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Gaensbauer JT, Dash N, Verma S, Hall DJ, Adler-Shohet FC, Li G, Lee G, Dinnes L, Wendorf K. Multidrug-resistant tuberculosis in children: A practical update on epidemiology, diagnosis, treatment and prevention. J Clin Tuberc Other Mycobact Dis 2024; 36:100449. [PMID: 38757115 PMCID: PMC11096739 DOI: 10.1016/j.jctube.2024.100449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Pediatric multidrug-resistant tuberculosis (MDR-TB) remains a significant global problem, and there are numerous barriers preventing children with MDR-TB from being identified, confirmed with microbiologic tests, and treated with a safe, practical, and effective regimen. However, several recent advances in diagnostics and treatment regimens have the promise to improve outcomes for children with MDR-TB. We introduce this review with two cases that exemplify both the challenges in management of MDR-TB in children, but also the potential to achieve a positive outcome. More than 30,000 cases of MDR-TB per year are believed to occur in children but less than 5% are confirmed microbiologically, contributing to poorer outcomes and excess mortality. Rapid molecular-based testing that provides information on rifampin susceptibility is increasingly globally available and recommended for all children suspected of TB disease--but remains limited by challenges obtaining appropriate samples and the paucibacillary nature of most pediatric TB. More complex assays allowing better characterization of drug-resistant isolates are emerging. For children diagnosed with MDR-TB, treatment regimens have traditionally been long and utilize multiple drugs associated with significant side effects, particularly injectable agents. Several new or repurposed drugs including bedaquiline, delamanid, clofazimine and linezolid now allow most treatment regimens to be shorter and all-oral. Yet data to support short, all-oral, novel regimens for young children containing pretomanid remain insufficient at present, and there is a compelling need to conduct pediatric trials of promising therapeutics and MDR-TB treatment regimens.
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Affiliation(s)
- James T. Gaensbauer
- Mayo Clinic Center for Tuberculosis, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nabaneeta Dash
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Verma
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - DJ Hall
- Division of Pediatric Hospital Medicine, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Felice C. Adler-Shohet
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Guyu Li
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Grace Lee
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | - Laura Dinnes
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | - Kristen Wendorf
- Department of Pediatrics, University of California San Francisco Benioff Children’s Hospital, Oakland, CA, USA
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Jin C, Wu Y, Chen J, Liu J, Zhang H, Qian Q, Pang T. Prevalence and Patterns of Drug-Resistant Mycobacterium tuberculosis in Newly Diagnosed Patients in China: A Systematic Review and Meta-Analysis. J Glob Antimicrob Resist 2024:S2213-7165(24)00106-1. [PMID: 38825149 DOI: 10.1016/j.jgar.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Tuberculosis (TB), one of the deadliest infectious diseases globally, is increasingly exacerbated in China by the emergence of resistant Mycobacterium tuberculosis (MTB) strains. Drug-resistant TB, including mono-drug resistant TB, multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB), presents significant public health challenges. METHODS We conducted a systematic literature review from January 2010 to February 2024 using databases such as PubMed, Embase, Web of Science, and Google Scholar. Our focus was on empirical data related to drug resistance patterns in newly diagnosed TB cases. Non-empirical studies were excluded through meticulous filtering. For meta-analysis, we used Review Manager (RevMan) 5.2 and assessed evidence quality using the Newcastle-Ottawa Scale (NOS). RESULTS Our search strategy identified 40 studies that met the inclusion criteria, encompassing a total sample size of 87,667 participants. Among new TB cases, the estimated prevalence of MDR-TB in China was 6.9% (95% CI: 5.6-8.1%). Prevalence rates for mono-drug resistance to first-line anti-TB medications were as follows: isoniazid at 18.2% (95% CI: 16.4-20.6%), rifampicin at 10.5% (95% CI: 8.6-12.8%), and ethambutol at 5.7% (95% CI: 4.1-7.3%). The prevalence of streptomycin resistance, a former first-line anti-TB drug, was 17.1% (95% CI: 14.6-19.1%). The prevalence of other types of mono-drug resistance was 15.2% (95% CI: 13.9-17.3%), and for XDR-TB, it was 0.9% (95% CI: 0.6-1.4%). CONCLUSIONS The high prevalence of drug-resistant TB in China poses a significant public health challenge. There is an urgent need for targeted interventions and continued surveillance to combat the spread of drug-resistant TB.
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Affiliation(s)
- Cong Jin
- School of Public Health, North China University of Science and Technology, Tangshan City, Hebei Province, 063210, China
| | - Yuting Wu
- School of Public Health, North China University of Science and Technology, Tangshan City, Hebei Province, 063210, China
| | - Jiangpo Chen
- Biotecnovo (Langfang) Medical Lab Co. Ltd., Langfang City, Heibei Province, 065001, China
| | - Jing Liu
- Department of Pharmacy, Guangyang Maternal and Child Care Health Hospital, Langfang City, Hebei Province, 065000, China
| | - Hongwei Zhang
- General Practice Department, The Fourth People's Hospital of Langfang, Langfang City, Hebei Province, 065700, China
| | - Qingzeng Qian
- School of Public Health, North China University of Science and Technology, Tangshan City, Hebei Province, 063210, China; Hebei Coordinated Innovation Center of Occupational Health and Safety, Tangshan City, Hebei Province, 063210, China.
| | - Tieliang Pang
- Biotecnovo (Langfang) Medical Lab Co. Ltd., Langfang City, Heibei Province, 065001, China.
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Li M, Deng B, Huang Y, Li Q, Han J, Tang S, Chen L. Trends and risk factors for drug-resistant tuberculosis among children in Sichuan, China: A 10-year retrospective analysis, 2013-2022. Medicine (Baltimore) 2024; 103:e37643. [PMID: 38608104 PMCID: PMC11018228 DOI: 10.1097/md.0000000000037643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/27/2024] [Indexed: 04/14/2024] Open
Abstract
To investigate the status of the drug-resistant tuberculosis (DR-TB) among children in Sichuan, and to find out the risk factors and high-risk population related to drug resistance among children. The clinical data of tuberculosis patients ≤14 years old with culture-confirmed tuberculosis hospitalized in Chengdu Public Health Clinical Center from January 2013 through December 2022 were collected. Clinical data such as gender, age, ethnicity, history of anti-TB treatment, history of exposure to tuberculosis, nutritional status, and specific drug resistance of the children were collected and recorded. The drug resistance of children in different age groups (0-4 years old, 5-9 years old, 10-14 years old) and different periods (2013-2017 and 2018-2022) were grouped and compared. Logistic regression analysis was to analyze analysis of risk factors of drug resistance in children. A total of 438 children with culture-confirmed tuberculosis were screened. Among them, 26.19% (11/42) were 0 to 4 years old, 33.33% (22/66) were 5 to 9 years old, and 36.67% (121/330) were 10 to 14 years old among the resistant children. There was no statistically significant difference in the resistance rate among the 3 groups (P = .385). The proportions of DR-TB, monoresistant tuberculosis, polydrug-resistant tuberculosis were decreased during 2019 to 2022 compared with 2013 to 2017 (P < .0001). The resistance rates of drug resistant, monoresistant, polydrug-resistant, isoniazid-resistant, and rifampicin resistant during 2018 to 2022 were decreased compared with those from 2013 to 2017 (P < .05), but the multi-drug resistance rate was not decreased (P = .131, without statistical difference). The results of logistic regression analysis showed that male gender OR = 1.566 (95% CI 1.035-2.369), a history of antituberculosis therapy OR = 4.049 (95% CI 1.442-11.367), and pulmonary and extrapulmonary tuberculosis OR = 7.335 (95% CI 1.401-38.392) were risk factors for the development of drug resistance; but fever OR = 0.581 (95% CI 0.355-0.950) was Protective factor. The total drug resistance rate of children in Sichuan showed a downward trend, but the rate of multi-drug-resistant tuberculosis was still at a high level, and the form of drug resistance was still severe. Absence of fever, male, retreatment, and pulmonary concurrent with extrapulmonary tuberculosis are risk factors for DR-TB in children.
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Affiliation(s)
- Maoying Li
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
| | - Bin Deng
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
| | - Yuhong Huang
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
| | - Qiong Li
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
| | - Jing Han
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
| | | | - Lei Chen
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
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Sun WW, Yang M, Chen XH, Fan LC, Wu HY, Zhang SJ, Chen Y, Fan L. Efficacy and safety of the all-oral bedaquiline-containing regimen as treatment for pediatric multidrug/rifampicin-resistant tuberculosis: a multicenter, retrospective, cohort study. Expert Rev Anti Infect Ther 2024; 22:219-227. [PMID: 37982155 DOI: 10.1080/14787210.2023.2285917] [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] [Received: 07/21/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE The study aimed to observe the efficacy and safety of an all-oral bedaquiline (BDQ)-containing regimen for pediatric multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) through a multicenter, retrospective study in China. METHODS In the study, pediatric patients receiving all-oral BDQ-containing regimen (BDQ group) with clinical matched control group were included, the control group received an injection-containing regimen. The treatment outcomes and the incidence of adverse events (AEs) were compared and analyzed. RESULTS 79 pediatric patients were enrolled, including 37 cases in BDQ group and 42 cases in the control group, the median age was 12 {8-16} and 11 {9-15} in both groups respectively. Favorable treatment outcome and cure rate in BDQ group were significantly higher than those in control group (100%vs 83.3%, p 0.03; 94.6%vs 63.3%, p 0.00). Median time of sputum culture conversion in BDQ group was significantly shorter than that in the control group (4 weeks vs 8 weeks, p 0.00). The incidence of AEs in the BDQ group was significantly less than that in the control group (48.6% vs 71.4%, p 0.03). No AEs leading to treatment discontinuation of BDQ occurred. CONCLUSIONS The all-oral BDQ-containing regimens may be effective and safe in the Chinese pediatric population.
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Affiliation(s)
- Wen-Wen Sun
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai, China
| | - Ming Yang
- Department of Tuberculosis, Chengdu Public Health Center, Chengdu, Sichuan Province, China
| | - Xiao-Hong Chen
- Department of Tuberculosis, Fuzhou Pulmonary Hospital, Fuzhou, Fujian Province, China
| | - Li-Chao Fan
- Department of Tuberculosis, Shenyang Tenth People's Hospital, Shenyang Chest Hospital, Shenyang, Liaoning Province, China
| | - Hao-Yu Wu
- Department of Tuberculosis, Shenyang Tenth People's Hospital, Shenyang Chest Hospital, Shenyang, Liaoning Province, China
| | - Shao-Jun Zhang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai, China
| | - Yu Chen
- Department of Tuberculosis, Shenyang Tenth People's Hospital, Shenyang Chest Hospital, Shenyang, Liaoning Province, China
| | - Lin Fan
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai, China
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Sun J, Fan L, Zhao Y, Wu H, Li R, Tian Y, Cheng M, Ma X, Ma Y, Yang X, Shen A, Yu Y, Chen Y. Analysis of Drug-Resistant Tuberculosis in Children in Shenyang, China, 2017-2021. Infect Drug Resist 2023; 16:6983-6998. [PMID: 37933293 PMCID: PMC10625755 DOI: 10.2147/idr.s428720] [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: 08/03/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
Objective Drug-resistant tuberculosis (DR-TB) in children seriously threatens TB control. Information on the epidemiology and characteristics of DR-TB in children in China is limited. We studied data in Shenyang Tenth People's Hospital to understand the DR-TB epidemiology in children in Shenyang. Design or Methods We retrospectively analyzed drug resistance testing data of pediatric TB patients between 2017 and 2021, and included 2976 clinically-diagnosed pediatric TB patients. We described the epidemiology of DR-TB and analyzed the trends of DR-TB incidence. The Kappa value was calculated to assess the agreement between MGIT 960 DST and Xpert MTB/RIF for detecting rifampicin resistance. Multivariate logistic regression was used to identify the risk factors for DR-TB in pediatric patients. Results Of the 2976 TB patients, 1076 were confirmed by MGIT 960 culture and/or Xpert MTB/RIF. Among the 806 patients identified by MGIT 960 culture, 232 cases (28.78%) were DR-TB. Resistance to the six drugs was in the following order: streptomycin (21.09%), isoniazid (9.35%), rifampin (15.01%), levofloxacin (6.20%), ethambutol (4.22%), and amikacin (3.23%). Alarmingly, 12.90% were MDR-TB (104/806), including 28 (3.47%) pre-XDR-TB. Of the 1076 pediatric TB patients, 295 (27.4%) developed DR-TB to any one drug (including 69 rifampicin-resistant cases identified by Xpert MTB/RIF only). No difference was found in the incidence of pediatric DR-TB between 2017 and 2021. Among 376 patients who were positive for both methods, using the MGIT 960 DST results as the gold standard, Xpert MTB/RIF's sensitivity for detecting rifampicin resistance was 91.38% and its specificity was 94.65%. Conclusion Between 2017 and 2021, the DR-TB incidence in children remained unchanged in Shenyang. RR-TB, MDR-TB, and even Pre-XDR-TB require attention in children with drug-resistant TB. Xpert MTB/RIF helped to detect more rifampicin-resistant pediatric patients; thus Xpert MTB/RIF should be widely used as an important complementary tool to detect rifampicin-resistant TB in children.
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Affiliation(s)
- Jiao Sun
- Tuberculosis Laboratory, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Lichao Fan
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Yanping Zhao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Haoyu Wu
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Ran Li
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Yao Tian
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Moxin Cheng
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Xin Ma
- Tuberculosis Laboratory, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Yingying Ma
- Tuberculosis Laboratory, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Xinru Yang
- Tuberculosis Laboratory, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Adong Shen
- National Clinical Research Center for Respiratory Disease, Beijing, People’s Republic of China
| | - Yanhong Yu
- Tuberculosis Laboratory, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
| | - Yu Chen
- Department of Tuberculosis, Shenyang Tenth People’s Hospital/Shenyang Chest Hospital, Shenyang, People’s Republic of China
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Mollalign H, Getahun M, Diriba G, Alemu A, Chala D, Tulu B, Ameni G. Genetic diversity and drug sensitivity profile of Mycobacterium tuberculosis among children in Ethiopia. PLoS One 2023; 18:e0284363. [PMID: 37506094 PMCID: PMC10381036 DOI: 10.1371/journal.pone.0284363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 03/29/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Worldwide, tuberculosis (TB) affects about one million children every year. The burden of the disease is higher in developing countries. However, there is limited information on the lineages and drug sensitivity patterns of Mycobacterium tuberculosis (M. tuberculosis) infecting children in these countries, including Ethiopia. Thus, this study aimed to characterize the different lineages of the M. tuberculosis complex causing childhood pulmonary tuberculosis and evaluate the drug-sensitivity patterns to the first-line anti-TB drugs. METHOD A total of 54 stored cultures were used in this study. The region of difference 9 (RD9) based polymerase chain reaction (PCR) and spoligotyping were employed for the identification of the isolates at the species and lineages level respectively. Lineage identification was done by using the pre-existing database. Identification of clustering of the spoligotype patterns was by using the SPOLIDB3-based model. The result was retrieved by the most probable family format. Furthermore, the phenotypic, and genotypic drug-sensitivity test (DST) was performed using Mycobacterium Growth Indicator Tube (MGIT™ 960) and GenoTypeMTBDRplus assay respectively. Data analysis was done using SPSS version 27 software. RESULT Spoligotyping produced 39 interpretable results for M. tuberculosis. The majority (74.4%) of them were clustered into 7 groups, while the rest (25.6%) were single. The Euro-American (EA) lineage was the predominant lineage (64.1%) followed by the East-African Indian (EAI) (30.8%) and M. Africanum (5.1%) lineages. The most predominant subtypes were SIT37 (15.4%), SIT149 (12.8%), SIT25 (7.7%), and SIT53 (7.7%). Furthermore, of the identified SITs, T1 and CAS families consisted of 38.5% and 28.2% of the lineages respectively. Drug susceptibility was 91.9% by phenotypic method and 97.4% by molecular assay. The overall prevalence of any resistance was 7.8% and there was a single MDR-TB. CONCLUSION Many of the isolates belong to the modern lineages (Euro American) representing the most common circulating strains in the country. More importantly, despites the tiny isolates tested, drug resistance is low. To fully describe the molecular epidemiology of MTBC lineages in children, we recommend a prospective large-scale study.
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Affiliation(s)
- Hilina Mollalign
- National Tuberculosis Reference Laboratory, TB/HIV Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Tropical and Infectious Diseases, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Muluwork Getahun
- National Tuberculosis Reference Laboratory, TB/HIV Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getu Diriba
- National Tuberculosis Reference Laboratory, TB/HIV Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ayinalem Alemu
- National Tuberculosis Reference Laboratory, TB/HIV Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Tropical and Infectious Diseases, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dawit Chala
- National Tuberculosis Reference Laboratory, TB/HIV Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Begna Tulu
- Tropical and Infectious Diseases, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Medical Laboratory Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gobena Ameni
- Tropical and Infectious Diseases, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
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Zhdanova S, Jiao WW, Sinkov V, Khromova P, Solovieva N, Mushkin A, Mokrousov I, Belopolskaya O, Masharsky A, Vyazovaya A, Rychkova L, Kolesnikova L, Zhuravlev V, Shen AD, Ogarkov O. Insight into Population Structure and Drug Resistance of Pediatric Tuberculosis Strains from China and Russia Gained through Whole-Genome Sequencing. Int J Mol Sci 2023; 24:10302. [PMID: 37373451 DOI: 10.3390/ijms241210302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to determine phenotypic and genotypic drug resistance patterns of Mycobacterium tuberculosis strains from children with tuberculosis (TB) in China and Russia, two high-burden countries for multi/extensively-drug resistant (MDR/XDR) TB. Whole-genome sequencing data of M. tuberculosis isolates from China (n = 137) and Russia (n = 60) were analyzed for phylogenetic markers and drug-resistance mutations, followed by comparison with phenotypic susceptibility data. The Beijing genotype was detected in 126 Chinese and 50 Russian isolates. The Euro-American lineage was detected in 10 Russian and 11 Chinese isolates. In the Russian collection, the Beijing genotype and Beijing B0/W148-cluster were dominated by MDR strains (68% and 94%, respectively). Ninety percent of B0/W148 strains were phenotypically pre-XDR. In the Chinese collection, neither of the Beijing sublineages was associated with MDR/pre-XDR status. MDR was mostly caused by low fitness cost mutations (rpoB S450L, katG S315T, rpsL K43R). Chinese rifampicin-resistant strains demonstrated a higher diversity of resistance mutations than Russian isolates (p = 0.003). The rifampicin and isoniazid resistance compensatory mutations were detected in some MDR strains, but they were not widespread. The molecular mechanisms of M. tuberculosis adaptation to anti-TB treatment are not unique to the pediatric strains, but they reflect the general situation with TB in Russia and China.
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Affiliation(s)
- Svetlana Zhdanova
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, 664003 Irkutsk, Russia
| | - Wei-Wei Jiao
- National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Disease, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Viacheslav Sinkov
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, 664003 Irkutsk, Russia
| | - Polina Khromova
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, 664003 Irkutsk, Russia
| | - Natalia Solovieva
- St. Petersburg Research Institute of Phthisiopulmonology, 191036 St. Petersburg, Russia
| | - Alexander Mushkin
- St. Petersburg Research Institute of Phthisiopulmonology, 191036 St. Petersburg, Russia
| | - Igor Mokrousov
- Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, 197101 St. Petersburg, Russia
- Henan International Joint Laboratory of Children's Infectious Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital Zhengzhou Children's Hospital, Zhengzhou 450012, China
| | - Olesya Belopolskaya
- The Bio-Bank Resource Center, Research Park, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Aleksey Masharsky
- The Bio-Bank Resource Center, Research Park, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Anna Vyazovaya
- Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, 197101 St. Petersburg, Russia
| | - Lubov Rychkova
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, 664003 Irkutsk, Russia
| | - Lubov Kolesnikova
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, 664003 Irkutsk, Russia
| | - Viacheslav Zhuravlev
- St. Petersburg Research Institute of Phthisiopulmonology, 191036 St. Petersburg, Russia
| | - A-Dong Shen
- National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Disease, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
- Henan International Joint Laboratory of Children's Infectious Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital Zhengzhou Children's Hospital, Zhengzhou 450012, China
| | - Oleg Ogarkov
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, 664003 Irkutsk, Russia
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Screening of Microbial Fermentation Products for Anti-M. tuberculosis Activity. Animals (Basel) 2022; 12:ani12151947. [PMID: 35953936 PMCID: PMC9367595 DOI: 10.3390/ani12151947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022] Open
Abstract
Simple Summary M. tuberculosis (M.tb) is the main pathogen of tuberculosis (TB). The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) M.tb has brought new challenges to the treatment of TB. Therefore, finding new materials for the development of natural anti-TB drugs is crucial to the prevention and treatment of TB. In order to discover new anti-TB drug materials, we isolated microorganisms from the soil and tested the anti-M.tb activity of their fermentation products. The results showed that the four fermentation products had anti-M.tb activities in vitro and in intracellular bacteria. The qPCR results showed that the four fermentation products down-regulated some growth-essential gene expression of M.tb. Thus, we speculated that the fermentation product may exert its anti-M.tb effect by down-regulating the expression of the essential genes of M.tb. Abstract Tuberculosis (TB), caused by M. tuberculosis (M.tb), is the leading infectious cause of mortality worldwide. The emergence of drug-resistant M.tb has made the control of TB more difficult. In our study, we investigated the ability of microorganism fermentation products from the soil to inhibit M.tb. We successfully identified four fermentation products (Micromonospora chokoriensis, Micromonospora purpureochromogenes, Micromonospora profundi, Streptomyces flavofungini) that inhibited the growth of M.tb in vitro and in intracellular bacteria at 25 μg/mL MIC. Importantly, the fermentation products decreased some essential gene expression levels for M.tb growth. Our data provide the possibility that microbial fermentation products have potential development value for anti-M.tb drugs.
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Song WM, Li YF, Liu YX, Liu Y, Yu CB, Liu JY, Li HC. Drug-Resistant Tuberculosis Among Children: A Systematic Review and Meta-Analysis. Front Public Health 2021; 9:721817. [PMID: 34490197 PMCID: PMC8416474 DOI: 10.3389/fpubh.2021.721817] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Drug-resistant tuberculosis (DR-TB), especially multidrug-resistant tuberculosis (MDR-TB) is a public health threat. Little is known about estimates of different profiles and rates of DR-TB among children globally. Methods: We did a systematic review and meta-analysis of observational studies reporting DR-TB among children by searching Embase, PubMed, and Scopus databases from January 1, 2000 to October 1, 2020. Publications reporting more than 60 children with bacteriological confirmed tuberculosis and phenotypical drug susceptibility testing (DST) results were included. Pooled proportions of MDR-TB and sub-analysis by age subgroups, regions, economical levels were performed. Results: We identified 4,063 studies, of which 37 were included. Of 23,652 pediatric TB patients, the proportions of DR-TB, MDR-TB, mono-resistant TB, polydrug resistant TB, extensively drug-resistant TB were 13.59% (1,964/14,453), 3.72% (881/23,652), 6.07% (529/8,719), 1.61% (119/7,361), 0.44% (30/6,763), respectively. The pooled proportion of MDR-TB among 23,652 children of 37 studies was 3.7% (95% CI, 3.5-4.0%). Rate of MDR-TB was much lower in high-income countries (1.8%) than that in lower-middle-income countries (6.3%) and upper-middle-income countries (7.3%). More specifically, the rates of MDR-TB were 1.7% in USA, 1.7% in UK, 2.9% in India, 6.0% in South Africa, 9.8% in China, respectively. Conclusions: The burden of DR-TB remains high in children, and there are potential associations between rates of pediatric MDR-TB and national economical levels. More interventions on child TB cases in low-income countries may be urgently needed in future.
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Affiliation(s)
- Wan-mei Song
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yi-fan Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yun-xia Liu
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Yao Liu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chun-bao Yu
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Jinan, China
| | - Jin-yue Liu
- Department of Intensive Care Unit, Shandong Provincial Third Hospital, Jinan, China
| | - Huai-chen Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
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10
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Zhou W, Yang B, Zou Y, Rahman K, Cao X, Lei Y, Lai R, Fu ZF, Chen X, Cao G. Screening of Compounds for Anti-tuberculosis Activity, and in vitro and in vivo Evaluation of Potential Candidates. Front Microbiol 2021; 12:658637. [PMID: 34276592 PMCID: PMC8278749 DOI: 10.3389/fmicb.2021.658637] [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] [Received: 01/26/2021] [Accepted: 05/26/2021] [Indexed: 12/12/2022] Open
Abstract
Tuberculosis (TB) is a debilitating infectious disease responsible for more than one million deaths per year. The emergence of drug-resistant TB poses an urgent need for the development of new anti-TB drugs. In this study, we screened a library of over 4,000 small molecules and found that orbifloxacin and the peptide AK15 possess significant bactericidal activity against Mycobacterium tuberculosis (Mtb) in vitro. Orbifloxacin also showed an effective ability on the clearance of intracellular Mtb and protect mice from a strong inflammatory response but not AK15. Moreover, we identified 17 nucleotide mutations responsible for orbifloxacin resistance by whole-genome sequencing. A critical point mutation (D94G) of the DNA gyrase (gyrA) gene was found to be the key role of resistance to orbifloxacin. The computational docking revealed that GyrA D94G point mutation can disrupt the orbifloxacin–protein gyrase interactions mediated by magnesium ion bridge. Overall, this study indicated the potential ability of orbifloxacin as an anti-tuberculosis drug, which can be used either alone or in combination with first-line antibiotics to achieve more effective therapy on TB.
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Affiliation(s)
- Wei Zhou
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Bing Yang
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Yanyan Zou
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Khaista Rahman
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Xiaojian Cao
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Yingying Lei
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Ren Lai
- Key Laboratory of Animal Models and Human Disease Mechanisms, Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, China
| | - Zhen F Fu
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Xi Chen
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Gang Cao
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China.,Bio-Medical Center, Huazhong Agricultural University, Wuhan, China.,Cooperative Innovation Center for Sustainable Pig Production (CICSPPS), Huazhong Agricultural University, Wuhan, China
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11
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Kuldeep J, Sharma SK, Sharma T, Singh BN, Siddiqi MI. Targeting Mycobacterium Tuberculosis Enoyl-Acyl Carrier Protein Reductase Using Computational Tools for Identification of Potential Inhibitor and their Biological Activity. Mol Inform 2020; 40:e2000211. [PMID: 33283460 DOI: 10.1002/minf.202000211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/18/2020] [Indexed: 01/07/2023]
Abstract
Enoyl-acyl carrier protein reductase (InhA) of type II fatty acid synthase system is involved in the synthesis of mycolic acids which is a major component of the bacterial cell wall. Since they are the key enzymes playing a very significant role in the FASII pathway of the bacterium. In this study, we have developed a workflow for identification of InhA inhibitors by utilizing in silico virtual screening approaches based on various machine learning algorithms followed by pharmacophore based virtual screening. The hits screened from the models were further subjected to molecular docking. Further, based on the XP docking score best twenty compounds were subjected to molecular dynamics study. Finally, nine compounds were shortlisted on the basis of best stable ligand RMSD, c-alpha RMSD, and RMSF plot for biological evaluation studies. Experimental validation of the shortlisted compounds identified one compound JFD01724 having potent inhibitory activity and was able to inhibit the growth of mycobacterium tuberculosis. Further medicinal chemistry efforts may help to improve the inhibitory potency of the identified compound.
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Affiliation(s)
- Jitendra Kuldeep
- Molecular & Structural Biology Division, CSIR-Central Drug Research Institute, Lucknow, India, 226031
| | - Sandeep K Sharma
- Microbiology Division, CSIR-Central Drug Research Institute, Lucknow, India, 226031
| | - Tanuj Sharma
- Molecular & Structural Biology Division, CSIR-Central Drug Research Institute, Lucknow, India, 226031
| | - Bhupendra N Singh
- Microbiology Division, CSIR-Central Drug Research Institute, Lucknow, India, 226031
| | - Mohammad Imran Siddiqi
- Molecular & Structural Biology Division, CSIR-Central Drug Research Institute, Lucknow, India, 226031
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12
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Xu Y, Li Q, Zhu M, Wu X, Wang D, Luo J, Li Y, Zhong J, Zeng P. The epidemiological characteristics and profile of drug-resistant tuberculosis among children with tuberculosis in Sichuan, China, 2015-2018: A retrospective study. Medicine (Baltimore) 2020; 99:e22608. [PMID: 33120748 PMCID: PMC7581151 DOI: 10.1097/md.0000000000022608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to investigate the epidemiological characteristics and profile of drug-resistant tuberculosis (DR-TB) among children with TB in Sichuan province of China.From January 2015 to December 2018, microbiological culture-confirmed child TB cases (aged <15 years old) were enrolled retrospectively. Epidemiological and clinical information from these cases, and the drug susceptibility testing results of the isolates were collected and analyzed.Of 317 culture-confirmed child TB cases, 16.7% (53/317) were aged under 5 years old. 54.9% were Tibetans, and 31.9% had clear history of contact with TB patients. More than half (53.9%) were not vaccinated by Calmette-Guérin bacillus (BCG). Thirty percent (n = 95) were diagnosed as severe TB, and 92.4% (n = 293) were new cases. The ratio of severe TB in BCG vaccinated group was significant lower than that observed in unvaccinated group (P < .01). Significantly higher proportion of severe TB among Tibetans than Han child TB cases was observed in BCG unvaccinated group (P < .01). The overall rate of DR-TB in this study was 24.3% (77/317) and 17 multidrug-resistant tuberculosis (MDR-TB) cases were identified with rate of MDR-TB at 5.4% (17/317). No extensively drug-resistant case was found. Thirteen out of 17 MDR-TB cases (76.4%) were Tibetan children. The ratio of any resistance to 4 first-line drugs identified were: isoniazid (INH), 15.5%; rifampicin (RIF), 9.1%; ethambutol, 0.6% and streptomycin, 6.0%, respectively. More than half of MDR patterns were resistant to INH + RIF (9/17), followed by at least resistance to INH + RIF + streptomycin (n = 7).This was the first investigation on the epidemiological characteristics and profiles of DR-TB among child TB cases in Southwest of China. Our findings indicated a potentially high risk of TB infection to Tibetan children in the concentrated Tibetan communities of Sichuan.
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Affiliation(s)
| | | | - Ma Zhu
- Chengdu Public Health Clinical Center
| | - Xueqi Wu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Jia Luo
- Chengdu Public Health Clinical Center
| | | | | | - Peibin Zeng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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13
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Wang MS, Liu XJ. Risk Factors for False-Negative Interferon-γ Release Assay Results in Culture-Confirmed Childhood TB. Am J Trop Med Hyg 2020; 101:1303-1307. [PMID: 31674295 DOI: 10.4269/ajtmh.18-0684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A negative interferon-γ release assay (IGRA) result might inappropriately lower the clinical suspicion for childhood tuberculosis (TB) and result in delayed treatment initiation. However, the risk factors associated with false-negative IGRA results in children remain unclear. Between May 2012 and January 2018, 156 culture-confirmed childhood TB patients who had received T-SPOT.TB test were included. Data, including demographic information and clinicopathological variables, were collected via questionnaires. Univariate and multivariate logistic regression analyses were performed to estimate the odds ratio (OR) and corresponding 95% CI of risk factors associated with false-negative T-SPOT.TB results. The positive rate of T-SPOT.TB test was 85.9% in childhood TB patients. Multivariate analysis revealed that younger age (≤ 9 years; OR = 4.782; 95% CI: 1.689, 13.539), weight for age (z-score > 0.37; OR = 4.256; 95% CI: 1.458, 12.428), and hypoproteinemia (total protein ≤ 68.4 g/L; OR = 7.131; 95% CI: 1.864, 27.271) were risk factors for false-negative T-SPOT.TB results in childhood TB. Younger age, overweight, and hypoproteinemia were found to be associated with false-negative T-SPOT.TB results in childhood TB. Health care professionals should consider these risk factors when evaluating suspected childhood TB with negative T-SPOT.TB results.
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Affiliation(s)
- Mao-Shui Wang
- Department of Lab Medicine, Shandong Provincial Chest Hospital, Jinan, China.,Department of Pediatrics, Qilu Hospital, Shandong University, Jinan, China
| | - Xin-Jie Liu
- Department of Pediatrics, Qilu Hospital, Shandong University, Jinan, China
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14
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Zhou XL, Chen QP, Wang MS. Prevalence of multidrug-resistant tuberculosis in suspected childhood tuberculosis in Shandong, China: a laboratory-based study. J Int Med Res 2019; 48:300060519869715. [PMID: 31538508 PMCID: PMC7372314 DOI: 10.1177/0300060519869715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective Currently, the prevalence of multidrug-resistant tuberculosis (MDR-TB) in
childhood tuberculosis (TB) in Shandong, China remains unclear. We
retrospectively conducted laboratory-based surveillance in a high TB burden
district, to analyze the local prevalence of MDR-TB in childhood TB. Methods We collected data, including microbiological results and demographic and
disease information, using a questionnaire and medical records. We used the
chi-squared test to compare the prevalence of MDR-TB in childhood TB between
two periods: 2008 to 2013 and 2014 to 2018. Results In Shandong, the prevalence of MDR-TB in childhood TB was low, at 5.6%.
Between 2008-2013 and 2014-2018 among children with TB, the prevalence of
MDR-TB remained unchanged, the proportion with pulmonary TB decreased from
78.3% to 64.9%, and the proportion with a TB contact history decreased from
20.5% to 9.9%. Conclusions The prevalence of MDR-TB among childhood TB in Shandong, China was low and
has remained stable over the past years. However, non-tuberculous
mycobacterial diseases may be a new challenge in the management of suspected
childhood TB.
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Affiliation(s)
- Xiao-Lin Zhou
- Department of Lab Medicine, Shandong Provincial Chest Hospital, Shandong University, Jinan, Shandong, China
| | - Qiao-Pei Chen
- Department of Clinical Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi, China
| | - Mao-Shui Wang
- Department of Lab Medicine, Shandong Provincial Chest Hospital, Shandong University, Jinan, Shandong, China
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15
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Arega B, Menbere F, Getachew Y. Prevalence of rifampicin resistant Mycobacterium tuberculosis among presumptive tuberculosis patients in selected governmental hospitals in Addis Ababa, Ethiopia. BMC Infect Dis 2019; 19:307. [PMID: 30947695 PMCID: PMC6449910 DOI: 10.1186/s12879-019-3943-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Rapid detection of rifampicin resistance is essential for early management and prevention of transmission of multidrug-resistant tuberculosis (MDR-TB). We studied the prevalence of rifampicin resistance of Mycobacterium tuberculosis (MTB) among presumptive TB patients in Addis Ababa, Ethiopia. METHODS A retrospective cross sectional study was conducted in three referral hospitals and the regional laboratory in Addis Ababa city from March 2015 to October 2017. Data was collected by data-extraction sheet from registration books. It was analyzed using SPSS version 20. Statistically significant association was taken with P < 0.05. RESULTS A total of 12,414 (11,672 adults and 742 paediatrics) TB presumptive patients were included in the study. The overall prevalence of TB was 15.11% (1876/12414) in all age groups and 13.6%(101/742) among paediatric population. Rifampicin resistant TB was 9.9% (186/1876) in all TB confirmed cases and 7.9% (8/101) in paediatric TB patients. The prevalence of rifampicin resistant TB among new and previously treated was 7.6 and 27.4%, respectively. Sex (being female) and previous TB treatment were significantly associated with rifampicin resistant TB. CONCLUSIONS Rifampicin-resistant TB is prevalent both among adult and paediatric TB patients. The strong association of rifampicin resistance with previous treatment in this study suggests the need to improve and monitor the treatment to limit the emergence of drug resistant TB.
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Affiliation(s)
- Balew Arega
- Yekatit 12 Hospital Medical College, P.O.Box 257, Addis Ababa, Ethiopia
| | - Fiqrte Menbere
- Department of Public health research emergency management core process, Addis Ababa Administrative health office regional laboratory, P.O.Box 3-30378, Addis Ababa, Ethiopia
| | - Yitagesu Getachew
- Department of internal Medicine, Yekatit 12 Hospital Medical College, P.O. Box 257, Addis Ababa, Ethiopia
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16
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Epstein RL, Bhagavathula M, Saag LA, Verma S, Kan CK, Mesick J, Kamineni P, White LF, Barnett ED, Salgame P, Hochberg NS. QuantiFERON ®-TB Gold In-Tube reliability for immigrants with parasitic infections in Boston, USA. Int J Tuberc Lung Dis 2019; 23:482-490. [PMID: 31064628 PMCID: PMC6690781 DOI: 10.5588/ijtld.18.0540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Accurate testing and treatment for latent tuberculous infection is necessary for tuberculosis elimination. Certain parasite infections are associated with increased tuberculin skin test positivity; species-specific effects on QuantiFERON®-TB Gold In-Tube (QGIT) have not been described. OBJECTIVE To determine whether infection with helminths or protozoa affects QGIT results. DESIGN We retrospectively analyzed QGIT and parasite testing results for immigrants screened in Boston, MA, USA, from 2012 to 2017. We also prospectively measured cytokines in QGIT supernatants for a subset (n = 68) with 1) helminths, 2) Blastocystis hominis, 3) other protozoa, and 4) no parasites. RESULTS Of 527 immigrants screened, 141 (26.8%) were QGIT-positive and 229 (43.4%) had parasites detected: 27/527 (5.1%) had helminths and 202/527 (38.3%) protozoa. Cytokine analysis revealed increased interleukin-10 concentrations with protozoa (P = 0.04), and non-significantly higher T-helper 2 concentrations with helminths compared with no parasites. No significant differences emerged in QGIT positivity or interferon-gamma concentrations in any group. CONCLUSION Study results support the use of QGIT in parasite-endemic settings. .
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Affiliation(s)
- R L Epstein
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Boston Medical Center, Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - M Bhagavathula
- Centre for Emerging Pathogens, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - L A Saag
- Boston University School of Public Health, Boston, Massachusetts, Department of Epidemiology, Vanderbilt University, Nashville, Tennessee
| | - S Verma
- Centre for Emerging Pathogens, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - C K Kan
- Boston University School of Public Health, Boston, Massachusetts, Boston University School of Medicine, Boston, Massachusetts
| | - J Mesick
- Boston University School of Public Health, Boston, Massachusetts, College of Osteopathic Medicine, Touro University California, Vallejo, California
| | - P Kamineni
- Boston University School of Public Health, Boston, Massachusetts
| | - L F White
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - E D Barnett
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Boston Medical Center
| | - P Salgame
- Centre for Emerging Pathogens, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - N S Hochberg
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, Boston University School of Public Health, Boston, Massachusetts
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