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Hou T, Wang J, Shi L, Fan S, Li J, Wang Q. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets. Open Med (Wars) 2024; 19:20240948. [PMID: 38911253 PMCID: PMC11193359 DOI: 10.1515/med-2024-0948] [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: 10/31/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 06/25/2024] Open
Abstract
Objective To investigate the clinical efficacy of dexamethasone (Dex) combined with isoniazid in tuberculous meningitis (TBM) and its effect on peripheral blood T cell subsets. Methods A total of 235 patients with TBM were divided into the control group (117 cases) and the observation group (118 cases). Both groups were given conventional treatment, the control group was further given isoniazid, and the observation group was further given Dex combined with isoniazid. The therapeutic effect and improvement of clinical symptoms were evaluated, peripheral blood T lymphocyte subsets and neurological function were observed, and patients' prognosis was evaluated. Results The total effective rate of the observation group was higher. The recovery time of cerebrospinal fluid (CSF) pressure, CSF protein content, CSF cell count, and hospital stays in the observation group were shorter. The duration of cervicogenic headache, fever, vomiting, and coma in the observation group was shorter. CD3+ and CD4+/CD8+ proportions in the observation group were higher, and CD8+ proportion was lower. The NIHSS score and MRS score of the observation group were lower, as well as the incidence of adverse reactions. Conclusion Dex combined with isoniazid alleviates clinical symptoms and neurological abnormalities and regulates peripheral blood T cell subsets in TBM.
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Affiliation(s)
- TianYong Hou
- Department of Infection Division, Taiyuan Fourth People’s Hospital, Taiyuan City, Shanxi Province, 030053, China
| | - JianWei Wang
- Department of Comprehensive Inspection, Taiyuan Fourth People’s Hospital, Taiyuan City, Shanxi Province, 030053, China
| | - Liang Shi
- Department of Infection Division, Taiyuan Fourth People’s Hospital, Taiyuan City, Shanxi Province, 030053, China
| | - ShuHui Fan
- Department of Medical Section, Taiyuan Fourth People’s Hospital, Taiyuan City, Shanxi Province, 030053, China
| | - JingYing Li
- Department of Inspection Division, Taiyuan Fourth People’s Hospital, Taiyuan City, Shanxi Province, 030053, China
| | - QuanHong Wang
- Department of Serous Cavity Tuberculosis, Taiyuan Fourth People’s Hospital, Wanbailin District, Taiyuan City, Shanxi Province, 030053, China
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Pinhata JMW, Ferrazoli L, Mendes FDF, Gonçalves MG, Rabello MCDS, Ghisi KT, Simonsen V, Cavalin RF, Lindoso AABP, de Oliveira RS. A descriptive study on isoniazid resistance-associated mutations, clustering and treatment outcomes of drug-resistant tuberculosis in a high burden country. Eur J Clin Microbiol Infect Dis 2024; 43:73-85. [PMID: 37943394 DOI: 10.1007/s10096-023-04693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE To describe katG and inhA mutations, clinical characteristics, treatment outcomes and clustering of drug-resistant tuberculosis (TB) in the State of São Paulo, southeast Brazil. METHODS Mycobacterium tuberculosis isolates from patients diagnosed with drug-resistant TB were screened for mutations in katG and inhA genes by line probe assay and Sanger sequencing, and typed by IS6110-restriction fragment-length polymorphism for clustering assessment. Clinical, epidemiological and demographic data were obtained from surveillance information systems for TB. RESULTS Among the 298 isolates studied, 127 (42.6%) were isoniazid-monoresistant, 36 (12.1%) polydrug-resistant, 93 (31.2%) MDR, 16 (5.4%) pre-extensively drug-resistant (pre-XDR), 9 (3%) extensively drug-resistant (XDR) and 17 (5.7%) susceptible after isoniazid retesting. The frequency of katG 315 mutations alone was higher in MDR isolates, while inhA promoter mutations alone were more common in isoniazid-monoresistant isolates. Twenty-six isolates phenotypically resistant to isoniazid had no mutations either in katG or inhA genes. The isolates with inhA mutations were found more frequently in clusters (75%) when compared to the isolates with katG 315 mutations (59.8%, p = 0.04). In our population, being 35-64 years old, presenting MDR-, pre-XDR- or XDR-TB and being a retreatment case were associated with unfavourable TB treatment outcomes. CONCLUSION We found that katG and inhA mutations were not equally distributed between isoniazid-monoresistant and MDR isolates. In our population, clustering was higher for isolates with inhA mutations. Finally, unfavourable TB outcomes were associated with specific factors.
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Affiliation(s)
- Juliana Maira Watanabe Pinhata
- Núcleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), Av. Dr. Arnaldo, 351, 9º Andar, São Paulo, SP, 01246-000, Brazil.
| | - Lucilaine Ferrazoli
- Núcleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), Av. Dr. Arnaldo, 351, 9º Andar, São Paulo, SP, 01246-000, Brazil
| | - Flávia de Freitas Mendes
- Núcleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), Av. Dr. Arnaldo, 351, 9º Andar, São Paulo, SP, 01246-000, Brazil
| | - Maria Gisele Gonçalves
- Núcleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), Av. Dr. Arnaldo, 351, 9º Andar, São Paulo, SP, 01246-000, Brazil
| | | | - Kelen Teixeira Ghisi
- Núcleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), Av. Dr. Arnaldo, 351, 9º Andar, São Paulo, SP, 01246-000, Brazil
| | - Vera Simonsen
- Núcleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), Av. Dr. Arnaldo, 351, 9º Andar, São Paulo, SP, 01246-000, Brazil
| | | | | | - Rosângela Siqueira de Oliveira
- Núcleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), Av. Dr. Arnaldo, 351, 9º Andar, São Paulo, SP, 01246-000, Brazil
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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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Robert M, Todd J, Ngowi BJ, Msuya SE, Ramadhani A, Sambu V, Jerry I, Mujuni MR, Mahande MJ, Ngocho JS, Maokola W. Determinants of isoniazid preventive therapy completion among people living with HIV attending care and treatment clinics from 2013 to 2017 in Dar es Salaam Region, Tanzania. A cross-sectional analytical study. BMC Infect Dis 2020; 20:276. [PMID: 32276618 PMCID: PMC7147031 DOI: 10.1186/s12879-020-04997-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/27/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least 6 months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor the six-month IPT completion since a suboptimal dose may not protect PLHIV from TB infection. This study determined the six-month IPT completion and factors associated with six-month IPT completion among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania. METHODS Secondary analysis of routine data from PLHIV attending 58 care and treatment clinics in Dar es Salaam region was used. PLHIV, aged 15 years and above, who screened negative for TB symptoms and initiated IPT from January, 2013 to June, 2017 were recruited. Modified Poisson regression with robust standard errors was used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account for health facility random effects in order to estimate adjusted PR (APR) for factors associated with IPT six-month completion. RESULTS A total of 29,382 PLHIV were initiated IPT, with 21,808 (74%) female. Overall 17,092 (58%) six-month IPT completion, increasing from 42% (773/1857) in year 2013 to 76% (2929/3856) in 2017. Multilevel multivariable model accounting for health facilities as clusters, showed PLHIV who were not on ART had 46% lower IPT completion compared to those were on ART (APR: 0.54: 95%CI: 0.45-0.64). There was 37% lower IPT completion among PLHIV who transferred from another clinic (APR: 0.63: 95% CI (0.54-0.74) compared to those who did not transfer. PLHIV aged 25-34 years had a 6% lower prevalence of IPT completion as compared to those aged 15 to 24 years (APR:0.94 95%CI:0.89-0.98). CONCLUSION The IPT completion rate in PLHIV increased over time, but there was lower IPT completion in PLHIV who transferred from other clinics, who were aged 25 to 34 years and those not on ART. Interventions to support IPT in these groups are urgently needed.
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Affiliation(s)
- Masanja Robert
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
- Mwenge Catholic University (MWECAU), P.O.Box 1226, Moshi, Tanzania
| | - Jim Todd
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
- London School of Hygiene and Tropical Medicine (LSTM), London, UK
| | - Bernard J. Ngowi
- National Institute for Medical Research-Muhimbili Medical Research Centre, P.O.Box 3436, Dar es Salaam, Tanzania
- University of Dar es Salaam College of Health and Allied Sciences, P.O.Box 68, Mbeya, Tanzania
| | - Sia E. Msuya
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
| | - Angella Ramadhani
- Ministry of Health, Community Development, Gender, Elderly and Children (NACP), Dodoma, Tanzania
| | - Veryhel Sambu
- Ministry of Health, Community Development, Gender, Elderly and Children (NACP), Dodoma, Tanzania
| | - Isaya Jerry
- Ministry of Health, Community Development, Gender, Elderly and Children (NACP), Dodoma, Tanzania
| | - Martin R. Mujuni
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
| | - Michael J. Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
| | - James S. Ngocho
- Department of Epidemiology and Biostatistics, Institute of Public Health Kilimanjaro Christian Medical University College (KCMUCo), P.O.Box 2240, Kilimanjaro, Tanzania
| | - Werner Maokola
- Mwenge Catholic University (MWECAU), P.O.Box 1226, Moshi, Tanzania
- Ministry of Health, Community Development, Gender, Elderly and Children (NACP), Dodoma, Tanzania
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Jiang T, Chen XS. Outcome Impacts Due to Pathogen-Specific Antimicrobial Resistance: A Narrative Review of Published Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041395. [PMID: 32098182 PMCID: PMC7068360 DOI: 10.3390/ijerph17041395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 12/19/2022]
Abstract
Antimicrobial resistance (AMR) has become a global threat to not only public health impacts but also clinical and economic outcomes. During the past decades, there have been many studies focusing on surveillance, mechanisms, and diagnostics of AMR in infectious diseases but the impacts on public health, clinical and economic outcomes due to emergence of these AMRs are rarely studied and reported. This review was aimed to summarize the findings from published studies to report the outcome impacts due to AMR of malaria, tuberculosis and HIV and briefly discuss the implications for application to other infectious diseases. PubMed/Medline and Google Scholar databases were used for search of empirical and peer-reviewed papers reporting public health, clinical and economic outcomes due to AMR of malaria, tuberculosis and HIV. Papers published through 1 December 2019 were included in this review. A total of 76 studies were included for this review, including 16, 49 and 11 on public health, clinical and economic outcomes, respectively. The synthesized data indicated that the emergence and spread of AMR of malaria, tuberculosis and HIV have resulted in adverse public health, clinical and economic outcomes. AMR of malaria, tuberculosis and HIV results in significant adverse impacts on public health, clinical and economic outcomes. Evidence from this review suggests the needs to consider the similar studies for other infectious diseases.
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Affiliation(s)
- Tingting Jiang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China;
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing 210042, China
| | - Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China;
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing 210042, China
- Correspondence: ; Tel.: +86-25-8547-8901
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Santos G, Oliveira O, Gaio R, Duarte R. Effect of Isoniazid Resistance on the Tuberculosis Treatment Outcome. Arch Bronconeumol 2017; 54:48-51. [PMID: 28712534 DOI: 10.1016/j.arbres.2017.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/10/2017] [Accepted: 06/12/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Gisela Santos
- Faculdade de Medicina, Universidade do Porto, Portugal.
| | - Olena Oliveira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal
| | - Rita Gaio
- Departamento de Matemática, Faculdade de Ciências da Universidade do Porto & Centro de Matemática da Universidade do Porto, Portugal
| | - Raquel Duarte
- Faculdade de Medicina, Universidade do Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal; Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
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