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Medrano BA, Lee M, Gemeinhardt G, Rodríguez-Herrera JE, García-Viveros M, Restrepo BI. Tuberculosis presentation and outcomes in older Hispanic adults from Tamaulipas, Mexico. Medicine (Baltimore) 2023; 102:e35458. [PMID: 37832052 PMCID: PMC10578661 DOI: 10.1097/md.0000000000035458] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/12/2023] [Indexed: 10/15/2023] Open
Abstract
Older people are at high risk of developing and dying from pulmonary infections like tuberculosis (TB), but there are few studies among them, particularly in Hispanics. To address these gaps, we sought to identify host factors associated with TB and adverse treatment outcomes in older Hispanics by conducting a cross-sectional study of TB surveillance data from Tamaulipas, Mexico (2006-2013; n = 8381). Multivariable logistic regressions were assessed for older adults (OA ≥65 years) when compared to young (YA, 18-39 years) and middle-aged adults (40-64 years). We found that the OA had features associated with a less complicated TB (e.g., lower prevalence of extra-pulmonary TB and less likely to abandon treatment or have drug resistant TB), and yet, were more likely to die during TB treatment (adj-OR 3.9, 95% 2.5, 5.25). Among the OA, excess alcohol use and low body mass index increased their odds of death during TB treatment, while a higher number of reported contacts (social support) was protective. Diabetes was not associated with adverse outcomes in OA. Although older age is a predictor of death during TB disease, OA are not prioritized by the World Health Organization for latent TB infection screening and treatment during contact investigations. With safer, short-course latent TB infection treatment available, we propose the inclusion of OA as a high-risk group in latent TB management guidelines.
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Affiliation(s)
- Belinda A. Medrano
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Brownsville campus, Brownsville, TX, USA
| | - Miryoung Lee
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Brownsville campus, Brownsville, TX, USA
| | - Gretchen Gemeinhardt
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | | | - Blanca I. Restrepo
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Brownsville campus, Brownsville, TX, USA
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
- School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, USA
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Hur YG, Hong JY, Choi DH, Kim A, Park SY, Kwon M, Kang K, Lee JM, Dockrell HM, Lee Y, Joo H, Cho SN. A Feasibility Study for Diagnosis of Latent Tuberculosis Infection Using an IGRA Point-of-Care Platform in South Korea. Yonsei Med J 2019; 60:375-380. [PMID: 30900424 PMCID: PMC6433574 DOI: 10.3349/ymj.2019.60.4.375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/18/2019] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE This study aimed to evaluate ichroma™ IGRA-TB, a novel point-of-care platform for assaying IFN-γ release, and to compare it with QuantiFERON-TB Gold In-Tube (QFT-GIT) for identifying Mycobacterium tuberculosis (M. tb) infection. MATERIALS AND METHODS We recruited 60 healthy subjects, and blood samples were obtained in QFT-GIT blood collection tubes. The blood collection tubes were incubated at 37°C, and culture supernatant was harvested after 18-24 hours. IFN-γ responses were assessed by the ichroma™ IGRA-TB cartridge and the QFT-GIT IFN-γ enzyme-linked immunosorbent assay. Three active TB patients were recruited as a positive control for M. tb infection. RESULTS The area under the receiver operating characteristic curve of the ichroma™ IGRA-TB test for differentiating between infected and non-infected individuals was 0.9706 (p<0.001). Inconsistent positivity between the two tests was found in three participants who showed weak positive IFN-γ responses (<1.0 IU/mL) with QFT-GIT. However, the two tests had excellent agreement (95.2%, κ=0.91, p<0.001), and a very strong positive correlation was observed between the IFN-γ values of both tests (r=0.91, p<0.001). CONCLUSION The diagnostic accuracy demonstrated in this study indicates that the ichroma™ IGRA-TB test could be used as a rapid diagnostic method for detecting latent TB infection. It may be particularly beneficial in resource-limited places that require cost-effective laboratory diagnostics.
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Affiliation(s)
- Yun Gyoung Hur
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea.
| | - Ji Young Hong
- Department of Pulmonary and Critical Care Medicine, Hallym University Medical Center, Chuncheon, Korea
| | | | - Ahreum Kim
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - So Yeong Park
- Department of Pulmonary and Critical Care Medicine, Hallym University Medical Center, Chuncheon, Korea
| | | | | | | | - Hazel M Dockrell
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Sang Nae Cho
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
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Abstract
SETTING In the United States, tuberculosis (TB) control is increasingly focusing on the identification of persons with latent tuberculous infection (LTBI). OBJECTIVE To characterize the local epidemiology of LTBI in Connecticut, USA. METHODS We used spatial analyses 1) to identify census tract-level clusters of reported LTBI and TB disease in Connecticut, 2) to compare persons and populations in clusters with those not in clusters, and 3) to compare persons with LTBI to those with TB disease. RESULTS Significant census tract-level spatial clusters of LTBI and TB disease were identified. Compared with persons with LTBI in non-clustered census tracts, those in clustered census tracts were more likely to be foreign-born and less likely to be of white non-Hispanic ethnicity. Populations in census tract clusters of high LTBI prevalence had greater crowding, persons living in poverty, and persons lacking health care insurance than populations not in clustered census tracts. Persons with LTBI were less likely than those with TB disease to be of Asian ethnicity, and persons with LTBI were more likely than those with TB disease to reside in a clustered census tract. CONCLUSIONS Characterizing fine-scale populations at risk for LTBI supports effective and culturally accessible screening and treatment programs.
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Affiliation(s)
- J Mullins
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA; University of Saint Joseph, West Hartford, Connecticut, Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - M N Lobato
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA; University of Saint Joseph, West Hartford, Connecticut, Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - K Bemis
- Connecticut Department of Public Health, Hartford, Connecticut, USA; Cook County Department of Public Health, Forest Park, Illinois, USA
| | - L Sosa
- Connecticut Department of Public Health, Hartford, Connecticut, USA
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Duchen D, Boyd AT, Annamalai A. Screening and Treatment Rates for Latent Tuberculosis Among Newly-Arrived Refugees in an Urban Facility in Connecticut. Conn Med 2017; 81:291-298. [PMID: 29738131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is a high prevalence of latent tuberculosis infection (LTBI) and risk of reactivation among refugees. This study describes LTBI prevalence, treatment initiation, and completion rates in refugee patients seen at one urban Connecticut hospital. This retrospective chart review includes 248 adult refugee patients screened between January 2009 and April 2012. Demographics, tuberculin skin test (TST) results, treatment initiation and completion rates, and treatment-related variables were collected. Ninety-eight percent of adult refugees received TST screening and 44.0% were diagnosed with LTBI. Of these, 95.5% initiated treatment, and of those, 48.2% completed treatment. Early treatment discontinuation was high, with 29.5% of patients diagnosed with LTBI defaulting after the first clinic visit. Despite near-universal screening within this refugee population, LTBI treatment initiation and completion rates remain low. Greater efforts should be made to ensure LTBI treatment initiation and completion among refugees through early case management and shorter treatment duration.
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Taylor EM, Painter J, Posey DL, Zhou W, Shetty S. Latent Tuberculosis Infection Among Immigrant and Refugee Children Arriving in the United States: 2010. J Immigr Minor Health 2016; 18:966-970. [PMID: 26364054 PMCID: PMC6062848 DOI: 10.1007/s10903-015-0273-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Immigrants and refugees age 2-14 years entering the United States from countries with estimated tuberculosis (TB) incidence rate ≥20 per 100,000 population are screened for TB. Children with TB disease are treated before US arrival. Children with positive tuberculin skin tests (TST), but negative TB evaluation during their pre-immigration examination, are classified with latent TB infection (LTBI) and are recommended for re-evaluation post-arrival. We examined post-immigration TB evaluation and therapy for children arriving with LTBI. We reviewed medical exam data from immigrant children with medical conditions and all refugee children arriving during 2010. Medical examination data were available for 67,334 children. Of these, 8231 (12 %) had LTBI pre-immigration; 5749 (70 %) were re-evaluated for TB post-immigration, and 64 % were retested by TST or IGRA. The pre-immigration LTBI diagnosis was changed for 38 % when retested by TST and for 71 % retested by IGRA. Estimated LTBI therapy initiation and completion rates were 68 and 12 %. In this population, testing with IGRA may limit the number of children targeted for therapy. Increased pre-immigration TB screening with post-immigration follow-up evaluation leading to completion of LTBI therapy should be encouraged to prevent TB reactivation.
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Affiliation(s)
- Eboni M Taylor
- Division of Global Migration and Quarantine, National Center of Emerging Zoonotic and Infectious Diseases, United States Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-04, Atlanta, GA, 30333, USA.
- United States Public Health Service Commissioned Corps, Washington, DC, USA.
| | - John Painter
- Division of Global Migration and Quarantine, National Center of Emerging Zoonotic and Infectious Diseases, United States Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-04, Atlanta, GA, 30333, USA
- United States Public Health Service Commissioned Corps, Washington, DC, USA
| | - Drew L Posey
- Division of Global Migration and Quarantine, National Center of Emerging Zoonotic and Infectious Diseases, United States Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-04, Atlanta, GA, 30333, USA
- United States Public Health Service Commissioned Corps, Washington, DC, USA
| | - Weigong Zhou
- Division of Global Migration and Quarantine, National Center of Emerging Zoonotic and Infectious Diseases, United States Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-04, Atlanta, GA, 30333, USA
- United States Public Health Service Commissioned Corps, Washington, DC, USA
| | - Sharmila Shetty
- Division of Global Migration and Quarantine, National Center of Emerging Zoonotic and Infectious Diseases, United States Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-04, Atlanta, GA, 30333, USA
- United States Public Health Service Commissioned Corps, Washington, DC, USA
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Bai XJ, Liang Y, Yang YR, Feng JD, Luo ZP, Zhang JX, Wu XQ. Potential novel markers to discriminate between active and latent tuberculosis infection in Chinese individuals. Comp Immunol Microbiol Infect Dis 2015; 44:8-13. [PMID: 26851588 DOI: 10.1016/j.cimid.2015.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 01/09/2023]
Abstract
Latent tuberculosis infection (LTBI) constitutes the main reservoir for reactivation tuberculosis. The finding of potential biomarkers for differentiating between TB and LTBI is very necessary. In this study, the immunological characteristics and potential diagnostic utility of Rv2029c, Rv2628 and Rv1813c proteins were assessed. These three proteins stimulated PBMCs from ELISPOT-positive LTBI subjects produced higher levels of IFN-γ in comparison with TB patients and ELISPOT-negative healthy subjects (p<0.05). BCG vaccination and non-TB respiratory disease had little influence on the immunological responses of Rv2029c and Rv2628 proteins (p>0.05). The LTBI diagnostic performance of Rv2029c was higher than Rv2628 and Rv1813c by ROC evaluation. But Rv2628 had much higher specificity than Rv2029c in active TB patients and uninfected healthy subjects. The IgG level against Rv1813c was higher in the TB group than in LTBI and uninfected healthy subjects (p<0.05). These results suggest that T cell response to Rv2628 and antibody against Rv1813c might be applicable as biomarkers to distinguish TB from LTBI and uninfected individuals.
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Affiliation(s)
- Xue-juan Bai
- Army Tuberculosis Prevention and Control Key Laboratory, Beijng Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute for Tuberculosis Research, The 309th Hospital of Chinese PLA, Beijing 100091, PR China; Department of Pathology, The 309th Hospital of Chinese PLA, Beijing 100091, PR China
| | - Yan Liang
- Army Tuberculosis Prevention and Control Key Laboratory, Beijng Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute for Tuberculosis Research, The 309th Hospital of Chinese PLA, Beijing 100091, PR China
| | - You-rong Yang
- Army Tuberculosis Prevention and Control Key Laboratory, Beijng Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute for Tuberculosis Research, The 309th Hospital of Chinese PLA, Beijing 100091, PR China
| | - Jin-dong Feng
- Department of Respiratory, The 309th Hospital of Chinese PLA, Beijing 100091, PR China
| | - Zhan-peng Luo
- Department of Orthopedics, The 309th Hospital of Chinese PLA, Beijing 100091, PR China
| | - Jun-Xian Zhang
- Army Tuberculosis Prevention and Control Key Laboratory, Beijng Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute for Tuberculosis Research, The 309th Hospital of Chinese PLA, Beijing 100091, PR China
| | - Xue-qiong Wu
- Army Tuberculosis Prevention and Control Key Laboratory, Beijng Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute for Tuberculosis Research, The 309th Hospital of Chinese PLA, Beijing 100091, PR China.
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Bapat PR, Husain AA, Daginawala HF, Agrawal NP, Panchbhai MS, Satav AR, Taori GM, Kashyap RS. The assessment of cytokines in Quantiferon supernatants for the diagnosis of latent TB infection in a tribal population of Melghat, India. J Infect Public Health 2015; 8:329-40. [PMID: 25824629 DOI: 10.1016/j.jiph.2015.02.003] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/04/2015] [Accepted: 02/13/2015] [Indexed: 11/19/2022] Open
Abstract
The tuberculin skin test (TST) and interferon-gamma release assays (IGRA), namely, the QuantiFERON-TB Gold test (QFT), remain the standard immunological diagnostic tools for latent tuberculosis (TB) infection (LTBI). However, the sub-optimal detection rates of both of these tests are major impediments in recognizing the population at risk. This study was aimed at evaluating additional cytokines besides interferon-gamma (IFN-γ) as biomarkers for improving LTBI diagnosis in the tribal population of Melghat, India. Seventy-four close TB contacts were stratified by QFT and TST results into: (i) QFT+/TST+ (n = 26), (ii) QFT+/TST- (n = 12), (iii) QFT-/TST- (n = 35) and (iv) QFT-/TST+ (n = 1) groups. A panel of cytokines (IL-6, IL-10, TNF-α and IL-2R) was then evaluated in antigen-stimulated QFT cell-free culture supernatants using IMMULITE-1000, an automated immunoassay analyzer. Cytokine estimation showed significantly higher levels of IL-6 in the QFT+/TST+ group, while significantly higher levels of IL-10 were found in the QFT-/TST- group. Correlation analysis identified a positive correlation between IL-6 and the QFT response (r = 0.6723, P < 0.0001), while a negative correlation was seen between QFT and IL-10 expression (r = -0.3271, P = 0.0044). Similarly, IL-6 was positively correlated with TST levels (r = 0.6631, P <0 .0001), and conversely, a negative correlation was found between TST and IL-10 expression (r = -0.5698, P < 0.0001). The positive and negative predictive values of IL-6 were found to be 92.59 and 93.33%, respectively, and the positive and negative predictive values of IL-10 were 96.55 and 91.18%, respectively. No significant impact of the demographic characteristics on cytokine positivity was observed. Our preliminary results suggest that the evaluation of additional cytokines in QFT cell-free culture supernatants may be valuable for the identification of LTBI. Combining IL-6 and IL-10 with QFT and/or TST could markedly improve the detection accuracy of LTBI. Our observations require investigation in larger well-characterized cohorts along with follow-up studies to further confirm the study outcome.
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Affiliation(s)
- Prachi R Bapat
- Research Centre, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Aliabbas A Husain
- Research Centre, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Hatim F Daginawala
- Research Centre, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Neha P Agrawal
- Research Centre, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Milind S Panchbhai
- Research Centre, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Ashish R Satav
- Meditation, AIDS, Health, Addiction & Nutrition (MAHAN) Trust, C/O Mahatma Gandhi Tribal Hospital, Karmagram, Utavali, Tahsil Dharni, Amravati, Maharashtra, India
| | - Girdhar M Taori
- Research Centre, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Rajpal S Kashyap
- Research Centre, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India.
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Maynard-Smith L, Fernando B, Hopkins S, Harber M, Lipman M. Managing latent tuberculosis in UK renal transplant units: how does practice compare with published guidance? Clin Med (Lond) 2014; 14:26-9. [PMID: 24532739 PMCID: PMC5873613 DOI: 10.7861/clinmedicine.14-1-26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Renal transplantation significantly increases the risk of active tuberculosis (TB) in individuals with latent TB infection (LTBI). UK transplant recipients are often born in TB endemic areas. Using a self-completed questionnaire, we evaluated how the 23 UK renal transplant units' LTBI management compared with recently published national guidance. Three-quarters had a management protocol, but only one-third of these were in line with the guidance. Interferon-gamma release assays were rarely used to confirm LTBI. Almost half of the units prescribed LTBI treatment at the wrong dose or duration. We conclude that units should develop local protocols in line with evidence-based guidance. This must be in a format that enables national audit programmes and quality improvement to be routinely performed.
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Affiliation(s)
- L Maynard-Smith
- Centre for Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - B Fernando
- Renal Transplant Unit, Royal Free London NHS Foundation Trust, London, UK
| | - S Hopkins
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - M Harber
- Renal Transplant Unit, Royal Free London NHS Foundation Trust, London, UK
| | - M Lipman
- Centre for Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
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Alsterlund R, Nived P. [Unexpectedly few findings of tuberculosis in foreign-born pregnant women. Results of screening in northeastern Skåne]. Lakartidningen 2013; 110:2112-2114. [PMID: 24437100] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Hirsch-Moverman Y, Colson PW, Bethel J, Franks J, El-Sadr WM. Can a peer-based intervention impact adherence to the treatment of latent tuberculous infection? Int J Tuberc Lung Dis 2013; 17:1178-85. [PMID: 23928167 PMCID: PMC4477799 DOI: 10.5588/ijtld.12.0823] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of a peer-based intervention on adherence to and completion of latent tuberculous infection (LTBI) treatment. METHODS Patients prescribed self-administered LTBI treatment were enrolled in a randomized controlled trial of an experimental, peer-based adherence support intervention. Primary outcomes were treatment adherence and completion. Adherence was assessed through self-report, electronic monitoring devices and clinic visits. RESULTS Of 250 participants, 70% were male; 71% were Black and 20% Latino; the mean age was 40 years; 67% were foreign-born and 39% were married. No significant baseline differences were noted between the intervention groups. Treatment completion was 61% in the intervention group compared to 57% in the controls (P = 0.482). The corresponding completion rate for other clinic patients was 44%. Foreign birth, marriage and history of mental illness were associated with non-completion of treatment after controlling for the intervention group; increased completion rates were found among foreign-born married persons and older participants. A substantial difference in adherence rates was observed between the intervention groups. Adherence among non-completers decreased early, while adherence among completers remained constant. CONCLUSIONS The peer-based intervention was not significantly associated with LTBI treatment completion, but was associated with greater adherence. Findings suggest the importance of interventions to support adherence that target early non-adherence with LTBI treatment, particularly in the first 2 months, when there is a substantial risk of default.
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Braun K, Larcombe L, Orr P, Nickerson P, Wolfe J, Sharma M. Killer immunoglobulin-like receptor (KIR) centromeric-AA haplotype is associated with ethnicity and tuberculosis disease in a Canadian First Nations cohort. PLoS One 2013; 8:e67842. [PMID: 23861818 PMCID: PMC3701593 DOI: 10.1371/journal.pone.0067842] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/21/2013] [Indexed: 01/12/2023] Open
Abstract
Killer immunoglobulin-like receptors (KIR) on natural killer (NK) cells interact with other immune cells to monitor the immune system and combat infectious diseases, such as tuberculosis (TB). The balance of activating and inhibiting KIR interactions helps determine the NK cell response. In order to examine the enrichment or depletion of KIRs as well as to explore the association between TB status and inhibitory/stimulatory KIR haplotypes, we performed KIR genotyping on samples from 93 Canadian First Nations (Dene, Cree, and Ojibwa) individuals from Manitoba with active, latent, or no TB infection, and 75 uninfected Caucasian controls. There were significant differences in KIR genes between Caucasians and First Nations samples and also between the First Nations ethnocultural groups (Dene, Cree, and Ojibwa). When analyzing ethnicity and tuberculosis status in the study population, it appears that the KIR profile and centromeric haplotype are more predictive than the presence or absence of individual genes. Specifically, the decreased presence of haplotype B centromeric genes and increased presence of centromeric-AA haplotypes in First Nations may contribute to an inhibitory immune profile, explaining the high rates of TB in this population.
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MESH Headings
- Adolescent
- Adult
- Aged
- Centromere
- Cohort Studies
- Female
- Gene Frequency
- Genetic Predisposition to Disease
- Haplotypes
- Humans
- Indians, North American
- Inuit
- Killer Cells, Natural/immunology
- Killer Cells, Natural/microbiology
- Latent Tuberculosis/ethnology
- Latent Tuberculosis/genetics
- Latent Tuberculosis/immunology
- Latent Tuberculosis/microbiology
- Linkage Disequilibrium
- Male
- Manitoba/epidemiology
- Middle Aged
- Receptors, KIR/classification
- Receptors, KIR/genetics
- Receptors, KIR/immunology
- Telomere
- Tuberculosis, Pulmonary/ethnology
- Tuberculosis, Pulmonary/genetics
- Tuberculosis, Pulmonary/immunology
- Tuberculosis, Pulmonary/microbiology
- White People
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Affiliation(s)
- Kali Braun
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Linda Larcombe
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pamela Orr
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter Nickerson
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joyce Wolfe
- National Reference Centre for Mycobacteriology, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Meenu Sharma
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
- National Reference Centre for Mycobacteriology, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- * E-mail:
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Horne DJ, Campo M, Ortiz JR, Oren E, Arentz M, Crothers K, Narita M. Association between smoking and latent tuberculosis in the U.S. population: an analysis of the National Health and Nutrition Examination Survey. PLoS One 2012; 7:e49050. [PMID: 23145066 PMCID: PMC3493513 DOI: 10.1371/journal.pone.0049050] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 10/03/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evidence of an association between cigarette smoking and latent tuberculosis infection (LTBI) is based on studies in special populations and/or from high prevalence settings. We sought to evaluate the association between LTBI and smoking in a low prevalence TB setting using population-based data from the National Health and Nutrition Examination Survey (NHANES). METHODS In 1999-2000, NHANES assessed LTBI (defined as a tuberculin skin test measurement ≥10 mm) in participants, and those ≥20 years of age were queried regarding their tobacco use and serum cotinine was measured. We evaluated the association of LTBI with self-reported smoking history and smoking intensity in multivariable logistic regression models that adjusted for known confounders (gender, age, birthplace, race/ethnicity, poverty, education, history of BCG vaccination, and history of household exposure to tuberculosis disease). RESULTS Estimated LTBI prevalence was 5.3% among those ≥20 years of age. The LTBI prevalence among never smokers, current smokers, and former smokers was 4.1%, 6.6%, and 6.2%, respectively. In a multivariable model, current smoking was associated with LTBI (OR 1.8; 95% CI, 1.1-2.9). The association between smoking and LTBI was strongest for Mexican-American and black individuals. In multivariate analysis stratified by race/ethnicity, cigarette packs per day among Mexican-American smokers and cotinine levels among black smokers, were significantly associated with LTBI. CONCLUSIONS In the large, representative, population-based NHANES sample, smoking was independently associated with significantly increased risks of LTBI. In certain populations, a greater risk of LTBI corresponded with increased smoking exposure.
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Affiliation(s)
- David J Horne
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
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Cowan J, Pandey S, Filion LG, Angel JB, Kumar A, Cameron DW. Comparison of interferon-γ-, interleukin (IL)-17- and IL-22-expressing CD4 T cells, IL-22-expressing granulocytes and proinflammatory cytokines during latent and active tuberculosis infection. Clin Exp Immunol 2012; 167:317-29. [PMID: 22236009 PMCID: PMC3278699 DOI: 10.1111/j.1365-2249.2011.04520.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [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] [Accepted: 11/03/2011] [Indexed: 01/17/2023] Open
Abstract
In this study, we investigated the role and expression of T helper type 17 (Th17) cells and Th17 cytokines in human tuberculosis. We show that the basal proportion of interferon (IFN)-γ-, interleukin (IL)-17- and IL-22-expressing CD4(+) T cells and IL-22-expressing granulocytes in peripheral blood were significantly lower in latently infected healthy individuals and active tuberculosis patients compared to healthy controls. In contrast, CD4(+) T cells expressing IL-17, IL-22 and IFN-γ were increased significantly following mycobacterial antigens stimulation in both latent and actively infected patients. Interestingly, proinflammatory IFN-γ and tumour necrosis factor (TNF)-α were increased following antigen stimulation in latent infection. Similarly, IL-1β, IL-4, IL-8, IL-22 and TNF-α were increased in the serum of latently infected individuals, whereas IL-6 and TNF-α were increased significantly in actively infected patients. Overall, we observed differential induction of IL-17-, IL-22- and IFN-γ-expressing CD4(+) T cells, IL-22-expressing granulocytes and proinflammatory cytokines in circulation and following antigenic stimulation in latent and active tuberculosis.
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Affiliation(s)
- J Cowan
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Mahan CS, Johnson DF, Curley C, van der Kuyp F. Concordance of a positive tuberculin skin test and an interferon gamma release assay in bacille Calmette-Guérin vaccinated persons. Int J Tuberc Lung Dis 2011; 15:174-i. [PMID: 21219677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND False-positive tuberculin skin test (TST) results due to prior bacille Calmette-Guérin (BCG) vaccination may lead to unnecessary treatment of presumed latent tuberculosis infection (LTBI). Recently approved interferon-gamma release assays (IGRAs) are more specific for LTBI in this group. METHODS A total of 316 BCG-vaccinated foreign-born individuals with a positive TST had a commercially available IGRA (QuantiFERON®-TB Gold In-Tube) performed as part of a two-step procedure to determine the need for isoniazid therapy. Baseline demographic information and TST size were recorded and analyzed for characteristics associated with an increased likelihood of having a positive IGRA. RESULTS Increasing age, male sex, origin from a country with a high prevalence of tuberculosis (TB), shorter time since arrival in the United States, and increasing TST size were all independently associated with a positive IGRA. CONCLUSION Patient characteristics and TST size can help determine those at highest risk for LTBI. A two-step procedure for LTBI screening should be considered for foreign-born persons with prior BCG vaccination and a positive TST.
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Affiliation(s)
- C S Mahan
- Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio 44109, USA.
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Alvarez GG, Clark M, Altpeter E, Douglas P, Jones J, Paty MC, Posey DL, Chemtob D. Pediatric tuberculosis immigration screening in high-immigration, low-incidence countries. Int J Tuberc Lung Dis 2010; 14:1530-1537. [PMID: 21144237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) screening in migrant children, including immigrants, refugees and asylum seekers, is an ongoing challenge in low TB incidence countries. Many children from high TB incidence countries harbor latent TB infection (LTBI), and some have active TB disease at the point of immigration into host nations. Young children who harbor LTBI have a high risk of progression to TB disease and are at a higher risk than adults of developing disseminated severe forms of TB with significant morbidity and mortality. Many countries have developed immigration TB screening programs to suit the needs of adults, but have not focused much attention on migrant children. OBJECTIVE To compare the TB immigration medical examination requirements in children in selected countries with high immigration and low TB incidence rates. DESIGN Descriptive study of TB immigration screening programs for systematically selected countries. RESULTS Of 18 eligible countries, 16 responded to the written survey and telephone interview. CONCLUSION No two countries had the same approach to TB screening among migrant children. The optimal evidenced-based manner in which to screen migrant children requires further research.
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Affiliation(s)
- G G Alvarez
- Division of Respirology, The Ottawa Hospital Research Institute, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada.
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