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Rajbhandari RM, de la Fuente J, Karmacharya D, Mathema S, Maharjan B, Dixit SM, Shrestha N, Queirós J, Gortázar C, Alves PC. Understanding Mycobacterium tuberculosis complex in elephants through a One Health approach: a systematic review. BMC Vet Res 2022; 18:262. [PMID: 35794608 PMCID: PMC9258206 DOI: 10.1186/s12917-022-03356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Mycobacterium tuberculosis complex (MTC) that causes the chronic infectious disease- tuberculosis (TB), often presents with a complicated epidemiological pattern where the transmission chain may include humans, domestic animals and wildlife, including elephants. TB has been reported globally in both captive and wild elephants. The One Health approach might be the most effective way of understanding the shared MTC infection dynamics in captive and wild animals like Asian elephants. This systematic review accumulates evidence on occurrence, transmission pathways, and preventive measures of TB in elephants from a One Health perspective. Results The prevalence of TB reported in elephant populations ranges from 0 to 23.33% and high prevalence’s are reported for elephants that are in close proximity to infected humans. The risk of elephant to human infection transmission increased significantly with exposure duration and contact with infected elephants. Some studies described the plausible TB transmission to captive elephants from other animals (wild and domestic), suggesting inter- and intra-species transmission. The results of this systematic review based on 27 relevant published works, suggest three overarching interrelated transmission pathways for M. tuberculosis infections in Asian elephants- i) humans and elephants, ii) other animals (wild or domestic) and elephants and iii) unclear sources of infection. Conclusions The progress made with new TB diagnostic tools provides multiple methods to choose from. However, lack of harmonization of TB testing in elephants and their human contacts remains a challenge to prevent TB in those animals. Routine TB screening among elephants and caretakers by setting up an occupational health program for early diagnosis of infection through combined efforts of public health, veterinary medicine, and occupational health experts is suggested. This implies the need for a One Health approach to elephant TB control. This review reveals the need for more research on Mycobacterium tuberculosis complex transmission pathways at the human-animal interface.
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de Araujo LS, Ribeiro-Alves M, Wipperman MF, Vorkas CK, Pessler F, Saad MHF. Transcriptomic Biomarkers for Tuberculosis: Validation of NPC2 as a Single mRNA Biomarker to Diagnose TB, Predict Disease Progression, and Monitor Treatment Response. Cells 2021; 10:cells10102704. [PMID: 34685683 PMCID: PMC8534371 DOI: 10.3390/cells10102704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/13/2022] Open
Abstract
External validation in different cohorts is a key step in the translational development of new biomarkers. We previously described three host mRNA whose expression in peripheral blood is significantly higher (NPC2) or lower (DOCK9 and EPHA4) in individuals with TB compared to latent TB infection (LTBI) and controls. We have now conducted an independent validation of these genes by re-analyzing publicly available transcriptomic datasets from Brazil, China, Haiti, India, South Africa, and the United Kingdom. Comparisons between TB and control/LTBI showed significant differential expression of all three genes (NPC2high p < 0.01, DOCK9low p < 0.01, and EPHA4low p < 0.05). NPC2high had the highest mean area under the ROC curve (AUROC) for the differentiation of TB vs. controls (0.95) and LTBI (0.94). In addition, NPC2 accurately distinguished TB from the clinically similar conditions pneumonia (AUROC, 0.88), non-active sarcoidosis (0.87), and lung cancer (0.86), but not from active sarcoidosis (0.66). Interestingly, individuals progressing from LTBI to TB showed a constant increase in NPC2 expression with time when compared to non-progressors (p < 0.05), with a significant change closer to manifestation of active disease (≤3 months, p = 0.003). Moreover, NPC2 expression normalized with completion of anti-TB treatment. Taken together, these results validate NPC2 mRNA as a diagnostic host biomarker for active TB independent of host genetic background. Moreover, they reveal its potential to predict progression from latent to active infection and to indicate a response to anti-TB treatment.
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Affiliation(s)
- Leonardo S. de Araujo
- Cellular Microbiology Laboratory, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 20045-360, Brazil;
- Research Group Biomarkers for Infectious Diseases, TWINCORE Centre for Experimental and Clinical Infection Research, 30519 Hannover, Germany
| | - Marcelo Ribeiro-Alves
- National Institute of Infectology Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, Brazil;
| | - Matthew F. Wipperman
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (M.F.W.); (C.K.V.)
- Clinical and Translational Science Center, Weill Cornell Medicine, New York, NY 10021, USA
| | - Charles Kyriakos Vorkas
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (M.F.W.); (C.K.V.)
- Division of Infectious Diseases, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Frank Pessler
- Research Group Biomarkers for Infectious Diseases, TWINCORE Centre for Experimental and Clinical Infection Research, 30519 Hannover, Germany
- Centre for Individualised Infection Medicine, 30625 Hannover, Germany
- Helmholtz Center for Infection Research, 38124 Braunschweig, Germany
- Correspondence: or (F.P.); or (M.H.F.S.); Tel.: +49-511-220027167 (F.P.); +55-21-25621598 (M.H.F.S.)
| | - Maria Helena Féres Saad
- Cellular Microbiology Laboratory, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 20045-360, Brazil;
- Correspondence: or (F.P.); or (M.H.F.S.); Tel.: +49-511-220027167 (F.P.); +55-21-25621598 (M.H.F.S.)
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Prevalence of Latent Tuberculosis Infection in the Middle East and North Africa: A Systematic Review. Pulm Med 2021; 2021:6680651. [PMID: 33564476 PMCID: PMC7864757 DOI: 10.1155/2021/6680651] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Data on the prevalence of latent tuberculosis infection (LTBI) in Middle Eastern and North African countries are scarce. We aimed to review all relevant published data in countries belonging to this region to determine the overall prevalence of LTBI in the Middle East and North Africa (MENA) region. Methods In this systematic review PubMed and Google Scholar databases were searched for observational, prospective, retrospective, cross-sectional, and cohort studies providing prevalence data of LTBI in any MENA country. Studies fulfilling the search criteria were incorporated in the review. Overall prevalence of LTBI with 95% confidence intervals (CI) was calculated using the random-effects model; heterogeneity was assessed using I2 statistics. Gender and age group-based subgroup analyses were performed to evaluate the basis of heterogeneity. Results The total number of overall LTBI studies identified was 956, of which 31 studies from ten countries within the MENA region were included that represented 12,439 subjects. The overall prevalence was 41.78% (95% CI 31.18% to 52.78%, I2 = 99.31%). By gender-based subgroup analysis, the prevalence of LTBI was 33.12% (95% CI 18.97% to 49.04%, I2 = 99.25%) and 32.65% (95% CI 19.79% to 47%, I2 = 98.89%) in males and females, respectively, while in the age-based subgroup analysis, the prevalence of LTBI was 0.44% (95% CI -0.05% to 0.9%), 3.37% (95% CI 2.23% to 4.74%, I2 = 0%), and 43.81% (95% CI 33.09% to 54.82%, I2 = 99.18%) for children, adolescents, and adults, respectively. Conclusion This systematic review reveals a high prevalence of LTBI in the MENA region; enhanced LTBI surveillance and prompt infection prevention steps are urgently needed to prevent active tuberculosis, this would help achieve the World Health Organization End TB Strategy 2035, and the United Nations Sustainable Development Goals 2030 target in the MENA region.
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Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020581. [PMID: 31963207 PMCID: PMC7027002 DOI: 10.3390/ijerph17020581] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 11/17/2022]
Abstract
Healthcare workers (HCWs) have increased risk for latent tuberculosis infection (LTBI) and tuberculosis (TB) disease due to their occupational exposure. For some years now, interferon-γ release assays (IGRAs) have replaced the tuberculin skin test for the diagnosis of LTBI in many countries. This review examined the occupational risk of LTBI in HCWs with IGRA testing in low incidence countries. A systematic review and meta-analysis of studies from 2005 onwards provide data regarding the prevalence of LTBI in HCWs. In addition, the pooled effect estimates were calculated for individual regions and occupational groups. 57 studies with 31,431 HCWs from four regions and a total of 25 countries were analysed. The prevalence of LTBI varied from 0.9 to 85.5%. The pooled estimation found the lowest prevalence of LTBI for North American and West Pacific countries (<5%), and the highest prevalence for Eastern Mediterranean countries (19.4%). An increased risk for LTBI was found only for administrative employees. Studies on the occupational risk of LTBI continue to show increased prevalence of HCWs, even in low-incidence countries. Good quality studies will continue to be needed to describe occupational exposure.
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Apriani L, McAllister S, Sharples K, Alisjahbana B, Ruslami R, Hill PC, Menzies D. Latent tuberculosis infection in healthcare workers in low- and middle-income countries: an updated systematic review. Eur Respir J 2019; 53:13993003.01789-2018. [PMID: 30792341 DOI: 10.1183/13993003.01789-2018] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
Abstract
Healthcare workers (HCWs) are at increased risk of latent tuberculosis (TB) infection (LTBI) and TB disease.We conducted an updated systematic review of the prevalence and incidence of LTBI in HCWs in low- and middle-income countries (LMICs), associated factors, and infection control practices. We searched MEDLINE, Embase and Web of Science (January 1, 2005-June 20, 2017) for studies published in any language. We obtained pooled estimates using random effects methods and investigated heterogeneity using meta-regression.85 studies (32 630 subjects) were included from 26 LMICs. Prevalence of a positive tuberculin skin test (TST) was 14-98% (mean 49%); prevalence of a positive interferon-γ release assay (IGRA) was 9-86% (mean 39%). Countries with TB incidence ≥300 per 100 000 had the highest prevalence (TST: pooled estimate 55%, 95% CI 41-69%; IGRA: pooled estimate 56%, 95% CI 39-73%). Annual incidence estimated from the TST was 1-38% (mean 17%); annual incidence estimated from the IGRA was 10-30% (mean 18%). The prevalence and incidence of a positive test was associated with years of work, work location, TB contact and job category. Only 15 studies reported on infection control measures in healthcare facilities, with limited implementation.HCWs in LMICs in high TB incidence settings remain at increased risk of acquiring LTBI. There is an urgent need for robust implementation of infection control measures.
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Affiliation(s)
- Lika Apriani
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia .,Dept of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Susan McAllister
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.,Dept of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Bachti Alisjahbana
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Dept of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Dept of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Philip C Hill
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Dick Menzies
- Montreal Chest Institute, McGill University Montreal, Montreal, QC, Canada
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Olivieri R, Scarnera S, Ciabattini A, De Vuono G, Manzi P, Pozzi G, Battista G, Medaglini D. Using IFN-gamma release assay to confirm tuberculin skin test improves the screening of latent tuberculosis infection in Italian healthcare workers. J Occup Med Toxicol 2016; 11:29. [PMID: 27279894 PMCID: PMC4897955 DOI: 10.1186/s12995-016-0117-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/24/2016] [Indexed: 12/01/2022] Open
Abstract
Background Healthcare workers (HCWs) represent a tuberculosis (TB) risk group for a wide range of tasks in healthcare, even in countries with low TB incidence, like Italy. Latent Tuberculosis Infection (LTBI) screening programs are an important tool for TB prevention in these setting. Methods A retrospective study under a LTBI screening program among HCWs at the Siena University Hospital (Italy), was conducted between September 2011 and July 2015. Tuberculin Skin Test (TST) was used as a first level examination; all TST-positive cases were tested with QuantiFERON-TB Gold In-Tube (QFT-GIT) test, together with a group of TST-negative subjects. Results Among the 2136 HCWs screened, 144 (6.7 %) were TST-positive and therefore tested with QFT-GIT, confirming a positive result in 36 cases (25 %). Agreement between two tests was poor (k = 0.092; 95 %, Confidence Interval [CI]- 0.048–0.136, p = 0.002). Among TST-positive cases, discordant results occurred more frequently in BCG vaccinated than unvaccinated HCWs (86.3 %, p < 0.001). The probability of a QFT-GIT-positive result increased according to the TST diameter (p = 0.001). No putative risk factor was associated with LTBI occurrence. Conclusions The use of QFT-GIT test as a second step in TST-positive cases offers an appropriate tool for LTBI detection, especially among BCG-vaccinated HCWs.
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Affiliation(s)
- Raffaela Olivieri
- Laboratorio di Microbiologia Molecolare e Biotecnologia, Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Sara Scarnera
- Medicina Preventiva e Sorveglianza Sanitaria, Dipartimento di Biotecnologie Mediche, Universita' degli Studi di Siena, Siena, Italy
| | - Annalisa Ciabattini
- Laboratorio di Microbiologia Molecolare e Biotecnologia, Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Giulia De Vuono
- Medicina Preventiva e Sorveglianza Sanitaria, Dipartimento di Biotecnologie Mediche, Universita' degli Studi di Siena, Siena, Italy
| | - Pietro Manzi
- Direzione Medica di Presidio, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gianni Pozzi
- Laboratorio di Microbiologia Molecolare e Biotecnologia, Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Giuseppe Battista
- Medicina Preventiva e Sorveglianza Sanitaria, Dipartimento di Biotecnologie Mediche, Universita' degli Studi di Siena, Siena, Italy
| | - Donata Medaglini
- Laboratorio di Microbiologia Molecolare e Biotecnologia, Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
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Salmanzadeh S, Abbasissifar H, Alavi SM. Comparison study of QuantiFERON test with tuberculin skin testing to diagnose latent tuberculosis infection among nurses working in teaching hospitals of Ahvaz, Iran. CASPIAN JOURNAL OF INTERNAL MEDICINE 2016; 7:82-7. [PMID: 27386058 PMCID: PMC4913709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
BACKGROUND Prompt diagnosis and treatment of latent tuberculosis (TB) infection (LTBI) are needed to control TB. The aim of the study was to compare the performance of Quanti FERON-TB test (QFT) with conventional TST for the diagnosis of LTBI. METHODS In this analytical - comparison study, we enrolled 87 nurses working in teaching hospitals in Ahvaz. All study subjects were tested by TST. TST results were interpreted as positive if induration was more than 10 mm. If the level of QFT after stimulation was equal or greater than 0.35 IU/ml, test was considered as positive. Data were analyzed with SPSS program. QFT results compared with induration in TST and its relation to all variables were investigated. RESULTS The rate of LTB diagnosis by TST and QFT was 31% and 35.6%, respectively. There was no significant difference between TST and QFT in LTB diagnosis (P=0.62). Among the 56 subjects who were TST- negative, 14 cases (approximately 25%) were QFT- positive and 42 (75%) were QFT- negative. Among the 31 cases (35.6%) that had TST- positive, 13 (42%) were QFT-positive and 18 (58%) were QFT- negative. The overall percent agreement was 63.2% (k=0.139, P=0.69), discordance %=15.9-20.7, sensitivity= 41.5% and specificity=75.5%. CONCLUSION Diagnostic value of QFT is similar to TST, when there is strong clinical and epidemiological evidence of LTB in a nurse with negative TST, adding QFT to diagnostic evaluation is associated with increased rate of LTB diagnosis.
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Affiliation(s)
- Shokrollah Salmanzadeh
- Health Research Institute, Infectious and Tropical Disease Research Center, Joundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Seyed Mohmmad Alavi
- Health Research Institute, Infectious and Tropical Disease Research Center, Joundishapur University of Medical Sciences, Ahvaz, Iran.,Correspondence: Seyed Mohammad Alavi, Health Research Institute, Infectious and Tropical Disease Research Center, Joundishapur University of Medical Sciences, Ahvaz, Iran. E-mail: , Tel: 0098 611 3387724, Fax: 0098 611 3387724
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Kalu EI, Ojide CK, Nwadike VU, Korie FC, Ibeneme CA, Okafor GC. Childhood tuberculosis in sub-Saharan Africa: A call to action. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(15)60928-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ratnatunga CN, Thevanesam V, Nandadeva D, Madegedara D, Athula Kumara K. Cross-sectional screening of healthcare workers at a regional chest clinic with an interferon gamma release assay: first report from Sri Lanka. ACTA ACUST UNITED AC 2015. [DOI: 10.1071/hi15002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Li W, Zhang T, Chen Y, Liu C, Peng W. Diagnostic Value of Convex Probe Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Mediastinal Tuberculous Lymphadenitis: A Systematic Review and Meta-Analysis. Med Sci Monit 2015; 21:2064-72. [PMID: 26177653 PMCID: PMC4510950 DOI: 10.12659/msm.894526] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely used in the diagnosis of mediastinal lymphadenopathies. Here, we performed a systematic review and meta-analysis to explore the diagnostic value of EBUS-TBNA in mediastinal tuberculous lymphadenopathy (TBLA). Material/Methods PubMed, EMBASE, and Sinoced were systematically searched for articles published in English or Chinese that reported the diagnostic yield of EBUS-TBNA in mediastinal TBLA. The quality of studies was assessed using the QualSyst tool. Using 95% confidence intervals (CI), the diagnostic yields of EBUS-TBNA were calculated for the individual studies, and the results were then pooled using a random-effects model. Heterogeneity and publication bias were also assessed. Results A total of 14 studies, consisting of 684 patients with mediastinal TBLA, were finally included. The pooled diagnostic yield of EBUS-TBNA for mediastinal TBLA was 80% (95% CI: 74–86%). Significant heterogeneity (I2=77.9%) and significant publication bias were detected (Begg’s test p=0.05 and Egger’s test p=0.02). From subgroup analyses, significant differences in the diagnostic yield of EBUS-TBNA were associated with Asian vs. European (UK) studies, retrospective vs. prospective studies, those employing rapid on-site cytological evaluation vs. not, those employing different anesthetic types, and those employing smear vs. culture. However, microbiological examination and the number of lymph node passes did not have a significant effect on the diagnostic yield of EBUS-TBNA. Fifteen minor complications for EBUS-TBNA were reported. Conclusions EBUS-TBNA appears to be an efficacious and safe procedure and should be used as an initial diagnostic tool for mediastinal TBLA.
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Affiliation(s)
- Wei Li
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Ting Zhang
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Yuqing Chen
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Chao Liu
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Wenjia Peng
- Department of Epidemiology and Health Statistics, Bengbu Medical College, Bengbu, Anhui, China (mainland)
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Hibah NAA, Hasan HEA. Prevalence of latent tuberculosis infection among multinational healthcare workers in Muhayil Saudi Arabia. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2015. [DOI: 10.4103/1687-8426.158078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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