1
|
Farina E, D'Amore C, Lancella L, Boccuzzi E, Ciofi Degli Atti ML, Reale A, Rossi P, Villani A, Raponi M, Raucci U. Alert sign and symptoms for the early diagnosis of pulmonary tuberculosis: analysis of patients followed by a tertiary pediatric hospital. Ital J Pediatr 2022; 48:90. [PMID: 35698090 PMCID: PMC9195307 DOI: 10.1186/s13052-022-01288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intercepting earlier suspected TB (Tuberculosis) cases clinically is necessary to reduce TB incidence, so we described signs and symptoms of retrospective cases of pulmonary TB and tried to evaluate which could be early warning signs. Methods We conducted a retrospective descriptive study of pulmonary TB cases in children in years 2005–2017; in years 2018–2020 we conducted a cohort prospective study enrolling patients < 18 years accessed to Emergency Department (ED) with signs/symptoms suggestive of pulmonary TB. Results In the retrospective analysis, 226 patients with pulmonary TB were studied. The most frequently described items were contact history (53.5%) and having parents from countries at risk (60.2%). Cough was referred in 49.5% of patients at onset, fever in 46%; these symptoms were persistent (lasting ≥ 10 days) in about 20%. Lymphadenopathy is described in 15.9%. The prospective study enrolled 85 patients of whom 14 (16.5%) were confirmed to be TB patients and 71 (83.5%) were non-TB cases. Lymphadenopathy and contact history were the most correlated variables. Fever and cough lasting ≥ 10 days were less frequently described in TB cases compared to non-TB patients (p < 0.05). Conclusions In low TB endemic countries, pulmonary TB at onset is characterized by different symptoms, i.e. persistent fever and cough are less described, while more relevant are contact history and lymphadenopathy. It was not possible to create a score because signs/symptoms usually suggestive of pulmonary TB (considered in the questionnaire) were not significant risk factors in our reality, a low TB country. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01288-5.
Collapse
Affiliation(s)
- Elisa Farina
- Unit of Internal Medicine, Celio Military Hospital, Rome, Italy
| | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- Division of Immunology and Infectious Diseases, Department (DPUO), University-Hospital Pediatric, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Elena Boccuzzi
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Antonino Reale
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paolo Rossi
- Medical Direction, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Alberto Villani
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Umberto Raucci
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| |
Collapse
|
2
|
Li R, Nordio F, Huang CC, Contreras C, Calderon R, Yataco R, Galea JT, Zhang Z, Becerra MC, Lecca L, Murray MB. Two Clinical Prediction Tools to Improve Tuberculosis Contact Investigation. Clin Infect Dis 2020; 71:e338-e350. [PMID: 31905406 PMCID: PMC7643741 DOI: 10.1093/cid/ciz1221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/02/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Efficient contact investigation strategies are needed for the early diagnosis of tuberculosis (TB) disease and treatment of latent TB infections. METHODS Between September 2009 and August 2012, we conducted a prospective cohort study in Lima, Peru, in which we enrolled and followed 14 044 household contacts of adults with pulmonary TB. We used information from a subset of this cohort to derive 2 clinical prediction tools that identify contacts of TB patients at elevated risk of progressing to active disease by training multivariable models that predict (1) coprevalent TB among all household contacts and (2) 1-year incident TB among adult contacts. We validated the models in a geographically distinct subcohort and compared the relative utilities of clinical decisions based on these tools to existing strategies. RESULTS In our cohort, 296 (2.1%) household contacts had coprevalent TB and 145 (1.9%) adult contacts developed incident TB within 1 year of index patient diagnosis. We predicted coprevalent disease using information that could be readily obtained at the time an index patient was diagnosed and predicted 1-year incident TB by including additional contact-specific characteristics. The area under the receiver operating characteristic curves for coprevalent TB and incident TB were 0.86 (95% confidence interval [CI], .83-.89]) and 0.72 (95% CI, .67-.77), respectively. These clinical tools give 5%-10% higher relative utilities than existing methods. CONCLUSIONS We present 2 tools that identify household contacts at high risk for TB disease based on reportable information from patient and contacts alone. The performance of these tools is comparable to biomarkers that are both more costly and less feasible than this approach.
Collapse
Affiliation(s)
- Ruoran Li
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Francesco Nordio
- TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Chuan-Chin Huang
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | | | | | - Jerome T Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Zibiao Zhang
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Leonid Lecca
- Socios En Salud, Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Du C, Wang S, Yu M, Chiu T, Wang J, Chuang P, Jou R, Chan P, Fang C. Effect of ventilation improvement during a tuberculosis outbreak in underventilated university buildings. INDOOR AIR 2020; 30:422-432. [PMID: 31883403 PMCID: PMC7217216 DOI: 10.1111/ina.12639] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/01/2019] [Accepted: 12/23/2019] [Indexed: 05/07/2023]
Abstract
The role of ventilation in preventing tuberculosis (TB) transmission has been widely proposed in infection control guidance. However, conclusive evidence is lacking. Modeling suggested the threshold of ventilation rate to reduce effective reproductive ratio (ratio between new secondary infectious cases and source cases) of TB to below 1 is corresponding to a carbon dioxide (CO2 ) level of 1000 parts per million (ppm). Here, we measured the effect of improving ventilation rate on a TB outbreak involving 27 TB cases and 1665 contacts in underventilated university buildings. Ventilation engineering decreased the maximum CO2 levels from 3204 ± 50 ppm to 591-603 ppm. Thereafter, the secondary attack rate of new contacts in university dropped to zero (mean follow-up duration: 5.9 years). Exposure to source TB cases under CO2 >1000 ppm indoor environment was a significant risk factor for contacts to become new infectious TB cases (P < .001). After adjusting for effects of contact investigation and latent TB infection treatment, improving ventilation rate to levels with CO2 <1000 ppm was independently associated with a 97% decrease (95% CI: 50%-99.9%) in the incidence of TB among contacts. These results show that maintaining adequate indoor ventilation could be a highly effective strategy for controlling TB outbreaks.
Collapse
Affiliation(s)
- Chun‐Ru Du
- Taipei Regional CenterTaiwan Centers for Disease ControlTaipeiTaiwan
| | - Shun‐Chih Wang
- Institute of LaborOccupational Safety and HealthMinistry of LaborTaipeiTaiwan
| | - Ming‐Chih Yu
- Division of Pulmonary MedicineDepartment of Internal MedicineWan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
- School of Respiratory TherapyCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Ting‐Fang Chiu
- Department of PediatricsTaipei City Hospital, Zhongxiao BranchTaipeiTaiwan
| | - Jann‐Yuan Wang
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Pei‐Chun Chuang
- Division of Planning and CoordinationTaiwan Centers for Disease ControlTaipeiTaiwan
| | - Ruwen Jou
- Center for Diagnostics and Vaccine DevelopmentTaiwan Centers for Disease ControlTaipeiTaiwan
- Institute of Microbiology and ImmunologyNational Yang‐Ming UniversityTaipeiTaiwan
| | - Pei‐Chun Chan
- Division of Chronic Infectious DiseasesTaiwan Centers for Disease ControlTaipeiTaiwan
- Division of Pediatric Infectious DiseasesDepartment of PediatricsNational Taiwan University HospitalTaipeiTaiwan
- Institute of Epidemiology and Preventive MedicineCollege of Public HealthNational Taiwan UniversityTaipeiTaiwan
| | - Chi‐Tai Fang
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
- Institute of Epidemiology and Preventive MedicineCollege of Public HealthNational Taiwan UniversityTaipeiTaiwan
| |
Collapse
|
4
|
Wingfield T, MacPherson P, Sodha P, Tucker A, Mithoo J, Squire SB, Cleary P. Contacts of underserved tuberculosis patients have higher odds of TB disease in North West England: a cohort study. Int J Tuberc Lung Dis 2020; 23:337-343. [PMID: 30871665 DOI: 10.5588/ijtld.18.0467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the association between patients' social risk factors and the risk of tuberculous infection and TB disease among their contacts in England. DESIGN This was a cohort study of all TB cases from North West England diagnosed between 27 March 2012 and 28 June 2016. The social risk factors of TB cases were evaluated to estimate their need for enhanced case management (ECM), from 0 (standard of care) to 3 (intensive social support). RESULTS A total of 2139 cases and their 10 019 contacts met the eligibility criteria. Being a contact of a patient with smear-positive TB with high ECM or being of Black Caribbean ethnicity was independently associated with greater odds of active TB disease (smear-positive vs. smear-negative, OR 5.3, 95%CI 3.2-8.7; ECM-3 vs. ECM-0, OR 2.2, 95%CI 1.01-5.0; Black Caribbean vs. White, OR 7.4, 95%CI 2.1-25). Being a contact of a patient with smear-positive TB or of Black Caribbean ethnicity was also independently associated with greater odds of tuberculous infection (smear-positive vs. smear-negative, OR 5.3, 95%CI 3.8-7.3; and Black Caribbean vs. White, OR 6.7, 95%CI 2.0-25). CONCLUSIONS The social complexity and ethnicity of patients were associated with tuberculous infection and TB disease in their contacts.
Collapse
Affiliation(s)
- T Wingfield
- Department of Clinical Infection, Microbiology, and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, Public Health England Field Service North West, Liverpool, Tropical and Infectious Diseases Unit, Royal Liverpool Hospital, Liverpool, LIV-TB Collaboration and Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK, Social Medicine, Infectious Diseases and Migration Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - P MacPherson
- LIV-TB Collaboration and Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK, HIV/TB Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - P Sodha
- Liverpool School of Medicine, Liverpool
| | - A Tucker
- Public Health England Field Service North West, Liverpool, Centre for Epidemiology, University of Manchester, Manchester
| | - J Mithoo
- LIV-TB Collaboration and Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - S B Squire
- LIV-TB Collaboration and Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - P Cleary
- Public Health England Field Service North West, Liverpool
| |
Collapse
|
5
|
Development and Validation of a Risk Scoring System for Cephamycin-Associated Hemorrhagic Events. Sci Rep 2019; 9:12905. [PMID: 31501462 PMCID: PMC6733795 DOI: 10.1038/s41598-019-49340-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 06/19/2019] [Indexed: 01/29/2023] Open
Abstract
Cephamycin-associated hemorrhages have been reported since their launch. This research aimed to determine risk factors for cephamycin-associated hemorrhagic events and produce a risk scoring system using National Taiwan University Hospital (NTUH) database. Patients who were older than 20 years old and consecutively used study antibiotics for more than 48 hours (epidode) at NTUH between January 1st, 2009 and December 31st, 2015 were included. The population was divided into two cohorts for evaluation of risk factors and validation of the scoring system. Multivariate logistic regression was used for the assessment of the adjusted association between factors and the outcome of interest. Results of the multivariate logistic regression were treated as the foundation to develop the risk scoring system. There were 46402 and 22681 episodes identified in 2009–2013 and 2014–2015 cohorts with 356 and 204 hemorrhagic events among respective cohorts. Use of cephamycins was associated with a higher risk for hemorrhagic outcomes (aOR 2.03, 95% CI 1.60–2.58). Other risk factors included chronic hepatic disease, at least 65 years old, prominent bleeding tendency, and bleeding history. A nine-score risk scoring system (AUROC = 0.8035, 95% CI 0.7794–0.8275; Hosmer-Lemeshow goodness-of-fit test p = 0.1044) was developed based on the identified risk factors, with higher scores indicating higher risk for bleeding. Use of cephamycins was associated with more hemorrhagic events compared with commonly used penicillins and cephalosporins. The established scoring system, CHABB, may help pharmacists identify high-risk patients and provide recommendations according to the predictive risk, and eventually enhance the overall quality of care.
Collapse
|
6
|
Martinez L, Handel A, Shen Y, Chakraburty S, Quinn FD, Stein CM, Malone LL, Zalwango S, Whalen CC. A Prospective Validation of a Clinical Algorithm to Detect Tuberculosis in Child Contacts. Am J Respir Crit Care Med 2019; 197:1214-1216. [PMID: 29035095 DOI: 10.1164/rccm.201706-1210le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Leonardo Martinez
- 1 University of Georgia Athens, Georgia.,2 Stanford University Stanford, California
| | | | - Ye Shen
- 1 University of Georgia Athens, Georgia
| | | | | | | | | | | | | |
Collapse
|
7
|
Paton NI, Borand L, Benedicto J, Kyi MM, Mahmud AM, Norazmi MN, Sharma N, Chuchottaworn C, Huang YW, Kaswandani N, Le Van H, Lui GCY, Mao TE. Diagnosis and management of latent tuberculosis infection in Asia: Review of current status and challenges. Int J Infect Dis 2019; 87:21-29. [PMID: 31301458 DOI: 10.1016/j.ijid.2019.07.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022] Open
Abstract
Asia has the highest burden of tuberculosis (TB) and latent TB infection (LTBI) in the world. Optimizing the diagnosis and treatment of LTBI is one of the key strategies for achieving the WHO 'End TB' targets. We report the discussions from the Asia Latent TubERculosis (ALTER) expert panel meeting held in 2018 in Singapore. In this meeting, a group of 13 TB experts from Bangladesh, Cambodia, Hong Kong, India, Indonesia, Malaysia, Myanmar, the Philippines, Singapore, Taiwan, Thailand and Vietnam convened to review the literature, discuss the barriers and propose strategies to improve the management of LTBI in Asia. Strategies for the optimization of risk group prioritization, diagnosis, treatment, and research of LTBI are reported. The perspectives presented herein, may help national programs and professional societies of the respective countries enhance the adoption of the WHO guidelines, scale-up the implementation of national guidelines based on the regional needs, and provide optimal guidance to clinicians for the programmatic management of LTBI.
Collapse
Affiliation(s)
- Nicholas I Paton
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Laurence Borand
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
| | - Jubert Benedicto
- Department of Internal Medicine, Adult Pulmonary Medicine, Philippine General Hospital, Manila, Philippines
| | - Mar Mar Kyi
- Insein General Hospital, Department of Medicine, University of Medicine (2), Yangon, Myanmar
| | | | | | - Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | | | - Yi-Wen Huang
- Acute Critical Care Department, Changhua Hospital, Ministry of Health and Welfare, Taiwan; Institute of Medicine, Chung Shan Medical University, Taiwan
| | - Nastiti Kaswandani
- Department of Child Health, Faculty of Medicine, University of Indonesia/Ciptomangunkusumo Hospital, Jakarta, Indonesia
| | | | - Grace C Y Lui
- Department of Medicine and Therapeutics, Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Tan Eang Mao
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| |
Collapse
|
8
|
Aksornchindarat W, Yodpinij N, Phetsuksiri B, Srisungngam S, Rudeeaneksin J, Bunchoo S, Klayut W, Sangkitporn S, Khawcharoenporn T. T-SPOT®.TB test and clinical risk scoring for diagnosis of latent tuberculosis infection among Thai healthcare workers. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 54:305-311. [PMID: 31221513 DOI: 10.1016/j.jmii.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/29/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Screening for latent tuberculosis infection (LTBI) is important to identify healthcare workers (HCWs) benefiting from preventive therapy. Interferon-gamma release assays (IGRAs) are sensitive and specific tests for LTBI diagnosis. However, in settings where IGRAs are not available, clinical risk assessment may be used as an alternative to diagnose LTBI. METHODS A cross-sectional study was conducted among HCWs of a tertiary-care university hospital in Thailand. All HCWs underwent T-SPOT®.TB test (T-SPOT) and assessment of LTBI clinical risks. Clinical risks associated with T-SPOT positivity were determined by multivariable logistic regression analysis and were given scores accordingly. The performance of the clinical risk scoring was evaluated in comparison to T-SPOT. RESULTS Among 140 enrolled HCWs, 125 (89%) were females, the median age was 27 years and 23 (16%) had T-SPOT positivity. Independent factors associated with T-SPOT positivity were age ≥30 years (adjusted odds ratio [aOR] 3.95; P = 0.002), working duration ≥60 months (aOR 3.75, P = 0.004) and frequency of TB contact ≥6 times (aOR 8.83, P = 0.005). The study's clinical risk scoring had the area under the curve by receiver operating curve analysis of 0.76 (P < 0.001) using T-SPOT positivity as a reference standard. The score of ≥3 had the best performance in diagnosing LTBI with sensitivity, specificity, positive predictive value and negative predictive value of 70%, 71%, 32% and 92%, respectively. CONCLUSIONS In this setting where LTBI was prevalent among HCWs but IGRAs are not widely available, the clinical risk scoring may be used as an alternative to diagnose LTBI in HCWs.
Collapse
Affiliation(s)
| | - Napat Yodpinij
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Benjawan Phetsuksiri
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Sopa Srisungngam
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Janisara Rudeeaneksin
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Supranee Bunchoo
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Wiphat Klayut
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Somchai Sangkitporn
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
| |
Collapse
|
9
|
Pintye J, Drake AL, Kinuthia J, Unger JA, Matemo D, Heffron RA, Barnabas RV, Kohler P, McClelland RS, John-Stewart G. A Risk Assessment Tool for Identifying Pregnant and Postpartum Women Who May Benefit From Preexposure Prophylaxis. Clin Infect Dis 2017; 64:751-758. [PMID: 28034882 DOI: 10.1093/cid/ciw850] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/12/2016] [Indexed: 01/05/2023] Open
Abstract
Background A human immunodeficiency virus (HIV) risk assessment tool for pregnant women could identify women who would most benefit from preexposure prophylaxis (PrEP) while minimizing unnecessary PrEP exposure. Methods Data from a prospective study of incident HIV among pregnant/postpartum women in Kenya were randomly divided into derivation (n = 654) and validation (n = 650) cohorts. A risk score was derived using multivariate Cox proportional hazards models and standard clinical prediction rules. Ability of the tool to predict maternal HIV acquisition was assessed using the area under the curve (AUC) and Brier score. Results The final risk score included the following predictors: having a male partner with unknown HIV status, number of lifetime sexual partners, syphilis, bacterial vaginosis (BV), and vaginal candidiasis. In the derivation cohort, AUC was 0.84 (95% confidence interval [CI], .72-.95) and each point increment in score was associated with a 52% (hazard ratio [HR], 1.52 [95% CI, 1.32-1.76]; P < .001) increase in HIV risk; the Brier score was 0.11. In the validation cohort, the score had similar AUC, Brier score, and estimated HRs. A simplified score that excluded BV and candidiasis yielded an AUC of 0.76 (95% CI, .67-.85); HIV incidence was higher among women with risk scores >6 than with scores ≤6 (7.3 vs 1.1 per 100 person-years, respectively; P < .001). Women with simplified scores >6 accounted for 16% of the population but 56% of HIV acquisitions. Conclusions A combination of indicators routinely assessed in antenatal clinics was predictive of HIV risk and could be used to prioritize pregnant women for PrEP.
Collapse
Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, USA.,Family and Child Nursing, University of Washington, Seattle, USA
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jennifer A Unger
- Departments of Global Health and Obstetrics and Gynecology, University of Washington, Box 359909, Seattle, WA, USA
| | - Daniel Matemo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Renee A Heffron
- Department of Global Health, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Ruanne V Barnabas
- Department of Global Health, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, USA.,Psychosocial and Community Health, University of Washington, Seattle, USA
| | - R Scott McClelland
- Department of Global Health, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, USA
| |
Collapse
|
10
|
Saunders MJ, Wingfield T, Tovar MA, Baldwin MR, Datta S, Zevallos K, Montoya R, Valencia TR, Friedland JS, Moulton LH, Gilman RH, Evans CA. A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort study. THE LANCET. INFECTIOUS DISEASES 2017; 17:1190-1199. [PMID: 28827142 PMCID: PMC7611139 DOI: 10.1016/s1473-3099(17)30447-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/23/2017] [Accepted: 06/29/2017] [Indexed: 10/28/2022]
Abstract
BACKGROUND Contacts of tuberculosis index cases are at increased risk of developing tuberculosis. Screening, preventive therapy, and surveillance for tuberculosis are underused interventions in contacts, particularly adults. We developed a score to predict risk of tuberculosis in adult contacts of tuberculosis index cases. METHODS In 2002-06, we recruited contacts aged 15 years or older of index cases with pulmonary tuberculosis who lived in desert shanty towns in Ventanilla, Peru. We followed up contacts for tuberculosis until February, 2016. We used a Cox proportional hazards model to identify index case, contact, and household risk factors for tuberculosis from which to derive a score and classify contacts as low, medium, or high risk. We validated the score in an urban community recruited in Callao, Peru, in 2014-15. FINDINGS In the derivation cohort, we identified 2017 contacts of 715 index cases, and median follow-up was 10·7 years (IQR 9·5-11·8). 178 (9%) of 2017 contacts developed tuberculosis during 19 147 person-years of follow-up (incidence 0·93 per 100 person-years, 95% CI 0·80-1·08). Risk factors for tuberculosis were body-mass index, previous tuberculosis, age, sustained exposure to the index case, the index case being in a male patient, lower community household socioeconomic position, indoor air pollution, previous tuberculosis among household members, and living in a household with a low number of windows per room. The 10-year risks of tuberculosis in the low-risk, medium-risk, and high-risk groups were, respectively, 2·8% (95% CI 1·7-4·4), 6·2% (4·8-8·1), and 20·6% (17·3-24·4). The 535 (27%) contacts classified as high risk accounted for 60% of the tuberculosis identified during follow-up. The score predicted tuberculosis independently of tuberculin skin test and index-case drug sensitivity results. In the external validation cohort, 65 (3%) of 1910 contacts developed tuberculosis during 3771 person-years of follow-up (incidence 1·7 per 100 person-years, 95% CI 1·4-2·2). The 2·5-year risks of tuberculosis in the low-risk, medium-risk, and high-risk groups were, respectively, 1·4% (95% CI 0·7-2·8), 3·9% (2·5-5·9), and 8·6%· (5·9-12·6). INTERPRETATION Our externally validated risk score could predict and stratify 10-year risk of developing tuberculosis in adult contacts, and could be used to prioritise tuberculosis control interventions for people most likely to benefit. FUNDING Wellcome Trust, Department for International Development Civil Society Challenge Fund, Joint Global Health Trials consortium, Bill & Melinda Gates Foundation, Imperial College National Institutes of Health Research Biomedical Research Centre, Foundation for Innovative New Diagnostics, Sir Halley Stewart Trust, WHO, TB REACH, and Innovation for Health and Development.
Collapse
Affiliation(s)
- Matthew J Saunders
- Section of Infectious Diseases and Immunity, Imperial College London, London, UK; Wellcome Trust Imperial College Centre for Global Health Research, London, UK; Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru.
| | - Tom Wingfield
- Section of Infectious Diseases and Immunity, Imperial College London, London, UK; Wellcome Trust Imperial College Centre for Global Health Research, London, UK; Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru; Institute for Infection and Global Health, University of Liverpool, Liverpool, UK; Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Marco A Tovar
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru
| | - Matthew R Baldwin
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru; Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Sumona Datta
- Section of Infectious Diseases and Immunity, Imperial College London, London, UK; Wellcome Trust Imperial College Centre for Global Health Research, London, UK; Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru
| | - Karine Zevallos
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru
| | - Rosario Montoya
- Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru
| | - Teresa R Valencia
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jon S Friedland
- Section of Infectious Diseases and Immunity, Imperial College London, London, UK; Wellcome Trust Imperial College Centre for Global Health Research, London, UK
| | - Larry H Moulton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert H Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlton A Evans
- Section of Infectious Diseases and Immunity, Imperial College London, London, UK; Wellcome Trust Imperial College Centre for Global Health Research, London, UK; Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru
| |
Collapse
|
11
|
Huang SF, Chen MH, Wang FD, Tsai CY, Fung CP, Su WJ. Efficacy of isoniazid salvage therapy for latent tuberculosis infection in patients with immune-mediated inflammatory disorders - A retrospective cohort study in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:784-793. [PMID: 28739436 DOI: 10.1016/j.jmii.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/28/2017] [Accepted: 04/28/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Active tuberculosis (TB) in patients with latent tuberculosis infection (LTBI) was associated with use of biological agents for immune-mediated inflammatory disorders (IMIDs). For decreasing active TB, isoniazid prophylaxis therapy was administered before biologic therapy among IMID patients with LTBI. However, for patients who had been received biologics for a long time with unknown status of LTBI or exposure history of active TB, the prevalence of LTBI and efficacy of isoniazid therapy were unclear. METHOD A retrospective cohort study was conducted during 2012-2014 in a tertiary medical center in Taiwan, and the incidence case of active TB was identified by the national TB registration system on October 1, 2015. RESULTS All 382 patients with 1532 person-years were followed up, the initial prevalence of LTBI by positive interferon-gamma releasing assay (IGRA+) was 17.5%. The prevalence of LTBI was increased in elder age (>20%, p < 0.05), chronic kidney disease (33%, p < 0.05), metabolic syndrome (26.3%, p < 0.05), but not related to the type of IMIDs or biologics. The crude incidences of TB were increased in elders (53.3/1000 person-year), abnormal chest film (49.6/1000 person-year), administration of tocilizumab (13.6/1000 person-year), and metabolic syndrome (56.1/1000 person-year), respectively. Among patents with LTBI, the incidence of active TB was lower in patients with isoniazid therapy (9.2/1000 person-year, p = 0.02) than without isoniazid therapy (92.2/1000 person-years), regardless the timing of initiating isoniazid therapy (p > 0.05). CONCLUSION Isoniazid therapy can prevent active TB from LTBI despite of the timing of biologics administration.
Collapse
Affiliation(s)
- Shiang-Fen Huang
- Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taiwan, ROC.
| | - Ming-Han Chen
- Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
| | - Fu-Der Wang
- Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taiwan, ROC.
| | - Chang-Youh Tsai
- Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
| | - Chang-Phone Fung
- Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
| | - Wei-Juin Su
- School of Medicine, National Yang-Ming University, Taiwan, ROC; Department of Chest Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
| |
Collapse
|
12
|
Aketi L, Kashongwe Z, Kinsiona C, Fueza SB, Kokolomami J, Bolie G, Lumbala P, Diayisu JS. Childhood Tuberculosis in a Sub-Saharan Tertiary Facility: Epidemiology and Factors Associated with Treatment Outcome. PLoS One 2016; 11:e0153914. [PMID: 27101146 PMCID: PMC4839557 DOI: 10.1371/journal.pone.0153914] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/06/2016] [Indexed: 12/12/2022] Open
Abstract
Childhood tuberculosis (TB) is a diagnostic challenge in developing countries, and patient outcome can be influenced by certain factors. We report the disease course, clinical profile and factors associated with treatment outcome in a tertiary facility of Kinshasa. Documentary and analytical studies were conducted using clinical and exploratory data for children aged up to 15 years who were admitted to the University Clinics of Kinshasa for TB. Data are presented as frequencies and averages, and binary and logistic regression analyses were performed. Of 283 children with TB, 82 (29.0%) had smear-negative TB, 40 (14.1%) had smear-positive TB, 159 (56.1%) had extra-pulmonary TB (EPTB), 2 (0.7%) had multidrug-resistant TB (MDR-TB), 167 (59.0%) completed treatment, 30 (10.6%) were cured, 7 (2.5%) failed treatment, 4 (1.4%) died, 55 (19.4%) were transferred to health centers nearest their home, and 20 (7.0%) were defaulters. In the binary analysis, reported TB contacts (p = 0.048), type of TB (p = 0.000), HIV status (p = 0.050), Ziehl-Nielsen test result (p = 0.000), Lowenstein culture (p = 0.004) and chest X-ray (p = 0.057) were associated with outcome. In the logistic regression, none of these factors was a significant predictor of outcome. Tertiary level care facilities must improve the diagnosis and care of patients with childhood TB, which justifies the development of alternative diagnostic techniques and the assessment of other factors that potentially affect outcome.
Collapse
Affiliation(s)
- Loukia Aketi
- Department of Pediatrics, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
- * E-mail:
| | - Zacharie Kashongwe
- Department of Internal Medicine, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Christian Kinsiona
- Department of Pediatrics, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Serge Bisuta Fueza
- Department of Internal Medicine, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
- National Tuberculosis Program, Kinshasa, Democratic Republic of Congo
| | - Jack Kokolomami
- Epidemiology and Biostatistics Department, Public Health School at the University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Grace Bolie
- Department of Pediatrics, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Paul Lumbala
- Department of Pediatrics, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Joseph Shiku Diayisu
- Department of Pediatrics, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| |
Collapse
|
13
|
Elkington P, Zumla A. Update in Mycobacterium tuberculosis lung disease 2014. Am J Respir Crit Care Med 2016; 192:793-8. [PMID: 26426784 DOI: 10.1164/rccm.201505-1009up] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Paul Elkington
- 1 National Institute for Health Research (NIHR) Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Alimuddin Zumla
- 2 Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, United Kingdom; and.,3 NIHR Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| |
Collapse
|
14
|
Siracusa CM, Brewington JJ, Brockbank JC, Guilbert TW. Update in Pediatric Lung Disease 2014. Am J Respir Crit Care Med 2016; 192:918-23. [PMID: 26469841 DOI: 10.1164/rccm.201504-0752up] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Christopher M Siracusa
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John J Brewington
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Justin C Brockbank
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Theresa W Guilbert
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
15
|
Chen YL, Chou CY, Chang MC, Lin HW, Huang CT, Hsieh SF, Chen CA, Cheng WF. IL17a and IL21 combined with surgical status predict the outcome of ovarian cancer patients. Endocr Relat Cancer 2015; 22:703-11. [PMID: 26150382 DOI: 10.1530/erc-15-0145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 12/19/2022]
Abstract
Aside from tumor cells, ovarian cancer-related ascites contains the immune components. The aim of this study was to evaluate whether a combination of clinical and immunological parameters can predict survival in patients with ovarian cancer. Ascites specimens and medical records from 144 ovarian cancer patients at our hospital were used as the derivation group to select target clinical and immunological factors to generate a risk-scoring system to predict patient survival. Eighty-two cases from another hospital were used as the validation group to evaluate this system. The surgical status and expression levels of interleukin 17a (IL17a) and IL21 in ascites were selected for the risk-scoring system in the derivation group. The areas under the receiver operating characteristic (AUROC) curves of the overall score for disease-free survival (DFS) of the ovarian cancer patients were 0.84 in the derivation group, 0.85 in the validation group, and 0.84 for all the patients. The AUROC curves of the overall score for overall survival (OS) of cases were 0.78 in the derivation group, 0.76 in the validation group, and 0.76 for all the studied patients. Good correlations between overall risk score and survival of the ovarian cancer patients were demonstrated by sub-grouping all participants into four groups (P for trend <0.001 for DFS and OS). Therefore, acombination of clinical and immunological parameters can provide a practical scoring system to predict the survival of patients with ovarian carcinoma. IL17a and IL21 can potentially be used as prognostic and therapeutic biomarkers.
Collapse
MESH Headings
- Adenocarcinoma, Clear Cell/metabolism
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Mucinous/metabolism
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Biomarkers, Tumor/metabolism
- Cystadenocarcinoma, Serous/metabolism
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/surgery
- Endometrial Neoplasms/metabolism
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Enzyme-Linked Immunosorbent Assay
- Female
- Follow-Up Studies
- Humans
- Interleukin-17/metabolism
- Interleukins/metabolism
- Middle Aged
- Neoplasm Grading
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/surgery
- Prognosis
- Prospective Studies
- ROC Curve
- Survival Rate
Collapse
Affiliation(s)
- Yu-Li Chen
- College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan Univer
| | - Cheng-Yang Chou
- College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
| | - Ming-Cheng Chang
- College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
| | - Han-Wei Lin
- College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
| | - Ching-Ting Huang
- College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
| | - Shu-Feng Hsieh
- College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
| | - Chi-An Chen
- College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
| | - Wen-Fang Cheng
- College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan College of MedicineGraduate Institute of Anatomy and Cell Biology, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyGynecologic Cancer Center, Cathay General Hospital, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, TaiwanDepartment of Obstetrics and GynecologyCollege of Medicine and the Hospital, National Cheng Kung University, Tainan, TaiwanCollege of MedicineGraduate Institute of OncologyCollege of MedicineGraduate Institute of Clinical Medicine, National Taiwan Univer
| |
Collapse
|
16
|
Lee SSJ, Lin HH, Tsai HC, Su IJ, Yang CH, Sun HY, Hung CC, Sy CL, Wu KS, Chen JK, Chen YS, Fang CT. A Clinical Algorithm to Identify HIV Patients at High Risk for Incident Active Tuberculosis: A Prospective 5-Year Cohort Study. PLoS One 2015; 10:e0135801. [PMID: 26280669 PMCID: PMC4539234 DOI: 10.1371/journal.pone.0135801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023] Open
Abstract
Background Predicting the risk of tuberculosis (TB) in people living with HIV (PLHIV) using a single test is currently not possible. We aimed to develop and validate a clinical algorithm, using baseline CD4 cell counts, HIV viral load (pVL), and interferon-gamma release assay (IGRA), to identify PLHIV who are at high risk for incident active TB in low-to-moderate TB burden settings where highly active antiretroviral therapy (HAART) is routinely provided. Materials and Methods A prospective, 5-year, cohort study of adult PLHIV was conducted from 2006 to 2012 in two hospitals in Taiwan. HAART was initiated based on contemporary guidelines (CD4 count < = 350/μL). Cox regression was used to identify the predictors of active TB and to construct the algorithm. The validation cohorts included 1455 HIV-infected individuals from previous published studies. Area under the receiver operating characteristic (ROC) curve was calculated. Results Seventeen of 772 participants developed active TB during a median follow-up period of 5.21 years. Baseline CD4 < 350/μL or pVL ≥ 100,000/mL was a predictor of active TB (adjusted HR 4.87, 95% CI 1.49–15.90, P = 0.009). A positive baseline IGRA predicted TB in patients with baseline CD4 ≥ 350/μL and pVL < 100,000/mL (adjusted HR 6.09, 95% CI 1.52–24.40, P = 0.01). Compared with an IGRA-alone strategy, the algorithm improved the sensitivity from 37.5% to 76.5%, the negative predictive value from 98.5% to 99.2%. Compared with an untargeted strategy, the algorithm spared 468 (60.6%) from unnecessary TB preventive treatment. Area under the ROC curve was 0.692 (95% CI: 0.587–0.798) for the study cohort and 0.792 (95% CI: 0.776–0.808) and 0.766 in the 2 validation cohorts. Conclusions A validated algorithm incorporating the baseline CD4 cell count, HIV viral load, and IGRA status can be used to guide targeted TB preventive treatment in PLHIV in low-to-moderate TB burden settings where HAART is routinely provided to all PLHIV. The implementation of this algorithm will avoid unnecessary exposure of low-risk patients to drug toxicity and simultaneously, reduce the burden of universal treatment on the healthcare system.
Collapse
Affiliation(s)
- Susan Shin-Jung Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsi-Hsun Lin
- Department of Infection Control and Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Chin Tsai
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ih-Jen Su
- National Health Research Institute, Zhu-nan, Taiwan
| | - Chin-Hui Yang
- Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Yun Sun
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Chin Hung
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Len Sy
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kuan-Sheng Wu
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jui-Kuang Chen
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| |
Collapse
|