1
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Chuang T, Fu P. Chronic pulmonary Aspergillosis in a patient with poorly controlled diabetes: A case report and literatures review. Respirol Case Rep 2024; 12:e01283. [PMID: 38282720 PMCID: PMC10811610 DOI: 10.1002/rcr2.1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024] Open
Abstract
Chronic pulmonary aspergillosis (CPA) often manifests in patients with a history of pulmonary tuberculosis and is typically characterized by recurrent hemoptysis, weight loss, and frequently coexists with poorly controlled diabetes. While weight gain is acknowledged as a valuable clinical marker for monitoring therapeutic responses in CPA, there is a scarcity of case reports exploring this aspect. Furthermore, the impact of stringent blood sugar management in diminishing CPA activity and preventing the recurrence of hemoptysis is also underreported. In this context, we present the case of a 64-year-old male who experienced massive hemoptysis. He had a background of uncontrolled diabetes and a history of fully treated pulmonary tuberculosis. Following therapeutic embolization, he was diagnosed with CPA that had transformed into invasive pulmonary aspergillosis (IPA) and underwent antifungal therapy for 9 months. Notably, we observed an inverse correlation between the patient's improved blood sugar control and weight gain with the serum IgG levels for Aspergillosis. This case highlights the potential benefits of non-invasive monitoring of CPA activity and the identification of treatment responders through effective blood sugar management and weight gain.
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Affiliation(s)
- Tzu‐I Chuang
- Division of Chest Medicine, Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
| | - Pin‐Kuei Fu
- Division of Chest Medicine, Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
- Division of Clinical Trial, Department of Medical ResearchTaichung Veterans General HospitalTaichungTaiwan
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2
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Cherchi A, Vaz A, Coelho A, Fregonese L, Thirstrup S. Tuberculosis medicines for children in Europe: an unmet medical need. ERJ Open Res 2023; 9:00730-2022. [PMID: 37609597 PMCID: PMC10440650 DOI: 10.1183/23120541.00730-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/25/2023] [Indexed: 08/24/2023] Open
Abstract
The availability of first-line medicines for the treatment of drug-susceptible tuberculosis (TB) is inconsistent across European countries. This is particularly worrisome for child-friendly medicines. There are reported examples of physicians being forced to adapt and/or combine formulations intended for adults to treat children with TB. Reduced compliance, unknown effects on treatment outcomes and unpredictable toxicity are potential consequences of resorting to these suboptimal treatment options. Furthermore, the use of these alternatives may increase the risk of drug-resistant TB. This study analysed the availability and use of TB medicines in the European Union (EU)/European Economic Area, with a particular focus on child-friendly formulations. We sought to carry out a full review of the situation by means of a survey involving the EU regulatory network. Countries were asked to confirm marketing status of anti-drug-susceptible-TB medicines, ways used to overcome their absence in their territory and the general difficulties they face to treat children with TB. Results confirmed that rifampicin suspension is the only child-friendly formulation available in Europe, approved in just 10 member states. Overall, 24 countries out of 30 considered the lack of adequate drug-susceptible TB medicines an unmet medical need. To overcome this, countries confirmed that they resort to importation or use adapted formulations. The joint forces of European institutions and pharmaceutical industry are crucial for the development of paediatric formulations and contribute to better compliance and health outcomes.
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Affiliation(s)
| | - Alexandra Vaz
- European Medicines Agency, Amsterdam, The Netherlands
| | - Ana Coelho
- European Medicines Agency, Amsterdam, The Netherlands
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3
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Roberts MB, Lee J, Murphy MC, Kim AY, Coglianese EE, Hilburn C. Case 37-2022: A 55-Year-Old Man with Fatigue, Weight Loss, and Pulmonary Nodules. N Engl J Med 2022; 387:2172-2183. [PMID: 36477035 DOI: 10.1056/nejmcpc2211357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Matthew B Roberts
- From the Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia (M.B.R.); and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Jarone Lee
- From the Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia (M.B.R.); and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Mark C Murphy
- From the Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia (M.B.R.); and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Arthur Y Kim
- From the Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia (M.B.R.); and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Erin E Coglianese
- From the Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia (M.B.R.); and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Caroline Hilburn
- From the Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia (M.B.R.); and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Emergency Medicine and Surgery (J.L.), Radiology (M.C.M.), Medicine (A.Y.K., E.E.C.), and Pathology (C.H.), Harvard Medical School - both in Boston
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4
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Mishra S, Saito K. Clinically encountered growth phenotypes of tuberculosis-causing bacilli and their in vitro study: A review. Front Cell Infect Microbiol 2022; 12:1029111. [PMID: 36439231 PMCID: PMC9684195 DOI: 10.3389/fcimb.2022.1029111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/20/2022] [Indexed: 07/11/2024] Open
Abstract
The clinical manifestations of tuberculosis (TB) vary widely in severity, site of infection, and outcomes of treatment-leading to simultaneous efforts to individualize therapy safely and to search for shorter regimens that can be successfully used across the clinical spectrum. In these endeavors, clinicians and researchers alike employ mycobacterial culture in rich media. However, even within the same patient, individual bacilli among the population can exhibit substantial variability in their culturability. Bacilli in vitro also demonstrate substantial heterogeneity in replication rate and cultivation requirements, as well as susceptibility to killing by antimicrobials. Understanding parallels in clinical, ex vivo and in vitro growth phenotype diversity may be key to identifying those phenotypes responsible for treatment failure, relapse, and the reactivation of bacilli that progresses TB infection to disease. This review briefly summarizes the current role of mycobacterial culture in the care of patients with TB and the ex vivo evidence of variability in TB culturability. We then discuss current advances in in vitro models that study heterogenous subpopulations within a genetically identical bulk culture, with an emphasis on the effect of oxidative stress on bacillary cultivation requirements. The review highlights the complexity that heterogeneity in mycobacterial growth brings to the interpretation of culture in clinical settings and research. It also underscores the intricacies present in the interplay between growth phenotypes and antimicrobial susceptibility. Better understanding of population dynamics and growth requirements over time and space promises to aid both the attempts to individualize TB treatment and to find uniformly effective therapies.
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Affiliation(s)
- Saurabh Mishra
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY, United States
| | - Kohta Saito
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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5
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Lara-Júnior CR, Ahouagi AEDO, Pinto IVL, Braga DG, Andrade TR, Ramalho-de-Oliveira D, do Nascimento MMG. Implementation and Effectiveness of a Pharmacotherapeutic Follow-Up Service for People with Tuberculosis in Primary Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14552. [PMID: 36361432 PMCID: PMC9655657 DOI: 10.3390/ijerph192114552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Tuberculosis (TB) is a disease of great relevance, responsible for 1.5 million deaths worldwide. Therefore, actions to control TB are necessary, and pharmacists may play an important role, especially in primary healthcare (PHC), where the diagnosis and management of this infection occurs. In a large Brazilian city, pharmacotherapeutic follow-up in PHC has been offered by pharmacists to people with TB since 2018. The objective of this study was to evaluate the implementation and effectiveness of this service though a longitudinal type 1 effectiveness-implementation hybrid study. Data were collected from January 2018 to February 2020 in the pharmaceutical services system. The service indicators were described and effectiveness was evaluated using Poisson regression analysis to compare the incidence of cure among patients using and not using the service. The service was performed in 148 PHC units by 82 pharmacists. Of the total of 1076 treatments, 721 were followed up by pharmacists, and TB was cured more frequently in these cases (90.4% attended vs. 73.5% unattended). The adjusted hazard ratio of cure among patients enrolled in the pharmacotherapeutic follow-up service was 2.71 (2.04-3.61; p < 0.001). Pharmacotherapeutic follow-up for people with TB significantly increased the incidence of cure and should be encouraged.
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Affiliation(s)
- Célio Rezende Lara-Júnior
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | | | | | | | | | - Djenane Ramalho-de-Oliveira
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Mariana Martins Gonzaga do Nascimento
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
- Pharmaceutical Products Department, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
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6
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Sotgiu G, Rosales-Klintz S, Centis R, D'Ambrosio L, Verduin R, Correia AM, Cirule A, Duarte R, Gadzheva B, Gualano G, Kunst H, Palmieri F, Riekstina V, Stefanova D, Tiberi S, van der Werf MJ, Migliori GB. TB management in the European Union/European Economic Area: a multi-centre survey. Int J Tuberc Lung Dis 2021; 25:126-133. [PMID: 33656424 PMCID: PMC7849393 DOI: 10.5588/ijtld.20.0849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Essential TB care in the European Union/European Economic Area (EU/EEA) comprises 21 standards for the diagnosis, treatment and prevention of TB that constitute the European Union Standards for Tuberculosis Care (ESTC). METHODS: In 2017, we conducted an audit on TB management and infection control measures against the ESTC standards. TB reference centres in five EU/EEA countries were purposely selected to represent the heterogeneous European TB burden and examine geographic variability. RESULTS: Data from 122 patients, diagnosed between 2012 and 2015 with multidrug-resistant TB (n = 49), extensively drug-resistant TB (XDR-TB) (n = 11), pre-XDR-TB (n = 29) and drug-susceptible TB (n = 33), showed that TB diagnosis and treatment practices were in general in agreement with the ESTC. CONCLUSION: Overall, TB management and infection control practices were in agreement with the ESTC in the selected EU/EEA reference centres. Areas for improvement include strengthening of integrated care services and further implementation of patient-centred approaches.
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Affiliation(s)
- G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - S Rosales-Klintz
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Italy
| | - L D'Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - R Verduin
- Verduin Public Health Consult, Oegstgeest, the Netherlands
| | - A M Correia
- Regional Health Administration of the North, Department of Public Health, Porto, Portugal
| | - A Cirule
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - R Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Department of Pneumology; Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - B Gadzheva
- The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) Programme, Department of Management of Specialized Donor-Funded Programmes, Ministry of Health, Sofia, Bulgaria
| | - G Gualano
- Respiratory Infectious Diseases Unit, L Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - H Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - F Palmieri
- Respiratory Infectious Diseases Unit, L Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - V Riekstina
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - D Stefanova
- St Sofia University Hospital for Active Treatment of Respiratory Diseases, Sofia, Bulgaria
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK, Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M J van der Werf
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Italy
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7
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Cheong XK, Abdul Hamid MF. Intrapleural alteplase and DNase for complex tuberculous pleurisy: a medical approach. Respirol Case Rep 2021; 9:e00706. [PMID: 33425359 PMCID: PMC7780015 DOI: 10.1002/rcr2.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/20/2020] [Accepted: 12/06/2020] [Indexed: 12/05/2022] Open
Abstract
Tuberculous pleurisy is extra-pulmonary tuberculosis caused by Mycobacterium tuberculosis (MTB), which is one of the main cause of pleural effusions in developing countries. Intercostal chest catheter is useful for drainage of infected pleural fluid and facilitates sepsis control. However, management might be challenging in complex tuberculous pleural effusion as the septations within the effusion hinder pleural drainage. Intrapleural fibrinolysis therapy improved infected fluid drainage and septic parameter in parapneumonic effusions; however, there seems to be little data on its use in tuberculous pleurisy. In our case series of seven patients with complex tuberculous pleurisy, the use of intrapleural alteplase and deoxyribonuclease (DNase) facilitated fluid drainage which resulted in clinical and radiological improvement. These medications should not be confined to bacterial aetiology only as our case series highlights that in complex tuberculous pleurisy, intrapleural alteplase and DNase may be used as an adjunctive treatment which are proven to be successful and safe.
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Affiliation(s)
- Xiong Khee Cheong
- Respiratory UnitUniversity Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
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8
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Martín-García M, Esteban J. Evaluating bedaquiline as a treatment option for multidrug-resistant tuberculosis. Expert Opin Pharmacother 2021; 22:535-541. [PMID: 33393406 DOI: 10.1080/14656566.2020.1867538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Despite efforts to the contrary, tuberculosis remains one of the leading causes of death in the world. The appearance of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis has increased the need for new therapeutic options against these strains.Areas covered: This review covers the in vitro susceptibility, pharmacokinetics, and pharmacodynamics of bedaquiline, a new drug shown to be active against M. tuberculosis-resistant strains. The authors further review clinical data concerning its use against MDR and XDR strains, discussing recent clinical guidelines from different international societies.Expert opinion: Available data demonstrate the usefulness of bedaquiline against resistant M. tuberculosis. Despite the difficulty in analyzing multidrug therapies, the use of bedaquiline in MDR and XDR tuberculosis increases success rates, allowing shortened treatments and lower drug use than previously recommended regimens. Moreover, the fact that MDR and XDR strains are common in many places creates a need to include this drug in the currently available protocols. It is essential to overcome the substantial barriers that some countries encounter in obtaining bedaquiline, as doing so will make therapeutic regimens including this drug available for all patients.
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Affiliation(s)
- Marta Martín-García
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
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9
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Abstract
Intrathecal administration of anti-infectives is indicated in central nervous system infections by multiresistant pathogens when drugs that can reach adequate cerebrospinal fluid (CSF) concentrations by systemic therapy are not available. Antibiotics that readily pass the blood-brain and blood-CSF barriers and/or that have low toxicity allowing an increase in the daily dosage should not be used for intrathecal therapy. Intrathecal therapy is accompanied by systemic treatment. Antibacterials indispensable for intrathecal therapy include aminoglycosides, colistin, daptomycin, tigecycline, and vancomycin. Limited experience suggests the utility of the antifungals amphotericin B and caspofungin. Intraventricular administration ensures distribution throughout the CSF compartment, whereas intralumbar dosing often fails to attain adequate antibiotic concentrations in the ventricles. The individual dose is determined by the estimated size of the CSF space and by the estimated clearance from CSF. For moderately lipophilic anti-infectives with a molecular weight above approximately 1,000 g/mol, as well as for hydrophilic drugs with a molecular weight above approximately 400 g/mol, one daily dose is normally adequate. The ventricular drain should be clamped for 15 to 120 min to facilitate the distribution of the anti-infective in the CSF space. Therapeutic drug monitoring of the trough levels is necessary only in cases of therapeutic failure.
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10
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Sotgiu G, Goletti D, Matteelli A. Global tuberculosis prevention: should we start from the beginning? Eur Respir J 2019; 54:54/3/1901394. [PMID: 31515266 DOI: 10.1183/13993003.01394-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases, Rome, Italy
| | - Alberto Matteelli
- Institute of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV co-infection and TB elimination, University of Brescia, Brescia, Italy
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11
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Saini V, Ammerman NC, Chang YS, Tasneen R, Chaisson RE, Jain S, Nuermberger E, Grosset JH. Treatment-Shortening Effect of a Novel Regimen Combining Clofazimine and High-Dose Rifapentine in Pathologically Distinct Mouse Models of Tuberculosis. Antimicrob Agents Chemother 2019; 63:e00388-19. [PMID: 30936097 PMCID: PMC6535519 DOI: 10.1128/aac.00388-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/22/2019] [Indexed: 01/09/2023] Open
Abstract
Clofazimine and high-dose rifapentine have each separately been associated with treatment-shortening activity when incorporated into tuberculosis (TB) treatment regimens. We hypothesized that both modifications, i.e., the addition of clofazimine and the replacement of rifampin with high-dose rifapentine, in the first-line regimen for drug-susceptible TB would significantly shorten the duration of treatment necessary for cure. We tested this hypothesis in a well-established BALB/c mouse model of TB chemotherapy and also in a C3HeB/FeJ mouse model in which mice can develop caseous necrotic lesions, an environment where rifapentine and clofazimine may individually be less effective. In both mouse models, replacing rifampin with high-dose rifapentine and adding clofazimine in the first-line regimen resulted in greater bactericidal and sterilizing activity than either modification alone, suggesting that a rifapentine- and clofazimine-containing regimen may have the potential to significantly shorten the treatment duration for drug-susceptible TB. These data provide preclinical evidence supporting the evaluation of regimens combining high-dose rifapentine and clofazimine in clinical trials.
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Affiliation(s)
- Vikram Saini
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole C Ammerman
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yong Seok Chang
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rokeya Tasneen
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard E Chaisson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sanjay Jain
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric Nuermberger
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jacques H Grosset
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Zhang T, Jiang G, Wen S, Huo F, Wang F, Huang H, Pang Y. Para-aminosalicylic acid increases the susceptibility to isoniazid in clinical isolates of Mycobacterium tuberculosis. Infect Drug Resist 2019; 12:825-829. [PMID: 31114264 PMCID: PMC6497846 DOI: 10.2147/idr.s200697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The purpose of this work was to assess the activity of para-aminosalicylic acid (PAS) in combination with isoniazid (INH) against clinical isolates of Mycobacterium tuberculosis (MTB). Materials and methods: A total of 72 MTB isolates with differential in vitro drug susceptibilities were included in this study, comprising 24 pan-susceptible, 24 MDR-TB, and 24 extensively drug-resistant (XDR) isolates. A microplate alamarBlue assay was performed to identify the minimal inhibitory concentrations (MICs) of MTB isolates. Results: The MIC50 of INH was 4 mg/L, and that of PAS was 0.063 mg/L against MTB isolates when single drug used. The combined use of INH and PAS resulted in 16-fold and 8-fold decrease in MIC50 for INH and PAS, respectively. The INH-PAS revealed synergistic activity in 94.4% of the isolates. In addition, there was no significant difference in the FIC index of the INH-PAS combination among individual isolates harboring different susceptibility pattern (P>0.05). Conclusion: The synergy between INH and PAS is demonstrated using non-multidrug-resistant (non-MDR) and MDR-TB strains, which will provide clinicians with useful hints to reuse this combination for treatment of TB patients in clinical practice.
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Affiliation(s)
- Tingting Zhang
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China.,Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China
| | - Guanglu Jiang
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China.,Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China
| | - Shu'an Wen
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China.,Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China
| | - Fengmin Huo
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China.,Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China
| | - Fen Wang
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China.,Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China.,Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China.,Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China
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13
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Abstract
PURPOSE OF REVIEW To summarize data regarding categories, detection methods, prevalence and patterns of drug resistance among patients with tuberculous pleural effusion (TPE) and to comment on the management of suspected drug-resistant TPE. RECENT FINDINGS Pleural and pulmonary tuberculosis (TB) present similar patterns of drug resistance. Approximately 10% and 6-10% of pleural Mycobacterium tuberculosis isolates are resistant to at least one first-line anti-TB drug or at least isoniazid, respectively. The prevalence of multidrug-resistant-pleural and extensively drug-resistant-pleural TB is 1-3% and 0-1%, respectively. SUMMARY Although guidelines suggest the empirical standard anti-TB regimen (i.e. 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol followed by 4 months of isoniazid and rifampicin) for TPE treatment, the data regarding drug resistance among TPE patients are limited. The few studies examining the issue report a notable drug resistance. In suspected drug-resistant TPE, every effort is warranted to isolate M. tuberculosis to perform drug susceptibility testing and provide guided therapy. For this purpose, the use of cultures or molecular methods with pleural biopsies is superior to their use in pleural fluid. If still M. tuberculosis cannot be detected, prolonged administration of ethambutol with isoniazid and rifampicin during the continuation phase of treatment might be considered.
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Affiliation(s)
- Vasileios S Skouras
- Department of Pulmonary Medicine, 401 General Army Hospital.,1st Department of Pulmonary Medicine, Hygeia Hospital
| | - Ioannis Kalomenidis
- 1st Department of Critical Care & Pulmonary Medicine, Medical School of Athens University, 'Evangelismos' General Hospital, Athens, Greece
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14
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Rabahi MF, Silva Júnior JLRD, Ferreira ACG, Tannus-Silva DGS, Conde MB. Tuberculosis treatment. ACTA ACUST UNITED AC 2019; 43:472-486. [PMID: 29340497 PMCID: PMC5792048 DOI: 10.1590/s1806-37562016000000388] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/04/2017] [Indexed: 01/22/2023]
Abstract
Tuberculosis treatment remains a challenge due to the need to consider, when approaching it, the context of individual and collective health. In addition, social and economic issues have been shown to be variables that need to be considered when it comes to treatment effectiveness. We conducted a critical review of the national and international literature on the treatment of tuberculosis in recent years with the aims of presenting health care workers with recommendations based on the situation in Brazil and better informing decision-making regarding tuberculosis patients so as to minimize morbidity and interrupt disease transmission.
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Affiliation(s)
- Marcelo Fouad Rabahi
- . Faculdade de Medicina, Universidade Federal de Goiás, Goiânia (GO) Brasil.,. Centro Universitário de Anápolis, Anápolis (GO) Brasil
| | | | - Anna Carolina Galvão Ferreira
- . Faculdade de Medicina, Universidade Federal de Goiás, Goiânia (GO) Brasil.,. Pontifícia Universidade Católica de Goiás, Goiânia (GO) Brasil
| | | | - Marcus Barreto Conde
- . Faculdade de Medicina de Petrópolis, Petrópolis (RJ) Brasil.,. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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15
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Ferreira MD, Neves CPD, Souza ABD, Beraldi-Magalhães F, Migliori GB, Kritski AL, Cordeiro-Santos M. Predictors of mortality among intensive care unit patients coinfected with tuberculosis and HIV. ACTA ACUST UNITED AC 2019; 44:118-124. [PMID: 29791547 PMCID: PMC6044649 DOI: 10.1590/s1806-37562017000000316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/14/2018] [Indexed: 01/09/2023]
Abstract
Objective: To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region. Methods: This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model. Results: During the study period, 120 patients with TB/HIV coinfection were admitted to the ICU. The mean age was 37.0 ± 11.7 years. Of the 120 patients evaluated, 94 (78.3%) died and 62 (66.0%) of those deaths having occurred within the first week after admission. Data on invasive mechanical ventilation (IMV) and ARDS were available for 86 and 67 patients, respectively Of those 86, 75 (87.2%) underwent IMV, and, of those 67, 48 (71.6%) presented with ARDS. The factors found to be independently associated with mortality were IMV (p = 0.002), hypoalbuminemia (p = 0.013), and CD4 count < 200 cells/mm3 (p = 0.002). Conclusions: A high early mortality rate was observed among TB/HIV coinfected ICU patients. The factors predictive of mortality in this population were IMV, hypoalbuminemia, and severe immunosuppression.
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Affiliation(s)
| | | | | | | | - Giovanni Battista Migliori
- Collaborating Centre for Tuberculosis and Lung Diseases, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Itália
| | - Afrânio Lineu Kritski
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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16
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Magis-Escurra C, Carvalho ACC, Kritski AL, Girardi E. Tuberculosis and comorbidities. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10022017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Pettit AC, Shepherd BE, Sterling TR. Treatment of drug-susceptible tuberculosis among people living with human immunodeficiency virus infection: an update. Curr Opin HIV AIDS 2018; 13:469-477. [PMID: 30222609 PMCID: PMC6389504 DOI: 10.1097/coh.0000000000000506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The present review describes recent advances in the treatment of drug-susceptible tuberculosis (DS-TB) among people living with human immunodeficiency virus (PLWH). RECENT FINDINGS Higher than standard rifampicin doses (>10 mg/kg/day) are well tolerated and have improved sterilizing activity. Standard pyrazinamide doses may result in low drug exposures; modeling reveals that higher doses (>25 mg/kg/day) may be required to reach target levels, although safety is unknown. Four-month fluoroquinolone-containing regimens are not recommended in the 2017 World Health Organization DS-TB treatment guidelines. These guidelines also recommend fixed-dose combination (FDC) therapy over single drug formulations based on patient preference, though FDC is not associated with improved outcomes. Treatment for 6 months is recommended, with an emphasis on expanded antiretroviral therapy (ART) coverage and monitoring for relapse among those not started on ART within 8 weeks of tuberculosis treatment. Directly observed therapy (DOT) is recommended over self-administered therapy, as is daily therapy over intermittent therapy - both are associated with better tuberculosis outcomes. SUMMARY Current WHO tuberculosis treatment guidelines recommend 6 months of daily tuberculosis treatment for PLWH who have DS-TB, and timely ART initiation. Higher rifampin and pyrazinamide doses may enhance treatment effectiveness, but safety data are needed. DOT and FDC therapy are recommended.
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Affiliation(s)
- April C. Pettit
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Tuberculosis Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bryan E. Shepherd
- Vanderbilt Tuberculosis Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy R. Sterling
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Tuberculosis Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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18
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Impact of Clofazimine Dosing on Treatment Shortening of the First-Line Regimen in a Mouse Model of Tuberculosis. Antimicrob Agents Chemother 2018; 62:AAC.00636-18. [PMID: 29735562 DOI: 10.1128/aac.00636-18] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/30/2018] [Indexed: 01/17/2023] Open
Abstract
The antileprosy drug clofazimine was recently repurposed as part of a newly endorsed short-course regimen for multidrug-resistant tuberculosis. It also enables significant treatment shortening when added to the first-line regimen for drug-susceptible tuberculosis in a mouse model. However, clofazimine causes dose- and duration-dependent skin discoloration in patients, and the optimal clofazimine dosing strategy in the context of the first-line regimen is unknown. We utilized a well-established mouse model to systematically address the impacts of duration, dose, and companion drugs on the treatment-shortening activity of clofazimine in the first-line regimen. In all studies, the primary outcome was relapse-free cure (culture-negative lungs) 6 months after stopping treatment, and the secondary outcome was bactericidal activity, i.e., the decline in the lung bacterial burden during treatment. Our findings indicate that clofazimine activity is most potent when coadministered with first-line drugs continuously throughout treatment and that equivalent treatment-shortening results are obtained with half the dose commonly used in mice. However, our studies also suggest that clofazimine at low exposures may have negative impacts on treatment outcomes, an effect that was evident only after the first 3 months of treatment. These data provide a sound evidence base to inform clofazimine dosing strategies to optimize the antituberculosis effect while minimizing skin discoloration. The results also underscore the importance of conducting long-term studies to allow the full evaluation of drugs administered in combination over long durations.
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19
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Migliori GB, Sotgiu G, Rosales-Klintz S, Centis R, D'Ambrosio L, Abubakar I, Bothamley G, Caminero JA, Cirillo DM, Dara M, de Vries G, Aliberti S, Dinh-Xuan AT, Duarte R, Midulla F, Solovic I, Subotic DR, Amicosante M, Correia AM, Cirule A, Gualano G, Kunst H, Palmieri F, Riekstina V, Tiberi S, Verduin R, van der Werf MJ. ERS/ECDC Statement: European Union standards for tuberculosis care, 2017 update. Eur Respir J 2018; 51:13993003.02678-2017. [PMID: 29678945 DOI: 10.1183/13993003.02678-2017] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/11/2018] [Indexed: 12/31/2022]
Abstract
The International Standards for Tuberculosis Care define the essential level of care for managing patients who have or are presumed to have tuberculosis, or are at increased risk of developing the disease. The resources and capacity in the European Union (EU) and the European Economic Area permit higher standards of care to secure quality and timely TB diagnosis, prevention and treatment. On this basis, the European Union Standards for Tuberculosis Care (ESTC) were published in 2012 as standards specifically tailored to the EU setting. Since the publication of the ESTC, new scientific evidence has become available and, therefore, the standards were reviewed and updated.A panel of international experts, led by a writing group from the European Respiratory Society (ERS) and the European Centre for Disease Prevention and Control (ECDC), updated the ESTC on the basis of new published evidence. The underlying principles of these patient-centred standards remain unchanged. The second edition of the ESTC includes 21 standards in the areas of diagnosis, treatment, HIV and comorbidities, and public health and prevention.The ESTC target clinicians and public health workers, provide an easy-to-use resource and act as a guide through all the required activities to ensure optimal diagnosis, treatment and prevention of TB.
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Affiliation(s)
- Giovanni Battista Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy.,Contributed equally
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Sassari, Italy.,Contributed equally
| | - Senia Rosales-Klintz
- European Centre for Disease Prevention and Control, Stockholm, Sweden.,Contributed equally
| | - Rosella Centis
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy.,Contributed equally
| | - Lia D'Ambrosio
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy.,Public Health Consulting Group, Lugano, Switzerland.,Contributed equally
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | | | - Jose Antonio Caminero
- Pneumology Dept, Hospital General de Gran Canaria "Dr. Negrin", Las Palmas de Gran Canaria, Spain.,MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, Div. of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Masoud Dara
- World Health Organization, Regional Office for Europe, UN City, Copenhagen, Denmark
| | | | - Stefano Aliberti
- School of Medicine and Surgery, University of Milan-Bicocca, UO Clinica Pneumologica, AO San Gerardo, Monza, Italy
| | - Anh Tuan Dinh-Xuan
- Dept of Respiratory Physiology, Cochin Hospital, Paris Descartes University, Paris, France
| | - Raquel Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Dept of Pneumology; Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fabio Midulla
- Dept of Paediatrics, Paediatric Emergency Unit, "Sapienza" University of Rome, Rome, Italy
| | - Ivan Solovic
- National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Ruzomberok, Slovakia
| | | | - Massimo Amicosante
- Dept of Biomedicine and Prevention and Animal Technology Station, University of Rome "Tor Vergata", Rome, Italy
| | - Ana Maria Correia
- Regional Health Administration of the North, Dept of Public Health, Porto, Portugal
| | - Andra Cirule
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London UK
| | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Vija Riekstina
- Dept of Methodology and Supervision, Riga East University Hospital, Riga, Latvia
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London UK.,Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Remi Verduin
- Verduin Public Health Consult, Oegstgeest, The Netherlands
| | - Marieke J van der Werf
- European Centre for Disease Prevention and Control, Stockholm, Sweden.,Contributed equally
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20
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Caminero JA, Piubello A, Scardigli A, Migliori G. Proposal for a standardised treatment regimen to manage pre- and extensively drug-resistant tuberculosis cases. Eur Respir J 2017; 50:50/1/1700648. [DOI: 10.1183/13993003.00648-2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/05/2022]
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21
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Solovic I, Abubakar I, Sotgiu G, Dara M, Goletti D, Duarte R, Aliberti S, de Benedictis FM, Ward B, Teixeira V, Gratziou C, Migliori GB. Standard operating procedures for tuberculosis care. Eur Respir J 2017; 49:49/6/1700515. [DOI: 10.1183/13993003.00515-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/16/2017] [Indexed: 11/05/2022]
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22
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Peloquin CA, Dorman SE, Vernon A, Battista Migliori G, Nahid P. Reply to Alffenaar et al. Clin Infect Dis 2016; 64:105-106. [DOI: 10.1093/cid/ciw679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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