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2.
BMC Infect Dis ; 19(1): 544, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221100

RESUMO

BACKGROUND: Bedaquiline was recently introduced into World Health Organization (WHO)-recommended regimens for treatment of drug resistant tuberculosis. There is limited data on the long-term safety of bedaquiline. Because bedaquiline prolongs the QT interval, there are concerns regarding cardiovascular safety. The Western Cape Province in South Africa has an established pharmacovigilance programme: a targeted spontaneous reporting system which solicits reports of suspected adverse drug reactions (ADRs) in patients with HIV-1 and/or tuberculosis infection. Since 2015, bedaquiline has been included in the treatment regimens recommended for resistant tuberculosis in South Africa. We describe ADRs in patients on bedaquiline-containing tuberculosis treatment that were reported to the Western Cape Pharmacovigilance programme. METHODS: We reviewed reports of suspected ADRs and deaths received between March 2015 and June 2016 involving patients receiving bedaquiline-containing tuberculosis treatment. A multidisciplinary panel assessed causality, and categorised suspected ADRs using World Health Organisation-Uppsala Monitoring Centre system categories. "Confirmed ADRs" included all ADRs categorised as definite, probable or possible. Preventability was assessed using Schumock and Thornton criteria. Where a confirmed ADR occurred in a patient who died, the panel categorised the extent to which the ADR contributed to the patient's death as follows: major contributor, contributor or non-contributor. RESULTS: Thirty-five suspected ADRs were reported in 32 patients, including 13 deaths. There were 30 confirmed ADRs, of which 23 were classified as "possible" and seven as "probable". Bedaquiline was implicated in 22 confirmed ADRs in 22 patients. The most common confirmed ADR in patients receiving bedaquiline was QT prolongation (8 cases, 7 of which were severe). A fatal arrhythmia was suspected in 4 sudden deaths. These 4 patients were all taking bedaquiline together with other QT-prolonging drugs. There were 8 non-bedaquiline-associated ADRs, of which 7 contributed to deaths. CONCLUSIONS: Confirmed ADRs in patients receiving bedaquiline reflect the known safety profile of bedaquiline. Quantifying the incidence and clinical consequences of severe QT-prolongation in patients receiving bedaquiline-containing regimens is a research priority to inform recommendations for patient monitoring in treatment programmes for drug resistant tuberculosis. Pharmacovigilance systems within tuberculosis treatment programmes should be supported and encouraged, to provide ongoing monitoring of treatment-limiting drug toxicity.


Assuntos
Antituberculosos/efeitos adversos , Doenças Cardiovasculares/etiologia , Diarilquinolinas/efeitos adversos , Adulto , Antituberculosos/uso terapêutico , Diarilquinolinas/uso terapêutico , Feminino , Infecções por HIV/complicações , Infecções por HIV/patologia , Humanos , Síndrome do QT Longo/tratamento farmacológico , Síndrome do QT Longo/etiologia , Masculino , África do Sul , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Tuberculose/patologia , Adulto Jovem
3.
Pan Afr Med J ; 32: 41, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31143346

RESUMO

Macrophage activation syndrome (MAS) is a rare disorder due to an inappropriate stimulation of macrophages in the bone marrow and in the lymphoid organs. It is defined based on clinical and cytohistological criteria as well as on laboratory tests. Primary syndrome can occur mostly in children or it can be secondary to different types of disorders: haematological, infectious diseases as well as different types of autoimmune diseases. Prognosis is poor, with a mortality rate of almost 50% from all causes. Treatment is based on specific treatment dependent upon the causative agent of the MAS and, in some cases, on etoposide, corticosteroids and immunogobulines, which should be administered at an early stage. MAS has been rarely described in association with tuberculosis. We here report two cases: an immunocompromised patient, the first case, an immunocompetent patient with multifocal tuberculosis complicated by macrophage activation syndrome, the second case. This study aims to emphasize on difficulty in treating macrophage activation syndrome associated with tuberculosis, on the need for an evaluation of benefit/risk ratio based on corticosteroid or immunosuppressant-related risk for developing immunosuppression, with possible worsening of tuberculosis.


Assuntos
Corticosteroides/administração & dosagem , Imunossupressores/administração & dosagem , Síndrome de Ativação Macrofágica/diagnóstico , Tuberculose/complicações , Adulto , Feminino , Humanos , Imunocompetência , Hospedeiro Imunocomprometido , Síndrome de Ativação Macrofágica/etiologia , Síndrome de Ativação Macrofágica/imunologia , Pessoa de Meia-Idade , Prognóstico
4.
BMC Infect Dis ; 19(1): 426, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096926

RESUMO

BACKGROUND: Diagnosing extrapulmonary tuberculosis (EPTB) is challenging and many patients are initiated on empirical anti-TB treatment without a laboratory confirmed diagnosis. Monitoring treatment response is thus important to ensure correct diagnosis and proper disease management. The definition of satisfactory response to treatment in EPTB remains unclear. The objectives of this study were to describe the clinical presentation of EPTB and the effect of treatment on clinical parameters. Further, to assess if simple clinical parameters, without laboratory data, could evaluate treatment response. METHODS: Prospective cohort study of presumptive EPTB patients at Mnazi Mmoja Hospital, Zanzibar. By using a composite reference standard, patients were categorized as TB or non-TB cases. The TB patients were followed during anti-TB treatment. RESULTS: There were 64 TB and 62 non-TB cases. The frequency of symptoms at baseline were comparable in TB and non-TB patients, with lymphadenitis and pleuritis as the most common manifestations. Among TB cases, there was a trend towards regression of lymphadenopathy after 2 months, and at treatment completion 24/28 (86%) cases showed full regression. Weight gain ≥5% was reported in 36/49 (73%) of the TB patients at 2 months and in 38/46 (83%) at treatment completion. After 2 months of treatment, a combination of clinical parameters; improvement of symptoms (50/50), ≥5% weight gain (36/49) and regression of physical signs (45/49) correlated with the treatment response. CONCLUSIONS: An algorithm including only simple clinical parameters could be used as an easy tool to assess treatment responses in low-resource settings. However, this needs to be tested on a larger sample size.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Líquido Ascítico/efeitos dos fármacos , Criança , Estudos de Coortes , Feminino , Hospitais , Humanos , Linfadenopatia/tratamento farmacológico , Linfadenopatia/etiologia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/tratamento farmacológico , Estudos Prospectivos , Tanzânia , Tuberculose/complicações , Ganho de Peso/efeitos dos fármacos
5.
Int J Infect Dis ; 84: 127-130, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31085315

RESUMO

OBJECTIVES: To estimate the incidence of diabetes, acute myocardial infarction (AMI), and stroke; and to determine factors associated with diabetes, AMI, and stroke incidence among patients previously treated for tuberculosis (TB) disease. METHODS: A retrospective cohort study was conducted among non-pediatric TB patients registered in the Taiwan National Health Insurance Research Database (NHIRD) from 2002-2013. Diabetes, AMI, and stroke incidence were defined by International Classification of Diseases (ICD)-9 codes, drug prescriptions, and records of patient's clinic visits. Cox proportional hazard models were used to estimate the hazard rate ratio (HR) of incident diabetes, AMI, and stroke. RESULTS: From 2002-2013, there were 157,444 patients treated for TB registered in NHIRD. Among 129,453 patients with no prior history of diabetes, the age-adjusted incidence rate (IR) of diabetes was 3.85 (95%CI 3.70-4.01) per 1000 person-years. Among 143,646 patients with no prior history of AMI, the age-adjusted IR of AMI as 3.26 (95%CI 3.13-3.40). Among 118,774 patients with no prior history of stroke, the age-adjusted IR of stroke was 16.08 (95%CI 15.76-16.32). CONCLUSIONS: Chronic non-communicable disease risk factors like dyslipidemia, hypertension, and chronic kidney disease diagnosed before time of TB diagnosis were predictive of diabetes, AMI, and stroke incidence.


Assuntos
Diabetes Mellitus/epidemiologia , Infarto do Miocárdio/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Tuberculose/complicações , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taiwan/epidemiologia , Tuberculose/tratamento farmacológico , Adulto Jovem
6.
BMC Infect Dis ; 19(1): 481, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142288

RESUMO

BACKGROUND: Delayed tuberculosis (TB) diagnosis and treatment increase morbidity, mortality, expenditure, and transmission in the community. This study assessed patient and provider related delays to diagnosis and treatment of TB. METHODS: A cross-sectional study was conducted among 735 new adult TB cases registered between January to December 2015 in 10 woredas equivalent to districts of southwestern Ethiopia. Data were collected through face-to-face interview of patients within the first 2 months of treatment initiation. Delay in days was tracked at three intervals: between onset of symptoms and self-presentation (Patient delay), Self-presentation to treatment initiation (Provider delay) and total delay. Days elapsed beyond median were used to define the delays. Bivariate and multiple logistic regression models were fit to identify predictors of delays and statistical significance was judged at p < 0.05. RESULT: The median (inter-quartile range) of patient, provider and total delays were 25 (IQR;15-36), 22 (IQR:9-48) and 55 (IQR:32-100) days, respectively. More than half (54.6%) of the total delay was attributed to health system. Prior self-treatment [adjusted Odds Ratio (aOR)]: 1.72, 95% confidence interval [CI]:1.07-2.75), HIV co-infection (aOR:1.8, 95% CI: 1.05-3.10) and extra-pulmonary TB (aOR: 1.54,95% CI:1.03-2.29) were independently associated with increased odds of patient delay. On the other hand initial presentation to health posts or private clinics (aOR: 1.42, 95% CI: 1.01, 2.0) and patient delay (aOR: 1.81, 95% CI: 1.33-2.50) significantly predicted longer provider delay. Finally, having extra pulmonary TB (aOR: 1.6, 95% CI: 1.07-2.38), prior consultation of traditional healer (aOR: 3.72, 95% CI: 1.01-13.77) and use of holy water (aOR: 2.73, 95% CI: 1.11, 6.70) independently predicted longer total delay. CONCLUSION: Tuberculosis patients waited too long time to initiate anti-TB treatment reflecting longer periods of morbidity and disease transmission. The delays are attributed to the patient, disease and health system related factors. Hence, improving community awareness, involving informal providers, health extension workers and TB treatment supporters can reduce the patient delay. Similarly, cough screening and improving diagnostic efficiencies of healthcare facilities should be in place to reduce the provider delays.


Assuntos
Tuberculose/diagnóstico , Adolescente , Adulto , Idoso , Antituberculosos/uso terapêutico , Estudos Transversais , Diagnóstico Tardio , Assistência à Saúde , Etiópia , Feminino , Infecções por HIV/complicações , Infecções por HIV/patologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Tempo para o Tratamento , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Adulto Jovem
7.
BMC Infect Dis ; 19(1): 306, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947701

RESUMO

BACKGROUND: Various integrated care models have been used to improve treatment completion of medications for chronic hepatitis B virus (HBV), chronic hepatitis C virus (HCV), Mycobacterium tuberculosis (TB), and Human immunodeficiency virus (HIV) among people with substance use disorders (SUD). We have conducted a systematic review to evaluate whether integrated models have impacts of the treatment of infectious diseases among marginalized people with SUD. METHODS: We searched MEDLINE/PubMed (1946 to 2018, on July 26, 2018) and Embase (from 1974 to 2018, on July 26, 2018) for randomized controlled trials (RCTs) and cohort studies evaluating diverse integrated models' effects on sustained virological response (SVR), HIV suppression, HBV curation or suppression, completion of TB treatment regimen among people with SUD. The included studies were assessed qualitatively. RESULTS: Altogether, 1640 studies, and references to 1135 related reviews and RCTs were considered, and only seven RCTs and three cohort studies fulfilled the inclusion criteria. We identified nine integrated care models. Two studies, one RCT and one cohort study, showed a significant effect of their integrated models. The RCT evaluated psychosocial treatment, opioid agonist treatment (OAT) and directly observed TB treatment, and found a significant increase in TB treatment completions among intervention group compared to control group (60% versus 13%, p < 0.01). The cohort study including OAT and TB treatments had an effect on TB treatment completion in hospitalized patients (89% versus 73%, p = 0.03). Eight out of ten studies showed no significant effects of their integrated care models on defined outcomes. One of which having included 363 participants in a RCT showed no effect on SVR compared to the control group when the results adjusted for active substance use and alcohol dependence in a post-hoc analysis (11% versus 7%, p = 0.49). CONCLUSIONS: The findings indicate uncertainty on the effects of integrated care models' on treatment for severe infectious diseases among people with SUD. Some studies point toward that integrated models could improve care of people with SUD, yet high-quality studies and preferably, sufficiently sized clinical trials are needed to conclude on the degree of impact.


Assuntos
Doenças Transmissíveis/diagnóstico , Prestação Integrada de Cuidados de Saúde , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Analgésicos Opioides/uso terapêutico , Antituberculosos/uso terapêutico , Doenças Transmissíveis/complicações , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/mortalidade , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Resposta Viral Sustentada , Tuberculose/complicações , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico
8.
Clin Nucl Med ; 44(6): e406-e408, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30932977

RESUMO

The present article presented a 47-year-old woman with areas of nodular swelling and discoloration involving bilateral lower limbs since 12 months. Biopsy from skin lesions revealed erythema nodosum. As erythema nodosum can be secondary to multiple etiologies, whole-body F-FDG PET/CT was performed to assess the disease distribution and guide the site of biopsy. F-FDG PET/CT revealed metabolically active mediastinal lymphadenopathy in addition to the skin lesions. Endobronchial ultrasound-guided biopsy from subcarinal lymph node revealed tuberculosis.


Assuntos
Eritema Nodoso/etiologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tuberculose/diagnóstico por imagem , Eritema Nodoso/patologia , Feminino , Fluordesoxiglucose F18 , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/etiologia , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos , Pele/patologia , Tuberculose/complicações
9.
Int J Infect Dis ; 82: 124-128, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30904679

RESUMO

BACKGROUND: Protocols for HIV care are widely accepted by all international organizations and are proven to reduce mortality and complications from living with HIV. Unfortunately, executing best practice recommendations in Sierra Leone is difficult due to shortages in staff, training, and medications. METHODS: From June 2016 to August 2016, we implemented both an HIV guideline-based clinical evaluation protocol and a patient-centered workflow for TB screening and CD4 testing in the HIV clinic at Koidu Government Hospital (KGH) in rural Sierra Leone. The primary outcome of interest was how often this service center resulted in a clinically significant change in the patients' HIV regimen. Reasons for changing regimen included diagnosis of co-infection with tuberculosis (TB), diagnosis of clinical or presumed immunologic treatment failure of antiretroviral (ART) medications and, need for adherence to weight-based dosing in pediatric patients. FINDINGS: A total of 188 patients with HIV were seen in the clinic; 49 (26%) of these patients had a clinically significant change in their HIV regimen. The most common reason for regimen change was TB co-infection diagnosis in 38 (20%) patients. The other reasons for HIV regimen changes included: eight children whose ART was adjusted to meet appropriate levels for weight-based guidelines, five patients diagnosed with presumed immunologic treatment failure (some also co-infected with tuberculosis), and two patients with a serious side effect to ART. INTERPRETATION: A comprehensive, patient-centric HIV clinic can result in high rates of case detection for tuberculosis and recognition of immunological ART failure.


Assuntos
Antirretrovirais/farmacologia , Infecções por HIV/tratamento farmacológico , Tuberculose/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Coinfecção , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , Humanos , Lactente , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Serra Leoa/epidemiologia , Falha de Tratamento , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Tuberculose/microbiologia , Adulto Jovem
10.
BMC Infect Dis ; 19(1): 254, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30866836

RESUMO

BACKGROUND: Tuberculosis and diabetes mellitus are significant global public health challenges. In Sub-Saharan Africa, study findings regarding prevalence of diabetes mellitus amongst tuberculosis patients have been inconsistent and highly variable. Therefore, this systematic review and meta-analysis estimates the overall prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa. METHODS: Four international databases (PubMed, Google Scholar, Science Direct and Cochrane Library) were systematically searched. We included all observational studies reporting the prevalence of DM among TB patients in Sub-Saharan Africa. All necessary data for this review were extracted using a standardized data extraction format by two authors (CT and AA1). STATA Version 14 statistical software was employed to conduct meta-analysis. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of the studies. Finally, a random effects meta-analysis model was computed to estimate the pooled prevalence of diabetes mellitus in TB patients. Besides, subgroup analysis was done based on different factors. RESULTS: In the meta-analysis, sixteen studies fulfilled the inclusion criteria and were included. The findings of these 16 studies revealed that the pooled prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa was 9.0% (95% CI: 6.0, 12.0%). The highest prevalence of diabetes mellitus among tuberculosis patients was found in Nigeria (15%), followed by Tanzania (11%), and then Ethiopia (10%). Besides, the prevalence of diabetes mellitus among HIV infected TB patients was (8.9%) which is slightly higher than HIV uninfected (7.7%) TB patients. CONCLUSION: Diabetes mellitus among tuberculosis patients in Sub-Saharan Africa was significantly high. Moreover, this study found that there was a high prevalence of DM among HIV infected than uninfected TB patients. It is strongly recommended to screen for DM among TB patients and special emphasis should be given for early screening of DM among TB/HIV co-infected patients.


Assuntos
Complicações do Diabetes/epidemiologia , Tuberculose , África ao Sul do Saara/epidemiologia , Humanos , Estudos Observacionais como Assunto , Prevalência , Tuberculose/complicações , Tuberculose/epidemiologia
11.
Int J Mycobacteriol ; 8(1): 107-109, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860190

RESUMO

Pulmonary tuberculosis can have a wide variety of presentations including hematological manifestations. We report a case of a young male patient who presented with complaints of generalized petechiae, gum bleeding, systemic lymphadenopathy, and severe thrombocytopenia. His bone marrow revealed normal megakaryocytes, and in the absence of hepatosplenomegaly, a diagnosis of immune thrombocytopenic purpura (ITP) was made. The thrombocytopenia responded to course of intravenous immune globulin. The smear made from fine-needle aspiration of cervical lymph nodes showed acid-fast bacilli. This case highlights the rare association of extrapulmonary tuberculosis with ITP.


Assuntos
Púrpura Trombocitopênica Idiopática/diagnóstico , Púrpura Trombocitopênica Idiopática/patologia , Tuberculose/complicações , Biópsia por Agulha Fina , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Linfócitos/microbiologia , Linfócitos/patologia , Masculino , Microscopia , Mycobacterium tuberculosis/isolamento & purificação , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
12.
BMC Pulm Med ; 19(1): 60, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30866909

RESUMO

BACKGROUND: Cambodia, a lower middle-income country of about 16 million individuals in southeast Asia, endures a high burden of both tuberculosis and other lower respiratory infections. Differentiating tuberculosis from other causes of respiratory infection has important clinical implications yet may be challenging to accomplish in the absence of diagnostic microbiology facilities. Furthermore, co-infection of tuberculosis with other bacterial lower respiratory infections may occur. The objective of this study was to determine the prevalence and etiologies of tuberculosis and other bacterial co-infection and to analyze the clinical and radiographic characteristics of patients presenting with respiratory infection to a provincial referral hospital in Cambodia. METHODS: We performed a retrospective, cross-sectional analysis of laboratory and clinical data, on patients presenting with respiratory symptoms to a chest clinic of a 260-bed provincial referral hospital in Cambodia. We analyzed mycobacterial and bacterial sputum test results, and demographics, medical history and chest radiography. RESULTS: Among 137 patients whose treating clinicians ordered sputum testing for tuberculosis and other bacteria, the median age was 52 years, 54% were male, 3% had HIV infection, and 26% were current smokers. Nearly all had chronic respiratory symptoms (> 96%) and abnormal chest radiographs (87%). Sputum testing was positive for tuberculosis in 40 patients (30%) and for bacteria in 60 patients (44%); 13 had tuberculosis and bacterial co-infection (9% overall; 33% of tuberculosis patients). Clinical characteristics were generally similar across pulmonary infection types, although co-infection was identified in 43% of patients with one or more cavitary lesions on chest radiography. Among those with bacterial growth on sputum culture, Gram negative bacilli (Klebsiella and Pseudomonas spp.) were the most commonly isolated. CONCLUSIONS: Among patients with symptoms of respiratory infections whose treating clinicians ordered sputum testing for tuberculosis and other bacteria, 9% of all patients and 33% of tuberculosis patients had tuberculosis and bacterial co-infection. Greater availability of microbiologic diagnostics for pulmonary tuberculosis and bacterial infection is critical to ensure appropriate diagnosis and management.


Assuntos
Infecções Bacterianas/complicações , Coinfecção/epidemiologia , Infecções Respiratórias/complicações , Escarro/microbiologia , Tuberculose/complicações , Adulto , Idoso , Infecções Bacterianas/epidemiologia , Camboja/epidemiologia , Coinfecção/microbiologia , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Tuberculose/epidemiologia
13.
Microb Pathog ; 130: 156-168, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30876870

RESUMO

Mycobacterium tuberculosis (Mtb) has coevolved with a human host to evade and exploit the immune system in multiple ways. Mtb is an enormously successful human pathogen that can remain undetected in hosts for decades without causing clinical disease. While tuberculosis (TB) represents a perfect prototype of host-pathogen interaction, it remains a major challenge to develop new therapies to combat mycobacterial infections. Additionally, recent studies emphasize on comorbidity of TB with different non-communicable diseases (NCDs), highlighting the impact of demographic and lifestyle changes on the global burden of TB. In the recent past, host-directed therapies have emerged as a novel and promising approach to treating TB. Drugs modulating host responses are likely to avoid the development of bacterial resistance which is a major public health concern for TB treatment. Interestingly, many of these drugs also form treatment strategies for non-communicable diseases. In general, technological advances along with novel host-directed therapies may open an exciting and promising research area, which can eventually deliver effective TB treatment as well as curtail the emergent synergy with NCDs.


Assuntos
Interações Hospedeiro-Patógeno , Imunomodulação , Doenças não Transmissíveis/terapia , Tuberculose/complicações , Tuberculose/terapia , Humanos
14.
Tuberculosis (Edinb) ; 114: 69-76, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30711160

RESUMO

The diagnosis of tuberculosis (TB) continues to pose substantial public health problems. The quest for diagnostic biomarkers for TB is therefore primordial. This study aimed to evaluate the diagnostic and anti-TB treatment monitoring potentials of some selected miRNAs. Quantitative real time polymerase chain reaction and Receiver operating characteristics were used to estimate the ability of miRNAs to discriminate between healthy controls (HEC), latent (LTB) and active TB (ATB). The study showed that: hsa-miR-29a-3p, hsa-miR-155-5p and hsa-miR-361-5p were significantly upregulated in ATB compared to HEC while hsa-miR-29a-3p, and hsa-miR-361-5p were also significantly up-regulated in ATB compared to LTB (all P ≤ 0.05). MiR-29a-3p showed a good (81.37%) distinguishing performance in discriminating ATB from HEC and a good (84.35%) diagnostic performance in discriminating ATB from LTB. The performance of miR-29a-3p present in the blood in discriminating active TB from latent TB and healthy controls indicates it may be a useful biomarker for diagnosis of TB. Because this miRNA is found in blood (plasma) which is easy to collect compared to sputum it could be used in pediatric and extra-pulmonary TB cases.


Assuntos
MicroRNAs/sangue , Tuberculose/diagnóstico , Adolescente , Adulto , Idoso , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Biomarcadores/sangue , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Coinfecção/diagnóstico , Diagnóstico Diferencial , Esquema de Medicação , Feminino , Perfilação da Expressão Gênica/métodos , Infecções por HIV/complicações , Humanos , Tuberculose Latente/complicações , Tuberculose Latente/diagnóstico , Tuberculose Latente/tratamento farmacológico , Tuberculose Latente/imunologia , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Tuberculose/imunologia , Regulação para Cima , Adulto Jovem
15.
BMC Public Health ; 19(1): 185, 2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30760257

RESUMO

BACKGROUND: The Philippines has a high burden of TB and HIV, yet the WHO estimates that only 13% of Filipino TB patients know their HIV status. This is partly attributable to the lack of trained HIV counselors and medical technologists (or laboratory technicians) at the primary healthcare level. In Africa where resources and manpower are also scarce, TB/HIV care is already delegated to community health workers. Evidence is scant however about the acceptability and feasibility of engaging community health workers to provide HIV counseling and testing (HCT) among TB patients in the Philippines. The objective of this paper is to describe and assess the acceptability and feasibility of delegating HCT among TB patients to barangay (community) health workers (BHWs) in the Philippines. METHODS: Mixed methods study that utilized surveys with patients (n = 89), BHWs (n = 81), and ten focus group discussions with key stakeholders (n = 49) in San Jose del Monte, a city with high HIV prevalence. A facility assessment (n = 17) was done using a modified version of WHO-Service Availability and Readiness Assessment questionnaire to assess feasibility (scale of 1 to 4) while acceptability from the perspective of patients and BHWs was determined using surveys. RESULTS: Only 47% of TB patients agreed to receive HIV counseling from BHWs, while 30% agreed to receive HIV testing. Doctors were preferred by patients as HIV counselors, while medical technologists were preferred as HIV test providers. Two out of three BHWs also disagreed to provide HCT but the same number felt that they could provide HCT if additional trainings were given to them. In the group discussions, BHWs preferred to only provide HIV counseling. Stakeholders said that only select BHWs who meet certain criteria should provide HIV counseling. Program managers and stakeholders rated delegation of HCT to BHWs as moderately feasible. CONCLUSIONS: Delegation of both HIV counseling and testing among TB patients to BHWs is feasible, but only delegation of HIV counseling is acceptable. Further studies are needed to guide revision of Philippine HCT policies to accommodate lay HIV counselors, and strengthen the mechanisms for delivering integrated TB and HIV services especially at the primary healthcare level.


Assuntos
Agentes Comunitários de Saúde , Delegação Vertical de Responsabilidades Profissionais/estatística & dados numéricos , Infecções por HIV/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tuberculose/psicologia , Adulto , Aconselhamento Diretivo/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Grupos Focais/estatística & dados numéricos , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Filipinas , Inquéritos e Questionários/estatística & dados numéricos , Tuberculose/complicações
16.
J Cutan Med Surg ; 23(1_suppl): 3S-12S, 2019 Jan/Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30789012

RESUMO

The paradigm for treating inflammatory diseases has shifted dramatically in the past 10 to 20 years with the discovery of targeted therapeutics or "biologic" agents. Patients with rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis, and psoriasis, among others, are reaping the benefits of decades of bench to bedside research, allowing them to live more productive lives with less side effects than traditional systemic therapies. Despite these advances, many physicians unfamiliar with biologics are left to care for the basic needs of these patients and may be unaware of the multisystem comorbidities associated with psoriasis and the screening, monitoring, and other special considerations required of biologics patients. This can be overwhelming to primary care physicians and inadvertently expose patients to undue risks. The aim of this review is to provide a practical approach for all health care providers caring for patients with psoriasis being treated with biologics to facilitate communication with their treating dermatologist and ultimately provide patients with more comprehensive care.


Assuntos
Produtos Biológicos/uso terapêutico , Infecções por HIV/complicações , Seleção de Pacientes , Psoríase/tratamento farmacológico , Produtos Biológicos/efeitos adversos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Contraindicações de Medicamentos , Depressão/complicações , Hepatite B/complicações , Hepatite B/diagnóstico , Humanos , Doenças Inflamatórias Intestinais/complicações , Guias de Prática Clínica como Assunto , Psoríase/complicações , Tuberculose/complicações , Tuberculose/diagnóstico
17.
BMC Infect Dis ; 19(1): 110, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717693

RESUMO

BACKGROUND: Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion. METHODS: We conducted a pilot randomized trial to evaluate the impact of GeneXpert screening on a mobile HIV testing unit. Adults (≥18y) underwent rapid HIV testing and TB symptom screening and were randomized to usual mobile unit care (providing sputum on the mobile unit sent out for GeneXpert testing) or the "Test & Treat TB" intervention with immediate GeneXpert testing. Symptomatic participants in usual care produced sputum that was sent for hospital-based GeneXpert testing; participants were contacted ~ 7 days later with results. In the "Test & Treat TB" intervention, HIV-infected or HIV-uninfected/TB symptomatic participants underwent GeneXpert testing on the mobile unit. GeneXpert+ participants received expedited TB treatment initiation, monthly SMS reminders and non-cash incentives. We assessed 6-month TB treatment outcomes. RESULTS: 4815 were eligible and enrolled; median age was 27 years (IQR 22 to 35). TB symptoms included cough (5%), weight loss (4%), night sweats (4%), and fever (3%). 42% of eligible participants produced sputum (intervention: 56%; usual care: 26%). Seven participants tested GeneXpert+, six in the intervention (3%, 95% CI 1%, 5%) and one in usual care (1%, 95% CI 0%, 6%). 5 of 6 intervention participants completed TB treatment; the GeneXpert+ participant in usual care did not. CONCLUSION: GeneXpert MTB/RIF screening on a mobile HIV testing unit is feasible. Yield for GeneXpert+ TB was low, however, the "Test & Treat TB" strategy led to high rates of TB treatment completion. TRIAL REGISTRATION: This study was registered on November 21, 2014 at ClinicalTrials.gov ( NCT02298309 ).


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Unidades Móveis de Saúde , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/diagnóstico , Adolescente , Adulto , Coinfecção/complicações , Coinfecção/diagnóstico , Feminino , HIV , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Mycobacterium tuberculosis/genética , Projetos Piloto , Sensibilidade e Especificidade , Testes Sorológicos , África do Sul , Tuberculose/complicações , Adulto Jovem
18.
BMC Infect Dis ; 19(1): 106, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717702

RESUMO

BACKGROUND: To investigate the status of anti-tuberculosis treatment in critically ill patients, and to explore the value of APACHE-II score in guiding anti-tuberculosis treatment. METHODS: This analysis included critically ill patients with tuberculosis. The utility of APACHE-II score for predicting drug withdrawal was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Among 320 patients enrolled (58 ± 22 years; 256 males), 147 (45.9%) had drugs withdrawn. The drug withdrawal group had higher APACHE-II score (median [interquartile range]: 21 [3-52] vs. 17 [4-42] points), higher CD4%, lower hemoglobin level, higher rates of chronic obstructive pulmonary disease (COPD) and chronic renal failure, and lower rate of extrapulmonary tuberculosis (P < 0.05). Logistic regression identified APACHE-II score > 18 (odds ratio [95% confidence interval]: 2.099 [1.321-3.334], P < 0.01), COPD (1.913 [1.028-3.561], P < 0.05) and hemoglobin level (0.987 [0.977-0.997], P < 0.05) as independent factors associated with drug withdrawal. At an optimal cutoff of 18.5, the sensitivity, specificity, positive predictive value and negative predictive value of APACHE-II score for predicting drug withdrawal was 59.2, 61.8, 56.9 and 64.1%, respectively. CONCLUSIONS: APACHE-II score > 18 points might predict patient tolerance of anti-tuberculosis treatment.


Assuntos
Antituberculosos/efeitos adversos , Estado Terminal , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Comorbidade , Estado Terminal/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Tuberculose/complicações , Tuberculose/epidemiologia , Suspensão de Tratamento/estatística & dados numéricos
19.
BMC Infect Dis ; 19(1): 107, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717705

RESUMO

BACKGROUND: Lost to follow-up (LTFU) negatively affects the treatment success of Anti-Retroviral Therapy (ART) and thus, increases Tuberculosis-Human Immunodeficiency Virus (TB/HIV) related morbidity, mortality and hospitalization. However, the incidence and predictors of loss to follow up (LTFU) among adults with TB/HIV co-infection have not yet well-investigated in Ethiopia. Therefore, this study was aimed at investigating the incidence and predictors of LTFU in the study setting in particular. METHODS: A facility based retrospective cohort study was employed among 305 (114 anemic and 191 normal) TB/HIV co-infected adults in two governmental hospitals (Mekelle Hospital and Ayder Comprehensive Specialized Hospital), Mekelle, Ethiopia from 2009 to 2016 and data were collected using checklist. Besides to descriptive statistics, a cox regression analysis was applied to identify statistically significant predictors of LTFU at 5% level of significance. Eventually, the Adjusted Hazard Ratio (AHR) and 95% Confidence Interval (CI) were estimated and interpreted for predictors of LTFU in the final cox model. RESULTS: Generally, 45 of 305 (14.8%) of TB/HIV co-infected adults were LTFU with an incidence rate of 4.5 new LTFUs per 100 Person Years (PYs) and a median follow up time of 3.1 years (Interquartile Range (IQR): 0.8-5.3 Years). Hemoglobin level ≤ 11.0 g/dl (AHR = 2.660; 95%CI: 1.459-4.848), and any history of OI/s (AHR = 3.795; 95%CI: 1.165-12.364) were risk factors of LTFU. While, adverse drug events (AHR = 0.451; 95%CI: 0.216-0.941), TB treatment completion (AHR = 0.121; 95% CI: 0.057-0.254), and being on Isoniazid Preventive Therapy (IPT) (AHR = 0.085; 95%CI: 0.012-0.628) had protective effect against LTFU. CONCLUSIONS: One in approximately seven TB/HIV co-infected adults had experienced of LTFU with an incidence rate 4.5 LTFUs per 100 PYs. The LTFU rate was higher among adults with low baseline hemoglobin level, no adverse drug events, presence of OI/s, failure to complete TB treatment, and being not on IPT. Therefore, it is advisable to treat anemia and active TB, and preventing the occurrence of OIs including TB using IPT to reduce the incidence of LTFU among TB/HIV co-infected adults.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Perda de Seguimento , Tuberculose/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Etiópia/epidemiologia , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Hospitais Públicos/estatística & dados numéricos , Hospitais Especializados/estatística & dados numéricos , Humanos , Incidência , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico
20.
Clin Nucl Med ; 44(4): e294-e295, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30762817

RESUMO

We present a case of a 22-year-old man with history of allogenic renal transplantation on immunosuppression, who underwent F-FDG-PET/CT to characterize a lesion in the transplanted kidney on ultrasonogram and contrast-enhanced computed tomography imaging. PET/CT revealed FDG avid lesion in the transplanted kidney and mural thickening involving the distal ileum, ileocecal junction, and ileocolic lymph nodes. Subsequent histopathological examination from the renal lesion revealed renal cell carcinoma in the transplanted kidney. Additionally, endoscopic biopsy from the ileal thickening revealed granulomatous inflammation, suggesting tuberculosis, which was missed on both ultrasonogram and contrast-enhanced CT imaging.


Assuntos
Carcinoma de Células Renais/terapia , Fluordesoxiglucose F18 , Intestinos/microbiologia , Neoplasias Renais/terapia , Transplante de Rim , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tuberculose/complicações , Biópsia , Carcinoma de Células Renais/complicações , Endoscopia , Humanos , Neoplasias Renais/complicações , Masculino , Tuberculose/diagnóstico por imagem , Tuberculose/patologia , Adulto Jovem
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