1
|
Anderson ES, Frazee BW. The Intersection of Substance Use Disorders and Infectious Diseases in the Emergency Department. Emerg Med Clin North Am 2024; 42:391-413. [PMID: 38641396 DOI: 10.1016/j.emc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Substance use disorders (SUDs) intersect clinically with many infectious diseases, leading to significant morbidity and mortality if either condition is inadequately treated. In this article, we will describe commonly seen SUDs in the emergency department (ED) as well as their associated infectious diseases, discuss social drivers of patient outcomes, and introduce novel ED-based interventions for co-occurring conditions. Clinicians should come away from this article with prescriptions for both antimicrobial medications and pharmacotherapy for SUDs, as well as an appreciation for social barriers, to care for these patients.
Collapse
Affiliation(s)
- Erik S Anderson
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA; Division of Addiction Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Bradley W Frazee
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA
| |
Collapse
|
2
|
Akkerman OW, Duarte R, Tiberi S, Schaaf HS, Lange C, Alffenaar JWC, Denholm J, Carvalho ACC, Bolhuis MS, Borisov S, Bruchfeld J, Cabibbe AM, Caminero JA, Carvalho I, Chakaya J, Centis R, Dalcomo MP, D Ambrosio L, Dedicoat M, Dheda K, Dooley KE, Furin J, García-García JM, van Hest NAH, de Jong BC, Kurhasani X, Märtson AG, Mpagama S, Torrico MM, Nunes E, Ong CWM, Palmero DJ, Ruslami R, Saktiawati AMI, Semuto C, Silva DR, Singla R, Solovic I, Srivastava S, de Steenwinkel JEM, Story A, Sturkenboom MGG, Tadolini M, Udwadia ZF, Verhage AR, Zellweger JP, Migliori GB. Clinical standards for drug-susceptible pulmonary TB. Int J Tuberc Lung Dis 2022; 26:592-604. [PMID: 35768923 PMCID: PMC9272737 DOI: 10.5588/ijtld.22.0228] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice´ for diagnosis, treatment and management of drug-susceptible pulmonary TB (PTB).METHODS: A panel of 54 global experts in the field of TB care, public health, microbiology, and pharmacology were identified; 46 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all 46 participants.RESULTS: Seven clinical standards were defined: Standard 1, all patients (adult or child) who have symptoms and signs compatible with PTB should undergo investigations to reach a diagnosis; Standard 2, adequate bacteriological tests should be conducted to exclude drug-resistant TB; Standard 3, an appropriate regimen recommended by WHO and national guidelines for the treatment of PTB should be identified; Standard 4, health education and counselling should be provided for each patient starting treatment; Standard 5, treatment monitoring should be conducted to assess adherence, follow patient progress, identify and manage adverse events, and detect development of resistance; Standard 6, a recommended series of patient examinations should be performed at the end of treatment; Standard 7, necessary public health actions should be conducted for each patient. We also identified priorities for future research into PTB.CONCLUSION: These consensus-based clinical standards will help to improve patient care by guiding clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment for PTB.
Collapse
Affiliation(s)
- O W Akkerman
- TB Center Beatrixoord, University Medical Center Groningen, University of Groningen, Haren, the Netherlands, Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R Duarte
- Centro Hospitalar de Vila Nova de Gaia/Espinho; Instituto de Ciencias Biomédicas de Abel Saalazar, Universidade do Porto, Instituto de Saúde Publica da Universidade do Porto, Unidade de Investigação Clínica, ARS Norte, Porto, Portugal
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Borstel, Germany, Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany, The Global Tuberculosis Program, Texas Children´s Hospital, Immigrant and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - J W C Alffenaar
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, NSW, Australia, School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Sydney, NSW, Australia, Westmead Hospital, Sydney, NSW, Australia
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Department of Infectious diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - A C C Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - M S Bolhuis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, Moscow, Russia
| | - J Bruchfeld
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden, Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden
| | - A M Cabibbe
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - J A Caminero
- Department of Pneumology, University General Hospital of Gran Canaria "Dr Negrin", Las Palmas, Spain, ALOSA (Active Learning over Sanitary Aspects) TB Academy, Spain
| | - I Carvalho
- Pediatric Department, Vila Nova de Gaia Outpatient Tuberculosis Centre, Vila Nova de Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - J Chakaya
- Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences. Liverpool School of Tropical Medicine, Liverpool, UK
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - M P Dalcomo
- Reference Center Helio Fraga, FIOCRUZ, Brazil
| | - L D Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - M Dedicoat
- Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - K Dheda
- Centre for Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa, South African Medical Research Council Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - K E Dooley
- Center for Tuberculosis Research, Johns Hopkins, Baltimore, MD
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - N A H van Hest
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Municipal Public Health Service Groningen, Groningen, The Netherlands
| | - B C de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - X Kurhasani
- UBT-Higher Education Institution Prishtina, Kosovo
| | - A G Märtson
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - S Mpagama
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzani, Kibong´oto Infectious Diseases Hospital, Sanya Juu, Siha, Kilimanjaro, United Republic of Tanzania
| | - M Munoz Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, México City, Mexico
| | - E Nunes
- Department of Pulmonology of Central Hospital of Maputo, Maputo, Mozambique, Faculty of Medicine of Eduardo Mondlane University, Maputo, Mozambique
| | - C W M Ong
- Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore, Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - D J Palmero
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - R Ruslami
- Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, Research Center for Care and Control of Infectious Disease (RC3iD), Universitas Padjadjaran, Bandung, Indonesia
| | - A M I Saktiawati
- Department of Internal Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - C Semuto
- Research, Innovation and Data Science Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - D R Silva
- Instituto Vaccarezza, Hospital Muñiz, Buenos Aires, Argentina
| | - R Singla
- National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | - I Solovic
- National Institute of Tuberculosis, Lung Diseases and Thoracic Surgery, Faculty of Health, Catholic University, Ružomberok, Vyšné Hágy, Slovakia
| | - S Srivastava
- Department of Pulmonary Immunology, University of Texas Health Science Centre at Tyler, Tyler, TX, USA
| | - J E M de Steenwinkel
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - A Story
- Institute of Epidemiology and Healthcare, University College London, London, UK, Find and Treat, University College Hospitals NHS Foundation Trust, London, UK
| | - M G G Sturkenboom
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M Tadolini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Z F Udwadia
- P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - A R Verhage
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J P Zellweger
- TB Competence Center, Swiss Lung Association, Berne, Switzerland
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| |
Collapse
|
3
|
Underner M, Peiffer G, Perriot J, Jaafari N. Republication de : Complications pulmonaires chez les consommateurs de cocaïne. JOURNAL EUROPÉEN DES URGENCES ET DE RÉANIMATION 2020. [DOI: 10.1016/j.jeurea.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
4
|
Drug misuse, tobacco smoking, alcohol and other social determinants of tuberculosis in UK-born adults in England: a community-based case-control study. Sci Rep 2020; 10:5639. [PMID: 32221405 PMCID: PMC7101386 DOI: 10.1038/s41598-020-62667-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/17/2020] [Indexed: 11/09/2022] Open
Abstract
Addressing social determinants of tuberculosis (TB) is essential to achieve elimination, including in low-incidence settings. We measured the association between socio-economic status and intermediate social determinants of health (SDHs, including drug misuse, tobacco smoking and alcohol), and TB, taking into account their clustering in individuals. We conducted a case-control study in 23–38 years old UK-born White adults with first tuberculosis episode, and randomly selected age and sex frequency-matched community controls. Data was collected on education, household overcrowding, tobacco smoking, alcohol and drugs use, and history of homelessness and prison. Analyses were done using logistic regression models, informed by a formal theoretical causal framework (Directed Acyclic Graph). 681 TB cases and 1183 controls were recruited. Tuberculosis odds were four times higher in subjects with education below GCSE O-levels, compared to higher education (OR = 3.94; 95%CI: 2.74, 5.67), after adjusting for other TB risk factors (age, sex, BCG-vaccination and stays ≥3 months in Africa/Asia). When simultaneously accounting for respective SDHs, higher tuberculosis risk was independently associated with tobacco smoking, drugs use (especially injectable drugs OR = 5.67; 95%CI: 2.68, 11.98), homelessness and area-level deprivation. Population Attributable Fraction estimates suggested that tobacco and class-A drug use were, respectively, responsible for 18% and 15% of TB cases in this group. Our findings suggest that socio-economic deprivation remains a driver of tuberculosis in England, including through drugs misuse, tobacco smoking, and homelessness. These findings further support the integration of health and social services in high-risk young adults to improve TB control efforts.
Collapse
|
5
|
Underner M, Peiffer G, Perriot J, Jaafari N. [Pulmonary complications in cocaine users]. Rev Mal Respir 2019; 37:45-59. [PMID: 31883817 DOI: 10.1016/j.rmr.2019.11.641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023]
Abstract
Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine use and pulmonary complications. Cocaine can be responsible for acute respiratory symptoms (cough, black sputum, hemoptysis, dyspnea, wheezing, chest pain) and for various pulmonary disorders including barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium), airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alveolar hemorrhage, alveolar pneumonia with carbonaceous material, bullous emphysema, acute eosinophilic pneumonia, pulmonary granulomatosis caused by talc or cellulose, interstitial pneumonitis and pulmonary fibrosis, vasculitis, pulmonary hypertension, pulmonary embolism and pulmonary infarction, mycotic pulmonary arterial aneurysms, septic emboli, aspiration pneumonia, community-acquired pneumonia, HIV-related opportunistic infections, latent tuberculosis infection, pulmonary tuberculosis, lung cancer and crack lung. Some of these complications are serious and may have a fatal outcome. Pulmonary function tests, thoracic tomodensitometry, bronchial fibroscopy with bronchoalveolar lavage and lung scintigraphy may be an aid to the diagnosis of these pulmonary compications. Cocaine use must be sought in case of respiratory symptoms in young persons.
Collapse
Affiliation(s)
- M Underner
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - G Peiffer
- Pneumologie, CHR Metz-Thionville, CHR Mercy, 57085 Metz cedex 3, France
| | - J Perriot
- Dispensaire Émile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
| |
Collapse
|
6
|
Janssen E, Cadet-Taïrou A, Gérome C, Vuolo M. Estimating the size of crack cocaine users in France: Methods for an elusive population with high heterogeneity. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102637. [PMID: 31881370 DOI: 10.1016/j.drugpo.2019.102637] [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: 06/14/2019] [Revised: 10/21/2019] [Accepted: 12/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite several sources corroborating an expanding market and increased visibility and greater diversity in users' profiles, very little is known about the number of crack cocaine users in France. METHOD The estimates rely on a single data source capture-recapture method. Annual data are extracted from treatment centres nationwide. To account for heterogeneity, we use an innovative zero-truncated geometric, regression-based estimator controlling for individual and centre characteristics. We use the well-known Zelterman estimator as a benchmark. RESULTS The number of crack cocaine users received in treatment centres increased dramatically, from 3388 in 2010 to 5143 in 2017 (+52%). The estimated number of crack cocaine users is believed to have tripled over the course of the same period (from 9775, 95% CI [8288-11530] to 28983 [24876-33766], respectively), with prevalences below 1‰, similar to other European countries. The coverage rate (observed number/estimated number of users) decreased in a similar fashion, indicating lower utilization. In particular, females and younger users are underestimated by data from treatment centres. CONCLUSION The prevalence of crack cocaine use is fairly low but steadily increasing. The diversity in users' profiles is a challenge to prevention and public health policies that should expand their scope to a more inclusive perspective of what defines crack cocaine users. Our method overcomes several methodological issues (data sources, data linkage, heterogeneity) and can be easily applied to a wide range of settings.
Collapse
Affiliation(s)
- Eric Janssen
- French Monitoring Centre on Drugs and Drug Addiction (Observatoire Français des Drogues et Toxicomanies - OFDT), 69 rue de Varenne, 75007 Paris, France.
| | - Agnès Cadet-Taïrou
- French Monitoring Centre on Drugs and Drug Addiction (Observatoire Français des Drogues et Toxicomanies - OFDT), 69 rue de Varenne, 75007 Paris, France
| | - Clément Gérome
- French Monitoring Centre on Drugs and Drug Addiction (Observatoire Français des Drogues et Toxicomanies - OFDT), 69 rue de Varenne, 75007 Paris, France
| | - Michael Vuolo
- Department of Sociology, Ohio State University, 238 Townsend Ave, 1885 Neil Avenue Mall, Columbus, OH 43210, USA
| |
Collapse
|
7
|
Santana MF, João GAP, Lacerda MVGD, Ferreira LCDL. Diabetes insipidus secondary to tuberculous meningoencephalitis with hypothalamic involvement extending to the hypophysis: a case report. Rev Soc Bras Med Trop 2019; 51:865-867. [PMID: 30517545 DOI: 10.1590/0037-8682-0455-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 07/18/2018] [Indexed: 11/22/2022] Open
Abstract
The involvement of Mycobacterium tuberculosis in the central nervous system (CNS) is an uncommon and devastating manifestation of tuberculosis. We report a case of disseminated tuberculosis presenting as meningoencephalitis, hypothalamic involvement with extension to the hypophysis, and secondary insipidus diabetes diagnosed at autopsy.
Collapse
Affiliation(s)
- Monique Freire Santana
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Departamento de Ensino e Pesquisa, Fundação Centro de Controle de Oncologia do Amazonas, Manaus, AM, Brasil
| | | | | | - Luiz Carlos de Lima Ferreira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Departamento de Patologia e Medicina Legal, Universidade Federal do Amazonas, Manaus, AM, Brasil
| |
Collapse
|
8
|
Silva DR, Muñoz-Torrico M, Duarte R, Galvão T, Bonini EH, Arbex FF, Arbex MA, Augusto VM, Rabahi MF, Mello FCDQ. Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs. ACTA ACUST UNITED AC 2019; 44:145-152. [PMID: 29791552 PMCID: PMC6044656 DOI: 10.1590/s1806-37562017000000443] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/09/2018] [Indexed: 11/22/2022]
Abstract
Tuberculosis continues to be a major public health problem. Although efforts to control the epidemic have reduced mortality and incidence, there are several predisposing factors that should be modified in order to reduce the burden of the disease. This review article will address some of the risk factors associated with tuberculosis infection and active tuberculosis, including diabetes, smoking, alcohol use, and the use of other drugs, all of which can also contribute to poor tuberculosis treatment results. Tuberculosis can also lead to complications in the course and management of other diseases, such as diabetes. It is therefore important to identify these comorbidities in tuberculosis patients in order to ensure adequate management of both conditions.
Collapse
Affiliation(s)
- Denise Rossato Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marcela Muñoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México
| | - Raquel Duarte
- Instituto de Saúde Publica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Tatiana Galvão
- Hospital Especializado Octávio Mangabeira, Secretaria de Saúde do Estado da Bahia, Salvador, BA, Brasil
| | | | | | - Marcos Abdo Arbex
- Faculdade de Medicina, Universidade de Araraquara, Araraquara, SP, Brasil
| | - Valéria Maria Augusto
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | |
Collapse
|
9
|
[Tuberculosis and comorbidities in urban areas in Argentina. A gender and age perspective]. BIOMEDICA 2018; 38:180-188. [PMID: 30184347 DOI: 10.7705/biomedica.v38i0.3904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/28/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Tuberculosis continues to be a major health problem in the world with an incidence of more than 10 million cases in 2015. There are factors that change the risk of developing the disease after infection, as well as the presentation of the disease. OBJECTIVE To determine the main comorbidities and demographic, clinical and microbiological characteristics of tuberculosis adult patients in Argentina from a gender and age perspective. MATERIALS AND METHODS We conducted a cross-sectional study in urban referral hospitals for patients with tuberculosis. We included tuberculosis patients of 15 years or more of age who were hospitalized or treated in outpatient clinics with bacteriologically confirmed pulmonary or extrapulmonary forms of the disease, as well as those who, although not bacteriologically confirmed, had clinical and radiological characteristics consistent with tuberculosis. The study period was from August 1st, 2015 to August 31st, 2016. RESULTS We included 378 patients. The median age was 37 years. Male gender was associated with extrapulmonary tuberculosis, hospitalization, smoking, drug addiction and alcoholism. Tuberculosis and aids (22.6%) was related to drug use, admission into hospital, extrapulmonary tuberculosis, nonaddiction to tobacco, non-pathological radiology, absence of cavitation, and negative sputum smear microscopy. Patients less than 40 years of age had a higher rate of drug addiction and low weight, while those aged 40 or over had a higher proportion of diabetes, alcoholism and chronic obstructive pulmonary disease (COPD). CONCLUSIONS This study will help recognize tuberculosis patients' characteristics and comorbidities influencing the development and evolution of the disease from an age and gender perspective to enable the development of social and community-based strategies.
Collapse
|
10
|
Oprea C, Ianache I, Calistru PI, Nica M, Ruta S, Smith C, Lipman M. Increasing incidence of HIV- associated tuberculosis in Romanian injecting drug users. HIV Med 2018; 19:316-323. [PMID: 29464834 DOI: 10.1111/hiv.12576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND A high prevalence of tuberculosis (TB) among HIV-positive injecting drug users (IDUs) may fuel the TB epidemic in the general population of Romania. We determined the frequency and characteristics of TB in HIV-infected IDUs referred to a national centre. METHODS Prospective observational cohort study of all newly-diagnosed HIV-positive IDUs admitted to Victor Babes Hospital, Bucharest, between January 2009 and December 2014. Socio-demographics, clinical characteristics and outcomes of HIV/TB co-infected IDUs were compared to HIV-positive IDUs without TB. RESULTS 170/598 (28.5%) HIV-infected IDUs were diagnosed with TB. The prevalence increased from 12.5% in 2009 to 32.1% in 2014 (P < 0.001). HIV/TB co-infected individuals had lower median CD4 cell counts 75 (vs. 450/mm3 , P < 0.0001) and higher median HIV viral loads 5.6 log10 (vs. 4.9 log10 , P < 0.0001) when presenting to healthcare services. 103/170 (60.6%) HIV/TB co-infected IDUs were diagnosed with pulmonary TB. Resistant Mycobacterium tuberculosis strains were common, with 18/105 (17.1%) of patients having Multi-Drug Resistant (MDR) disease. Higher mortality rate was associated with TB co-infection (P < 0.0001), extra-pulmonary TB (P = 0.0026) and extensively drug resistant TB (P = 0.024). CONCLUSIONS Tuberculosis (TB) is an increasing problem in HIV-infected IDUs in Romania. Presentation is often with advanced HIV, significant TB drug resistance and consequent outcomes are poor.
Collapse
Affiliation(s)
- C Oprea
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - I Ianache
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - P I Calistru
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - M Nica
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Laboratory of Bacteriology, Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - S Ruta
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Stefan S. Nicolau Institute of Virology, Bucharest, Romania
| | - C Smith
- Institute of Global Health, University College London, London, UK
| | - M Lipman
- Royal Free London NHS Foundation Trust, London, UK.,UCL Respiratory, Division of Medicine, University College London, London, UK
| |
Collapse
|
11
|
Drug addiction and alcoholism as predictors for tuberculosis treatment default in Brazil: a prospective cohort study. Epidemiol Infect 2017; 145:3516-3524. [PMID: 29173226 DOI: 10.1017/s0950268817002631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study aimed to evaluate the risk factors for tuberculosis (TB) treatment default in a priority city for disease control in Brazil. A cohort of TB cases diagnosed from 2008 to 2009 was followed up from patients' entry into three outpatient sites, in Juiz de Fora, Minas Gerais (Brazil), until the recording of the outcomes. Drug addiction, alcoholism and treatment site appeared to be independently associated with default. Current users of crack as the hardest drug (odds ratio (OR) 12·25, 95% confidence interval (CI) 3·04-49·26) were more likely to default than other hard drug users (OR 5·67, 95% CI 1·34-24·03), former users (OR 4·12, 95% CI 1·11-15·20) and those not known to use drugs (reference group). Consumers at high risk of alcoholism (OR 2·94, 95% CI 1·08-7·99) and those treated in an outpatient hospital unit (OR 8·22, 95% CI 2·79-24·21%) also were more likely to default. Our results establish that substance abuse was independently associated with default. National TB programmes might be more likely to achieve their control targets if they include interventions aimed at improving adherence and cure rates, by diagnosing and treating substance abuse concurrently with standard TB therapy.
Collapse
|
12
|
Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses. Drug Alcohol Depend 2017; 180:401-416. [PMID: 28982092 DOI: 10.1016/j.drugalcdep.2017.08.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist. METHODS A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486). RESULTS Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate. CONCLUSIONS Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.
Collapse
|
13
|
Strike C, Watson TM. Education and equipment for people who smoke crack cocaine in Canada: progress and limits. Harm Reduct J 2017; 14:17. [PMID: 28494810 PMCID: PMC5427547 DOI: 10.1186/s12954-017-0144-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People who smoke crack cocaine experience a wide variety of health-related issues. However, public health programming designed for this population is limited, particularly in comparison with programming for people who inject drugs. Canadian best practice recommendations encourage needle and syringe programs (NSPs) to provide education about safer crack cocaine smoking practices, distribute safer smoking equipment, and provide options for safer disposal of used equipment. METHODS We conducted an online survey of NSP managers across Canada to estimate the proportions of NSPs that provide education and distribute safer smoking equipment to people who smoke crack cocaine. We also assessed change in pipe distribution practices between 2008 and 2015 in the province of Ontario. RESULTS Analysis of data from 80 programs showed that the majority (0.76) provided education to clients on reducing risks associated with sharing crack cocaine smoking equipment and about when to replace smoking equipment (0.78). The majority (0.64) also distributed safer crack cocaine smoking equipment and over half of these programs (0.55) had done so for less than 5 years. Among programs that distributed pipes, 0.92 distributed the recommended heat-resistant Pyrex and/or borosilicate glass pipes. Only 0.50 of our full sample reported that their program provides clients with containers for safer disposal of used smoking equipment. The most common reasons for not distributing safer smoking equipment were not enough funding (0.32) and lack of client demand (0.25). Ontario-specific sub-analyses showed a significant increase in the proportion of programs distributing pipes in Ontario from 0.15 (2008) to 0.71 (2015). CONCLUSIONS Our findings point to important efforts by Canadian NSPs to reduce harm among people who smoke crack cocaine through provision of education and equipment, but there are still limits that could be addressed. Our study can provide guidance for future cross-jurisdiction studies to describe relationships involving harm reduction programs and provision of safer crack cocaine smoking education and equipment.
Collapse
Affiliation(s)
- Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7 Canada
| | - Tara Marie Watson
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Toronto, Ontario M5S 2S1 Canada
| |
Collapse
|
14
|
Aldridge RW, Zenner D, White PJ, Williamson EJ, Muzyamba MC, Dhavan P, Mosca D, Thomas HL, Lalor MK, Abubakar I, Hayward AC. Tuberculosis in migrants moving from high-incidence to low-incidence countries: a population-based cohort study of 519 955 migrants screened before entry to England, Wales, and Northern Ireland. Lancet 2016; 388:2510-2518. [PMID: 27742165 PMCID: PMC5121129 DOI: 10.1016/s0140-6736(16)31008-x] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Tuberculosis elimination in countries with a low incidence of the disease necessitates multiple interventions, including innovations in migrant screening. We examined a cohort of migrants screened for tuberculosis before entry to England, Wales, and Northern Ireland and tracked the development of disease in this group after arrival. METHODS As part of a pilot pre-entry screening programme for tuberculosis in 15 countries with a high incidence of the disease, the International Organization for Migration screened all applicants for UK visas aged 11 years or older who intended to stay for more than 6 months. Applicants underwent a chest radiograph, and any with results suggestive of tuberculosis underwent sputum testing and culture testing (when available). We tracked the development of tuberculosis in those who tested negative for the disease and subsequently migrated to England, Wales, and Northern Ireland with the Enhanced Tuberculosis Surveillance system. Primary outcomes were cases of all forms of tuberculosis (including clinically diagnosed cases), and bacteriologically confirmed pulmonary tuberculosis. FINDINGS Our study cohort was 519 955 migrants who were screened for tuberculosis before entry to the UK between Jan 1, 2006, and Dec 31, 2012. Cases notified on the Enhanced Tuberculosis Surveillance system between Jan 1, 2006, and Dec 31, 2013, were included. 1873 incident cases of all forms of tuberculosis were identified, and, on the basis of data for England, Wales, and Northern Ireland, the estimated incidence of all forms of tuberculosis in migrants screened before entry was 147 per 100 000 person-years (95% CI 140-154). The estimated incidence of bacteriologically confirmed pulmonary tuberculosis in migrants screened before entry was 49 per 100 000 person-years (95% CI 45-53). Migrants whose chest radiographs were compatible with active tuberculosis but with negative pre-entry microbiological results were at increased risk of tuberculosis compared with those with no radiographic abnormalities (incidence rate ratio 3·2, 95% CI 2·8-3·7; p<0·0001). Incidence of tuberculosis after migration increased significantly with increasing WHO-estimated prevalence of tuberculosis in migrants' countries of origin. 35 of 318 983 pre-entry screened migrants included in a secondary analysis with typing data were assumed index cases. Estimates of the rate of assumed reactivation tuberculosis ranged from 46 (95% CI 42-52) to 91 (82-102) per 100 000 population. INTERPRETATION Migrants from countries with a high incidence of tuberculosis screened before being granted entry to low-incidence countries pose a negligible risk of onward transmission but are at increased risk of tuberculosis, which could potentially be prevented through identification and treatment of latent infection in close collaboration with a pre-entry screening programme. FUNDING Wellcome Trust, UK National Institute for Health Research, UK Medical Research Council, Public Health England, and Department of Health Policy Research Programme.
Collapse
Affiliation(s)
- Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; Farr Institute of Health Informatics Research, University College London, London, UK; Institute for Global Health, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
| | - Dominik Zenner
- Institute for Global Health, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Peter J White
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Imperial College London, London, UK
| | | | - Morris C Muzyamba
- Institute for Global Health, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Poonam Dhavan
- Migration Health Division, International Organization for Migration, Geneva, Switzerland
| | - Davide Mosca
- Migration Health Division, International Organization for Migration, Geneva, Switzerland
| | - H Lucy Thomas
- Institute for Global Health, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Maeve K Lalor
- Institute for Global Health, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Andrew C Hayward
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; Farr Institute of Health Informatics Research, University College London, London, UK
| |
Collapse
|
15
|
Anderson C, Anderson SR, Maguire H, Hayward AC, Story A. Tuberculosis in London: the convergence of clinical and social complexity. Eur Respir J 2016; 48:1233-1236. [PMID: 27587555 DOI: 10.1183/13993003.00749-2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/11/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Charlotte Anderson
- Field Epidemiology Service - South East and London, Public Health England, London, UK
| | - Sarah R Anderson
- North West London Health Protection Team, Public Health England, London, UK
| | - Helen Maguire
- Field Epidemiology Service - South East and London, Public Health England, London, UK UCL Department of Infectious Disease Informatics, University College London, London, UK
| | - Andrew C Hayward
- UCL Department of Infectious Disease Informatics, University College London, London, UK
| | - Alistair Story
- Find&Treat, University College Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
16
|
Dugosh KL, Festinger DS, Lipkin JL. Identifying and Addressing the Unmet Health Care Needs of Drug Court Clients. J Subst Abuse Treat 2016; 71:30-35. [PMID: 27776674 DOI: 10.1016/j.jsat.2016.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/17/2016] [Accepted: 08/24/2016] [Indexed: 12/11/2022]
Abstract
Drug courts address issues such as employment and housing but largely miss the opportunity to address important health care issues. The current study examined the prevalence and correlates of chronic medical conditions among a sample of drug court clients who were participating in a clinical trial of an intervention to reduce HIV risk. A total of 256 clients completed a health survey at entry into the drug court program and 9 months post-entry. The baseline health survey included a comprehensive list of chronic medical conditions, and participants were asked to indicate which, if any, they had ever been diagnosed as having. They were also asked to indicate whether or not they were currently receiving treatment for each chronic condition that they endorsed. The follow-up survey was identical to the baseline survey, with the exception that it contained items reflecting (1) whether or not any member of the drug court team engaged in discussion with the client about each of the chronic conditions reported and (2) whether the client received a referral to medical care for endorsed conditions while in the drug court program. Results indicated that over 50% of clients reported at least one chronic condition and 21% reported more than one condition. Among those with chronic conditions, 71% reported having chronic conditions for which they were not currently receiving treatment. Unfortunately, drug court clients reported that the drug court team did little to address these unmet health needs. Findings from this study suggest that clients could benefit if drug court programs began to widen their focus to include addressing health-related issues.
Collapse
Affiliation(s)
- Karen L Dugosh
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States.
| | - David S Festinger
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States
| | - Jessica L Lipkin
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States
| |
Collapse
|
17
|
Voon P, Ti L, Dong H, Milloy MJ, Wood E, Kerr T, Hayashi K. Risky and rushed public crack cocaine smoking: the potential for supervised inhalation facilities. BMC Public Health 2016; 16:476. [PMID: 27266703 PMCID: PMC4895970 DOI: 10.1186/s12889-016-3137-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/19/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite the multitude of public health and community harms associated with crack cocaine use, little is known about factors associated with smoking crack in public and related risks such as rushed public crack smoking. METHODS Data were derived from two prospective cohort studies of people who use illicit drugs in Vancouver, Canada between 2010 and 2014. Multivariable generalized estimating equations were used to identify the prevalence and correlates of public crack smoking and rushed public crack smoking. RESULTS In total, 1085 participants who had smoked crack in the prior six months were eligible for the analysis, of which 379 (34.9 %) reported always or usually smoking crack in public in the previous six months at some point during the study period. Factors positively and independently associated with public crack smoking included public injection drug use (adjusted odds ratio [AOR]: 5.42, 95 % confidence interval [CI]: 3.76-7.82), homelessness (AOR: 3.48, 95 % CI: 2.77-4.36), at least daily crack use (AOR: 2.69, 95 % CI: 2.19-3.31), crack pipe sharing (AOR: 1.98, 95 % CI: 1.60-2.46), drug dealing (AOR: 1.59, 95 % CI: 1.30-1.94), recent incarceration (AOR: 1.47, 95 % CI: 1.09-1.98), noticing police presence when buying or using drugs (AOR: 1.30, 95 % CI: 1.06-1.60), and younger age (AOR: 1.03, 95 % CI: 1.01-1.04). Rushed public crack smoking, which was reported by 216 (28.8 %) of 751 participants who had smoked crack in public at least once during the study period, was positively and independently associated with homelessness (AOR: 2.61, 95 % CI: 1.96-3.49), at least daily crack use (AOR: 1.48, 95 % CI: 1.11-1.98), crack pipe sharing (AOR: 1.44, 95 % CI: 1.10-1.89), drug dealing (AOR: 1.39, 95 % CI: 1.04-1.86), and younger age (AOR: 1.02, 95 % CI: 1.01-1.04). CONCLUSIONS A high prevalence of public crack smoking and rushed public crack smoking was observed in this setting. These findings point to the need for implementing and evaluating evidence-based public health interventions, such as supervised inhalation facilities, to reduce the risks and harms associated with smoking crack in public.
Collapse
Affiliation(s)
- Pauline Voon
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6Z 1Z3, Canada
| | - Lianping Ti
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Huiru Dong
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - M-J Milloy
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Thomas Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kanna Hayashi
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| |
Collapse
|
18
|
Fischer B, Kuganesan S, Gallassi A, Malcher-Lopes R, van den Brink W, Wood E. Addressing the stimulant treatment gap: A call to investigate the therapeutic benefits potential of cannabinoids for crack-cocaine use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1177-82. [DOI: 10.1016/j.drugpo.2015.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 01/14/2023]
|
19
|
Bergen-Cico D, Lapple A. Examination of Safe Crack Use Kit Distribution from a Public Health Perspective. WORLD MEDICAL & HEALTH POLICY 2015. [DOI: 10.1002/wmh3.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
20
|
Social and clinical predictors of drug-resistant tuberculosis in a public hospital, Monterrey, Mexico. Ann Epidemiol 2014; 24:771-5. [DOI: 10.1016/j.annepidem.2014.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/02/2014] [Accepted: 07/03/2014] [Indexed: 11/21/2022]
|
21
|
Addiction aux drogues stimulantes (cocaïne, méthamphétamine et nouveaux produits de synthèse). MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0913-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
22
|
Ersche KD, Hagan CC, Smith DG, Abbott S, Jones PS, Apergis-Schoute AM, Döffinger R. Aberrant disgust responses and immune reactivity in cocaine-dependent men. Biol Psychiatry 2014; 75:140-7. [PMID: 24090796 PMCID: PMC3898808 DOI: 10.1016/j.biopsych.2013.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infectious diseases are the most common and cost-intensive health complications associated with drug addiction. There is wide belief that drug-dependent individuals expose themselves more regularly to disease-related pathogens through risky behaviors such as sharing pipes and needles, thereby increasing their risk for contracting an infectious disease. However, evidence is emerging indicating that not only lifestyle but also the immunomodulatory effects of addictive drugs, such as cocaine, may account for their high infection risk. As feelings of disgust are thought to be an important psychological mechanism in avoiding the exposure to pathogens, we sought to investigate behavioral, physiological, and immune responses to disgust-evoking cues in both cocaine-dependent and healthy men. METHODS All participants (N = 61) were exposed to neutral and disgust-evoking photographs depicting food and nonfood images while response accuracy, latency, and skin conductivity were recorded. Saliva samples were collected before and after exposure to neutral and disgusting images, respectively. Attitudes toward disgust and hygiene behaviors were assessed using questionnaire measures. RESULTS Response times to disgust-evoking photographs were prolonged in all participants, and specifically in cocaine-dependent individuals. While viewing the disgusting images, cocaine-dependent individuals exhibited aberrant skin conductivity and increased the secretion of the salivary cytokine interleukin-6 relative to control participants. CONCLUSION Our data provide evidence of a hypersensitivity to disgusting stimuli in cocaine-dependent individuals, possibly reflecting conditioned responses to noningestive sources of infection. Coupled with a lack of interoception of bodily signals, aberrant disgust responses might lead to increased infection susceptibility in affected individuals.
Collapse
Affiliation(s)
- Karen D Ersche
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
| | - Cindy C Hagan
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Dana G Smith
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Sanja Abbott
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - P Simon Jones
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Annemieke M Apergis-Schoute
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Rainer Döffinger
- Department of Clinical Biochemistry and Immunology, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| |
Collapse
|
23
|
Welsh C, Goldberg R, Tapscott S, Medoff D, Rosenberg S, Dixon L. "Shotgunning" in a population of patients with severe mental illness and comorbid substance use disorders. Am J Addict 2012; 21:120-5. [PMID: 22332854 DOI: 10.1111/j.1521-0391.2011.00201.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
"Shotgunning" refers to the practice of one individual forcibly exhaling smoke into the mouth of another, and may increase the risk of transmission of respiratory pathogens. The extent of shotgunning among individuals with co-occurring serious mental illness and substance use is unknown. We included questions about shotgunning in an interview of 236 participants of a study testing a model to prevent and treat HIV and hepatitis. Shotgunning was common (61% [145/236]) and correlated with increased substance use severity and several high-risk behaviors. Only 8% (11/145) understood that shotgunning could transmit disease. Further research and patient education on shotgunning is warranted.
Collapse
Affiliation(s)
- Christopher Welsh
- Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
| | | | | | | | | | | |
Collapse
|
24
|
Domanico A, Malta M. Implementation of harm reduction toward crack users in Brazil: barriers and achievements. Subst Use Misuse 2012; 47:535-46. [PMID: 22428821 DOI: 10.3109/10826084.2012.644170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
From 2002 to 2005, we evaluated five Brazilian harm reduction programs ran by active drug users who distributed pipes, condoms, educational material, and provided referral to crack users. System-wide barriers identified: funds discontinuation and legislation barriers toward fieldwork. Major achievements: increased access to health, social, and psychological support. Crack-cocaine users experience a plethora of health/social problems, attenuated by low-threshold and user-friendly interventions, particularly those developed by other drug users. However, a stronger political commitment is needed to face a fast growing crack-cocaine epidemic in Brazil, aiming to ensure availability/continuity of funds, implementation of large-scale interventions, outreach workers training, and proper evaluation.
Collapse
|
25
|
|
26
|
|
27
|
Do crack smoking practices change with the introduction of safer crack kits? Canadian Journal of Public Health 2011. [PMID: 21714316 DOI: 10.1007/bf03404893] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Crack smoking has increased in Vancouver despite the harms associated with its use. Many people who smoke crack share their equipment, thereby increasing their risk for infectious disease. This project explored the effects of outreach distribution of "safer crack kits" on smoking practices. METHODS Two cross-sectional surveys were conducted, the first prior to kit distribution and the second a year later. Participants were individuals who smoked crack and lived in Vancouver's inner city. Crack smoking practices and use of items in the crack kit were documented. RESULTS The results of the second survey (i.e., following 12 months of kit distribution) showed an increase in availability and use of safer use items; mouthpieces and condoms provided in the kit were used by 79% and 59% of recipients, respectively. Unsafe practices were reported post distribution: although 42% used brass screens, the majority reported that they usually used Brillo; over 40% of respondents reported using syringe plungers to scrape crack resin; and participants reported sharing crack-use paraphernalia. CONCLUSION While kit distribution made safer use items more accessible, its impact on safer use practice was limited. Our findings highlight the need for targeted distribution of safer use items. Future research should explore the dynamics of unsafe crack smoking practices and ways to leverage safer use messaging.
Collapse
|
28
|
Mitruka K, Oeltmann JE, Ijaz K, Haddad MB. Tuberculosis outbreak investigations in the United States, 2002-2008. Emerg Infect Dis 2011; 17:425-31. [PMID: 21392433 PMCID: PMC3166029 DOI: 10.3201/eid1703.101550] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To understand circumstances of tuberculosis transmission that strain public health resources, we systematically reviewed Centers for Disease Control and Prevention (CDC) staff reports of US outbreaks in which CDC participated during 2002–2008 that involved >3 culture-confirmed tuberculosis cases linked by genotype and epidemiology. Twenty-seven outbreaks, representing 398 patients, were reviewed. Twenty-four of the 27 outbreaks involved primarily US-born patients; substance abuse was another predominant feature of outbreaks. Prolonged infectiousness because of provider- and patient-related factors was common. In 17 outbreaks, a drug house was a notable contributing factor. The most frequently documented intervention to control the outbreak was prioritizing contacts according to risk for infection and disease progression to ensure that the highest risk contacts were completely evaluated. US-born persons with reported substance abuse most strongly characterized the tuberculosis outbreaks in this review. Substance abuse remains one of the greatest challenges to controlling tuberculosis transmission in the United States.
Collapse
Affiliation(s)
- Kiren Mitruka
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E10, Atlanta, GA 30333, USA.
| | | | | | | |
Collapse
|
29
|
Perri BR, Proops D, Moonan PK, Munsiff SS, Kreiswirth BN, Kurepina N, Goranson C, Ahuja SD. Mycobacterium tuberculosis cluster with developing drug resistance, New York, New York, USA, 2003-2009. Emerg Infect Dis 2011; 17:372-378. [PMID: 21392426 PMCID: PMC3166009 DOI: 10.3201/eid1703.101002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In 2004, identification of patients infected with the same Mycobacterium tuberculosis strain in New York, New York, USA, resulted in an outbreak investigation. The investigation involved data collection and analysis, establishing links between patients, and forming transmission hypotheses. Fifty-four geographically clustered cases were identified during 2003–2009. Initially, the M. tuberculosis strain was drug susceptible. However, in 2006, isoniazid resistance emerged, resulting in isoniazid-resistant M. tuberculosis among 17 (31%) patients. Compared with patients with drug-susceptible M. tuberculosis, a greater proportion of patients with isoniazid-resistant M. tuberculosis were US born and had a history of illegal drug use. No patients named one another as contacts. We used patient photographs to identify links between patients. Three links were associated with drug use among patients infected with isoniazid-resistant M.tuberculosis. The photographic method would have been more successful if used earlier in the investigation. Name-based contact investigation might not identify all contacts, particularly when illegal drug use is involved.
Collapse
|
30
|
Roy A, Abubakar I, Chapman A, Andrews N, Pattinson M, Lipman M, Rodrigues LC, Figueroa J, Tamne S, Catchpole M. A controlled trial of the knowledge impact of tuberculosis information leaflets among staff supporting substance misusers: pilot study. PLoS One 2011; 6:e20875. [PMID: 21698103 PMCID: PMC3117836 DOI: 10.1371/journal.pone.0020875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 05/11/2011] [Indexed: 11/18/2022] Open
Abstract
Background Information leaflets are widely used to increase awareness and knowledge of disease. Limited research has, to date, been undertaken to evaluate the efficacy of these information resources. This pilot study sought to determine whether information leaflets developed specifically for staff working with substance mis-users improved knowledge of tuberculosis (TB). Method Staffs working with individuals affected by substance mis-use were recruited between January and May 2008. All participants were subjectively allocated by their line manager either to receive the TB-specific leaflet or a control leaflet providing information on mental health. Level of knowledge of TB was assessed using questionnaires before and after the intervention and data analysed using McNemar's exact test for matched pairs. Results The control group showed no evidence of a change in knowledge of TB, whereas the TB questionnaire group demonstrated a significant increase in knowledge including TB being curable (81% correct before to 100% correct after), length of treatment required (42% before to 73% after), need to support direct observation (18% to 62%) and persistent fever being a symptom (56% to 87%). Among key workers, who have a central role in implementing a care plan, 88% reported never receiving any TB awareness-raising intervention prior to this study, despite 11% of all respondents having TB diagnosed among their clients. Conclusion Further randomized controlled trials are required to confirm the observed increase in short-term gain in knowledge and to investigate whether knowledge gain leads to change in health status.
Collapse
Affiliation(s)
- Anjana Roy
- Health Protection Services, Health Protection Agency, Colindale, London, United Kingdom
| | - Ibrahim Abubakar
- Health Protection Services, Health Protection Agency, Colindale, London, United Kingdom
- * E-mail:
| | - Ann Chapman
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Nick Andrews
- Health Protection Services, Health Protection Agency, Colindale, London, United Kingdom
| | - Mike Pattinson
- Operations Department, Crime Reduction Initiatives, Brighton, United Kingdom
| | - Marc Lipman
- Royal Free Hospital NHS Trust, Respiratory Medicine, Royal Free Hospital, London, United Kingdom
| | - Laura C. Rodrigues
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jose Figueroa
- Department of Public Health, NHS City and Hackney, London, United Kingdom
| | - Surinder Tamne
- Health Protection Services, Health Protection Agency, Colindale, London, United Kingdom
| | - Mike Catchpole
- Health Protection Services, Health Protection Agency, Colindale, London, United Kingdom
| |
Collapse
|
31
|
Gardy JL, Johnston JC, Ho Sui SJ, Cook VJ, Shah L, Brodkin E, Rempel S, Moore R, Zhao Y, Holt R, Varhol R, Birol I, Lem M, Sharma MK, Elwood K, Jones SJM, Brinkman FSL, Brunham RC, Tang P. Whole-genome sequencing and social-network analysis of a tuberculosis outbreak. N Engl J Med 2011; 364:730-9. [PMID: 21345102 DOI: 10.1056/nejmoa1003176] [Citation(s) in RCA: 520] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND An outbreak of tuberculosis occurred over a 3-year period in a medium-size community in British Columbia, Canada. The results of mycobacterial interspersed repetitive unit-variable-number tandem-repeat (MIRU-VNTR) genotyping suggested the outbreak was clonal. Traditional contact tracing did not identify a source. We used whole-genome sequencing and social-network analysis in an effort to describe the outbreak dynamics at a higher resolution. METHODS We sequenced the complete genomes of 32 Mycobacterium tuberculosis outbreak isolates and 4 historical isolates (from the same region but sampled before the outbreak) with matching genotypes, using short-read sequencing. Epidemiologic and genomic data were overlaid on a social network constructed by means of interviews with patients to determine the origins and transmission dynamics of the outbreak. RESULTS Whole-genome data revealed two genetically distinct lineages of M. tuberculosis with identical MIRU-VNTR genotypes, suggesting two concomitant outbreaks. Integration of social-network and phylogenetic analyses revealed several transmission events, including those involving "superspreaders." Both lineages descended from a common ancestor and had been detected in the community before the outbreak, suggesting a social, rather than genetic, trigger. Further epidemiologic investigation revealed that the onset of the outbreak coincided with a recorded increase in crack cocaine use in the community. CONCLUSIONS Through integration of large-scale bacterial whole-genome sequencing and social-network analysis, we show that a socioenvironmental factor--most likely increased crack cocaine use--triggered the simultaneous expansion of two extant lineages of M. tuberculosis that was sustained by key members of a high-risk social network. Genotyping and contact tracing alone did not capture the true dynamics of the outbreak. (Funded by Genome British Columbia and others.).
Collapse
Affiliation(s)
- Jennifer L Gardy
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Ribeiro LA, Sanchez ZM, Nappo SA. Surviving crack: a qualitative study of the strategies and tactics developed by Brazilian users to deal with the risks associated with the drug. BMC Public Health 2010; 10:671. [PMID: 21050465 PMCID: PMC3091576 DOI: 10.1186/1471-2458-10-671] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 11/04/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to marginalization, trafficking violence, conflicts with the police and organic and social psychological problems associated with the drug, crack is one of the most devastating drugs currently in use. However, there is evidence that some users manage to stay alive and active while using crack cocaine for many years, despite the numerous adversities and risks involved with this behavior. In this context, the aim of the present study was to identify the strategies and tactics developed by crack users to deal with the risks associated with the culture of use by examining the survival strategies employed by long-term users. METHOD A qualitative research method was used involving semi-structured, in-depth interviews. Twenty-eight crack users fulfilling a pre-defined enrollment criterion were interviewed. This criterion was defined as the long-term use of crack (i.e., at least four years). The sample was selected using information provided by key informants and distributed across eight different supply chains. The interviews were literally transcribed and analyzed via content analysis techniques using NVivo-8 software. RESULTS There was diversity in the sample with regard to economic and education levels. The average duration of crack use was 11.5 years. Respondents believed that the greatest risks of crack dependence were related to the drug's psychological effects (e.g., cravings and transient paranoid symptoms) and those arising from its illegality (e.g., clashes with the police and trafficking). Protection strategies focused on the control of the psychological effects, primarily through the consumption of alcohol and marijuana. To address the illegality of the drug, strategies were developed to deal with dealers and the police; these strategies were considered crucial for survival. CONCLUSIONS The strategies developed by the respondents focused on trying to protect themselves. They proved generally effective, though they involved risks of triggering additional problems (e.g., other dependencies) in the long term.
Collapse
Affiliation(s)
- Luciana A Ribeiro
- Universidade Federal de São Paulo/Psychobiology Department, Brazilian Center of Information of Psychotropic Drugs (CEBRID), Rua Napoleão de Barros, 925 - Vila Clementino, São Paulo, Brazil
| | - Zila M Sanchez
- Universidade Federal de São Paulo/Psychobiology Department, Brazilian Center of Information of Psychotropic Drugs (CEBRID), Rua Napoleão de Barros, 925 - Vila Clementino, São Paulo, Brazil
| | - Solange A Nappo
- Universidade Federal de São Paulo/Psychobiology Department, Brazilian Center of Information of Psychotropic Drugs (CEBRID), Rua Napoleão de Barros, 925 - Vila Clementino, São Paulo, Brazil
| |
Collapse
|
33
|
Carvalho ACC, Migliori GB, Cirillo DM. Tuberculosis in Europe: a problem of drug resistance or much more? Expert Rev Respir Med 2010; 4:189-200. [PMID: 20406085 DOI: 10.1586/ers.10.7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tuberculosis has re-emerged as a public health concern in high-income countries in the last few decades. The European region accounts for only 5% of world TB cases. The incidence of new TB cases in Europe varies from very low rates in Scandinavian countries (six to eight cases/100,000 population) to rates as high as 231 cases/100,000 population in Tajikistan; the Russian Federation is eleventh among the 22 high-burden TB countries. The estimated detection rate of new sputum smear-positive pulmonary cases and the treatment success rate in 2007 were poor compared with other WHO regions: 51% of cases were diagnosed and 70% of them completed a full course of anti-TB therapy, which is still a long way from the World Health Assembly targets (detection of 70% of infectious cases and successful treatment of 85% of them). The low success rate is largely attributable to the increasing number of drug-resistant TB cases: Eastern European countries are among those with the highest rates of multidrug-resistant (MDR)-TB (TB resistant to rifampicin and isoniazid) in the world. By the end of September 2009, at least one case of extensively drug-resistant TB (named XDR-TB and defined as a MDR-TB strain with additional resistance to any fluoroquinolone, and to at least one of three injectable drugs used in anti-TB treatment) had been reported by 25 countries in the WHO European Region. In Western Europe, TB continues to cause disease among elderly native-born individuals, although high-risk groups including immigrants, prisoners, HIV-infected persons and drug addicts significantly contribute to the overall burden. Improved TB control in Europe requires a large coordinated effort by all stakeholders, including governments, governmental and non-governmental institutions, as well as the academic and private sectors and affected communities.
Collapse
Affiliation(s)
- Anna C C Carvalho
- Institute of Infectious and Tropical Diseases, Università degli Studi di Brescia, Piazzale Spedali Civili 1, 25125 Brescia, Italy
| | | | | |
Collapse
|
34
|
Asghar RJ, Patlan DE, Miner MC, Rhodes HD, Solages A, Katz DJ, Beall DS, Ijaz K, Oeltmann JE. Limited utility of name-based tuberculosis contact investigations among persons using illicit drugs: results of an outbreak investigation. J Urban Health 2009; 86:776-80. [PMID: 19533366 PMCID: PMC2729866 DOI: 10.1007/s11524-009-9378-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 05/22/2009] [Indexed: 11/28/2022]
Abstract
Persons named by a patient with tuberculosis (TB) are the focus of traditional TB contact investigations. However, patients who use illicit drugs are often reluctant to name contacts. Between January 2004 and May 2005, 18 isoniazid-resistant TB cases with matching Mycobacterium tuberculosis genotypes (spoligotypes) were reported in Miami; most patients frequented crack houses and did not name potentially infected contacts. We reviewed medical records and re-interviewed patients about contacts and locations frequented to describe transmission patterns and make recommendations to control TB in this population. Observed contacts were not named but were encountered at the same crack houses as the patients. Contacts were evaluated for latent TB infection with a tuberculosis skin test (TST). All 18 patients had pulmonary TB. Twelve (67%) reported crack use and 14 (78%) any illicit drug use. Of the 187 contacts evaluated, 91 (49%) were named, 16 (8%) attended a church reported by a patient, 61 (33%) used a dialysis center reported by a patient, and 19 (10%) were observed contacts at local crack houses. Compared to named contacts, observed contacts were eight times as likely to have positive TST results (relative risk = 7.8; 95% confidence interval = 3.8-16.1). Dialysis center and church contacts had no elevated risk of a positive TST result. Testing observed contacts may provide a higher yield than traditional name-based contact investigations for tuberculosis patients who use illicit drugs or frequent venues characterized by illicit drug use.
Collapse
Affiliation(s)
- Rana Jawad Asghar
- Epidemic Intelligence Service, Office of Workforce and Career Development and Division of Global Public Health Capacity Development, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | |
Collapse
|