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1.
J Trop Pediatr ; 67(2)2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-34037789

RESUMO

OBJECTIVE: The objective of this study is to evaluate the feasibility and tolerability of new bacteriological samples to diagnose tuberculosis (TB) in HIV-infected children. METHOD AND PATIENTS: HIV1-infected children with suspicion of TB in Universitary Hospital Sourô Sanon (Burkina Faso) were included in a prospective cohort study. Children underwent three gastric aspirates (GA) if aged <4 years; two GA, one string test (ST) if aged 4-9 years and three sputum, one ST if aged 10-13 years. All children underwent one nasopharyngeal aspirate (NPA) and one stool sample. To assess feasibility and tolerability of procedures, adverse events were identified and pain was rated on different scales. Samples were tested by microscopy, culture, GeneXpert® (Xpert®). RESULTS: Sixty-three patients were included. Mean age was 8.92 years, 52.38% were females. Ninety-five GA, 67 sputum, 62 NPA, 60 stool and 55 ST had been performed. During sampling, the main adverse events were cough at 68/95 GA and 48/62 NPA; sneeze at 50/95 GA and 38/62 NPA and vomiting at 4/55 ST. On the behavioral scale, the average pain score during collection was 6.38/10 for GA; 7.70/10 for NPA and 1.03/10 for ST. Of the 31 cases of TB, bacteriological confirmation was made in 12 patients. CONCLUSION: ST, stool is well-tolerated alternatives specimens for diagnosing TB in children. NPA has a poor feasibility and tolerability in children.


Assuntos
Infecções por HIV , Mycobacterium tuberculosis , Tuberculose Pulmonar , Tuberculose , Burkina Faso , Criança , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade , Escarro , Tuberculose/complicações , Tuberculose/diagnóstico
3.
Sci Rep ; 11(1): 7901, 2021 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846378

RESUMO

Tuberculosis (TB) is the 10th leading cause of death worldwide, and since 2007 it has been the main cause of death from a single infectious agent, ranking above HIV/AIDS. The current COVID-19 is a pandemic which caused many deaths around the world. The danger is not only a coinfection as observed for TB and HIV for a long time, but that both TB and SARS-CoV-2 affect the respiratory organs and thus potentiate their effect or accelerate the critical course. A key public health priority during the emergence of a novel pathogen is the estimation of the clinical need to assure adequate medical treatment. This requires a correct adjustment to the critical case detection rate and the prediction of possible scenarios based on known patterns. The African continent faces constraining preconditions in regard to healthcare capacities and social welfare which may hinder required countermeasures. However, given the high TB prevalence rates, COVID-19 may show a particular severe course in respective African countries, e.g. South Africa. Using WHO's TB and public infrastructure data, we conservatively estimate that the symptomatic critical case rate, which affects the healthcare system, is between 8 and 12% due to the interaction of COVID-19 and TB, for a TB population of 0.52% in South Africa. This TB prevalence leads to a significant increase in the peak load of critical cases of COVID-19 patients and potentially exceeds current healthcare capacities.


Assuntos
COVID-19/complicações , COVID-19/epidemiologia , Infecções por HIV/complicações , Tuberculose/complicações , Coinfecção/epidemiologia , Controle de Doenças Transmissíveis , Comorbidade , Simulação por Computador , Atenção à Saúde , Humanos , Modelos Teóricos , Pandemias , Prevalência , Informática em Saúde Pública , África do Sul/epidemiologia
4.
Enferm Clin ; 31 Suppl 2: S291-S295, 2021 04.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33849184

RESUMO

The purpose was to identify knowledge and TB stigma, as well as its relationship with health-seeking behavior in HIV and TB co-infection patients. A cross-sectional study was conducted with 115 HIV and TB co-infection patients who visited the VCT Polyclinic in five hospitals in Jakarta. This study was using instruments: Brief HIV-Knowledge Questionnaire (HIV-KQ-18), Knowledge TB survey Questionnaire, Berger HIV stigma Scale, Tuberculosis-Related Stigma Scale. This study showed that respondents had good knowledge of TB (69.6%) and had a low stigma of TB (55.7%), and had a health-seeking behavior that did not delay consultation (55.7%). There was a significant relationship between TB knowledge (p-value: 0.042) and TB stigma (p-value: 0.026) with health-seeking behavior. The results of this study can be used as guidelines to improve education and counseling about TB knowledge and TB stigma in HIV and TB co-infection patients.


Assuntos
Coinfecção , Infecções por HIV , Tuberculose , Estudos Transversais , Infecções por HIV/complicações , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estigma Social , Tuberculose/complicações
6.
Int J Mol Sci ; 22(7)2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33917321

RESUMO

On 11 March 2020, the World Health Organization announced the Corona Virus Disease-2019 (COVID-19) as a global pandemic, which originated in China. At the host level, COVID-19, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), affects the respiratory system, with the clinical symptoms ranging from mild to severe or critical illness that often requires hospitalization and oxygen support. There is no specific therapy for COVID-19, as is the case for any common viral disease except drugs to reduce the viral load and alleviate the inflammatory symptoms. Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis (Mtb), also primarily affects the lungs and has clinical signs similar to pulmonary SARS-CoV-2 infection. Active TB is a leading killer among infectious diseases and adds to the burden of the COVID-19 pandemic worldwide. In immunocompetent individuals, primary Mtb infection can also lead to a non-progressive, asymptomatic latency. However, latent Mtb infection (LTBI) can reactivate symptomatic TB disease upon host immune-suppressing conditions. Importantly, the diagnosis and treatment of TB are hampered and admixed with COVID-19 control measures. The US-Center for Disease Control (US-CDC) recommends using antiviral drugs, Remdesivir or corticosteroid (CST), such as dexamethasone either alone or in-combination with specific recommendations for COVID-19 patients requiring hospitalization or oxygen support. However, CSTs can cause immunosuppression, besides their anti-inflammatory properties. The altered host immunity during COVID-19, combined with CST therapy, poses a significant risk for new secondary infections and/or reactivation of existing quiescent infections, such as LTBI. This review highlights CST therapy recommendations for COVID-19, various types and mechanisms of action of CSTs, the deadly combination of two respiratory infectious diseases COVID-19 and TB. It also discusses the importance of screening for LTBI to prevent TB reactivation during corticosteroid therapy for COVID-19.


Assuntos
Corticosteroides/uso terapêutico , COVID-19/tratamento farmacológico , Antituberculosos/uso terapêutico , Antivirais/uso terapêutico , COVID-19/complicações , COVID-19/patologia , COVID-19/virologia , Comorbidade , Humanos , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade
7.
Front Cell Infect Microbiol ; 11: 585919, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33816327

RESUMO

Biomarkers are critical for rapid diagnosis of tuberculosis (TB) and could benefit patients with AIDS where diagnosis of TB co-infection is challenging. Meta-analysis is an approach to combine the results of the studies with standard statistical method by weighting each study with different sample size. This study aimed to use meta-analysis to integrate transcriptome datasets from different studies and screen for TB biomarkers in patients who were HIV-positive. Five datasets were subjected to meta-analysis on whole-blood transcriptomes from 640 patients infected with HIV. A total of 293 differentially expressed genes (DEGs) were identified as significant (P<0.0001) using the random effective model to integrate the statistical results from each study. DEGs were enriched in biological processes related to TB, such as "Type I interferon signaling" and "stimulatory C-type lectin receptor signaling". Eighteen DEGs had at least a two-fold change in expression between patients infected with HIV who were TB-positive and those who were TB-negative. GBP4, SERPING1, ATF3 and CDKBN3 were selected as a biomarker panel to perform multivariable logistic regression analysis on TB status and relative gene expression levels. The biomarker panel showed excellent accuracy (AUC>0.90 for HIV+TB) in clinical trial and suggests that meta-analysis is an efficient method to integrate transcriptome datasets from different studies.


Assuntos
Coinfecção , Infecções por HIV , Tuberculose , Biomarcadores , Infecções por HIV/complicações , Humanos , Transcriptoma , Tuberculose/complicações , Tuberculose/diagnóstico
8.
BMC Pediatr ; 21(1): 136, 2021 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743621

RESUMO

BACKGROUND: In high tuberculosis (TB) burden settings, there is growing evidence that TB is common in children with pneumonia, the leading cause of death in children under 5 years worldwide. The current WHO standard of care (SOC) for young children with pneumonia considers a diagnosis of TB only if the child has a history of prolonged symptoms or fails to respond to antibiotic treatments. As a result, many children with TB-associated severe pneumonia are currently missed or diagnosed too late. We therefore propose a diagnostic trial to assess the impact on mortality of adding the systematic early detection of TB using Xpert MTB/RIF Ultra (Ultra) performed on nasopharyngeal aspirates (NPA) and stool samples to the WHO SOC for children with severe pneumonia, followed by immediate initiation of anti-TB treatment in children testing positive on any of the samples. METHODS: TB-Speed Pneumonia is a pragmatic stepped-wedge cluster randomized controlled trial conducted in six countries with high TB incidence rate (Côte d'Ivoire, Cameroon, Uganda, Mozambique, Zambia and Cambodia). We will enrol 3780 children under 5 years presenting with WHO-defined severe pneumonia across 15 hospitals over 18 months. All hospitals will start managing children using the WHO SOC for severe pneumonia; one hospital will be randomly selected to switch to the intervention every 5 weeks. The intervention consists of the WHO SOC plus rapid TB detection on the day of admission using Ultra performed on 1 nasopharyngeal aspirate and 1 stool sample. All children will be followed for 3 months, with systematic trial visits at day 3, discharge, 2 weeks post-discharge, and week 12. The primary endpoint is all-cause mortality 12 weeks after inclusion. Qualitative and health economic evaluations are embedded in the trial. DISCUSSION: In addition to testing the main hypothesis that molecular detection and early treatment will reduce TB mortality in children, the strength of such pragmatic research is that it provides some evidence regarding the feasibility of the intervention as part of routine care. Should this intervention be successful, safe and well tolerated, it could be systematically implemented at district hospital level where children with severe pneumonia are referred. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03831906 . Registered 6 February 2019.


Assuntos
Mycobacterium tuberculosis , Pneumonia , Tuberculose , Assistência ao Convalescente , Camboja , Camarões , Criança , Pré-Escolar , Humanos , Moçambique , Mycobacterium tuberculosis/genética , Alta do Paciente , Pneumonia/diagnóstico , Sensibilidade e Especificidade , Tuberculose/complicações , Tuberculose/diagnóstico , Uganda , Zâmbia
9.
Vestn Otorinolaringol ; 86(1): 11-14, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33720644

RESUMO

The lesion of middle ear as a variant of clinical manifestation of secondary tuberculosis, according to international scientific literature, is a rare condition. However, in terms of real clinical practice, the proportion of this pathology should not be underestimated due to the wide spread of tuberculosis infection among the population of developing countries, including the Russian Federation. One of the risk factors for the systemic spread of mycobacterial flora is a concomitant HIV infection, which often acts as an opportunistic pathological agent for tuberculosis. The treatment of such a state is always challenging because of the high aggressiveness of bacteria and the low immunological resistance of the patient. This article presents a clinical case of bilateral tuberculosis otitis media, which was a manifestation of tuberculosis infection that developed on the background of HIV infection.


Assuntos
Infecções por HIV , Otite Média , Tuberculose , Orelha Média , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Otite Média/complicações , Otite Média/diagnóstico , Federação Russa , Tuberculose/complicações , Tuberculose/diagnóstico
10.
Pulmonology ; 27(3): 248-256, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33547028

RESUMO

The scientific debate on the criteria guiding hospitalization of tuberculosis (TB) and COVID-19 patients is ongoing. The aim of this review is to present the available evidence on admission for TB and TB/COVID-19 patients and discuss the criteria guiding hospitalization. Furthermore, recommendations are made as derived from recently published World Health Organization documents, based on Global Tuberculosis Network (GTN) expert opinion. The core published documents and guidelines on the topic have been reviewed. The proportion of new TB cases admitted to hospital ranges between 50% and 100% while for multidrug-resistant (MDR) TB patients it ranges between 85 and 100% globally. For TB patients with COVID-19 the proportion of cases admitted is 58%, probably reflecting different scenarios related to the diagnosis of COVID-19 before, after or at the same time of the active TB episode. The hospital length of stay for drug-susceptible TB ranges from 20 to 60 days in most of countries, ranging from a mean of 10 days (USA) to around 90 days in the Russian Federation. Hospitalization is longer for MDR-TB (50-180 days). The most frequently stated reasons for recommending hospital admission include: severe TB, infection control concerns, co-morbidities and drug adverse events which cannot be managed at out-patient level. The review also provides suggestions on hospital requirements for safe admissions as well as patient discharge criteria, while underlining the relevance of patient-centred care through community/home-based care.


Assuntos
COVID-19/complicações , COVID-19/terapia , Hospitalização/estatística & dados numéricos , Tuberculose/complicações , Tuberculose/terapia , Consenso , Humanos , Tempo de Internação/estatística & dados numéricos , Guias de Prática Clínica como Assunto , SARS-CoV-2
11.
Int J Infect Dis ; 105: 267-273, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33610780

RESUMO

OBJECTIVES: To determine the prevalence and associated factors of diabetes mellitus (DM) among tuberculosis (TB) cases in Brunei Darussalam. METHODS: We conducted a retrospective cohort study among all TB patients registered between 2013 and 2018. Collected data include sociodemographics, comorbidities, and information related to their TB diagnosis and treatment outcomes. Associated factors of having DM among TB patients were investigated using logistic regression analyses. RESULTS: We identified a total of 1362 TB patients, among which 462 (33.9% [95%CI: 31.4%,36.5%]) also have DM. 70.6% (n = 326) were diagnosed with DM at least six months prior to their TB diagnosis. The incidence of newly diagnosed DM among TB patients was 74.2 per 1000 population. Significant factors of having TB and DM comorbidity were age (adjusted OR (adj. OR) = 1.04 [95%CI: 10.3,1.05]), classified as smear-positive pulmonary TB (adj. OR = 5.77 [95%CI: 3.71,9.22]), having the following underlying conditions: hypertension/heart disease (adj. OR = 24.05 [95%CI: 5.80,100.05]), renal disease (adj. OR = 7.34 [95%CI: 2.88,20.22]) and chronic obstructive pulmonary disease/asthma (adj. OR = 0.38 [95%CI: 0.22,0.64]). CONCLUSION: About one-third of TB cases in Brunei were also diagnosed with DM. Bi-directional screening could be a good strategy to facilitate early detection and treatment of both diseases.


Assuntos
Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Tuberculose/complicações , Adulto , Brunei/epidemiologia , Comorbidade , Diabetes Mellitus/microbiologia , Diagnóstico Precoce , Feminino , Humanos , Hipertensão/complicações , Incidência , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos
12.
Medicine (Baltimore) ; 100(7): e24787, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607832

RESUMO

RATIONALE: Tuberculosis is a common cause of phlyctenular keratoconjunctivitis, especially for patients who live in a high endemic area of tuberculosis. We report a rare case of pediatric phlyctenular keratoconjunctivitis associated with primary sinonasal tuberculosis. PATIENT CONCERNS: A 7-year-old boy presented with a 5-month history of redness of the left eye accompanied by mild visual impairment. Physical examination revealed elevated pinkish-white nodules with a circumcorneal hypervascularized lesion on the left conjunctiva. DIAGNOSIS: Computed tomography revealed an enhancing soft tissue mass in the left maxillary sinus with bone destruction. Histopathology of maxillary tissue showed chronic inflammation without granuloma. Special stain, culture and polymerase chain reaction for mycobacterium were initially negative. Left maxillary sinus tuberculosis was diagnosed by positive Mycobacterium tuberculosis polymerase chain reaction from formalin-fixed paraffin-embedded maxillary tissue. INTERVENTIONS: Two month of oral isoniazid, rifampicin, pyrazinamide, and ethambutol, followed by 10 months of oral isoniazid and rifampicin without topical eye drops agent were prescribed. OUTCOMES: Two months after initiation of treatment, the phlyctenular lesion had significantly improved. A follow-up computed tomography showed a significant reduction in the size of the maxillary sinus lesion and the extent of adjacent bone destruction. LESSONS: Primary sinonasal tuberculosis is an uncommon cause of phlyctenular keratoconjunctivitis in children. When microbiological and histopathological evidences are absent, polymerase chain reaction analysis has a crucial role in the diagnosis of tuberculosis, especially in patient with uncommon presentation.


Assuntos
Ceratoconjuntivite/etiologia , Doenças dos Seios Paranasais/diagnóstico , Tuberculose/diagnóstico , Antibióticos Antituberculose/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Isoniazida/uso terapêutico , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Órbita/diagnóstico por imagem , Órbita/patologia , Doenças dos Seios Paranasais/complicações , Doenças dos Seios Paranasais/tratamento farmacológico , Rifampina/uso terapêutico , Tomografia Computadorizada por Raios X , Tuberculose/complicações , Tuberculose/tratamento farmacológico
14.
Eur J Haematol ; 106(5): 654-661, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33523540

RESUMO

INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a cytokine storm syndrome associated with mortality rates of up to 88%. Standard therapy with high-dose glucocorticoids and etoposide used in adults is extrapolated from pediatric trials, with significant toxicity in older patients and those with poor performance status. The JAK1/2 inhibitor ruxolitinib has recently gained attention as a treatment option for HLH due to its broad cytokine-modulating abilities and safety profile. Herein we report our center's experience using ruxolitinib in the treatment of adult-onset secondary HLH. CASE SERIES: We report four patients with profound secondary HLH provoked by diverse triggers, including invasive pulmonary aspergillosis on background systemic lupus erythematosus, disseminated tuberculosis, and T-cell lymphoma treated with ruxolitinib as monotherapy or combination therapy in upfront and salvage settings. RESULTS: All four patients had rapid, sustained improvement in clinical status, inflammatory markers, and hematological cell counts followed by durable remission. Three patients developed manageable infectious complications postruxolitinib. CONCLUSIONS: This series demonstrates the effective use of JAK inhibition with ruxolitinib to control pathological immune activation in critically ill patients with secondary HLH and otherwise limited therapeutic options. JAK inhibition is also an area of urgent investigation for the treatment of cytokine storm associated with COVID-19.


Assuntos
Janus Quinases/antagonistas & inibidores , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Pirazóis/uso terapêutico , Adulto , COVID-19/complicações , Terapia Combinada , Síndrome da Liberação de Citocina/tratamento farmacológico , Síndrome da Liberação de Citocina/etiologia , Citocinas/sangue , Feminino , Humanos , Aspergilose Pulmonar Invasiva/complicações , Lúpus Eritematoso Sistêmico/complicações , Linfo-Histiocitose Hemofagocítica/etiologia , Linfoma de Células T/complicações , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Terapia de Salvação , Tuberculose/complicações , Adulto Jovem
15.
BMJ Case Rep ; 14(2)2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33608337

RESUMO

Isolated multidrug-resistant (MDR) tubercular tenosynovitis of the flexor tendons of finger without involvement of wrist is a rare presentation. Tenosynovitis of hand is an uncommon manifestation of extrapulmonary tuberculosis. Pyogenic flexor tenosynovitis of hand is frequently seen and is the closest differential. Non-specific clinical signs may lead to delay in diagnosis, which is often made after biopsy. Management includes surgical excision of necrotic tissue and infected synovium along with antitubercular therapy after histopathological diagnosis. MDR tuberculosis of hand is extremely rare and, to the best of our knowledge, has not been reported in the literature so far. We report an interesting case of MDR tubercular flexor tendon tenosynovitis of the little finger without any pulmonary involvement in an immunocompetent patient. The case was managed by complete synovectomy and second-line antitubercular therapy with complete resolution of disease and had no functional limitation.


Assuntos
Resistência a Múltiplos Medicamentos/efeitos dos fármacos , Dedos/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Tenossinovite/diagnóstico por imagem , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Antituberculosos/uso terapêutico , Clofazimina/uso terapêutico , Ciclosserina/uso terapêutico , Diagnóstico Diferencial , Etambutol/uso terapêutico , Feminino , Dedos/cirurgia , Humanos , Levofloxacino/uso terapêutico , Linezolida/uso terapêutico , Tendões/diagnóstico por imagem , Tenossinovite/etiologia , Tenossinovite/cirurgia , Adulto Jovem
16.
Nat Commun ; 12(1): 1141, 2021 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-33602926

RESUMO

The composition of the gastrointestinal microbiota influences systemic immune responses, but how this affects infectious disease pathogenesis and antibiotic therapy outcome is poorly understood. This question is rarely examined in humans due to the difficulty in dissociating the immunologic effects of antibiotic-induced pathogen clearance and microbiome alteration. Here, we analyze data from two longitudinal studies of tuberculosis (TB) therapy (35 and 20 individuals) and a cross sectional study from 55 healthy controls, in which we collected fecal samples (for microbiome analysis), sputum (for determination of Mycobacterium tuberculosis (Mtb) bacterial load), and peripheral blood (for transcriptomic analysis). We decouple microbiome effects from pathogen sterilization by comparing standard TB therapy with an experimental TB treatment that did not reduce Mtb bacterial load. Random forest regression to the microbiome-transcriptome-sputum data from the two longitudinal datasets reveals that renormalization of the TB inflammatory state is associated with Mtb pathogen clearance, increased abundance of Clusters IV and XIVa Clostridia, and decreased abundance of Bacilli and Proteobacteria. We find similar associations when applying machine learning to peripheral gene expression and microbiota profiling in the independent cohort of healthy individuals. Our findings indicate that antibiotic-induced reduction in pathogen burden and changes in the microbiome are independently associated with treatment-induced changes of the inflammatory response of active TB, and the response to antibiotic therapy may be a combined effect of pathogen killing and microbiome driven immunomodulation.


Assuntos
Microbioma Gastrointestinal , Inflamação/microbiologia , Inflamação/patologia , Tuberculose/complicações , Tuberculose/microbiologia , Adulto , Algoritmos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Carga Bacteriana/efeitos dos fármacos , Biodiversidade , Estudos de Casos e Controles , Estudos de Coortes , Microbioma Gastrointestinal/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Inflamação/complicações , Modelos Biológicos , Reprodutibilidade dos Testes , Tuberculose/tratamento farmacológico , Tuberculose/patologia
17.
PLoS One ; 16(1): e0245534, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33481833

RESUMO

Tuberculosis (TB) is the largest infectious disease with 10 million new active-TB patients and1.7 million deaths per year. Active-TB is an inflammatory disease and is increasingly viewed as an imbalance of immune responses to M. tb. infection. The mechanisms of a switch from latent infection to active disease is not well worked out but a shift in the immune responses is thought to be responsible. Increasingly, the role of gut microbiota has been described as a major influencer of the immune system. And because the gut is the largest immune organ, we aimed to analyze the gut microbiome in active-TB patients in a TB-endemic country, Pakistan. The study revealed that Ruminococcacea, Enetrobactericeae, Erysipelotrichaceae, Bifidobacterium, etc. were the major genera associated with active-TB, also associated with chronic inflammatory disease. Plasma antibody profiles against several M. tb. antigens, as specific biomarkers for active-TB, correlated closely with the patient gut microbial profiles. Besides, bcoA gene copy number, indicative of the level of butyrate production by the gut microbiome was five-fold lower in TB patients compared to healthy individuals. These findings suggest that gut health in TB patients is compromised, with implications for disease morbidity (e.g., severe weight loss) as well as immune impairment.


Assuntos
Disbiose/complicações , Doenças Endêmicas , Microbioma Gastrointestinal , Tuberculose/sangue , Tuberculose/microbiologia , Acil Coenzima A/genética , Adulto , Biomarcadores/sangue , Feminino , Dosagem de Genes , Humanos , Masculino , Tuberculose/complicações , Tuberculose/epidemiologia
18.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462021

RESUMO

We present two unusual presentations of extrapulmonary tuberculosis (EPTB) and more specifically intra-abdominal tuberculosis (TB). These cases were initially suspicious for ovarian cancer, presenting with non-specific symptoms, ultrasound-confirmed ascites and elevated cancer antigen 125 tumour marker (CA 125). However, in both cases chest imaging demonstrated enlarged mediastinal nodes amenable to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which confirmed the diagnosis of TB. Both cases were successfully treated with quadruple TB therapy.


Assuntos
Dor Abdominal/etiologia , Antígeno Ca-125/sangue , Tuberculose/diagnóstico , Adolescente , Biomarcadores/sangue , Nádegas , Feminino , Humanos , Pessoa de Meia-Idade , Tuberculose/sangue , Tuberculose/complicações
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