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Tekin A, Joghataee M, Rovati L, Truong HH, Castillo-Zambrano C, Kushagra K, Nikravangolsefid N, Ozkan M, Gupta A, Herasevich V, Domecq J, O’Horo J, Gajic O. Development and validation of a preliminary multivariable diagnostic model for identifying unusual infections in hospitalized patients. BIOMOLECULES & BIOMEDICINE 2024; 24:1387-1399. [PMID: 38643478 PMCID: PMC11379024 DOI: 10.17305/bb.2024.10447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024]
Abstract
Diagnostic delay leads to poor outcomes in infections, and it occurs more often when the causative agent is unusual. Delays are attributable to failing to consider such diagnoses in a timely fashion. Using routinely collected electronic health record (EHR) data, we built a preliminary multivariable diagnostic model for early identification of unusual fungal infections and tuberculosis in hospitalized patients. We conducted a two-gate case-control study. Cases encompassed adult patients admitted to 19 Mayo Clinic enterprise hospitals between January 2010 and March 2023 diagnosed with blastomycosis, cryptococcosis, histoplasmosis, mucormycosis, pneumocystosis, or tuberculosis. Control groups were drawn from all admitted patients (random controls) and those with community-acquired infections (ID-controls). Development and validation datasets were created using randomization for dividing cases and controls (7:3), with a secondary validation using ID-controls. A logistic regression model was constructed using baseline and laboratory variables, with the unusual infections of interest outcome. The derivation dataset comprised 1043 cases and 7000 random controls, while the 451 cases were compared to 3000 random controls and 1990 ID-controls for validation. Within the derivation dataset, the model achieved an area under the curve (AUC) of 0.88 (95% confidence interval [CI]: 0.87-0.89) with a good calibration accuracy (Hosmer-Lemeshow P = 0.623). Comparable performance was observed in the primary (AUC = 0.88; 95% CI: 0.86-0.9) and secondary validation datasets (AUC = 0.84; 95% CI: 0.82-0.86). In this multicenter study, an EHR-based preliminary diagnostic model accurately identified five unusual fungal infections and tuberculosis in hospitalized patients. With further validation, this model could help decrease time to diagnosis.
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Affiliation(s)
- Aysun Tekin
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohammad Joghataee
- Department of Business Analytics and Information Systems, Auburn University, Auburn, AL, USA
| | - Lucrezia Rovati
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Hong Hieu Truong
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Claudia Castillo-Zambrano
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kushagra Kushagra
- Department of Business Analytics and Information Systems, Auburn University, Auburn, AL, USA
| | - Nasrin Nikravangolsefid
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mahmut Ozkan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ashish Gupta
- Department of Business Analytics and Information Systems, Auburn University, Auburn, AL, USA
| | - Vitaly Herasevich
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juan Domecq
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - John O’Horo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Matteelli A, Churchyard G, Cirillo D, den Boon S, Falzon D, Hamada Y, Houben RMGJ, Kanchar A, Kritski A, Kumar B, Miller C, Menzies D, Masini T. Optimizing the cascade of prevention to protect people from tuberculosis: A potential game changer for reducing global tuberculosis incidence. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003306. [PMID: 38954723 PMCID: PMC11218967 DOI: 10.1371/journal.pgph.0003306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
The provision of tuberculosis preventive treatment is one of the critical interventions to reduce tuberculosis incidence and ultimately eliminate the disease, yet we still miss appropriate tools for an impactful intervention and treatment coverage remains low. We used recent data, epidemiological estimates, and research findings to analyze the challenges of each step of the cascade of tuberculosis prevention that currently delay the strategy implementation. We addressed research gaps and implementation bottlenecks that withhold key actions in tuberculosis case finding, testing for tuberculosis infection, provision of preventive treatment with safer, shorter regimens and supporting people to complete their treatment. Empowering communities to generate demand for preventive therapy and other prevention services in a holistic manner and providing adequate financial support to sustain implementation are essential requirements. The adoption of an effective, universal monitoring and evaluation system is a prerequisite to provide general and granular insight, and to steer progress of the tuberculosis infection strategy at global and local level.
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Affiliation(s)
- Alberto Matteelli
- Institute of Infectious and Tropical Diseases, WHO Collaborating Centre for Tuberculosis Prevention, University of Brescia, Brescia, Italy
| | - Gavin Churchyard
- The Aurum Institute, Parktown, South Africa, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Saskia den Boon
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Dennis Falzon
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Yohhei Hamada
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
- University College London, London, United Kingdom
| | - Rein M. G. J. Houben
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Avinash Kanchar
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Afrânio Kritski
- Rede Brasileira de Pesquisa em Tuberculose, REDE TB, Rio de Janeiro, Brasil
- Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Cecily Miller
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Dick Menzies
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
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Lee SJ, Lee S, Kim YH, Cha YS. Risk of lung diseases in patients with previous carbon monoxide poisoning: a nationwide population-based cohort study in the Republic of Korea. Clin Toxicol (Phila) 2024; 62:425-431. [PMID: 38946481 DOI: 10.1080/15563650.2024.2371020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/17/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Carbon monoxide poisoning is associated with severe damage to various organs. In this study, we aimed to determine if previous carbon monoxide poisoning was associated with an increased risk of lung diseases. METHODS The study population was derived from the National Health Insurance Service database of Korea between 1 January 2002 and 31 December 2021. Adults with carbon monoxide poisoning, with at least one visit to medical facilities between 2002 and 2021, were included. For comparison, an equal number of matched controls with the same index date were selected from the database. RESULTS A total of 28,618 patients with carbon monoxide poisoning and 28,618 matched controls were included in this study. Approximately 42.8 per cent of the patient and control groups were female, with a mean age of 51.3 years. In patients with carbon monoxide poisoning, there was a significant increase in the risk of lung cancer (adjusted hazard ratio, 1.84; 95 per cent confidence interval, 1.42-2.39; P < 0.001), chronic obstructive pulmonary disease (adjusted hazard ratio, 1.60; 95 per cent confidence interval, 1.36-1.89; P < 0.001), pulmonary tuberculosis (adjusted hazard ratio, 1.46; 95 per cent confidence interval, 1.13-1.88; P = 0.003), and non-tuberculous mycobacterial infection (adjusted hazard ratio, 1.54; 95 per cent confidence interval, 1.01-2.36; P = 0.047). DISCUSSION In this retrospective cohort study, previous carbon monoxide poisoning was associated with an increased risk of lung cancer, chronic obstructive pulmonary disease, pulmonary tuberculosis, and non-tuberculous mycobacterial infection. Further studies are needed to confirm such an association in other populations and the risk of lung diseases due to the toxic effect of carbon monoxide from different sources. CONCLUSIONS Previous carbon monoxide poisoning was associated with an increased risk of lung diseases, but the relative importance of the causes and sources of exposure was not known. The long-term management of survivors of acute carbon monoxide poisoning should include monitoring for lung cancer, chronic obstructive pulmonary disease, pulmonary tuberculosis, and non-tuberculous mycobacterial infection.
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Affiliation(s)
- Seok Jeong Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - You Hyun Kim
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Research Institute of Hyperbaric Medicine and Science, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Mihuta C, Socaci A, Hogea P, Tudorache E, Mihuta MS, Oancea C. Colliding Challenges: An Analysis of SARS-CoV-2 Infection in Patients with Pulmonary Tuberculosis versus SARS-CoV-2 Infection Alone. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:823. [PMID: 38793006 PMCID: PMC11123355 DOI: 10.3390/medicina60050823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The concurrent occurrence of tuberculosis and COVID-19 coinfection poses significant clinical complexities, warranting a nuanced approach to diagnosis, management, and patient care. Materials and Methods: A retrospective, cross-sectional study was conducted on two groups: one comprising 32 patients with pulmonary TB (PTB) and COVID-19 co-infection, and one including 100 patients with COVID-19 alone. Data was collected from medical records, including patient history, clinical parameters, laboratory, imaging results, and patient outcome. Results: A lower BMI emerges as a significant marker suggesting underlying PTB in patients with SARS-CoV-2 co-infection. Type 2 diabetes mellitus increases the risk of death in PTB-SARS-CoV-2 co-infection. Co-infected patients show lymphocytopenia and higher neutrophil levels, CRP, transaminases, and D-dimer levels. Elevated CRP and ALT levels are linked to increased co-infection likelihood. Certain parameters like SpO2, CRP, ALT, AST, and D-dimer effectively differentiate between co-infected and COVID-19 patients. Platelet-to-lymphocyte ratio is notably higher in co-infected individuals. Lesion severity on imaging is significantly associated with co-infection, highlighting imaging's diagnostic importance. Longer hospital stays are linked to co-infection but not significantly to death risk. Conclusions: Certain clinical and biological factors may serve as potential indicators of PTB co-infection in patients with SARS-CoV-2.
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Affiliation(s)
- Camil Mihuta
- Department of Doctoral Studies, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
| | - Adriana Socaci
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Department of Biology and Life Sciences, Faculty of Medicine, “Vasile Goldis” Western University of Arad, 310025 Arad, Romania
| | - Patricia Hogea
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Emanuela Tudorache
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Monica Simina Mihuta
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Cristian Oancea
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Sehgal IS, Dhooria S, Muthu V, Salzer HJF, Agarwal R. Burden, clinical features, and outcomes of post-tuberculosis chronic obstructive lung diseases. Curr Opin Pulm Med 2024; 30:156-166. [PMID: 37902135 DOI: 10.1097/mcp.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
PURPOSE OF REVIEW Post-tuberculosis lung disease (PTLD) is an increasingly recognized and debilitating consequence of pulmonary tuberculosis (PTB). In this review, we provide a comprehensive overview of PTLD with airflow obstruction (PTLD-AFO), focusing on its burden, pathophysiology, clinical manifestations, diagnostic methods, and management strategies. RECENT FINDINGS The relationship between PTLD and airflow obstruction is complex and multifactorial. Approximately 60% of the patients with PTLD have some spirometric abnormality. Obstruction is documented in 18-22% of PTLD patients. The host susceptibility and host response to mycobacterium drive the pathogenic mechanism of PTLD. A balance between inflammatory, anti-inflammatory, and fibrotic pathways decides whether an individual with PTB would have PTLD after microbiological cure. An obstructive abnormality in PTLD-AFO is primarily due to destruction of bronchial walls, aberrant healing, and reduction of mucosal glands. The most common finding on computed tomography (CT) of thorax in patients with PTLD-AFO is bronchiectasis and cavitation. Therefore, the 'Cole's vicious vortex' described in bronchiectasis applies to PTLD. A multidisciplinary approach is required for diagnosis and treatment. The disability-adjusted life-years (DALYs) attributed to PTLD represent about 50% of the total estimated burden of DALYs due to tuberculosis (TB). Patients with PTLD require comprehensive care that includes psychosocial support, pulmonary rehabilitation, and vaccination against respiratory pathogens. In the absence of trials evaluating different treatments for PTLD-AFO, therapy is primarily symptomatic. SUMMARY PTLD with airflow obstruction has considerable burden and causes a significant morbidity and mortality. However, many aspects of PTLD-AFO still need to be answered. Studies are required to evaluate different phenotypes, especially concerning Aspergillus -related complications. The treatment should be personalized based on the predominant phenotype of airflow obstruction. Extensive studies to understand the exact burden, pathogenesis, and treatment of PTBLD-AFO are needed.
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Affiliation(s)
- Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
| | - Helmut J F Salzer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine 4 - Pneumology, Kepler University Hospital
- Medical Faculty, Johannes Kepler University Linz, Linz
- Ignaz-Semmelweis-Institute, Interuniversity Institute for Infection Research, Vienna, Austria
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
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Suman SK, Chandrasekaran N, Priya Doss CG. Micro-nanoemulsion and nanoparticle-assisted drug delivery against drug-resistant tuberculosis: recent developments. Clin Microbiol Rev 2023; 36:e0008823. [PMID: 38032192 PMCID: PMC10732062 DOI: 10.1128/cmr.00088-23] [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] [Indexed: 12/01/2023] Open
Abstract
Tuberculosis (TB) is a major global health problem and the second most prevalent infectious killer after COVID-19. It is caused by Mycobacterium tuberculosis (Mtb) and has become increasingly challenging to treat due to drug resistance. The World Health Organization declared TB a global health emergency in 1993. Drug resistance in TB is driven by mutations in the bacterial genome that can be influenced by prolonged drug exposure and poor patient adherence. The development of drug-resistant forms of TB, such as multidrug resistant, extensively drug resistant, and totally drug resistant, poses significant therapeutic challenges. Researchers are exploring new drugs and novel drug delivery systems, such as nanotechnology-based therapies, to combat drug resistance. Nanodrug delivery offers targeted and precise drug delivery, improves treatment efficacy, and reduces adverse effects. Along with nanoscale drug delivery, a new generation of antibiotics with potent therapeutic efficacy, drug repurposing, and new treatment regimens (combinations) that can tackle the problem of drug resistance in a shorter duration could be promising therapies in clinical settings. However, the clinical translation of nanomedicines faces challenges such as safety, large-scale production, regulatory frameworks, and intellectual property issues. In this review, we present the current status, most recent findings, challenges, and limiting barriers to the use of emulsions and nanoparticles against drug-resistant TB.
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Affiliation(s)
- Simpal Kumar Suman
- School of Bio Sciences & Technology (SBST), Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Natarajan Chandrasekaran
- Centre for Nano Biotechnology (CNBT), Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - C. George Priya Doss
- Laboratory for Integrative Genomics, Department of Integrative Biology, School of Bio Sciences & Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
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Riccardi N, Occhineri S, Vanino E, Antonello RM, Pontarelli A, Saluzzo F, Masini T, Besozzi G, Tadolini M, Codecasa L. How We Treat Drug-Susceptible Pulmonary Tuberculosis: A Practical Guide for Clinicians. Antibiotics (Basel) 2023; 12:1733. [PMID: 38136767 PMCID: PMC10740448 DOI: 10.3390/antibiotics12121733] [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: 11/18/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide and pulmonary TB (PTB) is the main variant responsible for fueling transmission of the infection. Effective treatment of drug-susceptible (DS) TB is crucial to avoid the emergence of Mycobacterium tuberculosis-resistant strains. In this narrative review, through a fictional suggestive case of DS PTB, we guide the reader in a step-by-step commentary to provide an updated review of current evidence in the management of TB, from diagnosis to post-treatment follow-up. World Health Organization and Centre for Diseases Control (CDC) guidelines for TB, as well as the updated literature, were used to support this manuscript.
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Affiliation(s)
- Niccolò Riccardi
- StopTB Italia ODV, 20159 Milan, Italy
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, 56124 Pisa, Italy
| | - Sara Occhineri
- StopTB Italia ODV, 20159 Milan, Italy
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, 56124 Pisa, Italy
| | - Elisa Vanino
- StopTB Italia ODV, 20159 Milan, Italy
- Infectious Diseases Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48100 Ravenna, Italy
| | | | - Agostina Pontarelli
- StopTB Italia ODV, 20159 Milan, Italy
- Unit of Respiratory Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy
| | - Francesca Saluzzo
- StopTB Italia ODV, 20159 Milan, Italy
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute, San Raffaele University, 20132 Milan, Italy
| | | | | | - Marina Tadolini
- StopTB Italia ODV, 20159 Milan, Italy
- Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Luigi Codecasa
- StopTB Italia ODV, 20159 Milan, Italy
- Regional TB Reference Centre, Villa Marelli Institute, ASST Grande Ospedale Metropolitano Niguarda, 20159 Milan, Italy
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Gupta P, Singh P, Das A, Kumar R. Determinants of tuberculosis: an example of high tuberculosis burden in the Saharia tribe. Front Public Health 2023; 11:1226980. [PMID: 37920577 PMCID: PMC10619692 DOI: 10.3389/fpubh.2023.1226980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
Tuberculosis (TB) is a significant public health problem among the Saharia community, an underprivileged tribal group in the west-central part of India. There are several challenges for India's TB control program to curtail TB in the Saharia tribe. Malnutrition, poor health sector facilities, lower socio-economic status, and substance abuse are interconnected and synergistic factors contributing to a high burden of TB in the Saharia tribe. In this review, efforts are made to collate the findings of previous studies discussing the causes of high burden of TB in the Saharia tribe, social gaps for mitigating these preventable risk factors of TB in the Saharia tribe, and the plausible solutions for closing these gaps. The concept of Health in All Policies and intersectoral co-ordination is needed for the reduction of TB in the Saharia tribe and to make India TB-free by the year 2025.
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Affiliation(s)
| | | | | | - Ravindra Kumar
- ICMR-National Institute of Research in Tribal Health, Jabalpur, India
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Sy KTL, Horváth-Puhó E, Sørensen HT, Szépligeti SK, Heeren TC, Thomsen RW, Fox MP, Horsburgh, Jr. CR. Burden of Chronic Obstructive Pulmonary Disease Attributable to Tuberculosis: A Microsimulation Study. Am J Epidemiol 2023; 192:908-915. [PMID: 36813297 PMCID: PMC10505413 DOI: 10.1093/aje/kwad042] [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: 06/16/2022] [Revised: 12/18/2022] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Tuberculosis (TB) is a risk factor for chronic obstructive pulmonary disease (COPD), but COPD is also a predictor of TB. The excess life-years lost to COPD caused by TB can potentially be saved by screening for and treating TB infection. We examined the number of life-years that could be saved by preventing TB and TB-attributable COPD. We compared the observed (no intervention) and counterfactual microsimulation models constructed from observed rates in the Danish National Patient Registry (covering all Danish hospitals between 1995 and 2014). In the Danish population of TB and COPD-naive individuals (n = 5,206,922), 27,783 persons (0.5%) developed TB. Among those who developed TB, 14,438 (52.0%) developed TB with COPD. Preventing TB saved 186,469 life-years overall. The excess number of life-years lost to TB alone was 7.07 years per person, and the additional number of life-years lost among persons who developed COPD after TB was 4.86 years per person. The life-years lost to TB-associated COPD are substantial, even in regions where TB can be expected to be identified and treated promptly. Prevention of TB could prevent a substantial amount of COPD-related morbidity; the benefit of screening and treatment for TB infection is underestimated by considering morbidity from TB alone.
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Affiliation(s)
- Karla Therese L Sy
- Correspondence to Dr. Karla Therese Sy, Department of Epidemiology, School of Public Health, Boston University, Boston, MA 02118 (e-mail: )
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Chen Y, Hu W. Co-infection with Mycobacterium tuberculosis and Nocardia farcinica in a COPD patient: a case report. BMC Pulm Med 2023; 23:136. [PMID: 37087417 PMCID: PMC10122200 DOI: 10.1186/s12890-023-02434-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/13/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by persistent airflow limitation. Infection with either Mycobacterium tuberculosis or Nocardia in COPD patients has been reported. However, co-infection with Mycobacterium tuberculosis and Nocardia is rare. Herein, we described such a patient with COPD in a primary hospital, and the diagnosis process. CASE PRESENTATION A 79-year-old female farmer with COPD was consecutively admitted to two hospitals with chief complaints of worsening cough, sputum and gasping since January10, 2022. Microbiological examination was not performed at the first hospital due to unknown reasons, and empirical antibiotic treatment was not effective. The patient was subsequently referred to our hospital. After screening the source of infection and the pathogen, she was diagnosed with tuberculosis. However, the patient did not benefit from antituberculosis treatment, with no remission of respiratory tract symptoms. Cerebrospinal fluid and bronchoalveolar lavage fluid specimens were subsequently sent for microbiological examination. The results indicated Mycobacterium tuberculosis and Nocardia.spp. After four days of bacterial culture, Nocardia.spp grew on medium, and Nocardia.farcinica was identified by the MALDI-TOF MS system and 16 s RNA. The patient was prescribed trimethoprim sulfamethoxazole (TMP/SMX) in combination with anti-tuberculosis drugs to treat the co-infection. She showed gradual improvement and was discharged from the hospital on February 19, 2022. However, the follow-up results were unclear. CONCLUSIONS Co-infection with Nocardia and Mycobacterium tuberculosis should be considered in COPD patients. Repeated microbiological and microscopy examinations are essential in primary hospitals.
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Affiliation(s)
- Yingzhu Chen
- Department of Laboratory Medicine, Traditional Chinese Medicine Hospital of Dianjiang County, Chongqing, Chongqing, 408300, China
| | - Wei Hu
- Department of Renal Medicine, People's Hospital of Dianjiang County, Chongqing, Chongqing, 408300, China.
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Zavala MJ, Becker GL, Blount RJ. Interrelationships between tuberculosis and chronic obstructive pulmonary disease. Curr Opin Pulm Med 2023; 29:104-111. [PMID: 36647566 PMCID: PMC9877200 DOI: 10.1097/mcp.0000000000000938] [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] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Our objective was to review the current literature regarding socioeconomic, environmental, clinical, and immunologic factors common to chronic obstructive pulmonary disease (COPD) and tuberculosis (TB). RECENT FINDINGS Recent studies suggest that TB patients might be at increased risk for developing COPD. Conversely, additional prospective cohort studies have determined that COPD patients are at increased risk for active TB: a risk that appears to be partially mediated through inhaled corticosteroid use. Tobacco smoking, poverty, air pollution, and malnutrition are associated with COPD and TB. Vitamin D has been shown to prevent COPD exacerbations, but its use for preventing TB infection remains unclear. Surfactant deficiency, elevated matrix metalloproteinases, and toll-like receptor 4 polymorphisms play key roles in the pathogenesis of both diseases. SUMMARY Recent studies have elucidated interrelationships between COPD and TB. Future research is needed to optimize clinical and public health approaches that could mitigate risk factors contributing to both diseases.
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Affiliation(s)
- Michael J Zavala
- Division of Pulmonary and Critical Care Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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12
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Moon D, Jeong D, Kang YA, Choi H. Gender differences in tuberculosis patients with comorbidity: A cross-sectional study using national surveillance data and national health insurance claims data in South Korea. PLoS One 2023; 18:e0280678. [PMID: 36662895 PMCID: PMC9858888 DOI: 10.1371/journal.pone.0280678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
The coexistence of tuberculosis and other chronic diseases complicates disease management. Particularly, the lack of information on the difference in the prevalence of chronic diseases in tuberculosis based on age and gender can hinder the establishment of appropriate public health strategies. This study aimed to identify age- and gender-based differences in the prevalence of chronic diseases as comorbidities in patients with tuberculosis. An anonymized data source was established by linking the national health insurance claims data to the Korean national tuberculosis surveillance data from 2014 to 2018. The prevalence of chronic diseases was stratified by gender and age (age groups: ≤64, 65-74, and ≥75 years), and the differences in the prevalence of chronic diseases were analyzed by multinomial logistic regression and classified using the Charlson Comorbidity Index. A total of 148,055 patients with tuberculosis (61,199 women and 86,856 men) were included in this study. Among the patients aged ≥65 years, 48.2% were female and 38.1% were male. In this age group, the probability of chronic disease comorbidity was higher in female patients than in male patients. The prevalence of congestive heart failure and dementia as comorbidities in patients with tuberculosis increased more drastically with age in women than in men. Thus, the present study confirmed gender and age differences in the distribution of comorbidities among patients with tuberculosis. A more comprehensive gender-responsive approach for patients with tuberculosis and chronic diseases is required to alleviate the double burden of infectious diseases and non-communicable diseases in an aging society.
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Affiliation(s)
- Daseul Moon
- Center for Labor and Health, People’s Health Institute, Seoul, Republic of Korea
| | - Dawoon Jeong
- Research and Development Center, The Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Young Ae Kang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hongjo Choi
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea
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13
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Rao Y, Cao W, Qu J, Zhang X, Wang J, Wang J, Li G, Li D, Pei Y, Xu W, Gai X, Sun Y. More severe lung lesions in smoker patients with active pulmonary tuberculosis were associated with peripheral NK cell subsets. Tuberculosis (Edinb) 2023; 138:102293. [PMID: 36549189 DOI: 10.1016/j.tube.2022.102293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Both pulmonary tuberculosis (PTB) and cigarette smoke (CS) exposure may lead to lung damage. The potential impact of CS exposure on tuberculosis-associated lung damage and the disturbance of immune cells and mediators involved, need to be further elucidated. METHODS We firstly evaluated the chest X-ray (CXR) scores of a retrospective cohort of male patients with active PTB, followed for 6 months, and compared the scores between smoker (≥10 pack-years) and non-smoker patients. In a cross-sectional study, we measured the peripheral blood NK cell subsets and plasma inflammatory cytokines in male smoker and non-smoker patients with active PTB before anti-tuberculosis therapy, and the proportions of NK cell subsets and the levels of cytokines were analyzed for correlation with the CXR scores. RESULTS In the retrospective cohort, male smoker patients with active PTB showed a higher CXR score, characterized by more cavitary lesions, enlarged lymph nodes and emphysema, as compared to non-smokers. The cross-sectional study revealed that the CXR score in smoker patients was correlated inversely with the percentages of blood CD107a+, NKP46+, and TIGIT+ NK cells. CONCLUSION In patients with active PTB, CS exposure was associated with more severe lung lesions, which were correlated with peripheral NK cell subsets.
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Affiliation(s)
- Yafei Rao
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | - Wenli Cao
- Beijing Geriatric Hospital, Beijing, China
| | - Jingge Qu
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | - Xueyang Zhang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | - Jun Wang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | | | - Gen Li
- Beijing Geriatric Hospital, Beijing, China
| | - Danyang Li
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | - Yuqiang Pei
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | - Wei Xu
- Beijing Geriatric Hospital, Beijing, China
| | - Xiaoyan Gai
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China.
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China.
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14
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Raghu S. Challenges in treating tuberculosis in the elderly population in tertiary institute. Indian J Tuberc 2022; 69 Suppl 2:S225-S231. [PMID: 36400514 DOI: 10.1016/j.ijtb.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Tuberculosis (TB) epidemic is most prevalent in the India with increase in mortality and morbidity. Ongoing elderly population as a result of increase in health care facilities are at high risk of TB. Elderly people are four-fold more prone to TB. Most cases of TB in the elderly result from reactivation of latent TB due to immunosenescence. Major challenge in dealing with therapeutic aspects of elderly patients is recognising frailty to prevent loss of independence. Challenges facing with elderly TB are difficult to reach out to hospital because of poor health seeking behaviour especially elderly female either due to ignorance or neglected by the family members, atypical presentation mimicking other disorders leading to diagnostic delay, if at all diagnosed impoverished tolerance and adherence to treatment due to various factors like associated comorbidities leading to pill load, impaired renal and hepatic functions with aging and stigma. Emerging resistance with usage of non-standard treatment regimens lead to unpropitious outcomes and increases mortality. The mortality rate is six times higher in elderly compared to younger individuals. Hence elderly people need tertiary level health care facilities for enhancing the diagnosis and appropriate management of tuberculosis and its complications. New set of guidelines to be made for elderly to increase adherence and tolerance thereby decreasing drug interactions and adverse drug reactions. With the increased prevalence of TB in the elderly, it is the need of the hour for India, to focus on this vulnerable population as they are a potential source of infection in the community. Awareness to be created among the elderly community regarding this deadly disease and its outcomes to increase their health consciousness and medical attention. Priming the special focus on females coterie as they are the most neglected population in our society.
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Affiliation(s)
- Srikanti Raghu
- Department of Pulmonary Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India; Superintendent of Government Hospital for Chest and Communicable Diseases, Guntur, Andhra Pradesh, India.
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15
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Olmo-Fontánez AM, Turner J. Tuberculosis in an Aging World. Pathogens 2022; 11:pathogens11101101. [PMID: 36297158 PMCID: PMC9611089 DOI: 10.3390/pathogens11101101] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
Tuberculosis (TB) is one of the leading causes of death due to its being an infectious disease, caused by the airborne pathogen Mycobacterium tuberculosis (M.tb). Approximately one-fourth of the world’s population is infected with latent M.tb, and TB is considered a global threat killing over 4000 people every day. The risk of TB susceptibility and mortality is significantly increased in individuals aged 65 and older, confirming that the elderly represent one of the largest reservoirs for M.tb infection. The elderly population faces many challenges that increase their risk of developing respiratory diseases, including TB. The challenges the elderly face in this regard include the following: decreased lung function, immuno-senescence, inflammaging, adverse drug effects, low tolerance to anti-TB drugs, lack of suitable diagnoses/interventions, and age-associated comorbidities. In order to find new therapeutic strategies to maintain lung homeostasis and resistance to respiratory infections as we age, it is necessary to understand the molecular and cellular mechanisms behind natural lung aging. This review focuses primarily on why the elderly are more susceptible to TB disease and death, with a focus on pulmonary function and comorbidities.
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Affiliation(s)
- Angélica M. Olmo-Fontánez
- Host Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
- Integrated Biomedical Sciences Program, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Joanne Turner
- Host Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
- Correspondence:
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16
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Kılıç L, Altın S, Gönenç Ortaköylü M, Kanmaz ZD, Tutar T, Zehra Özkan G. Co-infection of COVID-19 and Tuberculosis. Turk Thorac J 2022; 23:58-62. [PMID: 35110202 PMCID: PMC9450003 DOI: 10.5152/turkthoracj.2022.21045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Tuberculosis and COVID-19 diseases occur more frequently in people with similar risk factors. This study aimed to share the data on active tuberculosis patients during the severe acute respiratory syndrome coronavirus 2 pandemic. MATERIAL AND METHODS The registration information of TB outpatient clinic between November 1, 2019, and April 20, 2020, was screened. A 7-question survey was administered to the patients who were diagnosed with active tuberculosis and who were agreed to participate in the study. RESULTS A total of 309 patients with active tuberculosis were evaluated, the average age of the patients was 42.5 ± 18.5 years, and 70% were male. The percentage of having at least 1 comorbidity was 30.4%. The percentage of coronavirus disease 2019 disease in our study population was 1.9%; none of the patients of coronavirus disease 2019 were taken into the intensive care unit or dead due to clinical deterioration and/or respiratory failure. On the other hand, in this process it was announced that 146 457 cases were diagnosed with coronavirus disease 2019 throughout the country, of which 72% had inpatient treatment, 2% died, and 944 patients were still being treated in the intensive care unit, of which 490 were intubated. The positivity ratio of the reverse transcription-polymerase chain reaction test was 20.0% in the study group, while 20.3% in the İstanbul population. CONCLUSION Tuberculosis patients might be more disadvantageous than the normal population in terms of the risk of exposure to severe acute respiratory syndrome coronavirus 2, but this does not cause an increase in the frequency and severity of coronavirus disease 2019 disease in active tuberculosis patients.
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Affiliation(s)
- Lütfiye Kılıç
- Department of Chest Diseases, Koç University Hospital, İstanbul, Turkey
| | - Sedat Altın
- Department of Chest Diseases, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Mediha Gönenç Ortaköylü
- Department of Chest Diseases, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Zehra Dilek Kanmaz
- Department of Chest Diseases, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Tayjen Tutar
- Zeytinburnu Tuberculosis Dispensary, İstanbul, Turkey
| | - Gülcihan Zehra Özkan
- Department of Operating Room Services, Nişantaşı University, Vocational School, İstanbul, Turkey
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17
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Bhatt K, Bhagavathula M, Verma S, Timmins GS, Deretic VP, Ellner JJ, Salgame P. Rapamycin modulates pulmonary pathology in a murine model of Mycobacterium tuberculosis infection. Dis Model Mech 2021; 14:272048. [PMID: 34486033 PMCID: PMC8560501 DOI: 10.1242/dmm.049018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/01/2021] [Indexed: 12/14/2022] Open
Abstract
Tuberculosis (TB) treatment regimens are lengthy, causing non-adherence to treatment. Inadequate treatment can lead to relapse and the development of drug resistance TB. Furthermore, patients often exhibit residual lung damage even after cure, increasing the risk for relapse and development of other chronic respiratory illnesses. Host-directed therapeutics are emerging as an attractive means to augment the success of TB treatment. In this study, we used C3HeB/FeJ mice as an experimental model to investigate the potential role of rapamycin, a mammalian target of rapamycin inhibitor, as an adjunctive therapy candidate during the treatment of Mycobacterium tuberculosis infection with moxifloxacin. We report that administration of rapamycin with or without moxifloxacin reduced infection-induced lung inflammation, and the number and size of caseating necrotic granulomas. Results from this study strengthen the potential use of rapamycin and its analogs as adjunct TB therapy, and importantly underscore the utility of the C3HeB/FeJ mouse model as a preclinical tool for evaluating host-directed therapy candidates for the treatment of TB. Summary: Rapamycin, an mTOR inhibitor, with or without moxifloxacin, reduces lung inflammation and the number and size of caseating necrotic granulomas in Mycobacterium tuberculosis-infected C3HeB/FeJ mice.
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Affiliation(s)
- Kamlesh Bhatt
- Center for Emerging Pathogens, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Madhuri Bhagavathula
- Center for Emerging Pathogens, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Sheetal Verma
- Center for Emerging Pathogens, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Graham S Timmins
- Department of Pharmaceutical Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - Vojo P Deretic
- Autophagy Inflammation and Metabolism (AIM) Center of Biomedical Research Excellence University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.,Department of Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Jerrold J Ellner
- Center for Emerging Pathogens, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Padmini Salgame
- Center for Emerging Pathogens, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
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18
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Hamada Y, Fong CJ, Copas A, Hurst JR, Rangaka MX. Risk for development of active tuberculosis in patients with chronic airway disease-a systematic review of evidence. Trans R Soc Trop Med Hyg 2021; 116:390-398. [PMID: 34383072 PMCID: PMC9070518 DOI: 10.1093/trstmh/trab122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Reports suggest an increased risk of tuberculosis (TB) in people with chronic airway diseases (CADs) such as chronic obstructive pulmonary disease (COPD), but evidence has not been systematically reviewed. We performed a systematic review by searching MEDLINE and Embase for studies published from 1 January 1993 to 15 January 2021 reporting the association between the incident risk of TB in people with CADs (asthma, COPD and bronchiectasis). Two reviewers independently assessed the quality of individual studies. We included nine studies, with two from low-income high TB burden countries. Three cohort studies reported a statistically significant independent association between COPD and the risk of TB in high-income countries (n=711 389). Hazard ratios for incident TB ranged from 1.44 to 3.14 adjusted for multiple confounders including age, sex and comorbidity. There was large between-study heterogeneity (I2=97.0%) across studies. The direction of effect on the TB risk from asthma was inconsistent. Chronic bronchitis or bronchiectasis studies were limited. The small number of available studies demonstrated an increased risk of TB in people with COPD; however, the magnitude of the increase varies by setting and population. Data in high TB burden countries and for other CADs are limited.
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Affiliation(s)
- Yohhei Hamada
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | | | - Andrew Copas
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, NW3 2PF, UK
| | - Molebogeng X Rangaka
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.,University of Cape Town, 7701 Cape Town, South Africa
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19
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Ku CC, Chen CC, Dixon S, Lin HH, Dodd PJ. Patient pathways of tuberculosis care-seeking and treatment: an individual-level analysis of National Health Insurance data in Taiwan. BMJ Glob Health 2021; 5:bmjgh-2019-002187. [PMID: 32565426 PMCID: PMC7307534 DOI: 10.1136/bmjgh-2019-002187] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Patients with tuberculosis (TB) often experience difficulties in accessing diagnosis and treatment. Patient pathway analysis identifies mismatches between TB patient care-seeking patterns and service coverage, but to date, studies have only employed cross-sectional aggregate data. Methods We developed an algorithmic approach to analyse and interpret patient-level routine data on healthcare use and to construct patients’ pathways from initial care-seeking to treatment outcome. We applied this to patients with TB in a simple random sample of one million patients’ records in the Taiwan National Health Insurance database. We analysed heterogeneity in pathway patterns, delays, service coverage and patient flows between different health system levels. Results We constructed 7255 pathways for 6258 patients. Patients most commonly initially sought care at the primary clinic level, where the capacity for diagnosing TB patients was 12%, before eventually initiating treatment at higher levels. Patient pathways are extremely heterogeneous prior to diagnosis, with the 10% most complex pathways accounting for 48% of all clinical encounters, and 55% of those pathways yet to initiate treatment after a year. Extended consideration of alternative diagnoses was more common for patients aged 65 years or older and for patients with chronic lung disease. Conclusion Our study demonstrates that longitudinal analysis of routine individual-level healthcare data can be used to generate a detailed picture of TB care-seeking pathways. This allows an understanding of several temporal aspects of care pathways, including lead times to care and the variability in patient pathways.
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Affiliation(s)
- Chu-Chang Ku
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Chien-Chou Chen
- Center for Applied Artificial Intelligence Research, Soochow University, Taipei, Taiwan
| | - Simon Dixon
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Hsien Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Peter J Dodd
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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20
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Tao NN, Li YF, Song WM, Liu JY, Zhang QY, Xu TT, Li SJ, An QQ, Liu SQ, Li HC. Risk factors for drug-resistant tuberculosis, the association between comorbidity status and drug-resistant patterns: a retrospective study of previously treated pulmonary tuberculosis in Shandong, China, during 2004-2019. BMJ Open 2021; 11:e044349. [PMID: 34135033 PMCID: PMC8211042 DOI: 10.1136/bmjopen-2020-044349] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study was designed to identify the risk factors for drug-resistant tuberculosis (DR-TB) and the association between comorbidity and drug resistance among retreated pulmonary tuberculosis (PTB). DESIGN A retrospective study was conducted among all the 36 monitoring sites in Shandong, China, over a 16-year period. Baseline characteristics were collected from the TB Surveillance System. Categorical variables were compared by Fisher's exact or Pearson's χ2 test. The risk factors for drug resistance were identified using univariable analysis and multivariable logistic models. The influence of comorbidity on different types of drug resistance was evaluated by performing multivariable logistic models with the covariates adjusted by age, sex, body mass index, drinking/smoking history and cavity. RESULTS A total of 10 975 patients with PTB were recorded during 2004-2019, and of these 1924 retreated PTB were finally included. Among retreated PTB, 26.2% were DR-TB and 12.5% had comorbidity. Smoking (adjusted OR (aOR): 1.69, 95% CI 1.19 to 2.39), cavity (aOR: 1.55, 95% CI 1.22 to 1.97) and comorbidity (aOR: 1.44, 95% CI 1.02 to 2.02) were risk factors for DR-TB. Of 504 DR-TB, 9.5% had diabetes mellitus, followed by hypertension (2.0%) and chronic obstructive pulmonary disease (1.8%). Patients with retreated PTB with comorbidity were more likely to be older, have more bad habits (smoking, alcohol abuse) and have clinical symptoms (expectoration, haemoptysis, weight loss). Comorbidity was significantly associated with DR-TB (aOR: 1.44, 95% CI 1.02 to 2.02), overall rifampin resistance (aOR: 2.17, 95% CI 1.41 to 3.36), overall streptomycin resistance (aOR: 1.51, 95% CI 1.00 to 2.27) and multidrug resistance (aOR: 1.96, 95% CI 1.17 to 3.27) compared with pan-susceptible patients (p<0.05). CONCLUSION Smoking, cavity and comorbidity lead to an increased risk of drug resistance among retreated PTB. Strategies to improve the host's health, including smoking cessation, screening and treatment of comorbidity, might contribute to the control of tuberculosis, especially DR-TB, in China.
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Affiliation(s)
- Ning-Ning Tao
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yi-Fan Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Wan-Mei Song
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jin-Yue Liu
- Department of Critical Care Medicine, Shandong Provincial Third Hospital, Jinan, Shandong, China
| | - Qian-Yun Zhang
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Ting-Ting Xu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shi-Jin Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Qi-Qi An
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Si-Qi Liu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Huai-Chen Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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21
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Chiu TF, Yu TM, Chiu CW, Lee BK, Lan TH, Li CY, Lin MC, Kao CH. Increased risk of pulmonary and extrapulmonary tuberculosis infection in patients with polycystic kidney disease: a nationwide population-based study with propensity score-matching analysis. J Transl Med 2021; 19:253. [PMID: 34107991 PMCID: PMC8191203 DOI: 10.1186/s12967-021-02921-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/02/2021] [Indexed: 11/29/2022] Open
Abstract
Background Polycystic kidney disease (PKD) is a common renal disorder affecting approximately 1 in 1000 live births. Tuberculosis (TB) is an infectious disease worldwide. This study investigated the risk of TB infection in patients with PKD. Methods A nationwide population-based cohort study was performed using Taiwan’s National Health Insurance Research Database. We used patients’ hospitalization files for the entire analysis during 2000–2012. As per diagnosis, we divided patients into PKD and non-PKD cohorts and the major outcome was TB infection. Results A total of 13,540 participants with 6770 patients in each cohort were enrolled. The PKD cohort had a higher risk of TB infection than did the non-PKD cohort after adjusting for age, sex, and comorbidities (adjusted hazard ratio (aHR) = 1.91, 95% confidence interval [CI] = 1.51–2.43). When classifying by sites of pulmonary TB (PTB) and extrapulmonary TB (EPTB), the PKD cohort demonstrated a significantly higher risk of EPTB (aHR = 2.44, 95% CI = 1.46–4.08) as well as a risk of PTB (aHR = 1.69, 95% CI = 1.29–2.22). When stratified by the presence or absence of a comorbidity, high TB infection risk was noted in the PKD patients without any comorbidity (HR = 2.69, 95% CI = 1.69–4.30). Conclusions Taken together, our findings suggest that PKD is associated with a 1.91-fold increased risk of TB infection. Medical professionls should maintain a high index of suspicion in daily practice for patients with PKD, particularly those with EPTB infection.
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Affiliation(s)
- Ting-Fang Chiu
- Department of Pediatrics, Taipei City Hospital Zhongxiao Branch, Taipei, Taiwan.,University of Taipei, Taipei, Taiwan.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Tung-Min Yu
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. .,Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Chih-Wei Chiu
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan.,Department of Post Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Brian K Lee
- University of Texas, Austin, Dell Seton Medical Center, Austin, USA
| | - Tsuo-Hung Lan
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan.,Department of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Chi-Yuan Li
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan.,Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Chen Lin
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. .,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan. .,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan.
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22
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Sundbaum JK, Arkema EV, Bruchfeld J, Jonsson J, Askling J, Baecklund E. Tuberculosis in Biologic-naïve Patients With Rheumatoid Arthritis: Risk Factors and Tuberculosis Characteristics. J Rheumatol 2021; 48:1243-1250. [PMID: 33795331 DOI: 10.3899/jrheum.201251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate risk factors and characteristics of active tuberculosis (TB) in biologic-naïve patients with rheumatoid arthritis (RA). METHODS We conducted a population-based case-control study using the Swedish Rheumatology Quality Register, the National Patient Register, and the Tuberculosis Register to identify RA patients with active TB and matched RA controls without TB between 2001-2014. Clinical data were obtained from medical records. TB risk was estimated as adjusted OR (aOR) with 95% CI using univariate and multivariable logistic regression analyses. RESULTS After validation of diagnoses, the study included 31 RA patients with TB and 122 matched RA controls. All except 3 cases had reactivation of latent TB. Pulmonary TB was most prevalent (84%). Ever use of methotrexate was not associated with increased TB risk (aOR 0.8, 95% CI 0.3-2.0), whereas ever treatment with leflunomide (aOR 6.0, 95% CI 1.5-24.7), azathioprine (aOR 3.8, 95% CI 1.1-13.8), and prednisolone (PSL; aOR 2.4, 95% CI 1.0-6.0) was. There were no significant differences between maximum dose of PSL, treatment duration with PSL before TB, or cumulative dose of PSL the year before TB diagnosis between cases and controls. Obstructive pulmonary disease was associated with an increased TB risk (aOR 3.9, 95% CI 1.5-10.7). CONCLUSION Several RA-associated factors may contribute to increased TB risk in biologic-naïve patients with RA, making the risk of TB activation difficult to predict in the individual patient. To further decrease TB in patients with RA, the results suggest that screening for latent TB should also be considered in biologic-naïve patients.
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Affiliation(s)
- Johanna Karlsson Sundbaum
- J. Karlsson Sundbaum, PhD, Assistant Professor, Rheumatology Unit, Department of Medical Sciences, Uppsala University, Uppsala, and Department of Health Sciences, Luleå University of Technology, Luleå;
| | - Elizabeth V Arkema
- E.V. Arkema, PhD, Assistant Professor, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Judith Bruchfeld
- J. Bruchfeld, PhD, Senior Consultant, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, and Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Jerker Jonsson
- J. Jonsson, PhD, Senior Consultant, Public Health Agency of Sweden, Stockholm
| | - Johan Askling
- J. Askling, PhD, Professor, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, and Rheumatology Division, Department of Medicine, Karolinska Institutet, Stockholm
| | - Eva Baecklund
- E. Baecklund, PhD, Associate Professor, Rheumatology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Hou J, Cao J, Tan P, Yu Y. Pneumocystis jiroveci pneumonia, Nocardia brasiliensis, and Mycobacterium tuberculosis co-infection in a myasthenia gravis patient: A case report. Medicine (Baltimore) 2021; 100:e24245. [PMID: 33429828 PMCID: PMC7793478 DOI: 10.1097/md.0000000000024245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 12/17/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junctions that leads to fluctuating weakness and disabling fatigability. Due to difficulty in breathing caused by weakness of the respiratory muscles, patients with MG are more susceptible to pneumonia and other respiratory infections. As many patients with MG are given immunosuppressive therapy, this makes them more prone to infections. However, coinfection with 3 pathogens is very rare. PATIENT CONCERNS Here, we report the case of a 41-year-old gentleman with MG who was receiving long-term steroid therapy. He presented with a cough with pale brown expectoration that occurred without obvious inducement, severe pain in the scapula, as well as swelling and weakness of both legs. Despite undergoing treatment, but his symptoms did not improve, prompting two additional hospital admissions over a period of several months. DIAGNOSIS Bronchoscopy and bronchoalveolar lavage (BAL) were performed, revealing the presence of Pneumocystis jirovecii , Nocardia brasiliensis, and Mycobacterium tuberculosis (MTB). N brasiliensis was identified by positive modified acid-fast Kinyoun staining as well as a positive colony culture identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry from the BAL sample. MTB was confirmed using GeneXpert, and due to the limitations of the culture conditions, methenamine silver stain was used to confirm Pneumocystis jirovecii. Next-generation sequencing (NGS) assay of the BAL samples also confirmed these pathogens. INTERVENTIONS The patient was transferred to a designated tuberculosis hospital and received anti-infective and anti-TB treatment. OUTCOMES During treatment at the designated hospital, the patient developed gastrointestinal bleeding and impaired liver function. One month later, he developed multiple organ failure, consolidation of the left lower lung, and pan-drug resistant bacteremia. He refused further treatment and was discharged. CONCLUSION In conclusion, physicians should be aware of the predisposition of MG patients to co-infections, especially patients with metabolic disorders, to avoid inadequate treatment and poor patient outcomes. Due to the limitations of culture conditions, NGS should be considered as a new technique for identifying pathogens.
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MESH Headings
- Adult
- Bronchoalveolar Lavage Fluid/microbiology
- Coinfection
- Diagnosis, Differential
- Humans
- Male
- Myasthenia Gravis
- Mycobacterium tuberculosis/isolation & purification
- Nocardia/isolation & purification
- Pneumocystis carinii/isolation & purification
- Pneumonia, Bacterial/complications
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/microbiology
- Pneumonia, Pneumocystis/complications
- Pneumonia, Pneumocystis/diagnosis
- Pneumonia, Pneumocystis/microbiology
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/microbiology
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Rakesh PS, Balakrishnan S, Mathew ME, Mrithunjayan S, Manu MS. Population Attributable Risk of Tuberculosis Vulnerabilities in Kerala, India. Indian J Community Med 2020; 45:367-370. [PMID: 33354021 PMCID: PMC7745824 DOI: 10.4103/ijcm.ijcm_336_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 06/15/2020] [Indexed: 11/04/2022] Open
Abstract
Background A robust disaggregated understanding of the determinants of tuberculosis (TB) in each local setting is essential for effective health system and policy action to control TB. Objectives The objective of the study was to identify population attributable risk (PAR) for TB disease based on the locally available evidences for Kerala, India. Methods Systematic review was done for risk factors of TB in the state. The second set of searches was done to understand the prevalence of the identified risk factors in general population in Kerala. With all available studies and reports, an expert group consensus was made to finalize state-specific prevalence of risk factors. Population attributable fractions were calculated for identified risk factors. Results PAR for TB disease in Kerala obtained was 24% for undernutrition, 15% for diabetes, 15% for tobacco use, and 1% for HIV. Conclusion Kerala state's PAR for TB was comparatively lower for HIV but higher for diabetes mellitus. Similar exercises for summarizing population risk factors need to happen at all states for making plans to effectively combat TB.
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Affiliation(s)
- P S Rakesh
- WHO RNTCP Technical Support Network, State TB Cell, Thiruvananthapuram, Kerala, India
| | - Shibu Balakrishnan
- WHO RNTCP Technical Support Network, State TB Cell, Thiruvananthapuram, Kerala, India
| | - Manu E Mathew
- WHO RNTCP Technical Support Network, State TB Cell, Thiruvananthapuram, Kerala, India
| | | | - M S Manu
- State TB Training and Demonstration Centre, Thiruvananthapuram, Kerala, India
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25
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Takasaka N, Seki Y, Fujisaki I, Uchiyama S, Matsubayashi S, Sato A, Yamanaka Y, Odashima K, Kazuyori T, Seki A, Takeda H, Ishikawa T, Kuwano K. Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis. BMC Pulm Med 2020; 20:287. [PMID: 33160360 PMCID: PMC7648401 DOI: 10.1186/s12890-020-01325-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB). Methods We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥ 1 based on low attenuation area < − 950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment. Results Mycobacterial median time to culture conversion (TCC) in 38 PTB patients with emphysema was 52.0 days [interquartile range (IQR) 29.0–66.0 days], which was significantly delayed compared with that in 41 patients without emphysema (28.0 days, IQR 14.0–42.0 days) (p < 0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [hazard ratio (HR): 2.43; 95% confidence interval (CI): 1.18–4.97; p = 0.015), cavities (HR: 2.15; 95% CI: 1.83–3.89; p = 0.012) and baseline time to TB detection within 2 weeks (HR: 2.95; 95% CI: 1.64–5.31; p < 0.0001). Cavities and consolidation were more often identified by CT in PTB patients with than without emphysema (71.05% vs 43.90%; p = 0.015, and 84.21% vs 60.98%; p = 0.021, respectively). Conclusions This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion.
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Affiliation(s)
- Naoki Takasaka
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan.
| | - Yoshitaka Seki
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Ikumi Fujisaki
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Shota Uchiyama
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Sachi Matsubayashi
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Akihito Sato
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Yumie Yamanaka
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Kyuto Odashima
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Taisuke Kazuyori
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Aya Seki
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Hiroshi Takeda
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Takeo Ishikawa
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Kazuyoshi Kuwano
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
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Di Gennaro F, Vittozzi P, Gualano G, Musso M, Mosti S, Mencarini P, Pareo C, Di Caro A, Schininà V, Girardi E, Palmieri F. Active Pulmonary Tuberculosis in Elderly Patients: A 2016-2019 Retrospective Analysis from an Italian Referral Hospital. Antibiotics (Basel) 2020; 9:antibiotics9080489. [PMID: 32784552 PMCID: PMC7459440 DOI: 10.3390/antibiotics9080489] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
Tuberculosis (TB) in the elderly (>65 years old) has increasingly become a global health problem. It has long been recognized that older people are vulnerable to developing tuberculosis. We retrospectively evaluated data from patients older than 65 years diagnosed with pulmonary TB admitted to the National Institute for Infectious Diseases L. Spallanzani, Rome, Italy, from 1 January 2016 to 31 December 2019. One hundred and six consecutive patients were diagnosed with pulmonary TB and 68% reported at least one comorbidity and 44% at least one of the TB risk-factors. Out of the 26 elderly patients who reported an adverse event, having risk factors for TB (O.R. (Odds Ratios) = 1.45; 95% CI 1.12-3.65) and the presence of cavities on Chest X-rays (O.R. = 1.42; 95% CI 1.08-2.73) resulted in being more likely to be associated with adverse events in elderly patients. Having weight loss (O.R. = 1.31; 95% CI 1.08-1.55) and dyspnea (O.R. = 1.23; 95% CI 1.13-1.41) resulted in being significant predictors of unsuccessful treatment outcome in elderly patients. Older people with TB represent a vulnerable group, with high mortality rate, with a challenging diagnosis. Hospitalizations in tertiary referral hospital with clinical expertise in TB management can be useful to improve the outcome of these fragile patients.
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Affiliation(s)
- Francesco Di Gennaro
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
- Correspondence: ; Tel.: +39-3924-804-707
| | - Pietro Vittozzi
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Maria Musso
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Silvia Mosti
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Paola Mencarini
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Carlo Pareo
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Antonino Di Caro
- Microbiology and Bio-Repository Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Vincenzo Schininà
- Diagnostic Imaging Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Enrico Girardi
- Clinical Epidemiology Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
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27
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Wang Y, Bahar MA, Jansen AME, Kocks JWH, Alffenaar JWC, Hak E, Wilffert B, Borgsteede SD. Improving antibacterial prescribing safety in the management of COPD exacerbations: systematic review of observational and clinical studies on potential drug interactions associated with frequently prescribed antibacterials among COPD patients. J Antimicrob Chemother 2020; 74:2848-2864. [PMID: 31127283 PMCID: PMC6814093 DOI: 10.1093/jac/dkz221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/13/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Guidelines advise the use of antibacterials (ABs) in the management of COPD exacerbations. COPD patients often have multiple comorbidities, such as diabetes mellitus and cardiac diseases, leading to polypharmacy. Consequently, drug–drug interactions (DDIs) may frequently occur, and may cause serious adverse events and treatment failure. Objectives (i) To review DDIs related to frequently prescribed ABs among COPD patients from observational and clinical studies. (ii) To improve AB prescribing safety in clinical practice by structuring DDIs according to comorbidities of COPD. Methods We conducted a systematic review by searching PubMed and Embase up to 8 February 2018 for clinical trials, cohort and case–control studies reporting DDIs of ABs used for COPD. Study design, subjects, sample size, pharmacological mechanism of DDI and effect of interaction were extracted. We evaluated levels of DDIs and quality of evidence according to established criteria and structured the data by possible comorbidities. Results In all, 318 articles were eligible for review, describing a wide range of drugs used for comorbidities and their potential DDIs with ABs. DDIs between ABs and co-administered drugs could be subdivided into: (i) co-administered drugs altering the pharmacokinetics of ABs; and (ii) ABs interfering with the pharmacokinetics of co-administered drugs. The DDIs could lead to therapeutic failures or toxicities. Conclusions DDIs related to ABs with clinical significance may involve a wide range of indicated drugs to treat comorbidities in COPD. The evidence presented can support (computer-supported) decision-making by health practitioners when prescribing ABs during COPD exacerbations in the case of co-medication.
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Affiliation(s)
- Yuanyuan Wang
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Muh Akbar Bahar
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Anouk M E Jansen
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Janwillem W H Kocks
- Department of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Faculty of Medicine and Health, School of Pharmacy and Westmead Hospital, University of Sydney, Sydney, Australia
| | - Eelko Hak
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sander D Borgsteede
- Department of Clinical Decision Support, Health Base Foundation, Houten, The Netherlands.,Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
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Estimating the Risk of Pneumonia in Patients With Schizophrenia Newly Receiving Clozapine: A Nationwide Cohort Study. J Clin Psychopharmacol 2020; 39:297-304. [PMID: 31188233 DOI: 10.1097/jcp.0000000000001052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE/BACKGROUND Patients with schizophrenia are vulnerable to pneumonia. Clozapine is associated with the greatest risk of pneumonia. We investigated the risk factors of pneumonia in patients with schizophrenia who use clozapine. METHODS/PROCEDURES We used a large cohort of patients with schizophrenia (N = 22,774) who newly use clozapine (baseline). We divided the data set into a training cohort (entry between 1998 and 2008, n = 18,496) and test cohort (entry between 2009 and 2012, n = 4278), where 483 and 168 patients developed pneumonia requiring hospitalization within 1 year after baseline, respectively. For prediction, we developed a static model using Cox proportional hazards regression and a dynamic model using Cox regression with time-dependent modeling. Areas under receiver operating curves (AUCs) for the predictive model were estimated in the training cohort and then in the test cohort for validation. FINDINGS/RESULTS Based on the baseline characteristics, the static model for predicting pneumonia in 3 periods (90, 180, and 365 days) was unsatisfactory (AUCs, 0.64, 0.64, and 0.65, respectively). The predictors were older age, male sex, history of nonpsychiatric hospitalization, dementia, asthma, and tuberculosis within 1 year before baseline. However, the results were improved (AUCs, 0.83, 0.79, and 0.77, respectively) after control for time-dependent variables, namely, duration of clozapine use and concomitant medications (ie, benzodiazepines, valproic acid, systemic corticosteroids). IMPLICATIONS/CONCLUSIONS Several risk factors for predicting subsequent pneumonia after initial use of clozapine were explored, including older age, male, history of nonpsychiatric hospitalization, dementia, asthma, tuberculosis, benzodiazepines, valproic acid, systemic corticosteroids, and the use duration of clozapine. Clinical staff can use the risk factors to administer evidence-based treatment.
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Medina A, López L, Martínez C, Aguirre S, Alarcón E. [Factors associated with tuberculosis mortality in Paraguay, 2015-2016Fatores associados à mortalidade por tuberculose no Paraguai, 2015-2016]. Rev Panam Salud Publica 2019; 43:e102. [PMID: 31892928 PMCID: PMC6922078 DOI: 10.26633/rpsp.2019.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe the socio-demographic and clinical-epidemiological characteristics and to determine the factors associated with the mortality of people diagnosed with tuberculosis (TB) in Paraguay. METHODS Operational research with a retrospective cohort design of cases diagnosed with TB in Paraguay between 2015-2016. The database of the National Tuberculosis Control Program was used. Chi-square and relative risk (RR) tests with a 95% confidence interval (95% CI) were used to determine the factors associated with mortality; in addition, a robust Poisson multiple regression model was adjusted. A significance level of 5% was used. RESULTS Five hundred and forty-one cases of TB were studied, of which 11.5% died. The factors increasing the risk of death were male sex (RR 1.26; 95% CI 1.1-1.50), infection with human immunodeficiency virus (RR 4.78; 95% CI 4.04-5.65) and chronic obstructive pulmonary disease (RR 1.70; 95% CI 1.19-2.42). Being deprived of one's liberty was a protective factor (RR 0.37; 95% CI 0.24-0.61). CONCLUSIONS The highest risk of death is presented by men and people with TB/HIV coinfection and the lowest risk is presented by people deprived of liberty. There is a need to improve diagnosis and follow-up of TB cases, with effective implementation of directly observed treatment (DOTS) and timely management of associated diseases such as HIV and chronic obstructive pulmonary disease.
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Affiliation(s)
- Angélica Medina
- Programa Nacional de Control de la TuberculosisMinisterio de Salud Pública y Bienestar SocialAsunciónParaguayPrograma Nacional de Control de la Tuberculosis, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay.
| | - Lucelly López
- Universidad Pontificia BolivarianaUniversidad Pontificia BolivarianaMedellínColombiaUniversidad Pontificia Bolivariana, Medellín, Colombia.
| | - Celia Martínez
- Facultad de Ciencias MédicasUniversidad Nacional de AsunciónAsunciónParaguayFacultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay.
| | - Sarita Aguirre
- Programa Nacional de Control de la TuberculosisMinisterio de Salud Pública y Bienestar SocialAsunciónParaguayPrograma Nacional de Control de la Tuberculosis, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay.
| | - Edith Alarcón
- Organización Panamericana de la Salud/Organización Mundial de la SaludWashington D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud/Organización Mundial de la Salud, Washington D.C., Estados Unidos de América.
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30
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Li Z, Mao X, Liu Q, Song H, He B, Shi P, Zhang Q, Li X, Wang J. Functional variations of the TLR4 gene in association with chronic obstructive pulmonary disease and pulmonary tuberculosis. BMC Pulm Med 2019; 19:184. [PMID: 31640653 PMCID: PMC6805358 DOI: 10.1186/s12890-019-0939-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/16/2019] [Indexed: 02/07/2023] Open
Abstract
Objective Chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis (PTB) share a number of common risk factors, including innate immunity-related genetic factors. In the present study, we compared the role of genetic variations of the TLR4 gene in susceptibility to COPD and PTB and illuminated the underlying molecular mechanism of functional single-nucleotide polymorphisms (SNPs). Methods A population-based case control study was performed in a Chinese Han population and included 152 COPD cases, 1601 PTB cases and 1727 controls. Five SNPs in the TLR4 gene (rs10759932, rs2737190, rs7873784, rs11536889, and rs10983755) were genotyped using TaqMan allelic discrimination technology. We estimated the effects of SNPs using the odds ratio (OR) together with 95% confidence interval (CI). Dual-luciferase reporter vectors expressing different genotypes of SNPs were constructed and transfected into the human HEK 293 T cell line to explore their effects on potential transcription activity. Results After Bonferroni correction, the genetic polymorphisms of all five SNPs remained significantly associated with COPD, while rs10759932 and rs2737190 were also associated with PTB. Compared with rs10759932-TT, individuals carrying TC (OR: 0.42, 95% CI: 0.28–0.64) or CC (OR: 0.24, 95% CI: 0.09–0.63) had a significantly reduced risk of COPD. However, individuals carrying TC (OR: 1.28, 95% CI: 1.11–1.49) or CC (OR: 1.26, 95% CI: 0.98–1.62) had an increased risk of PTB. The OR (95% CI) for allele rs10759932-C was 0.45 (0.32–0.62) for COPD and 1.18 (1.07–1.32) for PTB. For rs2737190, heterozygous AG was related to a decreased risk of COPD (OR: 0.32, 95% CI: 0.21–0.49) and an increased risk of PTB (OR: 1.30, 95% CI: 1.11–1.52). The dual-luciferase reporter assay showed decreased transcription activity caused by rs10759932-C and rs2737190-G. Conclusion Genetic polymorphisms of rs10759932 and rs2737190 in TLR4 are significantly related to both COPD and PTB but with inverse effects. The altered transcription activity caused by mutations in these two loci may partly explain the observed relationship.
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Affiliation(s)
- Zhongqi Li
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, People's Republic of China
| | - Xuhua Mao
- Department of Clinical Laboratory, Yixing People's Hospital, Wuxi, 214200, People's Republic of China
| | - Qiao Liu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, People's Republic of China
| | - Huan Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, People's Republic of China
| | - Biyu He
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, People's Republic of China
| | - Peiyi Shi
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, People's Republic of China
| | - Qun Zhang
- Health Management Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China.
| | - Xiaona Li
- Health Management Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Jianming Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, People's Republic of China. .,Key Laboratory of Infectious Diseases, School of Public Health, Nanjing Medical University, 211166, Nanjing, People's Republic of China.
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Smith J, Blom P. Those Who Don't Return: Improving Efforts to Address Tuberculosis Among Former Miners in Southern Africa. New Solut 2019; 29:76-104. [PMID: 30791826 DOI: 10.1177/1048291119832082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite increasing awareness regarding the role of oscillating migration in the mining industry as a major driving force in the spread of tuberculosis (TB) throughout southern Africa, very little work has focused on the historical and contextual factors which may contribute to former migrant miners' present-day risk of TB. Most research regarding migration-related and occupational influences on TB has been done on current miners still employed by the mining industry. Through both a historical and contemporary lens, this paper explores and elucidates the need to address the TB epidemic among former migrant mine workers and provides considerations to improve current interventions among this critical population.
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Affiliation(s)
- Jonathan Smith
- 1 Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Paul Blom
- 2 University of North Carolina at Chapel Hill, NC, USA
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Qiu J, Wang C, Pan X, Pan L, Huang X, Xu J, Ji X, Mao M. APACHE-II score for anti-tuberculosis tolerance in critically ill patients: a retrospective study. BMC Infect Dis 2019; 19:106. [PMID: 30717702 PMCID: PMC6360662 DOI: 10.1186/s12879-019-3751-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/28/2019] [Indexed: 02/08/2023] Open
Abstract
Background To investigate the status of anti-tuberculosis treatment in critically ill patients, and to explore the value of APACHE-II score in guiding anti-tuberculosis treatment. Methods This analysis included critically ill patients with tuberculosis. The utility of APACHE-II score for predicting drug withdrawal was evaluated using receiver operating characteristic (ROC) curve analysis. Results Among 320 patients enrolled (58 ± 22 years; 256 males), 147 (45.9%) had drugs withdrawn. The drug withdrawal group had higher APACHE-II score (median [interquartile range]: 21 [3–52] vs. 17 [4–42] points), higher CD4%, lower hemoglobin level, higher rates of chronic obstructive pulmonary disease (COPD) and chronic renal failure, and lower rate of extrapulmonary tuberculosis (P < 0.05). Logistic regression identified APACHE-II score > 18 (odds ratio [95% confidence interval]: 2.099 [1.321–3.334], P < 0.01), COPD (1.913 [1.028–3.561], P < 0.05) and hemoglobin level (0.987 [0.977–0.997], P < 0.05) as independent factors associated with drug withdrawal. At an optimal cutoff of 18.5, the sensitivity, specificity, positive predictive value and negative predictive value of APACHE-II score for predicting drug withdrawal was 59.2, 61.8, 56.9 and 64.1%, respectively. Conclusions APACHE-II score > 18 points might predict patient tolerance of anti-tuberculosis treatment.
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Affiliation(s)
- Junke Qiu
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Caihong Wang
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Xiaohong Pan
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Lei Pan
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Xiaoqing Huang
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Jiekun Xu
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Xiaobo Ji
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Minjie Mao
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China.
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Barreira-Silva P, Torrado E, Nebenzahl-Guimaraes H, Kallenius G, Correia-Neves M. Aetiopathogenesis, immunology and microbiology of tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10020917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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34
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Pradipta IS, Forsman LD, Bruchfeld J, Hak E, Alffenaar JW. Risk factors of multidrug-resistant tuberculosis: A global systematic review and meta-analysis. J Infect 2018; 77:469-478. [PMID: 30339803 DOI: 10.1016/j.jinf.2018.10.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/26/2018] [Accepted: 10/11/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Since the risk of multidrug-resistant tuberculosis (MDR-TB) may depend on the setting, we aimed to determine the associations of risk factors of MDR-TB across different regions. METHODS A systematic review and meta-analysis was performed with Pubmed and Embase databases. Information was retrieved on 37 pre-defined risk factors of MDR-TB. We estimated overall Mantel-Haenszel odds ratio as a measure of the association. RESULTS Factors of previous TB disease and treatment are the most important risk factors associated with MDR-TB. There was also a trend towards increased risk of MDR-TB for patients 40 years and older, unemployed, lacking health insurance, smear positive, with non-completion and failure of TB treatment, showing adverse drug reaction, non-adherent, HIV positive, with COPD and with M. Tuberculosis Beijing infection. Effect modification by geographical area was identified for several risk factors such as male gender, married patients, urban domicile, homelessness and history of imprisonment. CONCLUSIONS Assessment of risk factors of MDR-TB should be conducted regionally to develop the most effective strategy for MDR-TB control. Across all regions, factors associated with previous TB disease and treatment are essential risk factors, indicating the appropriateness of diagnosis, treatment and monitoring are an important requirements.
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Affiliation(s)
- Ivan Surya Pradipta
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Indonesia; University of Groningen, University Medical Centrum Groningen, Department of Clinical Pharmacy and Pharmacology, The Netherlands.
| | - Lina Davies Forsman
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Judith Bruchfeld
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Eelko Hak
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Jan-Willem Alffenaar
- University of Groningen, University Medical Centrum Groningen, Department of Clinical Pharmacy and Pharmacology, The Netherlands
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Liu HC, Hung GCL, Yang SY, Liao YT, Pan CH, Chen CC, Kuo CJ. Antipsychotic drugs and risk of newly diagnosed tuberculosis in schizophrenia. Psychiatry Clin Neurosci 2018; 72:789-800. [PMID: 29987915 DOI: 10.1111/pcn.12736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/18/2018] [Accepted: 07/03/2018] [Indexed: 11/29/2022]
Abstract
AIM Patients with schizophrenia have a higher incidence of tuberculosis than do people in the general population. Information is limited regarding the association between antipsychotic agents and the risk of tuberculosis in patients with schizophrenia. This exploratory study assessed the risk of tuberculosis among patients with schizophrenia on antipsychotic therapy. METHODS Among a nationwide schizophrenia cohort derived from the National Health Insurance Research Database in Taiwan (n = 32 399), we identified 284 patients who had developed newly diagnosed tuberculosis after their first psychiatric admission. Ten or fewer matched controls were selected randomly from the cohort for each patient based on risk-set sampling. We categorized exposure to antipsychotic medications by type and defined daily dose. Using multivariate methods, we explored individual antipsychotic agents for the risk of tuberculosis and employed a propensity-scoring method in sensitivity analyses to validate any associations. RESULTS Among the antipsychotic agents studied and after adjustment for covariates, current use of clozapine was the only antipsychotic agent associated with a 63% increased risk of tuberculosis (adjusted risk ratio = 1.63, P = 0.014). In addition, the association did not show a clear dose-dependent relationship. Clozapine combined with other antipsychotic agents showed a potential synergistic risk for tuberculosis (adjusted risk ratio = 2.30, P = 0.044). CONCLUSION This exploratory study suggests the potential risk of clozapine on the risk of tuberculosis, especially for those on clozapine in combination with other antipsychotics. Future studies are needed to verify the association.
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Affiliation(s)
- Hsing-Cheng Liu
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Galen Chin-Lun Hung
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Shu-Yu Yang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Tang Liao
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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36
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Stosic M, Vukovic D, Babic D, Antonijevic G, Foley KL, Vujcic I, Grujicic SS. Risk factors for multidrug-resistant tuberculosis among tuberculosis patients in Serbia: a case-control study. BMC Public Health 2018; 18:1114. [PMID: 30208864 PMCID: PMC6134722 DOI: 10.1186/s12889-018-6021-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/06/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Multidrug resistant (MDR) tuberculosis (TB) represents TB which is simultaneous resistant to at least rifampicin (R) and isoniazid (H). Identifying inadequate therapy as the main cause of this form of the disease and explaining the factors leading to its occurrence, numerous social determinants that affect the risk of developing resistance are highlighted. The objectives of the study was to identify independent factors of MDR-TB among tuberculosis patients. METHODS Case-control study was conducted from 1st September 2009 to 1st June 2014 in 31 healthcare institutions in Serbia where MDR-TB and TB patients were treated. TB patients infected with MDR- M. tuberculosis and non MDR- M. tuberculosis strain were considered as cases and controls, respectively. Cases and controls were matched by the date of hospitalization. The data was collected using structured questionnaire with face to face interview. Bivariate and multivariable logistic regression analysis (MLRA) were used to identify determinants associated with MDR-TB. RESULTS A total of 124 respondents, 31 cases and 93 controls were participated in the study. MLRA identified six significant independent risk factors for the occurrence of MDR-TB as follows: monthly income of the family (Odds ratio (OR) = 3.71; 95% Confidence Interval (CI) = 1.22-11.28), defaulting from treatment (OR = 3.33; 95% CI = 1.14-9.09), stigma associated with TB (OR = 2.97; 95% CI = 1.18-7.45), subjective feeling of sadness (OR = 4.05; 95% CI = 1.69-9.70), use of sedatives (OR = 2.79; 95% CI = 1.02-7.65) and chronic obstructive pulmonary disease (OR = 4.51; 95% CI = 1.07-18.96). CONCLUSION In order to reduce burden of drug resistance, strategies of controlling MDR-TB in Serbia should emphasize multi-sectorial actions, addressing health care and social needs of TB patients.
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Affiliation(s)
- Maja Stosic
- Department of HIV/AIDS, STIs, Viral Hepatitis and TB, Public Health Institute of Serbia, "Dr Milan Jovanovic Batut", Dr Subotica 5, Belgrade, 11000, Serbia
| | - Dejana Vukovic
- Institute of Social Medicine, Faculty of Medicine, Belgrade University, Dr Subotica 9, Belgrade, 11000, Serbia
| | - Dragan Babic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, Belgrade University, Dr Subotica 9, Belgrade, 11000, Serbia
| | - Gordana Antonijevic
- Special Hospital for Lung Diseases, "Ozren"Ozrenska bb, Sokobanja, 18230, Serbia
| | - Kristie L Foley
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Isidora Vujcic
- Institute of Epidemiology, Faculty of Medicine, Belgrade University, Visegradska 26, Belgrade, 11000, Serbia
| | - Sandra Sipetic Grujicic
- Institute of Epidemiology, Faculty of Medicine, Belgrade University, Visegradska 26, Belgrade, 11000, Serbia.
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Pearl JE, Das M, Cooper AM. Immunological roulette: Luck or something more? Considering the connections between host and environment in TB. Cell Mol Immunol 2018; 15:226-232. [PMID: 29375129 DOI: 10.1038/cmi.2017.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/24/2017] [Accepted: 10/29/2017] [Indexed: 02/07/2023] Open
Abstract
Accurate prediction of which patient will progress from a sub-clinical Mycobacterium tuberculosis infection to active tuberculosis represents an elusive, yet critical, clinical research objective. From the individual perspective, progression can be considered to be the product of a series of unfortunate events or even a run of bad luck. Here, we identify the subtle physiological relationships that can influence the odds of progression to active TB and how this progression may reflect directed dysbiosis in a number of interrelated systems. Most infected individuals who progress to disease have apparently good immune responses, but these responses are, at times, compromised by either local or systemic environmental factors. Obvious disease promoting processes, such as tissue-damaging granulomata, usually manifest in the lung, but illness is systemic. This apparent dichotomy between local and systemic reflects a clear need to define the factors that promote progression to active disease within the context of the body as a physiological whole. We discuss aspects of the host environment that can impact expression of immunity, including the microbiome, glucocorticoid-mediated regulation, catecholamines and interaction between the gut, liver and lung. We suggest the importance of integrating precision medicine into our analyses of experimental outcomes such that apparently conflicting results are not contentious, but rather reflect the impact of these subtle relationships with our environment and microbiota.
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Affiliation(s)
- John E Pearl
- Leicester Tuberculosis Research Group (LTBRG), Department of Infection Immunity and Inflammation, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Mrinal Das
- Leicester Tuberculosis Research Group (LTBRG), Department of Infection Immunity and Inflammation, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Andrea M Cooper
- Leicester Tuberculosis Research Group (LTBRG), Department of Infection Immunity and Inflammation, University of Leicester, University Road, Leicester LE1 7RH, UK
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Jin J, Li S, Yu W, Liu X, Sun Y. Emphysema and bronchiectasis in COPD patients with previous pulmonary tuberculosis: computed tomography features and clinical implications. Int J Chron Obstruct Pulmon Dis 2018; 13:375-384. [PMID: 29416328 PMCID: PMC5788930 DOI: 10.2147/copd.s152447] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Pulmonary tuberculosis (PTB) is a risk factor for COPD, but the clinical characteristics and the chest imaging features (emphysema and bronchiectasis) of COPD with previous PTB have not been studied well. Methods The presence, distribution, and severity of emphysema and bronchiectasis in COPD patients with and without previous PTB were evaluated by high-resolution computed tomography (HRCT) and compared. Demographic data, respiratory symptoms, lung function, and sputum culture of Pseudomonas aeruginosa were also compared between patients with and without previous PTB. Results A total of 231 COPD patients (82.2% ex- or current smokers, 67.5% male) were consecutively enrolled. Patients with previous PTB (45.0%) had more severe (p=0.045) and longer history (p=0.008) of dyspnea, more exacerbations in the previous year (p=0.011), and more positive culture of P. aeruginosa (p=0.001), compared with those without PTB. Patients with previous PTB showed a higher prevalence of bronchiectasis (p<0.001), which was more significant in lungs with tuberculosis (TB) lesions, and a higher percentage of more severe bronchiectasis (Bhalla score ≥2, p=0.031), compared with those without previous PTB. The overall prevalence of emphysema was not different between patients with and without previous PTB, but in those with previous PTB, a higher number of subjects with middle (p=0.001) and lower (p=0.019) lobe emphysema, higher severity score (p=0.028), higher prevalence of panlobular emphysema (p=0.013), and more extensive centrilobular emphysema (p=0.039) were observed. Notably, in patients with TB lesions localized in a single lung, no difference was found in the occurrence and severity of emphysema between the 2 lungs. Conclusion COPD patients with previous PTB had unique features of bronchiectasis and emphysema on HRCT, which were associated with significant dyspnea and higher frequency of severe exacerbations. While PTB may have a local effect on bronchiectasis, its involvement in airspace damage in COPD may be extensive, probably through interactions with cigarette smoke.
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Affiliation(s)
- Jianmin Jin
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Shuling Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Wenling Yu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Xiaofang Liu
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
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Bastos HN, Osório NS, Gagneux S, Comas I, Saraiva M. The Troika Host-Pathogen-Extrinsic Factors in Tuberculosis: Modulating Inflammation and Clinical Outcomes. Front Immunol 2018; 8:1948. [PMID: 29375571 PMCID: PMC5767228 DOI: 10.3389/fimmu.2017.01948] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/18/2017] [Indexed: 12/30/2022] Open
Abstract
The already enormous burden caused by tuberculosis (TB) will be further aggravated by the association of this disease with modern epidemics, as human immunodeficiency virus and diabetes. Furthermore, the increasingly aging population and the wider use of suppressive immune therapies hold the potential to enhance the incidence of TB. New preventive and therapeutic strategies based on recent advances on our understanding of TB are thus needed. In particular, understanding the intricate network of events modulating inflammation in TB will help to build more effective vaccines and host-directed therapies to stop TB. This review integrates the impact of host, pathogen, and extrinsic factors on inflammation and the almost scientifically unexplored complexity emerging from the interactions between these three factors. We highlight the exciting data showing a contribution of this troika for the clinical outcome of TB and the need of incorporating it when developing novel strategies to rewire the immune response in TB.
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Affiliation(s)
- Helder Novais Bastos
- Department of Pneumology, Centro Hospitalar do São João, Porto, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
| | - Nuno S Osório
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
| | - Sebastien Gagneux
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Iñaki Comas
- Institute of Biomedicine of Valencia (IBV-CSIC), Valencia, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Margarida Saraiva
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Instituto de Biologia Molecular e Celular (IBMC), University of Porto, Porto, Portugal
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40
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Shirazinia R, Saadati D, Zeinali E, Panahi Mishkar A. The Incidence and Epidemiology of Tuberculosis in Sistan Region: an Update to Past Researches. INTERNATIONAL JOURNAL OF BASIC SCIENCE IN MEDICINE 2017. [DOI: 10.15171/ijbsm.2017.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Tuberculosis (TB) is a chronic disease which spreads through respiration and
develops lesions in lung or other organs. The most usual kind of TB is pulmonary TB. The
highest incidence rate of TB is in the eastern neighbors of Iran rendering high TB incidence in
Sistan and Baluchistan province of Iran. The current research was conducted to investigate the
epidemiology of TB in the north of the province, the Sistan region.
Methods: In this survey, data of all suspected and established TB cases in the Zabol city was
collected from their profiles in health care centers during 2010-2013. The trend of the disease,
and its prevalence based on residency and gender were assessed.
Results: In this period of time, a total of 1800 TB cases were detected. Of these, 485 (27%) were
from urban areas and 1315 (73%) were from rural areas. The trend of TB identification increased
with a slope of nearly 46.4. In this research, the most resistance to drug was related to Isoniazid
and Rifampin and the least resistance was to ethambutol and streptomycin.
Conclusion: Dust storms in this area because of successive droughts and other living conditions
can make the region susceptible to TB disease. Therefore, people in this area, especially in rural
regions, should be given sufficient education to be protected against this infection.
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Affiliation(s)
- Reza Shirazinia
- Faculty of Veterinary Medicine, University of Zabol, Zabol, Iran
| | - Dariush Saadati
- Department of Food Hygiene and Quality Control, Faculty of Veterinary Medicine, University of Zabol, Zabol, Iran
| | - Elyas Zeinali
- Faculty of Veterinary Medicine, University of Zabol, Zabol, Iran
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Husta BC, Raoof S, Erzurum S, Mehta AC. Tracheobronchopathy From Inhaled Corticosteroids. Chest 2017; 152:1296-1305. [PMID: 28864055 DOI: 10.1016/j.chest.2017.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/06/2017] [Accepted: 08/01/2017] [Indexed: 12/17/2022] Open
Abstract
Inhaled corticosteroids (ICSs) have become the mainstay of asthma control. They are also recommended as an add-on therapy to long-acting beta agonists and anticholinergics in moderate to severe COPD with recurrent exacerbations. Ultimately this clinical practice has led to the widespread use of ICSs, which are supported by a more favorable side effect profile than that of systemic steroids.
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Affiliation(s)
- Bryan C Husta
- Lenox Hill Hospital, Hofstra Northwell School of Medicine, New York, NY
| | - Suhail Raoof
- Lenox Hill Hospital, Hofstra Northwell School of Medicine, New York, NY
| | - Serpil Erzurum
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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He XC, Tao NN, Liu Y, Zhang XX, Li HC. Epidemiological trends and outcomes of extensively drug-resistant tuberculosis in Shandong, China. BMC Infect Dis 2017; 17:555. [PMID: 28793873 PMCID: PMC5551028 DOI: 10.1186/s12879-017-2652-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 07/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extensively Drug-Resistant (XDR) Tuberculosis (TB) has posed a great threat to global health and finance systems, especially for developing countries with high TB and Multidrug-Resistant (MDR) TB burden. METHODS We retrospectively analyzed HIV-uninfected TB case confirmed and treated in Shandong Provincial Chest Hospital (SPCH) between January 2008 and December 2015. Unique characteristics of XDR-TB were identified; its longitudinal changes and survival were analyzed. RESULTS Between January 2008 and December 2015, a total of 144 cases were confirmed to be XDR-TB (2.5% of 5663 culture-confirmed TB cases; 27.9% of 516 MDR-TB cases). The proportion of XDR TB cases among MDR-TB cases has increased from 26.5% in 2008 to 44.5% in 2014 (Chi-Square test for trends: P < 0.01). Among the 144 XDR-TB cases, 21 patients (14.6%) had treatment success, 123 (85.1%) had poor treatment outcomes. Mortality was higher among XDR-TB cases than among MDR TB cases (8.3% vs. 3.8%, P = 0.033) and drug-susceptible TB cases (8.3% vs. 2.1%, P < 0.01). CONCLUSIONS XDR-TB cases comprise a substantial and increasing fraction of MDR-TB cases, causing poor treatment outcomes and high mortalities. Early drug susceptibility testing, adequate TB treatment and efficient infection control must be in place in future TB control strategies.
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Affiliation(s)
- Xiao-Chun He
- Department of Respiratory Medicine, Baoji Central Hospital, Baoji, Shaanxi, China
| | - Ning-Ning Tao
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Yao Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Xian-Xin Zhang
- Department of Respiratory Medicine, Shandong Provincial Chest Hospital, Jinan, Shandong, China
| | - Huai-Chen Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
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Imtiaz S, Shield KD, Roerecke M, Samokhvalov AV, Lönnroth K, Rehm J. Alcohol consumption as a risk factor for tuberculosis: meta-analyses and burden of disease. Eur Respir J 2017; 50:1700216. [PMID: 28705945 PMCID: PMC5540679 DOI: 10.1183/13993003.00216-2017] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/08/2017] [Indexed: 11/29/2022]
Abstract
Meta-analyses of alcohol use, alcohol dosage and alcohol-related problems as risk factors for tuberculosis incidence were undertaken. The global alcohol-attributable tuberculosis burden of disease was also re-estimated.Systematic searches were conducted, reference lists were reviewed and expert consultations were held to identify studies. Cohort and case-control studies were included if there were no temporal violations of exposure and outcome. Risk relations (RRs) were pooled by using categorical and dose-response meta-analyses. The alcohol-attributable tuberculosis burden of disease was estimated by using alcohol-attributable fractions.36 of 1108 studies were included. RRs for alcohol use and alcohol-related problems were 1.35 (95% CI 1.09-1.68; I2: 83%) and 3.33 (95% CI 2.14-5.19; 87%), respectively. Concerning alcohol dosage, tuberculosis risk rose as ethanol intake increased, with evidence of a threshold effect. Alcohol consumption caused 22.02 incident cases (95% CI 19.70-40.77) and 2.35 deaths (95% CI 2.05-4.79) per 100 000 people from tuberculosis in 2014. Alcohol-attributable tuberculosis incidence increased between 2000 and 2014 in most high tuberculosis burden countries, whereas mortality decreased.Alcohol consumption was associated with an increased risk of tuberculosis in all meta-analyses. It was consequently a major contributor to the tuberculosis burden of disease.
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Affiliation(s)
- Sameer Imtiaz
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kevin D Shield
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Andriy V Samokhvalov
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Knut Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jürgen Rehm
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Kim CJ, Yoon HK, Park MJ, Yoo KH, Jung KS, Park JW, Lim SY, Shim JJ, Lee YC, Kim YS, Oh YM, Kim S, Yoo CG. Inhaled indacaterol for the treatment of COPD patients with destroyed lung by tuberculosis and moderate-to-severe airflow limitation: results from the randomized INFINITY study. Int J Chron Obstruct Pulmon Dis 2017; 12:1589-1596. [PMID: 28615931 PMCID: PMC5459963 DOI: 10.2147/copd.s128750] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background and objective Pulmonary tuberculosis (TB) is a risk factor for chronic obstructive pulmonary disease (COPD); however, few clinical studies have investigated treatment effectiveness in COPD patients with destroyed lung by TB. The Indacaterol effectiveness in COPD patients with Tuberculosis history (INFINITY) study assessed the efficacy and safety of once-daily inhaled indacaterol 150 µg for the treatment of Korean COPD patients with destroyed lung by TB and moderate-to-severe airflow limitation. Methods This was a multicenter, double-blind, parallel-group study, in which eligible patients were randomized (1:1) to receive either once-daily indacaterol 150 µg or placebo for 8 weeks. The primary efficacy endpoint was change from baseline in trough forced expiratory volume in 1 s at Week 8; the secondary endpoints included changes in transition dyspnea index score and St George’s Respiratory Questionnaire for COPD score at Week 8. Safety was evaluated over 8 weeks. Results Of the 136 patients randomized, 119 (87.5%) completed the study treatment. At Week 8, indacaterol significantly improved trough forced expiratory volume in 1 s versus placebo (treatment difference [TD] 140 mL, P<0.001). Statistically significant improvement in transition dyspnea index score (TD =0.78, P<0.05) and numerical improvement in St George’s Respiratory Questionnaire for COPD score (TD =−2.36, P=0.3563) were observed with indacaterol versus placebo at Week 8. Incidence of adverse events was comparable between the treatment groups. Conclusion Indacaterol provided significantly superior bronchodilation, significant improvement in breathlessness and improved health status with comparable safety versus placebo in Korean COPD patients with destroyed lung by TB and moderate-to-severe airflow limitation.
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Affiliation(s)
- Cheong-Ju Kim
- Department of Internal Medicine, National Health Insurance System Ilsan Hospital, Koyang
| | - Hyoung-Kyu Yoon
- Division of Pulmonology, Department of Internal Medicine, St Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Myung-Jae Park
- Division of Respiratory and Critical Care Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul
| | - Kwang-Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Gwangjin-gu
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang-si
| | - Jeong-Woong Park
- Division of Pulmonary and Allergy Medicine, Gachon University Gil Medical Center, Incheon
| | - Seong Yong Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Jae Jeong Shim
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Yong Chul Lee
- Department of Internal Medicine and Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonbuk
| | - Young-Sam Kim
- Department of Internal Medicine, Yonsei University College of Medicine
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Song Kim
- Clinical Development and Medical Affairs, Novartis Korea Ltd., Seoul
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Leung JM, Tiew PY, Mac Aogáin M, Budden KF, Yong VFL, Thomas SS, Pethe K, Hansbro PM, Chotirmall SH. The role of acute and chronic respiratory colonization and infections in the pathogenesis of COPD. Respirology 2017; 22:634-650. [PMID: 28342288 PMCID: PMC7169176 DOI: 10.1111/resp.13032] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 12/16/2022]
Abstract
COPD is a major global concern, increasingly so in the context of ageing populations. The role of infections in disease pathogenesis and progression is known to be important, yet the mechanisms involved remain to be fully elucidated. While COPD pathogens such as Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae are strongly associated with acute exacerbations of COPD (AECOPD), the clinical relevance of these pathogens in stable COPD patients remains unclear. Immune responses in stable and colonized COPD patients are comparable to those detected in AECOPD, supporting a role for chronic colonization in COPD pathogenesis through perpetuation of deleterious immune responses. Advances in molecular diagnostics and metagenomics now allow the assessment of microbe-COPD interactions with unprecedented personalization and precision, revealing changes in microbiota associated with the COPD disease state. As microbial changes associated with AECOPD, disease severity and therapeutic intervention become apparent, a renewed focus has been placed on the microbiology of COPD and the characterization of the lung microbiome in both its acute and chronic states. Characterization of bacterial, viral and fungal microbiota as part of the lung microbiome has the potential to reveal previously unrecognized prognostic markers of COPD that predict disease outcome or infection susceptibility. Addressing such knowledge gaps will ultimately lead to a more complete understanding of the microbe-host interplay in COPD. This will permit clearer distinctions between acute and chronic infections and more granular patient stratification that will enable better management of these features and of COPD.
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Affiliation(s)
- Janice M. Leung
- Centre for Heart Lung InnovationVancouverBritish ColumbiaCanada
- Division of Respiratory Medicine, St Paul's HospitalUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Pei Yee Tiew
- Department of Respiratory and Critical Care MedicineSingapore General HospitalSingapore
| | - Micheál Mac Aogáin
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Kurtis F. Budden
- Priority Research Centre for Healthy LungsUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNewcastleNew South WalesAustralia
| | | | - Sangeeta S. Thomas
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Kevin Pethe
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Philip M. Hansbro
- Priority Research Centre for Healthy LungsUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNewcastleNew South WalesAustralia
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Choi CJ, Choi WS, Lee SY, Kim KS. The Definition of Past Tuberculosis Affects the Magnitude of Association between Pulmonary Tuberculosis and Respiratory Dysfunction: Korea National Health and Nutrition Examination Survey, 2008-2012. J Korean Med Sci 2017; 32:789-795. [PMID: 28378552 PMCID: PMC5383611 DOI: 10.3346/jkms.2017.32.5.789] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/11/2017] [Indexed: 12/13/2022] Open
Abstract
Tuberculosis (TB) is associated with an increased risk of chronic lung impairment. The aim of this study was to compare the clinical characteristics and lung functions according to definition of past TB. We used the population-based, Korea National Health and Nutrition Examination Survey (KNHANES) (2008-2012) to analyze 13,522 subjects age 40 years or older who underwent spirometry and chest X-ray (CXR). Subjects with TB lesions on CXR (with or without a history of TB) were older, more likely to be male, ever smokers, and of low socioeconomic status than subjects with only a history of TB or without evidence of TB. Airflow obstruction (AFO) was associated with only a history of TB (odds ratio [OR] 1.53, 95% confidence interval [CI] 0.95-2.46), only TB lesion on CXR (OR 2.37, 95% CI 1.80-3.12), and both a history and TB lesions on CXR (OR 4.47, 95% CI 3.07-6.51) after adjustment for gender, age, body mass index, education, income, and smoking amount (P for trend < 0.001). Spirometric restriction was associated with only a history of TB (OR 1.29, 95% CI 0.80-2.08), only TB lesions on CXR (OR 2.03, 95% CI 1.49-2.76), and both a history and TB lesions on CXR (OR 2.65, 95% CI 1.74-4.05) after adjustment for the above variables (P for trend < 0.001). How to define past TB in population study affects the magnitude of association between past TB and respiratory dysfunction. Without considering TB lesions on CXR, the association between TB and respiratory dysfunction could be underestimated.
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Affiliation(s)
- Chang Jin Choi
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Whan Seok Choi
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sook Young Lee
- Division of Pulmonology Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Soo Kim
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Sarkar M, Srinivasa, Madabhavi I, Kumar K. Tuberculosis associated chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2017; 11:285-295. [PMID: 28268242 DOI: 10.1111/crj.12621] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 01/03/2017] [Accepted: 02/26/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Reviewed the epidemiology, clinical characteristics, mechanisms, and treatment of tuberculosis associated chronic obstructive pulmonary disease. DATA SOURCE We searched PubMed, EMBASE, and the CINAHL from inception to June 2016. We used the following search terms: Tuberculosis, COPD, Tuberculosis associated COPD, and so forth. All types of study were chosen. RESULTS AND CONCLUSION Chronic obstructive pulmonary disease (COPD) and tuberculosis are significant public health problems, particularly in developing countries. Although, smoking is the conventional risk factor for COPD, nonsmoking related risk factors such as biomass fuel exposure, childhood lower-respiratory tract infections, chronic asthma, outdoor air pollution, and prior history of pulmonary tuberculosis have become important risk factors of COPD, particularly in developing countries. Past history of tuberculosis as a risk factor of chronic airflow obstruction has been reported in several studies. It may develop during the course of tuberculosis or after completion of tuberculosis treatment. Developing countries with large burden of tuberculosis can contribute significantly to the burden of chronic airflow obstruction. Prompt diagnosis and treatment of tuberculosis should be emphasized to lessen the future burden of chronic airflow obstruction.
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Affiliation(s)
- Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, IGMC, Shimla, Himachal Pradesh, India
| | - Srinivasa
- Department of Radiation Oncology, PGIMER, Chandigarh, India
| | - Irappa Madabhavi
- Department of Medical and Pediatric Oncology, Ahmedabad, Gujarat, India
| | - Kushal Kumar
- MBBS, Indira Gandhi Medical College, Shimla, India
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Alaridah N, Lutay N, Tenland E, Rönnholm A, Hallgren O, Puthia M, Westergren-Thorsson G, Godaly G. Mycobacteria Manipulate G-Protein-Coupled Receptors to Increase Mucosal Rac1 Expression in the Lungs. J Innate Immun 2016; 9:318-329. [PMID: 28013312 DOI: 10.1159/000453454] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/15/2016] [Indexed: 12/17/2022] Open
Abstract
Mycobacterium bovis bacille Calmette-Guérin (BCG) is currently the only approved vaccine against tuberculosis (TB). BCG mimics M. tuberculosis (Mtb) in its persistence in the body and is used as a benchmark to compare new vaccine candidates. BCG was originally designed for mucosal vaccination, but comprehensive knowledge about its interaction with epithelium is currently lacking. We used primary airway epithelial cells (AECs) and a murine model to investigate the initial events of mucosal BCG interactions. Furthermore, we analysed the impact of the G-protein-coupled receptors (GPCRs), CXCR1 and CXCR2, in this process, as these receptors were previously shown to be important during TB infection. BCG infection of AECs induced GPCR-dependent Rac1 up-regulation, resulting in actin redistribution. The altered distribution of the actin cytoskeleton involved the MAPK signalling pathway. Blocking of the CXCR1 or CXCR2 prior to infection decreased Rac1 expression, and increased epithelial transcriptional activity and epithelial cytokine production. BCG infection did not result in epithelial cell death as measured by p53 phosphorylation and annexin. This study demonstrated that BCG infection of AECs manipulated the GPCRs to suppress epithelial signalling pathways. Future vaccine strategies could thus be improved by targeting GPCRs.
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Affiliation(s)
- Nader Alaridah
- Division of Laboratory Medicine, Department of MIG, Lund University, Lund, Sweden
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Mattila T, Heliövaara M, Rissanen H, Knekt P, Puukka P, Vasankari T. Tuberculosis, Airway Obstruction and Mortality in a Finnish Population. COPD 2016; 14:143-149. [PMID: 27880044 DOI: 10.1080/15412555.2016.1250253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is little long-term follow-up data concerning the association between past pulmonary tuberculosis (TB), airway obstruction and mortality. We aimed to analyse a national health examination survey data from 6701 adult Finns undergoing spirometry between 1978 and 1980 (follow-up through 2013). We identified TB either through a disease history or by a TB-indicative scar on a chest x-ray. We specified obstruction using the lower limit of normal (LLN) and classified severity using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1-4. After adjusting for smoking and other confounders, past TB associated with obstruction. Compared to non-TB patients, the adjusted odds ratio (OR; 95% CI) of obstruction reached 2.21 (1.52-3.21) among patients with a scar recorded by one radiologist, 2.48 (1.63-3.78) when recorded by both radiologists and 4.59 (2.86-7.37) among patients with a disease history. Among those with neither past TB nor obstruction, with past TB only, with an obstruction only and with both, we found hazard ratios (HRs; 95% CIs) for subsequent mortality of 1.00 (reference), 1.11 (1.03-1.20), 1.62 (1.31-2.00) and 1.77 (1.45-2.16), adjusted for age, gender, smoking, body mass index (BMI), physical activity, education and general health. In conclusion, past TB strongly determines obstruction, although on its own quite weakly predicts premature death. TB and obstruction combined predict an additive mortality pattern.
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Affiliation(s)
- Tiina Mattila
- a Helsinki University Hospital , Department of Pulmonary Diseases , Helsinki , Finland.,b University of Helsinki Doctoral Programme in Clinical Research , Helsinki , Finland.,c National Institute for Health and Welfare , Helsinki , Finland
| | - Markku Heliövaara
- d Department of Health , National Institute for Health and Welfare , Helsinki , Finland
| | - Harri Rissanen
- d Department of Health , National Institute for Health and Welfare , Helsinki , Finland
| | - Paul Knekt
- d Department of Health , National Institute for Health and Welfare , Helsinki , Finland
| | - Pauli Puukka
- d Department of Health , National Institute for Health and Welfare , Helsinki , Finland
| | - Tuula Vasankari
- e University of Turku , Turku , Finland.,f Finnish Lung Health Association (FILHA) , Helsinki , Finland
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50
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Chen G, Wu C, Luo Z, Teng Y, Mao S. Platelet-lymphocyte ratios: a potential marker for pulmonary tuberculosis diagnosis in COPD patients. Int J Chron Obstruct Pulmon Dis 2016; 11:2737-2740. [PMID: 27843310 PMCID: PMC5098523 DOI: 10.2147/copd.s111254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In recent decades, morbidity and mortality have been found to be significantly increased in patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary tuberculosis (PTB). Platelet-lymphocyte ratio (PLR) is an indicator for inflammatory diseases. This study aims to investigate whether PLR could act as a potential marker for patients with COPD complicated with PTB. METHODS In this retrospective study, laboratory characteristics of 87 COPD patients complicated with PTB (determined by Mycobacterium tuberculosis positive culture from sputum or bronchial lavage fluid) and 83 COPD patients (as the control group, determined by M. tuberculosis culture negativity from sputum or bronchial lavage fluid) were investigated. Data obtained on the day of admission were analyzed. RESULTS PLR >216.82 was identified as the optimal cutoff value for discriminating COPD patients with PTB (sensitivity 92.4%, specificity 84.5%, positive-predictive value 91.6%, negative-predictive value 86.2%, and area under the curve [AUC] was 0.87) from patients with COPD alone. The AUC of PLR was significantly greater than that of neutrophil-lymphocyte count ratio (AUC, 0.74; 95% confidence interval, 0.67-0.81; P<0.01). CONCLUSION PLR could be developed as a valuable maker for identifying tuberculosis infection in COPD patients.
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Affiliation(s)
- Guozhong Chen
- Department of Respiratory Medicine, Yiwu Central Hospital, Yiwu, Zhejiang Province, People’s Republic of China
| | - Chunling Wu
- Department of Respiratory Medicine, Yiwu Central Hospital, Yiwu, Zhejiang Province, People’s Republic of China
| | - Zhiying Luo
- Department of Respiratory Medicine, Yiwu Central Hospital, Yiwu, Zhejiang Province, People’s Republic of China
| | - Yiming Teng
- Department of Respiratory Medicine, Yiwu Central Hospital, Yiwu, Zhejiang Province, People’s Republic of China
| | - Suping Mao
- Department of Respiratory Medicine, Yiwu Central Hospital, Yiwu, Zhejiang Province, People’s Republic of China
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