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BMJ Open Feb 2023To end tuberculosis (TB), the vast reservoir of 1.7-2.3 billion TB infections (TBIs) must be addressed, but achieving global TB preventive therapy (TPT) targets seems...
OBJECTIVES
To end tuberculosis (TB), the vast reservoir of 1.7-2.3 billion TB infections (TBIs) must be addressed, but achieving global TB preventive therapy (TPT) targets seems unlikely. This study assessed the feasibility of using interferon-γ release assays (IGRAs) at lower healthcare levels and the comparative performance of 3-month and 9-month daily TPT regimens (3HR/9H).
DESIGN, SETTING, PARTICIPANTS AND INTERVENTION
This cohort study was implemented in two provinces of Viet Nam from May 2019 to September 2020. Participants included household contacts (HHCs), vulnerable community members and healthcare workers (HCWs) recruited at community-based TB screening events or HHC investigations at primary care centres, who were followed up throughout TPT.
PRIMARY AND SECONDARY OUTCOMES
We constructed TBI care cascades describing indeterminate and positivity rates to assess feasibility, and initiation and completion rates to assess performance. We fitted mixed-effects logistic and stratified Cox models to identify factors associated with IGRA positivity and loss to follow-up (LTFU).
RESULTS
Among 5837 participants, the indeterminate rate was 0.8%, and 30.7% were IGRA positive. TPT initiation and completion rates were 63.3% (3HR=61.2% vs 9H=63.6%; p=0.147) and 80.6% (3HR=85.7% vs 9H=80.0%; p=0.522), respectively. Being male (adjusted OR=1.51; 95% CI: 1.28 to 1.78; p<0.001), aged 45-59 years (1.30; 1.05 to 1.60; p=0.018) and exhibiting TB-related abnormalities on X-ray (2.23; 1.38 to 3.61; p=0.001) were associated with positive IGRA results. Risk of IGRA positivity was lower in periurban districts (0.55; 0.36 to 0.85; p=0.007), aged <15 years (0.18; 0.13 to 0.26; p<0.001), aged 15-29 years (0.56; 0.42 to 0.75; p<0.001) and HCWs (0.34; 0.24 to 0.48; p<0.001). The 3HR regimen (adjusted HR=3.83; 1.49 to 9.84; p=0.005) and HCWs (1.38; 1.25 to 1.53; p<0.001) showed higher hazards of LTFU.
CONCLUSION
Providing IGRAs at lower healthcare levels is feasible and along with shorter regimens may expand access and uptake towards meeting TPT targets, but scale-up may require complementary advocacy and education for beneficiaries and providers.
Topics: Male; Humans; Female; Cohort Studies; Vietnam; Tuberculin Test; Tuberculosis; Latent Tuberculosis; Primary Health Care
PubMed: 36759036
DOI: 10.1136/bmjopen-2022-071537 -
International Journal of Infectious... Jan 2020Syria's protracted conflict has resulted in ideal conditions for the transmission of tuberculosis (TB) and the cultivation of drug-resistant strains. This paper compares... (Review)
Review
OBJECTIVES
Syria's protracted conflict has resulted in ideal conditions for the transmission of tuberculosis (TB) and the cultivation of drug-resistant strains. This paper compares TB control in Syria before and after the conflict using available data, examines the barriers posed by protracted conflict and those specific to Syria, and discusses what measures can be taken to address the control of TB in Syria.
RESULTS
Forced mass displacement and systematic violations of humanitarian law have resulted in overcrowding and the destruction of key infrastructure, leading to an increased risk of both drug-sensitive and resistant TB, while restricting the ability to diagnose, trace contacts, treat, and follow-up. Pre-conflict, TB in Syria was officially reported at 22 per 100 000 population; the official figure for 2017 of 19 per 100 000 is likely a vast underestimate given the challenges and barriers to case detection. Limited diagnostics also affect the diagnosis of multidrug- and rifampicin-resistant TB, reported as comprising 8.8% of new diagnoses in 2017.
CONCLUSIONS
The control of TB in Syria requires a multipronged, tailored, and pragmatic approach to improve timely diagnosis, increase detection, stop transmission, and mitigate the risk of drug resistance. Solutions must also consider vulnerable populations such as imprisoned and besieged communities where the risk of drug resistance is particularly high, and must recognize the limitations of national programming. Strengthening capacity to control TB in Syria with particular attention to these factors will positively impact other parallel conditions; this is key as attention turns to post-conflict reconstruction.
Topics: Antitubercular Agents; Armed Conflicts; Humans; Refugees; Syria; Tuberculosis; Vulnerable Populations
PubMed: 31639519
DOI: 10.1016/j.ijid.2019.10.015 -
European Journal of Public Health Aug 2022The COVID-19 pandemic could have negative effects on tuberculosis (TB) control. The objective was to assess the impact of the pandemic in contact tracing, TB and latent...
BACKGROUND
The COVID-19 pandemic could have negative effects on tuberculosis (TB) control. The objective was to assess the impact of the pandemic in contact tracing, TB and latent tuberculosis infection (LTBI) in contacts of patients with pulmonary TB in Catalonia (Spain).
METHODS
Contact tracing was carried out in cases of pulmonary TB detected during 14 months in the pre-pandemic period (1 January 2019 to 28 February 2020) and 14 months in the pandemic period (1 March 2020 to 30 April 2021). Contacts received the tuberculin skin test and/or interferon gamma release assay and it was determined whether they had TB or LTBI. Variables associated with TB or LTBI in contacts (study period and sociodemographic variables) were analyzed using adjusted odds ratio (aOR) and the 95% confidence intervals (95% CI).
RESULTS
The pre-pandemic and pandemic periods showed, respectively: 503 and 255 pulmonary TB reported cases (reduction of 50.7%); and 4676 and 1687 contacts studied (reduction of 36.1%). In these periods, the proportion of TB cases among the contacts was 1.9% (84/4307) and 2.2% (30/1381) (P = 0.608); and the proportion of LTBI was 25.3% (1090/4307) and 29.2% (403/1381) (P < 0.001). The pandemic period was associated to higher LTBI proportion (aOR = 1.3; 95% CI 1.1-1.5), taking into account the effect on LTBI of the other variables studied as sex, age, household contact and migrant status.
CONCLUSIONS
COVID-19 is affecting TB control due to less exhaustive TB and LTBI case detection. An increase in LTBI was observed during the pandemic period. Efforts should be made to improve detection of TB and LTBI among contacts of TB cases.
Topics: COVID-19; Contact Tracing; Humans; Latent Tuberculosis; Pandemics; Tuberculin Test; Tuberculosis; Tuberculosis, Pulmonary
PubMed: 35325093
DOI: 10.1093/eurpub/ckac031 -
Revista Espanola de Sanidad... 2021Latent TB infection (LTBI) affects 25% of the world's population. As long as this reservoir exists, the elimination of TB will not be feasible. The Assembly of the World... (Review)
Review
OBJECTIVES
Latent TB infection (LTBI) affects 25% of the world's population. As long as this reservoir exists, the elimination of TB will not be feasible. The Assembly of the World Health Organization adopted the "Global End TB" strategy for the elimination of TB in 2014. The objective of this review is to present strategies for risk groups that are candidates for the detection and treatment of LTBI.
MATERIAL AND METHOD
There is sufficient evidence of screening in: immunocompromised people (HIV-infected, biological therapies, alternative renal therapy, organ transplantation), recent immigrants, inmates in prison, people injecting drugs and homeless people, and workers from at-risk settings. Tests to diagnose LTBI include tuberculin skin test (TST) and gamma release assay interferon (IGRA). There is no reference test and the choice of one or the other will depend on logistical considerations, such as avoiding injection (TST) or not needing a second visit (IGRA). Treatment of LTBI is based on the use of isoniazide and rifampicin in short period of 3 or 4 months, using associations of rifampicin and isoniazide or rifampicin alone.
DISCUSSION
Given the estimated high prevalence of LTBI, renewed efforts are required to reduce the number of people with LTBI that includes a registration and monitoring system to observer progress, increased testing, and the use of short treatment guidelines.
Topics: Humans; Interferon-gamma Release Tests; Latent Tuberculosis; Rifampin; Tuberculin Test; Tuberculosis
PubMed: 33847703
DOI: 10.18176/resp.00028 -
The American Journal of Tropical... Jan 2022Children who live in leprosy-endemic areas are susceptible to infection due to early and frequent exposure to Mycobacterium leprae. Indonesia is on the verge of...
Children who live in leprosy-endemic areas are susceptible to infection due to early and frequent exposure to Mycobacterium leprae. Indonesia is on the verge of eliminating this disease (prevalence rate < 1/10,000 population), but pediatric leprosy continues to occur in low-endemic areas. This study aimed to evaluate pediatric leprosy over a decade in a tertiary hospital in Surabaya, Indonesia. A retrospective study of leprosy in children under 15 years old between 2010 and 2019 was conducted in the Morbus Hansen Division, Outpatient Clinic at Dr. Soetomo Hospital in Surabaya, Indonesia. Seventy pediatric leprosy cases were identified between 2010 and 2019, consisting of 58 multibacillary (MB)-type cases and 12 paucibacillary (PB)-type cases. Slit skin smear (SSS) was positive in 26 cases. There were two cases of grade-2 disability and 15 cases of leprosy reaction (erythema nodosum leprosum) in children at the time of diagnosis. There was an insignificant decline in the number of pediatric leprosy cases in the last 10 years. Cases and disabilities in children were found in some leprosy pocket areas even though the national elimination rate has been achieved. MB infections, disability, and treatment defaults were common problems in pediatric leprosy.
Topics: Adolescent; Child; Humans; Indonesia; Leprosy; Leprosy, Multibacillary; Mycobacterium leprae; Retrospective Studies
PubMed: 35008042
DOI: 10.4269/ajtmh.21-0458 -
Journal of Infection in Developing... Jun 2022Toxigenic Corynebacterium diphtheriae causes classical diphtheria. Skin infections by toxigenic or non-toxigenic Corynebacterium diphtheriae are prevalent in the tropics...
INTRODUCTION
Toxigenic Corynebacterium diphtheriae causes classical diphtheria. Skin infections by toxigenic or non-toxigenic Corynebacterium diphtheriae are prevalent in the tropics but are rarely reported.
CASE PRESENTATION
We report the identification of a non-toxigenic Corynebacterium diphtheriae (biovar Gravis) isolate in a 52-year-old Cambodian male. The patient presented purulent and non-healing ulcerations on the right hallux. The wound has healed after 7 days of antibiotic therapy with a favourable outcome.
CONCLUSIONS
This case represents, to our knowledge, the first report of Corynebacterium diphtheriae in Cambodia in the last 10 years, and highlights the lack of diagnosis and notifications of diphtheria. It is important to raise awareness among clinicians and to set up diphtheria surveillance in Cambodia.
Topics: Corynebacterium; Corynebacterium Infections; Corynebacterium diphtheriae; Diphtheria; Hallux; Humans; Male; Middle Aged
PubMed: 35797309
DOI: 10.3855/jidc.16153 -
International Journal of... 2022Increasing the extensity of latent tuberculosis infection (LTBI) treatment which is one of the important parameters of tuberculosis (TB) control and completing the...
AIM
Increasing the extensity of latent tuberculosis infection (LTBI) treatment which is one of the important parameters of tuberculosis (TB) control and completing the treatment in success are important. The purpose of this study is to evaluate LTBI treatment indications and treatment outcomes of patients who received LTBI treatment in İstanbul between 2016 and 2018.
METHODS
The treatment outcomes of people who started LTBI treatment registered in TB dispensaries in Istanbul between 2016 and 2018 were analyzed retrospectively according to the variables of the age groups, gender, dispensary subgroups, and prevention treatment indications. Data collected from the health institutions were evaluated.
RESULTS
26.920 patients received LTBI treatment in all Istanbul TB dispensaries between 2016 and 2018. The evaluation of LTBI treatment indications; contact 15.696, Tuberculin skin test (TST) positivity 2224, immunosuppression 8746, TST conversion 58, sequelae lesion 15, and other indications are identified as 181. The groups which diagnosed with TB disease, mortality, transfer, other, and still in treatment are excluded from the analysis of LTBI treatment outcomes. A total of 25.253 patients were analyzed. 65 percent of the patients had completed LTBI treatment. Variables effective for treatment outcomes are analyzed with logistic regression. Treatment discontinuation was statistically significantly lower in 2017 (odds ratio [OR]: 0.906 confidence interval [CI] [95%] [0.849-0.968]) and 2018 (OR: 0.635 CI [95%] [0.594-0.679]) compared to 2016. Treatment lost to follow-up was statistically significantly lower in those receiving LTBI treatment with the indication of tuberculin skin test positivity (OR: 0.541 CI [95%] [0.487-0.600]) and the indication of immunosuppression (OR: 0.284 CI [95%] [0.142-0.569]) compared to those who received LTBI treatment due to contact. When the treatment results are evaluated according to the TB incidence of the region where the dispensaries are located, treatment lost to follow-up was higher in 101-200 per 100,000 incidence group (OR: 1.201 CI [95%] [1.123-1.285]) and incidence of 201-370 per 100,000 (OR: 1.461 CI [95%] [1.358-1.572]). Treatment lost to follow-up was higher in dispensaries on the European side (OR: 1.293 CI [95%] [1.203-1389]) and the 0-35 age group (OR: 1.248 CI [95%] [1.168-1.333]).
CONCLUSION
In conclusion, the treatment completion rate should be improved for an effective LTBI treatment which is one of the important parameters of targeted TB elimination. Particularly people under the age of 35 years and regions with high-TB incidence should receive special care and close follow-up.
Topics: Humans; Adult; Latent Tuberculosis; Tuberculin Test; Interferon-gamma Release Tests; Retrospective Studies; Tuberculosis
PubMed: 36510932
DOI: 10.4103/ijmy.ijmy_196_22 -
Journal of Mother and Child Apr 2022Various guidelines are in place for management for COVID-19 and pulmonary tuberculosis (PTB) in pregnancy. However, to the best of our knowledge, there are no...
Various guidelines are in place for management for COVID-19 and pulmonary tuberculosis (PTB) in pregnancy. However, to the best of our knowledge, there are no significant guidelines for the management of COVID-19 and PTB co-infection in pregnancy. Pregnancy being an altered physiological state, the use of various drugs and their outcomes are altered. Here we present two cases of COVID-19 and PTB co-infection in pregnancy which were managed successfully.
Topics: COVID-19; Coinfection; Female; Humans; Latent Tuberculosis; Pregnancy; Tuberculosis; Tuberculosis, Pulmonary
PubMed: 34717056
DOI: 10.34763/jmotherandchild.20212502.d-21-00002 -
Western Pacific Surveillance and... 2023Mongolia has a high tuberculosis (TB) burden. Data from routine paper-based surveillance were used to describe the epidemiology of TB in Mongolia; the data included...
Mongolia has a high tuberculosis (TB) burden. Data from routine paper-based surveillance were used to describe the epidemiology of TB in Mongolia; the data included testing presumptive TB cases, TB notifications, drug-resistant cases, treatment outcomes and notifications in prisoners. The proportion of the population tested for TB increased between 2015 and 2019. The number and rate per 100 000 population of TB notifications decreased between 2015 and 2018 and then increased in 2019. Most TB notifications in 2019 were in the capital, Ulaanbaatar (59.3%), followed by the central (16.8%), Khangai (10.4%), east (8.5%) and west (5.0%) regions. About half of TB notifications nationally were bacteriologically confirmed (45.4% in 2015, 48.1% in 2019), with the proportion of bacteriologically confirmed TB per province or district varying from 0% to 66%. High TB notification rates were observed in 2019 for males aged 15-54 years (202 per 100 000 population) and females aged 15-34 years (190 per 100 000 population). Treatment success for all forms of TB was 90% in 2019 but was below the 90% target for bacteriologically confirmed cases. Between 2015 and 2019, the number of RR/MDR-TB notifications ranged from 265 to 211. The Mongolian National Tuberculosis Programme needs to continue its efforts in TB control, to further increase the programmatic impact and reduce the TB burden. It is recommended that Mongolia continue to increase TB screening, the use of Xpert testing, contact investigations and preventive treatments, and targeting interventions to the high-burden areas identified in this subnational analysis.
Topics: Male; Female; Humans; Mongolia; Tuberculosis; Tuberculosis, Multidrug-Resistant; Mass Screening; Contact Tracing
PubMed: 37064542
DOI: 10.5365/wpsar.2023.14.1.931 -
Emerging Infectious Diseases Mar 2022Although human infections caused by Mycobacterium mageritense are rare, there are some case reports involving sinusitis, pneumonia, and hospital-acquired infections in...
Although human infections caused by Mycobacterium mageritense are rare, there are some case reports involving sinusitis, pneumonia, and hospital-acquired infections in adults. We report a case of lymphadenitis caused by M. mageritense in a child in Spain.
Topics: Adult; Child; Family; Humans; Lymphadenitis; Mycobacteriaceae; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Pneumonia
PubMed: 35202540
DOI: 10.3201/eid2803.211486