[Tuberculosis among Ukrainian Refugees in Germany - A Comparison of Screening and Reporting Data]. / Tuberkulose bei ukrainischen Geflüchteten in Deutschland ­ ein Vergleich von Screening- und Meldedaten.

Since the onset of the war in Ukraine until November 2022, nearly 1 million people sought refuge in Germany. Despite efforts to reduce tuberculosis (TB) cases, Ukraine had a high TB incidence in 2020, with increased rates of multidrug-resistant TB. Conflict and war have historically been associated with TB spread due to delays in diagnosis, treatment interruptions, and increased transmission risks. The World Health Organization (WHO) estimated a rise in TB cases in the EU region due to refugee movements. In Germany, screening methods used in testing individuals in communal housing involving chest X-rays or immunological tests were variable. A survey conducted by the DZK within the nationwide TB working group evaluated TB screening methods and results for Ukrainian refugees. Out of 26,196 individuals aged over 15, 48 TB cases were detected, with a higher-than-expected incidence. About 42% of cases were multidrug-resistant TB. The screening findings differed from both the WHO's estimates as well as TB cases reported to the Robert Koch Institut (RKI) in 2022. A preliminary comparison of the numbers is presented here. The differing results emphasize the need for ongoing data collection and analysis to adapt resources and interventions to the evolving TB situation among Ukrainian refugees in Germany, especially considering the ongoing conflict and potential for increased TB cases in the future.

Clinically used broad-spectrum antibiotics compromise inflammatory monocyte-dependent antibacterial defense in the lung.

Hospital-acquired pneumonia (HAP) is associated with high mortality and costs, and frequently caused by multidrug-resistant (MDR) bacteria. Although prior antimicrobial therapy is a major risk factor for HAP, the underlying mechanism remains incompletely understood. Here, we demonstrate that antibiotic therapy in hospitalized patients is associated with decreased diversity of the gut microbiome and depletion of short-chain fatty acid (SCFA) producers. Infection experiments with mice transplanted with patient fecal material reveal that these antibiotic-induced microbiota perturbations impair pulmonary defense against MDR Klebsiella pneumoniae. This is dependent on inflammatory monocytes (IMs), whose fatty acid receptor (FFAR)2/3-controlled and phagolysosome-dependent antibacterial activity is compromized in mice transplanted with antibiotic-associated patient microbiota. Collectively, we characterize how clinically relevant antibiotics affect antimicrobial defense in the context of human microbiota, and reveal a critical impairment of IM´s antimicrobial activity. Our study provides additional arguments for the rational use of antibiotics and offers mechanistic insights for the development of novel prophylactic strategies to protect high-risk patients from HAP.

Post-tuberculosis sequelae in children and adolescents: a systematic review.

In 2020, an estimated total of 155 million people had survived tuberculosis. Among this number, a sizable proportion have considerable post-tuberculosis morbidity, as shown for the adult population. This systematic review aims to identify the spectrum and prevalence of post-tuberculosis sequelae in children and adolescents. Four databases were systematically searched from database inception to Feb 7, 2022, for literature on post-treatment outcomes of tuberculosis acquired during childhood. Of the 4613 identified publications, 71 studies were included in this systematic review. Studies on cohorts with comparably rare (most of which were extrapulmonary) tuberculosis presentations, such as spinal tuberculosis and tuberculous meningitis were over-represented; however, no study assessed long-term sequelae in a cohort with an average childhood tuberculosis spectrum. The descriptive analysis includes long-term outcomes of 3529 paediatric patients 1 month to 36 years after confirmed (47%) or clinical (53%) tuberculosis. In a considerable proportion of children, a broad spectrum of post-tuberculosis sequelae were identified, ranging from radiological residua after pulmonary tuberculosis, to disabling deformities after musculoskeletal and cutaneous tuberculosis, to somatic and psychosocial impairment after tuberculous meningitis. A better understanding and comprehensive assessment of post-tuberculosis sequelae in children are needed to improve tuberculosis care beyond antituberculous treatment.