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Ledesma JR, Ma J, Zhang M, Basting AVL, Chu HT, Vongpradith A, Novotney A, LeGrand KE, Xu YY, Dai X, Nicholson SI, Stafford LK, Carter A, Ross JM, Abbastabar H, Abdoun M, Abdulah DM, Aboagye RG, Abolhassani H, Abrha WA, Abubaker Ali H, Abu-Gharbieh E, Aburuz S, Addo IY, Adepoju AV, Adhikari K, Adnani QES, Adra S, Afework A, Aghamiri S, Agyemang-Duah W, Ahinkorah BO, Ahmad D, Ahmad S, Ahmadzade AM, Ahmed H, Ahmed M, Ahmed A, Akinosoglou K, AL-Ahdal TMA, Alam N, Albashtawy M, AlBataineh MT, Al-Gheethi AAS, Ali A, Ali EA, Ali L, Ali Z, Ali SSS, Allel K, Altaf A, Al-Tawfiq JA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amani R, Amusa GA, Amzat J, Andrews JR, Anil A, Anwer R, Aravkin AY, Areda D, Artamonov AA, Aruleba RT, Asemahagn MA, Atre SR, Aujayeb A, Azadi D, Azadnajafabad S, Azzam AY, Badar M, Badiye AD, Bagherieh S, Bahadorikhalili S, Baig AA, Banach M, Banik B, Bardhan M, Barqawi HJ, Basharat Z, Baskaran P, Basu S, Beiranvand M, Belete MA, Belew MA, Belgaumi UI, Beloukas A, Bettencourt PJG, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhargava A, Bhat V, Bhatti JS, Bhatti GK, Bikbov B, Bitra VR, Bjegovic-Mikanovic V, Buonsenso D, Burkart K, Bustanji Y, Butt ZA, Camargos P, Cao Y, Carr S, Carvalho F, Cegolon L, Cenderadewi M, Cevik M, Chahine Y, Chattu VK, Ching PR, Chopra H, Chung E, Claassens MM, Coberly K, Cruz-Martins N, Dabo B, Dadana S, Dadras O, Darban I, Darega Gela J, Darwesh AM, Dashti M, Demessa BH, Demisse B, Demissie S, Derese AMA, Deribe K, Desai HD, Devanbu VGC, Dhali A, Dhama K, Dhingra S, Do THP, Dongarwar D, Dsouza HL, Dube J, Dziedzic AM, Ed-Dra A, Efendi F, Effendi DE, Eftekharimehrabad A, Ekadinata N, Ekundayo TC, Elhadi M, Elilo LT, Emeto TI, Engelbert Bain L, Fagbamigbe AF, Fahim A, Feizkhah A, Fetensa G, Fischer F, Gaipov A, Gandhi AP, Gautam RK, Gebregergis MW, Gebrehiwot M, Gebrekidan KG, Ghaffari K, Ghassemi F, Ghazy RM, Goodridge A, Goyal A, Guan SY, Gudeta MD, Guled RA, Gultom NB, Gupta VB, Gupta VK, Gupta S, Hagins H, Hailu SG, Hailu WB, Hamidi S, Hanif A, Harapan H, Hasan RS, Hassan S, Haubold J, Hezam K, Hong SH, Horita N, Hossain MB, Hosseinzadeh M, Hostiuc M, Hostiuc S, Huynh HH, Ibitoye SE, Ikuta KS, Ilic IM, Ilic MD, Islam MR, Ismail NE, Ismail F, Jafarzadeh A, Jakovljevic M, Jalili M, Janodia MD, Jomehzadeh N, Jonas JB, Joseph N, Joshua CE, Kabir Z, Kamble BD, Kanchan T, Kandel H, Kanmodi KK, Kantar RS, Karaye IM, Karimi Behnagh A, Kassa GG, Kaur RJ, Kaur N, Khajuria H, Khamesipour F, Khan YH, Khan MN, Khan Suheb MZ, Khatab K, Khatami F, Kim MS, Kosen S, Koul PA, Koulmane Laxminarayana SL, Krishan K, Kucuk Bicer B, Kuddus MA, Kulimbet M, Kumar N, Lal DK, Landires I, Latief K, Le TDT, Le TTT, Ledda C, Lee M, Lee SW, Lerango TL, Lim SS, Liu C, Liu X, Lopukhov PD, Luo H, Lv H, Mahajan PB, Mahboobipour AA, Majeed A, Malakan Rad E, Malhotra K, Malik MSA, Malinga LA, Mallhi TH, Manilal A, Martinez-Guerra BA, Martins-Melo FR, Marzo RR, Masoumi-Asl H, Mathur V, Maude RJ, Mehrotra R, Memish ZA, Mendoza W, Menezes RG, Merza MA, Mestrovic T, Mhlanga L, Misra S, Misra AK, Mithra P, Moazen B, Mohammed H, Mokdad AH, Monasta L, Moore CE, Mousavi P, Mulita F, Musaigwa F, Muthusamy R, Nagarajan AJ, Naghavi P, Naik GR, Naik G, Nair S, Nair TS, Natto ZS, Nayak BP, Negash H, Nguyen DH, Nguyen VT, Niazi RK, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Oancea B, Obamiro KO, Odetokun IA, Odo DBO, Odukoya OO, Oh IH, Okereke CO, Okonji OC, Oren E, Ortiz-Brizuela E, Osuagwu UL, Ouyahia A, P A MP, Parija PP, Parikh RR, Park S, Parthasarathi A, Patil S, Pawar S, Peng M, Pepito VCF, Peprah P, Perdigão J, Perico N, Pham HT, Postma MJ, Prabhu ARA, Prasad M, Prashant A, Prates EJS, Rahim F, Rahman M, Rahman MA, Rahmati M, Rajaa S, Ramasamy SK, Rao IR, Rao SJ, Rapaka D, Rashid AM, Ratan ZA, Ravikumar N, Rawaf S, Reddy MMRK, Redwan EMM, Remuzzi G, Reyes LF, Rezaei N, Rezaeian M, Rezahosseini O, Rodrigues M, Roy P, Ruela GDA, Sabour S, Saddik B, Saeed U, Safi SZ, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Sahebkar A, Sahiledengle B, Sahoo SS, Salam N, Salami AA, Saleem S, Saleh MA, Samadi Kafil H, Samadzadeh S, Samodra YL, Sanjeev RK, Saravanan A, Sawyer SM, Selvaraj S, Senapati S, Senthilkumaran S, Shah PA, Shahid S, Shaikh MA, Sham S, Shamshirgaran MA, Shanawaz M, Sharath M, Sherchan SP, Shetty RS, Shirzad-Aski H, Shittu A, Siddig EE, Silva JP, Singh S, Singh P, Singh H, Singh JA, Siraj MS, Siswanto S, Solanki R, Solomon Y, Soriano JB, Sreeramareddy CT, Srivastava VK, Steiropoulos P, Swain CK, Tabuchi T, Tampa M, Tamuzi JJLL, Tat NY, Tavakoli Oliaee R, Teklay G, Tesfaye EG, Tessema B, Thangaraju P, Thapar R, Thum CCC, Ticoalu JHV, Tleyjeh IM, Tobe-Gai R, Toma TM, Tram KH, Udoakang AJ, Umar TP, Umeokonkwo CD, Vahabi SM, Vaithinathan AG, van Boven JFM, Varthya SB, Wang Z, Warsame MSA, Westerman R, Wonde TE, Yaghoubi S, Yi S, Yiğit V, Yon DK, Yonemoto N, Yu C, Zakham F, Zangiabadian M, Zeukeng F, Zhang H, Zhao Y, Zheng P, Zielińska M, Salomon JA, Reiner Jr RC, Naghavi M, Vos T, Hay SI, Murray CJL, Kyu HH. Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. THE LANCET. INFECTIOUS DISEASES 2024; 24:698-725. [PMID: 38518787 PMCID: PMC11187709 DOI: 10.1016/s1473-3099(24)00007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/09/2023] [Accepted: 01/08/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020. METHODS We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990-2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data. FINDINGS We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5-14 years, 6·29% (5·05 to 7·70) in those aged 15-49 years, 5·72% (4·02 to 7·39) in those aged 50-69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5-14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15-49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50-69 years, and a 3·29% (-5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (-713 to 2180) fewer deaths. INTERPRETATION Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups. FUNDING Bill & Melinda Gates Foundation.
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Shah H, Patel J, Rai S, Sinha A, Saxena D, Panchal S. Bridging the Gap: A Strategic Approach to Upscale Knowledge Among Diverse Healthcare Providers for Effective Tuberculosis Management in Gujarat, India. Cureus 2024; 16:e53255. [PMID: 38435933 PMCID: PMC10904687 DOI: 10.7759/cureus.53255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Tuberculosis (TB) remains a global health challenge, particularly in low- and middle-income countries. Knowledge gaps among healthcare providers (HCPs) significantly impact TB management, hindering timely care-seeking and effective interventions. OBJECTIVE The primary objective was to assess knowledge gaps among 3086 HCPs engaged in the National Tuberculosis Elimination Program (NTEP) implementation in Gujarat, India. The study provided a platform to develop and implement cadre-specific training modules to address identified knowledge deficiencies and enhance TB management. METHODOLOGY The study was conducted in two phases. Phase one was designed as a cross-sectional assessment to identify the knowledge gaps. Phase two involved the development of cadre-specific training modules based on identified deficiencies in the knowledge, crafted with collaboration from an expert panel. The training impact will be evaluated after completion of the training of all cadres through a comprehensive assessment. RESULTS Out of 3086 assessed HCPs, 26% scored below the passing benchmark, revealing significant knowledge gaps. The variations were observed among and within the same cadres, with the accredited social health activists (ASHAs) and community health workers showing higher proficiency while pharmacists and medical officers showed lower proficiency. The cadre-specific training modules and training cascade were designed to address these gaps and improve TB-related knowledge and skills. CONCLUSION The study underscores the critical need for targeted interventions to address knowledge gaps among HCPs involved in TB control. The customized HCP-specific training programs are recommended to enhance knowledge, improve TB management, and contribute to national TB elimination goals.
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Affiliation(s)
- Harsh Shah
- Department of Public Health Sciences, Indian Institute of Public Health Gandhinagar, Gandhinagar, IND
| | - Jay Patel
- Department of Public Health Sciences, Indian Institute of Public Health Gandhinagar, Gandhinagar, IND
| | - Sandeep Rai
- Department of Public Health Sciences, Indian Institute of Public Health Gandhinagar, Gandhinagar, IND
| | - Anish Sinha
- Department of Public Health Sciences, Indian Institute of Public Health Gandhinagar, Gandhinagar, IND
| | - Deepak Saxena
- Department of Public Health Sciences, Indian Institute of Public Health Gandhinagar, Gandhinagar, IND
| | - Shikha Panchal
- Department of Health and Family Welfare, Government of Gujarat, Gandhinagar, IND
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Medrano BA, Lee M, Gemeinhardt G, Rodríguez-Herrera JE, García-Viveros M, Restrepo BI. Tuberculosis presentation and outcomes in older Hispanic adults from Tamaulipas, Mexico. Medicine (Baltimore) 2023; 102:e35458. [PMID: 37832052 PMCID: PMC10578661 DOI: 10.1097/md.0000000000035458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/12/2023] [Indexed: 10/15/2023] Open
Abstract
Older people are at high risk of developing and dying from pulmonary infections like tuberculosis (TB), but there are few studies among them, particularly in Hispanics. To address these gaps, we sought to identify host factors associated with TB and adverse treatment outcomes in older Hispanics by conducting a cross-sectional study of TB surveillance data from Tamaulipas, Mexico (2006-2013; n = 8381). Multivariable logistic regressions were assessed for older adults (OA ≥65 years) when compared to young (YA, 18-39 years) and middle-aged adults (40-64 years). We found that the OA had features associated with a less complicated TB (e.g., lower prevalence of extra-pulmonary TB and less likely to abandon treatment or have drug resistant TB), and yet, were more likely to die during TB treatment (adj-OR 3.9, 95% 2.5, 5.25). Among the OA, excess alcohol use and low body mass index increased their odds of death during TB treatment, while a higher number of reported contacts (social support) was protective. Diabetes was not associated with adverse outcomes in OA. Although older age is a predictor of death during TB disease, OA are not prioritized by the World Health Organization for latent TB infection screening and treatment during contact investigations. With safer, short-course latent TB infection treatment available, we propose the inclusion of OA as a high-risk group in latent TB management guidelines.
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Affiliation(s)
- Belinda A. Medrano
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Brownsville campus, Brownsville, TX, USA
| | - Miryoung Lee
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Brownsville campus, Brownsville, TX, USA
| | - Gretchen Gemeinhardt
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | | | - Blanca I. Restrepo
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Brownsville campus, Brownsville, TX, USA
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
- School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, USA
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Teo AKJ, Morishita F, Islam T, Viney K, Ong CW, Kato S, Kim H, Liu Y, Oh KH, Yoshiyama T, Ohkado A, Rahevar K, Kawatsu L, Yanagawa M, Prem K, Yi S, Tran HTG, Marais BJ. Tuberculosis in older adults: challenges and best practices in the Western Pacific Region. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 36:100770. [PMID: 37547037 PMCID: PMC10398605 DOI: 10.1016/j.lanwpc.2023.100770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/18/2023] [Accepted: 04/02/2023] [Indexed: 08/08/2023]
Abstract
The Western Pacific has one of the fastest-growing older adult populations globally, and tuberculosis (TB) remains one of the foremost infectious causes of disease and death in the region. Older adults are at higher risk of TB due to immunosenescence, comorbidities, and increased institutionalisation. Atypical symptoms and reduced access to health services may delay care-seeking and TB diagnosis, while co-morbidity and increased risk of adverse drug reactions complicate TB treatment. Post-TB sequelae and socioeconomic challenges may decrease the quality of life after TB treatment completion. Despite their high disease burden and special challenges, there is a lack of regionally coordinated policies and guidelines to manage TB among older adults. Routine TB screening at aged-care facilities, age-friendly infrastructure and services, awareness of atypical TB features, integration of TB and non-communicable diseases services, and person-centred approaches to treatment support could improve TB management among older adults. Addressing these challenges and adopting the best practices identified should inform policy formulation and implementation. Funding This project was funded by 1) the World Health Organization Regional Office for the Western Pacific, with financial contributions from the Government of the Republic of Korea through the Korean Disease Control and Prevention Agency and the Government of Japan through the Ministry of Health, Labour and Welfare, and 2) NUS Start-up Grant. The funders had no role in the paper design, collection, analysis, and interpretation of data and in writing of the paper.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
| | - Fukushi Morishita
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Tauhid Islam
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kerri Viney
- World Health Organization, Global Tuberculosis Programme, Geneva, Switzerland
| | - Catherine W.M. Ong
- Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Seiya Kato
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - HeeJin Kim
- Korean National Tuberculosis Association, Seoul, Republic of Korea
| | - Yuhong Liu
- Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Kyung Hyun Oh
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Takashi Yoshiyama
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Akihiro Ohkado
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Kalpeshsinh Rahevar
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Lisa Kawatsu
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Manami Yanagawa
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Public Health Program, Touro University California, Vallejo, CA, USA
| | - Huong Thi Giang Tran
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Ben J. Marais
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
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Sreelatha S, Nagarajan U, Natarajan S. Protein targets in Mycobacterium tuberculosis and their inhibitors for therapeutic implications: A narrative review. Int J Biol Macromol 2023:125022. [PMID: 37244342 DOI: 10.1016/j.ijbiomac.2023.125022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 05/29/2023]
Abstract
Advancement in the area of anti-tubercular drug development has been full-fledged, yet, a very less number of drug molecules have reached phase II clinical trials, and therefore "End-TB" is still a global challenge. Inhibitors to specific metabolic pathways of Mycobacterium tuberculosis (Mtb) gain importance in strategizing anti-tuberculosis drug discovery. The lead compounds that target DNA replication, protein synthesis, cell wall biosynthesis, bacterial virulence and energy metabolism are emerging as potential chemotherapeutic options against Mtb growth and survival within the host. In recent times, the in silico approaches have become most promising tools in the identification of suitable inhibitors for specific protein targets of Mtb. An update in the fundamental understanding of these inhibitors and the mechanism of interaction may bring hope to future perspectives in novel drug development and delivery approaches. This review provides a collective impression of the small molecules with potential antimycobacterial activities and their target pathways in Mtb such as cell wall biosynthesis, DNA replication, transcription and translation, efflux pumps, antivirulence pathways and general metabolism. The mechanism of interaction of specific inhibitor with their respective protein targets has been discussed. The comprehensive knowledge of such an impactful area of research would essentially reflect in the discovery of novel drug molecules and effective delivery approaches. This narrative review encompasses the knowledge of emerging targets and promising n that could potentially translate in to the anti-TB-drug discovery.
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Affiliation(s)
- Souparnika Sreelatha
- Department of Biochemistry, ICMR-National Institute for Research in Tuberculosis, Chennai 600031, Tamil Nadu, India
| | - Usharani Nagarajan
- Department of Biochemistry, ICMR-National Institute for Research in Tuberculosis, Chennai 600031, Tamil Nadu, India
| | - Saravanan Natarajan
- Department of Biochemistry, ICMR-National Institute for Research in Tuberculosis, Chennai 600031, Tamil Nadu, India.
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Wang X, Li Y, Fu Q, Zhou M. Trends of a decade in risk factors of patient delay among pulmonary tuberculosis patients during fast aging and urbanization - analysis of surveillance data from 2008 to 2017 in Wuhan, China. BMC Public Health 2023; 23:803. [PMID: 37131129 PMCID: PMC10155439 DOI: 10.1186/s12889-023-15707-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a leading infectious cause of morbidity and mortality worldwide. However, delay in health care seeking has remained unacceptably high. The aim of this study was to clarify the trend of patient delay and its associated risk factors during rapid aging and urbanization in Wuhan, China from 2008 to 2017. METHODS A total of 63,720 TB patients registered at Wuhan TB Information Management System from January 2008 to December 2017 were included. Long patient delay (LPD) was defined as patient delay longer than 14 days. Independent associations of area and household identity with LPD, as well their interaction effect, were tested by logistic regression models. RESULTS Among 63,720 pulmonary TB patients, 71.3% were males, the mean age was 45.5 ± 18.8 years. The median patient delay was 10 days (IQR, 3-28). A total of 26,360 (41.3%) patients delayed for more than 14 days. The proportion of LPD decreased from 44.8% in 2008 to 38.3% in 2017. Similar trends were observed in all the subgroups by gender, age and household, except for living area. The proportion of LPD decreased from 46.3 to 32.8% in patients living near downtown and increased from 43.2 to 45.2% in patients living far from downtown. Further interaction effect analysis showed that among patients living far from downtown, the risk of LPD for local patients increased with age, while decreased with age for migrant patients. CONCLUSION Although the overall LPD among pulmonary TB patients declined in the past decade, the extent of reduction varied in different subgroups. The elderly local and young migrant patients living far from downtown are the most vulnerable groups to LPD in Wuhan, China.
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Affiliation(s)
- Xiaojun Wang
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
| | - Yuehua Li
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China.
| | - Meilan Zhou
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
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Usharani N, Kanth SV, Saravanan N. Current nanotechnological strategies using lipids, carbohydrates, proteins and metal conjugates-based carrier systems for diagnosis and treatment of tuberculosis - A review. Int J Biol Macromol 2023; 227:262-272. [PMID: 36521715 DOI: 10.1016/j.ijbiomac.2022.12.087] [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] [Received: 08/23/2022] [Revised: 12/03/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
Tuberculosis is a fatal disease caused by Mycobacterium tuberculosis with highest morbidity and mortality every year. The evolution of anti-TB drugs is promising in controlling and treating TB. Yet, the drug response varies depending on the bacterial load and host immunological profiles. The prolonged anti-TB treatment regimen and high pill burden leads to poor adherence to treatment and acquired drug resistance. In the clinical arena, sustainable nanotechnology improves the targeted strategies leading to enhance therapeutic recovery with minimum treatment duration and virtuous drug adherence. Determinants of nanosystems are the size, nature, formulation techniques, stable dosing patterns, bioavailability and toxicity. In the treatment of chronic illness, nanomedicines inclusive of biological macromolecules such as lipids, peptides, and nucleic acids occur to be a successive alternative to synthetic carriers. Most biological nanomaterials possess antimicrobial properties with other intrinsic characteristics. Recently, the pulmonary delivery of anti-TB drugs through polymeric nanocarrier systems is shown to be effective in achieving optimal drug levels in lungs for longer duration, enhanced tissue permeation and sustained systemic clearance. This thematic review provides a holistic insight into the nanodelivery systems pertinent to the therapeutic applications in pulmonary tuberculosis describing the choice of carriers, optimized process, metabolic action and excretion processes.
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Affiliation(s)
- Nagarajan Usharani
- Department of Biochemistry, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Swarna Vinodh Kanth
- Centre for Human and Organizational Resources Development, CSIR-Central Leather Research Institute, Chennai, India
| | - Natarajan Saravanan
- Department of Biochemistry, ICMR-National Institute for Research in Tuberculosis, Chennai, India.
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8
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Hassani S, Mohammadi Shahboulagi F, Foroughan M, Nadji SA, Tabarsi P, Ghaedamini Harouni G. Factors Associated with Medication Adherence in Elderly Individuals with Tuberculosis: A Qualitative Study. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:4056548. [PMID: 36937803 PMCID: PMC10017217 DOI: 10.1155/2023/4056548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/17/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
Methods This qualitative study was conducted in two phases, using an integrative literature review and individual interviews. Studies were gathered without time restriction from MEDLINE databases, Institute for Scientific Information (ISI), Google Scholar, Scopus, and EMBASE, as well as national databases, including Scientific Information Database and Magiran. The findings of 38 studies that met the inclusion criteria were analyzed through the conventional content analysis method based on the ecological approach. After reviewing and forming the data matrix, purposive sampling was performed among healthcare professionals, elderly tuberculosis patients aged 60 and over, and family caregivers of elderly patients to conduct individual interviews. Data obtained from 20 interviews were analyzed using the directed content analysis method. After coding, the data from individual interviews were entered based on similarity and difference in the categories of data matrix obtained from the literature review. Results In general, the aforementioned codes were placed in four main categories, including individual factors (i.e., biological factors, affective-emotional factors, behavioral factors, cognitive factors, tuberculosis-related factors, and economic factors), interpersonal factors (i.e., patient's relationship with treatment team and family-related factors), factors related to healthcare service provider centers (i.e., medical centers' facilities and capacity building in healthcare service provider), and extraorganizational factors (i.e., social factors and health policymaking). Conclusion The results of this study showed that medication adherence in elderly patients with tuberculosis was a complex and multidimensional phenomenon. Therefore, society, policymakers, and healthcare providers should scrutinize the factors affecting medication adherence in this group of patients to plan and implement more effective interventions.
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Affiliation(s)
- Somayeh Hassani
- 1Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Farahnaz Mohammadi Shahboulagi
- 2Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahshid Foroughan
- 1Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Seyed Alireza Nadji
- 3Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- 4Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamreza Ghaedamini Harouni
- 5Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
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9
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Nijiati M, Zhou R, Damaola M, Hu C, Li L, Qian B, Abulizi A, Kaisaier A, Cai C, Li H, Zou X. Deep learning based CT images automatic analysis model for active/non-active pulmonary tuberculosis differential diagnosis. Front Mol Biosci 2022; 9:1086047. [PMID: 36545511 PMCID: PMC9760807 DOI: 10.3389/fmolb.2022.1086047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/24/2022] [Indexed: 12/08/2022] Open
Abstract
Active pulmonary tuberculosis (ATB), which is more infectious and has a higher mortality rate compared with non-active pulmonary tuberculosis (non-ATB), needs to be diagnosed accurately and timely to prevent the tuberculosis from spreading and causing deaths. However, traditional differential diagnosis methods of active pulmonary tuberculosis involve bacteriological testing, sputum culturing and radiological images reading, which is time consuming and labour intensive. Therefore, an artificial intelligence model for ATB differential diagnosis would offer great assistance in clinical practice. In this study, computer tomography (CT) scans images and corresponding clinical information of 1160 ATB patients and 1131 patients with non-ATB were collected and divided into training, validation, and testing sets. A 3-dimension (3D) Nested UNet model was utilized to delineate lung field regions in the CT images, and three different pre-trained deep learning models including 3D VGG-16, 3D EfficientNet and 3D ResNet-50 were used for classification and differential diagnosis task. We also collected an external testing set with 100 ATB cases and 100 Non-ATB cases for further validation of the model. In the internal and external testing set, the 3D ResNet-50 model outperformed other models, reaching an AUC of 0.961 and 0.946, respectively. The 3D ResNet-50 model reached even higher levels of diagnostic accuracy than experienced radiologists, while the CT images reading and diagnosing speed was 10 times faster than human experts. The model was also capable of visualizing clinician interpretable lung lesion regions important for differential diagnosis, making it a powerful tool assisting ATB diagnosis. In conclusion, we developed an auxiliary tool to differentiate active and non-active pulmonary tuberculosis, which would have broad prospects in the bedside.
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Affiliation(s)
- Mayidili Nijiati
- Department of Radiology, The First People’s Hospital of Kashi Prefecture, Kashi, China
| | - Renbing Zhou
- Department of Radiology, The First People’s Hospital of Kashi Prefecture, Kashi, China
| | - Miriguli Damaola
- Department of Radiology, The First People’s Hospital of Kashi Prefecture, Kashi, China
| | - Chuling Hu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | | | | | | | - Chao Cai
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hongjun Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China,*Correspondence: Hongjun Li, ; Xiaoguang Zou,
| | - Xiaoguang Zou
- Clinical Medical Research Center, The First People’s Hospital of Kashi Prefecture, Kashi, China,*Correspondence: Hongjun Li, ; Xiaoguang Zou,
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10
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Trigui M, Ben Ayed H, Koubaa M, Ben Hmida M, Ben Jmaa M, Yaich S, Ben Jmaa T, Hammami F, Fki H, Damak J, Ben Jemaa M. Tuberculosis in elderly: Epidemiological profile, prognosis factors and chronological trends in Southern Tunisia, 1995-2016. J Infect Prev 2022; 23:255-262. [PMID: 36277862 PMCID: PMC9583438 DOI: 10.1177/17571774221127540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 07/22/2021] [Accepted: 06/13/2022] [Indexed: 11/03/2023] Open
Abstract
Background Tuberculosis (TB) has become a public health problem among elderly in developing countries with the gradual increase in life expectancy. Aim/Objective This study aimed to analyze the prognosis factors and chronological trends of TB in elderly in Southern Tunisia. Methods A retrospective study was conducted. All TB patients aged ≥60 years, recorded in the Center of TB Control between 1995 and 2016, were included. Chronological trends of TB were analyzed by calculating the correlation coefficient of Spearman (Rho). Multivariate analysis was done by binary logistic regression (Adjusted Odds ratio (AOR); CI; p) to determine the independent risk factors associated with unsuccessful outcome in elderly. A p value <0.05 was considered as statistically significant. Results Overall, 512 new elderly TB cases were notified between 1995 and 2016, with an average of 23.3 new cases/year. The mean TB incidence rate for elderly was 2.31/100,000 population/year. The case-fatality rate of 8.6%. Multivariate analysis showed that factors independently associated with unsuccessful outcome among elderly patients were age between 80 and 89 (AOR = 4.5; [95% CI: 2, 10.2]; p < 0.001), male gender (AOR = 2.2; [95% CI: 1.1, 4.4]; p = 0.026) and neuro-meningeal involvement (AOR = 4.6; [95% CI: 1.4, 14.8]; p = 0.011). The incidence of TB in elderly patients increased significantly from 0.95/100,000 population in 1995 to 2.17/100,000 population in 2016 (Rho = 0.48; p = 0.024). Discussion A better understanding of TB features in elderly and its chronological trends overtime would facilitate to put in place, in the national TB control program, strategies geared towards this group of people.
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Affiliation(s)
- Maroua Trigui
- Department of Community Health and
Epidemiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Houda Ben Ayed
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Department of Preventive Medicine and Hospital
Hygiene, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Makram Koubaa
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Mariem Ben Hmida
- Department of Community Health and
Epidemiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Maissa Ben Jmaa
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Department of Preventive Medicine and Hospital
Hygiene, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Sourour Yaich
- Department of Community Health and
Epidemiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Tarek Ben Jmaa
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Fatma Hammami
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Habib Fki
- Department of Preventive Medicine and Hospital
Hygiene, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Jamel Damak
- Department of Community Health and
Epidemiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Mounir Ben Jemaa
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
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11
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Sierra CJ, Downs CA. Screening and testing for latent tuberculosis infection among patients who are immunocompromised. Nurse Pract 2022; 47:32-39. [PMID: 36287735 DOI: 10.1097/01.npr.0000884860.99026.ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT It is critical to detect latent tuberculosis infection through screening and testing individuals at high risk of progression to active tuberculosis, including patients who are immunocompromised. NPs should be familiar with available testing for accurate diagnosis in order to expedite treatment.
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12
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Jiang Y, Luo L, Gui M, Liu L, Lin Y, Deng G, Chen J, Zhang P. Duration and Determinants of Delayed Diagnosis with Tuberculosis in Shenzhen, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2022; 15:1473-1481. [PMID: 35937967 PMCID: PMC9346302 DOI: 10.2147/rmhp.s367998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Early diagnosis and timely treatment of tuberculosis are critical for disease control and management. However, diagnostic delay remains severe around the world. We aim to evaluate the duration and factors associated with diagnostic delay of tuberculosis in Shenzhen, China. Methods We conducted a face-to-face interview to collect the whole care-seeking process of patients diagnosed with active TB in Shenzhen, China, from April 1 to September 30, 2021. The duration from symptom onset to confirmed diagnosis was recorded. The risk factors of diagnostic delay were identified by binary stepwise logistic regression analysis. Results Among 288 confirmed TB cases, 170 (59.0%) were delayed diagnosis. The median diagnostic delay was 39.5 days. Median patient delay was 23 days and health system delay was 7 days. Income ≤315USD/month (OR = 2.97 [95% CI: 1.15–7.69]), cough (OR = 3.00 [95% CI: 1.16–7.76]), weight loss (OR = 15.59 [95% CI: 1.85–131.56]), use of traditional Chinese Medicine (OR = 5.03 [95% CI: 1.04–24.31]) and over-the-counter cough syrup (OR = 2.73 [95% CI: 1.10–6.76]) were significant risk factors for patient delay. Fever (OR = 0.13[95% CI: 0.04–0.48]) and hemoptysis (OR = 0.06 [95% CI0.01–0.30]) were protective factors for patient delay. Cough (OR = 2.85 [95% CI: 1.49–5.49]) and availability of chest X-ray (OR = 0.21[CI: 0.11–0.39]) were factors associated with health system delay. Conclusion Delayed diagnosis of tuberculosis remains an unresolved problem. Patients with low income, self-treatment with over-the-counter medicine and accepting TCM suffered from a higher risk of patient delay. It is important to give more help to the vulnerable people and strengthen tuberculosis knowledge among primary health providers. Keeping all health providers alert to TB symptoms can facilitate earlier TB diagnosis and better disease control.
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Affiliation(s)
- Youli Jiang
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Lan Luo
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Min Gui
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Linlin Liu
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Yi Lin
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Guofang Deng
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Jingfang Chen
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
- Correspondence: Jingfang Chen; Peize Zhang, Email ;
| | - Peize Zhang
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
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13
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Predictors for Pulmonary Tuberculosis Outcome and Adverse Events in an Italian Referral Hospital: A Nine-Year Retrospective Study (2013–2021). Ann Glob Health 2022; 88:26. [PMID: 35582409 PMCID: PMC9053535 DOI: 10.5334/aogh.3677] [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] [Indexed: 12/02/2022] Open
Abstract
Background: The COVID-19 pandemic has undone years of progress in providing essential TB services and controlling the TB burden. Italy, a low TB burden country, has an incidence of 7.1 cases per 100,000 people. To control the TB spreading in Italy is critical to investigate the characteristics of patients with the worst outcomes and the highest risk of adverse events related to antituberculosis therapy. Therefore, we conducted a large retrospective study in TB patients admitted to the Clinic of Infectious Diseases University of Bari, Italy, in order to describe the clinical presentation and the factors associated with adverse events and outcomes. Methods: We retrospectively evaluated the patients admitted to the Clinic of Infectious Diseases from January 2013 to 15 December 2021. We stratified our cohort into two groups: <65 years of age and ≥65 years in order to assess any differences between the two groups. Two logistic regression models were implemented considering the dependent variables as: (I) the adverse events; and (II) the unsuccessful treatments. Results: In total, 206 consecutive patients [60% (n = 124) M, median age 39 years, range 16–92] were diagnosed and admitted with TB at Clinic of Infectious Diseases. Of the whole sample, 151 (74%) were <65 years and 55 (26%) were ≥65. Statistically significant differences between the two groups were detected (p-value < 0.05) for nationality (p-value = 0.01), previous contact with TB patient (p-value = 0.00), type of TB (p-value = 0.00), unsuccessful treatment (p-value = 0.00), length of hospitalization (p-value = 0.02) and diagnostic delay (p-value = 0.01). Adverse events related to TB drug regimen were reported in 24% (n = 49). Age < 65 years (O.R. = 3.91; 95% CI 1.72–4.21), non-Italian nationality (O.R. = 4.45; 95% CI 2.22–4.98.), homeless (O.R. = 3.23; 95% CI 2.58–4.54), presence of respiratory symptoms (O.R. = 1.23; 95% CI 1.10–1.90), diagnostic delay (O.R = 2.55; 95% CI 1.98–3.77) resulted associated with unsuccessful treatment outcome (death, failure or lost to follow up). Finally, age < 65 years (O.R. = 1.73; 95% CI 1.31–2.49), presence of pulmonary TB (O.R. = 1.15; 95% CI 1.02–1.35), length of hospitalization (O.R. = 1.82; 95% CI 1.35–2.57) and TB culture positive (O.R. = 1.35; 95% CI 1.12–1.82) were associated with adverse events in our populations. Conclusions: The pharmacological approach alone seems insufficient to treat and cure a disease whose ethiopathogenesis is not only due to the Mycobacterium tuberculosis, but also to the poverty or the social fragility. Our data suggest that young foreigners, the homeless, and the people with low social and economic status are at higher risk of an unfavorable outcome in low incidence TB countries. Targeted actions to support this highly vulnerable population both in terms of outcome and occurrence of adverse events are needed.
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Scordo JM, Aguillón-Durán GP, Ayala D, Quirino-Cerrillo AP, Rodríguez-Reyna E, Mora-Guzmán F, Caso JA, Ledezma-Campos E, Schlesinger LS, Torrelles JB, Turner J, Restrepo BI. A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor. PLoS One 2021; 16:e0255194. [PMID: 34324578 PMCID: PMC8321126 DOI: 10.1371/journal.pone.0255194] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/10/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Aging increases the risk of tuberculosis (TB) and its adverse outcomes, but most studies are based on secondary analyses, and few are in Hispanics. Diabetes is a risk factor for TB in adults, but its contribution in the elderly is unknown. We aimed to identify the role of diabetes and other risk factors for TB in elderly Hispanics. METHODS Cross-sectional study among newly-diagnosed TB patients, recent contacts (ReC), or community controls (CoC) totaling 646 participants, including 183 elderly (>60 years; 43 TB, 80 ReC, 60 CoC) and 463 adults (18 to 50 years; 80 TB, 301 ReC and 82 CoC). Host characteristics associated with TB and latent Mycobacterium tuberculosis infection (LTBI) were identified in the elderly by univariable and confirmed by multivariable logistic regression. RESULTS LTBI was more prevalent among the elderly CoC (55% vs. 23.2% in adults; p<0.001), but not in ReC (elderly 71.3% vs. adult 63.8%); p = 0.213). Risk factors for TB in the elderly included male sex (adj-OR 4.33, 95% CI 1.76, 10.65), smoking (adj-OR 2.55, 95% CI 1.01, 6.45) and low BMI (adj-OR 12.34, 95% CI 4.44, 34.33). Unexpectedly, type 2 diabetes was not associated with TB despite its high prevalence (adj-OR 0.38, 95% CI 0.06, 2.38), and BCG vaccination at birth was protective (adj-OR 0.16, 95% CI 0.06, 0.45). CONCLUSIONS We report novel distinctions in TB risk factors in the elderly vs. adults, notably in diabetes and BCG vaccination at birth. Further studies are warranted to address disparities in this vulnerable, understudied population.
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Affiliation(s)
- Julia M. Scordo
- Host Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, United States of America
- The University of Texas Health Science Center of San Antonio, San Antonio, TX, United States of America
| | | | - Doris Ayala
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX, United States of America
| | - Ana Paulina Quirino-Cerrillo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX, United States of America
| | - Eminé Rodríguez-Reyna
- Secretaria de Salud de Tamaulipas, Reynosa, Matamoros and Ciudad Victoria, Tamaulipas, México
| | - Francisco Mora-Guzmán
- Secretaria de Salud de Tamaulipas, Reynosa, Matamoros and Ciudad Victoria, Tamaulipas, México
| | - Jose A. Caso
- Biology Department, University of Texas Rio Grande Valley, Edinburg, TX, United States of America
- School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, United States of America
| | - Eder Ledezma-Campos
- Secretaria de Salud de Tamaulipas, Reynosa, Matamoros and Ciudad Victoria, Tamaulipas, México
| | - Larry S. Schlesinger
- Host Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, United States of America
| | - Jordi B. Torrelles
- Host Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, United States of America
| | - Joanne Turner
- Host Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, United States of America
| | - Blanca I. Restrepo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX, United States of America
- Biology Department, University of Texas Rio Grande Valley, Edinburg, TX, United States of America
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Iwaki Y, Rauniyar SK, Nomura S, Huang MC. Assessing Factors Associated with TB Awareness in Nepal: A National and Subnational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105124. [PMID: 34066015 PMCID: PMC8151409 DOI: 10.3390/ijerph18105124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
Tuberculosis (TB) has still remained a serious global health threat in low- and middle-income countries in recent years. As of 2021, Nepal is one of the high TB burden countries, with an increasing prevalence of cases. This study evaluates factors associated with TB awareness in Nepal. This study uses data from the Nepal Demographic and Health Survey, a cross-sectional survey carried out from June 2016 to January 2017. Multilevel logistic regression is performed to examine the association of demographic and socioeconomic factors with TB awareness. Our findings show a high level of TB awareness in all seven provinces of Nepal. Province 5 has the highest level of awareness (98.1%) among all provinces, followed by provinces 3 and 4, while province 6 has the lowest awareness level (93.2%) compared to others. Socioeconomic factors such as wealth, education and owning a mobile phone are significantly associated with TB awareness. Socioeconomic determinants are influential factors associated with TB awareness in Nepal. The wide variation in the proportion of awareness at a regional level emphasizes the importance of formulating tailored strategies to increase TB awareness. For instance, the use of mobile phones could be an effective strategy to promote TB awareness at a regional level. This study provides valuable evidence to support further research on the contribution of information and communication technology (ICT) usage to improving TB awareness in Nepal.
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Affiliation(s)
- Yoko Iwaki
- Science, Technology and Innovation Policy Program, National Graduate Institute for Policy Studies (GRIPS), 7-22-1 Roppongi, Minato-ku, Tokyo 106-8677, Japan
- Correspondence: ; Tel.: +81-3-6439-6000
| | - Santosh Kumar Rauniyar
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; (S.K.R.); (S.N.)
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; (S.K.R.); (S.N.)
- Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Michael C. Huang
- SciREX Center, National Graduate Institute for Policy Studies (GRIPS), 7-22-1 Roppongi, Minato-ku, Tokyo 106-8677, Japan;
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Viney K, Lowbridge C, Morishita F, Rahevar K, Oh KH, Islam T, Marais BJ. Evaluation of the 2016-2020 regional tuberculosis response framework, WHO Western Pacific Region. Bull World Health Organ 2021; 99:330-341A. [PMID: 33958821 PMCID: PMC8061668 DOI: 10.2471/blt.20.268060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/09/2020] [Accepted: 12/20/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To assess the implementation of the Regional framework for action on implementation of the End TB Strategy in the Western Pacific, 2016-2020 in countries and areas in the World Health Organization Western Pacific Region. METHODS We used a mixed methods approach to assess the framework's measurable and perceived impact. We conducted an analysis of national tuberculosis strategic plans, a cross-sectional survey of senior staff of tuberculosis programmes, key informant interviews and some country case studies. FINDINGS Of the 37 countries and areas of the Western Pacific Region, 14 had a national tuberculosis strategic plan, including all countries and areas with a high incidence of tuberculosis. Most senior tuberculosis programme staff who responded to the survey (16/23) found the regional framework useful when developing their national targets and grant applications. Programmatic challenges identified included financing, human resources, public-private mix, active case finding, and paediatric and drug-resistant tuberculosis. Most of the 17 key informants thought that the regional framework's categorization of actions (for all settings, for specific settings and for pre-elimination settings) was useful, but that the added value of the regional framework over other relevant documents was not obvious because of overlap in content. CONCLUSION The regional framework influenced national level tuberculosis control planning and implementation in a positive way. A future regional framework should provide a longer-term strategic horizon and specifically address emerging trends and persistent problems faced by countries or areas of the region.
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Affiliation(s)
- Kerri Viney
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, 2600, Australia
| | - Chris Lowbridge
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
| | - Fukushi Morishita
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Kalpeshsinh Rahevar
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Kyung H Oh
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Tauhid Islam
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Ben J Marais
- WHO Collaborating Centre for Tuberculosis and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
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Gautam N, Karki RR, Khanam R. Knowledge on tuberculosis and utilization of DOTS service by tuberculosis patients in Lalitpur District, Nepal. PLoS One 2021; 16:e0245686. [PMID: 33493188 PMCID: PMC7833137 DOI: 10.1371/journal.pone.0245686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tuberculosis is one of the major infectious diseases and is both complex and serious. It is spread from person to person through the air, causing a public health burden, especially in low- and middle-income countries. This study aims to assess the knowledge on tuberculosis and the utilization of Directly-Observed Therapy, Short Course (DOTS) service from the public DOTS centers in Lalitpur district of Nepal. METHOD A structured questionnaire was used to collect data from 23 DOTS centers in Lalitpur district. Univariate and multivariate logistic regression was applied to assess the knowledge on tuberculosis and utilization of DOTS among people living with tuberculosis. RESULTS Among 390 respondents, 80% of patients had knowledge of tuberculosis and 76.92% utilized the DOTS service from the DOTS center. People of higher age (50-60 years) [aOR; 13.96, 95% CI 4.79,40.68], [aOR; 10.84,95% CI 4.09,28.76] had significantly more knowledge on TB and utilization of the DOTS service compared to the younger group. Additionally, those who completed twelfth class [aOR; 2.25, 95% CI 0.46,11.07] and [aOR;2.47, 95% CI 0.51,11.28] had greater knowledge of Tuberculosis and utilization of DOTS compared to those who had not completed twelfth class. Likewise, compared to urban residents, respondents in rural areas (aOR; 0.51, 95% CI 0.27,0.97) had less knowledge of tuberculosis, (aOR; 0.57, 95% CI 0.32,1) and less chance of utilization of the DOTS service from the DOTS center. CONCLUSION Approximately one quarter of patients did not have adequate knowledge of tuberculosis and were not utilizing the DOTS service, particularly in younger age groups, people living in a combined family, with no education, poor economic position, and from rural areas. Findings of this study revealed that some specific programs are needed for enhancing the knowledge and utilization of DOTS, particularly for those patients whose economic situations extended from low to mid range.
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Affiliation(s)
- Nirmal Gautam
- Department of Public Health, Nobel College of Health Sciences, Kathmandu, Nepal
| | - Rewati Raj Karki
- Department of Public Health, Nobel College of Health Sciences, Kathmandu, Nepal
| | - Rasheda Khanam
- School of Business, The University of Southern Queensland, Toowoomba, Australia
- Centre for Health Research, The University of Southern Queensland, Toowoomba, Australia
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Morishita F, Viney K, Lowbridge C, Elsayed H, Oh KH, Rahevar K, Marais BJ, Islam T. Epidemiology of tuberculosis in the Western Pacific Region: Progress towards the 2020 milestones of the End TB Strategy. Western Pac Surveill Response J 2020; 11:10-23. [PMID: 34046237 PMCID: PMC8152824 DOI: 10.5365/wpsar.2020.11.3.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Since 2015, the End TB Strategy and the Regional Framework for Action on Implementation of the End TB Strategy in the Western Pacific 2016-2020 have guided national tuberculosis (TB) responses in countries and areas of the Region. This paper provides an overview of the TB epidemiological situation in the Western Pacific Region and of progress towards the 2020 milestones of the Strategy. A descriptive analysis was conducted of TB surveillance and programme data reported to WHO and estimates of the TB burden generated by WHO for the period 2000-2018. An estimated 1.8 million people developed TB and 90 000 people died from it in the Region in 2018. Since 2015, the estimated TB incidence rate and the estimated number of TB deaths in the Region decreased by 3% and 10%, with annual reduction rates of 1.0% and 3.4%, respectively. With current efforts, the Region is unlikely to achieve the 2020 milestones and other targets of the Strategy. Major challenges include: (1) wide variation in the geographical distribution and rate of TB incidence among countries; (2) a substantial proportion (23%) of TB cases that remain unreached, undiagnosed or unreported; (3) insufficient coverage of drug susceptibility testing (51%) for bacteriologically confirmed cases and limited use of WHO-recommended rapid diagnostics (11 countries reported < 60% coverage); (4) suboptimal treatment outcomes of TB (60% of countries reported < 85% success), of TB/HIV co-infection (79%) and of multidrug- or rifampicin-resistant TB (59%); (5) limited coverage of TB preventive treatment among people living with HIV (39%) and child contacts (12%); and (6) substantial proportions (35-70%) of TB-affected families facing catastrophic costs. For the Region to stay on track to achieve the End TB Strategy targets, an accelerated multisectoral response to TB is required in every country.
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Affiliation(s)
- Fukushi Morishita
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Kerri Viney
- Prevention, Diagnosis, Treatment, Care and Innovation Unit, Global TB Programme, World Health Organization, Geneva, Switzerland
- Centre for Research Excellence in Tuberculosis and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Chris Lowbridge
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Hend Elsayed
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Kyung Hyun Oh
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Kalpeshsinh Rahevar
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Ben J Marais
- Centre for Research Excellence in Tuberculosis and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Tauhid Islam
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
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Di Gennaro F, Vittozzi P, Gualano G, Musso M, Mosti S, Mencarini P, Pareo C, Di Caro A, Schininà V, Girardi E, Palmieri F. Active Pulmonary Tuberculosis in Elderly Patients: A 2016-2019 Retrospective Analysis from an Italian Referral Hospital. Antibiotics (Basel) 2020; 9:antibiotics9080489. [PMID: 32784552 PMCID: PMC7459440 DOI: 10.3390/antibiotics9080489] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
Tuberculosis (TB) in the elderly (>65 years old) has increasingly become a global health problem. It has long been recognized that older people are vulnerable to developing tuberculosis. We retrospectively evaluated data from patients older than 65 years diagnosed with pulmonary TB admitted to the National Institute for Infectious Diseases L. Spallanzani, Rome, Italy, from 1 January 2016 to 31 December 2019. One hundred and six consecutive patients were diagnosed with pulmonary TB and 68% reported at least one comorbidity and 44% at least one of the TB risk-factors. Out of the 26 elderly patients who reported an adverse event, having risk factors for TB (O.R. (Odds Ratios) = 1.45; 95% CI 1.12-3.65) and the presence of cavities on Chest X-rays (O.R. = 1.42; 95% CI 1.08-2.73) resulted in being more likely to be associated with adverse events in elderly patients. Having weight loss (O.R. = 1.31; 95% CI 1.08-1.55) and dyspnea (O.R. = 1.23; 95% CI 1.13-1.41) resulted in being significant predictors of unsuccessful treatment outcome in elderly patients. Older people with TB represent a vulnerable group, with high mortality rate, with a challenging diagnosis. Hospitalizations in tertiary referral hospital with clinical expertise in TB management can be useful to improve the outcome of these fragile patients.
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Affiliation(s)
- Francesco Di Gennaro
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
- Correspondence: ; Tel.: +39-3924-804-707
| | - Pietro Vittozzi
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Maria Musso
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Silvia Mosti
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Paola Mencarini
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Carlo Pareo
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Antonino Di Caro
- Microbiology and Bio-Repository Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Vincenzo Schininà
- Diagnostic Imaging Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Enrico Girardi
- Clinical Epidemiology Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
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20
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Ereso BM, Yimer SA, Gradmann C, Sagbakken M. Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study. PLoS One 2020; 15:e0226307. [PMID: 31895932 PMCID: PMC6939902 DOI: 10.1371/journal.pone.0226307] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/22/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ethiopia is one of the countries with a high burden of tuberculosis (TB). Jimma Zone has the lowest TB case notification rate compared to the national and World Health Organization's (WHO) targets. The aim of the present study was to identify barriers, and explore the origin of these barriers in relation to TB case finding. METHODS A qualitative study was conducted by using different data collection methods and sources. Sixty in-depth interviews with TB treatment providers, program managers and TB patients were included. In addition, 42 governmental health facilities were observed for availability of resources. Data obtained from the in-depth interviews were transcribed, coded, categorized and thematized. Atlas.ti version 7.1 software was used for the data coding and categorizing. RESULTS Inadequate resources for TB case finding, such as a shortage of health-care providers, inadequate basic infrastructure, and inadequate diagnostic equipment and supplies, as well as limited access to TB diagnostic services such as an absence of nearby health facilities providing TB diagnostic services and health system delays in the diagnostic process, were identified as barriers for TB case finding. We identified the absence of trained laboratory professionals in 11, the absence of clean water supply in 13 and the electricity in seven health facilities. Furthermore, we found that difficult topography, the absence of proper roads, an inadequate collaboration with other sectors (such as education), a turnover of laboratory professionals, and a low community mobilization, as the origin of some of these barriers. CONCLUSION Inadequate resources for TB case finding, and a limited access to diagnostic services, were major challenges affecting TB case finding. The optimal application of the directly observed treatment short course (Stop TB) strategy is crucial to increase the current low TB case notification rate. Practical strategies need to be designed to attract and retain health professionals in the health system.
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Affiliation(s)
- Berhane Megerssa Ereso
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- Department of Microbiology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
| | - Christoph Gradmann
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Mette Sagbakken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Hikone M, Ainoda Y, Sakamoto N, Ohnishi K. Clinical characteristics of elderly pulmonary tuberculosis in an acute-care general hospital in Tokyo, Japan: A 12-year retrospective study. J Infect Chemother 2019; 26:245-250. [PMID: 31822452 DOI: 10.1016/j.jiac.2019.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/04/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE A significant feature of tuberculosis (TB) in Japan is the fact that a high proportion of cases belong to the elderly population. Furthermore, previous reports have pointed out the delayed diagnosis of pulmonary TB in acute-care settings. We aimed to examine the clinical characteristics of pulmonary TB patients in an acute-care general hospital, particularly focusing on the elderly population. METHODS We retrospectively reviewed the medical records of patients with pulmonary TB who presented at our institution between May 2005 and December 2016. We described the overall clinical characteristics of these patients and compared them according to age. RESULTS Overall, 289 patients were eligible for the analysis, with a median age of 58 [42-73] years, and 29.4% being older than 70 years. Among the elderly patients, 42.4% were characterized by atypical presentation. CONCLUSION Our findings suggest that the elderly population tends to present as atypical cases lacking respiratory complaints, thereby being at a risk of misdiagnosis.
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Affiliation(s)
- Mayu Hikone
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan; Department of Emergency and Critical Care Center, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
| | | | - Naoya Sakamoto
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan
| | - Kenji Ohnishi
- Department of Infectious Diseases, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
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Kim H, Choi H, Yu S, Lee AY, Kim HO, Joh JS, Heo EY, Oh KH, Kim HJ, Chung H. Impact of Housing Provision Package on Treatment Outcome Among Homeless Tuberculosis Patients in South Korea. Asia Pac J Public Health 2019; 31:603-611. [PMID: 31522517 DOI: 10.1177/1010539519871779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to assess the effect of a housing provision package on treatment outcomes among homeless South Korean tuberculosis (TB) patients. We conducted a prospective, single-arm, community-based study with historical controls as follows: community-based intervention group (COM), who were provided housing, nutrition, and case management, and received directly observed therapy services; a first historical control that was treated as usual (TAU); and a second historical control that comprised homeless TB patients residing in long-term TB-care facility (FAC). A multivariable logistic regression model was constructed to identify predictors associated with treatment success among homeless TB patients. Treatment was successful in 86.0%, 58.3%, and 96.1% of patients in the COM, TAU, and FAC groups, respectively. Interventions, including those found in the COM and FAC groups, were the only predictors of treatment success. Therefore, we determined that housing provision package positively influenced the treatment outcomes of homeless TB patients.
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Affiliation(s)
- Hyunwoo Kim
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Hongjo Choi
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Sarah Yu
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - An-Yeol Lee
- Seoul Branch of Korean National Tuberculosis Association, Seoul, Republic of Korea
| | - Hye-Ok Kim
- Seoul Medical Center, Seoul, Republic of Korea
| | | | - Eun Young Heo
- Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kyung-Hyun Oh
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Hee Jin Kim
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
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Goto A, Komiya K, Kan T, Honjo K, Uchida S, Takikawa S, Yoshimatsu T, Fujimoto K, Johkoh T, Kadota JI. Factors associated with atypical radiological findings of pulmonary tuberculosis. PLoS One 2019; 14:e0220346. [PMID: 31344108 PMCID: PMC6657914 DOI: 10.1371/journal.pone.0220346] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/13/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Unusual radiological images may delay diagnosis of pulmonary tuberculosis. This study aimed to analyze the risk factors for an atypical radiological image in patients with pulmonary tuberculosis. METHODS We retrospectively analyzed data from patients admitted to one hospital from January 2013 to December 2016 for sputum smear-positive lung tuberculosis who underwent chest computed tomography (CT) on admission. Patients whose sputum cultures were positive for general bacteria were excluded. Patient characteristics and laboratory data were compared between patients with cavity and those without and between patients with upper predominant lung involvement and those without. RESULTS This study included 94 (93%) of 101 patients who underwent chest CT. The non-cavity group was older, had a greater number of females, had a lower C-reactive protein (CRP) level, and had a lower glomerular filtration rate. Multivariate analysis showed that a low CRP level (OR 0.808; 95% CI 0.674-0.967; p = 0.020) significantly predicted non-cavity pulmonary tuberculosis. The non-upper predominant lung involvement group was older and had a greater number of females, poorer performance status, a higher CRP level, and a lower serum albumin level. A poor performance status (OR 2.155; 95% CI 1.257-3.693; p = 0.005) was found to significantly predict pulmonary tuberculosis with non-upper predominant lung distributions. CONCLUSIONS A low CRP level and poor performance status were associated with non-cavity and non-upper predominant lung distribution, respectively, in patients with pulmonary tuberculosis. Tuberculosis patients with these characteristics may present unusual chest images.
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Affiliation(s)
- Akihiko Goto
- Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, Tsurumi, Beppu, Oita, Japan
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Idaigaoka, Hasama-machi, Yufu, Oita, Japan
| | - Kosaku Komiya
- Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, Tsurumi, Beppu, Oita, Japan
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Idaigaoka, Hasama-machi, Yufu, Oita, Japan
- * E-mail:
| | - Takamasa Kan
- Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, Tsurumi, Beppu, Oita, Japan
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Idaigaoka, Hasama-machi, Yufu, Oita, Japan
| | - Kokoro Honjo
- Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, Tsurumi, Beppu, Oita, Japan
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Idaigaoka, Hasama-machi, Yufu, Oita, Japan
| | - Sonoe Uchida
- Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, Tsurumi, Beppu, Oita, Japan
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Idaigaoka, Hasama-machi, Yufu, Oita, Japan
| | - Shuichi Takikawa
- Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, Tsurumi, Beppu, Oita, Japan
| | - Tetsuyuki Yoshimatsu
- Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, Tsurumi, Beppu, Oita, Japan
| | - Kiminori Fujimoto
- Radiology, Kurume University School of Medicine, 67-Asahimachi, Kurume, Japan
| | - Takeshi Johkoh
- Radiology, Kansai Rosai Hospital, Inabasou, Amagasaki, Hyogo, Japan
| | - Jun-ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Idaigaoka, Hasama-machi, Yufu, Oita, Japan
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Chong KC, Leung CC, Yew WW, Zee BCY, Tam GCH, Wang MH, Jia KM, Chung PH, Lau SYF, Han X, Yeoh EK. Mathematical modelling of the impact of treating latent tuberculosis infection in the elderly in a city with intermediate tuberculosis burden. Sci Rep 2019; 9:4869. [PMID: 30890762 PMCID: PMC6424958 DOI: 10.1038/s41598-019-41256-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/01/2019] [Indexed: 02/08/2023] Open
Abstract
Hong Kong is a high-income city with intermediate tuberculosis (TB) burden primarily driven by endogenous reactivations. A high proportion of remote latently infected people, particularly elderly, hinders the effectiveness of current strategies focusing on passive TB detection. In this study, we developed a mathematical model to evaluate the impact of treating latent TB infection (LTBI) in the elderly in addition to current TB control strategies. The model was calibrated using the annual age-stratified TB notifications from 1965-2013 in Hong Kong. Our results showed that at present, approximately 75% of annual new notifications were from reactivations. Given the present treatment completion rate, even if only a low to moderate proportion (approximately 20% to 40%) of elderly people were screened and treated for LTBI, the overall TB incidence could be reduced by almost 50%, to reach the 2025 milestone of the global End TB Strategy. Nevertheless, due to a high risk of hepatotoxicity in elderly population, benefit-risk ratios were mostly below unity; thus, intervention programs should be carefully formulated, including prioritising LTBI treatment for high-risk elderly groups who are closely monitored for possible adverse side effects.
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Affiliation(s)
- Ka Chun Chong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Chi Chiu Leung
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Wai Yew
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Benny Chung Ying Zee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Greta Chun Huen Tam
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Maggie Haitian Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Katherine Min Jia
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Pui Hong Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Steven Yuk Fai Lau
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiaoran Han
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Eng Kiong Yeoh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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Lee SH. Active Case Finding in the Elderly Tuberculosis in South Korea. Tuberc Respir Dis (Seoul) 2019; 82:261-263. [PMID: 31267723 PMCID: PMC6609521 DOI: 10.4046/trd.2019.0043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Seung Heon Lee
- Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
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Kirirabwa NS, Kimuli D, DeJene S, Nanziri C, Birabwa E, Okello DA, Suarez PG, Kasozi S, Byaruhanga R, Lukoye D. Response to anti-tuberculosis treatment by people over age 60 in Kampala, Uganda. PLoS One 2018; 13:e0208390. [PMID: 30566486 PMCID: PMC6300205 DOI: 10.1371/journal.pone.0208390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 11/18/2018] [Indexed: 12/13/2022] Open
Abstract
While old age is a known risk factor for developing active tuberculosis (TB), studies on TB in the population aged 60 years and older (considered elderly in this study) are few, especially in the developing world. Results of the TB prevalence survey in Uganda found high TB prevalence (570/100,000) in people over 65. We focused on treatment outcomes in the elderly to understand this epidemic better. We conducted a retrospective analysis of data from TB facility registers in Kampala City for the period 2014-2015. We analyzed the 2014-15 cohort with respect to age, sex, disease class, patients' human immunodeficiency virus (HIV) and directly observed therapy (DOT) status, type of facility, and treatment outcomes and compared findings in the elderly (≥60) and younger (<60) age groups. Of 15,429 records, 3.3% (514/15,429) were for elderly patients. The treatment success rate (TSR) among elderly TB patients (68.3%) was lower than that of the non-elderly (80.9%) and the overall TSR 80.5%, (12,417/15,429) in Kampala. Although the elderly were less likely to test positive for HIV than the young (AOR 0.39; 95% CI 0.33-0.48, p<0.001), they had a two-fold higher risk of unfavorable treatment outcomes (AOR 2.14; CI 1.84-2.72, p<0.001) and were more likely to die while on treatment (AOR 1.86; CI 1.27-2.73; p = 0.001). However, there was no statistically significantly difference between treatment outcomes among HIV-positive and HIV-negative elderly TB patients. Compared to the younger TB patients, elderly TB patients have markedly poorer treatment outcomes, although TB/HIV co-infection rates in this age group are lower.
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Affiliation(s)
| | - Derrick Kimuli
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Seyoum DeJene
- United States Agency for International Development, Kampala, Uganda
| | - Carol Nanziri
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Estella Birabwa
- United States Agency for International Development, Kampala, Uganda
| | - Daniel Ayen Okello
- Kampala Capital City Authority, Directorate of Public Health and Environment, Kampala, Uganda
| | | | - Samuel Kasozi
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Raymond Byaruhanga
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Deus Lukoye
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
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Wachinou AP, Agodokpessi G, Agbodande A, Affolabi D, Esse M, Adjibode O, Anagonou S. [Tuberculosis in older persons in African setting: Epidemiological, diagnostic and evolutive features]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:444-451. [PMID: 30279016 DOI: 10.1016/j.pneumo.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/21/2018] [Accepted: 08/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine the epidemiological, diagnostic and evolutives features of tuberculosis (TB) in older subjects in Benin. PATIENTS AND METHODS This was a retrospective cohort study of adults TB patients (age≥15 years) who were notified at all the Basic Management Units (BMU) in Benin from January 1st, 2013 to December 31st. Older subjects (age≥60 years) were compared to those less than 60 years named young subjects. The threshold of significance was set at 5%. RESULTS The analysis was carried out on 6531 cases adults cases notified during the period. 601 (9.2%) were 60 years old or above. The case notification rate (CNR) in elders was more than twice the CNR in young people (68 cases vs. 31 cases per 100,000 population). Older subjects were less often infected with HIV (9.3%) than young's (16.7%), P<0.0001. In new bacteriologically confirmed pulmonary TB negative for HIV, unfavorable treatment outcomes were more frequent in older subjects than in young subjects with more deaths (7.5% vs. 3.0%). On the other hand, in bacteriological confirmed TB seropositive for HIV and all the other cases, treatment outcomes were comparable between the two groups. CONCLUSION The high CNR and the high death rate in older subjects should plead for a specific care for an adapted management of TB case in this group.
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Affiliation(s)
- A P Wachinou
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin.
| | - G Agodokpessi
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin
| | - A Agbodande
- Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin; Service de médecine interne, Centre national hospitalier universitaire Hubert K. Maga (CNHU-HKM), Cotonou, Bénin
| | - D Affolabi
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin
| | - M Esse
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin
| | - O Adjibode
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin
| | - S Anagonou
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin
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Tarashi S, Ahmadi Badi S, Moshiri A, Nasehi M, Fateh A, Vaziri F, Siadat SD. The human microbiota in pulmonary tuberculosis: Not so innocent bystanders. Tuberculosis (Edinb) 2018; 113:215-221. [PMID: 30514505 DOI: 10.1016/j.tube.2018.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/22/2018] [Accepted: 10/23/2018] [Indexed: 12/12/2022]
Abstract
Mycobacterium tuberculosis (Mtb) infection is a worldwide health concern, which needs robust and efficient control strategies, and the evaluation of human microbiota can be very important in this regard. Dysbiosis of normal microbiota is an important issue in the pathogenesis of Mtb. However, only few studies demonstrated the interaction between Mtb infection and microbiota. The current study aimed at reviewing literature on gut and lung microbiota in Mtb infection. Eleven articles regarding gut and lung microbiota composition in individuals with Mtb infection were selected, and then the importance of gut-lung axis in Mtb infection was evaluated. Also the relationship between microbiota composition and Mtb infection were discussed in terms of treatment, epigenetic field, and biomarkers.
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Affiliation(s)
- Samira Tarashi
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Sara Ahmadi Badi
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Arfa Moshiri
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran; Gastroenterology and Liver Disease Research Center, Research Institute for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Experimental Therapy Unit, Laboratory of Oncology, G.Gaslini Children's Hospital, Genoa, Italy
| | - Mahshid Nasehi
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Fateh
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Farzam Vaziri
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Seyed Davar Siadat
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran.
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Goletti D, Petrone L, Ippolito G, Niccoli L, Nannini C, Cantini F. Preventive therapy for tuberculosis in rheumatological patients undergoing therapy with biological drugs. Expert Rev Anti Infect Ther 2018; 16:501-512. [PMID: 29848120 DOI: 10.1080/14787210.2018.1483238] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Latent tuberculosis infection (LTBI) accounts for almost a quarter of the world population, and, in 5-10% of the subjects with impaired immune-response against M. tuberculosis growth, it may progress to active tuberculosis (TB). In this review, we focus on the need to propose a screening for LTBI including preventive therapy offer in rheumatic patients undergoing therapy with biological drugs. Areas covered: We report on evidence that biologics are associated with an increased risk of active TB reactivation. This effect seems to be mainly limited to treatment with anti-tumor necrosis factor (TNF) agents, while non-anti-TNF-targeted biologics are not likely associated to any increased risk. We introduce the concept that the patients' coexisting host-related risk factors, such as comorbidities, are crucial to identify those at higher risk to reactivate TB. We report that preventive TB therapy is well tolerated in patients treated with biological drugs. Expert commentary: Availability of non-anti-TNF targeted biologics, that are not associated with an increased risk of TB reactivation, offers a great opportunity to tailor a therapeutic intervention at low/absent TB risk. After proper LTBI screening investigations, preventive TB therapy has been demonstrated to be effective and well-tolerated to reduce the risk of TB reactivation in rheumatic patients requiring biological drugs.
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Affiliation(s)
- Delia Goletti
- a Translational Research Unit, Department of Epidemiology and Preclinical Research , "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS , Rome , Italy
| | - Linda Petrone
- a Translational Research Unit, Department of Epidemiology and Preclinical Research , "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS , Rome , Italy
| | - Giuseppe Ippolito
- b Scientific Direction, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS , Rome , Italy
| | - Laura Niccoli
- c Department of Rheumatology , Hospital of Prato , Prato , Italy
| | - Carlotta Nannini
- c Department of Rheumatology , Hospital of Prato , Prato , Italy
| | - Fabrizio Cantini
- c Department of Rheumatology , Hospital of Prato , Prato , Italy
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Tuberculosis incidence rate among the homeless population: The impact of socio-demographic and health-related variables. Pulmonology 2018; 24:309-311. [PMID: 29884446 DOI: 10.1016/j.pulmoe.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/02/2018] [Accepted: 05/03/2018] [Indexed: 11/22/2022] Open
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Li J, Yip BHK, Leung C, Chung W, Kwok KO, Chan EYY, Yeoh E, Chung P. Screening for latent and active tuberculosis infection in the elderly at admission to residential care homes: A cost-effectiveness analysis in an intermediate disease burden area. PLoS One 2018; 13:e0189531. [PMID: 29293514 PMCID: PMC5749681 DOI: 10.1371/journal.pone.0189531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) in the elderly remains a challenge in intermediate disease burden areas like Hong Kong. Given a higher TB burden in the elderly and limited impact of current case-finding strategy by patient-initiated pathway, proactive screening approaches for the high-risk group could be optimal and increasingly need targeted economic evaluations. In this study, we examined whether and under what circumstance the screening strategies are cost-effective compared with no screening strategy for the elderly at admission to residential care homes. METHODS A decision analytic process based on Markov model was adopted to evaluate the cost-effectiveness of four strategies: (i) no screening, (ii) TB screening (CXR) and (iii) TB screening (Xpert) represent screening for TB in symptomatic elderly by chest X-ray and Xpert® MTB/RIF respectively, and (iv) LTBI/TB screening represents screening for latent and active TB infection by QuantiFERON®-TB Gold In-Tube and chest X-ray. The target population was a hypothetical cohort of 65-year-old people, using a health service provider perspective and a time horizon of 20 years. The outcomes were direct medical costs, life-years and quality-adjusted life-years (QALYs) measured by incremental cost-effectiveness ratio (ICER). RESULTS In the base-case analysis, no screening was the most cost-saving; TB screening (CXR) was dominated by TB screening (Xpert); LTBI/TB screening resulted in more life-years and QALYs accrued. The ICERs of LTBI/TB screening were US$19,712 and US$29,951 per QALY gained compared with no screening and TB screening (Xpert), respectively. At the willingness-to-pay threshold of US$50,000 per QALY gained, LTBI/TB screening was the most cost-effective when the probability of annual LTBI reactivation was greater than 0.155% and acceptability of LTBI/TB screening was greater than 38%. In 1,000 iterations of Monte Carlo simulation, the probabilities of no screening, TB screening (CXR), TB screening (Xpert), and LTBI/TB screening to be cost-effective were 0, 1.3%, 20.1%, and 78.6% respectively. CONCLUSIONS Screening for latent and active TB infection in Hong Kong elderly people at admission to residential care homes appears to be highly effective and cost-effective. The key findings may be the next key factor to bring down TB endemic in the elderly population among intermediate TB burden areas.
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Affiliation(s)
- Jun Li
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin H. K. Yip
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Chichiu Leung
- Tuberculosis and Chest Service, Department of Health, Hong Kong, China
| | - Wankyo Chung
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Kin On Kwok
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Emily Y. Y. Chan
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Engkiong Yeoh
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Puihong Chung
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
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Li J, Liu XQ, Jiang SW, Li X, Yu F, Wang Y, Peng Y, Gu XM, Sun YN, Zhang H, Wang LX. Improving tuberculosis case detection in underdeveloped multi-ethnic regions with high disease burden: a case study of integrated control program in China. Infect Dis Poverty 2017; 6:151. [PMID: 29183369 PMCID: PMC5706405 DOI: 10.1186/s40249-017-0365-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 10/03/2017] [Indexed: 11/26/2022] Open
Abstract
Background In the underdeveloped multi-ethnic regions of China, high tuberculosis (TB) burden and regional inequity in access to healthcare service increase the challenge of achieving the End TB goals. Among all the provinces, the highest TB burden is reported in Xinjiang, where ethnic minorities and older people have suffered most. However, current case-finding strategy is inadequate given the complex social determinants and suboptimal case detection rates. Thus, we developed an integrated TB control program to improve case detection and conducted a pilot in Xinjiang from 2014 to 2015. In this case study, we summarized the activities and key findings. We also shared the experiences and challenges of implementing interventions and provided recommendations to inform the TB control program in the future. Case presentation The pilot interventions were implemented in one selected town in Yining based on local TB control programs. By applying tailor-made educational materials, outreach TB educational activities were conducted in diverse ways. In 22 Masjids, the trained imams promoted TB education to the Muslims, covering 20,440 person-times in 88 delivered preaching sessions. In seven schools, 1944 students were educated by the teachers and contributed to educating 6929 family members. In the village communities, 13,073 residents participated in household education and screening. Among them, 12,292 people aged under 65 years were investigated for suspicious pulmonary TB symptoms, where six TB patients were diagnosed out of 89 TB suspects; 781 older people were mobilized for screening directly by chest X-ray, where 10 patients were diagnosed out of 692 participants. Supportive healthcare system, multi-sectoral cooperation and multi-channel financing mechanism were the successful experiences of implementation. The interventions were proved to be more effective than the previous performance: the number of TB suspects consulting doctors and patients detected increased by 50% and 26%, respectively. The potential challenges, implications and recommendations should been taken into account for further program improvement. Conclusions In underdeveloped multi-ethnic regions with high TB burden, improving case detection is necessary and the interventions can be feasible and effective within a supportive system. More intensive educational and training approaches, a high index of TB suspicion and prioritization of older people in screening are recommended. To sustain and scale up the program, the impacts, cost-effectiveness, feasibility and acceptability of interventions warrant further research and evaluation in each specific context. Electronic supplementary material The online version of this article (10.1186/s40249-017-0365-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun Li
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Xiao-Qiu Liu
- National Center for TB Control and Prevention, China CDC, 0515, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Shi-Wen Jiang
- National Center for TB Control and Prevention, China CDC, 0515, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Xue Li
- National Center for TB Control and Prevention, China CDC, 0515, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Fei Yu
- Yining Center for Disease Control and Prevention, Yili, China
| | - Yan Wang
- Yining Center for Disease Control and Prevention, Yili, China
| | - Yong Peng
- Yili Center for Disease Control and Prevention, Yili, China
| | - Xiao-Ming Gu
- Xinjiang Center for Disease Control and Prevention, Urumqi, China
| | - Yan-Ni Sun
- World Health Organization Beijing Office, Beijing, China
| | - Hui Zhang
- National Center for TB Control and Prevention, China CDC, 0515, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Li-Xia Wang
- National Center for TB Control and Prevention, China CDC, 0515, 155 Changbai Road, Changping District, Beijing, 102206, China
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Coffman J, Chanda-Kapata P, Marais BJ, Kapata N, Zumla A, Negin J. Tuberculosis among older adults in Zambia: burden and characteristics among a neglected group. BMC Public Health 2017; 17:804. [PMID: 29025403 PMCID: PMC5639764 DOI: 10.1186/s12889-017-4836-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/06/2017] [Indexed: 01/14/2023] Open
Abstract
Background The 2010 Global Burden of Disease estimates show that 57% of all TB deaths globally occurred among adults older than 50 years of age. Few studies document the TB burden among older adults in Southern Africa. We focused on adults older than 55 years to assess the relative TB burden and associated demographic factors. Methods A cross sectional nationally representative TB prevalence survey conducted of Zambian residents aged 15 years and above from 66 clusters across all the 10 provinces of Zambia. Evaluation included testing for TB as well as an in-depth questionnaire. We compared survey data for those aged 55 and older to those aged 15–54 years. Survey results were also compared with 2013 routinely collected programmatic notification data to generate future hypotheses regarding active and passive case finding. Results Among older adults with TB, 30/ 54 (55.6%) were male, 3/27 (11.1%) were HIV infected and 35/54 (64.8%) lived in rural areas. TB prevalence was higher in those aged ≥55 (0.7%) than in the 15–54 age group (0.5%). Males had higher rates of TB across both age groups with 0.7% (15–54) and 1.0% (≥55) compared with females 0.4% (15–54) and 0.6% (≥55). In rural areas, the prevalence of TB was significantly higher among older than younger adults (0.7% vs 0.3%), while the HIV infection rate was among TB patients was lower (11.1% vs 30.8%). The prevalence survey detected TB in 54/7484 (0.7%) of older adults compared to 3619/723,000 (0.5%) reported in 2013 programmatic data. Conclusion High TB rates among older adults in TB endemic areas justify consideration of active TB case finding and prevention strategies.
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Affiliation(s)
- Jenna Coffman
- School of Public Health, University of Sydney, Sydney, Australia.
| | - Pascalina Chanda-Kapata
- Department of Disease Surveillance, Control and Research, Ministry of Health, Lusaka, Zambia
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.,Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Nathan Kapata
- National TB and Leprosy Control Program, Lusaka, Zambia
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, University College London, London, UK
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
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