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1.
PLoS Negl Trop Dis ; 18(2): e0011968, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38359088

RESUMO

BACKGROUND: Patients with recurrent TB have an increased risk of higher mortality, lower success rate, and a relatively feeble likelihood of treatment completion than those with new-onset TB. This study aimed to assess the epidemiology of recurrent TB in Tanzania; specifically, we aim to determine the prevalence of TB recurrence and factors associated with unfavourable treatment outcomes among patients with recurrent TB in Tanzania from 2018 to 2021. METHODS: In this cross-sectional study, we utilized Tanzania's routinely collected national TB program data. The study involved a cohort of TB patients over a fixed treatment period registered in the TB and Leprosy case-based District Health Information System (DHIS2-ETL) database from 2018 to 2021 in Tanzania. We included patients' sociodemographic and clinical factors, facility characteristics, and TB treatment outcomes. We conducted bivariate analysis and multivariable multi-level mixed effects logistic regression of factors associated with TB recurrence and TB treatment outcomes to account for the correlations at the facility level. A purposeful selection method was used; the multivariable model included apriori selected variables (Age, Sex, and HIV status) and variables with a p-value <0.2 on bivariate analysis. The adjusted odds ratio and 95% confidence interval were recorded, and a p-value of less than 0.05 was considered statistically significant. FINDINGS: A total of 319,717 participants were included in the study; the majority were adults aged 25-49 (44.2%, n = 141,193) and above 50 years (31.6%, n = 101,039). About two-thirds were male (60.4%, n = 192,986), and more than one-fifth of participants (22.8%, n = 72,396) were HIV positive. Nearly two in every hundred TB patients had a recurrent TB episode (2.0%, n = 6,723). About 10% of patients with recurrent TB had unfavourable treatment outcomes (9.6%, n = 519). The odds of poor treatment outcomes were two-fold higher for participants receiving treatment at the central (aOR = 2.24; 95% CI 1.33-3.78) and coastal zones (aOR = 2.20; 95% CI 1.40-3.47) than the northern zone. HIV-positive participants had 62% extra odds of unfavourable treatment outcomes compared to their HIV-negative counterparts (aOR = 1.62; 95% CI 1.25-2.11). Bacteriological TB diagnosis (aOR = 1.39; 95% CI 1.02-1.90) was associated with a 39% additional risk of unfavourable treatment outcomes as compared to clinical TB diagnosis. Compared to community-based DOT, patients who received DOT at the facility had 1.39 times the odds of poor treatment outcomes (aOR = 1.39; 95%CI 1.04-1.85). CONCLUSION: TB recurrence in Tanzania accounts for 2% of all TB cases, and it is associated with poor treatment outcomes. Unfavourable treatment outcomes were recorded in 10% of patients with recurrent TB. Poor TB treatment outcome was associated with HIV-positive status, facility-based DOT, bacteriologically confirmed TB and receiving treatment at the hospital level, differing among regions. We recommend post-treatment follow-up for patients with recurrent TB, especially those coinfected with HIV. We also propose close follow-up for patients treated at the hospital facility level and strengthening primary health facilities in TB detection and management to facilitate early treatment initiation.


Assuntos
Infecções por HIV , Tuberculose , Adulto , Humanos , Masculino , Feminino , Antituberculosos/uso terapêutico , Tanzânia/epidemiologia , Estudos Transversais , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose/complicações , Resultado do Tratamento , Estudos Retrospectivos
2.
Infect Dis Poverty ; 13(1): 17, 2024 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-38369536

RESUMO

BACKGROUND: Tuberculosis is one of the most significant infectious diseases for global public health. The reallocation of healthcare resources and the restrictions imposed by the COVID-19 pandemic have hindered access to TB diagnosis and treatment. Increases in unfavorable outcomes of the disease have been observed in Brazil. The objective of this study was to analyze the spatial distribution of unfavorable TB treatment outcomes in Brazil before and during the pandemic. METHODS: An ecological study with spatial analysis was conducted with all 5569 municipalities in Brazil. All reported cases of tuberculosis between January 2010 and December 2021, as well as reported cases of COVID-19 from February 2020 to December 2021, were included. The outcomes studied encompass loss to follow-up, drug-resistant tuberculosis, and death. The Getis Ord GI* technique was employed to assess spatial association, and the Kernel density estimator was used to identify areas with concentrated increases or decreases in outcomes. Bivariate Local Moran's I was used to examine the spatial association between outcomes and COVID-19 incidence. The study was approved by the Research Ethics Committee of Ribeirão Preto Nursing School, University of São Paulo. RESULTS: There were 134,394 cases of loss to follow-up, 10,270 cases of drug resistance, and 37,863 deaths. Clusters of high and low values were identified for all three outcomes, indicating significant changes in the spatial distribution patterns. Increases in concentrations were observed for lost to follow-up cases in the Southeast, while reductions occurred in the Northeast, South, and Midwest. Drug-resistant tuberculosis experienced an increase in the Southern and Southeastern regions and a decrease in the Northeast and South. TB-related deaths showed notable concentrations in the Midwest, Northeast, South, and Southeast. There was an increase in high occurrence clusters for deaths after 2020 and 2021 in the Northeast. CONCLUSIONS: The pandemic has brought additional challenges, emphasizing the importance of enhancing efforts and disease control strategies, prioritizing early identification, treatment adherence, and follow-up. This commitment is vital for achieving the goal of tuberculosis elimination.


Assuntos
COVID-19 , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose , Humanos , Pandemias , Brasil/epidemiologia , Objetivos , Desenvolvimento Sustentável , COVID-19/epidemiologia , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia
3.
Front Cell Infect Microbiol ; 14: 1285493, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38312744

RESUMO

Background: Apoptosis is associated with the pathogenesis of Mycobacterium tuberculosis infection. This study aims to identify apoptosis-related genes as biomarkers for differentiating active tuberculosis (ATB) from latent tuberculosis infection (LTBI). Methods: The tuberculosis (TB) datasets (GSE19491, GSE62525, and GSE28623) were downloaded from the Gene Expression Omnibus (GEO) database. The diagnostic biomarkers differentiating ATB from LTBI were identified by combining the data of protein-protein interaction network, differentially expressed gene, Weighted Gene Co-Expression Network Analysis (WGCNA), and receiver operating characteristic (ROC) analyses. Machine learning algorithms were employed to validate the diagnostic ability of the biomarkers. Enrichment analysis for biomarkers was established, and potential drugs were predicted. The association between biomarkers and N6-methyladenosine (m6A) or 5-methylated cytosine (m5C) regulators was evaluated. Results: Six biomarkers including CASP1, TNFSF10, CASP4, CASP5, IFI16, and ATF3 were obtained for differentiating ATB from LTBI. They showed strong diagnostic performances, with area under ROC (AUC) values > 0.7. Enrichment analysis demonstrated that the biomarkers were involved in immune and inflammation responses. Furthermore, 24 drugs, including progesterone and emricasan, were predicted. The correlation analysis revealed that biomarkers were positively correlated with most m6A or m5C regulators. Conclusion: The six ARGs can serve as effective biomarkers differentiating ATB from LTBI and provide insight into the pathogenesis of Mycobacterium tuberculosis infection.


Assuntos
Tuberculose Latente , Mycobacterium tuberculosis , Tuberculose , Humanos , Tuberculose/diagnóstico , Biomarcadores/metabolismo , Apoptose
4.
J Microbiol ; 62(1): 49-62, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38337112

RESUMO

Tuberculosis (TB), a bacterial infectious disease caused by Mycobacterium tuberculosis (M. tuberculosis), is a significant global public health problem. Mycobacterium tuberculosis expresses a unique family of PE_PGRS proteins that have been implicated in pathogenesis. Despite numerous studies, the functions of most PE_PGRS proteins in the pathogenesis of mycobacterium infections remain unclear. PE_PGRS45 (Rv2615c) is only found in pathogenic mycobacteria. In this study, we successfully constructed a recombinant Mycobacterium smegmatis (M. smegmatis) strain which heterologously expresses the PE_PGRS45 protein. We found that overexpression of this cell wall-associated protein enhanced bacterial viability under stress in vitro and cell survival in macrophages. MS_PE_PGRS45 decreased the secretion of pro-inflammatory cytokines such as IL-1ß, IL-6, IL-12p40, and TNF-α. We also found that MS_PE_PGRS45 increased the expression of the anti-inflammatory cytokine IL-10 and altered macrophage-mediated immune responses. Furthermore, PE_PGRS45 enhanced the survival rate of M. smegmatis in macrophages by inhibiting cell apoptosis. Collectively, our findings show that PE_PGRS45 is a virulent factor actively involved in the interaction with the host macrophage.


Assuntos
Mycobacterium tuberculosis , Tuberculose , Humanos , Mycobacterium tuberculosis/genética , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Imunidade Inata , Citocinas/metabolismo , Apoptose , Mycobacterium smegmatis/genética
5.
PLoS One ; 19(2): e0298244, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38359007

RESUMO

BACKGROUND: Public health problems related to tuberculosis (TB) remain substantial globally, particularly in resource-limited countries. Determining TB treatment outcomes and identifying contributing factors are the basic components of the TB control strategy. In Ethiopia, different studies have been done on treatment outcomes and multiple associated factors, and there is also a little information on the effect of nutritional status on TB treatment outcomes. So there is a need for comprehensive research that examines the combined effects of multiple factors along with nutritional status. METHODS: A five-year institution-based retrospective cross-sectional study was conducted at Mizan Tepi University Teaching Hospital, South West Ethiopia. This study included all tuberculosis patients who were documented in the TB registration and had known treatment outcomes at the treatment facility between January 1, 2016, and December 31, 2020. Data was collected through a pretested structured data extraction checklist. Data were entered into Epidata version 3.1 and analyzed through SPSS version 22. Multiple logistic regression was employed to assess the association between dependent and independent variables. A p-value of less than 0.05 was considered statistically significant. RESULT: Of the total 625 TB patients, 283 (45.3%), 175 (28%), and 167 (26.7%) had smear-positive, extra-pulmonary, and smear-negative tuberculosis, respectively. The majority of study participants had normal weight (62.2%), were in the age group of 15-44 (67.4%), were new cases (73.8%), and were from urban areas (69.4%). About 32.2% of cases were HIV-positive. The overall unsuccessful treatment rate was 25%. From the total unsuccessful treatment rates, the highest proportion was a death rate of 90 (14.4%), followed by a treatment failure of 56 (9%). Being female (AOR = 1.7, 95% CI: 1.2-2.5), HIV positive (AOR = 2.7, 95% CI: 1.9-4.1), undernutrition (BMI<18.5kg/m2) (AOR = 1.9, 95% CI: 1.3-2.9), and smear-negative pulmonary TB (AOR = 1.6, 95% CI: 1-2.5) were independent predictors of unsuccessful treatment outcomes. CONCLUSION: The treatment success rate in the study area is very poor. Poor treatment outcomes were associated with undernutrition, female gender, HIV positivity and smear-negative pulmonary TB. So, continuous and serious supervision and monitoring of directly observed treatment short course (DOTS) program accomplishment, early detection of HIV and TB, prompt anti TB and antiretroviral treatment initiation and adherence, enhanced nutritional assessment, and counseling services need to be strengthened to improve treatment outcomes.


Assuntos
Infecções por HIV , Desnutrição , Tuberculose Pulmonar , Tuberculose , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Masculino , Estudos Retrospectivos , Estado Nutricional , Estudos Transversais , Universidades , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Resultado do Tratamento , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Hospitais Universitários , Hospitais de Ensino , Etiópia/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia
7.
Curr Microbiol ; 81(3): 90, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38311651

RESUMO

Toxin-Antitoxin (TA) systems are some small genetic modules in bacteria that play significant roles in resistance and tolerance development to antibiotics. Whole genome sequencing (WGS) is an effective method to analyze TA systems in pathogenic Mycobacteria. However, this study aimed to use a simple and inexpensive PCR-Sequencing approach to investigate the type II TA system. Using data from the WGS of Mycobacterium tuberculosis (M. tuberculosis) strain H37Rv and Mycobacterium bovis (M. bovis) strain BCG, primers specific to the relJK, mazEF3, and vapBC3 gene families were designed by Primer3 software. Following that, a total of 90 isolates were examined using the newly developed PCR assay, consisting of 64 M. tuberculosis and 26 M. bovis isolates, encompassing both 45 rifampin-sensitive and 45 rifampin-resistant strains. Finally, 28 isolates (including 14 rifampin-resistant isolates) were sent for sequencing, and their sequences were aligned and compared to the mentioned reference sequences. The amplicons size of mazEF3, relJK, and vapBC3 genes were 825, 875, and 934 bp, respectively. Furthermore, all tested isolates showed the specific amplicons for these TA families. To evaluate the specificity of the primers, PCR was performed on S. aureus and E.coli isolates. None of the examined samples had the desired amplicons. Therefore, the primers had acceptable specificity. The results indicated that the developed PCR-Sequencing approach can be used to effectively investigate certain types of TA systems. Considering high costs of WGS and difficulty in interpreting its results, such a simple and inexpensive method is beneficial in the evaluation of TA systems in Mycobacteria.


Assuntos
Mycobacterium bovis , Mycobacterium tuberculosis , Sistemas Toxina-Antitoxina , Tuberculose , Humanos , Mycobacterium tuberculosis/genética , Mycobacterium bovis/genética , Rifampina , Sistemas Toxina-Antitoxina/genética , Staphylococcus aureus/genética , Tuberculose/microbiologia , Reação em Cadeia da Polimerase/métodos
8.
PLoS One ; 19(2): e0298021, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38346004

RESUMO

OBJECTIVES: To assess the incidence and predictors of time to Tuberculosis (TB) development among Human Immunodeficiency Virus (HIV) positive patients attending follow-up care in health facilities of Hawassa, Ethiopia. METHODS: We conducted a retrospective cohort study from April 1-30, 2023. A total of 422 participants were selected using a simple random sampling method. Data was collected from the medical records of patients enrolled between January 1, 2018 -December 31, 2022, using the Kobo toolbox. We used Statistical Package for Social Studies (SPSS) version 26.0 for data analysis. To estimate the duration of TB-free survival, we applied the Kaplan-Meier survival function and fitted Cox proportional hazard models to identify the predictors of time to TB development. Adjusted hazard ratios (AHR) with 95% confidence intervals were calculated and statistical significance was declared at a P-value of 0.05. RESULTS: The overall incidence rate of TB among HIV-positive patients was 6.26 (95% CI: 4.79-8.17) per 100 person-years (PYs). Patients who did not complete TB Preventive Therapy (TPT) were more likely to have TB than those who did (AHR = 6.2, 95% CI: 2.34-16.34). In comparison to those who began antiretroviral therapy (ART) within a week, those who began after a week of linkage had a lower risk of TB development (AHR = 0.44, 95% CI: 0.21-0.89). Patients who received ART for six to twelve months (AHR = 0.18, 95% CI: 0.05-0.61) and for twelve months or longer (AHR = 0.004, 95% CI: 0.001-0.02) exhibited a decreased risk of TB development in comparison to those who had ART for less than six months. CONCLUSION: The incidence of TB among HIV-positive patients is still high. To alleviate this burden, special attention should be given to regimen optimization and provision of adherence support for better completion of TPT, sufficient patient preparation, thorough clinical evaluation for major (Opportunistic Infections) OIs prior to starting ART, and ensuring retention on ART.


Assuntos
Infecções por HIV , Soropositividade para HIV , Infecções Oportunistas , Tuberculose , Humanos , Estudos Retrospectivos , Tuberculose/complicações , Tuberculose/epidemiologia , Tuberculose/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Modelos de Riscos Proporcionais , Incidência , Etiópia/epidemiologia
9.
Front Public Health ; 12: 1249880, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38317798

RESUMO

Introduction: Numerous studies suggest that the risk of tuberculosis (TB) is linked to gene polymorphisms of the interleukin-12 receptor b subunit 1 (IL12RB1), but the association between IL12RB1 polymorphisms and TB susceptibility has not been thoroughly investigated. Methods: A meta-analysis was conducted based on eight case-control studies with 10,112 individuals to further explore this topic. A systematic search of PubMed, Web of Science, Excerpt Medica Database, and Google Scholar up until April 6th, 2023 was performed. ORs and 95% CIs were pooled using the random-effect model. The epidemiological credibility of all significant associations was assessed using the Venice criteria and false-positive report probability (FPRP) analyses. Results: The IL12RB1 rs11575934 and rs401502 showed solid evidence of no significant association with TB susceptibility. However, a weak association was observed between the IL12RB1 rs375947 biomarker and pulmonary tuberculosis (PTB) susceptibility (OR = 1.64, 95% CI: 1.22, 2.21). Discussion: These findings should be confirmed through larger, better-designed studies to clarify the relationship between biomarkers in IL12RB1 gene and different types of TB susceptibility.


Assuntos
Predisposição Genética para Doença , Tuberculose , Humanos , Receptores de Interleucina-12/genética , Tuberculose/genética , Polimorfismo Genético , Fatores de Risco
10.
Eur Rev Med Pharmacol Sci ; 28(2): 822-828, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38305625

RESUMO

OBJECTIVE: The purpose of this study is to investigate the mortality of patients with tuberculosis (TB) who need to be admitted to the intensive care unit (ICU) and to analyze the risk factors for mortality. PATIENTS AND METHODS: A retrospective analysis was conducted to collect clinical data of patients with TB who were hospitalized in the ICU at Hebei Chest Hospital between 2015 and 2020. Subsequent to data collection, a rigorous statistical analysis was conducted. RESULTS: A total of 99 patients with TB were admitted to the ICU of Hebei Chest Hospital from 2015 to 2020. After 28 days, 78 of the 99 eligible participants in this study died, while 21 survived. The mortality rate of patients with TB in the ICU was 78.79%. There was a significant difference in the length of stay in ICU, shock, drug, acute physiology, and chronic health evaluation (APACHE) II, procalcitonin, C-reactive protein, and albumin (p < 0.05). Further analysis indicated that the length of stay in the ICU, shock, APACHE II, and albumin were considered independent risk factors for mortality. CONCLUSIONS: In China, the mortality rate of patients with TB requiring admission to the ICU is very high. In these patients, a prolonged ICU stay, a high APACHE II score, the onset of shock in the ICU, and a low albumin level have a significant impact on the risk of mortality.


Assuntos
Unidades de Terapia Intensiva , Tuberculose , Humanos , Estudos Retrospectivos , Tempo de Internação , Fatores de Risco , Mortalidade Hospitalar , Albuminas , Prognóstico
11.
Front Public Health ; 12: 1343350, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38384875

RESUMO

Objective: Tuberculosis (TB) is a major public health concern in Ecuador and Colombia, considering that both countries are high-burden TB settings. Molecular epidemiology is crucial to understand the transmission dynamics of Mycobacterium tuberculosis complex (MTBC) and to identify active transmission clusters of regional importance. Methods: We studied the potential transmission of TB between Colombia and Ecuador through the analysis of the population structure of MTBC lineages circulating in the Ecuadorian province of Esmeraldas at the border with Colombia. A total of 105 MTBC strains were characterized by 24-loci MIRU-VNTR and spoligotyping. Results: MTBC lineage 4 is only present in Esmeraldas; no MTBC strains belonging to Lineage 2-sublineage Beijing were found despite its presence in other provinces of Ecuador and, in Colombia. Genotyping results revealed a high degree of diversity for MTBC in Esmeraldas: Neither active transmission clusters within this province nor including MTBC strains from Colombia or other provinces of Ecuador were found. Conclusion: Our data suggest that tuberculosis dynamics in this rural and isolated area may be not related to highly transmitted strains but could be influenced by other health determinants that favor TB relapse such as poverty and poor health system access. Further studies including a larger number of MTBC strains from Esmeraldas are necessary to test this hypothesis.


Assuntos
Mycobacterium tuberculosis , Tuberculose , Humanos , Mycobacterium tuberculosis/genética , Equador/epidemiologia , Estudos Retrospectivos , Colômbia/epidemiologia , Tuberculose/epidemiologia
12.
Radiology ; 310(2): e223090, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38411510

RESUMO

HISTORY: An 81-year-old man living in South Korea was referred to the pulmonology clinic because of abnormal findings at routine surveillance CT. His past medical history included right radical nephroureterectomy for ureteral cancer in 2016, transurethral resection of a bladder tumor in 2015, and tuberculous pleurisy in his third decade of life that was complicated by a chronic calcified empyema. He had been doing well clinically until 6 months prior, when he presented to an outside hospital with progressive right-sided chest pain and dyspnea and was found to have active tuberculosis. During that hospitalization, he underwent chest CT and CT-guided biopsy of an incidentally found thoracic lesion, which revealed chronic active inflammation. His symptoms improved after initiation of antituberculous medication, and he was discharged home to complete treatment. Because of interval growth of this lesion noted on a subsequent surveillance CT scan, he was referred to pulmonology for further evaluation. Laboratory tests obtained during his visit revealed mild leukocytosis (1258 cells × 109/L; normal range, 4000-10 000 cells × 109/L) with neutrophilic predominance (82% neutrophils; normal range, 50%-75% neutrophils), and a mildly elevated C-reactive protein level (3.17 mg/dL; normal range, 0-0.5 mg/dL). A sputum culture was negative for tuberculosis. The patient reported mild chest discomfort and dyspnea. Liver MRI was performed to further evaluate an abnormal lesion seen at CT. Given the patient's recent nonspecific biopsy results and tuberculosis treatment, no further work-up was pursued. Contrast-enhanced chest CT was performed 6 months later because the patient developed worsening chest pain and dyspnea. He remained afebrile, with persistent leukocytosis (1485 cells × 109/L) and an elevated C-reactive protein level (3.56 mg/dL). On the basis of the imaging findings, repeat CT-guided biopsy and PET/CT were performed, thereby enabling confirmation of the diagnosis, and appropriate treatment was initiated.


Assuntos
Empiema Pleural , Linfoma Difuso de Grandes Células B , Neoplasias Pleurais , Tuberculose , Masculino , Humanos , Idoso de 80 Anos ou mais , Proteína C-Reativa , Leucocitose , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Dor no Peito , Dispneia , Biópsia Guiada por Imagem
13.
J Fr Ophtalmol ; 47(2): 104070, 2024 Feb.
Artigo em Francês | MEDLINE | ID: mdl-38310692

RESUMO

INTRODUCTION: Rosai-Dorfman disease (RDD) is a sinus histiocytosis with massive lymphadenopathy. This rare condition is a benign disease of unknown etiology. Bilateral orbital localization of RDD is rare. OBSERVATION: The authors report the case of a 6-year-old child who presented with bilateral orbital-palpebral masses associated with chronic cervical lymphadenopathy. There were no laboratory signs of inflammation. Serological and tuberculosis screening tests were negative. Histopathological examination of a lymph node biopsy established a diagnosis of Rosai-Dorfman disease. The patient underwent surgical excision of the orbital lesions followed by long-term corticosteroid therapy. A favorable course was observed, with no sign of recurrence after one year of follow-up. CONCLUSION: Rosai-Dorfman disease is very rare in its bilateral orbital presentation. Histopathological diagnosis remains challenging. In Africa, the presence of chronic oculo-palpebral tumor associated with or without cervical lymphadenopathy must raise the suspicion of Rosai-Dorfman disease after ruling out tuberculosis and lymphoma.


Assuntos
Histiocitose Sinusal , Linfadenopatia , Doenças Orbitárias , Tuberculose , Humanos , Criança , Histiocitose Sinusal/diagnóstico , Histiocitose Sinusal/complicações , Histiocitose Sinusal/patologia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/complicações , Biópsia , Tuberculose/complicações
15.
Zhonghua Liu Xing Bing Xue Za Zhi ; 45(2): 237-241, 2024 Feb 10.
Artigo em Chinês | MEDLINE | ID: mdl-38413063

RESUMO

Objective: To understand the awareness and influencing factors of core information on tuberculosis prevention and control in the elderly population in China. Methods: The study included all participants aged ≥60 from the "13th Five-Year" National Tuberculosis Control Plan end-term assessment in 2020, with 13 706 valid questionnaires obtained. Multivariate logistic regression was used to analyze the influencing factors of the awareness rate of core information on tuberculosis prevention and control in the elderly. Results: The total awareness rate of core information on tuberculosis prevention and control in the elderly aged ≥60 was 78.4%, with the highest for "suspicious symptoms of pulmonary tuberculosis" (85.4%) and the lowest for "whether pulmonary tuberculosis can be cured" (65.3%). The complete awareness rate of core information on tuberculosis prevention and control in the elderly was 41.3%, and the proportion of those who received tuberculosis health education is 67.6%. Multivariate logistic regression analysis results showed that factors associated with low awareness of core information included females (OR=0.93, 95%CI: 0.86-1.00), ages 70- (OR=0.91, 95%CI: 0.84-0.98) and ≥80 (OR=0.77, 95%CI: 0.68-0.87) and minority ethnicity (OR=0.85, 95%CI: 0.74-0.99). Factors associated with high awareness of core information included educational levels of junior high school (OR=1.46, 95%CI: 1.34-1.58), high school (OR=1.62, 95%CI: 1.45-1.81), junior college (OR=1.37, 95%CI: 1.11-1.68), and an undergraduate degree or higher (OR=1.52, 95%CI: 1.09-2.11), and receiving tuberculosis health education (OR=2.13, 95%CI: 1.97-2.27). Conclusions: In 2020, the awareness rate of core information on tuberculosis prevention and control in Chinese older adults aged ≥60 was lower than the national planning target. Therefore, there should be an increased focus on health education about tuberculosis for elderly females, those aged ≥70, ethnic minorities, and those with lower education levels.


Assuntos
Tuberculose Pulmonar , Tuberculose , Feminino , Humanos , Idoso , Tuberculose/prevenção & controle , Estudantes , Educação em Saúde , China/epidemiologia
16.
Infect Dis Poverty ; 13(1): 20, 2024 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-38414000

RESUMO

BACKGROUND: The disease burden of tuberculosis (TB) was heavy in Hainan Province, China, and the information on transmission patterns was limited with few studies. This atudy aims to further explore the epidemiological characteristics and influencing factors of TB in Hainan Province, and thereby contribute valuable scientific evidences for TB elimination in Hainan Province. METHODS: The TB notification data in Hainan Province from 2013 to 2022 were collected from the Chinese National Disease Control Information System Tuberculosis Surveillance System, along with socio-economic data. The spatial-temporal and population distributions were analyzed, and spatial autocorrelation analysis was conducted to explore TB notification rate clustering. In addition, the epidemiological characteristics of the cases among in-country migrants were described, and the delay pattern in seeking medical care was investigated. Finally, a geographically and temporally weighted regression (GTWR) model was adopted to analyze the relationship between TB notification rate and socio-economic indicators. The tailored control suggestions in different regions for TB elimination was provided by understanding epidemiological characteristics and risk factors obtained by GTWR. RESULTS: From 2013 to 2022, 64,042 cases of TB were notified in Hainan Province. The estimated annual percentage change of TB notification rate in Hainan Province from 2013 to 2020 was - 6.88% [95% confidence interval (CI): - 5.30%, - 3.69%], with higher rates in central and southern regions. The majority of patients were males (76.33%) and farmers (67.80%). Cases among in-country migrants primarily originated from Sichuan (369 cases), Heilongjiang (267 cases), Hunan (236 cases), Guangdong (174 cases), and Guangxi (139 cases), accounting for 53%. The majority (98.83%) of TB cases were notified through passive case finding approaches, with delay in seeking care. The GTWR analysis showed that gross domestic product per capita, the number of medical institutions and health personnel per 10,000 people were main factors affecting the high TB notification rates in some regions in Hainan Province. Different regional tailored measures such as more TB specialized hospitals were proposed based on the characteristics of each region. CONCLUSIONS: The notification rate of TB in Hainan Province has been declining overall but still remained high in central and southern regions. Particular attention should be paid to the prevalence of TB among males, farmers, and out-of-province migrant populations. The notification rate was also influenced by economic development and medical conditions, indicating the need of more TB specialized hospitals, active surveillance and other tailored prevention and control measures to promote the progress of TB elimination in Hainan Province.


Assuntos
Tuberculose , Masculino , Humanos , Feminino , China/epidemiologia , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Fatores de Risco , Análise Espacial , Regressão Espacial
17.
Vaccine ; 42(6): 1311-1318, 2024 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-38307747

RESUMO

BACKGROUND: Tuberculosis remains a major public health problem in South Africa, with an estimated 300,000 cases and 55,000 deaths in 2021. New tuberculosis vaccines could play an important role in reducing this burden. Phase IIb trials have suggested efficacy of the M72/AS01E vaccine candidate and BCG-revaccination. The potential population impact of these vaccines is unknown. METHODS: We used an age-stratified transmission model of tuberculosis, calibrated to epidemiological data from South Africa, to estimate the potential health and economic impact of M72/AS01E vaccination and BCG-revaccination. We simulated M72/AS01E vaccination scenarios over the period 2030-2050 and BCG-revaccination scenarios over the period 2025-2050. We explored a range of product characteristics and delivery strategies. We calculated reductions in tuberculosis cases and deaths and costs and cost-effectiveness from health-system and societal perspectives. FINDINGS: M72/AS01E vaccination may have a larger impact than BCG-revaccination, averting approximately 80% more cases and deaths by 2050. Both vaccines were found to be cost-effective or cost saving (compared to no new vaccine) across a range of vaccine characteristics and delivery strategies from both the health system and societal perspective. The impact of M72/AS01E is dependent on the assumed efficacy of the vaccine in uninfected individuals. Extending BCG-revaccination to HIV-infected individuals on ART increased health impact by approximately 15%, but increased health system costs by approximately 70%. INTERPRETATION: Our results show that M72/AS01E vaccination or BCG-revaccination could be cost-effective in South Africa. However, there is considerable uncertainty in the estimated impact and costs due to uncertainty in vaccine characteristics and the choice of delivery strategy. FUNDING: This work was funded by the Bill & Melinda Gates Foundation (INV-001754). This work used the Cirrus UK National Tier-2 HPC Service at EPCC (https://www.cirrus.ac.uk) funded by the University of Edinburgh and EPSRC (EP/P020267/1).


Assuntos
Vacina BCG , Tuberculose , Humanos , África do Sul , Imunização Secundária , Tuberculose/prevenção & controle , Vacinação
18.
BMC Infect Dis ; 24(1): 242, 2024 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-38389045

RESUMO

BACKGROUND: Diabetes mellitus (DM) has a direct impact on the clinical manifestation and prognosis of active tuberculosis disease (TB) and is known to increase the chance of developing the condition. We sought to determine the prevalence of DM in adult Ugandan patients with recently diagnosed TB and the associated sociodemographic, anthropometric, and metabolic characteristics of TB-DM comorbidity. METHODS: In this cross-sectional study conducted at the adult TB treatment centres of three tertiary healthcare facilities in Uganda, we screened adult participants with recently diagnosed TB (diagnosed in < 2 months) for DM. All participants were screened with five tests; initially with a random blood glucose (RBG) test, and then later with fasting blood glucose (FBG), laboratory-based glycated hemoglobin (HbA1c), point-of-care (POC) HbA1c, and oral glucose tolerance test (OGTT) if the RBG was ≥ 6.1 mmol/l. The WHO guidelines for diagnosing and managing DM were used to support the DM diagnosis. To identify the factors associated with DM-TB comorbidity, logistic regression was used. RESULTS: A total of 232 participants with recently diagnosed TB were screened for DM. Of these, 160 (69%) were female. The median (IQR) age, body mass index, and RBG of all study participants was 35 (27-42) years, 19.2 (17.6-21.3) kg/m2, and 6.1 (5.5-7.2) mmol/l, respectively. About half of the participants (n = 117, 50.4%) had RBG level ≥ 6.1 mmol/l. Of these, 75 (64.1%) participants returned for re-testing. Diabetes mellitus was diagnosed in 32 participants, corresponding to a prevalence of 13.8% (95% CI 9.9-18.9). A new diagnosis of DM was noted in 29 (90.6%) participants. On logistic regression, age ≥ 40 years was associated with increased odds of TB and DM comorbidity (AOR 3.12, 95% CI 1.35-7.23, p = 0.008) while HIV coinfection was protective (AOR 0.27, 95% CI 0.10-0.74, p = 0.01). CONCLUSION: TB and DM comorbidity was relatively common in this study population. Routine screening for DM in adult Ugandan patients with recently diagnosed TB especially among those aged ≥ 40 years and HIV-negative patients should be encouraged in clinical practice.


Assuntos
Diabetes Mellitus , Tuberculose , Adulto , Humanos , Feminino , Masculino , Uganda/epidemiologia , Hemoglobinas Glicadas , Glicemia/metabolismo , Estudos Transversais , Tuberculose/complicações , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Comorbidade , Prevalência
19.
BMC Infect Dis ; 24(1): 238, 2024 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-38389060

RESUMO

BACKGROUND: Tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide, particularly in countries with limited resources. The emergence of drug resistance in mycobacterium tuberculosis (MTB), particularly rifampicin (RIF) resistance, hindered TB control efforts. Continuous surveillance and regular monitoring of drug-resistant TB, including rifampicin resistance (RR), are required for effective TB intervention strategies and prevention and control measures. OBJECTIVE: Determine the trend of TB and RR-TB among presumptive TB patients in Northwest Ethiopia. METHOD: A retrospective study was conducted at the University of Gondar Comprehensive Specialized Hospital (UoG-CSH). The study included TB registration logbook data from all patients who visited the hospital and were tested for MTB using the Xpert® MTB/RIF assay between 2015 and 2021. The SPSS version 26 software was used to enter, clean, and analyze the laboratory-based data. RESULTS: A total of 18,787 patient results were included, with 93.8% (17,615/18787) of them being successful, meaning they were not invalid, error, or aborted. About 10.5% (1846/17615) of the 17,615 results were MTB-positive, with 7.42% (137/1846) RIF resistant. Age, anti-TB treatment history, and diagnosis year were associated with the presence of MTB and RR-MTB. Tuberculosis (TB) prevalence was higher in productive age groups, whereas RR-TB prevalence was higher in the elderly. Regarding diagnosis year, the prevalence of TB and RR-TB showed a declining trend as the year progressed. While MTB was detected in 12.8% (471/3669) of new and 22.2% (151/679) of re-treatment presumptive TB patients, RR-MTB was detected in 8.5% (40/471) of new and 18.5% (28/151) of re-treatment TB cases. CONCLUSION: The prevalence of TB and RR-TB in the study area showed a declining trend over the years. While TB was more prevalent in productive age groups (15 to 45 years), RR-TB was more prevalent in older populations (over 45 years), than others. Moreover, patients with a history of anti-TB drug exposure were more likely to be positive for DR-TB, highlighting the need to strengthen DOT programs for proper management of TB treatment.


Assuntos
Antibióticos Antituberculose , Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose , Humanos , Idoso , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Rifampina/farmacologia , Rifampina/uso terapêutico , Antibióticos Antituberculose/uso terapêutico , Estudos Retrospectivos , Etiópia/epidemiologia , Farmacorresistência Bacteriana , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia
20.
BMC Womens Health ; 24(1): 99, 2024 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-38326846

RESUMO

BACKGROUND: Asherman syndrome is one of the endometrial factors that influence a woman's reproductive capacity. However, in our context, it needs to be well-documented. This study aimed to evaluate the clinical characteristics and hysteroscopic treatment outcomes of Asherman syndrome. METHOD: A retrospective follow-up study from January 1, 2019, to December 31, 2022, was conducted on cases of Asherman syndrome after hysteroscopic adhesiolysis at St.Paul's Hospital in Addis Ababa, Ethiopia. Clinical data were collected via telephone survey and checklist. Epidata-4.2 and SPSS-26 were employed for data entry and analysis, respectively. RESULT: A total of 177 study participants were included in the final analysis. The mean patient age was 31 years (range: 21-39) at the initial presentation, and 32.3 years (range: 22-40) during the phone interview. The majority of the patients (97.7%) had infertility, followed by menstrual abnormalities (73.5%). Among them, nearly half (47.5%) had severe, 38.4% had moderate, and 14.1% had mild Asherman syndrome. The review identified no factor for 51.4% of the participants. Endometrial tuberculosis affected 42 patients (23.7%). It was also the most frequent factor in both moderate and severe cases of Asherman syndrome. Only 14.7% of patients reported menstrual correction. Overall, 11% of women conceived. Nine patients miscarried, three delivered viable babies, and six were still pregnant. The overall rate of adhesion reformation was 36.2%. Four individuals had complications (3 uterine perforations and one fluid overload) making a complication rate of 2.3%. CONCLUSION: Our study revealed that severe forms of Asherman syndrome, which are marked by amenorrhea and infertility, were more common, leading to incredibly low rates of conception and the resumption of regular menstruation, as well as high recurrence rates. A high index of suspicion for Asherman syndrome, quick and sensitive diagnostic testing, and the development of a special algorithm to identify endometrial tuberculosis are therefore essential. Future multi-centered studies should focus on adhesion preventive techniques.


Assuntos
Ginatresia , Histeroscopia , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem , Etiópia , Seguimentos , Ginatresia/cirurgia , Ginatresia/complicações , Ginatresia/diagnóstico , Histeroscopia/métodos , Estudos Retrospectivos , Tuberculose/complicações
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