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Goolam Mahomed A, Maasdorp SD, Barnes R, van Aswegen H, Lupton-Smith A, Allwood B, Calligaro G, Feldman C, Kalla IS. South African Thoracic Society position statement on the management of non-cystic fibrosis bronchiectasis in adults: 2023. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i2.647. [PMID: 37638142 PMCID: PMC10450449 DOI: 10.7196/ajtccm.2023.v29i2.647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/10/2023] [Indexed: 08/29/2023] Open
Abstract
Background Bronchiectasis is a chronic lung disorder that affects the lives of many South Africans. Post-tuberculosis (TB) bronchiectasis is an important complication of previous pulmonary TB and a common cause of bronchiectasis in South Africa (SA). No previous statements on the management of bronchiectasis in SA have been published. Objectives To provide a position statement that will act as a template for the management of adult patients with bronchiectasis in SA. Methods The South African Thoracic Society appointed an editorial committee to compile a position statement on the management of adult non-cystic fibrosis (CF) bronchiectasis in SA. Results A position statement addressing the management of non-CF bronchiectasis in adults in SA was compiled. This position statement covers the epidemiology, aetiology, diagnosis, investigations and various aspects of management of adult patients with non-CF bronchiectasis in SA. Conclusion Bronchiectasis has largely been a neglected lung condition, but new research has improved the outlook for patients. Collaboration between interprofessional team members in patient management is important. In SA, more research into the epidemiology of bronchiectasis, especially post-TB bronchiectasis and HIV-associated bronchiectasis, is required. Abstract The South African Thoracic Society mandated a multidisciplinary team of healthcare providers to compile a position statement on the management of non-cystic fibrosis bronchiectasis in South Africa (SA). International guidelines on the management of bronchiectasis were reviewed and used as a basis from which the current position statement was compiled. This is the first position statement on the management of adult non-cystic fibrosis bronchiectasis in SA. A description of the epidemiology and aetiology of bronchiectasis is provided, as well as guidance on its diagnosis and management. The position statement provides guidance on the management of bronchiectasis to healthcare providers, policymakers and regulatory authorities.
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Affiliation(s)
| | - S D Maasdorp
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein,
South Africa
| | - R Barnes
- Department of Physiotherapy, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - H van Aswegen
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A Lupton-Smith
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - B Allwood
- Division of Pulmonology, Department of Internal Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Calligaro
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - C Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - I S Kalla
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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2
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Dou W, Abdalla HB, Chen X, Sun C, Chen X, Tian Q, Wang J, Zhou W, Chi W, Zhou X, Ye H, Bi C, Tian X, Yang Y, Wong A. ProbResist: a database for drug-resistant probiotic bacteria. Database (Oxford) 2022; 2022:6665407. [PMID: 35962763 PMCID: PMC9375527 DOI: 10.1093/database/baac064] [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: 10/19/2021] [Revised: 07/04/2022] [Accepted: 08/06/2022] [Indexed: 11/13/2022]
Abstract
Drug resistance remains a global threat, and the rising trend of consuming probiotic-containing foods, many of which harbor antibiotic resistant determinants, has raised serious health concerns. Currently, the lack of accessibility to location-, drug- and species-specific information of drug-resistant probiotics has hampered efforts to combat the global spread of drug resistance. Here, we describe the development of ProbResist, which is a manually curated online database that catalogs reports of probiotic bacteria that have been experimentally proven to be resistant to antibiotics. ProbResist allows users to search for information of drug resistance in probiotics by querying with the names of the bacteria, antibiotic or location. Retrieved results are presented in a downloadable table format containing the names of the antibiotic, probiotic species, resistant determinants, region where the study was conducted and digital article identifiers (PubMed Identifier and Digital Object Identifier) hyperlinked to the original sources. The webserver also presents a simple analysis of information stored in the database. Given the increasing reports of drug-resistant probiotics, an exclusive database is necessary to catalog them in one platform. It will enable medical practitioners and experts involved in policy making to access this information quickly and conveniently, thus contributing toward the broader goal of combating drug resistance.
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Affiliation(s)
- Wanying Dou
- Department of Computer Science, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
| | - Hemn Barzan Abdalla
- Department of Computer Science, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
| | - Xu Chen
- Department of Computer Science, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
| | - Changyi Sun
- Department of Biology, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
| | - Xuefei Chen
- Department of Biology, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
| | - Qiwen Tian
- Department of Biology, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
| | - Junyi Wang
- Department of Biology, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
| | - Wei Zhou
- Department of Biology, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
| | - Wei Chi
- Department of Biology, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
| | - Xuan Zhou
- Department of Biology, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
| | - Hailv Ye
- Department of Biology, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
| | - Chuyun Bi
- Department of Biology, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
- Wenzhou Municipal Key Lab for Applied Biomedical and Biopharmaceutical Informatics , Ouhai, Wenzhou, Zhejiang 325060, China
- Zhejiang Bioinformatics International Science and Technology Cooperation Center , Ouhai, Wenzhou, Zhejiang 325060, China
| | - Xuechen Tian
- Wenzhou Municipal Key Lab for Applied Biomedical and Biopharmaceutical Informatics , Ouhai, Wenzhou, Zhejiang 325060, China
- Zhejiang Bioinformatics International Science and Technology Cooperation Center , Ouhai, Wenzhou, Zhejiang 325060, China
| | - Yixin Yang
- Wenzhou Municipal Key Lab for Applied Biomedical and Biopharmaceutical Informatics , Ouhai, Wenzhou, Zhejiang 325060, China
- Zhejiang Bioinformatics International Science and Technology Cooperation Center , Ouhai, Wenzhou, Zhejiang 325060, China
| | - Aloysius Wong
- Department of Biology, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
- Wenzhou Municipal Key Lab for Applied Biomedical and Biopharmaceutical Informatics , Ouhai, Wenzhou, Zhejiang 325060, China
- Zhejiang Bioinformatics International Science and Technology Cooperation Center , Ouhai, Wenzhou, Zhejiang 325060, China
- Department of Computer Science, College of Science and Technology, Wenzhou-Kean University , 88 Daxue Road, Ouhai, Wenzhou, Zhejiang 325060, China
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3
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Sinitsyn MV, Kalinina MV, Belilovskiy EM, Galstyan AS, Reshetnikov MN, Plotkin DV. [The treatment of tuberculosis under current conditions]. TERAPEVT ARKH 2020; 92:86-94. [PMID: 33346467 DOI: 10.26442/00403660.2020.08.000762] [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: 09/01/2020] [Indexed: 12/25/2022]
Abstract
AIM Study of the current state of problems of treatment of patients with tuberculosis based on literature data and their own experience. MATERIALS AND METHODS In the Russian Federation, the number and proportion of patients with co-infection with HIV/tuberculosis continues to increase against the background of improvement in the main epidemiological indicants for tuberculosis. In 2017, 20.9% of newly diagnosed tuberculosis patients had HIV infection. The combination of the two infections significantly complicates the further improvement of the situation with tuberculosis, and the appearance of drug-resistant strains of Mycobacterium tuberculosis sometimes completely neutralizes the results of chemotherapy. The article describes the schemes of modern tuberculosis chemotherapy taking into account HIV/tuberculosis co-infection, as well as MDR in combination with surgical treatment methods, as well as analyzes the data of epidemiological monitoring of treatment of 1115 tuberculosis patients newly diagnosed in 2017 in Moscow, 360 tuberculosis patients with MDR MBT (cohort 20132014), the results of treatment with the use of new chemotherapy regimens for tuberculosis (bedaquiline, linezolid, moxifloxacin) in 36 patients, the effectiveness and safety of surgical methods in 192 patients. RESULTS The application of new individualized anti-TB chemotherapy schedules in patients with HIV co-infection/tuberculosis with MDR-MBT has allowed to improve the treatment efficacy. The surgical intervention combined with modern chemotherapy regimens in patients with HIV/tuberculosis co-infection with MDR MBT has been proved to be effective and safe, contributes to the improving the results of treatment for this category of patients. CONCLUSION The confluence of two global problems of co-infection HIV/TB and MDR TB, significantly prevents from the end of the tuberculosis epidemic in the world. At the same time, advances in the development and implementation of new anti-TB drugs and surgical treatment methods give hope for significant progress for resolving this situation.
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Affiliation(s)
- M V Sinitsyn
- Moscow Research and Clinical Center for Tuberculosis Control
| | - M V Kalinina
- Moscow Research and Clinical Center for Tuberculosis Control
| | - E M Belilovskiy
- Moscow Research and Clinical Center for Tuberculosis Control
| | - A S Galstyan
- Moscow Research and Clinical Center for Tuberculosis Control
| | - M N Reshetnikov
- Moscow Research and Clinical Center for Tuberculosis Control
| | - D V Plotkin
- Moscow Research and Clinical Center for Tuberculosis Control
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4
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Nathavitharana RR, Lederer P, Tierney DB, Nardell E. Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2020; 23:396-404. [PMID: 31064617 DOI: 10.5588/ijtld.18.0276] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) represents a major programmatic challenge at the national and global levels. Only ∼30% of patients with multidrug-resistant TB (MDR-TB) were diagnosed, and ∼25% were initiated on treatment for MDR-TB in 2016. Increasing evidence now points towards primary transmission of DR-TB, rather than inadequate treatment, as the main driver of the DR-TB epidemic. The cornerstone of DR-TB transmission prevention should be earlier diagnosis and prompt initiation of effective treatment for all patients with DR-TB. Despite the extensive scale-up of Xpert® MTB/RIF testing, major implementation barriers continue to limit its impact. Although there is longstanding evidence in support of the rapid impact of treatment on patient infectiousness, delays in the initiation of effective DR-TB treatment persist, resulting in ongoing transmission. However, it is also imperative to address the burden of latent drug-resistant tuberculous infection because it is estimated that many DR-TB patients will become infectious before seeking care and encounter various diagnostic delays before treatment. Addressing latent DR-TB primarily consists of identifying, treating and following the contacts of patients with MDR-TB, typically through household contact evaluation. Adjunctive measures, such as improved ventilation and use of germicidal ultraviolet technology can further reduce TB transmission in high-risk congregate settings. Although many gaps remain in our biological understanding of TB transmission, implementation barriers to early diagnosis and rapid initiation of effective DR-TB treatment can and must be overcome if we are to impact DR-TB incidence in the short and long term.
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Affiliation(s)
- R R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - P Lederer
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - D B Tierney
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - E Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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5
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Do specialist pulmonologists appropriately utilise thoracic surgery for drug-resistant pulmonary tuberculosis? A survey. Afr J Thorac Crit Care Med 2018; 24. [PMID: 34541507 PMCID: PMC8424776 DOI: 10.7196/sarj.2018.v24i3.185] [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] [Accepted: 02/26/2018] [Indexed: 11/08/2022] Open
Abstract
Background
Adjuvant lung resection in patients with drug-resistant tuberculosis (DR-TB) not only is cheaper than a 2-month course of drug
therapy for multidrug-resistant tuberculosis (MDR-TB) but also, more importantly, has a higher cure rate than medical therapy alone. The
cure rate for some MDR-TB patients treated with adjuvant lung resection is about 90%. With the more severe forms of DR-TB, surgical cure
rates in selected patients remain high, whereas cure rates decrease when only medical therapy is used. In addition, adjuvant lung resection
for DR-TB in selected patients with HIV co-infection does not appear to have a higher complication rate.
Objectives
To determine whether specialist pulmonologists in South Africa utilise thoracic surgical intervention for DR-TB appropriately.
Methods
A cross-sectional survey was conducted among pulmonologists of the South African Thoracic Society. The study tool was a
predesigned, anonymous questionnaire that included 17 closed-ended questions about the role of cardiothoracic surgery in the management
of DR-TB.
Results
A 50% response rate was achieved. The majority of respondents did not know the indications for adjuvant lung surgery in the setting
of DR-TB, but would have altered their referral behaviour had they been aware of these indications.
Conclusion
Participating pulmonologists’ uncertainty regarding optimal use of adjuvant lung resection for DR-TB suggests the need for
local guidelines and education initiatives relevant to the management of these patients. These strategies should include the participation of
both the pulmonologist and the cardiothoracic surgeon.
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6
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Govindaswamy A, Sakthi D, Pai R, Jeyaseelan L, Michael JS. Pyrosequencing: a rapid and effective sequencing method to diagnose drug-resistant tuberculosis. J Med Microbiol 2018; 67:1212-1216. [PMID: 30028665 DOI: 10.1099/jmm.0.000669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study was undertaken to evaluate the efficiency of the pyrosequencing (PSQ) assay for the rapid detection of resistance to rifampicin (RIF), fluoroquinolones (FQs) and second-line injectables (SLIs) such as capreomycin (CAP) and kanamycin (KAN) in Mycobacterium tuberculosis (Mtb) clinical isolates. METHODOLOGY Pyrosequencing is a simple and accurate short read DNA sequencing method for genome analysis. DNA extraction from Mtb clinical isolates was performed using Tris-HCl buffer and chloroform. The rpoB (RIF), gyrA (FQs) and rrs (aminoglycosides) genes were amplified, followed by sequencing using the PyroMark Q24 ID system. The PSQ results were compared with the results from the conventional drug susceptibility testing performed in the laboratory. RESULTS The sensitivity of the PSQ assay for the detection of resistance to RIF, FQ, CAP and KAN was 100 %, 100 %, 40 % and 50 %, respectively. The specificity of the PSQ assay was 100 %. CONCLUSION The PSQ assay is a rapid and effective method for detecting drug resistance mutations from Mtb clinical isolates in a short period of time.
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Affiliation(s)
- Aishwarya Govindaswamy
- 1Department of Clinical Microbiology, Christian Medical College, Vellore 632 004, India
| | - Dhananjayan Sakthi
- 2Department of General Pathology, Christian Medical College, Vellore 632 004, India
| | - Rekha Pai
- 2Department of General Pathology, Christian Medical College, Vellore 632 004, India
| | | | - Joy Sarojini Michael
- 1Department of Clinical Microbiology, Christian Medical College, Vellore 632 004, India
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7
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Schwellnus L, Roos R, Naidoo V. Physiotherapy management of patients undergoing thoracotomy procedure: A survey of current practice in Gauteng. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2017; 73:344. [PMID: 30135901 PMCID: PMC6093126 DOI: 10.4102/sajp.v73i1.344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 05/30/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Physiotherapy is included in the management of patients undergoing thoracic surgery. The aim of this study was to describe physiotherapy practice in the management of patients who undergo an open thoracotomy. METHODS A cross-sectional study using convenience sampling was undertaken. An electronic self-administered questionnaire was distributed via SurveyMonkey to 1389 physiotherapists registered with the South African Society of Physiotherapy in Gauteng. The data collection period was August and September 2014 and data were analysed descriptively. RESULTS A total of 323 physiotherapists (23.3%) responded to the survey and 141 (10.2%) indicated that they treated patients with open thoracotomies. Preoperative treatment was done by 65 (41.6%) and consisted of teaching supported coughing (92.3%; n = 60), sustained maximal inspiration (70.8%; n = 46) and the active cycle of breathing technique (69.2%; n = 45). One hundred and sixteen (82.3%) respondents treated patients during their hospital stay. Deep breathing exercises (97.6%; n = 83), coughing (95.3%; n = 81), early mobilisation (95.3%; n = 81), upper limb mobility exercises (91.8%; n = 78), chest wall vibrations (88.2%; n = 75) and trunk mobility exercises (85.9%; n = 73) were done frequently. Pain management modalities were less common, for example transcutaneous electrical nerve stimulation (12.9%; n = 11). Post hospital physiotherapy management was uncommon (32.6%; n = 46). CONCLUSION Physiotherapy related to early mobilisation in hospital is in line with evidence-based practice, but further education is needed regarding the need for physiotherapy post hospital discharge and pain management.
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Affiliation(s)
- Liezel Schwellnus
- Physiotherapy Department, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ronel Roos
- Physiotherapy Department, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Vaneshveri Naidoo
- Physiotherapy Department, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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8
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Ma Y, Pang Y, Du J, Liu Y, Li L, Gao W. Clinical outcomes for multi- and extensively drug resistant tuberculosis patients with adjunctive resectional lung surgery in Beijing, China. J Thorac Dis 2017; 9:841-845. [PMID: 28449494 DOI: 10.21037/jtd.2017.02.54] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of this study was to assess the performance of adjective resectional lung surgery for multidrug resistant (MDR-) and extensively drug resistant tuberculosis (XDR-TB) patients in Beijing, China. Between October 1992 and October 2012, 21 MDR/XDR patients undergoing pulmonary resection at Beijing Chest Hospital were enrolled in this study. The clinical outcomes of MDR- and XDR-TB patients were analyzed with a 3-year surgical follow-up. Out of 21 patients enrolled in this study, 20 patients (95.2%) had unilateral cavitary disease, and 1 patient (4.8%) exhibited bilateral cavitary disease. The most frequent cavitation was located in the left upper lung (38.1%, 8/21). In addition, 19 (90.5%) underwent lobectomy, and the other two (9.5%) underwent pneumonectomy due to obvious cavitation in both upper and lower fields of unilateral lung. After 3-year follow-up, eight patients (38.1%) were cured and 13 patients (61.9%) suffered from unfavorable outcomes. Of 13 patients with unfavorable outcomes, 5 patients (38.5%) died of further progression of TB disease, and 8 patients (61.5%) relapsed. Only 1 (14.3%) out of 7 XDR-TB patients was cured, compared with 7 (50.0%) out of 14 multidrug-resistant tuberculosis (MDR-TB) patients. In conclusion, our data demonstrate that if available, surgical treatment should be considered in MDR/XDR-TB patients in China. The subsequent treatment with second-line drugs may play the most important role in determining the final clinical outcome for MDR/XDR-TB patients.
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Affiliation(s)
- Yan Ma
- Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China.,Administration Office, Clinical Center on Tuberculosis, China CDC, Beijing 101149, China
| | - Yu Pang
- Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China.,National TB Clinical Laboratory, Clinical Center on Tuberculosis, China CDC, Beijing 101149, China
| | - Jian Du
- Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China.,Administration Office, Clinical Center on Tuberculosis, China CDC, Beijing 101149, China
| | - Yuhong Liu
- Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China.,Administration Office, Clinical Center on Tuberculosis, China CDC, Beijing 101149, China
| | - Liang Li
- Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China.,Administration Office, Clinical Center on Tuberculosis, China CDC, Beijing 101149, China
| | - Weiwei Gao
- Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China.,Administration Office, Clinical Center on Tuberculosis, China CDC, Beijing 101149, China
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9
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Corbetta L, Tofani A, Montinaro F, Michieletto L, Ceron L, Moroni C, Rogasi PG. Lobar Collapse Therapy Using Endobronchial Valves as a New Complementary Approach to Treat Cavities in Multidrug-Resistant Tuberculosis and Difficult-to-Treat Tuberculosis: A Case Series. Respiration 2016; 92:316-328. [DOI: 10.1159/000450757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 09/13/2016] [Indexed: 11/19/2022] Open
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10
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Famulla K, Sass P, Malik I, Akopian T, Kandror O, Alber M, Hinzen B, Ruebsamen-Schaeff H, Kalscheuer R, Goldberg AL, Brötz-Oesterhelt H. Acyldepsipeptide antibiotics kill mycobacteria by preventing the physiological functions of the ClpP1P2 protease. Mol Microbiol 2016; 101:194-209. [PMID: 26919556 DOI: 10.1111/mmi.13362] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 01/06/2023]
Abstract
The Clp protease complex in Mycobacterium tuberculosis is unusual in its composition, functional importance and activation mechanism. Whilst most bacterial species contain a single ClpP protein that is dispensable for normal growth, mycobacteria have two ClpPs, ClpP1 and ClpP2, which are essential for viability and together form the ClpP1P2 tetradecamer. Acyldepsipeptide antibiotics of the ADEP class inhibit the growth of Gram-positive firmicutes by activating ClpP and causing unregulated protein degradation. Here we show that, in contrast, mycobacteria are killed by ADEP through inhibition of ClpP function. Although ADEPs can stimulate purified M. tuberculosis ClpP1P2 to degrade larger peptides and unstructured proteins, this effect is weaker than for ClpP from other bacteria and depends on the presence of an additional activating factor (e.g. the dipeptide benzyloxycarbonyl-leucyl-leucine in vitro) to form the active ClpP1P2 tetradecamer. The cell division protein FtsZ, which is a particularly sensitive target for ADEP-activated ClpP in firmicutes, is not degraded in mycobacteria. Depletion of the ClpP1P2 level in a conditional Mycobacterium bovis BCG mutant enhanced killing by ADEP unlike in other bacteria. In summary, ADEPs kill mycobacteria by preventing interaction of ClpP1P2 with the regulatory ATPases, ClpX or ClpC1, thus inhibiting essential ATP-dependent protein degradation.
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Affiliation(s)
- Kirsten Famulla
- Department of Microbial Bioactive Compounds, Interfaculty Institute of Microbiology and Infection Medicine, University of Tuebingen, Tuebingen, Germany
| | - Peter Sass
- Department of Microbial Bioactive Compounds, Interfaculty Institute of Microbiology and Infection Medicine, University of Tuebingen, Tuebingen, Germany
| | - Imran Malik
- Department of Microbial Bioactive Compounds, Interfaculty Institute of Microbiology and Infection Medicine, University of Tuebingen, Tuebingen, Germany
| | - Tatos Akopian
- Department of Cell Biology, Harvard Medical School, Boston, MA, USA
| | - Olga Kandror
- Department of Cell Biology, Harvard Medical School, Boston, MA, USA
| | - Marina Alber
- Institute for Medical Microbiology and Hospital Hygiene, University of Duesseldorf, Duesseldorf, Germany
| | | | | | - Rainer Kalscheuer
- Institute for Medical Microbiology and Hospital Hygiene, University of Duesseldorf, Duesseldorf, Germany
| | | | - Heike Brötz-Oesterhelt
- Department of Microbial Bioactive Compounds, Interfaculty Institute of Microbiology and Infection Medicine, University of Tuebingen, Tuebingen, Germany
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11
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Jeon D. Medical Management of Drug-Resistant Tuberculosis. Tuberc Respir Dis (Seoul) 2015; 78:168-74. [PMID: 26175768 PMCID: PMC4499582 DOI: 10.4046/trd.2015.78.3.168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/15/2015] [Accepted: 03/19/2015] [Indexed: 12/20/2022] Open
Abstract
Drug-resistant tuberculosis (TB) is still a major threat worldwide. However, recent scientific advances in diagnostic and therapeutic tools have improved the management of drug-resistant TB. The development of rapid molecular testing methods allows for the early detection of drug resistance and prompt initiation of an appropriate treatment. In addition, there has been growing supportive evidence for shorter treatment regimens in multidrug-resistant TB; and for the first time in over 50 years, new anti-TB drugs have been developed. The World Health Organization has recently revised their guidelines, primarily based on evidence from a meta-analysis of individual patient data (n=9,153) derived from 32 observational studies, and outlined the recommended combination and correct use of available anti-TB drugs. This review summarizes the updated guidelines with a focus on the medical management of drug-resistant TB.
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Affiliation(s)
- Doosoo Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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