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Romero-Tamarit A, Vallès X, Munar-García M, Espinosa-Pereiro J, Saborit N, Tortola MT, Stojanovic Z, Roure S, Antuori A, Cardona PJ, Soriano-Arandes A, Martin-Nalda A, Espiau M, de Souza-Galvão ML, Jiménez MÁ, Noguera-Julian A, Molina I, Casas X, Domínguez-Álvarez M, Jové N, Gogichadze N, L Fonseca K, Arias L, Millet JP, Sánchez-Montalvá A, Vilaplana C. A longitudinal prospective study of active tuberculosis in a Western Europe setting: insights and findings. Infection 2024; 52:611-623. [PMID: 38349459 PMCID: PMC10954962 DOI: 10.1007/s15010-024-02184-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/12/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE This study investigates the potential of inflammatory parameters (IP), symptoms, and patient-related outcome measurements as biomarkers of severity and their ability to predict tuberculosis (TB) evolution. METHODS People with TB were included prospectively in the Stage-TB study conducted at five clinical sites in Barcelona (Spain) between April 2018 and December 2021. Data on demographics, epidemiology, clinical features, microbiology, and Sanit George Respiratory Questionnaire (SGRQ) and Kessler-10 as Health-Related Quality of Life (HRQoL) were collected at three time points during treatment. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil/lymphocyte, and monocyte/lymphocyte ratios (NLR and MLR), complement factors C3, C4, and cH50, clinical and microbiological data, and HRQoL questionnaires were assessed at baseline, 2 months, and 6 months. Their ability to predict sputum culture conversion (SCC) and symptom presence after 2 months of treatment was also analysed. RESULTS The study included 81 adults and 13 children with TB. The CRP, ESR, NLR, and MLR values, as well as the presence of symptoms, decreased significantly over time in both groups. Higher IP levels at baseline were associated with greater bacillary load and persistent symptoms. Clinical severity at baseline predicted a delayed SCC. Kessler-10 improved during follow-up, but self-reported lung impairment (SGRQ) persisted in all individuals after 6 months. CONCLUSIONS IP levels may indicate disease severity, and sustained high levels are linked to lower treatment efficacy. Baseline clinical severity is the best predictor of SCC. Implementing health strategies to evaluate lung function and mental health throughout the disease process may be crucial for individuals with TB.
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Affiliation(s)
- Arantxa Romero-Tamarit
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, Ctra. del Canyet, S/N, 08916, Badalona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Xavier Vallès
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, Ctra. del Canyet, S/N, 08916, Badalona, Spain
- North Metropolitan International Health Program (PROSICS), Badalona, Spain
- Territorial Clinical Directorate on Infectious Diseases and International Health Clinical Division within the Northern Metropolitan Management of the Catalan Institute of Health, Badalona, Spain
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
| | - María Munar-García
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, Ctra. del Canyet, S/N, 08916, Badalona, Spain
- Pompeu Fabra University, Barcelona, Spain
| | - Juan Espinosa-Pereiro
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
- International Health Program of the Catalan Institute of Health (PROSICS), Barcelona, Spain
- CIBER of Infectious Disease (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Núria Saborit
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Ma Teresa Tortola
- CIBER of Infectious Disease (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Department, Hospital Vall d'Hebron, Barcelona, Spain
- Mycobacterial Infection Study Group from the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIM-SEIMC), Barcelona, Spain
| | - Zoran Stojanovic
- Pneumology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- CIBER Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Sílvia Roure
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, Ctra. del Canyet, S/N, 08916, Badalona, Spain
- North Metropolitan International Health Program (PROSICS), Badalona, Spain
- Territorial Clinical Directorate on Infectious Diseases and International Health Clinical Division within the Northern Metropolitan Management of the Catalan Institute of Health, Badalona, Spain
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Infectious Diseases Department, Germans Trias i Pujol Hospital and Research Institute, 08916, Badalona, Spain
| | - Adrián Antuori
- CIBER Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Pere-Joan Cardona
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, Ctra. del Canyet, S/N, 08916, Badalona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
- CIBER Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Andrea Martin-Nalda
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - María Espiau
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Maria Luiza de Souza-Galvão
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Ma Ángeles Jiménez
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Servei de Malalties Infeccioses i Patologia Importada, Institut de Recerca Pediàtrica Sant Joan de Déu, 08950, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036, Barcelona, Spain
- Red de Investigación Traslacional en Infectología Pediátrica RITIP, 28029, Madrid, Spain
| | | | | | | | | | - Nino Gogichadze
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, Ctra. del Canyet, S/N, 08916, Badalona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Kaori L Fonseca
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, Ctra. del Canyet, S/N, 08916, Badalona, Spain
- CIBER Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Lilibeth Arias
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, Ctra. del Canyet, S/N, 08916, Badalona, Spain
- CIBER Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Joan-Pau Millet
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Serveis Clínics de Barcelona, Barcelona, Spain
- Epidemiology Service, Barcelona Public Health Agency, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
- International Health Program of the Catalan Institute of Health (PROSICS), Barcelona, Spain
- CIBER of Infectious Disease (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Mycobacterial Infection Study Group from the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIM-SEIMC), Barcelona, Spain
| | - Cristina Vilaplana
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, Ctra. del Canyet, S/N, 08916, Badalona, Spain.
- Autonomous University of Barcelona, Bellaterra, Spain.
- Territorial Clinical Directorate on Infectious Diseases and International Health Clinical Division within the Northern Metropolitan Management of the Catalan Institute of Health, Badalona, Spain.
- CIBER Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28029, Madrid, Spain.
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Hospital Universitari Germans Trias I Pujol, Badalona, Spain.
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Carreto-Binaghi LE, Sartillo-Mendoza LG, Muñoz-Torrico M, Guzmán-Beltrán S, Carranza C, Torres M, González Y, Juárez E. Serum pro-inflammatory biomarkers associated with improvement in quality of life in pulmonary tuberculosis. Front Immunol 2023; 14:1241121. [PMID: 37753080 PMCID: PMC10518397 DOI: 10.3389/fimmu.2023.1241121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Pulmonary dysfunction is an underestimated complication in tuberculosis (TB) infection, affecting quality of life (QoL). Although respiratory function tests objectively reflect lung disturbances in a specific moment, predictors of illness severity at the time of diagnosis are still lacking. Methods We measured serum pro-inflammatory cytokines (TNF-α and IL-8), eicosanoids (PGE2, LTB4, RvD1, Mar1, and LXA4), a marker of tissue damage (cell-free nucleosomes), and indicators of redox status (malonaldehyde, 8-isoprostane, total oxidants, and antioxidants), as well as a score of radiological abnormalities (SRA) and a QoL questionnaire, in 25 patients with pulmonary TB at the time of diagnosis (t0) and two months after the initiation of treatment (t2). Results We found higher antioxidant levels in the patients with the worst QoL at t0, and all the indicators of the prooxidant state were significantly reduced at t2, while the total antioxidant levels increased. LTB4, a pro-inflammatory eicosanoid, was diminished at t2, while all the pro-resolutory lipids decreased substantially. Significant correlations between the SRA and the QoL scores were observed, the latter showing a substantial reduction at t2, ranking it as a reliable tool for monitoring disease evolution during TB treatment. Discussion These results suggest that evaluating a combination of these markers might be a valuable predictor of QoL improvement and a treatment response indicator; in particular, the oxidation metabolites and eicosanoid ratios could also be proposed as a future target for adjuvant therapies to reduce inflammation-associated lung injury in TB disease.
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Affiliation(s)
- Laura E. Carreto-Binaghi
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Luis Gustavo Sartillo-Mendoza
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla (BUAP), Puebla, Mexico
- Becario de la Dirección General de Calidad y Educación en Salud, Secretaría de Salud, Mexico, Mexico
| | - Marcela Muñoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Silvia Guzmán-Beltrán
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Claudia Carranza
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Martha Torres
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Yolanda González
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Esmeralda Juárez
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
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Yuan YF, Ren ZX, Zhang C, Li GJ, Liu BZ, Li XD, Miao J, Li JF. Multitrack and multianchor point screw technique combined with the Wiltse approach for lesion debridement for lumbar tuberculosis. World J Clin Cases 2023; 11:3167-3175. [PMID: 37274032 PMCID: PMC10237128 DOI: 10.12998/wjcc.v11.i14.3167] [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: 01/17/2023] [Revised: 04/01/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND The incidence of lumbar tuberculosis is high worldwide, and effective treatment is a continuing problem.
AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.
METHODS The C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, oswestry disability index (ODI) and American Spinal Injury Association (ASIA) grade were recorded and analysed pre- and postoperatively.
RESULTS The CRP level and ESR returned to normal, and the VAS score and ODI were decreased at 3 mo postoperatively, with significant differences compared with the preoperative values (P < 0.01). Neurological dysfunction was relieved, and the ASIA grade increased, with no adverse events.
CONCLUSION The multitrack, multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.
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Affiliation(s)
- Yu-Fei Yuan
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Zhi-Xin Ren
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Cun Zhang
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Guan-Jun Li
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Bing-Zhi Liu
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Xiao-Dong Li
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Jie Miao
- Department of Orthopedic Surgery, Handan Central Hospital, Handan 056001, Hebei Province, China
| | - Jian-Fei Li
- Department of CT, Handan Central Hospital, Handan 056001, Hebei Province, China
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Shu-Yip S, Wong M, Iverson KR, Roa L, Lecca L, Sotomayor A, Mody GN. Referral Process for Surgical Management of Tuberculosis in Lima: A Qualitative Study. J Surg Res 2021; 267:384-390. [PMID: 34225051 DOI: 10.1016/j.jss.2021.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/03/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lung resection surgery can be a complementary therapy for managing tuberculosis (TB) complications, but access is lacking in high-burden areas. The referral process for surgical evaluation is not well described. This study aimed to elucidate the TB surgery referral process in Peru. METHODS A qualitative study was conducted using focus groups and interviews of health care providers from the Peruvian National TB Program. A semi-structured interview guide was developed with local partners. Focus groups and individual interviews were recorded and transcribed. Thematic analysis was used to reconstruct the referral process and identify barriers as well as areas for improvement. RESULTS A total of 12 sessions were recorded (7 interviews and 5 focus groups; 36 participants total). The main themes identified were: (1) Surgical referral workflow, (2) Unstandardized selection criteria for surgery, (3) Limited inter-institutional communication, and (4) Material barriers to surgical management. CONCLUSION Health care providers involved in the referral process of surgical management of tuberculosis in Lima reported a hierarchical referral workflow. Interinstitutional communication may be a critical interventional point to improve a patient's quality of care during the referral process.
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Affiliation(s)
- Sebastian Shu-Yip
- School of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru.; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.
| | | | - Katherine R Iverson
- University of California Davis, Medical Center, Department of Surgery, Sacramento, California
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta. Canada
| | - Leonid Lecca
- Socios En Salud, Lima, Peru. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Gita N Mody
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
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