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van Leth F, Brinkmann F, Cirillo DM, Dheda K, Duarte R, Guglielmetti L, Kuksa L, Lange C, Mitnick C, Skrahina A, Zaman K, Bothamley G. The Tuberculosis Network European Trials group (TBnet) ERS Clinical Research Collaboration: addressing drug-resistant tuberculosis through European cooperation. Eur Respir J 2019; 53:53/1/1802089. [PMID: 30606765 DOI: 10.1183/13993003.02089-2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/14/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Frank van Leth
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.,Amsterdam University Medical Centers, Location Meibergdreef, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Folke Brinkmann
- Universitaetskinderklinik fuer Kinder- und Jugendmedizin, Ruhr University, Bochum, Germany
| | - Daniela M Cirillo
- Emerging Bacterial Pathogens, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, UCT Lung Institute and Dept of Medicine, University of Cape Town, Cape Town, South Africa.,University College London, London, UK
| | - Raquel Duarte
- Pneumology Dept, Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal.,ISPUP-EP unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lorenzo Guglielmetti
- APHP, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France.,Sorbonne Université, Université Pierre et Marie Curie 06, Unité 1135, Team E13 (Bactériologie), CR7 INSERM, Centre d'Immunologie et des Maladies Infectieuses, Paris, France
| | - Liga Kuksa
- Riga East University Hospital, and WHO Collaborating Centre, Riga, Latvia
| | - Christoph Lange
- German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Borstel, Germany.,Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - Carole Mitnick
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Alena Skrahina
- The Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Khalequ Zaman
- ICDDRB Infectious Disease Division, Dhaka, Bangladesh
| | - Graham Bothamley
- Homerton University Hospital, London, UK.,Blizard Institute, Barts and The Royal London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
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Sane Schepisi M, Navarra A, Altet Gomez MN, Dudnyk A, Dyrhol-Riise AM, Esteban J, Giorgetti PF, Gualano G, Guglielmetti L, Heyckendorf J, Kaluzhenina A, Lange B, Lange C, Manika K, Miah J, Nanovic Z, Pontali E, Prego MR, Solovic I, Tiberi S, Palmieri F, Girardi E. Burden and Characteristics of the Comorbidity Tuberculosis-Diabetes in Europe: TBnet Prevalence Survey and Case-Control Study. Open Forum Infect Dis 2018; 6:ofy337. [PMID: 30697572 PMCID: PMC6330516 DOI: 10.1093/ofid/ofy337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/14/2018] [Indexed: 11/14/2022] Open
Abstract
Background The growing burden of diabetes mellitus (DM) is posing a threat to global tuberculosis (TB) control. DM triples the risk of developing TB, modifies the presenting features of pulmonary TB, and worsens TB treatment outcomes. We aimed to analyze the prevalence of DM among TB patients and to describe the characteristics and clinical presentation of TB-DM patients in Europe. Methods We performed a cross-sectional survey on the prevalence of DM among consecutively diagnosed adult TB patients in 11 European TB referral centers located in France, Germany, Greece, Italy, Russia, Slovakia, Spain, and the United Kingdom over the period 2007–2015. We also selected DM-TB cases and TB only controls with a 1:3 ratio to perform a case-control analysis, including patients selected from the countries mentioned above plus Norway and Ukraine. Results Among 3143 TB enrolled patients, DM prevalence overall was 10.7% and ranged from 4.4% in Greece to 28.5% in the United Kingdom. Patients’ median ages ranged from 36 to 49 years, and all centers had >60% males; the proportion of foreign-born patients varied widely across sites. In the case-control study, DM was independently associated with older age and, among older patients, with being foreign-born. Among patients with pulmonary involvement, cavities on chest imaging were more frequently observed among those with DM. Conclusions Diabetes mellitus represents a challenge for TB control in Europe, especially in foreign-born and in elderly patients. Specific screening strategies should be evaluated.
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Affiliation(s)
- Monica Sane Schepisi
- Clinical Epidemiology Unit, National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy
| | - Assunta Navarra
- Clinical Epidemiology Unit, National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy
| | - M Nieves Altet Gomez
- Unidad de Tratamiento Directamente Observado de la Tuberculosis "Servicios Clínicos," Barcelona, Spain
| | - Andrii Dudnyk
- Tuberculosis, Clinical Immunology & Allergy Department, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Anne Margarita Dyrhol-Riise
- Department of Infectious Diseases, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Department of Clinical Science, University of Bergen, Norway
| | - Jaime Esteban
- Departamento de Microbiología Clínica, Fundación Jiménez Díaz, Madrid, Spain
| | - Pier Francesco Giorgetti
- Clinica di Malattie Infettive e Tropicali, A. O. Spedali Civili di Brescia e Università di Brescia, Brescia, Italy
| | - Gina Gualano
- Clinical Department, National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy
| | - Lorenzo Guglielmetti
- Sanatorium, Centre Hospitalier de Bligny Briis-sous-Forges, Paris, France.,APHP, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France.,Sorbonne Université, Unité 1135, Team E13 (Bactériologie), CR7 INSERM, Centre d'Immunologie et des Maladies Infectieuses, Paris, France
| | - Jan Heyckendorf
- Research Center Borstel. German Center for Infection Research (DZIF), Borstel, Germany
| | - Anna Kaluzhenina
- Department of Phthisiopulmonology, Volgograd State Medical University, Volgograd, Russian Federation
| | - Berit Lange
- Infectious Disease Division, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.,Center for Chronic Immunodeficiency, Faculty of Medicine, Medical Center, University of Freiburg, Germany
| | - Christoph Lange
- Research Center Borstel. German Center for Infection Research (DZIF), Borstel, Germany
| | - Katerina Manika
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Jalal Miah
- Division of Infection, Barts Health NHS Trust, London, United Kingdom
| | - Zorica Nanovic
- Institute of Lung Diseases and Tuberculosis - Skopje, Institute of Lung Diseases and Tuberculosis - Skopje, Skopje, FYROM (Macedonia)
| | - Emanuele Pontali
- Divisione di Malattie Infettive, Ospedale Galliera - Genova, Genova, Italy
| | - Monica Rios Prego
- Enfermedades Infecciosas, Medicina Interna, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Simon Tiberi
- Division of Infection, Barts Health NHS Trust, London, United Kingdom
| | - Fabrizio Palmieri
- Clinical Department, National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy
| | - Enrico Girardi
- Clinical Epidemiology Unit, National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy
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Aguilera-Alonso D, Santiago-García B, Mellado-Peña MJ. Epidemiology of tuberculosis in Spain: Areas of improvement in epidemiological surveillance and contributions from the Spanish Network for the Study of Pediatric Tuberculosis. Enferm Infecc Microbiol Clin 2018; 37:68-69. [PMID: 29789180 DOI: 10.1016/j.eimc.2018.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 11/15/2022]
Affiliation(s)
- David Aguilera-Alonso
- Red Española de Estudio de Tuberculosis Pediátrica; Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Begoña Santiago-García
- Red Española de Estudio de Tuberculosis Pediátrica; Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, España
| | - María José Mellado-Peña
- Red Española de Estudio de Tuberculosis Pediátrica; Servicio de Pediatría Hospitalaria, Enfermedades Infecciosas y Tropicales, Hospital Infantil La Paz, Madrid, España; Instituto de Investigación Sanitaria Hospital La Paz, Madrid, España
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4
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Bothamley G. The Tuberculosis Network European Trials Group (TBNET): new directions in the management of tuberculosis. Breathe (Sheff) 2017; 13:e65-e71. [PMID: 28955407 PMCID: PMC5607618 DOI: 10.1183/20734735.005517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Tuberculosis Network European Trials Group (TBNET) is the largest clinical research organisation in Europe. Educational activities include the TBNET Academy and the European Advanced Course in Clinical Tuberculosis. Four of their publications are reviewed to show how the clinical management of tuberculosis is changing. Learn about @TBnet_EU, the largest clinical research organisation in Europehttp://ow.ly/NHTh30e53KE
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Bothamley GH, Ehlers C, Salonka I, Skrahina A, Orcau A, Codecasa LR, Ferrarese M, Pesut D, Solovic I, Dudnyk A, Anibarro L, Denkinger C, Guglielmetti L, Muylle I, Confalonieri M. Pregnancy in patients with tuberculosis: a TBNET cross-sectional survey. BMC Pregnancy Childbirth 2016; 16:304. [PMID: 27729022 PMCID: PMC5059923 DOI: 10.1186/s12884-016-1096-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 10/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Objectives: To determine whether the incidence of tuberculosis with pregnancy is more common than would be expected from the crude birth rate; to see whether there is significant delay in the diagnosis of tuberculosis during pregnancy. Method Design: A cross-sectional survey. Setting: 13 tuberculosis clinics within different European countries and the USA. Population/sample: All patients with tuberculosis seen at these clinics for a period > 1 year. Instrument: Questionnaire survey based on continuous data collection. Main outcome measures: number and proportion of women with tuberculosis who were pregnant; timing of diagnosis in relation to pregnancy, including those who were pregnant or delivered in the 3 months prior to the diagnosis of TB and those who developed TB within 3 months after delivery. Results Pregnancy occurred in 224 (1.5 %) of 15,217 TB patients and followed the expected rate predicted from the crude birth rate for the clinic populations. TB was diagnosed more commonly in the 3 months after delivery (n = 103) than during pregnancy (n = 68; χ2 = 25.1, P < 0.001). Conclusions TB is diagnosed more frequently after delivery, despite variations in local TB incidence and healthcare systems.
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Affiliation(s)
- Graham H Bothamley
- Department of Respiratory Medicine, Homerton University Hospital, London, E9 6SR, UK.
| | - Cordula Ehlers
- TBNET Office, Centre for Research-Borstel, Borstel, Germany
| | - Irina Salonka
- Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - Alena Skrahina
- Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - Angels Orcau
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Luigi R Codecasa
- Regional TB Reference Centre, Villa Marelli Institute, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Maurizio Ferrarese
- Regional TB Reference Centre, Villa Marelli Institute, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Dragica Pesut
- University of Belgrade School of Medicine, Belgrade, Serbia
| | - Ivan Solovic
- National Institute for Tuberculosis, Pulmonary Disease and Thoracic Surgery Vyšné Hágy, Ruzomberok, Slovakia
| | - Andrii Dudnyk
- National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Luis Anibarro
- Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | | | - Inge Muylle
- UMC St. Pieter - CHU St. Pierre, Brussels, Belgium
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Silva JP, Appelberg R, Gama FM. Antimicrobial peptides as novel anti-tuberculosis therapeutics. Biotechnol Adv 2016; 34:924-940. [PMID: 27235189 DOI: 10.1016/j.biotechadv.2016.05.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/20/2016] [Accepted: 05/22/2016] [Indexed: 12/30/2022]
Abstract
Tuberculosis (TB), a disease caused by the human pathogen Mycobacterium tuberculosis, has recently joined HIV/AIDS as the world's deadliest infectious disease, affecting around 9.6 million people worldwide in 2014. Of those, about 1.2 million died from the disease. Resistance acquisition to existing antibiotics, with the subsequent emergence of Multi-Drug Resistant mycobacteria strains, together with an increasing economic burden, has urged the development of new anti-TB drugs. In this scope, antimicrobial peptides (AMPs), which are small, cationic and amphipathic peptides that make part of the innate immune system, now arise as promising candidates for TB treatment. In this review, we analyze the potential of AMPs for this application. We address the mechanisms of action, advantages and disadvantages over conventional antibiotics and how problems associated with its use may be overcome to boost their therapeutic potential. Additionally, we address the challenges of translational development from benchside to bedside, evaluate the current development pipeline and analyze the expected global impact from a socio-economic standpoint. The quest for more efficient and more compliant anti-TB drugs, associated with the great therapeutic potential of emerging AMPs and the rising peptide market, provide an optimal environment for the emergence of AMPs as promising therapies. Still, their pharmacological properties need to be enhanced and manufacturing-associated issues need to be addressed.
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Affiliation(s)
- João P Silva
- CEB - Centre of Biological Engineering, University of Minho, Campus de Gualtar, Braga 4710-057, Portugal.
| | - Rui Appelberg
- Department of Immunophysiology, University of Porto, 4050-313 Porto, Portugal
| | - Francisco Miguel Gama
- CEB - Centre of Biological Engineering, University of Minho, Campus de Gualtar, Braga 4710-057, Portugal.
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Günther G, van Leth F, Alexandru S, Altet N, Avsar K, Bang D, Barbuta R, Bothamley G, Ciobanu A, Crudu V, Davilovits M, Dedicoat M, Duarte R, Gualano G, Kunst H, de Lange W, Leimane V, Magis-Escurra C, McLaughlin AM, Muylle I, Polcová V, Pontali E, Popa C, Rumetshofer R, Skrahina A, Solodovnikova V, Spinu V, Tiberi S, Viiklepp P, Lange C. Multidrug-resistant tuberculosis in Europe, 2010-2011. Emerg Infect Dis 2015; 21:409-16. [PMID: 25693485 PMCID: PMC4344280 DOI: 10.3201/eid2103.141343] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Drug-resistant Mycobacterium tuberculosis is challenging elimination of tuberculosis (TB). We evaluated risk factors for TB and levels of second-line drug resistance in M. tuberculosis in patients in Europe with multidrug-resistant (MDR) TB. A total of 380 patients with MDR TB and 376 patients with non-MDR TB were enrolled at 23 centers in 16 countries in Europe during 2010-2011. A total of 52.4% of MDR TB patients had never been treated for TB, which suggests primary transmission of MDR M. tuberculosis. At initiation of treatment for MDR TB, 59.7% of M. tuberculosis strains tested were resistant to pyrazinamide, 51.1% were resistant to ≥1 second-line drug, 26.6% were resistant to second-line injectable drugs, 17.6% were resistant to fluoroquinolones, and 6.8% were extensively drug resistant. Previous treatment for TB was the strongest risk factor for MDR TB. High levels of primary transmission and advanced resistance to second-line drugs characterize MDR TB cases in Europe.
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Zellweger JP, Sotgiu G, Block M, Dore S, Altet N, Blunschi R, Bogyi M, Bothamley G, Bothe C, Codecasa L, Costa P, Dominguez J, Duarte R, Fløe A, Fresard I, García-García JM, Goletti D, Halm P, Hellwig D, Henninger E, Heykes-Uden H, Horn L, Kruczak K, Latorre I, Pache G, Rath H, Ringshausen FC, Ruiz AS, Solovic I, Souza-Galvão MLD, Widmer U, Witte P, Lange C. Risk Assessment of Tuberculosis in Contacts by IFN-γ Release Assays. A Tuberculosis Network European Trials Group Study. Am J Respir Crit Care Med 2015; 191:1176-84. [DOI: 10.1164/rccm.201502-0232oc] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Günther G, Gomez GB, Lange C, Rupert S, van Leth F. Availability, price and affordability of anti-tuberculosis drugs in Europe: a TBNET survey. Eur Respir J 2014; 45:1081-8. [PMID: 25395035 DOI: 10.1183/09031936.00124614] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Data on availability and cost of anti-tuberculosis (TB) drugs in relation to affordability at national level are scarce. We performed a cross-sectional study on availability and cost of anti-TB drugs at major TB-reference centres in 37 European countries. Costs of standardised treatment regimens used for pan-sensitive TB, multidrug-resistant (MDR) TB, pre-extensively drug-resistant (XDR) TB, and XDR-TB were compared using a purchasing power analysis. Affordability was evaluated in relation to monthly national gross domestic products per capita (GDP). At least one second-line injectable and either moxifloxacin or levofloxacin were available in all countries. Linezolid and clofazimine were available in 79% and 46% of the countries, respectively. Drug cost for XDR-TB was three-times more expensive than those for MDR-TB. The average price of treatment for pan-sensitive TB represented a maximum of 8.5% of the monthly GDP across countries, while for standard MDR-TB treatment this was <30% in only six countries and more than 100% in four countries. Treatment of XDR-TB represented more than 100% of a month's GDP in all countries where the regimen was available. High cost and limited availability of drugs for treatment of drug-resistant TB, particularly beyond resistance to first-line drugs, are a major impediment to successful TB control in Europe.
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Affiliation(s)
- Gunar Günther
- Division of Clinical Infectious Diseases, German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Research Center, Borstel, Germany Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia Both authors contributed equally to the manuscript
| | - Gabriela B Gomez
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK Both authors contributed equally to the manuscript
| | - Christoph Lange
- Division of Clinical Infectious Diseases, German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Research Center, Borstel, Germany Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia
| | - Stephan Rupert
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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