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1.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(1): 92-96, 2020 Jan.
Artículo en Chino | MEDLINE | ID: mdl-31950796

RESUMEN

Objective: To evaluate the diagnostic value of T-cells enzyme linked immunospot (TSPOT.TB) in the children with tuberculosis. Methods: The clinical data was retrieved from 2 348 children who underwent TSPOT.TB test in the Children's Hospital of Chongqing Medical University from January 2017 to December 2017. The diagnostic value of TSPOT.TB in the children with tuberculosis was analyzed. Results: In the diagnosis of children tuberculosis, the sensitivity of TSPOT.TB was 84.0%, the specificity was 99.1%, the positive predictive value was 93.1%, and the negative predictive value was 97.8%. To the area under receiver operating characteristic (ROC) curve of TSPOT.TB, the area under the curve ( AUC) value of A antigen and B antigen were 0.893 and 0.883, respectively ( P<0.05). When the number of A or B antigens was less than 50, the sensitivity was increased with the increase of puncture number, but there was no clear linear relationship. TSPOT.TB had a highly sensitivity to childhood tuberculosis when the number of A or B antigens was greater than 50. In the true positive groups of TSPOT.TB, the sensitivity of pulmonary tuberculosis group was significantly higher than that of extrapulmonary tuberculosis group ( P<0.05). In addition, the sensitivity to TSPOT.TB increased with age. Conclusion: TSPOT.TB has high diagnostic value in the children with tuberculosis, which can rapidly assist to diagnose pediatric tuberculosis.


Asunto(s)
Ensayo de Immunospot Ligado a Enzimas , Tuberculosis , Niño , Humanos , Curva ROC , Sensibilidad y Especificidad , Linfocitos T/enzimología , Tuberculosis/diagnóstico
2.
BMC Infect Dis ; 19(1): 1047, 2019 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-31823734

RESUMEN

BACKGROUND: Molecular tests can allow the rapid detection of tuberculosis (TB) and multidrug-resistant TB (MDR-TB). TB-SPRINT 59-Plex Beamedex® is a microbead-based assay developed for the simultaneous spoligotyping and detection of MDR-TB. The accuracy and cost evaluation of new assays and technologies are of great importance for their routine use in clinics and in research laboratories. The aim of this study was to evaluate the performance of TB-SPRINT at three laboratory research centers in Brazil and calculate its mean cost (MC) and activity-based costing (ABC). METHODS: TB-SPRINT data were compared with the phenotypic and genotypic profiles obtained using Bactec™ MGIT™ 960 system and Genotype® MTBDRplus, respectively. RESULTS: Compared with MGIT, the accuracies of TB-SPRINT for the detection of rifampicin and isoniazid resistance ranged from 81 to 92% and 91.3 to 93.9%, respectively. Compared with MTBDRplus, the accuracies of TB-SPRINT for rifampicin and isoniazid were 99 and 94.2%, respectively. Moreover, the MC and ABC of TB-SPRINT were USD 127.78 and USD 109.94, respectively. CONCLUSION: TB-SPRINT showed good results for isoniazid and rifampicin resistance detection, but still needs improvement to achieve In Vitro Diagnostics standards.


Asunto(s)
Farmacorresistencia Bacteriana , Citometría de Flujo/métodos , Mycobacterium tuberculosis/genética , Tuberculosis/diagnóstico , Antituberculosos/farmacología , Proteínas Bacterianas/genética , Catalasa/genética , Costos y Análisis de Costo , ARN Polimerasas Dirigidas por ADN/genética , Farmacorresistencia Bacteriana/efectos de los fármacos , Citometría de Flujo/economía , Genotipo , Humanos , Isoniazida/farmacología , Pruebas de Sensibilidad Microbiana , Mutación , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/aislamiento & purificación , Regiones Promotoras Genéticas , Juego de Reactivos para Diagnóstico , Rifampin , Sensibilidad y Especificidad , Tuberculosis/economía
3.
Medicine (Baltimore) ; 98(49): e18073, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804315

RESUMEN

BACKGROUND: MPT64 and PstS1 are the earliest known immune-dominant antigens of Mycobacterium tuberculosis and have been commonly used as candidates in the diagnosis of tuberculosis. METHODS: We constructed recombinant plasmids pET-32a-Rv0934 and pET-32a-Rv1980c to express both wild and mutant forms of MPT64 and PstS1 and purified them. From November 9 to December 9, 2016, and November 9 to December 10, 2017, 96 patients with tuberculosis, 53 patients without tuberculosis, and 96 healthy volunteers were enrolled in this study. We used the purified proteins as antigens to perform T-spot and enzyme-linked immunosorbent assay (ELISA) for samples obtained from healthy volunteers and tuberculosis patients. RESULTS: Regarding T-spot, the area under the curve (AUC) values for MPT64-wild protein (MPT64-H37Rv) and MPT64-mutant protein (MPT64-FJ05395) were 0.723 and 0.750, respectively. The AUC values for PstS1-H37Rv, PstS1-FJ05132, and PstS1-JL06035 were 0.817, 0.796, and 0.745, respectively. With regard to ELISA, the AUC values for MPT64-H37Rv and MPT64-FJ05395 were 0.525 and 0.528, respectively, while those for PstS1-H37Rv, PstS1-FJ05132, PstS1-JL06035 were 0.588, 0.509, and 0.560, respectively. There was no difference between wild and mutant proteins when we used them as antigens to perform T-spot and ELISA assays. CONCLUSION: MPT64 and PstS1 are likely candidate diagnostic antigens for M tuberculosis T-spot test, at least in combination with other proteins. Polymorphisms of MPT64 and PstS1 had little effect on cell-mediated and humoral immunity in the host.


Asunto(s)
Transportadoras de Casetes de Unión a ATP/genética , Antígenos Bacterianos/genética , Proteínas Bacterianas/genética , Mycobacterium tuberculosis/genética , Tuberculosis/diagnóstico , Tuberculosis/inmunología , Femenino , Humanos , Inmunoensayo/métodos , Masculino , Plásmidos , Polimorfismo Genético
4.
N Engl J Med ; 381(26): 2569-2580, 2019 12 26.
Artículo en Inglés | MEDLINE | ID: mdl-31881145

RESUMEN

Rapid advances in DNA sequencing technology ("next-generation sequencing") have inspired optimism about the potential of human genomics for "precision medicine." Meanwhile, pathogen genomics is already delivering "precision public health" through more effective investigations of outbreaks of foodborne illnesses, better-targeted tuberculosis control, and more timely and granular influenza surveillance to inform the selection of vaccine strains. In this article, we describe how public health agencies have been adopting pathogen genomics to improve their effectiveness in almost all domains of infectious disease. This momentum is likely to continue, given the ongoing development in sequencing and sequencing-related technologies.


Asunto(s)
Brotes de Enfermedades , Enfermedades Transmitidas por los Alimentos/epidemiología , Genómica , Secuenciación de Nucleótidos de Alto Rendimiento , Gripe Humana/epidemiología , Salud Pública , Tuberculosis/epidemiología , Animales , Bacterias/genética , Enfermedades Transmitidas por los Alimentos/diagnóstico , Enfermedades Transmitidas por los Alimentos/microbiología , Enfermedades Transmitidas por los Alimentos/parasitología , Humanos , Gripe Humana/diagnóstico , Gripe Humana/microbiología , Metagenómica , Parásitos/genética , Tuberculosis/diagnóstico , Virus/genética
5.
BMC Infect Dis ; 19(1): 1006, 2019 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-31779590

RESUMEN

BACKGROUND: Monocytes are the predominant innate immune cells at the early stage of Mycobacterium tuberculosis (M. tb) infection as the host defense against intracellular pathogens. Understanding the profile of different monocyte subpopulations and the dynamics of monocyte-related biomarkers may be useful for the diagnosis and prognosis of tuberculosis. METHODS: We enrolled 129 individuals comprising patients with pulmonary tuberculosis (PTB) (n = 39), tuberculous pleurisy (TBP) (n = 28), malignant pleural effusion (MPE) (n = 21), latent tuberculosis infection (LTBI) (n = 20), and healthy controls (HC) (n = 21). Surface expression of CD14, CD16, and CD163 on monocytes was detected using flow cytometry. In addition, soluble CD163 (sCD163) was determined by enzyme linked immunosorbent assay. RESULTS: Higher frequency of CD14+CD16+ (15.7% vs 7.8%, P < 0.0001) and CD14-CD16+ (5.3% vs 2.5%, P = 0.0011) monocytes and a decreased percentage of CD14+CD16- (51.0% vs 70.4%, P = 0.0110) cells was observed in PTB patients than in HCs. Moreover, PTB patients displayed a higher frequency of CD163+ cells in CD16+ monocytes than those in the HC group (40.4% vs 11.3%, P < 0.0001). The level of sCD163 was elevated in TBP patients and was higher in pleural effusion than in plasma (2116.0 ng/ml vs 1236.0 ng/ml, P < 0.0001). sCD163 levels in pleural effusion and plasma could be used to distinguish TBP from MPE patients (cut-off values: 1950.0 and 934.7 ng/ml, respectively; AUCs: 0.8418 and 0.8136, respectively). Importantly, plasma sCD163 levels in TBP patients decreased significantly after anti-TB treatment. CONCLUSIONS: Higher expression of membrane and soluble CD163 in active tuberculosis patients might provide insights regarding the pathogenesis of tuberculosis, and sCD163 may be a novel biomarker to distinguish TBP from MPE and to predict disease severity.


Asunto(s)
Antígenos CD/análisis , Antígenos de Diferenciación Mielomonocítica/análisis , Monocitos/metabolismo , Receptores de Superficie Celular/análisis , Tuberculosis/diagnóstico , Adulto , Anciano , Antígenos CD/sangre , Antígenos CD/metabolismo , Antígenos de Diferenciación Mielomonocítica/sangre , Antígenos de Diferenciación Mielomonocítica/metabolismo , Área Bajo la Curva , Estudios de Casos y Controles , Femenino , Humanos , Inmunidad Innata , Receptores de Lipopolisacáridos/metabolismo , Masculino , Persona de Mediana Edad , Monocitos/citología , Monocitos/inmunología , Pronóstico , Curva ROC , Receptores de Superficie Celular/sangre , Receptores de Superficie Celular/metabolismo , Receptores de IgG/metabolismo , Índice de Severidad de la Enfermedad , Tuberculosis/inmunología , Tuberculosis/patología , Tuberculosis Pleural/inmunología , Tuberculosis Pleural/patología , Tuberculosis Pulmonar/inmunología , Tuberculosis Pulmonar/patología
6.
Praxis (Bern 1994) ; 108(15): 1019-1026, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31771497

RESUMEN

CME: Extrapulmonary Tuberculosis Abstract. While tuberculosis mostly manifests as pulmonary infection, a dissemination in any extrapulmonary organ is possible. Extrapulmonary tuberculosis mostly affects lymph nodes, pleura and bones. Patients with immunosuppressive conditions such as an HIV co-infection or immunosuppressive therapies like TNF-alpha-inhibitors have a higher risk of a dissemination of tuberculosis. Diagnosis of extrapulmonary tuberculosis is difficult, as microbiological testing mostly requires invasive procedures to obtain a sample for direct proof of tuberculosis by microscopy, culture, molecular methods (e.g. Xpert® MTB/RIF) or histology. Treatment follows guidelines of pulmonary tuberculosis with a two-month regimen consisting of four drugs (rifampicin, isoniazide, pyrazinamide and ethambuthol), followed by a four-month therapy with two drugs (rifampicin and isoniazide). Duration of therapy is extended in tuberculous meningitis to one year and in a skeletal dissemination up to six to nine months. Corticosteroids are recommended in cerebral and pericardial tuberculosis.


Asunto(s)
Antibióticos Antituberculosos , Mycobacterium tuberculosis , Tuberculosis , Antibióticos Antituberculosos/uso terapéutico , Humanos , Rifampin , Sensibilidad y Especificidad , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico
7.
BMC Infect Dis ; 19(1): 972, 2019 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-31727001

RESUMEN

BACKGROUND: In recent years, tuberculosis outbreaks in schools have occurred more frequently in China than in other parts of the world, and have posed a public health threat to students and their families. This systematic review aimed to understand the epidemiological characteristics of tuberculosis (TB) outbreaks and analyze the factors associated with TB outbreaks in schools in China. METHODS: We conducted this systematic review following the standard procedures of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The meta-analysis was performed with STATA using a random effects model. RESULTS: We included 107 studies involving 1795 student patients with TB in mainland China. The results of the systematic analysis indicated that TB outbreaks were more frequently reported in senior middle schools and in Eastern China. The outbreaks mainly occurred during the winter and spring, and the median outbreak duration was 4 months. The meta-analysis showed that the total attack rate and the class attack rate of tuberculosis outbreaks among students were 4.60% (95% CI 3.80 to 5.70%) and 22.70% (95% CI 19.20 to 27.00%), respectively. Subgroup analysis showed that outbreaks that occurred at universities or colleges had a relatively higher attack rate than those occurred in senior middle schools. The prevalence of latent tuberculosis infection (LTBI) among close contacts was 23.70% (95% CI 19.50 to 28.90%). The median case-finding interval was 2 months, and 47.40% of the index cases had a case-finding delay. CONCLUSION: The results of our review indicated that school TB outbreaks were reported most frequently in senior middle schools in China. The attack rates of outbreaks at universities or colleges were higher than those in senior middle schools. The TB outbreaks in schools usually occurred over prolonged periods. The case-finding delay in the index cases must be reduced to prevent transmission in classes and schools. Effective surveillance and screening of presumptive TB cases in schools should be strengthened to reduce outbreaks in schools.


Asunto(s)
Estudiantes/estadística & datos numéricos , Tuberculosis/diagnóstico , China/epidemiología , Bases de Datos Factuales , Brotes de Enfermedades , Humanos , Factores Sexuales , Tuberculosis/epidemiología
8.
Mikrobiyol Bul ; 53(4): 355-363, 2019 Oct.
Artículo en Turco | MEDLINE | ID: mdl-31709933

RESUMEN

One of the most important steps for the control of tuberculosis is rapid and accurate detection of Mycobacterium tuberculosis in clinical samples. The early and accurate diagnosis of tuberculosis allows the initiation of the effective treatment regimen as early as possible. However the early diagnosis of tuberculosis can be achieved by the integration of molecular methods into the diagnostic algorithm of tuberculosis together with the gold standard culture methods. For this reason, molecular methods have become valuable diagnostic tools in routine diagnostic laboratories in recent years. The aim of this study was to determine the diagnostic efficacy of Anyplex MTB/NTM test (Seegene, South Korea) used for the molecular diagnosis of tuberculosis in routine molecular diagnostic laboratories. In addition to this aim, a preliminary evaluation of in-house polymerase chain reaction (PCR) primers that was designed to produce a kit as an alternative against imported commercial kits was performed. Ten thousand six hundred fifthy two clinical specimens that were collected from suspected tuberculosis cases in three years were included in the study. All samples were tested by microscopic examination after staining, culture and real-time PCR (Rt-PCR) methods. The smears were examined by microscope after staining with Kinyoun method for the existence of acid resistant bacilli. For culture, following the N-acetyl-L-sistein-sodium hydroxide homogenization and decontamination procedure, the samples were inoculated into the MGIT (Mycobacteria Growth Indicator Tube) tubes (Becton Dickinson, USA). Rt-PCR method was performed by using Anyplex MTB/NTM test. In the first stage of the study, the performance of the Anyplex MTB/NTM test was compared with the gold standard culture method. M.tuberculosis was isolated in 178 specimens out of 10.652 (1.7%). After the comparison with the gold standard culture method, the sensitivity and specificity of Anyplex MTB/NTM test was found to be 84% and 99% respectively in pulmonary samples, and 74% and 99% respectively in extrapulmonary samples. In the second stage of the study, PCR method with laboratory designed primers was applied to 100 culture positive samples. The PCR results of 98 samples were found to be in agreement with the culture, while M.tuberculosis DNA was not detected in two samples. As a result of the study it was concluded that Anyplex MTB/NTM test is a rapid, practical and reliable method that can be used in routine tuberculosis diagnosis. The high agreement between PCR method using the laboratory-designed primers and the PCR method used in routine practice will lighten the way for the development of national tuberculosis molecular diagnostic kits with a relevant cost. In this way, it will be possible to perform rapid diagnosis in a more cost-effective manner in routine diagnosis laboratories.


Asunto(s)
Mycobacterium tuberculosis , Tuberculosis , Humanos , Reacción en Cadena en Tiempo Real de la Polimerasa/normas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Tuberculosis/diagnóstico , Tuberculosis/microbiología
9.
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
10.
Internist (Berl) ; 60(11): 1155-1175, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31641790

RESUMEN

Tuberculosis is a bacterial infectious disease that is usually transmitted by inhalation of droplets containing the bacteria. The World Health Organization (WHO) estimates that approximately 10 million patients were newly diagnosed with tuberculosis in 2017. Rapid diagnosis relies on a combination of imaging and microbiological, molecular, and, rarely, immunological tests. Genotypic methods enable early diagnosis and allow highly accurate prediction of drug resistance. Phenotypic (culture-based) methods are the diagnostic gold standard. Standard management of patients with pan drug-susceptible pulmonary tuberculosis includes a combination of rifampicin, isoniazid, ethambutol and pyrazinamide for 2 months followed by rifampicin and isoniazid for additional 4 months, which leads to cure rates of >80%. With individualized treatment schemes, similar cure rates can be achieved for patients with multidrug-resistant tuberculosis.


Asunto(s)
Antituberculosos/uso terapéutico , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Etambutol/uso terapéutico , Humanos , Isoniazida/uso terapéutico , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Tuberculosis/microbiología , Tuberculosis Resistente a Múltiples Medicamentos/microbiología
12.
Artículo en Chino | MEDLINE | ID: mdl-31594129

RESUMEN

Objective: To evaluate the performence of GeneXpert MTB/RIF and BACTEC-MGIT 960 on detecting Mycobacterium tuberculosis and rifampicin resistance for pneumoconiosis-associated tuberculosis patients. Methods: The recruited 133 suspected active pneumoconiosis-associated tuberculosis hospitalized cases, morning sputum samples were collected to do modified L-J culture, conventional proportion method drug susceptibility test, GeneXpert MTB/RIF and BACTEC-MGIT 960. Analyze the sensitivity and specificity of the 133 sputum from patients, the positive rates of patients with tuberculosis in GeneXpert MTB/RIF test, BACTEC-MGIT 960 and modified L-J culture were 37.59%, 34.59% and 30.08% respectively. There was no significant difference among the three tests respectively (P>0.05) . According to the modified L-J culture, the sensitivity of GeneXpert MTB/RIF and BACTEC-MGIT 960 in detecting tuberculosis were 92.5% and 95.0% respectively, and specificity in rifampicin resistance were 86.0% and 91.4% respectively. There was no significant difference between GeneXpert MTB/RIF and BACTEC-MGIT 960 (P>0.05) . According to conventional proportion method drug susceptibility test, the sensitivity of GeneXpert MTB/RIF and BACTEC-MGIT 960 in detecting rifampicin resistance were 90.0% and 100%, and specificity were 92.6% and 96.4%. There was no significant difference between GeneXpert MTB/RIF and BACTEC-MGIT 960 (P>0.05) . Conclusion: The GeneXpert MTB/RIF has good performence of detecting tuberculosis and rifampicin resistance. It has good application value among pneumoconiosis-associated tuberculosis patients.


Asunto(s)
Farmacorresistencia Bacteriana , Neumoconiosis/complicaciones , Neumoconiosis/microbiología , Tuberculosis/diagnóstico , Humanos , Mycobacterium tuberculosis , Rifampin , Sensibilidad y Especificidad , Esputo
13.
Pan Afr Med J ; 33: 158, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31565120

RESUMEN

Introduction: While HIV care among tuberculosis (TB) patients is successfully implemented and monitored, it is not routinely reported among "presumptive TB patients without TB". The present study describes the ascertainment of HIV status and receipt of antiretroviral therapy (ART) and the associated factors among presumptive TB patients (with and without TB) in 35 public health facilities of Masvingo district of Zimbabwe from January to June 2017. Methods: This was an analysis of secondary programme data. We performed log binomial regression to calculate adjusted relative risks (aRR) and 95% confidence intervals (CI). Results: Of 1369 presumptive TB patients, 1181 (86%) were ascertained for HIV status (98% among those subsequently diagnosed with TB, 83% among non-TB). Of them, 748 (63%) were HIV positive, more among TB patients (69%) than those without TB (61%). Among HIV-positive patients, 475 (64%) received ART, significantly higher among TB patients (78%) compared to those without TB (57%). Patients without TB were significantly more likely to have non-ascertained for HIV status (aRR=2.4, 95% CI=1.4-5.0) and not receiving ART (aRR=1.8, 95% CI=1.6-2.0), compared to those with TB. Conclusion: We found high rates of HIV status ascertainment among presumptive TB patients. But, ART uptake was poor among "presumptive TB patients without TB", despite implementation of "test and treat" strategy in Zimbabwe. The programme should step up the monitoring of HIV status and ART receipt among presumptive TB patients, by introducing an indicator in the quarterly reports of the national TB programme.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/diagnóstico , Tamizaje Masivo/métodos , Tuberculosis/epidemiología , Adolescente , Adulto , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Análisis de Regresión , Tuberculosis/diagnóstico , Adulto Joven , Zimbabwe
14.
Medicine (Baltimore) ; 98(42): e17416, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31626097

RESUMEN

This study aims to evaluate the clinical value of haptoglobin (Hp) and sCD163 testing for the differential diagnosis of pleural effusion, and investigate the correlation of Hp and sCD163 with the inflammatory response of the body.Pleural effusion samples were collected from 78 patients (38 tuberculous pleural effusions [TPE] and 40 malignant pleural effusions [MPE]). The concentrations of Hp and sCD163 in the pleural effusion were measured by enzyme-linked immunosorbent assay (ELISA).The concentrations of Hp and sCD163 were significantly higher in the TPE group than in the MPE group (P < .05). The sensitivity and specificity of the Hp test for the differential diagnosis of TPE and MPE was 82.4% and 86.1%, respectively (P < .01), while the cut off value was 779.05 ug/mL. Furthermore, the sensitivity and specificity of the sCD163 test for the differential diagnosis of TPE and MPE was 76.3% and 85.0%, respectively (P < .01), while the cut off value was 16,401.11 ng/mL. Moreover, the sensitivity and specificity of the combination of Hp and sCD163 tests for diagnosing TPE was 90.0% and 87.5%, respectively. Hp and IL-1ß, TNF-α, CRP and ESR were positively correlated in both the TPE group and MPE group (P < .05). Hp and sCD163 were positively correlated in the TPE group (r = 0.3735, P = .0209), but not in the MPE group (r = 0.22, P = .1684). However, there was no correlation between sCD163 and TNF-α, CRP and ESR in either the TPE group, or the MPE group (P > .05). Furthermore, sCD163 and IL-1ß were weakly correlated in the TPE group (r = 0.49, P = .0018), but these had no correlation in the MPE group (r = 0.068, P = .6767).Hp and sCD163 can be used as biological markers for the differential diagnosis of pleural effusion in clinic, and the level of Hp in pleural effusion may reflect the intensity of inflammation in the body to some extent.


Asunto(s)
Antígenos CD/sangre , Antígenos de Diferenciación Mielomonocítica/sangre , Haptoglobinas/análisis , Derrame Pleural Maligno/diagnóstico , Receptores de Superficie Celular/sangre , Tuberculosis/diagnóstico , Anciano , Biomarcadores/sangre , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Diagnóstico Diferencial , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Interleucina-1beta/sangre , Masculino , Persona de Mediana Edad , Derrame Pleural Maligno/sangre , Curva ROC , Sensibilidad y Especificidad , Factor de Necrosis Tumoral alfa/sangre
15.
Acta Paul. Enferm. (Online) ; 32(5): 554-563, Set.-Out. 2019. tab
Artículo en Portugués | LILACS-Express | ID: biblio-1038052

RESUMEN

Resumo Objetivo Analisar os aspectos associados ao desfecho dos casos de tuberculose nas pessoas que vivem com HIV. Métodos Estudo transversal, realizado entre 2010 a 2014 em um município de grande porte localizado no interior do estado de São Paulo, o qual é considerado prioritário para o controle da tuberculose. Utilizou-se dados secundários coletados nos sistemas de informação TBWEB, SINAN, SISCEL e SICLOM. Foram utilizadas técnicas de estatística descritiva e Regressão Logística Multinomial, considerando o desfecho (cura, abandono e óbito) como variável dependente e as informações sociodemográficas, clínicas e de acompanhamento clínico/terapêutico como independentes. Resultados Observou-se uma maior chance de ocorrência de desfecho desfavorável do tratamento da tuberculose entre as pessoas que viviam com HIV com menor escolaridade, com histórico de internação e sem o registro do tipo de tratamento realizado. Conclusão Reforça-se a necessidade de integração entre os programas de controle da tuberculose e de HIV/aids, bem como entre esses e os demais serviços das redes de atenção à saúde e rede de apoio social para a oferta de ações e serviços que contemplem as necessidades sociais, econômicas e de saúde, visando o adequado seguimento dos casos de coinfecção TB-HIV e a obtenção de desfechos favoráveis da tuberculose nas pessoas vivendo com HIV.


Resumen Objetivo analizar los aspectos asociados al desenlace de los casos de tuberculosis en personas que viven con el VIH. Métodos estudio transversal, realizado entre 2010 y 2014 en un municipio de gran tamaño localizado en el interior del estado de São Paulo, considerado prioritario para el control de la tuberculosis. Se utilizaron datos secundarios recolectados en los sistemas de información TBWEB, SINAN, SISCEL y SICLOM. Se utilizaron técnicas de estadística descriptiva y regresión logística multinomial, considerando el desenlace (cura, abandono y óbito) como variable dependiente y la información sociodemográfica, clínica y de seguimiento clínico/terapéutico como independiente. Resultados se observó una mayor posibilidad de desenlace desfavorable del tratamiento de la tuberculosis entre las personas que vivían con el VIH con menos escolaridad, con antecedentes de internación y sin registro del tipo de tratamiento realizado. Conclusión se refuerza la necesidad de integración entre los programas de control de la tuberculosis y de VIH/sida, así como también entre estos y los demás servicios de las redes de atención en salud y red de apoyo social para la oferta de acciones y servicios que contemplen las necesidades sociales, económicas y de salud, a fin de proporcionar un seguimiento adecuado de los casos de coinfección TB-HIV y obtener desenlaces favorables de la tuberculosis en las personas que viven con el VIH.


Abstract Objective To analyze the aspects associated with tuberculosis cases outcome among people living with HIV. Methods A cross-sectional study conducted between 2010 and 2014 in a large municipality located in the countryside of São Paulo State, which was considered a priority city for tuberculosis control. Secondary data collected in the TBWEB, SINAN, SISCEL and SICLOM information systems were used. Descriptive statistics and Multinomial Logistic Regression techniques were used, considering outcome (cure, default and death) as a dependent variable, and sociodemographic, clinical and clinical/therapeutic follow-up information as independent. Results A higher chance of occurrence of unfavorable TB treatment outcome in people living with HIV was observed among those with lower education degree, hospitalization history and without record of the treatment type received. Conclusion There should be integration between tuberculosis and HIV/AIDS control programs, as well as other services of health care networks and social support network for the provision of actions and services that address social, economic and health needs, aiming at the adequate follow-up of TB-HIV co-infection cases and the achievement of favorable tuberculosis outcomes in people living with HIV.


Asunto(s)
Tuberculosis/diagnóstico , Estudios Transversales , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , VIH
17.
J Assoc Physicians India ; 67(8): 31-34, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31562713

RESUMEN

Background: To evaluate the diagnostic accuracy of the Xpert MTB/RIF assay for the detection of M. tuberculosis in pulmonary and extra pulmonary specimens and to compare it with conventional techniques. Methods: A prospective study was conducted with the introduction of GeneXpert in a tertiary care hospital which relied on microscopy and culture for diagnosis of tuberculosis. All patients for whom geneXpert was ordered by the physician were included in the study. Samples which did not have accompanying microscopy or MGIT culture requests were excluded from the analysis of the results. Sensitivity and specificity of GeneXpert was calculated using liquid culture as the reference test. Results: Xpert MTB/RIF assay was performed on 742 samples of which 116 were positive for Mycobacterium tuberculosis. Rifampicin resistance was seen in 6 samples. The pulmonary samples showed a positivity rate of 16.8% while 17.1% of the extrapulmonary samples were positive by GeneXpert. A comparative analysis of microscopy, liquid culture and GeneXpert could be done for 88 samples. Of the 88 geneXpert positive samples, 42 were positive by smear microscopy and MGIT culture while 46 showed discordant results. Of these, 18 samples were positive by geneXpert but showed no growth in MGIT culture. 15 of these patients had undergone anti-tuberculous treatment (ATT) within the past 12 months. The sensitivity of geneXpert was 89.7% and specificity was 95.1% when compared to liquid culture as a gold standard. Sensitivity for extrapulmonary samples was 85.7% and specificity was 98.05%. Conclusion: To conclude, though GeneXpert detects tuberculosis within the shortest possible time, it still suffers from intermediate level sensitivity, which makes culture facilities relevant even in settings that offer an Xpert/Rif assay.


Asunto(s)
Bioensayo/métodos , Mycobacterium tuberculosis , Centros de Atención Terciaria , Tuberculosis/diagnóstico , Farmacorresistencia Bacteriana/genética , Humanos , India , Microscopía , Estudios Prospectivos , Rifampin , Sensibilidad y Especificidad , Esputo , Tuberculosis/microbiología
18.
Int J Mycobacteriol ; 8(3): 262-266, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31512602

RESUMEN

Background: Childhood tuberculosis (TB) is a major health problem worldwide, especially in developing countries. In 2015, there are estimated 950,000 cases of childhood TB. Since most TB in children is paucibacillary, this gives rise not only to problem in diagnosing but also in monitoring the response to anti-TB treatment as well. Soluble urokinase-type plasminogen activator receptor (suPAR), a glycosylphosphatidylinositol-linked membrane protein of various cells of immune system, is one of the potential biomarkers to be used in the management of TB. The objective of this study is to study the decrease of serum suPAR level after anti-TB treatment in children with TB and its association with patient characteristics. Methods: We conducted a prospective study on children suspected of having TB due to a history of contact with active TB case and symptoms such as coughing, fever, and enlarged lymph nodes. The diagnosis of TB is established by history, physical examination including anthropometric examination. Tuberculin skin test using PPD RT-23 and interferon-gamma releasing assay with Quantiferon TB-Gold Plus was performed. Chest X-rays were read by two independent radiologists. Microbiological examination was performed using microscopic examination and Xpert MTB/RIF. The level of suPAR before and after anti-TB treatment was examined with the Elisa method. Results: There was no significant difference of serum suPAR levels before and after anti-TB treatment (mean 0.71 [standard deviation 0.585] ng/mL; P = 0.072). There was no association between ages (P = 0.112), nutritional status (P = 0.228), diagnosis of pulmonary or extrapulmonary TB (P = 0.956), and radiological feature (P = 0.810) with serum suPAR levels decrease. Conclusion: There is no suPAR serum level decrease 2 months after treatment with anti-TB and there is no association with age, nutritional status, pulmonary or extrapulmonary TB diagnosis, and radiological feature.


Asunto(s)
Antituberculosos/uso terapéutico , Receptores del Activador de Plasminógeno Tipo Uroquinasa/sangre , Tuberculosis/tratamiento farmacológico , Adolescente , Biomarcadores/sangre , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Lactante , Masculino , Estudios Prospectivos , Tuberculosis/sangre , Tuberculosis/diagnóstico
19.
Pneumologie ; 73(9): 516-522, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31533173

RESUMEN

BACKGROUND: Big cities in Europe have the highest incidence rates of TB in otherwise low incidence settings. Understanding of the spatio-temporal patterns of TB incidence can support efforts for TB prevention and control in line with the End-TB Strategy of the WHO in such settings for low incidence settings. METHODS: Data from the municipal TB register of Cologne collected between 2006 and 2015 under the infection prevention legislation were retrieved, addresses geographically identified and all notified incident TB cases retrospectively analysed for their spatial and temporal distribution in this large German city using a geographic information system. RESULTS: During the analysed period 1,038 incident cases were reported, equivalent to an incidence rate of 10.03 cases per 100,000 inhabitants. Contagious pulmonary TB contributed 57 % of all cases. Distribution patterns changed over time with decreases in 37 and increases in 22 of the 77 urban sub-districts, three of which showing constant high rates of TB incidence. CONCLUSION: The study presents a complementary method to monitor the distribution and development of incident TB cases at a disaggregated level of urban sub-districts. Identification of areas with comparatively high incidence can support identification of clusters respectively their prevention and allow better planning for targeted local TB services.


Asunto(s)
Análisis Espacio-Temporal , Tuberculosis Pulmonar/epidemiología , Tuberculosis/epidemiología , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Niño , Preescolar , Femenino , Geografía , Alemania/epidemiología , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Distribución por Sexo , Factores Socioeconómicos , Tuberculosis/diagnóstico , Tuberculosis Pulmonar/diagnóstico
20.
Urologe A ; 58(10): 1219-1230, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31552438

RESUMEN

In the context of refugee migrations infectious diseases are being more frequently diagnosed, which the responsible physicians as well as urologists have never seen before. This is due to the poorer health and hygiene conditions in the country of origin, during the flight and in the refugee camps. In Europe increasing incidences of tuberculosis, schistosomiasis and scabies have recently been observed. Tuberculosis and schistosomiasis are often accompanied by unspecific symptoms or can resemble normally encountered urological diseases. Due to the highly contagious nature of scabies, a screening of new arrivals is recommended. A timely differential diagnostic inclusion of these disease patterns is enormously important. Despite the reduction in the numbers of asylum applications in Germany, a higher number of unregistered migrants is generally assumed, who also elude the healthcare system and can therefore contribute to the spread of these rare infectious diseases.


Asunto(s)
Tamizaje Masivo/métodos , Refugiados , Migrantes , Tuberculosis Urogenital/diagnóstico , Infecciones Urinarias/diagnóstico , Diagnóstico Diferencial , Alemania , Humanos , Infecciones del Sistema Genital/diagnóstico , Esquistosomiasis/diagnóstico , Tuberculosis/diagnóstico
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