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2.
BMC Infect Dis ; 21(1): 51, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430786

RESUMO

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) in HIV infected individuals is a serious threat to global efforts to combat tuberculosis. Inconsistent findings on the association between HIV infection and MDR-TB were present in many studies. We aimed to review existing data on the relationship between HIV infection and MDR-TB systematically to assess the contribution of HIV on MDR-TB worldwide. We also investigated the patterns of MDR-TB by age, country-wise income, study designs, and global regions. METHODS: We utilized PubMed, Google Scholar, and ScienceDirect databases to select eligible studies for meta-analysis that were published between January 12,010, and July 30, 2020. The random-effects model was used to obtain the pooled odds ratio of the crude association between HIV and MDR-TB with a 95% confidence interval. We investigated the potential publication-bias by checking funnel plot asymmetry and using the Egger's test. Moreover, we assessed the heterogeneity using the I2 statistic. Sensitivity analysis was performed based on sample size and adjustment factors. The protocol was registered with PROSPERO-CRD42019132752. RESULTS: We identified 1603 studies through a database search, and after subsequent eliminations we selected 54 studies including 430,534 TB patients. The pooled odds of MDR-TB was 1.42 times higher in HIV-positive patients than HIV-negative patients (OR=1.42,CI=1.17-1.71, I2=75.8%). Subgroup analysis revealed that the estimated pooled odds for South-East Asian countries was 1.86, which is the highest in WHO regions (OR=1.86,CI=1.30-2.67, I2=0.00%), followed by Europe and Africa. The effect estimate was found to be higher for primary MDR-TB (OR=2.76,CI=1.70-4.46, I2=0.00%). There was also a trend towards increased odds of MDR-TB for HIV patients older than 40 years (OR=1.56,CI=1.17-2.06). The association was found to be significant in high-burden TB countries (OR=1.75, CI=1.39-2.19) and in high-income countries (OR=1.55, CI=1.06-2.27). CONCLUSION: Such findings indicate that HIV infection raises the risk of MDR-TB, and after contrasting it with the results of the earlier pooled study, it appeared to be an upward risk trend. Moreover, we found that the risk is the highest in the South-East Asian region. A balanced allocation of resources is needed to halt both primary and secondary MDR-TB, particularly in HIV infected people with 40 years of age and older.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , HIV/isolamento & purificação , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto , África/epidemiologia , Antituberculosos/uso terapêutico , Ásia Sudeste/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Risco , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico
3.
Acta otorrinolaringol. esp ; 71(6): 349-357, nov.-dic. 2020. graf
Artigo em Inglês | IBECS | ID: ibc-198078

RESUMO

INTRODUCTION: The impact of medical interventions for reducing ototoxicity requires focus in contexts where safe non-ototoxic alternative drugs are not yet available. OBJECTIVES: The goal was to investigate the impact of medical intervention strategies for reducing the ototoxic effects of long-term use of aminoglycosides for the treatment of Multi-Drug Resistant Tuberculosis (MDR-TB) in adults at a rural hospital in the Eastern Cape, South Africa. METHODS: A retrospective record review with a control group design was used, with audiological and medical record reviews of all participants' files over a six-month period. A total of 86 participants (intervention group n = 32 and control group n = 54) were included. Descriptive and inferential statistics were used to analyze the data. RESULTS: Results revealed progressive hearing loss in both groups, with worsening of thresholds at each subsequent assessment session. The progression of the hearing loss, however, was much slower in the intervention group, with degree of hearing loss being more severe in the control group in the final session of assessment (36.78-71.74 dB), when compared to the intervention group (33-44.39 dB). Furthermore, the hearing loss in the intervention group remained in the high frequencies while that in the control group progressed to involve the lower frequencies on the audiogram. The most common medical intervention strategies employed in the current study were to reduce the dosage of the ototoxic drug (61%), with the daily dosage reduced to 800 mg in 39% of participants, while the administration of the drug was reduced from daily to thrice weekly in 22% of participants. CONCLUSIONS: The results reveal better hearing sensitivity over the treatment period in the intervention group when compared to the control group; thus suggesting that early medical strategies implemented had a significant preventive impact. Current findings are relevant to the audiological, medical and pharmaceutical fields, particularly within the South African context where resource constraints are a consideration in all treatment measures


INTRODUCCIÓN: El impacto de las intervenciones médicas para reducir la ototoxicidad requiere concentrarse en los contextos en los que no se dispone de fármacos alternativos no ototóxicos seguros. OBJETIVOS: El objetivo fue investigar el impacto de las intervenciones médicas para reducir los efectos ototóxicos del uso prolongado de aminoglucósidos para el tratamiento de la tuberculosis multirresistente a los fármacos (MDR-TB) en adultos, en un hospital rural en Cabo Oriental, Sudáfrica. MÉTODOS: Se realizó una revisión retrospectiva de historias con grupo control de las revisiones audiológicas y médicas de todos los participantes durante un periodo de 6 meses, incluyéndose a un total de 86 participantes (grupo intervención n = 32 y grupo control n = 54). Se utilizaron estadísticas descriptivas e inferenciales para analizar los datos. RESULTADOS: Los resultados revelaron hipoacusia progresiva en ambos grupos, con empeoramiento de los umbrales en cada examen sucesivo. Sin embargo, la progresión de la hipoacusia fue menor en el grupo intervención, siendo más severo el grado de pérdida auditiva en el grupo control en el examen final de evaluación (36,78-71,74 dB), en comparación con el grupo intervención (33-44,39 dB). Además, la hipoacusia se mantuvo en frecuencias altas en el grupo intervención, mientras que en el grupo control experimentó una progresión, incluyendo las frecuencias bajas en el audiograma. Las intervenciones médicas más comunes utilizadas en el presente estudio fueron la reducción de la dosis de fármacos ototóxicos (61%), reduciéndose la dosis diaria a 800 mg en el 39% de los participantes, mientras que la administración del fármaco se redujo de una a tres veces por semana en el 22% de los participantes. CONCLUSIONES: Los resultados revelan mejor sensibilidad auditiva a lo largo del periodo de tratamiento en el grupo intervención, en comparación con el grupo control, lo cual sugiere que las estrategias médicas tempranas implementadas tuvieron un impacto preventivo significativo. Los hallazgos actuales son relevantes para los campos audiológico, médico y farmacéutico, particularmente en el contexto de Sudáfrica, donde las limitaciones de recursos son dignas de consideración en todas las medidas de tratamiento


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Aminoglicosídeos/efeitos adversos , Antituberculosos/efeitos adversos , Perda Auditiva/induzido quimicamente , Perda Auditiva/prevenção & controle , Intervenção Médica Precoce/métodos , Estudos Retrospectivos , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Resultado do Tratamento , Audiometria de Tons Puros , Limiar Auditivo , África do Sul
4.
Am J Trop Med Hyg ; 103(5): 1986-1988, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32978934

RESUMO

The COVID-19 pandemic poses a unique threat to patients with multidrug-resistant tuberculosis (MDR-TB). We describe a case of a patient with pulmonary MDR-TB and COVID-19 in Port-au-Prince, Haiti, and highlight the challenges and approach to managing a patient with both diseases.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto , Haiti/epidemiologia , Humanos , Masculino , Pandemias
5.
Lancet ; 396(10248): 402-411, 2020 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-32771107

RESUMO

BACKGROUND: HIV-infection is associated with increased mortality during multidrug-resistant tuberculosis treatment, but the extent to which the use of antiretroviral therapy (ART) and anti-tuberculosis medications modify this risk are unclear. Our objective was to evaluate how use of these treatments altered mortality risk in HIV-positive adults with multidrug-resistant tuberculosis. METHODS: We did an individual patient data meta-analysis of adults 18 years or older with confirmed or presumed multidrug-resistant tuberculosis initiating tuberculosis treatment between 1993 and 2016. Data included ART use and anti-tuberculosis medications grouped according to WHO effectiveness categories. The primary analysis compared HIV-positive with HIV-negative patients in terms of death during multidrug-resistant tuberculosis treatment, excluding those lost to follow up, and was stratified by ART use. Analyses used logistic regression after exact matching on country World Bank income classification and drug resistance and propensity-score matching on age, sex, geographic site, year of multidrug-resistant tuberculosis treatment initiation, previous tuberculosis treatment, directly observed therapy, and acid-fast-bacilli smear-positivity to obtain adjusted odds ratios (aORs) and 95% CIs. Secondary analyses were conducted among those with HIV-infection. FINDINGS: We included 11 920 multidrug-resistant tuberculosis patients. 2997 (25%) were HIV-positive and on ART, 886 (7%) were HIV-positive and not on ART, and 1749 (15%) had extensively drug-resistant tuberculosis. By use of HIV-negative patients as reference, the aOR of death was 2·4 (95% CI 2·0-2·9) for all patients with HIV-infection, 1·8 (1·5-2·2) for HIV-positive patients on ART, and 4·2 (3·0-5·9) for HIV-positive patients with no or unknown ART. Among patients with HIV, use of at least one WHO Group A drug and specific use of moxifloxacin, levofloxacin, bedaquiline, or linezolid were associated with significantly decreased odds of death. INTERPRETATION: Use of ART and more effective anti-tuberculosis drugs is associated with lower odds of death among HIV-positive patients with multidrug-resistant tuberculosis. Access to these therapies should be urgently pursued. FUNDING: American Thoracic Society, Canadian Institutes of Health Research, US Centers for Disease Control and Prevention, European Respiratory Society, Infectious Diseases Society of America.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade , Adulto , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Fatores de Risco , Tuberculose Resistente a Múltiplos Medicamentos/complicações
6.
PLoS One ; 15(6): e0234651, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32544174

RESUMO

BACKGROUND: Imipenem, an intravenous antibiotic is recommended for use in drug resistant tuberculosis (DR-TB) when an effective regimen with combination of other second line drugs is not possible. Though the treatment success rates with carbapenems are promising, the twice daily injection of Imipenem usually requires patients to be hospitalized. The Médecins Sans Frontières independent clinic in Mumbai, India implemented ambulatory and home based management of patients receiving Imipenem through the use of port-a-cath. OBJECTIVE: We aimed to describe the adverse events and treatment outcomes of ambulatory pre- and XDR-TB patients initiated on imipenem through port-a-cath between January 2015 and June 2018 and to explore the challenges with this regimen as perceived by healthcare providers and patients. METHODS: A convergent mixed methods study with quantitative (longitudinal descriptive study using the routine data) and qualitative (descriptive study) part conducted concurrently. For the quantitative component, all XDR-TB and pre-XDR-TB initiated on imipenem containing regimen during January 2015-June 2018 were included. For qualitative component, interviews were carried out including patients who initiated on imipenem (n = 5) and healthcare providers (n = 7) involved in providing treatment. Treatment outcomes, culture conversion and adverse events during treatment were described. Thematic analysis was carried out for qualitative component. RESULTS: Of the 70 patients included, the mean age was 28.1 (standard deviation: 11.2) years and 36 (51.4%) were females. Fifty one (72.9%) had XDR-TB. All patients were resistant to fluoroquinilone, levofloxacin. Vomiting was reported by 55 (78.6%) patients and at least one episode of QTC prolongation (more than 500 msec by Fredrecia method) was detected in 25 (35.7%). Port-a-cath block and infection was seen in 11 (15.7%) and 20 (28.6%) patients respectively. Favourable outcomes were seen in 43 (61.4%) patients. Mortality was seen in 22 (31.4%) patients, 2 (2.9%) were lost-to-follow-up and 3 (4.3%) were declared as treatment failure. The overarching theme of the qualitative analysis was: Challenges in delivering Imipenem via port-a-cath device in ambulatory care. Major challenges identified were difficulties in adhering to drug dose timelines, vomiting, restricted mobility due to port-a-cath, paucity of infection control and space constraints at patients' home for optimal care. CONCLUSION: Administration of imipenem was feasible through port-a-cath. Though outcomes with ambulatory based imipenem containing regimens were promising, there were several challenges in providing care. The feasibility of infusion at day care facilities needs to explored to overcome challenges in infusion at patients home.


Assuntos
Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Imipenem/administração & dosagem , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Adulto , Instituições de Assistência Ambulatorial/normas , Antituberculosos/efeitos adversos , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/complicações , Feminino , Serviços de Assistência Domiciliar/normas , Humanos , Imipenem/efeitos adversos , Imipenem/normas , Índia , Controle de Infecções/normas , Masculino , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Dispositivos de Acesso Vascular , Vômito/induzido quimicamente
8.
BMC Infect Dis ; 20(1): 298, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321429

RESUMO

BACKGROUND: There are unique challenges in the diagnosis and management of multi drug resistant tuberculosis (MDR-TB) in children. It is difficult to obtain confirmatory microbiological diagnosis in TB pericarditis. It is essential to differentiate between drug sensitive and drug resistant forms of TB as it has a major bearing on the regimen used, and inappropriate TB treatment combined with steroid use for pericarditis can lead to deterioration. With lack of samples, the treatment decision relies on the drug resistance pattern of the close contact if available. Therapeutic challenges of MDR-TB management in a child involve use of toxic drugs that need to be judiciously handled. We report a 2 years 4 months old male child who was diagnosed with TB pericarditis and treated based on the resistance pattern of his mother who was on treatment for pulmonary MDR-TB. CASE PRESENTATION: This 2 years 4 months old male child was diagnosed with TB involving his pericardium. Getting him started on an appropriate regimen was delayed due to the difficulty in establishing microbiological confirmation and drug susceptibility. He was commenced on a regimen based on his mother's drug resistance pattern and required surgery due to cardiac failure during the course of his treatment. He successfully completed 2 years of therapy. CONCLUSIONS: This child's case demonstrates that despite unique challenges in diagnosis and management of drug resistant extra pulmonary tuberculosis in children, treatment of even complex forms can be successful. The need for high suspicion of MDR-TB, especially when there is close contact with pulmonary TB, careful design of an effective regimen that is tolerated by the child, indications for invasive surgical management of pericarditis, appropriate follow-up and management of adverse effects are emphasised.


Assuntos
Antituberculosos/uso terapêutico , Pericardite Tuberculosa/diagnóstico , Pericardite Tuberculosa/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos , Pré-Escolar , Seguimentos , Humanos , Masculino , Mycobacterium tuberculosis/efeitos dos fármacos , Pericardite Tuberculosa/cirurgia , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/terapia
9.
BMC Infect Dis ; 20(1): 315, 2020 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-32345228

RESUMO

BACKGROUND: Despite the predictive role of body weight variation in treatment outcome in multidrug-resistant tuberculosis (MDR-TB), few corroborating data are available. We studied weight variation in patients with MDR-TB to identify groups of weight change and to determine factors that influence these changes. METHODS: We analyzed patients with rifampicin resistance who were treated with an MDR-TB treatment regimen between June 07, 2016 and June 22, 2018 at three major drug-resistant TB centers in Guinea. Patients were seen monthly until the end of treatment. Clinical outcome was the body mass index (BMI). We used a linear mixed model to analyze trajectories of BMI and a latent class mixed model to identify groups of BMI trajectories. RESULTS: Of 232 patients treated for MDR-TB during the study period, 165 were analyzed. These patients had a total of 1387 visits, with a median of 5 visits (interquartile range, 3-8 visits). Monthly BMI increase was 0.24 (SE 0.02) per kg/m2. Factors associated with faster BMI progression were success of MDR-TB treatment (0.24 [SE 0.09] per kg/m2; p = 0.0205) and absence of lung cavities on X-ray (0.18 [0.06] per kg/m2; p = 0.0068). Two groups of BMI change were identified: rapid BMI increase (n = 121; 85%) and slow BMI increase (n = 22; 15%). Patients in the slow BMI increase group were mostly female (68%) had no history of TB treatment (41%), had a positive HIV infection (59%), and had a more severe clinical condition at baseline, characterized by a higher frequency of symptoms including depression (18%), dyspnea (68%), poor adherence to MDR-TB treatment (64%), lower platelet count, and higher SGOT. These patients also had a longer time to initial culture conversion (log-rank test: p = 0.0218). CONCLUSION: Quantitative BMI data on patients with MDR-TB treated with a short regimen allowed the identification of subgroups of patients with different trajectories of BMI and emphasized the usefulness of BMI as a biomarker for the monitoring of MDR-TB treatment outcome.


Assuntos
Antibióticos Antituberculose/uso terapêutico , Índice de Massa Corporal , Rifampina/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto , Estudos de Coortes , Depressão/etiologia , Dispneia/etiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Adulto Jovem
10.
J Acquir Immune Defic Syndr ; 83(1): 47-55, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31809360

RESUMO

BACKGROUND: South Africa has among the highest incidence of multidrug-resistant tuberculosis (MDR-TB) and more than 70% of patients are HIV co-infected. MDR-TB treatment is associated with frequent adverse events (AEs). Although guidelines recommend concurrent treatment of MDR-TB and HIV, safety data on concurrent therapy are limited. METHODS: We conducted a prospective observational study of MDR-TB patients with and without HIV-coinfection in South Africa between 2011 and 2015. Participants received standardized MDR-TB and HIV regimens. Participants were followed monthly for the duration of MDR-TB therapy and screened for clinical and laboratory AEs. Audiometry was performed monthly during the intensive phase; color discrimination testing was performed every 2 months. RESULTS: We enrolled 150 HIV-infected and 56 HIV-uninfected participants. Nearly all experienced at least one clinical (93%) or laboratory (96%) AE. The most common clinical AEs were peripheral neuropathy (50%) and difficulty sleeping (48%); the most common laboratory AEs were hypokalemia (47%) and decreased creatinine clearance (46%). Among 19 clinical and lab AEs examined, there were no differences by HIV status, except for diarrhea (27% HIV-infected vs. 13% HIV-uninfected, P = 0.03). Hearing loss was experienced by 72% of participants (8% severe loss). Fourteen percent experienced color discrimination loss (4% severe loss). There were no differences in frequency or severity of hearing or vision loss by HIV status. CONCLUSIONS: AEs were common, but not more frequent or severe among MDR-TB/HIV co-infected participants receiving concurrent antiretroviral therapy. Given the favorable treatment outcomes associated with concurrent treatment, antiretroviral therapy initiation should not be delayed in MDR-TB patients with HIV-coinfection.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto , Estudos de Casos e Controles , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Estudos Prospectivos , Tuberculose Resistente a Múltiplos Medicamentos/complicações
11.
PLoS One ; 14(11): e0219230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738780

RESUMO

BACKGROUND: Every year tuberculosis kills above half million women all over the world. Nonetheless, the factor affecting TB treatment outcome of women was less frequently studied and compared among countries. Hence, this study was aimed to measure and compare outcome of treatment and the death size of these two countries. METHOD: Socio demographic and clinical data of women treated for all form of tuberculosis in the past ten years 2007-2016 were collected from total of eight hospitals and six treatment centers of Tigray and Zigong respectively. Then, we measured the magnitude of TB, level of treatment success and identify factors associated with the unsuccessful TB outcome. RESULT: In the past ten years, a total of 5603(41.5%) and 4527 (24.5%) tuberculosis cases were observed in Tigray and Zigong respectively. Of those with treatment outcome record a total of 2602(92%) in Tigray and 3916(96.7%) in Zigong were successfully treated. Total of 170 (6%) cases in Tigray and 36(0.8%) cases in Zigong were dead. In Tigray, retreatment cases (aOR, 0.29; 95% CI: 0.16-0.53) and MDR-TB cases (aOR, 0.31; 95% CI: 0.003, 0.27) were less likely to show treatment success. However,, HIV co-infected TB cases (aOR, 3.58; 95% CI: 2.47, 5.18) were more likely to show treatment success compared with unknown HIV status. In Zigong, women with MDR TB (aOR, 0.90; 95%CI: 0.24, 0.34) were less likely to show treatment success and women in the age category of 15-49 (aOR, 1.55; 95% CI: 1.08, 2.206) were more likely to show treatment success. CONCLUSION: Big number of tuberculosis cases and death were observed in Tigray comparing with Zigong. Hence, a relevant measure should be considered to improve treatment outcome of women in Tigray regional state.


Assuntos
Tuberculose/tratamento farmacológico , Adolescente , Adulto , Antituberculosos/uso terapêutico , China/epidemiologia , Coinfecção/tratamento farmacológico , Coinfecção/mortalidade , Etiópia/epidemiologia , Feminino , Infecções por HIV/complicações , Humanos , Má Oclusão , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/mortalidade , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade , Adulto Jovem
12.
Health Qual Life Outcomes ; 17(1): 142, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420045

RESUMO

BACKGROUND: Substantial efforts are currently focused on investigating and developing new multidrug-resistant tuberculosis (MDR-TB) drugs and diagnostic methods. In Yemen, however, the evaluation of health-related quality of life (HRQoL) and the effect of current MDR-TB treatment on the QoL are commonly ignored. This study evaluated the HRQoL during and after treatment and identified the risk factors that are predictive of HRQoL score differences. METHOD: A prospective cohort study was conducted in four of the five main MDR-TB centres in Yemen. The patients confirmed with MDR-TB completed the SF-36 V2 survey at the beginning of treatment, end of treatment (continous phase) and at the 1 year follow-up after completing treatment. A total normal base score (NBS) of < 47 reflects impairment of functions, whereas a mental component summary (MCS) score of < 43 indicates a risk of depression. RESULT: At the beginning of treatment, the mean scores for all health domains were < 47 NBS points (PF = 40.7, RP = 16.1, BP = 21.6, GH = 28.3, VT = 14.55, SF = 25.9, RE = 13.7, and MH = 14.7). At the completion of treatment, all eight health domains increase compare to beginning of treatment (PF = 59.3, RP = 31.1, BP = 40.9, GH = 48.5, VT = 30.5, SF = 46.6, RE =26.6 & MH = 27.7), but a follow-up duration of 1 year after completing treatment showed decreased NBS points in all domains (PF = 51.5, RP = 30.6, BP = 39.1, GH = 47.8, VT = 30.2, SF = 43.7, RE =26.4 & MH = 27.2). Age, history of streptomycin use, baseline lung cavity, marital status and length of sickness before MDR-TB diagnosis were predictive of in PCS score differences, whereas, age, smoking, baseline lung cavity, stigma, residence, marital status and length of sickness before MDR-TB diagnosis were predictive of MCS scores differences. CONCLUSION: The length of sickness before DR-TB diagnosis was found to be predictive of the trends in both PCS and MCS scores. Despite the positive outcome of MDR-TB treatment, the low HRQoL scores obtained for all heath domains and especially for mental health reflect a high depression status of patients even after 1 year of completing therapy. Moreover, the poor HRQoL, particularly regarding mental health, of study participants at the end of treatment demands the need for urgent attention from national tuberculosis control programme managers. Therefore, the Yemen Ministry of Health and the National Tuberculosis Control Programme should implement an intervention programme to enhance HRQoL at the end of treatment to avoid any further negative consequences of MDRTB in patients after treatment. Moreover, The HRQoL data of patients with MDR-TB must be collected at the different stages of MDR-TB treatment to provide an additional parameter for assessing the effectiveness of the treatment programme. TRIAL REGISTRATION: SNOYEM 1452. Registered 01 February 2013.


Assuntos
Qualidade de Vida , Tuberculose Resistente a Múltiplos Medicamentos/psicologia , Adulto , Depressão/complicações , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Iêmen
13.
Pediatr Infect Dis J ; 38(10): 1025-1026, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31335574

RESUMO

We report the case of a 10-year-old child treated for latent tuberculosis infection (LTBI) with pyrazinamide (PZA) and levofloxacin after contact with a smear-positive multidrug-resistant tuberculosis adult. Over the course of the treatment, the patient developed a drug-induced fulminant hepatitis attributed to the combination of PZA and levofloxacin. This case highlights the hepatotoxicity of the association of second-line anti-TB treatment in children.


Assuntos
Antituberculosos/efeitos adversos , Tuberculose Latente/complicações , Tuberculose Latente/tratamento farmacológico , Necrose Hepática Massiva/induzido quimicamente , Necrose Hepática Massiva/patologia , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Antituberculosos/administração & dosagem , Criança , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Humanos , Levofloxacino/administração & dosagem , Levofloxacino/efeitos adversos , Masculino , Pirazinamida/administração & dosagem , Pirazinamida/efeitos adversos
14.
Int J Tuberc Lung Dis ; 23(6): 663-668, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31315697

RESUMO

China has been playing an increasingly important role in global health in recent decades. Substantial progress and reform has been made in the country's health care system, but China still hosts one third of the world's diabetes mellitus (DM) patients and one fifth of the world's tuberculosis (TB) patients. Recent economic and public health advancements have provided tools for new drug development and facilitated the implementation of novel strategies. However, a unique set of challenges exist, including regulatory barriers, ethical concerns and the lack of a unified system and approaches across disease areas. This article analyses the current disease situation in China and discusses China's potential role in the global battle against the TB and DM co-epidemic.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Tuberculose Resistente a Múltiplos Medicamentos/prevenção & controle , Tuberculose Pulmonar/prevenção & controle , China/epidemiologia , Comorbidade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Epidemias , Humanos , Serviços Preventivos de Saúde/tendências , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/epidemiologia
15.
PLoS One ; 14(6): e0218487, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31211809

RESUMO

BACKGROUND: Hypothyroidism is one of the adverse drug reactions that associated with Multidrug Resistant Tuberculosis (MDR-TB) medications. Extremely variable magnitude of hypothyroidism in MDR-TB patients has been reported from different parts of the world. However, there is no evidence that tried to estimate the pooled prevalence of hypothyroidism to confirm the rareness of hypothyroidism in MDR-TB patients on treatment. Therefore, we did a systematic review and meta-analysis to estimate the prevalence of hypothyroidism in MDR-TB patients on treatment, and to summarize the demographic and clinical characteristics of the patients. METHODS: We conducted a systematic review and meta-analysis on studies reported around the world on the prevalence of hypothyroidism in MDR-TB patients on treatment. We searched electronic databases: PubMed/Medline, EMBASE, CINAHL, Science Direct, Academic Search Complete and Google scholar for English language articles without limiting publication year. We also reviewed the bibliographies of relevant studies and conducted an electronic search for relevant conference abstracts. Eligible studies were cross-sectional and cohort studies that included at least five participants. We used a random-effects model to estimate the pooled prevalence of hypothyroidism. The registration number of this review study protocol is CRD42018109237. RESULTS: We included 30 studies and pooled data on a total of 6,241 MDR-TB patients. The crude prevalence of hypothyroidism was extremely heterogeneous. The pooled prevalence of hypothyroidism in MDR-TB patients on treatment was 17.0% (95% CI: 13.0-20.0). Ethionamide and para-aminosalicylic acid (PAS) were the most frequently reported drugs that associated with the occurrence of hypothyroidism. CONCLUSION: This review revealed that hypothyroidism is not a rare adverse drug reaction in MDR-TB patients on treatment. Ethionamide and PAS were the most frequently reported drugs that associated with the occurrence of hypothyroidism. Screening of hypothyroidism in MDR-TB patients on treatment is important while targeting patients on Ethionamide and PAS based treatment regimen.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Hipotireoidismo/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Ácido Aminossalicílico/efeitos adversos , Ácido Aminossalicílico/uso terapêutico , Antituberculosos/efeitos adversos , Antituberculosos/uso terapêutico , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Etionamida/efeitos adversos , Etionamida/uso terapêutico , Humanos , Hipotireoidismo/induzido quimicamente , Hipotireoidismo/microbiologia , Fatores de Risco , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia
16.
Health Qual Life Outcomes ; 17(1): 94, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151398

RESUMO

BACKGROUND: Adverse events (AEs) are common during treatment of drug-resistant tuberculosis (DR-TB). Little is known about the health-related quality of life (HRQoL) of patients receiving treatment for DR-TB or the effect of AEs on HRQoL. METHODS: We conducted a cross-sectional study among adult patients with laboratory-confirmed rifampicin resistant tuberculosis (TB) on DR-TB treatment at a public-sector outpatient DR-TB clinic in Johannesburg, South Africa between 02/2015-01/2018. Data on HRQoL using the Medical Outcomes Short Form-36 (SF-36) questionnaire and self-reported AEs were collected by trained interviewers through face-to-face interviews. We report averages for the eight major domains and mental (MCS) and physical health (PCS) component summary scores, stratified by whether AEs were reported in the last four weeks. For comparative purposes, we enrolled two other patient groups and included data on a separate group of healthy adults. RESULTS: We enrolled 149 DR-TB patients (median age 36 years IQR 29-43, 55% male, 77.9% HIV-positive, 81% on ART, 61.8% on a standard long-course regimen and 44.3% on DR-TB treatment for less than 6 months). 58/149 (38.9%) patients reported a total of 122 AEs in the preceding 4 weeks, of these the most common were joint pain (n = 22), peripheral neuropathy (n = 16), hearing loss (n = 15), nausea and vomiting (n = 12) and dizziness or vertigo (n = 11). SF-36 domains and summary scores (MCS and PCS) were lower in those who reported an AE compared to those who did not, and both were lower than healthy adults. Compared to those who did not report an AE, patients who reported AEs were more likely to have a low MCS (aRR 2.24 95% CI 1.53-3.27) and PCS (aRR 1.52 95% CI 1.07-2.18) summary score. HRQoL was lower among those on DR-TB treatment for 6 months or less. CONCLUSION: Results show that DR-TB had a substantial impact on patients' quality of life, but that AEs during the early months on treatment may be responsible for reducing HRQoL even further. Our findings highlight the negative effects of injectable agents on HRQoL. Patients require an integrative patient-centered approach to deal with DR-TB and HIV and the potential overlapping toxicities which may be worsened by concurrent treatment.


Assuntos
Antituberculosos/efeitos adversos , Qualidade de Vida , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/psicologia , Idoso , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , África do Sul/epidemiologia , Inquéritos e Questionários , Tuberculose Resistente a Múltiplos Medicamentos/complicações
17.
J Bras Pneumol ; 45(2): e20180324, 2019 Apr 25.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31038649

RESUMO

Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) continue to challenge physicians and public health specialists. Global treatment outcomes continue to be unsatisfactory, positive outcomes being achieved in only 54% of patients. Overall outcomes are even worse in patients infected with highly resistant strains. Treating MDR-/XDR-TB is difficult because of frequent adverse events, the long duration of drug regimens, the high costs of second-line drugs, chronic post-infectious sequelae, and loss of organ function. Ongoing research efforts (studies and trials) have various aims: increasing the rates of treatment success; understanding the potentialities of new and repurposed drugs; shortening the treatment duration; and reducing the rates of adverse events. It is hoped that better access to rapid diagnostics, increased awareness, and treatments that are more effective will reduce the rate of complications and of lung function impairment. This article aims to discuss the management of severe tuberculosis (defined as that which is potentially life threatening, requiring higher levels of care) and its sequelae, from intensive care to the postoperative period, rehabilitation, and recovery. We also discuss the nonpharmacological interventions available to manage chronic sequelae and improve patient quality of life. Because the majority of MDR-/XDR-TB cases evolve to lung function impairment (typically obstructive but occasionally restrictive), impaired quality of life, and low performance status (as measured by walk tests or other metrics), other interventions (e.g., smoking cessation, pulmonary rehabilitation, vaccination/prevention of secondary bacterial infections/exacerbations, complemented by psychological and nutritional support) are required.


Assuntos
Gerenciamento Clínico , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/terapia , Antituberculosos/uso terapêutico , Cuidados Críticos , Humanos , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/terapia
18.
Int J Infect Dis ; 83: 98-101, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30991140

RESUMO

HIV-positive TB co-infected patients are at increased risk of multidrug-resistant (MDR)-TB compared to HIV-negative patients. Co-treatment of MDR-TB and HIV is common particularly in Sub-Saharan Africa where the co-morbidity is endemic. We discuss potential cellular metabolic pathway-mediated drug-drug interactions and the possible effect on HIV treatment outcomes of commonly prescribed antiretroviral therapy.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto , Coinfecção/tratamento farmacológico , Interações Medicamentosas , Infecções por HIV/complicações , Humanos , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/complicações
20.
PLoS One ; 14(2): e0212969, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817798

RESUMO

OBJECTIVE: The evolution of antibiotic resistance is far outpacing the development of new antibiotics, causing global public health concern about infections that will increasingly be unresponsive to antimicrobials. This risk of emerging antibiotic resistance may be meaningfully altered in highly AIDS-immunocompromised populations. Such populations fundamentally alter the bacterial evolutionary landscape in two ways, which we seek to model and analyze. First, widespread, population-level immunoincompetence creates a novel host environment with disrupted selective pressures. Second, within AIDS-prevalent populations, the recommendation that antibiotics be taken to treat and prevent opportunistic infection raises the risk of selection for drug-resistant pathogens. DESIGN: To determine the impact of HIV/AIDS on the emergence of antibiotic resistance-specifically in the developing world where high prevalence and economic challenges complicate disease management. METHODS: We present an SEIR epidemiological model of bacterial infection, and parametrize it to capture HIV/AIDS-attributable emergence of resistance under conditions of both high and low HIV/AIDS prevalence. RESULTS: We demonstrate that HIV/AIDS-immunocompromised hosts can be responsible for a disproportionately greater contribution to emergence of resistance than would be expected based on population-wide HIV/AIDS prevalence alone. CONCLUSIONS: As such, the AIDS-immunocompromised have the potential become wellsprings of novel, resistant, opportunistic pathogen strains that can propagate into the broader global community. We discuss how public health policies for HIV/AIDS management can shape the evolutionary environment for opportunistic bacterial infections.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/imunologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Antituberculosos/uso terapêutico , Farmacorresistência Bacteriana , Humanos , Hospedeiro Imunocomprometido , Modelos Biológicos , Prevalência , Prática de Saúde Pública , Fatores de Risco , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico
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