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1.
BMC Infect Dis ; 20(1): 556, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32736602

RESUMEN

BACKGROUND: There is a general dearth of information on extrapulmonary tuberculosis (EPTB). Here, we investigated Mycobacterium tuberculosis (Mtb) drug resistance and transmission patterns in EPTB patients treated in the Tshwane metropolitan area, in South Africa. METHODS: Consecutive Mtb culture-positive non-pulmonary samples from unique EPTB patients underwent mycobacterial genotyping and were assigned to phylogenetic lineages and transmission clusters based on spoligotypes. MTBDRplus assay was used to search mutations for isoniazid and rifampin resistance. Machine learning algorithms were used to identify clinically meaningful patterns in data. We computed odds ratio (OR), attributable risk (AR) and corresponding 95% confidence intervals (CI). RESULTS: Of the 70 isolates examined, the largest cluster comprised 25 (36%) Mtb strains that belonged to the East Asian lineage. East Asian lineage was significantly more likely to occur within chains of transmission when compared to the Euro-American and East-African Indian lineages: OR = 10.11 (95% CI: 1.56-116). Lymphadenitis, meningitis and cutaneous TB, were significantly more likely to be associated with drug resistance: OR = 12.69 (95% CI: 1.82-141.60) and AR = 0.25 (95% CI: 0.06-0.43) when compared with other EPTB sites, which suggests that poor rifampin penetration might be a contributing factor. CONCLUSIONS: The majority of Mtb strains circulating in the Tshwane metropolis belongs to East Asian, Euro-American and East-African Indian lineages. Each of these are likely to be clustered, suggesting on-going EPTB transmission. Since 25% of the drug resistance was attributable to sanctuary EPTB sites notorious for poor rifampin penetration, we hypothesize that poor anti-tuberculosis drug dosing might have a role in the development of resistance.


Asunto(s)
Farmacorresistencia Bacteriana/genética , Mycobacterium tuberculosis/genética , Tuberculosis/transmisión , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Genotipo , Humanos , Lactante , Isoniazida/uso terapéutico , Aprendizaje Automático , Masculino , Persona de Mediana Edad , Mutación , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/patogenicidad , Filogenia , Rifampin/uso terapéutico , Sudáfrica , Tuberculosis/tratamiento farmacológico , Tuberculosis/microbiología , Tuberculosis Pulmonar/microbiología , Adulto Joven
2.
Medicine (Baltimore) ; 99(32): e21641, 2020 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-32769931

RESUMEN

RATIONALE: Intestinal tuberculosis (TB) is rarely seen in patients with end-stage renal disease (ESRD). We report an intestinal TB case with a clinical presentation similar to that of colon cancer in a patient with ESRD on hemodialysis. PATIENT CONCERNS: A 49-year-old man presented with a 3-month history of general weakness and anorexia. He had been treated for stage 5 chronic kidney disease (CKD) due to diabetic nephropathy for the last 3 years. His blood urea nitrogen and serum creatinine levels were 96.9 and 8.1 mg/dL, respectively, at the time of admission; azotemia was accompanied by severe anemia, hypoalbuminemia, hyperkalemia, and metabolic acidosis. Hemodialysis was initiated for suspected exacerbation of uremia; however, intermittent fever, night sweats, and abdominal discomfort persisted. DIAGNOSES: Abdominal computed tomography (CT) and whole-body F-fluorodeoxyglucose positron emission tomography were indicative of ascending colon cancer with lymph node metastases. However, colonoscopy with biopsy revealed the formation of submucosal caseating granuloma and acid-fast bacillus. INTERVENTIONS: We initiated quadruple therapy with isoniazid, rifampicin, pyrazinamide, and ethambutol. The patient continued the quadruple regimen for the first 2 months before switching to dual therapy and received anti-TB medications for a total of 12 months. OUTCOMES: After 9 months of standard anti-TB chemotherapy, polypoid residual lesions were noted during follow-up colonoscopy. Laparoscopy-assisted ileocecal resection was performed. No findings suggestive of recurrence of colonic TB were observed on follow-up abdominal CT at 6 months after discontinuation of anti-TB medications. LESSONS: If non-specific uremic symptoms persist in patients with advanced CKD, the possibility of extrapulmonary TB such as intestinal TB must be considered. Also, in patients with radiologic suspicion of colon cancer, endoscopy with biopsy should be performed promptly to exclude colonic TB with similar clinical manifestations.


Asunto(s)
Fallo Renal Crónico/complicaciones , Tuberculosis Gastrointestinal/etiología , Anorexia/etiología , Antituberculosos/uso terapéutico , Combinación de Medicamentos , Etambutol/uso terapéutico , Humanos , Isoniazida/uso terapéutico , Fallo Renal Crónico/fisiopatología , Masculino , Persona de Mediana Edad , Debilidad Muscular/etiología , Pirazinamida/uso terapéutico , Diálisis Renal/métodos , República de Corea , Rifampin/uso terapéutico , Tomografía Computarizada por Rayos X/métodos , Tuberculosis Gastrointestinal/fisiopatología
3.
BMC Infect Dis ; 20(1): 294, 2020 Apr 21.
Artículo en Inglés | MEDLINE | ID: mdl-32664847

RESUMEN

BACKGROUND: Tuberculosis (TB) is the most common opportunistic infection and the leading cause of death in people living with HIV (PLHIV). HIV-infected children are at a higher risk of TB infection and disease compared to those without HIV. Isoniazid preventive therapy (IPT) is an effective intervention in preventing progression of latent TB infection to active TB. The World Health Organization (WHO) currently recommends that all children aged > 12 months and adults living with HIV in whom active TB has been excluded should receive a 6-months course of IPT as part of a comprehensive package of HIV care. Despite this recommendation, the uptake of IPT among PLHIV has been suboptimal globally. This study sought to determine the factors affecting IPT uptake and completion among HIV-infected children in a large HIV care centre in Nairobi, Kenya. METHOD: This was a cross-sectional mixed methods study comprising of quantitative and qualitative study designs. Medical records of 225 HIV-infected children aged 1 to < 10 years, in care in the Kenyatta National Hospital Comprehensive Care Centre (KNH CCC) were retrospectively reviewed, and 8 purposively selected healthcare providers and 18 consecutively selected caregivers of children were interviewed. RESULTS: IPT uptake among CLHIV in care in the KNH CCC was 68% (152/225) while the treatment completion rate was 82% (94/115). IPT-related health education and counselling were the main facilitators of IPT uptake and completion, while fear of adverse drug reaction, pill burden and lack of an integrated monitoring and evaluation system for IPT were the major barriers. CONCLUSION: The IPT uptake in this study was low and fell short of the set global target of > 90%. The completion rate was however acceptable. There is an urgent need to address the identified barriers.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antituberculosos/uso terapéutico , Isoniazida/uso terapéutico , Tuberculosis Latente/tratamiento farmacológico , Tuberculosis Latente/prevención & control , Adulto , Antituberculosos/efectos adversos , Niño , Preescolar , Consejo , Estudios Transversales , Femenino , Personal de Salud , Humanos , Lactante , Isoniazida/efectos adversos , Kenia , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Investigación Cualitativa , Derivación y Consulta , Estudios Retrospectivos , Resultado del Tratamiento , Negativa del Paciente al Tratamiento
4.
Ann Hematol ; 99(9): 2201-2203, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32699943
5.
Int J Infect Dis ; 97: 69-77, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32474202

RESUMEN

OBJECTIVES: This study aimed to explore the relationship between glycosylated hemoglobin (HbA1c) and the risk of anti-tuberculosis (TB) drug resistance for TB-type 2 diabetes mellitus (T2DM) patients. METHODS: From March 2014 to June 2019, medical records from multiple centers were searched. Logistic regression analyses were performed. A predictive model for multidrug-resistance (MDR) was developed and validated. Calibration and discrimination of the model were assessed. RESULTS: Inconsistent results were found in the systemic review. A multicenter chart review with 657 records was thus conducted. The HbA1c <7% group and HbA1c ≥7% group had 390 and 267 patients, respectively. The HbA1c<7% group had a lower risk of developing rifampicin resistance, isoniazid resistance and MDR, with odd ratios (ORs) of 1.904 (p=0.001), 2.896 (p<0.001) and 3.228 (p<0.001), respectively. The between-group differences in the risk of anti-TB drug resistance were analyzed based on data from three provinces in China. After adding HbA1c grading, the predictive model for MDR (https://mengyuan.shinyapps.io/Shinyapp/) showed excellent capacity with an AUC of 75.4% in the training set (Sichuan and Gansu) and 73.9% in the internal validation set (Henan). The performances in calibration, prediction probabilities and net clinical benefit were significantly improved by HbA1c grading. CONCLUSIONS: HbA1c grading was an independent risk factor for isoniazid resistance and MDR in TB-T2DM patients.


Asunto(s)
Antituberculosos/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adulto , Anciano , Farmacorresistencia Bacteriana , Farmacorresistencia Bacteriana Múltiple , Femenino , Hemoglobina A Glucada/análisis , Humanos , Isoniazida/uso terapéutico , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/efectos de los fármacos , Oportunidad Relativa , Rifampin/uso terapéutico , Factores de Riesgo , Tuberculosis/tratamiento farmacológico
7.
BMC Infect Dis ; 20(1): 446, 2020 Jun 23.
Artículo en Inglés | MEDLINE | ID: mdl-32576154

RESUMEN

BACKGROUND: The emergence of drug-resistant tuberculosis (DR-TB) is a major healthcare concern worldwide. Here, we analyzed age-related trends in DR-TB rates in South Korea. METHODS: Drug susceptibility test results were collected from patients with culture-confirmed TB between 2015 and 2018 from eight university-affiliated hospitals. Patients were divided into three subgroups: younger (15-34 years), middle (35-59 years), and older (≥60 years) to compare drug-resistance patterns. To evaluate trends in age-stratified drug-resistance, chi-square test for linear trends was performed. RESULTS: Among enrolled native patients aged ≥15 years, 4.1% (179/4417), 1.2% (53/4417) and 7.2% (316/4417) were multidrug-resistant TB (MDR-TB), rifampicin-mono-resistant TB (RR-TB), and isoniazid-mono-resistant TB (Hr-TB), respectively. Proportions of Hr-TB cases were 5.4% (40/734), 7.2% (114/1593), and 7.8% (162/2090) in the younger, middle and older age groups, respectively. MDR/RR-TB case rates decreased significantly with age from 8.6% (63/734) in younger age group to 3.3% (68/2090) in older age group. Fluoroquinolone resistance was highest among second-line drugs, and there were no differences in resistance to fluoroquinolones and second-line injectable drugs among the three age groups. CONCLUSIONS: The number of MDR/RR-TB cases was highest in young patients. Effective public health interventions should include increased focus on rifampicin resistance in young patients.


Asunto(s)
Antituberculosos/uso terapéutico , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Fluoroquinolonas/uso terapéutico , Isoniazida/uso terapéutico , Mycobacterium tuberculosis/efectos de los fármacos , Rifampin/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adolescente , Adulto , Factores de Edad , Femenino , Humanos , Masculino , Persona de Mediana Edad , República de Corea , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
8.
PLoS One ; 15(5): e0233500, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32421749

RESUMEN

BACKGROUND: Meta-analyses on impact of isoniazid-resistant tuberculosis informed the World Health Organization recommendation of a levofloxacin-strengthened rifampicin-based regimen. We estimated the effect of initial rifampicin resistance (Rr) and/or isoniazid resistance (Hr) on treatment failure or relapse. We also determined the frequency of missed initial and acquired Rr to estimate the impact of true Hr. METHODS: Retrospective analysis of 7291 treatment episodes with known initial isoniazid and rifampicin status obtained from individual patient databases maintained by the Damien Foundation Bangladesh over 20 years. Drug susceptibility test results were confirmed by the programme's designated supra-national tuberculosis laboratory. To detect missed Rr among isolates routinely classified as Hr, rpoB gene sequencing was done randomly and on a sample selected for suspected missed Rr. RESULTS: Initial Hr caused a large recurrence excess after the 8-month regimen for new cases (rifampicin for two months), but had little impact on rifampicin-throughout regimens: (6 months, new cases; 3.8%; OR 0.8, 95%CI:0.3,2.8; 8 months, retreatment cases: 7.3%, OR 1.8; 95%CI:1.3,2.6). Rr was missed in 7.6% of randomly selected "Hr" strains. Acquired Rr was frequent among recurrences on rifampicin-throughout regimens, particularly after the retreatment regimen (31.9%). It was higher in mono-Hr (29.3%; aOR 3.5, 95%CI:1.5,8.5) and poly-Hr (53.3%; aOR 10.2, 95%CI 4.4,23.7) than in susceptible tuberculosis, but virtually absent after the 8-month new case regimen. Comparing Bangladesh (low Rr prevalence) with a high Rr prevalence setting,true Hr corrected for missed Rr caused only 2-3 treatment failures per 1000 TB cases (of whom 27% were retreatments) in both. CONCLUSIONS: Our analysis reveals a non-negligible extent of misclassifying as isoniazid resistance of what is actually missed multidrug-resistant tuberculosis. Recommending for such cases a "strengthened" regimen containing a fluoroquinolone provokes a direct route to extensive resistance while offering little benefit against the minor role of true Hr tuberculosis in rifampicin-throughout first-line regimen.


Asunto(s)
Resistencia a Medicamentos , Isoniazida/farmacología , Rifampin/farmacología , Adulto , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Bangladesh , Errores Diagnósticos , Resistencia a Medicamentos/efectos de los fármacos , Fluoroquinolonas/uso terapéutico , Humanos , Isoniazida/uso terapéutico , Recurrencia , Estudios Retrospectivos , Rifampin/uso terapéutico , Insuficiencia del Tratamiento , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos
9.
PLoS One ; 15(5): e0232841, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32469990

RESUMEN

BACKGROUND: Eswatini (formerly Swaziland) has one of the highest rates of TB and HIV co-disease in the world. Despite national efforts to improve service delivery and prevent TB and HIV transmission, rates remain high. A recent prospective, observational study of integrated, patient-selected IPT delivery showed extraordinary improvements in IPT adherence, running counter to previous assumptions. This prompted the need to understand contextual and unseen study factors that contributed to high rates of adherence. OBJECTIVE: To investigate high rates of IPT adherence rates among people living with HIV who participated in an observational study comparing modes of IPT delivery. METHODS: Community-based participatory research guided the development of in-person administration of semi-structured questionnaires. Observational and field note data were analyzed. Qualitative data were analyzed using content analysis. RESULTS: We interviewed 150 participants and analyzed responses from the 136 who remembered being given a choice of their IPT delivery method. Fifty-seven percent were female and the median age was 42. Nearly 67% of participants chose to receive facility-based IPT. High rates of self-reported IPT treatment adherence were linked to four key concepts: 1) adherence was positively impacted by community education; 2) disclosure of status served to empower participant completion; 3) mode of delivery perceptions positively impacted adherence; and 4) choice of treatment delivery seen as helpful but not essential for treatment completion. DISCUSSION: Achieving higher rates of IPT adherence in Eswatini and similar rural areas requires community-engaged education and outreach in coordination with care delivery systems.


Asunto(s)
Antituberculosos/uso terapéutico , Conducta de Elección , Isoniazida/uso terapéutico , Administración Masiva de Medicamentos/métodos , Cumplimiento de la Medicación/psicología , Sistemas de Medicación/organización & administración , Prioridad del Paciente , Tuberculosis/prevención & control , Adulto , Instituciones de Atención Ambulatoria , Antituberculosos/administración & dosificación , Agentes Comunitarios de Salud , Investigación Participativa Basada en la Comunidad , Comorbilidad , Esuatini/epidemiología , Femenino , Estudios de Seguimiento , Infecciones por VIH/epidemiología , Visita Domiciliaria , Humanos , Entrevistas como Asunto , Isoniazida/administración & dosificación , Masculino , Administración Masiva de Medicamentos/psicología , Tamizaje Masivo/organización & administración , Persona de Mediana Edad , Educación del Paciente como Asunto , Grupo Paritario , Investigación Cualitativa , Tuberculosis/diagnóstico , Tuberculosis/epidemiología
10.
BMC Infect Dis ; 20(1): 276, 2020 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-32276618

RESUMEN

BACKGROUND: Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least 6 months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor the six-month IPT completion since a suboptimal dose may not protect PLHIV from TB infection. This study determined the six-month IPT completion and factors associated with six-month IPT completion among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania. METHODS: Secondary analysis of routine data from PLHIV attending 58 care and treatment clinics in Dar es Salaam region was used. PLHIV, aged 15 years and above, who screened negative for TB symptoms and initiated IPT from January, 2013 to June, 2017 were recruited. Modified Poisson regression with robust standard errors was used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account for health facility random effects in order to estimate adjusted PR (APR) for factors associated with IPT six-month completion. RESULTS: A total of 29,382 PLHIV were initiated IPT, with 21,808 (74%) female. Overall 17,092 (58%) six-month IPT completion, increasing from 42% (773/1857) in year 2013 to 76% (2929/3856) in 2017. Multilevel multivariable model accounting for health facilities as clusters, showed PLHIV who were not on ART had 46% lower IPT completion compared to those were on ART (APR: 0.54: 95%CI: 0.45-0.64). There was 37% lower IPT completion among PLHIV who transferred from another clinic (APR: 0.63: 95% CI (0.54-0.74) compared to those who did not transfer. PLHIV aged 25-34 years had a 6% lower prevalence of IPT completion as compared to those aged 15 to 24 years (APR:0.94 95%CI:0.89-0.98). CONCLUSION: The IPT completion rate in PLHIV increased over time, but there was lower IPT completion in PLHIV who transferred from other clinics, who were aged 25 to 34 years and those not on ART. Interventions to support IPT in these groups are urgently needed.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Antituberculosos/uso terapéutico , Infecciones por VIH/complicaciones , Isoniazida/uso terapéutico , Tuberculosis/prevención & control , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adolescente , Adulto , Profilaxis Antibiótica , Estudios Transversales , Femenino , Humanos , Tuberculosis Latente/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Análisis Multinivel , Tanzanía/epidemiología , Tuberculosis/epidemiología , Adulto Joven
11.
An Bras Dermatol ; 95(3): 343-346, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32303434

RESUMEN

Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl-Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.


Asunto(s)
Artritis Reactiva/inmunología , Inmunocompetencia , Huésped Inmunocomprometido , Tuberculosis Cutánea/inmunología , Tuberculosis Cutánea/patología , Antituberculosos/uso terapéutico , Etambutol/uso terapéutico , Humanos , Isoniazida/uso terapéutico , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/inmunología , Úlcera Cutánea/patología , Resultado del Tratamiento , Tuberculosis Cutánea/tratamiento farmacológico , Adulto Joven
14.
Int J Infect Dis ; 95: 59-66, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32126324

RESUMEN

OBJECTIVE: To assess the incidence and determinants of tuberculosis (TB) among HIV-positive individuals in selected health facilities of Addis Ababa, Ethiopia, during the period January 2013 to December 2018. METHODS: Data were collected from the records of 566 HIV-positive individuals. A retrospective cohort study design was employed. Data were entered into Epi Info 7 and analyzed using IBM SPSS Statistics version 20. TB incidence density was determined per 100 person-years. Time-to-event distributions were estimated using Kaplan-Meier estimates. Survival curves and hazards across different categories were compared using log-rank tests. Determinants were identified using the Cox proportional hazards model. The hazard ratio (HR) and 95% confidence interval (CI) were computed. A p-value <0.05 in the multivariate analysis was considered statistically significant. RESULTS: A total of 566 HIV-positive individuals were followed for 2140.08 person-years, giving a TB incidence density rate of 6.82/100 person-years (146, 25.8%). The highest incidence was observed within the first year of follow-up. Independent determinants were large family size (adjusted HR (AHR) 1.783, 95% CI 1.113-2.855), lower baseline CD4 (AHR 2.568, 95% CI 1.602-4.116), and baseline body mass index <18.5 kg/m2 (AHR 1.907, 95% CI 1.530-2.690). Being enrolled in antiretroviral treatment (AHR 0.066, 95% CI 0.045-0.98) and taking isoniazid prophylaxis treatment (AHR 0.202, 95% CI 0.108-0.380) had a protective effect. CONCLUSIONS: TB is still a major cause of morbidity among HIV-positive individuals. Early HIV diagnosis, enrollment on antiretroviral treatment, and isoniazid prophylaxis treatment should be considered to decrease the TB risk.


Asunto(s)
Seropositividad para VIH/complicaciones , Tuberculosis/epidemiología , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Antituberculosos/uso terapéutico , Coinfección , Supervivencia sin Enfermedad , Etiopía/epidemiología , Femenino , Seropositividad para VIH/tratamiento farmacológico , Humanos , Incidencia , Isoniazida/uso terapéutico , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Tuberculosis/complicaciones , Tuberculosis/prevención & control , Adulto Joven
15.
PLoS One ; 15(3): e0229691, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32155169

RESUMEN

Isoniazid resistant Mycobacterium tuberculosis (Hr-TB) is the most frequently encountered TB resistance phenotype in North America but limited data exist on the effectiveness of current therapeutic regimens. Ineffective treatment of Hr-TB increases patient relapse and anti-mycobacterial resistance, specifically MDR-TB. We undertook a multi-centre, retrospective review of culture-positive Hr-TB patients in Alberta, Canada (2007-2017). We assessed incidence and treatment outcomes, with a focus on fluoroquinolone (FQ)-containing regimens, to understand the risk of unsuccessful outcomes. Rates of Hr-TB were determined using the mid-year provincial population and odds of unsuccessful treatment was calculated using a Fisher's Exact test. One hundred eight patients of median age 37 years (IQR: 26-50) were identified with Hr-TB (6.3%), 98 of whom were able to be analyzed. Seven percent reported prior treatment. Rate of foreign birth was high (95%), but continent of origin did not predict Hr-TB (p = 0.47). Mean compliance was 95% with no difference between FQ and non-FQ regimens (p = 1.00). Treatment success was high (91.8%). FQ-containing regimens were frequently initiated (70%), with no difference in unsuccessful outcomes compared to non-FQ-containing regimens (5.8% vs. 13.8%, OR 0.4, 95% CI 0.1-2.3, p = 0.23). Only one patient (1%) utilizing a less common non-FQ-based regimen including two months of pyrazinamide developed secondary multidrug resistance. Unsuccessful treatment was low (<10%) relative to comparable literature (~15%) and showed similar outcomes for FQ and non-FQ-based regimens and no deficit to those using intermittent fluoroquinolones in the continuation phase of treatment. Our findings are similar to recent data, however prospective, randomized trials of adequate power are needed to determine the optimal treatment for Hr-TB.


Asunto(s)
Antituberculosos/uso terapéutico , Isoniazida/uso terapéutico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Adulto , Alberta/epidemiología , Estudios de Cohortes , Farmacorresistencia Bacteriana , Emigrantes e Inmigrantes , Femenino , Fluoroquinolonas/uso terapéutico , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/efectos de los fármacos , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis/microbiología , Tuberculosis Pulmonar/microbiología
16.
Int J Infect Dis ; 92S: S26-S30, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114196

RESUMEN

BACKGROUND: After the breakup of the Soviet Union, the annual incidence of tuberculosis (TB) in children 15-17 years of age increased in the Russian Federation from 16 per 100 000 population in 1992 to 37 per 100 000 in 2009, and new control measures were implemented. METHODS: Children were screened annually for TB exposure with a tuberculin skin test (TST) at age 1-8 years. If positive, they were investigated for active TB. If no active TB was found, they were treated with isoniazid for 4-6 months; they then underwent 6-monthly skin tests (which included two recombinant proteins) until negative and annual skin tests thereafter. From the age of 8 years, the yearly follow-up was performed using the skin test that included two recombinant proteins, either until they became negative, developed active TB, or turned 18 years. RESULTS: The annual incidence of TB in Russian children decreased from 19.1 per 100 000 population in 2001 to 8.3 per 100 000 population in 2018. CONCLUSIONS: Annual screening for TB exposure with treatment for latent or active TB has reduced the annual incidence of TB in Russian children aged 15-17 years to 1992 levels.


Asunto(s)
Tuberculosis Latente/diagnóstico , Tuberculosis Latente/tratamiento farmacológico , Tuberculosis/epidemiología , Adolescente , Antituberculosos/uso terapéutico , Niño , Preescolar , Humanos , Incidencia , Lactante , Recién Nacido , Isoniazida/uso terapéutico , Tuberculosis Latente/epidemiología , Tamizaje Masivo , Federación de Rusia/epidemiología , Prueba de Tuberculina , Tuberculosis/tratamiento farmacológico
17.
Int J Infect Dis ; 92S: S37-S40, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114201

RESUMEN

China is one of the countries with a high burden of tuberculosis (TB) and latent tuberculosis infection (LTBI). It was recently estimated that China had the highest LTBI burden in the world, with approximately 350 million persons living with the infection. The prevalence of LTBI in China is overestimated by tuberculin skin test (TST) as compared to interferon-gamma release assay (IGRA). A population-based study found that IGRA positivity rates ranged between 13.5% and 19.8%. The annual TB infection rate in the rural population was 1.5% based on persistent positive IGRA results in converters. The development of active TB from LTBI in the general rural population was 0.87 per 100 person-years in the first 2 years among individuals who newly converted to IGRA-positive. TB control in students has been paid more attention by the government, which also improved LTBI management among students in close contact with active TB patients. A 3-month regimen of twice-weekly rifapentine plus isoniazid (3H2P2, both with a maximum dose of 600 mg) has been practiced for LTBI treatment in China for years. With respect to LTBI management in populations using immune inhibitors, an expert consensus on TB prevention and management in tumor necrosis factor antagonist application was published in 2013 in China. In order to achieve the global goals of the End TB Strategy, China needs innovative ideas and technologies to reduce the TB incidence by management of LTBI, such as the identification of populations for LTBI testing and treatment, selecting and developing reliable LTBI tests, exploring safe and effective preventive treatment tools, and establishing a set of optimized LTBI management systems.


Asunto(s)
Tuberculosis Latente/tratamiento farmacológico , Tuberculosis Latente/epidemiología , Antituberculosos/uso terapéutico , China/epidemiología , Humanos , Incidencia , Ensayos de Liberación de Interferón gamma , Isoniazida/uso terapéutico , Tuberculosis Latente/diagnóstico , Prevalencia , Rifampin/análogos & derivados , Rifampin/uso terapéutico , Población Rural , Prueba de Tuberculina , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores
18.
Int J Infect Dis ; 92S: S72-S77, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32171953

RESUMEN

OBJECTIVE: To estimate the cost of a screening program for identifying latent tuberculosis (TB) infections in migrants to Oman. METHODS: A Markov model was used to estimate the cost of screening using an interferon-gamma release assay (IGRA) applied to all migrants from high TB endemic countries, followed by preventive TB treatment. RESULTS: The model compared seven different scenarios, with a comparison of the direct cost and the quality-adjusted life-years (QALYs) saved. CONCLUSIONS: IGRA testing followed by 3 months of preventive treatment with rifapentine/isoniazid (3HP) was the most cost-effective intervention.


Asunto(s)
Ensayos de Liberación de Interferón gamma/economía , Tuberculosis Latente/diagnóstico , Migrantes , Análisis Costo-Beneficio , Femenino , Humanos , Isoniazida/uso terapéutico , Tuberculosis Latente/economía , Cadenas de Markov , Tamizaje Masivo , Omán , Años de Vida Ajustados por Calidad de Vida , Rifampin/análogos & derivados , Rifampin/uso terapéutico , Tuberculosis/prevención & control
19.
Med Sci Monit ; 26: e920350, 2020 Mar 07.
Artículo en Inglés | MEDLINE | ID: mdl-32145061

RESUMEN

BACKGROUND The aim of this study was to investigate the clinical characteristics and the risk factors associated with anti-tuberculosis (anti-TB) drug-induced liver injury (DILI). MATERIAL AND METHODS This retrospective study enrolled 140 hospitalized patients diagnosed with anti-TB DILI during January 2009 to December 2015. We assessed the baseline characteristics and performed regular follow-up up to the 24th week to assess the possible risk factors associated with the condition. RESULTS The study population was 58.6% male and 41.4% female patients; 20.7% were diagnosed with grades 4-5 DILI and 79.3% with grades 1-3 DILI. Female patients were significantly more likely to be diagnosed with grades 4-5 DILI than with grades 1-3 DILI (58.6% vs. 36.9%, p=0.036). Patients treated with a multidrug anti-TB regimen were more commonly affected with grades 4-5 DILI (86.2% vs. 68.5%, p=0.045). A significant number of patients who reinitiated anti-TB therapy suffered severe liver injury in comparison to patients with grades 1-3 DILI (41.4% vs. 10.8%, P<.001). Laboratory examinations revealed significantly higher values for total bilirubin (TBL), International normalized ratio (INR), and Hy's law (P<.001) in the grades 4-5 group compare to the grades 1-3 group. CONCLUSIONS Female gender, combination therapy for antitubercular drugs (isoniazid, rifampicin and pyrazinamide), re-challenge were the risk factors associated with the severity of anti-TB DILI.


Asunto(s)
Antituberculosos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Adulto , Antituberculosos/uso terapéutico , Femenino , Humanos , Isoniazida/efectos adversos , Isoniazida/uso terapéutico , Masculino , Persona de Mediana Edad , Pirazinamida/efectos adversos , Pirazinamida/uso terapéutico , Estudios Retrospectivos , Rifampin/efectos adversos , Rifampin/uso terapéutico , Factores de Riesgo , Tuberculosis/tratamiento farmacológico , Adulto Joven
20.
BMC Infect Dis ; 20(1): 245, 2020 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-32216747

RESUMEN

BACKGROUND: In resource limited settings, Tuberculosis (TB) is a major cause of morbidity and mortality among patients on antiretroviral treatment. Ethiopia is one of the 30 high TB burden countries. TB causes burden in healthcare system and challenge the effectiveness of HIV care. This study was to assess incidence and predictors of Tuberculosis among adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia, 2019. METHODS: Institution based retrospective follow up study was conducted among adults on ART newly enrolled from 2014 to 2018 at Debre Markos Referral Hospital. Simple random sampling technique was used to select patients chart. Data was entered to EPI- INFO version 7.2.2.6 and analyzed using Stata 14.0. Tuberculosis incidence rate was computed and described using frequency tables. Both bivariable and multivariable Cox proportional hazard models was fitted to identify predictors of TB. RESULTS: Out of the 536 patients chart reviewed, 494 patient records were included in the analysis. A total of 62 patients developed new TB cases during the follow up period of 1000.22 Person Years (PY); which gives an overall incidence rate of 6.19 cases per 100 PY (95% CI: 4.83-7.95). The highest rate was seen within the first year of follow up. After adjustment base line Hemoglobin < 10 g/dl (AHR = 5.25; 95% CI: 2.52-10.95), ambulatory/bedridden patients at enrolment (AHR = 2.31; 95% CI: 1.13-4.73), having fair or poor ART adherence (AHR = 3.22; 95% CI: 1.64-6.31) were associated with increased risk of tuberculosis whereas taking Isoniazid Preventive Therapy (IPT) (AHR = 0.33; 95% CI: 0.12-0.85) were protective factors of TB occurrence. CONCLUSION: TB incidence was high among adults on ART especially in the first year of enrollment to ART. Low hemoglobin level, ambulatory or bedridden functional status, non-adherence to ART and IPT usage status were found to be independent predictors. Hence, continuous follow up for ART adherence and provision of IPT has a great importance to reduce the risk of TB.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antirretrovirales/uso terapéutico , Tuberculosis/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/virología , Adolescente , Adulto , Antirretrovirales/efectos adversos , Antituberculosos/uso terapéutico , Supervivencia sin Enfermedad , Etiopía/epidemiología , Femenino , Estudios de Seguimiento , VIH/aislamiento & purificación , Humanos , Incidencia , Isoniazida/uso terapéutico , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/aislamiento & purificación , Pronóstico , Modelos de Riesgos Proporcionales , Derivación y Consulta , Estudios Retrospectivos , Tuberculosis/microbiología , Tuberculosis/prevención & control , Adulto Joven
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