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1.
BMC Infect Dis ; 20(1): 744, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33036570

RESUMEN

BACKGROUND: The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the twenty-first century. In high burden HIV/TB countries, the spread of COVID-19 among people living with HIV is a well-founded concern. A thorough understanding of HIV/TB and COVID-19 pandemics is important as the three diseases interact. This may clarify HIV/TB/COVID-19 as a newly related field. However, several gaps remain in the knowledge of the burden of COVID-19 on patients with TB and HIV. This study was conducted to review different studies on SARS-CoV, MERS-CoV or COVID-19 associated with HIV/TB co-infection or only TB, to understand the interactions between HIV, TB and COVID-19 and its implications on the burden of the COVID-19 among HIV/TB co-infected or TB patients, screening algorithm and clinical management. METHODS: We conducted an electronic search of potentially eligible studies published in English in the Cochrane Controlled Register of Trials, PubMed, Medrxiv, Google scholar and Clinical Trials Registry databases. We included case studies, case series and observational studies published between January, 2002 and July, 2020 in which SARS-CoV, MERS-CoV and COVID-19 co-infected to HIV/TB or TB in adults. We screened titles, abstracts and full articles for eligibility. Descriptive and meta-analysis were done and results have been presented in graphs and tables. RESULTS: After removing 95 duplicates, 58 out of 437 articles were assessed for eligibility, of which 14 studies were included for descriptive analysis and seven studies were included in the meta-analysis. Compared to the descriptive analysis, the meta-analysis showed strong evidence that current TB exposure was high-risk COVID-19 group (OR 1.67, 95% CI 1.06-2.65, P = 0.03). The pooled of COVID-19/TB severity rate increased from OR 4.50 (95% CI 1.12-18.10, P = 0.03), the recovery rate was high among COVID-19 compared to COVID-19/TB irrespective of HIV status (OR 2.23, 95% CI 1.83-2.74, P < 0.001) and the mortality was reduced among non-TB group (P < 0.001). CONCLUSION: In summary, TB was a risk factor for COVID-19 both in terms of severity and mortality irrespective of HIV status. Structured diagnostic algorithms and clinical management are suggested to improve COVID-19/HIV/TB or COVID-19/TB co-infections outcomes.


Asunto(s)
Coinfección/epidemiología , Infecciones por Coronavirus/epidemiología , Salud Global/estadística & datos numéricos , Infecciones por VIH/epidemiología , Neumonía Viral/epidemiología , Tuberculosis/epidemiología , Betacoronavirus , Infecciones por Coronavirus/mortalidad , Humanos , Pandemias , Neumonía Viral/mortalidad , Prevalencia , Sistema de Registros , Factores de Riesgo
2.
BMC Infect Dis ; 20(1): 720, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33004004

RESUMEN

BACKGROUND: Children living with sputum smear-positive adult tuberculosis (TB) patients are vulnerable to acquire tubercular infection. Contact tracing is an important strategy to control tubercular infection in the community. This study was done to find out prevalence of tuberculosis and tubercular infection in children living with sputum smear-positive adult patients receiving DOTS at recruitment and to find out incidence of tubercular infection and disease in these children on follow up. METHOD: Children (< 15 years) living in contact with adults on DOTS were grouped as < 6 years and 6-14 years. They were further sub grouped as being - uninfected, infected, diseased and on prophylaxis and were followed at 3, 6 and 9 months. Tuberculin skin test (TST) and chest X-ray were done. RESULTS: At recruitment 152 children were enrolled and 21.1% (n = 32) had TB. On follow up, 4.3% (n = 5), 5.8% (n = 6) and 11.6% (n = 11) children developed TB after 3, 6 and 9 months respectively.9 children did not come for the last follow up so the overall prevalence of TB disease at 9 months was 37.7% (n = 54). Out of the 128 children with TST reading 23.4% (n = 30) child contacts were found to be infected already at recruitment. The incidence of TST conversion was 20.7% (n = 18), 26.9% (n = 18) and 16.3% (n = 7) respectively. The overall prevalence of tubercular infection in the children, who were in contact with TB patients for 9 months was 74.5% (n = 73). CONCLUSION: About half the children were either suffering from TB or tubercular infection on recruitment. During 9 months follow up 22 unaffected children developed disease and 43acquired infection.


Asunto(s)
Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Composición Familiar , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Esputo/microbiología , Prueba de Tuberculina , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Adulto Joven
3.
Rev Assoc Med Bras (1992) ; 66(9): 1196-1202, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33027445

RESUMEN

OBJECTIVE: To describe the temporal trend, clinical profile, and the prevalence of risk factors and associated comorbidities in new cases of tuberculosis in the Northeast (2001-2016). METHODS: A prevalence study involving all tuberculosis cases registered in Northeast Brasil, 2001-2016. Data were obtained from the National System of Notification of Disorders. For statistical analysis, the inflection point regression model and descriptive statistics were used. RESULTS: 331,245 cases of tuberculosis were reported. The overall incidence rate decreased from 44.84/100,000 inhabitants (2001) to 30.92/100,000 inhabitants (2016), with a decreasing trend (AAPC: -2.3; p<0.001). The profile was characterized by men (73.53%), age 20-59 years (73.56%), pulmonary tuberculosis (86.37%), positive smear microscopy (54.78%). The main risk factors and comorbidities were: AIDS (4.64%), HIV (12.10%), Diabetes mellitus (5.46%), alcohol (11.63%), institutionalized, (4.31%) and deprived of liberty (2.30%). The cure rate was 70.66% and the abandonment rate was 9.11%. CONCLUSIONS: Even with a reduced incidence, tuberculosis represents a real public health problem in the Northeast region. The profile was characterized by a male population, in economically-active age, lung smear-positive pulmonary presentation, and the risk factors and comorbidities of Aids, TB/HIV co-infection, diabetes mellitus, alcohol consumption, institutionalized and deprived of freedom reflect the complexity of the challenges in facing the disease.


Asunto(s)
Tuberculosis , Adulto , Brasil , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Tuberculosis/epidemiología , Adulto Joven
4.
Can Respir J ; 2020: 1401053, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32934758

RESUMEN

Background: The threat of contagious infectious diseases is constantly evolving as demographic explosion, travel globalization, and changes in human lifestyle increase the risk of spreading pathogens, leading to accelerated changes in disease landscape. Of particular interest is the aftermath of superimposing viral epidemics (especially SARS-CoV-2) over long-standing diseases, such as tuberculosis (TB), which remains a significant disease for public health worldwide and especially in emerging economies. Methods and Results: The PubMed electronic database was systematically searched for relevant articles linking TB, influenza, and SARS-CoV viruses and subsequently assessed eligibility according to inclusion criteria. Using a data mining approach, we also queried the COVID-19 Open Research Dataset (CORD-19). We aimed to answer the following questions: What can be learned from other coronavirus outbreaks (focusing on TB patients)? Is coinfection (TB and SARS-CoV-2) more severe? Is there a vaccine for SARS-CoV-2? How does the TB vaccine affect COVID-19? How does one diagnosis affect the other? Discussions. Few essential elements about TB and SARS-CoV coinfections were discussed. First, lessons from past outbreaks (other coronaviruses) and influenza pandemic/seasonal outbreaks have taught the importance of infection control to avoid the severe impact on TB patients. Second, although challenging due to data scarcity, investigating the pathological pathways linking TB and SARS-CoV-2 leads to the idea that their coexistence might yield a more severe clinical evolution. Finally, we addressed the issues of vaccination and diagnostic reliability in the context of coinfection. Conclusions: Because viral respiratory infections and TB impede the host's immune responses, it can be assumed that their lethal synergism may contribute to more severe clinical evolution. Despite the rapidly growing number of cases, the data needed to predict the impact of the COVID-19 pandemic on patients with latent TB and TB sequelae still lies ahead. The trial is registered with NCT04327206, NCT01829490, and NCT04121494.


Asunto(s)
Coinfección/epidemiología , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Tuberculosis/epidemiología , Vacuna BCG/uso terapéutico , Betacoronavirus , Técnicas de Laboratorio Clínico , Coinfección/inmunología , Coinfección/fisiopatología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/fisiopatología , Citocinas/inmunología , Errores Diagnósticos , Brotes de Enfermedades , Humanos , Gripe Humana/epidemiología , Gripe Humana/fisiopatología , Coronavirus del Síndrome Respiratorio de Oriente Medio , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/inmunología , Neumonía Viral/fisiopatología , Virus del SRAS , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/fisiopatología , Índice de Severidad de la Enfermedad , Tuberculosis/inmunología , Tuberculosis/fisiopatología , Tuberculosis/prevención & control
5.
Ann Ist Super Sanita ; 56(3): 359-364, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32959802

RESUMEN

Current literature shows that secondary bacterial infections, although less frequent than in previous influenza pandemics, affect COVID-19 patients. Mycoplasma pneumoniae, Staphylococcus aureus, Legionella pneumophila, Streptococcus pneumoniae, Haemophilus and Klebsiella spp. are the main species isolated. Of note, Mycobacterium tuberculosis-COVID-19 coinfections are also reported. However, bacterial coinfection rates increase in patients admitted in the intensive care units, and those diseases can be due to super-infections by nosocomial antibiotic-resistant bacteria. This highlights the urgency to revise frequent and empiric prescription of broad-spectrum antibiotics in COVID-19 patients, with more attention to evidence-based studies and respect for the antimicrobial stewardship principles.


Asunto(s)
Infecciones Bacterianas/epidemiología , Betacoronavirus , Coinfección/epidemiología , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Programas de Optimización del Uso de los Antimicrobianos , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/transmisión , Infección Hospitalaria/epidemiología , Infección Hospitalaria/transmisión , Farmacorresistencia Microbiana , Diagnóstico Precoz , Humanos , Unidades de Cuidados Intensivos , Italia/epidemiología , Micosis/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Especificidad de la Especie , Tuberculosis/epidemiología
6.
S Afr Med J ; 110(7): 621-624, 2020 06 17.
Artículo en Inglés | MEDLINE | ID: mdl-32880335

RESUMEN

Infectious diseases pandemics have devastating health, social and economic consequences, especially in developing countries such as South Africa. Scarce medical resources must often be rationed effectively to contain the disease outbreak. In the case of COVID-19, even the best-resourced countries will have inadequate intensive care facilities for the large number of patients needing admission and ventilation. The scarcity of medical resources creates the need for national governments to establish admission criteria that are evidence-based and fair. Questions have been raised whether infection with HIV or tuberculosis (TB) may amplify the risk of adverse COVID-19 outcomes and therefore whether these conditions should be factored in when deciding on the rationing of intensive care facilities. In light of these questions, clinical evidence regarding inclusion of these infections as comorbidities relevant to intensive care unit admission triage criteria is investigated in the first of a two-part series of articles. There is currently no evidence to indicate that HIV or TB infection on their own predispose to an increased risk of infection with SARS-CoV-2 or worse outcomes for COVID-19. It is recommended that, as for other medical conditions, validated scoring systems for poor prognostic factors should be applied. A subsequent article examines the ethicolegal implications of limiting intensive care access of persons living with HIV or TB.


Asunto(s)
Infecciones por Coronavirus , Infecciones por VIH/epidemiología , Asignación de Recursos para la Atención de Salud/métodos , Unidades de Cuidados Intensivos , Pandemias , Neumonía Viral , Triaje/organización & administración , Tuberculosis/epidemiología , Betacoronavirus/aislamiento & purificación , Coinfección , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Necesidades y Demandas de Servicios de Salud/organización & administración , Humanos , Unidades de Cuidados Intensivos/economía , Unidades de Cuidados Intensivos/normas , Pandemias/economía , Selección de Paciente , Neumonía Viral/economía , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Pronóstico , Medición de Riesgo , Sudáfrica/epidemiología
7.
S Afr Med J ; 110(7): 625-628, 2020 06 17.
Artículo en Inglés | MEDLINE | ID: mdl-32880336

RESUMEN

The COVID-19 pandemic has brought discussions around the appropriate and fair rationing of scare resources to the forefront. This is of special importance in a country such as South Africa (SA), where scarce resources interface with high levels of need. A large proportion of the SA population has risk factors associated with worse COVID-19 outcomes. Many people are also potentially medically and socially vulnerable secondary to the high levels of infection with HIV and tuberculosis (TB) in the country. This is the second of two articles. The first examined the clinical evidence regarding the inclusion of HIV and TB as comorbidities relevant to intensive care unit (ICU) admission triage criteria. Given the fact that patients with HIV or TB may potentially be excluded from admission to an ICU on the basis of an assumption of lack of clinical suitability for critical care, in this article we explore the ethicolegal implications of limiting ICU access of persons living with HIV or TB. We argue that all allocation and rationing decisions must be in terms of SA law, which prohibits unfair discrimination. In addition, ethical decision-making demands accurate and evidence-based strategies for the fair distribution of limited resources. Rationing decisions and processes should be fair and based on visible and consistent criteria that can be subjected to objective scrutiny, with the ultimate aim of ensuring accountability, equity and fairness.


Asunto(s)
Infecciones por Coronavirus , Infecciones por VIH/epidemiología , Asignación de Recursos para la Atención de Salud/métodos , Unidades de Cuidados Intensivos , Pandemias , Selección de Paciente/ética , Neumonía Viral , Asignación de Recursos , Triaje , Tuberculosis/epidemiología , Betacoronavirus/aislamiento & purificación , Coinfección , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Necesidades y Demandas de Servicios de Salud/organización & administración , Humanos , Unidades de Cuidados Intensivos/economía , Unidades de Cuidados Intensivos/normas , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Asignación de Recursos/ética , Asignación de Recursos/legislación & jurisprudencia , Sudáfrica/epidemiología , Triaje/economía , Triaje/ética , Triaje/legislación & jurisprudencia
8.
Top Antivir Med ; 28(2): 455-458, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32886465

RESUMEN

Due to COVID-19, this year marked the first virtual Conference on Retroviruses and Opportunistic Infections (CROI) in the conference's 27-year history. There were important studies presented that provided new insights into the prevention, diagnosis, and treatment of tuberculosis (TB) and other HIV coinfections. Highlights related to TB and HIV coinfections from this year's meeting are reviewed below.


Asunto(s)
Coinfección/epidemiología , Infecciones por VIH/epidemiología , Infecciones Oportunistas/epidemiología , Salud Pública , Tuberculosis/epidemiología , Adulto , Fármacos Anti-VIH/uso terapéutico , Antituberculosos/uso terapéutico , Coinfección/diagnóstico , Coinfección/tratamiento farmacológico , Control de Enfermedades Transmisibles/organización & administración , Congresos como Asunto , Criptococosis/diagnóstico , Criptococosis/tratamiento farmacológico , Criptococosis/epidemiología , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , Lactante , Masculino , Micosis/diagnóstico , Micosis/tratamiento farmacológico , Micosis/epidemiología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Embarazo , Prevalencia , Prevención Primaria/métodos , Medición de Riesgo , Análisis de Supervivencia , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Interfaz Usuario-Computador , Adulto Joven
10.
PLoS Med ; 17(9): e1003218, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32903257

RESUMEN

BACKGROUND: A decade of Boko Haram insurgency brought conflict, mass displacement, and the destruction of basic infrastructure to Northeast Nigeria. Over 2 million internally displaced persons (IDPs) suffering from lack of basic hygienic conditions, malnutrition, and disease live in camps or are hosted by communities in the region, where the conflict has contributed to a massive destruction of health facilities. Infectious diseases like tuberculosis (TB) and HIV are especially difficult to address under such conditions, and IDPs are vulnerable to both. Although international investment supports some health interventions among IDPs, locally sourced solutions are lacking. METHODS AND FINDINGS: We evaluated the impact of an active case finding (ACF) intervention for TB and testing for HIV in IDP communities and provided linkages to treatment in 3 states in Northeast Nigeria: Adamawa, Gombe, and Yobe. The ACF was a component of a multistakeholder collaboration between government, civil society, and IDP community partners, which also included mapping of IDP populations and health services, supporting existing health facilities, developing a sample transport network, and organizing community outreach to support ACF. Between July 1, 2017, and June 30, 2018, ACF was conducted in 26 IDP camps and 963 host communities in 12 local government areas (LGAs) with another 12 LGAs serving as a control population. Outreach efforts resulted in 283,556 screening encounters. We screened 13,316 children and 270,239 adults including 150,303 (55.6%) adult women and 119,936 (44.4%) men. We tested 17,134 people for TB and 58,976 for HIV. We detected 1,423 people with TB and 874 people living with HIV. We linked 1,419 people to anti-TB treatment and 874 people with HIV to antiretroviral treatment sites. We evaluated additional TB cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF on TB case notifications. Through our efforts, bacteriologically confirmed TB notifications increased by 847 (45.1%) during the intervention period, with IDPs accounting for 46% of these notifications. The ITS analyses detected significant positive postintervention trend differences in TB notification rates between the intervention and control areas in all forms TB (incidence rate ratio [IRR] = 1.136 [1.072, 1.204]; p ≤ 0.001) and bacteriologically positive TB (IRR = 1.141 [1.058, 1.229]; p = 0.001). The TB prevalence (502 cases per 100,000 screening encounters) was 10 times the national notification rates and 2.3 times the estimated national incidence. Rates of HIV infection (1.8%) were higher than HIV prevalence estimates in the 3 states. Our study was limited by the nonrandom selection of LGAs. Furthermore, we did not use sensitive screening tools like chest X-ray and likely missed people with TB. CONCLUSIONS: In this study, we observed a burden of TB in IDP populations of Northeast Nigeria many times higher than national rates and HIV rates higher than state level estimates. The impact of the intervention showed that ACF can greatly increase TB case notifications. Engaging IDP communities, local governments, and civil society organizations is essential to ensuring the success of interventions targeting TB and HIV, and such approaches can provide sustained solutions to these and other health crises among vulnerable populations.


Asunto(s)
Intervención Médica Temprana/métodos , Infecciones por VIH/epidemiología , Tuberculosis/epidemiología , Adolescente , Adulto , Niño , Relaciones Comunidad-Institución , Femenino , Instituciones de Salud , Humanos , Incidencia , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , Refugiados , Adulto Joven
11.
Artículo en Inglés | MEDLINE | ID: mdl-32978339

RESUMEN

Almost half of the deaths worldwide caused by tuberculosis in 2018 occurred in the World Health Organization (WHO) South-East Asia Region, home to around a quarter of the global population. Maintaining robust progress in this region is therefore essential if the global goal of ending the tuberculosis epidemic is to be realized. Substantial gains have been made in the region, but the threat to health worldwide posed by the coronavirus disease 2019 (COVID-19) pandemic includes not only the direct effects of the pandemic but also the potential eclipsing of the global tuberculosis emergency. The results of modelling studies present stark warnings of a reversal of years of progress and a significant resurgence in deaths from tuberculosis. The COVID-19 pandemic has had variable impacts in the WHO South-East Asia Region to date, but in the countries most affected there has been targeted diversion and repurposing of tuberculosis services, health-care workers and diagnostic equipment. The combined effects of COVID-19, containment measures and fragmentation of tuberculosis services have resulted in delays in diagnosis or non-diagnosis and disruption in treatment resulting in increased morbidity, mortality, transmission and drug resistance. Countries of the region have made attempts to ensure continuity of services and civil society and nongovernmental organizations have instituted a range of innovative mechanisms to support national programmes. However, a comprehensive approach - including scaling up successful initiatives, empowering community leadership, harnessing digital tools, and implementing easily accessible cash transfers and nutrition support - will be critical to success. As COVID-19 recedes, countries will need "catch-up plans" to deploy supplementary measures to address the increased tuberculosis burden. Urgent, targeted and agile responses have the potential to mitigate and reverse the impact of the COVID-19 pandemic on tuberculosis in South-East Asia.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Erradicación de la Enfermedad , Pandemias , Neumonía Viral/epidemiología , Tuberculosis/prevención & control , Asia Sudoriental/epidemiología , Humanos , Tuberculosis/epidemiología , Organización Mundial de la Salud
12.
PLoS One ; 15(8): e0237865, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32866187

RESUMEN

BACKGROUND: Illness-related costs experienced by tuberculosis patients produce a severe economic impact on households, especially poor families. Few studies have investigated the full costs, including direct and indirect costs, at the patient and household levels in south-east China. METHODS: A case follow-up study was conducted in the Bao'an district of Shenzhen City, China. Eligible new and previously treated individuals with pulmonary tuberculosis (TB) during January 1st 2013 to June 30th 2013 were enrolled. Medical and non-medical costs as well as income loss were calculated in diagnosis and treatment periods, respectively. Factors associated with costs due to TB diagnosis, treatment and TB care (diagnosis + treatment) were explored respectively with a linear regression model. RESULTS: Of the total 514 TB patients enrolled, 95% were from the migrant population, and 65% were males, with a mean age of 32.25 (±10.11). The median costs due to TB diagnosis and TB treatment were 79 United States dollar (USD), 748USD (6.2897 China Yuan (CNY) = 1USD, 2013) per patient, respectively. The median costs due to TB care (diagnosis and treatment) per patient was 1218USD, corresponding to 26% of patients' annual income pre-illness. Those who visited more times to health facilities, hospitalized, received higher education, or occupied in national civil servant/services/retired staff might expense more before diagnosis. Costs due to TB treatment was significantly higher among migrant patients, sputum smear positive patients, and widowed/divorced population. Factors associated with less total costs were native patients, fewer times of visiting to health-care facilities and those with no hospitalization history due to TB. CONCLUSIONS: Although a free TB control policy is in force, patients with TB are still facing a heavy economic burden. More available interventions to reduce the financial burden on tuberculosis patients are urgently needed.


Asunto(s)
Costo de Enfermedad , Tuberculosis/diagnóstico , Tuberculosis/economía , Adulto , China/epidemiología , Factores de Confusión Epidemiológicos , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Tuberculosis/epidemiología , Tuberculosis/terapia , Adulto Joven
13.
Rev Lat Am Enfermagem ; 28: e3343, 2020.
Artículo en Portugués, Español, Inglés | MEDLINE | ID: mdl-32876291

RESUMEN

OBJECTIVE: to analyze the association between the occurrence of new tuberculosis cases and the Adapted Living Condition Index, and to describe the spatial distribution in an endemic municipality. METHOD: this is an analytical and ecological study that was developed from new cases in residents of an endemic municipality in the North Region of Brazil. The data were obtained from the Notifiable Diseases Information System and from the 2010 Demographic Census. The Adapted Living Conditions Index was obtained by factor analysis and its association with the occurrence of the disease was analyzed by means of the chi-square test. The type I error was set at 0.05. Kernel estimation was used to describe the density of tuberculosis in each census sector. RESULTS: the incidence coefficient was 97.5/100,000 inhabitants. The data showed a statistically significant association between the number of cases and socioeconomic class, with the fact that belonging to the highest economic class reduces the chance of the disease occurring. The thematic maps showed that tuberculosis was distributed in a heterogeneous way with a concentration in the Southern region of the municipality. CONCLUSION: tuberculosis, associated with precarious living conditions, reinforces the importance of discussion on social determinants in the health-disease process to subsidize equitable health actions in risk areas, upon a context of vulnerability.


Asunto(s)
Condiciones Sociales , Tuberculosis/epidemiología , Brasil/epidemiología , Ciudades , Humanos , Factores Socioeconómicos
14.
BMC Public Health ; 20(1): 1364, 2020 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-32891134

RESUMEN

BACKGROUND: The co-morbidity of cardiometabolic diseases in patients with Tuberculosis adds a significant burden in current health systems in developing countries including Nepal. The main objective of this study was to explore cardiometabolic risk factors among patients with Tuberculosis. METHODS: This was a cross-sectional study conducted among patients with tuberculosis in 12 tuberculosis treatment centers from eight districts of Nepal between May and July 2017. Interviews with participants were conducted using a structured questionnaire and were supplemented by anthropometric measurements and on-site blood glucose tests. Data were analyzed using descriptive and inferential statistics. RESULTS: Among 221 study participants, 138 (62.4%) had new smear-positive pulmonary tuberculosis, 24 (10.9%) had new smear-negative pulmonary tuberculosis and 34 (15.4%) had new extra- pulmonary tuberculosis. Overall, 43.1% of the patients with tuberculosis had at least one cardiometabolic risk factor. The prevalence of at least one cardiometabolic risk factor was more in male than female (47.8% versus 33.8%). Prevalence of tobacco (18.9% versus 4.8%), and alcohol (12.6% versus 6.5%) use was proportionately higher in male compared to female. The prevalence of hypertension (17% vs. 21%) and obesity (11.9% vs. 12.9%) was lower in male compared to females. Female (AOR = 0.47; CI: 0.23-0.94), those from Gandaki Province (AOR = 0.32; CI: 0.13-0.79) and literate (AOR = 0.49; CI: 0.25-0.96) had reduced risk of cardiometabolic disease risk factors. CONCLUSIONS: This study highlights the role of gender and socio-demographic characteristics associated with the risk of cardiometabolic diseases in patients with Tuberculosis. The findings from this study can guide medical practitioners and policy makers to consider clinical suspicion, diagnosis and treatment. National treatment guideline can benefit by integrating the management of non-communicable diseases in Tuberculosis treatment centers.


Asunto(s)
Hipertensión/epidemiología , Obesidad/epidemiología , Tuberculosis Pulmonar/epidemiología , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Comorbilidad , Estudios Transversales , Prestación de Atención de Salud , Femenino , Instituciones de Salud , Humanos , Hipertensión/etiología , Hipertensión/terapia , Masculino , Persona de Mediana Edad , Nepal/epidemiología , Enfermedades no Transmisibles/epidemiología , Obesidad/etiología , Obesidad/terapia , Prevalencia , Factores de Riesgo , Factores Sexuales , Uso de Tabaco/efectos adversos , Tuberculosis/epidemiología , Tuberculosis Pulmonar/terapia
15.
Infect Dis Poverty ; 9(1): 131, 2020 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-32938497

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) has emerged as a global health and economic security threat with staggering cumulative incidence worldwide. Given the severity of projections, hospitals across the globe are creating additional critical care surge capacity and limiting patient routine access to care for other diseases like tuberculosis (TB). The outbreak fuels panic in sub-Saharan Africa where the healthcare system is fragile in withstanding the disease. Here, we looked over the COVID-19 containment measures in Ethiopia in context from reliable sources and put forth recommendations that leverage the health system response to COVID-19 and TB. MAIN TEXT: Ethiopia shares a major proportion of the global burden of infectious diseases, while the patterns of COVID-19 are still at an earlier stage of the epidemiology curve. The Ethiopian government exerted tremendous efforts to curb the disease. It limited public gatherings, ordered school closures, directed high-risk civil servants to work from home, and closed borders. It suspended flights to 120 countries and restricted mass transports. It declared a five-month national state of emergency and granted a pardon for 20 402 prisoners. It officially postponed parliamentary and presidential elections. It launched the 'PM Abiy-Jack Ma initiative', which supports African countries with COVID-19 diagnostics and infection prevention and control commodities. It expanded its COVID-19 testing capacity to 38 countrywide laboratories. Many institutions are made available to provide clinical care and quarantine. However, the outbreak still has the potential for greater loss of life in Ethiopia if the community is unable to shape the regular behavioral and sociocultural norms that would facilitate the spread of the disease. The government needs to keep cautious that irregular migrants would fuel the disease. A robust testing capacity is needed to figure out the actual status of the disease. The pandemic has reduced TB care and research activities significantly and these need due attention. CONCLUSIONS: Ethiopia took several steps to detect, manage, and control COVID-19. More efforts are needed to increase testing capacity and bring about behavioral changes in the community. The country needs to put in place alternative options to mitigate interruptions of essential healthcare services and scientific researches of significant impact.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Tuberculosis/terapia , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Prestación de Atención de Salud , Monitoreo Epidemiológico , Etiopía/epidemiología , Femenino , Humanos , Masculino , Atención al Paciente , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/virología , Cuarentena , Viaje/estadística & datos numéricos , Tuberculosis/diagnóstico , Tuberculosis/epidemiología
16.
BMC Infect Dis ; 20(1): 706, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-32977747

RESUMEN

OBJECTIVES: To investigate the incidence of active tuberculosis (TB) among COPD patients using fluticasone/salmeterol or budesonide/formoterol, and to identify any differences between these two groups of patients. METHODS: The study enrolled COPD patients from Taiwan NHIRD who received treatment with fluticasone/salmeterol or budesonide/formoterol for > 90 days between 2004 and 2011. The incidence of active TB was the primary outcome. RESULTS: Among the intention-to-treat population prior to matching, the incidence rates of active TB were 0.94 and 0.61% in the fluticasone/salmeterol and budesonide/formoterol groups, respectively. After matching, the fluticasone/salmeterol group had significantly higher rates of active TB (adjusted HR, 1.41, 95% CI, 1.17-1.70) compared with the budesonide/formoterol group. The significant difference between these two groups remained after a competing risk analysis (HR, 1.45, 95% CI, 1.21-1.74). Following propensity score matching, the fluticasone/salmeterol group had significantly higher rates of active TB compared with the budesonide/formoterol group (adjusted HR, 1.45, 95% CI, 1.14-1.85). A similar trend was observed after a competing risk analysis (HR, 1.44, 95% CI, 1.19-1.75). A higher risk of active TB was observed in the fluticasone/salmeterol group compared with the budesonide/formoterol group across all subgroups, but some differences did not reach statistical significance. CONCLUSION: Fluticasone/salmeterol carried a higher risk of active TB compared with budesonide/formoterol among COPD patients.


Asunto(s)
Corticoesteroides/uso terapéutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapéutico , Combinación Budesonida y Fumarato de Formoterol/uso terapéutico , Combinación Fluticasona-Salmeterol/uso terapéutico , Mycobacterium tuberculosis , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Tuberculosis/epidemiología , Administración por Inhalación , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Agonistas de Receptores Adrenérgicos beta 2/administración & dosificación , Agonistas de Receptores Adrenérgicos beta 2/efectos adversos , Anciano , Combinación Budesonida y Fumarato de Formoterol/administración & dosificación , Combinación Budesonida y Fumarato de Formoterol/efectos adversos , Femenino , Combinación Fluticasona-Salmeterol/administración & dosificación , Combinación Fluticasona-Salmeterol/efectos adversos , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Factores de Riesgo , Taiwán/epidemiología
17.
BMC Infect Dis ; 20(1): 609, 2020 Aug 18.
Artículo en Inglés | MEDLINE | ID: mdl-32811463

RESUMEN

BACKGROUND: Ratios of different immune cell populations (i.e., monocyte-to-lymphocyte, neutrophil-to-lymphocyte, and platelet-to-lymphocyte ratios) have been studied as a means of predicting future tuberculosis (TB) disease risk or to assist in the diagnosis of incident TB disease. No studies to-date, however, have evaluated the potential of these ratios to predict or assist in the diagnosis of incident TB infection - the first step in the natural history of TB disease. METHODS: In this prospective study, we evaluated the complete blood count (CBC)-derived metrics of monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) as predictors of future TB infection risk or aids in the diagnosis of TB infection among 145 Tanzanian adolescents enrolled in the DAR-901 vaccine trial, using paired CBCs and interferon-gamma release assays (IGRAs) obtained at 0, 60 and 720 days after study enrollment. RESULTS: At baseline, there were no significant differences between study participants who remained persistently IGRA negative throughout the study period and those who subsequently converted to IGRA positive with respect to MLR (0.18 vs 0.17, p = 0.10), NLR (0.88 vs 1.02, p = 0.08), or PLR (115 vs 120, p = 0.28). Similarly, no significant differences were noted with respect to MLR, NLR, and PLR between IGRA converters and time-matched negative controls at the time of IGRA conversion. With respect to other blood cell measures, however, there were modest but significant differences between IGRA negatives and IGRA converters with respect to red blood cell count (4.8 vs 4.6 ×  106 cells/mcL, p = 0.008), hemoglobin (12.6 vs 12.3 g/dL, p = 0.01), and hematocrit (38.8 vs 37.8%, p = 0.005). CONCLUSIONS: In contrast to prior studies that have suggested that the ratios of different immune cell populations are associated with development of TB disease, our present findings do not demonstrate an association between these ratios and the development of TB infection. However, decreased red blood cell measures were associated with the subsequent development of TB infection, suggesting either that dysregulation of iron metabolism may play a role in TB pathogenesis or that following TB infection, iron dysregulation may precede IGRA positivity. TRIAL REGISTRATION: Clinicaltrials.gov NCT02712424 . Date of registration: March 14, 2016.


Asunto(s)
Recuento de Células Sanguíneas/métodos , Plaquetas , Linfocitos , Monocitos , Neutrófilos , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Adolescente , Femenino , Humanos , Incidencia , Ensayos de Liberación de Interferón gamma , Masculino , Estudios Prospectivos , Tanzanía/epidemiología , Tuberculosis/sangre , Tuberculosis/microbiología
18.
Malawi Med J ; 32(1): 37-44, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32733658

RESUMEN

Background: The report from the World Health Organization (WHO) reveals that health spending worldwide remains highly unequal as more than 80% of the world's population live in low and middle-income countries but only account for about 20% of global health expenditure. Another report by the WHO on the state of health financing in Africa published in 2013 intimates that countries that are part of their member states are still on the average level in meeting set goals in financing key health projects. Objective: The study set out to investigate the association between public and private spending and health status for eight selected African countries, namely Burundi, Eritrea, Ethiopia, Kenya, Rwanda, Sudan, Tanzania and Uganda. Health status indicators include the incidence of tuberculosis, mortality rates, maternal deaths and prevalence of HIV. Methods: Descriptive statistics and pairwise correlation are used to assess the relationship between healthcare spending and health status. Random and fixed effect models are further employed to provide insights into the association between descriptive statistics and pairwise correlation. We used annual data from the year 2000 to 2014 obtained from world development indicators. Results: The relationship between healthcare spending (public and private) and health status is statistically significant. Public healthcare expenditure has a higher association than private expenditure in reducing the mortality rate, tuberculosis and HIV for the average country in our sample. For example, an increase in public healthcare spending is negatively associated and statistically significant at 5% or better in reducing female mortality, male mortality, tuberculosis and HIV. Private healthcare spending is more impactful in the area of maternal deaths, where it is associated negatively and statistically significant at 1%. An increase in private healthcare spending is linked to a reduction in maternal deaths. We also compared the association between an increase in healthcare spending on males versus females and observed that public health expenditure impacts the health status of both sexes equally, however, private health expenditure provides a greater positive benefit to males. It is worth remembering that two goals of the United Nations agenda on sustainable development are gender equality and ensuring healthcare for all. Conclusion: The findings of this research call for the selected African countries to pay more attention to public healthcare expenditure in order to improve health status, especially since private healthcare which provides access to healthcare facilities for some poor people leads to costs that are a burden. So, future research should focus on analyzing components of private healthcare spending such as direct household out-of-pocket spending, private insurance and direct service payments by private corporations as dependent variables to understand what form of private investment should be encouraged.


Asunto(s)
Prestación de Atención de Salud/economía , Gastos en Salud , Indicadores de Salud , Estado de Salud , Financiación de la Atención de la Salud , Salud Pública/economía , Tuberculosis/epidemiología , África Oriental , Infecciones por VIH/economía , Infecciones por VIH/epidemiología , Humanos , Incidencia , Muerte Materna , Mortalidad , Prevalencia
20.
PLoS One ; 15(8): e0236407, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32790669

RESUMEN

INTRODUCTION: Patients with tuberculosis (TB) symptoms have high prevalence of HIV, and should be prioritised for HIV testing. METHODS: In a prospective cohort study in Bangwe primary care clinic, Blantyre, Malawi, all adults (18 years or older) presenting with an acute illness were screened for TB symptoms (cough, fever, night sweats, weight loss). Demographic characteristics were linked to exit interview by fingerprint bioidentification. Multivariable logistic regression models were constructed to estimate the proportion completing same-visit HIV testing, comparing between those with and without TB symptoms. RESULTS: There were 5427 adult attendees between 21/5/2018 and 6/9/2018. Exit interviews were performed for 2402 (44%). 276 patients were excluded from the analysis, being already on antiretroviral therapy (ART). Presentation with any TB symptom was common for men (54.6%) and women (57.4%). Overall 27.6% (585/ 2121) attenders reported being offered testing and 21.5% (455/2121) completed provider-initiated HIV testing and counselling (PITC) and received results. The proportions offered testing were similar among participants with and without TB symptoms (any TB symptom: 29.0% vs. 25.7%). This was consistent for each individual symptom; cough, weight loss, fever and night sweats. Multivariable regression models indicated men, younger adults and participants who had previously tested were more likely to complete PITC than women, older adults and those who had never previously tested. CONCLUSIONS: Same-visit completion of HIV testing was suboptimal, especially among groups known to have high prevalence of undiagnosed HIV. As countries approach universal coverage of ART, identifying and prioritising currently underserved groups for HIV testing will be essential.


Asunto(s)
Infecciones por VIH/diagnóstico , Tuberculosis/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Infecciones por VIH/epidemiología , Humanos , Malaui/epidemiología , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Atención Primaria de Salud , Estudios Prospectivos , Tuberculosis/epidemiología , Cobertura Universal del Seguro de Salud , Adulto Joven
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