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Sinha P, Ezhumalai K, Du X, Ponnuraja C, Dauphinais MR, Gupte N, Sarkar S, Gupta A, Gaikwad S, Thangakunam B, Paradkar M, Christopher DJ, Mave V, Viswanathan V, Ellner JJ, Kornfeld H, Horsburgh CR, Padmapriyadarsini C, Gupte A. Undernourished Household Contacts Are at Increased Risk of Tuberculosis (TB) Disease, but not TB Infection- a Multicenter Prospective Cohort Analysis. Clin Infect Dis 2024:ciae149. [PMID: 38652286 DOI: 10.1093/cid/ciae149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Indexed: 04/25/2024] Open
Abstract
Undernutrition is the leading risk factor for tuberculosis (TB) globally and in India. This multicenter prospective cohort analysis from India suggests that undernutrition is associated with increased risk of TB disease but not TB infection among household contacts of persons with TB.
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Affiliation(s)
- Pranay Sinha
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Komala Ezhumalai
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Xinyi Du
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Chinnaiyan Ponnuraja
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Madolyn Rose Dauphinais
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, BJMC Clinical Research Site, Pune, Maharashtra, India
| | | | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India
| | | | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Vijay Viswanathan
- Prof. M. Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India
| | - Jerrold J Ellner
- Center for Emerging Pathogens, Department of Medicine, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Hardy Kornfeld
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - C R Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Akshay Gupte
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Leavitt SV, Rodriguez CA, Bouton TC, Horsburgh CR, Abel Zur Wiesch P, Nichols BE, White LF, Jenkins HE. Outcomes for people with TB by disease severity at presentation. Int J Tuberc Lung Dis 2024; 28:142-147. [PMID: 38454178 DOI: 10.5588/ijtld.23.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND There is substantial heterogeneity in disease presentation for individuals with TB disease, which may correlate with disease outcomes. We estimated disease outcomes by disease severity at presentation among individuals with TB during the pre-chemotherapy era.METHODS We extracted data on people with TB enrolled between 1917 and 1948 in the USA, stratified by three disease severity categories at presentation using the U.S. National Tuberculosis Association diagnostic criteria. These criteria were based largely on radiographic findings ("minimal", "moderately advanced", and "far advanced"). We used Bayesian parametric survival analysis to model the survival distribution overall, and by disease severity and Bayesian logistic regression to estimate the severity-level specific natural recovery odds within 3 years.RESULTS People with minimal TB at presentation had a 2% (95% CrI 0-11%) probability of TB death within 5 years vs. 40% (95% CrI 15-68) for those with far advanced disease. Individuals with minimal disease had 13.62 times the odds (95% CrI 9.87-19.10) of natural recovery within 3 years vs. those with far advanced disease.CONCLUSION Mortality and natural recovery vary by disease severity at presentation. This supports continued work to evaluate individualized (e.g., shortened or longer) regimens based on disease severity at presentation, identified using radiography..
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Affiliation(s)
| | - C A Rodriguez
- Departments of Epidemiology, Boston University School of Public Health, Boston, MA
| | - T C Bouton
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, Boston University School of Medicine, Boston, MA
| | - C R Horsburgh
- Departments of Biostatistics and, Departments of Epidemiology, Boston University School of Public Health, Boston, MA, Boston University School of Medicine, Boston, MA, Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - P Abel Zur Wiesch
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Norway;, Center of Infectious Disease Dynamics, Pennsylvania State University, Philadelphia, PA, USA
| | - B E Nichols
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Yamkovoy K, Self JL, Jenkins HE, Horsburgh CR, White LF. Patterns of TB transmission in the United States, 2011-2017. Int J Tuberc Lung Dis 2024; 28:154-156. [PMID: 38454181 DOI: 10.5588/ijtld.23.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Affiliation(s)
- K Yamkovoy
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - J L Self
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - H E Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - C R Horsburgh
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, Departments of Global Health and Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - L F White
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
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Rodriguez CA, Horsburgh CR, Jenkins HE, White LF. Reply to 'Estimating TB survival - mind the immortal-time gap'. Int J Tuberc Lung Dis 2024; 28:66-67. [PMID: 38178287 DOI: 10.5588/ijtld.23.0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Affiliation(s)
- C A Rodriguez
- Departments of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - C R Horsburgh
- Departments of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - H E Jenkins
- Departments of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - L F White
- Departments of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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du Cros P, Greig J, Alffenaar JWC, Cross GB, Cousins C, Berry C, Khan U, Phillips PPJ, Velásquez GE, Furin J, Spigelman M, Denholm JT, Thi SS, Tiberi S, Huang GKL, Marks GB, Turkova A, Guglielmetti L, Chew KL, Nguyen HT, Ong CWM, Brigden G, Singh KP, Motta I, Lange C, Seddon JA, Nyang'wa BT, Maug AKJ, Gler MT, Dooley KE, Quelapio M, Tsogt B, Menzies D, Cox V, Upton CM, Skrahina A, McKenna L, Horsburgh CR, Dheda K, Marais BJ. Standards for clinical trials for treating TB. Int J Tuberc Lung Dis 2023; 27:885-898. [PMID: 38042969 PMCID: PMC10719894 DOI: 10.5588/ijtld.23.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND: The value, speed of completion and robustness of the evidence generated by TB treatment trials could be improved by implementing standards for best practice.METHODS: A global panel of experts participated in a Delphi process, using a 7-point Likert scale to score and revise draft standards until consensus was reached.RESULTS: Eleven standards were defined: Standard 1, high quality data on TB regimens are essential to inform clinical and programmatic management; Standard 2, the research questions addressed by TB trials should be relevant to affected communities, who should be included in all trial stages; Standard 3, trials should make every effort to be as inclusive as possible; Standard 4, the most efficient trial designs should be considered to improve the evidence base as quickly and cost effectively as possible, without compromising quality; Standard 5, trial governance should be in line with accepted good clinical practice; Standard 6, trials should investigate and report strategies that promote optimal engagement in care; Standard 7, where possible, TB trials should include pharmacokinetic and pharmacodynamic components; Standard 8, outcomes should include frequency of disease recurrence and post-treatment sequelae; Standard 9, TB trials should aim to harmonise key outcomes and data structures across studies; Standard 10, TB trials should include biobanking; Standard 11, treatment trials should invest in capacity strengthening of local trial and TB programme staff.CONCLUSION: These standards should improve the efficiency and effectiveness of evidence generation, as well as the translation of research into policy and practice.
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Affiliation(s)
- P du Cros
- Burnet Institute, Melbourne, VIC, Monash Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - J Greig
- Burnet Institute, Melbourne, VIC, Médecins Sans Frontières (MSF), Manson Unit, London, UK
| | - J-W C Alffenaar
- Sydney Infectious Diseases Institute (Sydney ID), and, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Westmead Hospital, Sydney, NSW
| | - G B Cross
- Burnet Institute, Melbourne, VIC, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - C Cousins
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - C Berry
- Médecins Sans Frontières (MSF), Manson Unit, London, UK
| | - U Khan
- Interactive Research and Development Global, Singapore City, Singapore
| | - P P J Phillips
- UCSF Center for Tuberculosis, Division of Pulmonary and Critical Care Medicine, and
| | - G E Velásquez
- UCSF Center for Tuberculosis, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA
| | - M Spigelman
- Global Alliance for TB Drug Development, New York, NY, USA
| | - J T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - S S Thi
- Eswatini National TB Control Program, Mbabane, Kingdom of Eswatini
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, GlaxoSmithKline, London, UK
| | - G K L Huang
- Burnet Institute, Melbourne, VIC, Northern Health Infectious Diseases, Northern Health, Melbourne, VIC
| | - G B Marks
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - A Turkova
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - L Guglielmetti
- Médecins Sans Frontières (MSF), Paris, Sorbonne Université, Institut national de la santé et de la recherche médicale, Unité 1135, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique Hôpitaux de Paris (APHP), Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries, Paris, France
| | - K L Chew
- Department of Laboratory Medicine, National University Hospital, Singapore City, Singapore
| | - H T Nguyen
- Research Department, Friends for International TB Relief, Ha Noi, Vietnam
| | - C W M Ong
- Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore City, Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore City, Institute of Healthcare Innovation & Technology, National University of Singapore, Singapore City, Singapore
| | - G Brigden
- The Global Fund, Geneva, Switzerland
| | - K P Singh
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia, Victorian Infectious Disease Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), TTU-TB, Borstel, Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - J A Seddon
- Department of Infectious Disease, Imperial College London, London, UK, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - B-T Nyang'wa
- Public Health Department, Operational Center Amsterdam (OCA), MSF, Amsterdam, The Netherlands
| | - A K J Maug
- Damien Foundation Bangladesh, Dhaka, Bangladesh
| | - M T Gler
- De La Salle Medical and Health Sciences Institute, Dasmariñas, the Philippines
| | - K E Dooley
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Quelapio
- Tropical Disease Foundation, Makati City, Manila, the Philippines, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - B Tsogt
- Mongolian Anti-TB Coalition, Ulaanbaatar, Mongolia
| | - D Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute & McGill International TB Centre, Montreal, QC, Canada
| | - V Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - C M Upton
- TASK Applied Science, Cape Town, South Africa
| | - A Skrahina
- The Republican Scientific and Practical Center for Pulmonology and TB, Minsk, Belarus
| | - L McKenna
- Treatment Action Group, New York, NY
| | - C R Horsburgh
- Departments of Global Health, Epidemiology, Biostatistics and Medicine, Schools of Public Health and Medicine, Boston University, Boston MA, USA
| | - K Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa, Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - B J Marais
- Sydney Infectious Diseases Institute (Sydney ID), and, The Children's Hospital at Westmead, Sydney, NSW, WHO Collaborating Centre in Tuberculosis, The University of Sydney, Sydney, NSW, Australia
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Rodriguez CA, Leavitt SV, Bouton TC, Horsburgh CR, Zur Wiesch PA, Nichols B, Jenkins HE, White LF. Survival of people with untreated TB: effects of time, geography and setting. Int J Tuberc Lung Dis 2023; 27:694-702. [PMID: 37608480 PMCID: PMC10443783 DOI: 10.5588/ijtld.22.0668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/30/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: An estimated 40% of people who developed TB in 2021 were not diagnosed or treated. Pre-chemotherapy era data are a rich resource on survival of people with untreated TB. We aimed to identify heterogeneities in these data to inform their more precise use.METHODS: We extracted survival data from pre-chemotherapy era papers reporting TB-specific mortality and/or natural recovery data. We used Bayesian parametric survival analysis to model the survival distribution, stratifying by geography (North America vs. Europe), time (pre-1930 vs. post-1930), and setting (sanitoria vs. non-sanitoria).RESULTS: We found 12 studies with TB-specific mortality data. Ten-year survival was 69% in North America (95% CI 54-81) and 36% in Europe (95% CI 10-71). Only 38% (95% CI 18-63) of non-sanitorium individuals survived to 10 years compared to 69% (95% CI 41-87) of sanitoria/hospitalized patients. There were no significant differences between people diagnosed pre-1930 and post-1930 (5-year survival pre-1930: 65%, 95% CI 44-88 vs. post-1930: 72%, 95% CI 41-94).CONCLUSIONS: Mortality and natural recovery risks vary substantially by location and setting. These heterogeneities need to be considered when using pre-chemotherapy data to make inferences about expected survival of people with undiagnosed TB.
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Affiliation(s)
| | - S V Leavitt
- Departments of Biostatistics, Boston University School of Public Health, Boston, MA
| | - T C Bouton
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, Boston University School of Medicine, Boston, MA, USA
| | - C R Horsburgh
- Departments of Epidemiology, and, Departments of Biostatistics, Boston University School of Public Health, Boston, MA
| | - P Abel Zur Wiesch
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway, Center of Infectious Disease Dynamics, Pennsylvania State University, Philadelphia, PA
| | - B Nichols
- Department of Global Health, Boston University School of Public Health, Boston, MA USA
| | - H E Jenkins
- Departments of Biostatistics, Boston University School of Public Health, Boston, MA
| | - L F White
- Departments of Biostatistics, Boston University School of Public Health, Boston, MA
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Acuña-Villaorduña C, Jacobson KR, Horsburgh CR, Canning M, Sinha P. Initial experience with BPaL-based regimens to treat multidrug-resistant TB. Int J Tuberc Lung Dis 2023; 27:649-650. [PMID: 37491751 PMCID: PMC10365559 DOI: 10.5588/ijtld.23.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- C Acuña-Villaorduña
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - K R Jacobson
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - C R Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, Departments of Epidemiology, Departments of Biostatistics, and, Departments of Global Health, Boston University School of Public Health, Boston, MA
| | - M Canning
- Boston Public Health Commission, Boston, MA, USA
| | - P Sinha
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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Motta I, Boeree M, Chesov D, Dheda K, Günther G, Horsburgh CR, Kherabi Y, Lange C, Lienhardt C, McIlleron HM, Paton NI, Stagg HR, Thwaites G, Udwadia Z, Van Crevel R, Velásquez GE, Wilkinson RJ, Guglielmetti L. Recent advances in the treatment of tuberculosis. Clin Microbiol Infect 2023:S1198-743X(23)00339-7. [PMID: 37482332 DOI: 10.1016/j.cmi.2023.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Tuberculosis (TB) is a global health challenge and one of the leading causes of death worldwide. In the last decade, the TB treatment landscape has dramatically changed. After long years of stagnation, new compounds entered the market (bedaquiline, delamanid, and pretomanid) and phase III clinical trials have shown promising results towards shortening duration of treatment for both drug-susceptible (Study 31/A5349, TRUNCATE-TB, and SHINE) and drug-resistant TB (STREAM, NiX-TB, ZeNix, and TB-PRACTECAL). Dose optimization of rifamycins and repurposed drugs has also brought hopes of further development of safe and effective regimens. Consequently, international and WHO clinical guidelines have been updated multiple times in the last years to keep pace with these advances. OBJECTIVES This narrative review aims to summarize the state-of-the-art on treatment of drug-susceptible and drug-resistant TB, as well as recent trial results and an overview of ongoing clinical trials. SOURCES A non-systematic literature review was conducted in PubMed and MEDLINE, focusing on the treatment of TB. Ongoing clinical trials were listed according to the authors' knowledge and completed consulting clinicaltrials.gov and other publicly available websites (www.resisttb.org/clinical-trials-progress-report, www.newtbdrugs.org/pipeline/trials). CONTENT This review summarizes the recent, major changes in the landscape for drug-susceptible and drug-resistant treatment, with a specific focus on their potential impact on patient outcomes and programmatic TB management. Moreover, insights in host-directed therapies, and advances in pharmacokinetics and pharmacogenomics are discussed. A thorough outline of ongoing therapeutic clinical trials is presented, highlighting different approaches and goals in current TB clinical research. IMPLICATIONS Future research should be directed to individualize regimens and protect these recent breakthroughs by preventing and identifying the selection of drug resistance and providing widespread, affordable, patient-centred access to new treatment options for all people affected by TB.
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Affiliation(s)
- Ilaria Motta
- Médecins Sans Frontières, Manson Unit, London, United Kingdom
| | - Martin Boeree
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dumitru Chesov
- Chiril Draganiuc Phthisiopneumology Institute, Chisinau, Moldova; Department of Pulmonology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gunar Günther
- Department of Pulmonology and Allergology, Inselspital, Bern University Hospital, Bern, Switzerland; Department of Medical Sciences, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Charles Robert Horsburgh
- Departments of Epidemiology, Biostatistics, Global Health and Medicine, Boston University, Boston, MA, United States
| | - Yousra Kherabi
- Infectious, and Tropical Diseases Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany; Department of International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany; Department of Pediatrics-Global Immigrant, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Christian Lienhardt
- Department of Translational Research Applied to HIV and Infectious Diseases, Institut de Recherche pour le Développement, Montpellier, France; Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen M McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Nicholas I Paton
- Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Helen R Stagg
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Zarir Udwadia
- Department of Internal Medicine and Pulmonology, Hinduja Hospital & Research Centre, Mumbai, India
| | - Reinout Van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Gustavo E Velásquez
- UCSF Center for Tuberculosis, University of California, San Francisco, San Francisco, CA, United States; Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Robert J Wilkinson
- Francis Crick Institute, London, United Kingdom; Department of Infectious Diseases, Imperial College London, United Kingdom
| | - Lorenzo Guglielmetti
- Sorbonne Université, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France; AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France.
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Myers B, Carney T, Rooney J, Malatesta S, Ragan EJ, White LF, Natcheva H, Bouton TC, Weber SE, Farhat M, McIlleron H, Theron D, Parry CDH, Horsburgh CR, Warren RM, Jacobson KR. Smoked drug use in patients with TB is associated with higher bacterial burden. Int J Tuberc Lung Dis 2023; 27:444-450. [PMID: 37231597 PMCID: PMC10407961 DOI: 10.5588/ijtld.22.0650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND: Smoking of illicit drugs may lead to more rapid TB disease progression or late treatment presentation, yet research on this topic is scant. We examined the association between smoked drug use and bacterial burden among patients newly initiated on drug-susceptible TB (DS-TB) therapy.METHODS: Data from 303 participants initiating DS-TB treatment in the Western Cape Province, South Africa, were analyzed. Smoked drug use was defined as self-reported or biologically verified methamphetamine, methaqualone and/or cannabis use. Proportional hazard and logistic regression models (adjusted for age, sex, HIV status and tobacco use) examined associations between smoked drug use and mycobacterial time to culture positivity (TTP), acid-fast bacilli sputum smear positivity and lung cavitation.RESULTS: People who smoked drugs (PWSD) comprised 54.8% (n = 166) of the cohort. TTP was faster for PWSD (hazard ratio 1.48, 95% CI 1.10-1.97; P = 0.008). Smear positivity was higher among PWSD (OR 2.28, 95% CI 1.22-4.34; P = 0.011). Smoked drug use (OR 1.08, 95% CI 0.62-1.87; P = 0.799) was not associated with increased cavitation.CONCLUSIONS: PWSD had a higher bacterial burden at diagnosis than those who do not smoke drugs. Screening for TB among PWSD in the community may facilitate earlier linkage to TB treatment and reduce community transmission.
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Affiliation(s)
- B Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia, Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - T Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Rooney
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - S Malatesta
- Department of Biostatistics, School of Public Health, Boston University, MA, USA
| | - E J Ragan
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - L F White
- Department of Biostatistics, School of Public Health, Boston University, MA, USA
| | - H Natcheva
- Department of Radiology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - T C Bouton
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - S E Weber
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - M Farhat
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA, Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - H McIlleron
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - D Theron
- Western Cape Department of Health, Pretoria, South Africa
| | - C D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - C R Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA, Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - R M Warren
- Department of Science and Technology, National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research, South Africa Medical Research Council for Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - K R Jacobson
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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Crowe HM, Hatch EE, Wang TR, Horsburgh CR, Mikkelsen EM, Kuohung W, Wise LA, Wesselink AK. Periconceptional antibiotic use and spontaneous abortion: A prospective cohort study. Paediatr Perinat Epidemiol 2023; 37:179-187. [PMID: 36303292 PMCID: PMC10038811 DOI: 10.1111/ppe.12931] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many reproductive-aged North Americans use antibiotics in the weeks preceding conception or during early pregnancy. Antibiotic use may influence risk of spontaneous abortion (SAB) by disrupting the reproductive tract microbiome or treating harmful infections. However, this association has not been extensively studied. OBJECTIVE To determine the extent to which periconceptional antibiotic use is associated with the risk of SAB. METHODS We analysed data from an internet-based preconception cohort study of pregnancy planners. Eligible participants self-identified as female, were aged 21-45 years, resided in the USA or Canada, and conceived during 12 months of follow-up (n = 7890). Participants completed an enrolment questionnaire during June 2013-September 2021 and bimonthly follow-up questionnaires for up to 12 months or until a reported pregnancy, whichever came first. Pregnant participants completed questionnaires in early (~8-9 weeks) and late (~32 weeks) gestation. We assessed antibiotic use, including type (penicillins, nitrofurantoin, cephalosporins and macrolides) and indication for use, during the previous 4 weeks on preconception questionnaires. Participants reported pregnancies and SAB on follow-up and pregnancy questionnaires. We used Cox proportional hazards regression models with gestational weeks as the time scale to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between periconceptional antibiotic use and SAB, controlling for potential demographic, medical, and lifestyle confounders. RESULTS Nineteen percent (n = 1537) of pregnancies ended in SAB. Participants reported periconceptional antibiotic use in 8% of pregnancies ending in SAB and 7% not ending in SAB. Periconceptional antibiotic use was not appreciably associated with SAB (adjusted HR 1.06, 95% CI 0.88, 1.28). We observed no strong associations between antibiotic type, indication for use, or recency of exposure and SAB risk. CONCLUSIONS Periconceptional antibiotic use was not appreciably associated with SAB in this study. This association is likely complicated by antibiotic type and dosage, timing of conception, and the individual's overall health.
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Affiliation(s)
- Holly Michelle Crowe
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Elliott Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Charles Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ellen Margrethe Mikkelsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren Anne Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amelia Kent Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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11
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Knudsen S, Babu SP, Ramakrishnan J, Jenkins HE, Joseph N, Cintron C, Narasimhan PB, Salgame P, Hochberg NS, Hom DL, Ellner J, Horsburgh CR, Sarkar S. M. tuberculosis infection before, during and after pregnancy. Int J Tuberc Lung Dis 2023; 27:72-74. [PMID: 36853122 DOI: 10.5588/ijtld.22.0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- S Knudsen
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - S P Babu
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - J Ramakrishnan
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - H E Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston MA, USA
| | - N Joseph
- Department of Microbiology, JIPMER, Puducherry, India
| | - C Cintron
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - P B Narasimhan
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - P Salgame
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - N S Hochberg
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - D L Hom
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - J Ellner
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - C R Horsburgh
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA, Department of Biostatistics, Boston University School of Public Health, Boston MA, USA, Departments of Epidemiology and Global Health, Boston University School of Public Health, Boston, MA, USA
| | - S Sarkar
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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12
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Schwalb A, Cachay R, Wright A, Phillips PPJ, Kaur P, Diacon AH, Ugarte-Gil C, Mitnick CD, Sterling TR, Gotuzzo E, Horsburgh CR. Factors associated with screening failure and study withdrawal in multidrug-resistant TB. Int J Tuberc Lung Dis 2022; 26:820-825. [PMID: 35996282 DOI: 10.5588/ijtld.21.0729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Multidrug-resistant TB (MDR-TB) clinical trial in Lima, Peru and Cape Town, South Africa.OBJECTIVE: To identify baseline factors associated with screening failure and study withdrawal in an MDR-TB clinical trial.DESIGN: We screened patients for a randomized, blinded, Phase II trial which assessed culture conversion over the first 6 months of treatment with varying doses of levofloxacin plus an optimized background regimen (ClinicalTrials.gov: NCT01918397). We identified factors for screening failure and study withdrawal using Poisson regression to calculate prevalence ratios and Cox proportional hazard regression to calculate hazard ratios. We adjusted for factors with P < 0.2.RESULTS: Of the 255 patients screened, 144 (56.5%) failed screening. The most common reason for screening failure was an unsuitable resistance profile on sputum-based molecular susceptibility testing (n = 105, 72.9%). No significant baseline predictors of screening failure were identified in the multivariable model. Of the 111 who were enrolled, 33 (30%) failed to complete treatment, mostly for non-adherence and consent withdrawal. No baseline factors predicted study withdrawal in the multivariable model.CONCLUSION: No baseline factors were independently associated with either screening failure or study withdrawal in this secondary analysis of a MDR-TB clinical trial.
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Affiliation(s)
- A Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - R Cachay
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - A Wright
- Vanderbilt University Medical Center, Vanderbilt Tuberculosis Center, Nashville, TN, USA
| | - P P J Phillips
- University of California San Francisco Center for Tuberculosis, San Francisco, CA, USA
| | - P Kaur
- Boston University, Departments of Epidemiology, Biostatistics, Global Health and Medicine, Boston, MA, USA
| | - A H Diacon
- TASK Applied Science and Stellenbosch University, Cape Town, South Africa
| | - C Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - C D Mitnick
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - T R Sterling
- Vanderbilt University Medical Center, Vanderbilt Tuberculosis Center, Nashville, TN, USA
| | - E Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - C R Horsburgh
- Boston University, Departments of Epidemiology, Biostatistics, Global Health and Medicine, Boston, MA, USA
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Magohe A, Kimario J, Lukmanji Z, Hendricks K, Koethe JR, Neke NM, Tvaroha S, Connor R, Mackenzie T, Waddell R, Maro I, Matee M, Pallangyo K, Bakari M, Horsburgh CR, von Reyn CF. Randomized, controlled trial of a protein-calorie supplement for women coinfected with HIV-TB. Int J Tuberc Lung Dis 2022; 26:798-800. [PMID: 35898141 DOI: 10.5588/ijtld.21.0669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A Magohe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - J Kimario
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Z Lukmanji
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - K Hendricks
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
| | - J R Koethe
- Vanderbilt University School of Medicine, Nashville, TN
| | - N M Neke
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - S Tvaroha
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
| | - R Connor
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
| | - T Mackenzie
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
| | - R Waddell
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
| | - I Maro
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - M Matee
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - K Pallangyo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - M Bakari
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - C R Horsburgh
- Boston University School of Public Health, Boston, MA, USA
| | - C F von Reyn
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Dartmouth, NH
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14
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Lazarchik A, Nyaruhirira AU, Chiang CY, Wares F, Horsburgh CR. Global availability of susceptibility testing for second-line anti-tuberculosis agents. Int J Tuberc Lung Dis 2022; 26:524-528. [PMID: 35650708 DOI: 10.5588/ijtld.21.0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: The continued development of new anti-TB agents brings with it a demand for accompanying treatment regimens to prevent the development of resistance. Effectively meeting this demand requires an understanding of the pathogen´s susceptibility to various treatment options, which in turn makes access to antibiotic susceptibility testing (AST) a paramount consideration in the global treatment of TB.METHODS: A 12-question, quantitative and qualitative survey was developed to gauge global capacity and access to AST. The survey was disseminated to members of the Global Laboratory Initiative, Global Drug-resistant TB Initiative, and the TB section of the International Union Against Tuberculosis and Lung Disease to solicit responses from pertinent stakeholders.RESULTS: A total of 323 complete responses representing 84 countries and all WHO Regions were collected. AST capacity for fluoroquinolones and second-line injectables was high in all WHO Regions. AST capacity for the new and repurposed drugs is highest in the European Region, Region of the Americas and the Western Pacific Region, but quite limited in the African and Eastern Mediterranean Regions. The AST turnaround time for second-line drugs was delayed compared to that for first-line drugs as samples needed to be sent farther for analysis. Common barriers to AST for second-line drugs were lack of specimen transportation infrastructure, high costs, and lack of specialised laboratory workers and specialised laboratory facilities.CONCLUSION: Without expanding global access to AST, the growing availability of new treatment options will likely be threatened by accompanying increase in resistance. There is an earnest and pressing need to improve capacity and access to AST alongside treatment options.
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Affiliation(s)
- A Lazarchik
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - C-Y Chiang
- Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan, Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - F Wares
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - C R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA, Departments of Biostatistics and Global Health Boston University School of Public Health and Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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15
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Kuzyk PV, Padilla R, Rybak NR, Hoshovska II, Kitov VO, Savchyna MO, Jenkins HE, Chiang SS, Horsburgh CR, Dolynska M, Petrenko V, Gychka SG. Missed Tuberculosis Diagnoses: Analysis of Pediatric Autopsy Data From General Hospitals in Lviv, Ukraine. J Pediatric Infect Dis Soc 2022; 11:300-302. [PMID: 35395086 PMCID: PMC9214781 DOI: 10.1093/jpids/piac016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022]
Abstract
We reviewed autopsy data from general hospitals in Lviv, Ukraine to understand pediatric mortality due to tuberculosis (TB). We identified 14 (0.6%) of 2345 autopsied children with unrecognized or untreated TB. More sensitive TB diagnostics for children and improved strategies for identifying which children require TB evaluation are urgently needed.
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Affiliation(s)
- Petro V Kuzyk
- Department of Pathological Anatomy, Bogomolets National Medical University, Kyiv, Ukraine
| | - Rachel Padilla
- School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Natasha R Rybak
- Infectious Diseases and Immunology, Miriam Hospital, Providence, Rhode Island, USA
| | | | | | - Mariia O Savchyna
- Department of Paediatric and Adolescent Diseases, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Helen E Jenkins
- Corresponding Author: Helen E. Jenkins, PhD, MSc, Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA. E-mail:
| | - Silvia S Chiang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA,Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Charles Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Maria Dolynska
- Department of Tuberculosis and Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Vasyl Petrenko
- Department of Tuberculosis and Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Sergiy G Gychka
- Department of Pathological Anatomy, Bogomolets National Medical University, Kyiv, Ukraine
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16
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Murali S, Krishnamoorthy Y, Knudsen S, Roy G, Ellner J, Horsburgh CR, Hochberg N, Salgame P, Prakash Babu S, Sarkar S. Comparison of profile and treatment outcomes between elderly and non-elderly tuberculosis patients in Puducherry and Tamil Nadu, South India. PLoS One 2021; 16:e0256773. [PMID: 34449817 PMCID: PMC8396735 DOI: 10.1371/journal.pone.0256773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
The rising geriatric population and the increased susceptibility of this age group to tuberculosis (TB), the deadliest single infectious agent, is bothersome for India. This study tried to explore the demographic and treatment outcome differences between the elderly (aged 60 years and above) and non-elderly TB (<60 years) patients from South India. This study was part of a large ongoing cohort study under the RePORT India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included in this study. Pretested and standardized questionnaire and tools were used to collect data and were stored securely for the entire cohort. Required demographic, anthropometric and treatment related variables were extracted from this database and analyzed using Stata version 14.0. Prevalence of elderly TB was summarized as percentage with 95% confidence interval (CI). Generalized linear modelling was attempted to find the factors associated with elderly TB. A total of 1,259 eligible TB patients were included into this present study. Mean (SD) of the participants in the elderly and non-elderly group was 65.8 (6.2) and 40.2 (12.0) respectively. Prevalence of elderly TB was 15.6% (95%CI: 13.6%-17.6%) with nearly 71% belonging to 60–69 age category. Male sex, OBC caste, poor education, unemployment, marriage, alcohol consumption and unable to work as per Karnofsky score were found to be significantly associated with an increased prevalence of elderly TB. Unfavorable outcomes (12% vs 6.5%, p value: 0.018), including death (9.3% vs 3.4%, p value: 0.001) were significantly higher among the elderly group when compared to their non-elderly counterparts. The current TB programme should have strategies to maintain follow up with due attention to adverse effects, social support and outcomes. Additional research should focus on predictors for unfavorable outcomes among the elderly TB group and explore ways to handle the same. Rendering adequate social support from the health system side and family side would be a good start.
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Affiliation(s)
- Sharan Murali
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
| | | | - Selby Knudsen
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America
| | - Gautam Roy
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
| | - Jerrold Ellner
- Department of Medicine, Rutgers University, Newark, NJ, United States of America
| | - Charles Robert Horsburgh
- School of Public Health, Epidemiology & Biostatistics, Boston University, Boston, MA, United States of America
| | - Natasha Hochberg
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America
| | - Padmini Salgame
- Department of Immunology, Rutgers University, Newark, NJ, United States of America
| | | | - Sonali Sarkar
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
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17
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Crowe HM, Wesselink AK, Wise LA, Wang TR, Horsburgh CR, Mikkelsen EM, Hatch EE. Antibiotics and fecundability among female pregnancy planners: a prospective cohort study. Hum Reprod 2021; 36:2761-2768. [PMID: 34269389 DOI: 10.1093/humrep/deab173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION To what extent is female preconception antibiotic use associated with fecundability? SUMMARY ANSWER Preconception antibiotic use overall was not appreciably associated with fecundability. WHAT IS KNOWN ALREADY Antibiotics are commonly used by women and are generally thought to be safe for use during pregnancy. However, little is known about possible effects of antibiotic use on fecundability, the per-cycle probability of conception. Previous research on this question has been limited to occupational rather than therapeutic exposure. STUDY DESIGN, SIZE, DURATION We analyzed data from an Internet-based preconception cohort study of 9524 female pregnancy planners aged 21-45 years residing in the USA and Canada who had been attempting to conceive for six or fewer cycles at study entry. Participants enrolled between June 2013 and September 2020 and completed baseline and bimonthly follow-up questionnaires for up to 12 months or until a reported pregnancy, whichever came first. The questions pertaining to antibiotic type and indication were added to the PRESTO questionnaires in March 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS We assessed antibiotic use in the previous 4 weeks at baseline and on each follow-up questionnaire. Participants provided the name of the specific antibiotic and the indication for use. Antibiotics were classified based on active ingredient (penicillins, macrolides, nitrofurantoin, nitroimidazole, cephalosporins, sulfonamides, quinolones, tetracyclines, lincosamides), and indications were classified by type of infection (respiratory, urinary tract, skin, vaginal, pelvic, and surgical). Participants reported pregnancy status on follow-up questionnaires. We used proportional probabilities regression to estimate fecundability ratios (FR), the per-cycle probability of conception comparing exposed with unexposed individuals, and 95% CI, adjusting for sociodemographics, lifestyle factors, and reproductive history. MAIN RESULTS AND THE ROLE OF CHANCE Overall, women who used antibiotics in the past 4 weeks at baseline had similar fecundability to those who had not used antibiotics (FR: 0.98, 95% CI: 0.89-1.07). Sulfonamides and lincosamides were associated with slightly increased fecundability (FR: 1.39, 95% CI: 0.90-2.15, and FR: 1.58 95% CI: 0.96-2.60, respectively), while macrolides were associated with slightly reduced fecundability (FR: 0.70, 95% CI: 0.47-1.04). Analyses of the indication for antibiotic use suggest that there is likely some confounding by indication. LIMITATIONS, REASONS FOR CAUTION Findings were imprecise for some antibiotic classes and indications for use owing to small numbers of antibiotic users in these categories. There are likely heterogeneous effects of different combinations of indications and treatments, which may be obscured in the overall null results, but cannot be further elucidated in this analysis. WIDER IMPLICATIONS OF THE FINDINGS There is little evidence that most antibiotics are associated with reduced fecundability. Antibiotics and the infections they treat are likely associated with fecundability through differing mechanisms, resulting in their association with increased fecundability in some circumstances and decreased fecundability in others. STUDY FUNDING/COMPETING INTEREST(S) This study was supported through funds provided by the National Institute of Child Health and Human Development, National Institutes of Health (R01-HD086742, R21-HD072326). L.A.W. has received in-kind donations from Swiss Precision Diagnostics, Sandstone Diagnostics, Fertility Friend, and Kindara for primary data collection in PRESTO. The other authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Holly Michelle Crowe
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Amelia Kent Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lauren Anne Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Ellen Margrethe Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
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Myers B, Carney T, Rooney J, Malatesta S, White LF, Parry CDH, Bouton TC, Ragan EJ, Horsburgh CR, Warren RM, Jacobson KR. Alcohol and Tobacco Use in a Tuberculosis Treatment Cohort during South Africa's COVID-19 Sales Bans: A Case Series. Int J Environ Res Public Health 2021; 18:5449. [PMID: 34069737 PMCID: PMC8161406 DOI: 10.3390/ijerph18105449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND South Africa temporarily banned alcohol and tobacco sales for about 20 weeks during the COVID-19 lockdown. We described changes in alcohol and tobacco consumption after implementation of these restrictions among a small number of participants in a tuberculosis treatment cohort. METHOD The timeline follow-back procedure and Fägerstrom test for nicotine dependence was used to collect monthly alcohol and tobacco use information. We report changes in heavy drinking days (HDD), average amount of absolute alcohol (AA) consumed per drinking day, and cigarettes smoked daily during the alcohol and tobacco ban compared to use prior to the ban. RESULTS Of the 61 participants for whom we have pre-ban and within-ban alcohol use information, 17 (27.9%) reported within-ban alcohol use. On average, participants reported one less HDD per fortnight (interquartile range (IQR): -4, 1), but their amount of AA consumed increased by 37.4 g per drinking occasion (IQR: -65.9 g, 71.0 g). Of 53 participants who reported pre-ban tobacco use, 17 (32.1%) stopped smoking during the ban. The number of participants smoking >10 cigarettes per day decreased from 8 to 1. CONCLUSIONS From these observations, we hypothesize that policies restricting alcohol and tobacco availability seem to enable some individuals to reduce their consumption. However, these appear to have little effect on the volume of AA consumed among individuals with more harmful patterns of drinking in the absence of additional behavior change interventions.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (T.C.); (C.D.H.P.)
- Division of Addiction Psychiatry, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (T.C.); (C.D.H.P.)
- Division of Addiction Psychiatry, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Jennifer Rooney
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
| | - Samantha Malatesta
- Department of Biostatistics, School of Public Health, Boston University, MA 02119, USA; (S.M.); (L.F.W.)
| | - Laura F. White
- Department of Biostatistics, School of Public Health, Boston University, MA 02119, USA; (S.M.); (L.F.W.)
| | - Charles D. H. Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (T.C.); (C.D.H.P.)
- Department of Psychiatry, Stellenbosch University, Tygerberg 7505, South Africa
| | - Tara C. Bouton
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
| | - Elizabeth J. Ragan
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
| | - Charles Robert Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
- Departments of Epidemiology, Biostatistics and Global Health, Boston University School of Public Health, Boston, MA 02119, USA
| | - Robin M. Warren
- Department of Science and Innovation, National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research, South Africa Medical Research Council for Tuberculosis Research, Stellenbosch University, Tygerberg 7505, South Africa;
| | - Karen R. Jacobson
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
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19
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Roy N, Krishnamoorthy Y, Rajaa S, Ezhumalai K, Madhusudhanan S, Raghupathy K, Knudsen S, Horsburgh CR, Hochberg NS, Salgame P, Ellner J, Subitha L, Babu SP, Sarkar S. Health-related quality of life and its effect on TB treatment outcomes. Int J Tuberc Lung Dis 2021; 25:318-320. [PMID: 33762076 DOI: 10.5588/ijtld.20.0722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- N Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Y Krishnamoorthy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S Rajaa
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - K Ezhumalai
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S Madhusudhanan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - K Raghupathy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S Knudsen
- Section of Infectious Diseases, Department of Medicine, Boston University School of Public Health, Boston, MA
| | - C R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - N S Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University School of Public Health, Boston, MA
| | - P Salgame
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - J Ellner
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - L Subitha
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S P Babu
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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20
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Ellappan K, Datta S, Muthuraj M, Lakshminarayanan S, Pleskunas JA, Horsburgh CR, Salgame P, Hochberg N, Sarkar S, Ellner JJ, Roy G, Jose M, Vinod Kumar S, Joseph NM. Evaluation of factors influencing Mycobacterium tuberculosis complex recovery and contamination rates in MGIT960. Indian J Tuberc 2020; 67:466-471. [PMID: 33077045 DOI: 10.1016/j.ijtb.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tuberculosis (TB) is a major public health problem worldwide. Contamination rate and poor recovery of Mycobacterium tuberculosis complex (MTBC) in MGIT960 culture may affect the early diagnosis of TB. Evidence is needed to determine the factors associated with contamination rates and MTBC recovery in MGIT960. Hence, we undertook this study to compare the factors influencing MTBC culture positivity and contamination rates in MGIT960 in patients with Pulmonary tuberculosis (PTB). METHODS A total of 849 sputum samples from newly diagnosed smear-positive TB cases enrolled into the Regional Prospective Observational Research for Tuberculosis India cohort between May 2014 to March 2017 were analyzed. Samples were inoculated into MGIT960 and positive cultures were examined for the presence of MTBC by immunochromatographic test for detection of MPT64 antigen. RESULTS Of the 849 cases, 811 (95.5%) were culture positive for MTBC, 23 (2.7%) were culture negative and 15 (1.8%) were contaminated. Salivary sputum showed significantly less culture yield compared to mucopurulent/blood stained samples (p = 0.021). Sputum from individuals <20 or ≥60 years showed lower culture yield of 93.9%, compared to those aged 20-59years (98.2%) (p = 0.002). Based on smear grading, culture isolation of MTBC by MGIT960 was 86.1%, 93.6% and 99.5% for negative, scanty and positive (1+/2+/3+) samples, respectively (p ≤ 0.0001). Sputum from HIV negative patients showed higher culture yield, compared to HIV positive patients (p ≤ 0.0001). Chest X-Ray revealed that patient with cavity showed higher culture isolation of MTBC compared to patients without cavity (p = 0.035). Contamination rates were higher in smear negatives (6.0%), compared to scanty (2.1%) and smear positives (1.1%) (p = 0.007). However, delay in transport of the specimen to the laboratory was the only independent factor significantly associated with increase in culture contamination. CONCLUSION Our results highlight that extremes of age, smear negativity, HIV infection, sputum quality and cavitation significantly influence the culture yield of MTBC, whereas transport duration and smear grading affected the contamination rates in MGIT960. Hence, addressing these factors may improve the diagnostic performance of MGIT960.
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Affiliation(s)
- Kalaiarasan Ellappan
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
| | - Suvrankar Datta
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
| | - Muthaiah Muthuraj
- Intermediate Reference Laboratory, Government Hospital for Chest Diseases, Pondicherry, India.
| | - Subitha Lakshminarayanan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
| | | | | | | | | | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
| | | | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
| | - Maria Jose
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
| | - Saka Vinod Kumar
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
| | - Noyal Mariya Joseph
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
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21
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Andrews JR, Cobelens F, Horsburgh CR, Hatherill M, Basu S, Hermans S, Wood R. Seasonal drivers of tuberculosis: evidence from over 100 years of notifications in Cape Town. Int J Tuberc Lung Dis 2020; 24:477-484. [PMID: 32398196 DOI: 10.5588/ijtld.19.0274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Tuberculosis incidence varies seasonally in many settings. However, the role of seasonal variation in reactivation vs. transmission is unclear.METHODS: We reviewed data on TB notifications in Cape Town, South Africa, from 1903 to 2017 (exclusive of 1995-2002, which were unavailable). Data from 2003 onward were stratified by HIV status, age and notification status (new vs. retreatment). We performed seasonal decomposition and time-dependent spectral analysis using wavelets to assess periodicity over time. We estimated monthly peak-to-peak seasonal amplitude of notifications as a percentage of the annual notification rate.RESULTS: A seasonal trend was intermittently detected between 1904 and 1994, particularly during periods of high notification rates, but was consistently and strongly evident between 2003 and 2017, with peaks in September through November, following winter. Among young children, a second, higher seasonal peak was observed in March. Seasonal variation was greater in children (<5 years, 54%, 95% CI 47-61; 5-14 years, 63%, 95% CI 58-69) than in adults (36%, 95% CI 33-39).CONCLUSIONS: Stronger seasonal effects were seen in children, in whom progression following recent infection is known to be the predominant driver of disease. These findings may support increased transmission in the winter as an important driver of TB in Cape Town.
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Affiliation(s)
- J R Andrews
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - F Cobelens
- Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam, the Netherlands
| | - C R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, US
| | - M Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Cape Town
| | - S Basu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - S Hermans
- Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam, the Netherlands
| | - R Wood
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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22
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Held K, McAnaw S, Chiang CY, Trebucq A, Horsburgh CR. Progress in global rollout of new multidrug-resistant tuberculosis treatments. Int J Tuberc Lung Dis 2020; 23:996-999. [PMID: 31615606 DOI: 10.5588/ijtld.19.0826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: The global multidrug-resistant tuberculosis (MDR-TB) epidemic has grown over the past decade and continues to be difficult to manage. In response, new drugs and treatment regimens have been recommended.OBJECTIVE: In 2017 and again in 2018, the International Union Against Tuberculosis and Lung Disease (The Union) drug-resistant (DR) TB Working Group collaborated with RESIST-TB to implement an internet survey to members of The Union around the world to assess access to these new treatment strategies.DESIGN: A nine-question survey was developed using SurveyMonkey®. The survey was open for participation to all members of The Union registered under the TB Section. Two reminders were sent during each survey. The responses were analyzed taking into account the WHO Region to which the respondent belonged.RESULTS: The 2018 survey showed a global increase in implementation of the shorter (9-month) MDR-TB regimen (from 33% to 56% of respondents, P < 0.001) and an increase in the use of bedaquiline and/or delamanid (from 25% to 41% of respondents, P < 0.001) compared to 2017. There were substantial variations in roll-out between WHO regions.CONCLUSION: These results demonstrate improvement in global implementation of the new treatment strategies over a 1-year period.
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Affiliation(s)
- K Held
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - S McAnaw
- Partners In Health, Boston, MA, USA
| | - C-Y Chiang
- Department of Tuberculosis and HIV, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - A Trebucq
- Department of Tuberculosis and HIV, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - C R Horsburgh
- Departments of Epidemiology, Biostatistics and Global Health, Boston University School of Public Health, and Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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23
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Ragan EJ, Kleinman MB, Sweigart B, Gnatienko N, Parry CD, Horsburgh CR, LaValley MP, Myers B, Jacobson KR. The impact of alcohol use on tuberculosis treatment outcomes: a systematic review and meta-analysis. Int J Tuberc Lung Dis 2020; 24:73-82. [PMID: 32005309 PMCID: PMC7491444 DOI: 10.5588/ijtld.19.0080] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Alcohol use is associated with increased risk of developing tuberculosis (TB) disease, yet the impact of alcohol use on TB treatment outcomes has not been summarized. We aimed to quantitatively review evidence of the relationship between alcohol use and poor TB treatment outcomes. We conducted a systematic review of PubMed, EMBASE, and Web of Science (January 1980-May 2018). We categorized studies as having a high- or low-quality alcohol use definition and examined poor treatment outcomes individually and as two aggregated definitions (i.e., including or excluding loss to follow-up [LTFU]). We analyzed drug-susceptible (DS-) and multidrug-resistant (MDR-) TB studies separately. Our systematic review yielded 111 studies reporting alcohol use as a predictor of DS- and MDR-TB treatment outcomes. Alcohol use was associated with increased odds of poor treatment outcomes (i.e., death, treatment failure, and LTFU) in DS (OR 1.99, 95% CI 1.57-2.51) and MDR-TB studies (OR 2.00, 95% CI 1.73-2.32). This association persisted for aggregated poor treatment outcomes excluding LTFU, each individual poor outcome, and across sub-group and sensitivity analyses. Only 19% of studies used high-quality alcohol definitions. Alcohol use significantly increased the risk of poor treatment outcomes in both DS- and MDR-TB patients. This study highlights the need for improved assessment of alcohol use in TB outcomes research and potentially modified treatment guidelines for TB patients who consume alcohol.
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Affiliation(s)
- E J Ragan
- Section of Infectious Diseases, Boston Medical Center, Boston, MA
| | - M B Kleinman
- Department of Psychology, University of Maryland, College Park, MD
| | - B Sweigart
- Department of Biostatistics, Boston University, Boston, MA
| | - N Gnatienko
- Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - C D Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - C R Horsburgh
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, Department of Biostatistics, Boston University, Boston, MA, Department of Global Health, Department of Epidemiology, Boston University, Boston, MA, USA
| | - M P LaValley
- Department of Biostatistics, Boston University, Boston, MA
| | - B Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - K R Jacobson
- Section of Infectious Diseases, Boston Medical Center, Boston, MA
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24
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Berhanu RH, Schnippel K, Kularatne R, Firnhaber C, Jacobson KR, Horsburgh CR, Lippincott CK. Can patients afford the cost of treatment for multidrug-resistant tuberculosis in Ethiopia? Int J Tuberc Lung Dis 2019; 22:358-362. [PMID: 29991400 DOI: 10.5588/ijtld.17.0837] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Ethiopia has a high prevalence of tuberculosis (TB) and is one of the countries with the highest burden of multidrug-resistant TB (MDR-TB). OBJECTIVE To understand the costs that patients incur in obtaining diagnosis and treatment for MDR-TB. DESIGN In March 2013, interviews were conducted with 169 MDR-TB patients at three hospitals in Ethiopia to identify the cost to patients and the impact on employment and family income. RESULTS The average MDR-TB patient incurred a total cost of US$1378, which represented 25 months of a mid-treatment household income of US$54. The impact on the patient's employment and on overall patient and family income was generally catastrophic: 74% of all respondents reported losing their jobs, 66% of patients lost household income, and household income was reduced by 38%. To help cover the costs, 38% of patients sold some type of property, while 7% leased out property and 41% took out loans, any of which could jeopardize their future financial situation even further. CONCLUSION Despite services being officially free of charge, most patients incurred catastrophic costs and suffered significant income loss as a result of obtaining diagnosis and treatment for MDR-TB.
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Affiliation(s)
- R H Berhanu
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina, USA, Department of Medicine, Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, Right to Care, Johannesburg
| | - K Schnippel
- Right to Care, Johannesburg, Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences
| | - R Kularatne
- National Institute for Communicable Diseases/National Health Laboratory Service and Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - C Firnhaber
- Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, Department of Medicine, Infectious Disease Division, University of Colorado, Denver, Colorado
| | - K R Jacobson
- Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - C R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - C K Lippincott
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
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25
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Saag LA, LaValley MP, Hochberg NS, Cegielski JP, Pleskunas JA, Linas BP, Horsburgh CR. Low body mass index and latent tuberculous infection: a systematic review and meta-analysis. Int J Tuberc Lung Dis 2019; 22:358-365. [PMID: 29562981 DOI: 10.5588/ijtld.17.0558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The well-documented association between underweight and increased incidence of active tuberculosis (TB) has not been extended to incidence or prevalence of latent tuberculous infection (LTBI). DESIGN After identifying studies that reported a categorical measure of body mass index (BMI) and used the tuberculin skin test (TST) or QuantiFERON®-TB Gold In-Tube (QFT) to measure LTBI, a maximum likelihood random-effects model was used to examine the pooled association between LTBI and low BMI (<18.5 kg/m2), compared with 1) normal BMI (18.5-25 kg/m2) and 2) a complementary group of all others, i.e., non-underweight subjects (BMI 18.5 kg/m2). RESULTS Among studies using TST, the odds ratios (ORs) showed a slight, non-statistically significant decrease in the odds of TST positivity in underweight persons compared with both groups (non-underweight, OR 0.88, 95%CI 0.73-1.05; normal weight, OR 0.96, 95%CI 0.77-1.20). Among studies using QFT, the OR suggested slightly decreased, yet non-significant, odds of QFT positivity in underweight compared with non-underweight subjects (OR 0.92, 95%CI 0.68-1.26), and significantly decreased odds of QFT positivity in underweight compared with normal weight subjects (OR 0.84, 95%CI 0.73-0.98). CONCLUSION These results suggest that underweight persons are not at an increased risk of LTBI. Screening this population for LTBI would not increase the yield of identified LTBI.
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Affiliation(s)
- L A Saag
- Department of Epidemiology, Department of Biostatistics
| | | | - N S Hochberg
- Department of Epidemiology, Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - J P Cegielski
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J A Pleskunas
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - B P Linas
- Department of Epidemiology, Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - C R Horsburgh
- Department of Epidemiology, Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
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26
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Chiang SS, Sheremeta Y, Padilla RS, Jenkins HE, Horsburgh CR, Petrenko V, Rybak NR. Pediatric Multidrug-resistant Tuberculosis in Kyiv City, Ukraine. J Epidemiol Glob Health 2019; 9:56-61. [PMID: 30932391 PMCID: PMC7024600 DOI: 10.2991/jegh.k.190225.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/16/2018] [Indexed: 12/02/2022] Open
Abstract
Few reports have described pediatric Multidrug-resistant Tuberculosis (MDR-TB) in the former Soviet republics, despite the fact that these countries have the highest proportion of TB cases that are MDR. We aimed to examine pediatric MDR-TB in Ukraine. This retrospective cohort study included all children <18 years of age who started undergoing MDR-TB treatment between January 1, 2011 and July 31, 2016 at Kyiv City Pediatric TB Hospital. From each child's clinical chart, we abstracted demographic and clinical data. Using Fisher's exact test, we compared characteristics between children with microbiologically confirmed vs. probable (i.e., clinically diagnosed) MDR-TB. The study population included 20 children with a median age of 5 years. At diagnosis, 12 (60%) had intrathoracic lymphadenopathy as their only radiographic abnormality, and two (10%) were asymptomatic. Children with confirmed MDR-TB were more likely to be adolescents or have radiologic abnormalities in addition to intrathoracic lymphadenopathy. Median treatment duration was 20 months. Eighteen (90%) children were treated successfully. The remaining two were transferred to another facility, and their final outcomes were unknown. The excellent outcomes in this cohort are consistent with high treatment success rates for pediatric MDR-TB reported in other parts of the world.
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Affiliation(s)
- Silvia Shinpei Chiang
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
- Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - Yana Sheremeta
- Department of Tuberculosis and Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | | | | | - Charles Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Vasyl Petrenko
- Department of Tuberculosis and Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Natasha Renee Rybak
- Department of Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
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27
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Berhanu RH, Schnippel K, Kularatne R, Firnhaber C, Jacobson KR, Horsburgh CR, Lippincott CK. Discordant rifampicin susceptibility results are associated with Xpert ® MTB/RIF probe B and probe binding delay. Int J Tuberc Lung Dis 2019; 23:358-362. [PMID: 30940300 PMCID: PMC6495054 DOI: 10.5588/ijtld.16.0837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Xpert® MTB/RIF is the first-line diagnostic test for Mycobacterium tuberculosis and rifampicin (RIF) resistance in South Africa. OBJECTIVE To describe the rates of Xpert RIF resistance not confirmed on follow-up testing, as well as the patient and test characteristics associated with discordant results. DESIGN Retrospective review of patients with isolates showing Xpert RIF resistance. Line-probe assay, phenotypic drug susceptibility testing or repeat Xpert were all considered confirmatory tests of RIF resistance. 'Discordance' was defined as a patient with RIF resistance identified on initial Xpert testing, with a subsequent confirmatory test indicating RIF susceptibility. Associations were analysed using Pearson χ² difference of proportions and modified Poisson regression. RESULTS RIF discordance occurred in 22/263 subjects and was associated with Xpert probe B, probe binding delay, as opposed to probe dropout, and probe binding delays (ΔCt) of between 4 and 4.9. CONCLUSION Discordant RIF resistance was common in our cohort and was associated with Xpert probe delay and use of probe B.
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Affiliation(s)
- R H Berhanu
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina, USA, Department of Medicine, Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, Right to Care, Johannesburg
| | - K Schnippel
- Right to Care, Johannesburg, Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences
| | - R Kularatne
- National Institute for Communicable Diseases/National Health Laboratory Service and Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - C Firnhaber
- Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, Department of Medicine, Infectious Disease Division, University of Colorado, Denver, Colorado
| | - K R Jacobson
- Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - C R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - C K Lippincott
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
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Mezwa K, McAnaw S, Chiang CY, Trébucq A, Horsburgh CR. Insights into drug-resistant tuberculosis treatment: results of The Union DR-TB Working Group Survey, 2017. Public Health Action 2018; 8:141-144. [PMID: 30271731 DOI: 10.5588/pha.18.0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/20/2018] [Indexed: 11/10/2022] Open
Abstract
The past 4 years have seen the introduction of new regimens and new drugs to treat multidrug-resistant tuberculosis (MDR-TB). To identify implementation trends over time, the DR-TB Working Group of the International Union Against Tuberculosis and Lung Disease (The Union), in collaboration with RESIST-TB, launched an online survey to Union members around the world. Survey results showed substantial diversity in treatment roll-out: 36% of respondents stated that their country is using the 9-month regimen for MDR-TB treatment; 41% are using bedaquiline and delamanid, but not the 9-month regimen; 28% are using both; and 22% of respondents indicated that their country does not currently offer either of these treatment options. Survey respondents also identified specific challenges to the introduction of shorter MDR-TB regimens and new drugs, including access to rapid diagnosis of fluoroquinolone resistance and case management. The results of this survey are intended to help identify research and implementation gaps while highlighting the importance of global implementation of scalable regimens for the treatment of MDR-TB.
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Affiliation(s)
- K Mezwa
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - S McAnaw
- Tuberculosis Department, Partners In Health, Boston, Massachusetts, USA
| | - C-Y Chiang
- Department of Lung Health, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A Trébucq
- Tuberculosis Division, The Union, Paris, France
| | - C R Horsburgh
- Departments of Epidemiology, Biostatistics and Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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McAnaw SE, Hesseling AC, Seddon JA, Dooley KE, Garcia-Prats AJ, Kim S, Jenkins HE, Schaaf HS, Sterling TR, Horsburgh CR. Pediatric multidrug-resistant tuberculosis clinical trials: challenges and opportunities. Int J Infect Dis 2017; 56:194-199. [PMID: 27955992 PMCID: PMC5606236 DOI: 10.1016/j.ijid.2016.11.423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/23/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022] Open
Abstract
On June 17, 2016, RESIST-TB, IMPAACT, Vital Strategies, and New Ventures jointly hosted the Pediatric Multidrug Resistant Tuberculosis Clinical Trials Landscape Meeting in Arlington, Virginia, USA. The meeting provided updates on current multidrug-resistant tuberculosis (MDR-TB) trials targeting pediatric populations and adult trials that have included pediatric patients. A series of presentations were given that discussed site capacity needs, community engagement, and additional interventions necessary for clinical trials to improve the treatment of pediatric MDR-TB. This article presents a summary of topics discussed, including the following: current trials ongoing and planned; the global burden of MDR-TB in children; current regimens for MDR-TB treatment in children; pharmacokinetics of second-line anti-tuberculosis medications in children; design, sample size, and statistical considerations for MDR-TB trials in children; selection of study population, design, and treatment arms for a trial of novel pediatric MDR-TB regimens; practical aspects of pediatric MDR-TB treatment trials; and strategies for integrating children into adult tuberculosis trials. These discussions elucidated barriers to pediatric MDR-TB clinical trials and provided insight into necessary next steps for progress in this field. Investigators and funding agencies need to respond to these recommendations so that important studies can be implemented, leading to improved treatment for children with MDR-TB.
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Affiliation(s)
- S E McAnaw
- RESIST TB, 801 Massachusetts Avenue, suite 389, Boston, MA 202118, USA.
| | - A C Hesseling
- RESIST TB, 801 Massachusetts Avenue, suite 389, Boston, MA 202118, USA
| | - J A Seddon
- RESIST TB, 801 Massachusetts Avenue, suite 389, Boston, MA 202118, USA
| | - K E Dooley
- RESIST TB, 801 Massachusetts Avenue, suite 389, Boston, MA 202118, USA
| | - A J Garcia-Prats
- RESIST TB, 801 Massachusetts Avenue, suite 389, Boston, MA 202118, USA
| | - S Kim
- RESIST TB, 801 Massachusetts Avenue, suite 389, Boston, MA 202118, USA
| | - H E Jenkins
- RESIST TB, 801 Massachusetts Avenue, suite 389, Boston, MA 202118, USA
| | - H S Schaaf
- RESIST TB, 801 Massachusetts Avenue, suite 389, Boston, MA 202118, USA
| | - T R Sterling
- RESIST TB, 801 Massachusetts Avenue, suite 389, Boston, MA 202118, USA
| | - C R Horsburgh
- RESIST TB, 801 Massachusetts Avenue, suite 389, Boston, MA 202118, USA
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30
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Moro RN, Sterling TR, Saukkonen J, Vernon A, Horsburgh CR, Chaisson RE, Hamilton CD, Villarino ME, Goldberg S. Factors associated with non-completion of follow-up: 33-month latent tuberculous infection treatment trial. Int J Tuberc Lung Dis 2017; 21:286-296. [PMID: 28087928 DOI: 10.5588/ijtld.16.0469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING A post-hoc exploratory analysis of a randomized, open-label clinical trial that enrolled 8053 participants from the United States, Canada, Brazil, and Spain. OBJECTIVE To assess factors associated with non-completion of study follow-up (NCF) in a 33-month latent tuberculous infection treatment trial, PREVENT TB. DESIGN Participants were randomized to receive 3 months of weekly directly observed therapy vs. 9 months of daily self-administered therapy. NCF was defined as failing to be followed for at least 993 days (33 months) from enrollment. Possible factors associated with NCF were analyzed using univariate and multivariate regression via Cox proportional hazard model. RESULTS Of 7061 adults selected for analysis, 841 (11.9%) did not complete study follow-up. Homelessness, young age, low education, history of incarceration, smoking, missing an early clinic visit, receiving isoniazid only, and male sex were significantly associated with NCF. Similar results were found in the North American region (United States and Canada) only. In Brazil and Spain, the only significant factor was missing an early clinic visit. CONCLUSIONS Study subjects at higher risk for NCF were identified by characteristics known at enrollment or in early follow-up. Evaluation of follow-up in other trials might help determine whether the identified factors consistently correlate with retention.
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Affiliation(s)
- R N Moro
- Centers for Disease Control and Prevention (CDC), Atlanta, CDC Foundation Research Collaboration, Atlanta, Georgia
| | - T R Sterling
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - J Saukkonen
- Boston University Schools of Public Health and Medicine, Boston, Massachusetts
| | - A Vernon
- Centers for Disease Control and Prevention (CDC), Atlanta
| | - C R Horsburgh
- Boston University Schools of Public Health and Medicine, Boston, Massachusetts
| | - R E Chaisson
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - C D Hamilton
- Duke University School of Medicine, Durham, Family Health International 360, Durham, North Carolina, USA
| | - M E Villarino
- Centers for Disease Control and Prevention (CDC), Atlanta
| | - S Goldberg
- Centers for Disease Control and Prevention (CDC), Atlanta
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Furin J, Alirol E, Allen E, Fielding K, Merle C, Abubakar I, Andersen J, Davies G, Dheda K, Diacon A, Dooley KE, Dravnice G, Eisenach K, Everitt D, Ferstenberg D, Goolam-Mahomed A, Grobusch MP, Gupta R, Harausz E, Harrington M, Horsburgh CR, Lienhardt C, McNeeley D, Mitnick CD, Nachman S, Nahid P, Nunn AJ, Phillips P, Rodriguez C, Shah S, Wells C, Thomas-Nyang'wa B, du Cros P. Drug-resistant tuberculosis clinical trials: proposed core research definitions in adults. Int J Tuberc Lung Dis 2017; 20:290-4. [PMID: 27046707 DOI: 10.5588/ijtld.15.0490] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) is a growing public health problem, and for the first time in decades, new drugs for the treatment of this disease have been developed. These new drugs have prompted strengthened efforts in DR-TB clinical trials research, and there are now multiple ongoing and planned DR-TB clinical trials. To facilitate comparability and maximise policy impact, a common set of core research definitions is needed, and this paper presents a core set of efficacy and safety definitions as well as other important considerations in DR-TB clinical trials work. To elaborate these definitions, a search of clinical trials registries, published manuscripts and conference proceedings was undertaken to identify groups conducting trials of new regimens for the treatment of DR-TB. Individuals from these groups developed the core set of definitions presented here. Further work is needed to validate and assess the utility of these definitions but they represent an important first step to ensure there is comparability in clinical trials on multidrug-resistant TB.
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Affiliation(s)
- J Furin
- TB Research Unit, Case Western Reserve University School of Medicine, Room E-202, 2210 Circle Dr, Cleveland, OH 44149, USA.
| | - E Alirol
- Manson Unit Médicins Sans Frontières, London, UK
| | - E Allen
- Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - K Fielding
- Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - C Merle
- Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - I Abubakar
- Department of Infection and Population Health, University College of London, London, UK
| | - J Andersen
- Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts, USA
| | - G Davies
- Institutes of Infection and Global Health and of Translational Medicine, University of Liverpool, Liverpool, UK
| | - K Dheda
- Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - A Diacon
- Biomedical Sciences, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa
| | - K E Dooley
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - G Dravnice
- Tuberculosis Foundation, KNCV, Amsterdam, The Netherlands
| | - K Eisenach
- Pathology and Microbiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - D Everitt
- Global Alliance for TB Drug Development, New York, New York, USA
| | | | | | - M P Grobusch
- Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Gupta
- Otsuka USA, Rockville, Maryland, USA
| | - E Harausz
- TB Research Unit, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - M Harrington
- Treatment Action Group, New York City, New York, USA
| | - C R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - C Lienhardt
- Stop TB Partnership & Stop TB Department, World Health Organization, Geneva, Switzerland
| | - D McNeeley
- Medical Service Corp International, Arlington, Virginia, USA
| | - C D Mitnick
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - S Nachman
- Department of Pediatrics, Stony Brook School of Medicine, Stony Brook, New York, USA
| | - P Nahid
- Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - A J Nunn
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - P Phillips
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - C Rodriguez
- Department of Respiratory Medicine, P D Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - S Shah
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - C Wells
- Otsuka USA, Rockville, Maryland, USA
| | | | - P du Cros
- Manson Unit Médicins Sans Frontières, London, UK
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Young KL, Huang W, Horsburgh CR, Linas BP, Assoumou SA. Eighteen- to 30-year-olds more likely to link to hepatitis C virus care: an opportunity to decrease transmission. J Viral Hepat 2016; 23:274-81. [PMID: 26572798 PMCID: PMC5481196 DOI: 10.1111/jvh.12489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/23/2015] [Indexed: 12/12/2022]
Abstract
Hepatitis C virus (HCV) infection incidence among 18- to 30-year-olds is increasing and guidelines recommend treatment of active injection drug users to limit transmission. We aimed to : measure linkage to HCV care among 18- to 30-year-olds and identify factors associated with linkage; compare linkage among 18- to 30-year-olds to that of patients >30 years. We used the electronic medical record at an urban safety net hospital to create a retrospective cohort with reactive HCV antibody between 2005 and 2010. We report seroprevalence and demographics of seropositive patients, and used multivariable logistic regression to identify factors associated with linkage to HCV care. We defined linkage as having evidence of HCV RNA testing after reactive antibody. Thirty two thousand four hundred and eighteen individuals were tested, including 8873 between 18 and 30 years. The seropositivity rate among those ages 18-30 was 10%. In multivariate analysis, among those 18-30, diagnosis location (Outpatient vs Inpatient/ED) (OR 1.78, 95% CI 1.28-2.49) and number of visits after diagnosis (OR 5.30, 95% CI 3.91-7.19) were associated with higher odds of linking to care. When we compared linkage in patients ages 18-30 to that among those older than 30, patients in the 18-30 years age group were more likely to link to HCV care than those in the older cohort even when controlling for gender, ethnicity, socioeconomic status, birthplace, diagnosis location and duration of follow-up. Eighteen- to 30-year-olds are more likely to link to HCV care than their older counterparts. During the interferon-free treatment era, there is an opportunity to prevent further HCV transmission in this population.
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Affiliation(s)
- K L Young
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - W Huang
- Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - C R Horsburgh
- Department of Medicine, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - B P Linas
- Department of Medicine, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- HIV Epidemiology and Outcomes Research Unit, Boston Medical Center, Boston, MA, USA
| | - S A Assoumou
- Department of Medicine, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
- HIV Epidemiology and Outcomes Research Unit, Boston Medical Center, Boston, MA, USA
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Hochberg NS, Kubiak RW, Tibbs A, Elder H, Sharnprapai S, Etkind S, Horsburgh CR. Effectiveness of reporting on latent tuberculous infection in Massachusetts, 2006-2008. Public Health Action 2015; 4:53-5. [PMID: 26423762 DOI: 10.5588/pha.13.0085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/06/2013] [Indexed: 11/10/2022] Open
Abstract
Massachusetts is one of five states that mandate the reporting of latent tuberculous infection (LTBI). We assessed 2006-2008 Massachusetts surveillance data for LTBI to describe the system and examine the characteristics of persons with LTBI. Over 3 years, 15 301 LTBI cases were reported (4742-5398/year). Among those with known country of birth (n = 11 655), 9983 (85.7%) were foreign-born. Substantial under-ascertainment and/or under-reporting appear likely; mandatory reporting does not appear sufficient for LTBI detection. Enhanced targeted testing, active LTBI surveillance, or laboratory-based surveillance may be needed to eliminate tuberculosis disease in the United States.
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Affiliation(s)
- N S Hochberg
- Boston University School of Public Health, Boston, Massachusetts ; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - R W Kubiak
- Boston University School of Public Health, Boston, Massachusetts
| | - A Tibbs
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - H Elder
- Boston University School of Public Health, Boston, Massachusetts
| | - S Sharnprapai
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - S Etkind
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - C R Horsburgh
- Boston University School of Public Health, Boston, Massachusetts
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O'Donnell MR, Chamblee S, von Reyn CF, Marsh BJ, Moreland JD, Narita M, Johnson LS, Horsburgh CR. Sustained reduction in tuberculosis incidence following a community-based participatory intervention. Public Health Action 2015; 2:23-6. [PMID: 26392941 DOI: 10.5588/pha.11.0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 02/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rates of latent tuberculosis infection (LTBI) and tuberculosis (TB) disease are elevated in the rural southeastern United States and among US- and foreign-born Black residents. To prevent TB and reduce TB transmission, community-based strategies are essential. OBJECTIVE To describe a community-based participatory intervention for improving the detection and treatment of LTBI and TB and reducing TB incidence. DESIGN In rural Florida, we carried out a community educational TB campaign from 1997 to 2000, including presentations at community events, a media campaign and working with local community groups to develop culturally appropriate prevention messages. The campaign was implemented concurrently with a population-based LTBI survey. RESULTS The annual TB incidence rate in the intervention area decreased from 81 per 100 000 in 1994-1997, to 42/ 100 000 in 1998-2001, and to 25/100 000 in 2002-2005 (P = 0.001). This decrease was not observed in communities where the intervention was not implemented. There was no decrease in the TB incidence rate ratio between Blacks and non-Blacks in either region during the study period. CONCLUSIONS We conclude that community participation in LTBI screening and TB education was associated with a substantial reduction in TB rates. Although the TB incidence rate ratio did not decrease between Blacks and non-Blacks, TB incidence fell in all racial groups.
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Affiliation(s)
- M R O'Donnell
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - S Chamblee
- Glades Health Initiative Inc, Belle Glade, Florida, USA
| | - C F von Reyn
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - B J Marsh
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - J D Moreland
- C L Brumback Health Center, Belle Glade, Florida, USA
| | - M Narita
- Tuberculosis Control Program, Public Health, Seattle and King County, Seattle, Washington, USA ; University of Washington School of Medicine, Seattle, Washington, USA
| | | | - C R Horsburgh
- Boston University School of Public Health, Boston, Massachusetts, USA
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35
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Hirsch-Moverman Y, Shrestha-Kuwahara R, Bethel J, Blumberg HM, Venkatappa TK, Horsburgh CR, Colson PW. Latent tuberculous infection in the United States and Canada: who completes treatment and why? Int J Tuberc Lung Dis 2015; 19:31-8. [PMID: 25519787 DOI: 10.5588/ijtld.14.0373] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To assess latent tuberculous infection (LTBI) treatment completion rates in a large prospective US/Canada multisite cohort and identify associated risk factors. METHODS This prospective cohort study assessed factors associated with LTBI treatment completion through interviews with persons who initiated treatment at 12 sites. Interviews were conducted at treatment initiation and completion/cessation. Participants received usual care according to each clinic's procedure. Multivariable models were constructed based on stepwise assessment of potential predictors and interactions. RESULTS Of 1515 participants initiating LTBI treatment, 1323 had information available on treatment completion; 617 (46.6%) completed treatment. Baseline predictors of completion included male sex, foreign birth, not thinking it would be a problem to take anti-tuberculosis medication, and having health insurance. Participants in stable housing who received monthly appointment reminders were more likely to complete treatment than those without stable housing or without monthly reminders. End-of-treatment predictors of non-completion included severe symptoms and the inconvenience of clinic/pharmacy schedules, barriers to care and changes of residence. Common reasons for treatment non-completion were patient concerns about tolerability/toxicity, appointment conflicts, low prioritization of TB, and forgetfulness. CONCLUSIONS Less than half of treatment initiators completed treatment in our multisite study. Addressing tangible issues such as not having health insurance, toxicity concerns, and clinic accessibility could help to improve treatment completion rates.
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Affiliation(s)
- Y Hirsch-Moverman
- Charles P Felton National Tuberculosis Center, ICAP, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | | | - J Bethel
- Westat, Rockville, Maryland, USA
| | - H M Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - C R Horsburgh
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - P W Colson
- Charles P Felton National Tuberculosis Center, ICAP, Mailman School of Public Health, Columbia University, New York City, New York, USA
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36
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Simonsen DF, Farkas DK, Søgaard M, Horsburgh CR, Sørensen HT, Thomsen RW. Tuberculosis and risk of cancer: a Danish nationwide cohort study. Int J Tuberc Lung Dis 2015; 18:1211-9. [PMID: 25216835 DOI: 10.5588/ijtld.14.0161] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the short- and long-term risk of cancer in patients with active tuberculosis (TB). DESIGN Using Danish nationwide databases, we quantified cancer risk in TB patients during 1978-2011 compared with the general population. RESULTS We observed 1747 cancers in 15 024 TB patients (median follow-up 8.5 years), reflecting a standardised incidence ratio (SIR) of 1.52 (95%CI 1.45-1.59). All-time SIR for extra-pulmonary cancer was 1.29 (95%CI 1.22-1.36) and for lung cancer it was 3.40 (95%CI 3.09-3.74). Absolute cancer risk 3 months after TB was 1.83% (SIR 11.09, 95%CI 9.82-12.48), with highly increased SIRs for malignant pleural mesothelioma (368.4), lung cancer (40.9), Hodgkin's lymphoma (30.6), ovarian cancer (26.4) and non-Hodgkin's malignant lymphoma (23.8). Between the 3-month and 5-year follow-up, the SIR for any cancer was 1.59 (95%CI 1.46-1.72), including 19- and 3-fold increases for malignant pleural mesothelioma and lung cancer. Beyond 5 years, the SIR of cancer was 1.17 (95%CI 1.10-1.25). Elevated long-term risks persisted for haematological (SIR 1.34, 95%CI 1.01-1.74) and tobacco-related cancers (SIR 1.78, 95%CI 1.60-1.97). CONCLUSION TB is a marker of occult lung cancer and several extra-pulmonary cancers. TB also predicts increased long-term risk of cancer, possibly related to chronic inflammation and shared risk factors, including immunosuppression and smoking.
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Affiliation(s)
- D F Simonsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - D K Farkas
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - M Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - C R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - H T Sørensen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - R W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Colson PW, Hirsch-Moverman Y, Bethel J, Vempaty P, Salcedo K, Wall K, Miranda W, Collins S, Horsburgh CR. Acceptance of treatment for latent tuberculosis infection: prospective cohort study in the United States and Canada. Int J Tuberc Lung Dis 2013; 17:473-9. [PMID: 23485381 DOI: 10.5588/ijtld.12.0697] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING An estimated 300 000 individuals are treated for latent tuberculosis infection (LTBI) in the United States and Canada annually. Little is known about the proportion or characteristics of those who decline treatment. OBJECTIVE To define the proportion of individuals in various groups who accept LTBI treatment and to identify factors associated with non-acceptance of treatment. DESIGN Persons offered LTBI treatment at 30 clinics in 12 Tuberculosis Epidemiologic Studies Consortium sites were prospectively enrolled. Multivariate regression models were constructed based on manual stepwise assessment of potential predictors. RESULTS Of 1692 participants enrolled from March 2007 to September 2008, 1515 (89.5%) accepted treatment and 177 (10.5%) declined. Predictors of acceptance included believing one could personally spread TB germs, having greater TB knowledge, finding clinic schedules convenient and having low acculturation. Predictors of non-acceptance included being a health care worker, being previously recommended for treatment and believing that taking medicines would be problematic. CONCLUSION This is the first prospective multisite study to examine predictors of LTBI treatment acceptance in general clinic populations. Greater efforts should be made to increase acceptance among health care workers, those previously recommended for treatment and those who expect problems with LTBI medicines. Ensuring convenient clinic schedules and TB education to increase knowledge could be important for ensuring acceptance.
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Affiliation(s)
- P W Colson
- Charles P Felton National Tuberculosis Center, International Center for AIDS Care and Treatment Programs, Columbia University, New York, New York 10027, USA.
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Reed E, Santana MC, Bowleg L, Welles SL, Horsburgh CR, Raj A. Experiences of racial discrimination and relation to sexual risk for HIV among a sample of urban black and African American men. J Urban Health 2013; 90:314-22. [PMID: 22674464 PMCID: PMC3675717 DOI: 10.1007/s11524-012-9690-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to examine racial discrimination and relation to sexual risk for HIV among a sample of urban black and African American men. Participants of this cross-sectional study were black and African American men (N = 703) between the ages of 18 and 65 years, recruited from four urban clinical sites in the northeast. Multivariate logistic regression models were used to analyze the relation of reported racial discrimination to the following: (1) sex trade involvement, (2) recent unprotected sex, and (3) reporting a number of sex partners in the past 12 months greater than the sample average. The majority of the sample (96%) reported racial discrimination. In adjusted analyses, men reporting high levels of discrimination were significantly more likely to report recent sex trade involvement (buying and/or selling) (adjusted odds ratio (AOR) range = 1.7-2.3), having recent unprotected vaginal sex with a female partner (AOR = 1.4, 95% confidence interval (CI), 1.1-2.0), and reporting more than four sex partners in the past year (AOR = 1.4, 95% CI, 1.1-1.9). Findings highlight the link between experiences of racial discrimination and men's sexual risk for HIV.
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Affiliation(s)
- E Reed
- Department of Prevention and Community Health, George Washington University School of Public Health, Washington, DC, USA.
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Horsburgh CR, Haxaire-Theeuwes M, Lienhardt C, Wingfield C, McNeeley D, Pyne-Mercier L, Keshavjee S, Varaine F. Compassionate use of and expanded access to new drugs for drug-resistant tuberculosis. Int J Tuberc Lung Dis 2012; 17:146-52. [PMID: 23211610 DOI: 10.5588/ijtld.12.0017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Several new classes of anti-tuberculosis agents are likely to become available in the coming decade. Ensuring prompt access to these drugs for patients without other treatment options is an important medical and public health issue. This article reviews the current state of 'compassionate use' and 'expanded access' programs for these new drugs, and identifies several shortcomings that will limit patient access to the drugs. A series of five steps is outlined that will need to be taken by national health bodies, international agencies and non-governmental organizations to prevent undue delays in access to new tuberculosis drugs for patients who could benefit from them. Following these steps can ensure that patients will be able to benefit from access to these drugs, while minimizing the risk of emergence of resistance to the drug.
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Affiliation(s)
- C R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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Larson EM, O'Donnell M, Chamblee S, Horsburgh CR, Marsh BJ, Moreland JD, Johnson LS, von Reyn CF. Dual skin tests with Mycobacterium avium sensitin and PPD to detect misdiagnosis of latent tuberculosis infection. Int J Tuberc Lung Dis 2012; 15:1504-9, i. [PMID: 22008764 DOI: 10.5588/ijtld.11.0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A positive tuberculin skin test (TST) may indicate cross-reacting immunity to non-tuberculous mycobacteria (NTM) and not latent tuberculosis infection (LTBI). OBJECTIVES To assess misclassification of LTBI, as assessed by skin testing with Mycobacterium avium sensitin (MaS), and to determine how this misclassification affects the analysis of risk factors for LTBI. METHODS In a population-based survey, participants underwent skin testing with M. tuberculosis purified protein derivative (PPD) and MaS. A PPD-dominant skin test was a reaction that was ≥ 3 mm larger than the MaS reaction; a MaS-dominant skin test was a reaction that was ≥ 3 mm larger than the PPD reaction. RESULTS Of 447 randomly selected persons, 135 (30%) had a positive PPD test. Of these, 21 (16%) were MaS- dominant, and were therefore attributable to NTM and misclassified as LTBI. PPD reactions of 5-14 mm were more likely to be misclassified than those ≥ 15 mm (OR = 5.0, 95%CI 1.9-13.2). Adjusting for misclassification had only a small impact on the analysis of risk factors for LTBI. CONCLUSIONS A substantial number of individuals who are diagnosed with LTBI are actually sensitized to NTM. Using dual skin testing would reduce misdiagnosis and prevent unnecessary treatment.
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Affiliation(s)
- E M Larson
- Boston University School of Public Health, Boston, Massachusetts 02118, USA
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Kabali C, von Reyn CF, Brooks DR, Waddell R, Mtei L, Bakari M, Matee M, Pallangyo K, Arbeit RD, Horsburgh CR. Completion of isoniazid preventive therapy and survival in HIV-infected, TST-positive adults in Tanzania. Int J Tuberc Lung Dis 2012; 15:1515-21, i. [PMID: 22008766 DOI: 10.5588/ijtld.10.0788] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The World Health Organization recommends the use of isoniazid preventive therapy (IPT) for human immunodeficiency virus (HIV) infected patients with a positive tuberculin skin test (TST). However, due to concerns about the effectiveness of IPT in community health care settings and the development of drug resistance, these recommendations have not been widely implemented in countries where tuberculosis (TB) and HIV co-infection is common. OBJECTIVE To evaluate the effectiveness of IPT on survival and TB incidence among HIV-infected patients in Tanzania. DESIGN A cohort study nested within a randomized trial of HIV-infected adults with baseline CD4 counts of ≥ 200 cells/μ l was conducted to compare survival and incidence of active TB between TST-positive subjects who did or did not complete 6 months of IPT in the period 2001-2008. RESULTS Of 558 TST-positive subjects in the analytic cohort, 488 completed 6 months of IPT and 70 did not. Completers had a decrease in mortality compared to non-completers (HR 0.4, 95%CI 0.2-0.8). However, the protective effect of IPT on the incidence of active TB was non-significant (HR 0.6, 95%CI 0.3-1.3). CONCLUSION Completion of IPT is associated with increased survival in HIV-infected adults with CD4 counts ≥ 200 cells/μ l and a positive TST.
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Affiliation(s)
- C Kabali
- Population Health Research Institute, Hamilton, Ontario, Canada.
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von Reyn CF, Kimambo S, Mtei L, Arbeit RD, Maro I, Bakari M, Matee M, Lahey T, Adams LV, Black W, Mackenzie T, Lyimo J, Tvaroha S, Waddell R, Kreiswirth B, Horsburgh CR, Pallangyo K. Disseminated tuberculosis in human immunodeficiency virus infection: ineffective immunity, polyclonal disease and high mortality. Int J Tuberc Lung Dis 2011; 15:1087-92. [PMID: 21740673 PMCID: PMC10511345 DOI: 10.5588/ijtld.10.0517] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disseminated tuberculosis (TB) is a major cause of death in patients with the acquired immune-deficiency syndrome (AIDS), but its pathogenesis and clinical features have not been defined prospectively. METHODS Human immunodeficiency virus (HIV) infected adults with a CD4 count ≥ 200 cells/μl and bacille Calmette-Guérin scar underwent immunologic evaluation and subsequent follow-up. RESULTS Among 20 subjects who developed disseminated TB, baseline tuberculin skin tests were ≥15 mm in 14 (70%) and lymphocyte proliferative responses to Mycobacterium tuberculosis were positive in 14 (70%). At the time of diagnosis, fever ≥2 weeks plus ≥5 kg weight loss was reported in 16 (80%) patients, abnormal chest X-rays in 7/17 (41%), and positive sputum cultures in 10 (50%); median CD4 count was 30 cells/μl (range 1-122). By insertion sequence (IS) 6110 analysis, 14 (70%) blood isolates were clustered and 3/8 (37%) concurrent sputum isolates represented a different strain (polyclonal disease). Empiric TB treatment was given to eight (40%) patients; 11 (55%) died within a month. CONCLUSIONS Disseminated TB in HIV occurs with cellular immune responses indicating prior mycobacterial infection, and IS6110 analysis suggests an often lethal combination of reactivation and newly acquired infection. Control will require effective prevention of both remotely and recently acquired infection, and wider use of empiric therapy in patients with advanced AIDS and prolonged fever.
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Affiliation(s)
- C F von Reyn
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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O'Donnell MR, Chamblee S, von Reyn CF, Ellerbrock TV, Johnson J, Marsh BJ, Moreland JD, Narita M, Pedrosa M, Johnson LS, Horsburgh CR. Racial disparities in primary and reactivation tuberculosis in a rural community in the southeastern United States. Int J Tuberc Lung Dis 2010; 14:733-740. [PMID: 20487612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
SETTING A rural section of a county in central Florida. BACKGROUND Racial disparities in tuberculosis disease (TB) are substantial in the United States. OBJECTIVE To determine if TB was attributable to primary infection, reactivation or both. DESIGN A population-based survey of latent tuberculosis infection (LTBI), a case-control analysis of TB, and a cluster analysis of TB isolates were performed between 1997 and 2001. RESULTS Of 447 survey participants, 135 (30%) had LTBI. Black race was strongly associated with LTBI among US-born (OR 2.6, 95%CI 1.3-5.5) and foreign-born subjects (OR 4.3, 95%CI 2.2-8.4). Risk factors for TB included human immunodeficiency virus (HIV; OR 27.4, 95%CI 10.1-74.1), drug use (OR 4.6, 95%CI 1.7-12.4) and Black race (OR 3.4, 95%CI 1.2-9.6). The population risk of TB attributable to Black race was 64%, while that attributable to HIV was 46%. Cluster analysis showed 67% of TB cases were clustered, but Blacks were not at a significantly increased risk of having a clustered isolate (OR 2.1, 95%CI 0.12-36.0). CONCLUSION Both reactivation TB and recent TB transmission were increased among Blacks in this community. Therefore, LTBI screening and intensive contact tracing, both followed by LTBI treatment, will be needed to reduce TB in Blacks.
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Affiliation(s)
- M R O'Donnell
- Section of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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O'Donnell MR, Padayatchi N, Master I, Osburn G, Horsburgh CR. Improved early results for patients with extensively drug-resistant tuberculosis and HIV in South Africa. Int J Tuberc Lung Dis 2009; 13:855-861. [PMID: 19555535 PMCID: PMC2855970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
SETTING A public tuberculosis (TB) referral hospital in KwaZulu-Natal, South Africa. OBJECTIVE To present treatment outcomes of patients with extensively drug-resistant tuberculosis (XDR-TB) patients and human immunodeficiency virus (HIV) coinfection with and without highly active antiretroviral therapy. METHODS Retrospective cohort study. Eligible patients had drug susceptibility testing that met a consensus definition for XDR-TB, and agreed to treatment. Therapy was based on drug susceptibilities, available medications and patient tolerance. RESULTS Overall, 60 XDR-TB patients initiated therapy with a median number of 5.5 drugs. Of these, 43 (72%) were HIV-positive, and 21 (49%) were on antiretroviral therapy; 29 HIV-infected patients (67%) had available CD4 counts, with a median CD4 count of 200.5 cells/mm(3) (standard deviation 127.4 cells/mm(3)). Of 60 patients, 31 (52%) had adverse events (AEs), and 17/60 patients (28%) had severe AEs. During follow-up, 12/60 (20%) experienced sputum culture conversion, while 25/60 (42%) patients died. None of the following was significantly associated with mortality: HIV status, previous MDR diagnosis or severe AEs. DISCUSSION In this study, it was possible to treat HIV-XDR-TB coinfected patients and prolong survival in a resource-limited setting. We highlight the challenges in treatment, including high frequencies of AEs and death. Expanded identification of cases, prompt referral for treatment, and attention to management of comorbidities may facilitate successful treatment of XDR-TB in HIV-infected patients.
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Affiliation(s)
- Max R O'Donnell
- Section of Pulmonary, Allergy, and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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von Reyn CF, Arbeit RD, Horsburgh CR, Ristola MA, Waddell RD, Tvaroha SM, Samore M, Hirschhorn LR, Lumio J, Lein AD, Grove MR, Tosteson ANA. Sources of disseminated Mycobacterium avium infection in AIDS. J Infect 2002; 44:166-70. [PMID: 12099743 DOI: 10.1053/jinf.2001.0950] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To identify the sources of disseminated Mycobacterium avium complex (MAC) infection in AIDS. METHODS HIV positive subjects with CD4 counts <100/mm(3) in Atlanta, Boston, New Hampshire and Finland were entered in a prospective cohort study. Subjects were interviewed about potential MAC exposures, had phlebotomy performed for determination of antibody to mycobacterial lipoarabinomannin and for culture. Patient-directed water samples were collected from places of residence, work and recreation. Patients were followed for the development of disseminated MAC. Univariate and multivariate risk factors for MAC were analyzed. RESULTS Disseminated MAC was identified in 31 (9%) subjects. Significant risks in univariate analysis included prior Pneumocystis carinii pneumonia (PCP) (hazard ratio 1.821), consumption of spring water (4.909), consumption of raw seafood (34.3), gastrointestinal endoscopy (2.894), and showering outside the home (0.388). PCP, showering and endoscopy remained significant in a Cox proportional hazards model. There was no association between M. avium colonization of home water and risk of MAC. In patients with CD4<25, median OD antibody levels to lipoarabinomannin at baseline were 0.054 among patients who did not develop MAC and 0.021 among patients who did develop MAC (P=0.077). CONCLUSIONS MAC infection results from diverse and likely undetectable environmental and nosocomial exposures. Mycobacterial infection before HIV infection may confer protection against disseminated MAC in advanced AIDS.
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Affiliation(s)
- C F von Reyn
- Infectious Disease Section, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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von Reyn CF, Horsburgh CR, Olivier KN, Barnes PF, Waddell R, Warren C, Tvaroha S, Jaeger AS, Lein AD, Alexander LN, Weber DJ, Tosteson AN. Skin test reactions to Mycobacterium tuberculosis purified protein derivative and Mycobacterium avium sensitin among health care workers and medical students in the United States. Int J Tuberc Lung Dis 2001; 5:1122-8. [PMID: 11769770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
SETTING Health care workers and medical students in the United States subject to annual tuberculin skin testing. OBJECTIVE To use skin testing with Mycobacterium avium sensitin (MAS) to determine contemporary rates of infection with non-tuberculous mycobacteria (NTM) and their effect on reactions to M. tuberculosis purified protein derivative (PPD). DESIGN Dual skin testing was performed with PPD and MAS on 784 health care workers and medical students in the northern and southern US. MAS reactions that were > or = 5 mm and also > or = 3 mm larger than the PPD reaction were defined as MAS dominant and due to NTM. RESULTS MAS reactions were > or = 5 mm in 40% and > or = 15 mm in 18% of subjects; 95% were MAS dominant. MAS dominant reactions were more common in the south than the north (P < 0.001). PPD reactions were > or = 15 mm in 3% of subjects. PPD reactions > or = 15 mm were more common among males, foreign born subjects and subjects with BCG immunization (all P < 0.001). MAS dominant reactions were found in 82% of subjects with 5-9 mm PPD reactions and 50% with 10-14 mm PPD reactions; these reactions were more common among whites (P = 0.046), US-born (P = 0.038) and subjects without BCG immunization (P = 0.004). CONCLUSIONS Infections with NTM are responsible for the majority of 5-14 mm PPD reactions among US-born health care workers and medical students subject to annual tuberculin testing.
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Affiliation(s)
- C F von Reyn
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Horsburgh CR, Gettings J, Alexander LN, Lennox JL. Disseminated Mycobacterium avium complex disease among patients infected with human immunodeficiency virus, 1985-2000. Clin Infect Dis 2001; 33:1938-43. [PMID: 11692307 DOI: 10.1086/324508] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2001] [Revised: 07/11/2001] [Indexed: 11/03/2022] Open
Abstract
Disseminated Mycobacterium avium complex disease remains a substantial cause of morbidity and mortality among patients with acquired immunodeficiency syndrome. From 1985 through 2000, we studied 1458 consecutive patients at Grady Memorial Hospital, Atlanta, with disseminated M. avium complex disease. There was a peak of 198 patients in the 1995, which decreased to 66 patients in 2000. In 1997, significantly more patients than in 1991 or 1994 were female (P<.001) or black (P<.001) and significantly fewer had acquired human immunodeficiency virus through homosexual contact (P<.001). In 1997, 50 (51%) of 99 of patients acquired M. avium complex disease despite receiving antimicrobial prophylaxis, but 32 (89%) of 36 patients did not adhere to the prophylaxis regimen. The median duration of survival of patients in 1991 was 110 days, whereas in 1994 it was 185 days, and in 1997 it was 339 days (P<.001). Prolonged survival was associated with receiving therapy that included clarithromycin and receiving combination antiretroviral therapy that included a protease inhibitor.
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Affiliation(s)
- C R Horsburgh
- Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA.
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Horsburgh CR. Current issues: hospital design qualities to facilitate healing. J Healthc Des 2001; 9:89-92. [PMID: 10539161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Bruce BB, Blass MA, Blumberg HM, Lennox JL, del Rio C, Horsburgh CR. Risk of Cryptosporidium parvum transmission between hospital roommates. Clin Infect Dis 2000; 31:947-50. [PMID: 11049775 DOI: 10.1086/318147] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/1999] [Revised: 03/15/2000] [Indexed: 11/03/2022] Open
Abstract
Patients with active diarrhea caused by infection with Cryptosporidium parvum can potentially contaminate the environment, which could serve as a risk for transmission to other patients in a hospital setting. A retrospective cohort study was performed to quantify the risk of nosocomial roommate-to-roommate transmission of Cryptosporidium and to evaluate the need for isolation of Cryptosporidium-infected patients. Thirty-seven human immunodeficiency virus (HIV)-infected roommates of 21 index patients with Cryptosporidium were identified between 1994 and 1996. Each exposed roommate (median CD4 cell count, 27cells/mm(3)) was matched to an HIV-infected, unexposed roommate with a similar CD4 cell count (median, 24 cells/mm(3)) who was present in the hospital during the same month but was not a roommate of a patient with Cryptosporidium infection. No patients with Cryptosporidium were identified among the 37 exposed roommates, and 1 case was identified among the 37 unexposed roommates. The risk ratio for chronic diarrhea was 0.80 (95% confidence interval [CI], 0.23-2.75) and for death was 1.04 (95% CI, 0.75-1.44). These results suggest that isolation of adult patients with Cryptosporidium diarrhea is not necessary to prevent roommate-to-roommate transmission of Cryptosporidium.
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Affiliation(s)
- B B Bruce
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Long EG, Ewing EP, Bartlett JH, Horsburgh CR, Birkness KA, Yakrus MA, Newman GW, Quinn FD. Changes in the virulence of Mycobacterium avium after passage through embryonated hens' eggs. FEMS Microbiol Lett 2000; 190:267-72. [PMID: 11034290 DOI: 10.1111/j.1574-6968.2000.tb09297.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Eight-day-old embryonated hen's eggs were used as a model to study Mycobacterium avium virulence. Strains isolated from human patients caused 20-90% mortality when eggs were infected by injection of bacterial suspensions into the amniotic sac. Virulence of examined strains subsequently decreased with passage through eggs to between 0 and 40% mortality in four passages. Virulence of the egg-attenuated strains could be restored by passage through human peripheral blood mononuclear cells. The site of infection in the egg was usually the mesodermal layer of the chorioallantoic membrane. A few small granulomas containing acid-fast bacteria were seen in the liver, but not in other organs. Death of chicken embryos may have resulted from destruction of the mesodermal layer of the chorioallantoic membrane with consequent respiratory failure. PBMCs infected with less virulent egg-passaged strains of M. avium produced higher levels of tumor necrosis factor-alpha than did peripheral blood mononuclear cells infected with more virulent nonpassaged strains.
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Affiliation(s)
- E G Long
- Division of AIDS, STD and TB Laboratory Research, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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