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Sharan Kumar VG, Pajanivel R, Boratne AV, Vimal Raj R. Impact of dietary counselling on the nutritional status and quality of life among pulmonary tuberculosis patients - A randomized control trial. Indian J Tuberc 2022; 69:201-206. [PMID: 35379402 DOI: 10.1016/j.ijtb.2021.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND & AIM Undernutrition and TB have a bidirectional relationship, which is especially relevant in the Indian context. Undernutrition is an established risk factor for the progression of latent TB infection to active TB. Undernutrition at the population level contributes to an estimated 55% of annual TB incidence in India. TB leads to weight loss, wasting, and worsening of nutritional status. Hence, the present study aimed to determine the impact of dietary counselling on the nutritional status and the health-related quality of life of PTB patients. MATERIALS & METHOD This was an interventional study (randomized controlled trial) that involved patients with PTB. 46 patients (23 patients as experimental and 23 patients as a control group) were enrolled in the study from June 2019 to February 2020 and they were divided into 2 categories based on BMI (underweight and normal weight). The special dietary counselling was given to the experimental group patients and the normal protocol was followed with the control group. The patients were followed up, till completion of treatment i.e., 6 months from enrolment. RESULTS In our study, nearly half of the patients were underweight and DM was the predominant comorbidity. The BMI increased after dietary counselling in the experimental group than the control group (P = 0.0053) in underweight individuals. Total protein (P = 0.0025), and serum albumin (P = 0.0048) levels were found to be significantly improved in the experimental group. SGRQ symptom score (P = 0.0036) has significantly reduced in the experimental group in underweight individuals than the control group. CONCLUSION Personalized dietary counselling was found to have a positive impact on BMI, total protein, and albumin levels in the experimental group, especially in underweight individuals. Besides, the quality of life measured using SGRQ showed that symptom score were also significantly reduced in the experimental group than the control group.
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Affiliation(s)
- V G Sharan Kumar
- Department of Pulmonary Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth - Deemed to Be University, Pillayarkuppam, Puducherry, 607402, India.
| | - R Pajanivel
- Department of Pulmonary Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth - Deemed to Be University, Pillayarkuppam, Puducherry, 607402, India
| | - Abhijit V Boratne
- Department of Community Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth - Deemed to Be University, Pillayarkuppam, Puducherry, 607402, India
| | - R Vimal Raj
- Department of Pulmonary Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth - Deemed to Be University, Pillayarkuppam, Puducherry, 607402, India
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Guillén-Nepita AL, Vázquez-Marrufo G, Cruz-Hernández A, García-Oliva F, Zepeda-Gurrola RC, Vázquez-Garcidueñas MS. Detailed epidemiological analysis as a strategy for evaluating the actual behavior of tuberculosis in an apparently low-incidence region. Pathog Glob Health 2020; 114:393-404. [PMID: 32924885 DOI: 10.1080/20477724.2020.1813488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Tuberculosis control in developing regions with apparent low incidence, like the low-income Mexican state of Michoacán, with mean annual incidence rates below 10/100,000 inhabitants, requires knowledge of the actual behavior of the disease. This can be determined using an epidemiological profile at sub-regional level, allowing disclosure of the clinical and social factors that may be hampering efforts to control tuberculosis. In this work, a detailed epidemiological profile was outlined using data of all new monthly cases registered in the National System of Epidemiological Surveillance Database for Michoacán municipalities from 2000 to 2012. Cases were grouped by gender and age, and sociodemographic data were obtained both from the National Institute of Statistics and Geography and from the United Nations Development Programme. Correlations were calculated by Chi-square, Mann-Whitney U, and Kruskal-Wallis H tests. We observed no statistically significant differences between notification rates for the years 2000, 2005 and 2010 (χ2 = 0.222, p = 0.895). The percentage of cases is similar between all age groups older than 15, while some regions had low notification rates but high proportions of pediatric cases. Higher proportions of cases of extrapulmonary tuberculosis were observed in municipalities in northern Michoacán. No correlation was found between municipal Human Development Index values and municipal notification rates. Michoacán is undergoing an epidemiological transition with three regions having different epidemiological profiles and particular needs for effective prevention and containment of tuberculosis. Our work shows the importance of the spatial scale of epidemiological profiles for determining specific regional needs of surveillance and containment.
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Christopher DJ, Jeyaseelan L, Michael JS, Veeraraghavan B, Manipadam MT, David T, Gupta M, Yadav B. Burden of diabetes among patients with tuberculosis: 10-year experience from a tertiary care referral teaching hospital in South India. Lung India 2020; 37:232-237. [PMID: 32367845 PMCID: PMC7353927 DOI: 10.4103/lungindia.lungindia_111_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Tuberculosis (TB) and diabetes mellitus (DM) are converging epidemics, each worsening the morbidity of the other. A study of the prevalence of DM in TB patients assumes great importance. Aims The study aims to evaluate the association between DM and TB over a 10-year period in a tertiary care hospital. Settings and Design A retrospective observational study in a southern Indian tertiary care teaching hospital was conducted. Materials and Methods All patients with TB diagnosed and treated during the 10-year study period were identified from the hospital database. All relevant clinical, microbiological, and laboratory results pertaining to diagnosis of DM were collected. The diagnosis of TB and DM was made as per the standard criteria. Statistical Analysis Categorical variables were analyzed using Chi-square test while continuous variables using independent sample t-test. Results From 2001 to 2012, we studied 1979 TB patients among whom data on DM were available. The prevalence of DM was 29%, 21%, and 14%, in smear positive, smear negative and extrapulmonary TB respectively (overall 24%). Diabetics were more likely to be men (77.3% vs. 61%;P = 0.001); >40 years of age (81.7% vs. 38.9%;P < 0.001); heavier (59.96 vs. 50.37;P = 0.004); tobacco smokers (16.1% vs. 8.1%;P < 0.001); and alcohol consumers (6.8% vs. 4%;P = 0.02). They were less likely to be HIV coinfected (1.8% vs. 6.1%;P < 0.001). HIV coinfection was seen in 5% of patients and was substantially higher in extrapulmonary TB group (19.4%). Multidrug-resistant TB was lower in DM (11.7%) compared to non-DM (15.9%) (P = 0.02). Overall, 48% of the DM patients were diagnosed at the time of TB diagnosis. Over 10 years, no obvious changes in the trend were evident. Conclusions Over a 10-year study period, 24% of the TB patients were diabetic, nearly half were detected at the time of TB diagnosis. There may be a good case for screening all TB patients for DM.
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Affiliation(s)
| | | | - Joy Sarojini Michael
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Thambu David
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mayank Gupta
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Bijesh Yadav
- Department of Biosatatistics, Christian Medical College, Vellore, Tamil Nadu, India
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4
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Lin CH, Kuo SC, Hsieh MC, Ho SY, Su IJ, Lin SH, Chi CY, Su SL, Liao CY, Chen YC, Hsu SR, Huang YC, Tseng FC, Wang SY, Dou HY, Lin SD, Lin JS, Tu ST, Yeh YP. Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: a community-based study in Taiwan. BMJ Open 2019; 9:e029948. [PMID: 31662365 PMCID: PMC6830704 DOI: 10.1136/bmjopen-2019-029948] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the association between diabetes and latent tuberculosis infections (LTBI) in high TB incidence areas. DESIGN Community-based comparison study. SETTING Outpatient diabetes clinics at 4 hospitals and 13 health centres in urban and rural townships. A community-based screening programme was used to recruit non-diabetic participants. PARTICIPANTS A total of 2948 patients with diabetes aged older than 40 years were recruited, and 453 non-diabetic participants from the community were enrolled. PRIMARY AND SECONDARY OUTCOME MEASURES The interferon-gamma release assay (IGRA) and the tuberculin skin test were used to detect LTBI. The IGRA result was used as a surrogate of LTBI in logistic regression analysis. RESULTS Diabetes was significantly associated with LTBI (adjusted OR (aOR)=1.59; 95% CI 1.11 to 2.28) and age correlated positively with LTBI. Many subjects with diabetes also had additional risk factors (current smokers (aOR=1.28; 95% CI 0.95 to 1.71), comorbid chronic kidney disease (aOR=1.26; 95% CI 1.03 to 1.55) and history of TB (aOR=2.08; 95% CI 1.19 to 3.63)). The presence of BCG scar was protective (aOR=0.66; 95% CI 0.51 to 0.85). Duration of diabetes and poor glycaemic control were unrelated to the risk of LTBI. CONCLUSION There was a moderately increased risk of LTBI in patients with diabetes from this high TB incidence area. This finding suggests LTBI screening for the diabetics be combined with other risk factors and comorbidities of TB to better identify high-risk groups and improve the efficacy of targeted screening for LTBI.
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Affiliation(s)
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Ming-Chia Hsieh
- Graduate Institute of Integrative Medicine, China Medical University, Taichung, Taiwan
- Intelligent Diabetes Metabolism and Exercise Center, China Medical University Hospital, Taichung, Taiwan
- Division of Clinical Nutrition, China Medical University Hospital, Taichung, Taiwan
| | - Shang-Yun Ho
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Ih-Jen Su
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Sheng-Hao Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
- Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan
| | - Chia-Yu Chi
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shih-Li Su
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chiung-Ying Liao
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Yee-Chun Chen
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Shang-Ren Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yuan-Chun Huang
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Fan-Chen Tseng
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Shu Yi Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Horng Yunn Dou
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Shi-Dou Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Jen-Shiou Lin
- Department of Laboratory Medicine, Changhua Christian hospital, Changhua, Taiwan
| | - Shih-Te Tu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yen-Po Yeh
- Innovation and Policy Center for Population Health and Sustainable Environment, National Taiwan University, Taipei, Taiwan
- Changhua Public Health Bureau, Changhua, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
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Kubiak RW, Sarkar S, Horsburgh CR, Roy G, Kratz M, Reshma A, Knudsen S, Salgame P, Ellner JJ, Drain PK, Hochberg NS. Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis. BMC Infect Dis 2019; 19:627. [PMID: 31311495 PMCID: PMC6636094 DOI: 10.1186/s12879-019-4244-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Studies to date have not investigated this interaction. METHODS We enrolled 919 newly diagnosed active TB patients and 1113 household contacts at Primary Health Centres in Puducherry and Tamil Nadu, India from 2014 to 2018. In cross-sectional analyses, we used generalized estimating equations to measure additive and multiplicative interaction of body mass index (BMI) and diabetes on two outcomes, active TB and LTBI. RESULTS Among overweight or obese adults, active TB prevalence was 12-times higher in diabetic compared to non-diabetic participants, 2.5-times higher among normal weight adults, and no different among underweight adults (P for interaction < 0.0001). Diabetes was associated with 50 additional active TB cases per 100 overweight or obese participants, 56 per 100 normal weight participants, and 17 per 100 underweight participants (P for interaction < 0.0001). Across BMI categories, screening 2.3-3.8 active TB patients yielded one hyperglycemic patient. LTBI prevalence did not differ by diabetes and BMI*diabetes interaction was not significant. CONCLUSIONS BMI and diabetes are associated with newly diagnosed active TB, but not LTBI. Diabetes conferred the greatest risk of active TB in overweight and obese adults whereas the burden of active TB associated with diabetes was similar for normal and overweight or obese adults. Hyperglycemia was common among all active TB patients. These findings highlight the importance of bi-directional diabetes-active TB screening in India.
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Affiliation(s)
- Rachel W Kubiak
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, USA
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Mario Kratz
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.,Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, USA.,Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Ayiraveetil Reshma
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Selby Knudsen
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Padmini Salgame
- Center for Emerging Pathogens, Department of Medicine, Rutgers-New Jersey Medical School, Newark, USA
| | - Jerrold J Ellner
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Center for Emerging Pathogens, Department of Medicine, Rutgers-New Jersey Medical School, Newark, USA.,Boston Medical Center, Boston, USA
| | - Paul K Drain
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.,Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - Natasha S Hochberg
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, USA.,Boston Medical Center, Boston, USA
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Merid MW, Gezie LD, Kassa GM, Muluneh AG, Akalu TY, Yenit MK. Incidence and predictors of major adverse drug events among drug-resistant tuberculosis patients on second-line anti-tuberculosis treatment in Amhara regional state public hospitals; Ethiopia: a retrospective cohort study. BMC Infect Dis 2019; 19:286. [PMID: 30917788 PMCID: PMC6437856 DOI: 10.1186/s12879-019-3919-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/19/2019] [Indexed: 11/22/2022] Open
Abstract
Background Second line anti-tuberculosis drugs are substantially complex, long term, more costly, and more toxic than first line anti-tuberculosis drugs. In Ethiopia, evidence on the incidence and predictors of adverse drug events has been limited. Thus, this study aimed at assessing incidence and predictors of major adverse drug events among drug resistant tuberculosis patients on second line tuberculosis treatment in Amhara Regional State public hospitals, Ethiopia. Methods A multi-center retrospective cohort study was conducted on 570 drug resistant tuberculosis Patients. Data were entered in to EPI-Data version 4.2.0.0 and exported to Stata version 14 for analysis. Proportional hazard assumption was checked. The univariate Weibull regression gamma frailty model was fitted. Cox-Snell residual was used to test goodness of fit and Akaike Information Criteria (AIC) for model selection. Hazard ratio with 95% CI was computed and variables with P-value < 0.05 in the multivariable analysis were taken as significant predictors for adverse drug event. Results A total of 570 patients were followed for 5045.09 person-month (PM) observation with a median follow-uptime of 8.23 months (Inter Quartile Range (IQR) =2.66–23.33). The overall incidence rate of major adverse drug events was 5.79 per 100 PM (95% CI: 5.16, 6.49). Incidence rate at the end of 2nd, 4th, and 6th months was 13.73, 9.25, 5.97 events per 100 PM observations, respectively. Age at 25–49 (Adjusted Hazard Ratio (AHR) = 3.36, 95% CI: 1.36, 8.28), and above 50 years (AHR = 5.60, 95% CI: 1.65, 19.05), co-morbid conditions (AHR = 2.74 CI: 1.12, 6.68), and anemia (AHR = 3.25 CI: 1.40, 7.53) were significant predictors of major adverse drug events. Conclusion The incidence rate of major adverse drug events in the early 6 months of treatment was higher than that of the subsequent months. Age above 25 years, base line anemia, and co-morbid conditions were independent predictors of adverse drug events. Thus, addressing significant predictors and strengthening continuous follow-ups are highly recommended in the study setting.
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Affiliation(s)
- Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia.
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Food Swamps and Poor Dietary Diversity: Longwave Development Implications in Southern African Cities. SUSTAINABILITY 2018. [DOI: 10.3390/su10124425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While the literature on food deserts focuses on limited availability of food in urban settings, ‘food swamps’ may better characterize the extensive prevalence and accessibility of cheap, highly processed foods. For urban populations, access to nutritionally inadequate poor-quality food has dire developmental consequences. The long-wave impacts of malnutrition at gestational and early childhood stages are negative and can be non-reversible. Moreover, those who survive into adulthood may face a lifetime of sub-optimal physical and mental development that undermines the second and third UN Sustainable Development Goals—to end hunger and to ensure healthy lives. This paper assesses the long-term health vulnerability of children with limited access to adequate and nutritious food in rapidly urbanizing cities. The analysis focuses on the African Urban Food Security Network (AFSUN) data drawn from 6453 household surveys in 11 cities and nine countries in Southern Africa. The results indicate that children in these households are consuming a limited diversity of food, have limited access to resources and have greater odds of experiencing both short-term and long-term food and nutrition insecurity. These findings demonstrate an underlying vulnerability to long-term health impacts stemming from nutritionally inadequate diets, with potentially significant costs to human capital.
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Abstract
Tuberculosis (TB) is one of the oldest infections afflicting humans yet remains the number one infectious disease killer worldwide. Despite decades of experience treating this disease, TB regimens require months of multidrug therapy, even for latent infections. There have been important recent advances in treatment options across the spectrum of TB, from latent infection to extensively drug-resistant (XDR) TB disease. In addition, new, potent drugs are emerging out of the development pipeline and are being tested in novel regimens in multiple currently enrolling trials. Shorter, safer regimens for many forms of TB are now available or are in our near-term vision. We review recent advances in TB therapeutics and provide an overview of the upcoming clinical trials landscape that will help define the future of worldwide TB treatment.
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Affiliation(s)
- Jeffrey A Tornheim
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA;
| | - Kelly E Dooley
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA; .,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.,Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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9
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Gurung LM, Bhatt LD, Karmacharya I, Yadav DK. Dietary Practice and Nutritional Status of Tuberculosis Patients in Pokhara: A Cross Sectional Study. Front Nutr 2018; 5:63. [PMID: 30167434 PMCID: PMC6106647 DOI: 10.3389/fnut.2018.00063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/22/2018] [Indexed: 11/15/2022] Open
Abstract
Background: Undernutrition increases the risk of progression from Tuberculosis (TB) infection to active TB disease and further leads to weight loss. Proper diet and nutrition play significant roles in treating TB patients. Active TB needs high energy requirement. The main aim of this study is to assess the dietary intake and nutritional status of TB patients in Pokhara city of Nepal. Methods: A cross-sectional descriptive study was carried out among 133 TB patients taking anti-tubercular drug. Data were collected using sequential sampling method. Data were collected from 4th October to 7th November, 2016. Results: This study revealed that about one-fifth of TB patients did not consume sufficient amount of calories as per RDA. More than one-third of patients were underweight during the time of registration and this is reduced to 21.8 percent in the present situation. Mean BMI was 20.99 kg/m2 (SD ± 5.81). Similarly, the mean BMI among Pulmonary TB (PTB) is 19.82 and 22.52 kg/m2 in Extra PTB. Working conditions and food intake frequency were significantly associated with calorie intake. This study found that the amount of calories, food frequency per day, types of TB, and nutritional status during registration were found to be associated with recent nutritional status. The statistical difference between mean BMI at registration and recent BMI and mean weight at registration and recent weight. Conclusion: Nutritional status has improved comparatively from the time of registration to the time of study. Proper nutritional counseling should be given to TB patients along with nutritional support to severely malnourished patients, and nutritional assessment of TB patients should be done periodically.
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Affiliation(s)
- Lal M Gurung
- Pokhara University, School of Health and Allied Sciences, Lekhnath, Nepal
| | - Laxman D Bhatt
- Pokhara University, School of Health and Allied Sciences, Lekhnath, Nepal
| | - Isha Karmacharya
- Pokhara University, School of Health and Allied Sciences, Lekhnath, Nepal
| | - Dipendra K Yadav
- Pokhara University, School of Health and Allied Sciences, Lekhnath, Nepal
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10
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Rao VG, Bhat J, Yadav R, Sharma RK, Muniyandi M. A comparative study of the socio-economic risk factors for pulmonary tuberculosis in the Saharia tribe of Madhya Pradesh, India. Trans R Soc Trop Med Hyg 2018; 112:272-278. [PMID: 29931208 DOI: 10.1093/trstmh/try052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background To determine the socio-economic risk factors for pulmonary tuberculosis (PTB) in the Saharia tribal community in Madhya Pradesh, Central India. Methods PTB cases detected during the year 2013-14 through a community active TB prevalence survey in the Shivpuri district, Madhya Pradesh were included in the study. For each case, three controls were selected randomly among the non-cases from the same village and the data on socio-economic risk factors were collected. Using logistic regression analysis, the risk factors for PTB disease were identified. Results A total of 220 cases and 660 controls participated in the study. Of the 13 risk factors studied, on multivariate analysis the risk of PTB was found to be significantly associated with malnutrition (adjusted odds ratio [AOR] 2.02 [95% confidence interval {CI} 1.46 to 2.79]), living in a kaccha (built of naturally occurring materials) house (AOR 2.72 [95% CI 1.44 to 5.11]) and tobacco smoking (mostly beedis; AOR 1.59 [95% CI 1.12 to 2.18]). Conclusions The findings highlight that malnutrition, poor living conditions in a Kaccha house (built of naturally occurring materials) and tobacco smoking are the major risk factors for PTB among Saharias, which need to be studied among other tribal populations in the country. There is a need to strengthen health and nutrition programmes in this community.
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Affiliation(s)
- Vikas Gangadhar Rao
- National Institute for Research in Tribal Health, Indian Council of Medical Research, Nagpur Road, P.O. Garha, Jabalpur - 482 003, Madhya Pradesh, India
| | - Jyothi Bhat
- National Institute for Research in Tribal Health, Indian Council of Medical Research, Nagpur Road, P.O. Garha, Jabalpur - 482 003, Madhya Pradesh, India
| | - Rajiv Yadav
- National Institute for Research in Tribal Health, Indian Council of Medical Research, Nagpur Road, P.O. Garha, Jabalpur - 482 003, Madhya Pradesh, India
| | - Ravendra Kumar Sharma
- National Institute for Research in Tribal Health, Indian Council of Medical Research, Nagpur Road, P.O. Garha, Jabalpur - 482 003, Madhya Pradesh, India
| | - Malaisamy Muniyandi
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, No.1, Mayor Sathiyamoorthy Road, Chetpet, Chennai - 600 031, Tamil Nadu, India
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11
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Dhiman R, Singh R. Recent advances for identification of new scaffolds and drug targets for Mycobacterium tuberculosis. IUBMB Life 2018; 70:905-916. [PMID: 29761628 DOI: 10.1002/iub.1863] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/07/2018] [Indexed: 02/06/2023]
Abstract
Tuberculosis (TB) is a leading cause of mortality and morbidity with an estimated 1.7 billion people latently infected with the pathogen worldwide. Clinically, TB infection presents itself as an asymptomatic infection, which gradually manifests to life threatening disease. The emergence of various drug resistant strains of Mycobacterium tuberculosis and lengthy duration of chemotherapy are major challenges in the field of TB drug development. Hence, there is an urgent need to develop scaffolds that possess a novel mechanism of action, can shorten the duration of therapy, and are active against both drug resistant and susceptible strains. In this review, we will discuss recent progress made in the field of TB drug development with emphasis on screening methods and drug targets from M. tuberculosis. The current review provides insights into mechanism of action of new scaffolds that are being evaluated in various stages of clinical trials. © 2018 IUBMB Life, 70(9):905-916, 2018.
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Affiliation(s)
- Rohan Dhiman
- Laboratory of Mycobacterial Immunology, Department of Life Science, National Institute of Technology, Rourkela, Odisha, India
| | - Ramandeep Singh
- Tuberculosis Research Laboratory, Vaccine and Infectious Disease Research Centre, Translational Health Science and Technology Institute, Haryana, India
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The impact of social protection and poverty elimination on global tuberculosis incidence: a statistical modelling analysis of Sustainable Development Goal 1. LANCET GLOBAL HEALTH 2018; 6:e514-e522. [PMID: 29580761 PMCID: PMC5968370 DOI: 10.1016/s2214-109x(18)30195-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/13/2018] [Accepted: 03/21/2018] [Indexed: 02/05/2023]
Abstract
Background The End TB Strategy and the Sustainable Development Goals (SDGs) are intimately linked by their common targets and approaches. SDG 1 aims to end extreme poverty and expand social protection coverage by 2030. Achievement of SDG 1 is likely to affect the tuberculosis epidemic through a range of pathways. We estimate the reduction in global tuberculosis incidence that could be obtained by reaching SDG 1. Methods We developed a conceptual framework linking key indicators of SDG 1 progress to tuberculosis incidence via well described risk factor pathways and populated it with data from the SDG data repository and the WHO tuberculosis database for 192 countries. Correlations and mediation analyses informed the strength of the association between the SDG 1 subtargets and tuberculosis incidence, resulting in a simplified framework for modelling. The simplified framework linked key indicators for SDG 1 directly to tuberculosis incidence. We applied an exponential decay model based on linear associations between SDG 1 indicators and tuberculosis incidence to estimate tuberculosis incidence in 2035. Findings Ending extreme poverty resulted in a reduction in global incidence of tuberculosis of 33·4% (95% credible interval 15·5–44·5) by 2035 and expanding social protection coverage resulted in a reduction in incidence of 76·1% (45·2–89·9) by 2035; both pathways together resulted in a reduction in incidence of 84·3% (54·7–94·9). Interpretation Full achievement of SDG 1 could have a substantial effect on the global burden of tuberculosis. Cross-sectoral approaches that promote poverty reduction and social protection expansion will be crucial complements to health interventions, accelerating progress towards the End TB targets. Funding World Health Organization.
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13
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Pedrazzoli D, Boccia D, Dodd PJ, Lönnroth K, Dowdy DW, Siroka A, Kimerling ME, White RG, Houben RMGJ. Modelling the social and structural determinants of tuberculosis: opportunities and challenges. Int J Tuberc Lung Dis 2017; 21:957-964. [PMID: 28826444 PMCID: PMC5566999 DOI: 10.5588/ijtld.16.0906] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/08/2017] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Despite the close link between tuberculosis (TB) and poverty, most mathematical models of TB have not addressed underlying social and structural determinants. OBJECTIVE To review studies employing mathematical modelling to evaluate the epidemiological impact of the structural determinants of TB. METHODS We systematically searched PubMed and personal libraries to identify eligible articles. We extracted data on the modelling techniques employed, research question, types of structural determinants modelled and setting. RESULTS From 232 records identified, we included eight articles published between 2008 and 2015; six employed population-based dynamic TB transmission models and two non-dynamic analytic models. Seven studies focused on proximal TB determinants (four on nutritional status, one on wealth, one on indoor air pollution, and one examined overcrowding, socio-economic and nutritional status), and one focused on macro-economic influences. CONCLUSIONS Few modelling studies have attempted to evaluate structural determinants of TB, resulting in key knowledge gaps. Despite the challenges of modelling such a complex system, models must broaden their scope to remain useful for policy making. Given the intersectoral nature of the interrelations between structural determinants and TB outcomes, this work will require multidisciplinary collaborations. A useful starting point would be to focus on developing relatively simple models that can strengthen our knowledge regarding the potential effect of the structural determinants on TB outcomes.
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Affiliation(s)
- D Pedrazzoli
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London
| | - D Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London
| | - P J Dodd
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Lönnroth
- World Health Organization, Global Tuberculosis Programme, Geneva, Switzerland, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Siroka
- World Health Organization, Global Tuberculosis Programme, Geneva, Switzerland
| | - M E Kimerling
- KNCV, Tuberculosis Foundation, The Hague, The Netherlands
| | - R G White
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London
| | - R M G J Houben
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London
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14
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Padmapriyadarsini C, Shobana M, Lakshmi M, Beena T, Swaminathan S. Undernutrition & tuberculosis in India: Situation analysis & the way forward. Indian J Med Res 2017; 144:11-20. [PMID: 27834321 PMCID: PMC5116882 DOI: 10.4103/0971-5916.193278] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Undernutrition and tuberculosis (TB) are linked and have a bidirectional relationship. Undernutrition increases the risk of TB which in turn, can lead to malnutrition. Undernutrition not only is a risk factor for progression of latent TB infection to active disease, but also increases the risk of drug toxicity, relapse and death once TB develops. The dietary intake of TB patients in the country is inadequate. Nutritional supplementation in patients with TB is associated with faster sputum conversion, higher cure and treatment completion rates, significant gain in body weight and body composition as well as better performance status. The Government of India has various social support schemes (including nutrition supplementation schemes) and policies, at the Centre as well as State levels. Here we discuss some successful examples and suggest a few solutions to address this gap; like considering TB patients as a vulnerable group for “Targeted Public Distribution System” and providing extra rations for the duration of treatment. Recommendations for the research community, civil societies, government organizations, non-governmental and corporate sector on the actions needed to achieve the goals of the End TB Strategy are also provided. Ultimately, reduction of TB burden in India and its elimination will require improving the nutritional status of the community as a whole.
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Affiliation(s)
- C Padmapriyadarsini
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - M Shobana
- Department of Home Science, Bharathidasan Government College for Women, Puducherry, India
| | - M Lakshmi
- Medical & Rural Health Services (TB), Tamil Nadu, India
| | - T Beena
- Department of Socio-Behavioral Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Soumya Swaminathan
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu; Director-General, Indian Council of Medical Research & Secretary, Department of Health Research, Government of India, New Delhi, India
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15
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Perez-Navarro LM, Restrepo BI, Fuentes-Dominguez FJ, Duggirala R, Morales-Romero J, López-Alvarenga JC, Comas I, Zenteno-Cuevas R. The effect size of type 2 diabetes mellitus on tuberculosis drug resistance and adverse treatment outcomes. Tuberculosis (Edinb) 2017; 103:83-91. [PMID: 28237037 DOI: 10.1016/j.tube.2017.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the effect size of type 2 diabetes mellitus (T2DM) on tuberculosis (TB) treatment outcomes and multi drug resistance (MDR). METHODS A cohort with 507 individuals with diagnosed TB included 183 with coexistence of T2DM and TB (TB-T2DM). Participants were identified at the time of TB diagnosis and followed during the course of TB treatment. Then we computed relative risks and adjustments by Cox proportional hazards for outcome variables (drug resistance, death, relapse, treatment failure), and the size of their effect as Cohen's-d. RESULTS Patients with TB-T2DM were more likely to remain positive for acid-fast bacilli after two months of anti-TB treatment RR = [2.01 (95% CI: 1.3, 3.1)], to have drug resistant (DR) [OR 3.5 (95% CI: 1.8, 6.7)] and multi-drug resistant (MDR) TB [OR 3.5 (95% CI: 1.8, 7.1)]. The Cohen's-d for DR or MDR in T2DM was 0.69 when compared with non-DM subjects. The T2DM patients had higher odds of resistance to isoniazid (OR 3.9, 95% CI: 2.01, 7.9), rifampicin (OR 3.4, 95% CI: 1.6, 7.2) and pyrazinamide (OR 9.4, 95% CI: 2.8, 25.6), and their effect sizes were ≥0.67. Patients with TB-T2DM (versus no DM) were more likely to present with MDR TB (HR 3.1; 95% CI: 1.7, 5.8; p < 0.001), treatment failure (HR 2.04; 95% CI: 1.07, 3.8; p = 0.02) and relapse (HR 1.86; 95% CI: 1.09, 3.1; p = 0.02), with effect size ≥0.34. CONCLUSION T2DM showed a substantial contribution to the presence of DR or MDR-TB and to adverse clinical outcomes during and after TB treatment. Our findings support the importance for routine screening of T2DM among newly-diagnosed TB patients in order to stratify them for immediate DR assessment, and highlight the need for clinical trials to evaluate variations to the standard TB treatment in TB-T2DM to prevent adverse treatment outcomes.
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Affiliation(s)
- Lucia Monserrat Perez-Navarro
- Nephrology Service, Research Division, Hospital General de México "Dr. Eduardo Liceaga", Mexico; Public Health Institute, University of Veracruz, Veracruz, Mexico
| | - Blanca I Restrepo
- University of Texas Health Science Center Houston, Brownsville Campus, Brownsville, TX, USA
| | | | - Ravindranath Duggirala
- South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | | | | | - Iñaki Comas
- Unidad de Genómica de la Tuberculosis, Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain
| | - Roberto Zenteno-Cuevas
- Public Health Institute, University of Veracruz, Veracruz, Mexico; Red multidisciplinaria de Investigación en tuberculosis, Mexico.
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16
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Houben RMGJ, Menzies NA, Sumner T, Huynh GH, Arinaminpathy N, Goldhaber-Fiebert JD, Lin HH, Wu CY, Mandal S, Pandey S, Suen SC, Bendavid E, Azman AS, Dowdy DW, Bacaër N, Rhines AS, Feldman MW, Handel A, Whalen CC, Chang ST, Wagner BG, Eckhoff PA, Trauer JM, Denholm JT, McBryde ES, Cohen T, Salomon JA, Pretorius C, Lalli M, Eaton JW, Boccia D, Hosseini M, Gomez GB, Sahu S, Daniels C, Ditiu L, Chin DP, Wang L, Chadha VK, Rade K, Dewan P, Hippner P, Charalambous S, Grant AD, Churchyard G, Pillay Y, Mametja LD, Kimerling ME, Vassall A, White RG. Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models. LANCET GLOBAL HEALTH 2016; 4:e806-e815. [PMID: 27720688 PMCID: PMC6375908 DOI: 10.1016/s2214-109x(16)30199-1] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/06/2016] [Accepted: 08/01/2016] [Indexed: 12/30/2022]
Abstract
Background The post-2015 End TB Strategy proposes targets of 50% reduction in tuberculosis incidence and 75% reduction in mortality from tuberculosis by 2025. We aimed to assess whether these targets are feasible in three high-burden countries with contrasting epidemiology and previous programmatic achievements. Methods 11 independently developed mathematical models of tuberculosis transmission projected the epidemiological impact of currently available tuberculosis interventions for prevention, diagnosis, and treatment in China, India, and South Africa. Models were calibrated with data on tuberculosis incidence and mortality in 2012. Representatives from national tuberculosis programmes and the advocacy community provided distinct country-specific intervention scenarios, which included screening for symptoms, active case finding, and preventive therapy. Findings Aggressive scale-up of any single intervention scenario could not achieve the post-2015 End TB Strategy targets in any country. However, the models projected that, in the South Africa national tuberculosis programme scenario, a combination of continuous isoniazid preventive therapy for individuals on antiretroviral therapy, expanded facility-based screening for symptoms of tuberculosis at health centres, and improved tuberculosis care could achieve a 55% reduction in incidence (range 31–62%) and a 72% reduction in mortality (range 64–82%) compared with 2015 levels. For India, and particularly for China, full scale-up of all interventions in tuberculosis-programme performance fell short of the 2025 targets, despite preventing a cumulative 3·4 million cases. The advocacy scenarios illustrated the high impact of detecting and treating latent tuberculosis. Interpretation Major reductions in tuberculosis burden seem possible with current interventions. However, additional interventions, adapted to country-specific tuberculosis epidemiology and health systems, are needed to reach the post-2015 End TB Strategy targets at country level. Funding Bill and Melinda Gates Foundation
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Affiliation(s)
- Rein M G J Houben
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Tom Sumner
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Nimalan Arinaminpathy
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK; Public Health Foundation of India, Delhi NCR, India
| | - Jeremy D Goldhaber-Fiebert
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Chieh-Yin Wu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | - Sze-Chuan Suen
- Management Science and Engineering Dept, Stanford University, Stanford, CA, USA
| | - Eran Bendavid
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Allison S Rhines
- Department of Biology, Stanford University, Stanford, CA, USA; Johnson & Johnson Global Public Health, Raritan, NJ, USA
| | | | - Andreas Handel
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Christopher C Whalen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | | | | | | | - James M Trauer
- The Burnet Institute, Melbourne, Australia; The Victorian Infectious Diseases Service, at the Peter Doherty Institute, Melbourne, Australia; Department of Microbiology and Immunology, the University of Melbourne at the Peter Doherty Institute, Melbourne, Australia
| | - Justin T Denholm
- The Victorian Infectious Diseases Service, at the Peter Doherty Institute, Melbourne, Australia; Department of Microbiology and Immunology, the University of Melbourne at the Peter Doherty Institute, Melbourne, Australia
| | - Emma S McBryde
- The Burnet Institute, Melbourne, Australia; The Victorian Infectious Diseases Service, at the Peter Doherty Institute, Melbourne, Australia; Department of Microbiology and Immunology, the University of Melbourne at the Peter Doherty Institute, Melbourne, Australia
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Joshua A Salomon
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Marek Lalli
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeffrey W Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Delia Boccia
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mehran Hosseini
- Strategic Information Department, The Global Fund, Geneva, Switzerland
| | - Gabriela B Gomez
- Department of Global Health, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Daniel P Chin
- Bill and Melinda Gates Foundation, China Office, Beijing, China
| | - Lixia Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Vineet K Chadha
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - Kiran Rade
- World Health Organization, Country Office for India, New Delhi, India
| | - Puneet Dewan
- The Bill & Melinda Gates Foundation, New Delhi, India
| | | | | | - Alison D Grant
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Gavin Churchyard
- Aurum Institute. Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Yogan Pillay
- National Department of Health, Pretoria, South Africa
| | | | - Michael E Kimerling
- Bill and Melinda Gates foundation, Seattle, WA, USA (currently KNCV Tuberculosisn Foundation, The Hague, Netherlands)
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard G White
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
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17
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Prince L, Andrews JR, Basu S, Goldhaber-Fiebert JD. Risk of self-reported symptoms or diagnosis of active tuberculosis in relationship to low body mass index, diabetes and their co-occurrence. Trop Med Int Health 2016; 21:1272-1281. [PMID: 27495971 DOI: 10.1111/tmi.12763] [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: 01/18/2023]
Abstract
OBJECTIVE Globally, tuberculosis prevalence has declined, but its risk factors have varied across place and time - low body mass index (BMI) has persisted while diabetes has increased. Using India's National Family Health Survey (NFHS), wave 3 and World Health Survey (WHS) data, we examined their relationships to support projection of future trends and targeted control efforts. METHODS Multivariate logistic regressions at the individual level with and without diabetes/BMI interactions assessed the relationship between tuberculosis, diabetes and low BMI and the importance of risk factor co-occurrence. Population-level analyses examined how tuberculosis incidence and prevalence varied with diabetes/low BMI co-occurrence. RESULTS In NFHS, diabetic individuals had higher predicted tuberculosis risks (diabetic vs. non-diabetic: 2.50% vs. 0.63% at low BMI; 0.81% vs. 0.20% at normal BMI; 0.37% vs. 0.09% at high BMI), which were not significantly different when modelled independently or allowing for risk modification with diabetes/low BMI co-occurrence. WHS findings were generally consistent. Population-level analysis found that diabetes/low BMI co-occurrence may be associated with elevated tuberculosis risk, although its predicted effect on tuberculosis incidence/prevalence was generally ≤0.2 percentage points and not robustly statistically significant. CONCLUSIONS Concerns about the additional elevation of tuberculosis risk from diabetes/low BMI co-occurrence and hence the need to coordinate tuberculosis control efforts around the nexus of co-occurring diabetes and low BMI may be premature. However, study findings robustly support the importance of individually targeting low BMI and diabetes as part of ongoing tuberculosis control efforts.
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Affiliation(s)
- L Prince
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - J R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - S Basu
- Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - J D Goldhaber-Fiebert
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
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18
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Pizzol D, Di Gennaro F, Chhaganlal KD, Fabrizio C, Monno L, Putoto G, Saracino A. Tuberculosis and diabetes: current state and future perspectives. Trop Med Int Health 2016; 21:694-702. [PMID: 27102229 DOI: 10.1111/tmi.12704] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review outlines the association between tuberculosis and diabetes, focusing on epidemiology, physiopathology, clinical aspects, diagnosis and treatment, and evaluates future perspectives, with particular attention to developing countries.
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Affiliation(s)
- Damiano Pizzol
- Research Section, Doctors with Africa CUAMM, Beira, Mozambique
| | | | - Kajal D Chhaganlal
- Center for Research in Infectious Diseases, Faculty of Health Sciences, Catholic University of Mozambique, Beira, Mozambique
| | | | - Laura Monno
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
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Coexistent Malnutrition Is Associated with Perturbations in Systemic and Antigen-Specific Cytokine Responses in Latent Tuberculosis Infection. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:339-45. [PMID: 26865593 DOI: 10.1128/cvi.00009-16] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/03/2016] [Indexed: 11/20/2022]
Abstract
Malnutrition, as defined by low body mass index (BMI), is a major risk factor for the development of active tuberculosis (TB), although the biological basis underlying this susceptibility remains poorly characterized. To verify whether malnutrition affects the systemic and antigen-specific cytokine levels in individuals with latent TB (LTB), we examined circulating and TB antigen-stimulated levels of cytokines in individuals with LTB and low BMI (LBMI) and compared them with those in individuals with LTB and normal BMI (NBMI). Coexistent LBMI with LTB was characterized by diminished circulating levels of type 1 (gamma interferon [IFN-γ] and tumor necrosis factor alpha [TNF-α]), type 2 (interleukin-4 [IL-4]), type 17 (IL-22), and other proinflammatory (IL-1α, IL-1β, and IL-6) cytokines but elevated levels of other type 2 (IL-5 and IL-13) and regulatory (IL-10 and transforming growth factor beta [TGF-β]) cytokines. In addition, LBMI with LTB was associated with diminished TB antigen-induced IFN-γ, TNF-α, IL-6, IL-1α, and IL-1β levels. Finally, there was a significant positive correlation between BMI values and TNF-α and IL-1β levels and a significant negative correlation between BMI values and IL-2, IL-10, and TGF-β levels in individuals with LTB. Therefore, our data reveal that latent TB with a coexistent low BMI is characterized by diminished protective cytokine responses and heightened regulatory cytokine responses, providing a potential biological mechanism for the increased risk of developing active TB.
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Alkabab YM, Al-Abdely HM, Heysell SK. Diabetes-related tuberculosis in the Middle East: an urgent need for regional research. Int J Infect Dis 2015; 40:64-70. [PMID: 26409203 PMCID: PMC4863943 DOI: 10.1016/j.ijid.2015.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/21/2015] [Accepted: 09/16/2015] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Diabetes mellitus (DM) triples the risk of tuberculosis (TB) disease, complicates TB treatment, and increases the risk of a poor TB outcome. As DM prevalence is increasing across the Middle East, this review was performed to identify regional gaps in knowledge and research priorities for DM/TB. METHODS Online databases were searched for studies published from Middle East countries on DM and TB and the studies summarized based on topic and major findings. Studies included had a principle hypothesis related to both diseases, or described TB patients with individual data on DM. RESULTS Fifty-nine studies from 10 countries met search criteria. No published studies were found from Lebanon, Bahrain, Syria, Jordan, Cyprus, or the United Arab Emirates. DM prevalence among TB patients was high, but varied considerably across studies. The vast majority of studies were not specifically designed to compare DM/TB and non-DM/TB patients, but many suggested worse treatment outcomes for DM/TB, in accordance with reports from other regions. CONCLUSIONS Opportunity exists for the regional study of bidirectional screening, management strategies for both DM and TB diseases, and whether such efforts could take place through the integration of services.
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Affiliation(s)
- Yosra M Alkabab
- Division of Infectious Diseases, King Khalid University Hospital, Riyadh, Saudi Arabia.
| | - Hail M Al-Abdely
- Division of Infectious Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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21
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Harries AD, Satyanarayana S, Kumar AMV, Nagaraja SB, Isaakidis P, Malhotra S, Achanta S, Naik B, Wilson N, Zachariah R, Lönnroth K, Kapur A. Epidemiology and interaction of diabetes mellitus and tuberculosis and challenges for care: a review. Public Health Action 2015; 3:S3-9. [PMID: 26393066 DOI: 10.5588/pha.13.0024] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 07/15/2013] [Indexed: 12/11/2022] Open
Abstract
The global burden of diabetes mellitus (DM) is immense, with numbers expected to rise to over 550 million by 2030. Countries in Asia, such as India and China, will bear the brunt of this unfolding epidemic. Persons with DM have a significantly increased risk of developing active tuberculosis (TB) that is two to three times higher than in persons without DM. This article reviews the epidemiology and interactions of these two diseases, discusses how the World Health Organization and International Union Against Tuberculosis and Lung Disease developed and launched the Collaborative Framework for the care and control of TB and DM, and examines three important challenges for care. These relate to 1) bi-directional screening of the two diseases, 2) treatment of patients with dual disease, and 3) prevention of TB in persons with DM. For each area, the gaps in knowledge and the priority research areas are highlighted. Undiagnosed, inadequately treated and poorly controlled DM appears to be a much greater threat to TB prevention and control than previously realised, and the problem needs to be addressed. Prevention of DM through attention to unhealthy diets, sedentary lifestyles and childhood and adult obesity must be included in broad non-communicable disease prevention strategies. This collaborative framework provides a template for action, and the recommendations now need to be implemented and evaluated in the field to lay down a firm foundation for the scaling up of interventions that work and are effective in tackling this dual burden of disease.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | | | - A M V Kumar
- The Union South-East Asia Office, New Delhi, India
| | - S B Nagaraja
- Office of the WHO Representative in India, World Health Organization, New Delhi, India ; Department of Community Medicine, Employees State Insurance Corporation (ESIC) Medical College, Bangalore, India
| | - P Isaakidis
- Médecins Sans Frontières, Brussels Operational Centre, Mumbai, India
| | - S Malhotra
- All India Institute of Medical Sciences, New Delhi, India
| | - S Achanta
- Office of the WHO Representative in India, World Health Organization, New Delhi, India
| | - B Naik
- Office of the WHO Representative in India, World Health Organization, New Delhi, India
| | - N Wilson
- The Union South-East Asia Office, New Delhi, India
| | - R Zachariah
- Medical Department, Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Luxembourg
| | - K Lönnroth
- Stop TB Department, World Health Organization, Geneva, Switzerland
| | - A Kapur
- World Diabetes Foundation, Gentofte, Denmark
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Delgado-Sánchez G, García-García L, Castellanos-Joya M, Cruz-Hervert P, Ferreyra-Reyes L, Ferreira-Guerrero E, Hernández A, Ortega-Baeza VM, Montero-Campos R, Sulca JA, Martínez-Olivares MDL, Mongua-Rodríguez N, Baez-Saldaña R, González-Roldán JF, López-Gatell H, Ponce-de-León A, Sifuentes-Osornio J, Jiménez-Corona ME. Association of Pulmonary Tuberculosis and Diabetes in Mexico: Analysis of the National Tuberculosis Registry 2000-2012. PLoS One 2015; 10:e0129312. [PMID: 26075393 PMCID: PMC4468212 DOI: 10.1371/journal.pone.0129312] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 05/07/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a public health problem in Mexico while the incidence of diabetes mellitus type 2 (DM) has increased rapidly in recent years. OBJECTIVE To describe the trends of incidence rates of pulmonary TB associated with DM and not associated with DM and to compare the results of treatment outcomes in patients with and without DM. MATERIALS AND METHODS We analysed the National Tuberculosis Registry from 2000 to 2012 including patients with pulmonary TB among individuals older than 20 years of age. The association between DM and treatment failure was analysed using logistic regression, accounting for clustering due to regional distribution. RESULTS In Mexico from 2000 to 2012, the incidence rates of pulmonary TB associated to DM increased by 82.64%, (p<0.001) in contrast to rates of pulmonary TB rate without DM, which decreased by 26.77%, (p<0.001). Patients with a prior diagnosis of DM had a greater likelihood of failing treatment (adjusted odds ratio, 1.34 (1.11-1.61) p<0.002) compared with patients who did not have DM. There was statistical evidence of interaction between DM and sex. The odds of treatment failure were increased in both sexes. CONCLUSION Our data suggest that the growing DM epidemic has an impact on the rates of pulmonary TB. In addition, patients who suffer from both diseases have a greater probability of treatment failure.
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Affiliation(s)
- Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Lourdes García-García
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
| | - Martín Castellanos-Joya
- Dirección de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Andrés Hernández
- Departamento de Epidemiología, Instituto Nacional de Enfermedades Respiratorias, México, Distrito Federal, México
| | - Victor Manuel Ortega-Baeza
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - José Antonio Sulca
- Dirección de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Ma. de Lourdes Martínez-Olivares
- Dirección de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Norma Mongua-Rodríguez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Renata Baez-Saldaña
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Jesús Felipe González-Roldán
- Dirección General, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Hugo López-Gatell
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - María Eugenia Jiménez-Corona
- Dirección General Adjunta de Epidemiología, Dirección General de Epidemiología, México, Distrito Federal, México
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Oxlade O, Huang CC, Murray M. Estimating the Impact of Reducing Under-Nutrition on the Tuberculosis Epidemic in the Central Eastern States of India: A Dynamic Modeling Study. PLoS One 2015; 10:e0128187. [PMID: 26046649 PMCID: PMC4457886 DOI: 10.1371/journal.pone.0128187] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 04/23/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) and under-nutrition are widespread in many low and middle-income countries. Momentum to prioritize under-nutrition has been growing at an international level, as demonstrated by the "Scaling Up Nutrition" movement. Low body mass index is an important risk factor for developing TB disease. The objective of this study was to project future trends in TB related outcomes under different scenarios for reducing under-nutrition in the adult population in the Central Eastern states of India. METHODS A compartmental TB transmission model stratified by body mass index was parameterized using national and regional data from India. We compared TB related mortality and incidence under several scenarios that represented a range of policies and programs designed to reduce the prevalence of under-nutrition, based on the experience and observed trends in similar countries. RESULTS The modeled nutrition intervention scenarios brought about reductions in TB incidence and TB related mortality in the Central Eastern Indian states ranging from 43% to 71% and 40% to 68% respectively, relative to the scenario of no nutritional intervention. Modest reductions in under-nutrition averted 4.8 (95% UR 0.5, 17.1) million TB cases and 1.6 (95% UR 0.5, 5.2) million TB related deaths over a period of 20 years of intervention, relative to the scenario of no nutritional intervention. Complete elimination of under-nutrition in the Central Eastern states averted 9.4 (95% UR 1.5, 30.6) million TB cases and 3.2 (95% UR 0.7-, 10.1) million TB related deaths, relative to the scenario of no nutritional intervention. CONCLUSION Our study suggests that intervening on under-nutrition could have a substantial impact on TB incidence and mortality in areas with high prevalence of under-nutrition, even if only small gains in under-nutrition can be achieved. Focusing on under-nutrition may be an effective way to reduce both rates of TB and other diseases associated with under-nutrition.
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Affiliation(s)
- Olivia Oxlade
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Chuan-Chin Huang
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Megan Murray
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Infectious Disease Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Statin, calcium channel blocker and Beta blocker therapy may decrease the incidence of tuberculosis infection in elderly Taiwanese patients with type 2 diabetes. Int J Mol Sci 2015; 16:11369-84. [PMID: 25993300 PMCID: PMC4463705 DOI: 10.3390/ijms160511369] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 01/23/2023] Open
Abstract
Background: It is well known that diabetes mellitus impairs immunity and therefore is an independent risk factor for tuberculosis. However, the influence of associated metabolic factors, such as hypertension, dyslipidemia and gout has yet to be confirmed. This study aimed to investigate whether the strong association between tuberculosis and diabetes mellitus is independent from the influence of hypertension and dyslipidemia, and its treatment in elderly Taiwanese patients. Methods: A total of 27,958 patients aged more than 65 years were identified from the National Health Insurance Research Database (NIHRD) in 1997 and were followed from 1998 to 2009. The demographic characteristics between the patients with and without diabetes were analyzed using the χ2 test. A total of 13,981 patients with type 2 diabetes were included in this study. Cox proportional hazard regression models were used to determine the independent effects of diabetes on the risk of tuberculosis. Results: After adjusting for age, sex, other co-morbidities and medications, calcium channel blocker, beta blocker and statin users had a lower independent association, with risk ratios of 0.76 (95% CI, 0.58–0.98), 0.72 (95% CI, 0.58–0.91) and 0.76 (95% CI, 0.60–0.97), respectively. Conclusion: Calcium channel blocker, beta blocker and statin therapy may decrease the incidence of tuberculosis infection in elderly Taiwanese patients with type 2 diabetes.
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Lönnroth K. Colliding epidemics requires collaborating programmes. Lancet Diabetes Endocrinol 2015; 3:306-7. [PMID: 25754413 DOI: 10.1016/s2213-8587(15)00037-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 02/23/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Knut Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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26
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Pan SC, Ku CC, Kao D, Ezzati M, Fang CT, Lin HH. Effect of diabetes on tuberculosis control in 13 countries with high tuberculosis: a modelling study. Lancet Diabetes Endocrinol 2015; 3:323-30. [PMID: 25754415 DOI: 10.1016/s2213-8587(15)00042-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diabetes increases the risk of tuberculosis incidence and the risk of adverse treatment outcomes in patients with tuberculosis. Because prevalence of diabetes is increasing in low-income and middle-income countries where the burden of tuberculosis is high, prevention of diabetes carries the potential to improve tuberculosis control worldwide. METHODS We used dynamic tuberculosis transmission models to analyse the potential effect of diabetes on tuberculosis epidemiology in 13 countries with high tuberculosis burden. We used data for previous diabetes prevalence in each country and constructed scenarios to represent the potential ranges of future diabetes prevalence. The country-specific model was calibrated to the estimated trend of tuberculosis incidence. We estimated the tuberculosis burden that can be reduced by alternative scenarios of diabetes prevention. FINDINGS If the prevalence of diabetes continues to rise as it has been in the past decade in the 13 countries (base case scenario), by 2035, the cumulative reduction in tuberculosis incidence would be 8·8% (95% credible interval [CrI] 4·0-15·8) and mortality would be 34·0% (30·3-39·6). Lowering the prevalence of diabetes by an absolute level of 6·6-13·8% could accelerate the decline of tuberculosis incidence by an absolute level of 11·5-25·2% and tuberculosis mortality by 8·7-19·4%. Compared with the base case scenario, stopping the rise of diabetes would avoid 6·0 million (95% CrI 5·1-6·9) incident cases and 1·1 million (1·0-1·3) tuberculosis deaths in 13 countries during 20 years. If interventions reduce diabetes incidence by 35% by 2025, 7·8 million (6·7-9·0) tuberculosis cases and 1·5 million (1·3-1·7) tuberculosis deaths could be averted by 2035. INTERPRETATION The diabetes epidemic could substantially affect tuberculosis epidemiology in high burden countries. The communicable disease and non-communicable disease sectors need to move beyond conventional boundaries and link with each other to form a joint response to diabetes and tuberculosis. FUNDING Taiwan National Science Council.
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Affiliation(s)
- Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chu-Chang Ku
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Diana Kao
- Department of Epidemiology and Biostatistics, University of British Columbia, Vancouver, Canada
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - Chi-Tai Fang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Syal K, Chakraborty S, Bhattacharyya R, Banerjee D. Combined inhalation and oral supplementation of Vitamin A and Vitamin D: A possible prevention and therapy for tuberculosis. Med Hypotheses 2015; 84:199-203. [DOI: 10.1016/j.mehy.2014.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 12/26/2014] [Indexed: 11/25/2022]
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Sharma P, Visnegarwala F, Tripathi V. Burgeoning double burden of tuberculosis and diabetes in India: Magnitude of the problem – Strategies and solutions. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2014. [DOI: 10.1016/j.cegh.2013.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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29
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Skowroński M, Zozulińska-Ziółkiewicz D, Barinow-Wojewódzki A. Tuberculosis and diabetes mellitus - an underappreciated association. Arch Med Sci 2014; 10:1019-27. [PMID: 25395955 PMCID: PMC4223145 DOI: 10.5114/aoms.2014.46220] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/17/2013] [Accepted: 10/07/2013] [Indexed: 12/20/2022] Open
Abstract
The current review presents up-to-date knowledge on tuberculosis (TB) in diabetic patients. On the basis of available literature, there is little doubt about the close relationship between these two conditions. Diabetes mellitus in this association may still contribute substantially to the burden of TB and negatively affect control of the latter. Chronic hyperglycemia at least to some extent may alter the clinical manifestation, radiological appearance, treatment outcome and prognosis of TB. Although the pathogenesis is not clear, diabetes may impair both innate and adaptive immune responses to Mycobacterium tuberculosis. Eventually, effective screening and dual management of the diseases have to be addressed both in low- and high-income countries in order to limit the negative effects of the forthcoming global diabetes epidemic.
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Affiliation(s)
- Marcin Skowroński
- Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
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30
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Angkurawaranon C, Jiraporncharoen W, Chenthanakij B, Doyle P, Nitsch D. Urbanization and non-communicable disease in Southeast Asia: a review of current evidence. Public Health 2014; 128:886-95. [DOI: 10.1016/j.puhe.2014.08.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/13/2014] [Accepted: 08/04/2014] [Indexed: 01/22/2023]
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Understanding the development and perception of global health for more effective student education. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2014; 87:231-40. [PMID: 25191139 PMCID: PMC4144278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The concept of "global health" that led to the establishment of the World Health Organization in the 1940s is still promoting a global health movement 70 years later. Today's global health acts first as a guiding principle for our effort to improve people's health across the globe. Furthermore, global health has become a branch of science, "global health science," supporting institutionalized education. Lastly, as a discipline, global health should focus on medical and health issues that: 1) are determined primarily by factors with a cross-cultural, cross-national, cross-regional, or global scope; 2) are local but have global significance if not appropriately managed; and 3) can only be efficiently managed through international or global efforts. Therefore, effective global health education must train students 1) to understand global health status; 2) to investigate both global and local health issues with a global perspective; and 3) to devise interventions to deal with these issues.
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Odone A, Houben RMGJ, White RG, Lönnroth K. The effect of diabetes and undernutrition trends on reaching 2035 global tuberculosis targets. Lancet Diabetes Endocrinol 2014; 2:754-64. [PMID: 25194888 DOI: 10.1016/s2213-8587(14)70164-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To achieve the post-2015 global tuberculosis target of 90% reduction in tuberculosis incidence by 2035, the present rate of decline must accelerate. Among factors that hinder tuberculosis control, malnutrition and diabetes are key challenges. We review available data to describe the complex relationship between tuberculosis, diabetes, and nutritional status. Additionally, we review past trends, present burden, and available future global projections for diabetes, overweight and obesity, as well as undernutrition and food insecurity. Using a mathematical model, we estimate the potential effect of these factors on tuberculosis burden up to 2035. Great potential exists for reduction of worldwide tuberculosis burden by combination of improved prevention and care of diabetes with reduction of undernutrition. To achieve this combination will require joint efforts and strong cross-programme links, enabling synergistic effects of public health policies that promote good nutrition and optimum clinical care for tuberculosis and diabetes.
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Affiliation(s)
- Anna Odone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Rein M G J Houben
- Tuberculosis Modelling Group, Tuberculosis Centre and Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard G White
- Tuberculosis Modelling Group, Tuberculosis Centre and Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Knut Lönnroth
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
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Lönnroth K, Roglic G, Harries AD. Improving tuberculosis prevention and care through addressing the global diabetes epidemic: from evidence to policy and practice. Lancet Diabetes Endocrinol 2014; 2:730-9. [PMID: 25194886 DOI: 10.1016/s2213-8587(14)70109-3] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diabetes triples the risk of tuberculosis and is also a risk factor for adverse tuberculosis treatment outcomes, including death. Prevalence of diabetes is increasing globally, but most rapidly in low-income and middle-income countries where tuberculosis is a grave public health problem. Growth in this double disease burden creates additional obstacles for tuberculosis care and prevention. We review how the evolution of evidence on the link between tuberculosis and diabetes has informed global policy on collaborative activities, and how practice is starting to change as a consequence. We conclude that coordinated planning and service delivery across communicable and non-communicable disease programmes is necessary, feasible, and creates synergies that will help to reduce the burden of both tuberculosis and diabetes.
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Affiliation(s)
- Knut Lönnroth
- Departments of Global TB Programme, World Health Organization, Geneva, Switzerland.
| | - Gojka Roglic
- Management of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
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Ley SD, Riley I, Beck HP. Tuberculosis in Papua New Guinea: from yesterday until today. Microbes Infect 2014; 16:607-14. [PMID: 25025486 DOI: 10.1016/j.micinf.2014.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 06/11/2014] [Accepted: 06/25/2014] [Indexed: 01/09/2023]
Abstract
Little is known about the situation of tuberculosis in Papua New Guinea despite its high TB burden, emerging drug resistance and rising HIV co-infection. This review gives an overview on the current situation of TB in PNG and identifies knowledge gaps that should urgently be addressed in the future.
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Affiliation(s)
- Serej D Ley
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4002 Basel, Switzerland; University of Basel, Petersgraben 2, CH-4002 Basel, Switzerland; Papua New Guinea Institute of Medical Research, Goroka EHP, Papua New Guinea
| | - Ian Riley
- School of Population Health, University of Queensland, School of Population Health Building, Herston Road, Herston Qld 4006, Australia
| | - Hans-Peter Beck
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4002 Basel, Switzerland; University of Basel, Petersgraben 2, CH-4002 Basel, Switzerland.
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Fisher-Hoch SP. Worldwide increase in diabetes: implications for tuberculosis control. Res Rep Trop Med 2014; 5:35-44. [PMID: 32669890 PMCID: PMC7337143 DOI: 10.2147/rrtm.s45082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/23/2014] [Indexed: 01/13/2023] Open
Abstract
Diabetes presents a greater threat to global tuberculosis (TB) control than previously appreciated, with risk of reversing the achievements of several decades. An estimated 382 million people worldwide currently have diabetes, half of whom are undiagnosed. Most live in low- and middle-income countries alongside many of the two billion individuals infected with TB. Though the frequency of TB in type 1 diabetes was known for centuries, only recently have we observed the tripling of TB in type 2 diabetes, most significantly in high-burden TB populations such as in Peru, Russia, and the People's Republic of China. In India diabetes is estimated to have increased TB cases by 46% between 1998 and 2008. Diabetes is a greater long-term threat to TB control than human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) since ten-fold more people are affected by diabetes than HIV/AIDS in larger geographic areas. Diabetes in TB increases drug resistance, treatment failure, and mortality, and may increase the spread of drug-resistant strains. Delayed or missed diagnosis fuels transmission of TB and hinders control of diabetes. Tailored treatment for diabetes patients requires well-designed clinical trials. The World Health Organization (WHO) framework for care and control of diabetes and TB needs improved screening strategies. Determination of how best to establish bi-directional screening is hampered by lack of affordable and reliable methods. Recommendations include education of health care providers, patients, and communities. Structured diabetes programs with registries and effective follow-up could be modeled on and communicate with existing TB programs. Vital research should address new diagnostic tools, lowering cost and evaluation of intervention strategies, as well as better understanding of the impaired immune responses that make diabetes patients more susceptible to TB leading to targeted therapies. Solutions will require the combination of good science, good decision-making, adequate funding, and political will.
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Affiliation(s)
- Susan P Fisher-Hoch
- Division of Epidemiology, Human Genetics and Environmental Science, University of Texas School of Public Health, Brownsville Campus, Brownsville, TX, USA
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Abstract
Running over timescales that span decades or centuries, the epidemiological transition provides the central narrative of global health. In this transition, a reduction in mortality is followed by a reduction in fertility, creating larger, older populations in which the main causes of illness and death are no longer acute infections of children but chronic diseases of adults. Since the year 2000, the Millennium Development Goals (MDGs) have provided a framework for accelerating the decline of infectious diseases, backed by a massive injection of foreign investment to low-income countries. Despite the successes of the MDGs era, the inhabitants of low-income countries still suffer an enormous burden of disease owing to diarrhoea, pneumonia, HIV/AIDS, tuberculosis, malaria and other pathogens. Adding to the predictable burden of endemic disease, the threat of pandemics is ever-present and global. With a view to the future, this review spotlights five aspects of the fight against infection beyond 2015, when the MDGs will be replaced by a new set of goals for poverty reduction and sustainable development. These aspects are: exploiting the biological links between infectious and non-infectious diseases; controlling infections among the new urban majority; enhancing the response to international health threats; expanding childhood immunization programmes to prevent acute and chronic diseases in adults; and working towards universal health coverage. By scanning the wider horizon now, infectious disease specialists have the chance to shape the post-2015 era of health and development.
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Affiliation(s)
- Christopher Dye
- Office of the Director General, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland
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The value of serum prealbumin in the diagnosis and therapeutic response of tuberculosis: a retrospective study. PLoS One 2013; 8:e79940. [PMID: 24260323 PMCID: PMC3833965 DOI: 10.1371/journal.pone.0079940] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 09/28/2013] [Indexed: 12/18/2022] Open
Abstract
Objective The aim of this study was to examine serum prealbumin (PA) levels in patients with tuberculosis and lung cancer, and to evaluate the correlations of serum PA levels with clinicopathological characteristics. Method Total 760 patients were included in the study: 320 patients with tuberculosis, 320 patients with lung cancer, and 120 healthy subjects. Serum PA was detected using a biochemical analyzer to determine the value of serum PA in the diagnosis and therapeutic response of tuberculosis. Results Compared to lung cancer and healthy individuals, TB patients were more frequent in suffering from low serum PA (75.0% vs.30.9% vs.6.7%,P<0.01), and the serum PA levels of TB patients were significantly reduced (137.5±42.4 mg/L vs. 183.5±49.1 mg/L vs. 240.0±43.9 mg/L, P<0.01). Among various clinical characteristics, type (with pleuritis), age (≥60), ESR (>20 mm/h) and smoking status (≥20 pack×years) were associated with low serum PA levels of TB patients, while ECOG performance status (≥2) was associated with low serum PA levels of lung cancer patients. The change of serum PA levels was in accordance with the therapeutic effects of anti-TB drugs, which might present a valuable and objective indicator for monitoring the therapeutic effects of TB drugs on TB patients. Conclusion Low serum prealbumin levels are very common in TB patients and can be served as a potential indicator for differential diagnosis of lung cancer and monitoring the therapeutic effects of TB drugs.
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Fisher-Hoch SP, Mathews CE, McCormick JB. Obesity, diabetes and pneumonia: the menacing interface of non-communicable and infectious diseases. Trop Med Int Health 2013; 18:1510-9. [PMID: 24237786 DOI: 10.1111/tmi.12206] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To review current knowledge on the epidemiological, clinical and biological impact of the pandemic of obesity and diabetes on pneumonias. METHODS We conducted a literature review using PubMed and EMBASE, supplemented by various sources. Given the disparate and fragmented nature of the literature, a formal systematic review was not possible. RESULTS In 2008, globally 10% of men and 14% of women were obese and an estimated 371 million had diabetes; half undiagnosed and many obese. Numbers are rising rapidly in low- and middle-income countries where the majority reside, but reliable data are lacking. The most frequent pneumonias in obesity and diabetes are tuberculosis, influenza and pneumococcal, staphylococcal and opportunistic pathogens. Diabetes impacts tuberculosis control and increases drug resistance and mortality. Mortality and morbidity from pneumococcal pneumonia and influenza are increased in obesity and diabetes. In addition to mechanical and physiological effects, there are considerable immunological abnormalities characterised by chronic, low-grade inflammation. Simultaneous up-regulation and dysregulation of both innate and adaptive immune responses impair control and killing of invading organisms. Prevention in those at risk is poorly practised, although screening for tuberculosis in diabetes is beginning in high-burden settings. CONCLUSIONS Pneumonia is a threat globally in obesity and diabetes with increased incidence and severity of disease. There is uncertainty about whether vaccines are equally effective in those with obesity and diabetes. Increased epidemiological, clinical and biological knowledge will be crucial to face this 21st century challenge.
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Affiliation(s)
- Susan P Fisher-Hoch
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Brownsville, TX, USA
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KV N, Duraisamy K, Balakrishnan S, M S, S JS, Sagili KD, Satyanarayana S, MV AK, Enarson DA. Outcome of tuberculosis treatment in patients with diabetes mellitus treated in the revised national tuberculosis control programme in Malappuram District, Kerala, India. PLoS One 2013; 8:e76275. [PMID: 24155897 PMCID: PMC3796581 DOI: 10.1371/journal.pone.0076275] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/26/2013] [Indexed: 11/18/2022] Open
Abstract
SETTINGS Kerala State, India has reported the greatest dual burden of Tuberculosis (TB) and Diabetes Mellitus (DM). Malappuram district in Kerala has monitored and recorded DM status and its control from 2010 under Revised National Tuberculosis Control Program (RNTCP). OBJECTIVES To assess, under programme conditions, comprehensiveness of recording DM status among TB cases and the TB treatment outcomes among DM patients (disaggregated by glycemic control) and compare with-non DM patients. DESIGN This retrospective record review included 3,116TB patients from April 2010 to September 2011.DM was defined as per international guidelines and TB treatment outcomes were categorized as favourable(cured and treatment completed) and unfavourable(death, default, failure and transfer out). Relative Risk (RR) and 95% confidence intervals(CI) were calculated to assess the risk of unfavourable outcomes. RESULTS DM status was recorded in 90% of TB cases and 667 (24%) had DM. 17% of DM patients and 23% of patients with unknown DM status had unfavourable outcomes but this difference was not statistically significant. Unadjusted RR for poor glycemic control or unknown control status for unfavourable outcome were (2.00; 95% CI 0.97-4.13) and (2.14; 95% CI 1.11-4.13). CONCLUSION This study could not confirm an adverse association between DM or its control during treatment and the course of response to TB treatment.DM screening in TB cases and recording of DM care needs to be improved to enable more conclusive evidence.
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Affiliation(s)
- Nandakumar KV
- District Tuberculosis Centre, Manjeri, Malappuram District, Kerala, India
| | | | - Shibu Balakrishnan
- Department of Tuberculosis, WHO Country Office for India, New Delhi, India
| | - Sunilkumar M
- State TB Training and Demonstration Centre, Trivandrum, Kerala, India
| | | | - Karuna D. Sagili
- International Union Against Tuberculosis and Lung Disease, South East Asia Regional Office, New Delhi, India
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, South East Asia Regional Office, New Delhi, India
| | - Ajay Kumar MV
- International Union Against Tuberculosis and Lung Disease, South East Asia Regional Office, New Delhi, India
| | - Donald A. Enarson
- International Union Against Tuberculosis and Lung Disease, Montreal, Quebec, Canada
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Determinants of Tuberculosis Infection among Adult HIV Positives Attending Clinical Care in Western Ethiopia: A Case-Control Study. AIDS Res Treat 2013; 2013:279876. [PMID: 24222846 PMCID: PMC3816017 DOI: 10.1155/2013/279876] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/06/2013] [Accepted: 09/02/2013] [Indexed: 11/17/2022] Open
Abstract
There has been a drastic rise of tuberculosis (TB) infection across the world associated with the pandemic occurrence of HIV/AIDS. There are various determinants factors that increase the chance of TB infection among HIV positives (TB/HIV confection) that varies contextually. This study aimed to assess the determinants of TB/HIV coinfection among adult HIV positives attending clinical care at two public health facilities in Nekemte, western Ethiopia. Unmatched case-control study was conducted from December 26, 2011, to February 29, 2012. Cases were 123 TB infected HIV positives, and controls were 246 non-TB infected HIV positives. Being divorced/widowed AOR = 3.02, 95% CI (1.70, 7.88), not attending formal education AOR = 4.32, 95% CI (2.20, 14.15), being underweight (BMI < 18.5 kg/m2) AOR = 3.87, 95% CI (2.18, 6.87), having history of diabetic mellitus AOR = 3.63, 95% CI (1.33, 9.94), and being in advanced WHO HIV/AIDS clinical staging AOR = 2.29, 95% CI (1.32, 3.98), were determinant factors associated with TB/HIV co-infection. Having a separate kitchen AOR = 0.48, 95% CI (0.28, 0.81) showed protective role. For most of these determinants interventions can be made at individual and institutional levels, whereas, factors like education and nutrition need societal level integrations.
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Joosten SA, Fletcher HA, Ottenhoff THM. A helicopter perspective on TB biomarkers: pathway and process based analysis of gene expression data provides new insight into TB pathogenesis. PLoS One 2013; 8:e73230. [PMID: 24066041 PMCID: PMC3774688 DOI: 10.1371/journal.pone.0073230] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/18/2013] [Indexed: 12/25/2022] Open
Abstract
Biomarker host genetic signatures are considered key tools for improved early diagnosis of tuberculosis (TB) disease (development). The analysis of gene expression changes based on a limited number of genes or single study designs, however, may not be sufficient for the identification of universal diagnostic biomarker profiles. Here we propose that biological pathway and process based analyses from multiple data sets may be more relevant for identification of key pathways in TB pathogenesis, and may reveal novel candidate diagnostic TB biomarkers. A number of independent genome-wide gene expression studies have recently been performed to study expression of biomarkers for TB disease. We have integrated the results from these independent studies and performed pathway- as well as biological process-based analysis on the total data set. Interestingly, IFNα/β signalling is not the single dominant pathway in the analysis of the total dataset, but combined, functional, analysis of biomarkers suggests a strong dominant role for myeloid cell involvement in inflammation.
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Affiliation(s)
- Simone A. Joosten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
| | | | - Tom H. M. Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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The prevalence of latent Mycobacterium tuberculosis infection based on an interferon-γ release assay: a cross-sectional survey among urban adults in Mwanza, Tanzania. PLoS One 2013; 8:e64008. [PMID: 23700446 PMCID: PMC3660306 DOI: 10.1371/journal.pone.0064008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/08/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION One third of the world's population is estimated to be latently infected with Mycobacterium tuberculosis (LTBI). Surveys of LTBI are rarely performed in resource poor TB high endemic countries like Tanzania although low-income countries harbor the largest burden of the worlds LTBI. The primary objective was to estimate the prevalence of LTBI in household contacts of pulmonary TB cases and a group of apparently healthy neighborhood controls in an urban setting of such a country. Secondly we assessed potential impact of LTBI on inflammation by quantitating circulating levels of an acute phase reactant: alpha-1-acid glycoprotein (AGP) in neighborhood controls. METHODS The study was nested within the framework of two nutrition studies among TB patients in Mwanza, Tanzania. Household contacts- and neighborhood controls were invited to participate. The study involved a questionnaire, BMI determination and blood samples to measure AGP, HIV testing and a Quantiferon Gold In tube (QFN-IT) test to detect signs of LTBI. RESULTS 245 household contacts and 192 neighborhood controls had available QFN-IT data. Among household contacts, the proportion of QFT-IT positive was 59% compared to 41% in the neighborhood controls (p = 0.001). In a linear regression model adjusted for sex, age, CD4 and HIV, a QFT-IT positive test was associated with a 10% higher level of alpha-1-acid glycoprotein(AGP) (10(B) 1.10, 95% CI 1.01; 1.20, p = 0.03), compared to individuals with a QFT-IT negative test. CONCLUSION LTBI is highly prevalent among apparently healthy urban Tanzanians even without known exposure to TB in the household. LTBI was found to be associated with elevated levels of AGP. The implications of this observation merit further studies.
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Reis-Santos B, Locatelli R, Horta BL, Faerstein E, Sanchez MN, Riley LW, Maciel EL. Socio-demographic and clinical differences in subjects with tuberculosis with and without diabetes mellitus in Brazil--a multivariate analysis. PLoS One 2013; 8:e62604. [PMID: 23638123 PMCID: PMC3634755 DOI: 10.1371/journal.pone.0062604] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/23/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Several studies have evaluated the relationship between diabetes mellitus (DM) and tuberculosis (TB), but the nature of this relationship is not fully understood. TB incidence may be influenced by immunosuppression from DM, but this association may be confounded by other clinical and socioeconomic factors. We aimed to assess socio-demographic and clinical differences in TB patients with and without DM. METHODS Using the Brazilian national surveillance system (SINAN), we compared 1,797 subjects with TB and DM with 29,275 subjects diagnosed with TB only in 2009. We performed multivariate analysis to identify factors associated with the presence of DM among TB patients. RESULTS Subjects with TB - DM were older; have initial positive sputum smear test (OR = 1.42, 95% CI 1.26-1.60), and were more likely to die from TB (OR = 1.44, 95% CI 1.03-2.01). They were less likely to have been institutionalized [in prison, shelter, orphanage, psychiatric hospital (OR = 0.74, 95% CI 0.60-0.93)]; developed extra pulmonary TB (OR = 0.62, 95% CI 0.51-0.75) and to return to TB treatment after abandonment (OR = 0.66, 95% CI 0.51-0.86). CONCLUSIONS Prevalence of NCD continues to rise in developing countries, especially with the rise of elderly population, the prevention and treatment of infectious diseases will be urgent. DM and TB represent a critical intersection between communicable and non-communicable diseases in these countries and the effect of DM on TB incidence and outcomes provide numerous opportunities for collaboration and management of these complex diseases in the national public health programs.
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Affiliation(s)
- Barbara Reis-Santos
- Lab-Epi UFES – Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Rodrigo Locatelli
- Lab-Epi UFES – Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Bernardo L. Horta
- Post-Graduate Programme in Epidemiology, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
| | - Eduardo Faerstein
- Post-Graduate Programme in Saúde Coletiva, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro N. Sanchez
- Departamento de Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brazil
| | - Lee W. Riley
- Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Ethel Leonor Maciel
- Lab-Epi UFES – Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
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Marais BJ, Lönnroth K, Lawn SD, Migliori GB, Mwaba P, Glaziou P, Bates M, Colagiuri R, Zijenah L, Swaminathan S, Memish ZA, Pletschette M, Hoelscher M, Abubakar I, Hasan R, Zafar A, Pantaleo G, Craig G, Kim P, Maeurer M, Schito M, Zumla A. Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts. THE LANCET. INFECTIOUS DISEASES 2013; 13:436-48. [PMID: 23531392 DOI: 10.1016/s1473-3099(13)70015-x] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recent data for the global burden of disease reflect major demographic and lifestyle changes, leading to a rise in non-communicable diseases. Most countries with high levels of tuberculosis face a large comorbidity burden from both non-communicable and communicable diseases. Traditional disease-specific approaches typically fail to recognise common features and potential synergies in integration of care, management, and control of non-communicable and communicable diseases. In resource-limited countries, the need to tackle a broader range of overlapping comorbid diseases is growing. Tuberculosis and HIV/AIDS persist as global emergencies. The lethal interaction between tuberculosis and HIV coinfection in adults, children, and pregnant women in sub-Saharan Africa exemplifies the need for well integrated approaches to disease management and control. Furthermore, links between diabetes mellitus, smoking, alcoholism, chronic lung diseases, cancer, immunosuppressive treatment, malnutrition, and tuberculosis are well recognised. Here, we focus on interactions, synergies, and challenges of integration of tuberculosis care with management strategies for non-communicable and communicable diseases without eroding the functionality of existing national programmes for tuberculosis. The need for sustained and increased funding for these initiatives is greater than ever and requires increased political and funder commitment.
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Affiliation(s)
- Ben J Marais
- Sydney Emerging Infections and Biosecurity Institute, and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Okamura K, Nagata N, Wakamatsu K, Yonemoto K, Ikegame S, Kajiki A, Takayama K, Nakanishi Y. Hypoalbuminemia and lymphocytopenia are predictive risk factors for in-hospital mortality in patients with tuberculosis. Intern Med 2013; 52:439-44. [PMID: 23411698 DOI: 10.2169/internalmedicine.52.8158] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to clarify the association between nutritional state on admission and in-hospital death in tuberculosis (TB) patients, including a high proportion of elderly patients. METHODS A retrospective cohort study of 246 TB patients was conducted. The serum albumin concentrations and peripheral blood lymphocyte counts were measured on admission, and the primary outcome of interest was in-hospital death. Patient mortality was categorized into two groups: TB death and non-TB death. A multivariate analysis was performed to evaluate the relationship between nutritional state on admission and in-hospital mortality in TB patients. RESULTS The median [interquartile range] patient age was 79 [69-83] years, and the in-hospital death rate was 20.73% (TB death: 26 patients; non-TB death: 25 patients). The multivariate analysis revealed that the serum albumin concentrations (OR: 0.21, 95% CI: 0.10-0.41; p<0.0001) and peripheral blood total lymphocyte counts (Category 2 [627.2-1,106.7/mm(3)] vs. 1 [<627.2/mm(3)]. OR: 0.28, 95% CI: 0.11-0.73; p=0.009, Category 3 [>1,106.7/mm(3)] vs. 1. OR: 0.24, 95% CI: 0.08-0.76, p=0.015) on admission were significantly associated with all in-hospital deaths in the TB patients. The serum albumin concentrations and peripheral blood total lymphocyte counts were also found to be associated with in-hospital deaths directly caused by TB. CONCLUSION Hypoalbuminemia and lymphocytopenia on admission are predictive risk factors for in-hospital mortality in TB patients. Nutritional defects should thus receive special attention in order to reduce TB patient mortality, particularly among elderly patients.
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Affiliation(s)
- Kyoko Okamura
- Department of Respiratory Medicine, National Hospital Organization Omuta National Hospital, Japan.
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High diabetes prevalence among tuberculosis cases in Kerala, India. PLoS One 2012; 7:e46502. [PMID: 23077512 PMCID: PMC3471898 DOI: 10.1371/journal.pone.0046502] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While diabetes mellitus (DM) is a known risk factor for tuberculosis, the prevalence among TB patients in India is unknown. Routine screening of TB patients for DM may be an opportunity for its early diagnosis and improved management and might improve TB treatment outcomes. We conducted a cross-sectional survey of TB patients registered from June-July 2011 in the state of Kerala, India, to determine the prevalence of DM. METHODOLOGY/PRINCIPAL FINDINGS A state-wide representative sample of TB patients in Kerala was interviewed and screened for DM using glycosylated hemoglobin (HbA1c); patients self-reporting a history of DM or those with HbA1c ≥6.5% were defined as diabetic. Among 552 TB patients screened, 243(44%) had DM - 128(23%) had previously known DM and 115(21%) were newly diagnosed - with higher prevalence among males and those aged >50 years. The number needed to screen(NNS) to find one newly diagnosed case of DM was just four. Of 128 TB patients with previously known DM, 107(84%) had HbA1c ≥7% indicating poor glycemic control. CONCLUSIONS/SIGNIFICANCE Nearly half of TB patients in Kerala have DM, and approximately half of these patients were newly-diagnosed during this survey. Routine screening of TB patients for DM using HbA1c yielded a large number of DM cases and offered earlier management opportunities which may improve TB and DM outcomes. However, the most cost-effective ways of DM screening need to be established by futher operational research.
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Bygbjerg IC. Double burden of noncommunicable and infectious diseases in developing countries. Science 2012; 337:1499-501. [PMID: 22997329 DOI: 10.1126/science.1223466] [Citation(s) in RCA: 188] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
On top of the unfinished agenda of infectious diseases in low- and middle-income countries, development, industrialization, urbanization, investment, and aging are drivers of an epidemic of noncommunicable diseases (NCDs). Malnutrition and infection in early life increase the risk of chronic NCDs in later life, and in adult life, combinations of major NCDs and infections, such as diabetes and tuberculosis, can interact adversely. Because intervention against either health problem will affect the other, intervening jointly against noncommunicable and infectious diseases, rather than competing for limited funds, is an important policy consideration requiring new thinking and approaches.
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Affiliation(s)
- I C Bygbjerg
- Copenhagen School of Global Health, Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, 5 Øster Farimagsgade, DK-1014, Copenhagen K, Denmark.
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Drug-resistant tuberculosis in Mumbai, India: An agenda for operations research. ACTA ACUST UNITED AC 2012; 1:45-53. [PMID: 24501697 PMCID: PMC3836418 DOI: 10.1016/j.orhc.2012.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 06/15/2012] [Indexed: 11/21/2022]
Abstract
Operations research (OR) is well established in India and is also a prominent feature of the global and local agendas for tuberculosis (TB) control. India accounts for a quarter of the global burden of TB and of new cases. Multidrug-resistant TB is a significant problem in Mumbai, India's most populous city, and there have been recent reports of totally resistant TB. Much thought has been given to the role of OR in addressing programmatic challenges, by both international partnerships and India's Revised National TB Control Programme. We attempt to summarize the major challenges to TB control in Mumbai, with an emphasis on drug resistance. Specific challenges include diagnosis of TB and defining cure, detecting drug resistant TB, multiple sources of health care in the private, public and informal sectors, co-infection with human immunodeficiency virus (HIV) and a concurrent epidemic of non-communicable diseases, suboptimal prescribing practices, and infection control. We propose a local agenda for OR: modeling the effects of newer technologies, active case detection, and changes in timing of activities, and mapping hotspots and contact networks; modeling the effects of drug control, changing the balance of ambulatory and inpatient care, and adverse drug reactions; modeling the effects of integration of TB and HIV diagnosis and management, and preventive drug therapy; and modeling the effects of initiatives to improve infection control.
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Chung-Delgado K, Revilla-Montag A, Guillen-Bravo S, Velez-Segovia E, Soria-Montoya A, Nuñez-Garbin A, Silva-Caso W, Bernabe-Ortiz A. Factors associated with anti-tuberculosis medication adverse effects: a case-control study in Lima, Peru. PLoS One 2011; 6:e27610. [PMID: 22110689 PMCID: PMC3217998 DOI: 10.1371/journal.pone.0027610] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 10/20/2011] [Indexed: 11/19/2022] Open
Abstract
Background Long-term exposure to anti-tuberculosis medication increases risk of adverse drug reactions and toxicity. The objective of this investigation was to determine factors associated with anti-tuberculosis adverse drug reactions in Lima, Peru, with special emphasis on MDR-TB medication, HIV infection, diabetes, age and tobacco use. Methodology and Results A case-control study was performed using information from Peruvian TB Programme. A case was defined as having reported an anti-TB adverse drug reaction during 2005–2010 with appropriate notification on clinical records. Controls were defined as not having reported a side effect, receiving anti-TB therapy during the same time that the case had appeared. Crude, and age- and sex-adjusted models were calculated using odds ratios (OR) and 95% confidence intervals (95%CI). A multivariable model was created to look for independent factors associated with side effect from anti-TB therapy. A total of 720 patients (144 cases and 576 controls) were analyzed. In our multivariable model, age, especially those over 40 years (OR = 3.93; 95%CI: 1.65–9.35), overweight/obesity (OR = 2.13; 95%CI: 1.17–3.89), anemia (OR = 2.10; IC95%: 1.13–3.92), MDR-TB medication (OR = 11.1; 95%CI: 6.29–19.6), and smoking (OR = 2.00; 95%CI: 1.03–3.87) were independently associated with adverse drug reactions. Conclusions Old age, anemia, MDR-TB medication, overweight/obesity status, and smoking history are independent risk factors associated with anti-tuberculosis adverse drug reactions. Patients with these risk factors should be monitored during the anti-TB therapy. A comprehensive clinical history and additional medical exams, including hematocrit and HIV-ELISA, might be useful to identify these patients.
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Affiliation(s)
- Kocfa Chung-Delgado
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
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