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1.
BMC Infect Dis ; 21(1): 1, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33390160

RESUMO

BACKGROUND: Undernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. In Sub-Saharan Africa (SSA), the impacts of these often inter-related conditions appear in a series of fragmented and inconclusive studies. Thus, this review examines the pooled effects of undernutrition on mortality and morbidities among adults living with HIV in SSA. METHODS: A systematic literature search was conducted from PubMed, EMBASE, CINAHL, and Scopus databases. All observational studies reporting the effects of undernutrition on mortality and morbidity among adults living with HIV in SSA were included. Heterogeneity between the included studies was assessed using the Cochrane Q-test and I2 statistics. Publication bias was assessed using Egger's and Begg's tests at a 5% significance level. Finally, a random-effects meta-analysis model was employed to estimate the overall adjusted hazard ratio. RESULTS: Of 4309 identified studies, 53 articles met the inclusion criteria and were included in this review. Of these, 40 studies were available for the meta-analysis. A meta-analysis of 23 cohort studies indicated that undernutrition significantly (AHR: 2.1, 95% CI: 1.8, 2.4) increased the risk of mortality among adults living with HIV, while severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% CI: 1.9, 2.8) as compared to mildly undernourished adults living with HIV. Furthermore, the pooled estimates of ten cohort studies revealed that undernutrition significantly increased the risk of developing tuberculosis (AHR: 2.1, 95% CI: 1.6, 2.7) among adults living with HIV. CONCLUSION: This review found that undernutrition has significant effects on mortality and morbidity among adults living with HIV. As the degree of undernutrition became more severe, mortality rate also increased. Therefore, findings from this review may be used to update the nutritional guidelines used for the management of PLHIV by different stakeholders, especially in limited-resource settings.


Assuntos
Infecções por HIV/epidemiologia , Desnutrição/epidemiologia , Tuberculose/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , África ao Sul do Saara/epidemiologia , Comorbidade , Infecções por HIV/mortalidade , Humanos , Morbidade , Prevalência , Tuberculose/etiologia
2.
Nat Commun ; 11(1): 5225, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33067434

RESUMO

Patients with type 2 diabetes (T2D) have a lower risk of Mycobacterium tuberculosis infection, progression from infection to tuberculosis (TB) disease, TB morality and TB recurrence, when being treated with metformin. However, a detailed mechanistic understanding of these protective effects is lacking. Here, we use mass cytometry to show that metformin treatment expands a population of memory-like antigen-inexperienced CD8+CXCR3+ T cells in naive mice, and in healthy individuals and patients with T2D. Metformin-educated CD8+ T cells have increased (i) mitochondrial mass, oxidative phosphorylation, and fatty acid oxidation; (ii) survival capacity; and (iii) anti-mycobacterial properties. CD8+ T cells from Cxcr3-/- mice do not exhibit this metformin-mediated metabolic programming. In BCG-vaccinated mice and guinea pigs, metformin enhances immunogenicity and protective efficacy against M. tuberculosis challenge. Collectively, these results demonstrate an important function of CD8+ T cells in metformin-derived host metabolic-fitness towards M. tuberculosis infection.


Assuntos
Linfócitos T CD8-Positivos/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Metformina/administração & dosagem , Animais , Vacina BCG/administração & dosagem , Vacina BCG/imunologia , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/imunologia , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Cobaias , Humanos , Masculino , Camundongos , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/imunologia , Mycobacterium tuberculosis/fisiologia , Tuberculose/etiologia , Tuberculose/imunologia , Tuberculose/microbiologia , Tuberculose/prevenção & controle
3.
Int J Infect Dis ; 96: 593-599, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505876

RESUMO

OBJECTIVE: To evaluate the performance of the modified Keith Edwards TB clinical diagnostic tool among HIV infected children. METHODS: Cross sectional study of 252 HIV infected children < 15 years old suspected with TB at four HIV/AIDS Care Clinics in Dodoma, Tanzania from November 2018 - March 2019. The modified Keith Edwards TB clinical diagnostic tool was compared to gastric aspirates, lymphnode aspirates or sputum gene x-pert MTB/RIF and TB culture. Sensitivity, specificity, negative and positive predictive value of the clinical tool were determined. Data was analyzed using SPSS version 25. RESULTS: Out of 252 children evaluated, 13.5% (34/252) had TB using the clinical diagnostic tool and 5.2% (13/252) had culture positive TB. The sensitivity of the clinical tool was 76.9%, specificity of 90%. Culture positive TB predictors were lymphadenopathy (AOR 13.74, 95%CI (3.86 - 48.86) p value < 0.001), weight loss (AOR 3.19,95%CI (1.38 - 7.36) p value 0.007), and difficulty breathing (AOR 7.25, 95%CI (1.54 - 34.16) p value 0.012). CONCLUSION: The utility of the modified Keith Edwards clinical diagnostic tool for Tuberculosis diagnosis among HIV infected children is limited, calling for further validation. HIV infected children with lymphadenopathy, failure to thrive and difficulty in breathing are at high risk of Tuberculosis.


Assuntos
Testes Diagnósticos de Rotina/métodos , Infecções por HIV/complicações , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Mycobacterium tuberculosis/genética , Prevalência , Sensibilidade e Especificidade , Escarro/microbiologia , Tanzânia/epidemiologia , Tuberculose/etiologia , Tuberculose/microbiologia
4.
Int J Infect Dis ; 97: 117-125, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32497805

RESUMO

BACKGROUND: Disseminated Bacillus Calmette-Guérin (BCG) disease (BCGosis) is a classical feature of children with primary immunodeficiency disorders (PIDs). METHODS: A 15-year retrospective review was conducted in KK Women's and Children's Hospital in Singapore, from January 2003 to October 2017. RESULTS: Ten patients were identified, the majority male (60.0%). The median age at presentation of symptoms of BCG infections was 3.8 (0.8 - 7.4) months. All the patients had likely underlying PIDS - four with Severe Combined Immunodeficiency (SCID), three with Mendelian Susceptibility to Mycobacterial Diseases (MSMD), one with Anhidrotic Ectodermal Dysplasia with Primary Immunodeficiency (EDA-ID), one with combined immunodeficiency (CID), and one with STAT-1 gain-of-function mutation. Definitive BCGosis was confirmed in all patients by the identification of Mycobacterium bovis subsp BCG from microbiological cultures. The susceptibility profiles of Mycobacterium bovis subsp BCG are as follows: Rifampicin (88.9%), Isoniazid (44.47%), Ethambutol (100.0%), Streptomycin (100.0%), Kanamycin (100.0%), Ethionamide (25.0%), and Ofloxacin (100.0%). Four patients (40.0%) received a three-drug regimen. Five patients (50.0%) underwent hematopoietic stem cell transplant (HSCT), of which three (60%) have recovered. Overall mortality was 50.0%. CONCLUSION: Disseminated BCG disease (BCGosis) should prompt immunology evaluation to determine the diagnosis of the immune defect. A three-drug regimen is adequate for treatment if the patient undergoes early HSCT.


Assuntos
Vacina BCG/efeitos adversos , Mycobacterium bovis , Doenças da Imunodeficiência Primária/complicações , Tuberculose/etiologia , Vacina BCG/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Doenças da Imunodeficiência Primária/terapia , Estudos Retrospectivos , Singapura , Tuberculose/tratamento farmacológico , Tuberculose/etnologia
5.
Ann Hum Biol ; 47(2): 89-93, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32429754

RESUMO

Cohort studies are special forms of longitudinal studies that have long been accepted as the primary designs to acquire information on the interaction between the environment and health and the subsequent aetiology and progression of disease. Richard Doll, Regius Professor of Medicine at Oxford University from 1969-1979, was the 20th century's pre-eminent epidemiologist in the UK. He used cohort studies to establish the relationship between smoking and health (primarily cancer) in the 1960s at a time when over 80% of British males smoked. However, the development of cohorts as a means of studying health and wellbeing across the lifespan is rooted in research on tuberculosis in Europe and America in the 1920s and 1930s. Cohort studies were recognised as the primary research design for the study of human growth and development between and during the wars in the USA. Their natural legacy as longitudinal studies emerged in Europe after WWII through a series of growth studies coordinated by the Centre Internationale de L'Enfance in Paris from the 1960s onwards. The failure of two nationally representative birth cohort studies in the USA and UK between 2010 and 2015 has highlighted the previous success of smaller birth cohorts and the advantages gained from standardised methods of measurement and assessment that allow amalgamation and metanalysis of different datasets.


Assuntos
Estudos de Coortes , Neoplasias , Saúde Pública/história , Fumar , Tuberculose , Europa (Continente) , História do Século XX , História do Século XXI , Humanos , Estudos Longitudinais , Neoplasias/induzido quimicamente , América do Norte , Fumar/efeitos adversos , Tuberculose/etiologia , Reino Unido
7.
Sci Rep ; 10(1): 5639, 2020 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-32221405

RESUMO

Addressing social determinants of tuberculosis (TB) is essential to achieve elimination, including in low-incidence settings. We measured the association between socio-economic status and intermediate social determinants of health (SDHs, including drug misuse, tobacco smoking and alcohol), and TB, taking into account their clustering in individuals. We conducted a case-control study in 23-38 years old UK-born White adults with first tuberculosis episode, and randomly selected age and sex frequency-matched community controls. Data was collected on education, household overcrowding, tobacco smoking, alcohol and drugs use, and history of homelessness and prison. Analyses were done using logistic regression models, informed by a formal theoretical causal framework (Directed Acyclic Graph). 681 TB cases and 1183 controls were recruited. Tuberculosis odds were four times higher in subjects with education below GCSE O-levels, compared to higher education (OR = 3.94; 95%CI: 2.74, 5.67), after adjusting for other TB risk factors (age, sex, BCG-vaccination and stays ≥3 months in Africa/Asia). When simultaneously accounting for respective SDHs, higher tuberculosis risk was independently associated with tobacco smoking, drugs use (especially injectable drugs OR = 5.67; 95%CI: 2.68, 11.98), homelessness and area-level deprivation. Population Attributable Fraction estimates suggested that tobacco and class-A drug use were, respectively, responsible for 18% and 15% of TB cases in this group. Our findings suggest that socio-economic deprivation remains a driver of tuberculosis in England, including through drugs misuse, tobacco smoking, and homelessness. These findings further support the integration of health and social services in high-risk young adults to improve TB control efforts.


Assuntos
Uso Indevido de Medicamentos/efeitos adversos , Etanol/efeitos adversos , Fumar/efeitos adversos , Determinantes Sociais da Saúde/estatística & dados numéricos , Fumar Tabaco/efeitos adversos , Tuberculose/epidemiologia , Tuberculose/etiologia , Adulto , Estudos de Casos e Controles , Usuários de Drogas/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Reino Unido/epidemiologia
8.
Glob Health Epidemiol Genom ; 5: e1, 2020 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-32180987

RESUMO

This study assessed the tobacco smoking-associated risk for tuberculous pleural effusion (TPE) in India. Ninety-two patients with TPE and 184 controls were randomly selected and assessed regarding their tobacco-smoking status and type, quantity and duration of tobacco used. Odds ratios (ORs) for the association of smoking cigarette, beedi and cigarette or beedi with TPE were 19.22 (p < 0.0001), 2.89 (p = 0.0006) and 4.57 (p < 0.0001) respectively. ORs for developing TPE increased with an increase in beedi/cigarette consumption, duration and pack years of smoking (p < 0.001 each). TPE was significantly associated with confounding risk factors viz., regular alcohol use (OR = 1.89, p = 0.019), history of contact with tuberculosis (TB) patient (OR = 8.07, p < 0.0001), past history of TB (OR = 22.31, p < 0.0001), family history of TB (OR = 9.05, p = 0.0002) and underweight (OR = 3.73, p = 0.0009). Smoking (OR = 3.07, p < 0.001), regular alcohol use (OR = 2.10, p = 0.018), history of contact with TB patient (OR = 4.01, p = 0.040), family history of TB (OR = 10.80, p = 0.001) and underweight (OR = 5.04, p < 0.001) were independently associated with TPE. Thus, both cigarette- and beedi-smoking have a significant association with TPE. The risk for TPE in tobacco smokers is dose- and duration-dependent.


Assuntos
Derrame Pleural/etiologia , Fumar Tabaco/efeitos adversos , Tuberculose/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Derrame Pleural/fisiopatologia , Fatores de Risco , Fumar Tabaco/psicologia , Tuberculose/fisiopatologia
9.
Rev. chil. enferm. respir ; 36(1): 51-61, mar. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1115463

RESUMO

La tuberculosis continúa siendo una de las principales causas de morbimortalidad a nivel mundial. En Chile, luego de un período de estancamiento, se ha observado un aumento de casos en los últimos dos años, llegando a una tasa de incidencia de 15,7 casos por 100.000 habitantes en 2018. El estudio busca dilucidar si este aumento es generalizado o si se produce en grupos específicos de la población, y en qué medida corresponde a cambios epidemiológicos u operacionales del programa. Se realizó un estudio descriptivo utilizando datos de fuentes secundarias oficiales para analizar los cambios en el número de casos de tuberculosis en los últimos dos años según áreas geográficas y grupos vulnerables. Además, se analizó el comportamiento de las actividades de pesquisa y diagnóstico de la enfermedad. Se observó aumento de casos en 6 regiones del país, siendo los extranjeros los que aumentan en mayor medida respecto a los otros grupos vulnerables, aunque la incidencia de tuberculosis en este grupo no afecta la incidencia entre los chilenos. La importancia de los extranjeros en el aumento de los casos se produce fundamentalmente en la Región Metropolitana, en cambio en las otras regiones son otros los grupos vulnerables prioritarios. En cuanto a la pesquisa y los métodos diagnósticos, éste puede ser un factor que colabora al aumento de casos en algunas regiones, pero en general no tiene un peso relevante. En conclusión, el aumento de casos de tuberculosis está focalizado a algunas áreas específicas lo que refuerza la importancia de los análisis locales y la definición de estrategias diferenciadas.


Tuberculosis (TB) continues to be one of the leading causes of morbidity and mortality worldwide. In Chile, after a period of stagnation, an increase in cases has been observed in the last two years, reaching an incidence rate of 15.7 per 100,000 inhabitants in 2018. The study seeks to elucidate whether this increase is widespread or if it occurs in specific groups, also if it corresponds to epidemiological or operational changes. A descriptive study was carry on using data from official secondary sources to analyze changes in the number of cases in the last two years according to geographic areas and risk groups. In addition, case finding and diagnosis activities of TB program was analyzed. Increase in cases was observed in 6 regions of the country and foreigner people had the largest increase compared to other risk groups, although the incidence among Chilean is not affected for this fact. The importance of foreigners in the increase of cases occurs mainly in metropolitan region, while in the other regions there are other priority risk groups. Case finding and diagnosis activities may be contribute to increase of cases in some regions, but it does not have a relevant weight in general. In conclusion, the increase of tuberculosis cases is focused on some specific areas, which reinforces the importance of local analysis and the definition of differentiated strategies.


Assuntos
Humanos , Tuberculose/epidemiologia , Tuberculose/etiologia , Grupos de Risco , Chile/epidemiologia , Epidemiologia Descritiva , Incidência , Emigrantes e Imigrantes
10.
Am J Gastroenterol ; 115(3): 340-349, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32032073

RESUMO

OBJECTIVES: Infliximab (IFX) or adalimumab (ADA) use in patients with inflammatory bowel disease (IBD) leads to increased risk of tuberculosis (TB). This meta-analysis evaluated the factors which determine this risk, with special focus on local TB incidence. METHODS: All studies until January 31, 2019, which reported the development of TB in patients with IBD on IFX/ADA, were included after searching PubMed and Embase. Data regarding disease type, number of patients on IFX/ADA, number of patients who developed TB, mean age at IFX/ADA initiation, median duration of development of TB, and latent TB (LTB) were extracted. The details on local TB incidence were obtained from the World Health Organization database, and the studies were stratified into low (<10/100,000), intermediate (10-40/100,000), and high TB burden countries (>40/100,000). Random effect meta-analysis was performed to calculate the overall pooled prevalence and prevalence based on local TB burden. RESULTS: Of 130,114 patients (128 studies), 373 developed TB (pooled prevalence: 0.08% [95% confidence interval {CI}: 0.05%-0.10%]). The risk increased with increasing TB burden, pooled prevalence being 0.02% (95% CI: 0.02%-0.03%), 0.21% (95% CI: -0.02% to 0.43%), and 1.59% (95% CI: 1.19%-2.00%) for low, intermediate, and high TB burden countries, respectively. Seventy-three percent of patients who developed TB had no evidence of LTB on screening, the proportion being independent of TB burden. There was no effect of disease or treatment type, study type, gender, age at IFX/ADA initiation, and follow-up duration on TB prevalence. DISCUSSION: TB risk in patients with IBD on IFX/ADA depends on the local TB burden and is independent of disease/treatment type.


Assuntos
Adalimumab/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Infliximab/uso terapêutico , Tuberculose/etiologia , Efeitos Psicossociais da Doença , Saúde Global , Humanos , Incidência , Doenças Inflamatórias Intestinais/complicações , Fatores de Risco , Tuberculose/epidemiologia
11.
J Int AIDS Soc ; 23(1): e25438, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31913556

RESUMO

INTRODUCTION: Tuberculosis (TB) is a leading cause of mortality among people living with HIV (PLHIV). An invigorated global END TB Strategy seeks to increase efforts in scaling up TB preventive therapy (TPT) as a central intervention for HIV programmes in an effort to contribute to a 90% reduction in TB incidence and 95% reduction in mortality by 2035. TPT in PLHIV should be part of a comprehensive approach to reduce TB transmission, illness and death that also includes TB active case-finding and prompt, effective and timely initiation of anti-TB therapy among PLHIV. However, the use and implementation of preventive strategies has remained deplorably inadequate and today TB prevention among PLHIV has become an urgent priority globally. DISCUSSION: We present a summary of the current and novel TPT regimens, including current evidence of use with antiretroviral regimens (ART). We review challenges and opportunities to scale-up TB prevention within HIV programmes, including the use of differentiated care approaches and demand creation for effective TB/HIV services delivery. TB preventive vaccines and diagnostics, including optimal algorithms, while important topics, are outside of the focus of this commentary. CONCLUSIONS: A number of new tools and strategies to make TPT a standard of care in HIV programmes have become available. The new TPT regimens are safe and effective and can be used with current ART, with attention being paid to potential drug-drug interactions between rifamycins and some classes of antiretrovirals. More research and development is needed to optimize TPT for small children, pregnant women and drug-resistant TB (DR-TB). Effective programmatic scale-up can be supported through context-adapted demand creation strategies and the inclusion of TPT in client-centred services, such as differentiated service delivery (DSD) models. Robust collaboration between the HIV and TB programmes represents a unique opportunity to ensure that TB, a preventable and curable condition, is no longer the number one cause of death in PLHIV.


Assuntos
Infecções por HIV/complicações , Tuberculose/prevenção & controle , Antirretrovirais/uso terapêutico , Antituberculosos/uso terapêutico , Interações Medicamentosas , Infecções por HIV/tratamento farmacológico , Humanos , Rifamicinas/uso terapêutico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose/etiologia
13.
Lancet HIV ; 7(1): e27-e37, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31727580

RESUMO

BACKGROUND: Tuberculosis, which is often undiagnosed, is the major cause of death among HIV-positive people. We aimed to test whether the use of a clinical algorithm enabling the initiation of empirical tuberculosis treatment by nurses in primary health-care clinics would reduce mortality compared with standard of care for adults with advanced HIV disease. METHODS: In this open-label cluster-randomised controlled trial, we recruited individuals from 24 primary health-care clinics in South Africa. The clinics were randomly assigned (1:1) to either deliver an intervention or routine care (control) using computer-generated random numbers. Eligible participants were HIV-positive adults (aged ≥18 years) with CD4 counts of 150 cells per µL or less, who had not had antiretroviral therapy (ART) in the past 6 months or tuberculosis treatment in the past 3 months, and did not require urgent hospital referral. In intervention clinics, study nurses assessed participants on the basis of tuberculosis symptoms, body-mass index, point-of-care haemoglobin concentrations, and urine lipoarabinomannan assay results. Participants classified by a study algorithm as having high probability of tuberculosis (positive urine lipoarabinomannan assay, body-mass index <18·5 kg/m2, or haemoglobin concentration <100 g/L) were recommended to start tuberculosis treatment immediately followed by ART 2 weeks later; participants classified as medium probability (tuberculosis symptoms, no high probability criteria) were recommended to have symptom-guided investigation; and participants classified as low probability (no tuberculosis symptoms or high probability criteria) were recommended to start ART immediately. In standard-of-care clinics, participants received treatment in accordance with South African guidelines. Investigators and participants were aware of treatment allocation. The primary outcome was all-cause mortality at 6 months, assessed in the intention-to-treat population. Safety was also analysed in the intention-to treat population. This trial is registered with the ISRCTN registry, ISRCTN35344604, and the South African National Clinical Trials Register, DOH-27-0812-3902. FINDINGS: Between Dec 19, 2012, and Dec 18, 2014, 3091 individuals were screened for eligibility, of whom 3053 were recruited, and 3022 (1507 participants in the intervention group and 1515 participants in the control group) were analysed for the primary outcome. 930 (61·7%) of 1507 participants in the intervention group versus 172 (11·4%) of 1515 participants in the control group had started tuberculosis treatment by 2 months. At 6 months, the mortality rate was 19·0 deaths per 100 person-years for the intervention group versus 21·6 deaths per 100 person-years in the control group (unadjusted hazard ratio [HR] 0·92, 95% CI 0·67-1·26, p=0·58; adjusted HR 0·87, 0·61-1·24, p=0·41). 28 (1·9%) of 1507 participants in the intervention group and ten (0·7%) of 1515 participants in the control group reported serious or severe adverse events. Grade 3 or 4 nausea and vomiting was the most common adverse event (ten participants in the intervention group and four participants in the control group). Among participants with adverse events, eight participants (six participants in the intervention group and two participants in the control group) died; none of the six deaths in the intervention group were attributed to the study intervention. INTERPRETATION: Our intervention substantially increased coverage of tuberculosis treatment in this high-risk population, but did not reduce mortality. FUNDING: Joint Global Health Trials (Medical Research Council, Department for International Development, Wellcome Trust).


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antituberculosos/administração & dosagem , Infecções por HIV/complicações , Tuberculose/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/etiologia , Adulto , Algoritmos , Fármacos Anti-HIV/administração & dosagem , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , África do Sul , Resultado do Tratamento , Tuberculose/etiologia
14.
J Bras Pneumol ; 46(2): e20190024, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31859704

RESUMO

OBJECTIVE: To determine the CT findings of multiple cavitary lung lesions that allow the differentiation between benign and malignant etiologies. METHODS: We reviewed CT scans, including patients with two or more cavitary lung lesions. We evaluated the number of cavitary lesions, their location, cavity wall thickness, and additional findings, correlating the variables with the diagnosis of a benign or malignant lesion. RESULTS: We reviewed the chest CT scans of 102 patients, 58 (56.9%) of whom were male. The average age was 50.5 ± 18.0 years. Benign and malignant lesions were diagnosed in 74 (72.6%) and 28 (27.4%) of the patients, respectively. On the CT scans, the mean number of cavities was 3, the mean wall thickness of the largest lesions was 6.0 mm, and the mean diameter of the largest lesions was 27.0 mm. The lesions were predominantly in the upper lobes, especially on the right (in 43.1%). In our comparison of the variables studied, a diagnosis of malignancy was not found to correlate significantly with the wall thickness of the largest cavity, lymph node enlargement, emphysema, consolidation, bronchiectasis, or bronchial obstruction. The presence of centrilobular nodules correlated significantly with the absence of malignant disease (p < 0.05). In contrast, a greater number of cavities correlated significantly with malignancy (p < 0.026). CONCLUSIONS: A larger number of cavitary lung lesions and the absence of centrilobular nodules may be characteristic of a malignant etiology. However, on the basis of our evaluation of the lesions in our sample, we cannot state that wall thickness is a good indicator of a benign or malignant etiology.


Assuntos
Pneumopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Tolerância Imunológica , Pneumopatias/etiologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose/diagnóstico por imagem , Tuberculose/etiologia
15.
Microb Pathog ; 139: 103894, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31805320

RESUMO

INTRODUCTION: Tuberculosis (TB) is considered as a serious complication of organ transplant; therefore, the detection and appropriate treatment of active TB infection is highly recommended for the reduction of mortality in the future. The aim of this review was to conduct a systematic review and meta-analysis assessing the prevalence of active TB infection in transplant recipients (TRs). MATERIAL AND METHODS: Electronic databases, including MEDLINE (via PubMed), SCOPUS and Web of Science were searched up to December 24, 2017. The prevalence of active TB was estimated using the random effects meta-analysis. Heterogeneity was evaluated by subgroup analysis. Data were analyzed by STATA version 14. RESULTS: The pooled prevalence of post-transplant active TB was estimated 3% [95% CI: 2-3]. The pooled prevalence of active TB in different transplant forms was as follows: renal,3% [95% CI: 2-4]; stem cell transplant (SCT), 1% [95% CI: 0-3]; lung, 4% [95% CI: 2-6]; heart, 3% [95% CI: 2-4]; liver, 1% [95% CI: 1], and hematopoietic stem cell transplant (HSCT), 2% [95% CI: 1-3]. The prevalence of different clinical presentations of TB was as follows: pulmonary TB (59%; 95% CI: 54-65), extra pulmonary TB (27%; 95% CI: 21-33), disseminated TB (15%; 95% CI: 12-19) and miliary TB (8%; 95% CI: 4-13). The pooled prevalence of different diagnostic tests was as follows: chest X-ray, 57% [95% CI, 46-67]; culture, 56% [95% CI, 45-68]; smear, 49% [95% CI, 40-58]; PCR, 43% [95% CI, 40-58]; histology, 26% [95% CI, 20-32], and tuberculin skin test, 19% [95% CI, 10-28]. CONCLUSION: A high suspicion level for TB, the early diagnosis and the prompt initiation of therapy could increase the survival rates among SOT patients. Overall, renal and lung TRs appear to have a higher predisposition for acquiring TB than other type of recipients. Monitoring of the high-risk recipients, prompt diagnosis, and appropriate treatment are required to manage TB infection among TRs especially in endemic areas.


Assuntos
Transplantados , Tuberculose/epidemiologia , Tuberculose/etiologia , Gerenciamento Clínico , Suscetibilidade a Doenças , Humanos , Transplante de Órgãos/efeitos adversos , Prevalência , Vigilância em Saúde Pública , Tuberculose/diagnóstico , Tuberculose/terapia
16.
Pediatr Infect Dis J ; 39(3): 258-259, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31876612

RESUMO

We are reporting a case of Bacillus Calmette-Guérin vaccine-disseminated infection in a 19-month-old HIV-negative girl diagnosed with severe combined immunodeficiency. While standard culture protocols failed to isolate and culture the Mycobacterium bovis Bacillus Calmette-Guérin strain, it was isolated from skin and mesenteric lymph node biopsies using the shell-vial assay, allowing whole-genome sequencing and in silico drug susceptibility testing.


Assuntos
Testes de Sensibilidade Microbiana/métodos , Mycobacterium bovis , Imunodeficiência Combinada Severa/complicações , Tuberculose/diagnóstico , Tuberculose/etiologia , Antituberculosos/uso terapêutico , Biópsia , Transplante de Medula Óssea/efeitos adversos , Transplante de Medula Óssea/métodos , Quimioterapia Combinada , Feminino , Humanos , Lactente , Linfonodos/microbiologia , Linfonodos/patologia , Mycobacterium bovis/efeitos dos fármacos , Mycobacterium bovis/genética , Mycobacterium bovis/imunologia , Imunodeficiência Combinada Severa/terapia , Úlcera Cutânea/etiologia , Úlcera Cutânea/patologia , Resultado do Tratamento , Tuberculose/tratamento farmacológico
17.
Acta Reumatol Port ; 45(4): 281-287, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33423034

RESUMO

Patients with inflammatory rheumatic diseases refractory to conventional disease modifying antirheumatic drugs (DMARDs)have been treated with biologics for the last two decades. It is also known that patients under biotechnological therapy present a higher risk of developing Tuberculosis (TB).Portugal has now a TB incidence classified as low. National recommendations advise on latent TB screening before the beginning of the biological therapy. This screening consists in the detection of risk factors and/or signs and symptoms of latent TB through clinical history, physical examination, chest X-ray, tuberculin skin test and Interferon Gamma Release Assay (IGRA) test. We describe five clinical cases of patients who underwent biotechnological therapy at our Hospital after 2006 and developed TB.


Assuntos
Antirreumáticos/efeitos adversos , Artrite/tratamento farmacológico , Tuberculose/etiologia , Inibidores do Fator de Necrose Tumoral/efeitos adversos , Adalimumab/efeitos adversos , Adolescente , Adulto , Anticorpos Monoclonais/efeitos adversos , Antituberculosos/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Infliximab/efeitos adversos , Testes de Liberação de Interferon-gama , Tuberculose Latente/diagnóstico , Masculino , Pessoa de Meia-Idade , Exame Físico , Fatores de Risco , Avaliação de Sintomas/métodos , Teste Tuberculínico , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/tratamento farmacológico , Tuberculose Miliar/etiologia , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/etiologia
18.
Rev Med Chil ; 147(8): 1042-1052, 2019 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-31859970

RESUMO

BACKGROUND: Recent data suggest an increase in tuberculosis (TB) incidence in Chile. AIM: To evaluate recent epidemiological trends, geographic extension and potential factors associated with TB reemergence in Chile. MATERIAL AND METHODS: Data analysis from official sources and trend analysis. RESULTS: TB incidence rate increased from 12.3 (2014) to 14.7 (2017) per 100,000 inhabitants. Morbidity rates also increased in nine out of 15 regions. The proportion of TB cases in specific groups has also increased in the last six years: HIV/AIDS (68%), immigrants (118%), drug users/alcoholics (267%) and homeless people (370%). Several indicators of the national TB program performance have deteriorated including TB case detection, HIV co-infection study and contact tracing activities. Overall results indicate a higher than expected case-fatality ratio (> 3%), high rates of loss from follow-up (> 5%), and low percentage of cohort healing rate (< 90%). This decline is associated with a Control Program with scarce human resources whose central budget decreased by 90% from 2008 to 2014. New molecular diagnostic tools and liquid media culture were only recently implemented. CONCLUSIONS: TB trends and overall program performance indicators have deteriorated in recent years in Chile and several factors appear to be involved. Multiple strategies will be required to rectify this situation.


Assuntos
Tuberculose/epidemiologia , Chile/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Geografia , Infecções por HIV/epidemiologia , Gastos em Saúde/tendências , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Incidência , Fatores de Risco , Fatores Socioeconômicos , Estatísticas não Paramétricas , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fatores de Tempo , Tuberculose/economia , Tuberculose/etiologia
19.
PLoS One ; 14(12): e0224963, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31790428

RESUMO

INTRODUCTION: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. The advent of immunobiologic therapy with TNF inhibitors agents, has been associated with a significant increase in incident cases of tuberculosis in this population. OBJECTIVE: To estimate the incidence of tuberculosis in patients receiving TNF inhibitors therapy for rheumatic diseases. As secondary objectives, we sought to evaluate mortality and the clinical impact of screening for latent tuberculosis infection. METHODS: This retrospective study included patients with rheumatic diseases of Public Health System from the Brazilian state, a high TB incidence area, who received prescriptions of TNF inhibitors agents between 2006 and 2016. RESULTS: A total of 5853 rheumatic disease patients were included. Patients were predominantly women (68.7%) aged 49.5 (± 14.7) years old. Forty-three cases of TB were found (2.86 cases per 1000 person-years; 18 times higher than in the general population). Adalimumab and certolizumab users presented a higher risk for TB development compared to etanercept users (RR: 3.11, 95%CI 1.16-8.35; 7.47, 95%CI 1.39-40.0, respectively). In a subgroup of patients, screening for latent tuberculosis infection was performed in 86% of patients, and 30.2% had a positive tuberculin skin test. Despite latent TB treatment, TB was diagnosed in 2 out of 74 (2.7%) patients. Overall, TB diagnosis did not increase mortality. CONCLUSION: In this population-based study of rheumatic disease patients from a high incident area, TNF inhibitor exposure was associated with an 18-time increased TB incidence. Adalimumab and certolizumab were associated with greater and earlier TB diagnosis compared to etanercept.


Assuntos
Anticorpos Monoclonais Humanizados/farmacologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/farmacologia , Antirreumáticos/uso terapêutico , Mycobacterium tuberculosis/imunologia , Doenças Reumáticas/tratamento farmacológico , Tuberculose/epidemiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Antirreumáticos/efeitos adversos , Brasil/epidemiologia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Tuberculose Latente/diagnóstico , Tuberculose Latente/mortalidade , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Retrospectivos , Teste Tuberculínico , Tuberculose/etiologia , Tuberculose/mortalidade
20.
J Immunol Res ; 2019: 6196532, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31583258

RESUMO

The interaction between diabetes and major world infections like TB is a major public health concern because of rapidly rising levels of diabetes. The dual burden of tuberculosis (TB) and diabetes mellitus (DM) has become a major global public health problem. Diabetes mellitus is a major risk factor for the development of active and latent tuberculosis. Immune mechanisms contributing to the increased susceptibility of diabetic patients to TB are due to the defects in bacterial recognition, phagocytic activity, and cellular activation which results in impaired production of chemokines and cytokines. The initiation of adaptive immunity is delayed by impaired antigen-presenting cell (APC) recruitment and function in hyperglycemic host, which results in reduced frequencies of Th1, Th2, and Th17 cells and its secretion of cytokines having a great role in activation of macrophage and inflammatory response of tuberculosis. In addition, impaired immune response and killing of intracellular bacteria potentially increase bacterial load, chronic inflammation, and central necrosis that facilitate bacterial dissemination and miliary tuberculosis. Understanding of the immunological and biochemical basis of TB susceptibility in diabetic patients will tell us the rational development of implementation and therapeutic strategies to alleviate the dual burden of the diseases. Therefore, the aim of this review was focused on the association between diabetes and tuberculosis, focusing on epidemiology, pathogenesis, and immune dysfunction in diabetes mellitus, and its association with susceptibility, severity, and treatment outcome failure to tuberculosis.


Assuntos
Complicações do Diabetes , Diabetes Mellitus/imunologia , Suscetibilidade a Doenças/imunologia , Mycobacterium tuberculosis/imunologia , Tuberculose/etiologia , Imunidade Adaptativa , Diabetes Mellitus/epidemiologia , Gerenciamento Clínico , Humanos , Imunidade Inata , Índice de Gravidade de Doença , Tuberculose/diagnóstico , Tuberculose/terapia
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