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Oo HS, Borry P. Contact investigation in multidrug-resistant tuberculosis: ethical challenges. Monash Bioeth Rev 2024; 42:16-27. [PMID: 38430345 DOI: 10.1007/s40592-024-00188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/03/2024]
Abstract
Contact investigation is an evidence-based intervention of multidrug-resistant tuberculosis (MDR-TB) to protect public health by interrupting the chain of transmission. In pursuit of contact investigation, patients' MDR-TB status has to be disclosed to third parties (to the minimum necessary) for tracing the contacts. Nevertheless, disclosure to third parties often unintentionally leads the MDR-TB patients suffered from social discrimination and stigma. For this reason, patients are less inclined to reveal their MDR-TB status and becomes a significant issue in contact investigation. This issue certainly turns into a negative impact on the public interest. Tension between keeping MDR-TB status confidential and safeguarding public health arises in relation to this issue. Regarding MDR-TB management, patient compliance with treatment and contact investigation are equally important. Patients might fail to comply with anti-TB therapy and be reluctant to seek healthcare due to disclosure concerns. In order to have treatment adherence, MDRTB patients should not live through social discrimination and stigma arising from disclosure and TB team has a duty to support them as a mean of reciprocity. However, implementation of contact investigation as a public health policy can still be challenging even with promising reciprocal support to the patients because MDR-TB patients are living in different contexts and situations. There can be no straight forward settlement but an appropriate justification for each distinct context is needed to strike a balance between individual confidentiality and public interest.
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Affiliation(s)
- Hnin Si Oo
- Master of Bioethics, KU Leuven, Leuven, Belgium.
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Alemu A, Bitew ZW, Diriba G, Gumi B. Risk factors associated with drug-resistant tuberculosis in Ethiopia: A systematic review and meta-analysis. Transbound Emerg Dis 2022; 69:2559-2572. [PMID: 34741434 DOI: 10.1111/tbed.14378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/15/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
The emergence of drug-resistant tuberculosis (DR-TB) is becoming a challenge to the national TB control programmes including Ethiopia. Different risk factors are associated with DR-TB. Identifying these risk factors in a local setting is important to strengthen the effort to prevent and control DR-TB. Thus, this study aimed to assess the risk factors associated with DR-TB in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist was followed to conduct this study. We systematically searched the articles from electronic databases and grey literature sources. We used the JBI tools to assess the quality of studies. Data were analysed using STATA version 15. We estimated the pooled odds ratio (OR) along with 95% Confidence Interval (CI). The forest plot and I2 heterogeneity test were used to assess heterogeneity among studies. We explored the presence of publication bias through visual inspection of the funnel plot and Egger's regression test. After screening 2238 articles, 27 studies were included in the final analysis. Based on the pooled analysis of the OR, unemployment (OR; 2.71, 95% CI; 1.64, 3.78), previous TB history (OR; 4.83, 95% CI; 3.02, 6.64), contact with known TB patient (OR; 1.72, 95% CI; 1.05, 2.40), contact with the known multi-drug resistant (MDR) TB patient (OR; 2.54, 95% CI; 1.46, 3.63) and having pulmonary TB (PTB; OR; 1.80, 95% CI; 1.14, 2.45) were found to be the risk factors of DR-TB, while elders (OR; 0.77, 95%CI; 0.60, 0.95) including above 45 years (OR; 0.76, 95%CI; 0.55, 0.97) and males (OR; 0.86, 95%CI; 0.76, 0.97) had lower DR-TB risk, compared to their counterparts. A previous history of TB treatment is a major risk factor for acquiring DR-TB in Ethiopia that might be due to poor adherence during the first-line anti-TB treatment. Besides, having contact with a TB patient, contact with an MDR-TB patient, having PTB and being unemployed were the risk factors of DR-TB in Ethiopia. Thus, active screening of TB contacts for DR-TB might help to detect DR-TB cases as early as possible and could help to mitigate its further transmission across the community.
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Affiliation(s)
- Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zebenay Workneh Bitew
- Department of Pediatric Nursing, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Balako Gumi
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Efficacy of integrating short-course chemotherapy with Chinese herbs to treat multi-drug resistant pulmonary tuberculosis in China: a study protocol. Infect Dis Poverty 2021; 10:131. [PMID: 34742353 PMCID: PMC8572065 DOI: 10.1186/s40249-021-00913-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
Background Tuberculosis (TB) caused Mycobacterium tuberculosis (M.tb) is one of infectious disease that lead a large number of morbidity and mortality all over the world. Although no reliable evidence has been found, it is considered that combining chemotherapeutic drugs with Chinese herbs can significantly improves the cure rate and the clinical therapeutic effect. Methods Multi-drug resistant pulmonary tuberculosis (MDR-PTB, n = 258) patients with Qi-yin deficiency syndrome will be randomly assigned into a treatment group (n = 172) or control/placebo group (n = 86). The treatment group will receive the chemotherapeutic drugs combined with Chinese herbs granules (1 + 3 granules), while the control group will receive the chemotherapeutic drugs combined with Chinese herbs placebo (1 + 3 placebo granules). In addition, MDR-PTB (n = 312) patients with Yin deficiency lung heat syndrome will be randomly assigned to a treatment (n = 208) or control/placebo (n = 104) group. The treatment group will receive the chemotherapeutic regimen combined with Chinese herbs granules (2 + 4 granules), while the control group will receive the chemotherapeutic drugs and Chinese herbs placebo (2 + 4 placebo granules). The primary outcome is cure rate, the secondary outcomes included time to sputum culture conversion, lesion absorption rate and cavity closure rate. BACTEC™ MGIT™ automated mycobacterial detection system will be used to evaluate the M.tb infection and drug resistance. Chi-square test and Cox regression will be conducted with SAS 9.4 Statistical software to analyze the data. Discussion The treatment cycle for MDR-PTB using standardized modern medicine could cause lengthy substantial side effects. Chinese herbs have been used for many years to treat MDR-PTB, but are without high-quality evidence. Hence, it is unknown whether Chinese herbs enhances the clinical therapeutic effect of synthetic drugs for treating MDR-PTB. Therefore, this study will be conducted to evaluate the clinical therapeutic effect of combining Chinese herbs and chemotherapeutic drugs to treat MDR-PTB cases. It will assist in screening new therapeutic drugs and establishing treatment plan that aims to improve the clinical therapeutic effect for MDR-PTB patients. Trial registration This trial was registered at ClinicalTrials.gov (ChiCTR1900027720) on 24 November 2019 (prospective registered). Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00913-5.
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Baluku JB, Mukasa D, Bongomin F, Stadelmann A, Nuwagira E, Haller S, Ntabadde K, Turyahabwe S. Gender differences among patients with drug resistant tuberculosis and HIV co-infection in Uganda: a countrywide retrospective cohort study. BMC Infect Dis 2021; 21:1093. [PMID: 34689736 PMCID: PMC8542192 DOI: 10.1186/s12879-021-06801-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/18/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Gender differences among patients with drug resistant tuberculosis (DRTB) and HIV co-infection could affect treatment outcomes. We compared characteristics and treatment outcomes of DRTB/HIV co-infected men and women in Uganda. METHODS We conducted a retrospective chart review of patients with DRTB from 16 treatment sites in Uganda. Eligible patients were aged ≥ 18 years, had confirmed DRTB, HIV co-infection and a treatment outcome registered between 2013 and 2019. We compared socio-demographic and clinical characteristics and tuberculosis treatment outcomes between men and women. Potential predictors of mortality were determined by cox proportional hazard regression analysis that controlled for gender. Statistical significance was set at p < 0.05. RESULTS Of 666 DRTB/HIV co-infected patients, 401 (60.2%) were men. The median (IQR) age of men and women was 37.0 (13.0) and 34.0 (13.0) years respectively (p < 0.001). Men were significantly more likely to be on tenofovir-based antiretroviral therapy (ART), high-dose isoniazid-containing DRTB regimen and to have history of cigarette or alcohol use. They were also more likely to have multi-drug resistant TB, isoniazid and streptomycin resistance and had higher creatinine, aspartate and gamma-glutamyl aminotransferase and total bilirubin levels. Conversely, women were more likely to be unemployed, unmarried, receive treatment from the national referral hospital and to have anemia, a capreomycin-containing DRTB regimen and zidovudine-based ART. Treatment success was observed among 437 (65.6%) and did not differ between the genders. However, mortality was higher among men than women (25.7% vs. 18.5%, p = 0.030) and men had a shorter mean (standard error) survival time (16.8 (0.42) vs. 19.0 (0.46) months), Log Rank test (p = 0.046). Predictors of mortality, after adjusting for gender, were cigarette smoking (aHR = 4.87, 95% CI 1.28-18.58, p = 0.020), an increase in alanine aminotransferase levels (aHR = 1.05, 95% CI 1.02-1.07, p < 0.001), and history of ART default (aHR = 3.86, 95% CI 1.31-11.37, p = 0.014) while a higher baseline CD4 count was associated with lower mortality (aHR = 0.94, 95% CI 0.89-0.99, p = 0.013 for every 10 cells/mm3 increment). CONCLUSION Mortality was higher among men than women with DRTB/HIV co-infection which could be explained by several sociodemographic and clinical differences.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Lung Institute, PO Box 26343, Kampala, Uganda
| | - David Mukasa
- grid.31501.360000 0004 0470 5905Complex Diseases and Genome Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Felix Bongomin
- grid.442626.00000 0001 0750 0866Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Anna Stadelmann
- grid.17635.360000000419368657Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN USA
| | - Edwin Nuwagira
- grid.33440.300000 0001 0232 6272Infectious Diseases Unit, Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sabine Haller
- grid.7400.30000 0004 1937 0650Department of Public and Global Health, Epidemiology, Biostatistics, & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kauthrah Ntabadde
- grid.415861.f0000 0004 1790 6116MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Stavia Turyahabwe
- grid.415705.2National Tuberculosis and Leprosy Control Program, Ministry of Health, Kampala, Uganda
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Nonghanphithak D, Chaiprasert A, Smithtikarn S, Kamolwat P, Pungrassami P, Chongsuvivatwong V, Mahasirimongkol S, Reechaipichitkul W, Leepiyasakulchai C, Phelan JE, Blair D, Clark TG, Faksri K. Clusters of Drug-Resistant Mycobacterium tuberculosis Detected by Whole-Genome Sequence Analysis of Nationwide Sample, Thailand, 2014-2017. Emerg Infect Dis 2021; 27:813-822. [PMID: 33622486 PMCID: PMC7920678 DOI: 10.3201/eid2703.204364] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Multidrug-resistant tuberculosis (MDR TB), pre-extensively drug-resistant tuberculosis (pre-XDR TB), and extensively drug-resistant tuberculosis (XDR TB) complicate disease control. We analyzed whole-genome sequence data for 579 phenotypically drug-resistant M. tuberculosis isolates (28% of available MDR/pre-XDR and all culturable XDR TB isolates collected in Thailand during 2014–2017). Most isolates were from lineage 2 (n = 482; 83.2%). Cluster analysis revealed that 281/579 isolates (48.5%) formed 89 clusters, including 205 MDR TB, 46 pre-XDR TB, 19 XDR TB, and 11 poly–drug-resistant TB isolates based on genotypic drug resistance. Members of most clusters had the same subset of drug resistance-associated mutations, supporting potential primary resistance in MDR TB (n = 176/205; 85.9%), pre-XDR TB (n = 29/46; 63.0%), and XDR TB (n = 14/19; 73.7%). Thirteen major clades were significantly associated with geography (p<0.001). Clusters of clonal origin contribute greatly to the high prevalence of drug-resistant TB in Thailand.
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Kassa GM, Merid MW, Muluneh AG. Khat Chewing and Clinical Conditions Determine the Epidemiology of Primary Drug Resistance Tuberculosis in Amhara Region of Ethiopia: A Multicenter Study. Infect Drug Resist 2021; 14:2449-2460. [PMID: 34234475 PMCID: PMC8255900 DOI: 10.2147/idr.s316268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Rifampicin and/or multidrug-resistant tuberculosis (RR/MDR-TB) remains an uncontrolled public health emergency that has been synergized by the recently increased person-to-person transmission in the community as primary RR/MDR-TB, which is defined as RR/MDR-TB in new TB patients with no prior exposure to anti-TB treatment for more than one month. This study aimed to measure the prevalence and associated factors of primary drug-resistance among drug-resistant tuberculosis patients, as evidenced by the Amhara region treatment initiating centers. METHODS An institutional-based multicenter cross-sectional study was conducted from September 2010 to December 2017, among 580 RR/MDR-TB patients on the second-line anti-TB drug in the Amhara regional state. Data were collected from patient charts and registration books using a standardized data abstraction sheet. The data were entered using Epi-data 4.2.0.0 and transferred to Stata 14 software for further data management and analysis. A bivariable and multivariable binary logistic model was run subsequently, and finally, a p-value of less than 0.05 with a 95% confidence interval (CI) was used to declare the significance of the explanatory variable. RESULTS The magnitude of primary drug resistance among drug-resistant tuberculosis patients was 15.69% (95% CI: 12.94, 18.89). Alcohol drinking (adjusted odds ratio [AOR] = 0.31, 95% CI: 0.12-0.82), khat chewing (AOR = 4.43; 95% CI: 1.67-11.76), ambulatory and bedridden functional status (AOR = 0.43; 95% CI: 0.24-0.76) and (AOR = 0.41; 95% CI: 0.19-0.91), respectively, positive sputum smear result (AOR = 0.48; 95% CI: 0.26-0.90), and HIV coinfection (AOR= 2.31; 95% CI: 1.31-4.06) remained statistically significant associated factors of primary RR/MDR-TB. CONCLUSION Primary drug resistance is a public health problem in the study setting. Different behavioral and clinical conditions were significant factors of primary drug-resistant development. Mitigation strategies targeted on the patient's clinical condition, substance-related behaviors, and universal DST coverage might be very important for early detection and treatment of RR/MDR-TB to prevent community-level transmission.
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Affiliation(s)
- Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Specialized Comprehensive Hospitals, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Specialized Comprehensive Hospitals, University of Gondar, Gondar, Ethiopia
| | - Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Specialized Comprehensive Hospitals, University of Gondar, Gondar, Ethiopia
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Tenzin C, Chansatitporn N, Dendup T, Dorji T, Lhazeen K, Tshering D, Pelzang T. Factors associated with multidrug-resistant tuberculosis (MDR-TB) in Bhutan: A nationwide case-control study. PLoS One 2020; 15:e0236250. [PMID: 32716965 PMCID: PMC7384628 DOI: 10.1371/journal.pone.0236250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 07/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) is a growing public health concern globally. In Bhutan, the rates of MDR-TB are high. Data on the risk factors of MDR-TB that can help inform policies are limited in Bhutan. This study aimed to determine the risk factors associated with MDR-TB. Methods A nationwide unmatched case-control study was conducted that included 79 MDR-TB cases and 118 controls. Data was collected by trained health workers through interviews using a structured questionnaire. Logistic regression analysis was performed to identify the risk factors associated with MDR-TB. Results The mean age of the participants was 32.4 and 33.7 years among the cases and the controls, respectively. In the multivariate analysis, the odds of having MDR-TB was higher among those who slept for less than 9 hours a day (AOR: 2.77, 95%CI: 1.11–6.92), frequently travelled in public transport (AOR: 2.96, 95% CI: 1.36–6.48), and had previous TB treatment (AOR: 5.90, 95%CI: 2.55–13.64). A greater number of rooms was also marginally associated with odds of having MDR-TB. Conclusions The findings suggest previous TB treatment, inadequate sleep duration, and travelling by public transport to be the risk factors associated with having MDR-TB in Bhutan. Intensification of early case detection, strengthening directly observed treatment strategy, improving treatment adherence, and increasing awareness can help control the rising MDR-TB epidemic.
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Affiliation(s)
- Chador Tenzin
- Bumthang General Hospital, Ministry of Health, Royal Government of Bhutan, Bumthang, Bhutan
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Natkamol Chansatitporn
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Tashi Dendup
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Tandin Dorji
- Department of Medical Services, Ministry of Health, Royal Government of Bhutan, Kawangjangsa, Thimphu, Bhutan
| | - Karma Lhazeen
- Department of Public Health, Ministry of Health, Royal Government of Bhutan, Kawangjangsa, Thimphu, Bhutan
| | - Dorji Tshering
- Central Regional Referral Hospital, Ministry of Health, Royal Government of Bhutan, Gelephu, Bhutan
| | - Thinley Pelzang
- Phuentsholing General Hospital, Ministry of Health, Royal Government of Bhutan, Phuentsholing, Bhutan
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Maiolini M, Gause S, Taylor J, Steakin T, Shipp G, Lamichhane P, Deshmukh B, Shinde V, Bishayee A, Deshmukh RR. The War against Tuberculosis: A Review of Natural Compounds and Their Derivatives. Molecules 2020; 25:molecules25133011. [PMID: 32630150 PMCID: PMC7412169 DOI: 10.3390/molecules25133011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
Tuberculosis (TB), caused by the bacterial organism Mycobacterium tuberculosis, pose a major threat to public health, especially in middle and low-income countries. Worldwide in 2018, approximately 10 million new cases of TB were reported to the World Health Organization (WHO). There are a limited number of medications available to treat TB; additionally, multi-drug resistant TB and extensively-drug resistant TB strains are becoming more prevalent. As a result of various factors, such as increased costs of developing new medications and adverse side effects from current medications, researchers continue to evaluate natural compounds for additional treatment options. These substances have the potential to target bacterial cell structures and may contribute to successful treatment. For example, a study reported that green and black tea, which contains epigallocatechin gallate (a phenolic antioxidant), may decrease the risk of contracting TB in experimental subjects; cumin (a seed from the parsley plant) has been demonstrated to improve the bioavailability of rifampicin, an important anti-TB medication, and propolis (a natural substance produced by honeybees) has been shown to improve the binding affinity of anti-TB medications to bacterial cell structures. In this article, we review the opportunistic pathogen M. tuberculosis, various potential therapeutic targets, available therapies, and natural compounds that may have anti-TB properties. In conclusion, different natural compounds alone as well as in combination with already approved medication regimens should continue to be investigated as treatment options for TB.
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Affiliation(s)
- Morgan Maiolini
- School of Pharmacy, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA; (M.M.); (S.G.); (J.T.); (T.S.)
| | - Stacey Gause
- School of Pharmacy, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA; (M.M.); (S.G.); (J.T.); (T.S.)
| | - Jerika Taylor
- School of Pharmacy, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA; (M.M.); (S.G.); (J.T.); (T.S.)
| | - Tara Steakin
- School of Pharmacy, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA; (M.M.); (S.G.); (J.T.); (T.S.)
| | - Ginger Shipp
- Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA;
| | - Purushottam Lamichhane
- School of Dental Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA;
| | - Bhushan Deshmukh
- Department of Chemistry, Kavayitri Bahinabai Chaudhari North Maharashtra University, Jalgaon 425 001, Maharashtra, India;
| | - Vaibhav Shinde
- Department of Pharmacognosy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune-411 038, Maharashtra, India;
| | - Anupam Bishayee
- Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA;
- Correspondence: or (A.B.); (R.R.D.); Tel.: +1-941-782-5950 (A.B.); +1-941-782-5646 (R.R.D.)
| | - Rahul R. Deshmukh
- Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA;
- Correspondence: or (A.B.); (R.R.D.); Tel.: +1-941-782-5950 (A.B.); +1-941-782-5646 (R.R.D.)
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Zhou Y, Anthony R, Wang S, Ou X, Liu D, Zhao Y, Soolingen DV. The epidemic of multidrug resistant tuberculosis in China in historical and phylogenetic perspectives. J Infect 2020; 80:444-453. [PMID: 31972213 DOI: 10.1016/j.jinf.2019.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES For the past decade, the epidemic of multidrug resistance tuberculosis (MDR-TB) stays high in China. We investigated the possible driving forces behind the epidemics from phylogenetic and historical perspectives. METHODS 420 representative strains were selected from the first national drug resistance survey based on their genotypes, drug susceptibility patterns and geographic information. We reconstructed the phylogeny by whole genome sequencing and compared it to the global phylogeny including MDR outbreaks reported in other settings. We estimated the historical trajectory of population dynamics by Bayesian Skygrid plot for all strains and MDR-TB alone. Integrating geographic information and mutations in drug resistance related genes, we investigated the spatial scale of transmission, recent selection of drug resistant mutant, and mechanism for fitness restoration. RESULTS Three new subgroups within Beijing clade are described for the first time, but none of the MDR-TB outbreak strains reported in other high MDR-TB burden settings is identified. The overall epidemics experienced two successive phases of expansion at different rates between 1660s and 1950s, followed by a sharp decline till today. Four fifths of the clustered MDR-TB strains suggest transmission of DR strains and nearly half suggest recent selection of (additional) mutations in rpoB. Among all identified transmission events, about one fifth occurred between far distant locations. Possible intergenic and intragenic compensatory mutations both presented in our dataset at comparable frequencies. CONCLUSIONS MDR-TB epidemic in China is not yet driven by the spread of a few highly successful clonal expansions but by repeated emergence of smaller and currently less successful clusters. However, internal migration and undertreatment could escalate MDR-TB epidemic. To prevent generating of drug resistance and restoration of fitness as well as to stop transmission of MDR-TB at early stage, national TB control program needs to strengthen management of floating populations and promote universal drug susceptibility testing in China.
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Affiliation(s)
- Yang Zhou
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai road, Changping District, Beijing, China; Radboud University Medical Center, Houtlaan 4, 6525 XZ Nijmegen, The Netherlands.
| | - Richard Anthony
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands
| | - Shengfen Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai road, Changping District, Beijing, China
| | - Xichao Ou
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai road, Changping District, Beijing, China
| | - Dongxin Liu
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai road, Changping District, Beijing, China
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai road, Changping District, Beijing, China.
| | - Dick van Soolingen
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands.
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Epidemiology of drug-resistant tuberculosis in Chongqing, China: A retrospective observational study from 2010 to 2017. PLoS One 2019; 14:e0216018. [PMID: 31821321 PMCID: PMC6903709 DOI: 10.1371/journal.pone.0216018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/07/2019] [Indexed: 11/26/2022] Open
Abstract
China is one of the top 30 countries with high multidrug-resistant tuberculosis (MDR-TB) and rifampin-resistant tuberculosis (RR-TB) burden. Chongqing is a southwest city of China with a large rural population. A retrospective observational study has been performed based on routine tuberculosis (TB) surveillance data in Chongqing from 2010 to 2017. The MDR/RR-TB notification rate increased from 0.03 cases per 100,000 population in 2010 to 2.1 cases per 100,000 population in 2017. The extensively drug-resistant TB (XDR-TB) notification rate has increased to 0.09 cases per 100,000 population in 2017. There was a decreasing detection gap between the number of notified MDR/RR-TB cases and the estimate number of MDR/RR-TB cases in new TB cases. The treatment success rate of MDR/RR-TB was 59% (95% confidence interval [CI], 53%-65%) in this period. Despite the progress achieved, the prevalence of MDR/RR-TB was still high facing challenges including detection gaps in new TB cases, the regional disparity, and the high risk for MDR/RR-TB in elderly people and farmers. Sustained government financing and policy support should be guaranteed in the future.
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Song WM, Shao Y, Liu JY, Tao NN, Liu Y, Zhang QY, Xu TT, Li SJ, Yu CB, Gao L, Cui LL, Li YF, Li HC. Primary drug resistance among tuberculosis patients with diabetes mellitus: a retrospective study among 7223 cases in China. Infect Drug Resist 2019; 12:2397-2407. [PMID: 31447568 PMCID: PMC6684854 DOI: 10.2147/idr.s217044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background Given the high burden of tuberculosis (TB) and diabetes mellitus (DM) in China and the worse outcome of TB-DM cases (refers to TB patients with diabetes), and drug-resistant tuberculosis cases (DR-TB), it is of great significance to explore the association between diabetes and primary DR-TB for TB elimination target in China. We assessed the clinical characteristics, drug-resistance profile, and increased risk of resistance among TB-DM patients across China from 2004 to 2017. Method 7223 cases with drug-susceptibility data were collected from Shandong, China. Categorical baseline characteristics of new TB cases were compared by DM status using Fisher's exact or Pearson Chi-square test. Univariable analysis and multivariable logistic models were used to estimate the association between diabetes and different drug-resistance profiles and the risk factors of primary drug resistance among TB-DM cases. Result Of 7223 newly diagnosed TB patients, 426 (5.90%) were TB-DM cases. TB-DM csaes were more likely to be older,accompanied by higher body mass index (BMI) and hypertension than TB-no DM cases (refers to TB patients without diabetes). The rates of DR-TB (21.83% vs 16.96%), polydrug resistant TB (PDR-TB, 6.10% vs 3.80%), isoniazid (INH)+streptomycin (SM)-resistant TB (4.93% vs 3.13%), and SM-resistant TB (16.20% vs 11.7%) among TB-DM group were higher than TB-no DM group, P<0.05. DM was significantly associated with any DR-TB (adjusted (aOR):1.30; 95% CI, 1.02-1.65), SM-related resistance (aOR: 1.43; 95% CI, 1.08-1.88), PDR-TB (OR: 1.57; 95% CI, 1.04-2.36; aOR: 1.59; 95% CI, 1.04-2.44), compared with pan-susceptible TB patients (P<0.05). Conclusion Our study indicated that TB-DM groups had a higher proportion of drug resistance than TB groups, and diabetes was identified as a risk factor of total DR, PDR, SM resistance and INH+SM resistance among newly diagnosed TB cases. Good management of diabetes and TB infection screening program among DM patients might be necessary for improving TB control in China.
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Affiliation(s)
- Wan-Mei Song
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China.,Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, People's Republic of China
| | - Yang Shao
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China
| | - Jin-Yue Liu
- Department of Clinical Medicine, School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250200, Shandong, People's Republic of China
| | - Ning-Ning Tao
- Department of Clinical Medicine, Medical College, Graduate School of Peking Union Medical College, Beijing 100005, People's Republic of China
| | - Yao Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China
| | - Qian-Yun Zhang
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China.,Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, People's Republic of China
| | - Ting-Ting Xu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China
| | - Shi-Jin Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China.,Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, People's Republic of China
| | - Chun-Bao Yu
- Department of Respiratory Medicine, Shandong Provincial Chest Hospital, Jinan 250013, Shandong, People's Republic of China
| | - Lei Gao
- National Health Commssion Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Liang-Liang Cui
- Department of Environmental Health, Jinan Municipal Center for Disease Control and Prevention, Jinan 250021, Shandong, People's Republic of China.,Department of Biostatistics, School of Public Health, Shandong University, Jinan 250012, Shandong, People's Republic of China
| | - Yi-Fan Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China
| | - Huai-Chen Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China.,Department of Chinese Medicine Integrated with Western Medicine, College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong, People's Republic of China
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12
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Dixit A, Freschi L, Vargas R, Calderon R, Sacchettini J, Drobniewski F, Galea JT, Contreras C, Yataco R, Zhang Z, Lecca L, Kolokotronis SO, Mathema B, Farhat MR. Whole genome sequencing identifies bacterial factors affecting transmission of multidrug-resistant tuberculosis in a high-prevalence setting. Sci Rep 2019; 9:5602. [PMID: 30944370 PMCID: PMC6447560 DOI: 10.1038/s41598-019-41967-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/20/2019] [Indexed: 11/09/2022] Open
Abstract
Whole genome sequencing (WGS) can elucidate Mycobacterium tuberculosis (Mtb) transmission patterns but more data is needed to guide its use in high-burden settings. In a household-based TB transmissibility study in Peru, we identified a large MIRU-VNTR Mtb cluster (148 isolates) with a range of resistance phenotypes, and studied host and bacterial factors contributing to its spread. WGS was performed on 61 of the 148 isolates. We compared transmission link inference using epidemiological or genomic data and estimated the dates of emergence of the cluster and antimicrobial drug resistance (DR) acquisition events by generating a time-calibrated phylogeny. Using a set of 12,032 public Mtb genomes, we determined bacterial factors characterizing this cluster and under positive selection in other Mtb lineages. Four of the 61 isolates were distantly related and the remaining 57 isolates diverged ca. 1968 (95%HPD: 1945-1985). Isoniazid resistance arose once and rifampin resistance emerged subsequently at least three times. Emergence of other DR types occurred as recently as within the last year of sampling. We identified five cluster-defining SNPs potentially contributing to transmissibility. In conclusion, clusters (as defined by MIRU-VNTR typing) may be circulating for decades in a high-burden setting. WGS allows for an enhanced understanding of transmission, drug resistance, and bacterial fitness factors.
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Affiliation(s)
- Avika Dixit
- Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | - Zibiao Zhang
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Leonid Lecca
- Harvard Medical School, Boston, MA, USA
- Socios En Salud, Lima, Peru
| | | | - Barun Mathema
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Maha R Farhat
- Harvard Medical School, Boston, MA, USA
- Massachussetts General Hospital, Boston, MA, USA
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13
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Huang L, Abe EM, Li XX, Bergquist R, Xu L, Xue JB, Ruan Y, Cao CL, Li SZ. Space-time clustering and associated risk factors of pulmonary tuberculosis in southwest China. Infect Dis Poverty 2018; 7:91. [PMID: 30115099 PMCID: PMC6097331 DOI: 10.1186/s40249-018-0470-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 07/30/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pulmonary tuberculosis (PTB,both smear positive and smear negative) is an airborne infectious disease of major public health concern in China and other parts of the world where PTB endemicity is reported. This study aims at identifying PTB spatio-temporal clusters and associated risk factors in Zhaotong prefecture-level city, located in southwest China, where the PTB notification rate was higher than the average rate in the entire country. METHODS Space-time scan statistics were carried out using PTB registered data in the nationwide TB online registration system from 2011 to 2015, to identify spatial clusters. PTB patients diagnosed between October 2015 and February 2016 were selected and a structured questionnaire was administered to collect a set of variables that includes socio-economic status, behavioural characteristics, local environmental and biological characteristics. Based on the discovery of detailed town-level spatio-temporal PTB clusters, we divided selected subjects into two groups including the cases that resides within and outside identified clusters. Then, logistic regression analysis was applied comparing the results of variables between the two groups. RESULTS A total of 1508 subjects consented and participated in the survey. Clusters for PTB cases were identified in 38 towns distributed over south-western Zhaotong. Logistic regression analysis showed that history of chronic bronchitis (OR = 3.683, 95% CI: 2.180-6.223), living in an urban area (OR = 5.876, 95% CI: 2.381-14.502) and using coal as the main fuel (OR = 9.356, 95% CI: 5.620-15.576) were independently associated with clustering. While, not smoking (OR = 0.340, 95% CI: 0.137-0.843) is the protection factor of spatial clustering. CONCLUSIONS We found PTB specially clustered in south-western Zhaotong. The strong associated factors influencing the PTB spatial cluster including: the history of chronic bronchitis, living in the urban area, smoking and the use of coal as the main fuel for cooking and heating. Therefore, efforts should be made to curtail these associated factors.
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Affiliation(s)
- Li Huang
- Yunnan provincial Center for Disease Control and Prevention, Kunming, China
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Ruijing Er road 207, Shanghai, 200025 China
- National Research Center for Tropical Disease, Shanghai, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Eniola Michael Abe
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Ruijing Er road 207, Shanghai, 200025 China
- National Research Center for Tropical Disease, Shanghai, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Xin-Xu Li
- Center for Drug Evaluation, China Food and Drug Administration, Beijing, China
| | | | - Lin Xu
- Yunnan provincial Center for Disease Control and Prevention, Kunming, China
| | - Jing-Bo Xue
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Ruijing Er road 207, Shanghai, 200025 China
- National Research Center for Tropical Disease, Shanghai, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Yao Ruan
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Ruijing Er road 207, Shanghai, 200025 China
- National Research Center for Tropical Disease, Shanghai, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Chun-Li Cao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Ruijing Er road 207, Shanghai, 200025 China
- National Research Center for Tropical Disease, Shanghai, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Shi-Zhu Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Ruijing Er road 207, Shanghai, 200025 China
- National Research Center for Tropical Disease, Shanghai, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
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14
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Demile B, Zenebu A, Shewaye H, Xia S, Guadie A. Risk factors associated with multidrug-resistant tuberculosis (MDR-TB) in a tertiary armed force referral and teaching hospital, Ethiopia. BMC Infect Dis 2018; 18:249. [PMID: 29855354 PMCID: PMC5984406 DOI: 10.1186/s12879-018-3167-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/25/2018] [Indexed: 12/12/2022] Open
Abstract
Background Ethiopia is one of the world health organization defined higher tuberculosis (TB) burden countries where the disease remains a massive public health threat. This study aimed to identify the prevalence and associated factors of multidrug-resistant tuberculosis (MDR-TB) using all armed force and civilian TB attendants in a tertiary level armed force hospital, where data for MDR-TB are previously unpublished. Methods Cross-sectional study was conducted from September 2014 to August 2015 in a tertiary level Armed Force Referral and Teaching Hospital (AFRTH), Ethiopia. Armed force members (n = 251) and civilians (n = 130) which has been undergone TB diagnosis at AFRTH were included. All the specimens collected were subjected to microscopic smear observation, culture growth and drug susceptibility testing. Data were analyzed using statistical package for social sciences following binary logistic regression and Chi-square. P-values < 0.05 were considered statistically significant. Results Among 381 TB patients, 355 (93.2%) new and 26 (6.8%) retreatment cases were identified. Culture and smear positive TB cases were identified in 297 (77.9%) and 252 (66.1%) patients, respectively. The overall prevalence of MDR-TB in AFRTH was found 1.8% (1.3% for armed force members and 0.5% for civilian patients) all of which were previously TB treated cases. The entire treatment success rates were 92.6% achieved highest in the armed force (active and pension) than the civilian patients. The failure and dead cases were also found 2.5 and 4.6%, respectively. Using bivariate analysis, category of attendants and TB contact history were strong predictors of MDR-TB in armed force and civilian patients. Moreover, human immunodeficiency virus (HIV) infection also identified a significant (OR = 14.6; 95% CI = 2.3–92.1; p = 0.004) predicting factor for MDR-TB in armed force members. However, sex, age and body mass index were not associated factor for MDR-TB. Conclusions In AFRTH, lower prevalence of MDR-TB was identified in armed force and civilian patients that were significantly associated with category of attendants, HIV infection and TB contact history. Considering armed force society as one segment of population significantly helps to plan a better MDR-TB control management, especially for countries classified as TB high burden country.
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Affiliation(s)
- Biresaw Demile
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China.,Department of TB/HIV, Armed Force Referral and Teaching Hospital, Addis Ababa, Ethiopia
| | - Amare Zenebu
- Department of TB/HIV, Armed Force Referral and Teaching Hospital, Addis Ababa, Ethiopia
| | - Haile Shewaye
- Department of TB/HIV, Armed Force Referral and Teaching Hospital, Addis Ababa, Ethiopia
| | - Siqing Xia
- State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai, China
| | - Awoke Guadie
- State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai, China. .,Department of Biology, College of Natural Sciences, Arba Minch University, P.O. Box 21, Arba Minch, Ethiopia.
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15
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Hashmi HJ, Javed H, Jamil N. Emerging epidemic of drug resistant tuberculosis in vulnerable populations of developing countries. Afr Health Sci 2017; 17:599-602. [PMID: 29062361 DOI: 10.4314/ahs.v17i2.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Hafiza Jawairia Hashmi
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | - Hasnain Javed
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | - Nazia Jamil
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
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16
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Mukati S, Julka A, Varudkar HG, Singapurwala M, Agrawat JC, Bhandari D, Jain A. A study of clinical profile of cases of MDR-TB and evaluation of challenges faced in initiation of second line Anti tuberculosis treatment for MDR-TB cases admitted in drug resistance tuberculosis center. Indian J Tuberc 2017; 66:358-363. [PMID: 31439180 DOI: 10.1016/j.ijtb.2016.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 11/12/2016] [Accepted: 11/24/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To study the clinical profile of cases, evaluation of comorbidities and problems encountered in initiation of second-line drugs for multidrug-resistant tuberculosis (MDR-TB) patients. METHODOLOGY A prospective observational study was conducted on MDR patients admitted in drug resistance tuberculosis (DRTB) center of RDGMC Surasa Ujjain, a rural medical college, over a span of one year. RESULTS Out of 130 admitted cases, majority (30%) were between 31 and 40 years of age. Males were predominant (70%). Females were significantly younger compared to males (p=0.00308). Most patients (83.8%) were underweight (body mass index (BMI)<18.5kg/m2). According to MDR-TB suspect criteria, majority were defaulter cases (39.23%). The anemia was the most common comorbidity (73.84%) among the study group followed by diabetes mellitus (9.23%), chronic obstructive pulmonary disease (COPD) (9.23%), 10 (7.69) asthma, 10 (7.69%) thyroid disease 9 (6.92%) followed by respiratory insufficiency 4 (3%), HIV 2 (1.5%), deep venous thrombosis (DVT) 2 (1.5%), renal failure 2 (1.5%), and hepatic failure 1 (0.76%). Majority had minimal lesion - 57 (43.8%), moderate - 38 (29.2%), and moderate advanced - 23 (17.7%) while far advanced was noted on X-rays in 12 (9.2%). A total of 91 (70%) cases had non-cavitary lesions and 39 (30%) had cavitary lesions, of which 27 were unilateral and 12 were bilateral. CONCLUSION The males were predominant in our study however females were affected at a younger age compared to the males. Most of the patients had taken Anti tuberculosis treatment (ATT) from Revised National Tuberculosis Control Program (RNTCP) in which defaulter and relapse were the major contributors of MDR-TB cases in our study. Radiological extent of lesions of these patients was less than expectation. Management of comorbidities is essential for compliance to treatment. It necessitates prolonged hospitalization and requires frequent follow-up in the DRTB center.
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Affiliation(s)
- Suneel Mukati
- Department of Pulmonary Medicine, R D Gardi Medical College, Agar Road, Ujjain, Madhya Pradesh, India.
| | - Arti Julka
- Department of Pulmonary Medicine, R D Gardi Medical College, Agar Road, Ujjain, Madhya Pradesh, India
| | - H G Varudkar
- Department of Pulmonary Medicine, R D Gardi Medical College, Agar Road, Ujjain, Madhya Pradesh, India
| | - Mustafa Singapurwala
- Department of Pulmonary Medicine, R D Gardi Medical College, Agar Road, Ujjain, Madhya Pradesh, India
| | - J C Agrawat
- Department of Pulmonary Medicine, R D Gardi Medical College, Agar Road, Ujjain, Madhya Pradesh, India
| | - Deepali Bhandari
- Department of Pulmonary Medicine, R D Gardi Medical College, Agar Road, Ujjain, Madhya Pradesh, India
| | - Anukool Jain
- Department of Pulmonary Medicine, R D Gardi Medical College, Agar Road, Ujjain, Madhya Pradesh, India
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17
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Salindri AD, Kipiani M, Kempker RR, Gandhi NR, Darchia L, Tukvadze N, Blumberg HM, Magee MJ. Diabetes Reduces the Rate of Sputum Culture Conversion in Patients With Newly Diagnosed Multidrug-Resistant Tuberculosis. Open Forum Infect Dis 2016; 3:ofw126. [PMID: 27419188 PMCID: PMC4942763 DOI: 10.1093/ofid/ofw126] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background. Diabetes is a risk factor for active tuberculosis (TB), but little is known about the relationship between diabetes and multidrug-resistant (MDR) TB. We aimed to assess risk factors for primary MDR TB, including diabetes, and determine whether diabetes reduced the rate of sputum culture conversion among patients with MDR TB. Methods. From 2011 to 2014, we conducted a cohort study at the National Center for Tuberculosis and Lung Diseases in Tbilisi, Georgia. Adult (≥35 years) patients with primary TB were eligible. Multidrug-resistant TB was defined as resistance to at least rifampicin and isoniazid. Patients with capillary glycosylated hemoglobin (HbA1c) ≥ 6.5% or previous diagnosis were defined to have diabetes. Polytomous regression was used to estimate the association of patient characteristics with drug resistance. Cox regression was used to compare rates of sputum culture conversion in patients with and without diabetes. Results. Among 318 patients with TB, 268 had drug-susceptibility test (DST) results. Among patients with DST results, 19.4% (52 of 268) had primary MDR TB and 13.4% (36 of 268) had diabetes. In multivariable analyses, diabetes (adjusted odds ratio [aOR], 2.51; 95% confidence interval [CI], 1.00-6.31) and lower socioeconomic status (aOR, 3.51; 95% CI, 1.56-8.20) were associated with primary MDR TB. Among patients with primary MDR TB, 44 (84.6%) converted sputum cultures to negative. The rate of sputum culture conversion was lower among patients with diabetes (adjusted hazard ratio [aHR], 0.34; 95% CI, .13-.87) and among smokers (aHR, 0.16; 95% CI, .04-.61). Conclusions. We found diabetes was associated with an increased risk of primary MDR TB; both diabetes and smoking were associated with a longer time to sputum culture conversion.
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Affiliation(s)
- Argita D Salindri
- Division of Epidemiology and Biostatistics , School of Public Health, Georgia State University
| | - Maia Kipiani
- National Center for Tuberculosis and Lung Disease, Tbilisi, Country of Georgia
| | - Russell R Kempker
- Division of Infectious Diseases, Department of Medicine , Emory University School of Medicine
| | - Neel R Gandhi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lasha Darchia
- National Center for Tuberculosis and Lung Disease, Tbilisi, Country of Georgia
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Disease, Tbilisi, Country of Georgia
| | - Henry M Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Matthew J Magee
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University; Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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18
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Zhou C, Jiang W, Yuan L, Lu W, He J, Zhao Q, Xu B. Access to Bacteriologic-Based Diagnosis in Smear Positive Retreatment Tuberculosis Patients in Rural China: A Cross-Sectional Study in Three Geographic Varied Provinces. PLoS One 2016; 11:e0146340. [PMID: 26751583 PMCID: PMC4713466 DOI: 10.1371/journal.pone.0146340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/16/2015] [Indexed: 11/26/2022] Open
Abstract
Objective To determine factors influencing the utilization and accessibility to bacteriologic-based tuberculosis (TB) diagnosis among sputum smear positive (SS+) retreatment TB patients, and to develop strategies for improving the case detection rate of MDR-TB in rural China. Study Design and Setting A cross-sectional study of SS+ TB retreatment patients was conducted in eight counties from three provinces with different implementation period and strategy of MDR-TB program in China. Demographic and socioeconomic parameters were collected by self-reporting questionnaires. Sputum samples were collected and cultured by the laboratory of county-designated TB clinics and delivered to prefectural Centers for Disease Prevention and Control (CDC) labs for DST with 4 first-line anti-TB drugs. Results Among the 196 SS+ retreatment patients, 61.22% received culture tests during current treatment. Patients from more developed regions (OR = 24.0 and 3.6, 95% CI: 8.6–67.3 and 1.1–11.6), with better socio-economic status (OR = 3. 8, 95% CI: 1.3–10.7), who had multiple previous anti-TB treatments (OR = 5.0, 95% CI: 1.6–15.9), and who failed in the most recent anti-TB treatment (OR = 2.6, 95% CI: 1.0–6.4) were more likely to receive culture tests. The percentage of isolates resistant to any of first-line anti-TB drugs and MDR-TB were 50.0% (95% CI: 39.8%-60.2%) and 30.4% (95% CI: 21.0%-39.8%) respectively. Conclusions Retreatment SS+ TB patients, high risk MDR-TB population, had poor utilization of access to bacteriologic-based TB diagnosis, which is far from optimal. The next step of anti-TB strategy should be focused on how to make bacteriological-based diagnosis cheaper, safer and more maneuverable, and how to assure the DST-guided treatment for these high-risk TB patients.
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Affiliation(s)
- Changming Zhou
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China
| | - Weili Jiang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China
| | - Li Yuan
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China
| | - Wei Lu
- Jiangsu Provincial Center for Disease Control, Nanjing, China
| | - Jinge He
- Sichuan Provincial Center for Disease Control, Chengdu, China
| | - Qi Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China.,Centre for Global Health, Karolinska institutet, Stockholm, Sweden
| | - Biao Xu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China.,Centre for Global Health, Karolinska institutet, Stockholm, Sweden
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19
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Tang S. Tackling challenges of TB/MDRTB in China: concerted actions are imperative. Infect Dis Poverty 2015; 4:19. [PMID: 25908975 PMCID: PMC4407541 DOI: 10.1186/s40249-015-0050-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/17/2015] [Indexed: 11/10/2022] Open
Abstract
China is the second largest TB epidemic with the most number of people infected with multi-drug resistant (MDR). Over the past decade, a large number of TB control projects have been funded by the government of China and international organizations, and epidemic in China has been effectively controlled. However TB control in China still faced many challenges. Strategies to address these challenges may include integrating the national TB control program into health insurance schemes, strengthening TB case management through involving the Chinese hospital in national TB control program, and reforming payment methods for TB care as part of health system reform in China.
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Affiliation(s)
- Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, USA ; Duke Kunshan University, Global Health Research Center, Kunshan, China
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