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Arora A, Harna B, Asnake G, Sonkawade V. Total hip arthroplasty in different types of advanced tubercular hip arthritis: is it justified. INTERNATIONAL ORTHOPAEDICS 2023; 47:2669-2681. [PMID: 37453982 DOI: 10.1007/s00264-023-05885-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) provides a good treatment option for the patients in late arthritis stage. We present our experience of THA in various spectrums of disease. METHODS Retrospective study including 23 advanced tubercular hip arthritis patients over a period of 13 years. The patients with active discharging sinus were excluded from the study. The patients were divided into three groups: group 1 (healed TB), group 2 (active TB), and group 3 (intraoperative surprise). The preoperative and postoperative antitubercular treatment (ATT) was administered to all the patients as per the protocol for various duration. All patients underwent THA (cementless or hybrid) after investigations including MRI. The patients were followed up with clinic-radiological and laboratory investigations. RESULTS The mean age of the patients was 58.2 years with 16 males and seven females. There were 14 healed TB hips, eight active TB hips, and one intraoperative TB hip patient. Preoperative ATT duration in group 1 varied from one to two weeks and in group 2 patient's average was 9.6 weeks (range: 6-12weeks). Postoperatively, ATT was given for a minimum of ten months extending to 16 months. Cementless THA was performed in 17 patients and hybrid THA (cemented stem) in six patients. Only one patient had aseptic loosening of the stem and revision arthroplasty was done. CONCLUSION THA is a viable option and provides mobile, stable hip in tubercular hip arthritis even in active TB hip patients. ATT is important in the management and prevent the reactivation of the disease.
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Affiliation(s)
- Anil Arora
- Department of Orthopedics and Joint Replacement, Max Superspeciality Hospital, Patparganj, Delhi, 110092, India
| | - Bushu Harna
- Department of Orthopedics, Indus Hospital, Mohali, India.
| | - Getnet Asnake
- Department of Orthopedics and Joint Replacement, Max Superspeciality Hospital, Patparganj, Delhi, 110092, India
| | - Venktesh Sonkawade
- Department of Orthopedics and Joint Replacement, Max Superspeciality Hospital, Patparganj, Delhi, 110092, India
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Siddiqi OK, Ghebremichael M, Musukuma K, Dang X, Mubanga E, Birbeck GL, Love S, Buback C, Kosloff B, Ayles H, Atadzhanov M, Koralnik IJ. LTA4H Prevalence and Mortality in Adult Zambians with Tuberculous Meningitis. Ann Neurol 2021; 90:994-998. [PMID: 34595756 DOI: 10.1002/ana.26240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/09/2021] [Accepted: 10/01/2021] [Indexed: 11/08/2022]
Abstract
We conducted a prospective cohort study to determine the prevalence of leukotriene A4 hydrolase (LTA4H) polymorphisms in Zambian adults with tuberculous meningitis (TBM) and its association with mortality. We completed genotype testing on 101 definite cases of TBM and 119 consecutive non-TBM controls. The distribution of genotypes among TBM patients was as follows: C/C (0.83), C/T (0.14), T/T (0.03). There was no significant difference in genotype distribution between TBM and non-TBM patients. We found no relationship between LTA4H polymorphism and survival. Prospective studies are needed to determine the benefit of adjuvant steroids in TBM based upon population LTA4H genotype. ANN NEUROL 2021.
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Affiliation(s)
- Omar K Siddiqi
- Global Neurology Program, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA.,Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston, MA.,Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Musie Ghebremichael
- Harvard Medical School and Ragon Institute of MGH, MIT, and Harvard, Boston, MA
| | - Kalo Musukuma
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Xin Dang
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eugene Mubanga
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Gretchen L Birbeck
- Department of Neurology, University of Rochester, Rochester, NY.,University Teaching Hospital, Neurology Research Office, Lusaka, Zambia
| | - Shawn Love
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA
| | - Clayton Buback
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Barry Kosloff
- Zambart, Lusaka, Zambia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Ayles
- Zambart, Lusaka, Zambia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Masharip Atadzhanov
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Igor J Koralnik
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
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3
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The Profile of the Patients with Double Infection HIV and TB in South West of Romania. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:107-113. [PMID: 34211756 PMCID: PMC8200610 DOI: 10.12865/chsj.47.01.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/14/2021] [Indexed: 11/18/2022]
Abstract
Background: Co-infection with human immunodeficiency virus (HIV) / tuberculosis (TB) raises important diagnostic and treatment problems as the lung is one of the target organs for HIV. Studies have shown that an HIV patient is 5-15 times more likely to switch from Koch's bacillus-infected status to active tuberculosis. Material and method: Retrospective study on 207 patients with HIV/TB coinfection in the Oltenia area registered in the Regional Center for Monitoring and Evaluation of HIV/AIDS infection in Craiova to define the profile of patients with double TB-HIV infection in southern Romania for cases registered between 2005-2015. Results: 53.14% of patients were females. Most cases were from rural areas (56.10%) Half of them are born between 1988 and 1990 but only 5% graduated university. 66.18% don’t have a job and are supported by state with a monthly minimum income. 29.4% are smokers. More than 60% of cases had pulmonary TB and other 25% had concomitant pulmonary and extrapulmonary TB. TB and HIV have been diagnosed almost at the same time in 25% of cases. At the time of TB diagnosis 75% of patients had CD4+lymphocytes count <200cel/ml. We also noticed the absence of prophylaxis for TB in patients infected with HIV (PIH) and high incidence of hepatitis B (30.43%). Conclusions: Clinical expression, radiological and bacteriological aspects are often atypical in HIV/TB coinfected patients. The lack of TB prophylaxis and TB endemicity in the studied area may justify the large number of TB cases in HIV-infected patients.
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Total Hip Arthroplasty in 52 Active Advanced Tubercular Arthritic Hips. J Arthroplasty 2021; 36:1035-1042. [PMID: 33097338 DOI: 10.1016/j.arth.2020.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The role of total hip arthroplasty (THA) in healed tuberculosis (TB) of the hip has been reported with success in the past. However, the role and success of THA in active TB of the hip has remained controversial. METHODS We retrospectively evaluated a prospective study of 52 THAs done for active TB of the hip in 51 patients. The protocol includes 3-6 months of effective preoperative and 9-18 months postoperative anti-TB therapy. All THAs were performed by the same surgeon (author 1). The selection criteria excluded patients with poor immunity, HIV +ve patient, and presence of discharging sinus. The type of THA implant includes 12 cemented, 38 uncemented, and 2 hybrid fixations. RESULTS The mean follow-up was 10.5 years (2-29). Six patients were (6 THAs) lost to follow up after 4 years, including 2 deaths unrelated to TB or THA. There was no reactivation of TB. Mean Harris Hip Score improved from preop 31.77 (20-51) to postop 88 (72-100) in the last follow-up. Two patients had delayed wound healing up to 21 days postop with no evidence of subsequent episode till last follow-up. There was no case of dislocation, neurological complication in any patient. Seven THAs underwent revision for aseptic loosening unrelated to TB. CONCLUSION Single-stage THA is safe in active advanced tubercular arthritic hips with good immunity status under cover of effective anti-TB therapy using strict preop selection protocol.
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Baluku JB, Musaazi J, Mulwana R, Mugabo AR, Bongomin F, Katagira W. Prevalence and Predictors of CD4+ T-Lymphocytopenia Among HIV-Negative Tuberculosis Patients in Uganda. Res Rep Trop Med 2020; 11:45-51. [PMID: 32612406 PMCID: PMC7323690 DOI: 10.2147/rrtm.s252550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose CD4+ T-lymphocytopenia is a risk for tuberculosis (TB) infection, reactivation and severe disease. We sought to determine the prevalence and predictors of CD4 T-lymphocytopenia among HIV-negative patients with bacteriologically confirmed TB in Uganda. Patients and Methods Eligible participants were adult HIV-negative patients with bacteriologically confirmed TB at the National TB Treatment Centre in Uganda. CD4+ and CD8+ T-lymphocyte counts were determined by flow cytometry. We defined CD4+ T-lymphocytopenia as a CD4+ T-lymphocyte count of <418 cells/mm3 as per the population estimate for Ugandans. We performed logistic regression analysis to determine predictors of CD4+ T-lymphocytopenia. Results We enrolled 216 participants whose mean age (standard deviation (±SD)) was 32.5 (±12.1) years, of whom 146 (67.6%) were males. The prevalence of CD4+ T-lymphocytopenia was 25% (54/216) (95% confidence interval (CI): 19.6-31.2%). Patients with anaemia (adjusted odds ratio (aOR): 3.83, 95% CI: 1.59-9.23, p = 0.003), weight loss (aOR: 3.61, 95% CI: 1.07-12.23, p = 0.039) and a low CD8+ T-cell count (aOR: 6.10, 95% CI: 2.68-13.89, p < 0.001) were more likely to have CD4+ T-lymphocytopenia while those with monocytosis (aOR: 0.35, 95% CI: 0.14-0.89, p = 0.028) were less likely to have CD4+ T-lymphocytopenia. Conclusion There was a high prevalence of CD4+ T-lymphocytopenia among HIV-negative TB patients. Patients with weight loss, anaemia and a low CD8+ count were more likely to have CD4+ T-lymphocytopenia while those with monocytosis were less likely to have CD4+ lymphocytopenia. The findings suggest that CD4+ lymphocytopenia is indicative of severe disease and globally impaired cell-mediated immune responses against TB.
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Affiliation(s)
- Joseph Baruch Baluku
- Mulago National Referral Hospital, Pulmonology Division, Kampala, Uganda.,Mildmay Uganda, Kampala, Uganda.,Makerere University Lung Institute, Kampala, Uganda
| | - Joseph Musaazi
- Makerere University Infectious Disease Institute, Kampala, Uganda
| | - Rose Mulwana
- Mulago National Referral Hospital, Pulmonology Division, Kampala, Uganda
| | | | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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6
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Dessie ZG, Zewotir T, Mwambi H, North D. Modelling immune deterioration, immune recovery and state-specific duration of HIV-infected women with viral load adjustment: using parametric multistate model. BMC Public Health 2020; 20:416. [PMID: 32228523 PMCID: PMC7106875 DOI: 10.1186/s12889-020-08530-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND CD4 cell and viral load count are highly correlated surrogate markers of human immunodeficiency virus (HIV) disease progression. In modelling the progression of HIV, previous studies mostly dealt with either CD4 cell counts or viral load alone. In this work, both biomarkers are in included one model, in order to study possible factors that affect the intensities of immune deterioration, immune recovery and state-specific duration of HIV-infected women. METHODS The data is from an ongoing prospective cohort study conducted among antiretroviral treatment (ART) naïve HIV-infected women in the province of KwaZulu-Natal, South Africa. Participants were enrolled in the acute HIV infection phase, then followed-up during chronic infection up to ART initiation. Full-parametric and semi-parametric Markov models were applied. Furthermore, the effect of the inclusion and exclusion viral load in the model was assessed. RESULTS Inclusion of a viral load component improves the efficiency of the model. The analysis results showed that patients who reported a stable sexual partner, having a higher educational level, higher physical health score and having a high mononuclear component score are more likely to spend more time in a good HIV state (particularly normal disease state). Patients with TB co-infection, with anemia, having a high liver abnormality score and patients who reported many sexual partners, had a significant increase in the intensities of immunological deterioration transitions. On the other hand, having high weight, higher education level, higher quality of life score, having high RBC parameters, high granulocyte component scores and high mononuclear component scores, significantly increased the intensities of immunological recovery transitions. CONCLUSION Inclusion of both CD4 cell count based disease progression states and viral load, in the time-homogeneous Markov model, assisted in modeling the complete disease progression of HIV/AIDS. Higher quality of life (QoL) domain scores, good clinical characteristics, stable sexual partner and higher educational level were found to be predictive factors for transition and length of stay in sequential adversity of HIV/AIDS.
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Affiliation(s)
- Zelalem G. Dessie
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
- College of Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Henry Mwambi
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
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7
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RNA Sensing of Mycobacterium tuberculosis and Its Impact on TB Vaccination Strategies. Vaccines (Basel) 2020; 8:vaccines8010067. [PMID: 32033104 PMCID: PMC7158685 DOI: 10.3390/vaccines8010067] [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] [Received: 12/11/2019] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis (TB) is still an important global threat and although the causing organism has been discovered long ago, effective prevention strategies are lacking. Mycobacterium tuberculosis (MTB) is a unique pathogen with a complex host interaction. Understanding the immune responses upon infection with MTB is crucial for the development of new vaccination strategies and therapeutic targets for TB. Recently, it has been proposed that sensing bacterial nucleic acid in antigen-presenting cells via intracellular pattern recognition receptors (PRRs) is a central mechanism for initiating an effective host immune response. Here, we summarize key findings of the impact of mycobacterial RNA sensing for innate and adaptive host immunity after MTB infection, with emphasis on endosomal toll-like receptors (TLRs) and cytosolic sensors such as NLRP3 and RLRs, modulating T-cell differentiation through IL-12, IL-21, and type I interferons. Ultimately, these immunological pathways may impact immune memory and TB vaccine efficacy. The novel findings described here may change our current understanding of the host response to MTB and potentially impact clinical research, as well as future vaccination design. In this review, the current state of the art is summarized, and an outlook is given on how progress can be made.
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8
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Li G, Yang F, He X, Liu Z, Pi J, Zhu Y, Ke X, Liu S, Ou M, Guo H, Zhang Z, Zeng G, Zhang G. Anti-tuberculosis (TB) chemotherapy dynamically rescues Th1 and CD8+ T effector levels in Han Chinese pulmonary TB patients. Microbes Infect 2019; 22:119-126. [PMID: 31678658 DOI: 10.1016/j.micinf.2019.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/30/2019] [Accepted: 10/23/2019] [Indexed: 12/16/2022]
Abstract
CD4+/CD8+ T cells play a major role in conferring immune protection against tuberculosis (TB), but it remains unknown how the immune responses of CD4+/CD8+ T cells exactly correlate with the clinical variables and disease statuses during anti-TB chemotherapy. To address this, several major immune parameters of CD4+/CD8+ T cells in peripheral blood derived from pulmonary TB patients and healthy volunteers were evaluated. We observed that active TB infection induced lower CD3+ T cell and CD4+ T cell levels but higher CD8+T cell levels, while anti-TB chemotherapy reversed these effects. Also, anti-TB treatment induced enhanced production of IL-2 and IFN-γ but reduced expression of IL-10 and IL-6. Moreover, the dynamic changes of CD3, CD4, and CD8 levels did not show a significant association with sputum smear positivity. However, the frequencies of IL-2+CD4+ or IL-10 + CD4+ T effector subpopulation or IL-1β production in peripheral blood showed significant difference between patients positive for sputum smear and patients negative for sputum smear after anti-TB treatment. These findings implicated that recovery of Th1/CD8+T cell effector levels might be critical immunological events in pulmonary TB patients after treatment and further suggested the importance of these immunological parameters as potential biomarkers for prediction of TB progress and prognosis.
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Affiliation(s)
- Guobao Li
- Department of Tuberculosis, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen 518112, China
| | - Fang Yang
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xing He
- National Clinical Research Center for Tuberculosis, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Zhi Liu
- Department of Tuberculosis, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen 518112, China
| | - Jiang Pi
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Sun Yat-sen University, Guangzhou, 510080, China; Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Yuzhen Zhu
- Guangdong Key Laboratory for Research and Development of Natural Drugs, Guangdong Medical University, Zhanjiang, 524023, China
| | - Xue Ke
- Department of Tuberculosis, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen 518112, China
| | - Shuyan Liu
- Department of Tuberculosis, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen 518112, China
| | - Min Ou
- Department of Tuberculosis, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen 518112, China
| | - Huixin Guo
- National Clinical Research Center for Tuberculosis and Guangdong Center for Tuberculosis Control, Guangzhou, 510430, China
| | - Zhuoran Zhang
- Beckman Research Institute, City of Hope National Cancer Center, Duarte, CA, 92618, USA
| | - Gucheng Zeng
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Guoliang Zhang
- National Clinical Research Center for Tuberculosis, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China.
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9
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Venturini E, Lodi L, Francolino I, Ricci S, Chiappini E, de Martino M, Galli L. CD3, CD4, CD8, CD19 and CD16/CD56 positive cells in tuberculosis infection and disease: Peculiar features in children. Int J Immunopathol Pharmacol 2019; 33:2058738419840241. [PMID: 30957643 PMCID: PMC6454648 DOI: 10.1177/2058738419840241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Pathogenesis of mycobacterial infection has been extensively studied determining
the fundamental role of host immunocompetence in disease progression. Cellular
adaptive immunity, in particular CD4+ cells, has shown to be crucial in the host
defence. A role of cytotoxic lymphocytes and humoral immunity has also been
established. However, few studies have been performed in low endemic countries
on immunological correlates of tuberculosis in paediatric patients. The present
study aims to fill this gap analysing the distribution and the absolute values
of the main lymphocyte subpopulations (CD3+, CD4+, CD8+, CD19+ and CD16+/CD56+)
in the different stages of tubercular infection in human immunodeficiency
virus–negative children living in low tubercular endemic countries. Results
obtained in children with latent tuberculosis, active tuberculosis and healthy
controls were compared. Moreover, quantitative analysis of interferon-γ levels
of mitogen-induced response was carried out within the different study groups.
The aim of this analysis was to enforce the comprehension of immune
modifications subsequent to Mycobacterium tuberculosis
infection. The major finding of our study was CD3+ and CD4+ absolute and
percentage depletion in children with active tuberculosis versus healthy
controls. Moreover, severe forms of active tuberculosis showed a marked
reduction in the CD4+ percentage in the context of a systemic impairment which
affects globally the absolute count of all peripheral lymphocyte subsets tested.
A relative increase of natural killer cells was proved in infected patients,
whereas no differences in B cells among the study groups were detected.
Mitogen-induced interferon-γ levels were significantly higher in children with
latent tuberculosis when compared to active tuberculosis and healthy controls,
demonstrating effective immune activation in those patients able to control the
infection.
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Affiliation(s)
| | | | | | | | | | - Maurizio de Martino
- Maurizio de Martino, Department of Health
Sciences and Anna Meyer Children’s University Hospital, University of Florence,
viale Pieraccini 24, 50139 Florence, Italy.
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10
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Prospective Cohort Study on Performance of Cerebrospinal Fluid (CSF) Xpert MTB/RIF, CSF Lipoarabinomannan (LAM) Lateral Flow Assay (LFA), and Urine LAM LFA for Diagnosis of Tuberculous Meningitis in Zambia. J Clin Microbiol 2019; 57:JCM.00652-19. [PMID: 31189584 DOI: 10.1128/jcm.00652-19] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/05/2019] [Indexed: 12/31/2022] Open
Abstract
Tuberculous meningitis (TBM) is a devastating infection of the central nervous system lacking an adequate point-of-care diagnostic test. We conducted a prospective cohort study of 550 Zambian adults with suspected TBM to determine the diagnostic accuracy of cerebrospinal fluid (CSF) Xpert MTB/RIF, CSF lipoarabinomannan (LAM), urine LAM, CSF total protein, and CSF glucose compared with the gold standard of CSF culture. We categorized patients with a positive CSF tuberculosis (TB) culture as definite TBM. We also assessed inpatient and 1-year mortality on definite TBM patients when CSF Xpert MTB/RIF results were available in real time to treating physicians relative to a historical comparison cohort in whom Xpert results were not available in real time. Of the 550 patients, 474 (86.2%) were HIV-infected and 105/550 (19.1%) had definite TBM based on a positive CSF culture. The sensitivity/specificity of the diagnostic tests were CSF Xpert MTB/RIF, 52.9%/94.2%; CSF LAM, 21.9%/94.2%; urine LAM, 24.1%/76.1%; and CSF glucose <40 mg/dl, and total protein, >100 mg/dl, 66.3%/90%. A model including CSF Xpert MTB/RIF, CSF LAM, CSF glucose, and CSF total protein demonstrated an area under the receiver operating curve of 0.90. The inpatient and 1-year mortality for definite TBM was 43% and 57%, respectively. There was low sensitivity for the diagnosis of TBM across all diagnostics tests. CSF Xpert MTB/RIF and CSF LAM are highly specific for the diagnosis of TBM. Despite the use of Xpert MTB/RIF for diagnostic purpose in real time, TBM was still associated with a high mortality in Zambian patients.
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11
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Olsson O, Björkman P, Jansson M, Balcha TT, Mulleta D, Yeba H, Valfridsson C, Carlsson F, Skogmar S. Plasma Profiles of Inflammatory Markers Associated With Active Tuberculosis in Antiretroviral Therapy-Naive Human Immunodeficiency Virus-Positive Individuals. Open Forum Infect Dis 2019; 6:ofz015. [PMID: 30800697 PMCID: PMC6379652 DOI: 10.1093/ofid/ofz015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/21/2019] [Indexed: 01/29/2023] Open
Abstract
Background Diagnosis of tuberculosis (TB) in human immunodeficiency virus (HIV)-coinfected individuals is challenging. We hypothesized that combinations of inflammatory markers could facilitate identification of active TB in HIV-positive individuals. Methods Participants were HIV-positive, treatment-naive adults systematically investigated for TB at Ethiopian health centers. Plasma samples from 130 subjects with TB (HIV+/TB+) and 130 subjects without TB (HIV+/TB−) were tested for concentration of the following markers: CCL5, C-reactive protein (CRP), interleukin (IL)-6, IL12-p70, IL-18, IL-27, interferon-γ-induced protein-10 (IP-10), procalcitonin (PCT), and soluble urokinase-type plasminogen activator receptor (suPAR). Analyzed markers were then assessed, either individually or in combination, with regard to infection status, CD4 cell count, and HIV ribonucleic acid (RNA) levels. Results The HIV+/TB+ subjects had higher levels of all markers, except IL12p70, compared with HIV+/TB− subjects. The CRP showed the best performance for TB identification (median 27.9 vs 1.8 mg/L for HIV+/TB+ and HIV+/TB−, respectively; area under the curve [AUC]: 0.80). Performance was increased when CRP was combined with suPAR analysis (AUC, 0.83 [0.93 for subjects with CD4 cell count <200 cells/mm3]). Irrespective of TB status, IP-10 concentrations correlated with HIV RNA levels, and both IP-10 and IL-18 were inversely correlated to CD4 cell counts. Conclusions Although CRP showed the best single marker discriminatory potential, combining CRP and suPAR analyses increased performance for TB identification.
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Affiliation(s)
- Oskar Olsson
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden
| | - Per Björkman
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden
| | - Marianne Jansson
- Department of Laboratory Medicine, Division of Medical Microbiology, Lund University, Sweden
| | - Taye Tolera Balcha
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden.,Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | | | - Christine Valfridsson
- Department of Experimental Medical Science, Section for Immunology, Lund University, Sweden
| | - Fredric Carlsson
- Department of Experimental Medical Science, Section for Immunology, Lund University, Sweden.,Department of Biology, Section for Molecular Cell Biology, Lund University, Sweden
| | - Sten Skogmar
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden
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12
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Active tuberculosis in patients with systemic lupus erythematosus from Southern China: a retrospective study. Clin Rheumatol 2018; 38:535-543. [DOI: 10.1007/s10067-018-4303-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/29/2018] [Accepted: 09/16/2018] [Indexed: 11/25/2022]
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13
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Luo X, Wu F, Ma J, Xiao H, Cui H. Immunological recovery in patients with pulmonary tuberculosis after intensive phase treatment. J Int Med Res 2018; 46:3539-3551. [PMID: 29756540 PMCID: PMC6136029 DOI: 10.1177/0300060518773258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objectives This study aimed to examine the change and significance of immune parameters
in patients with sputum smear-positive pulmonary tuberculosis (TB) after 2
months of intensive phase anti-TB treatment. Methods The immune parameters of 232 cases of sputum smear-positive pulmonary TB were
detected before and after 2 months of intensive phase anti-TB treatment and
compared with 50 cases from healthy volunteers (controls). The T lymphocyte
cell population in peripheral blood was detected using flow cytometry. Serum
levels of interleukin (IL)-1β, soluble interleukin-2 receptor, IL-6, and
tumour necrosis factor-α were measured by ELISA. Results After 2 months of intensive phase anti-TB treatment, a reduction in the
percentage of CD4+ T cells showed a significant restoration similar to that
of controls. Moreover, after intensive anti-TB treatment, serum levels of
IL-1β, soluble interleukin-2 receptor, IL-6, and tumour necrosis factor-α
were significantly decreased compared with before treatment. Additionally,
serum levels of IL-1β and IL-6 showed a diminished recovery compared with
controls. Conclusions Our findings suggest immunological recovery in patients with pulmonary TB
after intensive phase treatment. Therefore, serum cytokine levels are
considered potential host biomarkers for monitoring the response of
treatment for pulmonary TB.
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Affiliation(s)
- Xuejiao Luo
- *These authors contributed equally to this work
| | - Furong Wu
- *These authors contributed equally to this work
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Gupta RK, Majumdar K, Srivastava S, Varakanahalli S, Saran RK. Endoscopic Ultrasound-guided Cytodiagnosis of Adrenal Histoplasmosis with Reversible CD4 T-Lymphocytopenia and Jejunal Lymphangiectasia. J Cytol 2018; 35:110-113. [PMID: 29643659 PMCID: PMC5885598 DOI: 10.4103/joc.joc_234_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rakesh K Gupta
- Department of Pathology, G B Pant Institute of Postgraduate Medical Education and Research, Jawaharlal Nehru Marg, New Delhi, India
| | - Kaushik Majumdar
- Department of Pathology, G B Pant Institute of Postgraduate Medical Education and Research, Jawaharlal Nehru Marg, New Delhi, India
| | - Siddharth Srivastava
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Jawaharlal Nehru Marg, New Delhi, India
| | - Shivakumar Varakanahalli
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Jawaharlal Nehru Marg, New Delhi, India
| | - Ravindra K Saran
- Department of Pathology, G B Pant Institute of Postgraduate Medical Education and Research, Jawaharlal Nehru Marg, New Delhi, India
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Reepalu A, Balcha TT, Sturegård E, Medstrand P, Björkman P. Long-term Outcome of Antiretroviral Treatment in Patients With and Without Concomitant Tuberculosis Receiving Health Center-Based Care-Results From a Prospective Cohort Study. Open Forum Infect Dis 2017; 4:ofx219. [PMID: 29226173 PMCID: PMC5714222 DOI: 10.1093/ofid/ofx219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/28/2017] [Indexed: 02/02/2023] Open
Abstract
Background In order to increase treatment coverage, antiretroviral treatment (ART) is provided through primary health care in low-income high-burden countries, where tuberculosis (TB) co-infection is common. We investigated the long-term outcome of health center-based ART, with regard to concomitant TB. Methods ART-naïve adults were included in a prospective cohort at Ethiopian health centers and followed for up to 4 years after starting ART. All participants were investigated for active TB at inclusion. The primary study outcomes were the impact of concomitant TB on all-cause mortality, loss to follow-up (LTFU), and lack of virological suppression (VS). Kaplan-Meier survival estimates and Cox proportional hazards models with multivariate adjustments were used. Results In total, 141/729 (19%) subjects had concomitant TB, 85% with bacteriological confirmation (median CD4 count TB, 169 cells/mm3; IQR, 99-265; non-TB, 194 cells/mm3; IQR, 122-275). During follow-up (median, 2.5 years), 60 (8%) died and 58 (8%) were LTFU. After ≥6 months of ART, 131/630 (21%) had lack of VS. Concomitant TB did not influence the rates of death, LTFU, or VS. Male gender and malnutrition were associated with higher risk of adverse outcomes. Regardless of TB co-infection status, even after 3 years of ART, two-thirds of participants had CD4 counts below 500 cells/mm3. Conclusions Concomitant TB did not impact treatment outcomes in adults investigated for active TB before starting ART at Ethiopian health centers. However, one-third of patients had unsatisfactory long-term treatment outcomes and immunologic recovery was slow, illustrating the need for new interventions to optimize ART programs.
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Affiliation(s)
| | - Taye Tolera Balcha
- Clinical Infection Medicine.,Clinical Virology, Department of Translational Medicine, Lund University, Sweden
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Affiliation(s)
- O M P Jolobe
- From the Manchester Medical Society, Simon Building, Brunswick Street, Manchester M13 9PL, UK.
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17
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Pecego AC, Amancio RT, Ribeiro C, Mesquita EC, Medeiros DM, Cerbino J, Grinsztejn B, Bozza FA, Japiassu AM. Six-month survival of critically ill patients with HIV-related disease and tuberculosis: a retrospective study. BMC Infect Dis 2016; 16:270. [PMID: 27286652 PMCID: PMC4902956 DOI: 10.1186/s12879-016-1644-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/08/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Tuberculosis is one of the leading causes of death from infectious diseases worldwide, mainly after the human immunodeficiency virus (HIV) epidemics. Patient with HIV-related illness are more likely to present with severe TB due to immunosuppression. Very few studies have explored HIV/TB co-infection in critically ill patients. The goal of this study was to analyze factors associated with long-term mortality in critically ill patient with HIV-related disease coinfected with TB. METHODS We conducted a retrospective study in an infectious disease reference center in Brazil that included all patient with HIV-related illness admitted to the ICU with laboratory-confirmed tuberculosis from March 2007 until June 2012. Clinical and laboratory variables were analyzed based on six-month survival. RESULTS Forty-four patients with HIV-related illness with a confirmed diagnosis of tuberculosis were analyzed. The six-month mortality was 52 % (23 patients). The main causes of admission were respiratory failure (41 %), severe sepsis/septic shock (32 %) and coma/torpor (14 %). The median time between HIV diagnosis and ICU admission was 5 (1-60) months, and 41 % of patients received their HIV infection diagnosis ≤ 30 days before admission. The median CD4 count was 72 (IQR: 23-136) cells/mm(3). The clinical presentation was pulmonary tuberculosis in 22 patients (50 %) and disseminated TB in 20 patients (45.5 %). No aspect of TB diagnosis or treatment was different between survivors and nonsurvivors. Neurological dysfunction was more prevalent among nonsurvivors (43 % vs. 14 %, p = 0.04). The nadir CD4 cell count lower than 50 cells/mm(3) was independently associated with Six-month mortality (hazard ratio 4.58 [1.64-12.74], p < 0.01), while HIV diagnosis less than three months after positive serology was protective (hazard ratio 0.27, CI 95 % [0.10-0.72], p = 0.01). CONCLUSION The Six-month mortality of HIV critically ill patients with TB coinfection is high and strongly associated with the nadir CD4 cell count less than 50 cels/mm(3).
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Affiliation(s)
- Ana Carla Pecego
- Intensive Care Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Rodrigo T Amancio
- Intensive Care Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Camila Ribeiro
- Intensive Care Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Emersom C Mesquita
- Intensive Care Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Denise M Medeiros
- Intensive Care Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil
| | - José Cerbino
- Intensive Care Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Beatriz Grinsztejn
- STD/AIDS Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Fernando A Bozza
- Intensive Care Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil.,Instituto D'Or de Pesquisa e Ensino, Rua Diniz Cordeiro, n° 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Andre M Japiassu
- Intensive Care Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil.
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18
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Balkema CA, Irusen EM, Taljaard JJ, Zeier MD, Koegelenberg CF. A prospective study on the outcome of human immunodeficiency virus-infected patients requiring mechanical ventilation in a high-burden setting. QJM 2016; 109:35-40. [PMID: 25979269 DOI: 10.1093/qjmed/hcv086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a paucity of data on the mortality of patients admitted to the intensive care unit (ICU), despite the fact that human immunodeficiency virus (HIV)-related diseases represent a significant burden to health care resources particularly in sub-Saharan Africa. AIM To describe the outcome and prognostic factors of HIV-infected patients requiring mechanical ventilation in an ICU. DESIGN Prospective observational study. METHODS All 54 patients (34.8 ± 10.4 years, 38 females) admitted with confirmed HIV from October 2012 until May 2013 were enrolled. Disease severity was graded according to APACHEII score. Admission diagnoses, clinical features and laboratory investigations, complications and outcomes were recorded. RESULTS The mean length of ICU stay was 11.0 days (range: 1-49 days), and 33 patients survived (ICU mortality: 38.9%). The in-hospital mortality at 30 days was 48.1%. ICU mortality was associated with an AIDS-defining diagnosis (OR = 7.97, P = 0.003). Non-survivors had higher APACHEII scores (25.8 vs. 18.6, P = 0.001) and lower mean admission CD4 counts (102.5 vs. 225.2, P = 0.014). Multiple logistical regression analysis confirmed the independent predictive value of WHO stage 4 disease (P = 0.008), lower mean CD4 count on admission (P = 0.057) and higher APACHEII score (P = 0.010) on ICU mortality, and WHO stage 4 (P = 0.007) and higher APACHE II score (P = 0.003) on 30-day mortality. CONCLUSIONS The ICU mortality of mechanically ventilated HIV-positive patients was high. WHO stage 4 disease and a higher APACHEII score were predictive of both ICU and 30-day mortality, whereas a low CD4 count on admission was associated with ICU mortality.
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Affiliation(s)
| | | | - J J Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University & Tygerberg Academic Hospital, Western Cape Province, Cape Town, South Africa
| | - M D Zeier
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University & Tygerberg Academic Hospital, Western Cape Province, Cape Town, South Africa
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Skogmar S, Schön T, Balcha TT, Sturegård E, Jansson M, Björkman P. Plasma Levels of Neopterin and C-Reactive Protein (CRP) in Tuberculosis (TB) with and without HIV Coinfection in Relation to CD4 Cell Count. PLoS One 2015; 10:e0144292. [PMID: 26630153 PMCID: PMC4668010 DOI: 10.1371/journal.pone.0144292] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/16/2015] [Indexed: 12/20/2022] Open
Abstract
Background While the risk of TB is elevated in HIV-positive subjects with low CD4 cell counts, TB may in itself be associated with CD4 lymphocytopenia. We investigated markers of immune activation (neopterin) and inflammation (CRP) in TB patients with and without HIV coinfection and their association with CD4 cell levels, and determined their predictive capacity as alternative markers of advanced immunosuppression. Methods Participants selected from a cohort of adults with TB at Ethiopian health centers (195 HIV+/TB+, 170 HIV-/TB+) and 31 controls were tested for plasma levels of neopterin and CRP. Baseline levels of neopterin and CRP were correlated to CD4 cell count before and after anti-TB treatment (ATT). The performance to predict CD4 cell strata for both markers were investigated using receiver operating curves. Results Levels of both biomarkers were elevated in TB patients (neopterin: HIV+/TB+ 54 nmol/l, HIV-/TB+ 23 nmol/l, controls 3.8 nmol/l; CRP: HIV+/TB+ 36 μg/ml, HIV-/TB+ 33 μg/ml, controls 0.5 μg/ml). Neopterin levels were inversely correlated (-0.53, p<0.001) to CD4 cell count, whereas this correlation was weaker for CRP (-0.25, p<0.001). Neither of the markers had adequate predictive value for identification of subjects with CD4 cell count <100 cells/mm3 (area under the curve [AUC] 0.64 for neopterin, AUC 0.59 for CRP). Conclusion Neopterin levels were high in adults with TB, both with and without HIV coinfection, with inverse correlation to CD4 cell count. This suggests that immune activation may be involved in TB-related CD4 lymphocytopenia. However, neither neopterin nor CRP showed promise as alternative tests for immunosuppression in patients coinfected with HIV and TB.
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Affiliation(s)
- Sten Skogmar
- Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- * E-mail:
| | - Thomas Schön
- Department of Medical Microbiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Microbiology and Infectious diseases, Kalmar County Hospital, Kalmar, Sweden
| | - Taye Tolera Balcha
- Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Ministry of Health, Addis Ababa, Ethiopia
| | - Erik Sturegård
- Medical Microbiology, Department of Laboratory Medicine Malmö, Lund University, Malmö, Sweden
| | - Marianne Jansson
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Microbiology, Tumor and Cell biology, Karolinska Institute, Stockholm, Sweden
| | - Per Björkman
- Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Abate E, Belayneh M, Idh J, Diro E, Elias D, Britton S, Aseffa A, Stendahl O, Schön T. Asymptomatic Helminth Infection in Active Tuberculosis Is Associated with Increased Regulatory and Th-2 Responses and a Lower Sputum Smear Positivity. PLoS Negl Trop Dis 2015; 9:e0003994. [PMID: 26248316 PMCID: PMC4527760 DOI: 10.1371/journal.pntd.0003994] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 07/16/2015] [Indexed: 12/04/2022] Open
Abstract
Background The impact of intestinal helminth infection on the clinical presentation and immune response during active tuberculosis (TB) infection is not well characterized. Our aim was to investigate whether asymptomatic intestinal helminth infection alters the clinical signs and symptoms as well as the cell mediated immune responses in patients with active TB. Methodology Consecutive, newly diagnosed TB patients and healthy community controls (CCs) were recruited in North-west Ethiopia. TB-score, body mass index and stool samples were analyzed. Cells from HIV-negative TB patients (HIV-/TB) and from CCs were analyzed for regulatory T-cells (Tregs) and cytokine responses using flow cytometry and ELISPOT, respectively. Results A significantly higher ratio of helminth co-infection was observed in TB patients without HIV (Helm+/HIV-/TB) compared to HIV negative CCs, (40% (121/306) versus 28% (85/306), p = 0.003). Helm+/HIV-/TB patients showed significantly increased IL-5 secreting cells compared to Helm-/HIV-/TB (37 SFU (IQR:13–103) versus 2 SFU (1–50); p = 0.02, n = 30). Likewise, levels of absolute Tregs (9.4 (3.2–16.7) cells/μl versus 2.4 (1.1–4.0) cells/μl; p = 0.041) and IL-10 secreting cells (65 SFU (7–196) versus 1 SFU (0–31); p = 0.014) were significantly higher in Helm+/HIV-/TB patients compared to Helm-/HIV-/TB patients. In a multivariate analysis, a lower rate of sputum smear positivity for acid fast bacilli, lower body temperature, and eosinophilia were independently associated with helminth infection in TB patients. Conclusions Asymptomatic helminth infection is associated with increased regulatory T-cell and Th2-type responses and a lower rate of sputum smear positivity. Further studies are warranted to investigate the clinical and immunological impact of helminth infection in TB patients. The effects of helminth infection on chronic infectious diseases such as tuberculosis (TB) merit further characterization. There is limited data regarding the impact of helminth co-infection on clinical and immunological outcomes of TB from clinical field studies in high endemic areas. We tried to address some of these issues in a randomized clinical trial in order to investigate the impact of albendazole treatment on helminth co-infected TB patients. In the present study we focused on the clinical and immunological effects of helminth infection on TB. We found that concomitant asymptomatic helminth infection profoundly affects the immune phenotype of TB patients with a strong leaning towards Th2 types of immune response such as increased regulatory T cells as well as IL-5 and IL-10 secreting cells. Furthermore, helminth co-infection was associated with a significantly lower ratio of sputum smear positivity which correlated to the egg load in helminth positive TB patients. Whether the effect of helminth infection may have an impact on the diagnosis and treatment of active TB remains to be further investigated.
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Affiliation(s)
- Ebba Abate
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia
- Department of Medical Microbiology, Linköping University, Linköping, Sweden
- * E-mail:
| | - Meseret Belayneh
- Department of Medical Laboratory Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jonna Idh
- Department of Anaesthesia and Intensive Care, Västervik Hospital, Västervik, Sweden
| | - Ermias Diro
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Daniel Elias
- Department of cancer and inflammation, University of Southern Denmark, Odense, Denmark
| | - Sven Britton
- Department of Infectious diseases, Karolinska Hospital, Stockholm, Sweden
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Olle Stendahl
- Department of Medical Microbiology, Linköping University, Linköping, Sweden
| | - Thomas Schön
- Department of Medical Microbiology, Linköping University, Linköping, Sweden
- Department of Clinical Microbiology and Infectious Diseases, Kalmar County Hospital, Kalmar, Sweden
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Balcha TT, Skogmar S, Sturegård E, Schön T, Winqvist N, Reepalu A, Jemal ZH, Tibesso G, Björk J, Björkman P. A Clinical Scoring Algorithm for Determination of the Risk of Tuberculosis in HIV-Infected Adults: A Cohort Study Performed at Ethiopian Health Centers. Open Forum Infect Dis 2014; 1:ofu095. [PMID: 25734163 PMCID: PMC4324227 DOI: 10.1093/ofid/ofu095] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/16/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) tuberculosis (TB) symptom screening instrument (WHO-TB) can identify human immunodeficiency virus (HIV)-infected individuals at low risk of tuberculosis (TB); however, many patients report WHO-TB symptoms and require further TB investigations. We hypothesized that further clinical scoring could classify subjects with a positive WHO-TB screening result (WHO-TB(+)) for the likelihood of TB. METHODS HIV-infected adults eligible to initiate antiretroviral therapy (ART) were recruited and prospectively followed at 5 Ethiopian health centers. Irrespective of symptoms, all participants underwent sputum bacteriological testing for TB. Symptoms, physical findings, hemoglobin, and CD4 cell count results were compared between subjects with and those without bacteriologically confirmed TB. Variables associated with TB in WHO-TB(+) individuals were used to construct a scoring algorithm with multiple logistic regression analysis. RESULTS Among 812 participants, 137 (16.9%) had TB. One hundred fifty-nine persons (20%) had a negative WHO-TB screen, 10 of whom had TB (negative predictive value [NPV], 94% [95% confidence interval {CI}, 90%-97.5%]). For WHO-TB(+) subjects, the following variables were independently associated with TB, and were assigned 1 point each in the clinical scoring algorithm: cough, Karnofsky score ≤80, mid-upper arm circumference <20 cm, lymphadenopathy, and hemoglobin <10 g/dL. Among subjects with 0-1 points, 20 of 255 had TB (NPV, 92% [95% CI, 89%-95%]), vs 19 of 34 participants with ≥4 points (positive predictive value, 56% [95% CI, 39%-73%]). The use of WHO-TB alone identified 159 of 784 (20%) with a low risk of TB, vs 414 of 784 (53%) using WHO-TB followed by clinical scoring (P< .001). The difference in proportions of confirmed TB in these subsets was nonsignificant (6.3% vs 7.2%; P= .69). CONCLUSIONS Clinical scoring can further classify HIV-infected adults with positive WHO-TB screen to assess the risk of TB, and would reduce the number of patients in need of further TB investigations before starting ART. CLINICAL TRIALS REGISTRATION NCT01433796.
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Affiliation(s)
- T T Balcha
- Infectious Disease Research Unit, Department of Clinical Sciences Malmö , Lund University , Malmö , Sweden ; Ministry of Health , Addis Ababa , Ethiopia
| | - S Skogmar
- Infectious Disease Research Unit, Department of Clinical Sciences Malmö , Lund University , Malmö , Sweden
| | - E Sturegård
- Clinical Microbiology Unit, Department of Laboratory Sciences , Lund University , Malmö
| | - T Schön
- Department of Medical Microbiology, Faculty of Health Sciences , Linköping University ; Department of Clinical Microbiology and Infectious Diseases , Kalmar County Hospital
| | - N Winqvist
- Infectious Disease Research Unit, Department of Clinical Sciences Malmö , Lund University , Malmö , Sweden ; Regional Department of Infectious Disease Control and Prevention, Malmö , Sweden
| | - A Reepalu
- Infectious Disease Research Unit, Department of Clinical Sciences Malmö , Lund University , Malmö , Sweden
| | | | - G Tibesso
- International Center for AIDS Care and Treatment Programs-Ethiopia , Columbia University Mailman School of Public Health , Addis Ababa , Ethiopia
| | - J Björk
- Department of Laboratory Sciences , Lund University , Sweden
| | - P Björkman
- Infectious Disease Research Unit, Department of Clinical Sciences Malmö , Lund University , Malmö , Sweden
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Reepalu A, Balcha TT, Skogmar S, Jemal ZH, Sturegård E, Medstrand P, Björkman P. High rates of virological suppression in a cohort of human immunodeficiency virus-positive adults receiving antiretroviral therapy in ethiopian health centers irrespective of concomitant tuberculosis. Open Forum Infect Dis 2014; 1:ofu039. [PMID: 25734107 PMCID: PMC4324187 DOI: 10.1093/ofid/ofu039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 05/18/2014] [Indexed: 11/17/2022] Open
Abstract
Rates of virological suppression after 6 months of ART were high in a cohort of 678 HIV-positive adults managed in Ethiopian health centers, with no significant difference with regard to concomitant tuberculosis at baseline (TB 135; non-TB 543). Background. Antiretroviral therapy (ART) initiation during treatment for tuberculosis (TB) improves survival in human immunodeficiency virus (HIV)/TB-coinfected patients. We compared virological suppression (VS) rates, mortality, and retention in care in HIV-positive adults receiving care in 5 Ethiopian health centers with regard to TB coinfection. Methods. Human immunodeficiency virus-positive ART-naive adults eligible for ART initiation were prospectively recruited. At inclusion, all patients underwent microbiological investigations for TB (sputum smear, liquid culture, and polymerase chain reaction). Virological suppression rates after 6 months of ART (VS; viral load <40 and <400 copies/mL) with regard to TB status was the primary outcome. The impact of HIV/TB coinfection on VS rates was determined by multivariate regression analysis. Mortality and retention in care were analyzed by proportional hazard models. Results. Among 812 participants (TB, 158; non-TB, 654), 678 started ART during the follow-up period (TB, 135; non-TB, 543). No difference in retention in care between TB and non-TB patients was observed during follow-up; 25 (3.7%) patients died, and 17 (2.5%) were lost to follow-up (P = .30 and P = .83, respectively). Overall rates of VS at 6 months were 72.1% (<40 copies/mL) and 88.7% (<400 copies/mL), with similar results for subjects with and without TB coinfection (<40 copies/mL: 65 of 92 [70.7%] vs 304 of 420 [72.4%], P = .74; <400 copies/mL: 77 of 92 [83.7%] vs 377 of 420 [89.8%], P = .10, respectively). Conclusions. High rates of VS can be achieved in adults receiving ART at health centers, with no significant difference with regard to TB coinfection. These findings demonstrate the feasibility of combined ART and anti-TB treatment in primary healthcare in low-income countries. Clinical Trials Registration. NCT01433796.
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Affiliation(s)
- Anton Reepalu
- Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine
| | - Taye Tolera Balcha
- Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine ; Ministry of Health, Addis Ababa , Ethiopia
| | - Sten Skogmar
- Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine
| | | | - Erik Sturegård
- Clinical Microbiology , Regional and University Laboratories , Region Skåne , Sweden
| | - Patrik Medstrand
- Department of Laboratory Medicine Malmö , Lund University , Malmö , Sweden
| | - Per Björkman
- Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine
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