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Wubu B, Million Y, Gizachew M. Mycobacterium tuberculosis and human immunodeficiency virus co-infection and associated variables among presumptive pulmonary tuberculosis patients in Ethiopia; a health institution based cross-sectional study. Heliyon 2024; 10:e30939. [PMID: 38765044 PMCID: PMC11097054 DOI: 10.1016/j.heliyon.2024.e30939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/21/2024] Open
Abstract
Background Co-infection of Mycobacterium tuberculosis (MTB) and the Human Immunodeficiency Virus (HIV) is a major global public health issue, particularly in border areas of resource-limited nations, including Ethiopia. Objective To explore the prevalence and associated variables of MTB/HIV co-infection among PTB presumptive patients in Northwest Ethiopia. Methods From February to August 2021, a cross-sectional institutional investigation was conducted at the Metema and Abrehajira hospitals. Semi-structured questionnaires were used to collect socio-demographic and clinical data. The MTB/RIF Xpert assay was used to process sputum, and 3 ml of veins blood was collected for HIV rapid test (STAT-PAK, ABON, and SD BIOLINE HIV test algorithm) following the Ethiopian National HIV test algorithm. The Gene Xpert assay's sample processing control was checked to ensure data quality. Data entered into Epi-Data were exported to SPSS version 20 for analysis. Statistically significant variables (p-value ≤0.2) from bivariable analysis were included in multivariable analysis. A p-value ≤ 0.05 was judged statistically significant. Results This study included 314 PTB presumptive patients with a median age of 35.0 years, of which 178 (56.69 %) were males. Among all patients, 40(12.7 %) and 51(16.2 %) were PTB, and HIV seropositivity, respectively. Of the PTB patients, 14/40 (35 %) (95 % CI: 24.4-45.6) were co-infected with HIV/AIDS. Married patients were 70 % less likely than unmarried individuals (AOR = 0.3 CI; 0.07-0.98) to have MTB/HIV co-infection. Patients who had contact history with MDR-TB patients (AOR = 5 CI; 1.37-18.00), and those who had a history of alcohol use (AOR = 12.2 CI; 2.56-57.8) were more likely to have MTB-HIV co-infection than their peers. Conclusion Our findings showed that MTB-HIV co-infection is one of the most important community health concerns in the study area. Therefore, MTB/HIV cooperation activities should be fully in place to prevent co-infection and its impact on the population.
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Affiliation(s)
- Birhanu Wubu
- Department of Clinical Laboratory, Abrihajira Hospital, Amhara National Regional State, Abrihajira, Ethiopia
| | - Yihenew Million
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mucheye Gizachew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Engida HA, Gathungu DK, Ferede MM, Belay MA, Kawe PC, Mataru B. Optimal control and cost-effectiveness analysis for the human melioidosis model. Heliyon 2024; 10:e26487. [PMID: 38434022 PMCID: PMC10906177 DOI: 10.1016/j.heliyon.2024.e26487] [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: 05/17/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024] Open
Abstract
In this work, we formulated and investigated an optimal control problem of the melioidosis epidemic to explain the effectiveness of time-dependent control functions in controlling the spread of the epidemic. The basic reproduction number ( R 0 c ) with control measures is obtained, using the next-generation matrix approach and the impact of the controls on R 0 c is illustrated numerically. The optimal control problem is analyzed using Pontryagin's maximum principle to derive the optimality system. The optimality system is simulated using the forward-backward sweep method based on the fourth-order Runge-Kutta method in the MATLAB program to illustrate the impact of all the possible combinations of the control interventions on the transmission dynamics of the disease. The numerical results indicate that among strategies considered, strategy C is shown to be the most effective in reducing the number of infectious classes compared to both strategy A and strategy B. Furthermore, we carried out a cost-effectiveness analysis to determine the most cost-effective strategy and the result indicated that the strategy B (treatment control strategy) should be recommended to mitigate the spread and impact of the disease regarding the costs of the strategies.
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Affiliation(s)
- Habtamu Ayalew Engida
- Department of Applied Mathematics, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Duncan Kioi Gathungu
- Department of Mathematics, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200 City Square, Nairobi, Kenya
| | | | - Malede Atnaw Belay
- Department of Applied Mathematics, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Patiene Chouop Kawe
- Department of Mathematics, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200 City Square, Nairobi, Kenya
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Getahun GK, Gezahegn E, Endazenawe G, Shitemaw T, Negash Z, Dessu S. Survival status and risk factors for mortality among multidrug-resistant tuberculosis patients in Addis Ababa, Ethiopia: A retrospective follow-up study. J Clin Tuberc Other Mycobact Dis 2023; 33:100398. [PMID: 37767135 PMCID: PMC10520522 DOI: 10.1016/j.jctube.2023.100398] [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] [Indexed: 09/29/2023] Open
Abstract
Background Tuberculosis continues to be a major health concern around the world. It kills an estimated 1.6 million people each year. The World Health Organization (WHO) removed Ethiopia from its list of thirty countries having a high prevalence of MDR/RR-TB in 2021. As a result, the aim of this study was to assess the current context of survival status and risk factors of multidrug-resistant tuberculosis patients in Addis Ababa, Ethiopia, in 2022. Methods An institutional-based retrospective cohort study with 245 patients was undertaken using multidrug-resistant tuberculosis patients who were recruited from January 1st, 2018 to December 30th, 2021, in St. Peter's specialized hospital. To find independent predictors of survival status, Cox regression analysis was used. An adjusted hazard ratio with a 95% confidence interval and a p-value of < 0.05 was used to establish association and statistical significance. Results The result of the study revealed that the incidence of mortality in this study was 13.1% (95% CI: 10.3-16.5). Moreover, being male (AOR = 3.7: 95% CI = 1.2, 11.4), old age (AOR = 14: 95% CI = 3.0, 60.4), site of TB (AOR = 0.2: 95% CI = 0.03, 0.6), and presence of comorbidity (AOR = 9.2: 95% CI = 2.4, 35.3), were independent predictors of time to death. Conclusion Generally, the death rate among research participants was high. Moreover, male gender, old age, site of tuberculosis, and presence of other comorbidity were predictors of mortality among MDR-TB patients.
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Affiliation(s)
| | | | | | | | | | - Samuel Dessu
- College of Medicine and Health Sciences, Wolkite University, Ethiopia
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4
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Klowak M, Boggild AK. The efficacy of a whole foods, plant-based dietary lifestyle intervention for the treatment of peripheral neuropathic pain in leprosy: a randomized control trial protocol. Front Nutr 2023; 10:1196470. [PMID: 37469546 PMCID: PMC10352581 DOI: 10.3389/fnut.2023.1196470] [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: 03/29/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Despite effective treatment of leprosy via WHO-approved multi-drug therapy (MDT), patients still suffer from debilitating neuropathic sequelae, including peripheral neuropathic pain (PNP), and continue to develop intercurrent etiologies (such as diabetes), and progressive existing neuropathy over time. Strategies seeking to improve physiological and metabolic wellness, including those that reduce systemic inflammation and enhance immune responsiveness to neurotoxic factors may influence underlying neuropathic etiologies. A whole food plant-based diet (WFPBD) has been shown to be effective in the management of neuropathic pain due to diabetes, limiting severity and relevant symptomology. Diabetes remains a significant sequela of leprosy, as up to 50% of patients in reaction requiring corticosteroids, may develop a biochemical diabetes. As nutritional interventions may modulate both leprosy and diabetes, a specific exploration of these relationships remains relevant. Objectives (1) To demonstrate the effect of a WFPBD lifestyle intervention, on neuropathic pain variables in leprosy; and (2) To contextualize the significance of diet in the treatment of chronic sequelae in leprosy by evaluating tolerability and side effect profile. Methods A prospective, randomized, controlled, single-blind, multicentre interventional trial is described. Weekly one-hour dietary counseling sessions promoting a WFPBD emphasizing vegetables, fruits, whole-grains, nuts, and legumes, omitting animal products, and limiting fat intake over a six-month duration will be implemented. Participants will be 70 age and sex-matched individuals experiencing active or treated "cured" leprosy and PNP, randomized to either intervention or control groups. Primary outcome measures include efficacy via visual analog scale, subjective questionnaire and objective quantitative sensory testing, as well as safety, tolerability, and harms of a WFPBD on PNP in leprosy. This study will be initiated after Research Ethics Board (REB) approval at all participating sites, and in advance of study initiation, the trial will be registered at ClinicalTrials.gov. Expected impact It is hypothesized that WFPBDs will mitigate progression and severity of PNP and potentially reduce the adverse events related to standard corticosteroid treatment of leprosy reactions, thereby reducing disease severity. By examining the effects of WFPBDs on PNP in leprosy, we hope to illuminate data that will lead to the enhanced therapeutic management of this neglected tropical disease.
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Affiliation(s)
- Michael Klowak
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Andrea K. Boggild
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Tropical Disease Unit, Toronto General Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Hawwas HAEH, Aboueisha AKM, Fadel HM, El-Mahallawy HS. Salmonella serovars in sheep and goats and their probable zoonotic potential to humans in Suez Canal Area, Egypt. Acta Vet Scand 2022; 64:17. [PMID: 35906669 PMCID: PMC9336019 DOI: 10.1186/s13028-022-00637-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Salmonella is one of the most common and economically important zoonotic pathogens. This study aimed to determine the occurrence of Salmonella serovars in sheep and goats and their probable zoonotic risk to humans in Suez Canal area in Egypt. A total of 320 fecal samples from sheep (n = 120), goats (n = 100), and humans (n = 100) were collected and examined for the presence of Salmonella based on cultural and biochemical characteristics, and serological analysis. Moreover, the virulence of the identified Salmonella isolates was assessed by molecular screening for invA, stn, spvC, and sopB virulence genes using PCR. RESULTS Overall, the occurrence of Salmonella in sheep feces (23.3%) was higher than that in goat feces (7%) and human stool (13%) in the study area. The identified isolates belonged to 12 serotypes; ten, five, and eight from sheep, goats, and humans, respectively. The most frequently identified serotypes were S. Typhimurium from sheep feces, and S. Enteritidis from both goat feces and human stool, with four serotypes; S. Typhimurium, S. Enteritidis, S. Dublin and S. Saintpaul, were mutually shared between all of them. Demographic data revealed that diarrheic sheep (85.7%) and goats (25%) had a higher risk for Salmonella fecal carriage than non-diarrheic ones (19.5% and 6.25%, respectively). The prevalence of Salmonella infection in humans in contact with sheep and goats (28%) was significantly higher than its prevalence in people having a history of contact with animals other than sheep and goats (10%) and those having no history of animal contact (7.3%) (χ2 = 6.728, P ˂ 0.05). The stn, spvC, and sopB genes were detected in 98.1% of the isolates, with a significant, very strong positive correlation for their mutual presence (P < 0.05). Approximately 40.7% of isolates that carried the invA gene had a non-significant, very weak positive correlation with other virulence genes. The most common genotypic virulence profile for all isolates was stn, spvC, and sopB; however, invA, stn, spvC, and sopB was the frequent virulotype for S. Typhimurium, S. Tsevie, S. Apeyeme, and S. Infantis. CONCLUSIONS The present study highlights the role of apparently healthy and diarrheic sheep and goats as reservoirs and sources of human infection with virulent Salmonella serovars in the Suez Canal area.
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Affiliation(s)
- Hanan Abd El-Halim Hawwas
- Department of Hygiene, Zoonoses and Animal Behaviour, Faculty of Veterinary Medicine, Suez Canal University, 4.5 Kilo Ring Road St., Ismailia, 41522 Egypt
| | - Abdel-Karim Mahmoud Aboueisha
- Department of Hygiene, Zoonoses and Animal Behaviour, Faculty of Veterinary Medicine, Suez Canal University, 4.5 Kilo Ring Road St., Ismailia, 41522 Egypt
| | - Hanaa Mohamed Fadel
- Department of Hygiene, Zoonoses and Animal Behaviour, Faculty of Veterinary Medicine, Suez Canal University, 4.5 Kilo Ring Road St., Ismailia, 41522 Egypt
| | - Heba Sayed El-Mahallawy
- Department of Hygiene, Zoonoses and Animal Behaviour, Faculty of Veterinary Medicine, Suez Canal University, 4.5 Kilo Ring Road St., Ismailia, 41522 Egypt
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Badgeba A, Shimbre MS, Gebremichael MA, Bogale B, Berhanu M, Abdulkadir H. Determinants of Multidrug-Resistant Mycobacterium tuberculosis Infection: A Multicenter Study from Southern Ethiopia. Infect Drug Resist 2022; 15:3523-3535. [PMID: 35818450 PMCID: PMC9270894 DOI: 10.2147/idr.s363628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) continues to be a public health problem. Globally in 2019, a total of 465,000 people developed rifampicin-resistant TB (RR-TB), of which 78% had MDR-TB. There is a paucity of evidence on the determinants of MDR-TB in southern Ethiopia. Hence, this study aimed to assess the determinants of MDR-TB in southern Ethiopia. Methods A hospital-based case-control study was conducted in southern Ethiopia. The cases were all MDR-TB patients attending TB clinics, and controls were all patients who were declared as cured or treatment completed. The cases were selected by consecutive sampling, and a simple random sampling technique was used for controls. Multivariable logistic regression analysis was done to identify determinants of MDR-TB. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were computed, and statistical significance was declared at a P-value less than 5%. Results A total of 191 participants, 67 cases, and 124 controls were included. TB patients facing social stigma (AOR = 8.9, 95% CI: 2.3-34.6), living in a household with one room (AOR = 12.3, 95% CI: 2.3-63.5), and two rooms (AOR = 9.7, 95% CI: 1.7-54.8), having the previous history of TB treatment (AOR = 11.8, 95% CI: 2.9-47), having baseline body mass index (BMI) less than 18.5Kg/m2(AOR = 4.5, 95% CI: 1.2-16.8), and having pulmonary TB (AOR = 5.1, 95% CI: 1.33-19.8) were determinants of MDR-TB. Conclusion In this study, TB patients facing social stigma, living in one- and two-roomed houses, having a previous history of TB treatment, having low baseline BMI and pulmonary type of TB had higher odds of MDR-TB. Therefore, health workers in TB control programs should include mental health services in the TB care protocol, and priority should be given to malnutrition screening as a first-line diagnosis, nutritional supplements, and health education about proper housing.
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Affiliation(s)
- Abdulkerim Badgeba
- Department of Public Health, College of Medicine and Health Sciences, Werabe University, Werabe, Ethiopia
| | - Mulugeta Shegaze Shimbre
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | | | - Biruk Bogale
- School of Public Health, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Menur Berhanu
- Ohio State University Global One-Health Initiatives, Arba Minch, Ethiopia
| | - Hanan Abdulkadir
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Abera EG, Yeshitla W, Kene K, Gerema U, Assefa Y. Comparing the Treatment Outcomes of Tuberculosis Patients in a Private Clinic with a Governmental Health Center in Jimma City, Ethiopia: Retrospective Study. Infect Drug Resist 2022; 15:2491-2511. [PMID: 35586560 PMCID: PMC9109888 DOI: 10.2147/idr.s354855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis (TB) is a common and often deadly infectious disease caused by various strains of mycobacterium, usually mycobacterium tuberculosis in humans. The disease has major causes of morbidity and mortality, particularly where the diagnostic and control program is not far extended. Objective To compare the treatment outcomes of tuberculosis patients in a private clinic with a governmental health center in Jimma city, Ethiopia. Methods A 10-year cross-sectional retrospective systemic record review was conducted to compare the treatment outcomes, and to describe the socio-demographic factors associated with the outcome in a private clinic with a governmental health center in Jimma city, Jimma, Ethiopia from September 12, 2007, to September 10, 2017. Finally, SPSS/EPI INFO analyzed data. Results The present study revealed that within a 10 year duration the private clinic gives anti-TB treatment coverage for 582 patients whereas the governmental health center treats 510 patients. The treatment success rate of the private clinic is 98.1% which is 1.03-fold that of the governmental health center (95.3%); while the treatment failure of the private clinic was 0.2%, but there was no treatment failure in the governmental health center. Conclusion Both sectors achieved the expected WHO targets by newly recommended strategy for TB treatment, DOTS (Directly Observed Treatment Short Course) and treatment success is much better to standard. This shows good progress of DOTS strategy and a decrease of noncompliance in this area. Age, educational level, and the types of TB diagnosis and treatment outcome of the patients were statistically associated in both sectors. Better counseling and awareness about the disease should have to be given for every anti-TB treatment receiving patients, despite their educational level and occupational status in both sectors.
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Affiliation(s)
- Eyob Girma Abera
- Department of Public Health, Jimma University, Jimma, Oromia, Ethiopia
- Correspondence: Eyob Girma Abera, Department of Public Health, Jimma University, PO Box 378, Jimma University, Jimma, Oromia, Ethiopia, Tel +251910093601, Email ;
| | | | - Kumsa Kene
- Department of Biomedical Science, Jimma University, Jimma, Oromia, Ethiopia
| | - Urge Gerema
- Department of Biomedical Science, Jimma University, Jimma, Oromia, Ethiopia
| | - Yared Assefa
- Department of Civil Engineering, Jimma University, Jimma, Oromia, Ethiopia
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8
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Klowak M, Boggild AK. A review of nutrition in neuropathic pain of leprosy. Ther Adv Infect Dis 2022; 9:20499361221102663. [PMID: 35677111 PMCID: PMC9168857 DOI: 10.1177/20499361221102663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 05/03/2022] [Indexed: 11/15/2022] Open
Abstract
Leprosy is a neglected tropical disease (NTD) that continues to burden low- and middle-income countries (LMICs), despite being eliminated as a public health concern by the World Health Organization (WHO) in 2000. The causative agents, Mycobacterium leprae and Mycobacterium lepromatosis, affect nearly 200,000 individuals globally each year, with over 19,000 new cases detected in the Americas in 2020 alone. Canada has experienced an increasing incidence of leprosy, due to rising levels of travel and migration from endemic areas, reaching over 37,000 individuals with leprosy by the end of 2020. Patients experience a spectrum of signs and symptoms including hypopigmented cutaneous macules alongside peripheral neuropathy including peripheral neuropathic pain (PNP) and disabling sensory neuropathies. Despite the development of effective and curative therapeutics via multidrug therapy (MDT), many barriers to treatment adherence and effective immunological control of the pathogen challenge the care of patients with leprosy. Socioeconomic barriers, such as disability-related social stigma and often undiagnosed nutritional deficiencies, have resulted in heightened disease severity. PNP therapeutics are associated with significant side effects and remain ineffective as the majority of individuals will not experience a greater than 30% reduction of symptoms. Nutrient supplementation is known to be instrumental in reducing host oxidative stress, strengthening the immune system and mitigating comorbidities. Likewise, dietary lifestyle interventions known to be physiologically beneficial have recently emerged as powerful tools conferring neuroprotective effects, potentially mitigating PNP severity. However, a significant knowledge gap concerning the effect of adequate nutrition on host immunological control of leprosy and PNP severity exists. Further evaluation of this relationship will provide key insight into the pathogenesis of leprosy, strengthening the current body of literature.
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Affiliation(s)
- Michael Klowak
- Institute of Medical Science, University of
Toronto, Toronto, ON, Canada
| | - Andrea K. Boggild
- Tropical Disease Unit, Toronto General
Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4, Canada
- Institute of Medical Science, University of
Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto,
Toronto, ON, Canada
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9
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Faust L, Klowak M, MacRae C, Kopalakrishnan S, Showler AJ, Boggild AK. Ofloxacin-Containing Multidrug Therapy in Ambulatory Leprosy Patients: A Case Series. J Cutan Med Surg 2020; 25:45-52. [PMID: 32869655 DOI: 10.1177/1203475420952437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Standard dapsone and clofazimine-containing multidrug therapy (MDT) for leprosy is limited by drug tolerability, which poses treatment adherence barriers. Although ofloxacin-based regimens are promising alternatives, current efficacy and safety data are limited, particularly outside of endemic areas. We evaluated treatment outcomes in patients with leprosy receiving ofloxacin-containing MDT (OMDT) at our center. METHODS We performed a retrospective chart review of patients treated for leprosy at our center over an 8-year period (2011-2019). Primary outcomes evaluated were clinical cure rate, occurrence of leprosy reactions, antibiotic-related adverse events, and treatment adherence. Analyses were descriptive; however, data were stratified by age, sex, spectrum of disease, region of origin, and treatment regimen, and odds ratios were reported to assess associations with adverse outcomes. RESULTS Over the enrolment period, 26 patients were treated with OMDT (n = 19 multibacillary, n = 7 paucibacillary), and none were treated with clofazimine-based standard MDT. At the time of analysis, 23 patients (88%) had completed their course of treatment, and all were clinically cured, while 3 (12%) were still on treatment. Eighteen patients (69%) experienced either ENL (n = 7, 27%), type 1 reactions (n = 7, 27%), or both (n = 4, 15%). No patients stopped ofloxacin due to adverse drug effects, and there were no cases of allergic hypersensitivity, tendinopathy or rupture, or C. difficile colitis. CONCLUSIONS We demonstrate a high cure rate and tolerability of OMDT in this small case series over an 8-year period, suggesting its viability as an alternative to standard clofazimine-containing MDT.
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Affiliation(s)
- Lena Faust
- 5620 McGill International TB Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Michael Klowak
- 7938 Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Cara MacRae
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Adrienne J Showler
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,8368 Division of Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Andrea K Boggild
- Tropical Disease Unit, Toronto General Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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10
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Craig J, MacRae C, Melvin RG, Boggild AK. Case Report: A Case of Type 1 Leprosy Reaction and Dapsone Hypersensitivity Syndrome Complicating the Clinical Course of Multibacillary Leprosy. Am J Trop Med Hyg 2020; 100:1145-1148. [PMID: 30915953 DOI: 10.4269/ajtmh.18-0953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Type 1 reactions, characterized by increasing lesion erythema, pain, and nerve damage, commonly complicate leprosy. Dapsone hypersensitivity syndrome (DHS) is a potentially fatal reaction occurring 6-8 weeks into dapsone therapy. We present a case of intercurrent Type 1 reaction and DHS in a multibacillary leprosy patient recently started on multidrug treatment.
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Affiliation(s)
- Jeffrey Craig
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Lakeridge Health, Oshawa, Canada
| | - Cara MacRae
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | | | - Andrea K Boggild
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Tropical Disease Unit, Toronto General Hospital, Toronto, Canada
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11
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Yeung SHM, Mourad O, Klowak M, Showler AJ, Klowak S, Boggild AK. Implementation and evaluation of a quality and safety tool for ambulatory strongyloidiasis patients at high risk of adverse outcome. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2019; 5:3. [PMID: 30988956 PMCID: PMC6448213 DOI: 10.1186/s40794-019-0080-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/26/2019] [Indexed: 01/20/2023]
Abstract
Background Strongyloidiasis is a common infection in Canadian migrants that can cause life-threatening hyperinfection in immunosuppressed hosts. We designed and implemented a safety tool to guide management of patients with Strongyloides in order to prevent adverse outcomes. Methods: Patients treated at our centre for strongyloidiasis from January 1, 2013 to December 31, 2015 were identified through our ivermectin access log. Patients were categorized into pre-implementation and post-implementation groups. A retrospective chart review for predefined variables was conducted. Results Of 37 patients with strongyloidiasis, 26 were in the pre-implementation group and 11 were in the post-implementation group. Documented seroreversion (positive to negative) occurred in 42.1% of patients pre-implementation and 62.5% of patients post-implementation (p = 0.420). Documented stool clearance occurred in 80.0% of patients pre-implementation and 100.0% of patients post-implementation (p = 1.000). More patients were screened for HTLV-1 coinfection post-implementation (80.0%) versus pre-implementation (30.8%) (p = 0.011). Loss to follow-up after treatment occurred in 23.1% of patients pre-implementation and 20.0% of patients post-implementation (p = 1.000). Conclusions The safety tool may be useful in the treatment of patients with strongyloidiasis to improve documentation of patient outcomes and standardize care. Future research should include a powered prospective study. Electronic supplementary material The online version of this article (10.1186/s40794-019-0080-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabrina H M Yeung
- 1University of Toronto, 27 King's College Circle, Toronto, Ontario M5S1A1 Canada
| | - Omar Mourad
- 2Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Michael Klowak
- 3McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8 Canada
| | - Adrienne J Showler
- 4Georgetown University, 3800 Reservoir Rd NW, Washington, DC 20007 USA.,5Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street 13EN-218, Toronto, Ontario M5G2C4 Canada
| | - Stefanie Klowak
- 5Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street 13EN-218, Toronto, Ontario M5G2C4 Canada
| | - Andrea K Boggild
- 1University of Toronto, 27 King's College Circle, Toronto, Ontario M5S1A1 Canada.,5Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street 13EN-218, Toronto, Ontario M5G2C4 Canada.,6Public Health Ontario Laboratory, 661 University Avenue, Toronto, Ontario M5G1M1 Canada.,7Department of Medicine, University of Toronto, Toronto, Canada
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