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Rana HK, Singh AK, Kumar R, Pandey AK. Antitubercular drugs: possible role of natural products acting as antituberculosis medication in overcoming drug resistance and drug-induced hepatotoxicity. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:1251-1273. [PMID: 37665346 DOI: 10.1007/s00210-023-02679-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
Mycobacterium tuberculosis (Mtb) is a pathogenic bacterium which causes tuberculosis (TB). TB control programmes are facing threats from drug resistance. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) Mtb strains need longer and more expensive treatment with many medications resulting in more adverse effects and decreased chances of treatment outcomes. The World Health Organization (WHO) has emphasised the development of not just new individual anti-TB drugs, but also novel medication regimens as an alternative treatment option for the drug-resistant Mtb strains. Many plants, as well as marine creatures (sponge; Haliclona sp.) and fungi, have been continuously used to treat TB in various traditional treatment systems around the world, providing an almost limitless supply of active components. Natural products, in addition to their anti-mycobacterial action, can be used as adjuvant therapy to increase the efficacy of conventional anti-mycobacterial medications, reduce their side effects, and reverse MDR Mtb strain due to Mycobacterium's genetic flexibility and environmental adaptation. Several natural compounds such as quercetin, ursolic acid, berberine, thymoquinone, curcumin, phloretin, and propolis have shown potential anti-mycobacterial efficacy and are still being explored in preclinical and clinical investigations for confirmation of their efficacy and safety as anti-TB medication. However, more high-level randomized clinical trials are desperately required. The current review provides an overview of drug-resistant TB along with the latest anti-TB medications, drug-induced hepatotoxicity and oxidative stress. Further, the role and mechanisms of action of first and second-line anti-TB drugs and new drugs have been highlighted. Finally, the role of natural compounds as anti-TB medication and hepatoprotectants have been described and their mechanisms discussed.
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Affiliation(s)
- Harvesh Kumar Rana
- Department of Biochemistry, University of Allahabad, Prayagraj (Allahabad), 211002, India
- Department of Zoology, Feroze Gandhi College, Raebareli, 229001, India
| | - Amit Kumar Singh
- Department of Biochemistry, University of Allahabad, Prayagraj (Allahabad), 211002, India
- Department of Botany, BMK Government. Girls College, Balod, Chhattisgarh, 491226, India
| | - Ramesh Kumar
- Department of Biochemistry, University of Allahabad, Prayagraj (Allahabad), 211002, India
- Department of Biochemistry, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Abhay K Pandey
- Department of Biochemistry, University of Allahabad, Prayagraj (Allahabad), 211002, India.
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2
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Leavitt SV, Lee RS, Sebastiani P, Horsburgh CR, Jenkins HE, White LF. Estimating the relative probability of direct transmission between infectious disease patients. Int J Epidemiol 2021; 49:764-775. [PMID: 32211747 DOI: 10.1093/ije/dyaa031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Estimating infectious disease parameters such as the serial interval (time between symptom onset in primary and secondary cases) and reproductive number (average number of secondary cases produced by a primary case) are important in understanding infectious disease dynamics. Many estimation methods require linking cases by direct transmission, a difficult task for most diseases. METHODS Using a subset of cases with detailed genetic and/or contact investigation data to develop a training set of probable transmission events, we build a model to estimate the relative transmission probability for all case-pairs from demographic, spatial and clinical data. Our method is based on naive Bayes, a machine learning classification algorithm which uses the observed frequencies in the training dataset to estimate the probability that a pair is linked given a set of covariates. RESULTS In simulations, we find that the probabilities estimated using genetic distance between cases to define training transmission events are able to distinguish between truly linked and unlinked pairs with high accuracy (area under the receiver operating curve value of 95%). Additionally, only a subset of the cases, 10-50% depending on sample size, need to have detailed genetic data for our method to perform well. We show how these probabilities can be used to estimate the average effective reproductive number and apply our method to a tuberculosis outbreak in Hamburg, Germany. CONCLUSIONS Our method is a novel way to infer transmission dynamics in any dataset when only a subset of cases has rich contact investigation and/or genetic data.
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Affiliation(s)
- Sarah V Leavitt
- School of Public Health, Department of Biostatistics, Boston University, Boston, MA, USA
| | - Robyn S Lee
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,University of Toronto Dalla Lana School of Public Health Epidemiology Division, Toronto, ON, Canada
| | - Paola Sebastiani
- School of Public Health, Department of Biostatistics, Boston University, Boston, MA, USA
| | - C Robert Horsburgh
- School of Public Health, Department of Epidemiology, Boston University, Boston, MA, USA
| | - Helen E Jenkins
- School of Public Health, Department of Biostatistics, Boston University, Boston, MA, USA
| | - Laura F White
- School of Public Health, Department of Biostatistics, Boston University, Boston, MA, USA
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3
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Kakaire R, Kiwanuka N, Zalwango S, Sekandi JN, Quach THT, Castellanos ME, Quinn F, Whalen CC. Excess Risk of Tuberculous Infection among Extra-Household Contacts of Tuberculosis Cases in an African City. Clin Infect Dis 2020; 73:e3438-e3445. [PMID: 33064142 DOI: 10.1093/cid/ciaa1556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Although households of tuberculosis cases represent a setting for intense transmission of M. tuberculosis, household exposure accounts for less than 20% of transmission within a community. OBJECTIVES To estimate excess risk of M. tuberculosis infection among household and extra-household contacts of index cases. METHODS We performed a cross-sectional study in Kampala, Uganda, to delineate social networks of tuberculosis cases and matched controls without tuberculosis. We estimated the age-stratified prevalence difference of tuberculous infection between case and control networks, partitioned as household and extra-household contacts. RESULTS We enrolled 123 index cases, 124 index controls, and 2415 first-degree network contacts. The prevalence of infection was highest among household contacts of cases (61.5%), lowest among household contacts of controls (25.2%), and intermediary among extra-household tuberculosis contacts (44.9%) and extra-household control contacts (41.2%). The age-adjusted prevalence difference between extra-household contacts of cases and their controls was 5.4%. The prevalence of infection was similar among the majority of extra-household case contacts and corresponding controls (47%). CONCLUSIONS Most first-degree social network members of tuberculosis cases do not have adequate contact with the index case to experience additional risk for infection but appear instead to acquire infection through unrecognized exposures with infectious cases in the community.
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Affiliation(s)
- Robert Kakaire
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, United States.,Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, United States
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Juliet N Sekandi
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, United States.,Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, United States
| | - Trang Ho Thu Quach
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, United States.,Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, United States.,Faculty of Pharmacy, Ho Chi Minh City University of Technology (HUTECH), Vietnam
| | - Maria Eugenia Castellanos
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, United States.,Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, United States
| | - Frederick Quinn
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States
| | - Christopher C Whalen
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, United States.,Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, United States
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4
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Stewart RJ, Wortham J, Parvez F, Morris SB, Kirking HL, Cameron LH, Cruz AT. Tuberculosis Infection in Children. J Nurse Pract 2020; 16:673-678. [DOI: 10.1016/j.nurpra.2020.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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5
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Genomic epidemiology of Mycobacterium tuberculosis in Santa Catarina, Southern Brazil. Sci Rep 2020; 10:12891. [PMID: 32732910 PMCID: PMC7393130 DOI: 10.1038/s41598-020-69755-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/22/2020] [Indexed: 12/18/2022] Open
Abstract
Mycobacterium tuberculosis (M.tb), the pathogen responsible for tuberculosis (TB) poses as the major cause of death among infectious diseases. The knowledge about the molecular diversity of M.tb enables the implementation of more effective surveillance and control measures and, nowadays, Whole Genome Sequencing (WGS) holds the potential to produce high-resolution epidemiological data in a high-throughput manner. Florianópolis, the state capital of Santa Catarina (SC) in south Brazil, shows a high TB incidence (46.0/100,000). Here we carried out a WGS-based evaluation of the M.tb strain diversity, drug-resistance and ongoing transmission in the capital metropolitan region. Resistance to isoniazid, rifampicin, streptomycin was identified respectively in 4.0% (n = 6), 2.0% (n = 3) and 1.3% (n = 2) of the 151 studied strains by WGS. Besides, resistance to pyrazinamide and ethambutol was detected in 0.7% (n = 1) and reistance to ethionamide and fluoroquinolone (FQ) in 1.3% (n = 2), while a single (0.7%) multidrug-resistant (MDR) strain was identified. SNP-based typing classified all isolates into M.tb Lineage 4, with high proportion of sublineages LAM (60.3%), T (16.4%) and Haarlem (7.9%). The average core-genome distance between isolates was 420.3 SNPs, with 43.7% of all isolates grouped across 22 genomic clusters thereby showing the presence of important ongoing TB transmission events. Most clusters were geographically distributed across the study setting which highlights the need for an urgent interruption of these large transmission chains. The data conveyed by this study shows the presence of important and uncontrolled TB transmission in the metropolitan area and provides precise data to support TB control measures in this region.
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6
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Mycobacterium tuberculosis. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:100-115. [PMID: 29356839 DOI: 10.1007/s00103-017-2660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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7
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Verma S, Bhatt K, Lovey A, Ribeiro-Rodrigues R, Durbin J, Jones-López EC, Palaci M, Vinhas SA, Alland D, Dietze R, Ellner JJ, Salgame P. Transmission phenotype of Mycobacterium tuberculosis strains is mechanistically linked to induction of distinct pulmonary pathology. PLoS Pathog 2019; 15:e1007613. [PMID: 30840702 PMCID: PMC6422314 DOI: 10.1371/journal.ppat.1007613] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 03/18/2019] [Accepted: 02/02/2019] [Indexed: 12/19/2022] Open
Abstract
In a study of household contacts (HHC), households were categorized into High (HT) and Low (LT) transmission groups based on the proportion of HHC with a positive tuberculin skin test. The Mycobacterium tuberculosis (Mtb) strains from HT and LT index cases of the households were designated Mtb-HT and Mtb-LT, respectively. We found that C3HeB/FeJ mice infected with Mtb-LT strains exhibited significantly higher bacterial burden compared to Mtb-HT strains and also developed diffused inflammatory lung pathology. In stark contrast, a significant number of mice infected with Mtb-HT strains developed caseating granulomas, a lesion type with high potential to cavitate. None of the Mtb-HT infected animals developed diffused inflammatory lung pathology. A link was observed between increased in vitro replication of Mtb-LT strains and their ability to induce significantly high lipid droplet formation in macrophages. These results support that distinct early interactions of Mtb-HT and Mtb-LT strains with macrophages and subsequent differential trajectories in pathological disease may be the mechanism underlying their transmission potential.
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Affiliation(s)
- Sheetal Verma
- Rutgers University-New Jersey Medical School, Department of Medicine, Centre for Emerging Pathogens, Newark, New Jersey, United States of America
| | - Kamlesh Bhatt
- Rutgers University-New Jersey Medical School, Department of Medicine, Centre for Emerging Pathogens, Newark, New Jersey, United States of America
| | - Arianne Lovey
- Rutgers University-New Jersey Medical School, Department of Medicine, Centre for Emerging Pathogens, Newark, New Jersey, United States of America
| | - Rodrigo Ribeiro-Rodrigues
- Cellular and Molecular Immunology Laboratory, Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Joan Durbin
- Rutgers University-New Jersey Medical School, Department of Pathology, Newark, New Jersey, United States of America
| | - Edward C. Jones-López
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Moises Palaci
- Mycobacteriology Laboratory, Núcleo de Doenças de Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Solange A. Vinhas
- Mycobacteriology Laboratory, Núcleo de Doenças de Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - David Alland
- Rutgers University-New Jersey Medical School, Department of Medicine, Centre for Emerging Pathogens, Newark, New Jersey, United States of America
| | - Reynaldo Dietze
- Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil
- Global Health & Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jerrold J. Ellner
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Padmini Salgame
- Rutgers University-New Jersey Medical School, Department of Medicine, Centre for Emerging Pathogens, Newark, New Jersey, United States of America
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8
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Miller MA, Buss P, Roos EO, Hausler G, Dippenaar A, Mitchell E, van Schalkwyk L, Robbe-Austerman S, Waters WR, Sikar-Gang A, Lyashchenko KP, Parsons SDC, Warren R, van Helden P. Fatal Tuberculosis in a Free-Ranging African Elephant and One Health Implications of Human Pathogens in Wildlife. Front Vet Sci 2019; 6:18. [PMID: 30788347 PMCID: PMC6373532 DOI: 10.3389/fvets.2019.00018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/17/2019] [Indexed: 11/13/2022] Open
Abstract
Tuberculosis (TB) in humans is a global public health concern and the discovery of animal cases of Mycobacterium tuberculosis (Mtb) infection and disease, especially in multi-host settings, also has significant implications for public health, veterinary disease control, and conservation endeavors. This paper describes a fatal case of Mtb disease in a free-ranging African elephant (Loxodonta africana) in a high human TB burden region. Necropsy revealed extensive granulomatous pneumonia, from which Mtb was isolated and identified as a member of LAM3/F11 lineage; a common lineage found in humans in South Africa. These findings are contextualized within a framework of emerging Mtb disease in wildlife globally and highlights the importance of the One Health paradigm in addressing this anthroponotic threat to wildlife and the zoonotic implications.
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Affiliation(s)
- Michele A Miller
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for TB Research, Stellenbosch University, Cape Town, South Africa
| | - Peter Buss
- Veterinary Wildlife Services, South African National Parks, Kruger National Park, Skukuza, South Africa
| | - Eduard O Roos
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for TB Research, Stellenbosch University, Cape Town, South Africa
| | - Guy Hausler
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for TB Research, Stellenbosch University, Cape Town, South Africa
| | - Anzaan Dippenaar
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for TB Research, Stellenbosch University, Cape Town, South Africa
| | - Emily Mitchell
- Department of Research and Scientific Services, National Zoological Gardens, South African Biodiversity Institute, Pretoria, South Africa.,Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Louis van Schalkwyk
- Department of Agriculture, Forestry and Fisheries, Skukuza State Veterinary Office, Skukuza, South Africa
| | - Suelee Robbe-Austerman
- National Veterinary Services Laboratories, Animal Plant Health Inspection Service, United States Department of Agriculture, Ames, IA, United States
| | - W Ray Waters
- National Animal Disease Center, Agricultural Research Service, United States Department of Agriculture, Ames, IA, United States
| | | | | | - Sven D C Parsons
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for TB Research, Stellenbosch University, Cape Town, South Africa
| | - Robin Warren
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for TB Research, Stellenbosch University, Cape Town, South Africa
| | - Paul van Helden
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for TB Research, Stellenbosch University, Cape Town, South Africa
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9
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Ho ZJM, Chee CBE, Ong RTH, Sng LH, Peh WLJ, Cook AR, Hsu LY, Wang YT, Koh HF, Lee VJM. Investigation of a cluster of multi-drug resistant tuberculosis in a high-rise apartment block in Singapore. Int J Infect Dis 2018; 67:46-51. [DOI: 10.1016/j.ijid.2017.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 11/28/2022] Open
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10
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Vinhas SA, Jones-López EC, Ribeiro Rodrigues R, Gaeddert M, Peres RL, Marques-Rodrigues P, de Aguiar PPL, White LF, Alland D, Salgame P, Hom D, Ellner JJ, Dietze R, Collins LF, Shashkina E, Kreiswirth B, Palaci M. Strains of Mycobacterium tuberculosis transmitting infection in Brazilian households and those associated with community transmission of tuberculosis. Tuberculosis (Edinb) 2017; 104:79-86. [PMID: 28454653 DOI: 10.1016/j.tube.2017.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 12/16/2022]
Abstract
Molecular epidemiologic studies have shown that the dynamics of tuberculosis transmission varies geographically. We sought to determine which strains of Mycobacterium tuberculosis (MTB) were infecting household contacts (HHC), and which were causing clusters of tuberculosis (TB) disease in Vitoria-ES, Brazil. A total of 741 households contacts (445 TST +) and 139 index cases were characterized according to the proportion of contacts in each household that had a tuberculin skin test positive: low (LT) (≤40% TST+), high (HT) (≥70% TST+) and (40-70% TST+) intermediate (IT) transmission. IS6110-RFLP and spoligotyping analysis were performed only 139 MTB isolates from index cases and 841 community isolates. Clustering occurred in 45% of the entire study population. There was no statistically significant association between MTB household transmission category and clustering. Within the household study population, the proportion of clusters in HT and LT groups was similar (31% and 36%, respectively; p = 0.82). Among index cases isolates associated with households demonstrating TST conversion, the frequency of unique pattern genotypes was higher for index cases of the LT compared to HT households (p = 0.03). We concluded that clusters and lineages associated with MTB infection in HT households had no proclivity for increased transmission of TB in the community.
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Affiliation(s)
- Solange Alves Vinhas
- Núcleo de Doenças Infecciosas (NDI), Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Edward C Jones-López
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | | | - Mary Gaeddert
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Renata Lyrio Peres
- Núcleo de Doenças Infecciosas (NDI), Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | | | | | - Laura Forsberg White
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - David Alland
- Division of Infectious Diseases, Department of Medicine, New Jersey Medical School - Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Padmini Salgame
- Division of Infectious Diseases, Department of Medicine, New Jersey Medical School - Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - David Hom
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Jerrold J Ellner
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Reynaldo Dietze
- Núcleo de Doenças Infecciosas (NDI), Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Lauren F Collins
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Elena Shashkina
- Public Health Research Institute Center, New Jersey Medical School - Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Barry Kreiswirth
- Public Health Research Institute Center, New Jersey Medical School - Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Moisés Palaci
- Núcleo de Doenças Infecciosas (NDI), Universidade Federal do Espírito Santo (UFES), Vitória, Brazil.
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11
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Pourostadi M, Rashedi J, Mahdavi Poor B, Samadi Kafil H, Shirazi S, Asgharzadeh M. Molecular Diversity of Mycobacterium tuberculosis Strains in Northwestern Iran. Jundishapur J Microbiol 2016; 9:e35520. [PMID: 27800145 PMCID: PMC5086081 DOI: 10.5812/jjm.35520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 07/23/2016] [Accepted: 08/07/2016] [Indexed: 11/22/2022] Open
Abstract
Background Years after the development of antituberculosis (TB) drugs, many people continue to suffer from this disease. To control the spread of TB, strains of the Mycobacterium tuberculosis complex need to be determined, and sources of infection must be identified. Such steps should help to prevent transmission of the infection. Objectives The aim of this study was to perform molecular genotyping of isolates of the M. tuberculosis complex obtained from patients in northwestern Iran. Methods One hundred ninety-four culture-positive M. tuberculosis isolates obtained from patients in northwestern Iran were analyzed using the mycobacterial interspersed repetitive unit-exact tandem repeats (MIRU-ETR) method. Results The MIRU-ETR method distinguished 162 different patterns in the 194 isolates, comprising 23 clusters and 139 unique patterns. Its discriminatory power according to the Hunter-Gaston discriminatory index (HGDI) was 0.9978. The largest cluster contained six isolates. Conclusions This research indicated that various strains of M. tuberculosis were responsible for TB and that the majority of cases were due to reactivation.
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Affiliation(s)
- Mahya Pourostadi
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Jalil Rashedi
- Tuberculosis and Lung Disease Research Center, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding author: Jalil Rashedi, Tuberculosis and Lung Disease Research Center, Faculty of Paramedicine, Tabriz University of Medical Sciences, Golgasht Ave., Azadi St., Tabriz, IR Iran. Tel: +98-4133392633, Fax: +98-4133371971, E-mail:
| | - Behroz Mahdavi Poor
- Department of Laboratory Science, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Department of Medical Parasitology, Faculty of Medicine, Tarbiat Modares University, Tehran, IR Iran
| | - Hossein Samadi Kafil
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Samaneh Shirazi
- Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Mohammad Asgharzadeh
- Hematology-Oncology Research Center, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, IR Iran
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12
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Nasir ZA, Campos LC, Christie N, Colbeck I. Airborne biological hazards and urban transport infrastructure: current challenges and future directions. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:15757-66. [PMID: 27318484 PMCID: PMC4956722 DOI: 10.1007/s11356-016-7064-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/08/2016] [Indexed: 05/05/2023]
Abstract
Exposure to airborne biological hazards in an ever expanding urban transport infrastructure and highly diverse mobile population is of growing concern, in terms of both public health and biosecurity. The existing policies and practices on design, construction and operation of these infrastructures may have severe implications for airborne disease transmission, particularly, in the event of a pandemic or intentional release of biological of agents. This paper reviews existing knowledge on airborne disease transmission in different modes of transport, highlights the factors enhancing the vulnerability of transport infrastructures to airborne disease transmission, discusses the potential protection measures and identifies the research gaps in order to build a bioresilient transport infrastructure. The unification of security and public health research, inclusion of public health security concepts at the design and planning phase, and a holistic system approach involving all the stakeholders over the life cycle of transport infrastructure hold the key to mitigate the challenges posed by biological hazards in the twenty-first century transport infrastructure.
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Affiliation(s)
- Zaheer Ahmad Nasir
- School of Energy, Environment and Agrifood, Cranfield University, Cranfield, Bedfordshire, MK43 0AL, UK.
| | - Luiza Cintra Campos
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, WC1E 6BT, UK
| | - Nicola Christie
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, WC1E 6BT, UK
| | - Ian Colbeck
- School of Biological Sciences, University of Essex, Colchester, CO4 3SQ, UK
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13
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Shak EB, France AM, Cowan L, Starks AM, Grant J. Representativeness of Tuberculosis Genotyping Surveillance in the United States, 2009-2010. Public Health Rep 2016; 130:596-601. [PMID: 26556930 DOI: 10.1177/003335491513000607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Genotyping of Mycobacterium tuberculosis isolates contributes to tuberculosis (TB) control through detection of possible outbreaks. However, 20% of U.S. cases do not have an isolate for testing, and 10% of cases with isolates do not have a genotype reported. TB outbreaks in populations with incomplete genotyping data might be missed by genotyping-based outbreak detection. Therefore, we assessed the representativeness of TB genotyping data by comparing characteristics of cases reported during January 1, 2009-December 31, 2010, that had a genotype result with those cases that did not. Of 22,476 cases, 14,922 (66%) had a genotype result. Cases without genotype results were more likely to be patients <19 years of age, with unknown HIV status, of female sex, U.S.-born, and with no recent history of homelessness or substance abuse. Although cases with a genotype result are largely representative of all reported U.S. TB cases, outbreak detection methods that rely solely on genotyping data may underestimate TB transmission among certain groups.
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Affiliation(s)
- Emma B Shak
- Centers for Disease Control and Prevention, Scientific Education and Professional Development Program Office, Atlanta, GA ; Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, GA
| | - Anne Marie France
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, GA
| | - Lauren Cowan
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, GA
| | - Angela M Starks
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, GA
| | - Juliana Grant
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, GA
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Izumi K, Ohkado A, Uchimura K, Murase Y, Tatsumi Y, Kayebeta A, Watanabe Y, Ishikawa N. Detection of Tuberculosis Infection Hotspots Using Activity Spaces Based Spatial Approach in an Urban Tokyo, from 2003 to 2011. PLoS One 2015; 10:e0138831. [PMID: 26382251 PMCID: PMC4575109 DOI: 10.1371/journal.pone.0138831] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/03/2015] [Indexed: 11/28/2022] Open
Abstract
Background Identifying ongoing tuberculosis infection sites is crucial for breaking chains of transmission in tuberculosis-prevalent urban areas. Previous studies have pointed out that detection of local accumulation of tuberculosis patients based on their residential addresses may be limited by a lack of matching between residences and tuberculosis infection sites. This study aimed to identify possible tuberculosis hotspots using TB genotype clustering statuses and a concept of “activity space”, a place where patients spend most of their waking hours. We further compared the spatial distribution by different residential statuses and describe urban environmental features of the detected hotspots. Methods Culture-positive tuberculosis patients notified to Shinjuku city from 2003 to 2011 were enrolled in this case-based cross-sectional study, and their demographic and clinical information, TB genotype clustering statuses, and activity space were collected. Spatial statistics (Global Moran’s I and Getis-Ord Gi* statistics) identified significant hotspots in 152 census tracts, and urban environmental features and tuberculosis patients’ characteristics in these hotspots were assessed. Results Of the enrolled 643 culture-positive tuberculosis patients, 416 (64.2%) were general inhabitants, 42 (6.5%) were foreign-born people, and 184 were homeless people (28.6%). The percentage of overall genotype clustering was 43.7%. Genotype-clustered general inhabitants and homeless people formed significant hotspots around a major railway station, whereas the non-clustered general inhabitants formed no hotspots. This suggested the detected hotspots of activity spaces may reflect ongoing tuberculosis transmission sites and were characterized by smaller residential floor size and a higher proportion of non-working households. Conclusions Activity space-based spatial analysis suggested possible TB transmission sites around the major railway station and it can assist in further comprehension of TB transmission dynamics in an urban setting in Japan.
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Affiliation(s)
- Kiyohiko Izumi
- Department of Epidemiology and Clinical Research, the Research Institute of Tuberculosis, Japan Anti-tuberculosis Association (RIT/JATA), Kiyose city, Tokyo, Japan
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki city, Nagasaki, Japan
- * E-mail:
| | - Akihiro Ohkado
- Department of Epidemiology and Clinical Research, the Research Institute of Tuberculosis, Japan Anti-tuberculosis Association (RIT/JATA), Kiyose city, Tokyo, Japan
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki city, Nagasaki, Japan
| | - Kazuhiro Uchimura
- Department of Epidemiology and Clinical Research, the Research Institute of Tuberculosis, Japan Anti-tuberculosis Association (RIT/JATA), Kiyose city, Tokyo, Japan
| | - Yoshiro Murase
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-tuberculosis Association (RIT/JATA), Kiyose city, Tokyo, Japan
| | - Yuriko Tatsumi
- Department of Epidemiology and Clinical Research, the Research Institute of Tuberculosis, Japan Anti-tuberculosis Association (RIT/JATA), Kiyose city, Tokyo, Japan
| | - Aya Kayebeta
- Shinjuku City Public Health Center, Shinjuku city, Tokyo, Japan
| | - Yu Watanabe
- Shinjuku City Public Health Center, Shinjuku city, Tokyo, Japan
| | - Nobukatsu Ishikawa
- The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association (RIT/JATA), Kiyose city, Tokyo, Japan
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Zamudio C, Krapp F, Choi HW, Shah L, Ciampi A, Gotuzzo E, Heymann J, Seas C, Brewer TF. Public transportation and tuberculosis transmission in a high incidence setting. PLoS One 2015; 10:e0115230. [PMID: 25706530 PMCID: PMC4338233 DOI: 10.1371/journal.pone.0115230] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 10/30/2014] [Indexed: 11/30/2022] Open
Abstract
Background Tuberculosis (TB) transmission may occur with exposure to an infectious contact often in the setting of household environments, but extra-domiciliary transmission also may happen. We evaluated if using buses and/or minibuses as public transportation was associated with acquiring TB in a high incidence urban district in Lima, Peru. Methods Newly diagnosed TB cases with no history of previous treatment and community controls were recruited from August to December 2008 for a case-control study. Crude and adjusted odd ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression to study the association between bus/minibus use and TB risk. Results One hundred forty TB cases and 80 controls were included. The overall use of buses/minibuses was 44.9%; 53.3% (72/135) among cases and 30.4% (24/79) among controls [OR: 3.50, (95% CI: 1.60–7.64)]. In the TB group, 25.7% (36/140) of subjects reported having had a recent household TB contact, and 13% (18/139) reported having had a workplace TB contact; corresponding figures for controls were 3.8% (3/80) and 4.1% (3/73), respectively[OR: 8.88 (95% CI: 2.64–29.92), and OR: 3.89 (95% CI: 1.10–13.70)]. In multivariate analyses, age, household income, household contact and using buses/minibuses to commute to work were independently associated with TB [OR for bus/minibus use: 11.8 (95% CI: 1.45–96.07)]. Conclusions Bus/minibus use to commute to work is associated with TB risk in this high-incidence, urban population in Lima, Peru. Measures should be implemented to prevent TB transmission through this exposure.
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Affiliation(s)
- Carlos Zamudio
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Fiorella Krapp
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Howard W. Choi
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
| | - Lena Shah
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University. Montreal, Canada
| | - Antonio Ciampi
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University. Montreal, Canada
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Enfermedades Infecciosas, Tropicales y Dermatologicas, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Jody Heymann
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University. Montreal, Canada
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, United States of America
| | - Carlos Seas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Enfermedades Infecciosas, Tropicales y Dermatologicas, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Timothy F. Brewer
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, United States of America
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Diversity and evolution of Mycobacterium tuberculosis: moving to whole-genome-based approaches. Cold Spring Harb Perspect Med 2014; 4:a021188. [PMID: 25190252 DOI: 10.1101/cshperspect.a021188] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Genotyping of clinical Mycobacterium tuberculosis complex (MTBC) strains has become a standard tool for epidemiological tracing and for the investigation of the local and global strain population structure. Of special importance is the analysis of the expansion of multidrug (MDR) and extensively drug-resistant (XDR) strains. Classical genotyping and, more recently, whole-genome sequencing have revealed that the strains of the MTBC are more diverse than previously anticipated. Globally, several phylogenetic lineages can be distinguished whose geographical distribution is markedly variable. Strains of particular (sub)lineages, such as Beijing, seem to be more virulent and associated with enhanced resistance levels and fitness, likely fueling their spread in certain world regions. The upcoming generalization of whole-genome sequencing approaches will expectedly provide more comprehensive insights into the molecular and epidemiological mechanisms involved and lead to better diagnostic and therapeutic tools.
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Kanamori H, Kimura R, Weber DJ, Uchiyama B, Hirakata Y, Aso N, Kiryu K, Kaku M. Lessons learned from earthquake-related tuberculosis exposures in a community shelter, Japan, 2011. Am J Infect Control 2014; 42:246-8. [PMID: 24581013 DOI: 10.1016/j.ajic.2013.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Refugees and displaced populations after natural disasters have been vulnerable to tuberculosis. We report an active pulmonary tuberculosis case at a shelter and the subsequent contact investigation and review lessons learned from the 2011 Great East Japan Earthquake. METHODS The contact investigation was conducted to identify latent tuberculosis infection among a total of 95 contact persons, including 78 evacuees at the shelter, who were exposed to the index tuberculosis patient. The association between exposure time of contacts to a patient with active tuberculosis and results of interferon-γ release assay (IGRA) was also examined. RESULTS IGRA was positive in 9 (12.3%) of 73 evacuees at the shelter. Contacts who were exposed to active tuberculosis for more than 25 days were significantly more likely to be IGRA positive, compared with contacts exposed for less than 20 days. All of the 4 evacuees with latent tuberculosis infection who initiated treatment completed the regimen successfully. CONCLUSION When a disaster strikes and many people are living in shelters, it is essential for health care personnel to first suspect tuberculosis and implement prevention and control in collaboration with referral hospitals and public health centers.
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18
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Meriki HD, Tufon KA, Atanga PN, Ane-Anyangwe IN, Anong DN, Cho-Ngwa F, Nkuo-Akenji T. Drug resistance profiles of Mycobacterium tuberculosis complex and factors associated with drug resistance in the Northwest and Southwest Regions of Cameroon. PLoS One 2013; 8:e77410. [PMID: 24146991 PMCID: PMC3797785 DOI: 10.1371/journal.pone.0077410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/10/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Anti-tuberculosis drug resistance continues to be a major obstacle to tuberculosis (TB) control programmes with HIV being a major risk factor in developing TB. We investigated anti-TB drug resistance profiles and the impact of socioeconomic as well as behavioural factors on the prevalence of TB and drug resistance in two regions of Cameroon with such data paucity. METHODS This was a hospital-based study in which 1706 participants, comprising 1133 females and 573 males consecutively enrolled from selected TB and HIV treatment centres of the Northwest and Southwest regions. Demographic, clinical and self-reported risk behaviours and socioeconomic data were obtained with the consent of participants using questionnaires. Culture and drug resistance testing were performed according to standard procedures. RESULTS The prevalence of resistance to at least one anti-TB drug was 27.7% and multi-drug resistance was 5.9%. Smoking, concurrent alcohol consumption and smoking, being on antiretroviral therapy for ≤ 12 months and previous household contact with TB patient were independently associated with tuberculosis prevalence, while only previous tuberculosis infection was associated with drug resistance in a univariate analysis. CONCLUSION The study showed a high prevalence of drug resistance TB in the study population with only previous TB infection associated with drug resistance in a univariate analysis. It also provides evidence in our context, of the role of alcohol and smoking in increasing the risk of developing TB, which is more likely in people living with HIV/AIDS. Therefore, it is important for public health authorities to integrate and intensify alcohol/smoking abstention interventions in TB and HIV control programs in Cameroon.
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Affiliation(s)
- Henry D. Meriki
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Southwest Region, Cameroon
- Clinical Diagnostic Laboratory, Faculty of Science, University of Buea, Buea, Southwest region, Cameroon
| | - Kukwah A. Tufon
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Southwest Region, Cameroon
| | - Pascal N. Atanga
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Southwest Region, Cameroon
- Regional Technical Group for the Fight against HIV and AIDS, Regional Delegation of Public Health, Buea, Southwest Region, Cameroon
| | - Irene N. Ane-Anyangwe
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Southwest Region, Cameroon
| | - Damian N. Anong
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Southwest Region, Cameroon
| | - Fidelis Cho-Ngwa
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, Buea, Southwest region, Cameroon
| | - Theresa Nkuo-Akenji
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Southwest Region, Cameroon
- Clinical Diagnostic Laboratory, Faculty of Science, University of Buea, Buea, Southwest region, Cameroon
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Kumar K, Shorten RJ, Capocci S, Solamalai A, Goodburn A, Cropley I, McHugh TD, Lipman M. The value of “inform and advise” guidance in a case of extensive tuberculosis transmission. J Infect 2013; 67:158-60. [DOI: 10.1016/j.jinf.2013.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 10/27/2022]
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20
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Narasimhan P, Wood J, MacIntyre CR, Mathai D. Risk factors for tuberculosis. Pulm Med 2013; 2013:828939. [PMID: 23476764 PMCID: PMC3583136 DOI: 10.1155/2013/828939] [Citation(s) in RCA: 297] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 12/27/2012] [Accepted: 01/05/2013] [Indexed: 01/07/2023] Open
Abstract
The risk of progression from exposure to the tuberculosis bacilli to the development of active disease is a two-stage process governed by both exogenous and endogenous risk factors. Exogenous factors play a key role in accentuating the progression from exposure to infection among which the bacillary load in the sputum and the proximity of an individual to an infectious TB case are key factors. Similarly endogenous factors lead in progression from infection to active TB disease. Along with well-established risk factors (such as human immunodeficiency virus (HIV), malnutrition, and young age), emerging variables such as diabetes, indoor air pollution, alcohol, use of immunosuppressive drugs, and tobacco smoke play a significant role at both the individual and population level. Socioeconomic and behavioral factors are also shown to increase the susceptibility to infection. Specific groups such as health care workers and indigenous population are also at an increased risk of TB infection and disease. This paper summarizes these factors along with health system issues such as the effects of delay in diagnosis of TB in the transmission of the bacilli.
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Affiliation(s)
- Padmanesan Narasimhan
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia
| | - James Wood
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia
| | - Chandini Raina MacIntyre
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia
| | - Dilip Mathai
- Infectious Diseases Research and Training Centre, Department of Medicine-I and Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
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Tuberculosis Genotyping Information Management System: Enhancing Tuberculosis Surveillance in the United States. INFECTION GENETICS AND EVOLUTION 2012; 12:782-8. [DOI: 10.1016/j.meegid.2011.10.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/14/2011] [Accepted: 10/16/2011] [Indexed: 11/21/2022]
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Schürch AC, van Soolingen D. DNA fingerprinting of Mycobacterium tuberculosis: from phage typing to whole-genome sequencing. INFECTION GENETICS AND EVOLUTION 2011; 12:602-9. [PMID: 22067515 DOI: 10.1016/j.meegid.2011.08.032] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/12/2011] [Accepted: 08/19/2011] [Indexed: 11/26/2022]
Abstract
Current typing methods for Mycobacterium tuberculosis complex evolved from simple phenotypic approaches like phage typing and drug susceptibility profiling to DNA-based strain typing methods, such as IS6110-restriction fragment length polymorphisms (RFLP) and variable number of tandem repeats (VNTR) typing. Examples of the usefulness of molecular typing are source case finding and epidemiological linkage of tuberculosis (TB) cases, international transmission of MDR/XDR-TB, the discrimination between endogenous reactivation and exogenous re-infection as a cause of relapses after curative treatment of tuberculosis, the evidence of multiple M. tuberculosis infections, and the disclosure of laboratory cross-contaminations. Simultaneously, phylogenetic analyses were developed based on single nucleotide polymorphisms (SNPs), genomic deletions usually referred to as regions of difference (RDs) and spoligotyping which served both strain typing and phylogenetic analysis. National and international initiatives that rely on the application of these typing methods have brought significant insight into the molecular epidemiology of tuberculosis. However, current DNA fingerprinting methods have important limitations. They can often not distinguish between genetically closely related strains and the turn-over of these markers is variable. Moreover, the suitability of most DNA typing methods for phylogenetic reconstruction is limited as they show a high propensity of convergent evolution or misinfer genetic distances. In order to fully explore the possibilities of genotyping in the molecular epidemiology of tuberculosis and to study the phylogeny of the causative bacteria reliably, the application of whole-genome sequencing (WGS) analysis for all M. tuberculosis isolates is the optimal, although currently still a costly solution. In the last years WGS for typing of pathogens has been explored and yielded important additional information on strain diversity in comparison to the classical DNA typing methods. With the ongoing cost reduction of DNA sequencing it is possible that WGS will become the sole diagnostic tool in the secondary laboratory diagnosis of tuberculosis for identification, drug susceptibility testing and genetic characterization.
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Affiliation(s)
- Anita C Schürch
- Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (CIb/LIS, pb 22), P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
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Perri BR, Proops D, Moonan PK, Munsiff SS, Kreiswirth BN, Kurepina N, Goranson C, Ahuja SD. Mycobacterium tuberculosis cluster with developing drug resistance, New York, New York, USA, 2003-2009. Emerg Infect Dis 2011; 17:372-378. [PMID: 21392426 PMCID: PMC3166009 DOI: 10.3201/eid1703.101002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In 2004, identification of patients infected with the same Mycobacterium tuberculosis strain in New York, New York, USA, resulted in an outbreak investigation. The investigation involved data collection and analysis, establishing links between patients, and forming transmission hypotheses. Fifty-four geographically clustered cases were identified during 2003–2009. Initially, the M. tuberculosis strain was drug susceptible. However, in 2006, isoniazid resistance emerged, resulting in isoniazid-resistant M. tuberculosis among 17 (31%) patients. Compared with patients with drug-susceptible M. tuberculosis, a greater proportion of patients with isoniazid-resistant M. tuberculosis were US born and had a history of illegal drug use. No patients named one another as contacts. We used patient photographs to identify links between patients. Three links were associated with drug use among patients infected with isoniazid-resistant M.tuberculosis. The photographic method would have been more successful if used earlier in the investigation. Name-based contact investigation might not identify all contacts, particularly when illegal drug use is involved.
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Kamper-Jørgensen Z, Lillebaek T, Andersen AB. Occupational tuberculosis following extremely short exposure. CLINICAL RESPIRATORY JOURNAL 2010; 3:55-7. [PMID: 20298373 DOI: 10.1111/j.1752-699x.2008.00074.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Transmission of Mycobacterium tuberculosis (MT) in most cases requires extended exposure. OBJECTIVES To document that MT transmission may occur even after very short exposure. MATERIAL AND METHODS All first-time culture-confirmed tuberculosis (TB) cases in Denmark have since 1992 been subjected to genotyping, using the IS6110-Restriction Fragment Length Polymorphism (RFLP) technique. A young nurse with no risk factors developed pulmonary TB: the DNA pattern of her MT strain was compared to The Danish TB Subtyping Database, comprising >6000 DNA patterns from TB patients nationwide. RESULTS Only one single MT DNA pattern matched the DNA profile of the isolate from the nurse. The pattern originated from a patient shortly admitted to the department where she worked at the time. MT transmission had occurred in spite of very short exposure. CONCLUSION By adding modern molecular epidemiological methods to traditional epidemiological surveys, a more detailed picture of MT-transmission pathways can be obtained, showing that MT transmission can occur even after extremely short exposure. This stresses the necessity for adequate respiratory protection among hospital staff taking care of patients with pulmonary symptoms suspected for TB.
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Affiliation(s)
- Zaza Kamper-Jørgensen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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Rojpibulstit M, Chongsuvivatwong V. Drugstore personnel's management of a tuberculosis suspect: consideration of actual and perceived management. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.15.3.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To explore drugstore personnel's knowledge and practice on management of a suspected case of tuberculosis (TB).
Method
Seventy randomly selected drugstores in Songkhla province of Southern Thailand were visited by simulated clients (SCs) who asked for medication for relieving a one-month cough with fever. All questions asked by the drugstore personnel, advice given and drugs dispensed were noted and analysed. The drugstores were subsequently visited and the managers were interviewed.
Key findings
For the SC study, 55 out of 70 (79%) drugstore personnel took a history before dispensing drugs, but only 14 (20%) asked about cough duration. Only four drugstore personnel identified TB as a possible diagnosis for a case with one-month cough and fever, and only three recommended the SC to see a doctor. From the interviews, 46 (66%) perceived the probability of encountering TB at their workplace to be low. The knowledge on symptoms of suspected TB was poor. Sixty-eight (97%) would suspect TB if and only if the client with prolonged cough also had tiredness, weight loss, difficulty breathing or haemoptysis. In contrast to their practice with the SC, 46 (66%) claimed that they would recommend a client with one-month cough and fever to see a doctor.
Conclusions
The majority of drugstore personnel failed to detect suspected TB cases and did not give a proper referral. Interventions to educate drugstore personnel to recognise symptoms of suspected TB and to become aware in TB epidemics in this setting are urgently needed.
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Affiliation(s)
- Malee Rojpibulstit
- Clinical Pharmacy Department, Faculty of Pharmaceutical Sciences, Prince of Songkla University (PSU), Hat-Yai, Songkhla, Thailand
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Perdigão J, Milho C, Carrilho L, Brum L, Portugal I. Análise genotípica de isolados de Mycobacterium tuberculosis de um hospital em Lisboa, Portugal. REVISTA PORTUGUESA DE PNEUMOLOGIA 2009. [DOI: 10.1016/s0873-2159(15)30177-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Neely F, Maguire H, Le Brun F, Davies A, Gelb D, Yates S. High rate of transmission among contacts in large London outbreak of isoniazid mono-resistant tuberculosis. J Public Health (Oxf) 2009; 32:44-51. [PMID: 19542269 DOI: 10.1093/pubmed/fdp056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For a continuing London outbreak of isoniazid mono-resistant tuberculosis (TB), we aimed to determine transmission rates and risk factors for contacts of early cases, in order to inform future guidance on contact tracing. METHODS Paper-based proformas were completed by TB nurses, and then analysed using EpiInfo/SAS statistical software. RESULTS Forty community contacts (11%) became cases, 45 (13%) were recommended chemoprophylaxis and 270 (76%) were discharged clear of infection. The highest transmission rate was among contacts exposed to two or more cases (29% became cases) and close contacts of sputum smear-positive cases (22%). Other risk factors were being male and exposure to drug-using cases or cases with prison links. The number needed to be screened (NNS) to detect one case was lowest [5 (95% CI: 4-8)] for contacts of sputum smear-positive pulmonary cases, although the NNS was still only 20 (95% CI:8-72) for casual contacts of smear-positive cases. CONCLUSIONS Transmission of disease to contacts was high (11%) compared with other documented outbreaks (0.7-2%). The results support recommended guidelines for contact tracing but also provide grounds to recommend, for outbreak cases, screening of casual contacts of smear-positive cases and contacts exposed to more than one case, drug users or prisoners.
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Affiliation(s)
- F Neely
- Health Protection Agency (HPA), London region, 7th Floor, Holborn Gate, 330 High Holborn, London WC1V 7PP, UK
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Ringshausen FC, Schlösser S, Nienhaus A, Schablon A, Schultze-Werninghaus G, Rohde G. In-hospital contact investigation among health care workers after exposure to smear-negative tuberculosis. J Occup Med Toxicol 2009; 4:11. [PMID: 19505310 PMCID: PMC2698921 DOI: 10.1186/1745-6673-4-11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 06/08/2009] [Indexed: 11/17/2022] Open
Abstract
Background Smear-negative pulmonary tuberculosis (TB) accounts for a considerable proportion of TB transmission, which especially endangers health care workers (HCW). Novel Mycobacterium-tuberculosis-specific interferon-γ release assays (IGRAs) may offer the chance to define the burden of TB in HCW more accurately than the Mantoux tuberculin skin test (TST), but the data that is available regarding their performance in tracing smear-negative TB in the low-incidence, in-hospital setting, is limited. We conducted a large-scale, in-hospital contact investigation among HCW of a German university hospital after exposure to a single case of extensive smear-negative, culture-positive TB with pulmonary involvement. The objective of the present study was to evaluate an IGRA in comparison to the TST and to identify risk factors for test positivity. Methods Contacts were prospectively enrolled, evaluated using a standardized questionnaire, the IGRA QuantiFERON®-TB Gold in Tube (QFT-GIT) and the TST, and followed-up for two years. Active TB was ruled out by chest x-ray in QFT-GIT-positive subjects. Independent predictors of test positivity were established through the use of logistic regression analysis. Results Out of the 143 subjects analyzed, 82 (57.3%) had close contact, but only four (2.8%) experienced cumulative exposure to the index case >40 hours. QFT-GIT results were positive in 13 subjects (9.1%), while TST results were positive in 40 subjects (28.0%) at an induration >5 mm. Overall agreement was poor between both tests (kappa = 0.15). Age was the only predictor of QFT-GIT-positivity (Odds ratio 2.7, 95% confidence interval 1.32–5.46), while TST-positivity was significantly related to Bacillus Calmette-Guérin vaccination and foreign origin. Logistic regression analysis showed no relation between test results and exposure. No secondary cases of active TB were detected over an observational period of two years. Conclusion Our findings suggest a low contagiosity of the particular index case. The frequency of positive QFT-GIT results may in fact reflect the pre-existing prevalence of latent TB infection among the study population. TB transmission seems unlikely and contact tracing not generally warranted after cumulative exposure <40 hours. However, the substantially lower frequency of positive QFT-GIT results compared to the TST may contribute to enhanced TB control in health care.
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Affiliation(s)
- Felix C Ringshausen
- Department of Medicine III - Pneumology, Allergology and Sleep Medicine, University Hospital Bergmannsheil, Bochum, Germany.
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Rook GAW, Hernández-Pando R, Zumla A. Tuberculosis Due to High-Dose Challenge in Partially Immune Individuals: A Problem for Vaccination? J Infect Dis 2009; 199:613-8. [DOI: 10.1086/596654] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Abstract
BACKGROUND Delay in the treatment of patients with tuberculosis (TB) increases the risk of poor clinical outcomes--including death and transmission of disease--and may be reducible. OBJECTIVE To estimate delays in TB treatment in a Canadian, multicultural population and to examine factors associated with longer time to treatment. METHODS Adult cases of active TB from January 1998 to December 2001 from the Ontario Reportable Disease Information System were included. Time to treatment was defined as the number of days between symptom onset and treatment. RESULTS Data from 1753 TB patients (76% of eligible patients) were analyzed. Median time to treatment was 62 days (interquartile range 31 to 114 days). Time periods longer than the median time to treatment were independently associated with middle-aged patients (OR 1.54, 95% CI 1.21 to 1.98), foreign-born patients who had lived in Canada for more than 10 years (OR 1.47, 95% CI 1.02 to 2.12), patients with nonpulmonary disease (OR 1.57, 95% CI 1.28 to 1.92) and patients managed within certain health districts. CONCLUSION A time to TB treatment of two months or more is common in Ontario, and associated with several factors. Future studies are needed to build on these findings to decrease delay and improve individual and public health outcomes.
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Cain K, Mac Kenzie W, Castro K, LoBue P. Editorial Commentary:No Man Is an Island: Reducing Diagnostic Delays in Undocumented Foreign‐Born Persons Is Needed to Decrease the Risk of Tuberculosis Transmission. Clin Infect Dis 2008; 47:1284-6. [DOI: 10.1086/592573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Franchi A, Richeldi L, Parrinello G, Franco G. Room size is the major determinant for tuberculin conversion in health care workers exposed to a multidrug-resistant tuberculosis patient. Int Arch Occup Environ Health 2006; 80:533-8. [PMID: 17165066 DOI: 10.1007/s00420-006-0160-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Accepted: 11/02/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Transmission of Mycobacterium tuberculosis (MTB) to health care workers (HCWs) still represents a public health concern. A total of 71 obstetric workers underwent contact tracing after recent workplace exposure to a highly infectious multidrug-resistant tuberculosis patient [i.e., index case (IC)]. Aim of the study was to identify the main exposure predictors for the risk of conversion through evaluation of tuberculin screening results. METHODS HCWs were investigated by a questionnaire (community, occupational, IC exposure risk factors) and tuberculin skin test screening. RESULTS Conversion was detected in 5 (8%) of the 63 exposed workers and was not associated with either community or previous work-related risk factors. According to risk assessment, tuberculin conversion was related to neither amount time of exposure, workshifts, nor number of contacts. Conversely, an exposure to the IC in different hospital rooms was found significantly different among converters compared to non-converters (chi (2), P = 0.004). In particular, conversion was associated with exposure in two (obstetric emergency room, ambulatory discharge) out of the nine contact environments. Tuberculin conversion rates were associated with the room cubations of the exposure environments (chi (2) for trend, P < 0.01) and with worker age. In a logistic regression model adjusted for age, the lower room cubation was found the strongest predictor for tuberculin conversion (OR = 2.46, P = 0.02). CONCLUSION The study shows that the factors affecting airborne mycobacterial dose (patient infectiousness, low sized confined rooms) were the major determinants for MTB transmission after a brief exposure to a highly infectious TB case.
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Affiliation(s)
- Alberto Franchi
- Occupational Health Unit, Policlinico Hospital, 8th floor, room # 8.056, Via Largo del Pozzo 71, 41100 Modena, Italy.
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LICHAUCO JJT, TANKEH-TORRES SA, NAVARRA SV, DANS for the Task Force for TB Scre LF. Philippine guidelines on the screening for tuberculosis prior to the use of biologic agents. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1479-8077.2006.00182.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
INTRODUCTION The hospital is a favourable setting for the transmission of tubercle bacilli. The presence of susceptible subjects, often immunocompromised, increases the dangers. This risk extends to the patients' visitors and to the staff. It is therefore the responsibility of the hospital to establish preventative measures capable of reducing the risk of transmission or to reduce the effects by appropriate management of exposed subjects. BACKGROUND The modes and vectors of transmission are well established. The standardised prevention of transmission is achieved by isolation, the indications and duration of which are based on incomplete information. The surveillance of the carers by the doctor in charge, is based on precise recommendations depending on the risk of exposure. VIEWPOINT The objectives are a reduction diagnostic delay, a better determination of infectivity and its duration during treatment, and a more complete census of cases of hospital acquired tuberculosis. CONCLUSIONS The management of tuberculosis in hospital requires co-ordination of all involved including those outside the institution and a deliberate policy in the institution itself.
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Affiliation(s)
- P Fraisse
- Service de Pneumologie, Hôpital de Hautepierre, Strasbourg, France.
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Foxman B, Zhang L, Koopman JS, Manning SD, Marrs CF. Choosing an appropriate bacterial typing technique for epidemiologic studies. EPIDEMIOLOGIC PERSPECTIVES & INNOVATIONS : EP+I 2005; 2:10. [PMID: 16309556 PMCID: PMC1308839 DOI: 10.1186/1742-5573-2-10] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Accepted: 11/25/2005] [Indexed: 11/27/2022]
Abstract
A wide variety of bacterial typing systems are currently in use that vary greatly with respect to the effort required, cost, reliability and ability to discriminate between bacterial strains. No one technique is optimal for all forms of investigation. We discuss the desired level of discrimination and need for a biologic basis for grouping strains of apparently different types when using bacterial typing techniques for different epidemiologic applications: 1) confirming epidemiologic linkage in outbreak investigations, 2) generating hypotheses about epidemiologic relationships between bacterial strains in the absence of epidemiologic information, and 3) describing the distributions of bacterial types and identifying determinants of those distributions. Inferences made from molecular epidemiologic studies of bacteria depend upon both the typing technique selected and the study design used; thus, choice of typing technique is pivotal for increasing our understanding of the pathogenesis and transmission, and eventual disease prevention.
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Affiliation(s)
- Betsy Foxman
- Department of Epidemiology and Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Lixin Zhang
- Department of Epidemiology and Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - James S Koopman
- Department of Epidemiology and Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Shannon D Manning
- National Food Safety/ & Toxicology Center, Michigan State University, East Lansing, Michigan, USA
| | - Carl F Marrs
- Department of Epidemiology and Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Fraisse P. Transmission des bacilles tuberculeux : un contact occasionnel avec un cas index peut suffire. Rev Mal Respir 2005. [DOI: 10.1016/s0761-8425(05)73017-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Malik ANJ, Godfrey-Faussett P. Effects of genetic variability of Mycobacterium tuberculosis strains on the presentation of disease. THE LANCET. INFECTIOUS DISEASES 2005; 5:174-83. [PMID: 15766652 DOI: 10.1016/s1473-3099(05)01310-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The nature of the variability in the clinical and epidemiological consequences of Mycobacterium tuberculosis infection remains poorly understood. Environmental and host factors that contribute to the outcome of infection and disease presentation are well recognised, but the role of bacterial factors has been more elusive. The rapid increase in the understanding of the molecular basis of M tuberculosis over the past decades has revived research into its pathogenesis. DNA fingerprinting techniques have been used to distinguish between strains of M tuberculosis, and efforts to characterise the strains present within populations have led to increased understanding of their global distribution. This research has shown that in certain areas a small number of strains are causing a disproportionate number of cases of the disease. The sequencing of the complete genome of M tuberculosis has accelerated the development of molecular techniques to differentiate strains according to their genetic polymorphisms. Investigation into the reasons why some strains are predominant by genetic strain-typing techniques may clarify which bacterial factors contribute to disease. This knowledge has the potential to influence control and prevention strategies for tuberculosis in the future. However, there are still limitations in these techniques and their results. This review discusses molecular epidemiology and genetic studies, and their contribution to the understanding of the links between genotypic and phenotypic characteristics of M tuberculosis strains.
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Kammerer JS, McNabb SJN, Becerra JE, Rosenblum L, Shang N, Iademarco MF, Navin TR. Tuberculosis transmission in nontraditional settings: a decision-tree approach. Am J Prev Med 2005; 28:201-7. [PMID: 15710276 DOI: 10.1016/j.amepre.2004.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tuberculosis (TB) transmission in nontraditional settings and relationships (non-TSR) often eludes detection by conventional contact investigation and is increasingly common. The U.S.-based National Tuberculosis Genotyping and Surveillance Network collected epidemiologic data and genotyping results of Mycobacterium tuberculosis isolates from 1996 to 2000. METHODS In 2003-2004, we determined the number and characteristics of TB patients in non-TSR that were involved in recent transmission, generated a decision tree to profile those patients, and performed a case-control study to identify predictors of being in non-TSR. RESULTS Of 10,844 culture-positive reported TB cases that were genotyped, 4724 (43.6%) M. tuberculosis isolates were clustered with at least one other isolate. Among these, 520 (11%) had epidemiologic linkages discovered during conventional contact investigation or cluster investigation and confirmed by genotyping results. The decision tree identified race/ethnicity (non-Hispanic white or black) as having the greatest predictive ability to determine patients in non-TSR, followed by being aged 15 to 24 years and having positive or unknown HIV infection status. From the 520, 85 (16.4%) had non-TSR, and 435 (83.6%) had traditional settings and relationships (TSR). In multivariate analyses, patients in non-TSR were significantly more likely than those in TSR to be non-Hispanic white (adjusted odds ratio [aOR]=6.1; 95% confidence interval [CI]=1.7-21.1]) or to have an M. tuberculosis isolate resistant to rifampin (aOR=5.2; 95% CI=1.5-17.7). CONCLUSIONS Decision-tree analyses can be used to enhance both the efficiency and effectiveness of TB prevention and control activities in identifying patients in non-TSR.
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Affiliation(s)
- J Steve Kammerer
- Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Malakmadze N, González IM, Oemig T, Isiadinso I, Rembert D, McCauley MM, Wand P, Diem L, Cowan L, Palumbo GJ, Fraser M, Ijaz K. Unsuspected Recent Transmission of Tuberculosis among High-Risk Groups: Implications of Universal Tuberculosis Genotyping in Its Detection. Clin Infect Dis 2005; 40:366-73. [PMID: 15668858 DOI: 10.1086/427112] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Accepted: 09/14/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The initiation of universal genotyping revealed 3 clusters of 19 patients with tuberculosis (TB) in Wisconsin, with no apparent epidemiologic links among most of them. An epidemiologic investigation was conducted to determine whether genotype clustering resulted from recent transmission. METHODS We conducted additional interviews with patients and reviewed medical records. Places frequented by the patients while they were infectious were visited to identify contacts. RESULTS Our investigation revealed several previously unrecognized possible sites of TB transmission: a single-room occupancy hotel, 2 homeless shelters, 1 bar, and 2 crack houses. Seven patients with previously diagnosed TB were added to the clusters. Of 26 patients, we identified epidemiologic links for all but 1. Common risk factors among patients included alcohol abuse, crack cocaine use, homelessness, and unemployment. Additionally, 98 contacts missed during routine contact investigation were identified. CONCLUSIONS Transmission of TB, particularly among high-risk groups, may go undetected for years. Our investigation demonstrated the value of universal genotyping in revealing unsuspected recent TB transmission and previously unrecognized sites of transmission, which can be targeted for specific TB interventions.
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Affiliation(s)
- Naile Malakmadze
- Division of Applied Public Health Training, Epidemiology Program Office, National Center for HIV, STD and TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Richeldi L, Ewer K, Losi M, Bergamini BM, Roversi P, Deeks J, Fabbri LM, Lalvani A. T Cell–Based Tracking of Multidrug Resistant Tuberculosis Infection after Brief Exposure. Am J Respir Crit Care Med 2004; 170:288-95. [PMID: 15130907 DOI: 10.1164/rccm.200403-307oc] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Molecular epidemiology indicates significant transmission of Mycobacterium tuberculosis after casual contact with infectious tuberculosis cases. We investigated M. tuberculosis transmission after brief exposure using a T cell-based assay, the enzyme-linked-immunospot (ELISPOT) for IFN-gamma. After childbirth, a mother was diagnosed with sputum smear-positive multidrug-resistant tuberculosis. Forty-one neonates and 47 adults were present during her admission on the maternity unit; 11 weeks later, all underwent tuberculin skin testing (TST) and ELISPOT. We correlated test results with markers of exposure to the index case. The participants, who were asymptomatic and predominantly had no prior tuberculosis exposure, had 6.05 hours mean exposure (range: 0-65 hours) to the index case. Seventeen individuals, including two newborns, were ELISPOT-positive, and ELISPOT results correlated significantly with three of four predefined measures of tuberculosis exposure. For each hour sharing room air with the index case, the odds of a positive ELISPOT result increased by 1.05 (95% CI: 1.02-1.09, p = 0.003). Only four adults were TST-positive and TST results did not correlate with exposure. Thus, ELISPOT, but not TST, suggested quite extensive nosocomial transmission of multidrug-resistant M. tuberculosis after brief exposure. These results help to explain the apparent importance of casual contact for tuberculosis transmission, and may have implications for prevention.
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MESH Headings
- Adult
- BCG Vaccine/therapeutic use
- Cross Infection/diagnosis
- Cross Infection/drug therapy
- Cross Infection/immunology
- Cross Infection/microbiology
- Cross Infection/transmission
- Disease Transmission, Infectious/classification
- Drug Resistance, Multiple/immunology
- Enzyme-Linked Immunosorbent Assay
- Female
- Humans
- Hypersensitivity, Delayed/complications
- Hypersensitivity, Delayed/immunology
- Infant, Newborn
- Interferon-gamma
- Male
- Mycobacterium tuberculosis
- Odds Ratio
- Sensitivity and Specificity
- T-Lymphocytes/immunology
- Time Factors
- Tuberculin Test
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Multidrug-Resistant/immunology
- Tuberculosis, Multidrug-Resistant/microbiology
- Tuberculosis, Multidrug-Resistant/transmission
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Affiliation(s)
- Luca Richeldi
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom
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41
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Fennelly KP, Martyny JW, Fulton KE, Orme IM, Cave DM, Heifets LB. Cough-generated aerosols of Mycobacterium tuberculosis: a new method to study infectiousness. Am J Respir Crit Care Med 2003; 169:604-9. [PMID: 14656754 DOI: 10.1164/rccm.200308-1101oc] [Citation(s) in RCA: 198] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The concentration and size distribution of infectious aerosols produced by patients with pulmonary tuberculosis (TB) has never been directly measured. We aimed to assess the feasibility of a method that we developed to collect and quantify culturable cough-generated aerosols of Mycobacterium tuberculosis. Subjects were recruited from a referral hospital and most had multidrug-resistant TB. They coughed into a chamber containing microbial air samplers while cough frequency was measured during two 5-minute sessions. Cough-generated aerosol cultures were positive in 4 of 16 subjects (25%) with smear-positive pulmonary TB. There was a rapid decrease in the cough-generated aerosol cultures within the first 3 weeks of effective treatment. Culture-positive cough aerosols were associated with lack of treatment during the previous week (p = 0.007), and there was a trend in the association with cough frequency (p = 0.08). The size distributions of these aerosols were variable, but most particle sizes were in the respirable range. Quantification of viable cough-generated aerosols is feasible and offers a new approach to study infectiousness and transmission of M. tuberculosis and other airborne pathogens.
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MESH Headings
- Aerosols
- Air Microbiology
- Cough/microbiology
- DNA Fingerprinting
- DNA, Bacterial/analysis
- DNA, Bacterial/genetics
- Environmental Monitoring/methods
- Environmental Monitoring/standards
- Epidemiological Monitoring
- Feasibility Studies
- Female
- Humans
- Male
- Molecular Epidemiology
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/isolation & purification
- Mycobacterium tuberculosis/pathogenicity
- Particle Size
- Reproducibility of Results
- Selection Bias
- Sensitivity and Specificity
- Sputum/microbiology
- Tuberculosis, Multidrug-Resistant/complications
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Multidrug-Resistant/epidemiology
- Tuberculosis, Multidrug-Resistant/microbiology
- Tuberculosis, Multidrug-Resistant/transmission
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/microbiology
- Tuberculosis, Pulmonary/transmission
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Affiliation(s)
- Kevin P Fennelly
- Department of Medicine, Center for the Study of Emerging and Re-Emerging Pathogens, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA.
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Iñigo J, Arce A, Martín-Moreno JM, Herruzo R, Palenque E, Chaves F. Recent transmission of tuberculosis in Madrid: application of capture–recapture analysis to conventional and molecular epidemiology. Int J Epidemiol 2003; 32:763-9. [PMID: 14559746 DOI: 10.1093/ije/dyg098] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Population-based studies using a combination of molecular techniques and conventional epidemiological methods have been used to study the dynamics of tuberculosis (TB) transmission but the relative utility of each technique has not yet been established. METHODS A prospective population-based molecular and epidemiological study of patients diagnosed with TB was conducted in three urban districts of Madrid (Spain) during 1997-1999. Analysis was performed using the capture-recapture method including covariates in which conventional epidemiological data and the information on clustered cases obtained by DNA fingerprinting were regarded as independent and complementary procedures. RESULTS The estimate obtained by molecular analysis alone, that 31.6% of TB cases were due to recent transmission, was revised to 44.8% (95% CI: 31.4-58.2) using the capture-recapture method. The estimated completeness of the combined databases for identification of recent transmission was 59.2%. Underestimation of the true prevalence of recent transmission was higher with conventional epidemiology than molecular analysis, particularly for patients <35 years old and those with a history of imprisonment. CONCLUSIONS In this study, use of the capture-recapture technique allowed us to combine epidemiological information obtained by conventional and molecular methods to quantify the number of cases of recently transmitted TB in the community and identify specific populations at high risk of disease. This information is clearly important because such groups are a prime target for improved TB control measures. In the long term, this combination of techniques may contribute significantly to control the spread of TB.
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Affiliation(s)
- J Iñigo
- Dirección General de Salud Pública, Consejería de Sanidad de la Comunidad de Madrid, Aduana 29, 28013 Madrid, Spain.
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Affiliation(s)
- Peter F Barnes
- Center for Pulmonary and Infectious Disease Control, Department of Medicine, University of Texas Health Center, Tyler, TX 75708-3154, USA.
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Abstract
Approximately one-third of the world population is infected with Mycobacterium tuberculosis, the organism that causes tuberculosis (TB). After a brief resurgence beginning in the mid-1980s, the incidence of TB is once again declining in the United States. Health care workers, including dentists and their staff, however, remain at risk for occupational acquisition of the disease. This risk can be managed by educating dental health care workers about the oral and systemic manifestations of TB and the mechanisms by which it is spread so that appropriate measures may be taken in the office to minimize the opportunity for disease transmission.
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Affiliation(s)
- Joseph Rinaggio
- Department of Diagnostic Sciences, Room D-860, University of Medicine and Dentistry of New Jersey-New Jersey Dental School, 110 Bergen Street, Post Office Box 1709, Newark, NJ 07103, USA.
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Filliol I, Driscoll JR, van Soolingen D, Kreiswirth BN, Kremer K, Valétudie G, Dang DA, Barlow R, Banerjee D, Bifani PJ, Brudey K, Cataldi A, Cooksey RC, Cousins DV, Dale JW, Dellagostin OA, Drobniewski F, Engelmann G, Ferdinand S, Gascoyne-Binzi D, Gordon M, Gutierrez MC, Haas WH, Heersma H, Kassa-Kelembho E, Ho ML, Makristathis A, Mammina C, Martin G, Moström P, Mokrousov I, Narbonne V, Narvskaya O, Nastasi A, Niobe-Eyangoh SN, Pape JW, Rasolofo-Razanamparany V, Ridell M, Rossetti ML, Stauffer F, Suffys PN, Takiff H, Texier-Maugein J, Vincent V, de Waard JH, Sola C, Rastogi N. Snapshot of moving and expanding clones of Mycobacterium tuberculosis and their global distribution assessed by spoligotyping in an international study. J Clin Microbiol 2003; 41:1963-70. [PMID: 12734235 PMCID: PMC154710 DOI: 10.1128/jcm.41.5.1963-1970.2003] [Citation(s) in RCA: 196] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The present update on the global distribution of Mycobacterium tuberculosis complex spoligotypes provides both the octal and binary descriptions of the spoligotypes for M. tuberculosis complex, including Mycobacterium bovis, from >90 countries (13,008 patterns grouped into 813 shared types containing 11,708 isolates and 1,300 orphan patterns). A number of potential indices were developed to summarize the information on the biogeographical specificity of a given shared type, as well as its geographical spreading (matching code and spreading index, respectively). To facilitate the analysis of hundreds of spoligotypes each made up of a binary succession of 43 bits of information, a number of major and minor visual rules were also defined. A total of six major rules (A to F) with the precise description of the extra missing spacers (minor rules) were used to define 36 major clades (or families) of M. tuberculosis. Some major clades identified were the East African-Indian (EAI) clade, the Beijing clade, the Haarlem clade, the Latin American and Mediterranean (LAM) clade, the Central Asian (CAS) clade, a European clade of IS6110 low banders (X; highly prevalent in the United States and United Kingdom), and a widespread yet poorly defined clade (T). When the visual rules defined above were used for an automated labeling of the 813 shared types to define nine superfamilies of strains (Mycobacterium africanum, Beijing, M. bovis, EAI, CAS, T, Haarlem, X, and LAM), 96.9% of the shared types received a label, showing the potential for automated labeling of M. tuberculosis families in well-defined phylogeographical families. Intercontinental matches of shared types among eight continents and subcontinents (Africa, North America, Central America, South America, Europe, the Middle East and Central Asia, and the Far East) are analyzed and discussed.
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Affiliation(s)
- Ingrid Filliol
- Unité de la Tuberculose et des Mycobactéries, Institut Pasteur de Guadeloupe, Pointe-à-Pitre, Guadeloupe
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Cronin WA, Golub JE, Lathan MJ, Mukasa LN, Hooper N, Razeq JH, Baruch NG, Mulcahy D, Benjamin WH, Magder LS, Strickland GT, Bishai WR. Molecular epidemiology of tuberculosis in a low- to moderate-incidence state: are contact investigations enough? Emerg Infect Dis 2002; 8:1271-9. [PMID: 12453355 PMCID: PMC2738531 DOI: 10.3201/eid0811.020261] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To assess the circumstances of recent transmission of tuberculosis (TB) (progression to active disease <2 years after infection), we obtained DNA fingerprints for 1172 (99%) of 1179 Mycobacterium tuberculosis isolates collected from Maryland TB patients from 1996 to 2000. We also reviewed medical records and interviewed patients with genetically matching M. tuberculosis strains to identify epidemiologic links (cluster investigation). Traditional settings for transmission were defined as households or close relatives and friends; all other settings were considered nontraditional. Of 436 clustered patients, 115 had recently acquired TB. Cluster investigations were significantly more likely than contact investigations to identify patients who recently acquired TB in nontraditional settings (33/42 vs. 23/72, respectively; p<0.001). Transmission from a foreign-born person to a U.S.-born person was rare and occurred mainly in public settings. The time from symptom onset to diagnosis was twice as long for transmitters as for nontransmitters (16.8 vs. 8.5 weeks, respectively; p<0.01). Molecular epidemiologic studies showed that reducing diagnostic delays can prevent TB transmission in nontraditional settings, which elude contact investigations.
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Affiliation(s)
- Wendy A Cronin
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland 21201, USA.
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Weis SE, Pogoda JM, Yang Z, Cave MD, Wallace C, Kelley M, Barnes PF. Transmission dynamics of tuberculosis in Tarrant county, Texas. Am J Respir Crit Care Med 2002; 166:36-42. [PMID: 12091168 DOI: 10.1164/rccm.2109089] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To understand the transmission dynamics of tuberculosis in Tarrant County, Texas, we performed a population-based study of 159 patients with culture-proven tuberculosis, combining restriction fragment length polymorphism (RFLP) analysis of Mycobacterium tuberculosis isolates with prospective interviewing to identify epidemiologic links between patients. Patients whose isolates had identical or closely related RFLP patterns were considered a cluster. Seventy-six (48%) of 159 patients were in 19 clusters, suggesting that recent transmission accounted for 36% of tuberculosis morbidity. Unconditional logistic regression showed that birth in the United States, continuous residence in Tarrant County, a history of homelessness, and a history of visiting or working in bars were independent predictors of clustering. Four homeless shelters and five bars were associated with specific clusters, suggesting that they were sites of tuberculosis transmission. Patients in some clusters recognized more photographs of patients in their cluster than did patients outside their cluster. We conclude that (1) homeless shelters and bars are important sites of tuberculosis transmission in Tarrant County, and (2) the use of photograph recognition of patients with tuberculosis, in combination with RFLP analysis, has the potential to enhance tuberculosis control by facilitating identification of epidemiologic links between patients.
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Affiliation(s)
- Stephen E Weis
- Division of Public Health, Department of Medicine, University of North Texas Health Science Center at Fort Worth, 76107, USA.
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