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de Vries SG, Cremers AL, Heuvelings CC, Greve PF, Visser BJ, Bélard S, Janssen S, Spijker R, Shaw B, Hill RA, Zumla A, van der Werf MJ, Sandgren A, Grobusch MP. Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature. THE LANCET. INFECTIOUS DISEASES 2017; 17:e128-e143. [PMID: 28291721 DOI: 10.1016/s1473-3099(16)30531-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 10/11/2016] [Accepted: 11/03/2016] [Indexed: 01/25/2023]
Abstract
Tuberculosis disproportionately affects hard-to-reach populations, such as homeless people, migrants, refugees, prisoners, or drug users. These people often face challenges in accessing quality health care. We did a systematic review of the qualitative literature to identify barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by people from hard-to-reach populations in all European Union (EU), European Economic Area, EU candidate, and Organisation for Economic Co-operation and Development countries. The 12 studies included in this review mainly focused on migrants. Views on perceived susceptibility to and severity of tuberculosis varied widely and included many misconceptions. Stigma and challenges regarding access to health care were identified as barriers to tuberculosis diagnosis and treatment uptake, whereas support from nurses, family, and friends was a facilitator for treatment adherence. Further studies are required to identify barriers and facilitators to the improved identification and management of tuberculosis in hard-to-reach populations to inform recommendations for more effective tuberculosis control programmes.
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Affiliation(s)
- Sophia G de Vries
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anne L Cremers
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Charlotte C Heuvelings
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Patrick F Greve
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Benjamin J Visser
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Sabine Bélard
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Saskia Janssen
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - René Spijker
- Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Beth Shaw
- National Institute for Health and Care Excellence, Piccadilly Plaza, Manchester, UK
| | - Ruaraidh A Hill
- National Institute for Health and Care Excellence, Piccadilly Plaza, Manchester, UK; Health Services Research, University of Liverpool, Liverpool, UK
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | | | - Andreas Sandgren
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Garzelli C, Lari N, Rindi L. Genomic diversity of Mycobacterium tuberculosis Beijing strains isolated in Tuscany, Italy, based on large sequence deletions, SNPs in putative DNA repair genes and MIRU-VNTR polymorphisms. Tuberculosis (Edinb) 2016; 97:147-53. [DOI: 10.1016/j.tube.2015.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 12/28/2022]
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3
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A close-up on the epidemiology and transmission of multidrug-resistant tuberculosis in Poland. Eur J Clin Microbiol Infect Dis 2014; 34:41-53. [PMID: 25037868 DOI: 10.1007/s10096-014-2202-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
Abstract
Multidrug-resistant tuberculosis (MDR-TB) poses a serious challenge to the global control of the disease. The purpose of this study was to characterize MDR-TB patients from Poland and to determine the extent of MDR-TB disease attributable to recent transmission. The study included all 46 patients diagnosed with MDR-TB in Poland in 2004 and followed up for 6 years (until 2011). For each patient, sociodemographic and clinical characteristics, treatment outcomes, and bacteriological data were collected by the review of medical and laboratory records. Mycobacterium tuberculosis isolates from all patients were characterized using spoligotyping, mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing, IS6110 restriction fragment length polymorphism (RFLP) analysis, and sequencing analysis of drug resistance-associated loci (katG, mabA-inhA, rpoβ, rpsL, and embB). The majority of patients were male (86.9%), 40-64 years of age (60.8%), with a history of TB treatment (84.8%), and producing smear-positive sputa (86.9%). Twenty-two (47.8%) patients suffered from concomitant diseases and 28 (60.8%) were alcohol abusers. Treatment outcome assessment revealed that 8 (17.4%) patients were cured or completed therapy, while 15 (32.6%) died of TB, 11 (23.9%) defaulted, 8 (17.4%) failed, and 1 (2.2%) was transferred and lost to follow-up. Upon genotyping, 10 (21.7%) isolates were allocated in four clusters. These were further subdivided by mutational profiling. Overall, in 6 (13%) patients, MDR-TB was a result of recent transmission. For 4 (8.7%) of these patients, a direct epidemiological link was established. The study shows that the transmission of MDR-TB occurs at a low rate in Poland. Of urgent need is the implementation of a policy of enforced treatment of MDR-TB patients in Poland.
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Ingrosso L, Vescio F, Giuliani M, Migliori GB, Fattorini L, Severoni S, Rezza G. Risk factors for tuberculosis in foreign-born people (FBP) in Italy: a systematic review and meta-analysis. PLoS One 2014; 9:e94728. [PMID: 24733156 PMCID: PMC3986251 DOI: 10.1371/journal.pone.0094728] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/19/2014] [Indexed: 11/30/2022] Open
Abstract
In Italy, TB notifications in foreign-born people (FBP) are steadily increasing. To investigate this issue we did a meta-analysis on risk factors for FBP people. A systematic search was performed in PubMed and EMBASE from Jan-1980 to Jan-2013. We analysed HIV status, previous TB-treatment, intravenous drug use and alcohol abuse, and multidrug resistant TB. Odd ratio was used as a measure of effect. One and two-stages approaches were used. In the main analysis we used a 2-stages approach to include studies with only aggregate estimates. Among 1996 references, 18 fulfilled inclusion criteria. In TB-affected FBP people positive HIV-status was about 3 times higher than among Italians, after 1996 when combined antiretroviral therapy for HIV was introduced (OR: 2.91; 95%CI: 1.37; 6.17). No association was found between FBP and intravenous drug users in adults; after 1-stage meta-analysis foreign born people from highly endemic countries had a 4 times higher risk to be multidrug resistant TB than Italian people. Finally, TB-affected FBP were less likely than Italians to be alcoholics (OR: 0.10 95%CI: 0.01; 0.84) or of having received previous TB-treatment (OR: 0.55; 95%CI: 0.43; 0.71). An association of multidrug resistant TB with immigrant status as well as an association of Tuberculosis with HIV-positive status in foreign-born people are major findings of this analysis. Drugs and alcohol abuse do not appear to be risk factors for TB in FBP, however they cannot be discharged since may depend on cultural traditions and their role may change in the future along with the migratory waves. An effective control of TB risk factors among migrants is crucial to obtain the goal of TB eradication.
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Affiliation(s)
- Loredana Ingrosso
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Fenicia Vescio
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Massimo Giuliani
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Giovanni Battista Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
| | - Lanfranco Fattorini
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Santino Severoni
- Migration and Health, WHO European office for investment for health and development, Castello, Venice, Italy
| | - Giovanni Rezza
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Roma, Italy
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Influence of Hospitalization upon Diagnosis on the Risk of Tuberculosis Clustering. Mediterr J Hematol Infect Dis 2013; 5:e2013071. [PMID: 24363886 PMCID: PMC3867278 DOI: 10.4084/mjhid.2013.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 11/18/2013] [Indexed: 11/08/2022] Open
Abstract
Setting Culture-positive tuberculosis (TB) diagnosed in the metropolitan area of Milan (Italy) over a 5-year period (1995–1999). Objective To assess the impact of short-course hospitalization upon diagnosis on the overall risk of TB clustering. Design Restriction fragment length polymorphism profiles with a similarity of 100% defined a cluster. Uni- and multivariable logistic regression models were performed to assess factors associated with clustering. Results Among 1139 patients, 392 (34.4%) were hospitalized before or soon after diagnosis, 405 (35.6%) received domiciliary treatment since the diagnosis and 392 (30%) had no information about initial clinical management. One hundred fifteen molecular clusters involving 363 patients were identified. Using multivariable analysis, hospitalization was not significantly associated with clustering (OR 1.06, 95%CI 0.75–1.50, p=0.575). Subjects aged >65 years old (OR 0.60; 95CI%:0.37–0.95; p=0.016) and non-Italian born patients (OR 0.56; 95%CI:0.41–0.76; p<0.001) were running a lower risk of clustering. Conversely, HIV co-infected patients (OR 1.88, 95%CI:1.20–2.95, p=0.006) and those with MDR TB (OR 2.50, 95%CI:1.46–4.25, p=0.001) were significantly more likely to be involved in clusters. Conclusion In our cohort, domiciliary treatment was not associated with TB clustering. Expanding domiciliary treatment upon diagnosis appears as an advisable measure to reduce unnecessary costs for the health care system.
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Faccini M, Codecasa LR, Ciconali G, Cammarata S, Borriello CR, De Gioia C, Za A, Marino AF, Vighi V, Ferrarese M, Gesu G, Mazzola E, Castaldi S. Tuberculosis outbreak in a primary school, Milan, Italy. Emerg Infect Dis 2013; 19:485-7. [PMID: 23621942 PMCID: PMC3647646 DOI: 10.3201/eid1902.120527] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Investigation of an outbreak of tuberculosis (TB) in a primary school in Milan, Italy, found 15 schoolchildren had active TB disease and 173 had latent TB infection. TB was also identified in 2 homeless men near the school. Diagnostic delay, particularly in the index case-patient, contributed to the transmission of infection.
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Lucerna MA, Rodríguez-Contreras R, Barroso P, Martínez MJ, Sánchez-Benítez ML, García de Viedma D. [Molecular epidemiology of tuberculosis in Almeria (Spain). Factors associated with recent transmission]. Enferm Infecc Microbiol Clin 2011; 29:174-8. [PMID: 21353342 DOI: 10.1016/j.eimc.2010.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 06/22/2010] [Accepted: 06/29/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Molecular epidemiology is used in tuberculosis (TB) to identify clusters in which the cases are assumed to belong to the same recent transmission chain. An endogenous reactivation of latent TB is considered when the Mycobacterium tuberculosis isolates have a unique genotype. OBJECTIVE To describe factors associated with recent transmission of TB in Almeria, from 2003-2007. METHODS We conducted an observational prospective study that included patients with Mycobacterium tuberculosis positive culture. The strains were genotyped by Restriction Fragment Length Polymorphism and spoligotyping. Adjusted odds ratio and 95% confidence intervals were calculated to study factors associated with cluster groups, using a multivariate logistic regression model. RESULTS We analysed 427 isolates, of which 71% were from males and 56.2% of them belonged to foreign residents. Furthermore, 44% were classified as a cluster. The resistance to isoniazid was 8.4%. The factors associated with clusters were age, principally the group under 10 years (adjusted OR=12.75; 95% CI, 2.52-64.58) and the group aged between 50-59 years (adjusted OR=13.85; 95% CI, 3.04-63.17), and born in Spain (adjusted OR=2.17; 95% CI, 1.41-3.36). CONCLUSIONS In Almeria, native population, children under 10 years old and patients aged between 50-59 years have more probability to belong to the same recent transmission chain. The molecular epidemiology can be used to find out which population groups need more control and this information must be used in tuberculosis prevention programs.
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Nava-Aguilera E, López-Vidal Y, Harris E, Morales-Pérez A, Mitchell S, Flores-Moreno M, Villegas-Arrizón A, Legorreta-Soberanis J, Ledogar R, Andersson N. Clustering of Mycobacterium tuberculosis cases in Acapulco: Spoligotyping and risk factors. Clin Dev Immunol 2010; 2011:408375. [PMID: 21197077 PMCID: PMC3004385 DOI: 10.1155/2011/408375] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 09/28/2010] [Accepted: 10/12/2010] [Indexed: 11/18/2022]
Abstract
Recurrence and reinfection of tuberculosis have quite different implications for prevention. We identified 267 spoligotypes of Mycobacterium tuberculosis from consecutive tuberculosis patients in Acapulco, Mexico, to assess the level of clustering and risk factors for clustered strains. Point cluster analysis examined spatial clustering. Risk analysis relied on the Mantel Haenszel procedure to examine bivariate associations, then to develop risk profiles of combinations of risk factors. Supplementary analysis of the spoligotyping data used SpolTools. Spoligotyping identified 85 types, 50 of them previously unreported. The five most common spoligotypes accounted for 55% of tuberculosis cases. One cluster of 70 patients (26% of the series) produced a single spoligotype from the Manila Family (Clade EAI2). The high proportion (78%) of patients infected with cluster strains is compatible with recent transmission of TB in Acapulco. Geomatic analysis showed no spatial clustering; clustering was associated with a risk profile of uneducated cases who lived in single-room dwellings. The Manila emerging strain accounted for one in every four cases, confirming that one strain can predominate in a hyperendemic area.
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Affiliation(s)
- Elizabeth Nava-Aguilera
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Calle Pino S/N, Colonia El Roble, 39640 Acapulco, Guerrero, Mexico.
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Sustained intra- and inter-jurisdictional transmission of tuberculosis within a mobile, multi-ethnic social network: lessons for tuberculosis elimination. Canadian Journal of Public Health 2010. [PMID: 20737810 DOI: 10.1007/bf03404391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND A context-specific, spatial-temporal understanding of a chain of tuberculosis (TB) transmission can inform TB elimination strategy. METHODS Clinical, public health and molecular epidemiologic data were used to: 1) identify and describe a complex cluster of TB cases in Alberta, 2) elucidate transmission sequences, and 3) assess case-patient mobility. Socio-economic indicators in loci of transmission and the province at large were described. Factors seen to be fostering or hampering TB elimination were identified. RESULTS Over a 15-year period, 18 TB cases in Alberta and multiple cases in the Northwest Territories were determined to be due to the same strain. One patient was diagnosed at death; all others completed directly-observed therapy (DOT). Case-level analysis revealed that patients were highly mobile with transmission of the strain over 26,569 km2, an average of 2.8 different places of residence per patient during treatment, and contacts of sputum smear-positive cases spanning 9 of 17 regional health authorities. The majority of the contacts (57%) were attached to a single infectious case living in a homeless shelter. The three loci of transmission in Alberta were separated geographically but similar in terms of median incomes, rates of unemployment, levels of post-secondary education, and rates of population mobility (p < 0.0001). CONCLUSION Upon review of the experience, central oversight, intra- and inter-jurisdictional coordination and DOT were seen as fostering, and the absence of 'real-time' DNA fingerprinting, social network analysis, engineering controls in shelters and better determinants of health in loci of transmission were seen as hampering TB elimination.
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10
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Franzetti F, Codecasa L, Matteelli A, Degli Esposti A, Bandera A, Lacchini C, Lombardi A, Pinsi G, Zanini F, El-Hamad I, Gori A. Genotyping analyses of tuberculosis transmission among immigrant residents in Italy. Clin Microbiol Infect 2010; 16:1149-54. [DOI: 10.1111/j.1469-0691.2009.03080.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Houben RMGJ, Glynn JR. A systematic review and meta-analysis of molecular epidemiological studies of tuberculosis: development of a new tool to aid interpretation. Trop Med Int Health 2009; 14:892-909. [DOI: 10.1111/j.1365-3156.2009.02316.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Valim ARDM, Possuelo LG, Cafrune PI, Borges M, Ribeiro MO, Rossetti MLR, Zaha A. Evaluation and genotyping of multidrug-resistant cases of tuberculosis in southern Brazil. Microb Drug Resist 2006; 12:186-91. [PMID: 17002545 DOI: 10.1089/mdr.2006.12.186] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sixty isolates of Mycobacterium tuberculosis identified as multidrug-resistant (MDR) at a reference laboratory in Rio Grande do Sul State during the years 1999 and 2000 were analyzed using the IS6110-restriction fragment length polymorphism (RFLP) technique. We also genotyped 202 susceptible strains to compare the genotyping results, as well as the clinical and demographic data. Spacer oligotyping (spoligotyping) analysis was performed for isolates presenting low IS6110 copy number. Patients with identical DNA pattern strains were considered clustered. From 262 isolates, 94 (36%) belonged to 20 distinct RFLP clusters, and after spoligotyping analysis, 89 of the isolates (34%) remained in cluster. MDR isolates did not differ statistically in clustering proportion from susceptible strains. A significant association between the occurrence of MDR and previous tuberculosis (TB) treatment was observed (p < 0.001), as well as failure on TB treatment (p < 0.001). Human immunodeficiency virus (HIV)-positive patients were associated with susceptible tuberculosis (p = 0.024). We also identified that unmarried patients were more likely to develop TB due to recent transmission than married patients (p < 0.005). The introduction of directly observed therapy short-course (DOTS) strategy will be important in decreasing default and failure rates and avoiding the development of new MDR strains.
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Affiliation(s)
- Andréia Rosane de Moura Valim
- Centro de Biotecnologia and Programa de Pós-graduação em Biologia Celular e Molecular, Universidade Federal do Rio Grande do Sul, Brazil
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Gori A, Bandera A, Marchetti G, Degli Esposti A, Catozzi L, Nardi GP, Gazzola L, Ferrario G, van Embden JDA, van Soolingen D, Moroni M, Franzetti F. Spoligotyping and Mycobacterium tuberculosis. Emerg Infect Dis 2005. [PMID: 16102314 PMCID: PMC3320497 DOI: 10.3201/1108.040982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Speed of spoligotyping could be a benefit in the clinical setting. We evaluated the clinical usefulness of spoligotyping, a polymerase chain reaction–based method for simultaneous detection and typing of Mycobacterium tuberculosis strains, with acid-fast bacilli–positive slides from clinical specimens or mycobacterial cultures. Overall sensitivity and specificity were 97% and 95% for the detection of M. tuberculosis and 98% and 96% when used with clinical specimens. Laboratory turnaround time of spoligotyping was less than that for culture identification by a median of 20 days. In comparison with IS6110-based restriction fragment length polymorphism typing, spoligotyping overestimated the number of isolates with identical DNA fingerprints by ≈50%, but showed a 100% negative predictive value. Spoligotyping resulted in the modification of ongoing antimycobacterial treatment in 40 cases and appropriate therapy in the absence of cultures in 11 cases. The rapidity of this method in detection and typing could make it useful in the management of tuberculosis in a clinical setting.
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Affiliation(s)
- Andrea Gori
- Institute of Infectious Diseases, L. Sacco Hospital, University of Milan, Milan, Italy.
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14
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Gori A, Esposti AD, Bandera A, Mezzetti M, Sola C, Marchetti G, Ferrario G, Salerno F, Goyal M, Diaz R, Gazzola L, Codecasa L, Penati V, Rastogi N, Moroni M, Franzetti F. Comparison between spoligotyping and IS6110 restriction fragment length polymorphisms in molecular genotyping analysis of Mycobacterium tuberculosis strains. Mol Cell Probes 2005; 19:236-44. [PMID: 16038791 DOI: 10.1016/j.mcp.2005.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Accepted: 01/05/2005] [Indexed: 11/23/2022]
Abstract
Spoligotyping was compared with RFLP fingerprinting analysis in the identification of Mycobacterium tuberculosis strains. Spoligotyping sensitivity was 97.6% with a specificity of 47%. The global probability for two strains clustered with spoligotyping to be clustered also with RFLP analysis was 33%; the probability for two strains clustered with RFLP analysis to be clustered also with spoligotyping analysis was 95%. However, comparing the two methods in five outbreak episodes, full concordance was evidenced between spoligotyping and RFLP. Moreover, we evaluated the presence of our 17 largest spoligotyping clusters in spoligotyping databases from Caribbean countries, London and Cuba. Only five out of 17 patterns were present in all the cohorts. The conditional probability comparing spoligotyping and RFLP methods related to these patterns resulted in very low concordance (range from 2 to 38%). In conclusion, we confirm that spoligotyping when used alone overestimates the number of recent transmission and does not represent a suitable method for wide clinical practice application. However, it allows to get a first good picture of strain identity in a new setting and in more localized or confined settings, the probability of reaching the same result compared to RFLP was 100% confirming the usefulness of spoligotyping in the management of epidemic events, especially in hospitals, prisons and close communities.
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Affiliation(s)
- Andrea Gori
- Institute of Infectious Diseases and Tropical Medicine, Luigi Sacco Hospital, University of Milan, Via G.B.Grassi 74, Milan 20157, Italy.
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15
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Gori A, Bandera A, Marchetti G, Degli Esposti A, Catozzi L, Nardi GP, Gazzola L, Ferrario G, van Embden JDA, van Soolingen D, Moroni M, Franzetti F. Spoligotyping andMycobacterium tuberculosis. Emerg Infect Dis 2005; 11:1242-8. [PMID: 16102314 PMCID: PMC3320497 DOI: 10.3201/eid1108.040982] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We evaluated the clinical usefulness of spoligotyping, a polymerase chain reaction-based method for simultaneous detection and typing of Mycobacterium tuberculosis strains, with acid-fast bacilli-positive slides from clinical specimens or mycobacterial cultures. Overall sensitivity and specificity were 97% and 95% for the detection of M. tuberculosis and 98% and 96% when used with clinical specimens. Laboratory turnaround time of spoligotyping was less than that for culture identification by a median of 20 days. In comparison with IS6110-based restriction fragment length polymorphism typing, spoligotyping overestimated the number of isolates with identical DNA fingerprints by approximately 50%, but showed a 100% negative predictive value. Spoligotyping resulted in the modification of ongoing antimycobacterial treatment in 40 cases and appropriate therapy in the absence of cultures in 11 cases. The rapidity of this method in detection and typing could make it useful in the management of tuberculosis in a clinical setting.
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Affiliation(s)
- Andrea Gori
- Institute of Infectious Diseases, L. Sacco Hospital, University of Milan, Milan, Italy.
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16
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Lari N, Rindi L, Sola C, Bonanni D, Rastogi N, Tortoli E, Garzelli C. Genetic diversity, determined on the basis of katG463 and gyrA95 polymorphisms, Spoligotyping, and IS6110 typing, of Mycobacterium tuberculosis complex isolates from Italy. J Clin Microbiol 2005; 43:1617-24. [PMID: 15814975 PMCID: PMC1081388 DOI: 10.1128/jcm.43.4.1617-1624.2005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium tuberculosis complex isolates (n = 248) collected during a 1-year period in Tuscany, Italy, were genotyped for the katG463 and gyrA95 polymorphisms and by standard spacer oligonucleotide typing (spoligotyping) and IS6110 restriction fragment length polymorphism (RFLP) assays. Most of the isolates (n = 212; 85.5%) belonged to genotypic groups 2 and 3, which included most isolates from Italian-born patients. The remaining isolates were genotypic group 1 organisms, which were prevalent among foreign-born patients (29 of 36; 80.6%). Spoligotype analysis detected 116 unique patterns and 34 clusters including 166 isolates. The combination of spoligotyping and IS6110 RFLP analyses yielded 28 distinct clusters including 65 identical isolates (26.2%)--22 clusters with 2 isolates, 4 clusters with 3 isolates, 1 cluster with 4 isolates, and 1 cluster with 5 isolates--thus proving a low transmission rate in the community. Predominant spoligotypes representing 50% of clustered isolates were found in six clusters that included widespread type ST53 (clade T1) with 29 isolates (11.7% of total isolates); types ST50 and ST47 (Haarlem family) with 18 isolates (7.3%) and 8 isolates (3.2%), respectively; type ST42 (Latino-American and Mediterranean clade) with 13 isolates (5.2%); new type ST1737 (named "Tuscany") with 8 isolates (3.2%); and type ST1 (W-Beijing family) with 7 isolates (2.8%). Other spoligotype families, such as the Mycobacterium africanum, East African-Indian (EAI2/Manila), and central Asia 1 (CAS1/Delhi) families (all including organisms of genotypic group 1) and the Cameroun family (genotypic group 2), were detected especially among immigrant patients. The occurrence of genotypes originally found in distant geographic areas with a high prevalence of tuberculosis may represent a hallmark for changes in the dynamics of transmission of tuberculosis in the region in the near future.
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Affiliation(s)
- Nicoletta Lari
- Dipartimento di Patologia Sperimentale, Biotecnologie Mediche, Infettivologia, ed Epidemiologia, Università di Pisa, Via San Zeno 35/39, I-56127 Pisa, Italy
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Dolzani L, Rosato M, Sartori B, Banfi E, Lagatolla C, Predominato M, Fabris C, Tonin E, Gombac F, Monti-Bragadin C. Mycobacterium tuberculosis isolates belonging to katG gyrA group 2 are associated with clustered cases of tuberculosis in Italian patients. J Med Microbiol 2004; 53:155-159. [PMID: 14729938 DOI: 10.1099/jmm.0.05471-0] [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] [Indexed: 11/18/2022] Open
Abstract
Fifty-one consecutive isolates of Mycobacterium tuberculosis, collected during a 2-year period in the north-east of Italy, were subjected to IS6110-RFLP analysis to detect the presence of clusters and assigned to one of the three genotypic groups delineated by single nucleotide polymorphisms in the genes katG and gyrA. All the isolates collected from the local population belonged to group 2 or 3, while group 1 isolates were found only in specimens collected from African immigrants. Clustered cases of tuberculosis, which are likely to be related to recently transmitted infection, were found to be significantly associated with katG gyrA group 2. In the local situation, strains belonging to this group may therefore present a higher risk of transmission.
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Affiliation(s)
- L Dolzani
- Dipartimento di Scienze Biomediche, Università degli Studi di Trieste, Via Fleming 22, 34127 Trieste, Italy 2Modulo di Microbiologia Polmonare, Ospedale di Cattinara, Trieste, Italy
| | - M Rosato
- Dipartimento di Scienze Biomediche, Università degli Studi di Trieste, Via Fleming 22, 34127 Trieste, Italy 2Modulo di Microbiologia Polmonare, Ospedale di Cattinara, Trieste, Italy
| | - B Sartori
- Dipartimento di Scienze Biomediche, Università degli Studi di Trieste, Via Fleming 22, 34127 Trieste, Italy 2Modulo di Microbiologia Polmonare, Ospedale di Cattinara, Trieste, Italy
| | - E Banfi
- Dipartimento di Scienze Biomediche, Università degli Studi di Trieste, Via Fleming 22, 34127 Trieste, Italy 2Modulo di Microbiologia Polmonare, Ospedale di Cattinara, Trieste, Italy
| | - C Lagatolla
- Dipartimento di Scienze Biomediche, Università degli Studi di Trieste, Via Fleming 22, 34127 Trieste, Italy 2Modulo di Microbiologia Polmonare, Ospedale di Cattinara, Trieste, Italy
| | - M Predominato
- Dipartimento di Scienze Biomediche, Università degli Studi di Trieste, Via Fleming 22, 34127 Trieste, Italy 2Modulo di Microbiologia Polmonare, Ospedale di Cattinara, Trieste, Italy
| | - C Fabris
- Dipartimento di Scienze Biomediche, Università degli Studi di Trieste, Via Fleming 22, 34127 Trieste, Italy 2Modulo di Microbiologia Polmonare, Ospedale di Cattinara, Trieste, Italy
| | - E Tonin
- Dipartimento di Scienze Biomediche, Università degli Studi di Trieste, Via Fleming 22, 34127 Trieste, Italy 2Modulo di Microbiologia Polmonare, Ospedale di Cattinara, Trieste, Italy
| | - F Gombac
- Dipartimento di Scienze Biomediche, Università degli Studi di Trieste, Via Fleming 22, 34127 Trieste, Italy 2Modulo di Microbiologia Polmonare, Ospedale di Cattinara, Trieste, Italy
| | - C Monti-Bragadin
- Dipartimento di Scienze Biomediche, Università degli Studi di Trieste, Via Fleming 22, 34127 Trieste, Italy 2Modulo di Microbiologia Polmonare, Ospedale di Cattinara, Trieste, Italy
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Seidler A, Nienhaus A, Diel R. The transmission of tuberculosis in the light of new molecular biological approaches. Occup Environ Med 2004; 61:96-102. [PMID: 14739374 PMCID: PMC1740712 DOI: 10.1136/oem.2003.008573] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This review briefly summarises the recent achievements in tuberculosis epidemiology associated with the introduction of molecular methods, and considers the implications of these methods for the understanding of occupational tuberculosis transmission. Special attention is paid to the relative contribution of recently transmitted tuberculosis; risk factors for recent transmission; and the occurrence and frequency of exogenous reinfection. There is a need for occupational epidemiological studies, which should combine the methods of "classical" epidemiology with those of molecular epidemiology.
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Affiliation(s)
- A Seidler
- Institute of Occupational Medicine, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany.
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Serraino D, Puro V, Boumis E, Angeletti C, Girardi E, Petrosillo N, Ippolito G. Epidemiological aspects of major opportunistic infections of the respiratory tract in persons with AIDS: Europe, 1993-2000. AIDS 2003; 17:2109-16. [PMID: 14502014 DOI: 10.1097/00002030-200309260-00012] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE(S) To describe the epidemiology of Pneumocystis carinii pneumonia (PCP), pulmonary tuberculosis (PTB) and recurrent bacterial pneumonia (RBP) as AIDS-defining illnesses (ADI) in Europe. DESIGN Analysis of AIDS surveillance data collected in the World Health Organization European region by EuroHIV, Saint Maurice, France. METHODS Adult AIDS cases notified between 1993 and 2000 were studied. Since AIDS diagnosis may be constituted by up to four concurrent illnesses, polytomous logistic regression odds ratios (OR) and 95% confidence intervals (CI) were computed. Time trends and correlates of PCP, PTB or RBP were assessed. RESULTS There were 181 296 ADI among the 142 447 AIDS cases included in this study. PCP was the commonest ADI in western Europe (17.8%) and PTB (20.4%) was the commonest ADI in eastern Europe. Within western Europe, PTB was more common in the south than in the north (OR, 1.5) and increased steadily over time. RBP increased until 1998 (from 1.9% to 3.7%) and thereafter declined. Young age was associated with an excess risk for PTB and, in comparison with heterosexuals, homosexual men were at higher risk for PCP (OR, 1.3). Injecting drug users (IDU) (OR, 2.8; 95% CI, 2.6-3.1) and recipients of blood (OR, 1.7; 95% CI, 1.4-2.2) were at increased risk for RBP. CONCLUSIONS This analysis highlighted the continuing importance of PCP and the increasing importance of PTB as an ADI in western Europe, and it emphasized the need to investigate more thoroughly the vast epidemic of AIDS-associated PTB in eastern Europe. IDU and recipients of blood should be considered as target groups for vaccination against RBP.
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Affiliation(s)
- Diego Serraino
- Department of Epidemiology, National Institute for Infectious Diseases, IRCCS, Rome, Italy
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Spradling P, Ridzon R, Nitta AT, Kim J. Limited transmission of multidrug-resistant tuberculosis. Am J Respir Crit Care Med 2003; 167:473; author reply 473-4. [PMID: 12554633 DOI: 10.1164/ajrccm.167.3.297c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Munsiff SS, Bassoff T, Nivin B, Li J, Sharma A, Bifani P, Mathema B, Driscoll J, Kreiswirth BN. Molecular epidemiology of multidrug-resistant tuberculosis, New York City, 1995-1997. Emerg Infect Dis 2002; 8:1230-8. [PMID: 12453347 PMCID: PMC2737807 DOI: 10.3201/eid0811.020288] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
From January 1, 1995, to December 31, 1997, we reviewed records of all New York City patients who had multidrug-resistant tuberculosis (MDRTB); we performed insertion sequence (IS) 6110-based DNA genotyping on the isolates. Secondary genotyping was performed for low IS6110 copy band strains. Patients with identical DNA pattern strains were considered clustered. From 1995 through 1997, MDRTB was diagnosed in 241 patients; 217 (90%) had no prior treatment history, and 166 (68.9%) were born in the United States or Puerto Rico. Compared with non-MDRTB patients, MDRTB patients were more likely to be born in the United States, have HIV infection, and work in health care. Genotyping results were available for 234 patients; 153 (65.4%) were clustered, 126 (82.3%) of them in eight clusters of >or=4 patients. Epidemiologic links were identified for 30 (12.8%) patients; most had been exposed to patients diagnosed before the study period. These strains were likely transmitted in the early 1990 s when MDRTB outbreaks and tuberculosis transmission were widespread in New York.
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Affiliation(s)
- Sonal S Munsiff
- New York City Department of Health, New York, New York 10013, USA.
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