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1.
Pneumologie ; 73(9): 516-522, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31533173

RESUMO

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.


Assuntos
Análise Espaço-Temporal , Tuberculose Pulmonar/epidemiologia , Tuberculose/epidemiologia , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Geografia , Alemanha/epidemiologia , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Distribuição por Sexo , Fatores Socioeconômicos , Tuberculose/diagnóstico , Tuberculose Pulmonar/diagnóstico
2.
J Assoc Physicians India ; 67(8): 56-58, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31562718

RESUMO

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


Assuntos
Escarro/microbiologia , Tuberculose Pulmonar/epidemiologia , Antituberculosos , Humanos , Retratamento , Fatores de Risco , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico
3.
Braz J Infect Dis ; 23(4): 246-253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31421107

RESUMO

Accurate and rapid diagnostic tools are important aspects of managing tuberculosis (TB) cases appropriately. However, the sensitivity and specificity of diagnostic kits based on immune response such as the tuberculin skin test (TST) and interferon gamma release assay (IGRA) are still debated. Thus, the exploration and assessment of specific biomarker-targeted antibodies are needed for the development of an accurate and rapid diagnostic tool. The present study was conducted in patients with a respiratory problem suspected to be TB at Dr. Soetomo Hospital, Surabaya, Indonesia. Among 102 patients tested by GeneXpert and AFB, 59 serum samples were from cases retrospectively determined to have active TB. A total of 102 serum of healthy controls (HC) was also collected. The PPD antigen and the recombinant CFP-10 and ESAT-6 proteins were prepared. Antibody responses against these proteins were evaluated by ELISA. All samples were also screened for the possibility of Mycobacterium avium-intracellulare complex (MAC) infection using Capilla MaC kit. The results showed that TB patients had a significantly higher concentration of IgG antibody in response to PPD than the HC. In addition, the receiver operating characteristic (ROC) curve analysis showed that PPD was acceptable for diagnostic purposes with an AUC value of 0.835 (95% CI 0.770-0.900, p < 0.0001). However, ESAT-6 and CFP-10 had low AUCs, and 32 samples from both groups showed a low concentration of IgA antibody against all antigens. The MAC detection results also showed that the concentration of IgA in the HC group was the highest. The current results indicate that PPD is a better antigen for antibody-based detection of TB than ESAT-6 and CFP-10. Based on the MAC detection assay, 53 people in the HC group were probably infected with rapidly growing nontuberculous mycobacteria (NTM), although antibody response to PPD was low.


Assuntos
Formação de Anticorpos/imunologia , Antígenos de Bactérias/imunologia , Proteínas de Bactérias/imunologia , Mycobacterium tuberculosis/imunologia , Tuberculina/imunologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Indonésia , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Teste Tuberculínico , Tuberculose Pulmonar/sangue , Adulto Jovem
4.
Medicine (Baltimore) ; 98(33): e16761, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415374

RESUMO

RATIONALE: Liver transplanted patients have excellent survival rates, but infectious complications are a major cause of morbidity and mortality. Diagnosis and treatment of tuberculosis (TB) in liver recipients are very challenging. Specific recommendations for anti-TB treatment in liver transplanted patients are lacking. PATIENT CONCERNS AND DIAGNOSIS: A 22-year-old male liver transplanted patient because of biliary atresia showed unexpected acute hemoptysis while he was on immunosuppressive therapy with tacrolimus and mycophenolate mofetil. Computed tomography (CT) identified a pulmonary arteriovenous malformation (PAVM) successfully treated with endovascular embolization. A post-embolization thoracic CT revealed pulmonary cavitation and miliary pattern suggesting pulmonary TB causing PAVM. TB diagnosis was confirmed by microbiological assays and genetic amplification techniques. INTERVENTION: Anti-TB 4-drug regimen was started. Following the beginning of treatment, liver enzymes increased. In order to clarify if liver cytolysis was due to hepatotoxicity or hepatic rejection linked to the reduction of immunosuppression or a worsening of pre-existing graft hepatitis, a liver biopsy was performed. A mild graft rejection was found so that tacrolimus doses were increased despite the risk of tubercular dissemination. OUTCOME: The patient completed anti-TB therapy in 8 months with resolution of TB disease and stable liver disease. LESSONS: TB management in liver transplanted patients is challenging and needs to be individualized especially if chronic graft hepatitis is present.


Assuntos
Rejeição de Enxerto , Hospedeiro Imunocomprometido , Transplante de Fígado , Tuberculose Pulmonar/diagnóstico , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Feminino , Hemoptise/etiologia , Humanos , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico , Adulto Jovem
5.
BMC Infect Dis ; 19(1): 615, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299911

RESUMO

BACKGROUND: China contributed 8.9% of all incident cases of tuberculosis globally in 2017, and understanding the spatiotemporal distribution of pulmonary tuberculosis (PTB) in major transmission foci in the country is critical to ongoing efforts to improve population health. METHODS: We estimated annual PTB notification rates and their spatiotemporal distributions in Sichuan province, a major center of ongoing transmission, from 2005 to 2017. Time series decomposition was used to obtain trend components from the monthly incidence rate time series. Spatiotemporal cluster analyses were conducted to detect spatiotemporal clusters of PTB at the county level. RESULTS: From 2005 to 2017, 976,873 cases of active PTB and 388,739 cases of smear-positive PTB were reported in Sichuan Province, China. During this period, the overall reported incidence rate of active PTB decreased steadily at a rate of decrease (3.77 cases per 100,000 per year, 95% confidence interval (CI): 3.28-4.31) that was slightly faster than the national average rate of decrease (3.14 cases per 100,000 per year, 95% CI: 2.61-3.67). Although reported PTB incidence decreased significantly in most regions of the province, incidence was observed to be increasing in some counties with high HIV incidence and ethnic minority populations. Active and smear-positive PTB case reports exhibited seasonality, peaking in March and April, with apparent links to social dynamics and climatological factors. CONCLUSIONS: While PTB incidence rates decreased strikingly in the study area over the past decade, improvements have not been equally distributed. Additional surveillance and control efforts should be guided by the seasonal-trend and spatiotemporal cluster analyses presented here, focusing on areas with increasing incidence rates, and updated to reflect the latest information from real-time reporting.


Assuntos
Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , China/epidemiologia , Análise por Conglomerados , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estações do Ano , Análise Espaço-Temporal , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/transmissão , Adulto Jovem
6.
Medicine (Baltimore) ; 98(27): e16398, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277197

RESUMO

RATIONALE: Primary or reactivation pulmonary tuberculosis (TB) is frequent in immunocompromised patients such as those with human immunodeficiency virus (HIV) infection, chronic renal failure, poorly controlled diabetes, and hematologic malignancy. Immune system of patients with solid-organ cancer can be also altered by malignancy itself or chemotherapy. However, information on the effect of radiation on patient's immunity is scarce. Herein, we present a case of pulmonary TB occurring in a radiation field that mimics focal radiation pneumonitis in a patient who has received curative chemoradiation therapy for neck malignancy. We also performed literature review to understand the impact of radiation therapy on patients' immunity. PATIENT CONCERN: A 56-year-old male patient visited our hospital with a palpable mass in the right supraclavicular fossa which was later confirmed as metastatic squamous cell carcinoma. After completion of concurrent chemoradiation therapy, a focal consolidation was developed in the right upper lobe apex where radiation was applied. The patient did not have any symptoms or signs of infectious disease. DIAGNOSIS: Pulmonary TB was diagnosed through polymerase chain reaction (PCR) test and culture of sputum. INTERVENTION: Anti-TB medication was started. OUTCOME: The patient was tolerable to anti-TB medication and the size of TB lesion gradually decreased. LESSON: A suspicion of pulmonary TB should be given to patients with new infiltrates in radiation port due to impact of radiation therapy on local infection barriers and patients' immune system.


Assuntos
Pneumonite por Radiação/diagnóstico , Tuberculose Pulmonar/diagnóstico , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Quimiorradioterapia , Diagnóstico Diferencial , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade
7.
Pan Afr Med J ; 32: 170, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303939

RESUMO

Tuberculosis is a disease caused by tubercle bacillus infection. It can affect all of the body's organs. Pulmonary tuberculosis accounts for a little more than 50% of its occurrences. It is a public health problem worldwide, and developing countries in particular. Pseudotumoral bronchopulmonary tuberculosis is a particular form of tuberculosis in immunocompetent subject. It can manifests as a bronchial or pulmonary lesion, suggesting a neoplasia visible on chest CT scan or bronchoscopy. This similarity can confuse clinicians, making diagnosis challenging and requiring the use of invasive diagnostic techniques, since traditional means are often lacking. This increases burden of care and causes delayed treatment. This study aims to educate clinicians about this particular and uncommon form of tuberculosis, which should be suspected in patient with radiological findings compatible with the disease, especially since they live in a highly endemic country. Therapy and treatment duration are the same as for common forms of tuberculosis.


Assuntos
Neoplasias Brônquicas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Tuberculose Pulmonar/diagnóstico , Adulto , Broncoscopia/métodos , Diagnóstico Diferencial , Humanos , Imunocompetência , Masculino , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/patologia
8.
Pan Afr Med J ; 32: 196, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312308

RESUMO

Multidrug-resistant tuberculosis is a major challenge for the World Health Organization. Its growing incidence and the diagnostic and therapeutic difficulties make it a public health problem especially in the developing countries. We report two cases of extrapulmonary drug-resistant tuberculosis (nodal and osteo-articular) and five cases of pulmonary tuberculosis and extra-pulmonary tuberculosis (pleural, nodal, anal and neuro-meningeal) in hospitalized patients at the Hopital Moulay Youssef in Rabat. This study reports the issue of drug-resistant TB and highlights the role of genotypic tests in the diagnosis of extrapulmonary tuberculosis.


Assuntos
Antituberculosos/farmacologia , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adulto , Antituberculosos/administração & dosagem , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico
9.
BMC Infect Dis ; 19(1): 589, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277586

RESUMO

BACKGROUD: Early diagnosis of gastric tuberculosis is often challenging because the disease is very rare and its clinical manifestation is nonspecific and misleading. To raise the awareness and emphasize early diagnosis of gastric tuberculosis, we present a case of gastric tuberculosis secondary to pleural and pulmonary tuberculosis. CASE PRESENTATION: A 26-year-old woman complained gastric pain for 1 month but showed no other symptoms, who had no previous exposure to tuberculosis.Gastric stromal tumor was originally suspected. However, the pathology of her gastroscopic biopsy of the gastric lesion showed granulomatous lesions and caseating necrosis. Gene sequencing of the biopsy specimen identified deoxyribonucleic acid fragment of Mycobacterium tuberculosis. Chest computed tomography scan revealed nodular shadows in the lesser curvature soft tissue of the stomach, patchy densities and calcified nodular shadows in the upper right lung, bilateral pleural thickening, and calcified pleural nodules. Thus, the diagnosis was gastric tuberculosis secondary to pulmonary and pleural tuberculosis. The patient was hospitalized and treated with the antituberculosis therapy for 1 week. After discharged from the hospital, the patient continued routine antituberculosis therapy for 18 months and was follow-up was normal.Literature search found 22 cases of gastric tuberculosis reported from 2000 to 2016. Review of the 22 cases suggested that polymerase chain reaction has been increasingly used in the recent years in addition to the conventional histopathological and bacteriological approaches. CONCLUSION: Clinical presentation of gastric tuberculosis is not specific.When granuloma or caseation is detected on biopsy in patients who are suspected of having gastric malignancy or acid peptic diseases, polymerase chain reaction for Mycobacterium tuberculosis could be used as an available and sensitive diagnostic test in addition to pathology, acid-fast bacilli smear staining and culture.


Assuntos
Mycobacterium tuberculosis/genética , Reação em Cadeia da Polimerase/métodos , Tuberculose Gastrointestinal/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Biópsia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Gastrointestinal/tratamento farmacológico , Tuberculose Pleural/diagnóstico , Tuberculose Pleural/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico
10.
New Microbiol ; 42(3): 171-175, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31157399

RESUMO

Sputum acid-fast bacilli smear conversion is a fundamental index of treatment response and reduced infectivity in patients with pulmonary tuberculosis (P-TB). To date, there are no models to predict the time to sputum conversion based on patient characteristics. This study aims to ascertain the time to sputum conversion in patients with smear-positive P-TB under treatment, and the variables associated with time to smear conversion. We retrospectively evaluated the time to sputum smear conversion of 89 patients with smear-positive P-TB undergoing treatment at the S. Orsola-Malpighi University Hospital, Bologna (Italy), a referral centre for the diagnosis of TB. Multivariate Cox regression analysis was performed to document variables independently associated with time to conversion. Median time to sputum smear conversion was 24 days (IQR 12-54); the sputum smear converted within the first 2 months of treatment in 78.7% patients. Multivariate Cox regression analysis showed that older age, high baseline mycobacterial load detected by Xpert MTB/RIF, and severity of lung involvement are predictors of persistent smear positivity. The identification of risk factors delaying smear conversion allowed us to develop predictive models that may greatly facilitate the management of smear-positive patients in terms of the duration of respiratory isolation and treatment.


Assuntos
Mycobacterium tuberculosis , Escarro , Tuberculose Pulmonar , Fatores Etários , Humanos , Itália/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
11.
BMC Infect Dis ; 19(1): 542, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221109

RESUMO

BACKGROUND: Tuberculosis rapid molecular assays, including GeneXpert MTB/RIF® and Loopamp MTBC Detection Kit®, are highly sensitive and specific. Such performance does not automatically translate in improved disease control and highly depends on their use, local epidemiology and the diagnostic algorithms they're implemented within. We evaluate the performance of both assays and assess their impact on additional cases notification when implemented within WHO recommended tuberculosis diagnostic algorithms in Madagascar. METHODS: Five hundred forty eight presumptive pulmonary tuberculosis patients were prospectively recruited between November 2013 and December 2014 in Antananarivo, Madagascar, a high TB incidence sub-Saharan African urban setting. Both molecular assays were evaluated as first line or add-on testing following negative smear microscopy. Based on locally defined assay performance characteristics we measure the impact of both assays and WHO-recommended diagnostic algorithms on additional tuberculosis case notifications. RESULTS: High sensitivity and specificity was confirmed for both GeneXpert MTB/RIF® (86.6% (95% CI 81.1-90.7%) and 97.4% (95% CI 94.9-98.8%)) and Loopamp MTBC Detection Kit® (84.6% (95% CI 78.9-89.0%) and 98.4% (95% CI 96.2-99.4%)). Implementation of GeneXpert MTB/RIF® and Loopamp MTBC Detection Kit® increased tuberculosis diagnostic algorithms sensitivity from 73.6% (95% CI 67.1-79.3%) up to 88.1% (95% CI 82.8-91.9%). This increase was highest when molecular assays were used as add-on testing following negative smear microscopy. As add-on testing, GeneXpert MTB/RIF® and Loopamp MTBC Detection Kit® respectively improved case detection by 23.8 and 21.2% (p < 0.05). CONCLUSION: Including GeneXpert MTB/RIF® or Loopamp MTBC Detection Kit® molecular assays for TB detection on sputum samples from presumptive TB cases can significantly increase case notification in TB diagnostic centers. The TB case detection rate is further increased when those tests are use as second-line follow-on testing following negative smear microscopy results. A country wide scale-up and digital integration of molecular-based TB diagnosis assays shows promises for TB control in Madagascar.


Assuntos
Mycobacterium tuberculosis/genética , Técnicas de Amplificação de Ácido Nucleico/métodos , Tuberculose Pulmonar/diagnóstico , Adulto , DNA Bacteriano/isolamento & purificação , DNA Bacteriano/metabolismo , Feminino , Humanos , Madagáscar , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Escarro/microbiologia , Tuberculose Pulmonar/microbiologia
12.
BMC Infect Dis ; 19(1): 489, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151423

RESUMO

BACKGROUND: A delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in the Amhara Regional State, Ethiopia. METHODS: An institution based cross-sectional study was conducted on all adult drug resistant tuberculosis patients who initiated treatment from September 2010 to December 2017. Data were collected from patient charts, registration books, and computer databases using abstraction sheets. The data were entered using Epi-info version 7 and exported to SPSS version 20 for analysis. Summary statistics, like means, medians, and proportions were used to present it. Binary logistic regression was fitted; Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was also computed. Variables with p-value < 0.05 in the multi-variable logistic regression model was declared as significantly associated with treatment delay. RESULTS: The median time to commence treatment after drug resistant tuberculosis diagnosis was 8 (IQR: 3-37) days. Being diagnosed by Line probe assay [AOR = 5.59; 95% CI: 3.48-8.98], Culture [AOR = 5.15; 95% CI: 2.53-10.47], and history of injectable anti-TB drugs [AOR = 2.12; 95% CI: 1.41-3.19] were associated with treatment delays. CONCLUSION: Treatment delay was long, especially among patients diagnosed by Culture or LPA and those who had a prior history of injectable anti-TB drugs. That suggested that the need for universal accesses to rapid molecular diagnostic tests, such as Gene Xpert and the PMDT team were needed to promptly decide to minimize unnecessary delays.


Assuntos
Tempo para o Tratamento/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/diagnóstico , Adulto , Estudos Transversais , Diagnóstico Tardio/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Adulto Jovem
13.
BMC Public Health ; 19(1): 820, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238906

RESUMO

BACKGROUND: Delays in diagnosis and treatment of pulmonary tuberculosis are a major set-back to global tuberculosis control. There is currently no global evidence on the average delays thus, the most important contributor to total delay is unknown. We aimed to estimate average delay measures and to investigate sources for heterogeneity among studies assessing delay measures. METHODS: Systematic review of studies reporting mean (± standard deviation) or median (interquartile range, IQR) of patient, doctor, diagnostic, treatment, health system and/or total delays in journal articles indexed in PubMed. We pooled mean delays using random-effects inverse variance meta-analysis, investigated for variations in pooled estimates in subgroup analyses and explored for sources of heterogeneity using pre-specified explanatory variables. RESULTS: The systematic review included 198 studies (831,724 patients) from 78 countries. The median number of patients per study was 243 (IQR; 160-458) patients. Overall, the pooled mean total delay was 87.6 (95% CI: 81.4-93.9) days. The most important and largest contributor to total delay was patient delay with a pooled mean delay of 81 (95% CI: 70-92) days followed by doctor's delay and treatment delay with pooled mean delays of 29.5 (95% CI: 25.9-33.0) and 7.9 (95% CI: 6.9-8.9) days respectively. There was considerable heterogeneity in all pooled analyses (I2 > 95%). In the meta-regression models of mean delays, studies excluding extra-pulmonary tuberculosis patients reported increased mean doctor's delay by 45 days on average, non-use of chest x-ray and conducting studies in high income countries decreased mean treatment delay by 20 and 22 days on average, respectively. CONCLUSION: Strategies to address patients' delay could have important implications for the success of the global tuberculosis control programmes.


Assuntos
Diagnóstico Tardio , Tempo para o Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/terapia , Pesquisa Empírica , Humanos
14.
Medicine (Baltimore) ; 98(23): e15977, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169732

RESUMO

BACKGROUND: Tuberculosis (TB) is a highly contagious and chronic disease. The microbiological examination to confirm children TB disease are limited due to paucibacillary Mycobacterium, specimens and detecting facilities. Considering these limitations in diagnosing children TB, new and reliable methods that detect children TB should be developed. Recently, Interferon gamma-induced protein 10 (IP-10) has been identified as a sensitive parameter in detecting children TB. The present study aims to synthesis and analysis the diagnostic value of IP-10 for children TB. METHODS: We will search PubMed, Embase, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, and Chinese Biological Medical Databases. We will search relevant citations up to May 2019. The quality of individual study will be assessed using the Quality Assessment of Diagnostic Accuracy Studies tool-2 (QUADAS-2). Stata 14.0 software will be used to calculate the pooled sensitivity, pooled specificity, pooled positive likelihood ratio (PLR), pooled negative likelihood ratio (NLR), pooled diagnostic odds ratio (DOR), pre-test probability, post-test probability and the hierarchical summary receiver operating characteristic (HSROC) curve. RESULTS: The results of this study will be published in a peer-reviewed journal. DISCUSSION: The evidence will indicate that IP-10 test is an alternative immunological test in detecting children TB. This is a protocol of systematic review and meta-analysis, so the ethical approval and patient consent are not required. PROTOCOL REGISTRATION NUMBER: CRD42019129743.


Assuntos
Quimiocina CXCL10/análise , Testes Imunológicos/estatística & dados numéricos , Mycobacterium/imunologia , Tuberculose Pulmonar/diagnóstico , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Testes Imunológicos/métodos , Lactente , Funções Verossimilhança , Masculino , Metanálise como Assunto , Projetos de Pesquisa , Sensibilidade e Especificidade , Revisão Sistemática como Assunto , Tuberculose Pulmonar/imunologia
15.
BMC Infect Dis ; 19(1): 532, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208362

RESUMO

BACKGROUND: There is controversy regarding the relative influence of 'exogenous' versus 'endogenous' factors on the risk of progression from latent tuberculosis infection to active tuberculosis (TB) disease in children. METHODS: We conducted a cross-sectional analysis to identify risk factors for active tuberculosis in QuantiFERON®-TB Gold (QFT-G)-positive children aged 6-13 years attending 18 schools in Ulaanbaatar, Mongolia. Children underwent clinical and radiological screening for active tuberculosis, and data relating to potential risk factors for disease progression were collected by questionnaire and determination of serum 25-hydroxyvitamin D (25[OH]D) concentrations. Risk ratios were calculated using generalized estimating equations with adjustment for potential confounders. RESULTS: 129/938 (13.8%) QFT-positive children were diagnosed with active tuberculosis. Risk of active tuberculosis was independently associated with household exposure to pulmonary TB (adjusted risk ratio [aRR] 2.40, 95% CI 1.74 to 3.30, P < 0.001), month of sampling (adjusted risk ratio [aRR] for March-May vs. June-November 3.31, 95% CI 1.63 to 6.74, P < 0.001; aRR for December-February vs. June-November 2.53, 95% CI 1.23 to 5.19, P = 0.01) and active smoking by the child (aRR 5.23, 95% CI 2.70 to 10.12, P < 0.001). No statistically significant independent association was seen for age, sex, socio-economic factors, presence of a Bacillus Calmette-Guérin (BCG) scar, tobacco exposure or vitamin D status. CONCLUSIONS: Household exposure to active TB, winter or spring season and active smoking were independently associated with risk of active tuberculosis in QFT-positive children. Our findings highlight the potentially high yield of screening child household contacts of infectious index cases for active tuberculosis in low- and middle-income countries.


Assuntos
Tuberculose Latente/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adolescente , Criança , Estudos Transversais , Progressão da Doença , Feminino , Testes Hematológicos/métodos , Humanos , Tuberculose Latente/diagnóstico , Masculino , Programas de Rastreamento , Mongólia/epidemiologia , Mycobacterium bovis , Razão de Chances , Fatores de Risco , Fumar , Inquéritos e Questionários , Tuberculose Pulmonar/diagnóstico , Vitamina D/análogos & derivados , Vitamina D/sangue
16.
Rev. chil. radiol ; 25(2): 47-49, jun. 2019. tab, graf, ilus
Artigo em Espanhol | LILACS | ID: biblio-1013849

RESUMO

Resumen: Introducción: El objetivo de este estudio fue desarrollar un modelo predictivo sobre la presencia de tuberculosis pulmonar activa utilizando datos clínico-epidemiológicos y hallazgos de radiografía simple (Rx) y tomografía computadorizada (TC) de tórax. Material y métodos: Se realizó un estudio observacional, retrospectivo, descriptivo y analítico, que recopiló 22 variables clínico-epidemiológicas, 11 hallazgos radiológicos en Rx de tórax y 23 en la TC, que se realizaron en pacientes con sospecha clínica de tuberculosis pulmonar durante un período de 10 años. Se aplicó un modelo de regresión logística multivariado a los predictores potenciales de cultivo positivo, obteniendo un modelo predictivo. Resultados: Se recogieron 1.540 pacientes con sospecha clínica de tuberculosis a los que se les realizó Rx y TC torácico. El cultivo fue positivo en 101 casos. Se utilizó un proceso de eliminación hacia atrás para obtener el mejor conjunto de variables predictivas. Se obtuvieron 24 variables que fueron significativas (6 clínicas, 5 de Rx y 13 de TC) y se les asignó una puntuación. A la suma de estas puntuaciones se restó la edad en años multiplicada por 0,03. El modelo sugiere el diagnóstico de tuberculosis pulmonar activa en pacientes con una puntuación superior a 1,845. Obtuvo una sensibilidad de 85,1%, especificidad de 83,6%, valor predictivo positivo de 26,6%, y valor predictivo negativo de 98,7%. El área bajo la curva ROC fue de 0,9163. Conclusión: Este sistema de puntuación basado en criterios clínico-epidemiológicos y hallazgos radiológicos puede ayudar a diagnosticar tuberculosis pulmonar activa en casos de sospecha diagnóstica.


Abstract:Introduction: The objective of this study was to develop a predictive model on the presence of active pulmonary tuberculosis using clinical-epidemiological data and findings of chest radiography and thoracic computed tomography (CT). Material and methods: An observational, retrospective, descriptive and analytical study was conducted, which collected 22 clinical and epidemiological variables, 11 radiological findings on chest x-ray and 23 on CT that were performed in patients with clinical suspicion of pulmonary tuberculosis during a period of 10 years. A multivariate logistic regression model was applied to the potential predictors of positive culture, obtaining a predictive model. Results: We collected 1,540 patients with clinical suspicion of tuberculosis who underwent radiography and thoracic CT. The culture was positive in 101 cases. A backward elimination process was used to obtain the best set of predictive variables. We obtained 24 variables that were significant (6 clinical, 5 of chest plain films and 13 of CT) and were assigned a score. The sum of these scores was subtracted from the age in years and multiplied by 0.03. The model suggests the diagnosis of active pulmonary tuberculosis in patients with a score higher than 1.845. The model obtained a sensitivity of 85.1%, specificity of 83.6%, positive predictive value of 26.6, and negative predictive value of 98.7%. The area under the ROC curve was 0.9163. Conclusion: This scoring system based on clinical-epidemiological criteria and radiological findings can help rule out active pulmonary tuberculosis in cases of diagnostic suspicion.


Assuntos
Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , Previsões , Tuberculose Pulmonar/etiologia , Radiografia Torácica , Tomografia Computadorizada por Raios X , Epidemiologia Descritiva , Estudos Retrospectivos
17.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(6): 643-647, 2019 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-31238612

RESUMO

Objective: To analyze the epidemiological characteristics, trend and related factors of tuberculosis patients that delayed for care, in Wuhan from 2008 to 2017. Methods: Data regarding tuberculosis (TB) patients was collected from the tuberculosis management information system (TMIS), a part of the China information system for disease control and prevention from 2008 to 2017. A total of 64 208 tuberculosis patients, aged 0 to 95 years were included for the analysis. Unconditional logistic regression method was used to estimate those factors that associated with this study. Results: Days of delay among TB patients appeared as M=10 (P(25)-P(75): 3-28) day, in Wuhan, 2008-2017. The prevalence of the delay was 52.5% (33 703/64 208), presenting a downward trend from 2008 to 2017 (trend χ(2)=10.64, P<0.001), but the proportions of women and ≥65 year-olds were gradually increasing. Results from the multivariate logistic regression analysis showed that factors as: patients living far away from the city vs. near the city (OR=1.29, 95%CI: 1.25-1.35), and age above 45 years vs. younger than 25 years (the age 45-64 years group vs. aged less than 25 years group, OR=1.22, 95%CI: 1.15-1.29; the age 65 or above group vs. aged less than 25 years group, the OR=1.30, 95%CI: 1.22-1.39) were under higher risk on the delay of seeking care. Occupation, way of case-finding and classification of tuberculosis patients also appeared as influencing factors on this issue. Conclusions: Prevalence on the delay of care was 52.5% among tuberculosis patients in Wuhan, 2008-2017, but with an annual decrease. Attention should be paid to female, wrinkly or elderly tuberculosis patients regarding the delay of care on TB, in Wuhan.


Assuntos
Antituberculosos/uso terapêutico , Diagnóstico Tardio , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Características de Residência/estatística & dados numéricos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Assistência à Saúde/organização & administração , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Prevalência , Distribuição por Sexo , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia , Adulto Jovem
18.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(6): 432-437, 2019 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-31189229

RESUMO

Objective: To study the incremental cost-effectiveness of the second Xpert assay in detection of Mycobacterium tuberculosis (Mtb) and rifampicin (RIF) resistance. Methods: We continuously collected 2 896 specimens from suspected tuberculosis patients who had undergone 2 Xpert tests in a week from March 2015 to March 2018, including 2 402 suspected tuberculosis patients with 1 523 males and 879 females, with an average age of 50 years. Among them, 2 144 specimens of sputum and 258 cases of bronchoalveolar lavage fluid were collected. We also enrolled 494 patients with suspected extrapulmonary tuberculosis, 318 males and 176 females, with an average age of 42 years. Among them, 157 pleural effusion specimens, 106 cerebrospinal fluid specimens, 34 urine specimens and 197 pus specimens were collected. All specimens were subjected to two Xpert tests, smear microscopy, liquid rapid culture (BACTEC MGIT 960), and positively cultured bacteria were tested for drug susceptibility. Results: Among the 2 896 specimens from suspected tuberculosis patients, either one of the two Xpert test results was positive (including both tests were positive, the same below) in 1 639 patients, and 1 502 (91.6%) were positive in the first Xpert tests. The additional 137 (8.4%) test results were positive in the second tests. According to the smear test results, all specimens were divided into the smear negative group and the smear positive group. The second Xpert test was significantly higher than the smear-positive group (14.86%, 3.2%, P<0.001), and the extrapulmonary tuberculosis group was higher than the tuberculosis group (11.2%, 8.0%, P=0.12).Of the susceptibility test results, a total of 371 were rifampicin-resistant specimens. The first Xpert detected 91.4% (339/371), and the second Xpert detected the additional 8.1% (30/371).The cost increase of the second test was very significant. Tests were calculated at 650 yuan per time, the tuberculosis group was 1 184 yuan and 13 696 yuan(P<0.001); the extrapulmonary tuberculosis group was 1 755 yuan and 13 961 yuan(P<0.001). In the test of specimens of tuberculosis and extrapulmonary tuberculosis, the smear-negative specimen cost increase of the second Xpert test was lower than that of the smear-positive specimen. Conclusion: The second xpert test showed significant value-added cost-effectiveness in the diagnosis of tuberculosis.


Assuntos
Antibióticos Antituberculose/farmacologia , Técnicas Bacteriológicas/economia , Farmacorresistência Bacteriana , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Rifampina/farmacologia , Tuberculose Pulmonar/diagnóstico , Adulto , Técnicas Bacteriológicas/métodos , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Rifampina/uso terapêutico , Sensibilidade e Especificidade , Escarro/microbiologia , Tuberculose Pulmonar/economia
19.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(5): 609-613, 2019 May 30.
Artigo em Chinês | MEDLINE | ID: mdl-31140428

RESUMO

OBJECTIVE: To explore the value of interferon-inducible protein 10 (IP-10) in the auxiliary diagnosis of tuberculosis and the judgment of the severity of disease. METHODS: From February, 2013 to February, 2017, a total of 193 patients with TB admitted in our hospital and 84 healthy control subjects were recruited consecutively. The peripheral blood plasma levels of interferon-γ (IFN-γ) and IP-10 were detected using liquid phase chip (Luminex) technique. According to the number of lung fields affected by TB, the patients were divided into group A (with lesions in 1-2 lung fields), group B (3-4 lung fields) and group C (5-6 lung fields), The expressions of IFN-γ and IP-10 in 3 groups were compared. RESULTS: The plasma levels of IP-10 were significantly higher in TB patients than in the control subjects (P < 0.05), but IFN-γ levels were comparable between the two groups (P > 0.05). Among the TB patients, plasma IP-10 levels was the highest in group C (P < 0.05), and IFN-γ levels did not differ significantly among the 3 groups (P > 0.05). CONCLUSIONS: Plasma IP-10 has a certain reference value in the auxiliary diagnosis of active tuberculosis and the judgment of the severity of the disease.


Assuntos
Quimiocina CXCL10 , Tuberculose Pulmonar , Antígenos de Bactérias , Biomarcadores/sangue , Quimiocina CXCL10/sangue , Humanos , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/diagnóstico
20.
BMC Infect Dis ; 19(1): 408, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077154

RESUMO

BACKGROUND: Diagnosis of tuberculosis (TB) in children is challenging. Epidemiological data of childhood pulmonary tuberculosis (PTB) are urgently needed. METHODS: We described trends in epidemiology, clinical characteristics, and treatment outcomes in seven cities of Shandong province, China, during 2005-2017. Data were collected from the China Information System for Disease Control and Prevention. RESULTS: Among 6283 (2.4% of all PTB) PTB cases aged < 18 years, 56.5% were male patients, 39.3% were smear-positive and 98.6% were new cases. The overall incidence of childhood PTB declined (7.62 to 3.74 per 100,000) during 2005-2017, with a non-significant change of annual percentage after 2010. While the incidence of smear-positive PTB (6.09 to 0.38 per 100,000 population) decreased significantly, but the incidence of smear-negative PTB (1.52 to 3.36 per 100,000 population) increased significantly during 2005-2017. The overall treatment success occurred among 94.2% childhood PTB. Ten children (0.2%) died. CONCLUSION: The overall incidence of childhood PTB declined significantly with the disease burden shifting from smear-positive PTB to smear-negative PTB. The discrepancies between notifications and estimations in both TB morbidity and mortality of children need to be addressed urgently.


Assuntos
Tuberculose Pulmonar/epidemiologia , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico
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