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Suárez I, Fünger SM, Kröger S, Rademacher J, Fätkenheuer G, Rybniker J. The Diagnosis and Treatment of Tuberculosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:729-735. [PMID: 31755407 DOI: 10.3238/arztebl.2019.0729] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 04/21/2019] [Accepted: 08/01/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Around 10 million people worldwide contract tuberculosis every year. According to the World Health Organization (WHO), approximately one-quarter of the world's population is latently infected with Mycobacterium tuberculosis. In Ger- many, the incidence of tuberculosis was in decline over several decades but rose in 2015 to 7.3 new cases per 100 000 persons. In 2018, a total of 5429 new cases were documented, corresponding to 6.5 new cases per 100 000 persons. METHODS This article is based on literature retrieved by a selective search in PubMed and on the authors' clinical experience. RESULTS Tuberculosis involves the lungs in almost 75% of patients but can generally involve any organ. In Germany, the majority of patients come from high-incidence countries. If a patient's differential diagnosis includes tuberculosis, the main tests for the detection of the pathogen in sputum and tissue samples are culture (the gold standard), microscopy, and nucleic acid amplification tests. Imaging studies are also used for diagnosis and follow-up. The standard treatment consists of a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide, followed by a combination of isoniazid and rifampicin only. Liver damage is one of the more common adverse effects of this treatment, arising in 2.4% of patients. Multidrug-resistant tuberculosis, which is rare in Germany (around 100 cases per year), should be treated in special- ized centers. CONCLUSION Rapid diagnosis and targeted treatment are essential to prevent an unfavorable course of the disease as well as its transmission to other individuals. In patients presenting with unclear symptoms, tuberculosis should always be considered as a differential diagnosis. The diagnosis of latent tuberculosis and decision-making regarding its treatment are difficult because of the lack of specific biomarkers and of relevant data from clinical trials.
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Affiliation(s)
- Isabelle Suárez
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Cologne; German Center for Infection Research, Cologne-Bonn, Partner Site Cologne; Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin; Department of Pneumonology, Hanover Medical School
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Carlos R, Porras L, Sánchez Sánchez R. Otic tuberculosis. Case report. Med Clin (Barc) 2020; 157:148-149. [PMID: 32493620 DOI: 10.1016/j.medcli.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Roman Carlos
- Departamento de Otorrinolaringología, Hospital Universitario Reina Sofía, Córdoba, España.
| | - Lorena Porras
- Departamento de Otorrinolaringología, Hospital Universitario Reina Sofía, Córdoba, España
| | - Rafael Sánchez Sánchez
- Departamento de Anatomía Patológica, Hospital Universitario Reina Sofía, Córdoba, España
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Montiel Quezel-Guerraz N, Sánchez-Porto A, Ortega Torres M, Pérez Santos MJ, Acosta F, Guzman A, Correa Ruiz A, Bérmudez Ruiz P. Antituberculosis drug resistance in isolates of Mycobacterium tuberculosis complex in southeast Spain. J Glob Antimicrob Resist 2020; 20:183-186. [DOI: 10.1016/j.jgar.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/29/2019] [Accepted: 08/02/2019] [Indexed: 11/15/2022] Open
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Tuberculosis-Related Hospitalizations in a Low-Incidence Country: A Retrospective Analysis in Two Italian Infectious Diseases Wards. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010124. [PMID: 31878009 PMCID: PMC6981912 DOI: 10.3390/ijerph17010124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/16/2022]
Abstract
In recent years, a decrease in the incidence of tuberculosis (TB) has been recorded worldwide. However, an increase in TB cases has been reported in foreign people living in low-incidence countries, with an increase in extrapulmonary TB (EPTB) in the western region of the world. In the present work, a retrospective study was conducted in two Italian infectious diseases wards to evaluate the clinical characteristics of TB admission in the time period 2013-2017. A significant increase in TB was shown in the study period: 166 (71% males) patients with TB were enrolled, with ~70% coming from outside Italy (30% from Africa, 25% from Europe, and 13% from Asia and South America). Compared to foreign people, Italians were significantly older (71.5 (interquartile range, IQR: 44.5-80.0) vs. 30 (IQR: 24-40) years; p < 0.0001) more immunocompromised (48% vs. 17%; p < 0.0001), and affected by comorbidities (44% vs. 14%; p < 0.0001). EPTB represented 37% of all forms of the disease, and it was more incident in subjects coming from Africa than in those coming from Europe (39.3% vs. 20%, respectively). In logistic regression analysis, being European was protective (odd ratio, OR (95% CI): 0.2 (0.1-0.6); p = 0.004) against the development of EPTB forms. In conclusion, an increase in the rate of TB diagnosis was documented in two Italian reference centers in the period 2013-2017, with 39% of EPTB diagnosed in patients from outside Europe.
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Manika K, Kotoulas SC, Papadaki E, Kyreltsi P, Sionidou M, Kontakiotis T, Kioumis I. Tuberculosis treatment outcome in Thessaloniki, Greece - a single center study. Hippokratia 2019; 23:154-159. [PMID: 32742164 PMCID: PMC7377584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Greece is one of the few countries in the European Union/European Economic Area, which do not report tuberculosis (TB) treatment outcome. This study aimed to assess treatment outcomes and identify possible intervening factors in patients with TB in Thessaloniki, Greece, over the period 2012-2017. METHODS All patients diagnosed with TB -excluding rifampicin-resistant/multidrug-resistant (RR/MDR)-TB- during 2015-2017 were included in the study. Data on demographic characteristics, localization, diagnostic methods, resistance, and treatment outcome were recorded and compared to the period 2012-2014. RESULTS During the period 2015-2017, 82 patients (48 men) with a mean age of 53.8 ± 15.6 years were diagnosed with TB. No significant differences in demographics, microbiological, or treatment characteristics were detected between the two three-year periods, except for the percentage of immunocompromised patients, which was higher during 2015-2017 (15.9 % vs 5.6 %, p =0.029). In the total number of patients, two factors were significantly different between patients with a positive and negative outcome. The percentage of favorable outcome was higher for patients with extrapulmonary compared to pulmonary TB (90.9 % vs 70.5 %, p =0.044). Furthermore, the percentage of immunocompetent patients with a positive outcome was significantly higher in the second treatment period compared to the first (treatment success rate 66.7 % in 2012-2014 vs 84.1 % in 2015-2017, p =0.014). This difference was attributed to the presence of a social nurse who joined the center in 2015. CONCLUSIONS TB treatment success rate in Greece is below the World Health Organization standards. Interventions such as appropriate multidisciplinary staffing of TB centers may prove valuable in improving TB care in Greece. HIPPOKRATIA 2019, 23(4): 154-159.
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Affiliation(s)
- K Manika
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - S C Kotoulas
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - E Papadaki
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - P Kyreltsi
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - M Sionidou
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - T Kontakiotis
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - I Kioumis
- Respiratory Failure Department, Medical School, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
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Mantica G, Van der Merwe A, Terrone C, Gallo F, Zarrabi AD, Vlok AL, Ackermann HM, Territo A, Esperto F, Olapade-Olapa EO, Riccardi N, Bongers M, Bonkat G. Awareness of European practitioners toward uncommon tropical diseases: are we prepared to deal with mass migration? Results of an international survey. World J Urol 2019; 38:1773-1786. [PMID: 31538244 DOI: 10.1007/s00345-019-02957-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/13/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The recent rise in migration from Africa through the Mediterranean basin into Europe has resulted in an increased incidence of uncommon diseases such as schistosomiasis and genito-urinary tuberculosis, which were previously largely unknown in this region. This study aimed to evaluate the insight of European urologists into diagnosing and managing these disease conditions and to determine whether they were adequately prepared to deal with the changing disease spectrum in their countries. METHODS A survey including specific questions about the diagnosis and management of 'tropical' urological diseases was distributed among urologists working in Europe and Africa. Multivariate logistic regression models were performed to detect the continent (African or European) effect on knowledge of and insight into tropical urological diseases. RESULTS A total of 312 surveys were administered. African and European respondents accounted for 109 (36.09%) and 193 (63.91%) respondents, respectively. The multivariate logistic regression analysis demonstrated a significant deficiency in the knowledge of tropical urological diseases in the European cohort compared with the African cohort (p < 0.05). Moreover, in the European cohort, markedly superior knowledge of tropical urological diseases was observed for respondents who had previously worked in a developing country. CONCLUSIONS Though European urologists are not required to have the same insight as African urologists, they showed a very unsatisfactory knowledge of tropical urological diseases. The experience of working in a developing country could improve the knowledge of European urologists regarding tropical urological diseases.
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Affiliation(s)
- Guglielmo Mantica
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Francie Van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa. .,Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy.
| | - André Van der Merwe
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Francie Van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Fabio Gallo
- UO Biostatistics, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Amir D Zarrabi
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Francie Van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Adriaan L Vlok
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Francie Van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Hilgard M Ackermann
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Francie Van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Angelo Territo
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | | | - Emiola O Olapade-Olapa
- Department of Surgery, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Niccolò Riccardi
- Infectious Disease Clinic, San Raffaele Scientific Institute, Milan, Italy
| | - Marius Bongers
- Department of Urology, The Urology Hospital, Pretoria, South Africa
| | - Gernot Bonkat
- Alta Uro AG, Merian Iselin Klinik, Centre of Biomechanics and Calorimetry, University of Basel, Basel, Switzerland
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Suárez I, Maria Fünger S, Jung N, Lehmann C, Reimer RP, Mehrkens D, Bunte A, Plum G, Jaspers N, Schmidt M, Fätkenheuer G, Rybniker J. Severe disseminated tuberculosis in HIV-negative refugees. THE LANCET. INFECTIOUS DISEASES 2019; 19:e352-e359. [PMID: 31182290 DOI: 10.1016/s1473-3099(19)30162-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 12/17/2022]
Abstract
In high-income countries, the presentation of tuberculosis is changing, primarily because of migration, and understanding the specific health needs of susceptible populations is becoming increasingly important. Although disseminated tuberculosis is well documented in HIV-positive patients, the disease is poorly described and less expected in HIV-negative individuals. In this Grand Round, we report eight HIV-negative refugees, who presented with extensively disseminated tuberculosis. We discuss the multifactorial causes, such as deprivations during long journeys, precarious living conditions, and the experience of violence, which might add to nutritional factors and chronic disorders, eventually resulting in a state of predisposition to immune deficiency. We also show that disseminated tuberculosis is often difficult to diagnose when pulmonary symptoms are absent. Communication difficulties between refugees and health-care workers are another major hurdle, and every effort should be made to get a valid patient history. This medical history is crucial to guide imaging and other diagnostic procedures to establish a definite diagnosis, which should be confirmed by a positive tuberculosis culture. Because many of these patients are at risk for multidrug-resistant tuberculosis, drug susceptibility testing is imperative to guide therapy. In the absence of treatment guidelines for this entity, clinicians can determine treatment duration according to recommendations provided for extrapulmonary tuberculosis and affected organs. Paradoxical expansion of tuberculous lesions during therapy should be treated with corticosteroids. In many cases, treatment duration must be individualised and might even exceed 12 months.
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Affiliation(s)
- Isabelle Suárez
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Sarah Maria Fünger
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Clara Lehmann
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Robert Peter Reimer
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Dennis Mehrkens
- Department of Cardiovascular Medicine, University Heart Center, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Anne Bunte
- Public Health Department Cologne, Cologne, Germany
| | - Georg Plum
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Natalie Jaspers
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Matthias Schmidt
- Department for Nuclear Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.
| | - Jan Rybniker
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.
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Arnedo-Pena A, Romeu-Garcia MA, Meseguer-Ferrer N, Vivas-Fornas I, Vizcaino-Batllés A, Safont-Adsuara L, Bellido-Blasco JB, Moreno-Muñoz R. Pulmonary Versus Extrapulmonary Tuberculosis Associated Factors: A Case-Case Study. Microbiol Insights 2019; 12:1178636119840362. [PMID: 30992667 PMCID: PMC6449815 DOI: 10.1177/1178636119840362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) incidence remains low in health departments of Castellon and La Plana-Vila-real, but TB elimination is challenging. The objective of this study was to estimate associated factors of pulmonary tuberculosis (PTB) compared with extrapulmonary tuberculosis (ETB) and investigate epidemiological characteristics of these pathologies to orient control and prevention actions. MATERIALS AND METHODS A prospective case-case study was implemented by comparing PTB and ETB incidences during 2013-2016 from notification reports, epidemiological surveillance, and microbiological results of hospitals' laboratories Hospital General Castellon and La Plana-Vila-Real in the province of Castellon of Valencia region in Spain. In this design, cases were patients with PTB and controls were patients with ETB. Directed acyclic graph approach was used for selection of potential risk and confounding factors. Adjusted odds ratios (AORs) were estimated by logistic regression models. RESULTS The study included 136 patients with PTB and 57 patients with ETB, with microbiological confirmation of 93.4% and 52.6%, and the annual median of incidence rates were 7.5 and 3.1 per 100 000 inhabitants, respectively. In general, patients with PTB were younger with higher male proportion than patients with ETB. Risk factors of PTB were smoking tobacco (AOR = 3.98; 95% confidence interval [CI] = 1.66-9.56), social problems (social marginalization, homeless, residence in shelters for the poor, or stay in prison) (AOR = 3.39; 95% CI = 1.05-10.94), and contact with patients with TB (AOR = 2.51; 95% CI = 1.06-5.95). No-smoking tobacco and no-drug abuse interaction decrease PTB risk (AOR = 0.27; 95% CI = 0.12-0.64). From these results, specific measures of health promotion and prevention can be addressed. CONCLUSIONS The estimated associated factors of PTB may be prevented, and it was demonstrated that the case-case design is useful in the study of TB.
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Affiliation(s)
- Alberto Arnedo-Pena
- Epidemiology Division, Public Health
Center, Castellon, Spain
- Department Medicine Preventive and
Public Health, Faculty of Health Sciences, Public University of Navarra, Pamplona,
Spain
- CIBER—Epidemiology and Public Health,
Barcelona, Spain
| | | | | | | | | | | | - Juan Bautista Bellido-Blasco
- Epidemiology Division, Public Health
Center, Castellon, Spain
- CIBER—Epidemiology and Public Health,
Barcelona, Spain
- Department of Epidemiology and Public
Health. School of Medicine, Jaume I University, Castellon, Spain
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Treatment of a broncho-esophageal fistula complicated by severe ARDS. Infection 2018; 47:483-487. [PMID: 30417214 DOI: 10.1007/s15010-018-1247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Broncho-esophageal fistula formation is a rare complication of tuberculosis, most often seen in immunocompromised patients. METHODS AND RESULTS In this paper, we report the case of a young non-immunocompromised refugee from Somalia diagnosed with open pulmonary tuberculosis complicated by extensive osseous involvement and a broncho-esophageal fistula with consecutive aspiration of gastric contents. The patient rapidly developed a severe acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (ECMO) therapy for nearly 2 months. The fistula was initially treated by standard antituberculous combination therapy and implantation of an esophageal and a bronchial stent. Long-term antibiotic treatment was instituted for pneumonia and mediastinitis. 7 months later, discontinuity resection of the esophagus was performed and the bronchial fistula covered by an intercostal muscle flap. DISCUSSION This case illustrates that tuberculosis should always be suspected in patients from high-incidence countries in case of lung involvement and that an interdisciplinary approach including long-term intensive care management can enable successful treatment of tuberculosis with severe, near-fatal complications.
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