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2.
BMC Infect Dis ; 19(1): 923, 2019 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666021

RESUMEN

BACKGROUND: Pulmonary tuberculosis (TB) with detectable Mycobacterium tuberculosis in the sputum is a major source of transmission. In resource limited TB endemic settings, cure is declared through sputum smear examination for acid fast bacilli without performing culture. This may lead to erroneous treatment outcomes as viable bacteria may be missed due to the low sensitivity of direct smear method. The aim of this study was to investigate if sterilizing cure is achieved among the new pulmonary TB cases declared cured by sputum smear conversion and to evaluate the impact of addition of ethambutol in the continuation phase in achieving it. METHODS: New sputum smear-positive pulmonary TB patients registered at a tertiary care hospital in Pakistan from November 2013 to March 2014 were followed under standard Directly Observed Treatment Short Course strategy for 6 months. Half of these patients received ethambutol in addition to isoniazid and rifampicin in the continuation phase. Sputum specimens were examined on microscopy at 2 months and at the end of treatment. Sputa of patients with negative direct smear examination at the end of treatment were cultured. RESULTS: Among 5746 TB suspects, 1595 were new sputum smear positive pulmonary TB cases, and 533 were registered at our hospital. Among these, 504 converted sputum negative at 2 months and 348 converted at the end of 6 months of treatment and were declared cured. Sputa of 204/348 patients were cultured, and 12/204 (6%) were culture-positive. Culture positivity at 6 months was not associated with bacterial load, smoking, diabetes, presence of cavities, history of contact with TB patients, age, sex, socioeconomic status, or addition of ethambutol in the continuation phase. CONCLUSION: Viable cultivable bacilli were detected in 6% of cured patients, which would have significant impact on the control of TB. This highlights the need for an inexpensive and accurate surrogate marker for culture as it is not feasible to perform culture in routine for monitoring treatment response in the low-resource settings. The treatment outcome did not improve by addition of ethambutol emphasizing the need to find the optimal duration of treatment for individual or carefully selected groups of patients.


Asunto(s)
Antituberculosos/uso terapéutico , Etambutol/uso terapéutico , Mycobacterium tuberculosis/aislamiento & purificación , Esputo/microbiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología , Adolescente , Adulto , Anciano , Carga Bacteriana , Pruebas Diagnósticas de Rutina , Quimioterapia Combinada , Femenino , Humanos , Isoniazida/uso terapéutico , Masculino , Persona de Mediana Edad , Pakistán , Rifampin/uso terapéutico , Resultado del Tratamiento , Tuberculosis Pulmonar/diagnóstico por imagen , Adulto Joven
3.
BMC Infect Dis ; 19(1): 852, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615537

RESUMEN

BACKGROUND: The dual challenge of low diagnostic sensitivity of microscopy test and technical challenge of performing a TB culture test poses a problem for case detection and initiation of Tuberculosis (TB) second-line treatment. There is thus need for a rapid, reliable and easily accessible assay. This comparative analysis was performed to assess diagnostic performance characteristics of GeneXpert MTB/RIF and Line Probe Assay (LPA). METHODS: Three hundred twenty nine sputum samples of patients across the 47 counties in Kenya suspected to have drug resistant TB were picked and subjected to GeneXpert, LPA and Culture MGIT at the National TB Reference Laboratory. Sensitivity, specificity and predictive values were then determined to assess the performance characteristics of the various assays. RESULTS: Against culture MGIT as the gold standard for TB diagnosis, GeneXpert had a sensitivity, specificity, positive predictive value, and negative predictive value of 78.5, 64.9, 59.4 and 82.2% respectively while LPA had 98.4, 66.0, 65.4 and 98.4%. For diagnosis of rifampicin mono-resistance GeneXpert had a moderate agreement (Kappa 0.59, P < 0.01) (sensitivity 62.50%, specificity 96.50%) while LPA that had almost perfect agreement (Kappa = 0.89, p < 0.01) with a (sensitivity 90.0% and specificity 99.1%). CONCLUSION: LPA has a better performance characteristic to GeneXpert and an alternative to culture with regards to detection of RIF's mono-resistance.


Asunto(s)
Farmacorresistencia Bacteriana/genética , Mycobacterium tuberculosis/genética , Rifampin/uso terapéutico , Tuberculosis/diagnóstico , Proteínas Bacterianas/genética , Femenino , Humanos , Kenia , Masculino , Reacción en Cadena de la Polimerasa Multiplex/métodos , Mycobacterium tuberculosis/aislamiento & purificación , Hibridación de Ácido Nucleico/métodos , Oxidorreductasas/genética , Juego de Reactivos para Diagnóstico , Sensibilidad y Especificidad , Esputo/microbiología , Tuberculosis/tratamiento farmacológico
4.
BMC Infect Dis ; 19(1): 869, 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31640582

RESUMEN

BACKGROUND: Pandoraea species is a newly described genus, which is multidrug resistant and difficult to identify. Clinical isolates are mostly cultured from cystic fibrosis (CF) patients. CF is a rare disease in China, which makes Pandoraea a total stranger to Chinese physicians. Pandoraea genus is reported as an emerging pathogen in CF patients in most cases. However, there are few pieces of evidence that confirm Pandoraea can be more virulent in non-CF patients. The pathogenicity of Pandoraea genus is poorly understood, as well as its treatment. The incidence of Pandoraea induced infection in non-CF patients may be underestimated and it's important to identify and understand these organisms. CASE PRESENTATION: We report a 44-years-old man who suffered from pneumonia and died eventually. Before his condition deteriorated, a Gram-negative bacilli was cultured from his sputum and identified as Pandoraea Apista by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). CONCLUSION: Pandoraea spp. is an emerging opportunistic pathogen. The incidences of Pandoraea related infection in non-CF patients may be underestimated due to the difficulty of identification. All strains of Pandoraea show multi-drug resistance and highly variable susceptibility. To better treatment, species-level identification and antibiotic susceptibility test are necessary.


Asunto(s)
Burkholderiaceae/patogenicidad , Infecciones por Bacterias Gramnegativas/microbiología , Hemorragia Intracraneal Traumática/complicaciones , Neumonía Bacteriana/microbiología , Adulto , Burkholderiaceae/aislamiento & purificación , China , Fibrosis Quística/microbiología , Infecciones por Bacterias Gramnegativas/diagnóstico por imagen , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Hemorragia Intracraneal Traumática/etiología , Masculino , Neumonía Bacteriana/diagnóstico por imagen , Neumonía Bacteriana/tratamiento farmacológico , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Esputo/microbiología
5.
BMJ ; 367: l5894, 2019 10 24.
Artículo en Inglés | MEDLINE | ID: mdl-31649017

RESUMEN

OBJECTIVE: To measure the association between phenotypic drug resistance and the risk of tuberculosis infection and disease among household contacts of patients with pulmonary tuberculosis. SETTING: 106 district health centers in Lima, Peru between September 2009 and September 2012. DESIGN: Prospective cohort study. PARTICIPANTS: 10 160 household contacts of 3339 index patients with tuberculosis were classified on the basis of the drug resistance profile of the patient: 6189 were exposed to drug susceptible strains of Mycobacterium tuberculosis, 1659 to strains resistant to isoniazid or rifampicin, and 1541 to strains that were multidrug resistant (resistant to isoniazid and rifampicin). MAIN OUTCOME MEASURES: Tuberculosis infection (positive tuberculin skin test) and the incidence of active disease (diagnosed by positive sputum smear or chest radiograph) after 12 months of follow-up. RESULTS: Household contacts exposed to patients with multidrug resistant tuberculosis had an 8% (95% confidence interval 4% to 13%) higher risk of infection by the end of follow-up compared with household contacts of patients with drug sensitive tuberculosis. The relative hazard of incident tuberculosis disease did not differ among household contacts exposed to multidrug resistant tuberculosis and those exposed to drug sensitive tuberculosis (adjusted hazard ratio 1.28, 95% confidence interval 0.9 to 1.83). CONCLUSION: Household contacts of patients with multidrug resistant tuberculosis were at higher risk of tuberculosis infection than contacts exposed to drug sensitive tuberculosis. The risk of developing tuberculosis disease did not differ among contacts in both groups. The evidence invites guideline producers to take action by targeting drug resistant and drug sensitive tuberculosis, such as early detection and effective treatment of infection and disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT00676754.


Asunto(s)
Tuberculosis Resistente a Múltiples Medicamentos/transmisión , Tuberculosis Pulmonar/transmisión , Adolescente , Adulto , Anciano , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Niño , Preescolar , Trazado de Contacto/métodos , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Recién Nacido , Isoniazida/farmacología , Isoniazida/uso terapéutico , Estimación de Kaplan-Meier , Masculino , Pruebas de Sensibilidad Microbiana/métodos , Persona de Mediana Edad , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/aislamiento & purificación , Perú/epidemiología , Estudios Prospectivos , Rifampin/farmacología , Rifampin/uso terapéutico , Esputo/microbiología , Prueba de Tuberculina , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/microbiología , Adulto Joven
6.
BMC Infect Dis ; 19(1): 909, 2019 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-31664931

RESUMEN

BACKGROUND: Disseminated nontuberculous mycobacteria (NTM) infections occur mostly in immunocompromised patients. Therefore, it is difficult to diagnose disseminated NTM infections in patients without history of immunocompromised diseases or using immunosuppressant. Patients with anti-interferon-γ (IFN-γ) autoantibodies are vulnerable to intracellular infections, such as disseminated NTM. Currently, there is no widely used and efficient technique for the detection of anti-IFN-γ autoantibodies. Herein, we report a case of an apparently healthy patient with disseminated Mycobacterium avium complex (MAC) infection who tested positive for anti-IFN-γ autoantibodies. CASE PRESENTATION: A 64-year-old non-immunocompromised and apparently healthy Asian male presented to the emergency department with complaints of progressive chest pain for about 6 months and weight loss. A bulging tumour was found in the anterior chest wall. Chest computed tomography showed a lung mass over the right lower lobe and an osteolytic lesion with a soft tissue component at the sternum. Sonography-guided biopsies for the osteolytic lesion and sputum culture confirmed the presence of disseminated MAC infection. In addition, positive test result of anti-IFN-γ autoantibodies was noted. The patient was prescribed antibiotics. The lesions over the right lower lobe and sternum attenuated following the antibiotic treatment. CONCLUSION: Detection of anti-IFN-γ autoantibodies is important among previously healthy people with disseminated NTM infection. Presence of anti-IFN-γ autoantibodies may suggest a high risk of severe intracellular infection, such as disseminated NTM infection.


Asunto(s)
Autoanticuerpos/análisis , Interferón gamma/inmunología , Neoplasias Pulmonares/diagnóstico , Infecciones por Micobacterias no Tuberculosas/diagnóstico por imagen , Complejo Mycobacterium avium , Tuberculosis Pulmonar/diagnóstico por imagen , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Biopsia/métodos , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Micobacterias no Tuberculosas/tratamiento farmacológico , Infecciones por Micobacterias no Tuberculosas/microbiología , Infecciones por Micobacterias no Tuberculosas/patología , Infección por Mycobacterium avium-intracellulare/tratamiento farmacológico , Esputo/microbiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología , Tuberculosis Pulmonar/patología
7.
BMC Infect Dis ; 19(1): 915, 2019 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-31664936

RESUMEN

BACKGROUND: A bi-directional interaction between diabetes mellitus and tuberculosis is well established and has been likened to that between HIV and TB. Whereas HIV screening is standard of care test in sub Saharan Africa TB programs, the same is not true for diabetes mellitus (DM). Sub Saharan Africa, a region with high TB infection rates, is going through an epidemiological transition with rapidly rising prevalence of diabetes. We aimed at characterizing TB patients with DM in order to identify factors associated with TB-DM dual disease among patients attending TB clinics in Dar es Salaam. METHODS: A cross-sectional study was conducted between September 2016 and January 2017 among patients attending TB clinics in Dar es Salaam. We collected socio-demographic characteristics, anthropometric measurements and screened for diabetes by measuring fasting blood glucose that was followed by a 2 h postprandial glucose for participants with impaired fasting blood glucose. We examined for socio-demographic and clinical factors associated with diabetes using logistic regression analysis. RESULTS: Of the 660 enrolled participants with TB, 25 (3.8%) were on treatment for diabetes while 39 (6.1%) and 147 (23%) of the remaining 635 participants were ultimately diagnosed with DM and impaired fasting blood glucose respectively. The overall prevalence of DM was 9.7% (64/660). Independent risk factors for diabetes included: age > 44 years {OR 4.52, 95% CI: [1.28-15.89]}; family history of diabetes {OR 3.42, 95% [CI 1.88-6.21]}. HIV sero-positive TB patients were less likely to have DM compared to those who were HIV sero-negative {OR 0.35, 95% CI [0.17-0.73]}. CONCLUSIONS: Screening for diabetes should be advocated for TB patients aged above 44 years and/or with a family history of diabetes. HIV sero-negative TB patients were more likely to have DM compared to those who were HIV sero-positive. Further studies are needed to confirm this observation and the underlying factors.


Asunto(s)
Diabetes Mellitus/epidemiología , Tamizaje Masivo , Tuberculosis/epidemiología , Adulto , Glucemia/análisis , Estudios Transversales , Diabetes Mellitus/sangre , Femenino , VIH/inmunología , Seropositividad para VIH , Humanos , Modelos Logísticos , Masculino , Anamnesis , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Esputo/microbiología , Encuestas y Cuestionarios , Tanzanía/epidemiología , Tuberculosis/virología , Adulto Joven
8.
BMC Infect Dis ; 19(1): 859, 2019 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-31623569

RESUMEN

BACKGROUND: Tuberculosis (TB) remains one of the infectious diseases with a leading cause of death among adults worldwide. Metformin, a first-line medication for the treatment of type 2 diabetes, may have potential for treating TB. The aims of the present systematic review were to evaluate the impact of metformin prescription on the risk of tuberculosis diseases, the risk of latent TB infection (LTBI) and treatment outcomes of tuberculosis among patients with diabetic mellitus. METHODS: Databases were searched through March 2019. Observational studies reporting the effect of metformin prescription on the risk and treatment outcomes of TB were included in the systematic review. We qualitatively analyzed results of included studies, and then pooled estimate effects with 95% confidence intervals (CIs) of different outcome using random-effect meta-analyses. RESULTS: This systematic review included 6980 cases from 12 observational studies. The meta-analysis suggested that metformin prescription could decrease the risk of TB among diabetics (pooled odds ratio [OR], 0.38; 95%CI, 0.21 to 0.66). Metformin prescription was not related to a lower risk of LTBI (OR, 0.73; 95%CI, 0.30 to 1.79) in patients with diabetes. Metformin medication during the anti-tuberculosis treatment is significantly associated with a smaller TB mortality (OR, 0.47; 95%CI, 0.27 to 0.83), and a higher probability of sputum culture conversion at 2 months of TB disease (OR, 2.72; 95%CI, 1.11 to 6.69) among patients with diabetes. The relapse of TB was not statistically reduced by metformin prescription (OR, 0.55; 95%CI, 0.04 to 8.25) in diabetics. CONCLUSIONS: According to current observational evidence, metformin prescription significantly reduced the risk of TB in patients with diabetes mellitus. Treatment outcomes of TB disease could also be improved by the metformin medication among diabetics.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Tuberculosis/patología , Antituberculosos/uso terapéutico , Humanos , Oportunidad Relativa , Factores de Riesgo , Esputo/microbiología , Resultado del Tratamiento , Tuberculosis/tratamiento farmacológico , Tuberculosis/mortalidad
9.
N Engl J Med ; 381(14): 1347-1357, 2019 10 03.
Artículo en Inglés | MEDLINE | ID: mdl-31577876

RESUMEN

BACKGROUND: The World Health Organization has set ambitious targets for the global elimination of tuberculosis. However, these targets will not be achieved at the current rate of progress. METHODS: We performed a cluster-randomized, controlled trial in Ca Mau Province, Vietnam, to evaluate the effectiveness of active community-wide screening, as compared with standard passive case detection alone, for reducing the prevalence of tuberculosis. Persons 15 years of age or older who resided in 60 intervention clusters (subcommunes) were screened for pulmonary tuberculosis, regardless of symptoms, annually for 3 years, beginning in 2014, by means of rapid nucleic acid amplification testing of spontaneously expectorated sputum samples. Active screening was not performed in the 60 control clusters in the first 3 years. The primary outcome, measured in the fourth year, was the prevalence of microbiologically confirmed pulmonary tuberculosis among persons 15 years of age or older. The secondary outcome was the prevalence of tuberculosis infection, as assessed by an interferon gamma release assay in the fourth year, among children born in 2012. RESULTS: In the fourth-year prevalence survey, we tested 42,150 participants in the intervention group and 41,680 participants in the control group. A total of 53 participants in the intervention group (126 per 100,000 population) and 94 participants in the control group (226 per 100,000) had pulmonary tuberculosis, as confirmed by a positive nucleic acid amplification test for Mycobacterium tuberculosis (prevalence ratio, 0.56; 95% confidence interval [CI], 0.40 to 0.78; P<0.001). The prevalence of tuberculosis infection in children born in 2012 was 3.3% in the intervention group and 2.6% in the control group (prevalence ratio, 1.29; 95% CI, 0.70 to 2.36; P = 0.42). CONCLUSIONS: Three years of community-wide screening in persons 15 years of age or older who resided in Ca Mau Province, Vietnam, resulted in a lower prevalence of pulmonary tuberculosis in the fourth year than standard passive case detection alone. (Funded by the Australian National Health and Medical Research Council; ACT3 Australian New Zealand Clinical Trials Registry number, ACTRN12614000372684.).


Asunto(s)
Enfermedades Endémicas/prevención & control , Tamizaje Masivo/métodos , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Pulmonar/diagnóstico , Adolescente , Adulto , Niño , Servicios de Salud Comunitaria , Femenino , Humanos , Análisis de Intención de Tratar , Masculino , Mycobacterium tuberculosis/genética , Técnicas de Amplificación de Ácido Nucleico , Prevalencia , Esputo/microbiología , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/prevención & control , Vietnam/epidemiología , Adulto Joven
11.
J Assoc Physicians India ; 67(8): 56-58, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31562718

RESUMEN

Background: Identification of the characteristics that confer higher risk of relapse, failure, or default and factors associate with treatment outcome in retreatment cases may help in planning country-specific prevention strategies. Objective: To evaluate the risk factors for retreatment failure, default or relapse and factors responsible for the treatment outcome. Methods: In this study sputum positive pulmonary TB retreatment cases were included. All patients were treated by eight months Revised National Tuberculosis Control Program (RNTCP) Cat II regimen. Outcome was recorded as Cured, Failure, Death or Defaulted. Results: Patients having body weight > 45 kgs had higher cure rates (94.74%). Poor outcome was significantly higher in patient with cavitory lesions on Chest X ray (30.43% vs 7.14%) and in patient with bilateral lesions (28.57% vs 4.35%). Patients with initial sputum of 3 + grade was significantly associated with poor outcome than having sputum of scanty to 2 + grade (26.93% vs 8%). Conclusion: Patients presenting for TB retreatment have distinct demographic and clinical characteristics, important difference in retreatment outcomes in relation to different parameters. So, new country specific strategies are required to identify and address risk factor for retreatment cases and factors responsible for poor outcome of these cases.


Asunto(s)
Esputo/microbiología , Tuberculosis Pulmonar/epidemiología , Antituberculosos , Humanos , Retratamiento , Factores de Riesgo , Resultado del Tratamiento , Tuberculosis Pulmonar/diagnóstico
12.
Int J Mycobacteriol ; 8(3): 211-217, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31512595

RESUMEN

Background: This study explored the genetic diversity of Mycobacterium tuberculosis isolates in Egypt by spoligotyping in combination with pncA gene sequencing, spoNC. Methods: First, isolates were selected from 400 isolates positive for M. tuberculosis that referred to Central Labs Ministry of Health and then were subjected to the study analyses. Results: Twenty one isolates were found to be multidrug resistant (MDR) and 29 isolates were sensitive for isonizide (INH) and rifampicine (RIF) after testing by phenotypic drug susceptibility testing (DST) and Mycobacteria Growth Indicator Tube (MGIT). Spoligotyping yielded 45 patterns belonging to seven families that previously reported in neighboring countries such as Iraq, Syria, Iran, and Turkey. While four isolates were orphans. Conclusion: Application of spoNC on obtained spoligotype patterns enhances to reduce the clustering rate. Bejing family the predominant (34%) were subdivided by pncA sequence into three sensitive DST pncA wild type, three MDR-DST isolates showing cys14Arg mutation in pncA, two sensitive DST isolates with pncA Gly97Asp mutation, and three sensitive DST pncAVal128Gly mutation. The next most common CASI_DELHI family (16%) were subdivided by pncA sequencing into CASI_DELHI (st 381, MDR) including two pncA silent mutation ser65ser (tcc > tct) and CASI_DELHI (st26, sensitive) which included six pncA (wild-type) results, and Latin-American-Mediterranean 6 family (6%) all had PncA Gly97Asp mutation. We concluded that spoNC provides good snap shot for MDR surveillance and its country origin and performs early identification of outbreaks in Egypt.


Asunto(s)
Amidohidrolasas/genética , Mutación , Mycobacterium tuberculosis/genética , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Adolescente , Adulto , Anciano , Antituberculosos/farmacología , Técnicas de Tipificación Bacteriana , Egipto , Monitoreo Epidemiológico , Femenino , Variación Genética , Genotipo , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mycobacterium tuberculosis/efectos de los fármacos , Estudios Prospectivos , Pirazinamida/farmacología , Rifampin/farmacología , Análisis de Secuencia de ADN , Esputo/microbiología , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Adulto Joven
13.
Int J Mycobacteriol ; 8(3): 267-272, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31512603

RESUMEN

Background: Despite appropriate prevention and control measures, tuberculosis (TB) remains a significant contributor to maternal morbidity and mortality. Diagnosis of the disease in pregnancy is usually challenging, as the symptoms may be attributed to the pregnancy. Little is known about the true burden of the disease and its associated risk factors among pregnant women. This study sought to assess the prevalence of TB among pregnant women and associated sociodemographic characteristics in Ghana. Methods: The study used nationally representative data gathered from the national TB project in 2013. A total of 1747 pregnant women were sampled from 56 randomly selected diagnostic health centers across the ten regions of Ghana. TB was confirmed with Ziehl-Neelsen staining technique using morning sputum samples from pregnant women who reported coughing for more than 2 weeks. We assessed how the observed TB prevalence differed by some sociodemographic characteristics and other factors. We further examined the regional spatial distribution of pregnant women with TB in the country. Results: Up to 11.2% of the pregnant women had a history of cough during pregnancy. Eighteen (1.1%) cases of TB were confirmed among the pregnant women during the 2-year period, with the Eastern region of the country recording the highest (n = 13, 72%), followed by Volta region ( n = 2, 11.1%). No cases were recorded in five regions. The geographical region of residence was the only determinant of TB in pregnancy significantly associated with TB (P = 0.001). Conclusion: Although the burden of TB was found to be low, appropriate control measures have to be put in place to detect the disease during the early stages of pregnancy to safeguard the health of the expectant mother and the unborn child.


Asunto(s)
Salud Materna , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/microbiología , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/epidemiología , Adulto , Costo de Enfermedad , Tos/etiología , Femenino , Geografía , Ghana/epidemiología , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Embarazo , Prevalencia , Factores de Riesgo , Esputo/microbiología , Adulto Joven
14.
BMC Infect Dis ; 19(1): 818, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533644

RESUMEN

BACKGROUND: Multi-drug resistant Tuberculosis (MDR-TB) is a strain of Mycobacterium tuberculosis that is resistant to at least Rifampicin and Isoniazid drugs. The treatment success rate for MDR-TB cases is lower than for drug susceptible TB. Globally only 55% of MDR-TB patients were successfully treated. Monitoring the early treatment outcome and better understanding of the specific reasons for early unfavorable and unknown treatment outcome is crucial for preventing the emergence of further drug-resistant tuberculosis. However, this information is scarce in Ethiopia. Therefore, this study aimed to determine the intensive phase treatment outcome and contributing factors among patients treated for MDR-TB in Ethiopia. METHODS: A 6 year retrospective cohort record review was conducted in fourteen TICs all over the country. The records of 751 MDR-TB patients were randomly selected using simple random sampling technique. Data were collected using a pre-tested and structured checklist. Multivariable multinomial logistic regression was undertaken to identify the contributing factors. RESULTS: At the end of the intensive phase, 17.3% of MDR-TB patients had an unfavorable treatment outcome, while 16.8% had an unknown outcome with the remaining having a favorable outcome. The median duration of the intensive phase was 9.0 months (IQR 8.04-10.54). Having an unfavorable intensive phase treatment outcome was found significantly more common among older age [ARRR = 1.047, 95% CI (1.024, 1.072)] and those with a history of hypokalemia [ARRR = 0.512, 95% CI (0.280, 0.939)]. Having an unknown intensive phase treatment outcome was found to be more common among those treated under the ambulatory care [ARRR = 3.2, 95% CI (1.6, 6.2)], rural dwellers [ARRR = 0.370, 95% CI (0.199, 0.66)], those without a treatment supporter [ARRR = 0.022, 95% CI (0.002, 0.231)], and those with resistance to a limited number of drugs. CONCLUSION: We observed a higher rate of unfavorable and unknown treatment outcome in this study. To improve favorable treatment outcome more emphasis should be given to conducting all scheduled laboratory monitoring tests, assignment of treatment supporters for each patient and ensuring complete recording and reporting which could be enhanced by quarterly cohort review. Older aged and rural patients need special attention. Furthermore, the sample referral network should be strengthened.


Asunto(s)
Antituberculosos/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adulto , Etiopía , Femenino , Humanos , Hipopotasemia/patología , Modelos Logísticos , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Esputo/microbiología , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/patología , Adulto Joven
15.
BMC Infect Dis ; 19(1): 819, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533664

RESUMEN

BACKGROUND: Reports on the worldwide ascending trend of pulmonary nontuberculous mycobacteria (NTM) isolation rates and their effective role in respiratory tract infections are compelling. However, as yet, there are no such data relating to Tunisia. METHODS: Here we carried out a retrospective review of mycobacterial cultures originating from Northern Tunisia, which have been processed in the laboratory of mycobacteria of the Institut Pasteur de Tunis, during the time period 2002-2016. All pulmonary NTM (PNTM) isolates available for culture were characterized phenotypically and their taxonomic status was further established based on polymorphisms in rpoB, 16S rRNA, hsp65, and sodA DNA gene sequences. RESULTS: Of the 10,466 specimens collected from HIV-negative Tunisian patients with presumptive clinical pulmonary TB, 60 (0.6%) yielded PNTM isolates. An overall annual PNTM isolation prevalence of 0.2/100,000 was estimated. As far as could be ascertained, this isolation rate accounts amongst the lowest reported hitherto throughout the world. Among the 30 NTM isolates that were available for culture, 27 (90.0%) have been identified to the species level. The most commonly encountered species was Mycobacterium kansasii (23.3%) subtype 1. Strikingly, all M. kansasii cases were male patients originating from Bizerte, an industrialized region particularly known for iron industry. The remaining NTM species were M. fortuitum (16.6%), M. novocastrense (16.6%), M. chelonae (10.0%), M. gordonae (6.6%), M. gadium (6.6%), M. peregrinum (3.3%), M. porcinum (3.3%), and M. flavescens (3.3%). There were no bacteria of the M. avium complex, the most frequently isolated NTM globally, and the main driver of the rise of NTM-lung diseases. CONCLUSIONS: This study uncovered an exceptional low prevalence of PNTM isolation among HIV-negative TB suspects in Northern Tunisia, suggesting a very low burden of NTM pulmonary disease. However, the frequent isolation of M. kansasii subtype 1, the most pathogenic subtype, particularly from the industrialized region of Bizerte, strongly suggests its effective involvement in a typical pulmonary disease.


Asunto(s)
Infecciones por Micobacterias no Tuberculosas/diagnóstico , Micobacterias no Tuberculosas/aislamiento & purificación , Tuberculosis Pulmonar/diagnóstico , Adulto , Líquido del Lavado Bronquioalveolar/microbiología , Femenino , Humanos , Masculino , Infecciones por Micobacterias no Tuberculosas/epidemiología , Infecciones por Micobacterias no Tuberculosas/microbiología , Micobacterias no Tuberculosas/clasificación , Micobacterias no Tuberculosas/genética , Filogenia , Prevalencia , ARN Ribosómico 16S/química , ARN Ribosómico 16S/genética , ARN Ribosómico 16S/metabolismo , Estudios Retrospectivos , Esputo/microbiología , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/microbiología , Túnez/epidemiología
16.
Pan Afr Med J ; 33: 110, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31489088

RESUMEN

Introduction: The World Health Organization endorsed (2010) the use of Xpert MTB/RIF and countries are shifting from smear microscopy (smear)-based to Xpert MTB/RIF-based tuberculosis (TB) diagnostic algorithms. As with smear, sputum quality may predict the likelihood of obtaining a bacteriologically-confirmed TB when using Xpert MTB/RIF. Methods: From 08/12-11/2014, all people living with HIV were recruited at 22 clinics. For patients screened positive using the four TB symptoms their sputa were tested by Xpert MTB/RIF and smear. Laboratorians assessed and recorded sputum appearance and volume. The yield of bacteriologically-positive sputum evaluated using Xpert MTB/RIF and smear, likelihood-ratios were calculated. Results: Among 6,041 patients enrolled 2,296 were presumptive TB, 1,305 (56.8%) had > 1 sputa collected and 644/1,305 (49.3%) had both Xpert MTB/RIF and smear results. Since >1 sputa collected from 644 patients 954 sputa were tested by Xpert MTB/RIF and smear. Bacteriologically-positive sputum was two-fold higher with Xpert MTB/RIF 11.4% versus smear 5.3%, p < 0.001. Sputum appearance and quantity were not predictive of bacteriologically-positive results, except volume of 2ml to < 3ml, tested by Xpert MTB/RIF LR+= 1.26 (95% CI, 1.05-1.50). Conclusion: Xpert MTB/RIF test yield to bacteriologically-positive sputum was superior to smear. Sputum quality and quantity, however, were not consistently predictive of bacteriologically-positive results by Xpert MTB/RIF or smear.


Asunto(s)
Técnicas Bacteriológicas/métodos , Microscopía/métodos , Esputo/microbiología , Tuberculosis/diagnóstico , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Técnicas de Diagnóstico Molecular/métodos , Estudios Prospectivos , Tuberculosis/epidemiología
17.
Medicine (Baltimore) ; 98(36): e16826, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31490369

RESUMEN

The purpose of this study was to present the computed tomographic (CT) findings of lung abnormalities in macrolide-resistant Mycobacterium massiliense pulmonary disease and its changes in follow-up CT after antibiotic treatment.Chest CT scans of patients with macrolide-resistant M massiliense pulmonary disease (n = 19) were retrospectively reviewed. Patients were treated with multidrug therapy, and sputum examinations were performed. Follow-up CT scans obtained during antibiotic treatment after detection of macrolide resistance were also reviewed, if available (n = 13). The CT scores at detection of macrolide resistance and at the last follow-up periods were also compared.Of all patients with macrolide-resistant M massiliense pulmonary disease, 2 (11%) patients achieved sputum culture conversion during the follow-up period. The most common CT findings of M massiliense pulmonary disease at detection of macrolide resistance were bronchiectasis and bronchiolitis (n = 19, 100%), followed by consolidation (n = 16, 84%), cavities (n = 11, 58%), and nodules (n = 6, 32%). On the last follow-up CT, overall CT scores were increased in 8 (62%) of 13 patients, and total mean CT score was significantly increased (P = .021). For each CT pattern, the cavity showed the greatest increase in CT score (P = .027), followed by bronchiectasis (P = .038).Common CT findings of macrolide-resistant M massiliense pulmonary disease were similar to those of pulmonary disease caused by other species of nontuberculous mycobacteria at presentation. However, in macrolide-resistant M massiliense pulmonary disease, serial CT scans showed deterioration with cavitary and bronchiectatic change in most patients despite multidrug antibiotic therapy.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Macrólidos/farmacología , Infecciones por Micobacterias no Tuberculosas/tratamiento farmacológico , Enfermedades Respiratorias/tratamiento farmacológico , Anciano , Antibacterianos/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Macrólidos/uso terapéutico , Masculino , Persona de Mediana Edad , Infecciones por Micobacterias no Tuberculosas/diagnóstico por imagen , Infecciones por Micobacterias no Tuberculosas/microbiología , Infecciones por Micobacterias no Tuberculosas/patología , Mycobacterium abscessus , Enfermedades Respiratorias/diagnóstico por imagen , Enfermedades Respiratorias/microbiología , Enfermedades Respiratorias/patología , Estudios Retrospectivos , Esputo/microbiología , Tomografía Computarizada por Rayos X
18.
Glob Health Action ; 12(1): 1646024, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31500551

RESUMEN

Background: Most studies evaluate active case findings (ACF) for bacteriologically confirmed TB. Adapted diagnostic approaches are needed to identify cases with lower bacillary loads. Objectives: To assess the likelihood of diagnosing all forms of TB, including clinically diagnosed pulmonary and extra-pulmonary TB, using different ACF algorithms in Cambodia. Methods: Clients were stratified into 'high-risk' (presumptive TB plus TB contact, or history of TB, or presumptive HIV infection; n = 12,337) and 'moderate-risk' groups (presumptive TB; n = 28,804). Sputum samples were examined by sputum smear microscopy (SSM) or Xpert MTB/RIF (Xpert). Initially, chest X-ray using a mobile radiography unit was a follow-up test after a negative sputum examination [algorithms A (Xpert/X-ray) and B (SSM/X-ray)]. Subsequently, all clients received an X-ray [algorithms C (X-ray+Xpert) and D (Xray+SSM/Xpert)]. X-rays were interpreted on the spot. Results: Between 25 August 2014 and 31 March 2016, 2217 (5.4%) cases with all forms of TB cases were diagnosed among 41,141 adults. The majority of TB cases (1488; 67.1%) were diagnosed using X-ray. When X-rays were taken and interpreted the same day the sputum was collected, same-day diagnosis more than doubled. Overall, the number needed to test (NNT) to diagnose one case was 18.6 (95%CI:17.9-19.2). In the high-risk group the NNT was lower [algorithm D: NNT = 17.3(15.9-18.9)] compared with the 'moderate-risk group' [algorithm D: NNT = 20.8(19.6-22.2)]. In the high-risk group the NNT was lower when using Xpert as an initial test [algorithm A: NNT = 12.2(10.8-13.9) or algorithm C: NNT = 11.2(9.6-13.0)] compared with Xpert as a follow-up test [algorithm D: NNT = 17.3(15.9-18.9)]. Conclusion: To diagnose all TB forms, X-ray should be part of the diagnostic algorithm. The combination of X-ray and Xpert testing for high-risk clients was the most effective ACF approach in this setting.


Asunto(s)
Algoritmos , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Pulmonar/diagnóstico , Adolescente , Adulto , Cambodia/epidemiología , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Esputo/microbiología , Tuberculosis Pulmonar/epidemiología , Adulto Joven
19.
Tuberk Toraks ; 67(2): 92-101, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31414639

RESUMEN

Introduction: Tuberculosis (TB) is continuing to be a important public health problem in the undeveloped countries. Drug sensitivity rate should be monitored for the effective treatment and control in the TB. The aim of this study was to determine the rate of resistance to first line TB drugs in the Mycobacterium tuberculosis complex isolates. Materials and Methods: During one-year period, M. tuberculosis complex was isolated in the 1193 samples from 974 patients in the Mycobacterial Laboratory of Yedikule Chest Diseases and Chest Surgery Education and Research Hospital, Istanbul, Turkey. The majority of samples isolated in the M. tuberculosis complex were sputum (n= 897, 92.1%). Anti-TB drug susceptibility testing was performed with Mycobacterium Growth Indicator Tube 960 system. Result: Two hundred and sixty isolat (26.7%) were resistant to at least one of the four first-line anti-TB drugs tested. One hundred ninety seven isolates were resistances to isoniazid (20.2%); 82 to rifampin (8.4%), 63 to ethambutol (6.5%) and 140 to streptomycin (14.4%). Of the 197 isoniazid-resistant isolates, 89 (45.2%) isolates was only isoniazid-resistance, only rifampin-resistance were found 15.9% (n= 13), ethambutol 7.9% (n= 5) and streptomycin 30.7% (n= 43). There were 48 (4.9%) isolates with two drugresistance, 22 (2.3%) isolates with three drug-resistance, and 42 (4.3%) isolates with four drug-resistance. The multidrug resistance rate was 7% (68 of 974). There was no relationship with between the frequency of TB drug resistance and gender or age. The isoniazid--resistance and streptomycin-resistance were seen to tend to increase if together considered the results of this study with outcomes of previously reported studies from Turkey in the 1998-2003, 2004-2007 and 2008-2010 years. Conclusions: Monitoring of drug susceptibility test results can contribute to the management of TB treatment and increase treatment success. Isoniazid-resistance and streptomycin-resistance tend to increase in Turkey. Further clinical studies are needed to investigate regional and global factors affecting the development of resistance to first-line TB drugs.


Asunto(s)
Antituberculosos/farmacología , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adolescente , Adulto , Antituberculosos/uso terapéutico , Etambutol/farmacología , Etambutol/uso terapéutico , Femenino , Humanos , Isoniazida/farmacología , Isoniazida/uso terapéutico , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Salud Pública , Rifampin/farmacología , Rifampin/uso terapéutico , Esputo/microbiología , Estreptomicina/farmacología , Estreptomicina/uso terapéutico , Centros de Atención Terciaria , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Turquia , Adulto Joven
20.
Emerg Infect Dis ; 25(9): 1760-1762, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31441763

RESUMEN

Resistance to second-line tuberculosis drugs for patients with multidrug-resistant tuberculosis has emerged globally and is a potential risk factor for unfavorable outcomes of shorter duration drug regimens. We assessed the proportion of patients eligible for a shorter drug regimen in Uttar Pradesh, India, which had the highest rate of multidrug-resistant tuberculosis in India.


Asunto(s)
Antituberculosos/uso terapéutico , Fluoroquinolonas/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Antituberculosos/administración & dosificación , Esquema de Medicación , Fluoroquinolonas/administración & dosificación , Humanos , India/epidemiología , Esputo/microbiología , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Pulmonar/epidemiología
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