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Madaki S, Mohammed Y, Rogo LD, Yusuf M, Bala YG. Age and gender in drug resistance tuberculosis: a cross sectional case study at a national tuberculosis reference hospital in Nigeria. J Glob Antimicrob Resist 2024:S2213-7165(24)00170-X. [PMID: 39299497 DOI: 10.1016/j.jgar.2024.09.002] [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: 10/10/2023] [Revised: 07/14/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024] Open
Abstract
OBJECTIVES Drug resistance in tuberculosis (TB) is a very important public health threat which should not be ignored. Understanding gender, age and characteristics of individuals affected by TB (without HIV, diabetes or Hepatitis B complication), particularly in terms of drug resistance or susceptibility, is crucial for effective prevention and management strategies as most studies focus on TB/HIV coinfection. METHODS A cross-sectional case study of age and gender in 140 individuals grouped into: drug resistant (DR-TB), drug susceptible (DS-TB), and apparently healthy controls (AHCs). Data collection was through medical records and structured questionnaire. Statistical analyses compared age, gender, and selected risk factors across groups. RESULTS Mean age for DR-TB group was 32 years (SD≈ 2). 80.0% were ≤ 40 years and four times more likely to have DR-TB. 55% were male with 1.22 times more likelihood of DR-TB in males. Mean age for DS-TB group was 34 years (SD ≈ 12). 66.7% were ≤ 40 years old. Odds ratio of DS-TB in males was 2.16. Only 10% of DR-TB enrollees had BCG scars compared to 65% AHCs. High percentage of DR-TB reported handling raw meat (75%) and drinking unpasteurized milk (70%) compared to DS-TB. CONCLUSIONS The observed gender disparities and age-related factors especially in DR-TB, highlight the importance of considering age and gender factors in prevention, diagnosis, and treatment efforts of DR-TB. Findings also highlight the need to bridge gaps in awareness and prevention of zoonotic TB and issues around effective BCG vaccination and coverage.
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Affiliation(s)
- Suzie Madaki
- DEPARTMENT OF MEDICAL MICROBIOLOGY AND PARASITOLOGY, FACULTY OF CLINICAL SCIENCES, COLLEGE OF HEALTH SCIENCES, BAYERO UNIVERSITY KANO
| | - Yusuf Mohammed
- DEPARTMENT OF MEDICAL MICROBIOLOGY AND PARASITOLOGY, FACULTY OF CLINICAL SCIENCES, COLLEGE OF HEALTH SCIENCES, BAYERO UNIVERSITY KANO
| | - Lawal Dahiru Rogo
- DEPARTMENT OF MEDICAL LABORATORY SCIENCE, FACULTY OF CLINICAL SCIENCES, COLLEGE OF HEALTH SCIENCES, BAYERO UNIVERSITY KANO
| | - Mustapha Yusuf
- DEPARTMENT OF MEDICAL MICROBIOLOGY AND PARASITOLOGY, FACULTY OF CLINICAL SCIENCES, COLLEGE OF HEALTH SCIENCES, BAYERO UNIVERSITY KANO.
| | - Yazeed Garba Bala
- MOLECULAR LABORATORY, NATIONAL TUBERCULOSIS AND LEPROSY TRAINING CENTER, SAYE, ZARIA, KADUNA STATE
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Soliman MS, Hansen CH, Hanafy M, Shawky S, Rashed H, Abdullah M, Soliman NS, Gad MA, Khairat S, El-Kholy A, Talaat AM. Drug resistance and genomic variations among Mycobacterium tuberculosis isolates from The Nile Delta, Egypt. Sci Rep 2024; 14:20401. [PMID: 39223176 PMCID: PMC11369133 DOI: 10.1038/s41598-024-70199-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024] Open
Abstract
Tuberculosis is a global public health concern. Earlier reports suggested the emergence of high rates of drug resistant tuberculosis in Egypt. This study included 102 isolates of Mycobacterium tuberculosis collected from two reference laboratories in Cairo and Alexandria. All clinical isolates were sub-cultured on Löwenstein-Jensen medium and analyzed using both BD BACTEC MGIT 960 SIRE Kit and standard diffusion disk assays to identify the antibiotic sensitivity profile. Extracted genomic DNA was subjected to whole genome sequencing (WGS) using Illumina platform. Isolates that belong to lineage 4 represented > 80%, while lineage 3 represented only 11% of the isolates. The percentage of drug resistance for the streptomycin, isoniazid, rifampicin and ethambutol were 31.0, 17.2, 19.5 and 20.7, respectively. Nearly 47.1% of the isolates were sensitive to the four anti-tuberculous drugs, while only one isolate was resistant to all four drugs. In addition, several new and known mutations were identified by WGS. High rates of drug resistance and new mutations were identified in our isolates. Tuberculosis control measures should focus on the spread of mono (S, I, R, E)- and double (S, E)-drug resistant strains present at higher rates throughout the whole Nile Delta, Egypt.
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Affiliation(s)
- May S Soliman
- Department of Clinical and Chemical Pathology, Kasr Al Aini, Faculty of Medicine, Cairo University, Giza, Egypt.
| | - Chungyi H Hansen
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, USA
| | - Mostafa Hanafy
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, USA
- Department of Microbiology and Immunology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Sherine Shawky
- Microbiology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Heba Rashed
- Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Abdullah
- Central Public Health Laboratories, Ministry of Health and Population, Cairo, Egypt
| | - Noha Salah Soliman
- Department of Clinical and Chemical Pathology, Kasr Al Aini, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Maha A Gad
- Department of Clinical and Chemical Pathology, Kasr Al Aini, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Sahar Khairat
- Department of Clinical and Chemical Pathology, Kasr Al Aini, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Amani El-Kholy
- Department of Clinical and Chemical Pathology, Kasr Al Aini, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Adel M Talaat
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, USA
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Jin C, Wu Y, Chen J, Liu J, Zhang H, Qian Q, Pang T. Prevalence and patterns of drug-resistant Mycobacterium tuberculosis in newly diagnosed patients in China: A systematic review and meta-analysis. J Glob Antimicrob Resist 2024; 38:292-301. [PMID: 38825149 DOI: 10.1016/j.jgar.2024.05.018] [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: 03/22/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Tuberculosis (TB), one of the deadliest infectious diseases globally, is increasingly exacerbated in China by the emergence of resistant Mycobacterium tuberculosis (MTB) strains. Drug-resistant TB, including mono-drug-resistant TB, multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB), presents significant public health challenges. METHODS We conducted a systematic literature review from January 2010 to February 2024 using databases such as PubMed, Embase, Web of Science, and Google Scholar. Our focus was on empirical data related to drug resistance patterns in newly diagnosed TB cases. Non-empirical studies were excluded through meticulous filtering. For the meta-analysis, we used Review Manager (RevMan) 5.2 and assessed evidence quality using the Newcastle-Ottawa Scale (NOS). RESULTS Our search strategy identified 40 studies that met the inclusion criteria, encompassing a total sample size of 87,667 participants. Among new TB cases, the estimated prevalence of MDR-TB in China was 6.9% (95% CI: 5.6-8.1%). Prevalence rates for mono-drug resistance to first-line anti-TB medications were as follows: isoniazid at 18.2% (95% CI: 16.4-20.6%), rifampicin at 10.5% (95% CI: 8.6-12.8%), and ethambutol at 5.7% (95% CI: 4.1-7.3%). The prevalence of streptomycin resistance, a former first-line anti-TB drug, was 17.1% (95% CI: 14.6-19.1%). The prevalence of other types of mono-drug resistance was 15.2% (95% CI: 13.9-17.3%), and for XDR-TB, it was 0.9% (95% CI: 0.6-1.4%). CONCLUSIONS The high prevalence of drug-resistant TB in China poses a significant public health challenge. There is an urgent need for targeted interventions and continued surveillance to combat the spread of drug-resistant TB.
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Affiliation(s)
- Cong Jin
- School of Public Health, North China University of Science and Technology, Tangshan City, Hebei Province, China
| | - Yuting Wu
- School of Public Health, North China University of Science and Technology, Tangshan City, Hebei Province, China
| | - Jiangpo Chen
- Biotecnovo (Langfang) Medical Lab Co. Ltd., Langfang City, Heibei Province, China
| | - Jing Liu
- Department of Pharmacy, Guangyang Maternal and Child Care Health Hospital, Langfang City, Hebei Province, China
| | - Hongwei Zhang
- General Practice Department, The Fourth People's Hospital of Langfang, Langfang City, Hebei Province, China
| | - Qingzeng Qian
- School of Public Health, North China University of Science and Technology, Tangshan City, Hebei Province, China; Hebei Coordinated Innovation Center of Occupational Health and Safety, Tangshan City, Hebei Province, China.
| | - Tieliang Pang
- Biotecnovo (Langfang) Medical Lab Co. Ltd., Langfang City, Heibei Province, China
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4
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El-Demerdash AS, Alfaraj R, Farid FA, Yassin MH, Saleh AM, Dawwam GE. Essential oils as capsule disruptors: enhancing antibiotic efficacy against multidrug-resistant Klebsiella pneumoniae. Front Microbiol 2024; 15:1467460. [PMID: 39282565 PMCID: PMC11392748 DOI: 10.3389/fmicb.2024.1467460] [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: 07/19/2024] [Accepted: 08/13/2024] [Indexed: 09/19/2024] Open
Abstract
Background Multidrug-resistant Klebsiella pneumoniae (MDR-KP) poses a significant global health threat due to its involvement in severe infections and high mortality rates. The emergence of MDR strains necessitates the exploration of alternative therapeutic strategies. Methods K. pneumoniae isolates were obtained from human and animal sources. Antibacterial susceptibility testing was performed, followed by the evaluation of essential oil activity through inhibition zone, MIC, and MBC determinations. Checkerboard assays were conducted to assess synergistic effects with amikacin. Gene expression analysis and transmission electron microscopy were employed to elucidate the mechanisms of action. Molecular docking studies were performed to identify potential binding targets of bioactive compounds. Results Klebsiella pneumoniae was isolated from 25 of the100 samples examined, representing a prevalence rate of 25%. All isolates were found to be multidrug-resistant. Tea tree and thyme essential oils exhibited potent antibacterial activity and synergistic effects with amikacin. Notably, these combinations significantly downregulated the expression of key capsule virulence genes (wcaG, rmpA, magA, uge, and wabG), suggesting a novel mechanism for enhancing amikacin efficacy. Transmission electron microscopy revealed disrupted cell integrity in MDR-KP cells treated with the combinations. Molecular docking analysis identified Terpinen-4-ol, Farnesol, 1,4-Dihydroxy-p-menth-2-ene, and 7-Oxabicyclo [4.1.0] heptane as potential bioactive compounds responsible for the observed effects. Conclusion By effectively combating MDR-KP, this research holds promise for reducing antibiotic resistance, improving treatment outcomes, and ultimately enhancing potential care.
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Affiliation(s)
- Azza SalahEldin El-Demerdash
- Laboratory of Biotechnology, Department of Microbiology, Agricultural Research Center (ARC), Animal Health Research Institute (AHRI), Zagazig, Egypt
| | - Rihaf Alfaraj
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Faten A Farid
- Botany and Microbiology Department, Faculty of Science, Benha University, Benha, Egypt
| | - Mohamed H Yassin
- Botany and Microbiology Department, Faculty of Science, Benha University, Benha, Egypt
| | - Abdulrahman M Saleh
- Pharmaceutical Medicinal Chemistry and Drug Design Department, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, Egypt
- Epidemiological Surveillance Unit, Aweash El-Hagar Family Medicine Center, MOHP, Mansoura, Egypt
| | - Ghada E Dawwam
- Botany and Microbiology Department, Faculty of Science, Benha University, Benha, Egypt
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Chavula MP, Matenga TFL, Maritim P, Munakampe MN, Habib B, Liusha N, Banda J, Sinyangwe NN, Halwiindi H, Mweemba C, Mubanga A, Kaonga P, Chewe M, Phiri H, Zulu JM. Collaboration for implementation of decentralisation policy of multi drug-resistant tuberculosis services in Zambia. Health Res Policy Syst 2024; 22:112. [PMID: 39160603 PMCID: PMC11331766 DOI: 10.1186/s12961-024-01194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/20/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Multi-drug-resistant tuberculosis (MDR-TB) infections are a public health concern. Since 2017, the Ministry of Health (MoH) in Zambia, in collaboration with its partners, has been implementing decentralised MDR-TB services to address the limited community access to treatment. This study sought to explore the role of collaboration in the implementation of decentralised multi drug-resistant tuberculosis services in Zambia. METHODS A qualitative case study design was conducted in selected provinces in Zambia using in-depth and key informant interviews as data collection methods. We conducted a total of 112 interviews involving 18 healthcare workers, 17 community health workers, 32 patients and 21 caregivers in healthcare facilities located in 10 selected districts. Additionally, 24 key informant interviews were conducted with healthcare workers managers at facility, district, provincial, and national-levels. Thematic analysis was employed guided by the Integrative Framework for Collaborative Governance. FINDINGS The principled engagement was shaped by the global health agenda/summit meeting influence on the decentralisation of TB, engagement of stakeholders to initiate decentralisation, a supportive policy environment for the decentralisation process and guidelines and quarterly clinical expert committee meetings. The factors that influenced the shared motivation for the introduction of MDR-TB decentralisation included actors having a common understanding, limited access to health facilities and emergency transport services, a shared understanding of challenges in providing optimal patient monitoring and review and their appreciation of the value of evidence-based decision-making in the implementation of MDR- TB decentralisation. The capacity for joint action strategies included MoH initiating strategic partnerships in enhancing MDR-TB decentralisation, the role of leadership in organising training of healthcare workers and of multidisciplinary teams, inadequate coordination, supervision and monitoring of laboratory services and joint action in health infrastructural rehabilitation. CONCLUSIONS Principled engagement facilitated the involvement of various stakeholders, the dissemination of relevant policies and guidelines and regular quarterly meetings of clinical expert committees to ensure ongoing support and guidance. A shared motivation among actors was underpinned by a common understanding of the barriers faced while implementing decentralisation efforts. The capacity for joint action was demonstrated through several key strategies, however, challenges such as inadequate coordination, supervision and monitoring of laboratory services, as well as the need for collaborative efforts in health infrastructural rehabilitation were observed. Overall, collaboration has facilitated the creation of a more responsive and comprehensive TB care system, addressing the critical needs of patients and improving health outcomes.
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Affiliation(s)
- Malizgani Paul Chavula
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Tulani Francis L Matenga
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Patricia Maritim
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
- Yakini Health Research Institute, Lusaka, Zambia
| | - Margarate N Munakampe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
- Yakini Health Research Institute, Lusaka, Zambia
| | - Batuli Habib
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Namakando Liusha
- Ministry of Health, Kitwe Teaching Hospital, Off Kumboka Drive, P.O. Box 20969, Kitwe, Zambia
| | - Jeremiah Banda
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Ntazana N Sinyangwe
- Department of Environmental Health, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Hikabasa Halwiindi
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Chris Mweemba
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Angel Mubanga
- Ministry of Health, Ndeke House, Haile Selassie Avenue, P.O. box 30205, Lusaka, Zambia
| | - Patrick Kaonga
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mwimba Chewe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Henry Phiri
- Ministry of Health, Ndeke House, Haile Selassie Avenue, P.O. box 30205, Lusaka, Zambia
| | - Joseph Mumba Zulu
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
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6
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Jihwaprani MC, Sun Y, Rizky WC, Sula I, Saquib N. Establishing the Safety and Efficacy of Bedaquiline-Containing Regimen for the Treatment of Drug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Pulm Med 2024; 2024:5542658. [PMID: 39157539 PMCID: PMC11329311 DOI: 10.1155/2024/5542658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 08/20/2024] Open
Abstract
The risks and benefits of bedaquiline (BDQ) for treatment of drug-resistant tuberculosis (DR-TB) have not been firmly established. We aimed to assess the safety and efficacy of BDQ-containing regimens for the treatment of DR-TB as evidenced in available randomized controlled trials (RCTs). In this systematic review and meta-analysis, five databases (i.e., ClinicalTrials.gov, Cochrane CENTRAL, PubMed, ScienceDirect, and SinoMed) were searched. RCTs among DR-TB patients that had a control arm were eligible. The safety endpoints were all-cause mortality and serious adverse effects (SAEs). Efficacy outcomes were sputum culture conversion rate at 8-12 weeks and 24-26 weeks, treatment success, and time to culture conversion. A total of 476 records were screened; 18 met the eligibility criteria. The pooled analysis included 2520 participants (55.8% received BDQ-containing regimens, n = 1408). Pooled safety outcomes showed no significant reduction in all-cause mortality (relative risk [RR] [95%confidence interval (CI)] = 0.94 [0.41-2.20]) or SAEs (RR [95%CI] = 0.91 [0.67-1.23]) in the BDQ-regimen group. Pooled efficacy outcomes showed significantly superior culture conversion rates at 8-12 weeks (RR [95%CI] = 1.35 [1.10-1.65]) and 24-26 weeks (RR [95%CI] = 1.25 [1.15-1.36]), more treatment success (RR [95%CI] = 1.30 [1.17-1.44]), and a 17-day reduction in the time to culture conversion (standardized mean difference [SMD] [95%CI] = -17.46 [-34.82 to -0.11]) in the BDQ-regimen group (reference: non-BDQ regimen). Overall, BDQ regimens showed significant treatment effect against DR-TB but did not reduce mortality or SAEs.
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Affiliation(s)
| | - Yipeng Sun
- College of MedicineSulaiman Al Rajhi University, Bukayriyah, Al-Qassim, Saudi Arabia
| | - Wahyu Choirur Rizky
- Department of Anesthesiology and Intensive Care UnitRSUD Pangeran Jaya Sumitra General Hospital, Kotabaru, South Kalimantan, Indonesia
| | - Idris Sula
- College of MedicineSulaiman Al Rajhi University, Bukayriyah, Al-Qassim, Saudi Arabia
| | - Nazmus Saquib
- College of MedicineSulaiman Al Rajhi University, Bukayriyah, Al-Qassim, Saudi Arabia
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Kangongwe MH, Mwanza W, Mwamba M, Mwenya J, Muzyamba J, Mzyece J, Hamukale A, Tembo E, Nsama D, Chimzizi R, Mubanga A, Tambatamba B, Mudenda S, Lishimpi K. Drug resistance profiles of Mycobacterium tuberculosis clinical isolates by genotype MTBDRplus line probe assay in Zambia: findings and implications. JAC Antimicrob Resist 2024; 6:dlae122. [PMID: 39055721 PMCID: PMC11271804 DOI: 10.1093/jacamr/dlae122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
Background The emergence of drug resistance is a threat to global tuberculosis (TB) elimination goals. This study investigated the drug resistance profiles of Mycobacterium tuberculosis (M. tuberculosis) using the Genotype MTBDRplus Line Probe Assay at the National Tuberculosis Reference Laboratory (NTRL) in Zambia. Methods A cross-sectional study was conducted between January 2019 and December 2020. GenoType MTBDRplus line probe assay records for patients at the NTRL were reviewed to investigate drug susceptibility profiles of M. tuberculosis isolates to rifampicin and isoniazid. Data analysis was done using Stata version 16.1. Results Of the 241 patient records reviewed, 77% were for females. Overall, 44% of patients were newly diagnosed with TB, 29% had TB relapse, 10% treatment after failure and 8.3% treatment after loss to follow-up. This study found that 65% of M. tuberculosis isolates were susceptible to rifampicin and isoniazid. Consequently, 35% of the isolates were resistant to rifampicin and/or isoniazid and 21.2% were multidrug-resistant (MDR). Treatment after failure [relative risk ratios (RRR) = 6.1, 95% CI: 1.691-22.011] and treatment after loss to follow-up (RRR = 7.115, 95% CI: 1.995-25.378) were significantly associated with MDR-TB. Unknown HIV status was significantly associated with isoniazid mono-resistance (RRR = 5.449, 95% CI: 1.054-28.184). Conclusions This study found that 65% of M. tuberculosis isolates were susceptible to rifampicin and isoniazid while 35% were resistant. Consequently, a high prevalence of MDR-TB is of public health concern. There is a need to heighten laboratory surveillance and early detection of drug-resistant TB to prevent the associated morbidity and mortality.
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Affiliation(s)
- Mundia Hendrix Kangongwe
- Ministry of Health, Chest Diseases Laboratory, Lusaka, Zambia
- Institute for Basic and Biomedical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Winnie Mwanza
- Ministry of Health, National Tuberculosis and Leprosy Programme, Lusaka, Zambia
- Public Health, USAID-STAR Project
| | - Mutende Mwamba
- Ministry of Health, Chest Diseases Laboratory, Lusaka, Zambia
| | - Jonathan Mwenya
- Ministry of Health, Chest Diseases Laboratory, Lusaka, Zambia
| | - John Muzyamba
- Ministry of Health, Chest Diseases Laboratory, Lusaka, Zambia
| | - Judith Mzyece
- Ministry of Health, Laboratory and Pathological Services, Lusaka, Zambia
| | - Amos Hamukale
- Epidemiology and Surveillance, Zambia National Public Health Institute, Lusaka, Zambia
| | - Emmanuel Tembo
- Ministry of Health, National Tuberculosis and Leprosy Programme, Lusaka, Zambia
| | - Davy Nsama
- Ministry of Health, Laboratory and Pathological Services, Lusaka, Zambia
| | - Rehab Chimzizi
- Ministry of Health, National Tuberculosis and Leprosy Programme, Lusaka, Zambia
- Public Health, USAID-STAR Project
| | - Angel Mubanga
- Ministry of Health, National Tuberculosis and Leprosy Programme, Lusaka, Zambia
| | | | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Kennedy Lishimpi
- Technical Services, Ministry of Health Headquarters, Lusaka, Zambia
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8
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Chacko B, Chaudhry D, Peter JV, Khilnani GC, Saxena P, Sehgal IS, Ahuja K, Rodrigues C, Modi M, Jaiswal A, Jasiel GJ, Sahasrabudhe S, Bose P, Ahuja A, Suprapaneni V, Prajapat B, Manesh A, Chawla R, Guleria R. ISCCM Position Statement on the Approach to and Management of Critically Ill Patients with Tuberculosis. Indian J Crit Care Med 2024; 28:S67-S91. [PMID: 39234233 PMCID: PMC11369919 DOI: 10.5005/jp-journals-10071-24783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/24/2024] [Indexed: 09/06/2024] Open
Abstract
Tuberculosis (TB) is an important cause of morbidity and mortality globally. About 3-4% of hospitalized TB patients require admission to the intensive care unit (ICU); the mortality in these patients is around 50-60%. There is limited literature on the evaluation and management of patients with TB who required ICU admission. The Indian Society of Critical Care Medicine (ISCCM) constituted a working group to develop a position paper that provides recommendations on the various aspects of TB in the ICU setting based on available evidence. Seven domains were identified including the categorization of TB in the critically ill, diagnostic workup, drug therapy, TB in the immunocompromised host, organ support, infection control, and post-TB sequelae. Forty-one questions pertaining to these domains were identified and evidence-based position statements were generated, where available, keeping in focus the critical care aspects. Where evidence was not available, the recommendations were based on consensus. This position paper guides the approach to and management of critically ill patients with TB. How to cite this article Chacko B, Chaudhry D, Peter JV, Khilnani G, Saxena P, Sehgal IS, et al. isccm Position Statement on the Approach to and Management of Critically Ill Patients with Tuberculosis. Indian J Crit Care Med 2024;28(S2):S67-S91.
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Affiliation(s)
- Binila Chacko
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Pt BDS Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - John V Peter
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Prashant Saxena
- Department of Pulmonary, Critical Care and Sleep Medicine, Fortis Hospital, Vasant Kung, New Delhi, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Kunal Ahuja
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Camilla Rodrigues
- Department of Lab Medicine, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Manish Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Anand Jaiswal
- Deparment of Respiratory Diseases, Medanta Medicity, Gurugram, Haryana, India
| | - G Joel Jasiel
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shrikant Sahasrabudhe
- Department of Critical Care Medicine and Pulmonology, KIMS Manavata Hospital, Nashik, Maharashtra, India
| | - Prithviraj Bose
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aman Ahuja
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India
| | - Vineela Suprapaneni
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India
| | - Brijesh Prajapat
- Department of Pulmonary and Critical Care Medicine, Yashoda Group of Hospitals, Ghaziabad, Uttar Pradesh, India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajesh Chawla
- Department of Respiratory Medicine, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Randeep Guleria
- Institute of Internal Medicine and Respiratory and Sleep Medicine, Medanta Medical School, Gurugram, Haryana, India
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Iqhrammullah M, Yusnaini R, Amirah S, Mulya IC, Tsurayya G, Naufal MA, Santosa SF, Harapan H, Zulkifli B. Effect of tuberculosis-specific antigen stimulation on the diagnostic accuracy of interferon-γ inducible protein-10 in distinguishing active and latent tuberculosis infection: a meta-analysis. Microbes Infect 2024:105396. [PMID: 39032689 DOI: 10.1016/j.micinf.2024.105396] [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: 03/28/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Identifying active tuberculosis (ATB) from latent tuberculosis infection (LTBI) persists as a challenge, and interferon-γ inducible protein-10 (IP-10) has been employed as the solution. To further improve its diagnostic performance, the sample can be stimulated with TB specific antigen (TBAg). AIM To perform meta-analysis on diagnostic accuracy of unstimulated and TBAg-stimulated IP-10 in differentiating ATB from LTBI. METHODS Systematic search was performed on five major scientific databases as of 29 November 2023. Observational studies reporting diagnostic values of unstimulated or TBAg-stimulated IP-10 in identifying ATB from LTBI were included. Meta-analysis was carried out using two-level mixed-effect logistic regression model. RESULTS Twenty-five studies recruiting 2301 patients (1137 ATB versus 1164 LTBI) were included in the quantitative analysis. The pooled sensitivity and specifity of IP-10 were 72% (95%CI: 0.59-0.82) and 78% (95%CI: 0.63-0.88), respectively. As for TBAg-stimulated IP-10, the sensitivity and specifity were 82% (95%CI: 0.76-0.87) and 85% (95%CI: 0.73-0.92), respectively. The senstivity was reduced signiticantly (p < 0.01) when the patients with human immunodeficiency virus infection were included, except after the TBAg stimulation. CONCLUSION Stimulating IP-10 with TBAg could improve the diagnostic accuracy in differentiating ATB from LTBI.
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Affiliation(s)
- Muhammad Iqhrammullah
- Faculty of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh 23245, Indonesia.
| | - Rika Yusnaini
- Department of Nursing, Faculty of Medicine, Malikussaleh University, Lhokseumawe 24351, Indonesia
| | - Shakira Amirah
- Faculty of Medicine, Universitas Indonesia, Jakarta 40115, Indonesia
| | - Intan Chaharunia Mulya
- Education Program in Reproduction & Development, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria 3168, Australia
| | - Ghina Tsurayya
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Muhammad Alif Naufal
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Sukmawan Fajar Santosa
- Integrated Research Laboratory, Faculty of Veterinary Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
| | - Baidillah Zulkifli
- Laboratory of Physiology, Faculty of Veterinary Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia.
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Suresh P, Thulasidharan S, Kumar A, Sunil S, Roy M, Ramesh VP, Biswas R, Kunoor A, Biswas L. Drug Susceptibility and Mutation Profiles in Mycobacterium tuberculosis Isolates from a Tertiary Care Hospital in Kerala, India. Am J Trop Med Hyg 2024; 111:161-167. [PMID: 38772358 PMCID: PMC11229631 DOI: 10.4269/ajtmh.24-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/01/2024] [Indexed: 05/23/2024] Open
Abstract
The rising prevalence of drug-resistant Mycobacterium tuberculosis (MTB) strains poses a significant challenge to global tuberculosis (TB) control efforts. This study aimed to analyze drug resistance patterns and investigate the molecular characteristics of 193 MTB clinical isolates to shed light on the mechanisms of drug resistance. Of the 193 MTB clinical isolates, 28.5% (n = 53) exhibited mono-drug or multidrug resistance. Pyrazinamide mono-drug resistance (PZAr) was the most prevalent (17%, n = 33), followed by isoniazid mono-drug resistance (3.6%, n = 7). Rifampicin resistance was associated with mutations in the rpoB gene (D435Y, D435V, S450L, L452P). Isoniazid resistance mutations were found in the katG (S315T), inhA (C[-15] T), and ndh (R268H) genes, whereas ethambutol resistance mutations were observed in the embB gene (M306V, M306I, M306L, G406S, Q497R). Surprisingly, 94% of PZAr isolates (n = 31) showed no mutations in the pncA or rpsA genes. The presence of the R268H mutation in the ndh gene, not previously linked to PZAr, was detected in 15% of PZAr isolates (n = 5), suggesting its potential contribution to PZAr in specific cases but not as a predominant mechanism. The specific molecular mechanisms underlying PZAr in the majority of the isolates remain unknown, emphasizing the need for further research to uncover the contributing factors. These findings contribute to the understanding of drug resistance patterns and can guide future efforts in TB control and management.
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Affiliation(s)
- Parasmal Suresh
- Amrita Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Swathy Thulasidharan
- Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sunisha Sunil
- Amrita Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Maria Roy
- Amrita Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Varsha P. Ramesh
- Amrita Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Raja Biswas
- Amrita Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Akhilesh Kunoor
- Respiratory Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Lalitha Biswas
- Amrita Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Mustafa G, Almarshad F. Burden and Patterns of Multidrug-Resistant Tuberculosis in Pediatric and Adolescent Patients at a Tertiary Care Hospital in Pakistan. Cureus 2024; 16:e63246. [PMID: 39070314 PMCID: PMC11281994 DOI: 10.7759/cureus.63246] [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: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) presents a significant global health challenge, particularly in developing countries. This study focuses on the burden and pattern of pediatric and adolescent MDR-TB in a tertiary care hospital setting. Aims/objectives The main objective is to evaluate MDR-TB's prevalence and resistance patterns among pediatric and adolescent patients, highlighting critical demographic factors and resistance trends. Materials and methods The study utilized a prospective analytical design in two tertiary care facilities, focusing on children aged four months to 18 years diagnosed with extra-pulmonary tuberculosis. Data on demographic profiles, clinical outcomes, and drug resistance patterns were collected and analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 27.0, Armonk, NY). Results Out of 99 enrolled participants, 63 (63.64%) met the inclusion criteria. The mean age was 70.22±48.90 months. A significant proportion, 60 (95.2%) of the cases, originated from Punjab. Notably, 10 (15.9%) of the cultures demonstrated MDR, with specific resistance observed to isoniazid (INH) in 10 (15.9%) cases, rifampicin (RIF) in 11 (17.5%) cases, and pyrazinamide (PZA) in seven (11.1%) cases. The study also recorded a high prevalence of tuberculous meningitis, affecting 52 (82.5%) participants, and malnutrition, affecting 49 (77.8%). Conclusions MDR-TB in 10 (15.9%) of the study children and adolescents presenting in Pakistan's specialized health centres is a notable burden. This points to a need for better diagnostic methods and treatment plans for pediatric patients. Implementing advanced diagnostics and personalized therapies is crucial for managing MDR-TB in susceptible demographics. Our findings emphasize the importance of updating treatment protocols to tackle the impacts of MDR-TB and its evolving resistance.
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Affiliation(s)
- Ghulam Mustafa
- Department of Pediatric Medicine, College of Medicine, Shaqra University, Shaqra, SAU
- Department of Pediatrics, Nishtar Medical University and Hospital, Multan, Multan, PAK
| | - Feras Almarshad
- Department of Internal Medicine, College of Medicine, Shaqra University, Shaqra, SAU
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Alvitez J, Huarachi L, Temoche A, Rojas M, Alvitez-Temoche D, Espinoza-Carhuancho F, Mayta-Tovalino F. A 32-year global analyses on dynamic trends and geospatial visualization of genital tuberculosis and female infertility: A scientometric study. Heliyon 2024; 10:e31396. [PMID: 38818201 PMCID: PMC11137401 DOI: 10.1016/j.heliyon.2024.e31396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Genital tuberculosis (GT) is an infection that can affect the female reproductive system, including the uterus, cervix, and ovaries. Objective To perform a scientometric exploration to analyze the spatiotemporal trend, evolution, and emerging patterns of scholarly output on GT and female infertility. Methods An observational, descriptive, retrospective study employing a scientometric methodology was carried out. Metadata from scholarly articles spanning the years 1990-2022 were extracted from the Web of Science. The metadata from the chosen articles, totaling 172 manuscripts, were exported on May 17, 2023, in plain text format, which will allow the analysis and integration of the data in the software used. Results We found at 111 sources and found 172 documents on tuberculosis and female infertility. We observed an average annual growth rate of 7.46 %, and the average age of the documents was 10.4 years. The dual overlay map showed the distribution of scientific publications on tuberculosis and female infertility. Journals on the left side of the map are cited mainly in the journals on the right. We found that Clinical Infectious Diseases and Lancet journals condensed patterns and trends in 1995, while the Indian Journal of Tuberculosis did so in 1996. Dheda K., Joubert JJ., and Wang Y. were the authors who had India, Iran, and China as their main affiliation, respectively, and they mainly published their studies in the "American Journal of Respiratory and Critical Care Medicine" and "Tropical Doctor," among others. Conclusions This bibliometric study examined different sources and found an average annual growth rate of 7.46 %. Each article received an average of 16.48 citations. Different collaborative networks between countries were observed. In addition, there was a steady growth in published research in the field of tuberculosis and female infertility.
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Affiliation(s)
- Juan Alvitez
- Department of Social Medicine and Conduct, Faculty of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Luis Huarachi
- Department of Social Medicine and Conduct, Faculty of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Abigail Temoche
- Department of Social Medicine and Conduct, Faculty of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Miriam Rojas
- Department of Physiological Sciences, Faculty of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Daniel Alvitez-Temoche
- Academic Department, Faculty of Dentistry, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Fran Espinoza-Carhuancho
- Grupo de Bibliometria, Evaluacion de evidencia y Revisiones Sistematicas (BEERS), Human Medicine Career, Universidad Cientifica del Sur, Lima, Peru
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13
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Tang C, Wu L, Li M, Dai J, Shi Y, Wang Q, Xu F, Zheng L, Xiao X, Cai J, Zhang Y, Yang Y, Zheng X, Xiang G. High-throughput nanopore targeted sequencing for efficient drug resistance assay of Mycobacterium tuberculosis. Front Microbiol 2024; 15:1331656. [PMID: 38841074 PMCID: PMC11152171 DOI: 10.3389/fmicb.2024.1331656] [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: 11/01/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Drug-resistant tuberculosis (TB), especially multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB), is one of the urgent clinical problems and public health challenges. Culture-based phenotypic drug susceptibility testing (pDST) is time-consuming, and PCR-based assays are limited to hotspot mutations. In this study, we developed and validated a convenient and efficient approach based on high-throughput nanopore sequencing technology combined with multiplex PCR, namely nanopore targeted sequencing (NTS), to simultaneously sequence 18 genes associated with antibiotic resistance in Mycobacterium tuberculosis (MTB). The analytical performance of NTS was evaluated, and 99 clinical samples were collected to assess its clinical performance. The NTS results showed that MTB and its drug resistance were successfully identified in approximately 7.5 h. Furthermore, compared to the pDST and Xpert MTB/RIF assays, NTS provided much more drug resistance information, covering 14 anti-TB drugs, and it identified 20 clinical cases of drug-resistant MTB. The mutations underlying these drug-resistant cases were all verified using Sanger sequencing. Our approach for this TB drug resistance assay offers several advantages, including being culture-free, efficient, high-throughput, and highly accurate, which would be very helpful for clinical patient management and TB infection control.
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Affiliation(s)
- Chen Tang
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Laboratory Medicine, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lianpeng Wu
- Department of Clinical Laboratory, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Machao Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianyi Dai
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Ye Shi
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Laboratory Medicine, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiongdan Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Feng Xu
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Laboratory Medicine, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Laibao Zheng
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Laboratory Medicine, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xingxing Xiao
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Laboratory Medicine, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junwen Cai
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Laboratory Medicine, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yanjun Zhang
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Laboratory Medicine, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuting Yang
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Laboratory Medicine, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoqun Zheng
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Laboratory Medicine, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guangxin Xiang
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Laboratory Medicine, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Quiroz-Aldave JE, Durand-Vásquez MDC, Gamarra-Osorio ER, Concepción-Urteaga LA, Pecho-Silva S, Rodríguez-Hidalgo LA, Concepción-Zavaleta MJ. Drug-induced hypothyroidism in tuberculosis. Expert Rev Endocrinol Metab 2024; 19:199-206. [PMID: 38258451 DOI: 10.1080/17446651.2024.2307525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Adverse reactions to tuberculosis treatment can impact patient adherence and prognosis. Hypothyroidism is a frequent adverse reaction caused using ethionamide, prothionamide, and para-aminosalicylic acid and is often underdiagnosed. AREAS COVERED We searched Scielo, Scopus, and EMBASE databases, including 67 articles. Antitubercular drug-induced hypothyroidism has a prevalence of 17%. It occurs after 2 to 3 months of treatment and resolves within 4 to 6 weeks after discontinuation. It is postulated to result from the inhibition of thyroperoxidase function, blocking thyroid hormone synthesis. Symptoms are nonspecific, necessitating individualized thyroid-stimulating hormone measurement for detection. Specific guidelines for management are lacking, but initiation of treatment with levothyroxine, as is customary for primary hypothyroidism, is recommended. Discontinuation of antitubercular drugs is discouraged, as it may lead to unfavorable consequences. EXPERT OPINION Antitubercular drug-induced hypothyroidism is more common than previously thought, affecting one in six MDR-TB patients. Despite diagnostic and treatment recommendations, implementation is hindered in low-income countries due to the lack of certified laboratories. New drugs for tuberculosis treatment may affect thyroid function, requiring vigilant monitoring for complications, including hypothyroidism.
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Affiliation(s)
- Juan Eduardo Quiroz-Aldave
- Division of Non-communicable diseases, Endocrinology research line, Hospital de Apoyo Chepén, Chepén, Perú
| | | | | | | | - Samuel Pecho-Silva
- Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Perú
- Division of Pneumology, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
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Aispuro Pérez A, Osuna-Martínez U, Espinoza-Gallardo JA, Dorantes-Álvarez LA, Inzunza-Leyva GK, Dorantes-Bernal KE, Quiñonez-Bastidas GN. Prevalence of Drug-Resistant Tuberculosis in HIV-Positive and Diabetic Patients in Sinaloa, Mexico: A Retrospective Cross-Sectional Study. Trop Med Infect Dis 2024; 9:89. [PMID: 38668550 PMCID: PMC11054973 DOI: 10.3390/tropicalmed9040089] [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: 02/09/2024] [Revised: 03/11/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
Tuberculosis (TB) is a disease caused by the bacillus Mycobacterium tuberculosis (MTB). Human immunodeficiency virus (HIV) infection and type 2 diabetes mellitus (T2DM) are among the main risk factors for the development of TB and increase the risk of drug-resistant TB developing (DR-TB). The aim of this study was to estimate the prevalence of DR-TB in patients with HIV or T2DM in Sinaloa, Mexico. This was an observational and cross-sectional study. The analysis was conducted using the clinical data of patients registered on the National Epidemiological Surveillance System for TB (SINAVE/PUI-TB) platform with a presumed diagnosis of TB during 2019 to 2021 in Sinaloa, Mexico. The prevalence of DR-TB was estimated in HIV and T2DM patients, as well as the odds ratios for their sociodemographic variables, using the Chi-square test. There were 2, 4, and 4 TB-HIV cases and 2, 6, and 9 TB-T2DM cases during 2019, 2020, and 2021, respectively, whereas there were 2 and 1 DRTB-HIV and DRTB-T2DM cases, respectively. The results indicated that the WHO guidelines for DR-TB were not properly applied to this high-risk population. Hence, the appropriate application of guidelines for TB and DR-TB detection in these patients needs to be immediately implemented by the State health system.
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Affiliation(s)
- Analy Aispuro Pérez
- Facultad de Ciencias Químico-Biológicas, Universidad Autónoma de Sinaloa, Ciudad Universitaria, Culiacan 80013, Sinaloa, Mexico; (A.A.P.); (U.O.-M.)
| | - Ulises Osuna-Martínez
- Facultad de Ciencias Químico-Biológicas, Universidad Autónoma de Sinaloa, Ciudad Universitaria, Culiacan 80013, Sinaloa, Mexico; (A.A.P.); (U.O.-M.)
| | - Jose Angel Espinoza-Gallardo
- Coordinación Estatal de Tuberculosis, Servicios de Salud de Sinaloa, Secretaria de Salud Blvd, Alfonso Zaragoza Maytorena No. 2204, Fraccionamiento Bonanzas, Culiacan 80020, Sinaloa, Mexico (L.A.D.-Á.); (K.E.D.-B.)
| | - Luis Alfredo Dorantes-Álvarez
- Coordinación Estatal de Tuberculosis, Servicios de Salud de Sinaloa, Secretaria de Salud Blvd, Alfonso Zaragoza Maytorena No. 2204, Fraccionamiento Bonanzas, Culiacan 80020, Sinaloa, Mexico (L.A.D.-Á.); (K.E.D.-B.)
| | - Gerardo Kenny Inzunza-Leyva
- Coordinación Estatal de Tuberculosis, Servicios de Salud de Sinaloa, Secretaria de Salud Blvd, Alfonso Zaragoza Maytorena No. 2204, Fraccionamiento Bonanzas, Culiacan 80020, Sinaloa, Mexico (L.A.D.-Á.); (K.E.D.-B.)
| | - Kimberly Estefania Dorantes-Bernal
- Coordinación Estatal de Tuberculosis, Servicios de Salud de Sinaloa, Secretaria de Salud Blvd, Alfonso Zaragoza Maytorena No. 2204, Fraccionamiento Bonanzas, Culiacan 80020, Sinaloa, Mexico (L.A.D.-Á.); (K.E.D.-B.)
| | - Geovanna Nallely Quiñonez-Bastidas
- Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Eustaquio Buelna 91, Burocrata, Culiacan 80030, Sinaloa, Mexico
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Picanço L, Dutra RP, Saes MDO. [Temporal trend in the evaluation of adequate management for diagnosis and treatment of tuberculosis in primary health care in Brazil (2012-2018)]. CAD SAUDE PUBLICA 2024; 40:e00087723. [PMID: 38477729 DOI: 10.1590/0102-311xpt087723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/10/2023] [Indexed: 03/14/2024] Open
Abstract
This study aimed to analyze the presence of infrastructure and adequate work processes in primary health care (PHC) for the diagnosis, monitoring, and treatment of tuberculosis (TB) in Brazil from 2012 to 2018. This is a temporal trend study carried out with data from basic health units (BHU) evaluated in the cycles I (2012), II (2014), and III (2018) of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB). Variance-weighted least-squares regression was used to estimate annual changes, in percentage points, of the infrastructure and adequate work process of TB in relation to the macroregion, municipality size, Municipal Human Development Index, and Family Health Strategy coverage. The sample consisted of 13,842 BHU and 17,202 health teams in cycle I; 24,055 BHU and 29,778 teams in cycle II; and 28,939 BHU and 37,350 teams in cycle III. There was a gradual improvement in the proportion of infrastructure and work process for TB care over the three cycles of the PMAQ-AB, but none of the sites is fully adequate. The greatest trend of adequate infrastructure was observed in the South Region, and in 2018, 76.5% of the UBS had all the instruments for TB care. The greatest trend of adequate work process was in the North Region, and in 2018, 50.8% of the teams had all the items for TB care. The Brazilian National Program for Tuberculosis Control and the PMAQ-AB have contributed to these advances, but there is still a need to promote public policies that ensure the continuous improvement of TB care in PHC, the effectiveness of TB control and prevention measures.
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Affiliation(s)
- Larissa Picanço
- Universidade Federal do Rio Grande, Rio Grande, Brasil
- Hospital Escola, Universidade Federal de Pelotas, Pelotas, Brasil
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17
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Alarcon-Braga EA, Salazar-Valdivia FE, Estrada-Grossmann JM, Mendez-Guerra C, Pacheco-Barrios N, Al-Kassab-Córdova A. Pre-extensively drug-resistant and extensively drug-resistant tuberculosis in Latin America and the Caribbean: A systematic review and meta-analysis. Am J Infect Control 2024; 52:349-357. [PMID: 38061402 DOI: 10.1016/j.ajic.2023.12.001] [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: 08/04/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The growing threat from pre-extensively drug-resistant tuberculosis (pre-XDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) poses a major public health concern in Latin America and the Caribbean (LAC). Therefore, this study aimed to summarize the available evidence on the prevalence of pre-XDR-TB and XDR-TB among patients with multidrug-resistant tuberculosis in LAC. METHODS A systematic review was conducted in the following databases on June 3, 2023: PubMed, Scopus, Ovid Medline, Web of Science, Scielo and LILACS. We estimated pooled proportions using a random effects model (Dersimonian and Laird). The 95% confidence intervals (95% CI) were calculated using the binomial exact method (Clopper-Pearson Method). Subgroup (by time period and country) and sensitivity analyses were performed. RESULTS Twenty-nine studies were eligible for qualitative synthesis and 27 for meta-analysis (n = 15,565). The pooled prevalence of XDR-TB in the study participants was 5% (95% CI: 3%-6%), while that of pre-XDR-TB was 10% (95% CI 7%-14%). Cuba (6%, 95% CI 0%-17%) and Peru (6%, 95% CI 5%-7%) had the highest pooled prevalence of XDR-TB. Regarding pre-XDR-TB, Brazil (16%, 95% CI 11%-22%) and Peru (13%, 95% CI: 9%-16%) showed the highest prevalence. CONCLUSIONS The pooled prevalence of pre-XDR-TB and XDR-TB in LAC was 10% and 5%, respectively. Governments should strengthen drug-resistance surveillance and TB programs.
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Affiliation(s)
| | | | | | | | - Niels Pacheco-Barrios
- Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Peru; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Ali Al-Kassab-Córdova
- Centro de Excelencia en Estudios Sociales y Económicos en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
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Lv H, Zhang X, Zhang X, Bai J, You S, Li X, Li S, Wang Y, Zhang W, Xu Y. Global prevalence and burden of multidrug-resistant tuberculosis from 1990 to 2019. BMC Infect Dis 2024; 24:243. [PMID: 38388352 PMCID: PMC10885623 DOI: 10.1186/s12879-024-09079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Tuberculosis(TB) remains a pressing public health challenge, with multidrug-resistant tuberculosis (MDR-TB) emerging as a major threat. And healthcare authorities require reliable epidemiological evidence as a crucial reference to address this issue effectively. The aim was to offer a comprehensive epidemiological assessment of the global prevalence and burden of MDR-TB from 1990 to 2019. METHODS Estimates and 95% uncertainty intervals (UIs) for the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized disability-adjusted life years rate (ASR of DALYs), and age-standardized death rate (ASDR) of MDR-TB were obtained from the Global Burden of Disease (GBD) 2019 database. The prevalence and burden of MDR-TB in 2019 were illustrated in the population and regional distribution. Temporal trends were analyzed by using Joinpoint regression analysis to calculate the annual percentage change (APC), average annual percentage change (AAPC) and its 95% confidence interval(CI). RESULTS The estimates of the number of cases were 687,839(95% UIs: 365,512 to 1223,262), the ASPR were 8.26 per 100,000 (95%UIs: 4.61 to 15.20), the ASR of DALYs were 52.38 per 100,000 (95%UIs: 22.64 to 97.60) and the ASDR were 1.36 per 100,000 (95%UIs: 0.54 to 2.59) of MDR-TB at global in 2019. Substantial burden was observed in Africa and Southeast Asia. Males exhibited higher ASPR, ASR of DALYs, and ASDR than females across most age groups, with the burden of MDR-TB increasing with age. Additionally, significant increases were observed globally in the ASIR (AAPC = 5.8; 95%CI: 5.4 to 6.1; P < 0.001), ASPR (AAPC = 5.9; 95%CI: 5.4 to 6.4; P < 0.001), ASR of DALYs (AAPC = 4.6; 95%CI: 4.2 to 5.0; P < 0.001) and ASDR (AAPC = 4.4; 95%CI: 4.0 to 4.8; P < 0.001) of MDR-TB from 1990 to 2019. CONCLUSIONS This study underscored the persistent threat of drug-resistant tuberculosis to public health. It is imperative that countries and organizations worldwide take immediate and concerted action to implement measures aimed at significantly reducing the burden of TB.
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Affiliation(s)
- Hengliang Lv
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xin Zhang
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xueli Zhang
- Changchun University of Chinese Medicine, Changchun, China
| | - Junzhu Bai
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Shumeng You
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xuan Li
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Shenlong Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yong Wang
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Wenyi Zhang
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China.
- Chinese PLA Center for Disease Control and Prevention, Beijing, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.
| | - Yuanyong Xu
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China.
- Chinese PLA Center for Disease Control and Prevention, Beijing, China.
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Stephen S, Kadye A, Majuru XN, Madamombe T, Sokwe J, Madondo T, Tinarwo K, Tsuvani L, Kawome T, Malunga F, Simbi R. Diagnostic Performance of STANDARD™ M10 Multidrug-resistant Tuberculosis Assay for Detection of Mycobacterium tuberculosis and Rifampicin and Isoniazid Resistance in Zimbabwe. Int J Mycobacteriol 2024; 13:22-27. [PMID: 38771275 DOI: 10.4103/ijmy.ijmy_194_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/12/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Although Zimbabwe has transitioned out of the 30 high-burden countries, it still remained in the 30 high multidrug-resistant (MDR)/rifampicin-resistant tuberculosis (TB) burden. Rapid detection of rifampicin (RIF) and isoniazid (INH) is essential for the diagnosis of MDR-TB. The World Health Organization has recommended the use of molecular WHO-recommended rapid diagnostic (mWRD) for TB and DR-TB. STANDARD™ M10 MDR-TB assay is a new molecular rapid diagnostic assay developed by SD Biosensor for the detection of Mycobacterium tuberculosis (MTB) and RIF and INF resistance. This study aims to determine the diagnostic accuracy of STANDARD™ M10 MDR-TB assay. METHODS The study was conducted on 214 samples with different MTB and RIF and INH resistance status. The STANDARD™ M10 MDR-TB assay was performed according to the manufacturer's instructions. Xpert MTB/RIF Ultra, MGIT culture, and phenotypic drug susceptibility testing are used as comparative methods. RESULTS The sensitivity and specificity of STANDARD™ M10 MDR-TB assay for the detection of MTB are 99% and 97.9%, respectively. The sensitivity and specificity of the assay for detection of MDR-TB were 97.8% and 100%, respectively. CONCLUSION The STANDARD™ M10 MDR-TB assay demonstrated high diagnostic accuracy in the detection of MTB and RIF and INH resistance. This molecular assay can also be used as an alternative to other mWRD assays.
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Affiliation(s)
- Stephen Stephen
- National Microbiology Reference Laboratory-Tuberculosis (NMRL-TB), Sally Mugabe Central Hospital, Lobengula Street, Southerton, Harare, Zimbabwe
| | - Agrippa Kadye
- National Microbiology Reference Laboratory-Tuberculosis (NMRL-TB), Sally Mugabe Central Hospital, Lobengula Street, Southerton, Harare, Zimbabwe
| | - Xmas Ngoni Majuru
- National Microbiology Reference Laboratory-Tuberculosis (NMRL-TB), Sally Mugabe Central Hospital, Lobengula Street, Southerton, Harare, Zimbabwe
| | - Tariro Madamombe
- National Microbiology Reference Laboratory-Tuberculosis (NMRL-TB), Sally Mugabe Central Hospital, Lobengula Street, Southerton, Harare, Zimbabwe
| | - Janet Sokwe
- National Microbiology Reference Laboratory-Tuberculosis (NMRL-TB), Sally Mugabe Central Hospital, Lobengula Street, Southerton, Harare, Zimbabwe
| | - Tinashe Madondo
- National Microbiology Reference Laboratory-Tuberculosis (NMRL-TB), Sally Mugabe Central Hospital, Lobengula Street, Southerton, Harare, Zimbabwe
| | - Kennedy Tinarwo
- National Microbiology Reference Laboratory-Tuberculosis (NMRL-TB), Sally Mugabe Central Hospital, Lobengula Street, Southerton, Harare, Zimbabwe
| | - Linnience Tsuvani
- National Microbiology Reference Laboratory-Tuberculosis (NMRL-TB), Sally Mugabe Central Hospital, Lobengula Street, Southerton, Harare, Zimbabwe
| | - Takudzwa Kawome
- National Microbiology Reference Laboratory-Tuberculosis (NMRL-TB), Sally Mugabe Central Hospital, Lobengula Street, Southerton, Harare, Zimbabwe
| | - Florence Malunga
- National Microbiology Reference Laboratory-Tuberculosis (NMRL-TB), Sally Mugabe Central Hospital, Lobengula Street, Southerton, Harare, Zimbabwe
| | - Raiva Simbi
- Directorate of Laboratory Services, Ministry of Health and Child Care, Kaguvi Building, Fourth Street, Causeway, Harare, Zimbabwe
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Usmael K, Manyazewal T, Mohammed H, Yimer G, Oljira L, Roba KT, Hailemariam T, Adjeme T, Tesfaye D, Bisrat H, Ngadaya E, Woldeamanuel Y. Patterns of childhood tuberculosis diagnosis in Ethiopia: A multicenter cross-sectional study. RESEARCH SQUARE 2023:rs.3.rs-3758745. [PMID: 38234744 PMCID: PMC10793511 DOI: 10.21203/rs.3.rs-3758745/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Children share 12% of the global 10 million people infected with tuberculosis (TB) each year. Closing case detection gap in children remains difficult, with 56% of all children and 65% under-five with TB missed each year. We aimed to assess the patterns of childhood TB diagnosis and underlying determinants in Ethiopia when different TB diagnostic platforms are applied. Methods A multi-site, cross-sectional study was carried out in Ethiopia as part of the larger EXIT-TB study - evidence-based multiple focused integrated intensified TB screening package. Outpatient children aged ≤ 15 with cough of any duration seeking care at four healthcare facilities in Ethiopia were enrolled consecutively. Participants underwent sputum Xpert MTB/RIF and/or smear microscopy and posteroanterior chest X-ray (CXR), and their clinical and sociodemographic data were captured using a structured questionnaire. Data were analyzed using Stata version 23. Multiple regression model was computed to determine the factors that influence TB case detection, with a 95% confidence interval (CI) and p < 0.05 taken as statistically significant. Results A total of 438 children were enrolled. Of these, 399 had CXR examination of which 55 (13.8%) were suggestive of TB, 270 had Xpert MTB/RIF testing of which 32 (11.9%) were positive, and AFB smear microscopy was done for 51 children of which 2 (3.9%) were positive. Febrile children were more likely to be diagnosed with pulmonary TB than those without fever [aPR = 1.3, 95% CI (1.1-1.4)], and those with a TB contact history were more likely to be diagnosed with pulmonary TB than those with no such contacts [aPR = 1.2, 95% CI (1.1-1.3)]. Children from rural residences were more likely to be diagnosed with TB than those from urban residences [aPR = 1.3, 95% CI (1.1-1.5)]. Conclusion The findings showed that clinical diagnosis remains an important method of TB diagnosis in children and the preferred choice to avert underdiagnosis. A more sensitive TB diagnostic method for children was symptom screening, followed by CXR and Xpert MTB/RIF assay or smear microscopy. Hence, an algorithm that combines clinical, CXR, and microbiological confirmatory tests can improve the rate of pulmonary TB diagnosis in children till more accurate and cost-effective diagnostic tools are accessible. Fever, weight loss, and TB contact history are highly associated with TB positivity rates in children.
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Mori M, Villa S, Chiarelli LR, Meneghetti F, Bellinzoni M. Structural Study of a New MbtI-Inhibitor Complex: Towards an Optimized Model for Structure-Based Drug Discovery. Pharmaceuticals (Basel) 2023; 16:1559. [PMID: 38004425 PMCID: PMC10675255 DOI: 10.3390/ph16111559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
MbtI from Mycobacterium tuberculosis (Mtb) is a Mg2+-dependent salicylate synthase, belonging to the chorismate-utilizing enzyme (CUE) family. As a fundamental player in iron acquisition, MbtI promotes the survival and pathogenicity of Mtb in the infected host. Hence, it has emerged in the last decade as an innovative, potential target for the anti-virulence therapy of tuberculosis. In this context, 5-phenylfuran-2-carboxylic acids have been identified as potent MbtI inhibitors. The first co-crystal structure of MbtI in complex with a member of this class was described in 2020, showing the enzyme adopting an open configuration. Due to the high mobility of the loop adjacent to the binding pocket, large portions of the amino acid chain were not defined in the electron density map, hindering computational efforts aimed at structure-driven ligand optimization. Herein, we report a new, high-resolution co-crystal structure of MbtI with a furan-based derivative, in which the closed configuration of the enzyme allowed tracing the entirety of the active site pocket in the presence of the bound inhibitor. Moreover, we describe a new crystal structure of MbtI in open conformation and in complex with the known inhibitor methyl-AMT, suggesting that in vitro potency is not related to the observed enzyme conformation. These findings will prove fundamental to enhance the potency of this series via rational structure-based drug-design approaches.
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Affiliation(s)
- Matteo Mori
- Department of Pharmaceutical Sciences, University of Milan, Via L. Mangiagalli 25, 20133 Milano, Italy; (M.M.); (S.V.); (F.M.)
| | - Stefania Villa
- Department of Pharmaceutical Sciences, University of Milan, Via L. Mangiagalli 25, 20133 Milano, Italy; (M.M.); (S.V.); (F.M.)
| | - Laurent R. Chiarelli
- Department of Biology and Biotechnology “Lazzaro Spallanzani”, University of Pavia, Via A. Ferrata 9, 27100 Pavia, Italy;
| | - Fiorella Meneghetti
- Department of Pharmaceutical Sciences, University of Milan, Via L. Mangiagalli 25, 20133 Milano, Italy; (M.M.); (S.V.); (F.M.)
| | - Marco Bellinzoni
- Institut Pasteur, Université Paris Cité, CNRS UMR3528, Unité de Microbiologie Structurale, F-75015 Paris, France
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22
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Liu Y, Zhang L, Wu F, Liu Y, Li Y, Chen Y. Identification and validation of a pyroptosis-related signature in identifying active tuberculosis via a deep learning algorithm. Front Cell Infect Microbiol 2023; 13:1273140. [PMID: 38029270 PMCID: PMC10646574 DOI: 10.3389/fcimb.2023.1273140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Active tuberculosis (ATB), instigated by Mycobacterium tuberculosis (M.tb), rises as a primary instigator of morbidity and mortality within the realm of infectious illnesses. A significant portion of M.tb infections maintain an asymptomatic nature, recognizably termed as latent tuberculosis infections (LTBI). The complexities inherent to its diagnosis significantly hamper the initiatives aimed at its control and eventual eradication. Methodology Utilizing the Gene Expression Omnibus (GEO), we procured two dedicated microarray datasets, labeled GSE39940 and GSE37250. The technique of weighted correlation network analysis was employed to discern the co-expression modules from the differentially expressed genes derived from the first dataset, GSE39940. Consequently, a pyroptosis-related module was garnered, facilitating the identification of a pyroptosis-related signature (PRS) diagnostic model through the application of a neural network algorithm. With the aid of Single Sample Gene Set Enrichment Analysis (ssGSEA), we further examined the immune cells engaged in the pyroptosis process in the context of active ATB. Lastly, dataset GSE37250 played a crucial role as a validating cohort, aimed at evaluating the diagnostic prowess of our model. Results In executing the Weighted Gene Co-expression Network Analysis (WGCNA), a total of nine discrete co-expression modules were lucidly elucidated. Module 1 demonstrated a potent correlation with pyroptosis. A predictive diagnostic paradigm comprising three pyroptosis-related signatures, specifically AIM2, CASP8, and NAIP, was devised accordingly. The established PRS model exhibited outstanding accuracy across both cohorts, with the area under the curve (AUC) being respectively articulated as 0.946 and 0.787. Conclusion The present research succeeded in identifying the pyroptosis-related signature within the pathogenetic framework of ATB. Furthermore, we developed a diagnostic model which exuded a remarkable potential for efficient and accurate diagnosis.
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Affiliation(s)
- Yuchen Liu
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, China
- Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lifan Zhang
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, China
- Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengying Wu
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, China
- Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Liu
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, China
- Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanchun Li
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, China
- Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Chen
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, China
- Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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23
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Joshi T, Nain P, Bhamra P, Kaur J. Favorable clinical outcomes and anti-mycobacterial efficacy of pretomanid in patients with highly resistant tuberculosis: A review. Indian J Tuberc 2023; 71 Suppl 1:S130-S135. [PMID: 39067944 DOI: 10.1016/j.ijtb.2023.09.011] [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: 06/27/2022] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 07/30/2024]
Abstract
Rising cases of drug resistance of mycobacterium species are one of the biggest concerns when the goal is to eradicate TB (Tuberculosis) from the world by the year 2030. A limited number of treatment options as MTB (Mycobacterium tuberculosis) is getting resistant to anti-mycobacterial drugs either due to a patient's non-compliance towards treatment regimen or if a patient is infected by drug-resistant species of MTB. This review aims to assess the effectiveness of pretomanid, a recently approved drug for the treatment of extensively drug-resistant TB. A thorough search of databases like PubMed, Cochrane library, CDC, Research Gate, and Google scholar was used in order to find case reports and clinical trials providing data on the efficacy of pretomanid in different drug regimens. According to research trials conducted, the drug appears to be efficacious, safe, and well-tolerable. Only headache was the most frequently observed adverse drug event, and a high dose-related increase in serum creatinine level was seen, which came to normal after the drug was discontinued.
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Affiliation(s)
- Tanishq Joshi
- Department of Pharmacy Practice, MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala 133207, India
| | - Parminder Nain
- Department of Pharmacy Practice, CT Institute of Pharmaceutical Sciences, Shahpur, Jalandhar, Punjab 144020, India
| | - Prajwal Bhamra
- Department of Pharmacy Practice, MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala 133207, India
| | - Jaspreet Kaur
- Department of Pharmacy Practice, CT Institute of Pharmaceutical Sciences, Shahpur, Jalandhar, Punjab 144020, India.
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