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Hirabayashi R, Nakayama H, Yahaba M, Yamanashi H, Kawasaki T. Utility of interferon-gamma releasing assay for the diagnosis of active tuberculosis in children: A systematic review and meta-analysis. J Infect Chemother 2024; 30:516-525. [PMID: 38104794 DOI: 10.1016/j.jiac.2023.12.007] [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: 08/03/2023] [Revised: 09/27/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION The accurate diagnosis of tuberculosis (TB) in children is essential for its effective management and control. Reliable diagnostic tools that are currently available for identifying TB infection include the in vivo tuberculosis skin test (TST) and ex vivo interferon-gamma release assays (IGRAs). This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of IGRAs in children. METHODS Of the 768 screened studies, 47 met the eligibility criteria. Data from 9065 patients, including 1086 (12.0 %) with confirmed TB, were included in the analysis. The overall quality of the included studies, assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, was unclear. RESULTS The calculated pooled sensitivity and specificity of IGRAs in children were 0.85 (95 % confidence interval [CI]: 0.79-0.89) and 0.94 (95 % CI: 0.88-0.97), respectively. Subpopulation analysis revealed that the sensitivities and specificities were as follows: QuantiFERON tests: 0.83 (95 % CI: 0.74-0.89) and 0.93 (95 % CI: 0.87-0.96), T-SPOT: 0.87 (95 % CI: 0.79-0.91) and 0.99 (95 % CI: 0.85-1.00), IGRAs in children under 15 years: 0.77 (95 % CI: 0.43-0.94) and 0.96 (95 % CI: 0.84-0.97), and IGRAs in children under 5 years: 0.85 (95 % CI: 0.52-0.97) and 0.94 (95 % CI: 0.90-0.99), respectively. CONCLUSIONS This study demonstrated that the sensitivity and specificity of the IGRAs in children were moderate and high, respectively. Therefore, the IGRAs may be useful for detecting TB infection in children. CLINICAL TRIAL REGISTRATION The review protocol was prospectively registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000046737).
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Affiliation(s)
- Ryosuke Hirabayashi
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Japan
| | - Haruo Nakayama
- Department of Neurosurgery, Toho University Ohasi Medical Center, Japan
| | - Misuzu Yahaba
- Division of Infection Control, Chiba University Hospital, Japan
| | - Hirotomo Yamanashi
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takeshi Kawasaki
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan.
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Ma WW, Wang LC, Zhao DA, Wei N, Cui JW, Li SJ. Analysis of T-lymphocyte subsets and risk factors in children with tuberculosis. Tuberculosis (Edinb) 2024; 146:102496. [PMID: 38401266 DOI: 10.1016/j.tube.2024.102496] [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: 11/20/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Tuberculosis (TB) is not only related to infection but also involves immune factors. This study explores the changes in T-lymphocyte subsets in children with TB who are human immunodeficiency virus (HIV)-negative and examines their relationship using chest computed tomography (CT) scans. Additionally, the study identifies risk factors for severe TB (STB) in children and establishes relevant risk prediction models. METHODS We recruited 235 participants between 2018 and 2022, comprising 176 paediatric patients with TB who were HIV-negative and 59 age-matched children with bacterial community-acquired pneumonia (CAP). We quantitatively analysed and compared T-lymphocyte subsets between the two groups and among different types of TB infection. Both univariate and multivariate analyses of clinical and laboratory characteristics were conducted to identify independent risk factors for STB in children and to establish a risk prediction model. RESULTS The absolute counts of CD3, CD4 and CD8 T-cells in children with TB infection decreased significantly compared with bacterial CAP. The percentage of CD8 T-cells increased, whereas the percentage of CD4 T-cells did not change significantly. The absolute count of CD3, CD4 and CD8 T-cells in extrapulmonary TB (EPTB) was significantly higher than in extra-respiratory TB, with unchanged subset percentages. According to chest CT lesion classification, CD4 T-cell counts decreased significantly in S3 compared with S1 or S2, with no significant change in CD3 and CD8 T-cell counts and percentages. No significant differences were observed in lymphocyte subset counts and percentages between S1 and S2. Univariate analyses indicated that factors such as age, symptom duration, white blood cell count, platelet count, neutrophil-to-lymphocyte ratio (NLR), erythrocyte sedimentation rate, prealbumin level, albumin level, globulin level, albumin/globulin (A/G) ratio, high-sensitivity C-reactive protein (Hs-CRP) level and CD4 and CD8 T-cell counts are associated with STB. Multivariate logistic regression analysis revealed that age, Hs-CRP level, NLR, symptom duration and A/G ratio are independent risk factors for STB in children. Increased age, Hs-CRP levels and NLR, along with decreased A/G, correlate with increased susceptibility to STB. A nomogram model, based on these independent risk factors, demonstrated an area under the receiver operating characteristics curve of 0.867 (95% CI: 0.813-0.921). Internal verification confirmed the model's accuracy, with the calibration curve approaching the ideal and the Hosmer-Lemeshow goodness-of-fit test showing consistent results (χ2 = 12.212, p = 0.142). CONCLUSION In paediatric patients with TB, the absolute counts of all lymphocyte subsets were considerably reduced compared with those in patients with bacterial CAP. Clinicians should consider the possibility of EPTB infection in addition to respiratory infections in children with TB who have higher CD3, CD4 and CD8 T-cell counts than the ERTB group. Furthermore, CD4 T-cell counts correlated closely with the severity of chest CT lesions. Age, symptom duration, A/G ratio, Hs-CRP level and NLR were established as independent risk factors for STB. The nomogram model, based on these factors, offers effective discrimination and calibration in predicting STB in children.
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Affiliation(s)
- Wei-Wei Ma
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China
| | - Ling-Chao Wang
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China
| | - De-An Zhao
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China
| | - Na Wei
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China
| | - Jun-Wei Cui
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China
| | - Shu-Jun Li
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China.
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Zhang C, O’Connor S, Smith-Jeffcoat SE, Rodriguez DF, Guo H, Hao L, Chen H, Sun Y, Li Y, Xu J, Chen L, Xia L, Yang X, Date A, Cheng J. Implementing a continuous quality-improvement framework for tuberculosis infection prevention and control in healthcare facilities in China, 2017-2019. Infect Control Hosp Epidemiol 2024; 45:651-657. [PMID: 38268435 PMCID: PMC11027078 DOI: 10.1017/ice.2023.287] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Tuberculosis (TB) infection prevention and control (IPC) in healthcare facilities is key to reducing transmission risk. A framework for systematically improving TB IPC through training and mentorship was implemented in 9 healthcare facilities in China from 2017 to 2019. METHODS Facilities conducted standardized TB IPC assessments at baseline and quarterly thereafter for 18 months. Facility-based performance was assessed using quantifiable indicators for IPC core components and administrative, environmental, and respiratory protection controls, and as a composite of all control types We calculated the percentage changes in scores over time and differences by IPC control type and facility characteristics. RESULTS Scores for IPC core components increased by 72% during follow-up when averaged across facilities. The percentage changes for administrative, environmental, and respiratory protection controls were 39%, 46%, and 30%, respectively. Composite scores were 45% higher after the intervention. Overall, scores increased most during the first 6 months. There was no association between IPC implementation and provincial economic development or volume of TB services. CONCLUSIONS TB IPC policies and practices showed most improvement early during implementation and did not differ consistently by facility characteristics. The training component of the project helped increase the capacity of healthcare professionals to manage TB transmission risks. Lessons learned here will inform national TB IPC guidance.
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Affiliation(s)
- Canyou Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Stephanie O’Connor
- Global Health Center, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Sarah E. Smith-Jeffcoat
- Global Health Center, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Diana Forno Rodriguez
- Global Health Center, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Hui Guo
- CSL Behring Beijing Office, Beijing, China
| | - Ling Hao
- US Centers for Disease Control and Prevention China Office, Beijing, China
| | - Hui Chen
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanbo Sun
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, Heilongjiang, China
| | - Yan Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Jiying Xu
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Liang Chen
- Guangdong Provincial Institute of Public Health, Guangzhou, Guangdong, China
| | - Lan Xia
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Xing Yang
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Anand Date
- Global Health Center, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Jun Cheng
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Iswanti FC, Handayani KM, Kusumaningrum A, Yamazaki T, Handayani D, Sadikin M. Lysosomal enzymes and the oxygen burst capability of monocyte-derived macrophages in active drug-resistant tuberculosis patients in relation to cell attachment. Tuberculosis (Edinb) 2024; 146:102498. [PMID: 38461765 DOI: 10.1016/j.tube.2024.102498] [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: 09/20/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 03/12/2024]
Abstract
Drug resistance to tuberculosis (TB) has become an obstacle in eliminating tuberculosis. The transmission of drug-resistant TB from patients increases the incidence of primary drug-resistant (DR) TB in individuals who are in close contact. Therefore, it is necessary to incorporate an immunological approach into preventive therapy. This study focuses on the activity of lysosomal enzymes, oxygen bursts, and the attachment ability of macrophages among individuals diagnosed with active drug-resistant TB compared with close contacts with latent TB or healthy cases. We measured macrophage oxygen burst ability (Water-soluble tetrazolium salt (WST) test, Nitric Oxide production, and myeloperoxidase activity) and the degradative ability of lysosomes (activity of the β-glucuronidase and acid phosphatase enzymes). Six active DR-TB patients and 18 close-contact cases (8 Latent Tuberculosis Infection (LTBI); 10 healthy) were recruited at Universitas Indonesia Hospital. The macrophage attachment of the LTBI group was higher than in the other groups. NO production, myeloperoxidase activity, β-glucuronidase, and acid phosphatase were higher in the active DR-TB group. A negative correlation was uncovered between phagocytosis and NO production, myeloperoxidase activity, and lysosomal enzymes. The difference in macrophage function is expected to be a further reference in active DR-TB treatment or preventive therapy.
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Affiliation(s)
- Febriana Catur Iswanti
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Indonesia, 10430, Indonesia; Center of Hypoxia and Oxidative Stress Studies, Indonesia.
| | - Kurnia Maidarmi Handayani
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, 10430, Indonesia; Faculty of Medicine, Universitas Baiturrahmah, 25172, Indonesia.
| | - Ardiana Kusumaningrum
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia, Universitas Indonesia Hospital, 10430, Indonesia.
| | - Tomohiko Yamazaki
- Research Center for Macromolecules and Biomaterials, National Institute for Materials Science (NIMS), Tsukuba, 305-0047, Ibaraki, Japan.
| | - Diah Handayani
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Universitas Indonesia Hospital, 10430, Indonesia.
| | - Mohamad Sadikin
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Indonesia, 10430, Indonesia; Center of Hypoxia and Oxidative Stress Studies, Indonesia.
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Gunasekaran H, Sampath P, Thiruvengadam K, Malaisamy M, Ramasamy R, Ranganathan UD, Bethunaickan R. A systematic review and meta-analysis of circulating serum and plasma microRNAs in TB diagnosis. BMC Infect Dis 2024; 24:402. [PMID: 38622570 PMCID: PMC11017603 DOI: 10.1186/s12879-024-09232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/18/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) ranks as the second leading cause of death globally among all infectious diseases. This problem is likely due to the lack of biomarkers to differentiate the heterogeneous spectrum of infection. Therefore, the first step in solving this problem is to identify biomarkers to distinguish the different disease states of an individual and treat them accordingly. Circulating microRNA (miRNA) biomarkers are promising candidates for various diseases. In fact, we are yet to conceptualize how miRNA expression influences and predicts TB disease outcomes. Thus, this systematic review and meta-analysis aimed to assess the diagnostic efficacy of circulating miRNAs in Latent TB (LTB) and Active Pulmonary TB (PTB). METHODS Literature published between 2012 and 2021 was retrieved from PubMed, Web of Science, Cochrane, Scopus, Embase, and Google Scholar. Articles were screened based on inclusion and exclusion criteria, and their quality was assessed using the QUADAS-2 tool. Funnel plots and forest plots were generated to assess the likelihood of study bias and heterogeneity, respectively. RESULTS After the screening process, seven articles were selected for qualitative analysis. The study groups, which consisted of Healthy Control (HC) vs. TB and LTB vs. TB, exhibited an overall sensitivity of 81.9% (95% CI: 74.2, 87.7) and specificity of 68.3% (95% CI: 57.8, 77.2), respectively. However, our meta-analysis results highlighted two potentially valuable miRNA candidates, miR-197 and miR-144, for discriminating TB from HC. The miRNA signature model (miR197-3p, miR-let-7e-5p, and miR-223-3p) has also been shown to diagnose DR-TB with a sensitivity of 100%, but with a compromised specificity of only 75%. CONCLUSION miRNA biomarkers show a promising future for TB diagnostics. Further multicentre studies without biases are required to identify clinically valid biomarkers for different states of the TB disease spectrum. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42022302729).
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Affiliation(s)
- Harinisri Gunasekaran
- Department of Immunology, ICMR-National Institute for Research in Tuberculosis, No.1. Mayor Sathyamoorthy Road, 600 031, Chetpet, Chennai, India
- University of Madras, Chennai, India
| | - Pavithra Sampath
- Department of Immunology, ICMR-National Institute for Research in Tuberculosis, No.1. Mayor Sathyamoorthy Road, 600 031, Chetpet, Chennai, India
- University of Madras, Chennai, India
| | - Kannan Thiruvengadam
- Department of Epidemiology Statistics, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Muniyandi Malaisamy
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Rathinasabapati Ramasamy
- Library and Information Center, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Uma Devi Ranganathan
- Department of Immunology, ICMR-National Institute for Research in Tuberculosis, No.1. Mayor Sathyamoorthy Road, 600 031, Chetpet, Chennai, India
| | - Ramalingam Bethunaickan
- Department of Immunology, ICMR-National Institute for Research in Tuberculosis, No.1. Mayor Sathyamoorthy Road, 600 031, Chetpet, Chennai, India.
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Abdullahi LH, Oketch S, Komen H, Mbithi I, Millington K, Mulupi S, Chakaya J, Zulu EM. Gendered gaps to tuberculosis prevention and care in Kenya: a political economy analysis study. BMJ Open 2024; 14:e077989. [PMID: 38569714 DOI: 10.1136/bmjopen-2023-077989] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a public health concern in Kenya despite the massive global efforts towards ending TB. The impediments to TB prevention and care efforts include poor health systems, resource limitations and other sociopolitical contexts that inform policy and implementation. Notably, TB cases are much higher in men than women. Therefore, the political economy analysis (PEA) study provides in-depth contexts and understanding of the gender gaps to access and successful treatment for TB infection. DESIGN PEA adopts a qualitative, in-depth approach through key informant interviews (KII) and documentary analysis. SETTING AND PARTICIPANTS The KIIs were distributed among government entities, academia, non-state actors and community TB groups from Kenya. RESULTS The themes identified were mapped onto the applied PEA analysis framework domains. The contextual and institutional issues included gender concerns related to the disconnect between TB policies and gender inclusion aspects, such as low prioritisation for TB programmes, limited use of evidence to inform decisions and poor health system structures. The broad barriers influencing the social contexts for TB programmes were social stigma and cultural norms such as traditional interventions that negatively impact health-seeking behaviours. The themes around the economic situation were poverty and unemployment, food insecurity and malnutrition. The political context centred around the systemic and governance gaps in the health system from the national and devolved health functions. CONCLUSION Broad contextual factors identified from the PEA widen the disparity in targeted gender efforts toward men. Following the development of effective TB policies and strategies, it is essential to have well-planned gendered responsive interventions with a clear implementation plan and monitoring system to enhance access to TB prevention and care.
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Affiliation(s)
- Leila H Abdullahi
- Research Department, African Institute for Development Policy, Nairobi, Kenya
| | - Sandra Oketch
- African Institute for Development Policy (AFIDEP), Nairobi, Kenya
| | - Henry Komen
- African Institute for Development Policy (AFIDEP), Nairobi, Kenya
| | | | | | | | | | - Eliya M Zulu
- African Institute for Development Policy, Nairobi, Kenya
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Repele F, Alonzi T, Navarra A, Farroni C, Salmi A, Cuzzi G, Delogu G, Gualano G, Puro V, De Carli G, Girardi E, Palmieri F, Martineau AR, Goletti D. Detection of Mycobacterium tuberculosis DNA in CD34 + peripheral blood mononuclear cells of adults with tuberculosis infection and disease. Int J Infect Dis 2024; 141S:106999. [PMID: 38458427 DOI: 10.1016/j.ijid.2024.106999] [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: 01/25/2024] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES To investigate whether Mycobacterium tuberculosis (Mtb) DNA is detected in peripheral blood mononuclear cells (PBMC) of subjects with tuberculosis (TB) or TB infection (TBI) living in a low-burden country. METHODS We prospectively enrolled 57 patients with TB, 41 subjects with TBI, and 39 controls in Rome, Italy. PBMC were isolated, cluster of differentiation (CD)34+ and CD34- cells were immunomagnetic separated, DNA was extracted, and digital polymerase chain reaction for IS6110 and rpoB sequences was used to detect Mtb DNA in PBMC subsets and unfractionated PBMC. RESULTS We detected Mtb DNA at a low copy number in CD34+ cells in 4o f 30 (13%) patients with TB, 2 of 24 (8%) subjects with TBI, and 1 of 24 (4%) controls. Mtb DNA was detected in unfractionated PBMC in 3 of 51 (6%) patients with TB, 2 of 38 (5%) subjects with TBI, and 2 of 36 (6%) controls. In CD34- cells, only 1 of 31 (3%) subjects with TBI tested positive for Mtb DNA. CONCLUSIONS Mtb DNA was detected at low frequencies and levels in the PBMC of subjects with TBI and donors with TB living in a low-burden country. In particular, Mtb DNA was detected more frequently in CD34+ cells, supporting the hypothesis that these cells may represent a Mtb niche. This finding informs biological understanding of Mtb pathogenesis and may support the development of a microbial blood biomarker for Mtb infection.
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Affiliation(s)
- Federica Repele
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Tonino Alonzi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Assunta Navarra
- Department of Epidemiology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Chiara Farroni
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Andrea Salmi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Gilda Cuzzi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Giovanni Delogu
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie-Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy; Mater Olbia Hospital, Olbia, Italy
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Vincenzo Puro
- Department of Epidemiology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Gabriella De Carli
- Department of Epidemiology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Adrian R Martineau
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
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Rees CE, Swift BM, Haldar P. State-of-the-art detection of Mycobacterium tuberculosis in blood during tuberculosis infection using phage technology. Int J Infect Dis 2024; 141S:106991. [PMID: 38447755 DOI: 10.1016/j.ijid.2024.106991] [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: 02/01/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024] Open
Abstract
Tuberculosis (TB), an aerosol-transmitted infection caused by Mycobacterium tuberculosis (Mtb), remains the commonest cause of death globally, from an infectious bacterial disease. Nine years on from the launch of the World Health Organization (WHO)'s END-TB strategy, disease incidence rates are stubbornly unchanged [1]. While this represents, in part, a reversal of improving trends caused by the COVID-19 pandemic, it also reflects the fragility and inadequacy of healthcare systems to sustain TB control [2]. Although multifactorial, a key reason for this is the ineffectiveness of existing clinical tools to meet the two key objectives of the END-TB strategy-(i) early diagnosis and treatment of TB disease (to limit onward transmission); and (ii) disease prevention through screening for asymptomatic TB infection (TBI). Meeting both objectives will rely on the development of new biomarkers with high accuracy, but the global nature of the TB problem also requires that new tests are rapid, low cost and can be measured in patients by sampling from universally accessible sites. In this review, we will present the accumulating evidence for circulating Mtb in both TB disease and asymptomatic TBI and discuss the potential utility of novel bacteriophage-based technology for blood-based detection of Mtb.
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Affiliation(s)
| | - Benjamin Mc Swift
- Royal Veterinary College, Department of Pathobiology and Population Sciences, Herts, UK
| | - Pranabashis Haldar
- NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK.
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Petrucciani A, Hoerter A, Kotze L, Du Plessis N, Pienaar E. In silico agent-based modeling approach to characterize multiple in vitro tuberculosis infection models. PLoS One 2024; 19:e0299107. [PMID: 38517920 PMCID: PMC10959380 DOI: 10.1371/journal.pone.0299107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/05/2024] [Indexed: 03/24/2024] Open
Abstract
In vitro models of Mycobacterium tuberculosis (Mtb) infection are a valuable tool for examining host-pathogen interactions and screening drugs. With the development of more complex in vitro models, there is a need for tools to help analyze and integrate data from these models. To this end, we introduce an agent-based model (ABM) representation of the interactions between immune cells and bacteria in an in vitro setting. This in silico model was used to simulate both traditional and spheroid cell culture models by changing the movement rules and initial spatial layout of the cells in accordance with the respective in vitro models. The traditional and spheroid simulations were calibrated to published experimental data in a paired manner, by using the same parameters in both simulations. Within the calibrated simulations, heterogeneous outputs are seen for bacterial count and T cell infiltration into the macrophage core of the spheroid. The simulations also predict that equivalent numbers of activated macrophages do not necessarily result in similar bacterial reductions; that host immune responses can control bacterial growth in both spheroid structure dependent and independent manners; that STAT1 activation is the limiting step in macrophage activation in spheroids; and that drug screening and macrophage activation studies could have different outcomes depending on the in vitro culture used. Future model iterations will be guided by the limitations of the current model, specifically which parts of the output space were harder to reach. This ABM can be used to represent more in vitro Mtb infection models due to its flexible structure, thereby accelerating in vitro discoveries.
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Affiliation(s)
- Alexa Petrucciani
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Alexis Hoerter
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Leigh Kotze
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medical and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nelita Du Plessis
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medical and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elsje Pienaar
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, United States of America
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Liu JJ, Feng YP, Liu ZD, Guo J. Impact of delayed diagnosis and treatment on tuberculosis infection within families: A case report. Medicine (Baltimore) 2024; 103:e37406. [PMID: 38489738 PMCID: PMC10939690 DOI: 10.1097/md.0000000000037406] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND A 32-year-old male patient was diagnosed with a 30% left pneumothorax on November 5, 2020, during which chest imaging indicated abnormalities. Despite this, pulmonary tuberculosis (TB) was not diagnosed or treated at that time due to a negative result in the MGIT960 culture. The patient experienced symptoms of cough and expectoration on April 24, 2022. Upon repeating the chest imaging, the condition had worsened, confirming the presence of pulmonary TB, leading to the patient's hospitalization. On September 1, 2022, the 11-year-old daughter of the patient was diagnosed with pulmonary tuberculosis accompanied by bronchial tuberculosis and tuberculous pleurisy. METHODS The diagnosis of pulmonary tuberculosis was confirmed through sputum smears and Gene Xpert MTB/RIF testing, for the patient and his 11-year-old daughter in 2022. The patient underwent a 6-month combination therapy (2HRZE/4HR) comprising isoniazid, rifampicin, pyrazinamide, and ethambutol. His daughter with pulmonary tuberculosis accompanied by bronchial tuberculosis and tuberculous pleurisy underwent a 12-month combination therapy. RESULTS Late diagnosis and treatment delays contribute to tuberculosis infections within families. Fortunately, after more than 3 months of antituberculosis treatment, the patient experienced relief from cough and sputum secretion, and there was improvement observed in the chest CT scan. Six months later, the patient was successfully cured of TB. 12 months later, his daughter also was successfully cured of TB. CONCLUSION SUBSECTIONS Early diagnosis and treatment of tuberculosis (TB) is vital to reduce transmission, morbidity, and mortality.
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Affiliation(s)
- Jian-Jun Liu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
| | - Yin-Ping Feng
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
| | - Zhong-Da Liu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
| | - Jing Guo
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
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Salindri AD, Auld SC, Gujral UP, Urbina EM, Andrews JR, Huaman MA, Magee MJ. Tuberculosis infection and hypertension: prevalence estimates from the US National Health and Nutrition Examination Survey. BMJ Open 2024; 14:e075176. [PMID: 38479740 PMCID: PMC10936476 DOI: 10.1136/bmjopen-2023-075176] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 12/20/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Tuberculosis infection (TBI) is marked by dynamic host-pathogen interactions with persistent low-grade inflammation and is associated with increased risk of cardiovascular diseases (CVD) including acute coronary syndrome, myocardial infarction and stroke. However, few studies assess the relationship between TBI and hypertension, an intermediate of CVD. We sought to determine the association between TBI and hypertension using data representative of the adult US population. METHODS We performed cross-sectional analyses using data from the 2011-2012 US National Health and Nutrition Examination Survey (NHANES). Eligible participants included adults with valid QuantiFERON-TB Gold In-Tube (QFT-GIT) test results who also had blood pressure measures and no history of TB disease. TBI was defined by a positive QFT-GIT. We defined hypertension by either elevated measured blood pressure levels (ie, systolic ≥130 mm Hg or diastolic ≥80 mm Hg) or known hypertension indications (ie, self-reported previous diagnosis or use of antihypertensive medications). Analyses were performed using robust quasi-Poisson regressions and accounted for the stratified probability sampling design of NHANES. RESULTS The overall prevalence of TBI was 5.7% (95% CI 4.7% to 6.7%) and hypertension was present among 48.9% (95% CI 45.2% to 52.7%) of participants. The prevalence of hypertension was higher among those with TBI (58.5%, 95% CI 52.4% to 64.5%) than those without TBI (48.3%, 95% CI 44.5% to 52.1%) (prevalence ratio (PR) 1.2, 95% CI 1.1 to 1.3). However, after adjusting for confounders, the prevalence of hypertension was similar for those with and without TBI (adjusted PR 1.0, 95% CI 1.0 to 1.1). The unadjusted prevalence of hypertension was higher among those with TBI versus no TBI, especially among individuals without CVD risk factors including those with normal body mass index (PR 1.6, 95% CI 1.2 to 2.0), euglycaemia (PR 1.3, 95% CI 1.1 to 1.5) or non-smokers (PR 1.2, 95% CI 1.1 to 1.4). CONCLUSIONS More than half of adults with TBI in the USA had hypertension. Importantly, we observed a relationship between TBI and hypertension among those without established CVD risk factors. SUMMARY The prevalence of hypertension was high (59%) among adults with TBI in the USA. In addition, we found that the prevalence of hypertension was significantly higher among adults with positive QFT without established hypertension risk factors.
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Affiliation(s)
- Argita D Salindri
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sara C Auld
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Unjali P Gujral
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Elaine M Urbina
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Moises A Huaman
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew J Magee
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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12
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Doležalová K, Mališková B, Honegerová M, Hromádková M, Wallenfels J. TB index case tracing in the Roma community in the Czech Republic. Epidemiol Infect 2024; 152:e45. [PMID: 38465380 PMCID: PMC10964182 DOI: 10.1017/s0950268824000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
Tuberculosis (TB) contact tracing and TB preventive treatment are key tools in preventing the transmission of TB with the aim of eliminating the disease. Our study seeks to demonstrate how the infection spread from an individual patient to the entire community and how proactive contact tracing facilitated prompt diagnosis and treatment. Our work was conducted as a retrospective analysis of the spread of TB infection within the Roma community in the Czech Republic, following the case of an index patient who succumbed to pulmonary TB. Several levels of care and preventive and treatment measures are outlined. Confirming the identity of the Mycobacterium tuberculosis strain was achieved using molecular methods. Among the 39 individuals examined, TB disease was detected in eight patients and TB infection was detected in six patients. The investigation of contacts within this group yielded positive results in 36% of cases, necessitating treatment. The study's findings provide evidence that actively tracing individuals at risk can lead to early detection of cases, prompt treatment, and prevention of further disease transmission. The study also indicates that the highest risk of infection occurs within the sick person's household and that young children under the age of 5 are most susceptible to falling ill.
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Affiliation(s)
- Karolína Doležalová
- Clinic of Paediatrics, First Faculty of Medicine, Charles University in Prague and Thomayer University Hospital, Prague, Czech Republic
| | - Beatrix Mališková
- Pneumology Department, Hospital Mladá Boleslav, Mlada Boleslav, Czech Republic
| | - Michaela Honegerová
- Regional Public Health Institute of Central Bohemia, Central Bohemia, Czech Republic
| | - Michaela Hromádková
- National Reference Laboratory for Mycobacteria, National Institute of Public Health, Praha, Czech Republic
| | - Jiří Wallenfels
- National Tuberculosis Surveillance Unit, University Hospital Bulovka, Prague, Czech Republic
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13
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Ren W, Ma Z, Li Q, Liu R, Ma L, Yao C, Shang Y, Zhang X, Gao M, Li S, Pang Y. Antigen-specific chemokine profiles as biomarkers for detecting Mycobacterium tuberculosis infection. Front Immunol 2024; 15:1359555. [PMID: 38510248 PMCID: PMC10950995 DOI: 10.3389/fimmu.2024.1359555] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
Background Latent tuberculosis (TB) infection can progress to active TB, which perpetuates community transmission that undermines global TB control efforts. Clinically, interferon-γ release assays (IGRAs) are commonly used for active TB case detection. However, low IGRA sensitivity rates lead to false-negative results for a high proportion of active TB cases, thus highlighting IGRA ineffectiveness in differentiating MTB-infected individuals from healthy individuals. Methods Participants enrolled at Beijing Chest Hospital from May 2020-April 2022 were assigned to healthy control (HC), LTBI, IGRA-positive TB, and IGRA-negative TB groups. Screening cohort MTB antigen-specific blood plasma chemokine concentrations were measured using Luminex xMAP assays then were verified via testing of validation cohort samples. Results A total of 302 individuals meeting study inclusion criteria were assigned to screening and validation cohorts. Testing revealed significant differences in blood plasma levels of CXCL9, CXCL10, CXCL16, CXCL21, CCL1, CCL19, CCL27, TNF-α, and IL-4 between IGRA-negative TB and HC groups. Levels of CXCL9, CXCL10, IL-2, and CCL8 biomarkers were predictive for active TB, as reflected by AUC values of ≥0.9. CXCL9-based enzyme-linked immunosorbent assay sensitivity and specificity rates were 95.9% (95%CI: 91.7-98.3) and 100.0% (92.7-100.0), respectively. Statistically similar AUC values were obtained for CXCL9 and CXCL9-CXCL10 assays, thus demonstrating that combined analysis of CXCL10 and CXCL9 levels did not improve active TB diagnostic performance. Conclusion The MTB antigen stimulation-based CXCL9 assay may compensate for low IGRA diagnostic accuracy when used to diagnose IGRA-negative active TB cases and thus is an accurate and sensitive alternative to IGRAs for detecting MTB infection.
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Affiliation(s)
- Weicong Ren
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Zichun Ma
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Qiang Li
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Rongmei Liu
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Liping Ma
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Cong Yao
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yuanyuan Shang
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Xuxia Zhang
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Mengqiu Gao
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Shanshan Li
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yu Pang
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
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Miles EL, Spellar K, Williams D. Mycobacterium bovis infection of the appendix: a case of appendiceal tuberculosis in rural England. BMJ Case Rep 2024; 17:e258798. [PMID: 38442977 DOI: 10.1136/bcr-2023-258798] [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: 03/07/2024] Open
Abstract
Appendiceal tuberculosis is a rare mimic of acute appendicitis, demonstrated by several case reports of patients from tuberculosis endemic countries. On literature review, there are few cases reported of appendiceal tuberculosis in urban England, and no reports from rural England. This case describes a patient with primary appendiceal tuberculosis from a remote district hospital in England who underwent a diagnostic laparoscopy for suspected acute appendicitis. Intraoperatively, an abnormal appearance with extensive intra-abdominal adhesions was seen in addition to appendicitis, making the diagnosis dubious. Histology of the appendix was positive for acid-fast bacilli and culture of the intra-abdominal fluid revealed a diagnosis of Mycobacterium bovis infection. The mode of infection was thought to be reactivation of latent bovine tuberculosis from drinking unpasteurised milk in adolescence. Taking a focused history, particularly in those with a farming background, and intraoperative sampling for histology and culture are vital in the diagnosis of appendiceal tuberculosis.
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Affiliation(s)
- Esther Lucy Miles
- Obstetrics and Gynaecology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Kayleigh Spellar
- General Surgery, Royal Devon and Exeter NHS Foundation Trust, Barnstaple, UK
| | - David Williams
- General Surgery, Royal Devon and Exeter NHS Foundation Trust, Barnstaple, UK
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15
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Zeng J, Zhu D, Zhang H, Lin T, Song T. IGRA-based INH regimen for prevention of active tuberculosis after kidney transplantation: A single-centre retrospective study. Int J Antimicrob Agents 2024; 63:107093. [PMID: 38244813 DOI: 10.1016/j.ijantimicag.2024.107093] [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: 11/30/2022] [Revised: 09/22/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES To evaluate the effectiveness and safety of Interferon-gamma release Assay (IGRA)-based isoniazid (INH) prophylaxis strategy to prevent tuberculosis (TB) infection in kidney transplantation (KT) with a risk of TB occurrence. METHODS Adult KT recipients (KTRs) between June 2014 and July 2021 were retrospectively enrolled. The development of active TB after KT was evaluated. RESULTS Of 925 KTRs, 111 (12.0%) developed active TB. Among the 501 KTRs at a risk of TB occurrence, 70 (14.0%) patients developed active TB, while 41 (9.7%) of 424 patients without risk factors developed active TB (P = 0.05). Two hundred thirty-nine KTRs received IGRA test with 62 (25.9%) were positive. None of IGRA positive patients (0/40) receiving INH prophylaxis developed active TB, whereas 8 out of 22 patients who had positive IGRA results without INH prophylaxis developed active TB (0 vs. 36.4%, P < 0.01). Of note, for those in risk group but with negative IGRA result, no active TB was found even without INH prophylaxis. Although alanine aminotransferase and aspartate aminotransferase in INH prevention group were higher than those before treatment, they did not exceed three-fold of limit of reference range. CONCLUSIONS IGRA-based INH treatment is an effective and safe protocol to prevent the development of active TB in KTRs.
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Affiliation(s)
- Jun Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Daiwen Zhu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haohan Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Turun Song
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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16
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Adusumelli Y, Tabatneck M, Sherman S, Lamb G, Sabharwal V, Goldmann D, Epee-Bounya A, Haberer JE, Sandora TJ, Campbell JI. Pediatric Tuberculosis Infection Care Facilitators and Barriers: A Qualitative Study. Pediatrics 2024; 153:e2023063949. [PMID: 38327249 DOI: 10.1542/peds.2023-063949] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND A total of 700 000 US children and adolescents are estimated to have latent tuberculosis (TB) infection. Identifying facilitators and barriers to engaging in TB infection care is critical to preventing pediatric TB disease. We explored families' and clinicians' perspectives on pediatric TB infection diagnosis and care. METHODS We conducted individual interviews and small group discussions with primary care and subspecialty clinicians, and individual interviews with caregivers of children diagnosed with TB infection. We sought to elicit facilitators and barriers to TB infection care engagement. We used applied thematic analysis to elucidate themes relating to care engagement, and organized themes using a cascade-grounded pediatric TB infection care engagement framework. RESULTS We enrolled 19 caregivers and 24 clinicians. Key themes pertaining to facilitators and barriers to care emerged that variably affected engagement at different steps of care. Clinic and health system themes included the application of risk identification strategies and communication of risk; care ecosystem accessibility; programs to reduce cost-related barriers; and medication adherence support. Patient- and family-level themes included TB knowledge and beliefs; trust in clinicians, tests, and medical institutions; behavioral skills; child development and parenting; and family resources. CONCLUSIONS Risk identification, education techniques, trust, family resources, TB stigma, and care ecosystem accessibility enabled or impeded care cascade engagement. Our results delineate an integrated pediatric TB infection care engagement framework that can inform multilevel interventions to improve retention in the pediatric TB infection care cascade.
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Affiliation(s)
- Yamini Adusumelli
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | | | - Gabriella Lamb
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Vishakha Sabharwal
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Don Goldmann
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | | | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas J Sandora
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Jeffrey I Campbell
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
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17
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Burel JG, Wang W, Wuhrer M, Dedicoat M, Fletcher TE, Cunningham AF, O'Shea MK. IgG glycosylation associates with risk of progression from latent to active tuberculosis. J Infect 2024; 88:106115. [PMID: 38309308 DOI: 10.1016/j.jinf.2024.01.014] [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: 10/13/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES Glycosylation motifs shape antibody structure, stability and antigen affinity and play an important role in antibody localization and function. Serum IgG glycosylation profiles are significantly altered in infectious diseases, including tuberculosis (TB), but have not been studied in the context of progression from latent to active TB. METHODS We performed a longitudinal study of paired bulk IgG glycosylation and transcriptomic profiling in blood from individuals with active TB (ATB) or latent TB infection (LTBI) before and after treatment. RESULTS We identified that a combination of two IgG1 glycosylation traits were sufficient to distinguish ATB from LTBI with high specificity and sensitivity, prior to, and after treatment. Importantly, these two features positively correlated with previously defined cellular and RNA signatures of ATB risk in LTBI, namely monocyte to lymphocyte ratio and the expression of interferon (IFN)-associated gene signature of progression (IFN-risk signature) in blood prior to treatment. Additional glycosylation features at higher prevalence in LTBI individuals with high expression of the IFN-risk signature prior to treatment included fucosylation on IgG1, IgG2 and IgG3. CONCLUSIONS Together, our results demonstrate that bulk IgG glycosylation features could be useful in stratifying the risk of LTBI reactivation and progression to ATB.
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Affiliation(s)
- Julie G Burel
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Wenjun Wang
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin Dedicoat
- Department of Infection, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Thomas E Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - Adam F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Matthew K O'Shea
- Department of Infection, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
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Zhang H, Liao Y, Zhu Z, Liu H, Li D, Wang S. Assistance of next-generation sequencing for diagnosis of disseminated Bacillus Calmette-Guerin disease with X-SCID in an infant: a case report and literature review. Front Cell Infect Microbiol 2024; 14:1341236. [PMID: 38410723 PMCID: PMC10894915 DOI: 10.3389/fcimb.2024.1341236] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Bacille Calmette-Guérin (BCG) is a live strain of Mycobacterium bovis (M.bovis) for use as an attenuated vaccine to prevent tuberculosis (TB) infection, while it could also lead to an infection in immunodeficient patients. M.bovis could infect patients with immunodeficiency via BCG vaccination. Disseminated BCG disease (BCGosis) is extremely rare and has a high mortality rate. This article presents a case of a 3-month-old patient with disseminated BCG infection who was initially diagnosed with hemophagocytic syndrome (HPS) and eventually found to have X-linked severe combined immunodeficiency (X-SCID). M.bovis and its drug resistance genes were identified by metagenomics next-generation sequencing (mNGS) combined with targeted next-generation sequencing (tNGS) in blood and cerebrospinal fluid. Whole exome sequencing (WES) revealed a pathogenic variant in the common γ-chain gene (IL2RG), confirming X-SCID. Finally, antituberculosis therapy and umbilical cord blood transplantation were given to the patient. He was successfully cured of BCGosis, and his immune function was restored. The mNGS combined with the tNGS provided effective methods for diagnosing rare BCG infections in children. Their combined application significantly improved the sensitivity and specificity of the detection of M.bovis.
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Affiliation(s)
- Haiyang Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yi Liao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhensheng Zhu
- Depertment of Bioinformation, Hugobiotech Co., Ltd., Beijing, China
| | - Hanmin Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Deyuan Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Sisi Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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Perveen S, Negi A, Saini S, Gangwar A, Sharma R. Identification of Chemical Scaffolds Targeting Drug-Resistant and Latent Mycobacterium tuberculosis through High-Throughput Whole-Cell Screening. ACS Infect Dis 2024; 10:513-526. [PMID: 38238154 DOI: 10.1021/acsinfecdis.3c00463] [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: 02/10/2024]
Abstract
Identification of structurally unique chemical entities targeting unexplored bacterial targets is a prerequisite to combat increasing drug resistance against Mycobacterium tuberculosis. This study employed a whole-cell screening approach as an initial filter to scrutinize a 10,000-compound chemical library, resulting in the discovery of seven potent compounds with MIC values ranging from 1.56 to 25 μM. These compounds were categorized into four distinct chemical groups. Remarkably, they demonstrated efficacy against drug-resistant and nonreplicating tuberculosis strains, highlighting their effectiveness across different infection states. With a favorable selectivity index (>10), these compounds showed a safe therapeutic range and exhibited potency in an intracellular model of Mtb infection, mimicking the in vivo setup. Combining these identified hits with established anti-TB drugs revealed additive effects with rifampicin, isoniazid, and bedaquiline. Notably, IIIM-IDD-01 exhibited synergy with isoniazid and bedaquiline, likely due to their complementary mechanisms of targeting Mtb. Most potent hits, IIIM-IDD-01 and IIIM-IDD-02, displayed time- and concentration-dependent killing of Mtb. Mechanistic insights were sought through SEM and docking studies, although comprehensive evaluation is ongoing to unravel the hits' specific targets and modes of action. The hits demonstrated favorable pharmacokinetic properties (ADME-Tox) and showed a low risk of adverse effects, along with a predicted high level of oral bioavailability. These promising hits can serve as an initial basis for subsequent medicinal chemistry endeavors aimed at developing a new series of anti-TB agents. Moreover, the study affirms the significance of high-throughput in vitro assays for the TB drug discovery. It also emphasizes the necessity of targeting diverse TB strains to address the heterogeneity of tuberculosis bacteria.
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Affiliation(s)
- Summaya Perveen
- Infectious Diseases Division, CSIR- Indian Institute of Integrative Medicine, Jammu 180001, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Anjali Negi
- Infectious Diseases Division, CSIR- Indian Institute of Integrative Medicine, Jammu 180001, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Sapna Saini
- Infectious Diseases Division, CSIR- Indian Institute of Integrative Medicine, Jammu 180001, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Anjali Gangwar
- Infectious Diseases Division, CSIR- Indian Institute of Integrative Medicine, Jammu 180001, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Rashmi Sharma
- Infectious Diseases Division, CSIR- Indian Institute of Integrative Medicine, Jammu 180001, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
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Bidashimwa D, Ditekemena JD, Sigwadhi LN, Nkuta LM, Engetele E, Kilundu A, Chabikuli ON, Nachega JB. Completion of isoniazid preventive therapy for latent tuberculosis infection among children and adolescents compared to adults living with HIV in Kinshasa, Democratic Republic of the Congo. Trop Med Int Health 2024; 29:88-95. [PMID: 38123460 DOI: 10.1111/tmi.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Little is known about isoniazid preventive therapy (IPT) completion rates among children or adolescents compared to adults living with HIV in Kinshasa, Democratic Republic of the Congo (DRC). METHODS We conducted a retrospective cohort analysis including children, adolescents, and adults living with HIV who were treated at FHI360 and partners-implemented HIV care programs at six health zones in Kinshasa, DRC, from 2004 to 2020. The primary outcome was the proportion of children, adolescents versus adults who did complete 6 months of daily self-administered IPT. Log-binomial regression assessed independent predictors of IPT non-completion and Kaplan-Meier technique for survival analysis. RESULTS Of 11,691 eligible patients on ART who initiated IPT, 429 were children (<11 years), 804 adolescents (11-19 years), and 10,458 adults (≥20 years). The median age was 7 (IQR: 3-9) years for children, 15 (IQR: 13-17) years for adolescents, and 43 (35-51) years for adults. Among those who were initiated on IPT, 5625 out of 11,691 people living with HIV (PLHIV) had IPT completion outcome results, and an overall 3457/5625 (61.5%) completion rate was documented. Compared to adults, children and adolescents were less likely to complete IPT [104/199 (52.3%) and 268/525 (51.0%), respectively, vs. 3085/4901 (62.9%)]. After adjustment, the only independent predictors for IPT non-completion were health zone of residence and type of ART regimen. Kaplan-Meier analysis showed comparable poor survival among patients who completed IPT versus those who did not (p-value for log-rank test, 0.15). CONCLUSIONS The overall sub-optimal IPT completion rate in adults as well as children/adolescents in this setting is of great concern. Prospective studies are needed to elucidate the specific barriers to IPT completion among children, adolescents, and adults in DRC as well as the scale-up of evidence-informed interventions to improve IPT completion, such as adoption of shorter TB preventive regimens.
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Affiliation(s)
| | - John D Ditekemena
- Family Health International (FHI 360), Kinshasa, Democratic Republic of the Congo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Lovemore Nyasha Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Elodie Engetele
- Family Health International (FHI 360), Kinshasa, Democratic Republic of the Congo
| | - Apolinaire Kilundu
- National AIDS Control Program, Kinshasa, Democratic Republic of the Congo
| | - Otto N Chabikuli
- Family Health International (FHI 360), Durham, North Carolina, USA
- Public Health Program, Graduate School, Howard University, Washington, DC, USA
| | - Jean B Nachega
- Departments of Epidemiology, Infectious Diseases and Microbiology and Center for Global Health, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health; Center for Global Health, Johns Hopkins University Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
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Walles J, Winqvist N, Hansson SR, Sturegård E, Baqir H, Westman A, Kjerstadius T, Schön T, Björkman P. Pregnancy Outcomes in Women Screened for Tuberculosis Infection in Swedish Antenatal Care. Clin Infect Dis 2024; 78:125-132. [PMID: 37572363 PMCID: PMC10810708 DOI: 10.1093/cid/ciad465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/23/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) disease has been associated with pregnancy complications. However, the potential impact of TB infection (TBI) on pregnancy outcome is unknown. To investigate this, we conducted a register-based study in immigrant women screened with QuantiFERON assays for TBI in antenatal care in Sweden. METHODS Women with history of immigration from TB-endemic countries were eligible for inclusion if national identification numbers and available QuantiFERON results obtained during pregnancy from 2014 to 2018 were available. QuantiFERON results were linked to data on maternal characteristics and pregnancy outcomes from the national Pregnancy and Patient Registers. TBI was defined as nil-corrected QuantiFERON result ≥0.35 IU/mL, in the absence of TB disease. Pregnancies in women with TB disease or human immunodeficiency virus were excluded, as were multiplex pregnancies, pregnancies resulting in miscarriage, and pregnancies occurring >10 years after immigration. Odds of defined adverse pregnancy outcomes were compared by maternal TBI status using mixed effects logistic regression with adjustment for maternal age and region of origin. RESULTS In total, 7408 women with 12 443 pregnancies were included. In multivariable analysis, stillbirth (adjusted odds ratio [AOR], 1.90; 95% confidence interval [CI], 1.13-3.21; P = .016), severe preeclampsia (AOR, 1.62; 95% CI, 1.03-2.56; P = .036), low birthweight (<2500 g; AOR, 1.38; 95% CI, 1.01-1.88; P = .041), and emergency cesarean section (AOR, 1.28; 95% CI, 1.02-1.63; P = .033) were significantly associated with TBI. CONCLUSIONS Among immigrant women seeking antenatal care in Sweden, TBI was independently associated with adverse pregnancy outcomes. Further studies are needed to corroborate these findings and to explore mechanisms involved.
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Affiliation(s)
- John Walles
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Central Hospital, Kristianstad, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Skåne University Hospital Lund, Lund, Sweden
| | - Niclas Winqvist
- Skåne Regional Office for Infectious Disease Control and Prevention, Malmö, Sweden
| | - Stefan R Hansson
- Division of Obstetrics and Gynaecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Erik Sturegård
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Skåne University Hospital Lund, Lund, Sweden
| | - Haitham Baqir
- Department of Clinical Microbiology, Linköping University Hospital, Linköping, Sweden
| | - Anna Westman
- Department of Infectious Diseases, Danderyd Hospital, Stockholm, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska University Hospital Laboratory, Stockholm, Sweden
| | | | - Thomas Schön
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Infectious Diseases, Kalmar County Hospital, Linköping University, Kalmar, Sweden
- Department of Infectious Diseases, Linköping University, Linköping, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
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Chang M, Emam M, Chen X, Lu D, Zhang L, Zheng Y. An investigation of the effects of meteorological factors on the incidence of tuberculosis. Sci Rep 2024; 14:2088. [PMID: 38267494 PMCID: PMC10808229 DOI: 10.1038/s41598-024-52278-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
To explore the influence of meteorological factors on the incidence of tuberculosis (TB) in Yingjisha County, Kashgar Region, Xinjiang, and to provide a scientific basis for the prevention and control of TB. The Spearman correlation analysis and distribution lag nonlinear model analysis were conducted on the number of daily reported cases of TB from 2016 to 2023 to study the association effect of various meteorological factors and the daily incidence number of TB in Yingjisha County. A total of 13,288 TB cases were reported from January 2016 to June 2023, and June to October is the peak period of annual TB incidence. Spearman correlation analysis revealed that average daily temperature (AT) and average daily wind speed (WS) were positively correlated with TB incidence (rAT = 0.110, rWS = 0.090); and average daily relative humidity (RH) and TB incidence was negatively correlated (rRH = - 0.093). When AT was - 15 °C, the RR reached a maximum of 2.20 (95% CI: 0.77-6.29) at a lag of 21 days. When RH was 92%, the RR reached a maximum of 1.05 (95% CI: 0.92-1.19) at a lag of 6 days. When WS was 5.2 m/s, the RR reached a maximum of 1.30 (95% CI: 0.78-2.16) at a lag of 16 days. There is a non-linearity and a certain lag between meteorological factors and the occurrence and prevalence of TB in the population, which is mainly manifested in the fact that the risk of incidence of TB decreases with the increase of the daily AT, has a hazardous effect within a certain range of humidity as the average daily RH rises, and gradually increases with the increase of the average daily WS. Local residents are advised to pay attention to climate change so as to take appropriate preventive measures, especially women and middle and old age group should pay close attention to climate change and add more clothes in time, minimise travelling in hazy weather and windy and sandy weather, maintain good nutrition, adequate sleep and moderate exercise in daily life to enhance their immunity, wash hands frequently and ventilate the air, and try to avoid staying in humid and confined spaces in order to reduce the risk of latent TB patients developing the disease.
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Affiliation(s)
- Minli Chang
- College of Public Health, Xinjiang Medical University, Ürümqi, 830017, People's Republic of China
| | - Mawlanjan Emam
- Center for Disease Control and Prevention, Kashgar, People's Republic of China
| | - Xiaodie Chen
- College of Public Health, Xinjiang Medical University, Ürümqi, 830017, People's Republic of China
| | - Dongmei Lu
- Center of Pulmonary and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, People's Republic of China
| | - Liping Zhang
- College of Medical Engineering and Technology, Xinjiang Medical University, Ürümqi, 830017, People's Republic of China
| | - Yanling Zheng
- College of Medical Engineering and Technology, Xinjiang Medical University, Ürümqi, 830017, People's Republic of China.
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Badawi MM, SalahEldin MA, Idris AB, Idris EB, Mohamed SG. Tuberculosis in Sudan: systematic review and meta analysis. BMC Pulm Med 2024; 24:51. [PMID: 38263137 PMCID: PMC10807179 DOI: 10.1186/s12890-024-02865-6] [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: 05/07/2023] [Accepted: 01/17/2024] [Indexed: 01/25/2024] Open
Abstract
Every year, 10 million people fall ill with tuberculosis (TB). Despite being a preventable and curable disease, 1.5 million people die from TB each year -making it the world's top infectious disease. TB is the leading cause of death of people with HIV and also a major contributor to antimicrobial resistance. Its presumed that TB was the cause of 1% of the total deaths among inpatients in Sudan in 2017. The current study is aimed to provide pooled prevalence of Mycobacterium tuberculosis among Sudanese as well as to determine any socio-cultural risk factors associated. A systematic review of the literature was conducted and regulated in accordance with the PRISMA Statement. After abstract and full text screening only twenty-six articles met our inclusion criteria and passed the quality assessment procedure. Pulmonary tuberculosis prevalence was assessed in sixteen included studies among participants from Khartoum, Gezira, Kassala, Blue Nile, River Nile, White Nile, Gadarif, Red sea, North Kordofan, Northern State, Sennar and West Darfur States, representing a total sample size of 11,253 participants of suspected individuals such as febrile outpatients, TB patients' contacts and other groups such as HIV/AIDS patients, hemodialysis patients, School adolescents as well as pregnant women. The pooled prevalence was 30.72% [CI: 30.64, 30.81]. Moreover, Khartoum State recorded the highest pooled prevalence as 41.86% [CI: 14.69, 69.02] based on a total sample size of 2,737 participants. Furthermore, male gender and rural residence were found to be significantly associated with TB infection. Further research with larger sample sizes targeting prevalence and risk factors of TB among Sudanese population is needed to be conducted.
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Affiliation(s)
- M M Badawi
- Higher Academy for Strategic and Security Studies, Khartoum, Sudan.
| | - M A SalahEldin
- Medical Microbiology Department, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - A B Idris
- General Surgery Resident, Medical Specialization Board, Khartoum, Sudan
| | - E B Idris
- Department of medical microbiology, Rashid Medical Complex, Riyadh, Saudi Arabia
| | - S G Mohamed
- Medical Microbiology Department, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
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Hu Z, Shi L, Xie J, Fan XY. Editorial: Innate and adaptive immunity against tuberculosis infection: diagnostics, vaccines, and therapeutics. Front Immunol 2024; 15:1366976. [PMID: 38322257 PMCID: PMC10844819 DOI: 10.3389/fimmu.2024.1366976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Affiliation(s)
- Zhidong Hu
- Shanghai Public Health Clinical Center & Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Lanbo Shi
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Newark, NJ, United States
| | - Jianping Xie
- Chongqing Municipal Key Laboratory of Karst Environment, School of Life Sciences, Southwest University, Chongqing, China
| | - Xiao-Yong Fan
- Shanghai Public Health Clinical Center & Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
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Assefa DG, Dememew ZG, Zeleke ED, Manyazewal T, Bedru A. Financial burden of tuberculosis diagnosis and treatment for patients in Ethiopia: a systematic review and meta-analysis. BMC Public Health 2024; 24:260. [PMID: 38254019 PMCID: PMC10804496 DOI: 10.1186/s12889-024-17713-9] [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: 07/25/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Despite the diagnosis and treatment of tuberculosis (TB) given free of charge in many high-burden countries, the costs that patients face in the cascade of care remain a major concern. Here, we aimed to investigate the financial burden of TB diagnosis and treatment for people with TB in Ethiopia. METHOD For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, and Cochrane Center for Clinical Trials from December 1 2022 to 31 June 2023 for articles reporting the cost of diagnosis and treatment for patients regardless of their age with all forms of TB in Ethiopia. Major study outcomes were catastrophic costs, direct (out-of-pocket) pre-diagnosis, medical cost, and post-diagnosis costs, indirect (income loss) costs, coping costs, and total costs. We have used a threshold of 20% to define catastrophic costs. We used random-effects meta-analyses to calculate summary estimates of costs. R-studio software was used for analysis. The study is registered with PROSPERO: CRD42023387687. RESULT Twelve studies, with a total of 4792 patients with TB, were included in our analysis. At the 20% threshold of total expenses, 51% of patients (2301 participants from 5 studies, 95% CI: 36-65%, I2 = 97%) faced catastrophic costs due to bacteriologically confirmed drug-sensitive pulmonary TB. Private facility diagnosis, drug-resistance TB, TB-HIV co-infection, hospitalization, and occupation were found to be associated with catastrophic costs. Reduction in the total cost spent by the patients was associated with digital adherence interventions, community-based direct observed therapy, short-course MDR-TB treatment regimens, and active case-finding. Pre-diagnosis costs had a positive correlation with diagnosis delays and the number of facilities visited until diagnosis. Post-diagnosis costs had a positive correlation with rural residence and inpatient treatments. CONCLUSION Irrespective of a national policy of free TB service, more than half of TB patients are suffering catastrophic costs due to drug-sensitive pulmonary TB in Ethiopia and most of the patients spend a lot of money during the pre-diagnosis period and intensive phase, but declined drastically over time. Active case-finding, digital adherence interventions, community-based treatment, and comprehensive health insurance coverage have the potential to minimize the financial burden of TB diagnosis and treatment.
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Affiliation(s)
| | | | | | - Tsegahun Manyazewal
- College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Bedru
- KNCV Tuberculosis Foundation, Addis Ababa, Ethiopia
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26
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Dai X, Zhou L, He X, Hua J, Chen L, Lu Y. Identification of apoptosis-related gene signatures as potential biomarkers for differentiating active from latent tuberculosis via bioinformatics analysis. Front Cell Infect Microbiol 2024; 14:1285493. [PMID: 38312744 PMCID: PMC10834671 DOI: 10.3389/fcimb.2024.1285493] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Background Apoptosis is associated with the pathogenesis of Mycobacterium tuberculosis infection. This study aims to identify apoptosis-related genes as biomarkers for differentiating active tuberculosis (ATB) from latent tuberculosis infection (LTBI). Methods The tuberculosis (TB) datasets (GSE19491, GSE62525, and GSE28623) were downloaded from the Gene Expression Omnibus (GEO) database. The diagnostic biomarkers differentiating ATB from LTBI were identified by combining the data of protein-protein interaction network, differentially expressed gene, Weighted Gene Co-Expression Network Analysis (WGCNA), and receiver operating characteristic (ROC) analyses. Machine learning algorithms were employed to validate the diagnostic ability of the biomarkers. Enrichment analysis for biomarkers was established, and potential drugs were predicted. The association between biomarkers and N6-methyladenosine (m6A) or 5-methylated cytosine (m5C) regulators was evaluated. Results Six biomarkers including CASP1, TNFSF10, CASP4, CASP5, IFI16, and ATF3 were obtained for differentiating ATB from LTBI. They showed strong diagnostic performances, with area under ROC (AUC) values > 0.7. Enrichment analysis demonstrated that the biomarkers were involved in immune and inflammation responses. Furthermore, 24 drugs, including progesterone and emricasan, were predicted. The correlation analysis revealed that biomarkers were positively correlated with most m6A or m5C regulators. Conclusion The six ARGs can serve as effective biomarkers differentiating ATB from LTBI and provide insight into the pathogenesis of Mycobacterium tuberculosis infection.
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Affiliation(s)
- Xiaoting Dai
- Department of Infectious Diseases, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Litian Zhou
- Department of Neurosugery, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Xiaopu He
- Department of Geriatric Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Hua
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Chen
- Department of Infectious Diseases, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Yingying Lu
- Department of Clinical Laboratory, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Clinical Laboratory, Shanghai Pudong New Area People’s Hospital, Shanghai, China
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27
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Zhang L, Yang Z, Wu F, Ge Q, Zhang Y, Li D, Gao M, Liu X. Multiple cytokine analysis based on QuantiFERON-TB gold plus in different tuberculosis infection status: an exploratory study. BMC Infect Dis 2024; 24:28. [PMID: 38166667 PMCID: PMC10762904 DOI: 10.1186/s12879-023-08943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND More efficient and convenient diagnostic method is a desperate need to reduce the burden of tuberculosis (TB). This study explores the multiple cytokines secretion based on QuantiFERON-TB Gold Plus (QFT-Plus), and screens for optimal cytokines with diagnostic potential to differentiate TB infection status. METHODS Twenty active tuberculosis (ATB) patients, fifteen patients with latent TB infection (LTBI), ten patients with previous TB and ten healthy controls (HC) were enrolled. Whole blood samples were collected and stimulated by QFT-Plus TB1 and TB2 antigens. The levels of IFN-γ, TNF-α, IL-2, IL-6, IL-5, IL-10, IP-10, IL-1Ra, CXCL-1 and MCP-1 in supernatant were measured by Luminex bead-based multiplex assays. The receiver operating characteristic curve was used to evaluate the diagnostic accuracy of cytokine for distinguishing different TB infection status. RESULTS After stimulation with QFT-Plus TB1 and TB2 antigens, the levels of all cytokines, except IL-5 in TB2 tube, in ATB group were significantly higher than that in HC group. The levels of IL-1Ra concurrently showed the equally highest AUC for distinguishing TB infection from HC, followed by the levels of IP-10 in both TB1 tube and TB2 tube. Moreover, IP-10 levels displayed the largest AUC for distinguishing ATB patients from non-ATB patients. Meanwhile, the levels of IP-10 also demonstrated the largest AUC in both TB1 tube and TB2 tube for distinguishing ATB patients from LTBI. CONCLUSIONS In addition to conventional detection of IFN-γ, measuring IP-10 and IL-1Ra based on QFT-Plus may have the more tremendous potential to discriminate different TB infection status.
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Affiliation(s)
- Lifan Zhang
- Division of Infectious Diseases, Department of Internal medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, China
- Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengrong Yang
- Division of Infectious Diseases, Department of Internal medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengying Wu
- Division of Infectious Diseases, Department of Internal medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiping Ge
- Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yueqiu Zhang
- Division of Infectious Diseases, Department of Internal medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongyu Li
- Division of Infectious Diseases, Department of Internal medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengqiu Gao
- Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Xiaoqing Liu
- Division of Infectious Diseases, Department of Internal medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, China.
- Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Ishida E, Corrigan DT, Chen T, Liu Y, Kim RS, Song L, Rutledge TM, Magee DM, LaBaer J, Lowary TL, Lin PL, Achkar JM. Mucosal and systemic antigen-specific antibody responses correlate with protection against active tuberculosis in nonhuman primates. EBioMedicine 2024; 99:104897. [PMID: 38096687 PMCID: PMC10758715 DOI: 10.1016/j.ebiom.2023.104897] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Increasing evidence supports that antibodies can protect against active tuberculosis (TB) but knowledge of potentially protective antigens, especially in the airways, is limited. The main objective of this study was to identify antigen-specific airway and systemic immunoglobulin isotype responses associated with the outcome of controlled latent Mycobacterium tuberculosis (Mtb) infection (LTBI) versus uncontrolled infection (TB) in nonhuman primates. METHODS In a case-control design, using non-parametric group comparisons with false discovery rate adjustments, we assessed antibodies in 57 cynomolgus macaques which, following low-dose airway Mtb infection, developed either LTBI or TB. We investigated airway and systemic IgG, IgA, and IgM responses in paired bronchoalveolar lavage and plasma samples prior to, two-, and 5-6-months post Mtb infection using an antigen-unbiased approach with Mtb glycan and proteome-wide microarrays. FINDINGS Macaques that developed LTBI (n = 36) had significantly increased airway and plasma IgA reactivities to specific arabinomannan (AM) motifs prior to Mtb infection compared to those that developed TB (n = 21; p < 0.01, q < 0.05). Furthermore, LTBI macaques had higher plasma IgG reactivity to protein MTB32A (Rv0125) early post Mtb infection (p < 0.05) and increasing airway IgG responses to some proteins over time. INTERPRETATION Our results support a protective role of pre-existing mucosal (lung) and systemic IgA to specific Mtb glycan motifs, suggesting that prior exposure to nontuberculous mycobacteria could be protective against TB. They further suggest that IgG to Mtb proteins early post infection could provide an additional protective mechanism. These findings could inform TB vaccine development strategies. FUNDING NIH/NIAID AI117927, AI146329, and AI127173 to JMA.
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Affiliation(s)
- Elise Ishida
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Devin T Corrigan
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tingting Chen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yanyan Liu
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryung S Kim
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lusheng Song
- Virginia G. Piper Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Tara M Rutledge
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - D Mitchell Magee
- Virginia G. Piper Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Joshua LaBaer
- Virginia G. Piper Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Todd L Lowary
- Department of Chemistry, University of Alberta, Edmonton, AB, Canada; Institute of Biological Chemistry, Academia Sinica, Nangang Taipei, Taiwan; Institute of Biochemical Sciences, National Taiwan University, Taipei, Taiwan
| | - Philana Ling Lin
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jacqueline M Achkar
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
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Silver RF, Xia M, Storer CE, Jarvela JR, Moyer MC, Blazevic A, Stoeckel DA, Rakey EK, Tennant JM, Goll JB, Head RD, Hoft DF. Distinct gene expression signatures comparing latent tuberculosis infection with different routes of Bacillus Calmette-Guérin vaccination. Nat Commun 2023; 14:8507. [PMID: 38129388 PMCID: PMC10739751 DOI: 10.1038/s41467-023-44136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Tuberculosis remains an international health threat partly because of limited protection from pulmonary tuberculosis provided by standard intradermal vaccination with Bacillus of Calmette and Guérin (BCG); this may reflect the inability of intradermal vaccination to optimally induce pulmonary immunity. In contrast, respiratory Mycobacterium tuberculosis infection usually results in the immune-mediated bacillary containment of latent tuberculosis infection (LTBI). Here we present RNA-Seq-based assessments of systemic and pulmonary immune cells from LTBI participants and recipients of intradermal and oral BCG. LTBI individuals uniquely display ongoing immune activation and robust CD4 T cell recall responses in blood and lung. Intradermal BCG is associated with robust systemic immunity but only limited pulmonary immunity. Conversely, oral BCG induces limited systemic immunity but distinct pulmonary responses including enhanced inflammasome activation potentially associated with mucosal-associated invariant T cells. Further, IL-9 is identified as a component of systemic immunity in LTBI and intradermal BCG, and pulmonary immunity following oral BCG.
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Affiliation(s)
- Richard F Silver
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Pulmonary and Critical Care Medicine, The Louis Stokes Cleveland Department of Veterans' Affairs Medical Center, Cleveland, OH, USA.
| | - Mei Xia
- Division of Infectious Diseases, Allergy & Immunology, Saint Louis University School of Medicine, St. Louis, MO, USA
- Center for Vaccine Development, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Chad E Storer
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Jessica R Jarvela
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Pulmonary and Critical Care Medicine, The Louis Stokes Cleveland Department of Veterans' Affairs Medical Center, Cleveland, OH, USA
| | - Michelle C Moyer
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Pulmonary and Critical Care Medicine, The Louis Stokes Cleveland Department of Veterans' Affairs Medical Center, Cleveland, OH, USA
| | - Azra Blazevic
- Division of Infectious Diseases, Allergy & Immunology, Saint Louis University School of Medicine, St. Louis, MO, USA
- Center for Vaccine Development, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - David A Stoeckel
- Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Erin K Rakey
- Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Jan M Tennant
- Division of Infectious Diseases, Allergy & Immunology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Richard D Head
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel F Hoft
- Division of Infectious Diseases, Allergy & Immunology, Saint Louis University School of Medicine, St. Louis, MO, USA.
- Center for Vaccine Development, Saint Louis University School of Medicine, St. Louis, MO, USA.
- Department of Molecular Microbiology & Immunology Saint Louis University School of Medicine, St. Louis, MO, USA.
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Brooks MB, Pingali V, Nicholson T, Keshavjee S. Cost of inaction: a framework to estimate the economic cost of missing a patient with tuberculosis in the Indian context. BMJ Open 2023; 13:e070717. [PMID: 38128936 DOI: 10.1136/bmjopen-2022-070717] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES To estimate the economic impact of failure to find and treat tuberculosis disease and prevent tuberculosis infection from progressing to active disease. DESIGN Estimating the economic cost of not finding and treating a patient suffering from tuberculosis. SETTING Estimation methodology is developed in the Indian context, as informed by local costs and reported tuberculosis epidemiology. PARTICIPANTS No individual participants were included. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure is the total cost of patients with drug-susceptible and drug-resistant tuberculosis who are and are not found and treated by tuberculosis programmes, including costs for medications, lost productivity, healthcare services and furthered transmission. We calculate the economic burdens by varying the number of individuals a person sick with tuberculosis infects (10 or 15 people) and the risk of progression to tuberculosis disease if infected (5 or 8%). The secondary outcome measure is the amount saved by finding a patient early or who would not have otherwise been found. All costs are presented in US dollars (exchange rate: 72 Indian rupees/1 US$). RESULTS By finding and treating a patient early before furthered transmission occurs-or stopping progression of tuberculosis infection to tuberculosis disease with preventive therapy-the Indian health system can save US$5502 to US$15 825 and US$5846 to US$25 575, for each individual with drug-susceptible and drug-resistant tuberculosis, respectively, across scenarios. CONCLUSIONS These estimates provide crude, lower bounds for the potential costs of not appropriately diagnosing and treating a single patient with active tuberculosis in a timely manner, or preventing a patient with tuberculosis infection from progressing to active disease. The actual financial burden on society is far higher than estimated using this simple, short-term cost-effective analyses. Our results highlight the limitations of tuberculosis costing models to date, and demonstrate the importance of accounting for airborne transmission of tuberculosis.
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Affiliation(s)
- Meredith B Brooks
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Tom Nicholson
- Center for International Development, Duke University Sanford School of Public Policy, Durham, North Carolina, USA
- Advance Access & Delivery, Durham, North Carolina, USA
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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Tiruneh MG, Fenta ET, Anagaw TF, Bogale EK, Delie AM. Tuberculosis infection control practice and associated factors among health care workers in Ethiopia: Systematic review and meta-analysis. PLoS One 2023; 18:e0295555. [PMID: 38085729 PMCID: PMC10715661 DOI: 10.1371/journal.pone.0295555] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The poor practice of tuberculosis infection control may increase the risk of transmission of tuberculosis in healthcare settings. Thus, this study aimed to determine the pooled magnitude of good tuberculosis infection control practice and associated factors among healthcare workers in Ethiopia. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guideline was followed for this review and meta-analysis. The electronic databases (Pub Med, Cochrane Library, Google scholar and grey literatures) were searched to retrieve articles by using keywords. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used to assess the quality of studies. Heterogeneity was assessed using the I2 statistic. The meta-analysis with a 95% confidence interval using STATA 17 software was computed to present the pooled practice and odds ratio of the determinant factors. Publication bias was assessed visually by inspecting the funnel plot asymmetry and using statistical tests using the eggers and begs test. RESULTS Seven studies were included in this meta-analysis, with a total of 3256 health workers. The overall pooled magnitude of good tuberculosis infection control practice was 46.44% (95% CI: 34.21%, 58.67%). In subgroup analysis, the highest practice was in Addis Ababa 51.40% (95% CI: 47.40, 55.40%) and the lowest prevalence of tuberculosis infection control practice was in Amhara region 40.24% (95% CI: 15.46, 65.02%). Working in TB clinics (AOR; 7.42, 95% CI: 3.89, 14.13) and good TB related knowledge (AOR; 4.40, 95% CI: 1.76, 10.97) were the significant predictors of good TB infection control practice. CONCLUSIONS Only less than half of the health care workers had good practice of TB infection control. Working in TB clinics and having good TB related knowledge were statistically significant predictors of TB infection control practice. Periodic shifting of health care workers to work in TB clinics and an emphasis on TB infection control related skill based training was recommended to increase the TB infection control practice.
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Affiliation(s)
- Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Tadele Fentabil Anagaw
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Mebrat Delie
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
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Eisen S, Williams B, Cohen J. Infections in Asymptomatic Unaccompanied Asylum-seeking Children in London 2016-2022. Pediatr Infect Dis J 2023; 42:1051-1055. [PMID: 37725799 DOI: 10.1097/inf.0000000000004087] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Unaccompanied asylum-seeking children are at increased risk of infections and experience barriers to healthcare access. There is a lack of evidence to underpin existing national and international guidance regarding asymptomatic infection screening in this population. We describe the results from routine infection screening of 1104 unaccompanied asylum-seeking children attending for testing at 3 London centers. METHODS We performed a retrospective analysis of routinely collected data from all unaccompanied asylum-seeking children seen in 3 services in London, United Kingdom, between 2016 and 2022. RESULTS A total of 1104 unaccompanied asylum-seeking children attended clinic; all accepted screening. The median age was 16 years (range 11-18 years) and 987 (89%) were male. 407 (37%) had at least 1 infection; 116 (11%) had multiple infections. Tuberculosis infection and schistosomiasis were common (found in 18% and 17%, respectively). Hepatitis B infection was identified with a prevalence of 3.9%. Giardia 7.7%, tapeworm 3.3% and Strongyloides 2.8% were also commonly identified. CONCLUSIONS We report the largest known dataset to our knowledge of infection screening in asymptomatic unaccompanied asylum-seeking children in Europe to date. This data supports recommendations for routine asymptomatic screening in this high-risk cohort, based on the significant prevalence identified of infections of both personal and public health significance.
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Affiliation(s)
- Sarah Eisen
- From the Department of Paediatrics, UCLH Hospitals NHS Foundation Trust, London, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bhanu Williams
- Department of Paediatrics, Northwick Park NHS Trust, London, United Kingdom
| | - Jonathan Cohen
- Department of Paediatric Infectious Diseases, Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
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Witte P, Arvand M, Barth S, Diel R, Friesen I, Gastmeier P, Häcker B, Hauer B, Kuhns M, Nienhaus A, Otto-Knapp R, Richter E, Wischnewski N, Ziegler R, Bauer T. [Tuberculosis Infection Control & Hygiene - Recommendations of the DZK]. Pneumologie 2023; 77:983-1000. [PMID: 37832577 DOI: 10.1055/a-2172-9575] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Preventing the spread of the disease is an essential goal in the care and treatment of tuberculosis. In addition to early diagnosis and effective therapies, isolation of infectious patients and adequate hygiene measures are of particular importance for infection prevention. The present recommendations replace the previous recommendations "tuberculosis infection control" from 2012 and take into account the current national and international recommendations and as well as new scientific findings. After a description of the infection and the transmission pathways, the necessary prevention and hygiene measures in health care facilities are comprehensively presented. Since the last revision of the recommendations on infection prevention, international recommendations and the KRINKO recommendation on ending isolation have been changed. In accordance with this, under certain conditions in the case of sensitive tuberculosis, de-isolation in health care facilities can take place after 14 days without taking the sputum findings into account. The second part of the recommendations explains in detail the measures to be taken in special situations and areas, such as general practitioners, ambulance services and care facilities. Here, the recommendations on respiratory protection have been simplified; for staff, an FFP2 mask is now generally considered sufficient.
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Affiliation(s)
- Peter Witte
- Institut für Krankenhaushygiene, Universitätsklinikum JWK Minden, Minden
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | - Stefanie Barth
- Friedrich-Loeffler-Institut - Bundesforschungsinstitut für Tiergesundheit (FLI), Institut für molekulare Pathogenese, Jena
| | - Roland Diel
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
- Institut für Epidemiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
- Deutsches Zentrum für Lungenforschung, Airway Research Center North (ARCN), LungenClinic Großhansdorf, Großhansdorf
| | - Inna Friesen
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Leibniz Lungenzentrum, Borstel
| | - Petra Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Berlin
| | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | - Martin Kuhns
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Leibniz Lungenzentrum, Borstel
| | - Albert Nienhaus
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg
| | - Ralf Otto-Knapp
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | - Renate Ziegler
- Institut für Klinikhygiene, Medizinische Mikrobiologie und Klinische Infektiologie, Universitätsinstitut der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Nürnberg
| | - Torsten Bauer
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
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Zhang SX, Lu ZH, Wang MT, Shen YP, Duan L, Guan SY, Chen MX, Lu Y, Yang M, Wang L, Yang GB, Lv WW, Wang JC, Zheng JX. Assessing the association between the circulating levels of inflammatory cytokines and the risk of tuberculosis: A bidirectional two-sample mendelian randomization study. Infect Genet Evol 2023; 116:105524. [PMID: 37952650 DOI: 10.1016/j.meegid.2023.105524] [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] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Numerous observational studies have previously reported an association between inflammatory cytokines and tuberculosis (TB). However, the causal relationship between these factors remains unclear. Consequently, we conducted two-sample Mendelian randomization (MR) analyses to ascertain the causal link between levels of inflammatory cytokines and the risk of TB. METHODS Single nucleotide polymorphisms (SNPs) robustly associated with the cytokines, located in or close to their coding gene. SNP was obtained from genome-wide association studies (GWAS) of 8293 individuals of Finnish. TB data was obtained from the UK Biobank, which included 46,293 individuals of European ancestry (comprising 2277 TB cases and 46,056 controls). Two-sample, bi-directional MR analyses using inverse-variance weighted (IVW) method as the primary analysis. Followed by comprehensive sensitivity analyses to validate the robustness of results. RESULT The study showed that the causal relationship between circulating levels of interleukin (IL)-7 and risk of TB (odds ratio [OR] = 1.001, 95% confidence intervals [CIs]: 1.000, 1.003. p = 0.047). No causal associations were observed between other influencing factors and the occurrence of TB. Furthermore, the analysis revealed that TB infection exhibited negative causal associations with macrophage inflammatory protein 1 alpha ([MIP-1α], OR = 0.007, 95% CI: 0.000, 0.192. p = 0.004), IL-2 (OR = 0.014, 95% CI: 0.010, 0.427. p = 0.014), interleukin-2 receptor alpha chain([IL-2rα], OR = 0.019, 95% CI: 0.001, 0.525. p = 0.019) and basic fibroblast growth factor ([bFGF], OR = 0.066, 95% CI: 0.006, 0.700. p = 0.024). CONCLUSION The study has illuminated the causal link between inflammatory cytokines and TB, thereby enhancing our comprehension of the potential mechanisms underlying TB pathogenesis. This discovery offers promising avenues for the identification of novel therapeutic targets in TB treatment. These insights may ultimately pave the way for more effective treatment approaches, thereby improving patient outcomes.
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Affiliation(s)
- Shun-Xian Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China; Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, National Institute of Parasitic Diseases, Shanghai 200025, China; School of Global Health, Chinese Center for Tropical Diseases Research-Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhen-Hui Lu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Mei-Ti Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200032, China
| | - Yu-Ping Shen
- The Second affiliated Hospital of Zhejiang Chinese Medical University, Huangzhou 310012, China
| | - Lei Duan
- Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, National Institute of Parasitic Diseases, Shanghai 200025, China; School of Global Health, Chinese Center for Tropical Diseases Research-Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Shi-Yang Guan
- Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Mu-Xin Chen
- Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, National Institute of Parasitic Diseases, Shanghai 200025, China; School of Global Health, Chinese Center for Tropical Diseases Research-Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yan Lu
- Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, National Institute of Parasitic Diseases, Shanghai 200025, China; School of Global Health, Chinese Center for Tropical Diseases Research-Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ming Yang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Lei Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Guo-Bing Yang
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730000, China
| | - Wen-Wen Lv
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ji-Chun Wang
- Department of Science and Technology, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
| | - Jin-Xin Zheng
- Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, National Institute of Parasitic Diseases, Shanghai 200025, China; School of Global Health, Chinese Center for Tropical Diseases Research-Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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Guo X, Du W, Li J, Dong J, Shen X, Su C, Zhao A, Wu Y, Xu M. A Comparative Study on the Mechanism of Delayed-Type Hypersensitivity Mediated by the Recombinant Mycobacterium tuberculosis Fusion Protein ESAT6-CFP10 and Purified Protein Derivative. Int J Mol Sci 2023; 24:16612. [PMID: 38068935 PMCID: PMC10706316 DOI: 10.3390/ijms242316612] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
While purified protein derivative (PPD) is commonly used as skin diagnostic reagent for tuberculosis (TB) infection, it cannot distinguish effectively Bacillus Calmette-Guérin (BCG) vaccination from Mycobacterium tuberculosis (MTB) complex and nontuberculous mycobacteria infection. The new skin reagent ESAT6-CFP10 (EC) has favorable sensitivity and specificity, which can overcome limitations associated with PPD. At present, EC skin test reactions are mainly characterized by erythema, while PPD mainly causes induration. We conducted a comparative study on the potential differences between EC-induced erythema and PPD-induced induration using a guinea pig model. The size of EC-dependent erythema was similar to that of PPD-induced induration, and an inflammatory response characterized by the infiltration of monocytes, macrophages and lymphocytes, as well as tissue damage, appeared at the injection site. The lymphocytes included CD4+ T and CD8+ T cells, which released IFN-γ as the main cytokine. Both EC erythema and PPD induration could lead to increased levels of acute-phase proteins, and the differential pathways were similar, thus indicating that the main induced immune pathways were similar. The above results indicated that erythema produced by EC could generate the main delayed-type hypersensitivity (DTH) response characteristic of PPD induration, thereby suggesting that erythema might also have a certain diagnostic significance and provide a possible theoretical basis for its use as a diagnostic indicator for detecting MTB infection.
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Affiliation(s)
- Xiaonan Guo
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun 130012, China;
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Weixin Du
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Junli Li
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Jiaxin Dong
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Xiaobing Shen
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Cheng Su
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Aihua Zhao
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Yongge Wu
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun 130012, China;
| | - Miao Xu
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
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Dhhar G, McColl J, Kitai I, Levy DM, Verstegen RHJ. Syndrome pseudogrippal avec choc induit par la rifampicine chez une patiente atteinte d’infection tuberculeuse. CMAJ 2023; 195:E1489-E1491. [PMID: 37931950 PMCID: PMC10627566 DOI: 10.1503/cmaj.230317-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Affiliation(s)
- Gousia Dhhar
- Divisions de médecine interne générale (Dhhar) et de pharmacologie et toxicologie cliniques, Département de médecine (Dhhar), Université de Toronto, Toronto, Ont.; Département de pédiatrie (McColl) et Division de rhumatologie (McColl), Université de l'Alberta, Edmonton, Alb.; Département de pédiatrie (Kitai, Levy, Verstegen) et Division de maladies infectieuses, Département de pédiatrie (Kitai), Université de Toronto; Divisions de rhumatologie (Levy, Verstegen) et de pharmacologie et toxicologie cliniques, Département de pédiatrie (Verstegen), Hôpital pour enfants malades, Toronto, Ont
| | - Jeanine McColl
- Divisions de médecine interne générale (Dhhar) et de pharmacologie et toxicologie cliniques, Département de médecine (Dhhar), Université de Toronto, Toronto, Ont.; Département de pédiatrie (McColl) et Division de rhumatologie (McColl), Université de l'Alberta, Edmonton, Alb.; Département de pédiatrie (Kitai, Levy, Verstegen) et Division de maladies infectieuses, Département de pédiatrie (Kitai), Université de Toronto; Divisions de rhumatologie (Levy, Verstegen) et de pharmacologie et toxicologie cliniques, Département de pédiatrie (Verstegen), Hôpital pour enfants malades, Toronto, Ont
| | - Ian Kitai
- Divisions de médecine interne générale (Dhhar) et de pharmacologie et toxicologie cliniques, Département de médecine (Dhhar), Université de Toronto, Toronto, Ont.; Département de pédiatrie (McColl) et Division de rhumatologie (McColl), Université de l'Alberta, Edmonton, Alb.; Département de pédiatrie (Kitai, Levy, Verstegen) et Division de maladies infectieuses, Département de pédiatrie (Kitai), Université de Toronto; Divisions de rhumatologie (Levy, Verstegen) et de pharmacologie et toxicologie cliniques, Département de pédiatrie (Verstegen), Hôpital pour enfants malades, Toronto, Ont
| | - Deborah M Levy
- Divisions de médecine interne générale (Dhhar) et de pharmacologie et toxicologie cliniques, Département de médecine (Dhhar), Université de Toronto, Toronto, Ont.; Département de pédiatrie (McColl) et Division de rhumatologie (McColl), Université de l'Alberta, Edmonton, Alb.; Département de pédiatrie (Kitai, Levy, Verstegen) et Division de maladies infectieuses, Département de pédiatrie (Kitai), Université de Toronto; Divisions de rhumatologie (Levy, Verstegen) et de pharmacologie et toxicologie cliniques, Département de pédiatrie (Verstegen), Hôpital pour enfants malades, Toronto, Ont
| | - Ruud H J Verstegen
- Divisions de médecine interne générale (Dhhar) et de pharmacologie et toxicologie cliniques, Département de médecine (Dhhar), Université de Toronto, Toronto, Ont.; Département de pédiatrie (McColl) et Division de rhumatologie (McColl), Université de l'Alberta, Edmonton, Alb.; Département de pédiatrie (Kitai, Levy, Verstegen) et Division de maladies infectieuses, Département de pédiatrie (Kitai), Université de Toronto; Divisions de rhumatologie (Levy, Verstegen) et de pharmacologie et toxicologie cliniques, Département de pédiatrie (Verstegen), Hôpital pour enfants malades, Toronto, Ont.
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Cursi L, Lancella L, Mariani F, Martino L, Leccese B, Di Giuseppe M, Venuti F, Cristina R, Gentile L, Sali M, Delogu G, Valentini P, Buonsenso D. Monocyte-to-lymphocyte, neutrophil-to-lymphocyte and neutrophil-to-monocyte plus lymphocyte ratios in children with active tuberculosis: A multicentre study. Acta Paediatr 2023; 112:2418-2425. [PMID: 37540888 DOI: 10.1111/apa.16932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/06/2023]
Abstract
AIM Higher number of monocytes and neutrophils may correlate with active tuberculosis (TB) in children. However, the few paediatric studies available are limited by the small numbers of children with TB disease or infection included. METHODS We calculated the monocyte-to-lymphocyte-ratio (MLR), neutrophil-to-lymphocyte-ratio (NLR) and neutrophil-to-monocyte-plus-lymphocyte-ratio (NMLR) in children with active TB, latent TB infection (LTBI), other infectious and non-infectious conditions and healthy children evaluated in two referral centres in Rome. RESULTS Overall, 649 children were included (41.8% females, mean age of 5.74 years). MLR, NLR and NMLR values were always significantly higher in patients with TB compared with the other groups (p < 0.001). Considering the entire population with the outcome of TB diagnosis, NMLR, with a cut-off of 1.2, had a sensitivity of 63% and a specificity of 76% (AUC: 0.71 [0.64-0.78]); NLR, with a cut-off of 1.5, had a sensitivity of 61% and a specificity of 79% (AUC: 0.72 [0.65-0.79]); MLR, considering a cut-off of 0.2, was less sensitive (56%) but more specific (82%) with a similar AUC (0.72 [0.65-0.79]). CONCLUSION Our study provides further evidence that MLR, NLR and NMLR can serve as first level diagnostics to support the clinical suspicion of TB in children.
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Affiliation(s)
- Laura Cursi
- Infectious Disease Unit, Bambino Gesù Children's Hospital, Hospital University Pediatrics Clinical Area (APUO), IRCCS, Rome, Italy
| | - Laura Lancella
- Infectious Disease Unit, Bambino Gesù Children's Hospital, Hospital University Pediatrics Clinical Area (APUO), IRCCS, Rome, Italy
| | - Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Martino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bianca Leccese
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Martina Di Giuseppe
- Infectious Disease Unit, Bambino Gesù Children's Hospital, Hospital University Pediatrics Clinical Area (APUO), IRCCS, Rome, Italy
| | - Francesco Venuti
- Infectious Disease Unit, Bambino Gesù Children's Hospital, Hospital University Pediatrics Clinical Area (APUO), IRCCS, Rome, Italy
| | - Russo Cristina
- Virology and Mycobacteria Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Leonarda Gentile
- Virology and Mycobacteria Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michela Sali
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie-Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | - Giovanni Delogu
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie-Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
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Flores-Gonzalez J, Urbán-Solano A, Ramón-Luing LA, Cancino-Diaz JC, Contreras-Rodriguez A, Curiel-Quesada E, Hernández-Pando R, Chavez-Galan L. Active tuberculosis patients have high systemic IgG levels and B-cell fingerprinting, characterized by a reduced capacity to produce IFN-γ or IL-10 as a response to M.tb antigens. Front Immunol 2023; 14:1263458. [PMID: 38022616 PMCID: PMC10643169 DOI: 10.3389/fimmu.2023.1263458] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis (M.tb). B cells are the central mediator of the humoral response; they are responsible for producing antibodies in addition to mediating other functions. The role of the cellular response during the TB spectrum by B cells is still controversial. Methods In this study, we evaluated the distribution of the circulating B cell subsets in patients with active and latent TB (ATB and LTB, respectively) and how they respond to stimuli of protein or lipid from M.tb. Results Here, we show that ATB patients show an immune fingerprinting. However, patients with drug-sensitive- (DS-TB) or drug-resistant- (DR-TB) TB have altered frequencies of circulating B cells. DS-TB and DR-TB display a unique profile characterized by high systemic levels of IFN-γ, IL-10, IgG, IgG/IgM ratio, and total B cells. Moreover, B cells from DR-TB are less efficient in producing IL-10, and both DS-TB and DR-TB produce less IFN-γ in response to M.tb antigens. Conclusion These results provide new insights into the population dynamics of the cellular immune response by B cells against M.tb and suggest a fingerprinting to characterize the B-cell response on DR-TB.
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Affiliation(s)
- Julio Flores-Gonzalez
- Laboratory of Integrative Immunology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
- Department of Microbiology, Laboratory of Immunomicrobiology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Alexia Urbán-Solano
- Laboratory of Integrative Immunology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Lucero A. Ramón-Luing
- Laboratory of Integrative Immunology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Juan Carlos Cancino-Diaz
- Department of Microbiology, Laboratory of Immunomicrobiology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Araceli Contreras-Rodriguez
- Department of Microbiology, Laboratory of Immunomicrobiology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Everardo Curiel-Quesada
- Department of Biochemistry, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Rogelio Hernández-Pando
- Department of Pathology, Section of Experimental Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Leslie Chavez-Galan
- Laboratory of Integrative Immunology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
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Iwase SC, Edlefsen PT, Bhebhe L, Motsumi K, Moyo S, Happel AU, Shao D, Mmasa N, Schenkel S, Gasper MA, Dubois M, Files MA, Seshadri C, Duffy F, Aitchison J, Netea MG, Jao J, Cameron DW, Gray CM, Jaspan HB, Powis KM. T-SPOT.TB Reactivity in Southern African Children With and Without in Utero Human Immunodeficiency Virus Exposure. Clin Infect Dis 2023; 77:1133-1136. [PMID: 37293702 PMCID: PMC10573724 DOI: 10.1093/cid/ciad356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/10/2023] Open
Abstract
Infants who are human immunodeficiency virus (HIV)-exposed uninfected (iHEU) experience higher risk of infectious morbidity than infants HIV-unexposed uninfected (iHUU). We compared tuberculosis (TB) infection prevalence in 418 Bacillus Calmette-Guérin vaccinated sub-Saharan African iHEU and iHUU aged 9-18 months using T-SPOT.TB. Prevalence of TB infection was low and did not differ by HIV exposure status.
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Affiliation(s)
- Saori C Iwase
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Paul T Edlefsen
- Vaccine and Infectious Disease Division, Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Lynnette Bhebhe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kesego Motsumi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anna-Ursula Happel
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Danica Shao
- Vaccine and Infectious Disease Division, Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Nicholas Mmasa
- Surgical Department, County Durham and Darlington NHS Trust, Darlington Memorial Hospital, Darlington, United Kingdom
| | - Sara Schenkel
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Melanie A Gasper
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Melanie Dubois
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Megan A Files
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Chetan Seshadri
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Fergal Duffy
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - John Aitchison
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Jennifer Jao
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Pediatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald W Cameron
- Divisions of Infectious Diseases and Respirology, University of Ottawa at the Ottawa Hospital, Ottawa, Canada
| | - Clive M Gray
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Biomedical Research Institute, Stellenbosch University, Cape Town, South Africa
| | - Heather B Jaspan
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Kathleen M Powis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
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Khoza LB, Mulondo SA, Lebese RT. Perspectives on pregnant women's educational needs to prevent TB complications during pregnancy and the neonatal period. A qualitative study. BMC Public Health 2023; 23:1997. [PMID: 37833655 PMCID: PMC10576336 DOI: 10.1186/s12889-023-16770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) during pregnancy could confer a high risk for maternal and infant morbidity. Literature indicates that the global burden of active TB disease among pregnant women is not well researched. Statistics for South Africa from WHO give an estimated incidence of 360, 000 cases of TB in 2019; 14,000 people became ill with multidrug-resistant TB in 2019, with a rate of 615 per 100,000 population, implying that the cohorts included pregnant women with and without a diagnosis of TB infection. Therefore, the study aims to increase the understanding of the educational needs required to prevent TB complications during pregnancy and the neonatal period in women diagnosed with TB infection. METHODS The study used cross-sectional qualitative and descriptive designs to collect data in the clinical setting of the primary health care services of Limpopo Province, South Africa. The population comprised pregnant women diagnosed with TB infection. A non-probability purposive sampling technique was used to sample 2 health centers and 5 clinics in each of the three sampled districts. The targeted sample size was 63 and it was achieved even though data saturation was observed. Individual interviews were conducted, audiotaped, and transcribed. Guided by the study questions, a thematic content analysis of the findings was used. Ethical considerations were also observed. RESULTS Despite that pregnant women have general knowledge about TB disease, the knowledge and awareness regarding the prevention of TB complications in pregnancy and the neonatal period, information on TB/HIV and COVID-19 co-infections, and participants' knowledge about other non-infectious diseases that may affect the mother with TB infection and foetus showed a deficit. CONCLUSION Pregnant women with TB disease need to be educated on the negative effects of non-adherence to TB treatment during pregnancy and the neonatal period. There is a need to educate pregnant women about the variant signs and symptoms of TB, HIV and COVID-19 infections since there is a misconception that the three diseases are similar. It is important that pregnant mothers diagnosed with TB should start treatment as soon as possible.
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Affiliation(s)
- L B Khoza
- Department of Health Studies, University of South Africa, Pretoria, South Africa.
| | - S A Mulondo
- Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - R T Lebese
- Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
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Shen X, Wu T, Ji X, Yang K, Wang L, Peng Y, Huang G, Shen H, Sha W. Mycobacterium tuberculosis infection depressed cytotoxic T cells activity owing to decreasing NKG2C and increasing NKG2A expression. Mol Immunol 2023; 162:133-142. [PMID: 37683324 DOI: 10.1016/j.molimm.2023.08.014] [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: 04/12/2023] [Revised: 08/12/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
Cytotoxic T lymphocytes (CTLs) play protective roles in immunity against tuberculosis (TB) infection by strongly inhibiting intracellular mycobacterial growth. In TB infection, the impairing mechanism of CTLs function remains unclear. In this study, we identified that the cytotoxic granule molecules expression levels of perforin (PRF) and granulysin (GNLY) in CD3+ and CD8+ CTL cells were significantly depressed in TB patients compared to those in healthy donors. The frequencies of T-CTLs, co-expressing granzyme B (GZMB), PRF and GNLY, were obviously decreased in TB patients. Moreover, NKG2C highly expressed in T-CTLs, was an effective activator of cytotoxic activity of CD3+ T cells. And, NKG2C+CD3+ T cells potently inhibited intracellular mycobacterial growth. The proportions of NKG2C+ cells in CD3+ and CD8+ T cells were dramatically decreased in TB patients. Contrarily, NKG2A, an inhibitor of T cells cytotoxic activities, was highly expressed in T-CTLs of CD3+ and CD8+ T cells in TB patients. Here, we successfully discovered that depressed CTLs activities in TB patients were attributed to low expression of cytotoxic granule molecules and high expression of inhibitory NKG2A receptor, suppression of agonist receptor NKG2C. Thus, NKG2 receptors were potential targets for immunotherapy of tuberculosis, especially for multidrug-resistant tuberculosis.
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Affiliation(s)
- Xiaona Shen
- Shanghai Clinical Research Center for Infectious Disease (tuberculosis), Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Institute for Advanced Study, Tongji University School of Medicine, Shanghai, China
| | - Tian Wu
- Shanghai Clinical Research Center for Infectious Disease (tuberculosis), Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Institute for Advanced Study, Tongji University School of Medicine, Shanghai, China
| | - Xuejiao Ji
- Shanghai Clinical Research Center for Infectious Disease (tuberculosis), Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Institute for Advanced Study, Tongji University School of Medicine, Shanghai, China
| | - Kunfeng Yang
- College of Marine Life Sciences, Ocean University of China, Shandong, China
| | - Lei Wang
- Shanghai Clinical Research Center for Infectious Disease (tuberculosis), Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Institute for Advanced Study, Tongji University School of Medicine, Shanghai, China
| | - Ying Peng
- Shanghai Clinical Research Center for Infectious Disease (tuberculosis), Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Institute for Advanced Study, Tongji University School of Medicine, Shanghai, China.
| | - Guixian Huang
- Shanghai Clinical Research Center for Infectious Disease (tuberculosis), Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Institute for Advanced Study, Tongji University School of Medicine, Shanghai, China
| | - Hongbo Shen
- Shanghai Clinical Research Center for Infectious Disease (tuberculosis), Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Institute for Advanced Study, Tongji University School of Medicine, Shanghai, China.
| | - Wei Sha
- Shanghai Clinical Research Center for Infectious Disease (tuberculosis), Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Institute for Advanced Study, Tongji University School of Medicine, Shanghai, China.
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Ganmaa D, Chinbayar T, Khudaykov P, Nasantogtoh E, Ariunbuyan S, Enkhtsetseg T, Sarangua G, Chan A, Tserendagva D. Latent TB Infection, Vitamin D Status and COVID-19 Severity in Mongolian Patients. Nutrients 2023; 15:3979. [PMID: 37764763 PMCID: PMC10536319 DOI: 10.3390/nu15183979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
We aimed to determine potential risk factors for COVID-19 severity including serum vitamin D levels and latent TB infection among Mongolian inpatients diagnosed with COVID-19, and to study the effects of disease complications and treatment outcomes. This study included patients admitted to the Mongolian National Center for Communicable Disease, a main referral center for infectious disease in Mongolia, with COVID-19 ascertained by a positive PCR test. Patients' demographic, clinical, and laboratory data were analyzed. Of the 270 patients enrolled, 125 (46%) had mild-to-moderate illness, 86 (32%) had severe illness, and 59 (22%) had critical illness. Ten (91%) of the 11 patients who had active TB were hospitalized with severe or critical COVID-19, suggesting that they had a higher risk of falling into the severe category (OR = 10.6 [1.2; 92.0] 95% CI). Severe vitamin D deficiency (25(OH)D < 10 ng/mL) was present in 32% of the patients, but was not significantly associated with the severity of illness (p = 0.65). Older age, being male, having active TB and/or COPD were associated with greater COVID-19 severity, whereas a history of COVID-19 vaccination and the presence of a BCG vaccination scar were protective in terms of disease severity.
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Affiliation(s)
- Davaasambuu Ganmaa
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Tserendorj Chinbayar
- National Center for Communicable Disease, Ulaanbaatar 13335, Mongolia; (T.C.); (G.S.)
| | | | | | - Sukhbaatar Ariunbuyan
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Graduate School of Dentistry, Tohoku University, Sendai 980-8575, Japan;
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, Sendai 980-8575, Japan
- Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, Sendai 980-8575, Japan
| | | | - Ganbold Sarangua
- National Center for Communicable Disease, Ulaanbaatar 13335, Mongolia; (T.C.); (G.S.)
| | - Andrew Chan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Dalkh Tserendagva
- International School of Mongolian Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia;
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Carreto-Binaghi LE, Sartillo-Mendoza LG, Muñoz-Torrico M, Guzmán-Beltrán S, Carranza C, Torres M, González Y, Juárez E. Serum pro-inflammatory biomarkers associated with improvement in quality of life in pulmonary tuberculosis. Front Immunol 2023; 14:1241121. [PMID: 37753080 PMCID: PMC10518397 DOI: 10.3389/fimmu.2023.1241121] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Pulmonary dysfunction is an underestimated complication in tuberculosis (TB) infection, affecting quality of life (QoL). Although respiratory function tests objectively reflect lung disturbances in a specific moment, predictors of illness severity at the time of diagnosis are still lacking. Methods We measured serum pro-inflammatory cytokines (TNF-α and IL-8), eicosanoids (PGE2, LTB4, RvD1, Mar1, and LXA4), a marker of tissue damage (cell-free nucleosomes), and indicators of redox status (malonaldehyde, 8-isoprostane, total oxidants, and antioxidants), as well as a score of radiological abnormalities (SRA) and a QoL questionnaire, in 25 patients with pulmonary TB at the time of diagnosis (t0) and two months after the initiation of treatment (t2). Results We found higher antioxidant levels in the patients with the worst QoL at t0, and all the indicators of the prooxidant state were significantly reduced at t2, while the total antioxidant levels increased. LTB4, a pro-inflammatory eicosanoid, was diminished at t2, while all the pro-resolutory lipids decreased substantially. Significant correlations between the SRA and the QoL scores were observed, the latter showing a substantial reduction at t2, ranking it as a reliable tool for monitoring disease evolution during TB treatment. Discussion These results suggest that evaluating a combination of these markers might be a valuable predictor of QoL improvement and a treatment response indicator; in particular, the oxidation metabolites and eicosanoid ratios could also be proposed as a future target for adjuvant therapies to reduce inflammation-associated lung injury in TB disease.
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Affiliation(s)
- Laura E. Carreto-Binaghi
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Luis Gustavo Sartillo-Mendoza
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla (BUAP), Puebla, Mexico
- Becario de la Dirección General de Calidad y Educación en Salud, Secretaría de Salud, Mexico, Mexico
| | - Marcela Muñoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Silvia Guzmán-Beltrán
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Claudia Carranza
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Martha Torres
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Yolanda González
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Esmeralda Juárez
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
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Yan M, Campbell JR, Marras TK, Brode SK. Tests cutanés à la tuberculine et tests de libération de l’interféron γ pour le diagnostic de l’infection tuberculeuse. CMAJ 2023; 195:E1196-E1197. [PMID: 37696555 PMCID: PMC10495176 DOI: 10.1503/cmaj.221570-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Affiliation(s)
- Marie Yan
- Département de médecine (Yan, Marras, Brode), Université de Toronto, Toronto, Ont.; Programme de cliniciens-chercheurs (Yan), Université de la Colombie-Britannique, Vancouver, C.-B.; Départements de médecine et de santé des populations et de santé mondiale (Campbell), Faculté de médecine et des sciences de la santé, Université McGill; Centre international de TB de McGill (Campbell), Montréal, Qc; Division de pneumologie (Marras, Brode), Réseau universitaire de santé, Toronto, Ont.; Division de pneumologie (Brode), Centre de santé West Park, Toronto, Ont
| | - Jonathon R Campbell
- Département de médecine (Yan, Marras, Brode), Université de Toronto, Toronto, Ont.; Programme de cliniciens-chercheurs (Yan), Université de la Colombie-Britannique, Vancouver, C.-B.; Départements de médecine et de santé des populations et de santé mondiale (Campbell), Faculté de médecine et des sciences de la santé, Université McGill; Centre international de TB de McGill (Campbell), Montréal, Qc; Division de pneumologie (Marras, Brode), Réseau universitaire de santé, Toronto, Ont.; Division de pneumologie (Brode), Centre de santé West Park, Toronto, Ont
| | - Theodore K Marras
- Département de médecine (Yan, Marras, Brode), Université de Toronto, Toronto, Ont.; Programme de cliniciens-chercheurs (Yan), Université de la Colombie-Britannique, Vancouver, C.-B.; Départements de médecine et de santé des populations et de santé mondiale (Campbell), Faculté de médecine et des sciences de la santé, Université McGill; Centre international de TB de McGill (Campbell), Montréal, Qc; Division de pneumologie (Marras, Brode), Réseau universitaire de santé, Toronto, Ont.; Division de pneumologie (Brode), Centre de santé West Park, Toronto, Ont
| | - Sarah K Brode
- Département de médecine (Yan, Marras, Brode), Université de Toronto, Toronto, Ont.; Programme de cliniciens-chercheurs (Yan), Université de la Colombie-Britannique, Vancouver, C.-B.; Départements de médecine et de santé des populations et de santé mondiale (Campbell), Faculté de médecine et des sciences de la santé, Université McGill; Centre international de TB de McGill (Campbell), Montréal, Qc; Division de pneumologie (Marras, Brode), Réseau universitaire de santé, Toronto, Ont.; Division de pneumologie (Brode), Centre de santé West Park, Toronto, Ont.
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Sibhat MM, Mulugeta TN, Aklilu DW. Incidence of switching to second-line antiretroviral therapy and its predictors among children on antiretroviral therapy at general hospitals, Northern Ethiopia: A survival analysis. PLoS One 2023; 18:e0288132. [PMID: 37683027 PMCID: PMC10490964 DOI: 10.1371/journal.pone.0288132] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 06/20/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND With expanding access to pediatric antiretroviral therapy, several patients in the developing world were switched to the second-line regimen, and some require third-line medications. A delay in a second-line switch is associated with an increased risk of mortality and other undesired therapeutic outcomes, drives up program costs, and challenges the pediatric antiretroviral therapy service. Nevertheless, there remain limited and often conflicting estimates on second-line antiretroviral therapy use during childhood, especially in resource-limited settings like Ethiopia. Thus, this study intended to determine the incidence and predictors of switching to second-line antiretroviral therapy among children. METHODS A retrospective cohort study was conducted by reviewing records of 424 randomly selected children on first-line antiretroviral therapy from January 2014 to December 2018 at public hospitals in the Central and Southern Zones of Tigray, Northern Ethiopia. Data were collected using extraction tool; entered into Epi-data; cleaned, and analyzed by STATA version-14. Kaplan-Meier curve, log-rank test, and life table were used for data description and adjusted hazard ratios and p-value for analysis by Cox proportional hazard regression. Variables at a P-value of ≤0.20 in the bi-variable analysis were taken to multivariable analysis. Finally, statistical significance was declared at a P-value of ≤0.05. RESULTS AND CONCLUSION Analysis was conducted on 424 charts with a total person-time observation of 11686.1 child-months and an incidence switch rate of 5.6 (95%CI: 4.36-7.09) per 1000 child-month-observations. Being orphan [AHR = 2.36; 95%CI: 1.10-5.07], suboptimal adherence [AHR = 2.10; 95% CI: 1.12-3.92], drug toxicity [AHR = 7.05; 95% CI: 3.61-13.75], advanced latest clinical stage [AHR = 2.75; 95%CI: 1.05-7.15], and tuberculosis co-infection at baseline [AHR = 3.08; 95%CI: 1.26-7.51] were significantly associated with switch to second-line antiretroviral therapy regimen. Moreover, a long duration of follow-up [AHR = 0.75; 95% CI: 0.71-0.81] was associated with decreased risk of switching. Hence, it is better to prioritize strengthening the focused evaluation of tuberculosis co-infection and treatment failure with continuous adherence monitoring. Further research is also needed to evaluate the effect of drug resistance.
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Li A, Bao J, Gao S, He Y, Nie X, Hosyanto FF, He X, Li T, Xu L. MicroRNA hsa-miR-320a-3p and Its Targeted mRNA FKBP5 Were Differentially Expressed in Patients with HIV/TB Co-Infection. ACS Infect Dis 2023; 9:1742-1753. [PMID: 37624586 DOI: 10.1021/acsinfecdis.3c00211] [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: 08/26/2023]
Abstract
Among the PLWH (people living with HIV) population, the risk of developing active tuberculosis (TB) is increasing. Active TB also accelerates the deterioration of PLWH's immune function and is one of the leading causes of death in the PLWH population. So far, accurate diagnosis of active TB in the PLWH population remains challenging. Through data analysis of HIV/TB co-infection in the GEO database, the differentially expressed genes as well as their related microRNA (miRNA) were acquired and were further verified through clinical blood samples. Dual-luciferase assay was used to verify the mechanism of miRNA on mRNA. The enrichment of immune cells in database patient samples was analyzed by bioinformatics and finally verified by blood routine data. Our study found that FKBP5 (FK506 binding protein 5) was highly expressed in the HIV/TB co-infection group; hsa-miR-320a-3p was highly expressed in the HIV infection group but decreased in the HIV/TB co-infection group. Dual-luciferase assay results showed that hsa-miR-320a-3p mimics significantly reduced the relative luciferase activity of the WT-FKBP5 group; however, this phenomenon was not observed in the MUT-FKBP5 group. At the same time, as a key molecule of the immune-related pathway, FKBP5 is highly correlated with the amount of neutrophils, which provides a new suggestion for the treatment of the HIV/TB co-infection population. Our study found that hsa-miR-320a-3p can decrease FKBP5 expression, suggesting a potential regulatory role for FKBP5. The involvement of FKBP5 and its related molecule hsa-miR-320a-3p in HIV/TB co-infection proposes them as potential biomarkers for the diagnosis of active TB in the PLWH population.
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Affiliation(s)
- Anlong Li
- Department of Pathogenic Biology, School of Basic Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Jiajia Bao
- Department of Pathogenic Biology, School of Basic Medicine, Chongqing Medical University, Chongqing 400016, China
- Hospital-Acquired Infection Control Department, First People's Hospital of Jintang County, Chengdu 610400, China
| | - Sijia Gao
- Department of Pathogenic Biology, School of Basic Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Ying He
- Central Laboratory, Chongqing Public Health Medical Center, Southwest University Public Health Hospital, Chongqing 400036, China
| | - Xiaoping Nie
- Central Laboratory, Chongqing Public Health Medical Center, Southwest University Public Health Hospital, Chongqing 400036, China
| | | | - Xintong He
- Department of Pathogenic Biology, School of Basic Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Tongxin Li
- Central Laboratory, Chongqing Public Health Medical Center, Southwest University Public Health Hospital, Chongqing 400036, China
| | - Lei Xu
- Department of Pathogenic Biology, School of Basic Medicine, Chongqing Medical University, Chongqing 400016, China
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Tilahun M, Wegayehu T, Wondale B, Gebresilase TT, Gebreyohannes T, Tekola A, Alemu M, Neway S, Adnew B, Nassir MF, Kassahun Y, Aseffa A, Bobosha K. Phenotypic and genotypic drug susceptibility patterns of Mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Central and Southern Ethiopia. PLoS One 2023; 18:e0285063. [PMID: 37682820 PMCID: PMC10491001 DOI: 10.1371/journal.pone.0285063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION The persistence of tuberculosis (TB) infection in some patients after treatment has highlighted the importance of drug susceptibility testing (DST). This study aimed to determine the drug susceptibility patterns of Mycobacterium tuberculosis (M. tuberculosis) isolates from pulmonary TB (PTB) patients in Central and Southern Ethiopia. METHODS A health institution-based cross-sectional study was conducted between July 2021 and April 2022. Sputum samples were collected from newly diagnosed smear microscopy and/or Xpert MTB/RIF-positive PTB patients. The samples were processed and cultivated in Lowenstein-Jensen (LJ) pyruvate and glycerol medium. M. tuberculosis isolates were identified using polymerase chain reaction (PCR) based region of difference 9 (RD9) deletion typing. Phenotypic DST patterns of the isolates were characterized using the BACTEC MGIT™ 960 instrument with SIRE kit. Isoniazid (INH) and Rifampicin (RIF) resistant M. tuberculosis isolates were identified using the GenoType® MTBDRplus assay. RESULTS Sputum samples were collected from 350 PTB patients, 315 (90%) of which were culture-positive, and phenotypic and genotypic DST were determined for 266 and 261 isolates, respectively. Due to invalid results and missing data, 6% (16/266) of the isolates were excluded, while 94% (250/266) were included in the paired analysis. According to the findings, 14.4% (36/250) of the isolates tested positive for resistance to at least one anti-TB drug. Gene mutations were observed only in the rpoB and katG gene loci, indicating RIF and high-level INH resistance. The GenoType® MTBDRplus assay has a sensitivity of 42% and a specificity of 100% in detecting INH-resistant M. tuberculosis isolates, with a kappa value of 0.56 (95%CI: 0.36-0.76) compared to the BACTEC MGIT™ DST. The overall discordance between the two methods was 5.6% (14/250) for INH alone and 0% for RIF resistance and MDR-TB (resistance to both INH and RIF) detection. CONCLUSION This study reveals a higher prevalence of phenotypic and genotypic discordant INH-resistant M. tuberculosis isolates in the study area. The use of whole-genome sequencing (WGS) is essential for gaining a comprehensive understanding of these discrepancies within INH-resistant M. tuberculosis strains.
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Affiliation(s)
- Melaku Tilahun
- Department of Biology, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Teklu Wegayehu
- Department of Biology, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Biniam Wondale
- Department of Biology, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia
| | | | | | - Abraham Tekola
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Mekdes Alemu
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Sebsib Neway
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Bethlehem Adnew
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | - Yonas Kassahun
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Kidist Bobosha
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
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Dhhar G, McColl J, Kitai I, Levy DM, Verstegen RHJ. Rifampin-induced flu-like syndrome with shock in a patient with tuberculosis infection. CMAJ 2023; 195:E1151-E1153. [PMID: 37669793 PMCID: PMC10480000 DOI: 10.1503/cmaj.230317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Affiliation(s)
- Gousia Dhhar
- Division of General Internal Medicine (Dhhar), and of Clinical Pharmacology and Toxicology, Department of Medicine (Dhhar), University of Toronto, Toronto, Ont.; Department of Pediatrics (McColl), and Division of Rheumatology (McColl), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Kitai, Levy, Verstegen), and Division of Infectious Disease, Department of Paediatrics (Kitai), University of Toronto; Division of Rheumatology (Levy, Verstegen), and of Clinical Pharmacology & Toxicology, Department of Paediatrics (Verstegen), The Hospital for Sick Children, Toronto, Ont
| | - Jeanine McColl
- Division of General Internal Medicine (Dhhar), and of Clinical Pharmacology and Toxicology, Department of Medicine (Dhhar), University of Toronto, Toronto, Ont.; Department of Pediatrics (McColl), and Division of Rheumatology (McColl), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Kitai, Levy, Verstegen), and Division of Infectious Disease, Department of Paediatrics (Kitai), University of Toronto; Division of Rheumatology (Levy, Verstegen), and of Clinical Pharmacology & Toxicology, Department of Paediatrics (Verstegen), The Hospital for Sick Children, Toronto, Ont
| | - Ian Kitai
- Division of General Internal Medicine (Dhhar), and of Clinical Pharmacology and Toxicology, Department of Medicine (Dhhar), University of Toronto, Toronto, Ont.; Department of Pediatrics (McColl), and Division of Rheumatology (McColl), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Kitai, Levy, Verstegen), and Division of Infectious Disease, Department of Paediatrics (Kitai), University of Toronto; Division of Rheumatology (Levy, Verstegen), and of Clinical Pharmacology & Toxicology, Department of Paediatrics (Verstegen), The Hospital for Sick Children, Toronto, Ont
| | - Deborah M Levy
- Division of General Internal Medicine (Dhhar), and of Clinical Pharmacology and Toxicology, Department of Medicine (Dhhar), University of Toronto, Toronto, Ont.; Department of Pediatrics (McColl), and Division of Rheumatology (McColl), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Kitai, Levy, Verstegen), and Division of Infectious Disease, Department of Paediatrics (Kitai), University of Toronto; Division of Rheumatology (Levy, Verstegen), and of Clinical Pharmacology & Toxicology, Department of Paediatrics (Verstegen), The Hospital for Sick Children, Toronto, Ont
| | - Ruud H J Verstegen
- Division of General Internal Medicine (Dhhar), and of Clinical Pharmacology and Toxicology, Department of Medicine (Dhhar), University of Toronto, Toronto, Ont.; Department of Pediatrics (McColl), and Division of Rheumatology (McColl), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Kitai, Levy, Verstegen), and Division of Infectious Disease, Department of Paediatrics (Kitai), University of Toronto; Division of Rheumatology (Levy, Verstegen), and of Clinical Pharmacology & Toxicology, Department of Paediatrics (Verstegen), The Hospital for Sick Children, Toronto, Ont.
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Sheng Y, Hua H, Yong Y, Zhou L. Identification of Hub Genes and Typing of Tuberculosis Infections Based on Autophagy-Related Genes. Pol J Microbiol 2023; 72:223-238. [PMID: 37725899 PMCID: PMC10561080 DOI: 10.33073/pjm-2023-022] [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: 12/15/2022] [Accepted: 04/19/2023] [Indexed: 09/21/2023] Open
Abstract
Tuberculosis (TB) caused by Mycobacterium tuberculosis is one of the leading causes of morbidity and death in humans worldwide. Some autophagy genes associated with TB and some miRNAs regulating TB have been found, but the identification of autophagy-related genes in M. tuberculosis remains to be explored. Forty-seven autophagy-related genes differentially expressed in TB were identified in this study by analysis of TB-related datasets in the Gene Expression Omnibus (GEO) and autophagy-related genes in the Human Autophagy Database. The potential crucial genes affecting TB were found through the protein-protein interaction (PPI) network, and the possible pathways affected by these genes were verified. Analysis of the PPI network of miRNAs associated with M. tuberculosis infection and their target genes revealed that hsa-let-7, hsa-mir-155, hsa-mir-206, hsa-mir-26a, hsa-mir-30a, and hsa-mir-32 may regulate the expression of multiple autophagy-related genes (MAPK8, UVRAG, UKL2, and GABARAPL1) alone or in combination. Subsequently, Cytoscape was utilized to screen the differentially expressed genes related to autophagy. The hub genes (GABARAPL1 and ULK2) affecting TB were identified. Combined with Gene Set Enrichment Analysis (GSEA), the signaling pathways affected by the hub genes were verified. Finally, we divided TB patients into two subgroups based on autophagy-related genes, and the immune microenvironment of patients in different subgroups was significantly different. Our study found two autophagy-related hub genes that could affect TB and divide TB samples into two subgroups. This finding is of great significance for TB treatment and provides new ideas for exploring the pathogenesis of M. tuberculosis.
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Affiliation(s)
- Yunfeng Sheng
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haibo Hua
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Yong
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lihong Zhou
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Kim JW, Munavvar R, Kamil A, Haldar P. PET-CT for characterising TB infection (TBI) in immunocompetent subjects: a systematic review. J Med Microbiol 2023; 72. [PMID: 37750439 DOI: 10.1099/jmm.0.001749] [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: 09/27/2023] Open
Abstract
Introduction. There is emerging evidence of a potential role for PET-CT scan as an imaging biomarker to characterise the spectrum of tuberculosis infection (TBI) in humans and animal models.Gap Statement. Synthesis of available evidence from current literature is needed to understand the utility of PET-CT for characterising TBI and how this may inform application of PET-CT in future TBI research.Aim. The aims of this review are to summarise the evidence of PET-CT scan use in immunocompetent hosts with TBI, and compare PET-CT features observed in humans and animal models.Methodology. MEDLINE, Embase and PubMed Central were searched to identify relevant publications. Studies were selected if they reported PET-CT features in human or animals with TBI. Studies were excluded if immune deficiency was present at the time of the initial PET-CT scan.Results. Six studies - four in humans and two in non-human primates (NHP) were included for analysis. All six studies used 2-deoxy-2-[18F]fluoro-d-glucose (2-[18F]FDG) PET-CT. Features of TBI were comparable between NHP and humans, with 2-[18F]FDG avid intrathoracic lymph nodes observed during early infection. Progressive TBI was characterised in NHP by increasing 2-[18F]FDG avidity and size of lesions. Two human studies suggested that PET-CT can discriminate between active TB and inactive TBI. However, data synthesis was generally limited by human studies including inconsistent and poorly characterised cohorts and the small number of eligible studies for review.Conclusion. Our review provides some evidence, limited primarily to non-human primate models, of PET-CT utility as a highly sensitive imaging modality to reveal and characterise meaningful metabolic and structural change in early TBI. The few human studies identified exhibit considerable heterogeneity. Larger prospective studies are needed recruiting well characterised cohorts with TBI and adopting a standardized PET-CT protocol, to better understand utility of this imaging biomarker to support future research.
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Affiliation(s)
- Jee Whang Kim
- Department of Respiratory Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Anver Kamil
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pranabashis Haldar
- Department of Respiratory Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
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