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Salindri AD, Kipiani M, Lomtadze N, Tukvadze N, Avaliani Z, Blumberg HM, Masyn KE, Rothenberg RB, Kempker RR, Magee MJ. HIV co-infection increases the risk of post-tuberculosis mortality among persons who initiated treatment for drug-resistant tuberculosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.05.19.23290190. [PMID: 37293036 PMCID: PMC10246159 DOI: 10.1101/2023.05.19.23290190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Little is known regarding the relationship between common comorbidities in persons with tuberculosis (TB) (including human immunodeficiency virus [HIV], diabetes, and hepatitis C virus [HCV]) with post-TB mortality. We conducted a retrospective cohort study among persons who initiated treatment for rifampicin-resistant and multi/extensively drug-resistant (RR and M/XDR) TB reported to the country of Georgia's TB surveillance during 2009-2017. Exposures included HIV serologic status, diabetes, and HCV status. Our outcome was all-cause post-TB mortality determined by cross-validating vital status with Georgia's death registry through November 2019. We estimated adjusted hazard rate ratios (aHR) and 95% confidence intervals (CI) of post-TB mortality among participants with and without comorbidities using cause-specific hazard regressions. Among 1032 eligible participants, 34 (3.3%) died during treatment and 87 (8.7%) died post-TB treatment. Among those who died post-TB treatment, the median time to death was 21 months (interquartile range 7-39) post-TB treatment. After adjusting for confounders, the hazard rates of post-TB mortality were higher among participants with HIV co-infection (aHR=3.74, 95%CI 1.77-7.91) compared to those without HIV co-infection. In our cohort, post-TB mortality occurred most commonly in the first three years post-TB treatment. Linkage to care for common TB comorbidities post-treatment may reduce post-TB mortality rates.
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Affiliation(s)
- Argita D. Salindri
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA; and Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Maia Kipiani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia; and The University of Georgia, Tbilisi, Georgia
| | - Nino Lomtadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia; and The University of Georgia, Tbilisi, Georgia
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; and Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Zaza Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; and European University, Tbilisi, Georgia
| | - Henry M. Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Katherine E. Masyn
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA, Atlanta, GA, USA
| | - Richard B. Rothenberg
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA, Atlanta, GA, USA
| | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew J. Magee
- Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; and Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Faust L, Naidoo P, Caceres-Cardenas G, Ugarte-Gil C, Muyoyeta M, Kerkhoff AD, Nagarajan K, Satyanarayana S, Rakotosamimanana N, Grandjean Lapierre S, Adejumo OA, Kuye J, Oga-Omenka C, Pai M, Subbaraman R. Improving measurement of tuberculosis care cascades to enhance people-centred care. THE LANCET. INFECTIOUS DISEASES 2023; 23:e547-e557. [PMID: 37652066 DOI: 10.1016/s1473-3099(23)00375-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 09/02/2023]
Abstract
Care cascades represent the proportion of people reaching milestones in care for a disease and are widely used to track progress towards global targets for HIV and other diseases. Despite recent progress in estimating care cascades for tuberculosis (TB) disease, they have not been routinely applied at national and subnational levels, representing a lost opportunity for public health impact. As researchers who have estimated TB care cascades in high-incidence countries (India, Madagascar, Nigeria, Peru, South Africa, and Zambia), we describe the utility of care cascades and identify measurement challenges, including the lack of population-based disease burden data and electronic data capture, the under-reporting of people with TB navigating fragmented and privatised health systems, the heterogeneity of TB tests, and the lack of post-treatment follow-up. We outline an agenda for rectifying these gaps and argue that improving care cascade measurement is crucial to enhancing people-centred care and achieving the End TB goals.
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Affiliation(s)
- Lena Faust
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada; McGill International TB Centre, Montréal, QC, Canada
| | - Pren Naidoo
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - César Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Monde Muyoyeta
- Tuberculosis Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Andrew D Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
| | - Karikalan Nagarajan
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; South-East Asia Office, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | | | - Simon Grandjean Lapierre
- McGill International TB Centre, Montréal, QC, Canada; Mycobacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montréal, QC, Canada
| | | | - Joseph Kuye
- National Tuberculosis and Leprosy Control Program, Abuja, Nigeria
| | - Charity Oga-Omenka
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada; McGill International TB Centre, Montréal, QC, Canada
| | - Ramnath Subbaraman
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, MA, USA; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA.
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Lee CS, Ho CH, Liao KM, Wu YC, Shu CC. The incidence of tuberculosis recurrence: Impacts of treatment duration of and adherence to standard anti-tuberculous therapy. J Infect Public Health 2023; 16:1778-1783. [PMID: 37738694 DOI: 10.1016/j.jiph.2023.09.005] [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: 06/03/2023] [Revised: 08/28/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND We investigated the impacts of the standard treatment durations of and adherence to standard anti-tuberculous therapy (ATT) on recurrence after the successful completion of tuberculosis (TB) treatment. METHODS We recruited patients with TB who had received treatment for six or nine months from the 2008-2017 databases of the Taiwanese National Health Insurance Research Database. Treatment duration and adherence to standard ATT were analyzed for their impacts on recurrence within two years. Complete adherence to standard ATT was defined as daily use of ethambutol, isoniazid, pyrazinamide, and rifampin for the first two months, and daily use of isoniazid and rifampin for the first six months. RESULTS A total of 33,298 TB patients with new-onset TB were identified and classified into two groups by treatment duration: six months (n = 25,849, 77.63%) and nine months (n = 7449). Sex and age distributions varied between the groups. Treatment duration did not affect TB recurrence within two years (adjusted hazard ratio (AHR): 1.18, 95% confidence interval (C.I.) [0.96-1.44], p = 0.1156). Multivariable logistic regression showed that incomplete adherence to standard anti-tuberculous therapy (80-89% and 90-99% standard anti-TB therapy, AHR: 1.57, 95% C.I. [1.26-1.95], and 1.63, 95% C.I. [1.26-2.06], respectively, p < 0.0001) increased TB recurrence. In addition, male sex, older age, and comorbidity with diabetes mellitus or chronic obstructive pulmonary disease were independent risk factors for TB recurrence within two years. CONCLUSIONS TB recurrence was 1.54% within two years under a DOT era. TB treatment durations of six or nine months did not affect TB recurrence within two years after completion of TB treatment, but incomplete adherence to standard anti-tuberculous therapy might increase the TB recurrence rate.
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Affiliation(s)
- Chung-Shu Lee
- Department of Pulmonary and Critical Care Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan; Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Yu-Cih Wu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Menzies NA, Allwood BW, Dean AS, Dodd PJ, Houben RMGJ, James LP, Knight GM, Meghji J, Nguyen LN, Rachow A, Schumacher SG, Mirzayev F, Cohen T. Global burden of disease due to rifampicin-resistant tuberculosis: a mathematical modeling analysis. Nat Commun 2023; 14:6182. [PMID: 37794037 PMCID: PMC10550952 DOI: 10.1038/s41467-023-41937-9] [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: 07/10/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
In 2020, almost half a million individuals developed rifampicin-resistant tuberculosis (RR-TB). We estimated the global burden of RR-TB over the lifetime of affected individuals. We synthesized data on incidence, case detection, and treatment outcomes in 192 countries (99.99% of global tuberculosis). Using a mathematical model, we projected disability-adjusted life years (DALYs) over the lifetime for individuals developing tuberculosis in 2020 stratified by country, age, sex, HIV, and rifampicin resistance. Here we show that incident RR-TB in 2020 was responsible for an estimated 6.9 (95% uncertainty interval: 5.5, 8.5) million DALYs, 44% (31, 54) of which accrued among TB survivors. We estimated an average of 17 (14, 21) DALYs per person developing RR-TB, 34% (12, 56) greater than for rifampicin-susceptible tuberculosis. RR-TB burden per 100,000 was highest in former Soviet Union countries and southern African countries. While RR-TB causes substantial short-term morbidity and mortality, nearly half of the overall disease burden of RR-TB accrues among tuberculosis survivors. The substantial long-term health impacts among those surviving RR-TB disease suggest the need for improved post-treatment care and further justify increased health expenditures to prevent RR-TB transmission.
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Affiliation(s)
- Nicolas A Menzies
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA.
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, USA.
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
| | - Anna S Dean
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Pete J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Rein M G J Houben
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lyndon P James
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, USA
- Harvard Interfaculty Initiative in Health Policy, Harvard University, Cambridge, USA
| | - Gwenan M Knight
- AMR Centre, Department of Infectious Disease Epidemiology, EPH, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jamilah Meghji
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Linh N Nguyen
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Unit Global Health, Helmholtz Zentrum München, German Research Center for Environmental Health (HMGU), Neuherberg, Germany
| | - Samuel G Schumacher
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Fuad Mirzayev
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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Romanowski K, Law MR, Karim ME, Campbell JR, Hossain MB, Gilbert M, Cook VJ, Johnston JC. Healthcare Utilization After Respiratory Tuberculosis: A Controlled Interrupted Time Series Analysis. Clin Infect Dis 2023; 77:883-891. [PMID: 37158618 PMCID: PMC10506780 DOI: 10.1093/cid/ciad290] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Despite data suggesting elevated morbidity and mortality among people who have survived tuberculosis disease, the impact of respiratory tuberculosis on healthcare utilization in the years following diagnosis and treatment remains unclear. METHODS Using linked health administrative data from British Columbia, Canada, we identified foreign-born individuals treated for respiratory tuberculosis between 1990 and 2019. We matched each person with up to four people without a tuberculosis diagnosis from the same source cohort using propensity score matching. Then, using a controlled interrupted time series analysis, we measured outpatient physician encounters and inpatient hospital admissions in the 5 years following respiratory tuberculosis diagnosis and treatment. RESULTS We matched 1216 individuals treated for respiratory tuberculosis to 4864 non-tuberculosis controls. Immediately following the tuberculosis diagnostic and treatment period, the monthly rate of outpatient encounters in the tuberculosis group was 34.0% (95% confidence interval [CI]: 30.7%, 37.2%) higher than expected, and this trend was sustained for the duration of the post-tuberculosis period. The excess utilization represented an additional 12.2 (95% CI: 10.6, 14.9) outpatient encounters per person over the post-tuberculosis period, with respiratory morbidity a large contributor to the excess healthcare utilization. Results were similar for hospital admissions, with an additional 0.4 (95% CI: .3, .5) hospital admissions per person over the post-tuberculosis period. CONCLUSIONS Respiratory tuberculosis appears to have long-term impacts on healthcare utilization beyond treatment. These findings underscore the need for screening, assessment, and treatment of post-tuberculosis sequelae, as it may provide an opportunity to improve health and reduce resource use.
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Affiliation(s)
- Kamila Romanowski
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Jonathon R Campbell
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
- Departments of Medicine & Global and Public Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Md Belal Hossain
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Victoria J Cook
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - James C Johnston
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
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Boicean A, Bratu D, Fleaca SR, Vasile G, Shelly L, Birsan S, Bacila C, Hasegan A. Exploring the Potential of Fecal Microbiota Transplantation as a Therapy in Tuberculosis and Inflammatory Bowel Disease. Pathogens 2023; 12:1149. [PMID: 37764957 PMCID: PMC10535282 DOI: 10.3390/pathogens12091149] [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: 07/29/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
This review explores the potential benefits of fecal microbiota transplantation (FMT) as an adjunct treatment in tuberculosis (TB), drawing parallels from its efficacy in inflammatory bowel disease (IBD). FMT has shown promise in restoring the gut microbial balance and modulating immune responses in IBD patients. Considering the similarities in immunomodulation and dysbiosis between IBD and TB, this review hypothesizes that FMT may offer therapeutic benefits as an adjunct therapy in TB. Methods: We conducted a systematic review of the existing literature on FMT in IBD and TB, highlighting the mechanisms and potential implications of FMT in the therapeutic management of both conditions. The findings contribute to understanding FMT's potential role in TB treatment and underscore the necessity for future research in this direction to fully leverage its clinical applications. Conclusion: The integration of FMT into the comprehensive management of TB could potentially enhance treatment outcomes, reduce drug resistance, and mitigate the side effects of conventional therapies. Future research endeavors should focus on well-designed clinical trials to develop guidelines concerning the safety and short- and long-term benefits of FMT in TB patients, as well as to assess potential risks.
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Affiliation(s)
- Adrian Boicean
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (S.R.F.); (S.B.); (C.B.); (A.H.)
| | - Dan Bratu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (S.R.F.); (S.B.); (C.B.); (A.H.)
| | - Sorin Radu Fleaca
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (S.R.F.); (S.B.); (C.B.); (A.H.)
| | - Gligor Vasile
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (G.V.); (L.S.)
| | - Leeb Shelly
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (G.V.); (L.S.)
| | - Sabrina Birsan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (S.R.F.); (S.B.); (C.B.); (A.H.)
| | - Ciprian Bacila
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (S.R.F.); (S.B.); (C.B.); (A.H.)
| | - Adrian Hasegan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (S.R.F.); (S.B.); (C.B.); (A.H.)
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Cox SR, Kadam A, Atre S, Gupte AN, Sohn H, Gupte N, Sawant T, Mhadeshwar V, Thompson R, Kendall E, Hoffmann C, Suryavanshi N, Kerrigan D, Tripathy S, Kakrani A, Barthwal MS, Mave V, Golub JE. Tuberculosis (TB) Aftermath: study protocol for a hybrid type I effectiveness-implementation non-inferiority randomized trial in India comparing two active case finding (ACF) strategies among individuals treated for TB and their household contacts. Trials 2022; 23:635. [PMID: 35932062 PMCID: PMC9354295 DOI: 10.1186/s13063-022-06503-6] [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: 06/07/2022] [Accepted: 07/01/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Approximately 7% of all reported tuberculosis (TB) cases each year are recurrent, occurring among people who have had TB in the recent or distant past. TB recurrence is particularly common in India, which has the largest TB burden worldwide. Although patients recently treated for TB are at high risk of developing TB again, evidence around effective active case finding (ACF) strategies in this population is scarce. We will conduct a hybrid type I effectiveness-implementation non-inferiority randomized trial to compare the effectiveness, cost-effectiveness, and feasibility of two ACF strategies among individuals who have completed TB treatment and their household contacts (HHCs). METHODS We will enroll 1076 adults (≥ 18 years) who have completed TB treatment at a public TB unit (TU) in Pune, India, along with their HHCs (averaging two per patient, n = 2152). Participants will undergo symptom-based ACF by existing healthcare workers (HCWs) at 6-month intervals and will be randomized to either home-based ACF (HACF) or telephonic ACF (TACF). Symptomatic participants will undergo microbiologic testing through the program. Asymptomatic HHCs will be referred for TB preventive treatment (TPT) per national guidelines. The primary outcome is rate per 100 person-years of people diagnosed with new or recurrent TB by study arm, within 12 months following treatment completion. The secondary outcome is proportion of HHCs < 6 years, by study arm, initiated on TPT after ruling out TB disease. Study staff will collect socio-demographic and clinical data to identify risk factors for TB recurrence and will measure post-TB lung impairment. In both arms, an 18-month "mop-up" visit will be conducted to ascertain outcomes. We will use the RE-AIM framework to characterize implementation processes and explore acceptability through in-depth interviews with index patients, HHCs and HCWs (n = 100). Cost-effectiveness will be assessed by calculating the incremental cost per TB case detected within 12 months and projected for disability-adjusted life years averted based on modeled estimates of morbidity, mortality, and time with infectious TB. DISCUSSION This novel trial will guide India's scale-up of post-treatment ACF and provide an evidence base for designing strategies to detect recurrent and new TB in other high burden settings. TRIAL REGISTRATION NCT04333485 , registered April 3, 2020. CTRI/2020/05/025059 [Clinical Trials Registry of India], registered May 6 2020.
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Affiliation(s)
- Samyra R Cox
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA.
| | - Abhay Kadam
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Sachin Atre
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Akshay N Gupte
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Hojoon Sohn
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Nikhil Gupte
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Trupti Sawant
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Vishal Mhadeshwar
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Ryan Thompson
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Emily Kendall
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Christopher Hoffmann
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Nishi Suryavanshi
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Deanna Kerrigan
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- George Washington University, 2121 I St NW, Washington, D.C., 20052, USA
| | - Srikanth Tripathy
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Arjunlal Kakrani
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Madhusudan S Barthwal
- Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Maharashtra, 411018, India
| | - Vidya Mave
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Johns Hopkins India, G-4 & G-5, PHOENIX Building, OPP. to Residency Club, Pune, Maharashtra, 411001, India
| | - Jonathan E Golub
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
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Investigation on the cause of recurrent tuberculosis in a rural area in China using whole-genome sequencing: A retrospective cohort study. Tuberculosis (Edinb) 2022; 133:102174. [DOI: 10.1016/j.tube.2022.102174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/17/2022]
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Du J, Li Q, Liu M, Wang Y, Xue Z, Huo F, Zhang X, Shang Y, Li S, Huang H, Pang Y. Distinguishing Relapse From Reinfection With Whole-Genome Sequencing in Recurrent Pulmonary Tuberculosis: A Retrospective Cohort Study in Beijing, China. Front Microbiol 2021; 12:754352. [PMID: 34956119 PMCID: PMC8693897 DOI: 10.3389/fmicb.2021.754352] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Tuberculosis recurrence is still a major problem for the control of tuberculosis, and the cause of the recurrence is still unclear. Methods: We retrospectively recruited 68 pairs of samples of Mycobacterium tuberculosis (MTB) from recurrent TB cases in Beijing Chest Hospital between January 2008 and December 2019. The whole-genome sequencing was conducted to analyze single-nucleotide polymorphism (SNP) and to identify whether recurrent disease was due to relapse or reinfection. The BACTEC MGIT was performed to compare differences in drug susceptibility profiles between two episodes. Results: 62 (91.2%) out of 68 confirmed recurrence were due to relapse, whereas the remaining six (8.8%) were due to reinfection. And there was a strong association between earlier relapse and underlying chronic diseases. In addition, the MTB isolates from non-diabetic patients had a higher mutation rate than those from diabetic patients. A community transmission was also identified in our cohort. Levofloxacin resistance was the most frequently observed drug resistance for 12.9% relapse cases. Conclusion: The relapse of a previous episode in Beijing. The underlying chronic diseases are associated with an earlier TB relapse. MTB isolates were more prone to develop levofloxacin resistance than moxifloxacin resistance after FQ exposure. The patients at high-risk for relapses deserve more careful investigation.
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Affiliation(s)
- Jian Du
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Qing Li
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Min Liu
- Provincial Center for Tuberculosis Control and Prevention, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Yufeng Wang
- Department of Laboratory Quality Control, Innovation Alliance on Tuberculosis Diagnosis and Treatment (Beijing), Beijing, China
| | - Zhongtan Xue
- Department of Laboratory Quality Control, Innovation Alliance on Tuberculosis Diagnosis and Treatment (Beijing), Beijing, China
| | - Fengmin Huo
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Xuxia Zhang
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yuanyuan Shang
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Shanshan Li
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Yu Pang
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
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10
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Shao Y, Song H, Li G, Li Y, Li Y, Zhu L, Lu W, Chen C. Relapse or Re-Infection, the Situation of Recurrent Tuberculosis in Eastern China. Front Cell Infect Microbiol 2021; 11:638990. [PMID: 33816342 PMCID: PMC8010194 DOI: 10.3389/fcimb.2021.638990] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/01/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Recurrent tuberculosis (TB) is defined by more than one TB episode per patient and is caused by re-infection with a new Mycobacterium tuberculosis (Mtb) strain or relapse with the previous strain. Recurrence of TB is one important obstacle for End TB strategy in the world and elucidating the triggers of recurrence is important for the current TB control strategy in China. This study aimed to analyze the sources of recurrent TB by the molecular genotyping method. Method A population-based surveillance was undertaking on all culture-positive TB cases in Jiangsu province, China from 2013 to 2019. Phenotypic drug susceptibility test (DST) by proportion method and mycobacterial interspersed repetitive units-variable number of tandem repeat (MIRU-VNTR) were adopted for drug resistance and genotype detection. Results A total of 1451 culture-positive TB patients were collected and 30 (2.06%, 30/1451) TB cases had recurrent TB episodes. Except 7 isolates were failed during subculture, 23 paired isolates were assessed. After genotyping by MIRU-VNTR, 12 (52.17%, 12/23) paired recurrence TB were demonstrated as relapse and 11 (47.83%,11/23) paired cases were identified as re-infection. The average interval time for recurrence was 24.04 (95%CI: 19.37-28.71) months, and there was no significant difference between relapse and re-infection. For the relapsed cases, two paired isolates exhibited drug resistance shifting, while four paired isolates revealed inconsistent drug resistance among the re-infection group including two multidrug-resistant tuberculosis (MDR-TB) at the second episode. Conclusion Relapse and re-infection contributed equally to the current situation of recurrence TB in Jiangsu, China. Besides, more efficient treatment assessment, specific and vigorous interventions are urgently needed for MDR-TB patients, considering obvious performance among re-infection cases.
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Affiliation(s)
- Yan Shao
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Honghuan Song
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Guoli Li
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Yan Li
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Yishu Li
- Department of Epidemiology and Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Cheng Chen
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
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11
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Bea S, Lee H, Kim JH, Jang SH, Son H, Kwon JW, Shin JY. Adherence and Associated Factors of Treatment Regimen in Drug-Susceptible Tuberculosis Patients. Front Pharmacol 2021; 12:625078. [PMID: 33790788 PMCID: PMC8005597 DOI: 10.3389/fphar.2021.625078] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Adherence to tuberculosis (TB) drugs is one of the key aspects of global TB control, yet there is a lack of epidemiological evidence on the factors influencing adherence to TB drugs. Thus, this study aimed to explore the adherence and factors associated with adherence among TB patients in South Korea. Methods: We conducted a cohort study using a sampled national healthcare database from 2017 to 2018. Our study population included incident TB patients initiating quadruple or triple regimen who were available for follow-up for 180-days. Adherence was evaluated using the proportion of days covered (PDC): 1) adherent group: patients with PDC ≥80%; 2) non-adherent group: patients with PDC <80%. Kaplan-Meier analysis was conducted to calculate the median time-to-discontinuation in the study population. We calculated the adjusted odds ratios (aOR) with 95% confidence intervals (CI) to assess factors associated with adherence to TB drugs using logistic regression. Results: Of 987 patients, 558 (56.5%) were adherent and 429 (43.5%) were non-adherent, with the overall mean PDC of 68.87% (standard deviation, 33.37%). The median time-to-discontinuation was 113 days (interquartile range 96-136) in the study population. Patients initiating quadruple regimen were more likely to adhere in comparison to the triple regimen (aOR 4.14; 95% CI 2.78-6.17), while those aged ≥65 years (aOR 0.53; 95% CI 0.35-0.81), with a history of dementia (aOR 0.53; 95% CI 0.34-0.85), and with history of diabetes mellitus (aOR 0.70; 95% CI 0.52-0.96) were less likely to adhere to the drug. Conclusion: Approximately 45% of TB patients were non-adherent to the drug, which is a major concern for the treatment outcome. We call for intensified attention from the authorities and healthcare providers to reinforce patients' adherence to the prescribed TB drugs.
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Affiliation(s)
- Sungho Bea
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, South Korea
| | - Hyunjin Son
- Department of Preventive Medicine, College of Medicine, Dong-A University, Busan, South Korea
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
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12
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Liu Y, Zhang XX, Yu JJ, Liang C, Xing Q, Yao C, Li CY. Tuberculosis relapse is more common than reinfection in Beijing, China. Infect Dis (Lond) 2020; 52:858-865. [PMID: 32673126 DOI: 10.1080/23744235.2020.1794027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Yi Liu
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, PR China
| | - Xu Xia Zhang
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, PR China
| | - Jia Jia Yu
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, PR China
| | - Chen Liang
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, PR China
| | - Qing Xing
- Central laboratory, Beijing Research Institute for Tuberculosis Control, Beijing, PR China
| | - Cong Yao
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, PR China
| | - Chuan You Li
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, PR China
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13
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Subbaraman R, Jhaveri T, Nathavitharana RR. Closing gaps in the tuberculosis care cascade: an action-oriented research agenda. J Clin Tuberc Other Mycobact Dis 2020; 19:100144. [PMID: 32072022 PMCID: PMC7015982 DOI: 10.1016/j.jctube.2020.100144] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The care cascade-which evaluates outcomes across stages of patient engagement in a health system-is an important framework for assessing quality of tuberculosis (TB) care. In recent years, there has been progress in measuring care cascades in high TB burden countries; however, there are still shortcomings in our knowledge of how to reduce poor patient outcomes. In this paper, we outline a research agenda for understanding why patients fall through the cracks in the care cascade. The pathway for evidence generation will require new systematic reviews, observational cohort studies, intervention development and testing, and continuous quality improvement initiatives embedded within national TB programs. Certain gaps, such as pretreatment loss to follow-up and post-treatment disease recurrence, should be a priority given a relative paucity of high-quality research to understand and address poor outcomes. Research on interventions to reduce death and loss to follow-up during treatment should move beyond a focus on monitoring (or observation) strategies, to address patient needs including psychosocial and nutritional support. While key research questions vary for each gap, some patient populations may experience disparities across multiple stages of care and should be a priority for research, including men, individuals with a prior treatment history, and individuals with drug-resistant TB. Closing gaps in the care cascade will require investments in a bold and innovative action-oriented research agenda.
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Affiliation(s)
- Ramnath Subbaraman
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, USA
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, USA
| | - Tulip Jhaveri
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, USA
| | - Ruvandhi R. Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
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14
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Jiang T, Chen XS. Outcome Impacts Due to Pathogen-Specific Antimicrobial Resistance: A Narrative Review of Published Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041395. [PMID: 32098182 PMCID: PMC7068360 DOI: 10.3390/ijerph17041395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 12/19/2022]
Abstract
Antimicrobial resistance (AMR) has become a global threat to not only public health impacts but also clinical and economic outcomes. During the past decades, there have been many studies focusing on surveillance, mechanisms, and diagnostics of AMR in infectious diseases but the impacts on public health, clinical and economic outcomes due to emergence of these AMRs are rarely studied and reported. This review was aimed to summarize the findings from published studies to report the outcome impacts due to AMR of malaria, tuberculosis and HIV and briefly discuss the implications for application to other infectious diseases. PubMed/Medline and Google Scholar databases were used for search of empirical and peer-reviewed papers reporting public health, clinical and economic outcomes due to AMR of malaria, tuberculosis and HIV. Papers published through 1 December 2019 were included in this review. A total of 76 studies were included for this review, including 16, 49 and 11 on public health, clinical and economic outcomes, respectively. The synthesized data indicated that the emergence and spread of AMR of malaria, tuberculosis and HIV have resulted in adverse public health, clinical and economic outcomes. AMR of malaria, tuberculosis and HIV results in significant adverse impacts on public health, clinical and economic outcomes. Evidence from this review suggests the needs to consider the similar studies for other infectious diseases.
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Affiliation(s)
- Tingting Jiang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China;
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing 210042, China
| | - Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China;
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing 210042, China
- Correspondence: ; Tel.: +86-25-8547-8901
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15
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Brugueras S, Molina VI, Casas X, González YD, Forcada N, Romero D, Rodés A, Altet MN, Maldonado J, Martin-Sánchez M, Caylà JA, Orcau À, Rius C, Millet JP. Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia. PLoS One 2020; 15:e0227291. [PMID: 31940383 PMCID: PMC6961944 DOI: 10.1371/journal.pone.0227291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/16/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients with a history of tuberculosis (TB) have a high probability of recurrence because long-term cure is not always maintained in successfully treated patients. The aim of this study was to identify the probability of TB recurrence and its predictive factors in a cohort of socially vulnerable patients who completed treatment in the TB referral center in Catalonia, which acts as the center for patients with social and health problems. METHODS This retrospective open cohort study included all patients diagnosed with TB who were admitted and successfully treated in Serveis Clínics between 2000 and 2016 and who remained disease-free for a minimum of 1 year after treatment completion. We calculated the incidence density of TB recurrences per person-years of follow-up. We also estimated the cumulative incidence of TB recurrence at 1, 2, 5, and 10 years of follow-up. Bivariate analysis was conducted using Kaplan-Meier curves. Multivariate analysis was conducted using Cox regression. Hazard ratios (HR) were calculated with their 95% confidence intervals (95%CI). RESULTS There were 839 patients and 24 recurrences (2.9%), representing 0.49 per 100 person-years. The probability of a recurrence was 0.63% at 1 year of follow-up, 1.35% at 2 years, and 3.69% at 5 years. The multivariate analysis showed that the predictive factors of recurrence were age older than 34 years (aHR = 3.90; CI = 1.06-14.34 at age 35-45 years and aHR = 3.88; CI = 1.02-14.80 at age >45 years) and resistance to at least one anti-TB drug (aHR = 2.91; CI = 1.11-7.65). CONCLUSIONS Attention should be paid to socially vulnerable persons older than 34 years with a previous episode of resistant TB. Surveillance resources should be directed toward adequately treated patients who nevertheless have a high risk of recurrence.
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Affiliation(s)
- Sílvia Brugueras
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departamento de Pediatría, Obstetricia y Ginecología y Medicina Preventiva, Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | | | | | | | | | - Anna Rodés
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | | | | | - Mario Martin-Sánchez
- Preventive Medicine and Public Health Training Unit Parc de Salut Mar–Pompeu Fabra University—Public Health Agency of Barcelona (PSMar-UPF-ASPB), Barcelona, Spain
| | - Joan A. Caylà
- Foundation of the Tuberculosis Research Unit of Barcelona (fuiTB), Barcelona, Spain
| | - Àngels Orcau
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Foundation of the Tuberculosis Research Unit of Barcelona (fuiTB), Barcelona, Spain
| | - Cristina Rius
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departamento de Pediatría, Obstetricia y Ginecología y Medicina Preventiva, Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joan-Pau Millet
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Serveis Clínics, Barcelona, Spain
- Foundation of the Tuberculosis Research Unit of Barcelona (fuiTB), Barcelona, Spain
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16
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Micheva-Viteva S, Hong-Geller E. What Can Go Wrong When Applying Immune Modulation Therapies to Target Persistent Bacterial Infections. JOURNAL OF CELLULAR IMMUNOLOGY 2020; 2:1-5. [PMID: 32395721 PMCID: PMC7213599 DOI: 10.33696/immunology.2.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Antibiotics can treat the acute phase of a disease, but often do not completely clear the etiologic agent, allowing the pathogen to establish persistent infection that can revive the disease in a frustrating recurrence of infection. The mechanisms that control chronic bacterial infections are complex and involve pathogen adaptations that favor survival from both host immune responses and antibiotic bactericidal activity. Often, the causative agents of persistent infections are not drug-resistant species. Instead, bacterial persister cells temporarily enter a physiological state that is refractory to different classes of antibiotics. Supplemental therapies that potentiate antibiotic bactericidal efficiency and/or immune clearance of persistent pathogenic species may greatly improve the outcome of infectious disease. Here, we discuss the various outcomes in experimental studies in which a mega-dose of the energy-boosting vitamin B3 (nicotinamide) was applied in murine models of chronic infection to stimulate immune clearance of chronic infection or as an immune prophylactic treatment against the highly infectious pathogen, Burkholderia pseudomallei. It is our intent to raise awareness of the risks associated with immune modulation therapies. There is great variance in host immune responses to pathogenic bacteria. Each immune modulation approach needs to be tailored to a well-characterized host-pathogen interaction.
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Detection of Second Line Drug Resistance among Drug Resistant Mycobacterium Tuberculosis Isolates in Botswana. Pathogens 2019; 8:pathogens8040208. [PMID: 31661825 PMCID: PMC6963291 DOI: 10.3390/pathogens8040208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/14/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022] Open
Abstract
The emergence and transmission of multidrug resistant (MDR) and extensively drug resistant (XDR) Mycobacterium tuberculosis (M.tb) strains is a threat to global tuberculosis (TB) control. The early detection of drug resistance is critical for patient management. The aim of this study was to determine the proportion of isolates with additional second-line resistance among rifampicin and isoniazid resistant and MDR-TB isolates. A total of 66 M.tb isolates received at the National Tuberculosis Reference Laboratory between March 2012 and October 2013 with resistance to isoniazid, rifampicin or both were analyzed in this study. The genotypes of the M.tb isolates were determined by spoligotyping and second-line drug susceptibility testing was done using the Hain Genotype MTBDRsl line probe assay version 2.0. The treatment outcomes were defined according to the Botswana national and World Health Organization (WHO) guidelines. Of the 57 isolates analyzed, 33 (58%) were MDR-TB, 4 (7%) were additionally resistant to flouroquinolones and 3 (5%) were resistant to both fluoroquinolones and second-line injectable drugs. The most common fluoroquinolone resistance-conferring mutation detected was gyrA A90V. All XDR-TB cases remained smear or culture positive throughout the treatment. Our study findings indicate the importance of monitoring drug resistant TB cases to ensure rapid detection of second-line drug resistance.
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18
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Healthy survival after tuberculosis. THE LANCET. INFECTIOUS DISEASES 2019; 19:1045-1047. [PMID: 31324515 DOI: 10.1016/s1473-3099(19)30387-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 12/21/2022]
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19
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Browne SH, Umlauf A, Tucker AJ, Low J, Moser K, Gonzalez Garcia J, Peloquin CA, Blaschke T, Vaida F, Benson CA. Wirelessly observed therapy compared to directly observed therapy to confirm and support tuberculosis treatment adherence: A randomized controlled trial. PLoS Med 2019; 16:e1002891. [PMID: 31584944 PMCID: PMC6777756 DOI: 10.1371/journal.pmed.1002891] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 08/27/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Excellent adherence to tuberculosis (TB) treatment is critical to cure TB and avoid the emergence of resistance. Wirelessly observed therapy (WOT) is a novel patient self-management system consisting of an edible ingestion sensor (IS), external wearable patch, and paired mobile device that can detect and digitally record medication ingestions. Our study determined the accuracy of ingestion detection in clinical and home settings using WOT and subsequently compared, in a randomized control trial (RCT), confirmed daily adherence to medication in persons using WOT or directly observed therapy (DOT) during TB treatment. METHODS AND FINDINGS We evaluated WOT in persons with active Mycobacterium tuberculosis complex disease using IS-enabled combination isoniazid 150 mg/rifampin 300 mg (IS-Rifamate). Seventy-seven participants with drug-susceptible TB in the continuation phase of treatment, prescribed daily isoniazid 300 mg and rifampin 600 mg, used IS-Rifamate. The primary endpoints of the trial were determination of the positive detection accuracy (PDA) of WOT, defined as the percentage of ingestions detected by WOT administered under direct observation, and subsequently the proportion of prescribed doses confirmed by WOT compared to DOT. Initially participants received DOT and WOT simultaneously for 2-3 weeks to allow calculation of WOT PDA, and the 95% confidence interval (CI) was estimated using the bootstrap method with 10,000 samples. Sixty-one participants subsequently participated in an RCT to compare the proportion of prescribed doses confirmed by WOT and DOT. Participants were randomized 2:1 to receive WOT or maximal in-person DOT. In the WOT arm, if ingestions were not remotely confirmed, the participant was contacted within 24 hours by text or cell phone to provide support. The number of doses confirmed was collected, and nonparametric methods were used for group and individual comparisons to estimate the proportions of confirmed doses in each randomized arm with 95% CIs. Sensitivity analyses, not prespecified in the trial registration, were also performed, removing all nonworking (weekend and public holiday) and held-dose days. Participants, recruited from San Diego (SD) and Orange County (OC) Divisions of TB Control and Refugee Health, were 43.1 (range 18-80) years old, 57% male, 42% Asian, and 39% white with 49% Hispanic ethnicity. The PDA of WOT was 99.3% (CI 98.1; 100). Intent-to-treat (ITT) analysis within the RCT showed WOT confirmed 93% versus 63% DOT (p < 0.001) of daily doses prescribed. Secondary analysis removing all nonworking days (weekends and public holidays) and held doses from each arm showed WOT confirmed 95.6% versus 92.7% (p = 0.31); WOT was non-inferior to DOT (difference 2.8% CI [-1.8%, 9.1%]). One hundred percent of participants preferred using WOT. WOT associated adverse events were <10%, consisting of minor skin rash and pruritus associated with the patch. WOT provided longitudinal digital reporting in near real time, supporting patient self-management and allowing rapid remote identification of those who needed more support to maintain adherence. This study was conducted during the continuation phase of TB treatment, limiting its generalizability to the entire TB treatment course. CONCLUSIONS In terms of accuracy, WOT was equivalent to DOT. WOT was superior to DOT in supporting confirmed daily adherence to TB medications during the continuation phase of TB treatment and was overwhelmingly preferred by participants. WOT should be tested in high-burden TB settings, where it may substantially support low- and middle-income country (LMIC) TB programs. TRIAL REGISTRATION ClinicalTrials.gov NCT01960257.
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Affiliation(s)
- Sara H. Browne
- University of California San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Anya Umlauf
- University of California San Diego, La Jolla, California, United States of America
| | - Amanda J. Tucker
- University of California San Diego, La Jolla, California, United States of America
| | - Julie Low
- Orange County Health Care Agency, Santa Ana, California, United States of America
| | - Kathleen Moser
- Health and Human Services Agency, San Diego, California, United States of America
| | | | | | | | - Florin Vaida
- University of California San Diego, La Jolla, California, United States of America
| | - Constance A. Benson
- University of California San Diego, La Jolla, California, United States of America
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20
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Ssebuliba DM, Ouifki R. Effect of mixed infection on TB dynamics. INT J BIOMATH 2019. [DOI: 10.1142/s179352451950061x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Poor living conditions, overcrowding and strain diversity are some of the factors that influence mixed infection in Tuberculosis (TB) at the population level. We formulate a mathematical model for mixed infection in TB using nonlinear ordinary differential equations where such factors were represented as probabilities of acquiring mixed infection. A qualitative analysis of the model shows that it exhibits multiple endemic equilibria and backward bifurcation for certain parameter values. The reactivation rate and transmission rate of individuals with mixed infection were of importance as well as the probabilities for latent individuals to acquire mixed infection. We calculate the prevalence of mixed infection from the model and the effect of mixed infection on TB incidence, TB prevalence and Mycobacterium tuberculosis (MTB) infection rate. Numerical simulations show that mixed infection may explain high TB incidences in areas which have a high strain diversity, poor living conditions and are overcrowded even without HIV.
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Affiliation(s)
- Doreen Mbabazi Ssebuliba
- Faculty of Science, Kabale University, P. O. Box 317, Kabale, Uganda
- South African Centre for Epidemiological Modelling, and Analysis, 19 Jonkershoek, Mostertdrift, Stellenbosch, 7600, Cape Town, Western Cape, South Africa
| | - Rachid Ouifki
- South African Centre for Epidemiological Modelling, and Analysis, 19 Jonkershoek, Mostertdrift, Stellenbosch, 7600, Cape Town, Western Cape, South Africa
- Department of Mathematics and Applied Mathematics, University of Pretoria, Private bag X20, Hatfield, 0028 Pretoria, South Africa
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21
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Counoupas C, Triccas JA. The generation of T-cell memory to protect against tuberculosis. Immunol Cell Biol 2019; 97:656-663. [PMID: 31127962 DOI: 10.1111/imcb.12275] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 02/06/2023]
Abstract
Tuberculosis (TB) kills more individuals each year than any other single pathogen and a more effective vaccine is critical for the global control of the disease. Although there has been recent progress in the clinical testing of candidates, no new vaccine has been licensed for use and correlates of protective immunity in humans have not been defined. Prior Mycobacterium tuberculosis infection does not appear to confer long-term protective immunity in humans; thus mimicking the natural immune response to infection may not be a suitable approach to develop improved TB vaccines. Data from animal testing are used to progress vaccines through the "vaccine pipeline", but studies in animals have not been able to predict efficacy in humans. Furthermore, although the generation of conventional CD4+ T-cell responses are considered necessary to control infection with M. tuberculosis, these do not necessarily correlate with protection induced by candidate vaccines and other immune components may play a role, including donor unrestricted T cells, tissue-resident memory T cells and anti-M. tuberculosis antibodies. This review will summarize the current understanding of the protective immune responses following M. tuberculosis infection or vaccination, with a particular focus on vaccines that have recently entered clinical trials.
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Affiliation(s)
- Claudio Counoupas
- Discipline of Infectious Diseases and Immunology, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Tuberculosis Research Program, Centenary Institute, Sydney, NSW, Australia
| | - James A Triccas
- Discipline of Infectious Diseases and Immunology, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia
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22
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Muzanyi G, Mulumba Y, Mubiri P, Mayanja H, Johnson JL, Mupere E. Predictors of recurrent TB in sputum smear and culture positive adults: a prospective cohort study. Afr Health Sci 2019; 19:2091-2099. [PMID: 31656493 PMCID: PMC6794518 DOI: 10.4314/ahs.v19i2.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To explore simple inexpensive non-culture based predictors of recurrent pulmonary tuberculosis (PTB). Setting and study population HIV-infected and uninfected adults with the first episode of smear positive, culture-confirmed pulmonary tuberculosis in a high tuberculosis burden country. Design A nested prospective cohort study of participants with pulmonary tuberculosis (PTB) presenting to a hospital out-patient clinic. Results A total of 630 TB culture confirmed participants were followed up for eighteen months of which 57 (9%) developed recurrent recurrent TB. On univariate analysis,4.7% low grade(1+) pre-treatment sputum smear participants developed recurrent tuberculosis Vs 8.8% with high grade(3+) smears (OR=0.31,95%CI: 0.10–0.93, p=0.037).On multivariate analysis: participants with extensive fibro-cavitation had a high risk of recurrent TB Vs minimal end of treatment fibro-cavitation (18%Vs12%, OR=2.3,95%CI:1.09–4.68, p=0.03). Weight gain with HIV infection was assosciated with a high risk of recurrent TB Vs weight gain with no HIV infection(18%Vs 6%, OR=6.8,95%CI:165–27.83, p=0.008) where as weight gain with a low pre-treatment high bacillary burden was assosciated with a low risk of recurrent TB Vs weight gain with a high pre-treatmentbacillary burden(6.5%Vs7.9%, OR=0.2,95%CI:0.05–0.79, p=0.02). Conclusion Extensive end of treatment pulmonary fibro-cavitation, high pre-treatment bacillary burden with no weight gain and HIV infection could be reliable predictors of recurrent tuberculosis.
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Affiliation(s)
- Grace Muzanyi
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda
| | - Y Mulumba
- Uganda Cancer Institute, Kampala, Uganda
| | - Paul Mubiri
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda
| | - Harriet Mayanja
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda
| | - John L Johnson
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda
- Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Ezekiel Mupere
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda
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23
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Aljadani R, Ahmed AE, Al-Jahdali H. Tuberculosis mortality and associated factors at King Abdulaziz Medical City Hospital. BMC Infect Dis 2019; 19:427. [PMID: 31096930 PMCID: PMC6524290 DOI: 10.1186/s12879-019-4063-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) continues to be a public health challenge in Saudi Arabia, particularly for the elderly. This study was conducted to estimate mortality per 1000 person-year among TB and resistant TB cases and to identifying factors associated with mortality. METHODS This is a retrospective cohort study of 713 new TB cases at King Abdulaziz Medical City in Riyadh diagnosed between January 1, 2000, and December 31, 2016. Patient medical records and microbiology lab databases were used to identify TB cases. Through reviews were conducted of patients' medical records, including physician notes, physical examinations, radiology (scans and imaging), laboratory tests, and follow-up notes. Collected data include demographic information, clinical features, diagnoses, comorbidities, and death rates. RESULTS Of the 713 TB patients included in this study, 110 died, giving an average mortality rate of 22 per 1000 person-years (PY; 95% CI: 18.2-26.4). Elderly patients (≥ 60 years) had a higher mortality rate of 36.5 per 1000 PY (95% CI: 28.9-45.5). As age increases by one year, the hazard of mortality increase by 2.4% (aHR: 1.024 [95% CI: 1.009-1.039, P = 0.002]). Higher hazard of mortality was found among males (aHR: 2.014 [95% CI: 1.186-3.418, P = 0.010]). Patients with respiratory and other types of comorbidities and cancer had a higher mortality hazard (aHR: 1.898 [95% CI: 1.005-3.582, P = 0.048]; aHR: 2.346 [95% CI: 1.313-4.192, P = 0.004]; aHR: 3.292 [95% CI: 1.804-6.006, P = 0.001]), respectively. Multidrug-resistant TB (MDR-TB) was found in 2 cases (0.28%) (95% CI: 0.08-1.02), 1.68% were resistant to only one antibiotic, 0.14% had rifampicine-resistant TB (RR-TB), 0.28% had MDR-TB, and 0.14% had extensively drug-resistant TB (XDR-TB). CONCLUSIONS The mortality rate among TB patients was found to be 22 per 1000 person-year at our center. TB was associated with high mortality rates among males, the elderly, and patients with cancer, respiratory illness, and other comorbidities. Future clinical practice should include establishing an efficient TB diagnostic program and continued hazard assessment of TB treatment options.
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Affiliation(s)
| | - Anwar E Ahmed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hamdan Al-Jahdali
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
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24
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Mogashoa T, Melamu P, Ley SD, Streicher EM, Iketleng T, Kelentse N, Mupfumi L, Mokomane M, Kgwaadira B, Novitsky V, Kasvosve I, Moyo S, Warren RM, Gaseitsiwe S. Genetic diversity of Mycobacterium tuberculosis strains circulating in Botswana. PLoS One 2019; 14:e0216306. [PMID: 31063472 PMCID: PMC6504092 DOI: 10.1371/journal.pone.0216306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/17/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Molecular typing of Mycobacterium tuberculosis (M.tb) isolates can inform Tuberculosis (TB) control programs on the relative proportion of transmission driving the TB epidemic. There is limited data on the M. tb genotypes that are circulating in Botswana. The aim of this study was to generate baseline data on the genetic diversity of M.tb isolates circulating in the country. METHODS A total of 461 M.tb isolates received at the Botswana National Tuberculosis Reference Laboratory between March 2012 and October 2013 were included in this study. Drug susceptibility testing was conducted using the BD BACTEC MGIT 960 System. M.tb strains were genotyped using spoligotyping and spoligotype patterns were compared with existing patterns in the SITVIT Web database. A subset of drug resistant isolates which formed spoligo clusters (n = 65) was additionally genotyped with 12-loci MIRU. Factors associated with drug resistance and clustering were evaluated using logistic regression. RESULTS Of the 461 isolates genotyped, 458 showed 108 distinct spoligotype patterns. The predominant M.tb lineages were Lineage 4 (81.9%), Lineage 2 (9%) and Lineage 1 (7.2%). The predominant spoligotype families within Lineage 4 were LAM (33%), S (14%), T (16%), X (16%). Three hundred and ninety-two (86%) isolates could be grouped into 44 clusters (2-46 isolates per cluster); giving a clustering rate of 76%. We identified 173 (37.8%) drug resistant isolates, 48 (10.5%) of these were multi-drug resistant. MIRU typing of the drug resistant isolates allowed grouping of 46 isolates into 14 clusters, giving a clustering rate of 49.2%. There was no association between age, sex, treatment category, region and clustering. CONCLUSIONS This study highlights the complexity of the TB epidemic in Botswana with multiple strains contributing to disease and provides baseline data on the population structure of M.tb strains in Botswana.
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Affiliation(s)
- Tuelo Mogashoa
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Pinkie Melamu
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Serej D. Ley
- DST-NRF Centre of Excellence in Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Elizabeth M. Streicher
- DST-NRF Centre of Excellence in Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Thato Iketleng
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- College of Health Sciences, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Lucy Mupfumi
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Margaret Mokomane
- National Tuberculosis Reference Laboratory, Ministry of Health and Wellness, Gaborone, Botswana
| | - Botshelo Kgwaadira
- National Tuberculosis Reference Laboratory, Ministry of Health and Wellness, Gaborone, Botswana
| | - Vladimir Novitsky
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ishmael Kasvosve
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Robin M. Warren
- DST-NRF Centre of Excellence in Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail: ,
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25
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Intestinal dysbiosis compromises alveolar macrophage immunity to Mycobacterium tuberculosis. Mucosal Immunol 2019; 12:772-783. [PMID: 30783183 DOI: 10.1038/s41385-019-0147-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 01/27/2019] [Accepted: 01/29/2019] [Indexed: 02/08/2023]
Abstract
Current treatments for tuberculosis (TB) are effective in controlling Mycobacterium tuberculosis (Mtb) growth, yet have significant side effects and do not prevent reinfection. Therefore, it is critical to understand why our host defense system is unable to generate permanent immunity to Mtb despite prolonged anti-tuberculosis therapy (ATT). Here, we demonstrate that treatment of mice with the most widely used anti-TB drugs, rifampicin (RIF) or isoniazid (INH) and pyrazinamide (PYZ), significantly altered the composition of the gut microbiota. Unexpectedly, treatment of mice with the pro-Mtb drugs INH and PYZ, but not RIF, prior to Mtb infection resulted in an increased bacterial burden, an effect that was reversible by fecal transplantation from untreated animals. Mechanistically, susceptibility of INH/PYZ-treated mice was associated with impaired metabolism of alveolar macrophages and defective bactericidal activity. Collectively, these data indicate that dysbiosis induced by ATT administered to millions of individuals worldwide may have adverse effects on the anti-Mtb response of alveolar macrophages.
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26
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Singh S, Yabaji SM, Ali R, Srivastava KK, Haq W. Synthesis and biological activity of Ub2 derived peptides as potential host-directed antitubercular therapy. Chem Biol Drug Des 2019; 94:1330-1338. [PMID: 30805971 DOI: 10.1111/cbdd.13508] [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: 11/18/2018] [Revised: 01/24/2019] [Accepted: 02/09/2019] [Indexed: 11/27/2022]
Abstract
The correlation of mycobactericidal property of macrophages with its potential to deliver bacteria to hydrolytic lysosomes, augmented with ubiquitin-derived peptides (Ub2), activates the process of autophagy. This leads to the formation of phagolysosomes supported by factor involving increased cationic charges which regulate the acidic pH causing elimination of Mycobacterium. To better understand this interaction of cationic-rich ubiquitin-derived peptides with mycobacteria and to identify putative mycobacterial intrinsic resistance mechanisms for phagolysosome formation, we have synthesized a new series of Ub2 peptides, wherein the Gly residues are replaced with azaGly with the aim to improve metabolic stability. In addition to that a new methodology is reported for the synthesis of heteroaryl tethered peptides using azaGly as a linker. We have demonstrated that positive puncta (directly proportional to the acidification of lysosome) in cytosol was significantly increased after 6 hours on the treatment of macrophage with Ub2 peptide derivatives (1, 6, 10, and 11) causing the higher intensity of lysosome observed through LysoTracker Red Dye. The circular dichroism spectral studies are carried out in water and water:TFE mixture and demonstrated that the Ub2 peptides have helix-forming tendency in the presence of TFE. The recognizable intracellular killing of Mycobacterium tuberculosis by Ub2 peptides provides a new approach for host-directed therapy.
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Affiliation(s)
- Shalini Singh
- Medicinal and Process Chemistry Division, CSIR-Central Drug Research Institute, Lucknow, India
| | - Shivraj M Yabaji
- Microbiology Division, CSIR-Central Drug Research Institute, Lucknow, India
| | - Rafat Ali
- Medicinal and Process Chemistry Division, CSIR-Central Drug Research Institute, Lucknow, India
| | - Kishore K Srivastava
- Microbiology Division, CSIR-Central Drug Research Institute, Lucknow, India.,Academy of Scientific and Innovative Research, New Delhi, India
| | - Wahajul Haq
- Medicinal and Process Chemistry Division, CSIR-Central Drug Research Institute, Lucknow, India.,Academy of Scientific and Innovative Research, New Delhi, India
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27
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Subbaraman R, Nathavitharana RR, Mayer KH, Satyanarayana S, Chadha VK, Arinaminpathy N, Pai M. Constructing care cascades for active tuberculosis: A strategy for program monitoring and identifying gaps in quality of care. PLoS Med 2019; 16:e1002754. [PMID: 30811385 PMCID: PMC6392267 DOI: 10.1371/journal.pmed.1002754] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The cascade of care is a model for evaluating patient retention across sequential stages of care required to achieve a successful treatment outcome. This approach was first used to evaluate HIV care and has since been applied to other diseases. The tuberculosis (TB) community has only recently started using care cascade analyses to quantify gaps in quality of care. In this article, we describe methods for estimating gaps (patient losses) and steps (patients retained) in the care cascade for active TB disease. We highlight approaches for overcoming challenges in constructing the TB care cascade, which include difficulties in estimating the population-level burden of disease and the diagnostic gap due to the limited sensitivity of TB diagnostic tests. We also describe potential uses of this model for evaluating the impact of interventions to improve case finding, diagnosis, linkage to care, retention in care, and post-treatment monitoring of TB patients.
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Affiliation(s)
- Ramnath Subbaraman
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Ruvandhi R. Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kenneth H. Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Boston, Massachusetts, United States of America
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Vineet K. Chadha
- Central Leprosy Teaching and Research Institute, Chengalpattu, India
| | - Nimalan Arinaminpathy
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health and McGill International TB Centre, McGill University, Montreal, Canada
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28
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Butov D, Gumenuik M, Gumeniuk G, Tkachenko A, Kikinchuk V, Stepaniuk R, Peshenko A, Butova T. Effectiveness of anti-tuberculosis chemotherapy in patients with tuberculosis relapse compared with newly diagnosed patients. Int J Mycobacteriol 2019; 8:341-346. [DOI: 10.4103/ijmy.ijmy_158_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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29
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Kumar D, Goel C, Bansal AK, Bhardwaj AK. Delineating the factors associated with recurrence of tuberculosis in programmatic settings of rural health block, Himachal Pradesh, India. Indian J Tuberc 2018; 65:303-307. [PMID: 30522617 DOI: 10.1016/j.ijtb.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tuberculosis (TB) recurrence observed to be an important event in its treatment and has future implications under national TB control efforts. The present study was carried out to assess the recurrence rate along with its risk factors among patients undergoing treatment for TB under Revised National TB Control Program (RNTCP). MATERIAL AND METHODS Total 204 patients in health block of district Una, Himachal Pradesh were studied using pretested structured interviewer-administered questionnaire. Along with univariate a non-hierarchal multi-way frequency analysis (MFA) was done to study the one and multi-way effects between the discrete variables included in a hypothesized model. The variables were under-nutrition, pulmonary TB, injecting drug use (IDU), multi-drug resistant (MDR) TB, and past TB (recurrent cases). RESULTS Total 29 cases (14.2%) had recurrence (17.7/100,000 population) with significantly high fraction for alternate residence (Recurrent: 50.0%, Non-recurrent: 47.4%; p = 0.001), Multi-drug resistance (MDR) TB (Recurrent: 13.8%, Non-recurrent: 2.3%; p = 0.003), and sputum negative patients (Recurrent: 51.7%, Non-recurrent: 14.5%; p = 0.000). Non-recurrent cases had significantly high fraction for sputum positive cases (Recurrent: 48.3%, Non-recurrent: 72.1%; p = 0.011), and extra-pulmonary TB (Recurrent: 00.0%, Non-recurrent: 13.4%; p = 0.036). MFA observed all significant one-way effects. Significant two-way effects were IDU and pulmonary TB (p = 0.001), MDR and past TB (p = 0.004), IDU and past TB (p = 0.019), and IDU and MDR-TB (p = 0.039). CONCLUSION Proportion of TB recurrence was expected with a significant difference between the history of change of residence, MDR-TB, pulmonary and extra-pulmonary nature of the disease. Hypothesized model observed with a significant association of IDU, pulmonary TB, MDR-TB and past TB.
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Affiliation(s)
- Dinesh Kumar
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India.
| | - Chirag Goel
- Model Rural Health Research Unit (MRHRU), Haroli, Una, Himachal Pradesh, India
| | - Avi Kumar Bansal
- National JALMA Institute of Leprosy and Other Mycobacterial Diseases (NJIL&OMD), Agra, Uttar Pradesh, India
| | - Ashok Kumar Bhardwaj
- Community Medicine, Dr. Radhakrishanan Government Medical College, Hamirpur, Himachal Pradesh, India
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30
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Suzana S, Shanmugam S, Latha P.N. S, Michael JS. Molecular genotyping to differentiate endogenous reactivation and exogenous reinfection of recurrent tuberculosis. J Clin Tuberc Other Mycobact Dis 2018; 13:17-21. [PMID: 31720407 PMCID: PMC6830134 DOI: 10.1016/j.jctube.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/26/2018] [Accepted: 10/07/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Shirly Suzana
- Christian Medical College and Hospital Vellore, 632004, Tamil Nadu, India
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31
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Merker M, Barbier M, Cox H, Rasigade JP, Feuerriegel S, Kohl TA, Diel R, Borrell S, Gagneux S, Nikolayevskyy V, Andres S, Nübel U, Supply P, Wirth T, Niemann S. Compensatory evolution drives multidrug-resistant tuberculosis in Central Asia. eLife 2018; 7:38200. [PMID: 30373719 PMCID: PMC6207422 DOI: 10.7554/elife.38200] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/02/2018] [Indexed: 12/21/2022] Open
Abstract
Bacterial factors favoring the unprecedented multidrug-resistant tuberculosis (MDR-TB) epidemic in the former Soviet Union remain unclear. We utilized whole genome sequencing and Bayesian statistics to analyze the evolutionary history, temporal emergence of resistance and transmission networks of MDR Mycobacterium tuberculosis complex isolates from Karakalpakstan, Uzbekistan (2001-2006). One clade (termed Central Asian outbreak, CAO) dating back to 1974 (95% HPD 1969-1982) subsequently acquired resistance mediating mutations to eight anti-TB drugs. Introduction of standardized WHO-endorsed directly observed treatment, short-course in Karakalpakstan in 1998 likely selected for CAO-strains, comprising 75% of sampled MDR-TB isolates in 2005/2006. CAO-isolates were also identified in a published cohort from Russia (2008-2010). Similarly, the presence of mutations supposed to compensate bacterial fitness deficits was associated with transmission success and higher drug resistance rates. The genetic make-up of these MDR-strains threatens the success of both empirical and standardized MDR-TB therapies, including the newly WHO-endorsed short MDR-TB regimen in Uzbekistan.
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Affiliation(s)
- Matthias Merker
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany.,German Center for Infection Research, Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Maxime Barbier
- Laboratoire Biologie Intégrative des Populations, Evolution Moléculaire, Ecole Pratique des Hautes Etudes, PSL University, Paris, France.,Institut de Systématique, Evolution, Biodiversité, UMR-CNRS 7205, Muséum National d'Histoire Naturelle, Université Pierre et Marie Curie, Ecole Pratique des Hautes Etudes, Sorbonne Universités, Paris, France
| | - Helen Cox
- Division of Medical Microbiology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Jean-Philippe Rasigade
- Laboratoire Biologie Intégrative des Populations, Evolution Moléculaire, Ecole Pratique des Hautes Etudes, PSL University, Paris, France.,Institut de Systématique, Evolution, Biodiversité, UMR-CNRS 7205, Muséum National d'Histoire Naturelle, Université Pierre et Marie Curie, Ecole Pratique des Hautes Etudes, Sorbonne Universités, Paris, France.,CIRI INSERM U1111, University of Lyon, Lyon, France
| | - Silke Feuerriegel
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany.,German Center for Infection Research, Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Thomas Andreas Kohl
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany.,German Center for Infection Research, Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Roland Diel
- Institute for Epidemiology, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Sonia Borrell
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sebastien Gagneux
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Vladyslav Nikolayevskyy
- Imperial College London, London, United Kingdom.,Public Health England, London, United Kingdom
| | - Sönke Andres
- Division of Mycobacteriology, National Tuberculosis Reference Laboratory, Research Center Borstel, Borstel, Germany
| | - Ulrich Nübel
- Microbial Genome Research, Leibniz-Institut DSMZ- Deutsche Sammlung von Mikroorganismen und Zellkulturen, Braunschweig, Germany.,German Center for Infection Research, Braunschweig, Germany
| | - Philip Supply
- Université de Lille, CNRS UMR 8204, Inserm U1019, CHU de Lille, Institut Pasteur de Lille, Centre d'Infection et d'Immunité de Lille, Lille, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche, Center for Infection and Immunity of Lille, Lille, France.,Center for Infection and Immunity of Lille, Université de Lille Nord de France, Lille, France.,Center for Infection and Immunity of Lille, Institut Pasteur de Lille, Lille, France
| | - Thierry Wirth
- Laboratoire Biologie Intégrative des Populations, Evolution Moléculaire, Ecole Pratique des Hautes Etudes, PSL University, Paris, France.,Institut de Systématique, Evolution, Biodiversité, UMR-CNRS 7205, Muséum National d'Histoire Naturelle, Université Pierre et Marie Curie, Ecole Pratique des Hautes Etudes, Sorbonne Universités, Paris, France
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany.,German Center for Infection Research, Partner site Hamburg-Lübeck-Borstel-Riems, Germany
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Comparison of different treatments for isoniazid-resistant tuberculosis: an individual patient data meta-analysis. THE LANCET RESPIRATORY MEDICINE 2018; 6:265-275. [PMID: 29595509 DOI: 10.1016/s2213-2600(18)30078-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Isoniazid-resistant, rifampicin-susceptible (INH-R) tuberculosis is the most common form of drug resistance, and is associated with failure, relapse, and acquired rifampicin resistance if treated with first-line anti-tuberculosis drugs. The aim of the study was to compare success, mortality, and acquired rifampicin resistance in patients with INH-R pulmonary tuberculosis given different durations of rifampicin, ethambutol, and pyrazinamide (REZ); a fluoroquinolone plus 6 months or more of REZ; and streptomycin plus a core regimen of REZ. METHODS Studies with regimens and outcomes known for individual patients with INH-R tuberculosis were eligible, irrespective of the number of patients if randomised trials, or with at least 20 participants if a cohort study. Studies were identified from two relevant systematic reviews, an updated search of one of the systematic reviews (for papers published between April 1, 2015, and Feb 10, 2016), and personal communications. Individual patient data were obtained from authors of eligible studies. The individual patient data meta-analysis was performed with propensity score matched logistic regression to estimate adjusted odds ratios (aOR) and risk differences of treatment success (cure or treatment completion), death during treatment, and acquired rifampicin resistance. Outcomes were measured across different treatment regimens to assess the effects of: different durations of REZ (≤6 months vs >6 months); addition of a fluoroquinolone to REZ (fluoroquinolone plus 6 months or more of REZ vs 6 months or more of REZ); and addition of streptomycin to REZ (streptomycin plus 6 months of rifampicin and ethambutol and 1-3 months of pyrazinamide vs 6 months or more of REZ). The overall quality of the evidence was assessed using GRADE methodology. FINDINGS Individual patient data were requested for 57 cohort studies and 17 randomised trials including 8089 patients with INH-R tuberculosis. We received 33 datasets with 6424 patients, of which 3923 patients in 23 studies received regimens related to the study objectives. Compared with a daily regimen of 6 months of (H)REZ (REZ with or without isoniazid), extending the duration to 8-9 months had similar outcomes; as such, 6 months or more of (H)REZ was used for subsequent comparisons. Addition of a fluoroquinolone to 6 months or more of (H)REZ was associated with significantly greater treatment success (aOR 2·8, 95% CI 1·1-7·3), but no significant effect on mortality (aOR 0·7, 0·4-1·1) or acquired rifampicin resistance (aOR 0·1, 0·0-1·2). Compared with 6 months or more of (H)REZ, the standardised retreatment regimen (2 months of streptomycin, 3 months of pyrazinamide, and 8 months of isoniazid, rifampicin, and ethambutol) was associated with significantly worse treatment success (aOR 0·4, 0·2-0·7). The quality of the evidence was very low for all outcomes and treatment regimens assessed, owing to the observational nature of most of the data, the diverse settings, and the imprecision of estimates. INTERPRETATION In patients with INH-R tuberculosis, compared with treatment with at least 6 months of daily REZ, addition of a fluoroquinolone was associated with better treatment success, whereas addition of streptomycin was associated with less treatment success; however, the quality of the evidence was very low. These results support the conduct of randomised trials to identify the optimum regimen for this important and common form of drug-resistant tuberculosis. FUNDING World Health Organization and Canadian Institutes of Health Research.
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Jee B, Kumar S, Yadav R, Singh Y, Kumar A, Sharma N. Ursolic acid and carvacrol may be potential inhibitors of dormancy protein small heat shock protein16.3 of Mycobacterium tuberculosis. J Biomol Struct Dyn 2018; 36:3434-3443. [PMID: 28984500 DOI: 10.1080/07391102.2017.1389305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 09/17/2017] [Indexed: 12/16/2022]
Abstract
Small heat shock protein16.3 (sHSP16.3) is a crucial protein for survival of Mycobacterium tuberculosis (MTB) in its host. Besides, this protein acts as a molecular chaperone during stress and is indispensable for MTB's growth, virulence and cell-wall thickening. sHSP16.3 is also a promising candidate for vaccine, serodiagnosis and drug design as well. In the present study, we have targeted sHSP16.3 with two phytochemicals, namely ursolic acid and carvacrol using in silico approach. Molecular docking analysis showed that both phytochemicals (ursolic acid and carvacrol) have docked with sHSP16.3 and shown tendency to inhibit the function of this vital protein of MTB. In addition, both compounds have exhibited strong compatibility with sHSP16.3 during whole 60 ns duration of molecular dynamics simulation. Further, the molecular mechanic/generalized Born/Poisson-Boltzmann surface area (MM/G/P/BSA) free energies were calculated which showed that both phytocompounds have stable and favourable binding energies causing strong binding with binding site of sHSP16.3. Taking together, the data of present study suggest that both phytocompounds may be potential inhibitor of sHSP16.3 of MTB and a best alternative to standard anti-tuberculosis drugs.
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Affiliation(s)
- Babban Jee
- a Department of Health Research, Ministry of Health and Family Welfare , Government of India , New Delhi 110001 , India
| | - Sanjay Kumar
- b Molecular and Structural Biology Division , Central Drug Research Institute , Lucknow 226031 , India
| | - Renu Yadav
- c Department of Biotechnology , Acharya Nagarjuna University , Guntur 522510 , India
| | - Yogesh Singh
- d Institute of Physiology I , Eberhard-Karls-Tübingen University , Gmelinstraße5, Tübingen D-72076 , Germany
| | - Anuj Kumar
- e Advance Center for Computational and Applied Biotechnology, Uttarakhand Council for Biotechnology (UCB) , Dehradun 248007 , India
| | - Naveen Sharma
- a Department of Health Research, Ministry of Health and Family Welfare , Government of India , New Delhi 110001 , India
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Sarwar F, Sheikh S, Khan NU, Fatima SN. Tubercular septal abscess in a postoperative patient: a novel entity. BMJ Case Rep 2018; 2018:bcr-2018-224892. [PMID: 30206066 DOI: 10.1136/bcr-2018-224892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Extrapulmonary tuberculosis is a rather uncommon and potentially challenging phenomenon. Such manifestation, particularly in the scenario of a late postoperative period, is extremely rare and requires a high index of suspicion, prompt diagnosis and appropriate treatment.We present the case scenario of a patient with history of successfully treated pulmonary tuberculosis many years earlier, without any signs of recurrence, who developed primary nasal septal tuberculosis after undergoing septoplasty to correct his septal deviation. His postoperative course remained uneventful for 4 months. He then presented with a spontaneous nasal septal abscess, which proved to be tubercular in nature on investigations. Appropriate diagnosis was established, and the patient was treated successfully with antituberculous therapy.Recurrent tuberculosis may present a diagnostic challenge for healthcare professionals. Only a high index of suspicion, modern diagnostic tools and institution of appropriate treatment including surgical intervention as required will ensure a promising outcome.
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Affiliation(s)
- Fatima Sarwar
- Department of Paediatrics, KRL Hospital, Islamabad, Pakistan
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35
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Zong Z, Huo F, Shi J, Jing W, Ma Y, Liang Q, Jiang G, Dai G, Huang H, Pang Y. Relapse Versus Reinfection of Recurrent Tuberculosis Patients in a National Tuberculosis Specialized Hospital in Beijing, China. Front Microbiol 2018; 9:1858. [PMID: 30154770 PMCID: PMC6102324 DOI: 10.3389/fmicb.2018.01858] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 07/24/2018] [Indexed: 02/02/2023] Open
Abstract
Tuberculosis (TB) recurrence can result from either relapse of an original infection or exogenous reinfection with a new strain of Mycobacterium tuberculosis (MTB). The aim of this study was to assess the roles of relapse and reinfection among recurrent TB cases characterized by a high prevalence rate of drug-resistant TB within a hospital setting. After 58 paired recurrent TB cases were genotyped to distinguish relapse from reinfection, 37 (63.8%) were demonstrated to be relapse cases, while the remaining 21 were classified as reinfection cases. Statistical analysis revealed that male gender was a risk factor for TB reinfection, odds ratios and 95% confidence interval (OR [95% CI]: 4.188[1.012–17.392], P = 0.049). Of MTB isolates obtained from the 37 relapse cases, 11 exhibited conversion from susceptible to resistance to at least one antibiotic, with the most frequent emergence of drug resistance observed to be levofloxacin. For reinfection cases, reemergence of rifampicin-resistant isolates harboring double gene mutations, of codon 531 of rpoB and codon 306 of embB, were observed. In conclusion, our data demonstrate that relapse is a major mechanism leading to TB recurrence in Beijing Chest Hospital, a national hospital specialized in TB treatment. Moreover, male patients are at higher risk for reinfection. The extremely high rate of multidrug-resistant tuberculosis (MDR-TB) among reinfection cases reflects more successful transmission of MDR-TB strains versus non-resistant strains overall.
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Affiliation(s)
- Zhaojing Zong
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Fengmin Huo
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Jin Shi
- Beijing Pediatric Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Jing
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Yifeng Ma
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Qian Liang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Guanglu Jiang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Guangming Dai
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
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Rosser A, Richardson M, Wiselka MJ, Free RC, Woltmann G, Mukamolova GV, Pareek M. A nested case-control study of predictors for tuberculosis recurrence in a large UK Centre. BMC Infect Dis 2018; 18:94. [PMID: 29486715 PMCID: PMC5830048 DOI: 10.1186/s12879-017-2933-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023] Open
Abstract
Background Tuberculosis (TB) recurrence represents a challenge to control programs. In low incidence countries, the prevailing risk factors leading to recurrence are poorly characterised. Methods We conducted a nested case–control study using the Leicester TB service TBIT database. Cases were identified from database notifications between 1994 and 2014. Controls had one episode and were matched to cases on a ratio of two to one by the date of notification. Multiple imputation was used to account for missing data. Multivariate conditional logistic regression analysis was employed to identify clinical, sociodemographic and TB specific risk factors for recurrence. Results From a cohort of 4628 patients, 82 TB recurrences occurred (1.8%). Nineteen of 82 patients had paired isolates with MIRU-VNTR strain type profiles available, of which 84% were relapses and 16% reinfections. On multivariate analysis, smoking (OR 3.8; p = 0.04), grade 3/4 adverse drug reactions (OR 5.6; p = 0.02), ethnicity ‘Indian subcontinent’ (OR 8.5; p = <0.01), ethnicity ‘other’ (OR 31.2; p = 0.01) and receipt of immunosuppressants (OR 6.8; p = <0.01) were independent predictors of TB recurrence. Conclusions Within this UK setting, the rate of TB recurrence was low, predominantly due to relapse. The identification of an elevated recurrence risk amongst the ethnic group contributing most cases to the national TB burden presents an opportunity to improve individual and population health. Electronic supplementary material The online version of this article (10.1186/s12879-017-2933-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrew Rosser
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 7RH, UK.,Department of Infection and Tropical Medicine, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Matthew Richardson
- Department of Infection, Respiratory Biomedical Research Centre, Institute for Lung Health, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Martin J Wiselka
- Department of Infection and Tropical Medicine, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Robert C Free
- Department of Infection, Respiratory Biomedical Research Centre, Institute for Lung Health, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Gerrit Woltmann
- Department of Infection, Respiratory Biomedical Research Centre, Institute for Lung Health, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Galina V Mukamolova
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 7RH, UK
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 7RH, UK. .,Department of Infection and Tropical Medicine, University Hospitals Leicester NHS Trust, Leicester, UK.
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Silva TC, Matsuoka PDFS, Aquino DMCD, Caldas ADJM. Factors associated with tuberculosis retreatment in priority districts of Maranhão, Brazil. CIENCIA & SAUDE COLETIVA 2017; 22:4095-4104. [PMID: 29267726 DOI: 10.1590/1413-812320172212.20612015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/28/2016] [Indexed: 11/22/2022] Open
Abstract
This study investigated factors associated with cases of tuberculosis retreatment due to relapse and readmission after treatment abandonment. This is an analytical cross-sectional study type of cases reported in the Information System for Notifiable Diseases in priority municipalities in the State of Maranhão, from January 2005 to December 2010. A logistic regression model was used to identify the association. Patients aged between 40 and 59 years (OR = 1.49, p = 0.029) with a pulmonary clinical form (OR = 2.79, p = 0.016) were more likely to incur relapse. Readmissions after abandonment were more likely in males (OR = 1.53, p = 0.046), aged between 20 and 39 years (OR = 1.65, p = 0.007), with less than eight years of schooling (OR = 2.01, p = 0.037) and with alcohol dependence (OR=1.66, p = 0.037), which showed a higher probability of another abandonment (OR = 5.96, p < 0.001). These data reinforce the need for strategies aimed at this group, such as increased supervised treatment, intensified active search, post-discharge follow-up and health education action.
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Affiliation(s)
- Tereza Cristina Silva
- Departamento Acadêmico de Biologia, Instituto Federal de Educação Ciência e Tecnologia do Maranhão. Av. Getúlio Vargas 4, Monte Castelo. 65030-005 São Luís MA Brasil.
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Recurrent tuberculosis and associated factors: A five - year countrywide study in Uzbekistan. PLoS One 2017; 12:e0176473. [PMID: 28472053 PMCID: PMC5417503 DOI: 10.1371/journal.pone.0176473] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 04/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Uzbekistan, despite stable and relatively high tuberculosis treatment success rates, relatively high rates of recurrent tuberculosis have recently been reported. Recurrent tuberculosis is when a patient who was treated for pulmonary tuberculosis and cured, later develops the disease again. This requires closer analysis to identify possible causes and recommend interventions to improve the situation. Using countrywide data, this study aimed to analyse trends in recurrent tuberculosis cases and describe their associations with socio-demographic and clinical factors. METHOD Countrywide retrospective cohort study comparing recurrent tuberculosis patients with all new tuberculosis patients registered within the NTP between January 2006 and December 2010 using routinely collected data. Determinants studied were baseline characteristics and treatment outcomes. RESULTS Of 107,380 registered patients during the period January 2006 and December 2010, 9358 (8.7%) were recurrent cases. Between 2006 and 2008, the number of recurrent cases per annum increased from 1530 to 2081, then fell slightly thereafter from 2081 to 1888 cases. The proportion of all notified cases during this period increased from 6.5% to 9.9%. Factors associated with recurrent tuberculosis included age (35-55 years old), having smear positive pulmonary tuberculosis, residing in certain areas of Uzbekistan, having particular co-morbidities (including chronic obstructive pulmonary disease and HIV), and being unemployed, a pensioner or disabled. Recurrent tuberculosis patients also had a higher likelihood of having an unfavourable treatment outcome. CONCLUSION Despite signs of declining national tuberculosis notifications between 2006 and 2010, the relative proportion of recurrent cases appears to have increased. These findings, together with the identification of possible risk factors associated with recurrent tuberculosis, highlight various areas where Uzbekistan needs to focus its tuberculosis control efforts, particularly in light of the country's rapidly emerging multi drug resistant tuberculosis epidemic.
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Shen X, Yang C, Wu J, Lin S, Gao X, Wu Z, Tian J, Gan M, Luo T, Wang L, Yu C, Mei J, Pan Q, DeRiemer K, Yuan Z, Gao Q. Recurrent tuberculosis in an urban area in China: Relapse or exogenous reinfection? Tuberculosis (Edinb) 2017; 103:97-104. [PMID: 28237039 PMCID: PMC5638046 DOI: 10.1016/j.tube.2017.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 12/12/2022]
Abstract
Recurrent tuberculosis is an important indicator of the effectiveness of tuberculosis control and can occur by relapse or exogenous reinfection. We conducted a retrospective cohort study on all bacteriologically confirmed tuberculosis cases that were successfully treated between 2000 and 2012 in Shanghai, an urban area with a high number but a low prevalence rate of tuberculosis cases and a low prevalence of HIV infection. Genotyping the Mycobacterium tuberculosis from clinical isolates was used to distinguish between relapse and reinfection. In total, 5.3% (710/13,417) of successfully treated cases had a recurrence, a rate of 7.55 (95% CI 7.01-8.13) episodes per 1000 person-years, more than 18 times the rate of tuberculosis in the general population. Patients who were male, age 30-59, retreatment cases, had cavitation, diabetes, drug-resistant or multidrug-resistant tuberculosis in their initial episode of tuberculosis, were at high risk for a recurrence. Among 141 recurrent cases that had paired isolates, 59 (41.8%) had different genotypes, indicating reinfection with a different strain. Patients who completed treatment were still at high risk of another episode of tuberculosis and exogenous reinfection contributed a significant proportion of the recurrent tuberculosis cases. Targeted control strategies are needed to prevent new tuberculosis infections in this setting.
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Affiliation(s)
- Xin Shen
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China; The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China
| | - Chongguang Yang
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China; Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06510, USA
| | - Jie Wu
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Senlin Lin
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Xu Gao
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China
| | - Zheyuan Wu
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Jiyun Tian
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China
| | - Mingyu Gan
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China
| | - Tao Luo
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China
| | - Lili Wang
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Chenlei Yu
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Jian Mei
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Qichao Pan
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China
| | - Kathryn DeRiemer
- School of Medicine, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA.
| | - ZhengAn Yuan
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhong Shan Road, Shanghai, 200336, China.
| | - Qian Gao
- The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Science, Fudan University, Shanghai, 200032, China.
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Perdigão J, Clemente S, Ramos J, Masakidi P, Machado D, Silva C, Couto I, Viveiros M, Taveira N, Portugal I. Genetic diversity, transmission dynamics and drug resistance of Mycobacterium tuberculosis in Angola. Sci Rep 2017; 7:42814. [PMID: 28230095 PMCID: PMC5322374 DOI: 10.1038/srep42814] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/16/2017] [Indexed: 12/02/2022] Open
Abstract
Tuberculosis (TB) poses a serious public health problem in Angola. No surveillance data on drug resistance is available and nothing is known regarding the genetic diversity and population structure of circulating Mycobacterium tuberculosis strains. Here, we have genotyped and evaluated drug susceptibility of 89 Mycobacterium tuberculosis clinical isolates from Luanda. Thirty-three different spoligotype profiles corresponding to 24 different Shared International Types (SIT) and 9 orphan profiles were detected. SIT 20 (LAM1) was the most prevalent (n = 16, 18.2%) followed by SIT 42 (LAM9; n = 15, 17.1%). Overall, the M. tuberculosis population structure in this sample was dominated by LAM (64.8%) and T (33.0%) strains. Twenty-four-loci MIRU-VNTR analysis revealed that a total of 13 isolates were grouped in 5 distinct clusters. Drug susceptibility data showed that 22 (24.7%) of the 89 clinical isolates were resistant to one or more antibacillary drugs of which 4 (4.5%) were multidrug resistant. In conclusion, this study demonstrates a high predominance of LAM strains circulating in the Luanda setting and the presence of recent transmission events. The rate and the emergence dynamics of drug resistant TB found in this sample are significant and highlight the need of further studies specifically focused on MDR-TB transmission.
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Affiliation(s)
- João Perdigão
- iMed.ULisboa - Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - Sofia Clemente
- Hospital da Divina Providência, Serviço de Doenças Infecciosas, Luanda, Angola
| | - Jorge Ramos
- Unidade de Microbiologia Médica, Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Pedro Masakidi
- Hospital da Divina Providência, Serviço de Doenças Infecciosas, Luanda, Angola
| | - Diana Machado
- Unidade de Microbiologia Médica, Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Carla Silva
- iMed.ULisboa - Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - Isabel Couto
- Unidade de Microbiologia Médica, Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Miguel Viveiros
- Unidade de Microbiologia Médica, Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Nuno Taveira
- iMed.ULisboa - Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz, Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal
| | - Isabel Portugal
- iMed.ULisboa - Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
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Sun Y, Harley D, Vally H, Sleigh A. Impact of Multidrug Resistance on Tuberculosis Recurrence and Long-Term Outcome in China. PLoS One 2017; 12:e0168865. [PMID: 28118372 PMCID: PMC5261560 DOI: 10.1371/journal.pone.0168865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022] Open
Abstract
Little is known about the impact of drug resistance on recurrence in TB. We conducted a cohort study to measure the impact of multi-drug resistance (MDR) on TB recurrence over nine years in Henan Province China. We reviewed medical records and conducted field interviews of 100 MDR and 150 non-MDR TB patients who were treated between 2001 and 2002. We compared long-term recurrence rates, risk factors, and outcomes in 2010 for 234 individuals who could be followed up. About one third (29.5%, 69/234) suffered recurrence after completion of treatment. The overall recurrence rate was 35/1,000 patient-years (PY), with a much higher rate (65/1,000 PY) among MDR-TB patients. MDR (HR: 2.75; CI: 1.58–4.79) and patient annual household income less than 10,000 Yuan (HR: 2.05; CI 1.11–3.80) were associated with recurrence. The mean time for recurrence among MDR-TB patients was 5.7 years, compared to 7.2 years among non-MDR-TB patients. Among the recurrence group members, 61.3% died, and 18.8% had failed treatments. We believe that the high TB recurrence rate after 9 years suggests that a high cure rate cannot accurately predict long-term outcome. We recommend that TB surveillance and control should be strengthened with a focus on MDR-TB and directly observed treatment, to reduce TB recurrence and transmission of MDR-TB.
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Affiliation(s)
- Yanni Sun
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia
- * E-mail:
| | - David Harley
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia
| | - Hassan Vally
- School of Public Health & Human Biosciences, La Trobe University, Melbourne, Victoria, Australia
| | - Adrian Sleigh
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia
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Gegia M, Winters N, Benedetti A, van Soolingen D, Menzies D. Treatment of isoniazid-resistant tuberculosis with first-line drugs: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2016; 17:223-234. [PMID: 27865891 DOI: 10.1016/s1473-3099(16)30407-8] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/02/2016] [Accepted: 09/02/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The results of some reports have suggested that treatment of isoniazid-resistant tuberculosis with the recommended regimens of first-line drugs might be suboptimal. We updated a previous systematic review of treatment outcomes associated with use of first-line drugs in patients with tuberculosis resistant to isoniazid but not rifampicin. METHODS In this systematic review, we updated the results of a previous review to include randomised trials and cohort studies published in English, French, or Spanish to March 31, 2015, containing results of standardised treatment of patients with bacteriologically confirmed isoniazid-resistant tuberculosis (but not multidrug-resistant tuberculosis-ie, not resistant to rifampicin) in whom failure and relapse were bacteriologically confirmed. Results in patients with drug-sensitive tuberculosis included in the same studies were also analysed. We pooled treatment outcomes with random-effects meta-analysis. FINDINGS We identified 19 cohort studies and 33 trials with 3744 patients with isoniazid-resistant tuberculosis and 19 012 patients with drug-sensitive disease. The pooled rates of failure or relapse, or both, and acquired drug resistance with all drug regimens were 15% (95% CI 12-18) and 3·6% (2-5), respectively, in patients with isoniazid-resistant tuberculosis and 4% (3-5) and 0·6% (0·3-0·9) in those with drug-sensitive tuberculosis. Of patients with initial isoniazid-resistant tuberculosis with acquired drug resistance, 96% (93-99) had acquired multidrug-resistant disease. Treatment of isoniazid-resistant tuberculosis with the WHO standard regimen for new patients resulted in treatment failure, relapse, and acquired multidrug resistance in 11% (6-17), 10% (5-15) and 8% (3-13), respectively; treatment with the standard WHO regimen for previously treated patients resulted in treatment failure in 6% (2-10), relapse in 5% (2-8), and acquisition of multidrug resistance in 3% (0-6). For patients with drug-sensitive disease treated with the standard retreatment regimen the rates were 1% (0-2), 5% (4-7), and 0·3% (0-0·6). INTERPRETATION Treatment of isoniazid-resistant tuberculosis with first-line drugs resulted in suboptimal outcomes, supporting the need for better regimens. Standardised empirical treatment of new cases could be contributing substantially to the multidrug-resistant epidemic, particularly in settings where the prevalence of isoniazid resistance is high. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Medea Gegia
- Global TB Programme, WHO, Geneva, Switzerland
| | - Nicholas Winters
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Andrea Benedetti
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | | | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada.
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Mitnick CD, White RA, Lu C, Rodriguez CA, Bayona J, Becerra MC, Burgos M, Centis R, Cohen T, Cox H, D'Ambrosio L, Danilovitz M, Falzon D, Gelmanova IY, Gler MT, Grinsdale JA, Holtz TH, Keshavjee S, Leimane V, Menzies D, Migliori GB, Milstein MB, Mishustin SP, Pagano M, Quelapio MI, Shean K, Shin SS, Tolman AW, van der Walt ML, Van Deun A, Viiklepp P. Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method. Eur Respir J 2016; 48:1160-1170. [PMID: 27587552 PMCID: PMC5045442 DOI: 10.1183/13993003.00462-2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/03/2016] [Indexed: 11/12/2022]
Abstract
Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection. We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference. Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34–0.42) for all patients and 0.33 (0.25–0.42) for HIV-co-infected patients. Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests. Monthly culture monitoring is crucial to earlier detection of treatment failure in MDR-TB patientshttp://ow.ly/w2MI301mK8M
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Affiliation(s)
- Carole D Mitnick
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA
| | - Richard A White
- Dept of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Dept of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway
| | - Chunling Lu
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
| | - Carly A Rodriguez
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Mercedes C Becerra
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
| | - Marcos Burgos
- Dept of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Rosella Centis
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
| | - Theodore Cohen
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Helen Cox
- Médecins Sans Frontières, Cape Town, South Africa
| | - Lia D'Ambrosio
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy Public Health Consulting Group, Lugano, Switzerland
| | | | - Dennis Falzon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Jennifer A Grinsdale
- Tuberculosis Control, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Timothy H Holtz
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Salmaan Keshavjee
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
| | - Vaira Leimane
- State Agency for Tuberculosis and Lung Diseases (TPSVA), Riga, Latvia
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Giovanni Battista Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
| | - Meredith B Milstein
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | | | - Marcello Pagano
- Dept of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Maria I Quelapio
- Tropical Disease Foundation, Philippine Institute of Tuberculosis, Makati City, Philippines
| | - Karen Shean
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sonya S Shin
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA Socios en Salud Sucursal, Lima, Peru
| | - Arielle W Tolman
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Martha L van der Walt
- South African Medical Research Council, Tuberculosis Research Platform, Pretoria, South Africa
| | | | - Piret Viiklepp
- National Institute for Heath Development, Tallinn, Estonia
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Rai PK, Chodisetti SB, Nadeem S, Maurya SK, Gowthaman U, Zeng W, Janmeja AK, Jackson DC, Agrewala JN. A novel therapeutic strategy of lipidated promiscuous peptide against Mycobacterium tuberculosis by eliciting Th1 and Th17 immunity of host. Sci Rep 2016; 6:23917. [PMID: 27052185 PMCID: PMC4823727 DOI: 10.1038/srep23917] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/16/2016] [Indexed: 02/06/2023] Open
Abstract
Regardless of the fact that potent drug-regimen is currently available, tuberculosis continues to kill 1.5 million people annually. Tuberculosis patients are not only inflicted by the trauma of disease but they also suffer from the harmful side-effects, immune suppression and drug resistance instigated by prolonged therapy. It is an exigency to introduce radical changes in the existing drug-regime and discover safer and better therapeutic measures. Hence, we designed a novel therapeutic strategy by reinforcing the efficacy of drugs to kill Mtb by concurrently boosting host immunity by L91. L91 is chimera of promiscuous epitope of Acr1 antigen of Mtb and TLR-2 agonist Pam2Cys. The adjunct therapy using drugs and L91 (D-L91) significantly declined the bacterial load in Mtb infected animals. The mechanism involved was through enhancement of IFN-γ+TNF-α+ polyfunctional Th1 cells and IL-17A+IFN-γ+ Th17 cells, enduring memory CD4 T cells and downregulation of PD-1. The down-regulation of PD-1 prevents CD4 T cells from undergoing exhaustion and improves their function against Mtb. Importantly, the immune response observed in animals could be replicated using T cells of tuberculosis patients on drug therapy. In future, D-L91 therapy can invigorate drugs potency to treat tuberculosis patients and reduce the dose and duration of drug-regime.
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Affiliation(s)
- Pradeep K Rai
- CSIR-Institute of Microbial Technology, Chandigarh, India
| | | | - Sajid Nadeem
- CSIR-Institute of Microbial Technology, Chandigarh, India
| | | | | | - Weiguang Zeng
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville 3010, Victoria, Australia
| | - Ashok K Janmeja
- Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India
| | - David C Jackson
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville 3010, Victoria, Australia
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Tafess K, Mengistu B, Woldeyohannes D, Sisay S. Determining treatment outcome of smear-positive pulmonary tuberculosis cases in Afar Regional State, Ethiopia: A retrospective facility based study. Int J Mycobacteriol 2016; 5:164-9. [PMID: 27242227 DOI: 10.1016/j.ijmyco.2016.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE/BACKGROUND The World Health Organization (WHO) declared tuberculosis (TB) as a global public health emergency and recommended directly observed treatment, short-course (DOTS) as a standard strategy to control the disease. In Ethiopia the strategy was started in 1992 as a pilot in the Arsi and Bale zone, Oromia Region. The DOTS strategy has been subsequently scaled up in the country and implemented at a national level reaching better coverage, although there are recognizable variations from region to region and district to district. The aim of this study was to assess the impact of the DOTS strategy on smear-positive pulmonary TB case findings and their treatment outcomes in the Afar Regional State, Ethiopia, from 2003 to 2012 and from 2002 to 2011, respectively. METHODS A health facility-based retrospective study was conducted. Data were collected and reported on a quarterly basis using the WHO reporting format for TB case findings and their treatment outcomes from all DOTS-implementing health facilities in all zones of the region to the Federal Ministry of Health. RESULTS A total of 34,894 of TB cases had been registered in the period from 2003 to 2012. Out of these, 11,595 (33.2%) were smear-positive pulmonary TB, 13,859 (39.7%) smear-negative pulmonary TB, and 9838 (28.2%) extrapulmonary TB. The case detection rate (CDR) of smear-positive pulmonary TB had increased from 18.3% to 37.2%, with the average value being 32% (standard deviation=6.8) from the total TB cases to its peak of 39% in 2008. The treatment success rate (TSR) had an average value of 86.2% from 2002 to 2011 with its peak value being 96.5% in 2007. Moreover, the average values of treatment defaulter and treatment failure rate were 2.9% and 2.7%, respectively. CONCLUSION The implementation for the DOTS strategy in the area improved the CDR of smear-positive TB, although it is unacceptably lower than the recommended WHO target of 70%. Additionally, the WHO target of 85% for TSR had already been achieved in the region. However, continued efforts should be in place to increase the CDR and maintain the high TSR registered.
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Affiliation(s)
- Ketema Tafess
- Department of Medical Laboratory Sciences, College of Health Sciences, Arsi University, Asella, Ethiopia.
| | - Belete Mengistu
- Directorate of Pastoralist Health Promotion and Disease Prevention, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Desalegn Woldeyohannes
- Department of Zoonoses, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Moosazadeh M, Bahrampour A, Nasehi M, Khanjani N. The incidence of recurrence of tuberculosis and its related factors in smear-positive pulmonary tuberculosis patients in Iran: A retrospective cohort study. Lung India 2015; 32:557-60. [PMID: 26664159 PMCID: PMC4663856 DOI: 10.4103/0970-2113.168113] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Aim: Studying the recurrence of smear-positive pulmonary tuberculosis (TB) is a convenient way to evaluate the effectiveness of TB control programs and identify vulnerable patients. In the present study, the rate of recurrence of TB and its predictors were determined in Iran. Materials and Methods: This study was a retrospective cohort. Eligible people were patients with smear-positive TB who were diagnosed from 2002 to 2011. The end of the follow-up time was December 2013. The number of people who entered the cohort was 1,271 subjects. In order to determine the predictors of recurrence, multivariate logistic regression was used. Analysis was done using SPSS 20. Results: The recurrence incidence was 8.3% and in 85.9% of these patients, it occurred in the time interval of 1-5 years after successful treatment. The recurrence rate was not significantly related to gender, age group, and diabetes. But it was significantly higher in patients whose sputum smear grading before treatment was 2 + or more, patients with positive sputum smear at the end of the second month of the treatment, patients who had completed treatment, and patients who were smokers (P < 0.05). Conclusions: Our study showed that a considerable percentage of smear-positive pulmonary TB patients experience recurrence and that some patients are at a higher risk of recurrence.
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Affiliation(s)
- Mahmood Moosazadeh
- Department of Biostatistics and Epidemiology, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Bahrampour
- Department of Biostatistics and Epidemiology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahshid Nasehi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Narges Khanjani
- Department of Biostatistics and Epidemiology, Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
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MOOSAZADEH M, KHANJANI N, NASEHI M, BAHRAMPOUR A. Predicting the Incidence of Smear Positive Tuberculosis Cases in Iran Using Time Series Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:1526-34. [PMID: 26744711 PMCID: PMC4703233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
BACKGROUND Determining the temporal variation and forecasting the incidence of smear positive tuberculosis (TB) can play an important role in promoting the TB control program. Its results may be used as a decision-supportive tool for planning and allocating resources. The present study forecasts the incidence of smear positive TB in Iran. METHODS This a longitudinal study using monthly tuberculosis incidence data recorded in the Iranian National Tuberculosis Control Program. The sum of registered cases in each month created 84 time points. Time series methods were used for analysis. Based on the residual chart of ACF, PACF, Ljung-Box tests and the lowest levels of AIC and BIC, the most suitable model was selected. RESULTS From April 2005 until March 2012, 34012 smear positive TB cases were recorded. The mean of TB monthly incidence was 404.9 (SD=54.7). The highest number of cases was registered in May and the difference in monthly incidence of smear positive TB was significant (P<0.001). SARIMA (0,1,1)(0,1,1)12 was selected as the most adequate model for prediction. It was predicted that the incidence of smear positive TB for 2015 will be about 9.8 per 100,000 people. CONCLUSION Based on the seasonal pattern of smear positive TB recorded cases, seasonal ARIMA model was suitable for predicting its incidence. Meanwhile, prediction results show an increasing trend of smear positive TB cases in Iran.
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Affiliation(s)
- Mahmood MOOSAZADEH
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Narges KHANJANI
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran,Monash Centre for Occupational & Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia,Corresponding Author:
| | - Mahshid NASEHI
- Dept. of Epidemiology, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas BAHRAMPOUR
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
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Woldeyohannes D, Sisay S, Mengistu B, Kassa H. Directly observed treatment short-course (DOTS) for treatment of new tuberculosis cases in Somali Regional State, Eastern Ethiopia: ten years retrospective study. BMC Res Notes 2015; 8:357. [PMID: 26285700 PMCID: PMC4539707 DOI: 10.1186/s13104-015-1325-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 08/11/2015] [Indexed: 11/25/2022] Open
Abstract
Background A third of the world population is infected with tuberculosis (TB) bacilli. TB accounts for 25 % of all avoidable deaths in developing countries. The objective of the study was to assess impact of directly observed treatment short-course (DOTS) strategy on new tuberculosis case finding and treatment outcomes in Somali Regional State, Ethiopia from 2003 up to 2012 and from 2004 up to 2013, respectively. Methods A health facility based retrospective study was employed. Quarterly reports were collected using World Health Organization (WHO) reporting format for TB case finding and treatment outcome from all zones in the region to the Federal Ministry of Health. Results A total of 31, 198 all types of new TB cases were registered and reported during the period from 2003 up to 2012, in the region. Out of these, smear positive pulmonary TB cases were 12,466 (40 %), and 10,537 (33.8 %) and 8195 (26.2 %) for smear negative pulmonary TB and extra-pulmonary TB cases, respectively. An average case detection rate (CDR) of 19.1 % (SD 3.6) and treatment success rate (TSR) of 85.5 % (SD 5.0) for smear positive pulmonary TB were reported for the specified years period. For the overall study period, trend chi-squire analysis for CDR was X2 = 2.1; P > 0.05 and X2 = 5.64; P < 0.05 for TSR. Conclusions The recommended TSR set by WHO was achieved (85.5 %) and the CDR reported was far below (19.1 %) from the recommended target. Extensive efforts should be established to maintain the achieved TSR and to increase the low CDR for the smear positive pulmonary TB cases through implementing alternative case finding strategies.
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Affiliation(s)
- Desalegn Woldeyohannes
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P.O.Box 1176, Addis Ababa, Ethiopia.
| | - Solomon Sisay
- Department of Clinical, John Hopkins University-TSEHAI Project, P.O.Box 5606, Addis Ababa, Ethiopia.
| | - Belete Mengistu
- Directorate of Pastoralist Health Promotion and Disease Prevention, Federal Ministry of Health, P.O.Box 1234, Addis Ababa, Ethiopia.
| | - Hiwot Kassa
- Department of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.Box 196, Gondar, Ethiopia.
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Resistance profile and risk factors of drug resistant tuberculosis in the Baltic countries. Tuberculosis (Edinb) 2015; 95:581-8. [PMID: 26164355 DOI: 10.1016/j.tube.2015.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 05/06/2015] [Accepted: 05/29/2015] [Indexed: 11/24/2022]
Abstract
The rates of multi- and extensively drug-resistant tuberculosis (X/MDRTB) in the Baltic countries are the highest within the European Union hampering recent achievements of national TB control programmes. We included all consecutive culture-confirmed X/MDRTB patients registered for treatment in 2009 in Latvia, Lithuania and Estonia into this multicenter case-control study. Cases were compared with randomly selected controls with non-MDRTB registered for treatment in the same year across these sites. Of 495 MDRTB patients, 243 (49.7%) showed resistance to at least one second-line drug, 206 (42.1%) had pre-XDRTB (i.e. MDRTB with additional resistance to a second-line injectable or fluoroquinolones) and 64 (13.1%) had XDRTB. Younger age, male gender and known contact with an MDRTB case were associated with increased risk of primary infection with X/MDRTB strains. Previous treatment and alcohol abuse were strong predictors for MDRTB acquisition; defaults and failures in the past triggered XDRTB development. All patients received appropriate therapy; less than half of the patients were fully adherent. An erroneous treatment strategy is unlikely to drive resistance development. Increasing patients' compliance, addressing issues of social support, rapid detection of drug resistance and improving infection control is crucial for prevention of further spread of X/MDRTB and achieving higher cure rates.
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50
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Westerlund EE, Tovar MA, Lönnermark E, Montoya R, Evans CA. Tuberculosis-related knowledge is associated with patient outcomes in shantytown residents; results from a cohort study, Peru. J Infect 2015; 71:347-57. [PMID: 26033695 DOI: 10.1016/j.jinf.2015.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Tuberculosis is frequent among poor and marginalized people whose limited tuberculosis-related knowledge may impair healthcare access. We characterised tuberculosis-related knowledge and associations with delayed treatment and treatment outcome. METHODS Tuberculosis patients (n = 943), people being tested for suspected tuberculosis (n = 2020), and randomly selected healthy controls (n = 476) in 16 periurban shantytowns were interviewed characterizing: socio-demographic factors; tuberculosis risk-factors; and patients' treatment delay. Principle component analysis was used to generate a tuberculosis-related knowledge score. Patients were followed-up for median 7.7 years. Factors associated with tuberculosis treatment delay, treatment outcome and tuberculosis recurrence were assessed using linear, logistic and Cox regression. RESULTS Tuberculosis-related knowledge was poor, especially in older people who had not completed schooling and had never been diagnosed with tuberculosis. Tuberculosis treatment delay was median 60 days and was more delayed for patients who were poorer, older, had more severe tuberculosis and in only unadjusted analysis with incomplete schooling and low tuberculosis-related knowledge (all p ≤ 0.03). Lower than median tuberculosis-related knowledge was associated with tuberculosis recurrence (unadjusted hazard ratio = 2.1, p = 0.008), and this association was independent of co-morbidities, disease severity and demographic factors (multiple regression adjusted hazard ratio = 2.6, p = 0.008). CONCLUSIONS Low tuberculosis-related knowledge independently predicted tuberculosis recurrence. Thus health education may improve tuberculosis prognosis.
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Affiliation(s)
- Emma E Westerlund
- IFHAD: Innovation For Health And Development, Laboratory of Research and Development #218, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Marco A Tovar
- IFHAD: Innovation For Health And Development, Laboratory of Research and Development #218, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru; Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benefica Prisma, Lima, Peru
| | - Elisabet Lönnermark
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Rosario Montoya
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benefica Prisma, Lima, Peru
| | - Carlton A Evans
- IFHAD: Innovation For Health And Development, Laboratory of Research and Development #218, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru; Infectious Diseases & Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK.
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