | - Amelia C. Crampin
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
- Karonga Prevention Study, Malawi
| | | | - Kim Mallard
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Francesc Coll
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Palwasha Khan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
| | | | | | - Rui P. A. Pereira
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Ruth McNerney
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - David Harris
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | | | - Taane G. Clark
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Judith R. Glynn
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
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Field N, Lim MSC, Murray J, Dowdeswell RJ, Glynn JR, Sonnenberg P. Timing, rates, and causes of death in a large South African tuberculosis programme. BMC Infect Dis 2014; 14:3858. [PMID: 25528248 PMCID: PMC4297465 DOI: 10.1186/s12879-014-0679-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 12/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) mortality remains high across sub-Saharan Africa despite integration of TB and HIV/ART programmes. To inform programme design and service delivery, we estimated mortality by time from starting TB treatment. METHODS Routinely collected data on TB treatment, vital status, and the timing and causes of death, were linked to cardio-respiratory autopsy data, from 1995-2008, from a cohort of male platinum miners in South Africa. Records were expanded into person-months at risk (pm). RESULTS 4162 TB episodes were registered; 3170 men were treated for the first time and 833 men underwent retreatment. Overall, 509 men died, with a case fatality of 12.2% and mortality rate of 2.0/100 pm. Mortality was highest in the first month after starting TB treatment for first (2.3/100 pm) and retreatment episodes (4.8/100 pm). When stratified by HIV status, case fatality was higher in HIV positive men not on ART (first episode 14.0%; retreatment episode 26.2%) and those on ART (12.0%; 22.0%) than men of negative or unknown HIV status (2.6%; 3.6%). Mortality was also highest in the first month for each of these groups. Mortality risk factors included older age, previous TB, HIV, pulmonary TB, and diagnostic uncertainty. The proportion of deaths attributable to TB was consistently overestimated in clinical records versus cardio-respiratory autopsy. CONCLUSIONS Programme mortality was highest in those with HIV and during the first month of TB treatment in all groups, and many deaths were not caused by TB. Resource allocation should prioritise TB prevention and accurate earlier diagnosis, recognise the role of HIV, and ensure effective clinical care in the early stages of TB treatment.
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Affiliation(s)
- Nigel Field
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre (off Capper St), London, WC1E6JB, UK.
| | - Megan S C Lim
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre (off Capper St), London, WC1E6JB, UK.
- Centre for Population Health, Burnet Institute, Melbourne, Australia.
| | - Jill Murray
- National Institute for Occupational Health, National Health Laboratory Service and School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | | | - Judith R Glynn
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre (off Capper St), London, WC1E6JB, UK.
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Avery K, Abbara A, Ghani R, Davidson RN. Recurrent tuberculosis at a large tuberculosis centre in the UK. J Infect 2014; 70:427-9. [PMID: 25481404 DOI: 10.1016/j.jinf.2014.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 11/25/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
Affiliation(s)
- K Avery
- University of East Anglia, UK
| | - A Abbara
- London Northwest Healthcare NHS Trust, Northwick Park Hospital, London, UK.
| | - R Ghani
- London Northwest Healthcare NHS Trust, Northwick Park Hospital, London, UK
| | - R N Davidson
- London Northwest Healthcare NHS Trust, Northwick Park Hospital, London, UK
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Optimal tuberculosis prevention and control strategy from a mathematical model based on real data. Bull Math Biol 2014; 76:1566-89. [PMID: 24849770 DOI: 10.1007/s11538-014-9962-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
A mathematical control model for the transmission dynamics of tuberculosis (TB) in South Korea is developed on the basis of the reported active-TB and relapse-TB incidence data. In this work, optimal control theory is used to propose optimal TB prevention and control strategy and rearrange the government TB budget for the best TB elimination plan. The impact of distancing, case finding, and/or case holding controls are investigated when the number of infected and infectious individuals are minimized, while the intervention costs are kept low. The implementation of optimal control measures shows that the distancing control, such as isolation of infectious people, early TB patient detection, and educational program/campaign for healthy control, is the most effective control factor for the prevention of TB transmission in South Korea.
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P K C, Nagaral J, M N N, G P, B R H, Vinaykumar MV. TB-DOTS Outcome in Relation to HIV Status: Experience in a Medical College. J Clin Diagn Res 2014; 8:74-6. [PMID: 24596728 DOI: 10.7860/jcdr/2014/7416.3975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/24/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE There is scarce information regarding TB associated with Human Immunodeficiency Virus (HIV) infection treated under routine program conditions in medical colleges of India. This study evaluates the clinical profile and outcome of TB-DOTS treatment by HIV status. METHODS Total two hundred and eighty TB patients registered under Revised National Tuberculosis Control Program Revised National TB Control Program (RNTCP) during January 2011 and December 2012 in a teaching hospital of South India were enrolled in the study. The demographic profile, treatment related data of these patients was obtained from RNTCP treatment card and the DOTS outcome of all enrolled cases depending on their HIV status was evaluated. Data was analysed using descriptive statistics and chi-square test. RESULTS Among 280 TB patients enrolled 41 were HIV positive patients and 239 HIV negative. About 21% patients were retreatment patients. Over all, pulmonary TB was still the commonest form of TB among the registered patients. However, Extra Pulmonary (EPTB) was high among HIV positive TB patients. Treatment success among HIV positive TB patients was lower than HIV negative TB patients (61% vs. 79%). Further, 19.5% HIV positive and 8.3% HIV negative patients died. The proportions of defaulters and failures were similar in HIV positive and HIV negative patients. CONCLUSION HIV co-infected TB patients responded poorly to DOTS as evidenced by lower success rates and higher mortality than HIV negative TB patients. A significant proportion of retreatment patients in our study is the matter of concern.
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Affiliation(s)
- Chennaveerappa P K
- Associate Professor, Department of Pulmonary Medicine, Hassan Institute of Medical Sciences , Hassan, Karnataka, India
| | - Jayashree Nagaral
- Assistant Professor, Department of Pharmacology, Hassan Institute of Medical Sciences , Hassan, Karnataka, India
| | - Nareshkumar M N
- Junior Resident, Department of Pulmonary Medicine, Hassan Institute of Medical Sciences , Hassan, Karnataka, India
| | - Praveen G
- Assistant Professor, Department of Community Medicine, Hassan Institute of Medical Sciences , Hassan, Karnataka, India
| | - Halesha B R
- Assistant Professor, Department of General Medicine, Hassan Institute of Medical Sciences , Hassan, Karnataka, India
| | - M V Vinaykumar
- Assistant Professor, Department of ENT, Hassan Institute of Medical Sciences , Hassan, Karnataka, India
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Phillips PPJ, Fielding K, Nunn AJ. An evaluation of culture results during treatment for tuberculosis as surrogate endpoints for treatment failure and relapse. PLoS One 2013; 8:e63840. [PMID: 23667677 PMCID: PMC3648512 DOI: 10.1371/journal.pone.0063840] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 04/11/2013] [Indexed: 02/01/2023] Open
Abstract
It is widely acknowledged that new regimens are urgently needed for the treatment of tuberculosis. The primary endpoint in the Phase III trials is a composite outcome of failure at the end of treatment or relapse after stopping treatment. Such trials are usually both long and expensive. Valid surrogate endpoints measured during or at the end of treatment could dramatically reduce both the time and cost of assessing the effectiveness of new regimens. The objective of this study was to evaluate sputum culture results on solid media during treatment as surrogate endpoints for poor outcome. Data were obtained from twelve randomised controlled trials conducted by the British Medical Research Council in the 1970s and 80s in East Africa and East Asia, consisting of 6974 participants and 49 different treatment regimens. The month two culture result was shown to be a poor surrogate in East Africa but a good surrogate in Hong Kong. In contrast, the month three culture was a good surrogate in trials conducted in East Africa but not in Hong Kong. As well as differences in location, ethnicity and probable strain of Mycobacteria tuberculosis, Hong Kong trials more often evaluated regimens with rifampicin throughout and intermittent regimens, and patients in East African trials more often presented with extensive cavitation and were slower to convert to culture negative during treatment. An endpoint that is a summary measure of the longitudinal profile of culture results over time or that is able to detect the presence of M. tuberculosis later in treatment is more likely to be a better endpoint for a phase II trial than a culture result at a single time point and may prove to be an acceptable surrogate. More data are needed before any endpoint can be used as a surrogate in a confirmatory phase III trial.
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Abstract
OBJECTIVE To estimate the impact of antiretroviral therapy (ART) on the incidence of recurrent tuberculosis (TB) in an African population. DESIGN A long-term population cohort in Karonga District, northern Malawi. METHODS Patients who had completed treatment for laboratory-confirmed TB diagnosed since 1996 were visited annually to record vital status, ART use and screen for TB. Survival analysis estimated the effect of HIV/ART status at completion of treatment on mortality and recurrence. Analyses were stratified by time since treatment completion to estimate the effects on relapse (predominates during first year) and reinfection disease (predominates later). RESULTS Among 1133 index TB cases contributing 4353 person-years of follow-up, there were 307 deaths and 103 laboratory-confirmed recurrences (recurrence rate 4.6 per 100 person-years). Half the recurrences occurred in the first year since completing treatment. HIV infection increased the recurrence rate [rate ratio adjusted for age, sex, period and TB type 2.69, 95% confidence interval (CI) 1.69-4.26], but with less effect in the first year (adjusted rate ratio 1.71, 95% CI 0.87-3.35) than subsequently (adjusted rate ratio 4.2, 95% CI 2.16-8.15). Recurrence rates on ART were intermediate between those of HIV-negative individuals and HIV-positive individuals without ART. Compared with HIV-positive individuals without ART, the adjusted rate ratio was 0.74 (95% CI 0.27-2.06) in the first year, and 0.43 (95% CI 0.11-1.73) later. CONCLUSION The increased incidence of TB recurrence observed in HIV-positive patients appeared to be reduced by ART. The effects are mostly on later (likely reinfection) disease so the impact of ART on reducing recurrence will be highest in high TB incidence settings.
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Laboratory diagnosis of tuberculosis in resource-poor countries: challenges and opportunities. Clin Microbiol Rev 2011; 24:314-50. [PMID: 21482728 DOI: 10.1128/cmr.00059-10] [Citation(s) in RCA: 298] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
With an estimated 9.4 million new cases globally, tuberculosis (TB) continues to be a major public health concern. Eighty percent of all cases worldwide occur in 22 high-burden, mainly resource-poor settings. This devastating impact of tuberculosis on vulnerable populations is also driven by its deadly synergy with HIV. Therefore, building capacity and enhancing universal access to rapid and accurate laboratory diagnostics are necessary to control TB and HIV-TB coinfections in resource-limited countries. The present review describes several new and established methods as well as the issues and challenges associated with implementing quality tuberculosis laboratory services in such countries. Recently, the WHO has endorsed some of these novel methods, and they have been made available at discounted prices for procurement by the public health sector of high-burden countries. In addition, international and national laboratory partners and donors are currently evaluating other new diagnostics that will allow further and more rapid testing in point-of-care settings. While some techniques are simple, others have complex requirements, and therefore, it is important to carefully determine how to link these new tests and incorporate them within a country's national diagnostic algorithm. Finally, the successful implementation of these methods is dependent on key partnerships in the international laboratory community and ensuring that adequate quality assurance programs are inherent in each country's laboratory network.
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Challenges of Phase III study design for trials of new drug regimens for the treatment of TB. Future Med Chem 2010; 2:1273-82. [DOI: 10.4155/fmc.10.221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The standard WHO-recommended 6-month four-drug regimen for the treatment of tuberculosis is highly effective in clinical trial settings, but this level of efficacy is not always achieved in practice. Shorter, simpler regimens that promote better treatment adherence are urgently needed. In addition, it will be necessary to demonstrate noninferiority rather than superiority over the 6-month regimen. There are considerable challenges in designing and conducting noninferiority Phase III trials of new drug regimens. These include the choice of the margin of noninferiority, the primary outcome measure and strategies for handling nonassessable patients and reinfected patients in the analysis. Most of these trials are likely to be large and expensive and public–private partnerships will be required to conduct them.
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