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Rekart ML, Thit P, Oluya M, Moe S, Hasan T, Parpieva N, Safaev K, Khristusev A, Zinaida T, Singh J, Allamuratova S, Azamat I, Restrepo CG, Sitali N, Achar J, Alvaraez JL, Sinha A. A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020. IJTLD OPEN 2024; 1:285-291. [PMID: 39035427 PMCID: PMC11257092 DOI: 10.5588/ijtldopen.23.0533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/21/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Isoniazid (INH, H) resistance is the most common drug-resistant TB pattern, with treatment success rates lower than those in drug-susceptible TB. The WHO recommends a 6-month regimen of rifampicin (RIF, R), ethambutol (EMB, E), pyrazinamide (PZA, Z), and levofloxacin (Lfx) (6REZLfx) for INH-resistant, RIF-susceptible TB (HRRS-TB). Uzbekistan has a high burden of TB (62/100,000 population) and multidrug-resistant TB (12/100,000 population). METHODS We conducted a retrospective, descriptive study of microbiologically confirmed HRRS-TB using routinely collected programmatic data from 2009 to 2020. RESULTS We included 854 HRRS-TB cases. Treatment success was 80.2% overall. For REZLfx, the treatment success rate was 92.0% over a short treatment duration, with no amplifications to RIF or second-line anti-TB drug resistance. We documented 46 regimens with REZLfx plus linezolid (success 87.0%) and 539 regimens using kanamycin or capreomycin (success 76.6%). We identified 37 treatment failures (4.3%), 30 deaths (3.5%), 25 resistance amplifications (2.9%), including eight to RIF (0.9%), and 99 lost to follow-up (LTFU) cases (11.6%). Unsuccessful outcomes were more common with older age, diabetes, chest X-ray cavities, smear positivity, smear-positive persistence, and male sex. LTFU was more common with injection-containing regimens. CONCLUSIONS REZLfx is a safe and effective first-line treatment for INH-resistant, RIF-susceptible TB. Treatment success was lower and LTFU was higher for injection-containing regimens.
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Affiliation(s)
- M L Rekart
- Médecins Sans Frontières (MSF), Amsterdam, The Netherlands
| | - P Thit
- MSF, Tashkent, Uzbekistan
| | | | - S Moe
- MSF, Tashkent, Uzbekistan
| | | | - N Parpieva
- Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent, Uzbekistan
| | - K Safaev
- Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent, Uzbekistan
| | | | - T Zinaida
- Republican Center of Tuberculosis and Pulmonology, Nukus, Uzbekistan
| | | | | | | | | | | | - J Achar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Inbaraj LR, Shewade HD, Daniel J, Srinivasalu VA, Paul J, Satish S, Kirubakaran R, Padmapriyadarsini C. Effectiveness and safety of Levofloxacin containing regimen in the treatment of Isoniazid mono-resistant pulmonary Tuberculosis: a systematic review. Front Med (Lausanne) 2023; 10:1085010. [PMID: 37415768 PMCID: PMC10321706 DOI: 10.3389/fmed.2023.1085010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/10/2023] [Indexed: 07/08/2023] Open
Abstract
Background We aimed to determine the effectiveness and safety of the Levofloxacin-containing regimen that the World Health Organization is currently recommending for the treatment of Isoniazid mono-resistant pulmonary Tuberculosis. Methods Our eligible criteria for the studies to be included were; randomized controlled trials or cohort studies that focused on adults with Isoniazid mono-resistant tuberculosis (HrTB) and treated with a Levofloxacin-containing regimen along with first-line anti-tubercular drugs; they should have had a control group treated with first-line without Levofloxacin; should have reported treatment success rate, mortality, recurrence, progression to multidrug-resistant Tuberculosis. We performed the search in MEDLINE, EMBASE, Epistemonikos, Google Scholar, and Clinical trials registry. Two authors independently screened the titles/abstracts and full texts that were retained after the initial screening, and a third author resolved disagreements. Results Our search found 4,813 records after excluding duplicates. We excluded 4,768 records after screening the titles and abstracts, retaining 44 records. Subsequently, 36 articles were excluded after the full-text screening, and eight appeared to have partially fulfilled the inclusion criteria. We contacted the respective authors, and none responded positively. Hence, no articles were included in the meta-analysis. Conclusion We found no "quality" evidence currently on the effectiveness and safety of Levofloxacin in treating HrTB. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022290333, identifier: CRD42022290333.
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Affiliation(s)
- Leeberk Raja Inbaraj
- Department of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - Hemant Deepak Shewade
- Division of Health System Research, Indian Council of Medical Research – National Institute of Epidemiology, Chennai, India
| | - Jefferson Daniel
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - Vignes Anand Srinivasalu
- Department of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - Jabez Paul
- Prof. BV Moses Centre for Evidence Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
| | - S. Satish
- Division of Health System Research, Indian Council of Medical Research – National Institute of Epidemiology, Chennai, India
| | | | - Chandrasekaran Padmapriyadarsini
- Department of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
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Zhu J, Liu J, Bao Z, Cao H, Wang S, Li X, Ning Z, Hoffner S, Hu Y, Davies Forsman L. Acquired drug resistance during the turnaround time for drug susceptibility testing impacts outcome of tuberculosis. Tuberculosis (Edinb) 2023; 140:102341. [PMID: 37086709 DOI: 10.1016/j.tube.2023.102341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The impacts of acquired resistance to first-line drugs other than rifampicin during turnaround time (TAT) for drug susceptibility testing (DST) on tuberculosis (TB) treatment are unclear. METHOD We performed a prospective cohort study to test acquired resistance to isoniazid, ethambutol and pyrazinamide during TAT for DST as risk factors for prolonged time to sputum culture conversion (SCC) and treatment failure in China. Participants included had a baseline DST result for a Mycobacterium tuberculosis (Mtb) isolate collected at TB diagnosis and a follow-up DST result for a Mtb isolate collected upon baseline DST results availability. Acquired drug resistance was identified by comparing baseline and follow-up DST results. RESULTS This study included 65 patients with acquired resistance Mtb isolates and 130 patients with consistent drug susceptibility profiles. Cox proportional hazard regression analysis demonstrated acquired isoniazid resistance (aHR 0.50, 95%CI: 0.29-0.85) and acquired pyrazinamide resistance (aHR 0.54, 95%CI: 0.36-0.81) were associated with prolonged time to SCC. Moreover, acquired isoniazid resistance (aOR 7.64, 95%CI: 2.39-16.08) and acquired pyrazinamide resistance (aOR 5.71, 95%CI: 2.31-14.12) were independently associated with treatment failure. CONCLUSION Acquired resistance to isoniazid and/or pyrazinamide during TAT for DST was associated with prolonged time to SCC as well as treatment failure.
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Affiliation(s)
- Jiahui Zhu
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - Jia Liu
- The Fifth People's Hospital of Suzhou, Infectious Disease Hospital Affiliated to Soochow University, Suzhou, China
| | - Ziwei Bao
- The Fifth People's Hospital of Suzhou, Infectious Disease Hospital Affiliated to Soochow University, Suzhou, China
| | - Hong Cao
- Department of Tuberculosis Control, Zigong Center for Disease Control and Prevention, Zigong, China
| | - Sainan Wang
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Xuliang Li
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Zhu Ning
- Department of Tuberculosis Control, Zigong Center for Disease Control and Prevention, Zigong, China
| | - Sven Hoffner
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Yi Hu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Lina Davies Forsman
- Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institutet, Solna, Sweden.
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Hernandez-Romieu AC, Little BP, Bernheim A, Schechter MC, Ray SM, Bizune D, Kempker R. Increasing Number and Volume of Cavitary Lesions on Chest Computed Tomography Are Associated With Prolonged Time to Culture Conversion in Pulmonary Tuberculosis. Open Forum Infect Dis 2019; 6:ofz232. [PMID: 31263730 PMCID: PMC6590978 DOI: 10.1093/ofid/ofz232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background Cavitary lesions (CLs) primarily identified by chest x-ray (CXR) have been associated with worse clinical outcomes among patients with pulmonary tuberculosis (PTB). Chest computed tomography (CT), which has better resolution and increased sensitivity to detect lung abnormalities, has been understudied in PTB patients. We compared detection of CLs by CT and CXR and assessed their association with time to sputum culture conversion (tSCC). Methods This was a retrospective cohort study of 141 PTB patients who underwent CT. We used multivariate Cox proportional hazards models to evaluate the association between CLs on CXR and the number and single largest volume of CLs on CT with tSCC. Results Thirty (21%) and 75 (53%) patients had CLs on CXR and CT, respectively. CT detected cavities in an additional 44 patients (31%) compared with CXR. After multivariable adjustment, we observed a negative association between CLs and tSCC, with an adjusted hazard ratio (aHR) of 0.56 (95% confidence interval [CI], 0.32 to 0.97) for single CLs and 0.31 (95% CI, 0.16 to 0.60) for multiple CLs present on CT. Patients with a CL volume ≥25 mL had a prolonged tSCC (aHR, 0.39; 95% CI, 0.21 to 0.72). CLs on CXR were not associated with increased tSCC after multivariable adjustment. Conclusions CT detected a larger number of cavities in patients with PTB relative to CXR. We observed an association between increasing number and volume of CLs on CT and delayed tSCC independent of sputum microscopy result. Our findings highlight a potential role for CT in the clinical and research setting as a tool to risk-stratify patients with PTB.
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Affiliation(s)
| | - Brent P Little
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam Bernheim
- Department of Radiology, School of Medicine, Emory University, Atlanta, Georgia
| | - Marcos C Schechter
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, Georgia
| | - Susan M Ray
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, Georgia
| | - Destani Bizune
- Epidemiology and Statistics Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Russell Kempker
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, Georgia.,Department of Internal Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Isoniazid Monoresistance and Rate of Culture Conversion among Patients in the State of Georgia with Confirmed Tuberculosis, 2009-2014. Ann Am Thorac Soc 2019; 15:331-340. [PMID: 29131662 DOI: 10.1513/annalsats.201702-147oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Isoniazid-monoresistant tuberculosis (INH-monoresistant TB) is the most common drug-resistant TB type in the United States; however, its impact on TB treatment outcomes is not clear. OBJECTIVES This study aims to understand 1) factors associated with INH-monoresistant TB and 2) the association between INH monoresistance and response to TB treatment. METHODS We studied all patients with TB (age, ≥15 yr) reported to the Georgia State Electronic Notifiable Disease Surveillance System (SENDSS) from 2009 to 2014. INH-monoresistant TB was defined as a Mycobacterium tuberculosis isolate resistant to isoniazid only. Time to sputum culture conversion was defined as the time (measured in days) from TB treatment initiation to the date of the first consistently negative culture result reported to the SENDSS. Logistic regression and Cox proportional hazard models were used to estimate the odds and hazard rate of sputum culture conversion, all-cause mortality, and poor TB outcome among patients with INH-monoresistant TB. RESULTS Among 1,141 culture-confirmed patients with available drug susceptibility testing results, 998 (87.5%) were susceptible to TB first-line drugs, and 143 (12.5%) were patients with INH-monoresistant TB. In multivariable analysis, male sex (adjusted odds ratio [aOR], 1.62; 95% confidence interval [CI], 1.01-2.67) and homelessness (aOR, 5.55; 95% CI, 3.38-9.17) were associated with higher odds of INH-monoresistant TB. In the same multivariable model, older age (≥65 yr old) (aOR, 0.21; 95% CI, 0.07-0.55) and miliary disease (aOR, 0.19; 95% CI, 0.01-0.96) were associated with lower odds of INH-monoresistant TB. Among 1,116 patients with pulmonary TB, the median time to sputum culture conversion was 30 days (interquartile range, 13-58). The rate of culture conversion was similar among patients with and without INH monoresistance (adjusted cause-specific hazard ratio, 1.15; 95% CI, 0.95-1.40). INH-monoresistant TB was not significantly associated with poor TB treatment outcomes (aOR, 1.61; 95% CI, 0.67-3.70) or mortality during TB treatment (aOR, 1.72; 95% CI, 0.58-4.94). CONCLUSIONS Our findings suggest that compared with drug-susceptible TB, patients in Georgia with INH-monoresistant TB have a similar response to TB treatment including culture conversion rate, final TB treatment outcome, and all-cause mortality.
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Synthesis, anticancer activity and mechanism of iron chelator derived from 2,6-diacetylpyridine bis(acylhydrazones). J Inorg Biochem 2019; 193:1-8. [DOI: 10.1016/j.jinorgbio.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/01/2019] [Accepted: 01/07/2019] [Indexed: 12/11/2022]
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Abstract
Tuberculosis (TB) remains a common cause of infection and disease in much of the world. The majority of disease occurs from reactivation months or years after initial infection and most often involves the lungs. Sputum smears for acid-fast bacilli remain the initial diagnostic test but have limited sensitivity and specificity. Nucleic acid amplification tests are more sensitive and specific and can detect some mutations that cause drug resistance. Treatment of TB resistant to rifamycins alone or in combination with isoniazid and other drugs remains difficult and should be done in consultation with an expert in treating drug-resistant disease.
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Bizune DJ, Kempker RR, Kagei M, Yamin A, Mohamed O, Holland DP, Oladele A, Wang YF, Rebolledo PA, Blumberg HM, Ray SM, Schechter MC. Treatment Complexities Among Patients with Tuberculosis in a High HIV Prevalence Cohort in the United States. AIDS Res Hum Retroviruses 2018; 34:1050-1057. [PMID: 30105915 DOI: 10.1089/aid.2018.0126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The association between human immunodeficiency virus (HIV) infection and tuberculosis (TB) mortality has been studied extensively, but the impact of HIV on other clinically relevant aspects of TB care such as TB drug-related adverse events (AEs), hospital readmissions, and TB treatment duration is less well characterized. We describe the association of HIV infection with TB clinical complexities and outcomes in a high HIV prevalence cohort in the United States. This is a retrospective cohort study among patients treated for culture-confirmed TB between 2008 and 2015 at an inner-city hospital in Atlanta, GA. Univariate analysis was used to estimate association of HIV with TB treatment interruption due to AEs, hospital readmissions, and treatment duration. Final unfavorable TB treatment outcome was defined as death, loss to follow-up, or recurrent TB. Logistic regression modeling was used to estimate association of HIV with final unfavorable outcomes. Among 274 patients with TB, 96 (35%) had HIV coinfection. HIV-positive patients had more TB treatment interruptions due to AE (34% vs. 15%), were more likely to have a hospital readmission (50% vs. 21%), and received longer TB treatment (9.9 months vs. 8.8 months) compared to HIV-negative patients (p < .01 for all). HIV infection was not associated with final unfavorable outcomes in univariate [odds ratio (OR) = 1.86; confidence interval (95% CI) 0.99-3.49] or multivariate analysis (aOR = 1.13; 95% CI 0.52-2.39) (p ≥ .05 for both). While HIV infection was not associated with final unfavorable TB outcomes, TB/HIV coinfected patients had more complex treatment course underscoring the importance of maintaining resources and expertise to treat coinfected patients in our and similar settings.
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Affiliation(s)
| | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Aliya Yamin
- Communicable Disease Prevention Branch, Fulton County Board of Health, Atlanta, Georgia
| | - Omar Mohamed
- Communicable Disease Prevention Branch, Fulton County Board of Health, Atlanta, Georgia
| | - David P. Holland
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Communicable Disease Prevention Branch, Fulton County Board of Health, Atlanta, Georgia
| | | | - Yun F. Wang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Pathology, Grady Memorial Hospital, Atlanta, Georgia
| | - Paulina A. Rebolledo
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Henry M. Blumberg
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Susan M. Ray
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Marcos C. Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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