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1.
BMC Health Serv Res ; 21(1): 627, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193133

RESUMO

BACKGROUND: The End-TB strategy aims to see a world free of tuberculosis (TB) by the coming decade through detecting and treating all cases irrespective of socioeconomic inequalities. However, case detections and treatment outcomes have not been as they should be in Somali pastoral settings of Ethiopia. Hence, this study aimed to explore the challenges that hinder the delivery and utilization of TB services in pastoral areas. METHODS: A qualitative study was conducted between December 2017 and October 2018 among pastoralist patients with delay of ≥2 months in seeking healthcare, healthcare providers and programme managers. Data were collected from different sources using 41 in-depth interviews, observations of facilities and a review meeting of providers from 50 health facilities. The data were transcribed, coded and analyzed to identify pre-defined and emerging sub-themes. ATLAS.ti version 7.0 was used for coding data, categorizing codes, and visualizing networks. RESULTS: Poor knowledge of TB and its services, limited accessibility (unreachability, unavailability and unacceptability), pastoralism, and initial healthcare-seeking at informal drug vendors that provide improper medications were the key barriers hindering the uptake of TB medical services. Inadequate infrastructure, shortage of trained and enthused providers, interruptions of drugs and laboratory supplies, scarce equipment, programme management gaps, lack of tailored approach, low private engagement, and cross-border movement were the major challenges affecting the provision of TB services for pastoral communities. The root factors were limited potential healthcare coverage, lack of zonal and district TB units, mobility and drought, strategy and funding gaps, and poor development infrastructure. CONCLUSION: In pastoral settings of Ethiopia, the major challenges of TB services are limited access, illicit medication practices, inadequate resources, structural deficits, and lack of tailored approaches. Hence, for the pastoral TB control to be successful, mobile screening and treatment modalities and engaging rural drug vendors will be instrumental in enhancing case findings and treatment compliance; whereas, service expansion and management decentralization will be essential to create responsive structures for overcoming challenges.


Assuntos
Tuberculose , Etiópia/epidemiologia , Instalações de Saúde , Humanos , População Rural , Somália , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico
2.
BMC Infect Dis ; 21(1): 641, 2021 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-34217245

RESUMO

BACKGROUND: Recent approaches to TB control have focused on identifying and treating active cases to halt further transmission. Patients with TB symptoms often delay to seek care, get appropriate diagnosis, and initiate effective treatment. These delays are partly influenced by whom the patients contact within their community network. We aimed to evaluate the community drivers of diagnostic delay in an urban setting in Uganda. METHODS: In this study we analyze data from a retrospective cohort of 194 TB patients in Kampala, Uganda. We characterized the patterns of contacts made by patients seeking care for TB symptoms. The main outcome of interest was total community contact delay, defined as the time patients spent seeking care before visiting a provider capable of diagnosing TB. RESULTS: Visits to health providers without access to appropriate diagnostic services accounted for 56% of contacts made by cohort members, and were significantly associated with community contact delay, as were symptoms common to other prevalent illnesses, such as bone and joint pain. CONCLUSIONS: Education programs aimed at primary care providers, as well as other community members, may benefit case identification, by informing them of rarer symptoms of TB, potential for co-infections of TB and other prevalent diseases, and the availability of diagnostic services.


Assuntos
Diagnóstico Tardio , Acesso aos Serviços de Saúde/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Tuberculose/diagnóstico , Tuberculose/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Saúde Pública , Estudos Retrospectivos , Uganda , Adulto Jovem
4.
J Coll Physicians Surg Pak ; 30(7): 829-832, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34271785

RESUMO

OBJECTIVES: To compare the DNA-based sputum evaluation with histopathology for the diagnosis of tracheo-bronchial tuberculosis (TBTB). STUDY DESIGN: Case series.   Place and Duration of Study: Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, Tianjin, China, from January to June 2017. METHODOLOGY: TBTB patients, who underwent bronchoscopy during the study period, were included. Their bronchoscopy presentations, histopathology, and induced sputum deoxyribonucleic acid (DNA) and culture results were analysed. Results were expressed as frequency percentage. RESULTS: There were 110 subjects. Most patients were young females with coughing. The main TBTB subtype was fibrostenotic, while the most common findings were single level lesions and lobar bronchi. The diagnostic rates were 40.43%, 67.86%, and 68.54% for DNA-based analysis of induced sputum, histopathology, and induced sputum culture, respectively. Only in the edematous-hyperemic subtype was the positivity rate of DNA-based analysis of induced sputum higher than in histopathology. In the fibrostenotic subtype, the histopathologic results were superior for diagnosis. CONCLUSION: A combination of induced sputum and biopsy using DNA-based methods is a superior and exact method to diagnose TBTB. DNA-based analysis of induced sputum for mycobacterium tuberculosis can be used for preliminary impressions. Key Words: Tracheo-bronchial tuberculosis, Mycobacterium tuberculosis, Pathology, Multiplex polymerase chain reaction, Sputum.


Assuntos
Mycobacterium tuberculosis , Tuberculose Pulmonar , Tuberculose , Broncoscopia , China/epidemiologia , Feminino , Humanos , Mycobacterium tuberculosis/genética , Escarro , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia
5.
J Med Case Rep ; 15(1): 351, 2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34275479

RESUMO

BACKGROUND: Hodgkin's Lymphoma (HL) is a rare malignancy characterised histologically by the presence of Reed-Sternberg cells. Diagnosis of lymphomas can be difficult due to broad, non-specific presentations of disease, which can be similar to several other conditions ranging from infective, inflammatory or malignant causes, with one of the most common differentials being tuberculosis (TB). We aim to highlight the diagnostic dilemma of TB versus lymphoma with an atypical presentation of HL and explored areas for further research and improvement with a non-systematic literature review using MEDLINE database and Google Scholar. Written consent was obtained from the patient in compliance with ethical guidelines. CASE PRESENTATION: A 23-year-old Asian female initially presented to rheumatology with over a one-year history of neuropathic pain, alongside abnormal white cell count and inflammatory markers. This was investigated with magnetic resonance imaging resulting in an incidental finding of mediastinal mass and pulmonary infiltrates. An initial diagnosis of TB was made despite testing negative for acid-fast bacilli and anti-tubercular treatment was commenced. Four months later, following clinical deterioration and further investigations, a mediastinal biopsy assisted in diagnosing Stage IV HL. CONCLUSIONS: Lymphoma is often misdiagnosed as TB, prolonging time to treatment and may adversely impact patient prognosis due to disease progression. Existing TB guidelines for smear-negative cases are not clear when to consider alternative diagnoses. In smear-negative TB, lymphoma should be considered as a differential and definitive diagnostic tests such as molecular testing and histological examination of biopsies should be considered earlier in the diagnostic work-up to prevent diagnostic delay.


Assuntos
Doença de Hodgkin , Tuberculose , Adulto , Biópsia , Diagnóstico Tardio , Feminino , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/tratamento farmacológico , Humanos , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Adulto Jovem
6.
BMC Res Notes ; 14(1): 247, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193258

RESUMO

OBJECTIVES: A novel 3-gene host transcriptional signature (GBP5, DUSP3 and KLF2) has been validated for tuberculosis (TB) treatment monitoring using laboratory-based RNA sequencing platforms. The signature was recently translated by Cepheid into a prototype cartridge-based test that can be run on the GeneXpert instrument. In this study, we prospectively evaluated the change in the expression of the cartridge-based 3-gene signature following treatment initiation among pulmonary TB patients who were microbiologically cured at the end of treatment. RESULTS: The 3-gene signature expression level (TB score) changed significantly over time with respect to baseline among 31 pulmonary TB patients. The greatest increase in TB score occurred within the first month of treatment (median fold-increase in TB score: 1.08 [IQR 0.54-1.52]) and plateaued after 4 months of treatment (median TB score: 1.97 [IQR: 1.03-2.33]). The rapid and substantial increase of the TB score in the first month of treatment holds promise for the early identification of patients that respond to TB treatment. The plateau in TB score at 4 months may indicate early clearance of disease and could direct treatment to be shortened. These hypotheses need to be further explored with larger prospective treatment monitoring studies.


Assuntos
Mycobacterium tuberculosis , Tuberculose Pulmonar , Tuberculose , Testes Diagnósticos de Rotina , Humanos , Mycobacterium tuberculosis/genética , Estudos Prospectivos , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/genética
7.
Rev Bras Epidemiol ; 24: e210035, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34133620

RESUMO

OBJECTIVES: Healthcare workers (HCWs) have a high risk of acquiring tuberculosis infection (TBI). However, annual testing is resource-consuming. We aimed to develop a predictive model to identify HCWs best targeted for TBI screening. METHODOLOGY: We conducted a secondary analysis of previously published results of 708 HCWs working in primary care services in five Brazilian State capitals who underwent two TBI tests: tuberculin skin test and Quantiferon®-TB Gold in-tube. We used a classification and regression tree (CART) model to predict HCWs with negative results for both tests. The performance of the model was evaluated using the receiver operating characteristics (ROC) curve and the area under the curve (AUC), cross-validated using the same dataset. RESULTS: Among the 708 HCWs, 247 (34.9%) had negative results for both tests. CART identified that physician or a community health agent were twice more likely to be uninfected (probability = 0.60) than registered or aid nurse (probability = 0.28) when working less than 5.5 years in the primary care setting. In cross validation, the predictive accuracy was 68% [95% confidence interval (95%CI): 65 - 71], AUC was 62% (95%CI 58 - 66), specificity was 78% (95%CI 74 - 81), and sensitivity was 44% (95%CI 38 - 50). CONCLUSION: Despite the low predictive power of this model, CART allowed to identify subgroups with higher probability of having both tests negative. The inclusion of new information related to TBI risk may contribute to the construction of a model with greater predictive power using the same CART technique.


Assuntos
Tuberculose , Brasil/epidemiologia , Estudos Transversais , Pessoal de Saúde , Humanos , Fatores de Risco , Tuberculose/diagnóstico , Tuberculose/epidemiologia
8.
Cas Lek Cesk ; 160(2-3): 93-96, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34134498

RESUMO

The aim of the article is to describe the development of the principles of medicine based on the evidence (EBM) based on postulates of Robert Koch, Nobel prize winner, protagonist of the "Golden Age" medical bacteriology, founder of a concept of modern microbiology and infectology. Kochs work led to the discovery of a causal relationship between exposure to a specific pathogen and disease on the example of identifying the cause of anthrax - Bacillus anthracis, a disease whose symptoms vary depending on the mode of transmission (gastrointestinal ingestion, cutaneous form on contact and pulmonary manifestations when inhaled). Tuberculosis caused by Kochs bacillus, Mycobacterium tuberculosis, yet still affecting 1.7 billion people (about 25 % of the world's population), in 95 % of cases in developing countries, where poverty and high prevalence of HIV are part of everyday life. Koch also discovered Vibrio cholerae, the pathogen responsible for seven recorded pandemics, and hitherto sporadic epidemics in recent years. The main contribution of the Kochs four postulates formulation was the principle, which helped to reveal the causal relationship between the pathogenic microbe to protrude infectious disease and obtain reliable evidence in improving credibility of diagnosis of infectious diseases. Other stages in the development of EBM were formulated by Bradford Hill in his nine principles, which are valid as well for noncommunicable diseases. The subjects of discussion are limitations and restrictions of present EBM and its essentials and the use in rational preventive, diagnostic and treatment strategies.


Assuntos
Antraz , Bacteriologia , Mycobacterium tuberculosis , Tuberculose , Medicina Baseada em Evidências , Alemanha , Humanos , Tuberculose/diagnóstico , Tuberculose/epidemiologia
9.
J Med Life ; 14(2): 165-169, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104238

RESUMO

Tuberculosis (TB) in pregnancy is not only a matter of the past; it is also a current problem. These days, TB appears through mass migration and tourism in countries where it was believed that this condition is eradicated. Adequate knowledge about the medical history of patients, risk factors, diagnosis and treatment of tuberculosis should be part of the armamentarium of each physician involved in clinical practice. TB is mainly found in urban and socially deprived areas. Due to the length of the treatment, there is an increased risk of drug resistance in partially treated patients. Strong knowledge about the history, risk factors, diagnosis and treatment of TB should be part of the armamentarium of each physician. Many practitioners are reluctant to request a chest X-ray in pregnancy due to the fear of harming the fetus. Bypassing a diagnosis can have a devastating effect on the mother and fetus, as well as their family and medical staff. This article discusses the matters of diagnosis and treatment of asymptomatic infection and active TB in pregnancy.


Assuntos
Complicações Infecciosas na Gravidez/patologia , Tuberculose/patologia , Farmacorresistência Bacteriana , Feminino , Humanos , Programas de Rastreamento , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Fatores de Risco , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/terapia
10.
Trials ; 22(1): 391, 2021 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-34120649

RESUMO

BACKGROUND: Throughout the last decade, tuberculosis (TB) treatment success has not surpassed 90%, the global target. The impact of mobile health interventions (MHIs) on TB treatment outcomes is unknown, especially in low- and middle-income countries (LMICs). MHIs, including interactive voice response technology (IVRT), may enhance adherence and retention in the care of patients with tuberculosis and improve TB treatment outcomes. This study seeks to determine the impact of IVRT-based MHI on TB treatment success (treatment completion and cure rates) in patients with TB receiving care at five public health facilities in Uganda. METHODS: We used a theory-based and human-centered design (HCD) to adapt an already piloted software to design "Call for life-TB" (CFL-TB), an MHI that utilizes IVRT to deliver adherence and appointment reminders and allows remote symptom reporting. This open-label, multicenter, randomized controlled trial (RCT), with nested qualitative and economic evaluation studies, will determine the impact of CFL-TB on TB treatment success in patients with drug-susceptible TB in Uganda. Participants (n = 274) at the five study sites will be randomized (1:1 ratio) to either control (standard of care) or intervention (adherence and appointment reminders, and health tips) arms. Multivariable regression models will be used to compare treatment success, adherence to treatment and clinic appointments, and treatment completion at 6 months post-enrolment. Additionally, we will determine the cost-effectiveness, acceptability, and perceptions of stakeholders. The study received national ethical approval and was conducted in accordance with the international ethical guidelines. DISCUSSION: This randomized controlled trial aims to evaluate interactive voice response technology in the context of resource-limited settings with a high burden of TB and high illiteracy rates. The software to be evaluated was developed using HCD and the intervention was based on the IMB model. The software is tailored to the local context and is interoperable with the MHI ecosystem. The HCD approach ensures higher usability of the MHI by integrating human factors in the prototype development. This research will contribute towards the understanding of the implementation and impact of the MHI on TB treatment outcomes and the health system, especially in LMICs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04709159 . Registered on January 14, 2021.


Assuntos
Telefone Celular , Tuberculose , Humanos , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Software , Resultado do Tratamento , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Uganda
11.
Emerg Infect Dis ; 27(7): 1831-1839, 2021 07.
Artigo em Inglês | MEDLINE | ID: covidwho-1278364

RESUMO

The coronavirus disease (COVID-19) pandemic might affect tuberculosis (TB) diagnosis and patient care. We analyzed a citywide electronic TB register in Blantyre, Malawi and interviewed TB officers. Malawi did not have an official COVID-19 lockdown but closed schools and borders on March 23, 2020. In an interrupted time series analysis, we noted an immediate 35.9% reduction in TB notifications in April 2020; notifications recovered to near prepandemic numbers by December 2020. However, 333 fewer cumulative TB notifications were received than anticipated. Women and girls were affected more (30.7% fewer cases) than men and boys (20.9% fewer cases). Fear of COVID-19 infection, temporary facility closures, inadequate personal protective equipment, and COVID-19 stigma because of similar symptoms to TB were mentioned as reasons for fewer people being diagnosed with TB. Public health measures could benefit control of both TB and COVID-19, but only if TB diagnostic services remain accessible and are considered safe to attend.


Assuntos
COVID-19 , Tuberculose , Controle de Doenças Transmissíveis , Feminino , Humanos , Malaui/epidemiologia , Masculino , Pandemias , SARS-CoV-2 , Tuberculose/diagnóstico , Tuberculose/epidemiologia
13.
Euro Surveill ; 26(24)2021 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-1278341

RESUMO

We assessed the impact of COVID-19 on diagnostic services for tuberculosis (TB) by national reference laboratories in the WHO European Region. Of 35 laboratories, 30 reported declines in TB sample numbers, amounting up to > 50% of the pre-COVID-19 volumes. Sixteen reported reagent or consumable shortages. Nineteen reallocated ressources to SARS-CoV-2 testing, resulting in an overall increase in workload, largely without a concomitant increase in personnel (n = 14). This poses a risk to meeting the 2025 milestones of the End TB Strategy.


Assuntos
COVID-19 , Tuberculose , Teste para COVID-19 , Humanos , Laboratórios , Pandemias , SARS-CoV-2 , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Organização Mundial da Saúde
14.
Euro Surveill ; 26(24)2021 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-1278340

RESUMO

BackgroundEssential health services, including for tuberculosis (TB), are being affected by public health and social measures (PHSM) introduced to control COVID-19. In many settings, TB resources, facilities and equipment are being redirected towards COVID-19 response.AimWe sought to assess the COVID-19 pandemic's impact on TB services in the World Health Organization (WHO) European Region.MethodsThe fifty-three European Region Member States were asked to report qualitative and quantitative data in quarter one and two (Q1 and Q2) 2020. TB notifications were triangulated with the severity score on domestic movement restrictions to assess how they may have influenced TB detection.ResultsTwenty-nine countries reported monthly TB notifications for the first half of 2019 and 2020. TB notifications decreased by 35.5% during Q2 2020 compared with Q2 2019, which is six-fold more than the average annual decrease of 5.1% documented during 2015-2019. The number of patients enrolled in rifampicin-resistant/multidrug-resistant TB treatment also decreased dramatically in Q2 2020, by 33.5%. The highest movement restriction severity score was observed between April and May 2020, which coincided with the highest observed decrease in TB notifications.ConclusionA decrease in TB detection and enrolment to treatment may cause increases in TB burden and threatens the Region's ability to reach the TB targets of the 2030 Sustainable Development Goals, still this might be mitigated with rapid restoration of TB services and the implementation of targeted interventions during periods with severe PHSM in place, such as those introduced in response to the COVID-19 pandemic.


Assuntos
COVID-19 , Tuberculose , Humanos , Pandemias , SARS-CoV-2 , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Organização Mundial da Saúde
15.
Front Public Health ; 9: 644536, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1259404

RESUMO

Background: To contain the pandemic of COVID-19, China has implemented a series of public health interventions that impacted the tuberculosis control substantially, but these impacts may vary greatly depending on the severity of the local COVID-19 epidemic. The impact of COVID-19 on TB control in Ningxia Hui Autonomous Region is little known. Methods: Based on the national TB Information Management System (TBIMS), this study accessed the actual impact of COVID-19 on TB by comparing TB notifications, pre-treatment delays, and clinical characteristics of TB cases between 2020 COVID-19 period and 2017-2019 baseline. The data were divided into three periods based on the response started to fight against COVID-19 in Ningxia Hui Autonomous Region, including the control period (10 weeks before the pandemic), intensive period (10 weeks during the Ningxia Hui Autonomous Region lockdown), and regular (10 additional weeks after Ningxia Hui Autonomous Region reopen). Results: TB notification dropped sharply in the first week of the intensive period but took significantly longer to return to the previous level in 2020 compared with the 2017-2019 baseline. Totally, the TB notification rates decreased by more than 60% in the intensive period of COVID-19 compared with the average level of 2017-2019. The sputum smear-positive rate of TB patients diagnosed in intensive period of COVID-19 was significantly higher than that in the corresponding periods of 2017-2019 (P < 0.001). The rate of cavity on X-ray inspection of TB cases diagnosed in the intensive period of COVID-19 was significantly higher than that in period 2 of 2017-2019 (23.5 vs. 15.4%, P = 0.004). The patients' delay in the intensive period was significantly longer than that before the pandemic (P = 0.047). Conclusions: The TB notification in Ningxia was impacted dramatically by the pandemic of COVID-19. To compensate for the large numbers of missed diagnosis as well as delayed diagnosis during the intensive period of COVID-19, an urgent restoration of normal TB services, and further emphasis on enhanced active case finding and scale-up of household contact tracing and screening for TB-related symptoms or manifestation, will be essential.


Assuntos
COVID-19 , Tuberculose , China/epidemiologia , Controle de Doenças Transmissíveis , Humanos , Pandemias , SARS-CoV-2 , Tempo para o Tratamento , Tuberculose/diagnóstico
16.
Euro Surveill ; 26(24)2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34142649

RESUMO

BackgroundEssential health services, including for tuberculosis (TB), are being affected by public health and social measures (PHSM) introduced to control COVID-19. In many settings, TB resources, facilities and equipment are being redirected towards COVID-19 response.AimWe sought to assess the COVID-19 pandemic's impact on TB services in the World Health Organization (WHO) European Region.MethodsThe fifty-three European Region Member States were asked to report qualitative and quantitative data in quarter one and two (Q1 and Q2) 2020. TB notifications were triangulated with the severity score on domestic movement restrictions to assess how they may have influenced TB detection.ResultsTwenty-nine countries reported monthly TB notifications for the first half of 2019 and 2020. TB notifications decreased by 35.5% during Q2 2020 compared with Q2 2019, which is six-fold more than the average annual decrease of 5.1% documented during 2015-2019. The number of patients enrolled in rifampicin-resistant/multidrug-resistant TB treatment also decreased dramatically in Q2 2020, by 33.5%. The highest movement restriction severity score was observed between April and May 2020, which coincided with the highest observed decrease in TB notifications.ConclusionA decrease in TB detection and enrolment to treatment may cause increases in TB burden and threatens the Region's ability to reach the TB targets of the 2030 Sustainable Development Goals, still this might be mitigated with rapid restoration of TB services and the implementation of targeted interventions during periods with severe PHSM in place, such as those introduced in response to the COVID-19 pandemic.


Assuntos
COVID-19 , Tuberculose , Humanos , Pandemias , SARS-CoV-2 , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Organização Mundial da Saúde
17.
Euro Surveill ; 26(24)2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34142651

RESUMO

We assessed the impact of COVID-19 on diagnostic services for tuberculosis (TB) by national reference laboratories in the WHO European Region. Of 35 laboratories, 30 reported declines in TB sample numbers, amounting up to > 50% of the pre-COVID-19 volumes. Sixteen reported reagent or consumable shortages. Nineteen reallocated ressources to SARS-CoV-2 testing, resulting in an overall increase in workload, largely without a concomitant increase in personnel (n = 14). This poses a risk to meeting the 2025 milestones of the End TB Strategy.


Assuntos
COVID-19 , Tuberculose , Teste para COVID-19 , Humanos , Laboratórios , Pandemias , SARS-CoV-2 , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Organização Mundial da Saúde
18.
Emerg Infect Dis ; 27(7): 1831-1839, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34152962

RESUMO

The coronavirus disease (COVID-19) pandemic might affect tuberculosis (TB) diagnosis and patient care. We analyzed a citywide electronic TB register in Blantyre, Malawi and interviewed TB officers. Malawi did not have an official COVID-19 lockdown but closed schools and borders on March 23, 2020. In an interrupted time series analysis, we noted an immediate 35.9% reduction in TB notifications in April 2020; notifications recovered to near prepandemic numbers by December 2020. However, 333 fewer cumulative TB notifications were received than anticipated. Women and girls were affected more (30.7% fewer cases) than men and boys (20.9% fewer cases). Fear of COVID-19 infection, temporary facility closures, inadequate personal protective equipment, and COVID-19 stigma because of similar symptoms to TB were mentioned as reasons for fewer people being diagnosed with TB. Public health measures could benefit control of both TB and COVID-19, but only if TB diagnostic services remain accessible and are considered safe to attend.


Assuntos
COVID-19 , Tuberculose , Controle de Doenças Transmissíveis , Feminino , Humanos , Malaui/epidemiologia , Masculino , Pandemias , SARS-CoV-2 , Tuberculose/diagnóstico , Tuberculose/epidemiologia
19.
BMJ Case Rep ; 14(6)2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162605

RESUMO

Gallbladder tuberculosis (TB) as an isolated infection and is an extremely rare entity even in parts of the world with endemicity. Though it has myriad ways of presentation, it can be cured successfully. We present a case of a 53-year-old man who presented with epigastric fullness and bloating with on and off low-grade fever for 2 months and significant weight loss. He underwent a CT scan, which showed a soft tissue gallbladder mass causing mural thickening of the antrum and lesser curvature. This was followed by a CT-guided core biopsy and gastric antrum biopsy via gastroscopy. Histopathology revealed chronic granulomatous inflammation in both samples. Various clinical presentations of gallbladder TB have been reported in literature, but to the best of our knowledge, the present case has a unique presentation and has never been reported before.


Assuntos
Neoplasias da Vesícula Biliar , Tuberculose , Biópsia , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico
20.
Front Public Health ; 9: 644536, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34095053

RESUMO

Background: To contain the pandemic of COVID-19, China has implemented a series of public health interventions that impacted the tuberculosis control substantially, but these impacts may vary greatly depending on the severity of the local COVID-19 epidemic. The impact of COVID-19 on TB control in Ningxia Hui Autonomous Region is little known. Methods: Based on the national TB Information Management System (TBIMS), this study accessed the actual impact of COVID-19 on TB by comparing TB notifications, pre-treatment delays, and clinical characteristics of TB cases between 2020 COVID-19 period and 2017-2019 baseline. The data were divided into three periods based on the response started to fight against COVID-19 in Ningxia Hui Autonomous Region, including the control period (10 weeks before the pandemic), intensive period (10 weeks during the Ningxia Hui Autonomous Region lockdown), and regular (10 additional weeks after Ningxia Hui Autonomous Region reopen). Results: TB notification dropped sharply in the first week of the intensive period but took significantly longer to return to the previous level in 2020 compared with the 2017-2019 baseline. Totally, the TB notification rates decreased by more than 60% in the intensive period of COVID-19 compared with the average level of 2017-2019. The sputum smear-positive rate of TB patients diagnosed in intensive period of COVID-19 was significantly higher than that in the corresponding periods of 2017-2019 (P < 0.001). The rate of cavity on X-ray inspection of TB cases diagnosed in the intensive period of COVID-19 was significantly higher than that in period 2 of 2017-2019 (23.5 vs. 15.4%, P = 0.004). The patients' delay in the intensive period was significantly longer than that before the pandemic (P = 0.047). Conclusions: The TB notification in Ningxia was impacted dramatically by the pandemic of COVID-19. To compensate for the large numbers of missed diagnosis as well as delayed diagnosis during the intensive period of COVID-19, an urgent restoration of normal TB services, and further emphasis on enhanced active case finding and scale-up of household contact tracing and screening for TB-related symptoms or manifestation, will be essential.


Assuntos
COVID-19 , Tuberculose , China/epidemiologia , Controle de Doenças Transmissíveis , Humanos , Pandemias , SARS-CoV-2 , Tempo para o Tratamento , Tuberculose/diagnóstico
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