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Fehr J, Gunda R, Siedner MJ, Hanekom W, Ndung’u T, Grant A, Lippert C, Wong EB. CAD4TB software updates: different triaging thresholds require caution by users and regulation by authorities. Int J Tuberc Lung Dis 2023; 27:157-160. [PMID: 36853104 PMCID: PMC9904401 DOI: 10.5588/ijtld.22.0437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- J. Fehr
- Africa Health Research Institute, KwaZulu-Natal, South Africa
,Digital Health & Machine Learning, Hasso Plattner Institute for Digital Engineering, Potsdam, Germany
,Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
| | - R. Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa
,School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
,Division of Infection and Immunity, University College London, London, UK
| | - M. J. Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
,School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
,Harvard Medical School, Boston, MA, USA
,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - W. Hanekom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - T. Ndung’u
- Africa Health Research Institute, KwaZulu-Natal, South Africa
,Division of Infection and Immunity, University College London, London, UK
,HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
,Ragon Institute of MGH, MIT and Harvard University, Cambridge, MA, USA
| | - A. Grant
- Africa Health Research Institute, KwaZulu-Natal, South Africa
,School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
,London School of Hygiene & Tropical Medicine, London, UK
,School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - C. Lippert
- Digital Health & Machine Learning, Hasso Plattner Institute for Digital Engineering, Potsdam, Germany
,Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
,Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E. B. Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
,Division of Infectious Diseases, University of Alabama at Birmingham, AL, USA
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Ellis R, Hatherill M, Tait D, Snowden M, Churchyard G, Hanekom W, Evans T, Ginsberg A. Innovative clinical trial designs to rationalize TB vaccine development. Tuberculosis (Edinb) 2015; 95:352-7. [DOI: 10.1016/j.tube.2015.02.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/04/2015] [Accepted: 02/06/2015] [Indexed: 12/22/2022]
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Hanekom W. Tuberculosis vaccines. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.523] [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: 11/28/2022] Open
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Sutherland JS, Loxton AG, Haks MC, Kassa D, Ambrose L, Lee JS, Ran L, van Baarle D, Maertzdorf J, Howe R, Mayanja-Kizza H, Boom WH, Thiel BA, Crampin AC, Hanekom W, Ota MOC, Dockrell H, Walzl G, Kaufmann SHE, Ottenhoff THM. Differential gene expression of activating Fcγ receptor classifies active tuberculosis regardless of human immunodeficiency virus status or ethnicity. Clin Microbiol Infect 2013; 20:O230-8. [PMID: 24205913 DOI: 10.1111/1469-0691.12383] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [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: 06/08/2013] [Revised: 08/07/2013] [Accepted: 08/30/2013] [Indexed: 12/19/2022]
Abstract
New diagnostics and vaccines for tuberculosis (TB) are urgently needed, but require an understanding of the requirements for protection from/susceptibility to TB. Previous studies have used unbiased approaches to determine gene signatures in single-site populations. The present study utilized a targeted approach, reverse transcriptase multiplex ligation-dependent probe amplification (RT-MLPA), to validate these genes in a multisite study. We analysed ex vivo whole blood RNA from a total of 523 participants across four sub-Saharan countries (Ethiopia, Malawi, South Africa, and The Gambia) with differences in TB and human immunodeficiency virus (HIV) status. We found a number of genes that were expressed at significantly lower levels in participants with active disease than in those with latent TB infection (LTBI), with restoration following successful TB treatment. The most consistent classifier of active disease was FCGR1A (high-affinity IgG Fc receptor 1 (CD64)), which was the only marker expressed at significantly higher levels in participants with active TB than in those with LTBI before treatment regardless of HIV status or genetic background. This is the first study to identify a biomarker for TB that is not affected by HIV status or geo-genetic differences. These data provide valuable clues for understanding TB pathogenesis, and also provide a proof-of-concept for the use of RT-MLPA in rapid and inexpensive validation of unbiased gene expression findings.
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Rustomjee R, Mcleod R, Hanekom W, Steel G, Mahomed H, Hawkridge A, Welte A, Sinanovic E, Loots G, Grobler A, Mvusi L, Gray G, Hesseling A, Ginsberg A, Lienhardt C, Shea J, Tong X, Lockhart S, Churchyard G. Key issues in the clinical development and implementation of TB vaccines in South Africa. Tuberculosis (Edinb) 2012; 92:359-64. [DOI: 10.1016/j.tube.2012.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 05/04/2012] [Indexed: 11/29/2022]
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Gonzalez-Angulo Y, Wiysonge CS, Geldenhuys H, Hanekom W, Mahomed H, Hussey G, Hatherill M. Sputum induction for the diagnosis of pulmonary tuberculosis: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2011; 31:1619-30. [PMID: 22095153 DOI: 10.1007/s10096-011-1485-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 10/31/2011] [Indexed: 10/15/2022]
Abstract
Sputum induction (SI) has been proposed as the optimal sample collection method for patients with paucibacillary tuberculosis (TB). Studies reporting the culture of Mycobacterium tuberculosis from SI were reviewed. A random-effects meta-analysis of diagnostic yield (numerator M. tuberculosis SI culture-positive cases; denominator all culture-positive cases) was conducted. Diagnostic yields (95% confidence intervals, CIs) were displayed as Forest plots. Heterogeneity was evaluated using Chi-squared and I-squared tests and meta-regression analysis. Ninety publications were screened, 28 full-text papers reviewed, and 17 analyzed. Collectively, n=627 SI culture-positive cases among n=975 culture-confirmed TB cases were reported. The diagnostic yield of SI ranged from 35 to 95%. The pooled diagnostic yield was 74% (CI 65-81%), with significant heterogeneity (p<0.0001, I2=86%). There were no statistically significant differences in the yield between sub-groups defined by human immunodeficiency virus (HIV) prevalence or age. Univariate analysis demonstrated that the use of fiberoptic bronchoscopy (FOB) as the comparator method was associated with a 22% reduction (CI 2-42%) in the diagnostic yield of SI. However, after adjustment for confounding, the meta-regression analysis showed that FOB usage (p=0.21) and saline concentration (p=0.31) were not independently associated with the diagnostic yield. SI will detect approximately three-quarters of M. tuberculosis culture-positive cases under study conditions. Significant heterogeneity in the diagnostic yield was not explained by HIV prevalence, age, or the use of FOB as the comparator method. The use of a particular nebulized saline concentration for SI cannot be recommended on the basis of this meta-regression analysis.
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Affiliation(s)
- Y Gonzalez-Angulo
- South African Tuberculosis Vaccine Initiative (SATVI), Wernher Beit Building N2.10, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
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Gupta A, Koetz B, Hanekom W, O'Brien J, Wanders J, Jansen M. 453 Population pharmacokinetics (PK) and exposure/response relationships of the receptor tyrosine kinase inhibitor E7080 in phase I studies. European Journal of Cancer Supplements 2010. [DOI: 10.1016/s1359-6349(10)72160-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Geldenhuys H, Verver S, Surtie S, Hatherill M, van Leth F, Kafaar F, Tameris M, Kleynhans W, Luabeya KK, Moyo S, Sikhondze W, Hanekom W, Mahomed H. The tuberculin skin test: a comparison of ruler and calliper readings. Int J Tuberc Lung Dis 2010; 14:1266-1271. [PMID: 20843417] [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: 05/29/2023] Open
Abstract
BACKGROUND The Mantoux tuberculin skin test (TST) is widely used to diagnose latent infection with Mycobacterium tuberculosis. TST skin induration may be measured either by a transparent ruler or by a pair of callipers. We hypothesised that the type of instrument used may affect the reading. OBJECTIVE To determine whether variability in Mantoux TST measurement is affected by the type of reading instrument. METHOD A TST (Mantoux method) was performed among healthy adolescents. The indurations were read with among ruler and calliper by two independent readers. Limits of agreement and Kappa (κ) scores at TST positivity cut-off points were calculated. A Bland-Altman graph was constructed. RESULTS The 95% limits of agreement between instruments ranged from -5 mm to 3 mm. The limits of agreement between readers ranged from -5 mm to 4 mm. κ scores between instruments were respectively 0.7 and 0.8 at 15 mm and 10 mm cut-offs. CONCLUSION The variability between readers of TST indurations is not influenced by changing the reading instrument.
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Affiliation(s)
- H Geldenhuys
- South African Tuberculosis Vaccine Initiative, University of Cape Town, Cape Town, South Africa.
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Hong DS, Koetz BS, Kurzrock R, Senzer NN, Hanekom W, Naing A, Wheler JJ, Mink J, Ren M, Nemunaitis JJ. Phase I dose-escalation study of E7080, a selective tyrosine kinase inhibitor, administered orally to patients with solid tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moyo S, Verver S, Mahomed H, Hawkridge A, Kibel M, Hatherill M, Tameris M, Geldenhuys H, Hanekom W, Hussey G. Age-related tuberculosis incidence and severity in children under 5 years of age in Cape Town, South Africa. Int J Tuberc Lung Dis 2010; 14:149-154. [PMID: 20074404] [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: 05/28/2023] Open
Abstract
SETTING Limited data are available on the characteristics of tuberculosis (TB) disease in young children, especially in high-burden countries. OBJECTIVE To assess the incidence and severity of TB in children aged <5 years. METHODS TB records and chest radiographs of children born in Cape Town in 1999 and diagnosed with TB between 1999 and 2004 were reviewed retrospectively. RESULTS A total of 1607 cases were registered. The cumulative incidence of definite (bacteriologically confirmed) and probable (radiological evidence and > or =1 TB clinical feature) TB in children aged <5 years was 2.9% and was highest between the ages of 12 and 23 months. Of 1233 children with definite or probable TB, 506 (41%) had severe disease (dissemination, cavities or >1 lobe involved). The under 5 years incidence of disseminated TB was 0.33%. Of 239 (15%) cases that were bacteriologically confirmed, clinical features typical of TB disease were individually present in <60%. The most common combined symptoms were cough for >2 weeks and weight loss, occurring in 43/239 (18%). CONCLUSION TB incidence was high, and peaked in children aged 12-23 months. Many children experienced severe disease. A fifth of children with microbiologically confirmed disease presented with only one feature typically associated with TB.
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Affiliation(s)
- S Moyo
- South African Tuberculosis Vaccine Initiative, University of Cape Town, Cape Town, South Africa.
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Nqoko BS, Day C, Mansoor N, de Kock M, Hughes J, Hussey G, Hanekom W. P16-05. Upregulation of PD-1 and CTLA-4 on HIV-specific T cells in HIV-infected infants. Retrovirology 2009. [PMCID: PMC2767731 DOI: 10.1186/1742-4690-6-s3-p234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Hawkridge A, Hatherill M, Little F, Goetz MA, Barker L, Mahomed H, Sadoff J, Hanekom W, Gaiter L. Efficacy of percutaneous versus intradermal BCG in the prevention of tuberculosis in South Africa infants: Randomised trial. Rev Port Pneumol 2009; 15:747-9. [PMID: 25965923 DOI: 10.1016/s0873-2159(15)30174-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Scriba TJ, Kalsdorf B, Wood K, Wilkinson R, Day C, Hanekom W, Dheda K, Dawson R, Lange C, Kalsdorf B. Die HIV-Infektion beeinträchtigt die Immunantwort der CD4-T-Zellen in der BAL gegen Mykobakterien. Pneumologie 2009. [DOI: 10.1055/s-0029-1213938] [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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Kalsdorf B, Ernst M, Wilkinson R, Hofmeister J, Ross S, Abrahams D, Isaacs F, Black G, Hassan H, Walzl G, Hanekom W, Lange C, Scriba T. Inflammatory response of a subset of IL-17 and IL-22-producing CD4+ T cells in human Mtb-infection. Pneumologie 2008. [DOI: 10.1055/s-2008-1074420] [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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Levy ML, Godfrey S, Irving CS, Sheikh A, Hanekom W, Bush A, Lachman P. Wheeze detection: recordings vs. assessment of physician and parent. J Asthma 2005; 41:845-53. [PMID: 15641634 DOI: 10.1081/jas-200038451] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Parental and professional agreement as to the presence of wheezing in infants and preschool children has been shown to be poor. Agreement on the absence or presence of physical signs on chest examination in these populations is far from perfect, even among experienced physicians. OBJECTIVES We sought to compare the assessment of a parent, nurse, and physician with the "gold standard" of acoustic analysis for the presence of wheezing in infants and preschool children attending a hospital clinic. SETTING AND SUBJECTS Urban district general hospital in North London, England. Wheezy children under 6 years old attending a "walk-in" emergency pediatric ambulatory care unit. RESULTS Comparisions were completed on 31 children (age range 4-62 months). The severity of wheeze was independently evaluated by a parent, nurse, and experienced pediatrician, and these were compared with breath sounds recorded and analyzed by acoustic techniques for the presence and severity of wheezing. In only 10 of 31 (32%) children did the parent and the physician agree on the wheeze severity score. In 13 infants, the parent scored higher than the doctor and in 8 the parent scored lower. In 16 (52%) of the children, there was complete agreement as to the severity of wheezing by the nurse and the physician. In 24 of the 31 children (77%), the acoustic wheeze score agreed with the physician wheeze score; in 6 children the acoustic score was lower and in 1 it was higher. CONCLUSIONS The physician was able reliably to judge the severity of wheeze measured objectively, whereas nurses and parents were not. This study has important implications for the interpretation of parental questionnaire studies of asthma prevalence and severity.
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Affiliation(s)
- M L Levy
- Kenton Bridge Medical Centre, London, UK.
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