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1.
Pan Afr Med J ; 39: 97, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34466199

RESUMO

Introduction: an estimated 25% of the world population is infected with Mycobacterium tuberculosis. In 2017, new tuberculosis cases were estimated at 10 million, while 1.6 million tuberculosis related deaths were recorded, 25% residing in Africa. Treatment outcomes of multi drug resistant Tuberculosis patients in Zimbabwe has been well documented but the role of bacteriological monitoring on treatment outcomes has not been systematically evaluated. The objective of the study was to determine the role of bacteriological monitoring using culture and drug susceptibility tests on treatment outcomes among patients with multi drug resistant tuberculosis. Methods: a retrospective, secondary data analysis was conducted using routinely collected data of patients with multi drug resistant TB in Zimbabwe. Frequencies were used to summarize categorical variables and a generalized linear model with a log-link function and a Poisson distribution was used to assess factors associated with unfavourable outcomes. The level of significance was set at P-Value<0.05. Results: about the study collected data from 473 records of patients with an average age of 36.35 years. Forty-nine percent (49%) were male and 51% were female. Results showed that when a patient has baseline culture result missing, has no culture conversion result, regardless of having a follow up culture and drug susceptibility test result, the risk of developing unfavourable outcomes increase by 3.9 times compared to a patient who has received all the three (3) bacteriological monitoring tests. Conclusion: results highlights the need for consistent bacteriological monitoring of patients to avert unfavourable treatment outcomes.


Assuntos
Antituberculosos/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Estudos Retrospectivos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto Jovem , Zimbábue/epidemiologia
2.
Nat Commun ; 12(1): 4702, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34349104

RESUMO

Mycobacterium tuberculosis can adapt to changing environments by non-heritable mechanisms. Frame-shifting insertions and deletions (indels) may also participate in adaptation through gene disruption, which could be reversed by secondary introduction of a frame-restoring indel. We present ScarTrek, a program that scans genomic data for indels, including those that together disrupt and restore a gene's reading frame, producing "frame-shift scars" suggestive of reversible gene inactivation. We use ScarTrek to analyze 5977 clinical M. tuberculosis isolates. We show that indel frequency inversely correlates with genomic linguistic complexity and varies with gene-position and gene-essentiality. Using ScarTrek, we detect 74 unique frame-shift scars in 48 genes, with a 3.74% population-level incidence of unique scar events. We find multiple scars in the ESX-1 gene cluster. Six scars show evidence of convergent evolution while the rest shared a common ancestor. Our results suggest that sequential indels are a mechanism for reversible gene silencing and adaptation in M. tuberculosis.


Assuntos
Adaptação Fisiológica/genética , Inativação Gênica , Mycobacterium tuberculosis/genética , Fases de Leitura/genética , Evolução Molecular , Genes Bacterianos/genética , Genoma Bacteriano/genética , Humanos , Mutação INDEL , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/microbiologia
3.
Medicine (Baltimore) ; 100(29): e26778, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398057

RESUMO

BACKGROUND: This study aimed to assess whether Xpert MTB/RIF Ultra (Xpert Ultra) can effectively diagnose tuberculosis meningitis (TBM) and to simultaneously compare its effectiveness with Xpert in diagnosing TBM in the same population. METHODS: On August 12, 2020, Wanfang Database, China National Knowledge Infrastructure, Embase, Cochrane Library, and PubMed were searched for studies evaluating the diagnostic accuracy of Xpert Ultra for TBM. Then, we assessed the efficacy of Xpert Ultra against a composite reference standard and culture. If applicable, we also examined the diagnostic efficacy of Xpert in the same population. Heterogeneity was then explored by meta-regression, subgroup, and sensitivity analyses. RESULTS: Six studies containing 601 specimens reported the diagnostic efficacy of Xpert Ultra for TBM, with a composite reference standard. No study had compared the efficacy between Xpert Ultra and culture. The pooled sensitivity of Xpert Ultra was 64% (95% confidence interval [CI]: 45-80), and the I2 value was 86% (95% CI: 76-96); its specificity for TBM was consistently 100%. In the same population, 5 studies compared the diagnostic efficacy between Xpert Ultra and Xpert for TBM. The pooled sensitivity of Xpert Ultra and Xpert was 68% (95% CI: 46-84; I2 = 87%) and 37% (95% CI: 25-50; I2 = 72%), respectively. The studies were significantly heterogeneous in terms of sensitivity but not heterogeneous in specificity. CONCLUSIONS: Xpert Ultra was more sensitive than Xpert, but both were specific (100%). Therefore, Xpert Ultra had an excellent diagnostic efficacy for TBM, and it could be the preferred initial test for TBM.


Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Meníngea/diagnóstico , Testes Diagnósticos de Rotina , Humanos , Técnicas de Diagnóstico Molecular , Mycobacterium tuberculosis/genética , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Tuberculose Meníngea/diagnóstico por imagem
4.
Med Sci Monit ; 27: e934292, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34366429

RESUMO

The World Health Organization (WHO) estimated that in 2019, 10.0 million people worldwide developed tuberculosis (TB), with 1.4 million deaths from TB in that year. Infection with Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampin and an additional chemotherapeutic agent is known as multidrug-resistant TB (MDR TB). Until recently, the prevalence of drug resistance in patients with TB has been poorly understood due to a lack of infection surveillance and molecular testing. Countries with the highest prevalence of TB, including MDR TB, are also those most affected by the COVID-19 pandemic. The identification of MDR TB requires careful monitoring and resources for molecular testing. Previous treatment regimens have required intravenous treatments of long duration and high cost. The 2020 and 2021 recommendations from the WHO for the management of drug-susceptible TB and MDR TB have included oral treatment regimens and reduced treatment duration. This Editorial aims to present the rationale for the 2020 and 2021 recommendations from the WHO for the management of drug-susceptible TB and MDR TB.


Assuntos
Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose/tratamento farmacológico , Antituberculosos/uso terapêutico , Protocolos Clínicos/normas , Saúde Global , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/epidemiologia , Organização Mundial da Saúde
5.
Medicine (Baltimore) ; 100(31): e26841, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397855

RESUMO

ABSTRACT: Smear-positive pulmonary tuberculosis (SPPTB) is the major contributor to the spread of tuberculosis (TB) infection, and it creates high morbidity and mortality worldwide. The objective of this study was to determine the predictors of delayed sputum smear conversion at the end of the intensive phase of TB treatment in Kota Kinabalu, Malaysia.This retrospective study was conducted utilising data of SPPTB patients treated in 5 TB treatment centres located in Kota Kinabalu, Malaysia from 2013 to 2018. Pulmonary TB (PTB) patients included in the study were those who had at least completed the intensive phase of anti-TB treatment with sputum smear results at the end of the 2nd month of treatment. The factors associated with delayed sputum smear conversion were analyzed using multiple logistic regression analysis. Predictors of sputum smear conversion at the end of intensive phase were evaluated.A total of 2641 patients from the 2013 to 2018 periods were included in this study. One hundred eighty nine (7.2%) patients were identified as having delayed sputum smear conversion at the end of the intensive phase treatment. Factors of moderate (advanced odd ratio [aOR]: 1.7) and advanced (aOR: 2.7) chest X-ray findings at diagnosis, age range of >60 (aOR: 2.1), year of enrolment 2016 (aOR: 2.8), 2017 (aOR: 3.9), and 2018 (aOR: 2.8), smokers (aOR: 1.5), no directly observed treatment short-course (DOTS) supervisor (aOR: 6.9), non-Malaysian citizens (aOR: 1.5), and suburban home locations (aOR: 1.6) were associated with delayed sputum smear conversion at the end of the intensive phase of the treatment.To improve sputum smear conversion success rate, the early detection of PTB cases has to be fine-tuned so as to reduce late or severe case presentation during diagnosis. Efforts must also be in place to encourage PTB patients to quit smoking. The percentage of patients assigned with DOTS supervisors should be increased while at the same time ensuring that vulnerable groups such as those residing in suburban localities, the elderly and migrant TB patients are provided with proper follow-up treatment and management.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose Latente , Mycobacterium tuberculosis , Escarro/microbiologia , Tuberculose Pulmonar , Assistência ao Convalescente/métodos , Assistência ao Convalescente/normas , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/etiologia , Tuberculose Latente/prevenção & controle , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Determinação de Necessidades de Cuidados de Saúde , Radiografia Torácica/métodos , Radiografia Torácica/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/terapia , Tuberculose Pulmonar/transmissão
6.
Medicine (Baltimore) ; 100(31): e26897, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397866

RESUMO

ABSTRACT: Although complication with non-mycobacterial pneumonia among patients with pulmonary tuberculosis (TB) may lead to poor prognosis, discrimination between TB complicated with and without non-mycobacterial pneumonia using radiological imaging has not been fully elucidated. We aimed to clarify the differences in chest computed tomography (CT) features between pulmonary TB patients with culture-positive and culture-negative sputum for non-mycobacteria.We retrospectively included consecutive patients admitted to our hospital from January 2013 to December 2015 for bacteriologically-confirmed pulmonary TB, who were tested by sputum culture for non-mycobacteria, and who underwent chest CT within 2 weeks before or after admission. Chest CT features were compared between pulmonary TB patients who had positive non-mycobacterial cultures and in those who had not.Of 202 patients with pulmonary TB, 186 (92%) were tested by sputum culture for non-mycobacteria and underwent chest CT. Among these, non-mycobacteria were isolated in 118 patients (63%), while 68 patients (37%) had negative cultures. Patients with a positive culture for non-mycobacteria were significantly older and had lower levels of physical activity and albumin, higher levels of C-reactive protein, and a greater number of respiratory failures. By CT, emphysematous lesions, ground-glass opacities, airspace consolidation, air-bronchogram, interlobular septal thickening, bronchiectasis, pleural effusion, pleural thickening, and lymph node enlargement were more frequently in patients with a positive culture for non-mycobacteria. These chest CT features could be helpful for detecting complication with non-mycobacterial pneumonia in patients with pulmonary TB.


Assuntos
Antibacterianos/uso terapêutico , Pulmão/diagnóstico por imagem , Pneumonia Bacteriana , Escarro/microbiologia , Tomografia Computadorizada por Raios X/métodos , Tuberculose Pulmonar , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/epidemiologia , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/epidemiologia , Prognóstico , Estudos Retrospectivos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
7.
Tuberk Toraks ; 69(2): 160-166, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34256506

RESUMO

Introduction: This study aimed to evaluate the performance of the Xpert MTB/RIF assay in the identification of M. tuberculosis in pulmonary and extrapulmonary clinical samples by taking the results of the BACTEC MGIT 960TB culture system as a reference. Materials and Methods: A total of 11,341 specimens sent to Sivas Cumhuriyet University Application and Research Hospital Tuberculosis Laboratory for microbiological examination with suspicion of tuberculosis infection between January 2013 and December 2019 were examined, and 6847 clinical specimens that underwent culture (BACTEC MGIT 960TB), Xpert MTB/RIF and AFB (Acid-fast bacilli) testing were selected and included in our study. Of the samples included in the study, 5096 samples were pulmonary, and 1751 were extrapulmonary samples. Result: In our study, sensitivity, specificity, PPV and NPV values of Xpert MTB/ RIF and AFB were calculated by taking TB culture test as reference test. The sensitivity of the Xpert MTB/RIF assay was calculated as 96.1%, specificity as 99.7%, positive predictive value (PPV) as 88.2%, and negative predictive value (NPV) as 99.9%. These values for pulmonary samples were determined as 98.3%, 99.7%, 89.9%, and 99.9%, respectively. For extrapulmonary samples, the sensitivity of the assay was found as 89.4%, specificity as 99.5%, PPV as 82.9%, and NPV as 99.7%. The sensitivity and PPV values for AFBpositive samples were found to be 99.0% and 97.1%, respectively. For AFB negative samples, the sensitivity, specificity, PPV, and NPV values were determined as 90.5%, 99.7%, 73.8%, and 99.9%, respectively. Conclusions: A large number of clinical samples were studied with the Xpert MTB/RIF test in our study. It can be a guide in determining the performance of the test under the conditions of our country. Especially in the diagnosis of extrapulmonary TB, the effectiveness of the Xpert MTB/RIF assay has not been certainly proven in countries having a moderate prevalence of TB, such as Turkey. In most of the published studies, only a small part of the samples is extrapulmonary samples. So, our study provides valuable results in terms of evaluating a large number of extrapulmonary samples.


Assuntos
Técnicas de Diagnóstico Molecular/normas , Kit de Reagentes para Diagnóstico/normas , Tuberculose/diagnóstico , Humanos , Pulmão/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Escarro/microbiologia , Tuberculose/microbiologia , Turquia
8.
Tuberk Toraks ; 69(2): 279-284, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34256520

RESUMO

Methylene blue is used for bacterial staining in microbiology and as an antidote drug in medicine. In this study, we aimed to investigate the antimicrobial effects of methylene blue against Mycobacterium tuberculosis complex clinical isolates. Seventeen stored M. tuberculosis complex clinical isolates were included in the study. The isolates were inoculated into Mycobacteria Growth Indicator Tubes and incubated in Automated Mycobacterial Detection System. Mycobacteria Growth Indicator tubes containing methylene blue at critical concentrations of 0.2, 2, 20, 1000 µg ml-1 and control tube were prepared. Antimicrobial susceptibility testing was performed using Automated Mycobacterial Detection System which is gold standard for second line anti-tuberculosis drug testing. At the end of the study, six clinical isolates were susceptible to methylene blue at all critical concentrations. Five isolates were susceptible to only 1000 µg ml-1 methylene blue. Three isolates were susceptible to 1000 and 20 µg ml-1 methylene blue. Susceptibility rate was found as 94% when the critical proportion was accepted 400 GU (1/100 of control). Significant relationship was observed between the administered methylene blue concentrations and bacterial survival rate in statistical analysis. We conclude that methylene blue may become a potential anti-tuberculosis agent due to its well-known side effects and dosing regimens.


Assuntos
Antituberculosos/farmacologia , Azul de Metileno/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Humanos , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/isolamento & purificação
9.
BMC Infect Dis ; 21(1): 629, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210287

RESUMO

BACKGROUND: Along with the medical development, organ transplant patients increase dramatically. Since these transplant patients take immunosuppressants for a long term, their immune functions are in a suppressed state, prone to all kinds of opportunistic infections and cancer. However, it is rarely reported that the kidney transplant recipients (KTRs) have pulmonary tuberculosis and lung cancer simultaneously. CASE PRESENTATION: A 60-year-old male was admitted because of persistent lung shadow for 2 years without any obvious symptom 8 years after renal transplant. T-SPOT test was positive but other etiological examinations for Mycobacterium tuberculosis were negative. Chest CT scan revealed two pulmonary lesions in the right upper and lower lobe respectively. 18F-fluorodesoxyglucose positron-emission tomography (FDG-PET) CT found FDG intake increased in both pulmonary consolidation lesions. CT-guided percutaneous transthoracic needle biopsy revealed lung adenocarcinoma and tuberculosis. The video-assisted thoracoscopic surgery was operated to resect the malignancy lesions. The patient received specific anti-tuberculosis therapy and was discharged. At the follow-up of 6 months post drug withdrawal, the patient was recovered very well. CONCLUSIONS: We for the first time reported co-existence of smear-negative pulmonary TB and lung adenocarcinoma in a KTR, which highlighted the clinical awareness of co-occurrence of TB and malignancy after renal transplant and emphasized the value of biopsy and 18F-FDG-PET in early diagnosis of TB and cancer.


Assuntos
Adenocarcinoma/complicações , Transplante de Rim , Neoplasias Pulmonares/complicações , Tuberculose Pulmonar/complicações , Adenocarcinoma/cirurgia , China/epidemiologia , Etambutol/uso terapêutico , Fluordesoxiglucose F18 , Humanos , Biópsia Guiada por Imagem , Isoniazida/uso terapêutico , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Moxifloxacina/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Cirurgia Torácica Vídeoassistida , Resultado do Tratamento , Tuberculose Pulmonar/tratamento farmacológico
10.
Genome Med ; 13(1): 121, 2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34321076

RESUMO

BACKGROUND: Pathogen whole genome sequencing (WGS) is being incorporated into public health surveillance and disease control systems worldwide and has the potential to make significant contributions to infectious disease surveillance, outbreak investigation and infection prevention and control. However, to date, there are limited data regarding (i) the optimal models for integration of genomic data into epidemiological investigations and (ii) how to quantify and evaluate public health impacts resulting from genomic epidemiological investigations. METHODS: We developed the Pathogen Genomics in Public HeAlth Surveillance Evaluation (PG-PHASE) Framework to guide examination of the use of WGS in public health surveillance and disease control. We illustrate the use of this framework with three pathogens as case studies: Listeria monocytogenes, Mycobacterium tuberculosis and SARS-CoV-2. RESULTS: The framework utilises an adaptable whole-of-system approach towards understanding how interconnected elements in the public health application of pathogen genomics contribute to public health processes and outcomes. The three phases of the PG-PHASE Framework are designed to support understanding of WGS laboratory processes, analysis, reporting and data sharing, and how genomic data are utilised in public health practice across all stages, from the decision to send an isolate or sample for sequencing to the use of sequence data in public health surveillance, investigation and decision-making. Importantly, the phases can be used separately or in conjunction, depending on the need of the evaluator. Subsequent to conducting evaluation underpinned by the framework, avenues may be developed for strategic investment or interventions to improve utilisation of whole genome sequencing. CONCLUSIONS: Comprehensive evaluation is critical to support health departments, public health laboratories and other stakeholders to successfully incorporate microbial genomics into public health practice. The PG-PHASE Framework aims to assist public health laboratories, health departments and authorities who are either considering transitioning to whole genome sequencing or intending to assess the integration of WGS in public health practice, including the capacity to detect and respond to outbreaks and associated costs, challenges and facilitators in the utilisation of microbial genomics and public health impacts.


Assuntos
Ciência da Implementação , Infecções/diagnóstico , Listeria monocytogenes/isolamento & purificação , Mycobacterium tuberculosis/isolamento & purificação , SARS-CoV-2/isolamento & purificação , Sequenciamento Completo do Genoma/métodos , Genoma Bacteriano , Genoma Viral , Humanos , Infecções/epidemiologia , Listeria monocytogenes/genética , Mycobacterium tuberculosis/genética , Vigilância da População , Saúde Pública , SARS-CoV-2/genética
12.
Methods Mol Biol ; 2314: 399-457, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34235665

RESUMO

Whole-genome sequencing (WGS) has shown immense value in enabling identification and characterization of bacterial taxa. This is particularly true for mycobacteria, where culture-based characterization becomes delayed by the inherently slow growth rate of these organisms. This chapter reviews the general techniques behind WGS and their optimization, existing techniques for species-level identification and the advantages of WGS for this purpose, and a variety of useful tools for the genomic characterization of mycobacterial strains.


Assuntos
DNA Bacteriano/análise , Genoma Bacteriano , Genômica/métodos , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/genética , Análise de Sequência de DNA/métodos , Sequenciamento Completo do Genoma/métodos , DNA Bacteriano/genética , Humanos , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/isolamento & purificação
13.
Medicine (Baltimore) ; 100(23): e25754, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114982

RESUMO

ABSTRACT: Our objective was to identify independent risk factors for predicting which patients in the Chinese population would likely develop respiratory failure.A descriptive analysis was conducted of demographic and clinical data of patients with tuberculous empyema (TE) admitted to the Beijing Chest Hospital, Capital Medical University between January 2001 and January 2020. Risk factors associated with postsurgical respiratory failure in TE patients were identified based on results of analyses based on univariable and multivariable logistic regression models.A total of 139 TE patients who underwent surgical treatment in the Beijing Chest Hospital, Capital Medical University from January 2001 to January 2020 were enrolled in this study. Cases included 109 male and 30 female patients, with an overall mean age (range 17-73) of 39.3 years. Of 139 TE patients, 26 (18.7%) experienced respiratory failure after surgery. Among significant risk factors for postsurgical respiratory failure, intraoperative blood loss volume greater than 1000 mL had the highest odds ratio value of 6.452. In addition, a pathologic preoperative pulmonary function test result showing a high partial pressure of carbon dioxide level was an independent risk factor for respiratory failure. Moreover, the presence of tuberculosis lesions in the contralateral lung was another significant risk factor for respiratory failure, as determined using multivariate analysis.Respiratory failure is a predominant complication experienced by TE patients undergoing surgery. High intraoperative blood loss, high preoperative high partial pressure of carbon dioxide level, and tuberculosis lesion(s) in the contralateral lung of TE patients were associated with increased risk of postoperative respiratory failure.


Assuntos
Perda Sanguínea Cirúrgica , Empiema Tuberculoso/cirurgia , Complicações Pós-Operatórias , Insuficiência Respiratória , Medição de Risco , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Tuberculose Pulmonar , Adulto , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Dióxido de Carbono/análise , China/epidemiologia , Empiema Tuberculoso/sangue , Empiema Tuberculoso/diagnóstico , Empiema Tuberculoso/epidemiologia , Feminino , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Testes de Função Respiratória/métodos , Testes de Função Respiratória/estatística & dados numéricos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Procedimentos Cirúrgicos Torácicos/métodos , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/cirurgia
14.
BMC Infect Dis ; 21(1): 605, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34171989

RESUMO

BACKGROUND: Detection of pyrazinamide (PZA) resistance in Mycobacterium tuberculosis (TB) patients is critical, especially in dealing with multidrug-resistant Mycobacterium tuberculosis (MDR-TB) case. Up to date, PZA drug susceptibility testing (DST) has not been regularly performed in China. The prevalence and molecular characteristics of PZA resistance in M.tuberculosis isolates, especially MDR-TB have not been studied in Ningbo, China. This study aimed to analyze the phenotypic and molecular characterization of PZA resistance among MDR-TB isolates in Ningbo. METHODS: A total of 110 MDR-TB isolates were collected from the TB patients who were recorded at local TB dispensaries in Ningbo. All clinical isolates were examined by drug susceptibility testing and genotyping. DNA sequencing was used to detect mutations in the pncA gene associated with PZA resistance. RESULTS: The prevalence of PZA resistance among MDR-TB strains in Ningbo was 59.1%. With regard to the history and the outcome of treatments among MDR-TB cases, the percentages of re-treated MDR-TB patients in the PZA-resistant group and of successful patients in PZA-susceptible group were significantly higher than the ones in the PZA-susceptible group and in the PZA-resistant group, respectively (P = 0.027, P = 0.020). The results showed that the resistance of streptomycin (67.7% vs 46.7%, P = 0.027), ethambutol (56.9% vs 33.3%, P = 0.015), ofloxacin (43.1% vs 11.1%, P = 0.000), levofloxacin (43.1% vs 11.1%, P = 0.000), pre-XDR (pre-Xtensively Drug Resistance) (38.5% vs 15.6%, P = 0.009), were more frequently adverted among PZA-resistant isolates compared with PZA-susceptible isolates. In addition, 110 MDR-TB was composed of 87 (PZA resistant, 78.5%) Beijing strains and 23 (PZA resistant, 21.5%) non-Beijing strains. Fifty-four out of 65 (83.1%) PZA-resistant MDR strains harbored a mutation located in the pncA gene and the majority (90.7%) were point mutations. Compared with the phenotypic characterization, DNA sequencing of pncA has sensitivity and specificity of 83.1 and 95.6%. CONCLUSION: The mutations within pncA gene was the primary mechanism of PZA resistance among MDR-TB and DNA sequencing of pncA gene could provide a rapid detection evidence in PZA drug resistance of MDR-TB in Ningbo.


Assuntos
Antituberculosos/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Pirazinamida/farmacologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amidoidrolases/genética , Pequim , China , DNA Bacteriano , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mutação , Mycobacterium tuberculosis/isolamento & purificação , Fenótipo , Análise de Sequência de DNA , Adulto Jovem
15.
Cochrane Database Syst Rev ; 5: CD012972, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-34097769

RESUMO

BACKGROUND: The World Health Organization (WHO) recommends Xpert MTB/RIF in place of smear microscopy to diagnose tuberculosis (TB), and many countries have adopted it into their diagnostic algorithms. However, it is not clear whether the greater accuracy of the test translates into improved health outcomes. OBJECTIVES: To assess the impact of Xpert MTB/RIF on patient outcomes in people being investigated for tuberculosis. SEARCH METHODS: We searched the following databases, without language restriction, from 2007 to 24 July 2020: Cochrane Infectious Disease Group (CIDG) Specialized Register; CENTRAL; MEDLINE OVID; Embase OVID; CINAHL EBSCO; LILACS BIREME; Science Citation Index Expanded (Web of Science), Social Sciences citation index (Web of Science), and Conference Proceedings Citation Index - Social Science & Humanities (Web of Science). We also searched the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and the Pan African Clinical Trials Registry for ongoing trials. SELECTION CRITERIA: We included individual- and cluster-randomized trials, and before-after studies, in participants being investigated for tuberculosis. We analysed the randomized and non-randomized studies separately.  DATA COLLECTION AND ANALYSIS: For each study, two review authors independently extracted data, using a piloted data extraction tool. We assessed the risk of bias using Cochrane and Effective Practice and Organisation of Care (EPOC) tools. We used random effects meta-analysis to allow for heterogeneity between studies in setting and design.  The certainty of the  evidence in the randomized trials was assessed by GRADE. MAIN RESULTS: We included 12 studies: eight were randomized controlled trials (RCTs), and four were before-and-after studies. Most included RCTs had a low risk of bias in most domains of the Cochrane 'Risk of bias' tool. There was inconclusive evidence of an effect of Xpert MTB/RIF on all-cause mortality, both overall (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.75 to 1.05; 5 RCTs, 9932 participants, moderate-certainty evidence), and restricted to studies with six-month follow-up (RR 0.98, 95% CI 0.78 to 1.22; 3 RCTs, 8143 participants; moderate-certainty evidence). There was probably a reduction in mortality in participants known to be infected with HIV (odds ratio (OR) 0.80, 95% CI 0.67 to 0.96; 5 RCTs, 5855 participants; moderate-certainty evidence). It is uncertain whether Xpert MTB/RIF has no or a modest effect on the proportion of participants starting tuberculosis treatment who had a successful treatment outcome (OR) 1.10, 95% CI 0.96 to 1.26; 3RCTs, 4802 participants; moderate-certainty evidence). There was also inconclusive evidence of an effect on the  proportion of participants who were treated for tuberculosis (RR 1.10, 95% CI 0.98 to 1.23; 5 RCTs, 8793 participants; moderate-certainty evidence). The proportion of participants treated for tuberculosis who had bacteriological confirmation was probably higher in the Xpert MTB/RIF group (RR 1.44, 95% CI 1.29 to 1.61; 6 RCTs, 2068 participants; moderate-certainty evidence). The proportion of participants with bacteriological confirmation who were lost to follow-up pre-treatment was probably reduced (RR 0.59, 95% CI 0.41 to 0.85; 3 RCTs, 1217 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: We were unable to confidently rule in or rule out the effect on all-cause mortality of using Xpert MTB/RIF rather than smear microscopy. Xpert MTB/RIF probably reduces mortality among participants known to be infected with HIV. We are uncertain whether Xpert MTB/RIF has a modest effect or not on the proportion treated or, among those treated, on the proportion with a successful outcome. It probably does not have a substantial effect on these outcomes. Xpert MTB/RIF probably increases both the proportion of treated participants who had bacteriological confirmation, and the proportion with a laboratory-confirmed diagnosis who were treated. These findings may inform decisions about uptake alongside evidence on cost-effectiveness and implementation.


Assuntos
Antibióticos Antituberculose/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real/métodos , Rifampina/farmacologia , Tuberculose Pulmonar/diagnóstico , Viés , Intervalos de Confiança , Estudos Controlados Antes e Depois , Farmacorresistência Bacteriana , Infecções por HIV/mortalidade , Humanos , Mycobacterium tuberculosis/genética , Técnicas de Amplificação de Ácido Nucleico/métodos , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , Kit de Reagentes para Diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/mortalidade
16.
Pan Afr Med J ; 38: 279, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122706

RESUMO

Introduction: drug-resistant tuberculosis is a major global health problem and a threat to health security given the increase in the number of cases and the challenges associated with care. Besides, the relationship between poor nutritional status and tuberculosis is clearly established. For relevant and evidence-based public health decision-making regarding the management of malnutrition in patients with drug-resistant tuberculosis in the initial phase, it is essential to estimate the prevalence of malnutrition and understand the risk factors associated with it. Methods: we performed a retrospective cohort study in drug-resistant tuberculosis patients aged 18 years and older, among which the nutritional status was assessed through BMI. All predictors were included in a prediction model using the multivariate logistic model according to the lowest Akaike criterion. Discrimination and model calibration was evaluated using receiver performance analysis, and the Hosmer and Lemeshow test. Results: this study revealed a prevalence of malnutrition of 64.7% in drug-resistant tuberculosis patients in our 218-patient series. The factors associated with malnutrition were: unsuccessful treatment, the active presence of mycobacterium tuberculosis, increased bacteriological conversion time, increased serum creatinine, increased transaminase SGPT of the liver, and anaemia. Some of the factors not associated with malnutrition included the history of anti-tuberculosis treatment, vomiting, hepatic SGPT, initial AFB count, smear and culture conversion time, depression, and chest X-ray. Conclusion: malnutrition remains a concern among drug-resistant tuberculosis patients in Guinea as it affects more than half of them with a negative impact on the outcome of treatment. Implementing specific interventions for these high-risk patients, including nutritional supplementation, psychosocial support, and treatment for tuberculosis, can improve management for better treatment outcomes.


Assuntos
Antituberculosos/administração & dosagem , Desnutrição/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto , Estudos de Coortes , Feminino , Guiné/epidemiologia , Humanos , Masculino , Desnutrição/etiologia , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Prevalência , Estudos Retrospectivos , Fatores de Risco , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto Jovem
17.
BMC Infect Dis ; 21(1): 513, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074248

RESUMO

BACKGROUND: In resource-limited settings, sputum smear conversion is used to document treatment response. Many People living with HIV (PLHIV) are smear-negative at baseline. The Xpert MTB/RIF test can indirectly measure bacterial load through cycle threshold (ct) values. This study aimed to determine if baseline Xpert MTB/RIF could predict time to culture negativity in PLHIV with newly diagnosed TB. METHODS: A subset of 138 PLHIV from the 'SOUTH' study on outcomes related to TB and antiretroviral drug concentrations were included. Bacterial load was estimated by Mycobacterium Growth Indicator Tubes (MGIT) culture time-to-positivity (TTP) and Lowenstein Jensen (LJ) colony counts. Changes in TTP and colony counts were analyzed with Poisson Generalised Estimating Equations (GEE) and multilevel ordered logistic regression models, respectively, while time to culture negativity analysed with Cox proportional hazard models. ROC curves were used to explore the accuracy of the ct value in predicting culture negativity. RESULTS: A total of 81 patients (58.7%) were males, median age 34 (IQR 29  ̶ 40) years, median CD4 cell count of 180 (IQR 68  ̶ 345) cells/µL and 77.5% were ART naive. The median baseline ct value was 25.1 (IQR 21.0  ̶ 30.1). A unit Increase in the ct value was associated with a 5% (IRR = 1.05 95% CI 1.04  ̶ 1.06) and 3% (IRR = 1.03 95% CI 1.03  ̶ 1.04) increase in TTP at week 2 and 4 respectively. With LJ culture, a patient's colony grade was reduced by 0.86 times (0R = 0.86 95% CI 0.74  ̶ 0.97) at week 2 and 0.84 times (OR = 0.84 95% CI 0.79  ̶ 0.95 P = 0.002) at week 4 for every unit increase in the baseline ct value. There was a 3% higher likelihood of earlier conversion to negativity for every unit increase in the ct value. A ct cut point ≥28 best predicted culture negativity at week 4 with a sensitivity of 91. 7% & specificity 53.7% while a cut point ≥23 best predicted culture negativity at week 8. CONCLUSION: Baseline Xpert MTB/RIF ct values predict sputum conversion in PLHIV on anti-TB treatment. Surrogate biomarkers for sputum conversion in PLHIV are still a research priority.


Assuntos
Carga Bacteriana/métodos , Infecções por HIV/epidemiologia , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Adulto , Antirretrovirais/sangue , Antituberculosos/uso terapêutico , Contagem de Linfócito CD4 , Contagem de Colônia Microbiana , Feminino , Infecções por HIV/sangue , Humanos , Masculino , Técnicas de Amplificação de Ácido Nucleico , Razão de Chances , Estudos Retrospectivos , Sensibilidade e Especificidade , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Uganda/epidemiologia
18.
BMC Infect Dis ; 21(1): 575, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130662

RESUMO

BACKGROUND: A pleural fluid adenosine deaminase (ADA) has been used globally to assist in the diagnosis of a tuberculous pleural effusion (TPE) with a notable negative predictive value. CASE PRESENTATION: We report a case of a patient with a negative pleural fluid ADA who was found to have culture-positive and biopsy-proven Mycobacterium tuberculosis. CONCLUSIONS: This case shows the importance of pursuing gold standard diagnostic studies when clinical suspicion remains high despite negative preliminary testing. We further describe gaps in research to improve pleural fluid biomarkers for TPE.


Assuntos
Adenosina Desaminase/análise , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pleural/diagnóstico , Adenosina Desaminase/metabolismo , Adulto , Antituberculosos/uso terapêutico , Biomarcadores/análise , Biópsia/métodos , Exsudatos e Transudatos , Humanos , Masculino , Derrame Pleural/diagnóstico , Derrame Pleural/microbiologia , Valor Preditivo dos Testes , Resultado do Tratamento , Tuberculose Pleural/tratamento farmacológico , Tuberculose Pleural/enzimologia
19.
J Ayub Med Coll Abbottabad ; 33(2): 332-334, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137555

RESUMO

Mycobacterium Tuberculosis may infect any organ in the body, when it affects ocular tissue symptoms are vague and hence diagnosis is challenging, through a number of cases reported in our clinic it is emphasized to make quantiferon test as part of routine investigation for cases of presenting with uveitis thus leading to timely diagnosis and accurate treatment.


Assuntos
Teste Tuberculínico , Tuberculose Ocular/diagnóstico , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Ocular/classificação , Tuberculose Ocular/patologia , Tuberculose Ocular/terapia , Uveíte/diagnóstico , Uveíte/microbiologia , Uveíte/prevenção & controle
20.
N Engl J Med ; 384(18): 1705-1718, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33951360

RESUMO

BACKGROUND: Rifapentine-based regimens have potent antimycobacterial activity that may allow for a shorter course in patients with drug-susceptible pulmonary tuberculosis. METHODS: In an open-label, phase 3, randomized, controlled trial involving persons with newly diagnosed pulmonary tuberculosis from 13 countries, we compared two 4-month rifapentine-based regimens with a standard 6-month regimen consisting of rifampin, isoniazid, pyrazinamide, and ethambutol (control) using a noninferiority margin of 6.6 percentage points. In one 4-month regimen, rifampin was replaced with rifapentine; in the other, rifampin was replaced with rifapentine and ethambutol with moxifloxacin. The primary efficacy outcome was survival free of tuberculosis at 12 months. RESULTS: Among 2516 participants who had undergone randomization, 2343 had a culture positive for Mycobacterium tuberculosis that was not resistant to isoniazid, rifampin, or fluoroquinolones (microbiologically eligible population; 768 in the control group, 791 in the rifapentine-moxifloxacin group, and 784 in the rifapentine group), of whom 194 were coinfected with human immunodeficiency virus and 1703 had cavitation on chest radiography. A total of 2234 participants could be assessed for the primary outcome (assessable population; 726 in the control group, 756 in the rifapentine-moxifloxacin group, and 752 in the rifapentine group). Rifapentine with moxifloxacin was noninferior to the control in the microbiologically eligible population (15.5% vs. 14.6% had an unfavorable outcome; difference, 1.0 percentage point; 95% confidence interval [CI], -2.6 to 4.5) and in the assessable population (11.6% vs. 9.6%; difference, 2.0 percentage points; 95% CI, -1.1 to 5.1). Noninferiority was shown in the secondary and sensitivity analyses. Rifapentine without moxifloxacin was not shown to be noninferior to the control in either population (17.7% vs. 14.6% with an unfavorable outcome in the microbiologically eligible population; difference, 3.0 percentage points [95% CI, -0.6 to 6.6]; and 14.2% vs. 9.6% in the assessable population; difference, 4.4 percentage points [95% CI, 1.2 to 7.7]). Adverse events of grade 3 or higher occurred during the on-treatment period in 19.3% of participants in the control group, 18.8% in the rifapentine-moxifloxacin group, and 14.3% in the rifapentine group. CONCLUSIONS: The efficacy of a 4-month rifapentine-based regimen containing moxifloxacin was noninferior to the standard 6-month regimen in the treatment of tuberculosis. (Funded by the Centers for Disease Control and Prevention and others; Study 31/A5349 ClinicalTrials.gov number, NCT02410772.).


Assuntos
Antibióticos Antituberculose/administração & dosagem , Antituberculosos/uso terapêutico , Moxifloxacina/administração & dosagem , Mycobacterium tuberculosis/isolamento & purificação , Rifampina/administração & dosagem , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Antibióticos Antituberculose/efeitos adversos , Antituberculosos/efeitos adversos , Criança , Intervalos de Confiança , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Masculino , Moxifloxacina/efeitos adversos , Rifampina/efeitos adversos , Adulto Jovem
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