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Li X, Luo X, Wang B, Fu L, Chen X, Lu Y. Clofazimine inhibits innate immunity against Mycobacterium tuberculosis by NF-κB. mSphere 2024; 9:e0025424. [PMID: 39046230 PMCID: PMC11351037 DOI: 10.1128/msphere.00254-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024] Open
Abstract
Tuberculosis (TB) remains one of the infectious diseases with high incidence and high mortality. About a quarter of the population has been latently infected with Mycobacterium tuberculosis. At present, the available TB treatment strategies have the disadvantages of too long treatment duration and serious adverse reactions. The sustained inflammatory response leads to permanent tissue damage. Unfortunately, the current selection of treatment regimens does not consider the immunomodulatory effects of various drugs. In this study, we preliminarily evaluated the effects of commonly used anti-tuberculosis drugs on innate immunity at the cellular level. The results showed that clofazimine (CFZ) has a significant innate immunosuppressive effect. CFZ significantly inhibited cytokines and type I interferons (IFNα and IFNβ) expression under both lipopolysaccharide stimulation and CFZ-resistant strain infection. In further mechanistic studies, CFZ strongly inhibited the phosphorylation of nuclear factor kappa B (NF-κB) p65 and had no significant effect on the phosphorylation of p38. In conclusion, our study found that CFZ suppresses innate immunity against Mycobacterium tuberculosis by NF-κB, which should be considered in future regimen development. IMPORTANCE The complete elimination of Mycobacterium tuberculosis (Mtb), the etiologic agent of TB, from TB patients is a complicated process that takes a long time. The excessive immune inflammatory response of the host for a long time causes irreversible organic damage to the lungs and liver. Current antibiotic-based treatment options involve multiple complex drug combinations, often targeting different physiological processes of Mtb. Given the high incidence of post-tuberculosis lung disease, we should also consider the immunomodulatory properties of other drugs when selecting drug combinations.
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Affiliation(s)
- Xinda Li
- Department of Pharmacology, Beijing Chest Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Xiaoyi Luo
- Department of Pharmacology, Beijing Chest Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Bin Wang
- Department of Pharmacology, Beijing Chest Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Lei Fu
- Department of Pharmacology, Beijing Chest Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Xi Chen
- Department of Pharmacology, Beijing Chest Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yu Lu
- Department of Pharmacology, Beijing Chest Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
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Nkereuwem E, Ageiwaa Owusu S, Fabian Edem V, Kampmann B, Togun T. Post-tuberculosis lung disease in children and adolescents: A scoping review of definitions, measuring tools, and research gaps. Paediatr Respir Rev 2024:S1526-0542(24)00055-1. [PMID: 39129097 DOI: 10.1016/j.prrv.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/06/2024] [Accepted: 07/12/2024] [Indexed: 08/13/2024]
Abstract
Tuberculosis (TB) survivors, especially children and adolescents, can develop chronic respiratory problems called post-tuberculosis lung disease (PTLD). We conducted a scoping review to identify the current knowledge gaps on PTLD definitions, measuring tools, and research specific to this age group. We searched MEDLINE, EMBASE, Global Health, CINAHL, and Web of Science for studies published between January 1, 2000, and March 1, 2024, and identified 16 studies. Our review found that no consistent definition of PTLD was used in the studies, and the measurement tools used varied widely. Moreover, there was a lack of research on children under five years old, who are disproportionately affected by TB. Also, symptom screening tools designed for adults were frequently used in these studies, raising concerns about their accuracy in detecting PTLD in children and adolescents. Several critical research gaps require attention to improve our understanding and treatment of PTLD. Firstly, the use of inconsistent definitions of PTLD across studies makes it challenging to compare research findings and gain a clear understanding of the condition. Therefore, we need to include an objective measurement of respiratory health, such as a comprehensive post-TB lung function assessment for children and adolescents. It is also crucial to determine the optimal timing and frequency of post-TB assessments for effective PTLD detection. Furthermore, we need more knowledge of the modifiable risk factors for PTLD. The scarcity of prospective studies makes it difficult to establish causality and track the long-term course of the disease in children and adolescents. Finally, current approaches to PTLD management often fail to consider patient-reported outcomes and strategies for social support. Addressing these research gaps in future studies can improve our understanding and management of paediatric PTLD, leading to better long-term health outcomes for this vulnerable population.
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Affiliation(s)
- Esin Nkereuwem
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Sheila Ageiwaa Owusu
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Victory Fabian Edem
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Charité Centre for Global Health, Institute of International Health, Berlin, Germany
| | - Toyin Togun
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; TB Centre, London School of Hygiene and Tropical Medicine, London, UK
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3
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Wu S, Zhang H, Wang Y, Wang J, Zhang P, Asakawa T, Lin Y. Call for special attention to the caregiver burden of patients with drug-resistant tuberculosis in low- and middle-income countries. Biosci Trends 2023; 17:405-408. [PMID: 37839889 DOI: 10.5582/bst.2023.01243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
The tuberculosis (TB)-related caregiver burden (CB), and particularly the multidrug and extensively drug-resistant tuberculosis (M/XDR-TB)-related CB, is not rare in caregivers caring for TB patients, especially when a family member is the caregiver. However, the existing studies on this topic are insufficient. This study briefly summarized the risk factors for the imposition of a TB-related CB and reasons why caregivers for patients with M/XDR-TB are more susceptible to a CB. We propose that special measures should be implemented to alleviate the TB-related CB based on our clinical experience and insights from China. This may improve the situation of caregivers for TB patients and ultimately improve the quality of life of TB patients.
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Affiliation(s)
- Shuqi Wu
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Hailin Zhang
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Yi Wang
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Jin Wang
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Peize Zhang
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Tetsuya Asakawa
- Institute of Neurology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Yi Lin
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
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4
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Vaishnav B, Pailla R. An Interesting Sequel of Pulmonary Tuberculosis. Cureus 2023; 15:e48928. [PMID: 38111462 PMCID: PMC10726081 DOI: 10.7759/cureus.48928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/20/2023] Open
Abstract
Tuberculosis (TB), although a preventable and curable disease, accounts for a high burden of morbidity in developing countries like India. Lung scarring and damage is a common sequel of pulmonary tuberculosis (PTB). Here, we report an interesting case of a patient with a history of PTB diagnosed four years ago and on subsequent visits was diagnosed with squamous cell carcinoma of the lung at the site of the TB scar. The development of malignancy in the old PTB scar is a controversial yet often diagnosed sequel of PTB.
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Affiliation(s)
- Bhumika Vaishnav
- General Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Ruchitha Pailla
- General Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
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5
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Ivanova O, Hoffmann VS, Lange C, Hoelscher M, Rachow A. Post-tuberculosis lung impairment: systematic review and meta-analysis of spirometry data from 14 621 people. Eur Respir Rev 2023; 32:220221. [PMID: 37076175 PMCID: PMC10113954 DOI: 10.1183/16000617.0221-2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/17/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND A substantial proportion of tuberculosis patients remain with pulmonary symptoms and reduced physical capacity despite successful treatment. We performed a systematic review to analyse the burden of post-tuberculosis lung impairment measured by lung function testing. METHODS We searched the PubMed database for articles published between database inception and November 2020 and performed meta-analyses to estimate the prevalence, type and severity of lung impairment among drug-susceptible and multidrug-resistant tuberculosis survivors. Methodological quality of included studies was assessed using the Newcastle-Ottawa scale. RESULTS 54 articles were included in this review. For subjects with former drug-susceptible tuberculosis, the combined estimated mean was 76.6% (95% CI 71.6-81.6) of predicted for forced expiratory volume in 1 s (FEV1) and 81.8% (95% CI 77.4-86.2) for forced vital capacity (FVC). In former patients with multidrug-resistant tuberculosis, it was 65.9% (95% CI 57.1-74.7) for FEV1 and 76.0% (95% CI 66.3-85.8) for FVC, respectively. The analysis of impairment types in former patients with drug-susceptible and multidrug-resistant tuberculosis showed that 22.0% versus 19.0% had obstructive, 23.0% versus 22.0% restrictive and 15.0% versus 43.0% had mixed impairment type, respectively. In the majority of studies, at least 10-15% of tuberculosis survivors had severe lung impairment. CONCLUSIONS This systematic review showed long-term abnormal spirometry results in a significant proportion of tuberculosis survivors.
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Affiliation(s)
- Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- These authors contributed equally to this manuscript
| | - Verena Sophia Hoffmann
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- These authors contributed equally to this manuscript
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Centre for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
- Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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6
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Taylor J, Bastos ML, Lachapelle-Chisholm S, Mayo NE, Johnston J, Menzies D. Residual respiratory disability after successful treatment of pulmonary tuberculosis: a systematic review and meta-analysis. EClinicalMedicine 2023; 59:101979. [PMID: 37205923 PMCID: PMC10189364 DOI: 10.1016/j.eclinm.2023.101979] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Background Pulmonary tuberculosis (PTB) can result in long-term health consequences, even after successful treatment. We conducted a systematic review and meta-analysis to estimate the occurrence of respiratory impairment, other disability states, and respiratory complications following successful PTB treatment. Methods We identified studies from January 1, 1960, to December 6, 2022, describing populations of all ages that successfully completed treatment for active PTB and had been assessed for at least one of the following outcomes: occurrence of respiratory impairment, other disability states, or respiratory complications following PTB treatment. Studies were excluded if they reported on participants with self-reported TB, extra-pulmonary TB, inactive TB, latent TB, or if participants had been selected on the basis of having more advanced disease. Study characteristics and outcome-related data were abstracted. Meta-analysis was performed using a random effects model. We adapted the Newcastle Ottawa Scale to evaluate the methodological quality of the included studies. Heterogeneity was assessed using the I2 statistic and prediction intervals. Publication bias was assessed using Doi plots and LFK indices. This study is registered with PROSPERO (CRD42021276327). Findings 61 studies with 41,014 participants with PTB were included. In 42 studies reporting post-treatment lung function measurements, 59.1% (I2 = 98.3%) of participants with PTB had abnormal spirometry compared to 5.4% (I2 = 97.4%) of controls. Specifically, 17.8% (I2 = 96.6%) had obstruction, 21.3% (I2 = 95.4%) restriction, and 12.7% (I2 = 93.2%) a mixed pattern. Among 13 studies with 3179 participants with PTB, 72.6% (I2 = 92.8%) of participants with PTB had a Medical Research Council dyspnoea score of 1-2 and 24.7% (I2 = 92.2%) a score of 3-5. Mean 6-min walk distance in 13 studies was 440.5 m (I2 = 99.0%) in all participants (78.9% predicted, I2 = 98.9%) and 403.0 m (I2 = 95.1%) among MDR-TB participants in 3 studies (70.5% predicted, I2 = 97.6%). Four studies reported data on incidence of lung cancer, with an incidence rate ratio of 4.0 (95% CI 2.1-7.6) and incidence rate difference of 2.7 per 1000 person-years (95% CI 1.2-4.2) when compared to controls. Quality assessment indicated overall low-quality evidence in this field, heterogeneity was high for pooled estimates of nearly all outcomes of interest, and publication bias was considered likely for almost all outcomes. Interpretation The occurrence of post-PTB respiratory impairment, other disability states, and respiratory complications is high, adding to the potential benefits of disease prevention, and highlighting the need for optimised management after successful treatment. Funding Canadian Institutes of Health Research Foundation Grant.
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Affiliation(s)
- Joshua Taylor
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Mayara Lisboa Bastos
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Departments of Epidemiology, Biostatistics and Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - Sophie Lachapelle-Chisholm
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Nancy E. Mayo
- Centre for Outcomes Research and Evaluation, McGill University, Montreal, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - James Johnston
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Departments of Epidemiology, Biostatistics and Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, McGill University, Montreal, QC, Canada
- Corresponding author. 5252 de Maisonneuve West, Room 3D.58, McGill University, Montreal, QC H4A 3S5, Canada.
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7
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Nightingale R, Carlin F, Meghji J, McMullen K, Evans D, van der Zalm MM, Anthony MG, Bittencourt M, Byrne A, du Preez K, Coetzee M, Feris C, Goussard P, Hirasen K, Bouwer J, Hoddinott G, Huaman MA, Inglis-Jassiem G, Ivanova O, Karmadwala F, Schaaf HS, Schoeman I, Seddon JA, Sineke T, Solomons R, Thiart M, van Toorn R, Fujiwara PI, Romanowski K, Marais S, Hesseling AC, Johnston J, Allwood B, Muhwa JC, Mortimer K. Post-TB health and wellbeing. Int J Tuberc Lung Dis 2023; 27:248-283. [PMID: 37035971 PMCID: PMC10094053 DOI: 10.5588/ijtld.22.0514] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 04/11/2023] Open
Abstract
TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the '1st International Post-Tuberculosis Symposium´ called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.
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Affiliation(s)
- R Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Respiratory Medicine, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK
| | - F Carlin
- Department of Infectious Diseases, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK
| | - J Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Respiratory Medicine, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - K McMullen
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - D Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M G Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M Bittencourt
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | - A Byrne
- Department of Thoracic Medicine, St Vincent´s Hospital Clinical School University of New South Wales, Sydney, NSW, Australia
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M Coetzee
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C Feris
- Occupational Therapy Department, Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Namibia, Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Tygerberg, South Africa
| | - P Goussard
- Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - K Hirasen
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Bouwer
- Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M A Huaman
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - G Inglis-Jassiem
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, German Centre for Infection Research, Partner Site Munich, Munich, Germany
| | - F Karmadwala
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, Department of Infectious Diseases, Imperial College London, London, UK
| | - T Sineke
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - M Thiart
- Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - R van Toorn
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - P I Fujiwara
- Task Force, Global Plan to End TB, 2023-2030, Stop TB Partnership, Geneva, Switzerland
| | - K Romanowski
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - S Marais
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa, Neurology Research Group, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Johnston
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - B Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine, Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J C Muhwa
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
| | - K Mortimer
- Department of Respiratory Medicine, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK, Department of Medicine, University of Cambridge, Cambridge, UK, Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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8
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Thoker ZA, Madan K, Mittal S, Tiwari P, Shah TH, Mohan A, Hadda V, Guleria R. Clinical Profile and Quality of Life of Patients With Post-pulmonary Tuberculosis Sequelae Presenting to a Tertiary Care Hospital. Cureus 2023; 15:e36354. [PMID: 37082491 PMCID: PMC10112386 DOI: 10.7759/cureus.36354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/21/2023] Open
Abstract
Background and objective There is a dearth of studies on the clinical presentation of patients with post-pulmonary tuberculosis (PTB) sequelae and its impact on their quality of life (QoL). In light of this, we conducted this study to analyze the clinical profile and QoL in patients with post-PTB sequelae. Methods Patients with a history of treated PTB and evidence of radiological damage were enrolled prospectively from November 2018 till June 2020 to study their clinical profile and QoL as per the eligibility criteria. A detailed clinical history was taken along with posteroanterior-view chest X-rays and CT scans of the thorax with bronchial angiography in patients with hemoptysis. QoL was assessed using the Hindi version of St. George's Respiratory Questionnaire (SGRQ) for which permission was obtained from the St. George's University of London. SGRQ scores were calculated using score calculation algorithms (Microsoft Excel-based) and missing data imputation as recommended by its developer. Results A total of 174 patients were included in the analysis. The analyzed population was relatively younger (mean age: 44.27 years) with BMIs leaning toward the lower side of normal (median: 19.6 kg/m²); the majority of the patients were males (59%) and non-smokers (77%). PTB had been diagnosed clinico-radiologically in the majority (68%) of patients with non-compliance to antitubercular treatment (ATT) being reported by only 9% of patients. Multiple courses of ATT were received by about one-third of patients, mainly on a clinico-radiologic basis. Systemic hypertension (HTN) (11%) and diabetes mellitus (DM) (9%) were the most common comorbidities. The most common symptom complex found was cough, expectoration, and dyspnea (n=102, 59%). At least one incidence of massive hemoptysis was reported by 20% of patients. Bronchial artery embolization (BAE) was performed for moderate to massive hemoptysis in 26% of patients with a success rate of >90%. One-fifth of the study participants required hospitalization for exacerbation of respiratory symptoms with more than half of these (59%) requiring ventilatory support. Health-related QoL was significantly impaired as reflected by a median SGRQ total score of 45.53. The most affected domain of QoL was the activity domain (mean score: 45.47). Females had worse QoL as compared to males (p=0.0062), and so did underweight patients (p=0.048). The prolonged duration of the illness also significantly impaired the QoL (p<0.001, r=0.313). Conclusion The sequelae of PTB are under-recognized even among physicians and are frequently misdiagnosed as active PTB. The QoL is more severely affected due to residual damage. This study highlights the clinical profile of this patient population and underscores the need to recognize post-PTB sequelae as a separate entity. An important remedy to mitigate its long-term consequences is its inclusion and recognition in national and international TB guidelines to facilitate its early identification and promote further research to address its evidence-based management.
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9
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Akalu TY, Clements AC, Wolde HF, Alene KA. Prevalence of long-term physical sequelae among patients treated with multi-drug and extensively drug-resistant tuberculosis: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101900. [PMID: 36942158 PMCID: PMC10023854 DOI: 10.1016/j.eclinm.2023.101900] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Physical sequelae related to multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) are emerging and under-recognised global challenges. This systematic review and meta-analysis aimed to quantify the prevalence and the types of long-term physical sequelae associated with patients treated for MDR- and XDR-TB. METHODS We systematically searched CINAHL (EBSCO), MEDLINE (via Ovid), Embase, Scopus, and Web of Science from inception through to July 1, 2022, and the last search was updated to January 23, 2023. We included studies reporting physical sequelae associated with all forms of drug-resistant TB, including rifampicin-resistant TB (RR-TB), MDR-TB, Pre-XDR-TB, and XDR-TB. The primary outcome of interest was long-term physical sequelae. Meta-analysis was conducted using a random-effect model to estimate the pooled proportion of physical sequelae. The sources of heterogeneity were explored through meta-regression using study characteristics as covariates. The research protocol was registered in PROSPERO (CRD42021250909). FINDINGS From 3047 unique publications identified, 66 studies consisting of 37,380 patients conducted in 30 different countries were included in the meta-analysis. The overall pooled estimate was 44.4% (95% Confidence Interval (CI): 36.7-52.1) for respiratory sequelae, 26.7% (95% CI: 23.85-29.7) for hearing sequelae, 10.1% (95% CI: 7.0-13.2) for musculoskeletal sequelae, 8.4% (95% CI: 6.5-10.3) for neurological sequelae, 8.1% (95% CI: 6.3-10.0) for renal sequelae, 7.3% (95% CI: 5.1-9.4) for hepatic sequelae, and 4.5% (95% CI: 2.7-6.3) for visual sequelae. There was substantial heterogeneity in the estimates. The stratified analysis showed that the pooled prevalence of hearing sequelae was 26.6% (95% CI: 12.3-40.9), neurological sequelae was 31.5% (95% CI: 5.5-57.5), and musculoskeletal sequelae were 21.5% (95% CI: 9.9-33.1) for patients with XDR-TB, which were higher than the pooled prevalence of sequelae among patients with MDR-TB. Respiratory sequelae were the highest in low-income countries (59.3%) and after completion of MDR-TB treatment (57.7%). INTERPRETATION This systematic review found that long-term physical sequelae such as respiratory, hearing, musculoskeletal, neurological, renal, hepatic, and visual sequelae were common among survivors of MDR- and XDR-TB. There was a significant difference in the prevalence of sequelae between patients with MDR- and XDR-TB. Post-MDR- and XDR-TB treatment surveillance for adverse outcomes needs to be incorporated into the current programmatic management of MDR-TB to enable early detection and prevention of post-treatment sequelae. FUNDING Australian National Health and Medical Research Council, through an Emerging Leadership Investigator grant, and the Curtin University Higher Degree Research scholarship.
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Affiliation(s)
- Temesgen Yihunie Akalu
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Corresponding author. School of Population Health, Faculty of Health Sciences, Curtin University, Kent St, Bentley, WA 6102, Western Australia, Australia.
| | - Archie C.A. Clements
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Haileab Fekadu Wolde
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Zavala MJ, Becker GL, Blount RJ. Interrelationships between tuberculosis and chronic obstructive pulmonary disease. Curr Opin Pulm Med 2023; 29:104-111. [PMID: 36647566 PMCID: PMC9877200 DOI: 10.1097/mcp.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Our objective was to review the current literature regarding socioeconomic, environmental, clinical, and immunologic factors common to chronic obstructive pulmonary disease (COPD) and tuberculosis (TB). RECENT FINDINGS Recent studies suggest that TB patients might be at increased risk for developing COPD. Conversely, additional prospective cohort studies have determined that COPD patients are at increased risk for active TB: a risk that appears to be partially mediated through inhaled corticosteroid use. Tobacco smoking, poverty, air pollution, and malnutrition are associated with COPD and TB. Vitamin D has been shown to prevent COPD exacerbations, but its use for preventing TB infection remains unclear. Surfactant deficiency, elevated matrix metalloproteinases, and toll-like receptor 4 polymorphisms play key roles in the pathogenesis of both diseases. SUMMARY Recent studies have elucidated interrelationships between COPD and TB. Future research is needed to optimize clinical and public health approaches that could mitigate risk factors contributing to both diseases.
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Affiliation(s)
- Michael J Zavala
- Division of Pulmonary and Critical Care Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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First and Second-Line Anti-Tuberculosis Drug-Resistance Patterns in Pulmonary Tuberculosis Patients in Zambia. Antibiotics (Basel) 2023; 12:antibiotics12010166. [PMID: 36671366 PMCID: PMC9855139 DOI: 10.3390/antibiotics12010166] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Drug-resistant tuberculosis has continued to be a serious global health threat defined by complexity as well as higher morbidity and mortality wherever it occurs, Zambia included. However, the paucity of information on drug-susceptibility patterns of both first-line and second-line anti-tuberculosis (anti-TB) drugs, including the new and repurposed drugs used in the management of drug-resistant tuberculosis in Zambia, was the major thrust for conducting this study. METHODS A total of 132 bacteriologically confirmed TB isolates were collected from patients with pulmonary TB during the period from April 2020 to December 2021 in Southern and Eastern Provinces of Zambia. Drug-resistance profiles were determined according to four first-line and five second-line anti-TB drugs. Standard mycobacteriological methods were used to isolate and determine phenotypic drug susceptibility. Data on the participants' social-demographic characteristics were obtained using a pre-test checklist. RESULTS Overall, the prevalence of resistance to one or more anti-TB drugs was 23.5% (31/132, 95% CI: 16.5-31.6%). A total of 9.8% (13/132, 95% CI: 5.3-16.2%) of the patients had multidrug-resistant TB and 1.2% were new cases, while 25.5% had a history of being previously treated for TB. Among those with mono-resistant TB strains, isoniazid (INH) resistance was the highest at 9.8% (13/132, 95% CI: 5.3-16.2%). Two (2/31) (6.5%) XDR-TB and one (1/31) (3.2%) pre-XDR-TB cases were identified among the MDR-TB patients. Previously treated patients were 40 times more likely (OR; 40.3, 95% CI: 11.1-146.5%) to have drug-resistant TB than those who had no history of being treated for TB. CONCLUSION This study has established a high rate of multidrug-resistant TB and has further identified both pre-XDR- and XDR-TB. There is a need to intensify surveillance of MDR- and XDR-TB to inform future guidelines for effective treatment and monitoring.
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12
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Maleche-Obimbo E, Odhiambo MA, Njeri L, Mburu M, Jaoko W, Were F, Graham SM. Magnitude and factors associated with post-tuberculosis lung disease in low- and middle-income countries: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000805. [PMID: 36962784 PMCID: PMC10021795 DOI: 10.1371/journal.pgph.0000805] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/03/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Emerging evidence suggests that after completion of treatment for tuberculosis (TB) a significant proportion of patients experience sequelae. However, there is limited synthesized evidence on this from low-income countries, from Sub-Saharan Africa, and in HIV infected individuals. We seek to provide an updated comprehensive systematic review and meta-analysis on the magnitude and factors associated with post-TB lung disease (PTLD) in low- and middle-income countries (LMICs). METHODS We searched PubMed, Embase and CINAHL for studies from LMICs with data on post-TB lung health in patients who had previously completed treatment for pulmonary TB. Data on study characteristics, prevalence of PTLD-specifically abnormal lung function (spirometry), persisting respiratory symptoms and radiologic abnormalities were abstracted. Statistical analysis was performed using Microsoft Excel and R version 4.1 software, and random effects meta-analysis conducted to compute pooled prevalence of PTLD, evaluate heterogeneity, and assess factors associated with PTLD. RESULTS We identified 32 eligible studies with 6225 participants. Twenty-one studies were from Africa, 16 included HIV infected participants, spirometry was conducted in 20 studies, symptom assessment in 16 and chest imaging in eight. Pooled prevalence of abnormal lung function was 46.7%, persistent respiratory symptoms 41.0%, and radiologic abnormalities 64.6%. Magnitude of any type of PTLD varied by HIV status (HIV- 66.9%, HIV+ 32.8%, p = 0.0013), across geographic setting (SE Asia 57.5%, Southern America 50.8%, and Africa 38.2%, p = 0.0118), and across urban-rural settings (symptom prevalence: rural 68.8%, urban 39.1%, mixed settings 27.9%, p = 0.0035), but not by income settings, sex or age-group. CONCLUSIONS There is high burden of post-TB persistent respiratory symptoms, functional lung impairment and radiologic structural abnormalities in individuals living in LMICs. Burden varies across settings and by HIV status. This evidence may be valuable to advocate for and inform implementation of structured health care specific to the needs of this vulnerable population of individuals.
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Affiliation(s)
| | | | - Lynette Njeri
- School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Moses Mburu
- Clinical Trials Facility, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Walter Jaoko
- Department of Medical Microbiology & Immunology, University of Nairobi, Nairobi, Kenya
| | - Fredrick Were
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - Stephen M. Graham
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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13
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Alene KA, Wangdi K, Colquhoun S, Chani K, Islam T, Rahevar K, Morishita F, Byrne A, Clark J, Viney K. Tuberculosis related disability: a systematic review and meta-analysis. BMC Med 2021; 19:203. [PMID: 34496845 PMCID: PMC8426113 DOI: 10.1186/s12916-021-02063-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The sustainable development goals aim to improve health for all by 2030. They incorporate ambitious goals regarding tuberculosis (TB), which may be a significant cause of disability, yet to be quantified. Therefore, we aimed to quantify the prevalence and types of TB-related disabilities. METHODS We performed a systematic review of TB-related disabilities. The pooled prevalence of disabilities was calculated using the inverse variance heterogeneity model. The maps of the proportions of common types of disabilities by country income level were created. RESULTS We included a total of 131 studies (217,475 patients) that were conducted in 49 countries. The most common type of disabilities were mental health disorders (23.1%), respiratory impairment (20.7%), musculoskeletal impairment (17.1%), hearing impairment (14.5%), visual impairment (9.8%), renal impairment (5.7%), and neurological impairment (1.6%). The prevalence of respiratory impairment (61.2%) and mental health disorders (42.0%) was highest in low-income countries while neurological impairment was highest in lower middle-income countries (25.6%). Drug-resistant TB was associated with respiratory (58.7%), neurological (37.2%), and hearing impairments (25.0%) and mental health disorders (26.0%), respectively. CONCLUSIONS TB-related disabilities were frequently reported. More uniform reporting tools for TB-related disability and further research to better quantify and mitigate it are urgently needed. PROSPERO REGISTRATION NUMBER CRD42019147488.
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Affiliation(s)
- Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Kent St, Bentley, Perth, 6102 Western Australia Australia
- Telethon Kids Institute, 15 Hospital Ave, Nedlands, Perth, Western Australia 6009 Australia
- Research School of Population Health, The Australian National University, 62 Mills Road, Acton, Canberra, ACT 2601 Australia
| | - Kinley Wangdi
- Research School of Population Health, The Australian National University, 62 Mills Road, Acton, Canberra, ACT 2601 Australia
| | - Samantha Colquhoun
- Research School of Population Health, The Australian National University, 62 Mills Road, Acton, Canberra, ACT 2601 Australia
| | - Kudakwashe Chani
- Research School of Population Health, The Australian National University, 62 Mills Road, Acton, Canberra, ACT 2601 Australia
| | - Tauhid Islam
- World Health Organization (WHO) Regional Office for the Western Pacific, The Philippines, Manila, Philippines
| | - Kalpeshsinh Rahevar
- World Health Organization (WHO) Regional Office for the Western Pacific, The Philippines, Manila, Philippines
| | - Fukushi Morishita
- World Health Organization (WHO) Regional Office for the Western Pacific, The Philippines, Manila, Philippines
| | - Anthony Byrne
- St Vincent’s Hospital, Sydney, 406 Victoria St, Darlinghurst, Sydney, 2010 New South Wales Australia
- The University of New South Wales, Randwick, Sydney, 2031 New South Wales Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, 4266 Queensland Australia
| | - Kerri Viney
- Research School of Population Health, The Australian National University, 62 Mills Road, Acton, Canberra, ACT 2601 Australia
- Karolinska Institutet, Solnavägen 1, 171 77 Solna, Stockholm, Sweden
- The University of Sydney, University Road, Camperdown, Sydney, 2066 New South Wales Australia
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Zubair SM, Ali MG, Irfan M. Post tuberculosis radiological sequelae in patients treated for pulmonary and pleural tuberculosis at a tertiary center in Pakistan. Monaldi Arch Chest Dis 2021; 92. [PMID: 34340298 DOI: 10.4081/monaldi.2021.1814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
Treating tuberculosis (TB) is not the end of the disease because of the wide spectrum of post TB sequelae associated with the disease. There is insufficient data on post TB radiological sequelae. The aim of this study is to evaluate the post TB radiological sequelae on chest x-rays in patients who had completed the treatment for pulmonary and pleural TB at a tertiary care hospital of a high TB burden country. This is a retrospective cross-sectional study conducted on patients treated for pulmonary and pleural TB. Adult patients (18 years or above) with a clinical or microbiological diagnosis of pulmonary or pleural TB were included. Patients were classified on the basis of site of TB into pulmonary and pleural TB. Post-treatment radiological sequelae on chest x-ray were evaluated and divided into three main types i.e. fibrosis, bronchiectasis and pleural thickening. During the study period a total of 321 patients were included with a mean age of 44(SD±19) years. Only 17.13% (n=55) patients had normal chest x-rays at the end of treatment and 82.87% (n=266) patients had post-TB radiological sequelae with fibrosis being the most common followed by pleural thickening. The post TB radiological sequelae were high in patients who had diabetes mellitus (78.94%), AFB smear-positive (90.19%), AFB culture-positive (89.84%), Xpert MTB/Rif positive (88.40%) and with drug-resistant TB (100%). As a clinician, one should be aware of all the post TB sequelae so that early diagnosis and management can be facilitated.
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Affiliation(s)
- Syed Muhammad Zubair
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Aga Khan University Hospital, Karachi.
| | - Mariyam Gohar Ali
- Department of Pulmonary and Critical Care Medicine, Dr. Ziauddin Univeristy Hospital, Karachi.
| | - Muhammad Irfan
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Aga Khan University Hospital, Karachi.
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15
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The effects of MDR/RR-TB treatment on HIV disease: A systematic review of literature. PLoS One 2021; 16:e0248174. [PMID: 33667271 PMCID: PMC7935310 DOI: 10.1371/journal.pone.0248174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 02/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background Multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) and human immunodeficiency virus (HIV) co-infection are a deadly combination. While evidence on the effects of HIV co-infection on MDR/RR-TB treatment outcomes is well-documented, little published evidence describes the effects of MDR/RR-TB treatment on HIV disease. Methods We conducted a review of literature published prior to June 2020. We searched Pubmed, CINAHL, and EMBASE using variations of the terms “multidrug-resistant tuberculosis,” “HIV,” and either “CD4” or “viral load.” Two reviewers independently completed title and abstract screening, full-text screening, article evaluation, and data extraction. We also included five published articles evaluated as evidence by the World Health Organization (WHO) in preparation for the 2019 MDR/RR-TB treatment guideline update. Results A total of 459 references were returned, with 362 remaining after duplicate removal. Following article screening, six manuscripts were included. Articles reported CD4 count and/or viral load results for MDR/RR-TB and HIV co-infected patients during and/or after MDR/RR-TB treatment. The additional five references identified from the WHO guideline revision did not report HIV disease indicators after MDR/RR-TB initiation. Conclusion There is a paucity of evidence on HIV disease indicators following MDR/RR-TB treatment. Researchers should report longitudinal HIV disease indicators in co-infected patients in publications.
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16
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Kumar Rai D, Kumar R. Identification of risk factors for radiological sequelae in patients treated for pulmonary tuberculosis: Prospective observational cohort study. Indian J Tuberc 2020; 67:534-538. [PMID: 33077056 DOI: 10.1016/j.ijtb.2020.07.026] [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: 05/14/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE OF STUDY This study is designed to assess risk factors & magnitude of residual radiological lesion in patients treated for pulmonary tuberculosis. METHODS This is a retrospective observational cohort study which included patients who were newly diagnosed as pulmonary tuberculosis and have completed 6 months of treatment. STATISTICAL ANALYSIS Categorical data were expressed as proportion and continuous data were expressed as mean ± SD. The obtained data were analysed by means of frequency distribution table and descriptive statistics using SPSS version 20 for Windows (SPSS Inc., Chicago, Ill, USA) and Chi-square test and student t test were used for statistical analysis. We assessed association between risk factors and development of radiological sequelae, using univariate statistical analysis and odds ratio. P-values less than 0.05 were considered statistically significant. RESULTS Data from 128 patients was used for analysis. The average age in this cohort was 32.84 ± 17.47 years and 68.75% patients were male. Residual x-ray lesions were observed in 92 (71.87%) cases out of 128 study patients. 72.82% of residual lesions appeared as parenchymal fibrosis, 13.04% as bronchiectasis, 2.17% as cavity & 3.26% appeared as calcification. Patients with advanced lesions (34.78% vs 16.66%), bilateral lesions (29.34% vs 11.11%) or cavity (18.47% vs 2.77%) in chest x-ray or Sputum smear positivity for AFB were found to have significant radiological sequelae. Among the variables associated with the risk of having pulmonary tuberculosis sequelae were cavity (OR: 7.03), sputum smear positive for AFB (OR: 4.03), Advanced lesions (OR: 3.38) & bilateral lesions (OR: 2.90) in chest x-ray. CONCLUSION This study concluded that a large number of patients remain with residual radiological sequelae despite good clinical response. Patients with extensive lesions, presence of cavity or bilateral involvement in chest x-ray and sputum smear positive for acid fast bacilli were often associated with residual radiological opacity.
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Affiliation(s)
| | - Rahul Kumar
- Department of Pulmonary Medicine, AIIMS, Patna, 801505, India
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17
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Nuwagira E, Stadelman A, Baluku JB, Rhein J, Byakika-Kibwika P, Mayanja H, Kunisaki KM. Obstructive lung disease and quality of life after cure of multi-drug-resistant tuberculosis in Uganda: a cross-sectional study. Trop Med Health 2020; 48:34. [PMID: 32476983 PMCID: PMC7236316 DOI: 10.1186/s41182-020-00221-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background Pulmonary multi-drug-resistant tuberculosis (MDR TB) alters lung architecture and involves lengthy treatment duration, high pill burden, drug adverse effects, travel restrictions, and stigma. Literature about pulmonary function and health-related quality of life (QoL) of patients treated for MDR TB is limited. This study sought to determine the prevalence of chronic obstructive pulmonary disease (COPD) and QoL of patients who were treated for pulmonary MDR TB. Methods Participants who completed 18 months of pulmonary MDR TB treatment and considered cured were eligible to be evaluated in a cross-sectional study. We performed post-bronchodilator spirometry to measure forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). COPD was defined as FEV1/FVC < 0.7; health-related QoL was assessed using the Medical Outcomes Survey for HIV (MOS-HIV) and St. George's Respiratory Questionnaire (SGRQ). Linear and logistic regression models were used to assess associations with COPD, health-related QoL, and other characteristics of the cohort. Results A total of 95 participants were enrolled. Median age of the cohort was 39 years (interquartile range (IQR), 29-45), and 55 (58%) were HIV-positive. COPD prevalence was 23% (22/95). Median SGRQ score was normal at 7.8 (IQR, 3.1-14.8). Median mental and physical health summary scores were significantly impaired, at 58.6 (IQR, 52.0-61.5) and 52.9 (IQR, 47.8-57.9), respectively, on a scale of 0 to 100 where 100 represents excellent physical or mental health. In this sample, 19% (18/95) of participants were in the lowest relative socioeconomic position (SEP) while 34% (32/95) were in the highest relative SEP. Belonging in the lowest SEP group was the strongest predictor of COPD. Conclusion Individuals who have completed MDR TB treatment have a high prevalence of COPD and low mental and physical health summary scores. Our study highlights the need for pulmonary rehabilitation programs in patients with a low socioeconomic position (SEP) after MDR TB treatment.
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Affiliation(s)
- Edwin Nuwagira
- 1Department of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Anna Stadelman
- 2Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN USA.,3Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN USA
| | - Joseph Baruch Baluku
- 4Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joshua Rhein
- 2Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | | | - Harriet Mayanja
- 4Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ken M Kunisaki
- 5Section of Pulmonary, Critical Care and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, MN USA.,6Division of Pulmonology, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN USA
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Stek C, Allwood B, Du Bruyn E, Buyze J, Schutz C, Thienemann F, Lombard A, Wilkinson RJ, Meintjes G, Lynen L. The effect of HIV-associated tuberculosis, tuberculosis-IRIS and prednisone on lung function. Eur Respir J 2020; 55:13993003.01692-2019. [PMID: 31862762 PMCID: PMC7066470 DOI: 10.1183/13993003.01692-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/29/2019] [Indexed: 12/26/2022]
Abstract
Residual pulmonary impairment is common after treatment for tuberculosis (TB). Lung function data in patients with HIV-associated TB are scarce, especially in the context of paradoxical TB-associated immune reconstitution inflammatory syndrome (TB-IRIS) and prophylactic prednisone. We aimed to determine the prevalence of lung function abnormalities in patients with HIV-associated TB and CD4 counts ≤100 cells·μL−1 and assess the effect of prophylactic prednisone and the development of paradoxical TB-IRIS on pulmonary impairment. We performed spirometry, 6-min walk test (6MWT) and chest radiography at baseline (week 0) and at weeks 4, 12 and 28 in participants of the PredART trial, which evaluated a 28-day course of prednisone to prevent TB-IRIS in patients with HIV-associated TB commencing antiretroviral therapy. 153 participants underwent spirometry and/or 6MWT at one or more time points. Abnormal spirometry measurements were present in 66% of participants at week 0 and 50% at week 28; low forced vital capacity was the commonest abnormality. Chest radiographs showed little or no abnormalities in the majority of participants. Prednisone use resulted in a 42 m greater 6-min walk distance and a 4.9% higher percentage of predicted forced expiratory volume in 1 s at week 4; these differences were no longer significantly different from week 12 onwards. TB-IRIS did not significantly impair lung function outcome. Residual pulmonary impairment is common in HIV-associated TB. In patients with low CD4 counts, neither prophylactic prednisone as used in our study nor the development of TB-IRIS significantly affected week-28 pulmonary outcome. Post-tuberculosis lung disease is common in patients with HIV-associated TB at high risk of TB-IRIS (CD4 count ≤100 cells·μL−1). Neither TB-IRIS itself, nor prednisone treatment, affected long-term pulmonary outcomes in a South African clinical setting.http://bit.ly/2RjMl9c
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Affiliation(s)
- Cari Stek
- Dept of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium .,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Brian Allwood
- Division of Pulmonology, Dept of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Elsa Du Bruyn
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jozefien Buyze
- Dept of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Charlotte Schutz
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Friedrich Thienemann
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Adele Lombard
- Division of Pulmonology, Dept of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Dept of Medicine, University of Cape Town, Cape Town, South Africa.,Dept of Medicine, Imperial College London, London, UK.,The Francis Crick Institute, London, UK
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lutgarde Lynen
- Dept of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Rai DK, Kirti R, Kumar S, Karmakar S, Thakur S. Radiological difference between new sputum-positive and sputum-negative pulmonary tuberculosis. J Family Med Prim Care 2019; 8:2810-2813. [PMID: 31681647 PMCID: PMC6820435 DOI: 10.4103/jfmpc.jfmpc_652_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/14/2019] [Accepted: 09/03/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction: The current guidelines for the diagnosis of pulmonary tuberculosis (PTB) are based primarily on the demonstration of acid-fast bacilli (AFB) on sputum microscopy and chest radiograph. Knowing various radiological manifestations and their association with sputum microscopy findings can allow for early diagnosis and early initiation of treatment. Aims: This study was performed to compare the chest radiograph features seen in sputum-positive and sputum-negative tuberculosis patients, respectively. Materials and Methods: It was a prospective observational study, which included 147 consecutive patients newly diagnosed and treated as PTB between Jan 2018 and July 2018. Chest X-ray was reviewed by 2 independent radiologists and the findings were compared between sputum-positive and sputum-negative PTB cases. The obtained data were analyzed by statistics using SPSS version 15 for Windows (SPSS Inc., Chicago, IL) and χ2 test and Student t test were used for statistical analysis. P values < 0.05 were considered statistically significant. Results: Out of a total of 147 patients, 38 (25 males and 13 females, mean age 35.23 ± 18.40) were sputum positive and 109 (77 males and 32 females, mean age 36.07 ± 18.15) were sputum negative. The frequency of patchy consolidation (78.94% vs 49.54%) and cavitation (36.84% vs 15.59%) was significantly higher in sputum-positive PTB (P < 0.05). Radiological lesions like nodular shadow (10.09% vs 2.63%), cystic lesion (13.76% vs 5.26%), fibrosis (12.84% vs 7.89%), miliary shadows (2.75% vs 2.63%), and pleural effusion (1.83% vs 0%) were seen more commonly with sputum-negative PTB but the difference was not statistically significant for any of these features. Sputum-positive PTB tends to occur more commonly on the left side (47.36%) compared with sputum-negative PTB (27.52%) (P < 0.05). 34.21% and 35.77% of the chest X-ray lesions were bilateral in sputum-positive and sputum-negative PTB, respectively. Conclusion: Patchy infiltration and cavitation on chest X-ray are seen more frequently in sputum-positive cases of PTB compared with sputum-negative cases.
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Affiliation(s)
- Deependra K Rai
- Associate Professor and Head, Department of Pulmonary Medicine, AIIMS, Patna, Bihar, India
| | - Ravi Kirti
- Associate Professor and Head, Department of General Medicine AIIMS, Patna, Bihar, India
| | - Subhash Kumar
- Assiciate Professor, Department of Radio Diagnosis, AIIMS, Patna, Bihar, India
| | - Saurabh Karmakar
- Associate Professor, Department of Pulmonary Medicine, AIIMS, Patna, Bihar, India
| | - Somesh Thakur
- Associate Professor, Department of Pulmonary Medicine, AIIMS, Patna, Bihar, India
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Roba AA, Dasa TT, Weldegebreal F, Asfaw A, Mitiku H, Teklemariam Z, Naganuri M, Geddugol BJ, Mesfin F, Befikadu H, Tesfaye E. Tuberculosis patients are physically challenged and socially isolated: A mixed methods case-control study of Health Related Quality of Life in Eastern Ethiopia. PLoS One 2018; 13:e0204697. [PMID: 30321189 PMCID: PMC6188627 DOI: 10.1371/journal.pone.0204697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/12/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Pulmonary tuberculosis (TB) impairs respiratory physiology and functional ability, resulting in economic and social dependence upon others. Patients with tuberculosis especially multi drug resistant (MDR-TB) suffer from social isolation, stigma, lack of support and economic constraints. In Ethiopia, the trend of MDR TB is increasing and becoming a serious public health problem. However, little is known about patients except treatment outcomes, financial burden and psychological distress with serious deficiency of data on Health Related Quality of Life (HRQOL). Hence, the aim of this study was to assess HRQOL of MDR TB patients in comparison with drug sensitive pulmonary TB (DSTB) patients. METHODS We included 100 cases of MDR and 300 controls with DSTB who were matched by sex. Data were collected using SF- 36v2 TM questionnaire and analysed with SPSS version 20. Independent t-test and conditional logistic regression analysis was done considering P-values of less than 0.05 statistically significant. Eight in-depth interviews were also conducted with both groups and represented with verbatim quotations and narrative texts. RESULTS There were no statistically significant differences in mean scores for health related quality of life between cases and controls (57.61±16.42 and 59.13±22.10) nor were there significant differences in physical functioning, role disruption due to physical problems, vitality, social functioning, role disruption due to emotional distress, or overall mental health. Individuals with MDR-TB were significantly more likely to be single, a current student, and with lower education and families with more than 5 people than individuals with Drug sensitive TB, all of which were significantly associated with poorer HRQOL (p<0.05). There was good internal consistency of the scale scores, with a Cronbach's alpha value of 0.73. CONCLUSION Individuals with MDR-TB reported statistically worse general health but less bodily pain than individuals with Drug sensitive TB. To regain the role function they lost, we recommend that health facilities, media and all other stakeholders educate the community, households and students about pulmonary tuberculosis, treatment, prevention methods and therapeutic approaches towards TB patients, specifically MDR-TB.
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Affiliation(s)
- Aklilu Abrham Roba
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | | | - Fitsum Weldegebreal
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Abyot Asfaw
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Habtamu Mitiku
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Zelalem Teklemariam
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Mahantash Naganuri
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | | | - Frehiwot Mesfin
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Hilina Befikadu
- Haramaya University, College of Social Sciences and Humanities, Dire Dawa, Ethiopia
| | - Eden Tesfaye
- Haramaya University, College of Natural and Computational Sciences, Dire Dawa, Ethiopia
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Mental health disorders, social stressors, and health-related quality of life in patients with multidrug-resistant tuberculosis: A systematic review and meta-analysis. J Infect 2018; 77:357-367. [PMID: 30036607 DOI: 10.1016/j.jinf.2018.07.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Mental health disorders, social stress, and poor health-related quality of life are commonly reported among people with tuberculosis (TB). We conducted a systematic review and meta-analysis to quantify mental health disorders, social stressors, and health-related quality of life in patients with multidrug-resistant tuberculosis (MDR-TB). METHODS We searched PubMed, SCOPUS, ProQuest, Web of Science, and PsycINFO databases for studies that reported data on mental health disorders, social stressors, and health-related quality of life among MDR-TB patients. Hand-searching the reference lists of included studies was also performed. Studies were selected according to pre-defined selection criteria and data were extracted by two authors. Pooled prevalence and weighted mean difference estimates were performed using random-effects meta-analysis. Heterogeneity was explored using meta-regression, and subgroup analyses were performed. RESULTS We included a total of 40 studies that were conducted in 20 countries. Depression, anxiety, and psychosis were the most common mental health disorders reported in the studies. The overall pooled prevalence was 25% (95% confidence interval (CI): 14, 39) for depression, 24% (95% CI: 2, 57) for anxiety, and 10% (95% CI: 7, 14) for psychosis. There was substantial heterogeneity in the estimates. The stratified analysis showed that the prevalence of psychosis was 4% (95% CI: 0, 22) before MDR-TB treatment commencement, and 9% (95% CI: 5, 13) after MDR-TB treatment commencement. The most common social stressors reported were stigma, discrimination, isolation, and a lack of social support. Health-related quality of life was significantly lower among MDR-TB patients when compared to drug-susceptible TB patients (Q = 9.88, p = 0.01, I2 = 80%). CONCLUSIONS This review found that mental health and social functioning are compromised in a significant proportion of MDR-TB patients, a finding confirmed by the poor health-related quality of life reported. Thus, there is a substantial need for integrating mental health services, social protection and social support into the clinical and programmatic management of MDR-TB.
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