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Erkihun M, Kiros T, Berhan A, Ayele B. Multi-drug-resistant tuberculosis and its associated factors among pulmonary tuberculosis patients linked to first-line anti-tuberculosis drugs in north-west Ethiopia. J Med Microbiol 2023; 72. [PMID: 38099651 DOI: 10.1099/jmm.0.001775] [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] [Indexed: 12/18/2023] Open
Abstract
Introduction. Multi-drug-resistant tuberculosis (MDR-TB) is an emerging global challenge. Ethiopia is one of the 20 top countries with the highest estimated numbers of incidents of MDR-TB. Recently, the World Health Organization warned that drug-resistant TB is escalating and called for concerted action to reduce the spread of drug resistance.Hypothesis. The current study investigated MDR-TB in patients receiving first-line anti-TB drug treatment and associated factors.Aim. The study aimed to determine the prevalence of MDR-TB and its associated factors among smear-positive pulmonary TB patients receiving first-line anti-TB drug treatment.Methodology. An institution-based cross-sectional study was employed. All data were collected from laboratory result log books and information via a questionnaire. Samples from 205 smear-positive pulmonary TB patients were selected among first-line drug treatment by a systematic sampling method. Specimens were transported to Felege Hiwot referral hospital laboratory for GeneXpert testing. Factors associated with an outcome variable in binary multi-variable logistic regression analysis at P<0.05 were considered statistically significant variables. An ethical approval letter was taken to the respective health facility and written consent was obtained from each participant.Results. The overall prevalence of MDR-TB was 9.3 % (95 % CI, 5.4 13.7 %). Sign and symptom experience of anti-TB drug side effects [adjusted odds ratio (AOR)=0.18, 95 % CI=0.03-0.99, P=0.049] and co-morbidity (AOR=0.03, 95 % CI=0.01-0.55, P=0.02) were statistically associated with the development of MDR-TB infectionConclusion. The prevalence of MDR-TB was high (9.3 %) and contributed highly to new cases (8.3 %). Factors associated with MDR-TB were previous treatment, co-morbidity and laboratory diagnosis method prior to TB treatment. Therefore, this finding aims to maximize early detection and treatment, strengthening TB infection control, and proper implementation of directly observed therapy short course recommendations to reduce the burden of MDR-TB.
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Affiliation(s)
- Mulat Erkihun
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor, University Debre Tabor, Debre Tabor, Ethiopia
| | - Teklehaimanot Kiros
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor, University Debre Tabor, Debre Tabor, Ethiopia
| | - Ayenew Berhan
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor, University Debre Tabor, Debre Tabor, Ethiopia
| | - Bayu Ayele
- Laboratory Service Unit, Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia
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Numpong S, Kengganpanich M, Kaewkungwal J, Pan-ngum W, Silachamroon U, Kasetjaroen Y, Lawpoolsri S. Confronting and Coping with Multidrug-Resistant Tuberculosis: Life Experiences in Thailand. Qual Health Res 2022; 32:159-167. [PMID: 34845946 PMCID: PMC8739603 DOI: 10.1177/10497323211049777] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this article, we aimed to understand the life experiences of Thai persons diagnosed with multi-drug-resistant tuberculosis (MDR-TB). A qualitative study using a face-to-face in-depth interview was conducted at a hospital in Thailand which has the highest prevalence of MDR-TB in the country between January and February 2019. Twenty persons living with MDR-TB in Thailand were purposively selected to represent a variety of experiences based on different gender, ages, and treatment phases. Qualitative data were transcribed and thematic analysis was applied to identify common themes and sub-themes. The results indicated that all participants faced emotional difficulties, such as fear of death, fear of stigmatization, confusion, and sadness when first knowing of their diagnosis. Family and social support were the main ways that the patients coped with difficult situations. Suicidal ideas were more prevalent among patients with poor family support. Screening for mental health problems should be routinely performed in MDR-TB patients. Proper health education should be provided to patients and families to reduce emotional difficulties and stigmatization.
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Affiliation(s)
- Samorn Numpong
- Faculty of Tropical Medicine, Department of Tropical Hygiene, Mahidol University, Bangkok, Thailand
| | - Mondha Kengganpanich
- Faculty of Public Health, Department of Health Education and Behavioral Sciences, Mahidol University, Bangkok, Thailand
| | - Jaranit Kaewkungwal
- Faculty of Tropical Medicine, Department of Tropical Hygiene, Mahidol University, Bangkok, Thailand
| | - Wirichada Pan-ngum
- Faculty of Tropical Medicine, Department of Tropical Hygiene, Mahidol University, Bangkok, Thailand
| | - Udomsak Silachamroon
- Faculty of Tropical Medicine, Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Yuthichai Kasetjaroen
- AIDS, Tuberculosis and Sexually Transmitted Disease Control Division, The Health Department, Bangkok Metropolitan Administration, Bangkok, Thailand
| | - Saranath Lawpoolsri
- Faculty of Tropical Medicine, Department of Tropical Hygiene, Mahidol University, Bangkok, Thailand
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Xing W, Zhang R, Jiang W, Zhang T, Pender M, Zhou J, Pu J, Liu S, Wang G, Chen Y, Li J, Hu D, Tang S, Li Y. Adherence to Multidrug Resistant Tuberculosis Treatment and Case Management in Chongqing, China - A Mixed Method Research Study. Infect Drug Resist 2021; 14:999-1012. [PMID: 33758516 PMCID: PMC7979342 DOI: 10.2147/idr.s293583] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Aim This paper evaluated the treatment adherence for multidrug-resistant tuberculosis (MDR-TB) and MDR-TB case management (MTCM) in Chongqing, China in order to identify factors associated with poor treatment adherence and case management. Methods Surveys with 132 MDR-TB patients and six in-depth interviews with health care workers (HCWs) from primary health centers (PHC), doctors from MDR-TB designated hospitals and MDR-TB patients were conducted. Surveys collected demographic and socio-economic characteristics, as well as factors associated with treatment and case management. In-depth interviews gathered information on treatment and case management experience and adherence behaviors. Results Patient surveys found the two main reasons for poor adherence were negative side-effects from the treatment and busy work schedules. In-depth interviews with key stakeholders found that self-perceived symptom improvement, negative side-effects from treatment and financial difficulties were the main reasons for poor adherence. MDR-TB patients from urban areas, who were unmarried, were female, had migrant status, and whose treatments were supervised by health care workers from primary health clinics, had poorer treatment adherence (P<0.05). Among the MDR-TB patients surveyed, 86.7% received any type of MTCM in general (received any kind of MTCM from HCWs in PHC, MDR-TB designated hospital and centers of disease control/TB dispensaries and 62.50% received MTCM from HCWs in PHC sectors). Patients from suburban areas were more likely to receive both MTCM in general (OR=6.70) and MTCM from HCWs in MDR-TB designated hospitals (OR=2.77), but female patients (OR=0.26) were less likely to receive MTCM from HCWs in PHC sectors, and patients who were not educated about MTCM by TB doctors in designated hospitals were less likely to receive MTCM in general (OR=0.14). Patients who had not been hospitalized were less likely to receive MTCM from HCWs in MDR-TB designated hospitals (OR=0.21). Conclusion Stronger MTCM by HCWs in PHC sectors would improve treatment adherence among MDR-TB patients. Community-based patient-centered models of MTCM in PHC sectors and the use of digital health technology could help to improve case management and thereby improve adherence.
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Affiliation(s)
- Wei Xing
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Rui Zhang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Weixi Jiang
- Duke Kunshan University, Kunshan, Jiangsu, People's Republic of China
| | - Ting Zhang
- Department of Districts and Counties, Chongqing Institute of TB Prevention and Treatment, Chongqing, People's Republic of China
| | - Michelle Pender
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Jie Pu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Yong Chen
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Jin Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Daiyu Hu
- Chongqing Institute of TB Prevention and Treatment, Chongqing, People's Republic of China
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
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Imperiale BR, García A, Minotti A, González Montaner P, Moracho L, Morcillo NS, Palmero DJ, Sasiain MDC, de la Barrera S. Th22 response induced by Mycobacterium tuberculosis strains is closely related to severity of pulmonary lesions and bacillary load in patients with multi-drug-resistant tuberculosis. Clin Exp Immunol 2021; 203:267-280. [PMID: 33128773 PMCID: PMC7806416 DOI: 10.1111/cei.13544] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/17/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
The role of interleukin-22 (IL-22) in the pathogenesis or tissue repair in human tuberculosis (TB) remains to be established. Here, we aimed to explore the ex-vivo and in-vitro T helper 22 (Th22) response in TB patients and healthy donors (HD) induced by different local multi-drug-resistant (MDR) Mvcobacterium tuberculosis (Mtb) strains. For this purpose, peripheral blood mononuclear cells from drug-susceptible (S-TB) MDR-TB patients and HD were stimulated with local MDR strains and the laboratory strain H37Rv. IL-22 and IL-17 expression and senescent status were assessed in CD4+ and CD8+ cells by flow cytometry, while IL-22 amount was measured in plasma and culture supernatants by enzyme-linked immunosorbent assay (ELISA). We found lower IL-22 amounts in plasma from TB patients than HD, together with a decrease in the number of circulating T cells expressing IL-22. In a similar manner, all Mtb strains enhanced IL-22 secretion and expanded IL-22+ cells within CD4+ and CD8+ subsets, being the highest levels detected in S-TB patients. In MDR-TB, low systemic and Mtb-induced Th22 responses associated with high sputum bacillary load and bilateralism of lung lesions, suggesting that Th22 response could be influencing the ability of MDR-TB patients to control bacillary growth and tissue damage. In addition, in MDR-TB patients we observed that the higher the percentage of IL-22+ cells, the lower the proportion of programmed cell death 1 (PD-1)+ or CD57+ T cells. Furthermore, the highest proportion of senescent T cells was associated with severe lung lesions and bacillary load. Thus, T cell senescence would markedly influence Th22 response mounted by MDR-TB patients.
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Affiliation(s)
- B. R. Imperiale
- Institute of Experimental Medicine (IMEX)‐CONICETNational Academy of MedicineBuenos Aires CityArgentina
| | - A. García
- Dr. F.J. Muñiz HospitalBuenos Aires CityArgentina
| | - A. Minotti
- Institute of Experimental Medicine (IMEX)‐CONICETNational Academy of MedicineBuenos Aires CityArgentina
| | - P. González Montaner
- Dr. F.J. Muñiz HospitalBuenos Aires CityArgentina
- Vaccareza InstituteUBABuenos Aires CityArgentina
| | - L. Moracho
- Dr. F.J. Muñiz HospitalBuenos Aires CityArgentina
| | - N. S. Morcillo
- Tuberculosis and Mycobacterioses LaboratoryDr. Antonio A. Cetrángolo HospitalBuenos Aires ProvinceArgentina
| | - D. J. Palmero
- Dr. F.J. Muñiz HospitalBuenos Aires CityArgentina
- Vaccareza InstituteUBABuenos Aires CityArgentina
| | - M. del Carmen Sasiain
- Institute of Experimental Medicine (IMEX)‐CONICETNational Academy of MedicineBuenos Aires CityArgentina
| | - S. de la Barrera
- Institute of Experimental Medicine (IMEX)‐CONICETNational Academy of MedicineBuenos Aires CityArgentina
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Venugopala KN, Kandeel M, Pillay M, Deb PK, Abdallah HH, Mahomoodally MF, Chopra D. Anti-Tubercular Properties of 4-Amino-5-(4-Fluoro-3- Phenoxyphenyl)-4 H-1,2,4-Triazole-3-Thiol and Its Schiff Bases: Computational Input and Molecular Dynamics. Antibiotics (Basel) 2020; 9:E559. [PMID: 32878018 DOI: 10.3390/antibiotics9090559] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 12/26/2022] Open
Abstract
In the present investigation, the parent compound 4-amino-5-(4-fluoro-3-phenoxyphenyl)-4H-1,2,4-triazole-3-thiol (1) and its Schiff bases 2, 3, and 4 were subjected to whole-cell anti-TB against H37Rv and multi-drug-resistant (MDR) strains of Mycobacterium tuberculosis (MTB) by resazurin microtiter assay (REMA) plate method. Test compound 1 exhibited promising anti-TB activity against H37Rv and MDR strains of MTB at 5.5 µg/mL and 11 µg/mL, respectively. An attempt to identify the suitable molecular target for compound 1 was performed using a set of triazole thiol cellular targets, including β-ketoacyl carrier protein synthase III (FABH), β-ketoacyl ACP synthase I (KasA), CYP121, dihydrofolate reductase, enoyl-acyl carrier protein reductase, and N-acetylglucosamine-1-phosphate uridyltransferase. MTB β-ketoacyl ACP synthase I (KasA) was identified as the cellular target for the promising anti-TB parent compound 1 via docking and molecular dynamics simulation. MM(GB/PB)SA binding free energy calculation revealed stronger binding of compound 1 compared with KasA standard inhibitor thiolactomycin (TLM). The inhibitory mechanism of test compound 1 involves the formation of hydrogen bonding with the catalytic histidine residues, and it also impedes access of fatty-acid substrates to the active site through interference with α5–α6 helix movement. Test compound 1-specific structural changes at the ALA274–ALA281 loop might be the contributing factor underlying the stronger anti-TB effect of compound 1 when compared with TLM, as it tends to adopt a closed conformation for the access of malonyl substrate to its binding site.
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Tekalegn Y, Woldeyohannes D, Assefa T, Aman R, Sahiledengle B. Predictors of Time to Sputum Culture Conversion Among Drug-Resistant Tuberculosis Patients in Oromia Region Hospitals, Ethiopia. Infect Drug Resist 2020; 13:2547-2556. [PMID: 32821129 PMCID: PMC7419643 DOI: 10.2147/idr.s250878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/17/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Multi-drug-resistant tuberculosis occurs when the tuberculosis bacteria develop resistance to at least the two most effective first-line anti-tuberculosis drugs, isoniazid and rifampicin. Sputum culture conversion is one of the indicators to monitor patients’ prognosis throughout the treatment. Hence, this study aimed to assess time to culture conversion and its determinants among drug-resistant tuberculosis patients. Patients and Methods A total of 228 drug-resistant tuberculosis patients in selected hospitals in Oromia region, Ethiopia, were included in this study. Descriptive statistics like median time to sputum smear and culture conversion were computed. Bivariate and multivariate Cox proportional hazard models were used to identify the independent predictors of time to culture conversion. The adjusted hazard ratio (AHR) with 95% confidence interval (CI) was used to report the strength of association. Statistical significance was declared at p <0.05. Results The median age of the study participants was 28 years with inter-quartile range of (IQR) of 22–32 years, and 60% of the patients were male. The median time to culture conversion was 61 days (IQR: 34–92 days). The proportion of sputum culture conversion at 2nd, 4th, and 6th months of treatment initiation was 47%, 82.5%, and 89%, respectively. The final adjusted multivariate Cox proportional hazard model revealed that patients with massive effusion on chest radiographic finding had a 60%-decreased culture conversion time (AHR: 0.4, 95% CI: 0.1–0.9). Patients with abnormalities without cavitations (AHR: 0.5, 95% CI: 0.2–0.9) and those with uninterpreted findings (AHR: 0.3 95% CI: 0.1–0.5) had delayed culture conversion time. Conclusion Chest radiographic findings such as massive effusion, abnormalities without cavitations, and uninterpreted findings were found to be predictors of time to sputum culture conversion. Patients with such characteristics have prolonged culture conversion time. Hence, they may need special attention during the treatment.
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Affiliation(s)
- Yohannes Tekalegn
- Department of Public Health, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Demelash Woldeyohannes
- Department of Public Health, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Tesfaye Assefa
- Department of Nursing, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Rameto Aman
- Department of Public Health, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Biniyam Sahiledengle
- Department of Public Health, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
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Ciza F, Gils T, Sawadogo M, Decroo T, Roggi A, Piubello A, Ortuño-Gutiérrez N. Course of Adverse Events during Short Treatment Regimen in Patients with Rifampicin-Resistant Tuberculosis in Burundi. J Clin Med 2020; 9:jcm9061873. [PMID: 32560052 PMCID: PMC7356788 DOI: 10.3390/jcm9061873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 11/16/2022] Open
Abstract
The introduction of the nine-month short-treatment regimen (STR) has drastically improved outcomes of rifampicin-resistant tuberculosis (RR-TB) treatment. Adverse events (AE) commonly occur, including injectable-induced hearing loss. In Burundi we retrospectively assessed the frequency of adverse events and treatment modifications in all patients who initiated the STR between 2013–2017. Among 225 included patients, 93% were successfully treated without relapse, 5% died, 1% was lost-to-follow-up, 0.4% had treatment failure and 0.4% relapsed after completion. AE were reported in 53%, with grade 3 or 4 AE in 4% of patients. AE occurred after a median of two months. Hepatotoxicity (31%), gastro-intestinal toxicity (22%) and ototoxicity (10%) were most commonly reported. One patient suffered severe hearing loss. Following AE, 7% of patients had a dose reduction and 1% a drug interruption. Kanamycin-induced ototoxicity led to 94% of modifications. All 18 patients with a modified regimen were cured relapse-free. In this exhaustive national RR-TB cohort, RR-TB was treated successfully with the STR. Adverse events were infrequent. To replace the present STR, all-oral regimens should be at least as effective and also less toxic. During and after transition, monitoring, management, and documentation of AE will remain essential.
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Affiliation(s)
- François Ciza
- Damien Foundation, Burundi 15, Avenue du Poisson 15, Ntahangwa, Bujumbura 2426, Burundi; (F.C.); (M.S.)
| | - Tinne Gils
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium;
- Correspondence: ; Tel.: +32-32-476666
| | - Michel Sawadogo
- Damien Foundation, Burundi 15, Avenue du Poisson 15, Ntahangwa, Bujumbura 2426, Burundi; (F.C.); (M.S.)
| | - Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium;
- Research Foundation Flanders, Egmonstraat 5, 1000 Brussels, Belgium
| | - Alberto Roggi
- Damien Foundation, Boulevard Léopold-II 263, 1081 Brussels, Belgium; (A.R.); (N.O.-G.)
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Wang J, Xiong K, Zhao S, Zhang C, Zhang J, Xu L, Ma A. Long-Term Effects of Multi-Drug-Resistant Tuberculosis Treatment on Gut Microbiota and Its Health Consequences. Front Microbiol 2020; 11:53. [PMID: 32082283 PMCID: PMC7002438 DOI: 10.3389/fmicb.2020.00053] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/13/2020] [Indexed: 01/07/2023] Open
Abstract
Gut microbiota dysbiosis has adverse health effects on human body. Multi-drug-resistant tuberculosis (MDR-TB) treatment uses a variety of antibiotics typically for more than 20 months, which may induce gut microbiota dysbiosis. The aim of this study is to investigate the long-term effects of MDR-TB treatment on human gut microbiota and its related health consequences. A total of 76 participants were recruited at a hospital in Linyi, China. The study included one active MDR-TB treatment group, one recovered group from MDR-TB and two treatment-naive tuberculosis groups as control. The two treatment-naïve tuberculosis groups were constructed to match the sex and the age of the active MDR-TB treatment and the recovered group, respectively. The fecal and blood samples were collected and analyzed for gut microbiota and metabolic parameters. An altered gut microbiota community and a loss of richness were observed during the MDR-TB treatment. Strikingly, 3-8 years after recovery and discontinuing the treatment, the gut microbiota still exhibited an altered taxonomic composition (p = 0.001) and a 16% decrease in richness (p = 0.018) compared to the gut microbiota before the treatment. The abundance of fifty-eight bacterial genera was significantly changed in the MDR-TB recovered group versus the untreated control group. Although there were persistent and pervasive gut microbiota alterations, no gastrointestinal symptom such as abdominal pain, diarrhea, nausea, flatulence, and constipation was observed in the recovered group. However, chronic disorders may be indicated by the elevated level of low-density lipoprotein cholesterol (LDLC) (p = 0.034) and total cholesterol (TC) (p = 0.017). These adverse lipid changes were associated with the altered gut bacterial taxa, including phylum Firmicutes and Verrucomicrobia and genera Adlercreutzia, Akkermansia, Butyricicoccus, Coprococcus, Clostridioides, Eubacterium, Erysipelatoclostridium, Fusicatenibacter, Klebsiella, Psychrobacter, and Streptococcus. Collectively, MDR-TB treatment induced a lasting gut microbiota dysbiosis, which was associated with unfavorable changes in lipid profile.
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Affiliation(s)
- Jinyu Wang
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, China
| | - Ke Xiong
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, China
| | | | - Chao Zhang
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, China
| | - Jianwen Zhang
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, China
| | - Lei Xu
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, China
| | - Aiguo Ma
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, China
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Bell C, Skordilis K, Al-Baaj F, Bentall A. Imported bugs, not beasts: extensively drug-resistant tuberculosis and acute kidney injury. Clin Kidney J 2015; 7:609-12. [PMID: 25859383 PMCID: PMC4389139 DOI: 10.1093/ckj/sfu102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/08/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- Caroline Bell
- Department of Nephrology , University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Kassiani Skordilis
- Department of Histopathology , University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Fouad Al-Baaj
- Department of Nephrology , University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK ; Department of Nephrology , Sandwell and West Birmingham Hospital , Birmingham , UK
| | - Andrew Bentall
- Department of Nephrology , University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK ; Department of Nephrology , Sandwell and West Birmingham Hospital , Birmingham , UK ; School of Immunity and Infection, University of Birmingham, UK
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Padayatchi N, Loveday M, Naidu N. Drug-resistant tuberculosis control in South Africa: scientific advances and health system strengthening are complementary. Expert Opin Pharmacother 2014; 15:2113-6. [PMID: 25226528 DOI: 10.1517/14656566.2014.953053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/05/2022]
Abstract
We examine some aspects of the South African health system that have contributed to the current multi- and extensively drug-resistant tuberculosis (M(X)DR-TB) epidemic and identify opportunities for change and improvement. Implementation of several recent major scientific advances have the potential to accelerate the control of M(X)DR-TB, but health systems strengthening will be essential.
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Affiliation(s)
- Nesri Padayatchi
- University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Centre for AIDS Programme of Research in South Africa (CAPRISA) , 2nd Floor, DDMRI, 719 Umbilo Road, Durban, 4013 , South Africa +27 31 260 4555 ; +27 31 260 4549 ;
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Nunn AJ, Rusen ID, Van Deun A, Torrea G, Phillips PPJ, Chiang CY, Squire SB, Madan J, Meredith SK. Evaluation of a standardized treatment regimen of anti-tuberculosis drugs for patients with multi-drug-resistant tuberculosis (STREAM): study protocol for a randomized controlled trial. Trials 2014; 15:353. [PMID: 25199531 PMCID: PMC4164715 DOI: 10.1186/1745-6215-15-353] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [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: 05/22/2014] [Accepted: 08/28/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In contrast to drug-sensitive tuberculosis, the guidelines for the treatment of multi-drug-resistant tuberculosis (MDR-TB) have a very poor evidence base; current recommendations, based on expert opinion, are that patients should be treated for a minimum of 20 months. A series of cohort studies conducted in Bangladesh identified a nine-month regimen with very promising results. There is a need to evaluate this regimen in comparison with the currently recommended regimen in a randomized controlled trial in a variety of settings, including patients with HIV-coinfection. METHODS/DESIGN STREAM is a multi-centre randomized trial of non-inferiority design comparing a nine-month regimen to the treatment currently recommended by the World Health Organization in patients with MDR pulmonary TB with no evidence on line probe assay of fluoroquinolone or kanamycin resistance. The nine-month regimen includes clofazimine and high-dose moxifloxacin and can be extended to 11 months in the event of delay in smear conversion. The primary outcome is based on the bacteriological status of the patients at 27 months post-randomization. Based on the assumption that the nine-month regimen will be slightly more effective than the control regimen and, given a 10% margin of non-inferiority, a total of 400 patients are required to be enrolled. Health economics data are being collected on all patients in selected sites. DISCUSSION The results from the study in Bangladesh and cohorts in progress elsewhere are encouraging, but for this regimen to be recommended more widely than in a research setting, robust evidence is needed from a randomized clinical trial. Results from the STREAM trial together with data from ongoing cohorts should provide the evidence necessary to revise current recommendations for the treatment for MDR-TB. TRIAL REGISTRATION This trial was registered with clincaltrials.gov (registration number: ISRCTN78372190) on 14 October 2010.
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Affiliation(s)
- Andrew J Nunn
- />Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH UK
| | - ID Rusen
- />International Union Against Tuberculosis and Lung Disease, 68, bd Saint-Michel, 75006 Paris, France
| | - Armand Van Deun
- />International Union Against Tuberculosis and Lung Disease, 68, bd Saint-Michel, 75006 Paris, France
- />Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Gabriela Torrea
- />Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Patrick PJ Phillips
- />Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH UK
| | - Chen-Yuan Chiang
- />International Union Against Tuberculosis and Lung Disease, 68, bd Saint-Michel, 75006 Paris, France
- />Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, No 111, Section 3, Hsin-Long Road, Taipei City, 116 Taiwan
| | - S Bertel Squire
- />Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA UK
| | - Jason Madan
- />Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - Sarah K Meredith
- />Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH UK
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Shahemabadi AS, Hosseini AZ, Shaghsempour S, Masjedi MR, Rayani M, Pouramiri M. Evaluation of T cell immune responses in multi-drug-resistant tuberculosis (MDR-TB) patients to Mycobacterium tuberculosis total lipid antigens. Clin Exp Immunol 2007; 149:285-94. [PMID: 17490401 PMCID: PMC1941963 DOI: 10.1111/j.1365-2249.2007.03406.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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] [Accepted: 03/29/2007] [Indexed: 11/30/2022] Open
Abstract
Mycobacterium tuberculosis lipid antigens produce significant T cell responses in healthy tuberculin reactor [purified protein derivative (PPD-positive] individuals. In the present study, proliferation and interferon (IFN)-gamma/interleukin (IL)-4 responses were analysed to M. tuberculosis total lipid antigens in T lymphocytes from 25 patients with multi-drug-resistant tuberculosis (MDR-TB). The obtained results were compared with those of 30 asymptomatic healthy PPD-positive and 30 healthy tuberculin skin test negative (PPD-negative) subjects. Peripheral blood mononuclear cells (PBMCs) and T cells (CD4(+) and CD8(+)) were stimulated using autologous immature dendritic cells. Proliferation responses were assessed using 3-{4,5-dimethylthiazol-2-yl}-2,5 diphenyl tetrazolium bromide (MTT). IFN-gamma/IL-4 concentrations in the supernatant of the CD4(+) and CD8(+)T cells were measured by enzyme-linked immunosorbent assay. Proliferation assay showed that the peripheral blood mononuclear cells and CD4(+) T cells from the MDR-TB patients responded significantly less to the M. tuberculosis total lipid antigens than to the CD4(+) T cells in the PPD-positive subjects. Total lipid antigen-specific proliferative responses in the CD8(+) T cells from the MDR-TB patients were minimally detected and the responses were similar to those of the PPD-positive subjects. IFN-gamma production by the CD4(+) T cells stimulated by total lipid antigens from the MDR-TB patients was decreased significantly compared with the PPD-positive individuals, whereas IL-4 production in the patients was elevated. IFN-gamma and IL-4 production in the CD8(+) T cells of the MDR-TB patients was similar to those of the PPD-positive subjects. In conclusion, it is suggested that stimulated CD4(+) T cells by M. tuberculosis total lipid antigens may be shifted to T helper 2 responses in MDR-TB patients.
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Affiliation(s)
- A S Shahemabadi
- Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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