ABSTRACT
Co-infection with tuberculosis (TB) and leprosy is thought to occur infrequently, but has been reported in settings highly endemic for both infectious diseases. We report for the first time a case where treatment for multidrug-resistant TB (MDR-TB) led to the 'unmasking' of clinically silent leprosy through the precipitation of a type-1 immunological reaction. Current treatment regimens for MDR-TB may contain a number of drugs, such as levo-floxacin and clofazimine, which also have activity against M. leprae. A treatment regimen containing drugs active against both mycobacterial species may be used to achieve cure. Individual considerations on drug-drug interactions, potential additive toxicities and other comorbidities should be taken into account.
Il est considéré que la co-infection tuberculose (TB) et la lèpre est peu fréquente, mais elle a été signalée dans des milieux très endémiques pour les deux maladies infectieuses. Nous signalons pour la première fois un cas de traitement de la TB multirésistante (MDR-TB) 'démasquant' la lèpre cliniquement silencieuse par précipitation d'une réaction immunologique de type 1. Les schémas thérapeutiques actuels pour la MDR-TB peuvent contenir un certain nombre de médicaments, comme la lévofloxacine et la clofazimine, qui ont également une activité contre M. leprae. Un régime de traitement contenant des médicaments actifs contre les deux espèces mycobactériennes peut être utilisé pour obtenir la guérison. Les considérations individuelles sur les interactions médicamenteuses, les toxicités additives potentielles et les autres comorbidités doivent être prises en compte.
Se considera que la coinfección por tuberculosis (TB) y lepra es infrecuente, pero se han informado casos de concomitancia en entornos con alta endemicidad por ambas enfermedades infecciosas. En el presente artículo se comunica por primera vez un caso de tratamiento de la TB multirresistente (MDR-TB) que desenmascaró una lepra asintomática, tras desencadenar una reacción inmunitaria de tipo 1. Las pautas actuales de tratamiento de la MDR-TB pueden comportar un cierto número de fármacos como la levofloxacina y la clofazimina, que tienen también actividad contra el Mycobacterium leprae. Con el objeto de alcanzar la curación, se puede utilizar un esquema terapéutico que contenga fármacos activos contra ambas especies de micobacterias. En cada caso, es importante tener en cuenta los aspectos de las interacciones medicamentosas, la posible toxicidad acumulada y otras afecciones concomitantes.
ABSTRACT
The World Health Organization has recommended that testing for high-risk human papillomavirus (HPV) (hrHPV) infection be incorporated into cervical screening programs in all settings worldwide. In many high-burden, low-income countries, it will not be feasible to achieve high cervical screening coverage using hrHPV assays that require clinician-collected samples. We conducted the first evaluation of self-collected vaginal specimens compared with clinician-collected cervical specimens for the detection of hrHPV infection using the Xpert HPV test. Women aged 30 to 54 years attending two well-woman clinics in Papua New Guinea were invited to participate and provided self-collected vaginal and clinician-collected cervical cytobrush specimens. Both specimen types were tested at the point of care by using the Xpert HPV test. Women were given their cervical test result the same day. Those with a positive hrHPV test and positive examination upon visual inspection of the cervix with acetic acid were offered same-day cervical cryotherapy. A total of 1,005 women were enrolled, with 124 (12.3%; 95% confidence interval [CI], 10.3%, 14.4%) being positive for any hrHPV infection. There was a 99.4% overall percent agreement (OPA) between vaginal and cervical tests for HPV-16 (95% CI, 98.9%, 99.9%), a 98.5% OPA for HPV-18/45 (95% CI, 97.7%, 99.3%), a 94.4% OPA for other hrHPV infections (95% CI, 92.9%, 95.9%), and a 93.4% OPA for all hrHPV types combined (95% CI, 91.8%, 95.0%). Self-collected vaginal specimens had excellent agreement with clinician-collected cervical specimens for the detection of hrHPV infection using the Xpert HPV test. This approach provides for the first time an opportunity to incorporate point-of-care hrHPV testing into clinical cervical screening algorithms in high-burden, low-income settings.
Subject(s)
Early Detection of Cancer/methods , Molecular Diagnostic Techniques/methods , Papillomaviridae/isolation & purification , Papillomavirus Infections/diagnosis , Point-of-Care Systems , Specimen Handling/methods , Adult , Female , Humans , Middle Aged , Papua New GuineaABSTRACT
In many parts of the world weighing women in antenatal clinics is no longer thought to be important. At Port Moresby General Hospital we noticed that failure to gain weight in the third trimester (or weight loss) was associated with poor perinatal outcomes. To investigate this issue we designed a prospective case-control study to determine whether poor weight gain in the third trimester is a useful clinical indicator of poor placental function by being associated with intrauterine growth restriction (IUGR) or inadequate placental function in labour by being significantly associated with suspected intrapartum fetal compromise, birth asphyxia, meconium aspiration syndrome and neonatal intensive care unit admission. We found that a failure to gain weight for more than three weeks preceding the onset of labour was significantly associated with intrapartum fetal compromise (OR 2.24), IUGR (OR 2.88), meconium aspiration syndrome (OR 4.19), the presence of thick meconium or the passage of meconium during labour (OR 2.26) and the need for admission to the neonatal intensive care unit for more than 24 hours (OR 2.22). Weighing women in the antenatal clinic setting is a useful way of screening for deteriorating or inadequate placental function, and is particularly relevant in settings where more sophisticated modalities of screening and diagnosis of placental function are not available.
