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2.
BMC Infect Dis ; 20(1): 556, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736602

RESUMO

BACKGROUND: There is a general dearth of information on extrapulmonary tuberculosis (EPTB). Here, we investigated Mycobacterium tuberculosis (Mtb) drug resistance and transmission patterns in EPTB patients treated in the Tshwane metropolitan area, in South Africa. METHODS: Consecutive Mtb culture-positive non-pulmonary samples from unique EPTB patients underwent mycobacterial genotyping and were assigned to phylogenetic lineages and transmission clusters based on spoligotypes. MTBDRplus assay was used to search mutations for isoniazid and rifampin resistance. Machine learning algorithms were used to identify clinically meaningful patterns in data. We computed odds ratio (OR), attributable risk (AR) and corresponding 95% confidence intervals (CI). RESULTS: Of the 70 isolates examined, the largest cluster comprised 25 (36%) Mtb strains that belonged to the East Asian lineage. East Asian lineage was significantly more likely to occur within chains of transmission when compared to the Euro-American and East-African Indian lineages: OR = 10.11 (95% CI: 1.56-116). Lymphadenitis, meningitis and cutaneous TB, were significantly more likely to be associated with drug resistance: OR = 12.69 (95% CI: 1.82-141.60) and AR = 0.25 (95% CI: 0.06-0.43) when compared with other EPTB sites, which suggests that poor rifampin penetration might be a contributing factor. CONCLUSIONS: The majority of Mtb strains circulating in the Tshwane metropolis belongs to East Asian, Euro-American and East-African Indian lineages. Each of these are likely to be clustered, suggesting on-going EPTB transmission. Since 25% of the drug resistance was attributable to sanctuary EPTB sites notorious for poor rifampin penetration, we hypothesize that poor anti-tuberculosis drug dosing might have a role in the development of resistance.


Assuntos
Farmacorresistência Bacteriana/genética , Mycobacterium tuberculosis/genética , Tuberculose/transmissão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Genótipo , Humanos , Lactente , Isoniazida/uso terapêutico , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Mutação , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/patogenicidade , Filogenia , Rifampina/uso terapêutico , África do Sul , Tuberculose/tratamento farmacológico , Tuberculose/microbiologia , Tuberculose Pulmonar/microbiologia , Adulto Jovem
4.
J Dent Res ; 99(10): 1192-1198, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32614681

RESUMO

Dental health care workers are in close contact to their patients and are therefore at higher risk for contracting airborne infectious diseases. The transmission rates of airborne pathogens from patient to dental health care workers are unknown. With the outbreaks of infectious diseases, such as seasonal influenza, occasional outbreaks of measles and tuberculosis, and the current pandemic of the coronavirus disease COVID-19, it is important to estimate the risks for dental health care workers. Therefore, the transmission probability of these airborne infectious diseases was estimated via mathematical modeling. The transmission probability was modeled for Mycobacterium tuberculosis, Legionella pneumophila, measles virus, influenza virus, and coronaviruses per a modified version of the Wells-Riley equation. This equation incorporated the indoor air quality by using carbon dioxide as a proxy and added the respiratory protection rate from medical face masks and N95 respirators. Scenario-specific analyses, uncertainty analyses, and sensitivity analyses were run to produce probability rates. A high transmission probability was characterized by high patient infectiousness, the absence of respiratory protection, and poor indoor air quality. The highest transmission probabilities were estimated for measles virus (100%), coronaviruses (99.4%), influenza virus (89.4%), and M. tuberculosis (84.0%). The low-risk scenario leads to transmission probabilities of 4.5% for measles virus and 0% for the other pathogens. From the sensitivity analysis, it shows that the transmission probability is strongly driven by indoor air quality, followed by patient infectiousness, and the least by respiratory protection from medical face mask use. Airborne infection transmission of pathogens such as measles virus and coronaviruses is likely to occur in the dental practice. The risk magnitude, however, is highly dependent on specific conditions in each dental clinic. Improved indoor air quality by ventilation, which reduces carbon dioxide, is the most important factor that will either strongly increase or decrease the probability of the transmission of a pathogen.


Assuntos
Infecções por Coronavirus/transmissão , Clínicas Odontológicas , Influenza Humana/transmissão , Doença dos Legionários/transmissão , Sarampo/transmissão , Pneumonia Viral/transmissão , Tuberculose/transmissão , Betacoronavirus , Humanos , Modelos Teóricos , Pandemias , Risco
5.
J Environ Public Health ; 2020: 3402527, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32612665

RESUMO

Background: Tuberculosis remains the leading cause of death due to infectious diseases worldwide ranking above HIV/AIDS, and Nigeria is rated as the 7th worldwide and the 2nd in Africa among the 30 countries highly burdened with tuberculosis worldwide. Aim: To investigate the challenges encountered by nurses in the care of TB patients in a Federal Teaching Hospital in Nigeria. Setting. Ekiti State, Southwest Nigeria. Methods: A qualitative contextual method was utilized with the sample size determined by data saturation. Data collection was done through an audiotaped, semistructured interview. The study sample consisted of 20 professional nurses working in the medical and paediatric wards of a selected Federal Teaching Hospital in South West, Nigeria. Data was analysed using Tesch's content analysis approach. Results: The majority of the participants were females within the age group of 31-40 years. Challenges included inadequate availability of personal protective equipment (PPE), lack of isolation wards, delegating the care of tuberculosis patients to young inexperienced nurses, long process in diagnosing patients with tuberculosis, lack of policies protecting the nurses from exposure to tuberculosis, and inadequate training. The major concern was the fear of contracting tuberculosis. Conclusion: The study suggested that there should be a provision of adequate personal protective equipment; tuberculosis designated wards and provision of periodic training to update the nurses on care of tuberculosis patients. Establishment and execution of hospital policies and practices along with support are equally essential in facilitating a safe workplace for nurses.


Assuntos
Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Enfermeiras e Enfermeiros , Saúde do Trabalhador , Tuberculose/prevenção & controle , Adulto , Feminino , Pesquisas sobre Serviços de Saúde , Hospitais de Ensino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Masculino , Nigéria/epidemiologia , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Saúde do Trabalhador/estatística & dados numéricos , Fatores de Risco , Tuberculose/epidemiologia , Tuberculose/transmissão
9.
N Z Med J ; 133(1513): 89-96, 2020 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-32325472

RESUMO

New Zealand could be the first country in the world to eliminate tuberculosis (TB). We propose a TB elimination strategy based on the eight-point World Health Organization (WHO) action framework for low incidence countries. Priority actions recommended by the WHO include 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) identify active TB and undertake screening for latent tuberculosis infection (LTBI) in recent TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. In New Zealand, central government needs to take greater responsibility for TB policy and programme governance. Urgent action is required to prevent TB in higher risk groups including Maori communities, and to enable immigration screening to detect and treat LTBI. Clinical services need to be supported to implement new guidelines for LTBI that enable better targeting of screening and shorter, safer treatment regimens. Access to WHO recommended treatment regimens needs to be guaranteed for drug-resistant TB. Better use of existing data could better define priority areas for action and assist in the evaluation of current control activities. Access to GeneXpert® MTB-RIF near the point of care and whole genome sequencing nationally would greatly improve clinical and public health management through early identification of drug resistance and outbreaks. New Zealand already has a world-class TB research community that could be better deployed to assist high-incidence countries through research and training.


Assuntos
Erradicação de Doenças , Tuberculose/prevenção & controle , Humanos , Programas de Rastreamento , Nova Zelândia , Grupo com Ancestrais Oceânicos , Saúde Pública , Vigilância em Saúde Pública , Tuberculose/epidemiologia , Tuberculose/transmissão
10.
Trop Doct ; 50(3): 280-281, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32316859

RESUMO

Measurements of rate of oxygen consumption (VO2) recorded during controlled exercise is used to assess cardiovascular health in test individuals. In low- or middle-income countries, where Mycobacterium tuberculosis is common and older VO2 systems are in use, three specific preventative measures should be in place to prevent the transmission of tuberculosis. These include: (1) disinfecting reusable plastic masks and rubber tubing with bleach solution; (2) limiting maximum exposure of test individuals to Cl2 gas to <1-3 ppm for a duration of ≤15 min to prevent respiratory distress; and (3) carefully inspecting for degradation of plastic VO2 masks and rubber tubing repeatedly disinfected with bleach and replace these at the first signs of deterioration.


Assuntos
Países em Desenvolvimento , Teste de Esforço , Consumo de Oxigênio/fisiologia , Tuberculose/prevenção & controle , Adulto , Contaminação de Equipamentos/prevenção & controle , Teste de Esforço/instrumentação , Humanos , Masculino , Mycobacterium tuberculosis , Fatores de Tempo , Tuberculose/transmissão
11.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-47095

RESUMO

As novas orientações da Organização Mundial da Saúde (OMS) ajudarão a acelerar os esforços dos países para impedir que pessoas infectadas com tuberculose (TB) desenvolvam a doença, graças à administração de tratamento preventivo. Estima-se que um quarto da população mundial está infectada com o bacilo da tuberculose.


Assuntos
Tuberculose/prevenção & controle , Tuberculose/transmissão , Tuberculose/mortalidade , Tuberculose/tratamento farmacológico
13.
PLoS Comput Biol ; 16(3): e1007687, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32218567

RESUMO

Tuberculosis (TB) remains a public health threat in low TB incidence countries, through a combination of reactivated disease and onward transmission. Using surveillance data from the United Kingdom (UK) and the Netherlands (NL), we demonstrate a simple and predictable relationship between the probability of observing a cluster and its size (the number of cases with a single genotype). We demonstrate that the full range of observed cluster sizes can be described using a modified branching process model with the individual reproduction number following a Poisson lognormal distribution. We estimate that, on average, between 2010 and 2015, a TB case generated 0.41 (95% CrI 0.30,0.60) secondary cases in the UK, and 0.24 (0.14,0.48) secondary cases in the NL. A majority of cases did not generate any secondary cases. Recent transmission accounted for 39% (26%,60%) of UK cases and 23%(13%,37%) of NL cases. We predict that reducing UK transmission rates to those observed in the NL would result in 538(266,818) fewer cases annually in the UK. In conclusion, while TB in low incidence countries is strongly associated with reactivated infections, we demonstrate that recent transmission remains sufficient to warrant policies aimed at limiting local TB spread.


Assuntos
Modelos Biológicos , Tuberculose , Biologia Computacional , Epidemiologia , Humanos , Incidência , Mycobacterium tuberculosis/genética , Países Baixos/epidemiologia , Tuberculose/epidemiologia , Tuberculose/transmissão , Reino Unido/epidemiologia
14.
Int J Infect Dis ; 92S: S55-S59, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114191

RESUMO

Contact investigation is the search for secondary cases of tuberculosis (TB) or latent tuberculosis infection (LTBI) among contacts of patients with a transmissible form of TB, usually smear-positive pulmonary disease. The aim is to detect those who have already started developing TB in order to initiate treatment as soon as possible and prevent further transmission of the disease, and also to detect those who have been infected and could benefit from a preventive treatment before the development of TB. The implementation of preventive therapy for persons with the highest risk of developing TB, that is the reduction of the pool of future cases of TB, is now considered one of the activities able to support a decline in the prevalence of TB. This implies that the search for infected contacts and the prevention of TB should be performed in parallel with diagnostic and curative activities. The implementation of screening activities, at least for exposed children and immunocompromised persons, seems to be feasible without unaffordable costs, even in high TB burden settings.


Assuntos
Busca de Comunicante , Tuberculose/prevenção & controle , Adolescente , Adulto , Criança , Pré-Escolar , União Europeia , Humanos , Tuberculose Latente/epidemiologia , Modelos Biológicos , Prevalência , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/transmissão
16.
Curr Opin Pulm Med ; 26(3): 197-202, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32149751

RESUMO

PURPOSE OF REVIEW: Mass gathering events bring people from across all continents increasing the risk of spread of aerosol transmissible respiratory tract infections. Respiratory tract infections for instance in pilgrims attending the world's largest recurring annual pilgrimage, the Hajj are common. We review recent literature on viral and bacterial infectious diseases with special focus on the Hajj. RECENT FINDINGS: The prevalence of bacterial and viral infections continue to increase, because of the acquisition of rhinovirus, coronaviruses (229E, HKU1, OC43), influenza A H1N1, Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus during Hajj. Whilst MERS-CoV continues to circulate in the Middle East, no cases of MERS-CoV have yet been identified in pilgrims during Hajj. SUMMARY: Respiratory tract infections are a major cause of morbidity in pilgrims attending mass gathering events. The management of severe respiratory infections should consider investigation and empirical coverage for the most likely agents based on syndromic surveillance data from hosting country and /or other relevant exposure history during events. Pneumococcal and Pertussis vaccines should be recommended for Hajj pilgrims.


Assuntos
Infecções por Coronavirus/transmissão , Influenza Humana/transmissão , Islamismo , Sarampo/transmissão , Pneumonia Pneumocócica/transmissão , Infecções Respiratórias/transmissão , Viagem , Tuberculose/transmissão , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/transmissão , Coronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/transmissão , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Sarampo/epidemiologia , Sarampo/prevenção & controle , Oriente Médio/epidemiologia , Infecções por Picornaviridae/epidemiologia , Infecções por Picornaviridae/transmissão , Vacinas Pneumocócicas/uso terapêutico , Pneumonia Pneumocócica/epidemiologia , Pneumonia Pneumocócica/prevenção & controle , Prevalência , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/prevenção & controle , Streptococcus pneumoniae , Tuberculose/epidemiologia , Viroses/epidemiologia , Viroses/transmissão , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Coqueluche/transmissão
18.
BMC Infect Dis ; 20(1): 120, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041530

RESUMO

BACKGROUND: While several studies have assessed the associations between biological factors and tuberculosis (TB) transmission, our understanding of the associations between TB transmission and social and economic factors remains incomplete. We aimed to explore associations between community TB transmission and socio-economic factors within a high TB-HIV burdened setting. METHODS: We conducted a cross-sectional molecular epidemiology study among adult patients attending a routine TB clinic. Demographic and clinical data were extracted from TB registers and clinical folders; social and economic data were collected using interviewer-administered questionnaires; Mycobacterium tuberculosis isolates were genotyped and classified as clustered/non-clustered using IS6110-based Restriction Fragment Length Polymorphism. Composite "social" and "economic" scores were generated from social and economic data. Data were analyzed using StataCorp version 15.0 software. Stratified, bivariable analyses were performed using chi-squared. Wilcoxon signed rank tests; univariable and multivariable logistic regression models were developed to explore associations in the social, economic, traditional and composite TB risk factors with TB transmission. RESULTS: Of the 505 patient Mtb  strains, 348(69%) cases were classified as clustered and 157(31%) were non-clustered. Clustered cases were more likely to have lived longer in the study community, (odds ratio [OR] = 1.05, 95% Confidence interval [C.I]:1.02-1.09, p = 0.006); in the same house (OR = 1.04, C.I: 0.99-1.08, p = 0.06); and had increased household crowding conditions (i.e fewer rooms used for sleeping, OR = 0.45, C.I:0.21-0.95, p = 0.04). Although a higher proportion of clustered cases had a low economic score, no statistically significant association was found between clustering and either the economic score (p = 0.13) or social score (p = 0.26). CONCLUSIONS: We report a novel association between Mtb transmission and prolonged stay within a high burdened community. Transmission was also associated with fewer rooms for sleeping in a household. Increased social interaction and prolonged residence in a high burdened community are important factors linked to Mtb transmission, possibly due to increased probability of higher effective contact rates. The possible importance of degrees of poverty within low socio-economic setting warrants further study.


Assuntos
Mycobacterium tuberculosis/genética , Tuberculose/epidemiologia , Tuberculose/transmissão , Adolescente , Adulto , Idoso , Cidades , Análise por Conglomerados , Estudos Transversais , DNA Bacteriano/genética , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/isolamento & purificação , Fatores de Risco , Fatores Socioeconômicos , África do Sul/epidemiologia , Adulto Jovem
19.
Epidemiol Infect ; 148: e15, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-32014080

RESUMO

Yukon Territory (YT) is a remote region in northern Canada with ongoing spread of tuberculosis (TB). To explore the utility of whole genome sequencing (WGS) for TB surveillance and monitoring in a setting with detailed contact tracing and interview data, we used a mixed-methods approach. Our analysis included all culture-confirmed cases in YT (2005-2014) and incorporated data from 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) genotyping, WGS and contact tracing. We compared field-based (contact investigation (CI) data + MIRU-VNTR) and genomic-based (WGS + MIRU-VNTR + basic case data) investigations to identify the most likely source of each person's TB and assessed the knowledge, attitudes and practices of programme personnel around genotyping and genomics using online, multiple-choice surveys (n = 4) and an in-person group interview (n = 5). Field- and genomics-based approaches agreed for 26 of 32 (81%) cases on likely location of TB acquisition. There was less agreement in the identification of specific source cases (13/22 or 59% of cases). Single-locus MIRU-VNTR variants and limited genetic diversity complicated the analysis. Qualitative data indicated that participants viewed genomic epidemiology as a useful tool to streamline investigations, particularly in differentiating latent TB reactivation from the recent transmission. Based on this, genomic data could be used to enhance CIs, focus resources, target interventions and aid in TB programme evaluation.


Assuntos
Busca de Comunicante/métodos , Epidemiologia Molecular/métodos , Tipagem Molecular/métodos , Mycobacterium/classificação , Mycobacterium/genética , Tuberculose/epidemiologia , Sequenciamento Completo do Genoma/métodos , Transmissão de Doença Infecciosa , Genótipo , Humanos , Mycobacterium/isolamento & purificação , Tuberculose/transmissão , Yukon/epidemiologia
20.
PLoS One ; 15(1): e0228102, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995631

RESUMO

BACKGROUND: The age-specific epidemiology of child and adolescent tuberculosis (TB) is poorly understood, especially in rural areas of East Africa. We sought to characterize the age-specific prevalence and predictors of TB infection among children and adolescents living in rural Uganda, and to explore the contribution of household TB exposure on TB infection. METHODS: From 2015-2016 we placed and read 3,121 tuberculin skin tests (TST) in children (5-11 years old) and adolescents (12-19 years old) participating in a nested household survey in 9 rural Eastern Ugandan communities. TB infection was defined as a positive TST (induration ≥10mm or ≥5mm if living with HIV). Age-specific prevalence was estimated using inverse probability weighting to adjust for incomplete measurement. Generalized estimating equations were used to assess the association between TB infection and multi-level predictors. RESULTS: The adjusted prevalence of TB infection was 8.5% (95%CI: 6.9-10.4) in children and 16.7% (95% CI:14.0-19.7) in adolescents. Nine percent of children and adolescents with a prevalent TB infection had a household TB contact. Among children, having a household TB contact was strongly associated with TB infection (aOR 5.5, 95% CI: 1.7-16.9), but the strength of this association declined among adolescents and did not meet significance (aOR 2.3, 95% CI: 0.8-7.0). The population attributable faction of TB infection due to a household TB contact was 8% for children and 4% among adolescents. Mobile children and adolescents who travel outside of their community for school had a 1.7 (95% CI 1.0-2.9) fold higher odds of TB infection than those who attended school in the community. CONCLUSION: Children and adolescents in this area of rural eastern Uganda suffer a significant burden of TB. The majority of TB infections are not explained by a known household TB contact. Our findings underscore the need for community-based TB prevention interventions, especially among mobile youth.


Assuntos
Efeitos Psicossociais da Doença , Características da Família , População Rural , Tuberculose/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prevalência , Tuberculose/transmissão , Uganda/epidemiologia
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