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Berneri M, Murray F, Davel S. A rare case of vertebral osteomyelitis with associated epidural abscess complicating BCG immunotherapy for transitional cell carcinoma of the bladder. IDCases 2023; 32:e01773. [PMID: 37187939 PMCID: PMC10176054 DOI: 10.1016/j.idcr.2023.e01773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Abstract
Bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis was first described as a vaccine against tuberculosis in 1921. The use of intravesical BCG to treat non-muscle invasive bladder cancer (NMIBC) was first described by Morales in 1921. The therapeutic effect of BCG is related to stimulation of the immune system following direct contact with tumour cells. As a result of this intended immune response some minor symptoms including fever, malaise and bladder irritation manifesting as dysuria, urinary frequency and mild haematuria, are expected. These side effects are however, generally easily managed and well tolerated. Severe complications are rare and can be temporally remote from the instillation of therapy. In this report we describe the case of a 74-year-old immunocompetent man with biopsy confirmed BCG T11/12 discitis and adjacent osteomyelitis of the T11/T12 vertebral bodies with an associated an epidural abscess following intravesical administration of BCG therapy for recurrent bladder transitional cell carcinoma (TCC).
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Affiliation(s)
- Massimo Berneri
- Joondalup Health Campus, Cnr Grant Blvd &, Shenton Ave, Joondalup, WA 6027, Australia
| | - Fionnuala Murray
- St John of God Hospital Subiaco, WA 6008, Australia
- Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia
- Corresponding author at: Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia.
| | - Sue Davel
- Joondalup Health Campus, Cnr Grant Blvd &, Shenton Ave, Joondalup, WA 6027, Australia
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Yang X, Huang J, Chen X, Xiao Z, Wang X, Chen Y, Zheng W, Chen W, Chen H, Lei S, Hu Y, Li S. Rapid and Visual Differentiation of Mycobacterium tuberculosis From the Mycobacterium tuberculosis Complex Using Multiplex Loop-Mediated Isothermal Amplification Coupled With a Nanoparticle-Based Lateral Flow Biosensor. Front Microbiol 2021; 12:708658. [PMID: 34408738 PMCID: PMC8365424 DOI: 10.3389/fmicb.2021.708658] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/06/2021] [Indexed: 01/21/2023] Open
Abstract
Tuberculosis (TB) is a chronic infectious disease mainly caused by Mycobacterium tuberculosis (MTB), but other members of the Mycobacterium tuberculosis complex (MTBC), especially Mycobacterium bovis (pyrazinamide-resistant organisms), may also be involved. Thus, the ability to rapidly detect and identify MTB from other MTBC members (e.g., M. bovis, Mycobacterium microti, Mycobacterium africanum) is essential for the prevention and treatment of TB. A novel diagnostic method for the rapid detection and differentiation of MTB, which employs multiplex loop-mediated isothermal amplification (mLAMP) combined with a nanoparticle-based lateral flow biosensor (LFB), was established (mLAMP-LFB). Two sets of specific primers that target the IS6110 and mtp40 genes were designed according to the principle of LAMP. Various pathogens were used to optimize and evaluate the mLAMP-LFB assay. The optimal conditions for mLAMP-LFB were determined to be 66°C and 40 min, and the amplicons were directly verified by observing the test lines on the biosensor. The LAMP assay limit of detection (LoD) was 125 fg per vessel for the pure genomic DNA of MTB and 4.8 × 103 CFU/ml for the sputum samples, and the analytical specificity was 100%. In addition, the whole process, including the clinical specimen processing (35 min), isothermal amplification (40 min), and result confirmation (1-2 min), could be completed in approximately 80 min. Thus, mLAMP-LFB is a rapid, reliable, and sensitive method that is able to detect representative members of MTBC and simultaneously differentiate MTB from other MTBC members, and it can be used as a potential screening tool for TB in clinical, field, and basic laboratory settings.
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Affiliation(s)
- Xinggui Yang
- Public Health School, Guizhou Medical University, Guiyang, China.,Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Junfei Huang
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Xu Chen
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China.,The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Ziyu Xiao
- Public Health School, Guizhou Medical University, Guiyang, China.,Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Xiaojuan Wang
- Public Health School, Guizhou Medical University, Guiyang, China.,Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Yijiang Chen
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Wenlin Zheng
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Wei Chen
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Huijuan Chen
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Shiguang Lei
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Yong Hu
- Public Health School, Guizhou Medical University, Guiyang, China
| | - Shijun Li
- Public Health School, Guizhou Medical University, Guiyang, China.,Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
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Mbelele PM, Sauli E, Mpolya EA, Mohamed SY, Addo KK, Mfinanga SG, Heysell SK, Mpagama S. TB or not TB? Definitive determination of species within the Mycobacterium tuberculosis complex in unprocessed sputum from adults with presumed multidrug-resistant tuberculosis. Trop Med Int Health 2021; 26:1057-1067. [PMID: 34107112 PMCID: PMC8886495 DOI: 10.1111/tmi.13638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives Differences among Mycobacterium tuberculosis complex (MTC) species may predict drug resistance or treatment success. Thus, we optimised and deployed the genotype MTBC assay (gMTBC) to identify MTC to the species level, and then performed comparative genotypic drug‐susceptibility testing to anti‐tuberculosis drugs from direct sputum of patients with presumed multidrug‐resistant tuberculosis (MDR‐TB) by the MTBDRplus/sl reference method. Methods Patients with positive Xpert® MTB/RIF (Xpert) results were consented to provide early‐morning‐sputum for testing by the gMTBC and the reference MTBDRplus/sl. Chi‐square or Fisher’s exact test compared proportions. Modified Poisson regression modelled detection of MTC by gMTBC. Results Among 73 patients, 53 (73%) were male and had a mean age of 43 (95% CI; 40–45) years. In total, 34 (47%), 36 (49%) and 38 (55%) had positive gMTBC, culture and MTBDR respectively. Forty patients (55%) had low quantity MTC by Xpert, including 31 (78%) with a negative culture. gMTBC was more likely to be positive in patients with chest cavity 4.18 (1.31–13.32, P = 0.016), high‐quantity MTC by Xpert 3.03 (1.35–6.82, P = 0.007) and sputum smear positivity 1.93 (1.19–3.14, P = 0.008). The accuracy of gMTBC in detecting MTC was 95% (95% CI; 86–98; κ = 0.89) compared to MTBDRplus/sl. All M. tuberculosis/canettii identified by gMTB were susceptible to fluoroquinolone and aminoglycosides/capreomycin. Conclusions The concordance between the gMTBC assay and MTBDRplus/sl in detecting MTC was high but lagged behind the yield of Xpert MTB/RIF. All M. tuberculosis/canettii were susceptible to fluoroquinolones, a core drug in MDR‐TB treatment regimens.
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Affiliation(s)
- Peter M Mbelele
- Kibong'oto Infectious Diseases Hospital, Kilimanjaro, Tanzania.,Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Elingarami Sauli
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Emmanuel A Mpolya
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Sagal Y Mohamed
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Kennedy K Addo
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Sayoki G Mfinanga
- National Institute for Medical Research, Muhimbili Center, Dar es salaam, Tanzania.,Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Stellah Mpagama
- Kibong'oto Infectious Diseases Hospital, Kilimanjaro, Tanzania.,Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
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Calderwood CJ, Wilson JP, Fielding KL, Harris RC, Karat AS, Mansukhani R, Falconer J, Bergstrom M, Johnson SM, McCreesh N, Monk EJM, Odayar J, Scott PJ, Stokes SA, Theodorou H, Moore DAJ. Dynamics of sputum conversion during effective tuberculosis treatment: A systematic review and meta-analysis. PLoS Med 2021; 18:e1003566. [PMID: 33901173 PMCID: PMC8109831 DOI: 10.1371/journal.pmed.1003566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 05/10/2021] [Accepted: 02/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Two weeks' isolation is widely recommended for people commencing treatment for pulmonary tuberculosis (TB). The evidence that this corresponds to clearance of potentially infectious tuberculous mycobacteria in sputum is not well established. This World Health Organization-commissioned review investigated sputum sterilisation dynamics during TB treatment. METHODS AND FINDINGS For the main analysis, 2 systematic literature searches of OvidSP MEDLINE, Embase, and Global Health, and EBSCO CINAHL Plus were conducted to identify studies with data on TB infectiousness (all studies to search date, 1 December 2017) and all randomised controlled trials (RCTs) for drug-susceptible TB (from 1 January 1990 to search date, 20 February 2018). Included articles reported on patients receiving effective treatment for culture-confirmed drug-susceptible pulmonary TB. The outcome of interest was sputum bacteriological conversion: the proportion of patients having converted by a defined time point or a summary measure of time to conversion, assessed by smear or culture. Any study design with 10 or more particpants was considered. Record sifting and data extraction were performed in duplicate. Random effects meta-analyses were performed. A narrative summary additionally describes the results of a systematic search for data evaluating infectiousness from humans to experimental animals (PubMed, all studies to 27 March 2018). Other evidence on duration of infectiousness-including studies reporting on cough dynamics, human tuberculin skin test conversion, or early bactericidal activity of TB treatments-was outside the scope of this review. The literature search was repeated on 22 November 2020, at the request of the editors, to identify studies published after the previous censor date. Four small studies reporting 3 different outcome measures were identified, which included no data that would alter the findings of the review; they are not included in the meta-analyses. Of 5,290 identified records, 44 were included. Twenty-seven (61%) were RCTs and 17 (39%) were cohort studies. Thirteen studies (30%) reported data from Africa, 12 (27%) from Asia, 6 (14%) from South America, 5 (11%) from North America, and 4 (9%) from Europe. Four studies reported data from multiple continents. Summary estimates suggested smear conversion in 9% of patients at 2 weeks (95% CI 3%-24%, 1 single study [N = 1]), and 82% of patients at 2 months of treatment (95% CI 78%-86%, N = 10). Among baseline smear-positive patients, solid culture conversion occurred by 2 weeks in 5% (95% CI 0%-14%, N = 2), increasing to 88% at 2 months (95% CI 84%-92%, N = 20). At equivalent time points, liquid culture conversion was achieved in 3% (95% CI 1%-16%, N = 1) and 59% (95% CI 47%-70%, N = 8). Significant heterogeneity was observed. Further interrogation of the data to explain this heterogeneity was limited by the lack of disaggregation of results, including by factors such as HIV status, baseline smear status, and the presence or absence of lung cavitation. CONCLUSIONS This systematic review found that most patients remained culture positive at 2 weeks of TB treatment, challenging the view that individuals are not infectious after this interval. Culture positivity is, however, only 1 component of infectiousness, with reduced cough frequency and aerosol generation after TB treatment initiation likely to also be important. Studies that integrate our findings with data on cough dynamics could provide a more complete perspective on potential transmission of Mycobacterium tuberculosis by individuals on treatment. TRIAL REGISTRATION Systematic review registration: PROSPERO 85226.
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Affiliation(s)
| | - James P. Wilson
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Rebecca C. Harris
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aaron S. Karat
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Raoul Mansukhani
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jane Falconer
- Library & Archives Service, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Malin Bergstrom
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah M. Johnson
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicky McCreesh
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Edward J. M. Monk
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jasantha Odayar
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter J. Scott
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah A. Stokes
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Theodorou
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David A. J. Moore
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Ejo M, Hassane-Harouna S, Souleymane MB, Lempens P, Dockx J, Uwizeye C, De Rijk P, Decroo T, Diro E, Torrea G, Rigouts L, Piubello A, de Jong BC. Multidrug-resistant patients receiving treatment in Niger who are infected with M. tuberculosis Cameroon family convert faster in smear and culture than those with M. tuberculosis Ghana family. Tuberculosis (Edinb) 2020; 122:101922. [PMID: 32275231 DOI: 10.1016/j.tube.2020.101922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
In this study, we analyzed the M. tuberculosis complex (MTBc) population structure among multidrug-resistant TB (MDR-TB) patients in Niger and tested whether the Cameroon family displayed a slower response to MDR-TB treatment. We genotyped baseline clinical isolates that had been collected from pulmonary MDR-TB patients recruited consecutively between 2008 and 2016 in Niger. Spoligotyping was used to analyze the genetic diversity of mycobacterial lineages, and Kaplan Meier's analysis to compare treatment outcomes. A total of 222 MTBc isolates were genotyped; 204 (91,9%) were identified as the Euro-American L4 lineage, with the Ghana family (106, 47,4%) and the Cameroon family (63, 28,4%) being predominant. Patients infected by Cameroon family isolates 61(96,8%) showed faster conversion (log-rank p < 0.01) than those infected with Ghana family isolates (91,5%), and were more likely to experience favorable outcome (adjusted odds ratio [aOR] 4.4; 95%CI 1.1-17.9]; p = 0.015). We found no association between MTBc families and second-line drug resistance profiles (p > 0.05). Our findings show that MDR-TB in Niger is caused by major spoligotypes of the Euro-American L4; with more rapid smear and culture conversion in patients infected with the Cameroon family. These first insights may alert clinicians that slow conversion may be associated with the type of infecting strain.
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Affiliation(s)
- Mebrat Ejo
- Institute of Tropical Medicine (ITM), Nationalestraat 155, B-2000, Antwerpen, Belgium; University of Gondar, P. Box 196, Gondar, Ethiopia; University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, B- 2610, Antwerpen, Wilrijk, Antwerp, Belgium
| | | | | | - Pauline Lempens
- Institute of Tropical Medicine (ITM), Nationalestraat 155, B-2000, Antwerpen, Belgium
| | - Jeroen Dockx
- University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, B- 2610, Antwerpen, Wilrijk, Antwerp, Belgium
| | - Cecile Uwizeye
- Institute of Tropical Medicine (ITM), Nationalestraat 155, B-2000, Antwerpen, Belgium
| | - Pim De Rijk
- Institute of Tropical Medicine (ITM), Nationalestraat 155, B-2000, Antwerpen, Belgium
| | - Tom Decroo
- Institute of Tropical Medicine (ITM), Nationalestraat 155, B-2000, Antwerpen, Belgium; Research Foundation Flanders, Brussels, Belgium
| | - Ermias Diro
- University of Gondar, P. Box 196, Gondar, Ethiopia
| | - Gabriela Torrea
- Institute of Tropical Medicine (ITM), Nationalestraat 155, B-2000, Antwerpen, Belgium
| | - Leen Rigouts
- Institute of Tropical Medicine (ITM), Nationalestraat 155, B-2000, Antwerpen, Belgium; University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, B- 2610, Antwerpen, Wilrijk, Antwerp, Belgium
| | - Alberto Piubello
- Damien Foundation, Brussels, Belgium; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Bouke C de Jong
- Institute of Tropical Medicine (ITM), Nationalestraat 155, B-2000, Antwerpen, Belgium.
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