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Vacca M, Wilhelms B, Zange S, Avsar K, Gesierich W, Heiß-Neumann M. Thoracic manifestations of tularaemia: a case series. Infection 2024:10.1007/s15010-024-02204-1. [PMID: 38457094 DOI: 10.1007/s15010-024-02204-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Tularaemia is a zoonotic disease caused by Francisella tularensis, a highly virulent bacterium that affects humans and small wild animals. It is transmitted through direct contact with infected animals or indirectly through contaminated soil, water or arthropod bites (e.g. ticks). Primary thoracic manifestations of tularaemia are infrequent and, therefore, a diagnostic challenge for clinicians. METHODS We report six tularaemia cases with exclusively thoracic involvement diagnosed in a clinic for pulmonary diseases in Bavaria between 10/2020 and 02/2022. RESULTS All patients lived or were active in rural areas, four reported a recent tick bite. All patients presented with thoracic lymphadenopathy and pulmonary tumours or consolidations; all underwent bronchoscopy with EBUS-TBNA of lymph nodes, three lung biopsies as well. Five patients showed inflammatory changes in the endobronchial mucosa. The main histological findings were necrotic epithelioid granulomas with remarkable granulocyte infiltration. All cases were identified by positive serology, five by PCR (here identification of F.t. ssp. Holarctica) from biopsy as well. As first-line therapy, oral ciprofloxacin was given (5/6); in 2/6 cases, a combination of quinolone-rifampicin was given. CONCLUSIONS Pulmonary tularaemia may occur after tick bites and without extrathoracic manifestations. In patients who present with thoracic lymphadenopathy and pulmonary consolidations and who are exposed to increased outdoor activities, tularaemia should be included in the diagnostic pathway. Histologically, the presence of neutrophil-granulocyte infiltrations might help to distinguish tularaemia from other granulomatous infections, e.g. tuberculosis. The combination of quinolone-rifampicin rather than i.v. gentamicin reduced length of hospital stay in two patients.
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Affiliation(s)
- M Vacca
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany.
| | - B Wilhelms
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
- Department of Internal Medicine, Krankenhaus Barmherzige Brüder, Munich, Germany
| | - S Zange
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - K Avsar
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
- Lungenaerzte am Rundfunkplatz, Munich, Germany
| | - W Gesierich
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | - M Heiß-Neumann
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
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2
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Salzer HJF, Reimann M, Oertel C, Davidsen JR, Laursen CB, Van Braeckel E, Agarwal R, Avsar K, Munteanu O, Irfan M, Lange C. Aspergillus-specific IgG antibodies for diagnosing chronic pulmonary aspergillosis compared to the reference standard. Clin Microbiol Infect 2023; 29:1605.e1-1605.e4. [PMID: 37689265 DOI: 10.1016/j.cmi.2023.08.032] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES To evaluate the performance of Aspergillus-specific IgG antibodies for diagnosing chronic pulmonary aspergillosis (CPA) by using a cohort of patients with histologically proven CPA as a reference standard. METHODS We collected Aspergillus-specific IgG antibody titres from patients with histologically proven CPA in collaboration with CPAnet study sites in Denmark, Germany, Belgium, India, Moldova, and Pakistan (N = 47). Additionally, sera from diseased and healthy controls were prospectively collected at the Medical Clinic of the Research Center, Borstel, Germany (n = 303). Aspergillus-specific IgG antibody titres were measured by the ImmunoCAP® assay (Phadia 100, Thermo Fisher Scientific, Uppsala, Sweden). An Aspergillus-specific IgG antibody titre ≥50 mgA/L was considered positive. RESULTS Using patients with histologically proven CPA as the reference standard, the ImmunoCAP® Aspergillus-specific IgG antibody test had a sensitivity and specificity of 85.1% (95% CI: 71.7-93.8%) and 83.6% (95% CI: 78.0-88.3%), respectively. Patients with histologically proven CPA had significantly higher Aspergillus-specific IgG antibody titre with a median of 83.45 mgA/L (interquartile range 38.9-115.5) than all other cohorts (p < 0.001). False-positive test results occurred in one-third of 79 healthy controls. DISCUSSION Our study results confirm a high sensitivity of the Aspergillus-specific IgG antibody test for the diagnosis of CPA when using patients with histologically proven CPA as a reference standard. However, positive test results should always match radiological findings as false-positive test results limit the interpretation of the test.
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Affiliation(s)
- Helmut J F Salzer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine 4 - Pneumology, Kepler University Hospital, Linz, Austria; Medical Faculty, Johannes Kepler University Linz, Linz, Austria; Ignaz-Semmelweis-Institute, Interuniversity Institute for Infection Research, Vienna, Austria.
| | - Maja Reimann
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - Carolin Oertel
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - Jesper Rømhild Davidsen
- Pulmonary Aspergillosis Centre Denmark (PACD), Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian B Laursen
- Pulmonary Aspergillosis Centre Denmark (PACD), Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Eva Van Braeckel
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Korkut Avsar
- Infectious Disease Department, Asklepios Fachkliniken München-Gauting, Munich, Germany; Lungenärzte am Rundfunkplatz, Munich, Germany
| | - Oxana Munteanu
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of Moldova
| | - Muhammed Irfan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Braunschweig, Germany; International Health/Infectious Diseases, University of Lu¨beck, Lu¨beck, Germany; Department of Medicine, Karolinska Institute, Stockholm, Sweden
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3
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Otto-Knapp R, Häcker B, Krieger D, Stete K, Starzacher K, Maier C, Heyckendorf J, Avsar K, Suárez I, Rybniker J, Bauer T, Günther G, Lange C. Long-term multidrug- and rifampicin-resistant tuberculosis treatment outcome by new WHO definitions in Germany. Eur Respir J 2022; 60:13993003.00765-2022. [DOI: 10.1183/13993003.00765-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
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4
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Heyckendorf J, Marwitz S, Reimann M, Avsar K, DiNardo AR, Günther G, Hoelscher M, Ibraim E, Kalsdorf B, Kaufmann SHE, Kontsevaya I, van Leth F, Mandalakas AM, Maurer FP, Müller M, Nitschkowski D, Olaru ID, Popa C, Rachow A, Rolling T, Rybniker J, Salzer HJF, Sanchez-Carballo P, Schuhmann M, Schaub D, Spinu V, Suárez I, Terhalle E, Unnewehr M, Weiner J, Goldmann T, Lange C. Prediction of anti-tuberculosis treatment duration based on a 22-gene transcriptomic model. Eur Respir J 2021; 58:13993003.03492-2020. [PMID: 33574078 DOI: 10.1183/13993003.03492-2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/20/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The World Health Organization recommends standardised treatment durations for patients with tuberculosis (TB). We identified and validated a host-RNA signature as a biomarker for individualised therapy durations for patients with drug-susceptible (DS)- and multidrug-resistant (MDR)-TB. METHODS Adult patients with pulmonary TB were prospectively enrolled into five independent cohorts in Germany and Romania. Clinical and microbiological data and whole blood for RNA transcriptomic analysis were collected at pre-defined time points throughout therapy. Treatment outcomes were ascertained by TBnet criteria (6-month culture status/1-year follow-up). A whole-blood RNA therapy-end model was developed in a multistep process involving a machine-learning algorithm to identify hypothetical individual end-of-treatment time points. RESULTS 50 patients with DS-TB and 30 patients with MDR-TB were recruited in the German identification cohorts (DS-GIC and MDR-GIC, respectively); 28 patients with DS-TB and 32 patients with MDR-TB in the German validation cohorts (DS-GVC and MDR-GVC, respectively); and 52 patients with MDR-TB in the Romanian validation cohort (MDR-RVC). A 22-gene RNA model (TB22) that defined cure-associated end-of-therapy time points was derived from the DS- and MDR-GIC data. The TB22 model was superior to other published signatures to accurately predict clinical outcomes for patients in the DS-GVC (area under the curve 0.94, 95% CI 0.9-0.98) and suggests that cure may be achieved with shorter treatment durations for TB patients in the MDR-GIC (mean reduction 218.0 days, 34.2%; p<0.001), the MDR-GVC (mean reduction 211.0 days, 32.9%; p<0.001) and the MDR-RVC (mean reduction of 161.0 days, 23.4%; p=0.001). CONCLUSION Biomarker-guided management may substantially shorten the duration of therapy for many patients with MDR-TB.
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Affiliation(s)
- Jan Heyckendorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany .,German Center for Infection Research (DZIF), Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.,Authors contributed equally
| | - Sebastian Marwitz
- Pathology of the Universal Medical Center Schleswig-Holstein (UKSH) and the Research Center Borstel, Campus Borstel, Airway Research Center North (ARCN), Borstel, Germany.,German Center for Lung Research (DZL), Germany.,Authors contributed equally
| | - Maja Reimann
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.,Authors contributed equally
| | - Korkut Avsar
- Asklepios Fachkliniken München-Gauting, Munich, Germany
| | - Andrew R DiNardo
- The Global TB Program, Dept of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Gunar Günther
- Dept of Medicine, University of Namibia School of Medicine, Windhoek, Namibia.,Inselspital Bern, Dept of Pulmonology, Bern, Switzerland
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Elmira Ibraim
- Institutul de Pneumoftiziologie "Marius Nasta", MDR-TB Research Department, Bucharest, Romania
| | - Barbara Kalsdorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
| | - Stefan H E Kaufmann
- Max Planck Institute for Infection Biology, Berlin, Germany.,Max Planck Institute for Biophysical Chemistry, Göttingen, Germany.,Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA
| | - Irina Kontsevaya
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
| | - Frank van Leth
- Dept of Global Health, Amsterdam University Medical Centres, Location AMC, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Anna M Mandalakas
- The Global TB Program, Dept of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Florian P Maurer
- National and WHO Supranational Reference Laboratory for Mycobacteria, Research Center Borstel, Borstel, Germany.,Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Dörte Nitschkowski
- Pathology of the Universal Medical Center Schleswig-Holstein (UKSH) and the Research Center Borstel, Campus Borstel, Airway Research Center North (ARCN), Borstel, Germany.,German Center for Lung Research (DZL), Germany
| | - Ioana D Olaru
- London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Cristina Popa
- Institutul de Pneumoftiziologie "Marius Nasta", MDR-TB Research Department, Bucharest, Romania
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Thierry Rolling
- German Center for Infection Research (DZIF), Germany.,Division of Infectious Diseases, I. Dept of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Dept of Clinical Immunology of Infectious Diseases, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Jan Rybniker
- Dept I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | | | - Patricia Sanchez-Carballo
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
| | | | - Dagmar Schaub
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
| | - Victor Spinu
- Institutul de Pneumoftiziologie "Marius Nasta", MDR-TB Research Department, Bucharest, Romania
| | - Isabelle Suárez
- Dept I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
| | - Elena Terhalle
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
| | - Markus Unnewehr
- Dept of Respiratory Medicine and Infectious Diseases, St. Barbara-Klinik, Hamm, Germany.,University of Witten-Herdecke, Witten, Germany
| | - January Weiner
- Berlin Institute of HealthCUBI (Core Unit Bioinformatics), Berlin, Germany
| | - Torsten Goldmann
- Pathology of the Universal Medical Center Schleswig-Holstein (UKSH) and the Research Center Borstel, Campus Borstel, Airway Research Center North (ARCN), Borstel, Germany.,German Center for Lung Research (DZL), Germany.,Authors contributed equally
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.,Dept of Medicine, Karolinska Institute, Stockholm, Sweden.,Authors contributed equally
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5
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Avsar K. Tuberkulose - Wann daran denken, wie diagnostizieren? CME (Berl) 2021; 18:9-19. [PMID: 34127916 PMCID: PMC8190733 DOI: 10.1007/s11298-021-2038-7] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Obwohl die Tuberkulose mithilfe von Antibiotika gut heilbar ist und die Zahlen in Deutschland wieder stetig rückläufig sind, stirbt rechnerisch alle 22 Sekunden auf der Welt ein Mensch an Tuberkulose, 95% davon in Entwicklungs- und Schwellenländern. Die WHO hat in ihrer End-Tuberkulose-Strategie das Ziel formuliert, im Vergleich zu 2015 die Zahl der Tuberkuloseerkrankungen pro 100.000 Einwohner bis 2035 weltweit um 90% und die Zahl der Todesfälle um 95% zu senken. Die Coronakrise hat hier zu großen Rückschritten geführt, fast zwei Drittel der Tuberkuloseprogramme weltweit sind unterbrochen worden. Damit ist in vielen Teilen der Welt die Erreichung dieser Ziele gefährdet und es wird sogar mit zunehmenden Fallzahlen in den nächsten Jahren gerechnet. Aber gerade die Tatsache, dass die Erkrankung bei uns seltener wird führt zu einer Zunahme der Dauer vom ersten Symptom bis zur Tuberkulosediagnose. Der vorliegende Artikel soll Ihnen eine Hilfestellung geben, wann die Tuberkulose in die Differenzialdiagnostik einzubeziehen ist und wie das Krankheitsbild diagnostiziert werden kann. Die Therapie, ihre häufigsten Nebenwirkungen und die Problematik resistenter Tuberkuloseformen werden ebenfalls kurz dargestellt.
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Affiliation(s)
- Korkut Avsar
- Asklepios Fachkliniken München-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
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6
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Maharjan B, Thapa J, Shah DK, Shrestha B, Avsar K, Suzuki Y, Nakajima C. Evaluation of Xpert MTB/RIF with microscopy and culture for the diagnosis of tuberculosis in a referral laboratory in Nepal. Jpn J Infect Dis 2021; 74:517-521. [PMID: 33790069 DOI: 10.7883/yoken.jjid.2020.921] [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] [Indexed: 11/17/2022]
Abstract
Sputum microscopy and Xpert MTB/RIF are the primary rapid diagnostic methods for tuberculosis (TB) in Nepal. Disagreements among Xpert, microscopy, and culture, for example, cases with Xpert positive and microscopy negative, were frequently observed in Nepal including in our reference laboratory. The objective of this study was to compare the effectiveness of Xpert with culture and microscopy for TB diagnosis in Nepal. A total of 125 TB suspected sputum samples were processed for Xpert, microscopy, and culture. The Xpert results when compared with culture showed 100% sensitivity and 97.4% specificity with an excellent agreement (kappa = 0.96), whereas microscopy showed the sensitivity and specificity of 43.2% and 98.7%, respectively, with a moderate agreement (kappa = 0.4). The sensitivity and specificity of microscopy, when compared with Xpert, were 43.5% and 100%, respectively. The majority of Xpert positive samples of a medium MTB detection and all samples of low and very low MTB detection were missed by microscopy. Our study showed that Xpert MTB/RIF is a reliable tool for the diagnosis and management of TB in Nepal. Because of its high cost and sustainability, alternative simple and rapid diagnostic methods with a similar efficiency would be helpful for TB control in Nepal.
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Affiliation(s)
- Bhagwan Maharjan
- Nepal Anti-Tuberculosis Association/German Nepal TB Project (NATA/GENETUP), Nepal
| | - Jeewan Thapa
- Division of Bioresources, Hokkaido University, Research Center for Zoonosis Control, Japan
| | | | - Bhabana Shrestha
- Nepal Anti-Tuberculosis Association/German Nepal TB Project (NATA/GENETUP), Nepal
| | - Korkut Avsar
- KuratoriumTuberkulose in der Welt e.V, Germany.,Asklepios Klinik, Germany
| | - Yasuhiko Suzuki
- Division of Bioresources, Hokkaido University, Research Center for Zoonosis Control, Japan.,The Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-Core), Hokkaido University, Japan
| | - Chie Nakajima
- Division of Bioresources, Hokkaido University, Research Center for Zoonosis Control, Japan.,The Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-Core), Hokkaido University, Japan
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7
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Hofmann-Thiel S, Plesnik S, Mihalic M, Heiß-Neumann M, Avsar K, Beutler M, Hoffmann H. Clinical Evaluation of BD MAX MDR-TB Assay for Direct Detection of Mycobacterium tuberculosis Complex and Resistance Markers. J Mol Diagn 2020; 22:1280-1286. [PMID: 32688054 DOI: 10.1016/j.jmoldx.2020.06.013] [Citation(s) in RCA: 4] [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] [Received: 04/14/2020] [Revised: 06/10/2020] [Accepted: 06/26/2020] [Indexed: 11/29/2022] Open
Abstract
BD MAX MDR-TB assay is a new molecular platform for the detection of Mycobacterium tuberculosis complex (MTBC) in clinical specimens and simultaneous detection of resistance toward isoniazid and rifampicin. This study assessed the assay's diagnostic accuracy by using pre-characterized MTBC culture-negative (n = 257), smear-negative/MTBC culture-positive (n = 93), and smear-positive/MTBC culture-positive (n = 153) respiratory specimens. Compared with culture, the overall sensitivity and specificity of BD MAX MDR-TB were 86.6% and 100%, respectively; sensitivities for smear-positive and smear-negative samples were 100% and 64.5%. Sensitivity and specificity for isoniazid and rifampicin resistance were 58.3% (biased low due to sample collection strategy in low prevalence setting), 99.3%, 100%, and 98.2%, compared with phenotypic drug resistance testing and 100%, 99.4%, 100%, and 99.4%, compared with GenoType MTBDRplus. In conclusion, BD MAX MDR-TB is an accurate assay for the diagnostic detection of MTBC in respiratory samples and its resistance toward the most important anti-TB drugs isoniazid and rifampicin. Due to its medium to high throughput, good validity, and ease of use, the assay will be of great benefit for medium-sized to large TB diagnostic centers.
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Affiliation(s)
- Sabine Hofmann-Thiel
- SYNLAB Gauting, SYNLAB MVZ Human Genetics, Munich, Germany; World Health Organization (WHO)-Supranational Reference Laboratory of Tuberculosis, Institute of Microbiology and Laboratory Diagnostics (IML) red GmbH, Munich-Gauting, Germany.
| | - Sara Plesnik
- World Health Organization (WHO)-Supranational Reference Laboratory of Tuberculosis, Institute of Microbiology and Laboratory Diagnostics (IML) red GmbH, Munich-Gauting, Germany
| | - Marina Mihalic
- World Health Organization (WHO)-Supranational Reference Laboratory of Tuberculosis, Institute of Microbiology and Laboratory Diagnostics (IML) red GmbH, Munich-Gauting, Germany
| | - Marion Heiß-Neumann
- Infectious Disease Department, Asklepios Pulmonary Hospital, Munich-Gauting, Germany
| | - Korkut Avsar
- Infectious Disease Department, Asklepios Pulmonary Hospital, Munich-Gauting, Germany
| | - Markus Beutler
- World Health Organization (WHO)-Supranational Reference Laboratory of Tuberculosis, Institute of Microbiology and Laboratory Diagnostics (IML) red GmbH, Munich-Gauting, Germany
| | - Harald Hoffmann
- SYNLAB Gauting, SYNLAB MVZ Human Genetics, Munich, Germany; World Health Organization (WHO)-Supranational Reference Laboratory of Tuberculosis, Institute of Microbiology and Laboratory Diagnostics (IML) red GmbH, Munich-Gauting, Germany
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8
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Günther G, van Leth F, Alexandru S, Altet N, Avsar K, Bang D, Barbuta R, Bothamley G, Ciobanu A, Crudu V, Danilovits M, Dedicoat M, Duarte R, Gualano G, Kunst H, de Lange W, Leimane V, McLaughlin AM, Magis-Escurra C, Muylle I, Polcová V, Popa C, Rumetshofer R, Skrahina A, Solodovnikova V, Spinu V, Tiberi S, Viiklepp P, Lange C. Clinical Management of Multidrug-Resistant Tuberculosis in 16 European Countries. Am J Respir Crit Care Med 2019; 198:379-386. [PMID: 29509468 DOI: 10.1164/rccm.201710-2141oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. OBJECTIVES To document the management and treatment outcome in patients with MDR-TB in Europe. METHODS We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). MEASUREMENTS AND MAIN RESULTS A total of 380 patients with MDR-TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include 1 year of follow-up after the end of treatment showed similar frequency of relapse-free cure in low- (58.3%), intermediate- (55.8%), and high-incidence (57.1%) countries, but highest frequency of failure in high-incidence countries (24.1% vs. 14.6%). CONCLUSIONS Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.
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Affiliation(s)
- Gunar Günther
- 1 Research Center Borstel, Clinical Infectious Diseases, German Center for Infection Research, Borstel, Germany.,2 Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia
| | - Frank van Leth
- 3 Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,4 Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Sofia Alexandru
- 5 Institute of Phthisiopneumology, Chisinau, Republic of Moldova
| | - Neus Altet
- 6 Hospital Universitari Vall d'Hebron, Research Institute-IDIAP Jordi Gol, Barcelona, Spain
| | | | - Didi Bang
- 8 Statens Serum Institut, Copenhagen, Denmark
| | - Raisa Barbuta
- 9 Balti Municipal Hospital, Balti, Republic of Moldova
| | | | - Ana Ciobanu
- 5 Institute of Phthisiopneumology, Chisinau, Republic of Moldova
| | - Valeriu Crudu
- 5 Institute of Phthisiopneumology, Chisinau, Republic of Moldova.,11 National Tuberculosis Reference Laboratory, Chisinau, Republic of Moldova
| | | | - Martin Dedicoat
- 13 Heart of England Foundation Trust, Birmingham, United Kingdom.,14 University of Warwick, Coventry, United Kingdom
| | - Raquel Duarte
- 15 EpiUnit, Institute of Public Health, Porto University, Porto, Portugal.,16 Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Gina Gualano
- 17 National Institute for Infectious Diseases "L, Spallanzani," Rome, Italy
| | - Heinke Kunst
- 18 Queen Mary University, London, United Kingdom
| | - Wiel de Lange
- 19 University of Groningen, University Medical Center Groningen, Tuberculosis Centre Beatrixoord, Haren, the Netherlands
| | - Vaira Leimane
- 20 Riga East University Hospital, Tuberculosis and Lung Diseases Centre, Riga, Latvia
| | | | - Cecile Magis-Escurra
- 22 Radboud University Medical Centre-TB Expert Centre UCCZ Dekkerswald, Nijmegen-Groesbeek, the Netherlands
| | - Inge Muylle
- 23 University Medical Center St. Pieter, Brussels, Belgium
| | | | | | | | - Alena Skrahina
- 27 Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Varvara Solodovnikova
- 27 Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | | | - Simon Tiberi
- 28 Ospedale Eugenio Morelli Reference Hospital for MDR and HIV-TB, Sondalo, Italy.,29 Barts Health NHS Trust, London, United Kingdom
| | - Piret Viiklepp
- 30 National Institute for Health Development, Tallinn, Estonia
| | - Christoph Lange
- 1 Research Center Borstel, Clinical Infectious Diseases, German Center for Infection Research, Borstel, Germany.,31 International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.,32 Department of Medicine, Karolinska Institute, Stockholm, Sweden; and.,33 German Center for Infection Research, Borstel, Germany
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9
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Heyckendorf J, van Leth F, Avsar K, Glattki G, Günther G, Kalsdorf B, Müller M, Olaru ID, Rolling T, Salzer HJF, Schuhmann M, Terhalle E, Lange C. Treatment responses in multidrug-resistant tuberculosis in Germany. Int J Tuberc Lung Dis 2019; 22:399-406. [PMID: 29562987 DOI: 10.5588/ijtld.17.0741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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 Excellent treatment outcomes have recently been reported for patients with multi/extensively drug-resistant tuberculosis (M/XDR-TB) in settings where optimal resources for individualised therapy are available. OBJECTIVE To ascertain whether differences remain in treatment responses between patients with M/XDR-TB and those with non-M/XDR-TB. METHOD Patients with TB were prospectively enrolled between March 2013 and March 2016 at five hospitals in Germany. Treatment was conducted following current guidelines and individualised on the basis of drug susceptibility testing. Two-month and 6-month sputum smear and sputum culture conversion rates were assessed. A clinical and radiological score were used to assess response to anti-tuberculosis treatment. RESULTS Non-M/XDR-TB (n = 29) and M/XDR-TB (n = 46) patients showed similar rates of microbiological conversion: 2-month smear conversion rate, 90% vs. 78%; culture conversion rate, 67% vs. 61%; time to smear conversion, 19 days (IQR 10-32) vs. 31 days (IQR 14-56) (P = 0.066); time to culture conversion, 39 days (IQR 17-67) vs. 39 days (IQR 6-85) (P = 0.191). Both clinical and radiological scores decreased after the introduction of anti-tuberculosis treatment. CONCLUSION There were no significant differences in scores between the two groups until 6 months of treatment. Under optimal clinical conditions, with the availability of novel diagnostics and a wide range of therapeutic options for individualised treatment, patients with M/XDR-TB achieved 6-month culture conversion rates that were compatible with those in patients with non-M/XDR-TB.
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Affiliation(s)
- J Heyckendorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), Brunswick, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
| | - F van Leth
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - K Avsar
- Asklepios Fachkliniken München-Gauting, Munich
| | - G Glattki
- Karl-Hansen-Klinik, Bad Lippspringe, Germany
| | - G Günther
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), Brunswick, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany, Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia
| | - B Kalsdorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), Brunswick, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
| | - M Müller
- Sankt Katharinen-Krankenhaus, Frankfurt
| | - I D Olaru
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), Brunswick
| | - T Rolling
- German Center for Infection Research (DZIF), Brunswick, Sections of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Clinical Research Unit, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg
| | - H J F Salzer
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), Brunswick, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
| | - M Schuhmann
- Thoraxklinik-Heidelberg, Heidelberg, Germany
| | - E Terhalle
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), Brunswick, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), Brunswick, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany, Department of Medicine, Karolinska Institute, Stockholm, Sweden
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10
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Maharjan B, Nakajima C, Isoda N, Thapa J, Poudel A, Shah Y, Yamaguchi T, Shrestha B, Hoffmann H, Avsar K, Shrestha A, Gordon SV, Suzuki Y. Genetic diversity and distribution dynamics of multidrug-resistant Mycobacterium tuberculosis isolates in Nepal. Sci Rep 2018; 8:16634. [PMID: 30413747 PMCID: PMC6226479 DOI: 10.1038/s41598-018-34306-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 10/11/2018] [Indexed: 01/06/2023] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is an emerging public health problem in Nepal. Despite the implementation of a successful TB control program in Nepal, notifications of MDR-TB are increasing, yet the reasons are unknown. The objective of this study was to understand the genetic diversity and epidemiological characteristics of MDR-Mycobacterium tuberculosis (MTB) isolates in Nepal. We isolated and genotyped 498 MDR-MTB isolates collected from April 2009 to March 2013 and analyzed the patients' background information. Our results showed that the lineage 2 (Beijing family) was the most predominant lineage (n = 241; 48.4%), followed by lineage 3 (n = 153, 30.7%). Lineage 4 was the third most prevalent (n = 73, 14.5%) followed by lineage 1 (n = 32, 6.4%). The lineages were significantly associated with geographic region, ethnic group, age and sex of patients. The Beijing genotype was found to have an important role in transmitting MDR-TB in Nepal and was significantly associated with the eastern region, mongoloid ethnic group and younger age group. We conclude that early diagnosis and treatment including molecular-epidemiological surveillance of MDR-TB cases will help to control transmission of MDR-TB in Nepal.
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Affiliation(s)
- Bhagwan Maharjan
- German Nepal TB Project (GENETUP/NATA), Kathmandu, Nepal.,Division of Bioresources, Hokkaido University, Research Center for Zoonosis Control, Hokkaido, Japan
| | - Chie Nakajima
- Division of Bioresources, Hokkaido University, Research Center for Zoonosis Control, Hokkaido, Japan.,Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido, Japan
| | - Norikazu Isoda
- Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido, Japan.,Unit of Risk Analysis and Management, Research Center for Zoonosis Control, Hokkaido, Japan
| | - Jeewan Thapa
- Division of Bioresources, Hokkaido University, Research Center for Zoonosis Control, Hokkaido, Japan
| | - Ajay Poudel
- Department of Microbiology, Chitwan Medical College Teaching Hospital, Chitwan, Nepal
| | - Yogendra Shah
- Division of Bioresources, Hokkaido University, Research Center for Zoonosis Control, Hokkaido, Japan
| | - Tomoyuki Yamaguchi
- Division of Bioresources, Hokkaido University, Research Center for Zoonosis Control, Hokkaido, Japan
| | | | - Harald Hoffmann
- WHO-Supranational Reference Laboratory of Tuberculosis, Munich, Gauting, Germany.,KuratoriumTuberkulose in der Welt e.V, München-Gauting, Germany
| | - Korkut Avsar
- KuratoriumTuberkulose in der Welt e.V, München-Gauting, Germany.,Asklepios Klinik, Gauting, Germany
| | - Ashish Shrestha
- National Tuberculosis Center, Thimi, Bhaktapur, Nepal.,World Health Organization, Kathmandu, Nepal
| | - Stephen V Gordon
- Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido, Japan.,UCD School of Veterinary Medicine, University College Dublin, Dublin, D04 W6F6, Ireland
| | - Yasuhiko Suzuki
- Division of Bioresources, Hokkaido University, Research Center for Zoonosis Control, Hokkaido, Japan. .,Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido, Japan.
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11
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Karg O, Avsar K, Hoffmann H. Sputumgewinnung – Schritt für Schritt. Pneumologie 2018. [DOI: 10.1055/a-0645-4789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Heyckendorf J, van Leth F, Kalsdorf B, Olaru ID, Günther G, Salzer H, Terhalle E, Rolling T, Glattki G, Müller M, Schuhmann M, Avsar K, Lange C. Relapse-free cure from multidrug-resistant tuberculosis in Germany. Eur Respir J 2018; 51:51/2/1702122. [DOI: 10.1183/13993003.02122-2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/20/2017] [Indexed: 11/05/2022]
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13
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Maharjan B, Kelly-Cirino CD, Weirich A, Curry PS, Hoffman H, Avsar K, Shrestha B. Evaluation of OMNIgene®•SPUTUM-stabilised sputum for long-term transport and Xpert® MTB/RIF testing in Nepal. Int J Tuberc Lung Dis 2018; 20:1661-1667. [PMID: 28000586 DOI: 10.5588/ijtld.16.0421] [Citation(s) in RCA: 6] [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 German Nepal TB Project, National Tuberculosis Reference Laboratory, Kathmandu, Nepal. OBJECTIVE To evaluate whether transporting samples in OMNIgene®•SPUTUM (OM-S) reagent from a peripheral collection site to a central laboratory in Nepal can improve tuberculosis (TB) detection and increase the sensitivity of Xpert® MTB/RIF testing. DESIGN One hundred sputum samples were split manually. Each portion was assigned to the OM-S group (OM-S added at collection, airline-couriered without cold chain, no other processing required) or the standard-of-care (SOC) group (samples airline-couriered on ice, sodium hydroxide + N-acetyl-L-cysteine processing required at the laboratory). Smear microscopy and Xpert testing were performed. RESULTS Transport time was 2-13 days. Overall smear results were comparable (respectively 58% and 56% smear-negative results in the OM-S and SOC groups). The rate of smear-positive, Mycobacterium tuberculosis-positive (MTB+) sample detection was identical for both treatment groups, at 95%. More smear-negative MTB+ samples were detected in the OM-S group (17% vs. 13%, P = 0.0655). CONCLUSION Sputum samples treated with OM-S can undergo multiday ambient-temperature transport and yield comparable smear and Xpert results to those of SOC samples. Further investigation with larger sample sizes is required to assess whether treating sputum samples with OM-S could increase the sensitivity of Xpert testing in smear-negative samples.
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Affiliation(s)
- B Maharjan
- German Nepal TB Project (GENETUP)/Nepal Anti-Tuberculosis Association, Kathmandu, Nepal
| | | | - A Weirich
- DNA Genotek, Ottawa, Ontario, Canada
| | - P S Curry
- DNA Genotek, Ottawa, Ontario, Canada
| | - H Hoffman
- Kuratorium Tuberkulose in der Welt, München-Gauting, Germany
| | - K Avsar
- Kuratorium Tuberkulose in der Welt, München-Gauting, Germany
| | - B Shrestha
- German Nepal TB Project (GENETUP)/Nepal Anti-Tuberculosis Association, Kathmandu, Nepal
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14
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Magis-Escurra C, Günther G, Lange C, Alexandru S, Altet N, Avsar K, Bang D, Barbuta R, Bothamley G, Ciobanu A, Crudu V, Davilovits M, Dedicoat M, Duarte R, Gualano G, Kunst H, de Lange W, Leimane V, McLaughlin AM, Muylle I, Polcová V, Popa C, Rumetshofer R, Skrahina A, Solodovnikova V, Spinu V, Tiberi S, Viiklepp P, van Leth F. Treatment outcomes of MDR-TB and HIV co-infection in Europe. Eur Respir J 2017; 49:49/6/1602363. [DOI: 10.1183/13993003.02363-2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/22/2017] [Indexed: 11/05/2022]
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15
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Mavi SC, Göres R, Shresta B, Maharjan B, Behr J, Avsar K, Hoffmann H. Aktive Fallfindung mit standardisiertem Behandlungsalgorithmus ermöglicht eine maßgebliche Verbesserung der Tuberkulose-Fallfindung von Kindern in Kathmandu/Nepal (TRACK). Pneumologie 2017. [DOI: 10.1055/s-0037-1598486] [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: 10/20/2022]
Affiliation(s)
- SC Mavi
- Zentrum für Pneumologie und Thoraxchirurgie, Asklepios Fachkliniken München-Gauting; Kuratorium Tuberkulose in der Welt e.V., Who-Supranational Reference Laboratory of Tuberculosis
| | - R Göres
- Zentrum für Pneumologie und Thoraxchirurgie, Asklepios Fachkliniken München-Gauting; Kuratorium Tuberkulose in der Welt e.V., Who-Supranational Reference Laboratory of Tuberculosis
| | | | | | - J Behr
- Zentrum für Pneumologie und Thoraxchirurgie, Asklepios Fachkliniken München-Gauting; Med. Klinik V, LMU, München, Mitglied des Dzl
| | - K Avsar
- Zentrum für Pneumologie und Thoraxchirurgie, Asklepios Fachkliniken München-Gauting; Kuratorium Tuberkulose in der Welt e.V., Who-Supranational Reference Laboratory of Tuberculosis
| | - H Hoffmann
- Synlab Mvz Gauting; Kuratorium Tuberkulose in der Welt e.V., Who-Supranational Reference Laboratory of Tuberculosis
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16
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Hoffmann H, Avsar K, Göres R, Mavi SC, Hofmann-Thiel S. Equal sensitivity of the new generation QuantiFERON-TB Gold plus in direct comparison with the presious test version QuantiFERON-TB Gold IT. Pneumologie 2017. [DOI: 10.1055/s-0037-1598495] [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: 10/20/2022]
Affiliation(s)
- H Hoffmann
- Synlab – Med. Versorgungszentrum Gauting,am Who Supranationalen Referenzlabor für Tuberkulose
| | - K Avsar
- Zentrum für Pneumologie und Thoraxchirurgie, Asklepios Fachkliniken München-Gauting
| | - R Göres
- Infectious Disease Department, Asklepios Hospital Munich-Gauting
| | - SC Mavi
- Zentrum für Pneumologie und Thoraxchirurgie, Asklepios Fachkliniken München-Gauting
| | - S Hofmann-Thiel
- Synlab Mvz Gauting; Iml Red GmbH, Who Supranational Reference Laboratory for Tb
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17
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Avsar K, Göres R, Mavi SC, Hoffmann H, Behr J. Tuberkulose bei Flüchtlingen – Erfahrungen eines süddeutschen Zentrums mit Röntgen-Thorax-Untersuchungen nach Asylverfahrensgesetz. Pneumologie 2017. [DOI: 10.1055/s-0037-1598485] [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: 10/20/2022]
Affiliation(s)
- K Avsar
- Klinik für Pneumologie, Asklepios Fachkliniken München-Gauting
| | - R Göres
- Klinik für Pneumologie, Asklepios Fachkliniken München-Gauting
| | - SC Mavi
- Klinik für Pneumologie, Asklepios Fachkliniken München-Gauting
| | | | - J Behr
- Klinik für Pneumologie, Asklepios Fachkliniken München-Gauting
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18
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Günther G, Lange C, Alexandru S, Altet N, Avsar K, Bang D, Barbuta R, Bothamley G, Ciobanu A, Crudu V, Danilovits M, Dedicoat M, Duarte R, Gualano G, Kunst H, de Lange W, Leimane V, Magis-Escurra C, McLaughlin AM, Muylle I, Polcová V, Popa C, Rumetshofer R, Skrahina A, Solodovnikova V, Spinu V, Tiberi S, Viiklepp P, van Leth F. Treatment Outcomes in Multidrug-Resistant Tuberculosis. N Engl J Med 2016; 375:1103-5. [PMID: 27626539 DOI: 10.1056/nejmc1603274] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | - Neus Altet
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Didi Bang
- Statens Serum Institut, Copenhagen, Denmark
| | | | | | - Ana Ciobanu
- Institute of Phtisiopneumology, Chisinau, Moldova
| | | | | | - Martin Dedicoat
- Heart of England Foundation Trust, Birmingham, United Kingdom
| | | | - Gina Gualano
- Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Heinke Kunst
- Queen Mary University Hospital, London, United Kingdom
| | - Wiel de Lange
- University Medical Center Groningen, Groningen, the Netherlands
| | | | | | | | - Inge Muylle
- University Medical Center St. Pieter, Brussels, Belgium
| | | | | | | | - Alena Skrahina
- Republican Research and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Varvara Solodovnikova
- Republican Research and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus
| | | | | | - Piret Viiklepp
- National Institute for Health Development, Tallinn, Estonia
| | - Frank van Leth
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
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19
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Avsar K, Behr J, Lindner M, Morresi-Hauf A. [Endobronchial Ultrasound Guided Needle Aspiration of a Lung Cyst and Eosinophilic Pneumonia]. Pneumologie 2016; 70:505-9. [PMID: 27512929 DOI: 10.1055/s-0042-109483] [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: 10/21/2022]
Abstract
We report the case of a young male patient with a solitary pulmonary echinococcus cyst. The diagnosis of Cystic Echinococcosis is based on clinical findings, imaging and serology. In the setting of lung cysts the diagnosis can be difficult, particularly as the sensitivity of the serologic tests is lower compared to liver cysts. Bronchoscopic ultrasound of the cystic lesion and respectively the analysis of the cyst aspirate can lead to the diagnosis. In the present case an eosinophilic pneumonia as the result of the puncture has to be discussed.
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Affiliation(s)
- K Avsar
- Klinik für Pneumologie, Asklepios-Fachkliniken München-Gauting
| | - J Behr
- Klinik für Pneumologie, Asklepios-Fachkliniken München-Gauting
| | - M Lindner
- Thoraxchirurgisches Zentrum München, Asklepios Fachkliniken München-Gauting
| | - A Morresi-Hauf
- Institut für Pathologie, Asklepios-Fachkliniken München-Gauting
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20
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Hoffmann H, Avsar K, Göres R, Mavi SC, Hofmann-Thiel S. Equal sensitivity of the new generation QuantiFERON-TB Gold plus in direct comparison with the previous test version QuantiFERON-TB Gold IT. Clin Microbiol Infect 2016; 22:701-3. [DOI: 10.1016/j.cmi.2016.05.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 12/01/2022]
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Abstract
Diffuse pulmonary ossification (DPO) represents an uncommon condition usually associated with different underlying pulmonary and extrapulmonary diseases. In this work, we discuss eleven patients of our clinic with the diagnosis of a diffuse pulmonary ossification. We focus on histological changes in the surrounding lung tissue. Clinical and radiological findings were analysed. The aim of the study is to collect data for a better understanding of this condition, especially in association with interstitial lung disease.Three patients with interstitial lung disease had histological findings of UIP. The follow-up data of these patients showed a benign course of the disease.The analysis of the clinical data yielded a very heterogenous group. Regarding these fact we assume, that DPO is not an own entity, but a pathological epiphenomenon in the context of different conditions, possibly with pathogenetic overlap.
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Affiliation(s)
- K Avsar
- Klinik für Pneumologie, Asklepios-Fachkliniken München-Gauting (Chefarzt: Prof. Dr. J. Behr)
| | - J Behr
- Klinik für Pneumologie, Asklepios-Fachkliniken München-Gauting (Chefarzt: Prof. Dr. J. Behr)
| | - A Morresi-Hauf
- Institut für Pathologie, Asklepios-Fachkliniken München-Gauting (Leiterin: Dr. A. Morresi-Hauf)
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22
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Günther G, van Leth F, Alexandru S, Altet N, Avsar K, Bang D, Barbuta R, Bothamley G, Ciobanu A, Crudu V, Davilovits M, Dedicoat M, Duarte R, Gualano G, Kunst H, de Lange W, Leimane V, Magis-Escurra C, McLaughlin AM, Muylle I, Polcová V, Pontali E, Popa C, Rumetshofer R, Skrahina A, Solodovnikova V, Spinu V, Tiberi S, Viiklepp P, Lange C. Multidrug-resistant tuberculosis in Europe, 2010-2011. Emerg Infect Dis 2015; 21:409-16. [PMID: 25693485 PMCID: PMC4344280 DOI: 10.3201/eid2103.141343] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Drug-resistant Mycobacterium tuberculosis is challenging elimination of tuberculosis (TB). We evaluated risk factors for TB and levels of second-line drug resistance in M. tuberculosis in patients in Europe with multidrug-resistant (MDR) TB. A total of 380 patients with MDR TB and 376 patients with non-MDR TB were enrolled at 23 centers in 16 countries in Europe during 2010-2011. A total of 52.4% of MDR TB patients had never been treated for TB, which suggests primary transmission of MDR M. tuberculosis. At initiation of treatment for MDR TB, 59.7% of M. tuberculosis strains tested were resistant to pyrazinamide, 51.1% were resistant to ≥1 second-line drug, 26.6% were resistant to second-line injectable drugs, 17.6% were resistant to fluoroquinolones, and 6.8% were extensively drug resistant. Previous treatment for TB was the strongest risk factor for MDR TB. High levels of primary transmission and advanced resistance to second-line drugs characterize MDR TB cases in Europe.
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Fliedner F, Avsar K, Hoffmann H, Thiel S, Behr J. Erworbene Resistenz gegenüber Chinolonen unter Behandlung einer MDR-Tuberkulose. Pneumologie 2015. [DOI: 10.1055/s-0035-1544803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Morresi-Hauf A, Avsar K, Hölters J. Lungenkrebs bei UIP. Ein Fallbericht. Pneumologie 2011. [DOI: 10.1055/s-0031-1272182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Avsar K, Neher A, Hoffmann H, Häußinger K. DRESS-Syndrom (Drug rash, Eosinophilia and Systemic Symtoms) auf Ethambutol-Therapie. Pneumologie 2010. [DOI: 10.1055/s-0030-1251380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Kurt Y, Akin ML, Demirbas S, Uluutku AH, Gulderen M, Avsar K, Celenk T. D-Dimer in the Early Diagnosis of Acute Mesenteric Ischemia Secondary to Arterial Occlusion in Rats. Eur Surg Res 2008; 37:216-9. [PMID: 16260871 DOI: 10.1159/000087866] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [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: 03/30/2005] [Accepted: 07/27/2005] [Indexed: 01/10/2023]
Abstract
BACKGROUND Early diagnosis of mesenteric ischemia can be life saving. The aim of this study is to investigate the time-dependent diagnostic value of plasma D-dimer and other ancillary laboratory evaluations such as creatine phosphokinase, lactic dehydrogenase, aspartate aminotransferase, alanine aminotransferase, amylase, and leukocyte count in an experimental superior mesenteric arterial occlusion (SMA-O) model in rats. METHODS Forty male Wistar-Albino rats were separated into 4 groups: 2-, 4-, 6-, and 12-hour SMA-O groups. After laparotomy, the SMA was identified and ligated for 2, 4, 6 and 12 h in the 4 respective study groups. Blood samples were taken for laboratory tests 2 h after laparotomy in the control group and at the end of the ischemic period in the study groups. RESULTS The longer the duration of mesenteric ischemia, the higher were the serum D-dimer levels in the study groups, and statistical significance was obtained at 2 h (p = 0.021). Sensitivity, positive predictive value, negative predictive value, and accuracy of the relation were 88.8, 88.8, 100 and 90%, respectively. Leukocyte count was significantly higher than controls after 12 h. No other laboratory parameter correlated positively with the duration of mesenteric ischemia. CONCLUSION Serum D-dimer measurements may be a valuable diagnostic parameter in the early diagnosis of mesenteric ischemia.
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Affiliation(s)
- Y Kurt
- Department of General Surgery, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
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27
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Akcam FZ, Kaya O, Basoglu N, Avsar K, Yayli G. E-test minimum inhibitory concentrations for tigecycline against nosocomial Acinetobacter baumannii strains. J Chemother 2007; 19:230-1. [PMID: 17434835 DOI: 10.1179/joc.2007.19.2.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- F Zeynep Akcam
- Suleyman Demirel University, Medical School, Department of Infectious Disease and Clinical Microbiology, Isparta, Turkey.
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28
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Stanzel F, Kempa A, Avsar K, Grosch E, Häußinger K. Erste Erfahrungen mit der Schlingenabtragung in der interventionellen Bronchoskopie. Pneumologie 2007. [DOI: 10.1055/s-2007-973176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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29
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Nalbant S, Akmaz I, Kaplan M, Avsar K, Solmazgul E, Sahan B. Does rofecoxib increase TNF-alpha levels? Clin Exp Rheumatol 2006; 24:361-5. [PMID: 16956424] [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: 05/11/2023]
Abstract
OBJECTIVE Rofecoxib (Vioxx), the first COX-2 selective non-steroidal anti-inflammatory drug (NSAID), was recently withdrawn from the market due to the increased risk of acute myocardial infarction. The precise mechanism responsible for this phenomenon still remains unknown. Tumor necrosis factor alpha (TNF-alpha) is a cytokine, possibly most responsible for mortality in patients with acute myocardial infarction. However, this study was designed to study possible effects of rofecoxib on the level of TNF-alpha by using MSU crystal induced inflammation in the rat subcutaneous air pouch model. METHODS Rat subcutaneous air pouches were produced and examinations commenced 6 days later. Control groups received only MSU crystals, or no crystals or drugs. To begin with, rofecoxib (30 mg/kg), indomethacin (20 mg/kg) or diclofenac (3 mg/kg) were administered to groups of 5 rats each. Thirty minutes later, MSU crystals were injected into air pouches, except for the negative control group. Twenty-four hours later, the rats were sacrificed for aspiration of fluid and for the dissection of pouch walls to determine leukocyte counts, pouch wall histology, and to assay IL-10 and TNF-alpha. RESULTS Intra-pouch injection of MSU crystals, compared to non-injected pouches, caused an increase in white blood cell count (WBC) (30 +/- 44.7 versus 4508 +/- 792.3 cells/mm3), in the numbers of pouch wall vessels (vascular index) (4.8 +/- 0.3 versus 11.4 +/- 1.5 vessels/high-power field) and in TNF-alpha (50.0 +/- 13.4 versus 70.34 +/- 20.9 ng/mL), but not in interleukin-10 (IL-10) (60.6 +/- 63.0versus 61.48 +/- 7.1). WBC and vascular index were significantly reduced in all study groups compared to the control group (p < 0.05). Levels of TNF- in fluids were unexpectedly and significantly (p < 0.05) increased in all cases. The highest level of TNF-alpha was found in the rofecoxib group. In contrast to TNF-alpha, IL-10 levels were significantly (p < 0.05) decreased in all three drug groups. Indomethacin tended to suppress inflammation more effectively. However, there was no significant difference between the groups for IL-10 (p > 0.05). CONCLUSION All three NSAIDs exhibited anti-inflammatory activity against MSU crystal induced inflammation. The difference in anti-inflammatory effects of these three non-steroidal drugs is seen not only in the anti-inflammatory effect on MSU induced inflammation but also in the nature of the effects. Refocoxib tended to increase the TNF-alpha level. Whether increased TNF-alpha levels can help explain the side effect of COX-2 specific inhibitors still requires further studies.
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Affiliation(s)
- S Nalbant
- Gata Heh Iç Hastaliklari Servisi, Haydarpaşa, Istanbul, Turkey.
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30
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Avsar K, Stanzel F, Häußinger K, Morresi-Hauf A. Streptococcus equui ssp. zooepidemicus und Hämoptysen: ein Zusammenhang? Pneumologie 2005. [DOI: 10.1055/s-2005-864384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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